How to Make PIO Shots Your Friend

**Even though we're still in the gray area of denial & acceptance of our 1st failed IVF cycle, I wanted to post this in the hopes of MAYBE helping ease some fears of anyone worried about progesterone injections. I've actually been working on this post for the past week and was planning to post it even if our cycle worked. Regardless of the outcome, we've done 2 weeks of PIO pretty smoothly and I wanted to share it. ((*Side note: We weren't originally going to share the results of our test BUT we were shocked when it came back negative this week and it hurt more than I imagined it would. We couldn't keep it in and so here we are. We can't start up right away, Dr. suggestion, so will be keeping busy in the meantime.))

How to Make PIO Shots Your Friend 

... or at least not the most dreaded thing on Earth.

It's no surprise that I hate needles. I am practically terrified of them! Infertility hitting the #TeamRicci house 4 years ago pretty much meant life was laughing in my face and throwing me right into the fire of facing my fears. Lots and lots and LOTS of needles... Acupuncture needles. Multiple blood draw needles. Hormone injection needles. I've become somewhat used to these 3 kinds and they are honestly pretty small in relation to the big league of needles. Even though I slowly got semi used to them, I still always feared THE BIG ONES- the PIO needles. A one and a half inch needle that needs to go into the butt/hip muscle. Ouchy. One big reason I was scared of moving to IVF was because I dreaded the PIO shot. Now being on the flip side, I'm telling you it's not nearly as bad as I feared. Here are my reasons for choosing it and some tips that have worked wonders for not making it so bad! I hope they help! 

Why PIO? 

PIO is short for "progesterone in oil". Progesterone is a necessary hormone for getting pregnant and staying pregnant. It's needed in IVF cycles because you're essentially tricking your body into what's happening and re-wiring the system by supplementing it until it produces enough of it on its own. 

There are a few forms of progesterone to choose from (apparently there is a pill (?? still confused on this and the success of it but it's been mentioned in a few places. I wonder if it's just a mythical creature at this point!) but that option was not given to me... I obviously would have chosen that one in a heartbeat if so!!)... Progesterone injections -OR- vaginal suppository cream. Yup, you read that right. Eww. Quite honestly, NEITHER of these sound fun. It was a big toss up to me in the beginning and became a game of which is the lesser of the 2 evils. Avoiding needles was the easy choice for me, but I did a lot of research and thinking, and the thought of being uncomfortable literally ALL day from the suppositories was NOT a welcoming thought whatsoever. I would have needed to use them 2-3x a day and I know I would have been EXTREMELY self conscious, uncomfortable, and downright miserable... All. Day. Long. I was not looking forward to the injections and the big needle either, but I knew it would only be literally a few minutes of misery compared to all day. So a tough decision became an easy one: injections it was. 

These injections are IM, intramuscular, hence why the needle is so long. The baby needles I used for the stimulation drugs are only a half inch and go into the fat of your stomach, so they can be shorter. Going into the muscle requires a longer needle. They also need to be in the upper outer quadrant of your butt/hip muscle. This image is perfect because it shows a grid and gives a general target zone for each side. It's 1 injection and night and is recommended to alternate sides each night so that you give your muscles a break. The picture below is a general guideline. Use the top of the butt crack (for lack of a better term, sorry) as a horizontal line point. Then split each butt cheek vertically in half. Inject in that upper outer section. This helps avoid your sciatic nerve, which would not be fun to hit. I've seen images where the shaded area is down and more in the butt than hip, and I've read that either are fine. I've heard it hurts more in the lower outer area because it's fattier and that's also where you actually sit/bend from. We used this image and I was pretty comfortable most days (once I realized to NOT tense up so much. The first 2-3 days were rough bc I was tense so my muscles obviously hurt at injection site but also my back was tight and on fire from tensing that up as well).  It's helpful to have your nurse draw target zones at first if you want. 

In hindsight, I'm so glad I chose the injections. Little did we know at the time, but it is a really wonderful way to involve Scott. He offered to do them before and I knew he kind of wanted to, but he would joke about looking forward to sticking me with a needle. (Brat :) ). When it came time for the first one (our trigger shot), he froze and almost couldn't do it. But he did, partly because we had no choice, and he was great at it!! Now, he really enjoys doing them for me. 

How do we make it bearable? 

This is our nightly routine:

1. Apply a small amount of numbing cream (We use lidocaine cream; got it on Amazon but some Drs may prescribe it. Ours said we could just buy it. It was about $20 on Amazon and it's a 1oz bottle which doesn't seem like much, but we've barely dented it with 1-2 weeks worth.) Cover the area with a piece of plastic wrap and let it take effect for about 25 mins. (Maybe less but this number works for me!)

2. Ice Ice Baby. I've read some people say no to ice, but a bunch of my friends also recommended it, so I've used it since day 1 and it's helped. My Dr office never gave any tips either way, they said whatever works (they felt some was psychological but it all helps me, the worrier). Anyway, ice works for ME, I wrap an ice pack on a paper town and hold it right over the plastic wrap for about 5-10 mins (maybe start with 10 your first time). 

**During this time play some music to motivate you. Maybe it's something upbeat to put you in a good mood; maybe it's something sentimental; whatever works. It helps distract me anyway. 

3. Take off plastic wrap & clean skin with alcohol swabs. Scott uses 2 each night- one to wipe away the cream and another just to make sure it's all gone. 

4. Decide if you're standing or laying down; do whatever works for you. We prep everything on the kitchen counter and when it's time, I stand and lean over the counter on my elbows. I use a small couch pillow and actually lean on that for support & comfort (and to bury your face in if scared). I also put all my weight on the opposite leg and relax the leg of the side that's being targeted. It helps relax the muscle so you're not tense. 

4. Go time. Do not look, just let hubby do his job. (*If doing them yourself, Way to go!! I give you tons of credit.) I find that not looking at the needle helps me forget how big it actually is. (1.5inch, 22 gauge). Scott usually draws it up and preps it for me while I'm numbing or icing... We were instructed to do 1cc or 1mL each night but I suppose that could be different for different protocols. (We were given 18g needles to draw it up and 22g to inject. Look at the thickness of the 18g and suddenly the 22g doesn't seem so bad!! Look once if you've already seen them and are scared. If you haven't seen them, don't look.)

This bottle gets us about 10 injections. (10mL)

*I swear that on most days all I feel is a little pinch. Sometimes I can feel the oil going in, but it just feels like a little pressure, not pain. Breathing through it also helps. 

(Photo credits here to our close friend, Manny, who was visiting at time of transfer & got to document our shot process. Not sure I want to post the video yet though bc I am always self conscious and hate myself on video- haha!) :)

5. When done, Scott applies gauze and massages the injection area for a minute or so. This helps the oil settle and spread/absorb. Apply a bandaid when done massaging the area (just for fun- it's not actually needed!). The bandaid also serves as a target for next time so you remember the spot. 

6. Apply a heating pad. This is like a nice treat at the end. :) We heat ours in the microwave for 1-1.5 mins and then I relax on the couch with it. 

That's it!! You certainly don't have to follow all (or any!) of our steps, but just sharing what works for us. Just for reference, one night last week I experienced just how well the numbing cream and ice work for me... I had an awful migraine the other night and since I couldn't take anything but Tylenol (at least until the pregnancy test, and beyond if we are pregnant), the migraine wasn't going anywhere but was actually getting worse. It hurt so bad I literally threw up bc it was so severe. In the time I got sick, my numbing cream wore off and we didn't have time to ice it because we wanted to get the shot done before I possibly got sick again. Cream wearing off and no ice made the needle hurt and I realized just how well our little system works. 

*SOME YouTube videos work well too. Key word= Some... Some made me inspired and it looked like a piece of cake. Others made me more nervous than I already was. These are my 2 favs...

Progesterone Party- Self Injection (I love this one because she makes it FUN... and she gives it to herself (eeeek!! Props to you, girl!!). She makes it look so easy & this is where I got the idea for the numbing cream)

Tips from a nurse (I liked this one because it's professional advice and she makes it not seem so scary!!)

I would say our experience was pretty on par with these videos. I hope the links work- if not, I'll try to fix it later on. 

Good luck! Hang in there!! If I can survive it, so can you!! 

XOXO,

Stace

#TeamRicci

They say...

(Posted by Scott)
They say...that when you get to hold your baby for the first time you learn to love all over again, almost as if you have never loved something so much before.  They say this but what about all of us that are out there that get the big fat negatives.  What about the fact that you pray and hope and look at the stars and want it to happen so much but the day the test comes they say sorry, this is not good news.  I don't handle heartbreak well.  And by that I mean I hold it in and try to let it out but it never comes out when I want it to.  I want to cry with my wife, but my "man brain" will not let me.  They say that you need to let it out.  They say that it will happen.  No offense to anyone and even to myself at this point but, I need it to happen.  This will be a short post because I am pissed and angry and sad and being torn up inside but what happens to the guys out there when "they say...."  I know that the females will read this out there and say I know that my husband/partner has gone through this.  I  had to tell my poor, crying wife over and over tonight to stop saying sorry.  Its not her fault.  Honestly we would have never been in this situation if it weren't for me not having swimmers.  They say it will work out.  They say if you keep trying it will be there.  I got off the phone with our doctor tonight and honestly after talking to him and hearing the next steps and the plans that they have, it amazed me.  But what truly amazed me is the sincerity in his voice when he called at 750pm and knowing that he had to make that call.  I don't care how much money I have to spend to have a child with Stacy but this guy made me want to keep trying and want to keep pushing forward.  They say it will happen and honestly we gotta believe that it will, but right now its hard.  They say...

Embryo Transfer & Beyond

"A person's a person, no matter how small." -Horton/Dr. Seuss :) 

I'll start with the focal point of this post, and of the past week- our sweet little embryo. I LOVE that we get a picture of it (magnified tons- it's so small and microscopic, it's like a tiny spec and yet holds so much wonder!).

I saw this on the ground the night before our embryo transfer. I couldn't resist taking a pic of it. Our really good friend, Manny, was visiting for the weekend and the 3 of us had dinner at a nearby park along the river, and I found this on our way back to the car. I saw a heart so I thought it was fun. 

The morning of transfer, this was my horoscope!!! Woa!! Talk about hope and excitement! :) 

So off we go to the Dr.'s office! We had a 10:30 appointment (lucky us!! First one of the day!) but were instructed to arrive by 10:00 and have a full bladder by 10:30. No problem for me, mine seems to be the size of a peanut; I always have to go! We get there, the waiting room was so quiet and empty ?(only 1 other patient, BIG difference from retrieval day) and I start drinking...

Yup, that's a 32oz Gatorade bottle. It wasn't full when I brought it along and started drinking, but I did put some water in it when I was done with the Gatorade. (In hindsight, finishing the bottle was mistake #1. Adding more water was mistake #2, but I didn't know that yet.)

We get called down to the lab area around 10:20 and I get so happy things are running on schedule. We are instructed to change and come out when ready. I had to wear the same type of gown for retrieval, but I only had to take off everything waist down, I could keep everhtnjng else on, yay. Of course my lucky socks stayed on though. (Plus they want your feet warm and cozy anyway, so it's either my socks or theirs, which are not so cute). Scott obviously kept everhtnjng on but had to put these classy things over his clothes and hair. Ha! There's just no way to look good in these outfits! :) So we will make fun of it! 

Ready to get this show on the road! 

Finally all set, we go into the procedure room (same room egg retrieval was in) and just wait. At this time it's about 10:30 on the dot. Excitement sets in, nerves set in. The embryologist comes in a few mins later and happily tells us we are going to transfer one beautiful AA embryo. We always said we would love to transfer 2, have twins, and be done. But we obviously trust the Dr's judgement. They thought it best to do just one because of 2 factors- my age, and the quality of the embryo. Since I'm young and it was a great embryo, there's more of a chance it could split. They didn't want to put in 2 and end up with 3-4 babies. Fine by us! So 1 it was! 

She then told us that we had quite a few embryos developing and that she would call the next day with a more solid report. She planned to cryopreserve/freeze a few that day and then give some another day to develop before freezing them... However, it looked like we had a good number make it to good quality stages. 

So here we are with the picture of the star of the day- our beautiful embryo, 5 days after fertilization. How cool is that! 

At this point, I really have to pee, and the Dr isn't even in sight yet. The nurse realized how badly I needed to go and she let me go use the bathroom. I was afraid of emptying my bladder completely but she said "I saw how much you drank, you'll be fine!". So I go and feel soooo much better. Then, silly me, I drink a few more sips of water when I return. (Not a good idea.) 

The Dr's (one main one to do the transfer and another to assist) arrive and by this time it's around 11:00 or so and I have to pee SO badly, again! It's as if I hadn't even gone 10 mins ago. Eek. I tell them I think it's too full and they say it's probably okay and we will get started shortly. They come back after what feels like an eternity and onward we go. 

I'll try to spare some of the details but let me just say that my bladder was WAY too full. I will NOT drink so much next time, knowing that I have a small/sensitive bladder. No one told me it could be as bad as it was and I honestly felt like, for me anyway, it was torture. It was the hardest part of the process so far because it was the longest. The stimulation injections in my stomach sucked because they stung and burned, but it was over shortly. I had to hold my super full bladder, ready to explode, for a good 45-50 minutes, NOT KIDDING. Scott is my witness (and hero!). Wowsa!

Imagine having to pee as bad as you ever had, multiply it by 50 (according to Scott), and hold it for almost an hour. Laying there in an awkward position, ultrasound probes and other tools inside of you AND an abdominal ultrasound tool pushing on your belly/bladder is no task for the weak. Woa. I kept warning them that I was afraid of peeing on them, and they assured me I wouldn't be the first or last. (Thankfully I did not, but it took all of my strength not to.) 

The transfer itself involves somewhat of the following: internal ultrasound and abdominal ultrasound to determine the best pathway to the uterus. They mapped out a path and then a speculum (my LEAST fav tool- bleh) is inserted and they clean your cervix. Then a catheter is inserted. (Some of this hurts only a teeny bit, but when you're super tense & your bladder is so full it hurts, this whole process hurts quite a lot.) You can see a lot of this on the ultrasound screen, and Scott was mostly watching. I, however, was wincing, clenching, sweating, complaining, trying to breath, trying so hard not to cry or lose control of my bladder (in fear we would have to start all over again), and just downright miserable. I always envisioned this being a positive happy moment filled with love and hope, yet I was squeezing Scott's hand SOO hard I'm surprised I didn't break it. 

Once the prime spot inside your uterus is determined by the Dr, they wait for the embryologist to being in the embryo, loaded in a thinner catheter. That catheter is inserted into the one already in place and it's pushed up to the top. At this point I was trying to be really aware because this was THE moment. The Dr. told us to watch the tip of the catheter and look for a "shooting star" when they counted down. They counted to 3 and then there it was, our shooting star- a little white blob came out of the catheter and was there sitting in my uterus. It may not sound like much but it was pretty magical and amazing. Scott was emotional and I was all smiles. I would have cried out of joy too if I wasn't still in pain from my bladder. 

There it was, our little shooting star, finally placed back in its home. At this point I was extremely happy and grateful that it was finally there, life was finally inside, and also grateful that all the tools and such were being removed and I was moved back to a normal laying down flat position. 

But I still couldn't pee yet. They want you to lay down for about 20 mins. The Dr asked if I wanted a bed pan and I said I never ever thought I would say yes to that but there was no way in hell I could hold it another 20 mins. So I said yes.... But if never came. 10 mins must have passed and I was getting worse by the second and I kept yelling at Scott (out of pure crankiness) to please find someone and ask for one but no one was around. Finally they returned a few mins later and said I could get up and use the bathroom but then come back for the remaining 10 mins. PHEWWW. It helped tremendously and even though it wouldn't all come out (from being squeezed tight for almost an hour), it helped big time. Then I laid down the remaining time and we were free to go home. (After I peed another 4x before the ride home! Ha!)

Soooooo happy to show off our beautiful embryo!! The pic on the right is the ultrasound image of when it was actually transferred. We can pinpoint the exact tiny white spot that contains our embryo. Pretty awesome! Sent on our way and advised to take it easy and take off the next day from work. They don't want you on strict bed rest but don't want the stress of work. Being that transfer day was Sunday, staff at my school actually reported on Monday for the first day back, for 2 staff days and kids arriving Wednesday. My bosses are 100% supportive of what we are going through and Scott and I actually felt (with the encouragement of some friends/coworkers) that a second day was smart. Why risk it after all we've put out there. What's one more day? Plus there was a heat wave this week, perfect timing to go back to school with no air conditioning- and my classroom is one of the hottest in the whole building. I have an entire wall of windows that don't open, only let heat in. 2 days of work to just relax and do whatever I wanted, within reason, sounded way more relaxing and hopeful for future baby Ricci to settle in after "move-in day". 

Once we got home, all I could do was stare at the pic and make fun collages. Look at our cute little family of 3. <3 :)

At one point in the day, Scott and Manny ran out to get some groceries and stuff for dinner, and Scott returned with these beautiful flowers for me. What a guy~ I mean really, I know how lucky I am to have him on a daily basis, but he really stepped up to the plate Sunday. During my whole 45 mins or so of torture, Scott held my hand the ENTIRE time. He was right in my face making me look at him and breathe. He tried to distract me and make me calm. He kept reassuring me how great I was doing and how proud of me he was. It made every bit worth it (sort of). :) Thanks, hun. I would NEVER be able to get through something like that alone or with anyone else. Plus I could squeeze his hand as hard as I wanted and know I probably wasn't even making him flinch. 

That night, I GLADLY took the PIO injection. Gladly. One tiny pinch and a minute of mild discomfort was nothing now. Manny was there with us and as you know we usually play music to help keep me calm, distracted, or pumped up for the shots. First it was a fast, pumped up, dancy song, and then when it was done, "Home" by Phillip Phillips came on. I immediately burst into tears (FINALLY!!!) because the emotions finally hit me. "Home" is one of my absolute favorite songs; I've loved it from the first time I heard it, back from the summer olympics a few years ago. It was used in a commercial for the US Women's gymnastics team. Then it grew and now I'm a big Phillip Phillips fan. Anyway, "Home" and the lyrics have always connected me to trying to get pregnant. I always imagined when we finally are (with a viable pregnancy that will last to full term), I connect the "I'm gonna make this place your home" lyrics to making my belly a home for our future baby. So anyway, I start crying happy tears and ask Scott if he played it on purpose (of course he did). I then explain to Manny what I just said, and he got a little filled up too. I was just so extremely hopeful and excited that our embryo is finally home. So he snapped this pic of us (once I stopped crying).

Good luck and God Speed, little one. I hope you snuggle in and get cozy. We'd love for you to stick around for the long haul with us! <3 

Flash forward to Monday, my first day off. Everyone else was headed back to school and I missed it for the first time ever. A part of me was bummed to miss social time and all the "Welcome back"s, and catching up on everyone's summer, but a big part of me didn't mind it. I was on Cloud 9 in a happy bubble of my own. Manny hung around for the morning then headed home, Scott was back to work, and it was me and the jellybean just relaxing. I went out to lunch with my friend Kortney, we sat by the river after, and then I just completely relaxed the rest of the day. It felt great!! 

Below are images of typically developing embryos. Top left is the fertilized egg and then what happens while it develops and cells multiply into a blastocyst/embryo in the bottom middle. *(Our embryo looked just like this, it's "textbook" as one of our friends said, and we were surprised how perfectly round this one was. They don't all look this way and I'm certain our others aren't either as they chose the best one for first dibs.) The bottom right image is the embryo starting to hatch so that it can implant and attach to the uterine wall.

Our embryologist called with a final report. She ended up freezing 4 embryos on Sunday and let a few more wait to Monday, where she froze 4 more. So in addition to the embryo we put back in, we still have 8 frozen embryos in storage!!! We are thrilled with that number, as it's almost double what seems to be the norm. We are extremely thankful and completely realize how luck we've been this cycle. We started with 25 eggs retrieved, 22of which were mature. Out of those 22 mature eggs, 18 fertilized. Then from those 18, a total of 9 made it to healthy, good quality embryo stage. The rest could have dropped off for any number of reasons and that's totally normal. We expected that and once we heard 18, I said 9, at half, would be incredible. That means we have many more tries if this doesn't work, or for tries with a future sibling.  We would only have to repeat an egg retrieval if we run out of those frozen embryos. Hopefully we don't need to do that, but if we do, it shouldn't be for a long while. 

Being a Disney nut, I had to create a fun way to announce our great results. I saw pics of people posting with snowflake pics and I did see one Elsa reference, so I got to work with my photo apps and.... Ta-Da!! :) :) 

Tuesday was just as relaxing and wonderful as Monday. I sat outside for a bit in the morning and then drove up to visit my best friend, Alli. Alli has 2 adorable children, one of which is my Godson, and we currently live about an hour away from each other but try to see each other once a month or so. We had a picnic with the kids at an old historical site right along the river and it was a beautiful day. 

For now, we just wait. For now, I can't do anything high impact (no Zumba for a bit) or lift anything crazy. For now, we just wait and wait and wait. (And hope and pray LOTS.)

Here also comes the moment where most of you might be bummed... Scott and I have decided that it's best, for US, not to share the testing date or results. We are giving a general 2-week time frame of our test, but we don't plan to tell anyone exactly when the test is OR what the results are. We've already been down that road of announcing too soon, when we miscarried at 5 weeks. Too many people found out in that week of excitement, which made it more crushing. It was too hard to announce a positive to lose it so soon after. I completely understand and respect the 10-12 week thing before announcing. SO much can happen in those weeks. 

Plus, we've always felt robbed of the element of surprise when it comes to that. I always wanted to surprise people with a pregnancy announcement. That doesn't happen when your story is out there for the world and all of social media to see. Yes, that's been our choice and No, I don't regret a single bit of it. I am 100000% thankful and glad we've decided to be so completely open about our story. It's helped us cope in more ways than anyone on the outside could understand. It's made us stronger. It's gained us extreme support. I don't regret that. But I think for us, we want to keep these next steps quiet. From here, I expect this could all go down a few possible ways:

1. This cycle works, we get a positive, and we announce when the time comes. 

2. This cycle doesn't work (either right away or after a few weeks), and ALL we have to do is start over with a frozen embryo transfer (FET) cycle next month or when my body is cleared to start. That may involve some injections and hormone supplements here and there, but nothing like starting over again. It'll be a much smoother process. 

Whichever try works, it should hopefully work between now and Christmas. Then expect an announcement from there. Hopefully. If things go completely haywire, I'll jump back on to say what the holdup is and what happened. We hope it doesn't come to that, but you just never know. Sure there's a higher chance now that I will get pregnant soon, but there are so many crazy variables in every pregnancy try that it's just out of our hands. We hope for the best, remain positive, and we'll see what happens. 

In the meantime, we still need to do my nightly progesterone injections. If I'm not pregnant, we'll stop and start back up with the next try. If I am pregnant, we'll have to continue for another 4-6 weeks or so. Either way, we'll still be doing them, for this cycle or another, so it won't really be an indicator of success or failure. My mood overall shouldn't be either. I'm excited to have come so far and regardless of a positive or negative, I know in my heart that we are finally closer to the finish line. If not now, maybe next month. At least I know fertilization has occurred and there's life inside each transfer. That's the important part. Please be respectful of our decision and don't ask when the test is or try to pry into the details. Feel free to guess on your own, but don't share it with me. I have a terrible poker face and don't want to feel pressured into sharing when we aren't ready.  I know this will be hard at work because everyone knows the deal and they all want it almost as badly as we do, but I'm going to try my best to stay my happy self, whether it works now or later. 

That's all for now folks. Signing off from updates until it's the right time for us and remaining positive, calm, relaxed, and hopeful. 

As always, thank you for the tremendous support, love, positivity, and prayers. We feel it. <3 <3

Love, 

Stace & Scott

#TeamRicci