Fig Stims

"I saw myself sitting in the crotch of this fig tree, starving to death, just because I couldn't make up my mind which of the figs I would choose. I wanted each and every one of them, but choosing one meant losing all the rest, and, as I sat there, unable to decide, the figs began to wrinkle and go black, and, one by one, they plopped to the ground at my feet."

- Sylvia Plath- The Bell Jar

From the deafening silence that met my last post, I am guessing you are all trying to tell me something. What could it be? Either you do not like clowns, or you are sulking about my unwillingness to talk about my stim options.

Oh what the hell, I may as well go over the Stims Menu now, since I am in a midweek floppy mood, and have nothing better to talk about.

I should explain that I don't always do particularly well when presented with too much choice. I mean, just recently I had a fugue moment in *Insert Conglomerate Coffee Chain here*, where I stood for a good ten minutes, slackjawed and dazed, so overwhelmed was I by the array of beverage decisions. Too much choice and I become like that character in Plath's Bell Jar -with the damn fig tree.

OK. Let me begin by offering up a handy link to the "European to American" fertility medication brand name translator. Also to say, my main dilemma revolves around method of delivery into my trembling flesh. Namely, the relative merits of the pen versus the auto-injector, if in fact there is a difference. So that's where all you come in, my infertile comrades.

Basically, in ascending order of cost I can have:

* Menogen (urinary based product (that is, the wee of menopausal women) injected intramuscularly)
* Menopur (also wee-based, but injected sub-q using an auto-injector)
* Gonal-F (prefilled pen, injected sub-q. Comes with "free" Ovitrelle sub-q trigger shot, also by pen)
* Gonal F Multidose (injected sub-q using an auto-injector. Again with the "free" sub-q trigger shot. Those drug companies are all heart, eh?).
* Puregon (cost unknown, pen or vials)

Since I expect to have to give myself all my shots, intramuscular injections are a total out. I can barely spell the word "intramuscularly", never mind cope with jabbing myself in the ass. So that narrows it down a little.

Initially, my inclination was to simply go for the Gonal-F and then thrash out the pen versus auto-injector question. But then I did a little Googling of Menopur (aka Repronex) and found this, a recent study which suggests that Menopur may work a bit better than Gonal-F. And it's slightly cheaper than the Gonal-F- not that I'm really going to start nickel and diming at this point. But you know- why pay more for something that does not work as well- if you don't need to?

The Gonal-F option is a straightforward prefilled pen or multidose auto-injector, the latter being much more expensive. So, all things considered that seems to take us to a choice between the Menopur auto-injector and the Gonal-F pen.

Hopefully, you are following all of this, dazzled and awed by my keen powers of decision-making.

My question is whether the auto-injector is what I think it is? From what I can work out, a bix of mixing up of meds is involved, then you load it up, press to the injection site and push the button. Hey, presto, Stim-U-Matic. Or is there more to it than that? My first reaction when I heard of it was "hell, yes, get me one of those!" No trembling hand, no force of will to jam a needle into quivering flesh. Just click and go, baby.

But then, weirdly, the more I thought of it, the more freaked out I became by the idea of the auto-injector. I am all about the uber-control, here, people. If I do have to plunge a needle into my abdomen, part of me thinks it would be better to be able to see it coming, and to control it. Plus, I have done so much visualisation of the injecting with the pen to get over the latent dread (not to mention watching this video over and over again). And I think I am now almost up to the job with Le Pen.

Plus, I have seen the Gonal-F pen, and it's really quite cute, as far as those things go. A nice perky red with the pleasing little dial for the dosage. I mean, one might as well opt for aesthetically pleasing gear while one is at it, right? I have read that in contast, the Menopur auto-injector is a bit bulky and well...scary. Plus all that mixing- I am one of those people who goes through life, trying to fix various fuck-ups large and small whilst muttering, "If only I had read the directions. Must. learn. to. read. directions." So I am sort of guessing that mixing of crucial meds would not be my forte.

Anyway, whadda ya think? Possibly more effective, cheaper Menopur via auto-injector, or jaunty Gonal-F in its convenient jabby pen? What would you do or what have you done? I should stress I don't mean to be overdramatic with the fig tree analogy- at the end of the day, it's probably not that big a deal.

But these things can keep a girl up at night. So your thoughts and your vice- whether assy or ad- would be much appreciated.

Comments

[MM]

I've used the Gonal F pen and can tell you that it was insanely easy to use. But I've also used an auto injector and it was by far less angst inducing. You just tap it on your skin. There's no weird moment where you're asking yourself, "Why the hell am I about to stab myself with a needle?!" So that's what I'd do, but neither option is that bad. Good luck!

[zarqa]

I've used the Follistim pen and if the Gonal-F pen is anything like it, then, yes, it is very easy/painless. It is designed for self-administration. So even if you could wrangle a volunteer, it works best if you do it yourself.

And I used Repronex. I left the calculations for both and the injecting of the Repronex to my husband though. My math and biology knowledge goes out the window when it's my own body we're talking about. It was enough to "be" injected without having to think about injecting.

[Emily]

Well, for me, it was the clown thing ;) Just kidding.

I have nothing to offer in terms of medications, but wish you luck.

[md]

Have only used gonal-f. i found it very easy to use, but then I like to watch when i have a blood test etc..
MD

[InSpring]

Too much choice indeed. I have to use Menopur with Gonal-F multidose - they get mixed together into one shot and then injected. My nurse said it would be hard to use the pen and mix - are you suppose to mix and use both or just one or the other? I think they're different kinds of meds - right? Boy am I the wrong person to attempt to answer your question since I'm an IVF virgin myself.

I used a Follistim pen for my IUI's and I found it easy to inject myself - first just doing my thighs and then when I got up the nerve, my belly.

When I cycle, my DH is going to be my injector, that's kind of what's pushed at the clinics here - keeps the man involved or some such thing.

[B. Mare]

I think it's just one type the whole way through the stimming- in other words, no mixing. I have no idea why that is!

[Suz]

I've used the pen and also find it pretty easy; I do most of my own shots. I don't know about the other option....

[Julie]

The little bit of stimming I did was with the needle - not the pens. I have to tell you, it's really not that big of a deal. I could hardly feel the sub-q shots and my husband gave me the IM shots and they were pretty much a breeze but understand, I got cancelled half way through my second cycle of injectibles. I didn't have the "pleasure" of doing PIO shots. Just Gonal F, Repronex (hated that shit) and HcG.

[Jen]

I start with my Follistim pen and my Repronex (mix-it-yourself) regular injections on Sat, so I will let you know which I prefer. The pen idea kind of freaks me out, just because now I will fear all pens stashing secret needle compartments. Good luck deciding!

[Pamplemousse]

Gonal-f multidose with auto-injector here! I have never actually had to inject myself normally with a needle and I actually don't know if I could. The trigger has always been sub-q too.

What does your clinic recommend for stims as it seems a bit odd that they leave it up to you but you don't have anything to compare with, KWIM?

[Menita]

The pen, the pen, the most excellent pen, tra la! No pain and easy to prep.

[Julia S]

First of all, do you still want me to call you tonight? I'll email to confirm.

Second, oh oh oh! I know this one! Pick me! My only comment on the pen is that the dosing does not seem as flexible as a needle (I could be wrong, I am deducing this from studying the internet photos) and I wound up on 112.5 ui for a few days. It is something to consider.

[Dead Bug]

Hmmm...interesting question. Never used an auto-injector, so I can't speak to that, but I've had the Gonal-F pen, the Follistim pen, Gonal-F in vials and Repronex in vials. The pens are extremely easy to use but somewhat rigid: if, for example, your dose doesn't multiply evenly into the number of IUs in the pen, you either have to do multiple injections to use up the last bits or do some fancy extracting and combining. The vials and the associated mixing and shot needles are pretty easy to work with and offer a lot more flexibility. For example, I am combining 225 IU Follistim and 150 IU Ganirelix with 75 IU Repronex each evening, and end up with just the one shot for all three. Takes a bit more work but anything that results in fewer shots makes me pretty happy.

For me, the Follistim and Gonal F were not very painful, regardless of whether they were administered by pen or syringe, but the Repronex burns and stings. Both of my R.E.'s were insistent upon including both the Folli or Gonal F (which are basically identical) with the piss-derived Repronex.

--Bugs

[Dead Bug]

Hmmm...interesting question. Never used an auto-injector, so I can't speak to that, but I've had the Gonal-F pen, the Follistim pen, Gonal-F in vials and Repronex in vials. The pens are extremely easy to use but somewhat rigid: if, for example, your dose doesn't multiply evenly into the number of IUs in the pen, you either have to do multiple injections to use up the last bits or do some fancy extracting and combining. The vials and the associated mixing and shot needles are pretty easy to work with and offer a lot more flexibility. For example, I am combining 225 IU Follistim and 150 IU Ganirelix with 75 IU Repronex each evening, and end up with just the one shot for all three. Takes a bit more work but anything that results in fewer shots makes me pretty happy.

For me, the Follistim and Gonal F were not very painful, regardless of whether they were administered by pen or syringe, but the Repronex burns and stings. Both of my R.E.'s were insistent upon including both the Folli or Gonal F (which are basically identical) with the piss-derived Repronex.

--Bugs

[J]

Delurking...
I've never tried the pen or the auto-injector. For me, the mixing ended up being a nice little ritual, like drinking tea. That said, I didn't have to do it in the morning when I was likely to be in more of a hurry. The sub-q needles didn't end up giving me any trouble, which was shocking because I share your needle phobia to the nth degree. About the med choice -- my RE likes to have some LH in the mix for egg quality, but she's just one doctor, so who knows. The Repronex did sting like crazy, unlike the Gonal-F.

All your med/delivery options sound reasonable -- I'm crossing my fingers that everything goes very smoothly!

[J]

And Mare, my deepest condolences to you and to everyone living in the UK for today's atrocites in London.

[ms pickled eggs]

Although it's all been pretty much covered, I'm giving a UK perspective as I don't think we have the same pens as they do in the US. At least we didn't a couple of years ago. The auto-injector is (as you thought) just a device for giving the injection without having to poke it into your leg yourself. You still have to mix the drugs in a syringe, then the syringe is dropped into the auto-injector, press the button and the drugs are injected into your leg/stomach. It is a bit bulky and it makes a fairly loud bang, but I found it easier than injecting myself. I don't have any fear of needles but would find it difficult to deliberately hurt myself by sticking a needle into my thigh. Mr PE was no help at all and could barely even be in the room when I was injecting, so I had to do it myself.

I can't remember which drugs I used, but it wasn't any of them. I'm sure different FSH or FSH/LH combinations are recommended for different fertility problems but I can't remember which for what. (Sorry)

[Amyesq]

Exactly what Bugs said. I think I had the excact same cocktail she does. Anything with a pen I would highly recommend. Oh, and please try not to let that video freak you out too much. It makes it look much harder than it actually is. After the third or so day you will have it down pretty well. Think about a driver's ed video where they show you doing your seatbelt, adjusting mirrors, etc, undoing the brake, etc, etc. You think "Crap! How am I going to remember all that?" and now you don't even think about those things.

Thinking of you muchly and planning our exploits for the Spring. Of course you will be, like, nine months pregnant by then and probably rethinking the whole letting me stay thing but we can cross that bridge when we come to it....

[T]

Your RE doesn't have a suggestion on menopur vs. gonal f? What dosage will you be on? Different women react differently on the manufactured vs. old nun's pee - or some, like me, react exactly the same. I know, how dull.

Helpful huh?

[alex]

Like you I am doing IVF. Unlike you I am doing very little research which is extremely odd for me which normally I do the opposite. I am soooo piggy backing here on your research. Just call me a leach.

[patricia]

All I can see are figs. Sorry. I'm useless.

I swear I would have commented on your last post if I had read it in time!

[londongrrl]

I've used both! here's what I know-
-I didn't see any difference in response
-My second consultant said menopur was used much less now - less predictable? It's certainly cheaper
-The auto-injector is great (and yes, you don't see the needle go in), but the mixing is fiddly and I had several days late on in stims where I would have scan, go to work, wait for blood results and then be told whether or not to inject. Very hard to mix in work toilets, gonal-f pen much easier
-Gonal-f pen doesn't last more than a month (supposedly) once de-refrigerated
-and its doses are less flexible; minimum is 37.5 I think.
- I injected in the thigh, much less anxiety inducing than abdomen
-It's fun. Kind of....

[susan]

Hi Mare,
I've used sub-q shots and pens. Both are fine, pens a little easier but require refrigeration, which is tricky when traveling. Whatever you choose, make sure to have a little ritual. Ours was... every time I used an alcohol swab, I'd proclaim "Time to swab me belly - arrrgh" in my best pirate voice. You can borrow it if you like.

Also, switching gears, so glad you're safe and sound.

[JennaM]

God, I love that Plath quote. The narrator's quandary seems so simple, so much so that it seems like a trap to make a move. That's exactly how I feel about making IF decisions.

[jen]

Hey....I am going to start the gonal f pen or the follistim pen soon. I am extremely phobic of needles. Do you really need the EMLA cream so you can't feel it? Is it equivalent to a mosquito bite? I am trying to find ways to reassure myself, so any help would be appreciated! Thanks!