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Stimulating Discussion

pills on spoon.jpg

a blog by Murgdan

"Stimulating" is defined as "‘to excite to growth or to greater activity’, ‘to rouse to action or effort’, ‘spur on’, ‘to invigorate’." There are few things more exciting or invigorating than realizing that you may be just a few short weeks away from finally getting pregnant.

The initiation of the true IVF cycle action begins with the ‘stimulation phase,' affectionately known as ‘stims.’ It is during this phase that the ovaries are ‘roused to action’ or ‘excited to greater activity.’ It is during this phase that (hopefully) multiple follicles are ‘spurred on’ to produce and mature a harvest of fertilizable eggs.

There is so much involved in even getting to the point of beginning ‘stims.’

When the large box of drugs first arrives, it can be a bit overwhelming to an assisted reproduction newcomer. What do these drugs do? Why are there so many of them? How will my body be affected? Why do I have to take birth control when I want more than anything to give birth? And to make it even more difficult, there are multiple protocols, multiple phases, multiple drugs, multiple routes, and multiple opinions.

One woman may take Lupron in large doses to suppress her pituitary function, while another takes it in micro-doses to stimulate her ovaries, and still someone else may not take any at all. One may take progesterone in the form of an oily injection, while another inserts it vaginally three or four times a day. One physician writes a scrip for estrogen patches, while another believes that pills are the only ways to go.

Multiple options . . . Multiple opinions . . . Confusion is less than stimulating. If only it could be simple.

My cycle was fairly simple. I was on a ‘standard’ protocol, which is common for a first-timer. So? What happens during a ‘standard’ protocol?

Prior to beginning the stimulation, the ovaries are generally placed into a state of suppression. A suppression check will generally take place at which an estrogen level will be tested and the ovaries and uterus will be examined (with the ever-more-familiar internal ultrasound). When I went for my suppression check no cysts presented and my antral follicle count was >20. This means there are at least 10 small follicles on each ovary that could be stimulated to mature during the cycle. The number may be smaller than that, and that is OK. Everyone is different. If the estrogen level and the ultrasound are acceptable, you will be instructed to begin ‘stims.’

During the IVF process, you will delve deep into the dark corners of that large box of drugs that arrived on your doorstep. The first of these drugs may be Lupron. Lupron is a drug that helps to suppress the body’s own natural production of the hormones Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). My regimen included 11 days during the suppression phase, and the dose was decreased to 5 units during stimulation. The continuation of this drug will prevent my body from being able to ovulate on its own during the stimulation phase. It will also help my ovaries to produce multiple large follicles, rather than choosing to mature only one dominant follicle (as the body usually does each month).

The major drug of the stimulation phase is FSH. Yes, that’s right—we already mentioned FSH here. Basically, the goal is to shut down the body’s ability to produce FSH using the Lupron, and then give massive doses of FSH through injection. The FSH will stimulate those resting antral follicles that contain eggs to grow and mature. The dose of FSH may change during the cycle, as your doctor monitors your blood estrogen level and follicle growth via ultrasound.

Another type of drug that may be taken during ‘stims’ is called Human Menopausal Gonadotropin (HMG). Take note of the words “human” and “menopausal” in the name, because that describes a little bit about how the drug is made. It is created by purifying the urine of menopausal women. Yes, you read that correctly. This drug contains FSH, but it also contains LH. Menopausal women produce large amounts of FSH and LH because the pituitary gland (that makes FSH and LH) is working overtime pumping out massive amounts of the stuff to try and get the ovaries to respond and produce some eggs (along with estrogen and progesterone). Unfortunately, the ovaries of menopausal women don’t respond, so the FSH and LH levels remain at a consistently high level. Someone came up with the bright idea to use the urine of these women to manufacture a drug that can put those high levels of FSH and LH to good use.

Like FSH, LH is produced naturally by our body and it helps to mature eggs before ovulation (which it causes). Since the Lupron depletes natural production of FSH and LH, the HMG will restore a very small level of this substance like would naturally be found in the body. I was on very small daily doses of HMG, and it was increased at the end of my cycle. This type of drug is not used in all IVF cycles, and in some it is the only drug used for stimulation. There are several studies that report HMG stimulates the development of high quality large follicles, leading to high quality embryos and increased pregnancy rates. Of course, the largest of these studies was conducted by the company who manufactures the drug, so one must always read between the lines. In any case, it is important that you trust your physician’s professional opinion. I have found that they are all very different. Again, everyone has an opinion.

I was able to mix all of those drugs together for one whopping subcutaneous injection. I’m proud to report it was physically a fairly painless process.

If becoming a human-pincushion-science-experiment is what it takes to have a baby…I’m all in. And I’ll be in again if I need to be.

Now wasn’t that stimulating?

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