Following on from my earlier post on the decision process and costs of egg banking, this post considers the actual hormonal stimulation including to the actual ova retrieval through punctuation and the aftermath. It covers both the physiological and psychological impact it had on me.
Following my first consultation at the clinic and OK fertility test results showing a relatively low (but for my age average) AMH value of 2.10 ng/ml and other OK hormonal levels, I made a decision to go ahead with it. Due to the significant price differences between Spain and Germany for medication, I had already bought the medication during the consultation visit to Spain. For the purpose of transport in my hand luggage with thermal packs, IVI had prepared a note to the border guards/ airport security so to not cause a problem with several packs of fluids and needles in my hand luggage.
So how does it work?
In order to harvest a sufficient number of ova at retrieval time, women have to undergo hormonal stimulation, which is the same procedure women undergo when preparing for IVF or another fertility treatment. There are several protocols, but my consultant doctor in Madrid had prepared an antagonist protocol, which I was to follow.
Switch from Madrid to Valencia no issue
It must be mentioned here that although I had my first consultation in Madrid not in Valencia, I switched clinics for two reasons: First, the Madrid clinic was closed for the entire month of August and for the last week in July. Second, I had a friend living in Valencia, who could take care of me when I went through with the procedure. The switch did not represent a problem, though I later thought that perhaps had I stayed in Madrid, I would ave received more attention from my assigned doctor.
1. Taking the pill
Since I wanted to be able to have the ova retrieval in July 2016 but was not ready in early July, I was asked to take microgynon at the first day of my period for a total period of 14 days. In fact, there are additional reasons why doctors give the pill for a short period: to get rid of cysts and ensure the ovaries are shut down prior to the stimulation.
Accordingly, I started using microgynon for 14 days starting with the first day of my period, at the end of which I waited for 4-5 days until I got my period.
2. Starting the injections
On the evening of my first day of my period I was meant to start hormonal stimulation. For the coming 8-10 days I was to inject myself between the hours of 8- 10 pm with 225 mg/ 0.375 ml of Bemfola and 75 UI/0.25 mg of Menopur. The protocol would be varied based on my reaction to the treatment, and the ultrasound scans showing the growth of the follicles.
For people who have not injected themselves previously doing so may not be easy at the beginning. However, a few days in the process it does not seem such a big deal anymore. Throughout the treatment I wasted many syringes. It really wasn't my strong point.
Bemfola is in a pre-filled injection pen, which is easy to deal with (the picture shows a pen after usage).
The same isn't true for Menopur, which comes in a flask with dissolvent and the actual solid active ingredient in a separate flask. So, one needs to load the needle with the dissolvent, inject it into the flask and then mix it, then load the needle with the mixture to inject.
I injected myself from Day1 until Day5 every evening with 225 UI Bemfola and 75 UI Menopur.
3. Day 5 ultrasound scan
On Day5 I had my first ultrasound scan at a local gynecologist, which showed 6 follicles between the sizes of 9mm to 14 mm in each ovary. The ultra sound was also to measure my cervic lining. This wasn't a bad result, and commensurate with my age. Given the size of the biggest follicles, IVI asked me to come to Valencia ASAP, i.e. earlier than I expected. Usually, requires to be at the centre 2-3 days ahead of the punctuation.
By the time my belly had already swollen significantly, and my emotional state was generally less stable.
The centre requires an ECG that is prepared a maximum of a week prior to the punctuation, the punctuation done under general anaesthesia. I had gone for the ECG to the GP, who transferred me to the cardiologist (it turned out that everything was OK). For the ECG I had to pay separately.
Following review of the scans, my doctor instructed me to start also injecting Orgalutran 0.25 ml. Thankfully, it is also in a pre-filled syringes. So by Day6 I had to inject myself with three meds.
(Orgalutran pre-filled syringe)
4. Valencia
I arrived in Valencia on Day6 in the evening having booked myself into a hotel not too far from the centre and comfortable enough that I'd be able to order food to the hotel room if I so wanted.
IVI has state of the art technical facilities. Everyone was always very friendly and helpful. It even offers an app for apple and android devices with which to monitor appointments, follicle growth etc.
For the following two days, I would come to IVI in the morning to do the blood tests for estradiol (E2) and progesterone (P4) and would return in the afternoon to get the results and do ultrasound scans. My right ovary wasn't doing as well as my left one and three of the follicles went back in size. The same was not the case in the left ovary. I continued with the injections of Bemfola, Menopur and Orgalutran until and inclusive Day8, the punctuation was to be on Day 11. I continued with Orgalutran on Day9. By Day9, 8 follicles had grown to between 18 mm - 23 mm in size. Three were smaller.
Besides the psychological toll, one side effect I found hardest to deal with was the swelling to my belly, and the weight gain (which was probably caused by overeating for emotional reasons, not the hormones (7kg in total)). By Day9 I truly looked pregnant. Constantly thinking about fertility was also not to my liking. In fact, I got the urge to go check out baby clothes (while I was just about to delay pregnancy).
5. Preparing the punctuation
While I stopped Bemfola, Menopur on Day8, on Day9 I was to inject myself at 10:15 pm (i.e. exactly 36 hours prior to the punctuation) with Decapeptyl 0.2 ml to prevent early ovulation, in addition to Orgalutran. I also was asked to take Ibuprofen 600 mg for dinner.
On Day10, I had Azitromicine 500mg, antibiotics, for lunch and dinner, as well as another Decapeptyl 0.2 ml injection plus another Ibuprofen.
6. The punctuation
The punctuation was scheduled for 10:15 am on Day11. I was to arrive 30 minutes early to get prepared. Everyone was very pleasant, the room I was allocated nice and clean. Since it was a Sunday, the punctuation would not be done by my doctor but by the doctor who was to be on duty on that Sunday. He did not speak English well, so one of the international office staff was actually there for the punctuation to translate for me. I had been asked to bring house shoes, a night gown as well as only very comfortable clothes. However, since they provided me with slippers and an over gown at the hospital, neither the night gown nor the house shoes were in fact necessary.
IVI asks patients to specifically bring a friend or family member. Whereas I had specifically come to Valencia to stay with a friend, that friend turned out to be away when I was in Valencia and I actually had to go alone. Due to that reason, I stayed a few hours longer at the hospital. I would strongly advice everyone to bring a friend. It's pretty rough alone.
The doctor retrieved only 7 eggs as 3 follicles had been empty. It later turned out that 3 eggs were immature. Accordingly, it did not go as well as I had hoped it would.
7. Aftermath
After the punctuation, the hospital served me a croissant, a small muffin and a tea. I returned to the hotel by taxi and most likely due to the antibiotics, I spent most of the afternoon in the bathroom (if not sleeping or binge watching TV). For me it was a rough day. I realised that I had not bought sufficient water for my thirst, which was immense, and that perhaps isotonic drinks would have been useful to buy prior to the punctuation.
Given my bad result, I knew I had to consider whether I'd do the procedure again.