When I went through my first IVF cycle in May 2017, the medications were a total mystery to me. I wish I had found a blog like this to help me through the whole mess because I was already stressed out enough trying to navigate the land of IVF let alone navigating the land of IVF medications too. I was TERRIFIED of having to inject myself with needles. I have never been able to look while they are drawing blood or starting an IV. So this was something I put off because of not only the cost of IVF, but my fear to have to inject medications into my hips and stomach.
Intake Exam:
You have to do an initial evaluation for IVF to determine where you are at from a fertility health standpoint. It doesn't matter if you are healthy or you could stand to lose a few pounds, it is a requirement to starting IVF. Sometimes you have issues that are just dealt as part of your hand, and other times you have great fertility into your 40's, it really just depends. So in my case, keep in mind that although I was pretty healthy overall and 33 years old, I did not show great fertility when I started preparing for IVF in March 2017. My Anti Mullerian Hormone level was a 0.3, and they want you to be closer to 1 or 2 at least for good ovarian reserve. My day 3 FSH was also higher than they'd like to see which is another bad sign for fertility.
https://www.shadygrovefertility.com/blog/diagnosing-infertility/infertility-tests-checking-amh-fsh-levels/
My protocol of medications was fairly high, as I found that it costs approximately 6k for medications each time I do a fresh IVF Retrieval. For a fresh retrieval there are a lot more doctors visits, and it is about 7 times more expensive than a frozen embryo transfer. A fresh retrieval requires more injections and other fertility medications, too. The whole process revolves around stimulating your ovaries to produce as many mature eggs as possible. As I learned, you will only have one egg that is "mature" on either ovary at a time typically, so this process can often result in over stimulating the ovaries causing a condition called Ovarian hyper stimulation syndrome , or OHSS.
IVF Medications:
IVF drugs are like some sort of underground drug market, or at least they feel that way because you can't just go to Walgreen's or Giant Eagle pharmacy to grab more IVF injections if you run out. Receiving calls from multiple pharmacies when I had no idea what was ordered for me or how to go about obtaining the right medications and dosages was completely stressful and confusing for me. I wanted to know what was ordered so I could be sure they got everything correct, or check that I was getting the best deal because I was spending 6k on medications. You'd think that would be a given, but it is not.
The IVF clinics will order your medications for you directly from whomever they deem to be the cheapest pharmacy. What you don't get warned about is that this pharmacy may change from one cycle to the next, which you find out upon answering the phone call after you start another cycle. My first IVF retrieval medications were ordered through Freedom Fertility, but for my Frozen transfers and most recent IVF #2 cycle medications, MDR Pharmacy has been the go to choice. These "pharmacies" will deliver your medications next day for free, however someone has to be available at the house to sign for the medications during the fresh retrieval cycles. Some injections must be refrigerated and signed for because they are considered a controlled substance in states like Pennsylvania. Too bad covering infertility insurance isn't also required of this state!!!
Injection wise, I found the stomach ones to be easier than the intramuscular ones. Maybe its just because the needle is longer for the intramuscular ones. Not to say that they don't all suck! Other than when you are doing the progesterone in oil injections, I would recommend using ice on the location you are injecting before you do it and after if it feels good.
Here is my Fresh transfer protocol medication wise:
Vivelle Patch
5 x boxes Ganirellix or Cetrotide (injections)
5 x boxes Gonadatropin FSH (Follistim or Gonal-F injections)
75 IU FSH & LH (Menopur injection) x 5vials x 5 boxes
HCG "trigger shot" (Pregnyl, Ovidrel injection)
In my opinion, when I had to do Menopur, it stung and sometimes bruised me when it was injected and bled a little. The other ones weren't as bad although the HCG shot is not fun because its intramuscular and the needle is much longer! However, hopefully when you are doing it you will be excited about the future retrieval step and moving forward so it will help ease the pain :)
https://www.babble.com/pregnancy/what-its-like-to-give-up-your-body-to-ivf-meds/
Fresh transfer # 2 (Low dose)
Femara 2.5mg
5 x boxes Ganirellix or Cetrotide (injections)
75 IU FSH & LH (Menopur injection) x 5vials x 5 boxes
HCG "trigger shot" (Pregnyl, Ovidrel injection)
Femara is a substitute for the Gonadatropins, so its one less injection than previously and you do not end up increasing the FSH/LF Menopur doses above the 150/night like I ended up doing with the regular IVF (I ended up at 225, or one extra vial a night). I did a little better with this cycle and was able to get two eggs versus only one when I tried the above protocol back to back. Some patients that have a tough time responding to the regular IVF dosing (esp those that need the high ones because of their FSH levels), have been found to respond better to this more gentle cycle. Typically I think people end up with 3 on average, but I am not quite average unfortunately. Femara has little to no side effects unlike its cousin Clomid. The other meds are stomach injections and smaller needles but like I mentioned they have their own quirks. Like Ganirelix is easy to prepare because it doesn't require mixing, but it has an uneven needle (almost like its barbed) so it can be a little tougher to inject than Menopur.
Frozen Transfers:
For a frozen transfer, you will be prescribed some combination of estrogen and progesterone. My doctor insists that the studies have shown injectable estrogen and progesterone in oil to be the best success, but when you do a fresh transfer, they do not use this protocol for whatever reason. There is also an option to insert estrogen pills vaginally as well as the progesterone supplements (Endometrin), or to take the estrogen by mouth and do the progesterone supplements vaginally (this was prescribed to me for my only fresh transfer I've done). The progesterone inserts are a bit messy but not as painful as doing injections into your hip or thigh muscle. But again, the success rates favor the injections so that was what I did despite my being sick of needles. The delestrogen shot was every 3 days, in the hip muscle. It stung some, but it was bearable in my opinion after going through a fresh cycle with all the medications daily.
You start with only the estrogen injections until you are deemed to have a thick enough lining to start the progesterone. Those shots must be done daily and a 5 day window must occur before you can do a frozen transfer after these injections are started. Then after the transfer, they continue until you either get a negative pregnancy test 14 days later or get to 10 weeks gestation. I will not sugar coat it - the progesterone shots suck, because they are longer and they are also in the hip muscle. You may bruise if you draw any blood, but the worst part is the lump you feel afterwards from the oil. Because of this I would only recommend a warm compress before/after the injection, as doing ice will result in the oil solidifying in your hip which lasts for some time as I can attest to.
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