Thursday, November 8, 2012

A Tutorial on Surrogate IVF Meds

Before I start in on this, I would like to remind everyone that I am not a doctor.  This information is from what has been explained to me by my fertility doctors and gathered off the internet.  Also, my only experience is with the surrogate end of the IVF spectrum.  I know nothing about the egg donor portion or someone doing IVF for herself, where in both cases you would be stimulating large numbers of your own eggs for harvesting.  Since I am a gestational surrogate and my genetic material will not be used in creating this baby, the goal is the exact opposite - temporarily shutting my ovaries down so I don't ovulate and accidentally get pregnant with my own child.

As a further note, my meds will not be the same as another surrogate's meds.  Each doctor/clinic has their own protocol that they like to use.  The medications come in the form of injections, tablets to be ingested orally or inserted vaginally, and patches, or any combination of these.  Heck, there may be some system of administration I don't even know about.

Here is a list of the meds I will be taking along with a brief (maybe) description of their purpose:

Birth Control Pills
The point of birth control pills is to hormonally regulate your cycle so they can sync you up with whoever is providing the eggs, which in my case is an egg donor.  Since embryos cannot live indefinitely on their own, it's imperative that my body be ready to receive them within 3-5 days after they are harvested from the donor.  So what they do is have you on active only birth control pills (the first three weeks in the pack) continually until they are ready to prep your body to receive the embryos.  I have been on active only birth control pills since August.  In theory, you should not get your period during this time.  In my case, my period waited two weeks and then came anyway, and I have been spotting ever since.  So I've had a not-quite-period for over 4 weeks now.  Yay me!  Once I am established on the next drug, lupron, I will stop taking the birth control pills.

Lupron is the drug that I will begin taking tomorrow.  Its purpose is to inhibit the hormones that the body normally secretes leading up to ovulation, basically putting the ovaries to sleep for a while.  It is delivered with a subcutaneous injection (like insulin shots for diabetics).  I have to take this shot every day between 6 and 10pm.  Possible side effects include: hot flashes, weight gain, migraines, and extreme moodiness.  Basically, the same as if I were to suddenly become menopausal.  Luckily I will only be on this drug for about 4 weeks.

Once the body is on lupron, it will not ovulate on its own.  Unfortunately, that also means that it will not prepare itself for possible pregnancy by thickening the uterine lining.  So once we have shut down the body's ability to prepare itself naturally, we need to reintroduce estrogen so that the uterus will be nice and thick for embryo implantation.  I will be using Vivelle estrogen patches to accomplish this goal.  In the weeks leading up to the embryo transfer, I will have a couple of ultrasounds to make sure my lining is thickening properly.  If it looks like I need a little boost, I will also be put on Estrace tablets (which are taken either orally or vaginally depending on how much they need to be absorbed) to thicken my lining some more.  I will remain on these throughout the first several weeks of pregnancy until my body wakes up, realizes it's pregnant, and starts producing estrogen on its own.

Baby Aspirin
At the time I start taking estrogen to thicken my lining, I am also supposed to take a daily dose of baby aspirin.  In addition to preventing blood clots (which some of the other drugs can increase the risk of), it also increases blood flow to the uterus and helps make the lining nice and thick.

Progesterone in Oil (PIO)
This is the drug that everyone fears, the ones that come with the big bad needles.  Normally once you ovulate, your body naturally produces progesterone to prepare your uterine lining for implantation (make it nice and sticky, so to speak).  Once a pregnancy is achieved, the body produces increased levels of progesterone to help the embryo hold on and develop the placenta.  If a pregnancy is not achieved, progesterone levels drop, and the lining is shed (resulting in a woman's menstrual period).  Since in my case I won't ovulate, it is VERY VERY important for me to artificially keep my progesterone levels elevated.  If they drop, I will automatically miscarry.

That's where the progesterone in oil comes in.  It is delivered by intramuscular injection, meaning that the needle needs to be big enough to get it all the way through the layers of skin and into the muscle.  It is also suspended in oil, which means it is very thick, hard to administer, and can leave large lumps under the skin where it was injected.  It is most commonly injected into the hip/butt area.  I will also have to remain on this drug for the first several weeks of pregnancy.  Eventually, the placenta begins producing its own progesterone, and I will no longer need to substitute artificially.

I have found that most surrogates have to take daily injections of PIO.  Luckily for me, my doctor's protocol only requires me to have one of these shots every 3 days (which means each cheek will only have to be assaulted every 6 days)!  Why?  Because I will be also taking progesterone in another form...

Progesterone Vaginal Suppositories
I will be using Endometrin vaginal insert tablets twice a day until my body is producing enough progesterone to sustain the pregnancy on its own.  These essentially do the same thing as the PIO shots, which different side effects: discharge and possible irritation.  When the nurse coordinator was going over all of the drugs with me, she told me these are actually what she gets the most complaints about.  Maybe this is because her surros don't have to take shots as often as most?  I don't know.

In addition to these main drugs, I also received in my box of wonders some prenatal vitamins, antibiotics (to prevent any infection that could be caused during the actual embryo transfer), and Valium (which is something I can opt to take to help me relax before the transfer procedure).

Let me know if you have any questions of if I was way off base somewhere!

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