Lupron: Day 5. Stims: Day 3

Loving those Gonal F Pens

Broke out my first of eight Gonal F pens today, courtesy of an angel Crone that was selling off her unused stims after moving on down the road toward adoption. :-) I'm doing 450iu a day, and each pen has 450iu (and then a bit to spare), so I've got precisely 8 days left of stims.

I was a bit intimidated by this whole pen business. They're a bit intimidating with their dials and multiple pen tips. The instruction page that they come with is also daunting...so many instructions that if they're all that you have to go by, you are nearly sure to fuck it up.

But my Crone friend drew me out a nice little schematic and that, along with the cheat sheet from Dr. Moustache's nurse, made it damned easy. One thing that is disconcerting is that the medicine in the pen is CONCENTRATED: 450iu/0.75ml. I'm used to mixing 1ml (or 1cc) of diluent into 3 vials of FSH to make 225iu/1ml. So with the pen I'm only injecting something like 0.375 of an ml into myself at a time. It feels like a drop in the bucket as compared to what I'm used to.

So here is what I've surmised is the way to use these things, hopefully I've got it right (*see caveat below):

1. Wash hands well.
   
2. Remove large white pen cap from pen.
   
3. Wipe threaded area with alcohol. Keep this area clean.
   
4. Take out a needle tip. Peel off the back and carefully screw it onto pen tip until it's secure.
   
5. "Prime" the pen (first use only):
• Turn dial to 37.5
  
• Pull plunger out till it's out as far as it'll go (you'll hear a click)
  
• Holding pen upright, tap to get bubbles to tip (if there are any).
  
• Depress plunger (into air). You'll hear a click and should see a drop of fluid at the needle tip. If no liquid comes out, reprime the pen till it does.
  
• The pen is ready to be programmed for your dosage now.
  
6. Turn dial to the number of IU's that you need. Line up number to black line. MAKE SURE THIS IS THE CORRECT DOSE!
   
7. Pull plunger out as far as it will go. You will hear a series of clicks.
   
8. Look at the plunger side. There are red numbers. This number should match your dosage. If it's smaller, that's all the medicine you have left in the pen. Two things you can do here: break injection into two so that you don't waste what's left in the first pen OR just get a new pen. If what is on the smaller dial (with red numbers) is MORE than you wanted this means that you dialed in too much the first time. Eject the entire amount into a sterile container and get a new pen. Key: You can dial in too little and get away with it, but if you dial in too much you've just wasted that entire dosage.
   
9. Okay, you're ready to dispense.
   
10. Swab the area where you're going to inject the medicine with alcohol. Let it dry so you don't get a sting when you inject yourself. Avoid the area close to your belly button, and areas directly below it. (There are acupuncture spots all around this area, so be careful where you're injecting. Talk to your acupuncturist about where the safe injection zones area).
11. With clean fingers, grab a chunk of clean skin and make a tent (ie, upside down "V") with the skin.
    
12. Inject needle at 90 degree angle (ie, perpendicular) to skin. (Helps to inject into the area inside the "V"). Don't jam the needle base into your skin.
    
13. Depress plunger slowly. You'll hear a series of clicks.
    
14. Hold needle in place for 5 seconds to makes sure medicine is all in there.
    
15. Pull needle out carefully and dispose in safety box.
    
16. Optional: Wipe injection area with alcohol pad and gently massage.

CYA Caveat: This isn't intended to replace the advise of a doctor - it's more for entertainment/blog value than anything. I'm not a doctor and take no responsibility for the instructions here. This is just what I did for my injections and although it worked for me, it might not work for you. Please refer to the instructions your Gonal F pen came with.

Now, the box says (on a 450iu pen) that each pen contains 568iu in order to deliver 450iu of medicine. So there's an extra 118iu of Gonal F (ie, recombinant urofollitropin) in each pen. Holy smokes. That's a shitload of extra medication in each and every pen. 118iu * 8 pens leaves me an extra 944iu of Gonal F leftover. That's two entire days dosages in those pens, and then some. Whoa. Very cool. Even though my nurse didn't recommend my doing this, I plan on extracting those last IUs into leftover sterile Bravelle vials and saving them for a rainy day. Why the hell not? It's valuable stuff. Liquid gold! Think of it this way. A single 75iu vial of Bravelle (brand name urine derived urofollitropin) costs $75 at the local Costco. Gonal F is even more expensive than is Bravelle or it's generic cousin because it's recombinantly formed from genetically engineered bacteria that pump out the isolated stuff in vats. Gonal F is purer than Bravelle or the generic urofollitripin (aka Follistim in the UK). Dr. Moustache said to me in January 2005 that the recombinant is just as good as the urine derived. But is it?

I found one paper that cites that, "recombinant FSH is more effective than urofollitropin for controlled ovarian stimulation in women undergoing ART". No references were given on that site. And yet another paper [pdf] says that,

"Recombinant human FSH has been shown to be more effective than urinary FSH in IVF/embryo transfer treatment. Compared with urinary FSH, a significantly lower total dose of recombinant FSH is required and for a shorter period. Furthermore, a significantly higher number of large follicles, oocytes, and embryos are obtained with recombinant humans FSH, which results in significantly more ongoing pregnancies."

This paper has references that I'm not going to recite here, but this gives me reason to pause. This time I've used urine derived FSH during the first two days (a crucial time when follicles are being recruited) and now that I'm onto day 3 I've switched to the Gonal F, the Big Guns. The order was at Dr. Moustache's direction (use the dried urine derived stuff first) and now I'm wondering if I should have gone for the better, recombinant, FSH first in order to get more follicles out and running.

It's always something. Isn't it?

The Lupron Speaketh

And lest you think that I'm truly impervious to this lupron crap, my ovaries just started to ache about an hour ago. Big time. As in, they both feel like they're on fire. I didn't have symptoms like this till I was near to retrieval last time. WTF? Is this the superior kick-ass Gonal F doing its work? Oh yeah, and I just bitched J out over lunch for being out of town on work next Wednesday because there's a chance, a very good chance I will add, that I might be doing my transfer that very day. You see, my first monitoring U/S is on Friday, and if I'm "good to go" on Friday, retrieval will be on Sunday and transfer on Wednesday. I'm totally peeved that he might not be here to:

1. Drive me TO the transfer (J: "You can drive yourself to it, can't you?". Me: "Yeah? But how do I get home Einstein? Dr. Moustache said NO ACTIVITY whatsoever. Bedrest doesn't include driving."
   
2. Drive me home (J: "Can't your mom drive you back?" Me: "She's 89. Are you insane? She'll get lost unless I'm guiding her the entire time...and I'm supposed to be prone."), and
   
3. Keep my mom at bay while I'm recovering. She can't hear very well and having to speak LOUDLY to convey the most simple information stresses me out to no end. I can be talking loudly, not in anger, but just trying to convey information, but somehow my body perceives this as stress. My pulse rises, my blood pressure surges upwards, and I suddenly feel like I've flipped out. Just for having to speak loudly. Weird, but true.
   

But what is the probability that I'll be ready on my first U/S? Last cycle I was ready on the second U/S, but then I only used the urine derived urofollitropin. According to the second article I mentioned above, I should be ready earlier, hence, a Sunday retrieval and a Wednesday transfer. Grrr....... I wouldn't doubt it if I'm ready earlier anyways. I've responded quite differently this time 'round, so anything is possible.

And I thought that this cycle was going to be stress-free. I prayed it would be stress free and that J would be 100% THERE. There for any disaster or emergency that came my way. There in the OR when the embryos were being put in. But there are no guarantees with J. I think he's having a disconnect, a problem with priorities. That is all that there is that can explain this. I just don't understand how a man can blow $11,000 on a cycle and not want everything to be perfect. It's beyond me. It's just so far out there I cannot fathom it or comprehend where he is at today.

Yes, the lupron rose it's ugly head today and hurled out some miserable things. I thought I was going to be impervious...alas...no. I'm not.

This cycle is going to be a fucking white knuckle ride until it's over.

Sigh.