Nose sprays and needles

March 2022 came around (although not before Gary and I had gone skiing for our 40,000th "One Last Blowout Holiday Before Kids"), and we were both invited in to the Cotswold Fertility Unit in Cheltenham for our IVF planning meeting. This involved an absolute encyclopeadia of consent forms for both of us, including questions about what we would like to happen with any eggs or embryos created during the process should one of us die, and whether either of us had been convicted of sexual abuse - really light reading - and a reminder that the exercise I love - running, heavy lifting, anything strenuous that could twist or damage my overstimulated ovaries - would have to stop. I also had another internal ultrasound. Nothing untoward here - low follicle count, couple of fibroids, let's crack on. 

A couple of days later, a refrigerated van arrived with two boxes; one containing a sharps bin, two boxes of Nafarelin nasal spray, an awful lot of progesterone vaginal suppositories and a mechanical syringe with far too many needle tips, and the other (which needed to be kept in the fridge) containing all of the vials of Ovaleap that I'd need for the cycle, plus a pre-filled mechanical syringe of Ovitrelle. 

***

...Sorry, what?

There are other drugs and variations of IVF depending on circumstances, but I was put through a long protocol (which means shutting everything down and then restarting under completely controlled conditions, rather than short protocol, which cuts out the shutting down bit and is timed with your natural cycle) using the following:

• Nafarelin nasal spray - shuts down your oestrogen production; this eventually causes a bleed to 'flush out' the uterus and ovaries and creates a baseline environment. This stage is called downregulation.
• Ovaleap - the stimulation drug, injected for 10-14 days, that puts the ovaries into hyperdrive and recruits as many follicles as possible to produce eggs all at the same time.
• Ovitrelle - the trigger drug; this is a one-off injection that must be taken at an exact time given by the clinic, to tie in with the scheduled time of egg retrieval.
• Progesterone suppositories - starting from just before embryo transfer and onwards for a number of weeks if the pregnancy is successful, these are used three times a day and help prepare the uterus lining to help the embryo stick.

***

Timing was everything. Google Sheets and alarm clocks became my best friends.

On Day 21 of my menstrual cycle, I enjoyed my last bit of strenuous exercise for a while and began taking two sniffs of the Nafarelin, twice a day, for 24 days. It was gross - there was no way of stopping the liquid from dribbling down the back of my throat and it tasted like a mixture of the eraser end of those ink correction pens we used to use at school, and rotten farts. It also caused the absolute MOTHER of heavy periods - I'd been told to expect a heavier bleed than a normal period, but when you consider my normal periods were already pretty monstrous, this was something else. I was used to using both a tampon and a heavy absorbency pad anyway, but for a few days I was flooding both on an hourly basis. 

A few days in, I also developed an awful pain around the area of my right ovary*, which would come on in the morning and leave me almost doubled over for a couple of hours - something that we never found a cause for but it was suggested that it was due to my hormones being shut down and my ovaries and fibroids (which are hormone-fed) complaining. Luckily, I was able to work from home at the time (I had been told that a positive Covid test could jeopardise the entire cycle, and so we were essentially self-isolating again), and was able to rush to the bathroom as often as I needed for period admin, and wedge a hot water bottle between my abdomen and the arm of my desk chair; the heat and pressure took the edge off slightly.

*It was my left ovary that would later become cancerous, so I don't think that this was connected to my diagnosis.

As you'd imagine from shutting down hormones, my emotions were all over the place. Not only was the fact I was having to go through IVF in the first place weighing heavy, but everything set me off. Adverts, movies, a picture of something cute... A friend's dog put his head on my lap one Saturday morning like he knew I was in pain, and before I knew it I was bawling again. 

After 21 days of the nasal spray - and bleeding for 14 of them - I returned to the clinic for another ultrasound. This was the downregulation scan, to check that the lining of my uterus was thin and my ovaries had been shut down. Downregulation had been achieved, and so the next day I was able to cut down the Nafarelin to one sniff twice a day, and start injecting myself every evening with Ovaleap. I'd decided already that I wanted to be able to do this myself, but Gary had also been thoroughly briefed. As it turned out, it was absolutely fine. The dosage was set on the pen so that all you had to do was insert a cartridge of the drug, screw a new needle on and press a button to deliver the dose. One cartridge would cover two and a half doses, so every third day I would need to inject twice, but the needles were so thin that it didn't take much to grab a squishy bit from somewhere around my tummy, take a deep breath and slide the needle in virtually painlessly. 

(If you're interested, you can watch an instructional video here.)

And so it continued - one sniff in the morning, go about my day (and probably cry a lot), one sniff in the evening and inject into my tummy - for nine days. During this time, the pain in my right hand side vanished as if by magic, although Janis the fibroid was certainly making herself known - not only could I feel it for the first time, but when I lay down I could see a visible lump in my abdomen. 

On Day 9 of injections, it was back to Cheltenham for another scan, this time to count how many follicles had grown. If a good number of them were over a certain size then I would be given instructions on how and precisely when to take the trigger shot of Ovitrelle. If it looked like there was still some growing to do, I'd be invited back in two days' time for another scan, and then the next day, and the next... But this first time, we were delighted to be told that actually, considering my low follicle count, a lot of them had grown to a good size - 14 in total! So much so, that the Ovitrelle was scheduled for two days later, at exactly 22:15, and I was booked into Oxford Fertility Clinic for egg retrieval for two days after that again at 10:15.

After 37 days of meds, things were finally about to start!