Ovulation induction with FSH injections

The first step for us was timed intercourse with follicle stimulating hormone (FSH) injections. The aim of the injections is to develop follicle/s, stimulating the ovaries to ovulate and allow fertilisation to occur naturally by timed intercourse. I was under the impression that if I can produce an egg there shouldn’t be any reason why it can’t be fertilised naturally. Well, it sure wasn’t as easy as that and we faced six failed cycles.

The aim of this cycle was to produce one or two dominant follicles. We started at a very low dose of Puregon because with PCOS there’s a higher chance of overstimulating (producing too many follicles) which could result in multiple pregnancy and in two of my cycles ‘octomum’ where we had to cancel the cycle. Due to the low dose medication, most of the stimming continued for over 20 days (one cycle was over 40 days so you can imagine my disbelief when my period arrived after being absent for years). It was all very slow and steady with 20+ days of having internal ultrasounds every three days and frequent blood tests to check hormone levels. Regular ultrasounds are necessary to check the number of follicles and their development. Each appointment cost $100 – $130 in addition to the cost of medication. We were lucky enough that our FS only charged us for the first five appointments per cycle. To this day we have spent thousands and thousands of dollars on tests, scans, appointments, medication, IVF – we have a folder of receipts but we have no idea of what we have spent up until now. We just know that one day it will all be worth it.

We were to have sex every second day during the stimming then at a specific window of time once a trigger injection is given for ovulation. There’s nothing more romantic about being told when to and when not to have sex!

Injections are administered in the stomach through an epipen looking device. I’ve never really been fussed about needles but did get nervous about injecting myself for the first time. Daniel is definitely not a needle person and I knew there was no way he would be able to inject me. We watched YouTube videos about loading the pen and injecting the needle. They made it look so quick and easy. To be honest I couldn’t feel a thing when injecting Puregon. It was definitely the easiest and pain free needle with little side effects. After the first failed cycle my FS prescribed Ovidrel as an extra support to stimulate follicle growth. I was taking Puregon every night plus the Ovidrel injection every second night. My fridge was beginning to look like a drug lab.

 

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Puregon and Ovidrel pens
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mixing the powder and liquid for the trigger

I administered injections at 6pm each night. I knew that at this time I would usually be home from work, and if it was on a weekend I could do it at home before we went out. On one occasion we went to see a show in the city and had dinner at a nice restaurant beforehand. I had taken my meds to work with me and left them in the fridge along with an ice pack in the freezer. We had a 5.30pm dinner booked so we could make the show and I knew I’d need to do the injections in the bathroom. As it got close to 6pm I got up with my freezer bag and went into the bathroom. I went in the toilet and locked the door. There was only one unisex toilet and I was freaked out at the thought of people waiting outside. I was nervous and shaky. I quickly did the Puregon injection but in a panic dropped the needle tip for the Ovidrel injection in the bin. I desperately tried to ruffle through the bin (ewww) but had no luck. I quickly left the bathroom to tell Daniel what had happened. He tried to reassure me in his calmest tone that it would be ok and we could just inject the second needle when we got home. I was distracted for the rest of the evening until we walked through the door at home.

Failed cycles
#1 – poor follicle response
#2 – bleeding
#3 – overstimulation
#4 – BFN (big fat negative)
#5 – bleeding
#6 – overstimulation

Our last failed cycle was in December 2016 and we decided to take a break over Christmas before commencing IVF.

 

Balancing work and IVF

One concern I had when commencing fertility treatment was how I would juggle it all with work. I decided to tell my boss early on during my fertility treatment. I honestly think I would have had a breakdown if I went through the whole process without the support of my employer. I think it would have added to the stress if I chose to keep my treatment private.

As we did ovulation induction with injections prior to IVF for approximately six months, I was having scans every three days and frequent blood tests and although my work is only a 10 minute drive from the clinic, it took time to get there, find parking, have my appointment and pick up any meds. I would end up being out of the office for one or two hours at a time. I’m very lucky that I have a flexible workplace with wonderful colleagues and very supportive and understanding management. If ever there are last minute appointment changes or I’ve had to miss an important meeting at work, it’s never an issue. IVF treatment is time consuming and at times very demanding and my absence was never questioned. I think your choice to disclose your treatment will ultimately come down to your relationship with your employer and how comfortable you feel discussing it with them.

There is no right or wrong about working during fertility treatment and IVF. For me, I worked full time during ovulation induction with injections and dropped a day when I commenced IVF. Do what works for you. I know some people who have worked full time and some who have worked part time. Do what you’re comfortable with and what suits you best.

Initial information and IVF costs

After you have met with your FS and all of the relevant testing is conducted, you and your partner will require police checks, child protection orders and will need to participate in a mandatory counselling session where you are given the chance to ask any questions, raise concerns, discuss and sign consent forms. You will also meet with your nurse who will go through with you a detailed example of your treatment plan and visual slides of what happens during the egg retrieval and transfer. Daniel was not impressed to learn of the invasive details! The session went for about 90 minutes and was information overload. We both walked out a little speechless. Know that you don’t need to remember everything that was said during this appointment. Your nurse and FS are always available for questions or concerns and are with you every step of the way. When you get to your IVF cycle, you’re given a thorough plan of what to do each day and at what time. Here is an example of the cycle plan we were presented with at our initial appointment with our nurse.

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The clinic will also get you in touch with someone from the accounts department who will discuss payment options with you. We were given an initial quote of $10,000 – $12,600 per cycle, yes PER CYCLE, excluding the cost of meds and egg retrieval. What a joke!! We had the option of paying the full amount up front at the beginning of the cycle, 50% at the start and 50% at the end or the full amount to be paid after egg collection. We opted for the last option. You aren’t given any notice as to the exact day payment will be taken so don’t be alarmed when your bank account is down $10,000+.

Dealing with infertility

It was no surprise that once we were married, people didn’t hesitate to ask:
“Are you pregnant yet?”
“When are you starting a family?”
“What are you waiting for? Clock’s ticking!”
“Why aren’t you drinking?”

I took it in my stride for a while, told people not to worry and that we’d let them know when I was pregnant. I’m generally a positive and open person but this is one thing that really annoys me and everyone else who is going through struggles with fertility. You never know the situation people are in – they could be grieving a miscarriage, they may be suffering in silence, in the process of fertility treatment or have faced numerous failed IVF cycles. You may not realise the effect this can have on someone but I can assure you they probably want to punch you in the face and tell you to f$*% off. If this can detract one person from asking this question then this post has achieved its purpose!

When you’re trying to conceive, everyone around you seems to be pregnant or having babies. It starts to get to you when you hear of all the teen pregnancies and people getting pregnant without trying, or hearing of parents who neglect their children or hearing people constantly complaining about their pregnancy and kids. It’s obvious they haven’t faced the challenges of infertility. I urge you to think before you speak. Your seemingly innocent questions and comments may be received with a fake smile that’s hiding a deep pain, frustration and stress beneath. The bottom line is whether you’re a family member, friend or just a nosy person in general, it’s really none of your business and if someone wants to let you in they will do so at their own time.

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History

Medical conditions: Polycystic Ovarian Syndrome (PCOS) and Thalassemia Minor (not related to my infertility). Sperm count on the lower end.

PCOS is a common hormonal disorder affecting 12-18 per cent of women of reproductive age. Women with PCOS may not ovulate (release eggs). There are several symptoms that can be present and you don’t need to have all of them to be diagnosed. These symptoms include:

  • irregular menstruation or amenorrhea (no periods),
  • excess facial and/or body hair,
  • acne
  • hair loss
  • infertility
  • ovarian cysts
  • obesity
  • insulin resistance putting you at risk of developing type 2 diabetes

I had my first period quite late at age 15. I always had irregular cycles that were initially 6 – 12 months long. My GP put me on the pill at the age of 17 which masked my PCOS symptoms while regulating my cycles. I was on a variety of different pills over the course of about seven years before deciding to take a break to see if I could have a natural period. Months and months passed with no sign of my cycle. I had heard it could take a little while for your cycle and hormones to return to normal after stopping the pill but to this day, it hasn’t come without medical intervention.

In the years that followed, I had a laparoscopy to check for endometriosis which thankfully came back all clear. I was referred to an Endocrinologist who put me on Metformin to improve insulin levels in the hope of regulating my cycle, but I had no luck. Four years passed and still no period. My Endo did a whole range of testing and came to the conclusion that when we were ready to start a family she would send me straight to a fertility specialist at Melbourne IVF (MIVF). Since our wedding on 25 April 2015, we decided that it would be worth giving it a shot for a few months to see if we could get pregnant naturally.

Approximately five months after our wedding we went to a MIVF seminar where we heard from a number of Fertility Specialists (FS), dietitians and doctors. This is where we first heard our FS speak. Both of us knew straight away that we wanted him to be my FS. The next day I called MIVF and booked an appointment to see him. He has been so amazing every step of the way from our very first appointment and we couldn’t be in better hands. I want to stress how important it is to feel comfortable with your FS and have that ‘good feeling’ about who you choose to share your journey with. It’s personal and invasive and you never know how long the road will be.

Image: Affinity Magazine 

About

Thanks for visiting my blog Road To Mummy.

My husband Daniel and I have been together for 11.5 years in total and have been married for two of those years. We have been trying to conceive for approximately 18 months now. I always had a thought at the back of my mind that we might need assistance with fertility when the time came (you will read more detail about this in my posts). I naively thought that IVF was almost the easy way out – sure it would be a costly and emotional journey, but I had no idea about all the highs and lows faced by so many women going through fertility treatment and IVF. This blog is about our journey from the beginning and the fertility treatments we have endured since trying to conceive. I’ve found comfort in reading blogs and forums and know that I’m in no way alone in this journey. I hope that by sharing our story, I can give others information about what to expect at each stage of fertility treatment, whilst documenting each step in my Road To Mummy.

When undergoing fertility treatment and IVF, you’re juggling life, work, your partner, family and friends while spending hours going back and forth to appointments at the hospital and pathology, picking up medication, having tests, scans and completing endless paperwork. It seems like a never ending cycle. If you’re lucky enough to find some spare time, you generally don’t have the energy or mental and physical capacity to do much else other than watch Netflix and laze on the couch.

Fertility treatment and the anticipation of waiting for each step can totally consume your life. The road is long and tiring and there are so many unknowns. I hold onto hope that one day we will have our miracle.

Vanessa xx

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