Chapter 9 - IVF for Dumbies Class
When my first child turned eighteen months old we started thinking about “trying” for our second. I love how I say trying as if I was a fertile myrtle that could have one too many glasses of wine and some hot sex and opps get pregnant. Nevertheless my husband and I decided we wanted to start fertility treatments again, our version of “trying”. We did five rounds of Clomid and four IUIs (the first round of Clomid nothing happened).
The week before Thanksgiving 2014 my husband and I attended our IVF orientation class, we both took half days off of work. I assumed that IVF orientation class was all about the injections. I thought we were going to learn how to administer the shots. Were we going to practice on ourselves or on mannequins? I didn’t know, but I knew it was all about the shots. I told my friends this class was to teach me about the shots. No. Wrong. Not even close.
Prior to the class I called one of the few people I knew that had gone through IVF, a former co-worker. She explained to me that there are stomach shots and ass shots. After talking with her I knew, well no, I thought, I could administer the stomach shots myself, but I was nervous about the ass shots. I didn’t know if I could reach the proper place in my ass to administer the shot. My husband works long hours and isn’t home every night to shoot me in the ass. I went into IVF orientation class with lots of ass shot questions. Silly me.
IVF orientation class is like high school biology. There is a one-hundred slide power point that explains exactly what IVF is and what it does. Where the science originated, how it’s been improved over the years.
The other couple seemed very nice. They were strict fertility clinic rule followers in the beginning. I tried so hard. “Hi! I’m Sarah. I have PCOS.” No talking. No smiling. What about a side smile? Nope. Just watch the slides.
About half way through the power point I whispered to my husband, “Where are the slides about the ass shots?”
He looked at me like I was a stranger talking to him in the ‘quiet car’ on the train. “Shut up and pay attention,” he whispered back.
The slides continued. No drinking alcohol of any kind.
Wait what? Like not at all?
No exercise of any kind.
Ehh that’s ok, that doesn’t really apply to me.
We were given folders. We were supposed to focus on the legal documents first and the protocol papers second. The legal documents are daunting.
What happens to your embryos in the unlikely event of both you and your spouse dying?
What happens to your embryos if you divorce?
Do you want to donate your embryos to science to help teach other doctors how to become embryologists?
We had to make all of these decisions sitting at a conference table across from another couple who was also making the same decisions. Awkward.
Now came time to talk about my protocol. I was being put on Follistim (stomach injection), with the possibility of adding Menopur (stomach injection). Both these injections were to stimulate the ovaries to make the eggs. I was then going to be put on Ganirelix (stomach injection). The Ganirelix was to suppress my body so that my eggs didn’t release on their own. We needed the eggs to release exactly when the doctors were ready to catch them and not a moment sooner.
“Omaha! Omaha! Hut!” (That’s a Peyton Manning reference for the dwindling number of men who are still reading this blog. I’m assuming that my male readers are dropping like flies. -There’s something about reading about this woman with an ultrasound wand up her cooter that makes me what to reach for my fantasy football magazine – says every man. Ever.)
I was told that all of my injections and syringes were being called into my mail away pharmacy for me. This isn’t the type of stuff you can pick up at your local CVS. I was given the number for the mail away pharmacy, I learned quickly that I was on the phone with them more than anyone else in my life for that month. The number was saved in my phone just a step away from being added to my favorites and putting a cute caller ID picture with it.
What about the ass shots?
What are the ass shots?
Why is no one talking to me about the fucking ass shots?
The other couple started smiling a little each time I said 'ass shots' and because I’m an insecure person who measures my self-worth on if I make other people laugh I continued to say it, a LOT. Maybe they are rule breakers after all. Rebels.
The ass shots are only after they take the eggs out of you, I was told. The ass shots are Progesterone in Oil. The needle is huge and the liquid is very think. The nurse told us that we should hold the vial of the liquid in our armpits for a few minutes prior to injecting it in order to make the solution easier to inject. She then took out a mannequin from a secret cabinet in the wall. She took out some needles and a vial of the ass shot liquid. Finally! Injection teaching time!
She looked outside the conference room, as if she were passing a note in high school bio. She told us that she is not supposed to teach us this but that she would show us it very quickly. She ‘drew up’ the needle with the progesterone solution and allowed my husband and the other husband there to inject the oil into the mannequin’s ass so that the husbands could feel the thickness of the liquid and they would know how hard they need to push. (‘Drew up’ is cool nurse talk for holding the vial of liquid upside down and pulling out the plunger on the syringe to fill the syringe with the liquid.) After this secret and short demo she quickly took the mannequin away and hid it.
That was it?
What about all the other injections?
Who is going to teach me how to do this?
What if I can’t give myself the injections?
I asked all of these questions. The nurse seemed to have full confidence that I could do it on my own. She told me to download an app, there’s an app for that, called Freedom Pharmacy. It had different videos of all the injections. How to prep them - how to inject them - where to inject them.
That night I downloaded the app and watched in horror. The first video I watched was for the Follistim injection. There was a woman’s voice on the video and a woman’s hands prepping the injection. She had very fake acrylic nails and all I could think of was, ‘Really? You couldn’t have found someone who could be the hand model and injector with better nails?’ I was fixated on the nails. The Follistim injection seemed pretty easy according to the nail-lady. It was a ‘pen’ like system. You dial out the nob to your prescribed dosage, pinch your skin, inject the needle into your skin, release the pinch, push the solution down into your skin and pull out the needle. Nail-lady made it look very easy.
The next video I watched was for the Ganirelix, which was my suppressant so that my eggs didn’t release on their own. Nail-lady was back again, same nails, different colored t-shirt. This injection seemed pretty easy as well. Small micro-needle. Not a ‘pen’ system this time but an actual needle with syringe. I watched the video. ‘I can totally handle this, and with a better manicure.’ I thought.
The next video I watched was the Progesterone in Oil video. The ass shots. Same nail-lady. The prep looked like the others, easy. I can totally do this. I am a pro and all I have done so far is watch the videos. The needle on this shot is significantly larger and longer than the others. The nail-lady prepares her ass for the injection. She pinches her butt and then FUCKING JAMS the needle in. I scream out loud in shock. I am breathing heavy and my face is turning red with anxiety. ‘What was that? Why did she jam it in so hard? What?’ I rewind and watch the nail-lady bludgeon herself in the ass again. Enough of this, I’m getting a glass of wine or two while I still can. I put my phone down and try not to think about the trauma I just saw, while at the same time obsessing over it.
I bring my phone to Shameeka the next day and show her the ass shot video. She yelps as the nail-lady slams the needle into her ass. Shameeka hands me back the phone, shaking her head saying, “This is going to suck for you.”
December 1, 2014 is day two of my cycle. I wake up at four-forty-five in the morning. I leave the house at six. At this hour of the morning the trip should take forty to forty-five minutes max. I’m cruising down the highways in the black of the early winter morning and everything comes to a halt. There is a massive traffic jam on the Deegan (87). I’m stuck. I can’t go anywhere. I start freaking out as the minutes are ticking by. Every minute that I am stuck in traffic is a minute that I am not early for the clinic and if I am not early for the clinic I can’t get my blood and ultrasound first and if I can’t get those things first then I will not make it to work on time. To most people getting to work on time is a relative thing. When you are a school teacher you are contractually obligated to be in your classroom at a certain time. If you are late, everyone notices. Not just because the other teachers are nosy bitches, but because you have twenty-four ten year olds unsupervised outside your classroom. It is not ok to be late. It is a big deal, one that I take very seriously.
I am stuck in my car. My heart in pounding. I can’t even call my school to tell them that I will most likely be late because it is still too early in the morning. I punch the clinic’s address into my GPS, praying that there is another way. I get off the highway around Yankee stadium. I drive on all the back roads like a mad taxi driver, swerving between lanes, running yellow lights (ok, they were really red lights, but whatever). I’m actually pretty impressed with my driving and, because I am me, I start thinking that I am driving like Jason Bourne. Awesome.
The clock hits seven and I start calling my school because the early secretary should be there by now. I call again and again, she finally answers. I explain to her that I was in a ton of traffic and that I am not even at the clinic yet. She seems surprised that I am talking so openly about the fertility clinic. I can tell because when she repeats the words f-f-fertility c-c-clinic she stutters a little bit.
It’s a fertility clinic Rose, not prison, it’s ok.
She tells me to keep her updated and that if need be someone will watch my twenty-four fourth graders until I get there.
Really? The school won’t just leave them in the hallway? No shit, thanks.
After the clinic I rush to school, driving like Jason Bourne the whole way. So impressed with myself. I get to work around eight-twenty which is not actually humanly possible, but I did it. Rose is even surprised, which is huge because nothing surprises Rose. That day I go to see my assistant principal. She needs to know what is going on. December is a very busy month. I have forty parent-teacher conferences already scheduled for the middle of the month, which would be totally fine if not for the IVF follicle extraction that is also pending for day fourteen of my cycle, the middle of the month. There is no way to know on December 1st when they will take out my follicles so we will need to play it by ear.
Teachers are planners, we are not good at ‘playing it by ear’. I explain to her that I am going through IVF. I explain to her what that exactly means (I find it odd how so many people in 2017 don't know what IVF is - oh wait... it's because no one talks about it).
I ask for her permission, if it comes to it, could I please do my parent-teacher conferences over the phone. She agrees and tells me that we just need to wait and see what happens.
We need to plan, we need a backup plan. I think to myself.
I get the call later in the day. It is time to start the shots.