A blog about Surrogacy/IVF Medicines

Just thought I would update with a timely medication blog.  I started the progesterone shots on Thursday and will continue these daily until about 10 weeks.  So I wanted to share information about the medications that  surrogates may find themselves on during an IVF Cycle.  Just as a disclaimer, I am not a Reproductive Endocrinologist.  I am just a surrogate who has been around the medication a few times.

Necessary Medications:
Birth Control
Lupron
Estrogen
Progesterone

Routes of Medication:
Patch
Oral
Vaginal
Injections

Birth Control Pills are necessary to quiet the ovaries.  When doing IVF, they have a specific date in mind that they want to keep your ovaries from taking over and producing the hormones that they are using to alter your cycle.  The doctor wants ovaries with small follicles on them and the birth control can also help to reduce fluid that is in the uterus. You will usually be on this medication for  Cycle Day (CD) 1-16 or the entire pack until you start your next cycle -- the next cycle meaning the one that you will use to transfer the embryo.

Lupron injections are also used to suppress ovulation.  It can be used or fresh or frozen embryo transfer, but generally used on fresh transfers because they need to get the surrogate's cycle synced with the Intended Mother or Egg Donor.  This medication is crazy expensive and rarely covered by insurances.  It is also called Loopy Lupron because it gives this foggy state of mind.  It can be used for frozen cycles when the surrogate's ovaries are not suppressed with just birth control and estrogen and also if there is free fluid inside the uterus that would not be an ideal environment for an embryo to snuggle in. - I am not familiar with the dates this is used as I have only done frozen transfers.

Estrogen is used to further silence your ovaries.   It also builds up that lining that the embryo will be snuggling into.  Estrogen is started anywhere between CD1-4 usually.  It is continued until week 10 of the pregnancy.  Prior to the start of the progesterone, many times women experience extreme headaches from the imbalance of hormones used to manipulate a cycle for IVF.  These headaches cannot be fixed with any over the counter efforts -- the only thing that will help is adding the progesterone in to balance out those headaches.  Estrogen can be given in many different forms.  It can be given in a patch you put on your belly or lower back as well as being taken orally.  The blue tablets can also be inserted vaginally which then creates a gross blue discharge ... Did I mention you do this for 10 weeks?  Finally, you can take estrogen in the form of injections and usually it is given twice a week or every third day. 

Progesterone is the final medication added into a cycling protocol usually. Generally it begins 5 days before IVF is to occur. When having a natural cycle, progesterone is released when the follicle cyst bursts.  Progesterone is the hormone that signals to your body to not shed it's lining yet.  When you have a sudden drop of progesterone, that is when you have your period.  Progesterone is made by the cyst of a follicle until the placenta begins to grows and then the placenta takes over the creation of progesterone. 

Progesterone is generally prescribed in 2 forms -- injection and vaginal.  Occasionally it can be given orally bit is considered less effective.

In the form of injection, progesterone is generally mixed with some form of oil -- think cooking types of oil-- sesame oil, cottonseed, ethyl oleate, and peanut oils.  The problem with injections is that some people may be allergic to the oil that is prescribed causing big itchy whelped hives.  It can also cause painful lumps from the ultra thick oil.  The needles for this are 1.5 inches long (yes the needle goes all of the way into your muscle up to the plastic) and you must have an injection every night for about 8 weeks (until you are 10 weeks pregnant usually).  Many surrogates have reported painful lumps after having injections for weeks and surrogates sometimes report nerve damage years later.  More recently, the pharmaceutical industry is trying to create a subcutaneous progesterone injection that is water based which means less allergic reactions and less lumps

In the case of vaginal insertion for progesterone, there are a few options.  Crinone is a gel that is inserted into the vagina.  Suppositories or pessaries are also used.  One specific brand is endometrin.  When I was on this protocol in the past, I had to have 3 vaginal suppositories a day.  These suppositories are $12+ per dose so $36 per day or about $2000 per cycle and insurance will not cover this often.  Whereas Progesterone injections and syringes are often covered by most insurances with no copay. Aside from that, what goes in, must come out.  With suppositories, you are leaky every single day, all day for 8 weeks.  Many people also end up having some type of reaction or have vaginal infections from the suppositories.

But Melanie, why are you telling us all of this!?  Well because many times people ask me about surrogacy and I think people think about the end result but forget how the surrogates get there.  It is not an easy process.  If you don't like needles, this may not be for you.  If you cannot commit to taking medication every single day at the same time, sometimes multiple times a day, then this is not the journey for you.  If you would rely on the money made from surrogacy to live day to day, this is not the journey for you.  If you aren't ready to say "I am done growing my family" this may not be for you.  These synthetic hormones can really screw up a body and make it so you have secondary infertility where the woman cannot conceive in the future. Do you want that for your future?  These are all things that other people won't tell you about -- but I will.  Surrogacy itself is a beautiful journey.  The end result is beautiful.  But not everything about the journey is glamorous. 

Do you have questions for me about surrogacy?