Infertility by the Numbers – Drugs, Drugs, and More Drugs Part 2

This post starts off where my last one left off. If you haven’t read it, good to at least go back and read the intro paragraphs where I explain the reason for these posts. In this post, I’ll talk about other drugs that I took while undergoing IUIs.

4. Prometrium

Prometrium is a progesterone supplement that comes in round little balls. Its most common use is as hormone replacement therapy for post menopausal women, but it is often used to supplement progesterone in fertility treatments.

I first started using prometrium as part of my IUI protocol – taking it several times a day between the procedure date and the pregnancy test date. The fun part about the prometrium was that I had to insert the little balls vaginally, which was a whole new experience for me.

Prometrium’s most common side effects are deceptively similar to early pregnancy syptoms – fatigue and sore, tender breasts, which of course makes for an interesting two weeks while waiting to find out if you’re pregnant or not!

5. HCG trigger shot

The HCG trigger was a shot that I took before the actual IUI procedure (for IVF, which is more fresh in my mind, it is taken 12 hours before the egg retrieval; I believe for IUI it’s more like 24-36 hours beforehand, and in any case the precision of the timing is not as critical).

HCG is the hormone that your body produces when pregnant (it’s what shows up on pregnancy tests), and for fertility treatments, it is often used to “release” the eggs once ultrasounds show that they are big (and therefore mature) enough. For IUIs, the trigger shot results in ovulation, while IVF is timed such that the eggs are retrieved just before you would ovulate on your own.

Initially, the Dr. would do the shot himself, but for my injectable IUI cycle and my IVF, I administered it myself, since I was already giving myself other shots.

The somewhat crazy thing with the HCG trigger shot is that you have to mix it up yourself – there’s a powder and a liquid and you mix them up together and then inject. This extra step adds to the stress of the treatments (not to mention that, unlike most of the other drugs, the shot needs to be precisely timed with the timing of your procedure, so I spent lots of time worrying that I would miss my window).

6. Femara (letrozole)

Now that I’ve discussed some “ancillary” drugs, it’s time to get back to the good stuff! After three rounds of clomid, I was ready to move on to other fertility drugs. My Dr. suggested that for my next IUI we’d do femara, and if need be, add some injectable medication.

Femara is similar to clomid in that its a little white pill, and I took it for several days at the start of my cycle. It can also be used to induce/enhance ovulation, however people tend to have fewer side effects from it (most importantly, it is not known to thin your uterine lining like clomid can).

The catch is that (in Canada at least), femara is not approved for use in fertility treatments – rather it is a drug used to treat breast cancer. Therefore, before being able to take it, I had to sign a release with my Dr. that I understood this. Femara also came with the reassuring warnings that it should not be taken if you are trying to, or suspect you may be pregnant (?!), but my Dr. reassured me that since I was only taking it early in the cycle, it would be long gone from my system by the time I may become pregnant.

My Dr. had me come in for an ultrasound several days after taking the femara, and based on what he saw, decided that we would add injectable drugs to complement the femara.

7. Puregon (Follistim)

Puregon (also known as Follistim) is an injectable fertility drug. I first took it in small doses in my femara/injectable cycle, and later also took it as part of my IVF.

Once you move onto injectables you feel like you’re in the big time – no more little white pills, bring on the needles! The other thing you notice right away is the big time cost. While a cycle of clomid or femara will cost about $100 (give or take), injectables for an IVF cycle will set you back thousands of dollars (less for an IUI, as you don’t want to grow as many eggs, but still much more expensive than pills).

And then there’s the injectable side of it – yes now you (or your partner) have to give yourself needles. The nice thing about Puregon is that it comes in a great delivery system – you inject cartridges into something that looks like a pen, you set the dial to how much you need to take, and in it goes. It’s pretty fool proof, and the needle is super thin so once you finally get the courage to jab yourself, it goes in like butter and you barely feel it.

Doing those first few shots though is difficult. I had heard that it hurts less to do the shot yourself, so since I am a wimp when it comes to pain, and my husband is squeamish, we decided that I would do all of my injections myself. In order for my husband to feel like part of the process, he would sit with me in the room, help me get everything set up, and then look away when I actually did the shot.

This is one of the difficult things about fertility treatments – no matter what the underlying source of the infertility is, except in rare cases, it is the woman who has to take all the medication, and go through the actual procedures, so I found it helpful to involve my husband wherever possible to keep him as invested in the process as I was.

8. Orgalutran 

This is another injectable medication that I took as part of my last IUI. At one of my early ultrasounds, the Dr. noted that I had one follicle that was much bigger than the others. Therefore, the risk was that I could ovulate from this follicle too early in the cycle. The orgalutran was supposed to prevent ovulation from happening, so that the other follicles could catch up. If I remember correctly, I had to take it two nights in a row. It came in a pre filled syringe, but I was supposed to only inject half of it each night, which of course was another thing to stress and worry about.

This last IUI cycle again yielded two eggs for me, and again resulted in a negative pregnancy test. At this point, after 6 IUI’s, we decided that it was time to move onto IVF. My last post in this series will explain all of the drugs I took in preparation for, during, and after my IVF cycles.

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