Saturday, March 28, 2009

Because I’m special, DAMN IT!!

I’m home.

Sorry I haven’t updated. I’ve been very tired, and, frankly, sad. I’ll explain the sad part, but let me update chronologically.

Insanely early morning flight on Wednesday. Dropped my bags at the hotel and took a cab to the clinic. Short wait, then the u/s tech checked my bladder and said it wasn’t full enough. (I just had to pee when I got off the plane.) Chugged a LOT of water. Definitely full enough, but then the RE was delayed with a hysteroscopy. The tech handed me a small cup and said I could pee just that much. Damn, it’s hard to stop once you start peeing when your bladder is painfully full. Still waiting, so the u/s tech checked me again. “Oh, you’re very full!” Duh! Handed me another cup and said I could fill it 1 ½ times. OY!

Then the RE was ready. Last time we transferred 3 lovely day 2 embryos and I did not get pregnant. This time we decided on 4. They all survived the thaw with all cells intact. Although, honestly, I really don’t think one of them counts, as it was only 1 cell. We transferred a 5 cell, two 4 cell, and the little 1 cell. Then I lay on the table in bladder agony until I could get up to pee. I swear, it felt like I peed for 5 minutes straight. I know it wasn’t really that long, but it sure felt like it.

Why am I feeling sad? At my urging, the RE checked my progesterone levels. Let me preface this by saying that before I started cycling I did a lot of research on the effectiveness of vaginal versus intramuscular progesterone (PIO). Here are a few research articles: one, two, three. My NY RE is adamant about vaginal progesterone being as effective as PIO. When I consulted another top NY RE before cycling and asked him about the research, he agreed with it, but said he prefers PIO because there was a problem several years ago with one brand of vaginal progesterone. So, I felt fairly confident about not needing to stick myself in the ass with a long, large gauge needle. The day of my FET last month I had my levels checked as well, since I had read about the exceptions who do not absorb it well vaginally. It was a bit low, so the RE told me to add more. Progesterone supplements are very important for a FET since there is no corpus luteum (empty egg follicle) producing progesterone. At the time I was using four 200mg capsules up the hooha a day. She had me add an additional three 100mg prometrium pills per day. Also up the hooha. So I was poking progesterone up there SEVEN times a day. We figured that would be enough.

Anyway, as I said, at my request, we checked my levels on Wednesday before I left the clinic. As the last time, I was shoving a lot of progesterone where the sun don’t shine. Shortly after I got back to my hotel I got a call from the RE. My levels sucked. I was so exhausted at this point, but I got in a cab and went back to the clinic for a vial of PIO and some big scary needles. Even though there was no reason to think I wouldn’t absorb vaginal progesterone well, I’m feeling guilt and sadness for the 3 beautiful embies that were transferred last month.

Although I have every reason to be hopeful about this cycle, I’m feeling the failure of the last cycle all over again.

Any tips from self PIOers? A friend used em1a cream. Any thoughts on that? So far I have found it easiest to inject while sitting. Easier to twist around and keep the syringe steady. I have also added 1ovenox (blood thinner) injections this cycle as a precaution, since I have a heterozygous MTHFR gene mutation. This single mutation is generally not thought to cause thrombophilia, but we are being proactive. But because of the 1ovenox, I am much more apt to bruise badly from the big PIO needles. The last couple of nights I used a warm compress on my butt (used the little hotel room coffee maker to heat up water, then poured it over a washcloth), but I think that contributed to the BIG bruise (about 3”x1”) I have on one side. And that’s the side I have to inject again tonight. Damn. I was thinking about trying an ice pack this time. Suggestions please.

So there you have it. Good times.

Let the 2WW insanity begin!


Rebel With.A.Cause said...

Dora, I think that since you are using the LOvenox, you are going to bruise no matter what. What we do is use a heating pad on the area first, and I actually load up the PIO and stick it back there to... this makes it very thin. Then after the shot, I rub the area really hard for like 3 minutes. I haven't had any bruises so far, and this is how we are going to do it this time to.

I hope this helps you out sweetie!!


Michelle said...

Sorry I have not had to do any of that yet but I wish you all the luck with it. It sounds very painful and it must be so hard to do it by yourself. I admire your strength ad I really hope this time it works for you. ora you really deserve all the happiness there is to offer. Good Luck Girl!

'Murgdan' said...

Yikes, yep, the 1ovenox will probably make you bruise no matter what. You can try icing your butt first (which will vasoconstrict the area and may cause less bruising)...just a theory, I have no actual experience with this.

'Murgdan' said...

Oh, and I'm hoping for all the best for you...the 2WW is so hard!

Nikki said...

I agree - the Lovenox will make you bruise any which way. But with ice packs or warming the injection site, and rubbing the area after the injection, it will help keep the shot lesser painful for you.

Good luck!

Pepper said...

I swear by the steps in this YouTube video: I also sit on a heating pad afterwards, which helps disperse the oil. This is counteractive to the only thing that may minimize bruising: icing the area. (I do ice my hep injection sites before and after. I still bruise, but I like to think the bruises are smaller than if I hadn't iced.)

I do my PIO injections lying down. It's just easier for me not to have to worry about balancing on one foot while trying to take the pressure off the other foot.

Just be sure to take extra calcium with the 1ovenox because it does leach calcium from the bones.

Sorry to hear about your P4 levels. I really think the PIO will help. Keep us posted!

battynurse said...

Yay for 4 embies.
Sorry about the PIO but lets hope it works better. My first IVF they had me use the crin0ne and I started my period 4 days before I was supposed to test (even though I had a positive pee stick). Whether it would have stuck or not I don't know. I also don't know which level dropped enough for me to start bleeding because doc wouldn't check but for my second cycle I basically insisted on PIO. It's a pain but for me it was worth it. I did some of the injections in my outer thigh area which is an ok IM site but it hurt too bad there so I started doing them on my backside and it hurt less. I still had bruises and I think with the lovenox that you will for sure. I hope the PIO though makes for a sticky pregnancy.

Kristin said...

Ice ice baby (at least where you inject the lovenox)! Hot packs will cause more blood flow which will cause more bleeding. Good luck chica. I'm praying for you.

calliope said...

I so hear you on the progesterone regrets. When I finally learned just how much progesterone I needed I was so so sad about all the cycles that failed where I CLEARLY was not getting enough. For my FET I was on progesterone EVERY way you can take it: oral pills twice a day, pills up the va jay jay twice a day, and 200 of PIO in the bum every night.

My trick is to warm the oil before injecting. I get a washcloth damp and microwave it for 30 secs. As that is cooking I pull up the oil and remove the pull up needle. Then I roll the syringe (needle free) into the warm washcloth. As that is warming things up I prep my hip with the alcohol. Then I unroll the syringe, put on the inject needle, and pop the washcloth back into the micro for 10 secs. I then did the inject SLOWLY and used the rewarmed washcloth to massage it in.

thinking of you LOTS and lots.

Heather said...

Congrats, Dora, on what will hopefully be a successful transfer this time! I'll have every finger and toe crossed for each day of your tww. :) I have no experience with PIO, so I'm not much use in that department. But last night I had to laugh because I (again) saw the episode of House where Cuddy asks House to give her a (PIO?) injection...SO not realistic, I'm sure, considering how lily-white her butt bruising there! lol

Thanks so much for your recent comments on my blog...your input has really helped my state of mind, especially considering how much research you've done. I hope that we BOTH will be the lucky ones. :) I'm pulling for you!

Heather said...

PS--How is angrycanrn doing? She hasn't posted in quite a while, so I'm hoping she's doing okay. Let her know we're concerned about her, OK? Thanks! :)

Beautiful Mess said...

I don't have any advice but i do have a lot of good luck vibes coming your way.

Meg said...

I don't have any advice but I do think you're super tough for being able to give yourself those injections. I'm feeling a bit woozy just thinking about those needles.

I hope your wait goes by quickly and has a very happy ending!

Geohde said...


It's normal for blood levels of P4 to be a bit sucky on the pessaries- they're not absorbed systemically much, the local levels at the uterus are much higher. Good luck with the PIO, I've never had to use it, daily IM shots? Ouchie!



Billy said...

Don't have any advice, just wish it all goes well with as much less bruising as possible, and hopefully painless as well.

Baby Smiling In Back Seat said...

Seconding what Geohde said, my RE told me that the PIO shows up better in the blood tests but that the suppositories do seem to work fine at the "source."

I'd do everything that InfertileMadWoman suggested. I was expressly told not to ice, because it would make the PIO thicken and result in lumps in your butt. I also kept the PIO vial in my bra for a while beforehand to warm it and then heated the filled syringe just a bit -- but be careful not to heat it too much and burn yourself from within!

The other thing I tried for self-injections (but my husband wasn't out of town long enough for me to fully go through the circuit) was to have the nurse draw "targets" on my butt. Then, so that I wasn't hitting the same spot constantly, I used the target like a clock for positioning. Left 12:00, right 12:00, left 6:00, right 6:00, L3, R3, L9, R9, L center... Does that make sense?

The one-celled embryo is more evidence of the original clinic being fanatics. I don't know of any other clinic that would freeze a one-cell!

Good for you for speaking up and catching the progesterone issue.

Glad you're home safe! Sending all sorts of good thoughts your way.

Phoebe said...

Welcome to the 2ww, the club none of us really wants to be a part of.

What works for me for PIO shots is to ice the injection site. Then, I warm up the PIO vial in a hot water bath for about a minute before loading it into the syringe. My husband does my shots. Oh, and I use a 1" needle. This has worked pretty good. I massage it a bit after the injection. If I get a lump, I'll use a hot water bottle and that usually makes the lump go away, but it doesn't happen very often. I also use a homeopathic cream remedy for bruises. Overall, it hasn't been as bad as I thought.


Jo said...

Oh. Good times, you said it. Just want you to know I am thinking about you.

I Believe in Miracles said...

Good job with the PIO! Those are my pain in the butt - literally. I used ice for 20 min ahead of time and then rubbed it with a hot washcloth afterwards. That was typically the best for me in terms of not bruising and the hurt going away.

I'm praying for those little 4 for you. ~~HUGS~~

AnotherDreamer said...

I am glad they're being proactive this time :) No advice, but what Kristin said makes sense. Ice may help.

Good luck hun!!!

Shinejil said...

Good luck, Dora! I hope the injects get a bit easier and less bruisy.

I've got all digits crossed for you...

The Steadfast Warrior said...

I really hope this cycle goes much better. I'm glad you found out about your progesterone issues. Good luck with the TWW!

Anonymous said...

I LOVE ice!!!! Cannot tell you how much. Honestly with ice I have never felt the needles, but this could also be due to my excesssive padding in that area.

I am lucky to have my DH administer shots most times, but I just got back from a trip where I had to do my own. I put the ice pack on - probably too long for some official people, but I don't want to feel it! Usually about 5 minutes. I prop it inside my underwear and I can do other things (like unload the dishwasher) while I'm chillin.

Just to be sure - you only use the big 18 gauge needles to get the oil out of the bottle - then you switch the head to a 22g. Which still looks huge, but I swear if you are iced up you can't feel it. I have heard of people using 25g needles, but it is harder to push the oil through (so it takes longer).

I guess I am lucky that it has never bothered me (except the scariness of thinking about it) - I sometimes feel a bit itchy around the injections sites but not too bad. Good luck - hope this helps!

S said...

Ok I'm such a newb, but I found your site again! mwahahahahah! whew.

WAHOOOO you're PUPO! dont you just love that feeling?? I know I do. I'm addicted. F#ck what the shrinks say! Kick that sad feeling out for now, mate, no need to feel it now, for now, just be happy that you're "technically pregnant". Later, if you need to, that's when you put the sad hat back on. Just sharing my way of dealing with my current cycle.

I wanted to add my comments on the vaginal progesterone. Almost 100% of fertility specialists in Australia (and our clinics have a very good reputation all around) use vaginal progesterone, because the absorption is just about the same if not higher (sorry, dont have any cool articles for you, but I know if you read the crinone product booklet online, it explains in excruciating detail). crinone is usually used for stim cycles because the govt subsidises (for now!!) two boxes on transfer. For FETs, patients are given a choice between 3-4 200mg pessaries a day or 1-2 crinone AND 1-2 200mg pessaries a day. Note that crinone doesnt show up in bloodwork in accurate doses, unlike the pessaries.

Hope that makes sense! As you've already used vaginal, I suppose you don't really have a choice about the PIO. :( I've never used it so don't really have any tips for you.

Oh I hear you about the lovenox :( I don't have a clotting issue but my FS loves to put me on everything "just in case" (me rolling my eyes here). clexane is such a case. only a man would invent that blunt piece of crap needle, the sadistic f#cking thing. 2 weeks of use and it looks like I'm a domestic abuse victim... (hmm maybe I could use that against M, mwahaha).

I really, really hope this cycle works for you, so you don't have to spend any more money on IVF for a while! I have no idea about insurance in the US but that SUCKS that its mostly not covered. Grrr!

Loads of hang in there hugs!!