IVF Injections
Stimulation drugs day by day - a personal tale of jabs and meltdowns
Travellers beware - more potential delays to your journey
It is still a solid 6 weeks before Christmas and my IVF cycle is in peril for bumping up against the festive holiday. “The clinic closes between Christmas and New Year to undertake its annual deep clean”, a verbal shit grenade the Clinician casually threw my way during our appointment. “So we cannot start any cycles from mid November until the New Year. If you fall into that period, you need to wait until your next cycle in January. But I’m sure you are aware of that”.
I’m never sure, how they are so sure, that I am aware. I have read every word on their website - twice, because it is a hard site to navigate. All the leaflets and forms sent to my home I have read carefully, numerous times, whilst drinking a caffeinated drink to ensure full concentration. I take notes at appointments with a pen and pad, embarrassingly geeky behaviour. So I can say with full confidence that, no, I have not been previously informed of ‘the annual deep clean’.
Start of my short protocol IVF cycle
Aunt Flo has an unshakeable sense of humour and just as I need her to arrive on time, she delays her appearance by a week.
Maybe I will become one of those mystical women who falls pregnant immediately before the start of fertility treatment. Maybe I will tour the country giving presentations to fertility challenged individuals telling them ‘not to give up hope’ and letting them know that ‘I am proof’. Maybe I will come up with a hand signal, like Katniss Everdeen, to express my powerful message through a simple gesture in order to save my voice.
My period starts.
Or maybe not. I call my IVF clinic to book in for my baseline scan, where the clinic check that my ovaries haven’t started doing anything weird or worrying. I also arrange for collection of the first tranche of my IVF drugs. This is it, the start of IVF proper. Marked in blood.
Collecting my IVF drugs
In addition to a baby, a key hope from my IVF cycle is that collection and storage of my IVF drugs gives me enough material for an entertaining anecdote. Something along the lines of a box of hormones being delivered to the wrong floor of my office building, then stored in the work fridge, wedged between bottles of milk with possessive initials scrawled on the top and tupperware of the previous night’s leftovers brought in for lunch. Or a photo of my fridge at home so loaded with syringes that there is only space for one solemn, bright red tomate, squeezed into the corner of one shelf (impactfully placed for the purposes of a photo).
Alas, the reality requires too much creative liberty to construct anything other than a tedious relaying of an administrative process. So that is what I have done.
I empty my fridge in preparation for its metamorphosis into a drug storage facility. I drive to the clinic and collect the first week of drugs from the clinic pharmacy. I carry them to my car, rather than the expected lug, as these hormones, the most expensive thing I own, should surely be bigger and heavier than a small box. I drive home with extreme and unnecessary caution.
I spread the drugs out on the kitchen table for the obligatory ‘IVF drugs photo’, which features in no album but which I send to Joe with some predictable remark about ‘being a drug lord’.
My clinic only entrusts me with enough drugs to get me to the next appointment, when I collect the next installment to take me to the next date, like an IVF treasure hunt.
I sit at the kitchen table reading the descriptions on each box, for want of something better to do. I turn over in my hands each small cardboard rectangle, containing powders, vials, my hopes and dreams, and I realise that I have no idea what they do and replace them carefully on the table.
In front of me is the next month and thousands of pounds, represented in powdered form. It induces a sudden panic in me, followed by a quick but heartfelt weep.
Then it is time to crack on with the rest of my otherwise standard day. As all of my drugs are to be kept at room temperature, my first task is a food shop to restock my empty fridge.
The first injection
A needle, containing drugs and injection ready? Wouldn’t that be marvellous. It is not what happens.
The drugs are in separate parts that I assemble myself. It is a bit like if IKEA did biomedical products, but with better and more detailed written instructions and without the funny little man they draw.
My inventory of IVF accoutrement:
two different types of needles,
a syringe,
sterile water,
powder (which becomes the hormone to inject, once mixed with the water), and
a thick yellow plastic tub called a ‘sharps bin’.
I make an effort to hide my sharps bin from any visitors to my house. It is intentionally eye-catching and unmistakably medical, an object that demands an explanatory footnote. It is a bright yellow thick plastic box adorned with a skull and crossbones warning image in which to safely discard my sharp objects (syringes, needles, etc) so that my husband and cat do not accidentally prick themselves and start growing boobs, or having babies. I was told clearly by the clinic not to slide the lid of the sharps bin to the fully closed position until either it was full, or I was done. Once shut, one cannot reopen that stubborn little death box.
Mixing hormones and preparing a syringe requires a sterile environment, otherwise known as my kitchen table, wiped clean. Not hospital standards of cleanliness, one can only hope, but probably good enough.
The clinic’s instructions on how to prepare and undertake the injections fills one and a half pages of A4. We agree that Joe will be the mixologist and I will be the patient. I slowly, clearly and unnecessarily loudly, read him the instructions in the phone voice I reserve for utility companies.
We have been shown the process by a nurse at our implications appointment and we have the instructions, but failing that (as with everything else in life one doesn’t know how to do) there is always YouTube.
The result is a blood bath. For Joe, not me. Luckily.
Whilst pulling off the tightly wedged cap on the big fat mixing needle, he manages to pierce his finger almost to the bone, he tells me. He has drawn up no hormones, only blood. I console Joe, wrap his finger in tissues to prevent him from bleeding on our cat, reclean my ‘sterile area’, replace the now contaminated needle with a fresh one and continue the hormonal chemistry class alone.
What are IVF stimulation drugs?
Stimulation drugs, which are hormone injections, encourage the ovaries to produce multiple eggs. The infertility community often refers to these drugs as ‘stims’ or ‘up regs’, mostly to exclude interlopers from joining our sad sack group through the use of incomprehensible shorthand. At the same time as the stimulating hormones, drugs are also taken to prevent the ovaries releasing the maturing eggs.
Disclaimer - The following are the drugs I am taking. The amount of each drug and the brand of drug will vary and is unique to each clinic and IVF cycle.
Cetrotide (I take 250 MCG each morning)
Cetrotide is taken to prevent premature ovulation. It stops my ovaries from popping out multiple juicy eggs before the doctors are ready to collect them in a petri dish.
The medical mechanism for this, courtesy of Dr Google as I have no clue, is by blocking the effects of gonadotropin-releasing hormone (GnRH) which controls the secretion of luteinizing hormone (LH).
As a drug, Cetrotide is tricky to mix. The powder dissolves slowly and its thick, gelatinous consistency makes the air bubbles hard to remove. I learn to take an ‘anti James Bond’ approach of stirred and not shaken. I insert the liquid into the vial, then I circle it slowly around the edge of the glass so that it laps up all the powder like a gently approaching wave.
The first time I met Cetrotide, I mixed her by shaking. Big mistake. The bubbles resembled a hormone jacuzzi and required me to flick the side of the glass vial over and over, in desperate concentration, trying to eliminate the air before I injected. I looked like I was auditioning as an extra in Trainspotting.
On a positive note, Cetrotide injects like a dream. The viscous liquid coursing into my fat is so satisfying.
Menopur, (I take every evening, alternating between doses of 75 IU and 150 IU)
Made up of follicle-stimulating hormone (FSH), I take Menopur to stimulate my ovaries to grow follicles and eggs.
In terms of mixing the drug and preparing the injection, Menopur is the opposite experience to Cetrotide. Menopur mixes easily, with the powder dissolving almost instantly. The consistency is similar to water, which allows any air bubbles to be easily removed with flicks of the syringe.
Do IVF injections hurt?
Pain thresholds vary, but given that my threshold is low, I feel comfortable saying that IVF injections are less of an ordeal than I had anticipated.
This all comes with the caveat that I am on a short cycle IVF protocol, which means that I have not spent the weeks prior to my IVF enduring additional down regulation injections (click here for the difference between short versus long protocol). I have heard of down regulation strategies to vary the injection site, working around the belly button like a clock face, so that there is no need to inject into a bruise.
Do Cetrotide injections hurt?
Cetrotide gets a bad press. If it had Amazon reviews, which it doesn’t and shouldn’t because it is prescription only, there would be a substantial number of one stars touting phrases like ‘bad bruising’, ‘intense stinging’ and ‘drawing of blood’. But for me Cetrotide is a solid 4 star.
Cetrotide is often said to create an itchy red rash on the skin at the site of the injection. This is apparently normal. Well, as normal as an itchy red rash ever is. I only experience one small red rash, which I proudly wear as an IVF warrior scar for the whole 30 minutes it lasts. Would one even call that a rash? As a child, my mum told me to hold a fluffy caterpillar (poisonous, of course) because it looked 'cute' . Now that was a rash.
During my first injection of Cetrotide, a tiny amount of blood from my belly fat drew up into the needle, hence Cetrotide dropping a star in my fictional review. I carried on with the injection, like the trooper that I am, before going on to read the final step in the accompanying instructions was not to continue with the injection if blood is drawn up into the needle. The instructions ordered me to discard the needle and start over.
A short call to the nurses helpline at the IVF clinic and I was reassured. The injection was fine, my IVF round was not ruined and I can be unintentionally dramatic. The nurse asked me if I had injected all of the Cetrotide. “Yes, all of the Cetrotide” I replied, “along with a bit of blood and quite a lot of air”. Her response was wonderfully dismissive. “You are injecting into fat, not into a vein, sweetie, so let's not panic”. The instructions imply that air bubbles are a disaster, but the nurse confirms they are in fact 'nothing to worry about'. And the blood? Oh, a bit of blood never hurt anyone, especially when it is your own.
Do Menopur injections hurt?
Menopur, on the other hand, is a stingy little bitch. On most occasions I cannot feel a thing and on others it feels like when I accidentally put lemon juice on a paper cut. It is never at the level of a bee sting, let us not be dramatic. It never bruised or drew blood, like its cousin Cetrotide.
Entering into an injection routine
After only a few days, the complexity of 1.5 pages of instructions shifts into a mundane routine. The process of injecting becomes rote learnt, like tying a tie or shoe laces, only sharper and with the chance of accidental blood.
What continues to surprise me is how long it takes to inject liquid into fat. People practise injections on oranges, but it feels like potatoes would be more appropriate , a solid dense mass with nowhere for the liquid to go.
And then it falls apart with Menopur Meltdown Day
Infertility exposes me to a whole range of new life experiences, all of them shit, and in IVF history, the 18 November shall henceforth be known as Menopur Meltdown Day.
I shall paint it for you. I am on the hen do of a close friend, in an edgy bar in Soho, London, shooting up in the toilet. A public loo is about as far from a sterile environment as one can get, especially in this bar, where pristine and clean would detract from its vibe, so I was being obsessive about the needle and all the component parts not touching anything. I am an hour and a half away from home and this is my last dose of 150 IU of Menopur.
It all appears to be going swimmingly, hygiene aside. I have photographic proof for Instagram, on which I am charting and sharing my IVF experience. Photographs of calm and ordered moments immediately before an incident are existentially creepy, like the opening sequence in every episode of Casualty, or the photo I have from a holiday in Kenya, with me smiling at the camera a millisecond before I was headbutted by a giraffe.
It appears to the naked eye to be a satisfactorily constructed IVF jab. But, wait for it.
Eliminate air bubble, check.
Insert needle into tummy fat, check.
Plunge the back of the syringe....
Plunge the syringe….
Why can’t I push in the back of the syringe?
This feels really…
tough, it won't budge.
Push harder...
The Menopur squirts out of the back of the syringe all over the toilet floor. I later learn that a build up of pressure, due to me not properly fastening the needle, caused the syringe to burst.
All my fears about sterile environments disappear as I kneel next to my hormone puddle and wonder whether I can somehow scrape it back into the syringe and try again. Is it acceptable to include a drop of stranger's urine, dirt from shoes, with the added possibility of a surprise pube? Even in my sobbing, edging toward hysterical state, I realise that any medical professional is unlikely to recommend this option.
My clinic has a 24 hour emergency phone number staffed by angels, who have chosen to take the human form of IVF nurses. Essentially, it is the 'fuck up helpline'. I call immediately, controlling my tears long enough to explain that I have been an idiot and accidentally squirted my drugs onto the floor of a loo.
The nurse wants to know how much I actually managed to inject. “Nearly all of it?” is her optimistic first question. None of it. I am desperate to know if I have messed up my first IVF cycle, so the next expression of optimism is mine. “Was this a disaster? Was it? Be honest. Although not too blunt, as I’m rather hormonal.”
The nurse reassures me that Menopur can be taken within a time window of an hour or two, and it did not have to be exactly the same time each day. This is in contrast to Cetrotide, which requires more exact timings. All of this is news to me and something they could have, possibly should have, told me from the start.
We agree that I am to dash home immediately, via a tube, train and a walk, ditch the hen mid-do, hope that our friendship survives (mine and the hen I mean, not the nurse, although the nurse is lovely) and take my final 50 IU dose of Menopur. I would then attend the clinic the following morning to collect a replacement Menopur for the one that is currently acting as a slip hazard in the women’s toilets. Despite reassurance from the nurse that this shouldn't impact my IVF cycle, I practically have to feel my way home I am crying so hard.
This may be my only IVF meltdown, but it is epic. Lesson learnt from Menopur Meltdown Day - make sure the needle is attached to the syringe securely and push it until it clicks.
CLICKS.
Just a little tip from me.
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