Wednesday, September 9, 2020

Just Say 'Yes' To (Fertility) Drugs

Our embaby match accepted, it was time to pump my body full of hormones to prepare for the transfer. Like many an IVF warrior, I dropped hundreds of dollars at a specialty pharmacy and came home with armloads of medications. I set all the pills, patches, syringes, needles, vials, and a sharps container on my dresser, turning my bedroom into a drug den.

I’d heard horror stories about how fertility drugs made women “hormotional,” headachy, fatigued, acne-ridden, and bloated. I’d watched YouTube videos of beautiful young women injecting themselves with medication, leaving bruises behind on their otherwise impeccable abdomens, thighs, and butts. I was scared of the side effects – long-term and short-term – but I also remembered a line by Brene Brown: “Daring greatly is being brave and afraid every minute of the day at the exact same time.” I was both, and that was OK.

The protocol started with birth control pills, used to suppress ovulation and control my cycle. I was wary of the seemingly innocuous pills because in the past, they made my depression worse and caused weight gain despite my overzealous exercise regimen. But the pill must have improved since the last time I tried it, because for the three weeks I was on it, I had no side effects.

Next up was a daily injection of Lupron, which would put my reproductive system into medical menopause. I’d never injected myself with anything, but Dr. Midler had given me a helpful motto: “A pinch and an inch,” meaning I should stick the needle in a pinch of belly fat at least an inch away from my belly-button. I sucked the liquid drug into the thin needle, stabbed it into my belly fat, and plunged the medication into me. It stung for a second, but wasn’t painful. I did these injections daily for three weeks. Again, I had no side effects.

Then it was on to estrogen patches, used in fertility treatments to bolster the endometrial lining where the embaby would implant. Every two days, I unwrapped a pair of patches from their girly-colored packages and plastered them on my love handles. Aside from gluey, gray square outlines left behind on my skin when I removed them, I had no side effects. If I got pregnant, I would continue to use these until 12 weeks gestation.

In addition to starting all these drugs, I went into Dr. Baby-Maker’s office regularly for vaginal ultrasounds. A sonographer would insert a dildo-like probe inside me and I’d watch her guide the wand around, capturing images of my womb that I couldn’t interpret. At my lining check, which would decide whether or not the transfer could proceed as scheduled, I was hoping for an endometrial lining measurement of 6 to 8 mm. Mine was 14 mm. “That is a miracle lining,” my (favorite) sonographer, Suzy said. I beamed. I was so proud of my body and grateful to God that we’d made it this far.

It was all going so well…until about a week before the transfer, when I was told to start progesterone.

Progesterone is one of the hormones that help sustain a pregnancy. In synthetic form, it’s often mixed with oil, making it thick and difficult to inject…unless you have a huge needle. My West Coast IVF treatment coordinator sent me written directions on injecting the drug, walked me through it on the phone, and then I supplemented her guidance with a YouTube video featuring a no-nonsense Nurse Linda who demonstrated how to do the shot in the upper outer quadrant of my ass. It all looked easy enough – because it is easier when someone does it for you. But my husband was of no help in this department (just the sight of needles made him queasy), so I had to inject myself.

I used a wide needle to aspirate the progesterone out of the vial, then I had to change to a thinner (but very long and no less intimidating) needle that I would jab into my hindquarters. Changing needles was tricky, and caused my hands to shake and my whole body to sweat profusely. In one of my first attempts, the wide needle wouldn’t twist off and I ended up perforating my hand three times and bleeding all over. When I tried with a second needle, the cap came off crooked and bent the needle beneath it. I had to toss it all in my sharps container and try, try again.

But getting the syringe prepped wasn’t even the hard part – sticking the needle in my own butt at a 90-degree angle was. I was stabbing myself blind. After swabbing the injection site with alcohol and inserting the needle in my gluteus maximus, but before plunging the medication in, I had to pull up on the plunger slightly to make sure I hadn’t hit an artery (if I had, there would be blood in the syringe, and I would need to remove the needle and reinsert it elsewhere). Every time I did this, I felt like I was in an outtake of Pulp Fiction. When no blood came up, I breathed a sigh of relief. The few times it did turn crimson, though, I freaked.

There were other injection mishaps, too, of course. I didn’t always remember to shut the bedroom door, and more than once our dog or cat (or both) charged into the room and catapulted on the bed when I was mid-injection. Sometimes, no matter how hard I pushed on the plunger, the liquid didn’t budge. (This can happen if the medication is too cold. Some women carry the vial of progesterone around in their bra for a few minutes before injecting to warm it up.) Other times, I forgot to bring the alcohol wipes and Band-Aids over to the bed to clean up after the injection and I ended up bleeding on the sheets.

I decided to try injecting myself in the top of my thigh instead, and found that while it made my quads marathon-sore, if I alternated thighs each night, and massaged the area after the shot, it was much easier than trying to give myself the shot in the rear end. But even if the injections went off without a hitch (which was rarely), they left big gray bruises on my pale skin that turned to moldy green hues before slowly fading away.

I came to dread the 8 p.m. reminder on my phone to do the progesterone shots. But the only alternative was progesterone suppositories, which weren’t as effective, had to be inserted several times a day, and were said to be very sloppy. Given the choice, stabbing myself every night seemed preferable to fingering myself multiple times per day and having a constant sludge in my underwear.

It was going to be a long 12 weeks. Then again, if I was still injecting myself with progesterone three months from now, that would be a blessing because it would mean the pregnancy had survived.

“This transfer better work the first time,” I told my husband. “Because I’m not doing all this again.”

While my body was ready to receive a donor-donor embryo, my mind started playing tricks on me. Maybe it was the hormones, but as transfer day approached, doubts crept in. Did we really need to do this? Were we prepared for a potential miscarriage? Could we afford another kid? Were we crazy?

I couldn’t figure this out on my own and I knew it. So before I boarded a plane to Sacramento, I needed to get my head shrunk…

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