Towards the end of June, legal clearance was just around the corner so I messaged the fertility clinic to ask when I should take my placebo birth control pills. They responded with an overview of their current transfer protocol, but told me not to trigger my period just yet. Once legal clearance was “issued” by NYSC and reviewed by a supervisor at the clinic, we were full steam ahead. I was to call them on Day 1 of my cycle to schedule a “baseline” appt which could be on cycle day 2, 3, or 4.
A few days later, I received a text message from a mail order pharmacy to call them at my convenience. When I called, they knew I was a GC and just confirmed my shipping address and the date by when I would need the meds, then said they would “contact IPs for payment”. It was so nice that they were familiar with surrogacy lingo! The dads did shop around a little to make sure they were using the pharmacy with the best pricing (since I’m not diagnosed with infertility, all IVF meds are cash pay rather than run through insurance).
I stopped my “active” birth control pills and my cycle started right on cue so I called the clinic to schedule my “baseline appointment” for two days later which I happened to have off anyway! The day before, I printed some blank calendars to take with me to the clinic to map out a nice color coded med schedule. I also received a really sweet care package from NYSC that contained lucky transfer day socks and shirt, a “Surro Meds” fabric pouch, a 7-day pill organizer, a pineapple necklace (that my daughter immediately commandeered), belly butter, and a shotblocker. I thought this was such a nice touch!
At my baseline appt, they did an ultrasound to check lining thickness (they want to see it nice and thin when you’re on day 2-4 of your cycle) as well as bloodwork (estrogen, thyroid, progesterone, hCG, FSH, and LH levels). My endometrial lining was a 4.4 and all my bloodwork looked great! It was time to start meds and return a week later for a lining check. After the lining check appt, I was to return for an hCG wash the following Wednesday and transfer day would be Friday! hCG, or Human Chorionic Gonadotropin, is a hormone secreted by the body in pregnancy (it’s what is detected in urine and blood pregnancy tests). Some clinics have their surrogates administer an hCG “trigger shot” prior to transfer, but this was going to be squirted into my uterus via the cervix. We had our tentative cycle schedule and everything was starting to feel really real!
The clinic we were using is known for a lot of off-label use of the medications in their protocol. I was started on the following medications (in addition to the Vit D and Prenatal Vitamin I was already on:
Estrace (oral)-Estrogen is commonly prescribed for women undergoing IVF as a way to help maintain the endometrial lining of the uterus. Estrogen supplements help the endometrium grow and prepare for a pregnancy.
Doxycycline (oral)-An oral antibiotic such as Z-pack is prescribed at the beginning of each cycle to attempt to eradicate bacteria that may interfere with conception or potentially cause miscarriage.
Prednisone (oral)-A synthetic hormone with anti-inflammatory and immuno-suppressive abilities. Used to treat a range of conditions, including allergies, blood disorders, respiratory problems, skin problems along with fertility issues.
Low-Dose Naltrexone (oral)-Traditionally developed to block the effects of opioid medication and treat addiction, LDN acts as an immunomodulator and increases the body’s ability to heal itself. Through unknown mechanisms, it can improve fertility outcomes.
Aspirin (oral)– Low-dose aspirin (81mg) treatment has been shown to improve ovarian responsiveness, uterine and ovarian blood flow velocity, implantation, and pregnancy rates in patients undergoing fertility treatments.
I started my meds the morning after my baseline appt! Over the next few days I noticed that the prednisone seemed to make me have to pee a ton and had me feeling very wired (normal), and the doxy (though it made my skin look amazing) gave me some vaginal irritation that I was able to keep from turning into a yeast infection by drinking Kombucha! Funny enough, Kyle told me that the CEO of one of my favorite Kombucha brands had a baby via surrogacy on my birthday the year prior! The clinic had also warned me to take the LDN at bedtime because it can cause drowsiness…they weren’t kidding! I slept like a rock the whole week. No other side effects noted!
My lining check and repeat bloodwork appt went awesome; my lining was “perfectly fluffy”. It was estimated to be a 9.2 (later measured a 10.4). When we heard 9.2 (29 backwards) the dads and I started to talk to the nurse at the clinic about a strange coincidence that was happening with a lot of numbers surrounding the journey. Jon’s birthday was 02/29, my birthday was 04/29, transfer day was tentatively 07/29 (the 7th month and my daughter was born on the 7th!). Our nurse told us her softball number was 29. Way too cool!
That day, I was told the following meds were to be added to my regimen on various days over the next week:
Prometrium (vaginal suppository)-Progesterone is needed to prepare the lining of the uterus so it can receive a fertilized egg. Progesterone helps you become and stay pregnant. This medication is used to increase the level of progesterone in women undergoing fertility treatment because these treatments can decrease progesterone levels.
Progesterone In Oil (PIO) (IM injection)-Given concurrently with vaginal progesterone.
Prograf (oral)-Prograf is an immunosuppressant originally created as an anti-rejection drug for organ transplant recipients.
I had the clinic nurse draw circles on my back in permanent marker to indicate my injection sites. I wanted to make sure the PIO shots would be going in exactly the right spot(s), and also that I could rotate sites so that I wouldn’t get sore. She was awesome at entertaining my need for exact instruction :)
My phone rang later that day during my afternoon at work. The clinic nurse on the line informed me that my TSH level had come back “a little high” (5.05) so I was also started on 50mcg of Synthroid because a high TSH can cause miscarriage (they wanted to see it less than 3). We would recheck my level the day of my hCG wash and go from there! I looked back to see what my TSH had been trending and it was 3.31 at my baseline appt after being 2.32 during med clearance. I was pretty frustrated that they hadn’t started me on the Synthroid at the start of this cycle but *shrug* you can’t change the past.
The day of my hCG wash (four days after starting Synthroid), I stopped in to the clinic for a blood draw at the crack of dawn before work so we could get the results by the afternoon. I worked a half day and arrived for my hCG wash about 15 minutes early. While I was waiting, my phone rang, and when I saw that it was the clinic calling, I just knew it was bad news. My heart sank as the RN came out to the waiting room to tell me in person that my TSH was still too high (4.58) and that unfortunately this meant a cancelled cycle. I asked her to call the dads for me to break the news. She called them with my phone on speakerphone and explained. They were, of course, wonderful about it, knowing that I had taken my Synthroid absolutely perfectly the last 5 days, and that my body just needed more time to adjust. We learned that I would come off all medications except for the Prednisone, LDN, Prenatal, and Vit D in order to trigger a period. I would call with cycle day 1 and we’d get right back on the proverbial horse!
tl;dr Timeline
June 21st – Reached Out to Fertility Clinic
July 7th – Medications Ordered by Clinic
July 9th – Took Last Birth Control Pill
July 12th – First Day of Cycle
July 14th – Baseline U/S, Bloodwork, Meds Instructions, and Meds Arrived
July 15th – Med Start!
July 22nd – Lining Check U/S, Bloodwork, and More Meds Instructions
July 23rd – Started Synthroid
July 27th – Cycle Cancelled
Stay tuned for my blog entry on Cycle #2 and Transfer Day :)
With love,
K
