Protocol!

Yesterday was an amazing day. I feel so much better after finally getting so many of my questions answered at the clinic yesterday. We got there around 9:30 AM and George went to the lab to do his part, hehe. Our clinic requires a back-up sample to be frozen just in case for some reason he can't give a sample on the day of retrieval. The great news is that his SA came back amazing. Our best ever. 210 million sperm with over 50% of those motile. We couldn't have asked for a better backup. At 10:30, we went in for our education class.

There were 2 other couples in there with us. We had to watch several videos on how to give the shots, then the nurse came in and gave us a large folder full of information and release forms. We went through all of the information in the packet about the different meds, how and when to administer shots, the different side effects and the typical schedule. We found out that we even get our own little voice mail box that we call in to every day for instructions and messages about the ultrasound results and such. I like knowing we have a number to call instead of always waiting for the nurses to call us with results.

After the main class, the nurse took each couple separately to discuss our protocol and answer any questions we had. We went last so we were at the clinic until after 1:00, but it was so worth it! I still am not sure if I'll be on birth control pills or not yet. The doctor is afraid I'm not really ovulating and so my periods aren't a true shedding of the lining. I, on the other hand, think I am ovulating. Anyway, they are going to discuss it and I might possibly have to go in to get a blood test done this month after my temp rises to see whether I really did O or not. If not, I start bcp for about 10 days. If I did, no bcp needed. I'll find out for sure later this week what the plan is there.

Either way, I should be starting stims around the second week of October! Yay! Here is my official protocol (Antagon Protocol):

• CD2 - Baseline ultrasound and blood draw. 225 mg of Follistim and 10 units Microdose Ovidrel each night in my upper arm. Also begin baby aspirin for the rest of the cycle.
• CD5 - Second blood draw to check levels.
• CD6 - Somewhere around here, I will start a nightly shot of Ganirelix. This is the antagon drug that keeps my eggs from ovulating while the rest of the smaller follies catch up.
• CD7 - Third blood draw and ultrasound to check progress of follicles and hormones. At this point, we start taking everything one step at a time depending on how everything is going. I'll go in for either daily or every-other-day monitoring appointments.
• CD12-14 - Sometime around here, depending on response, I will be given instructions on our trigger shot! This will be my first intramuscular shot, ouch! My trigger shot is going to be accompanied by a Lupron shot as well, to help prevent against OHSS (ovarian hyper stimulation syndrome).
• Beta Check - The day after trigger, I go in for another blood draw to make sure my HCG levels are high enough. If not, I will get a second trigger shot.
• Retrieval! - Hopefully around CD14-17, I will go in for my retrieval. This will most likely be done in the morning. They will knock me out with anesthesia, so George is definitely coming with me. He's actually going to try to make it to all the appointments, but it will depend on his work schedule so we'll see! Anyway, I'm nervous about this step because I've only ever gone under anesthesia once before when I had my wisdom teeth out and waking up was really emotional for me.
• After Retrieval - Begin 4 days of Medrol (a low steroid that will slightly suppress my immunity so my body doesn't reject the embryos when they are transferred). Also begin an antibiotic.
• Day after retrieval - Progesterone Injections begin! These are also intramuscular and I've heard they are a pain, so not looking forward to this, but it'll all be worth it.
• Fertilization Report - Lab calls to give us the results of the fertilization. We'll find out how many of my eggs fertilized and how they are looking after a couple of days in the lab. Fingers crossed! They will also let us know here whether to be ready for a 3-Day Transfer or a 5-Day Transfer. We are hoping for a five day, but I know both can be successful.
• Transfer - Hopefully around CD 17-19. We plan on transferring the 2 best embies! My hope is that we have two near-perfect little ones to transfer in! Most transfers happen in the afternoons, so I'm planning to go in for an acupuncture treatment before the transfer and again after. Part of this will depend on whether or not the transfer happens on a weekday or not.
• Post-Transfer - 3 days of bed rest. Progesterone injections continue for 2 weeks. 14 days past transfer, I go in for my first beta pregnancy test. It's a LONG wait compared to most people whose blogs I've read. Usually, tests are done 9 days post transfer, so I'll have to make a decision about whether to test at home or not. I'm not sure if I'd rather find out early or just wait until the nurse calls. Eek!
• Betas - One at 14 days past, another at 16 days past and a final beta at 18 days past.
• Positive Beta - If I have a positive beta, I will continue Progesterone injections for one more week, then switch to vaginal suppositories. Normally, they wait to do an ultrasound until a month after positive pregnancy test, but the nurse heard me out about my fears of waiting so long and said that if it would stress me out to wait so long, they could do it 2 weeks after, which would be 6 weeks pregnant.
• Negative Beta - Injections and meds will all stop and I will wait for my period to start again. At this point, we will regroup and figure out what's next for us. Right now, I realize this is a possibility, that nothing is guaranteed, but I'm still picturing us with a positive result and a baby nine months later! 

I think that covers everything. Oh, I'll also be on Estrace for part of it, but I think that comes after transfer. My nurse has already called in all my meds, but they won't be delivered until closer to October. I feel so much peace now that we have a plan in hand and I know exactly which drugs I'll be on and how to do the shots. We're about 32 days away from starting injections, so it's really feeling real and close! I hope this next month flies by, because I'm ready to get started. I know that over the next couple of months, there will be lots of ups and downs, but I'm going to do my best to stay positive and be hopeful that in the end, we will be pregnant.