The Process Part 3

Returning back to the long process before the IVF procedure was done…so far we’ve covered the application in January, the conference call with the IPs in March, the screenings in June, and that brings us to negotiating the contract in July. Due to confidentiality, I cannot go into great detail. I do want to touch on it a bit though.

The contract is between the Intended Parents and the Gestational Carrier. It is lengthy and full of legalese. So as you can imagine, even though for the most part it’s standard and straightforward, you really need a lawyer to review it properly. The good thing is, as a carrier, all expenses are covered, including legal expenses. So the agency provided the contact information for some lawyers relatively close to me who handle these sorts of things. Then it was up to me to contact them to review the contract with me and handle the negotiations. After that it was as simple as providing the attorney with the contact information for the agency for payment. So they keep it pretty simple and easy for the carriers.

I’m in South Florida, and the lawyers provided were in Boca Raton and Orlando. I had trouble reaching the attorney in Boca, so I decided to work with the attorney in Orlando. I didn’t have to worry about meeting with him in person. A draft copy of the contract was provided to me and my attorney. I read through it and then discussed it with him over the phone, going over any questions I had. Then he handled going back and forth with lawyers for the Intended Parents, until we reached an agreement and executed it.

It took a few weeks, but that was really more because after I chose my attorney, he became a bit more difficult to get in touch with. It ended up aggravating me a bit, because I had hoped to wrap it up in a week. But because I found myself waiting to hear back from him for days at a time both at the beginning and at the end of the negotiations, and then there were a couple things we went back and forth on, it ended up taking most of July to finalize.

As I said, the bulk of the contract is standard and not really something the carriers need to be worried about. Most of what was stated I was surprised about, and I would think wouldn’t even need to be stated. But I guess because of crazy people who take babies, they have to be stated. Overall, they need to cover any and all possibilities of outcomes and conditions based on pregnancy outcomes, carriers’ rights, intended parents’ rights, and compensation plus all covered expenses, etc. And when I say all possible outcomes, I do mean ALL possible outcomes, from failed attempts at pregnancy to the death of anyone involved. The bulk of the contract goes toward covering all the different possibilities. But it is important to read through everything and make sure you are clear on it all and ask any and all questions you may have. If there is anything you are in disagreement on, discuss it with your attorney and negotiate it.

Following the execution of the contract, at the end of July, I spoke with my IVF nurse at the clinic, and she coordinated with all parties involved to schedule the first IVF transfer and then start me on the medications for the cycle. Due to several factors including my cycle, the timeline on the medications, and everyone's schedules, the first IVF transfer was tentatively scheduled for September 22^nd.

At that point, I had already been on birth control for a couple months, to control my cycle and prevent ovulation. I had to continue the birth control for one more month. Then, at the end of August, I stopped the birth control pills and I started Lupron injections. All my medications were shipped to me overnight from a pharmacy that handles all this for our clinic, up by them. Anytime I need refills, I just contact them and they take care of it immediately. I never really have to worry about my medications other than making sure I don't run out. I also was started on estrace (oral estrogen) not long after starting the Lupron, and I stayed on that indefinitely. I believe it is supposed to go until the 9^th week of pregnancy. So back to the Lupron, this is the paragraph on Lupron from my information packet:

"Leuprolide Acetate (Lupron) is the synthetic hormone that stimulates the pituitary gland to secrete LH and FSH production. However, when a woman starts to take Lupron, her pituitary gland is exposed to a constant level and the effect is just the opposite. After an initial acceleration in LH and FSH production, the pituitary stops producing these hormones. Ovulation is prevented and estrogen levels drop. As a result, the patient often has symptoms of menopause, including hot flashes, headaches and mood swings. Other side effects include insomnia, night sweats and decreased libido."

While it's easy to look at the possible side effects and start to freak, I did not. I had committed to this and figured, if I felt any side effects, I'd get through it, but I wasn't all that concerned about it. In reality, there were two things I noticed, but they were very slight and didn't inhibit me in any way. I noticed that I was overall generally warmer. Usually, I get cold very easily, but after starting the Lupron, I was a little bit warmer. It's kind of hard to explain. It wasn't a significant difference. And it wasn't hot flashes. It was just all the time. I used to prefer my thermostat at home be about 77-78 degrees Fahrenheit. But now I prefer it to be about 75-77 degrees Fahrenheit. The other thing I noticed was that I had a little bit more trouble falling asleep. I didn't have full out insomnia, but it took me about 30-60 minutes to fall asleep at night. Aside from those two things, I did not notice any side effects, not even hormonal mood swings, which was the only thing I was really expecting. I only had to take the Lupron for a couple weeks, so these side effects were brief and went away as soon as I stopped.

As far as the injections went, they were every day during the same two hour period (preferably at night). The needle for these particular injections was small...about half an inch long. It is meant to be injected subcutaneously, or just under the skin. The injection site was my lower abdomen alternating the right and left side each day. I would have to pinch the skin together and inject it. My packet included careful instructions for the injections from prep to completion. I had the Lupron injections for about 3 weeks. I remember being somewhat nervous about it since I’ve never self-injected before. But I found it pretty easy and painless. Most of the time it didn’t hurt at all. It would occasionally hurt a little, but no more than a bug bite.

After 3 weeks of Lupron, it was time for me to switch to the big guns…progesterone. Progesterone was fun, in a not so fun way, because the needle was about an inch and a half long, and the progesterone is thick so it takes longer to inject. The Lupron was quick in and out. The progesterone, because of how it is, was a little more complicated and took longer. Progesterone comes in an oil. Don’t ask me why or to explain it because I can’t. But it comes in an oil. I actually had two different kinds over the time I was taking it. The first they put me on was in ethyloleate and wasn’t quite as thick as the second. So basically it was a little bit easier to inject. More on that in a moment. The second was in sesame oil, and because of this, they had to confirm I don’t have a peanut allergy as well. My IVF nurse told me that the reason for the switch was because the one in the sesame oil takes longer for the body to absorb so it lasts over a couple more days, which the doctor wanted. They didn’t expound on that further or indicate that there was any problem in my test results to indicate I needed the switch.  They just switched me. The switch actually came at the end of the week I found out I was pregnant. I started the progesterone a little less than one week before the IVF transfer, and it’s meant to be injected every day until about 9 weeks or so into the pregnancy. Remember, though, that the weeks of pregnancy are counted from the beginning of the cycle month. So when I found out I was pregnant, I would have been considered 4-5 weeks. I’m not sure which one exactly because the pregnancy test is done, in this case, a few days to a week sooner than it would be done in a normal pregnancy, because most women wouldn’t even notice that they need to take one that soon. So upon a positive pregnancy test, you’re looking at about another 4-5 weeks of progesterone injections. The purpose of the progesterone is to help support the pregnancy until the placenta is producing enough progesterone to support it without the injections. This is needed because the medications have basically turned off your natural reproductive cycle and are stimulating it synthetically in order to prevent you from ovulating. So your body needs the extra progesterone to support a pregnancy. The possible side effects pain/swelling at injection site, breast tenderness, headache, weight gain/loss, acne, nausea, increased body/facial hair, loss of scalp hair, drowsiness or dizziness, but I had none of them.

Anyway, back to the injections themselves…because it is so thick, it first requires a bigger needle to fill the syringe easily. Then you change the needle head (I really don’t know what else to call it!) with a smaller needle. When I say bigger and smaller, I don’t mean length, I mean width. An 18 gauge needle is used to fill the syringe, and then a 25 gauge needle for injection. I didn’t even know you could change the needle on a syringe like that. But it’s pretty easy!

Now we’ve just got the syringe filled, there’s still much more to come! The main issue with the progesterone injections is they cause muscle soreness. They are injected intramuscularly in the upper outer quadrant of the bum. I was really really nervous about these because of the length of the needle, but again, the injections turned out not to hurt, most of the time. Occasionally they’d sting, but not usually. I quickly learned the next day, though, that the true discomfort from these injections is the muscle soreness. So that brings me back to the process of the injections. After you fill the syringe, it’s highly recommended that you then hold the syringe under running warm water. To be honest, I used the hottest it would go, so that it would fully warm the medication throughout. If you remember your science, warming a liquid makes it more fluid so it flows faster. Or something to that effect. I don’t remember the specific terminology! Less viscous maybe?  But it was easier to inject the progesterone after the fluid was warmed by hot water. Now, I say this, but it still wasn’t a fast injection. I guess you could say a normal injection would take literally a second to push the liquid through the syringe. The progesterone injections would still take a good 20-30 seconds to push all the way through the syringe because it is that thick. After you’re done, it’s also highly recommended to massage the site with a washcloth soaked in warm water while walking. And I do mean all 3 things…warm washcloth, massage, walk. You do this for a few minutes. All of these things combined would help the muscle soreness not be quite as bad. It was still always there, but I did notice a difference the more effort I put into following all these steps. It would be the difference of a mild, tender soreness to feeling like a bad bruise that hurt a lot every time you hit it. If I didn’t do it well, if my daughter would accidentally hit the area, it would hurt enough for me to jump and yell. There was one time as well that, I don’t know how I managed to do it, but something must have gone slightly wrong when I injected the needle. The progesterone went in fine. But when I took the needle out, it came out at an different angle, and I accidentally cut myself with it. The tip basically scraped across the skin when it came out and cut me. It wasn’t a bad cut. It was more annoying than anything else, and I still don’t know how I managed to do that! It was my only mishap with the needles though. It is a little tricky to do it since I’m injecting myself in the butt, so you have to turn funny to do it. But I’ve managed fine.

Once they switched me to the progesterone in sesame oil, I found that the oil was even thicker, and even harder to inject. Even holding it under steaming hot water for 5 minutes barely helped. It would actually hurt my thumb when injecting it because it was so thick and difficult to push through the syringe. I would have to stop and reposition my thumb while doing it. BUT, I found that with the sesame oil version, the muscle soreness was much much less. Even though the injections were much more difficult, I do think that I prefer the sesame oil version because of the difference in the level of muscle soreness. I must admit though, after 4 weeks of progesterone injections, I was growing weary of it. I definitely think that is one of the hardest parts of this process because of the length of time you have to do it. It’s worth it in the end though, for the final result.

One other thing I have found, which I can only assume is a result of the progesterone injections, is it seems to have possibly affected my nerves on the sides of my hips in those areas. I don’t really know how to describe it. It has been about a week and a half since I stopped the injections, and I will still occasionally have pains there. Once my daughter hit me in the area, and I had a very sharp pain deep within the area. That happened a couple other times as well. I feel like it’s almost like those areas were practically pin cushions and perhaps it just takes a bit of time to fully heal.

Anyway, the last set of medications I had to take in preparation for the IVF was some extra pills the week of the transfer. One was an antibiotic and the other was Methylprednisolone, a corticosteroid hormone. I’m not exactly sure of why I needed to take the Methylprednisolone. I trust the doctors; they told me what I needed to take; I took it. It was only for one week. But remember, I was already taking the estrace as well. The estrace was 2 in the morning and 2 at night, and it didn’t matter if they were with or without food. The antibiotic was 1 in the morning and 1 at night, recommended without food to improve absorption. The Medrol was 1 in the evening with food. And don’t forget the prenatals. I have a prenatal pack that is 2 vitamins a day, 4 calcium supplements a day, and 3 omega supplements a day, all best to take with food. And on top of that, I also was prescribed synthroid for my thyroid in June. At my screenings, they found that my thyroid was slightly hypo. Not enough to be a significant problem for an adult, but enough to cause birth defects if trying to have a baby. So I also have to take 1 Synthroid pill in the morning, 30-60 minutes before eating.  So what I had that one week was a very complicated pill schedule! The first day I took the antibiotic, without food, I quickly learned that I could not do that again. It may have been recommended, but it made me so nauseous that I really thought I was going to puke and didn’t trust myself to drive to my appointment. I didn’t even trust myself to stand up! So after that, I did have it with a little bit of food. Not too much, but enough so that I did not experience that level of nausea again. And I must say, I’m very glad it was only 1 week that I had to take all of those medications! The rest of the time, the pills aren’t bad. They’re easy to manage.

So…that finally brings us up to speed on the process, from the first application to the medications prepping me for the IVF transfer, which I took for about a month prior to the transfer, and continue to about the 9^th week of pregnancy.