Now that it's getting close, I keep going back to my notes from the IVF class last month to see what's coming. AND I found out, in doing so, that I was totally wrong about what all this stuff is. So I'm going to review. (Teaching is the best way to learn, right?)
Lupron is central to the ovarian-suppression phase and is designed to drain your reproductive hormones. According to my notes, the Lupron will come in a little bottle and will look dangerously empty. It won't look like there's enough for the whole cycle, but allegedly there is. So says Nurse Jennifer. You inject 10 units every morning with an orange-capped insulin needle. It can be injected anywhere you can pinch the skin, but the stomach is often least painful (so long as-- and I was vague about this before-- you don't insert it along the longitudinal line of the navel). You poke it in at a 90-degree angle; my notes say that 45 is too shallow. Not sure why.
Side effects are due to low estrogen levels. The most common are headaches and, just before you begin FSH, nighttime hot flashes.
FSH (Follical Stimulating Hormone)
FSH is the beginning of the ovarian-stimulation phase. Right around Day 27 of the cycle, you have a "suppression check"-- something that the Nashville people take very seriously. It's a super-long appointment, we're told. They check estrogen (technically estradiol or E2) levels, do a pelvic ultrasound, and do a test run of embryo transfer where they use the catheter to "map the cervix" and figure out which things twist which way. I guess so they don't poke your innards too hard during the real thing. Once they see how all that plays out (the E2 level should be below 50), they kick off the FSH. What's ridiculous is that the Lupron has been suppressing your FSH all this time, so after the suppression check they wean you off the Lupron while jacking you back up with the FSH.
FSH is definitely supposed to be injected into the belly. The average dose is 300IU. There are a few different ways of administering it. We picked Follistim because Nurse Jennifer said that was what PGD manager Amy would want-- and we were grateful because the four options they gave us were confusing as fuck.
This one scared me most. It's a powder that you mix with sodium chloride, and there's a whole long thing about the "q-cap," which goes on top of the syringe... All of which is to say that my eyes began to glaze over at, say, step three out of what the Bravelle website describes in eighteen. (You can take a look at their website for the FIVE videos it takes to explain this, along with the PDF instruction sheet.) Per my notes, Bravelle is a pain in the ass, but cheaper than the pens at about $50 for 74IU.
2) Menopur: Also a powder; uses the exact same process as above. It's not clear to me what's different about the two, as they're made by the same company. According to the Menopur folks, it is "the most widely used and extensively studied reproductive hormone, proven to be both safe and effective." Not claimed about Bravelle. Both Menopur and Bravelle contain a combination of FSH and LH (luteinizing hormone), but in different concentrations-- Menopur has a higher level of LH. Our doctors didn't give us any sign that one is better than the other, and from a casual Googling it looks like a lot of doctors put women on a combination of the two, or switch depending on what's effective.
Progesterone in Oil