Infertility: Follistim, Ganirelix and Pregnyl, OH MY!

 Welcome to infertility drug injections 101… Follistim, Ganirelix and Pregnyl.

Soooo, after another unsuccessful month of using Femara with an IUI, we headed off to see Dr. H at North Shore LIJ Center for Human Reproduction for another infertility checkup. He does a quick sonogram and confirms that the room is vacant, a la “no bun in the oven”.

Dr. H says, “Are you ready to go to the next level?”. We simply reply, “yep”.

We’ve been trying to conceive with Clomid and Femara, both natural and IUI for a couple of years. We had two that ended in miscarriages and the others never took. Ah, the joys of unexplained infertility.

Dr. H tells us that he’d like to do a round or two of injections with IUI’s and then head over to IVF land if those don’t work. While the thought of going IVF is scary because we’ve kind of always looked at IVF as “the last resort”, it’s also comforting in a way because this could also be our best chance of success. Dr. H jots down some notes and directs us to go see the nurses after my wife gets dressed. He calculates that based on this being day 2 of my wife’s cycle that we need to start the drugs immediately.

What are Follistim, Ganirelix and Pregnyl?

Follistim is a hormone that will trigger your ovaries to produce large quantities of eggs. The average woman will ovulate one egg per month. With Follistim, you can produce a LOT more.

Follistim AQ

Ganirelix is meant to keep you from ovulating early. Since your body is only used to having one egg at a time, it wants to drop each egg as soon as it’s ripe. We want them all to come down together, so you take Ganirelix to keep them in a happy bunch.

Ganirelix

Pregnyl aka HCG Shot is the same hormone that women produce naturally. The difference here is that the shot you take is about 10,000 times more of the hormone that you would normally produce. This is done to make all the eggs rain down together.

The nurse brings us over to the “education room” which is just a cubicle with brochures and samples of various drug products all over the place (who ever came up with the term “hospital clean”???). She runs through a blistering fast, crash course in assembling the Follistim pen, dropping the vial into it, screw on the needle, dial in the dosage and stab my wife in the gut while counting to five. Wait! Don’t forget that you need to pinch the crap out of her belly first and stab THAT with the needle. Whoa…

The nurse (who now sounds like an auctioneer) then runs us through the process for Ganirelix and Pregnyl, which are normal syringes and are pretty much the same process as the pen. We smile and nod while our eyes glaze over. We sigh in relief when we are handed a dvd with most of those instructions on it.

Next we have a round of confusion as we try to determine which drugs our insurance will cover. If they won’t cover the Follistim, then we have to go for another brand that does pretty much the same thing except that it doesn’t have the handy pen injector. Instead you have to take a freeze dried pill, drop it in a vial, put some sterile water in it, mix it, suck it up in a syringe and then inject it. Luckily we are spared further misery when we find out that our insurance is A-OK with Follistim. There is a catch, however. Apparently, these drugs are extremely expensive (in the $2,000 to $3,000 range) and our insurance normally wants us to order the drugs from them and they’ll ship them. Since we don’t have time for that, we have to get a special authorization from them. After jumping through some hoops, they finally come back and tell us they’re giving us a one time authorization to get them from some pharmacy we’ve never heard of. The pharmacy will deliver them to our house later that day.

After some serious complaining with the pharmacy (they wanted to deliver by 11pm!) the infertility drugs showed up at our front door around 8pm. Luckily, my wife remembered to ask them to include a box of the Alcohol Wipes. Much more convenient and safer feeling than a cotton ball and a bottle of alcohol.

We crack open the dvd and start watching. It’s pretty scary and intimidating at first. I’ve never given a shot to anyone in my life and considering that these drugs cost more per ounce than gold, a mistake could be either very painful for my wife or very expensive or both. The truth is, once I watched the dvd and put the pen together, it became clear that this wasn’t as big a deal as we thought it was.

Here are a couple of pointers that I was worried about that the dvd explained.
     – The Follistim drug should be refrigerated until you are going to use it. They actually suggest leaving it out at room temperature for a few hours before using it as it can be more comfortable. Once you start a vial, it can be left at room temperature and is good for about a month.

     – The needle should be removed and thrown out after each injection. There are spares that come with the vials of Follistim.

     – when you are dialing in the doseage, if you accidentally go to far, do NOT try to go back the other way. This will just squirt out some of the Follistim. Instead, keep going all the way up. You can then push it back down and begin again (do it slowly to make sure you are actually at the end and aren’t going to spray the whole vial out).

Let The Fun Begin!

With some nerves and trepidation, we pull up a chair, sit the wife down and prepare. Wipe everything really well with alcohol, take the Follistim pen, screw on the needle, crank up the dial to 150 iu, pinch the wife’s belly, tell her to look away (she’s squeamish) and go in for the kill. The needle is extremely thin and went in suprisingly easily. I slowly pushed in the plunger while counting to five, unpinch the belly then pull out the needle. Not so bad after all!

Just nine more days of this to go!

10 Days Of Side Effects

Over the next 10 days, we get the routine down pretty well. By the end of the second day, my wife is quite bloated and feeling pregnant even though she’s not. Most of her clothes become too tight and she’s generally uncomfortable.

About 5 days into the cycle, we started doing the Ganirelix injections in the morning and continued the Follistim injections in the evening.

We go in to see Dr. H a couple of times for check ups and ultrasounds to see how the eggs are progressing. On our last checkup, we had 7 or 8 eggs. The doc ordered a blood test to check levels and said he’d get back to us. When the levels came back, the doc was concerned that my wife may be susceptible for hyper stimulation and may produce too many eggs for IUI (due to risk of multiple pregnancies) so he told us to drop the Follistim dosage from 150 iu to 75iu. We were then told to do this for a few more days then use the Pregnyl (HCG shot) on Sunday.

Three Days of IUI’s

Following the Pregnyl (HCG Shot) on Sunday, we were scheduled for our first IUI insemination on Tuesday.

I was finally called up for my end of the process and went to meet my date (a cute, sterile, plastic specimen cup) first thing in the morning (I am NOT a morning person). My wife and I have a system worked out where I deliver the now occupied cup to her just as she is ready to head to the doctors office (I do NOT fulfill this obligation at the doctors office if at all possible based on past experience and my need to retain the little pride I have left after this process). We try to go to the doctors office together whenever possible, but I also try not to take too much time off of work.

Sperm Collection Cup

She dutifully places the cup between her breasts (suggested by the doctor’s office to keep it near body temperature) and she heads off to see Dr. H for the IUI insemination. The insemination is uneventful. The nurses and lab techs compliment me on having a sperm count of 54 million and a motility of 97% (never thought I’d get the gold star in THAT subject – LOL).

The post insemination sonogram shows that the eggs in the right ovary are just about ready to drop, but the ones in the left ovary have not quite gotten to that point yet. He asks my wife to come back in the following day for a second IUI insemination. This is fairly normal for them. If they catch the egg just as it’s about to leave, they like to do a second IUI the next day to (as they say) sandwich the egg between two doses of sperm thereby all but guaranteeing the egg will have some company at some point in its journey down the tubes.

sperm

Wednesday morning, more of the same… Me and the cup spending more quality time together in the morning. I hand off the boys to my wife and she heads off to see the good doctor. More compliments are received today on the sperm count with my all time record of 63 million and 97% motility.
So much for being told to abstain for two days prior to the iui to keep the sperm count up. The post iui sonogram shows the the right ovary has released the eggs but the left one won’t let ’em go. Meh! Doc says to come back again tomorrow! Holy Moley!

Thursday morning… I’m now starting to feel my relationship with the specimen cups is suffocating me. I think we need some time apart. I do what I gotta do and hand off the goods. No compliments today though. I have produced a measly 28 million sperm. I believe morale is down at the factory and the union has commenced a work slowdown out of protest. Doc delivers the goods and post IUI sonogram shows the eggs have left the building (yay!).

Now We Wait

The problem with using the injection fertility drugs is that they artificially raise the horomone levels that pregnancy tests use to tell you if you are pregnant. This means that  you can’t use the old “pee on the stick” pregnancy test. You have to go to the doctor’s office for a blood test 10 days after the IUI.

As we’re waiting for the 10 days to pass, thoughts of twins and other scenarios dance in my head. Of course I’m worried about the possibility of multiples as they are much more complicated, but I’m also excited as I can’t help but feel that with 7 or 8 eggs and three days of IUI’s we HAVE to have achieved at least ONE pregnancy.

Well, we didn’t have to wait long, my wife got her period a full five days early and blew out any hopes or thoughts of pregnancy. What the hell???

We went to see the doc on day two after the period started. He asked us if we wanted to do another month of injections with IUI and if that didn’t work, go to In Vitro Fertilization. We agreed that that seemed like the best way to go. He did and sonogram and confirmed that there was nothing going on. He didn’t explain anything or ponder what went wrong with us. He just accepted that there was nothing there and carried on. To add insult to injury, he found several cysts on the ovaries (a known side effect of the infertility drugs) and said that ruled out using the injectables this month (fuck!).

Dr. H said if we wanted to, we could do a natural (no drugs) IUI this month based on our fertility monitor, but he’d leave that up to us.

He told us to schedule an In Vitro Fertilization consultation with him in the mean time, which is apparently a requirement before starting THAT lovely process.

 

…Man will occasionally stumble over the truth, but usually manages to pick himself up, walk over or around it, and carry on. – Winston Churchill

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5 Responses to “Infertility: Follistim, Ganirelix and Pregnyl, OH MY!”


  • My husband and I wish you the best of luck. We are going through the exact same process. I am currently on the 2 week wait after our first cycle of Follistim, with HCG, and IUI. I am already cramping and worried my period will come early as your wifes did. I’ll keep my fingers crossed for you. Hang in there. This is definitely a hard process to go through, but it will all be worth it in the end.

  • We were pretty bummed after this cycle. We went for the IVF consult and did a round of IVF. We are BFP (pregnant!)!! We are at week 16 right now and are keeping our fingers, eyes and toes crossed that the little bean keeps on going! I will put up another post soon detailing that adventure.

    There is hope, dear. NEVER NEVER NEVER give up!!!

  • I am on a second cylce of Folistim. My first cycle was 125iu for 6 days and I didn’t get a positive response. My eggs did not produce and i didn’t start my period. My doctor put me on birth control to onset my period in which it came.
    I was put back on Follistim with a dose of 225iu. I saw my doctor on the 6 day of medication and the Ultrasound did not show even one egg ripening. My question is: why isn’t this Follistim working? Is there an alternative then using this medication?

  • Not everyone responds to these drugs the same way. Some people are very sensitive to them and others are almost immune.

    The good news is that there are several different drugs that work in different ways but produce the same results. Your doctor should be able to suggest alternatives to Follistim such as Bravelle that your body may react better with.

    Have you had tests done to verify that you are able to ovulate normally or is that the source of your fertility issues?

  • Frustrated in Florida

    Hi,
    I was on the pill 2 months, then on a drug called Letrozole 25mg 3 days after my period started, 4 days later I had an ultrasound and was found to have 8 eggs 6 to 7mm in diameter, that evening I started follistim 125iu and the next evening 125 iu and today I had another ultrasound and all my eggs are gone! They say I ovulated, but I’m not meant to ovulate for 3 more days!!! Has any one had this happen to them? I’ve got Hashimoto’s thyroiditis and on 50mcg of Levoxyl. It is such a let down I don’t know what went wrong and the doctors aren’t saying anything till my progesteron blood test comes back. Can the eggs explode or be over stimulated? This is my first time.
    I’d be glad if any one could help me or give me some advice.

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