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Let me start by saying that I’d consider myself to be an experienced Repronex user. My first experience with Repronex was quite painful, but I thought I’d figured it all out after that. Turns out I was wrong. Check out the damage I managed to inflict on myself tonight.

P1000380

See that little pooch sticking out of my belly? Yup…that’s Repronex. It’s just sitting there. Doing nothing. Nothing other than making my belly stick out. Lovely.

P1000389

These shots were taken about a minute after I finished the injection…you can see a beautiful bruise already developing. So it turns out that I can’t even manage to inject myself without leaving a black and blue knot sticking out of my stomach. It feels like a rock and though it’s painless right now, I’m not convinced that’s how it’s going to feel tomorrow. Here’s hoping that this is just a fluke and not indicative of how the rest of the cycle will go.

Welcome to IVF version 3.5…enjoy your stay.

UPDATE: Just had to share the shiner I’ve developed overnight…isn’t it a beauty? Ah the things we’ll do for a baby.P1000393

Because Kami asked, and because these are things I wish I knew BEFORE doing my first PIO shots, here is a list of things I found helpful.

According to me (and I’m no authority on PIO), PIO shots are just like real estate: location, location, location! From my experience, nothing plays more of a factor in whether your shot will hurt like the worst pulled muscle of your life or not than location. After the debacle that was my very first PIO shot, I decided to ask some experienced women for advice on what I was doing wrong, and here’s the info they gave me.

“The point of reference I always use for my hubby to shoot me up is basically behind the hip bone. That is the place where the diagram shows in my pictures from my RE. So I always put my hand on my hipbone and then he matches the area on my behind.”

“Two ways that help me visualize where the area is (which is more on the back of the hip than the butt, even though we call them “butt shots”) are: 1) Draw a vertical line up from the center of your butt cheek and draw a horizontal line across from the top of your crack. Take where they intersect and then move UP about two inches. Or 2) Have your DH line up the outside (pinky) of his hand with your hip bone (where you rest your hands when you put your hands on your hips), with his thumb extended (so his hand makes an “L”). The area that’s framed by the the “L” is where you give the injection. I can find the area that way using my own hand (I give myself the injections), but it’s harder to explain b/c I twist my hand all around.”

I personally use the “L” strategy and that seems to work the best for me. I line up the pinky of my right hand on my left hip bone with my thumb extended out towards my crack. That gives me the right spot to inject horizontally. Then I use the two inches above the crack rule to figure out where to line it up vertically. As I’m sitting here though, feeling that pokey part of my hip bone that juts out in the front of your body is almost EXACTLY where I do the shot, only on my backside, so the advice from the first woman seems spot on too.

The thing about finding the right spot that was really challenging to me was to realize that the shot is not a butt shot at all. I think I thought that since women always talk about their “butt shots” and how their butts are so sore that the shot needed to be much lower than it really should be. Plus I felt like the higher up I went, the less “padding” there would be and it would hurt more. I couldn’t be more wrong. I’m sure there’s an upper limit to where the shot can be done, but I certainly haven’t hit it yet, and to me it is definitely more of a hip shot than a butt shot.

So once you’ve got the location mastered, here are some other tips that I’ve stolen from other people to make things go smoothly.

  • Opposite of a lupron or stim shot, you want to flatten or stretch out the area as much as you can before doing the shot. The more taut, the better. This makes it easier for the needle to go in.
  • Same as a lupron or stim shot, the faster you get that needle in, the better. Though the needle is long and scary, it really DOES NOT HURT GOING IN, but get it in there quickly.
  • Warm your PIO before you inject it. There is one of two ways to do this. After drawing up your PIO, let it heat up inside of a heating pad or warm washcloth for a bit. The other way to do this, and I’m not sure if this is technically recommended (you should probably check with your nurse first to make sure this doesn’t deteriorate the chemical makeup of the PIO or anything) is to run warm water over the vial. I set mine in the stopper of the sink and let warm water run over it while I get my needles set up. By the time I’m done setting everything up, the oil is warm and ready to go. The theory behind warming the PIO is that warmer oil is thinner and therefore easier to inject and disperses easier inside you. However, please BE CAREFUL! Do NOT let your oil get hot or you can burn yourself. I’ve never done this, though I’m guessing it hurts like crazy.
  • Injecting into a tense muscle can cause more pain. To make sure that your muscle isn’t tense, make sure that you wiggle the toes on the foot of the side you are injecting into. This can be done while lying on the bed, leaning over a counter top, or if you’re self-injecting like I do, balancing on your other foot (it’s not difficult, I promise).
  • And finally, don’t forget to change your needle after you draw up the PIO!!! You do not want to inject with that huge needle they give you to pull up the PIO with! Never done this one either, but I can’t imagine it would be fun.
  •  

    Does anyone else have any fun PIO tips they’d like to share?

    Edited to add that Stephanie’s comment on yesterday’s post includes a GREAT description of where to give the shot, and a picture to boot!! Be sure to check it out and while you’re at it, head over to her blog and wish her some luck today with her beta!

    Remember this post about Repronex and how much it sucked for me for the thee days that I took it? Well, it’s time for my friend Repronex and I to get reacquainted. That’s right, it’s two vials of Repronex a night for hopefully the next 10 to 12 days. It’s time to get this show on the road kids. Let’s hope the ride is smooth and ends with a baby.

    I’m not going to lie, the one thing I was afraid of most in the entire IVF process was not the emotional aspect of things, not the surgery that is egg retrieval, not the possibility of failure. No, the thing I was afraid of most was the PIO shots. It was the freaking huge needle that was destined for my butt. Seriously, the mere thought of it made me sweat with fear.

    As it turns out, PIO is just like everyone says…it’s not as bad as you’d think it is. After the huge debacle that was my first PIO shot, things have been a breeze. I’ve got a system down and it works for me. The shots themselves are not painful and I really haven’t gotten any of the lumps, knots or welts that many women suffer from. I still have minor issues working myself up to actually sticking that mammoth needle in my butt, but it’s short lived.

    By far the worst part of PIO for me is having to continue taking the shot every night even after a negative test and knowing that I’m not pregnant. Yes, I tested yesterday and there wasn’t even a hint of a line…not even an evap to tease me into thinking I’m actually pregnant. Nope…just a plain old negative test, just like all of the others that I’ve seen before. So here I am injecting a hormone into myself every night in an attempt to maintain a pregnancy that isn’t even there.

    How insane is that? Really. It’s ridiculous.

    So I have three more days of PIO shots until my beta, when I will no longer have to continue this charade.

    My clinic requires a break cycle in between failed cycles (ugh, I can’t believe we failed!), so we’ll start BCP’s again sometime in February and get to the fun part of a new cycle in March. In the meantime, we’re taking a cruise in February and you can bet that I will be taking full advantage of all of the sugar, dairy and alcohol that I can get my hands on that week.

    As disappointed as I feel like I should be, I actually feel ok. Which is slightly disturbing. What the hell is wrong with me? Seriously.

    Our beautiful Babies

    Here are the beautiful embryos that we transferred on Tuesday. Please note that I have no idea what a good blast and a good morula are supposed to look like, and though my RE did not provide us with any kind of grades for them, he told me that they looked “great.” I feel good about that and though it’s entirely possible that he was blowing sunshine up my ass, I’d like to continue to believe that they are great. So, if you’re knowledgeable about what quality embryos are supposed to look like and mine happen to be not be as beautiful as I think they are, PLEASE don’t say anything! I’m quite content just muddling along thinking that we have two really great chances to be pregnant this cycle.

    So far the PIO shots have been going well. My first one was kind of a debacle and I’m still not convinced that I did it right. It bled like crazy and left a huge purple and red bruise that is still lingering 6 days later. I’m not quite sure how one small pin prick can leave a bruise about an inch in diameter, with random fingers of color shooting out from the hub of the bruise, but I somehow managed it. I think I may have been doing it too far to the center of my back, versus on the side by my hip. I’ve since switched over to my left side right by my hip and that seems to be going better for me. I sit on my hot pad after I do the shot until I go to bed and then sleep on the hot pad all night long too, and that seems to keep the muscle soreness to a minimum. I think that the oil is starting to accumulate over there on the left side since I’ve done the last 5 shots on that side, so maybe it’s time to switch over to the right side and give the left a rest for a bit.

    Oh, and I wanted to follow up on this post about my support group. For the first time since the original “do we have too many pregnant women in our group?” e-mail, we finally had more than four women at our meeting last night. We discussed all of our options as a group and decided that the only choices we really had were to stay with the original group of women regardless of where they are in the whole process, or to split the group based on personal situation and “graduate” women over to a new group once they get pregnant or have a baby. The problem with the second option is that we are a pretty small group to begin with (I would say the most we’ve ever had at one meeting was 8 people), and so splitting by status would leave us with a bunch of really small group (one mommy, two preggos and ~5 still trying) and it’s not really a support group if you’re the only one in it, is it?

    Because of this, we decided that we really like our group as it is and don’t want to split it out into multiple groups. We enjoy each other’s company and have grown close to each other since we started meeting nearly a year ago and want to stay together all as one. So the plan is to close the group to new members, and stay together as we are right now. The compromise to be made then, is to realize that the dynamic of the group is undoubtedly going to change as more and more of us become pregnant. This is not to say that it’s not going to be focused on infertility anymore, but just to recognize that we are now more a group of friends coming together to discuss our common bond and how we are dealing with things. This is a relief for me personally, since I really enjoy these women and look forward to meeting with them every two weeks. I love how we all have different perspectives on the same things and that we all bring something different to the table. I have learned so much from these women and am so thankful to have them as a part of my life. They are truly my friends and for that I am so grateful.

    All in all, life is good and I feel very optimistic.

    Things aren’t too exciting here. Just busy taking my birth control pills and baby aspirins every night. I hate this part of the cycle because it’s so incredibly boring. You wait so long to actually START the IVF cycle, and then you have to endure three weeks of BCP’s. This cycle is even worse than last cycle since the lupron and BCP don’t overlap this time, so I won’t even start injections until the 29th.

    Call me crazy, but it doesn’t seem like I’m getting any closer to having a baby unless I’m actually injecting drugs into my body. Sad, isn’t it? It’s probably even more pathetic because I actually really enjoy doing the injections now. It’s like I’m a part of some warped “cool kid club” that gets to shoot up every night.

    I guess I’m not alone in this mentality though. Last week at my support group meeting, I found out that two of my buddies were going to be on the exact same schedule for IVF and I was going to be a week behind the two of them. While the three of us were discussing our upcoming cycles, our friend who is about 26 weeks pregnant with an IVF baby stated that she was so jealous that we were all cycling together and she wanted to cycle with us. It struck me as a crazy, odd comment, but now I’m beginning to understand it. If you’re not injecting, you’re obviously not having fun, right? I’m turning into some sort of sick needle sticking addict, I fear. But I digress.

    Obviously the 29th cannot get here soon enough, though I do think that the time will fly by quickly. My job will be changing a bit in the coming weeks due to someone quitting, and I’m sure that will keep me busy. Also, my husband may be getting a new job/promotion as a result of this same person quitting, so that’s a thrilling prospect as well.

    All in all, things are going well. We’re just doing what we seem to be doing a lot of lately…waiting.

    For our last IVF attempt, I was prescribed 150 units of Follistim in the mornings and 150 units of Repronex in the evenings. I was totally psyched to do the Repronex because it came in these neat little glass vials and you had to mix the solution up with the concentrated powdered meds each time and then transfer that solution into yet another vial of the concentrated Repronex. I felt like a chemist the first time I had to mix up the solution and had so much fun doing it. The medicine itself looked like an Altoid and I imagined that it would take a while for the solution to dissolve the medicine. Boy was I wrong. The second the solution hits the little lozenge of medicine, it instantly disappears and completely dissolved. Crazy, and very cool!

    Anyway, the fun of mixing up the Repronex was quickly negated by the pain of the injection itself. I had heard in advance that Repronex does tend to sting more than your average stim med, so I tried to prepare myself for that. I wasn’t too concerned with the poking part of the injection because the needle seemed very similar in size and length to the Follistim needle, which was a breeze, and I was planning to inject the meds nice and slow in an effort to minimize the sting.

    All of my efforts were for naught. Injecting the meds did sting, but not so bad that it was unbearable or anything. The problem was that once the meds went in, they didn’t seem to go anywhere. It was as though I had a little pouch of liquid sitting right below my skin that I could swish around with my fingertips. It was definitely sore immediately after I injected it. I was hoping that it would feel better in the morning, but I was sorely wrong (pun intended). When I woke up in the morning, the entire left side of my stomach was tender. It hurt to cough, sneeze, sit up, or anything that remotely engaged my stomach muscles. I was miserable. I seriously thought that I had somehow managed to hit a stomach muscle of some sort when I stuck myself.

    After a couple of days and some Reiki from my mom, the tenderness started to go away. I’m still not sure if I just really messed up that first injection somehow, or if my body was just starting to get used to the Repronex, but I did eventually feel better.

    The point of all of this? Thankfully there will be NO Repronex included in my protocol this next time around; just Follistim. I am very thankful for that and will not miss the Repronex at all, even if it means I don’t get to play chemist anymore.

    I can’t believe how fast this past three weeks has gone by.  When I started the birth control pills, the end of the third row of pills seemed an eternity away.  But now it’s here and I’ve reached the last one.  From here on out, it’s lupron only and that makes me feel like I’m getting somewhere.

    Assuming that my baseline u/s next Thursday goes well, then I’m also only two weeks away from starting stims.  It feels like I’ve come so far already that to think that I still have two weeks to go before we even get to the good stuff is a little disheartening, but I know that the time will pass quickly.

    This Friday we are leaving to go to Colorado for a few days and we’ll swing by the clinic on our way back for my baseline.  I’ll start stims the following Monday, so to me it feels like I just need to make it to Friday and then the time will fly by and I’ll be stimming before I know it!

    We went to a wedding this weekend, so I had to do my lupron shot at the reception.  It went fine with the minor exception that I completely forgot to do it until 45 minutes after I was supposed to.  I had even set my cell phone alarm to remind me to take it, by my purse got separated from me and it was too loud to hear the alarm anyway.  I think since I’m still on the BCP’s it should be fine, plus it was within and hour of when I was due to take it, so I’m not going to let the lateness bother me.

    I also had some kind of illness this weekend.  My allergies have been really bothering me lately and I thought that they were just acting up a lot.  On Saturday I felt miserable from about 5pm on and by about 10pm I was convinced that I had a fever.  I managed to tough it out and we stayed at the wedding until about 11:30 when I just couldn’t take it anymore.

    We got home and I used my charting thermometer to take my temp and found out I had a fever of 100.5.  I self diagnosed myself with a sinus infection (though I’ve never actually had one before) and took all kinds of meds and went straight to bed.  In the morning my fever had broken and my headache was gone, but the congestion remained. 

    Now I’m feeling just OK and hoping that everything resolved itself soon since it would really suck to be sick in Colorado.  I would imagine that congestion and pressure is just that much worse at elevation, so if I’m not feeling better by Wednesday, I guess I’ll have to make a trip to the doctor.

    Other than that, we’re just cruising along, doing lupron injections and counting down the days until Colorado!

    T minus 15 minutes until my first Lupron shot. I’m so excited, it’s ridiculous! Really, no one should be this excited to give themselves injections.

    But I can’t help it! We’re really doing this!!!

     

    The meds have arrived! I don’t know what it is about reciving my meds that is so exciting, but I thought I was going to explode when my box finally arrived. I wanted to take it home IMMEDIATELY to open it and look at everything.

    I was finally able to leave for lunch about an hour later and took these pics.

    Here is my HUGE box of meds next to my laptop for reference.

    Here are all of the meds and needles spread out for your viewing pleasure.

    And here is everything all sorted and put into its respective storage container to avoid confusion.

    Finally, here is the top of my progesterone in oil bottle, which I thought was quite funny.

    You see, I’m somewhat terrified of doing the intramuscular shots, so to open the box and see those words made me feel as though the PIO was indeed flipping me off. I sincerely hope that those words are not at all indicative of how the PIO shots will go down.

    I feel like a crazy woman for even saying this, but I can’t wait to start putting all of those meds in my body! Lupron starts on Tuesday and I cannot wait!

    I just called the pharmacy to order my meds and holy crap, I’m so freaking excited! I don’t know what it is about actually ordering the meds that is so thrilling to me, but I can hardly contain myself right now! Maybe it’s just because actually ordering the meds means that this is really real and it’s really going to happen. Our IVF cycle has seemed so far away for so long now that I kind of felt like it was never going to get here and therefore kept my excitement to a minimum.

    Anyway, the pharmacy that my office uses is one of those old school pharmacies with a lunch counter and a soda fountain amongst all of the regular pharmacy items. A quick Google search brings up nothing about the drug aspect of the pharmacy, only rave reviews about the ice cream and soda fountain. Since we are from out of state, they are shipping my meds to me so there’s no real reason to visit the pharmacy, but I’m very intrigued now and we might have to make a stop during one of our visits just to check it out!

    The pharmacist was very nice and told me that he’ll include with the shipment his business card with his cell phone number on it so that if I need anything after hours I can reach him. How cool is that? The nurse who did our IVF class told us that the pharmacy is just great to work with and always goes the extra mile to make sure that their patients are well cared for. She said that they’ve even had situations in the past where patients were in an emergency situation and needed extra meds or whatever and the pharmacy provided them to the patient and then checked with the clinic later. Because of the distance factor I obviously wouldn’t be able to take advantage of that if the situation were to come up, but it’s so nice to know that the pharmacist would be there to answer my emergency questions if I had any.

    I asked the pharmacist what meds the clinic had called in for me and he stated that amongst the suppressing meds, stimulating meds and antibiotics, two trigger shots were included. Curious, I asked if it was Ovidrel and he said yes. He said that two Ovidrel shots are the equivalent of one shot of Novarel, which is the more commonly used intramuscular trigger shot. I was relieved to hear that they had called in Ovidrel for me since I’m still pretty freaked out about doing the IM shots. Doing the Ovidrel means that I won’t have to worry about somehow messing up the IM trigger shot and endangering my ovulation and therefore egg retrieval. Sweet relief. I’ll deal with my IM injection fears another day!

    So for now we’re actually rolling along, popping birth control pills and baby aspirin every night. We’ll start our antibiotics in a week and a half, and the Lupron shortly thereafter. Because Mark will be out of town the fourth week of September when we really should be having our egg retrieval, I’m going to stay on the Lupron an extra week to eliminate the conflict. That means that we’ll be pushing everything back a week and makes the entire cycle a bit longer as well, but it means less stress in trying to work around the work commitment, so we’re ok with it.

    I’ve printed off a copy of my calendar and keep it in the bathroom. Every night after I take my pills, I make a big black X on the day with my super fat Sharpie marker. It makes me feel like we’re making progress and that we’re one day closer to what we desire so badly and that feels good.

    So I have immensely enjoyed riding my bike to work the past few days (it’s National Bike to Work Week, for those who are unaware). All of the trees are spouting leaves and the crabapples and magnolias are in bloom. It’s gorgeous.

    But even more wonderful than the physical beauty, is the smell. The smell of lilac and magnolias is just intoxicating. The smell of a freshly cut lawn… These are the smells that take me back to my childhood, a time when things were simpler and I had no cares in the world. All of the neighborhood kids would stay outside playing games until the sun went down and our parents called us in to get ready for bed. It’s a nice reprieve from the reality of being an adult and all of the responsibilities that come along with it.

    As for the source of my confusion, I’m fairly certain that I’ve already ovulated. This doesn’t make any sense at all though, since I’ve been testing twice a day since Saturday and never got a surge. I took my Ovidrel trigger shot last night at 8pm, and according to Dr. O, most women ovulate right around 38 hours after taking the trigger. If that’s true, then I shouldn’t ovulate until 10 am tomorrow.

    So what gives? Are my surges just so short that testing twice a day isn’t catching it? Or does my body react weirdly to the HCG shot and ovulate early? I don’t know. I will definitely be asking Dr. O tomorrow.

    Other than this morning, I haven’t been temping at all this cycle so I have no idea where my coverline should be, but tomorrow’s temp should tell the tale. If it’s high, as I expect that it will be, we’re skipping the IUI. I’m definitely bummed about this, especially since we didn’t get any old fashioned baby making in lately because we were abstaining for the IUI. It basically translates into a wasted cycle, which makes me sad. I was having a really good feeling about this cycle and to have it end as a bust is disappointing.

    I see that my blog has been hit a few times by women doing a search with the terms “fertility” and “Femara.” I don’t want anyone to get the wrong idea about Femara from my previous post Fertility Hogs and Why Femara Sucks, because as a whole it has been GREAT for me. Since I started seeing my new RE and we bumped the dose up to 12.5mg, I’ve had 3-4 follicles and my lining was great. I also have great cervical fluid and nearly no side effects to speak of, other than the one day of intense headache and a few days of sore shoulders.

    I’ve never been on Clomid so I can’t provide an objective comparison, but Femara is rumored to have fewer side effects, and I’ll definitely take that. Many women seem to have issues with Clomid thinning their lining and drying up their cervical fluid, neither of which I’ve encountered on Femara.

    And as for the study that seems to suggest that Femara is linked to higher rates of birth defects, I think that a number of the methods used for that study were flawed and therefore the study holds no weight for me. If you’re concerned about the reports of higher birth defect rates when using Femara (Letrozole) then I would encourage you to read this article. It certainly helped to calm my fears.

    I will continue to use Femara until it is determined that Femara and IUI will not work for us at which point we will move on to injectibles or IVF. I’m willing to assume the risk (however large or small it may be) in order to gain the benefits (shorter half life, doesn’t thin the lining, doesn’t dry up CF) that Letrozole has over Clomid.

    So here’s today’s gripe. A couple of years ago when Chili was just a puppy, I was walking him and Popeye around the block. A few houses down from ours, a little boy came running up to us and just LOVED Chili (who wouldn’t though, right? That dog is freaking adorable!). So I asked him if he had a dog of his own. He said no and his mom came up behind me and said “He doesn’t need a dog, he’s got 5 brothers and sisters to keep him occupied!” Yikes. That’s a lot of children. So a couple of weeks ago, I was driving down the street and I see the same mom crossing the street to pick up a ball one of her kids kicked across the street. She was as big as a house, clearly ready to be popping out another child soon. Yesterday as I was riding home from work, I notice that there are pink balloons all over their yard and a “It’s a girl sign in the front yard. Good lord, the next child has arrived.

    I immediately think that this is clearly a very selfish woman. She is hogging all of the fertility on the block, and very obnoxiously so. She’s already got SIX children! What in the world does she need with another one? Share the love woman! Then I thought about the formers owners of our house who told us that the block is known for twins. They had a set, the next-door neighbors have a set, and two houses down there was a set. So what the heck is up with all of the fertility hogs that live on my block?

    End of rant.

    And because I know that you are super curious as to why Femara sucks, here’s my explanation. Yesterday I had really, really, REALLY bad tension in my shoulders and I had a terrible headache yesterday too. My shoulders were super tight last month around this same time frame, and I also suffered from a really bad headache then too. Of course I should give Femara the benefit of the doubt and say that my sore shoulders could have been from sleeping funny the night before, and that my headache was probably due to the fact that I am really bad at drinking water during the weekend, so I was probably just massively dehydrated, but the coincidence seems too obvious to ignore. Either way, I’m feeling much better today and I’m hoping that this month works for us so that I don’t have to go through this again next month!

     

    Our History

    Dec 2006 - Started trying to conceive
    Summer 2007 - Semen analysis (great), progesterone test (normal)
    Dec 2007 - SHG normal
    Jan 2008 - 1st RE appointment
    Feb - Mar 2008 - Diagnosed with elevated FSH levels, 2 rounds of IUI with 5mg of Femara
    Apr - Jun 2008 - Seeing a new RE. 3 rounds of IUI with 12.5mg of Femara, all busts. HSG normal
    July 2008 - Moving on to IVF at a new clinic
    Aug/Sep 2008 - 1st IVF cycle - cancelled due to poor response
    Nov/Dec 2008 - Retry IVF, transferred one blast and one morula, negative beta
    Feb/Mar 2009 - 2nd IVF cycle - Antagonist protocol
    May 2009 - 3rd and final attempt at IVF - Antagonist protocol
    Feb 18th, 2010 - our One Small Wish comes true: Nina Adele is born.

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