Tuesday, October 2, 2007

Follystim

My first experience with injectable fertility drugs was nothing like I had imagined. I think I was expecting the bad TV movie version, with the old-school syringes, 2 inch long needles, and crazy mood swings.

My RE prescribed 75 IU of Follistim, to be injected on days 3-7 of my cycle. Whereas Clomid indirectly promotes follicle stimulating hormone (FSH) production by inhibiting estrogen, Follistim is straight recombinant FSH (so it’s not extracted from the urine of postmenopausal women like some of the more old-school FSH drugs). When I started taking it, I went online to try to find other women’s experience with Follistim, and I wasn’t able to find much. It seems many more women are given Gonal-F, a similar drug. They are both recombinant FSH, and I’m not sure why one is prescribed more than the other.

Follistim comes with this nifty pen that you use to dial up your dose for the injection. I had a 5 minute training session with my nurse to learn how to do use it. It’s pretty easy, and the cool design definitely made me feel less anxious about injecting myself with massive amounts of hormones. The injection itself is pretty simple:

· Pick a spot on your abdomen, and swab it with an alcohol wipe
· Dial up the Follistim pen and insert the needle, making sure a small drop of the drug appears at the end of the needle (this part was a little tricky—more on that later)
· Pinch your belly at the chosen injection site, insert the needle, inject, wait 5 seconds
· Remove the needle, and dispose of it in the cute little Sharps container that came with the drugs.

The first injection went off without a hitch. The second time, I had a major panic, when I couldn’t figure out whether any drug had been injected. I hadn’t seen any liquid at the tip of the needle and it didn’t seem like the level of drug had gone down in the vial. I finally just reloaded the pen, and was able to watch the liquid go down as I injected it. I hadn’t realized that could happen, so I was very careful with each subsequent injection. I switched sides with each injection, but a couple of nights I bled a little bit and developed a bruise at the injection site.

I had heard that the drugs could cause mood swings, but I didn’t really experience that at all. In fact, the lack of side effects initially convinced me that they weren’t working.

I went to the RE for an ultrasound on day 8, and the technician counted 17 follicles, divided pretty evenly between my ovaries. The follicles on the right side were much bigger, and I had two that she measured at 15 mm. I knew that the follicles had to get to 18-20 mm before they would trigger ovulation, but I was encouraged that there was something there. I was a little concerned about the number of follicles, but the technician assured me that wasn’t unusual for someone with PCOS. They instructed me to do another injection that night, but to reduce the dose to 25 IU. This would help along the bigger follicles, while preventing too many of them from progressing.

I returned the next day, excited to see the progress of my follicles. They pretty much looked the same as they had on day 8. They told me to do another injection of 50 IU that night.

When I came back on day 10, it was clear that the follicles weren’t progressing. When the ultrasound machine is out of paper, the technician will hand me a notepad, and have me write down the sizes of the follicles. She had me do it this day, and as she rattled off numbers, I could feel the tears forming in my eyes. I knew then that the cycle was a failure, and we weren’t going to move on to IUI this month.

I talked to my doctor later that day, and she confirmed what I had suspected. I had read that the first injectable cycle is more or less trial and error. It gives your doctor a chance to see how your body is going to respond to the drug, and to determine the optimal dosage.

Knowing that, my heart still broke when I learned that the cycle had failed. I had convinced myself that it was going to work this time. I had wondered how I would explain why I wasn’t having beer at our weekly happy hour at work, or why I didn’t want to go out for sushi. Talking with my family about a potential trip next summer, I wondered if I would be too pregnant to travel. I was angry with myself for getting my hopes up; but without hope, how would you ever have the will to do this month after month?

My RE said we could try again, lowering the initial dose to 50 IU, to try to get fewer follicles so we won’t have to lower the dose mid-cycle. She mentioned again that we could go straight to IVF, but backed off when she saw how upset I was. So we’re going to try the Follistim again, hopefully making it through to the IUI.

3 comments:

sharah said...

Hello! Just popped over from the stirrup queens. I'm at the point where we're having to decide whether to move to IUI/IVF as well, and I wanted to let you know that you're not alone. It sucks. But I love your scoring system to decide which one -- I think we ended up with the same decision :)

Familyof2 said...

good luck w/the next go around! Your RE sounds great! They could have let you "keep going" adn then you could have over stimulated, and ended up w/OHSS.

Good luck next cycle. I hope its the winner. From one PCOSer to another...its a pain!

orodemniades said...

I'm glad your RE is hip to the whole monitoring thing and I hope you get much, much better results the next time around.