Fourth appointment for my IVF #2

My follies are growing fast! We have seen 4 of them with sizes 9-14mm. I am still on the same medication, which is actually a relief because in my IVF #1 I think by this stage I have around 2 or 3 injections per day.

Third appointment for my IVF #2

I’ve got 3 visible follicles seen in my ultrasound which ranges from 8-10mm. I hope that in the next few days they would continue to grow more and that more follicles will be spotted. My doctor recommended the same medication (Pergoveris 300 IU) for 3 days. I also did my blood work after.

Second appointment for my IVF #2

Days before this appointment, I observed that my period became heavier (it started to be so light). But on the day of my second appointment (D6 of my period), it was reduced to almost spotting. After my TransV, my doctor said that I can start my ovarian stimulation. She prescribed Pergoveris 300 IU for 3 days. Pergoveris injections contain the two active ingredients, follitropin alfa and lutropin alfa. Lutropin alfa is a synthetic version of a natural pituitary hormone called luteinising hormone (LH). Follitropin alfa is a synthetic version of a natural sex hormone called follicle stimulating hormone (FSH). In the ovaries in women, FSH and LH increase the number of growing follicles and stimulate their development.

After taking my routine blood test for my baseline hormone levels, I went to the basement floor to take my injection. The Filipina nurse was not there. Instead, there was the Indian nurse that I’ve previously met during one of my operations. She insisted on giving the shot because she wanted to show me how to prepare the injection. One box of Pergoveris contains two vials— powder and solvent solution for injection. The powder vial contains 150 IU (equivalent to 11 micrograms) of follitropin alfa and 75 IU (equivalent to 3 micrograms) of lutropin alfa). Since my prescription is 300 IU of follitropin alfa, I need to take 2 boxes of Pergoveris in one shot. The nurse inserted the syringe (with big needle) into the solvent vial and took out the liquid. Then she injected the solvent into the vial of powder. After the powder is dissolved, the solution is taken back into the syringe. She then injected the solution into the second vial of powder (second box of Pergoveris), which completes the 300 IU of follitropin alfa. As soon as the powder is dissolved, the solution is taken back into the syringe. The big needle is then replaced with a finer one and then injected in my tummy below the belly button. I’m glad that the other solvent was spared because it would mean more liquid injected! The drug was a bit painful but it doesn’t linger.

First appointment for my IVF #2

The problem with my breakthrough bleeding (see previous post: Summary of IVF#1) is that I had difficulty in assessing the start of my period. After having a failed IVF cycle (IVF#1) followed by a hysteroscopy, my doctor prescribed birth control pills before I could start IVF#2. I read that menstruation period usually comes 3-5 days after the last pill. Since I was constantly having spotting, I found it challenging to determine if it is the start of my genuine period or just the usual spotting (a side effect of taking the pill). Three days after my last pill, I got bright red spotting that is more than usual (but not yet enough for me to wear a pad). The next day was more blood but still very light. After reading some posts in the internet, I decided that this should be it! I called the IVF clinic and asked for an appointment for that day since it is D2 of my period. Fortunately, they squeezed me in Dr. M’s busy schedule.

After my TransV ultrasound, my doctor said that I am ready to start my treatment. She changed my medications though. She prescribed two days of Gonapeptyl 0.1 mg injection which is for hypophysary inhibition or blocking of pituitary gland in order to prevent premature ovulation during ovarian stimulation. Just like in IVF#1, I took a shot of Ceftriaxone 1g antibiotic injection. I was also advised to take the same set of drugs as my previous IVF cycle: Vibramycin 100mg (taken twice daily) and Folic acid 5mg (taken once daily).

 

We took home the Gonapeptyl injections. This injection is the easiest one to administer because it is ready to use.. no need to mix, measure, or transfer to the syringe. The needle is also small and thin. As usual, my home nurse (my husband) gave me my shot. Perhaps it’s because I am now used to injections that I’ve become more prick-tolerant.. or maybe my nurse has become a pro in giving the shots!

Summary of IVF #1

After a series of 3 ectopic pregnancies, all I have is my right ovary. Both my fallopian tubes and my left ovary were surgically removed. Since I only have one remaining ovary, our only option to get pregnant with our own child is through In-Vitro Fertilization (IVF). We made some research about IVF in the Philippines and the UAE. After some thought, we decided to have the procedure in the UAE.

We waited for 2 years before starting with IVF. The first reason is for my surgery to heal completely (it’s like having a CS operation). The second is to be more financially ready for the high costs of the procedure.

I left my job a month before the procedure. We started IVF #1 in May 2013. The procedure starts on the second or third day of your period. For the first 5 days, I was taking one injection per day. On day 6 to 10, the injections increased from 2-4 shots per day. These injections stimulate the ovary so that more follicles (the egg is inside the follicle) will grow and become mature. On the 12^th day, my follicles were collected. A total of 8 follicles were taken-- of which 7 were matured. But only 5 eggs were successfully fertilized. After 3 days, only 3 embryos have survived. They have transferred the best 2 embryos back to my uterus. After 8 days, my beta HCG (which determines the pregnancy) is only 2.2. I tested again after 4 days and my beta HCG dropped to almost zero, which indicates negative pregnancy and failed IVF.

During the failed IVF assessment, my doctor recommended that I undergo hysteroscopy and endometrial scratching. She said that this will “clean” my uterus and remove polyps and fibroids. Based on internet research, I also learned that there seems to be higher pregnancy rate after endometrial scratching. This is not part of the IVF package that we have availed so this is an extra cost that we have not taken into budget. However, we are ready to pay for anything that may increase the chances of pregnancy. The procedure is done under general anesthesia so I didn’t feel anything. However, after the procedure I felt minor cramps. I also had spotting until the day of my period. Though it may also be breakthrough spotting caused by the birth control pills that I was prescribed to take.

The next step is to wait for my period so we could begin with IVF #2.