Entry 4: the second step is orientation.
At 10 am sharp, one of the lovely nurses collects us all from the NYU Langone Fertility Clinic lobby (where by the way, they have free wifi – they know their audience) and we head upstairs to a conference room. She projects this PowerPoint– it felt almost like I was in a meeting. There were only about five of us in ‘class’, which was a pleasant surprise.
She goes through all kinds of logistics about what doctors are on call, when, etc. Then she gets into what I was really interested in: how this all works in terms of timing, drugs, and when payments are due.
Here’s the simplest breakdown:
Before your cycle/treatment begins, your doctor will have done certain tests on you to know what kinds of drugs and how much you’ll start with. The nurses typically want to call your drugs in early, so that when you start your period, your drugs are handy.
There are three to four drugs that just about everyone has to take, with some variations depending on every individual. I won’t get into the different brands because that’s not super important. What’s important is to understand what they do:
Gonadotropins: Yes, it’s an injection. These guys stimulate the ovaries to produce as many follicles as possible. In a normal cycle, you may get 1-2. When you freeze your eggs, they want A LOT more than that – anywhere from 10-20+ (I have a friend who ended up with 35 frozen eggs in one cycle. Bitch.). So, essentially, they turn you into a laying hen. I was prescribed Follistim at 450IU’s, which is on the high side. Most start at 300. I guess my eggs need a lot of help.
GnRH Antagonists: Yes, it’s also an injection. This prevents premature ovulation. They don’t want you ovulating, obviously, because they want to remove your eggs, not have them go wandering out on their own.
GnRH Agonists: You guessed it, it’s another shot. You typically wouldn’t take this shot and the antagonist. Your doctor determines which you take. It’s not clear to me yet how that’s determined, but I’m learning as I go.
I was prescribed a GnRH Antagonist called Antagon.
hCG: Yup, a shot. This is what’s typically known as the trigger shot. This bad boy has to be injected within 10 minutes of your determined time, because it mimics the LH surge that precedes ovulation. Your eggs are retrieved 34-37 hours after the trigger is administered.
The big take-away from learning about the drugs: because your dosage may fluctuate throughout the process, ask the prescribing nurse if you can avoid picking up and paying for all of the drugs all at once. You may not need as much your initial prescription calls for, and they are really, really, really expensive. So unless you plan to sell them on the black market, see if you can pick-up as you go.
Now that you know the drugs and what they do, here is how they fit into your cycle (everyone’s cycle varies so this is just an average example):
The oocyte cryopreservation treatment begins on the second day of your period. On your second day, you go to the doctor first thing in the morning for blood work and an ultrasound. You should have picked up your shots from the pharmacist at this point because you may have to start your gonadotropins that evening, depending on the blood work results.
On day 3-6 of your cycle, you typically don’t have to go to the doctor for any blood work, but you’ll take half of your total dose of gonadotropins in the morning, the other half in the evening.
On day 7, you go back for blood work and another ultrasound, and take your gonadotropins in the evening only.
On day 8, more blood work and another ultrasound, and you might begin your antagonist shot. You take that in the morning, and gonadotropins in the evening.
Day 9, no blood work or ultra sound, but same deal with the shots: antagonist in the morning, gonadotropin in the evening.
Day 10-11, back to the doctor for blood work and ultrasound, and shots in the morning and night.
Day 12 is trigger shot day. Again, this shot is very precise in its timing. Then 34-37 hours later, you go in for retrieval.
So, depending on how long your cycle is, you’re done on day 14, and you find out how many eggs you laid!
And now, I wait. My cycle will begin some time around January 24th, so I’ve already given fair warning at work that I will not be traveling. Maybe I should also warn them that pumping myself full of hormones might turn me into a raging lunatic.
Total cost of orientation: $0.
Image Sourced From: http://mashable.com/2012/08/07/skillshare-hybrid-classes/