TAXES: We visited the tax guy Thursday evening. It’s someone Mr. W has used in the past and I’m happy he found his way back and took me along. We were hoping we wouldn’t have to pay (much) given that our expenses are at an all-time high right now. Imagine our relief when we got a refund, and our tax refund came out to, not as much as last year’s, but about 1/3 as much. We’ll just say that if applied 100% to my “fertility credit card,” will pay off more than half of it. It’s like getting 20% off on fertility treatments. But now I’m thinking, we’re letting the government withhold way too much of our money for taxes. I should increase my exemptions for this year. (Mr. W has himself plus 8, I have just myself plus 1.) So, that went well. 🙂 The tax guy’s modest office lobby is well-stocked with hospitality, too, but I couldn’t indulge in the red wine, chilled white wine, Cokes and diet Cokes, coffee (which they had run out of anyway), so I chewed on a lemon Tootsie Roll (I didn’t know these existed!), flipped through a celeb mag, and played a form of Scrabble on my cell phone with Jordan and Mr. W. (They both cheat. What kind of word is “vim,” anyway? They both played it against me. Hmmph.)

FERTILITY DOCTOR VISIT: Friday morning, we went in to our fertility appointment. First, they did another ultrasound to count my follicles again. I don’t know what these drugs have been doing, but I’ve never seen my follicles (egg sacs in the ovaries) look so clear on ultrasound. I could finally tell what my doctor was counting. He pointed to various large dark circles and said these are the good follicles that will mature and he will take the egg from them. He pointed to various medium and smaller sized dark circles and said these probably won’t mature much, given how young and small they are, so he’ll just ignore them when he’s doing the egg extractions. He counted the viable (large) follicles. SEVEN on each side. Woohoo! (And, ouch.) I’m definitely at the right stage to change over my Lupron drug (halt ovulation) to Menopur and Follistim (start egg ripening). Since we were on the subject, I noted to him, “I didn’t feel anything on Lupron.”
“You’re not supposed to,” he said. “One out of six or so women get menopausal type symptoms, but most don’t feel anything at all.” Mr. W said he would’ve thought I’d be one of the six since I’m “sensitive to medication.” Lucky for him I’m not, although it’d be interesting to get a glimpse into what I’d be like at menopause.
After the ultrasound, I went to the phlebotomist station for a blood draw to test my hormone levels. We discussed what happened last time they drew blood early morning. (Before we left for the airport on our Europe vacation, we went to the fertility doctor’s for multiple blood draws. I stood up when I was done, waited for Mr. W to be done, then when I was at the payment desk, I started feeling nauseated. It got worse until I had to tell the receptionist to stop talking because I needed somewhere to sit down. Then ringing in my ears set in and I started getting a “static” thing going on the outside edges of my vision, which closed in until my vision went black. I told them I couldn’t see anything and felt really sick. A nurse and Mr. W led me into an empty room to a chair and the nurse fanned me (I had broken out in cold sweat) while feeding me a box of juice. Soon the ringing gave way to a water rushing sound and I could hear better and I started seeing shadows moving around in black and white. My vision then came back and they instructed me to sit there while Mr. W kept fanning. Apparently juice in the morning before a blood draw was not enough for my little body.) The nurse said losing vision without losing consciousness was “weird,” cuz usually people that start to black out on their vision faint. This gives me a little concern about “going under” during the egg retrieval; what if I’m paralyzed and blind but I’m conscious and can FEEL and hear? *vomit*

After the blood draw, we went into a separate nurse’s office and the nurse who was with me at the ultrasound came in to explain my next course of medication for the next 8 days. Apparently I’m not done with Lupron. I’m just going to halve the dose to the “5” line (.05ml?) on the tiny skinny subcutaneous syringe (the ones with the orange caps in the photo), and administer that in the mornings as I have been doing the last 10 days. I guess that explains why I got an entire separate pack of insulin syringes in addition to the ones that came in the Lupron box, and why I still have half the vial of Lupron left over. “We still don’t want you to ovulate,” the nurse explained. I’m adding Menopur to the morning Lupron poke, though. I found out Menopur can also be administered subcutaneously, so I was greatly relieved. That means I can still do it myself. But this one’s trickier to set up. Apparently the syringes for Menopur comes with a “mixing needle” attached to the syringe. She said I don’t have to use that because it’s more difficult, so to just twist that needle off and throw it away into the Sharps container (provided). That was a relief, because the “mixing needle” is thick, long, and scary. I then screw on a “Q-Cap,” which is shaped like those ointment tube caps that have an inset puncture point on the other side that you have to turn around and push into the foil seal of the ointment tube opening to puncture it. So you screw the Q-Cap onto the syringe and use it to puncture a small vial of clear fluid. The way the cap is shaped also snaps onto the vial. You then use the syringe to draw up the liquid through the hole at the tip of the puncture point into the syringe. Then you pull off the vial and insert the Q-Cap with syringe onto a second vial of white powder. Squeeze the liquid from the syringe into the vial, shake the vial, mix the two. Then draw up that bottle of mixed meds into the syringe. Remove the Q-cap and vial, screw on the thin half-inch subcutaneous needle head, squeeze the air out, tap out the air bubbles, and you’re all set.
In addition to those 2 morning shots, I have to do a Follistim shot, also subcutaneous, at night. This injection “pen” is the stupidest invention in my kit. The concept is cool; you load a vial of the liquid into the middle of the pen. You screw on a new needle tip. You turn the back of the pen until your directed dosage (225 iu for me) shows up in the window. You inject the half-inch needle into your skin and push the button at the back of the pen with your thumb. You pull out the pen, toss the needle, and you’re done until the next dose. Here’s the impracticality of it: The vial is preloaded with 300 iu of medication. My second dose, I use up the remainder of the vial (75 iu) and have to open the pen, pop in a new vial, screw in a new needle head after tossing the old one, turn the dial to administer the rest of my dose (150 iu), and re-poke and re-inject. That’s TWO POKES for one dose! And then the next day, I’m going to have 150 iu left, so I use it all up, then put in a new vial, turn it to dispense the remainder of my dose (75 iu), repoke AGAIN, and I’ll have 225 iu left in there, the full correct dose, for the next night. To make keeping track of all this easier, the Follistim pen kit has an instructional booklet with a chart in the back pages you write your doses and remaining iu’s in, like a checkbook register. WHAT THE HELL! The preloaded vial is 2/3 empty. Why can’t they fill the damn thing up so I get more uses out of one vial, or better yet, dump all that liquid into one big vial and let me draw up my own dose like I do with Lupron? Argh. It’s such a ridiculously fancy zippered kit, too. See the right side of the first photo. At least it’s in the proper colors of blue and yellow, altho it’s more of a Cal navy blue than the UCLA royal blue. =P

So this morning, I tried the new meds. Mr. W has always been eager to help and so far I hadn’t needed him to. He asks often, though, if I’d like him to do the shots for me. This morning, he woke up before 6am and laid there, fidgeting, keeping me awake. Then 45 minutes later, he prodded me and said, “Want me to set up the shots for you?” I said no, I could do it. He said he paid good attention to the nurse and can do the mixing. I said I can handle it. He offered to do one while I do the other. I still declined, and he said then I’d have to get up now and start setting up the shots to keep to my time regimen of adminstering the shots 12 hours apart each time. I got up and while I was in the restroom, I heard him opening up packaging, heard the clink of vials and the snapping of the Q-cap. I just let him do it while I set up the Lupron. It must’ve been fun for him. After he drew all the Menopur fluid into the larger syringe, I balked. There is SO MUCH FLUID in there, almost 2.5 ml. I’ve been used to .10 ml on the Lupron.
“How is all that liquid going to fit with a little half-inch needle under my skin?!” I wailed. He handed me the syringe. I stared at it, freezing up. I thought of what commenter Bat said (in my Pincushion post) about the discomfort in shots coming from the volume of liquid going in, and not from the prick itself.
“Want me to do it?” he asked again.
“Okay,” I said in a small voice.
I swabbed my problematic right side (which was next up in order of stabbings), sat on the bed, and administered my little .05 ml of Lupron. I felt nothing, which was great, except when the needle came out, a larger drop of blood appeared. Stupid right side. I was still gripping my abdomenal fat roll with my left hand per protocol for injection, and turned my head. “Don’t put it right where I put the other one,” I said in paranoia.
“I won’t, I’ll put it right here,” he pointed to a spot about a third of an inch away from the blood drop.
As I looked away, he went for it. “Hey, that’s good, I didn’t feel it,” I said. A second or two passed. Then I felt the fluid. “Ow. Well, it doesn’t hurt exactly, just sort of sore. Ow. Okay, I’m going to start letting go of my fat now so there’s more room for the fluid to go. Ow. That’s uncomfortable, it feels like pressure inside…” When I fully released my fat roll (I know, this sounds gross), the pressure was relieved significantly.
“Okay, and I’m done,” he said.
“Leave it in there for 5 seconds before you pull it out to let the drug settle,” I said. I had read that somewhere, altho it was probably the instructions for the Follistim pen that I’d be using later that night. My mind was a whirlwind. I figure it couldn’t hurt to prevent liquid from squirting back out like the stream from a clown’s lapel flower. I didn’t feel the needle come out, and he certainly didn’t leave a big mark on my skin the way I did with my dinky little injection, which was already bruising purple under the skin. So he did good, despite the fact that he dropped the Q-Cap when he took it out of the packaging and he stabbed himself with the needle before he administered my shot.
I laid back on the bed, afraid that movement would squeeze the fluid out. How does that much fluid fit in there?! I could feel the pressure as my fat cells were being pushed aside to make room. A minute later I got up and went about my morning and the pressure feeling went away after a few minutes. Now, almost 3 hours later, I still feel normal, not that there’s anything to cause mood swings anyhow. We’ll see how the evening’s Follistim goes.

NEW ANTICIPATION: The fertility doctor’s office called me a few hours after our morning visit yesterday. They said the blood test results show that my estrogen is indeed suppressed, so everything’s on schedule and going as expected. They said to go ahead and start the new drug treatment the next day (today). I go in on Monday for a blood test just so they can make sure the hormone levels of the new injections don’t need to be adjusted (I hope they adjust DOWN!). I go in again on Wednesday morning for another ultrasound and blood test to check the status of my eggs now that they’re being told to ripen, and to recheck hormone levels. At that point, they should be able to tell when the eggs will be ready for collection. (Like a hen.) Presently they expect tentative extraction dates sometime in the week after, so they’re going to call Mr. W’s urologist to clear Monday through Wednesday of the week after next for sperm retrieval. Whenever I’m set for egg harvesting, Mr. W will get the sperm retrieval done the day before so that it will be prepared and ready to fertilize my eggs the day my eggs come out. After that, I will get the best embryo implanted in 3 days or 5 days, depending how well the embryos are developing in their little petri dish beds. Throughout all this, I will be undergoing various shots and I’d still be shooting up, intramuscularly, a couple of weeks after the implantation.

I woke up in the middle of the night last night and stayed awake a bit. I thought of how I’m not going to have sex for a year (cuz right now I’m in menses and after that we’ll both be going through surgery for sperm/egg retrieval and after that I’ll be pregnant and that just seems wrong to give the kid a visitor before he’s truly met his dad). And I thought of how starting now, our lives (well, mine mostly) will never be the same again and it will be completely new territory. I felt a little pensive, and I wondered if this was fear, or maybe cold feet. But then Mr. W snuggled up to me in his sleep and I remembered that one of his traits, which has sometimes annoyed me, is his overeagerness to help and take over on things that I’m doing, which has made me feel like he thinks I’m inept, but maybe when it comes to a baby, I’d really, truly BE inept. I’d certainly be inexperienced. I thought of how a couple of days ago, he was sitting on my La-Z-Boy recliner reading his iPad and I sat perpendicularly curled up on his lap, and he’d patted an empty spot between his stomach and my lap, and said, “In a year, there’s going to be a baby laying right here on us.” And I thought of how I’d been afraid that marriage would be a goodbye to all the things I loved about my life — the freedom to wander around the house nekkid or sloppy, the luxury of falling asleep downstairs in front of the TV for naps, the availability to hang out with friends and take trips — and how none of those things really changed. And then, with my husband curled up behind me and with my cat luxuriously balled in front of me and the rain beating outside, I fell asleep again.