Science!

(Source: Know Your Meme.)

As a former chemistry nerd (I was a chemical engineering major at NCSU, until I realized that I'd much rather sit around and write papers), one of the most interesting things about going through IVF is learning about all of the medical procedures and how the medicine works.

At the beginning of each cycle, I have my blood checked to measure my Estradiol levels and have a baseline ultrasound to ensure that there are no cysts in my ovaries and to ensure that everything looks OK. After I've been on stimulating hormones for several days, then I go back for an ultrasound and a blood check every other day until the egg retrieval.

I have had 11 ultrasounds since mid-September, which I think is more than are conducted during 9 months of pregnancy!

The first time Brian and I saw an ultrasound screen, it looked pretty much like a bunch of static. Today when I looked at it, I could actually see the discrete follicles and could understand exactly what the doctor was describing. It's fairly amazing how much practice helps. :-) (The ultrasounds also confirm that my uterine lining thickens for implantation as the Estradiol levels rise.)

I am very, very, very fortunate that I have really good veins, so blood draws are not an issue. I could never understand why people didn't like needles, until I witnessed Brian get his blood drawn last month. As it turns out everyone is very different, it took the nurse several times to eventually get his blood, whereas she has just done mine on the first try! (I've never had a nurse *not* get it on the first try.)

Before our first round of IVF we had to have our blood drawn and run through a panel of tests (as required by the FDA). The good news is that neither of us have

• hepatitis,
• HIV, or
• Syphilis.

I also received confirmation that my blood type is, indeed, O+ and that I've had the chicken pox and have received my rubella immunizations. (Separately, we've also both received a booster for Tetanus, Dyptheria, and Pertussis.) And before our IUI, I had my Prolactin and several other hormone levels checked.

Because I ovulated early for our first round of IVF, with each blood draw this time, they check, in addition to my Estradiol level, my LH and progesterone levels. The goal is for the Estradiol to rise and for the LH and progesterone to stay low. (A spike in LH/progesterone would indicate that my pituitary gland is telling my ovaries to ovulate.) So far it's working! In particular, I think it's incredible how my Estradiol levels rise (over the course of 11 days): 48.4 -> 435.4 -> 757.4

So, how does all this happen? Well, that's where the chemistry comes in!

(Source: Our kitchen table.)

A few days into a cycle, I start injections twice a day (just under the skin with a very thin needle in my stomach) of a drug called Lupron, which suppresses my ovaries (by telling my pituitary gland to dump out all the LH and not tell my ovaries to ovulate). 

After a few days of Lupron, then I add in two drugs called Follistim and Menopur. These drugs stimulate my ovaries. The Menopur is powder in a vial, so I'm able to inject the Follistim (which is a liquid in a needle) directly into the Menopur vial. Then I take the Lupron injection and inject it directly into the Menopur vial. THEN I take 0.5cc of NaCl (saline solution) to finish dissolving the Menopur powder. Then I draw all the liquid up into a needle and do one injection. I could live without giving myself the shots, but I love mixing up all the medicine. It reminds me of chemistry lab!

If you're interested, this is a neat video by another fertility clinic that shows how most of my medicines are mixed. I watched it a lot in December to make sure I didn't mess up!

(Source: Carolina Conceptions.)

I do this twice a day for approximately 10 days. The injections usually sting for about 20 minutes, but they really aren't too bad and because none of them are injected in a muscle, it doesn't hurt once the stinging stops.

Now, as extra insurance to make sure I don't ovulate early, after several days of stimulating medicines, I add another drug called Ganirelix, which also tells my brain to not ovulate. This injection comes in a pre-filled syringe and I have to inject it separately each night. Last cycle, I was able to mix it in to the Menopur vial, but this month I'm not supposed to because I'm also on Lupron. 

The goal during all of this is to get my ovarian follicles to grow and produce as many mature eggs as possible, so that they can be retrieved by the doctor, while also telling my brain "no, don't ovulate yet!" It's really quite miraculous!

Once the doctor sees on my ultrasound that the follicles are the right size, I'll stop taking all of the previous drugs and do one final injection of a drug called Ovidrel, which tells my brain "OK, NOW. GO!" and if this is timed exactly right (36 hours after the injection), the doctor can go in, while I'm under "waking anesthesia," and retrieve the eggs out of each follicle to start the in vitro part of IVF. :-)

If you're curious, some of these drugs make people really crazy because of the hormone changes. I have been very, very fortunate with few side effects. I've had a few moments were my temper has been really short, but, in general, I'm not too crazy. (At least I don't think.)