IVF Cost: New Zealand Edition

As promised, here is my breakdown. It may be helpful to compare with my US cycle costs, but keep in mind the 5+ year time gap and of course, the differences in protocol. As a brief recap, in the US, our first and only IVF cycle there, we did a sort of combined long priming with high stim protocol. Here in NZ, we did shorter priming and low stim protocols. We had 3 attempted IVF cycles, the second was converted to an IUI.

Cost breakdown in NZD (current exchange rate 1.49 NZD to 1 USD):

Initial costs: Appointment to see if we could qualify for public funding- $195

First clinic appointment	235
orientation appointment	250
estrogen	5
letrozole	5
IVF (‘Natural’ IVF, regular would be $7000)	5500
orgalutran (5 shots, $125 each)	625
ovidrel (1 shot)	180
suppositories (1 box utrogestan)	32
PICSI (not charged)
intralipid appointment	195
intralipid IV	800
acupuncture (first clinic tried, 1 appointment)	80
acupuncture (other clinic, 4 appointments)	390

So the total for this cycle plus the initial costs is $8,492. This would be roughly equivalent to $5,685 USD.

On to the next cycle, which was converted to an IUI. First, we received a credit for $800 from the previous cycle because we had no transfer. That was applied to this and subtracted from the IUI cost we paid.

IUI ($800 subtracted for credit from cycle 1)	460
menopur ($60 per vial)	300
ovidrel (1 shot)	180
suppositories (1 box utrogestan)	32
acupuncture (4 visits)	360

The total for this round was $1,332. Roughly $891 USD.

And finally, our truly last IVF round:

IVF (charged for full IVF instead of natural)	7000
orgalutran + menopur	1205
ovidrel (1 shot)	180
suppositories (1 box utrogestan)	32
acupuncture (2 visits)	180

Total $8,597 minus $800 credit for no transfer, which we are awaiting, leaving the true total $7,797, roughly $5,220 USD. They were supposed to charge us the same ‘natural’ IVF rate of $5500 instead of the $7k even though we did use menopur, but then they also realized they didn’t charge us for the ICSI, which would have been $1800 (more than the $1500 they overcharged), so they offered to leave it at the $7k charge, essentially saving us $300.

And, that is that. So, a grand total of $17,621 ($11,797 USD) for our 3 unsuccessful attempts here in NZ vs our one successful attempt in the US, which came out to $17,619 USD for just the IVF part I believe. And then of course there are all of the supplements, which are just too much organization-wise to try to include at the moment!

If only we had been successful here, it would have been a much better deal. And if we had been able to qualify for public funding that would have been even better. Unfortunately for us, those things didn’t happen. And we are now working on moving on and closing this chapter of our lives. We went to a counseling session at the clinic (which we paid for as part of the costs above included with each cycle). It was helpful, there is a lot to work through. This infertility struggle has been such a big part of our lives and our marriage for nearly a decade, and has shaped so much of the person I am now. I’m glad that they offer it and hope others use it. I will try to continue to use it, as she said there’s no limit on meeting with her. She also offered some resources including a group here for people that were unsuccessful having another child that we hope to connect with.

As always, thanks for reading. Sending lots of love to you, wherever you are in your journey. The world needs a lot more love these days. ❤

IVF Attempt #4 Outcome

Well, we learned that my concerns were, in fact, valid. Out of the 5 eggs retrieved, one was unsuitable for ICSI (I believe she said it was immature), the other 4 were injected, but one didn’t survive the process. The next morning another one had met the same fate, one had double the chromosomes (from the egg?), and one hadn’t showed any signs of fertilization yet, so they let it go for another day. And just like that we were down to one. Once again, the extra time did not help. So, again, there will be no transfer.

It’s incredibly disappointing. And really feels like the end of the road for us this time. I still feel like there probably is a protocol that exists that could work for us, but we no longer have the time, money, energy or a Dr. that we feel is invested enough to figure it out.

It’s a lot. A lot of feelings.

In some ways it feels liberating. Like it’s finally not hanging over our head constantly. We no longer have to carefully weigh any larger expense with saving money for more treatments. I no longer have to be so careful about what I eat, what I drink, what supplements I take, how warm or cold my body gets… It’s strange. I’ve been so careful for so long (literally the better part of a decade), it feels really weird to not have to be thinking about all of those things. I’m still taking it a little slow, restocking gluten free foods etc. for now, but I think I’ll start to ease up on that. It’s going to take some time to transition I think.

I’m devastated that my sweet girl will never get to have a sibling, she’ll always be a little lonely in that respect. My sisters and I certainly didn’t have the greatest relationship growing up, but family is family, and it’s nice not to be totally alone. Especially since we’re so far from cousins etc. now. She’s stuck with just us. And the friends she makes. I know there are other options (egg donation, adoption), but I don’t see us pursuing either of those at this point. I’m grieving the fact that I’ll never have another chance to be pregnant- it was such an awesome experience. And that we’ll never have another little person in our family.

We feel extremely grateful and so very lucky that we have our little girl, that everything did manage to fall into place for us with just enough magic. In some ways I feel guilty we didn’t try harder, faster after her birth.

It feels like a relief to give my body a break though. To be able to move on toward the rest of my life and focus on other things. Though my recovery was not terrible, it hasn’t been great either. I think it’s really just done with all of this.

There are still questions that I/we will need to answer, do I keep taking the thyroid medication? What do I do with all of the extra supplements I just purchased? What about the medications I still have more of (letrozole, utrogestan)? What do we do with the baby things that we saved and brought all the way to NZ with hope that we’d have another need for them? And all of the things back in the US that my parents and sister have been saving? I’m sure there will be more that will surface over the coming days, weeks, months.

I’ll do a final cost breakdown, and a comparison of IVF in the US vs NZ.

Until then, good luck wherever you are in your journey, and thank you for reading.

A photo of my girl on her own road, I hope it will be less bumpy than mine.

IVF Attempt #4, Retrieval #3

Yep, we did it. I’m still very nervous about quality, fertilization and beyond, but we got 5 eggs! Kind of crazy that it’s only 1 less egg than our original IVF, where we had twice as many follicles going in… I’m still not sure why we didn’t get more eggs from that, but anyway, here we are.

Yesterday I was feeling really down about it all, but by bedtime we kind of decided to make the best of it. I did some fertility yoga and meditations to help me get back some positive energy. I did my usual supplements but skipped the baby aspirin to help prevent excessive bleeding. I made sure to have a snack before bed since it would be a long time until I could eat again!

Today I unfortunately woke up around 5am and wasn’t able to fall back to sleep but stayed in bed trying to rest and spend some quality time with those little eggs before they were plucked out of me to go on their own journey. There’s a lot to think about these days in the wee hours of the morning, from covid to the current political insanity and back to the IVF…

My husband got our little one ready for her day and took her to school while I got some last minute things ready to take with us, including the paracetamol to take 1 hour before the collection. We were on the road early for a change! We actually had extra time looking for and once we found a parking spot so I did another short meditation recording in the car before we went inside.

Because of covid we had to wear masks into the hospital and the fertility clinic. I wasn’t sure if they’d have me wear one for the actual procedure (they did), or if they would give me a sterile medical grade one (they didn’t), so I wore my home made one the whole time. The other major downside to doing this during covid times is that my husband couldn’t come in with me for the collection this time. That was disappointing as that had been such a nice change from our original retrieval experience. The mask made the oxygen tube in my nose a little more uncomfortable as it kind of pressed on it, but was otherwise fine. They kicked in the drugs pretty fast this time so I didn’t have much of a chance to miss having him with me once I got in there.

As I came back to the recovery room someone said they got 5 eggs, but I guess my husband didn’t hear. When he did find out, he was pretty surprised! I might not have mentioned the small 5th follicle to him in a way that he remembered that it existed! The embryologist asked if we still wanted to do ICSI or if we just wanted to do regular IVF, we had already decided we were going to stick with ICSI (the clinic decided they weren’t going to do PICSI anymore, so just regular this time). She had said she could call me with an update on how the eggs looked (immature/overmature etc. this afternoon, but she never did- really hoping this isn’t a bad sign). I asked the Dr who did the collection if she could tell how big the small follicle had been and she guessed around 12mm. Anyway, I think I was a little less groggy this time around and had some tea and rested for a bit. My heart rate, blood pressure and blood oxygen were all fine so after I went to the bathroom we were able to get going, to finally get me some food, as it was past noon at this point!

We decided to pick up food on the way home instead of going in a restaurant for our post egg collection lunch date (the only kind of date we seem to get these days!), partly because of covid and because we didn’t have that much time before pick up for my daughter. I blissfully ate some food in the car and the rest on the couch at home, parked in front of my favorite movie with a heat pack on my belly.

I’m starting to feel a bit more soreness this evening as the meds are fully wearing off. I really hope this wasn’t all for nothing again… hoping most of the 5 will fertilize and at least 1 will make it to freeze, along with the fresh transfer we may be doing later this week. I know that’s super optimistic, so trying not to get my hopes up too much. It’s out of our hands for a few days, but still trying to keep sending those eggs the best stay strong, fertilize, and grow vibes I can!

Photos of some special things I brought along: I decided to wear (what I’m pretty sure are) the same socks I wore to my first retrieval because things didn’t go perfectly then either, but we did end up with our amazing little girl. I hope we can be so lucky this time around. And my necklace is a sea star that I got in Cabo on our last trip before our successful transfer. In my mind I was thinking the 5 points on the star were appropriate for our 5 follicles (even though I’d been focusing on the 4 larger ones), but I didn’t really let my self even consider getting all 5 eggs. Surprisingly they let me wear it the whole time (I remember they wouldn’t let me wear the necklace my friend had lent me during our first retrieval). Thanks for reading!

IVF Attempt #4: Day 10 Scan + Trigger

Well, we have our answer on how fast they’re growing… and the answer is, too fast. Ugh.

Today started off well, we hit the lab for my blood test with perfect timing, no one waiting, in and out quickly. Then had a lovely walk through a beautiful park and yummy breakfast out at a cafe in the park. Then things went downhill. We had parked in a different spot that was a bit far from the cafe. I decided to leave the orgalutran/ganirelix shot in the car because I’d need to do it before my appointment but my husband said he’d get the car so I could do it in there instead of trying to find someplace in the cafe/park. Unfortunately that plan took a bit longer than expected so by the time I was back in the car, shot in hand/belly, it was about 15 min late. Not ideal. Which meant I was also running late to the appointment.

I had a different Dr. than I’d had before who did the scan, it was fine, I think he did try to measure carefully, did each one twice unlike many others I’ve had. Unfortunately the measurements were not what we were hoping for. He measured the largest at 20, then 19, 17 and 15mm. Our target range for the lead follicle remember was 16-18mm based on this study. So we were way beyond that… again.

I can’t believe we’re back in basically the same situation we were in before, debating about whether or not to keep going when we know we’ve missed our goal- which was basically the whole reason we tried again, to hit that earlier trigger/retrieval window. I know this time we have the two smaller follicles, which is great… but if going past the window physiologically changes all of the egg cells (not just the bigger ones) and makes them less likely to succeed then I just don’t know if we really are in that much better of a position. I realize that without focusing on this study, it would look like we were in a pretty decent position, with 4 follicles growing at a similar rate and within a fairly close size range to each other.

I think we were just really thrown off by things happening so much faster this cycle than in all of our previous ones. At first it was exciting, and looked promising, but now I’m concerned that it went too fast and I’m nervous about the quality. They each grew between 4 and 6 mm over the 2 days based on the measurements we have. So to have hit our window, I would have needed to have an appointment yesterday (when they would have been about 13, 15.5, 16, 17.5, and done the trigger last night for a retrieval on Sunday (tomorrow). But we didn’t. Hard to believe how much difference a day can make.

I went to an acupuncture appointment yesterday and she did some stim vibrations with needles over my ovaries. I wonder if it was too much 😦

So here we are.

I’m going to go through with the trigger now, but we’re still deciding about the retrieval. Why is it so hard to get the pieces to fall into place! Even just to put our minds at ease about giving this our best last shot! If we don’t do it, we’ll wonder if we missed out on it working, and possibly have less follicles if we try again, if we go through with it and it doesn’t work, we’ll feel like we should have cancelled and started over and made sure to hit the window. I don’t know. All I know is that with my first IVF we triggered with the lead follicle at 23mm and 1 out of 6 eggs became our little girl. And last time we triggered with the largest around 21 or 22 and out of 2 eggs we didn’t even get fertilization. So, who knows?!

Here are 3 of my 4 follicles today. The largest on the left you can see by itself (blocking the 2nd largest), the other two are the two smaller ones on the right. There was still one much smaller one, but I don’t even remember the size he said for that one.

Update: My estrogen level was 2,075. That’s quite high… So only 8 days of stims before trigger and my estrogen and follicle growth rate were both really high for this early in a cycle. I’m not sure what to make of all of this, especially when taking letrozole for the duration of stims is supposed to lower estrogen levels according to this study, but they also used 5mg instead of 2.5mg. I know that estrogen going up too much is not a great thing either. I’m feeling pretty depressed about it all 😦

IVF Attempt #4: Day 8 Scan

The moment of truth, to see if those 6 follicles we caught a glimpse of at the baseline (day 2 scan) would pull through for us, aided by the mighty menopur and lucky letrozole…

We talked about our action plan last night, since my husband had to stay here to get the little one off to kindy and I would need to head out early to get my blood test and make it to my appointment. If there was only one follicle again, we would definitely cancel (aka. probably switch to IUI because I think we’d end up saving $ that way and still get in something). If there were 2, we were on the fence, but leaning toward bailing/IUI. If 3 or more we would feel good about going forward.

I was feeling cautiously positive, because they’d told me that my estrogen level on Tuesday had been 399. I wasn’t sure I had heard correctly, so I didn’t want to get my hopes up. I looked back at my previous numbers for estrogen on/around day 6 and 399 is far higher than the letrozole IVF cycles we had done where our values were less than 50, and even higher than our original IVF which was about 200 at the same point in the cycle. She confirmed for me today that 399 was the correct value. I’m thinking the lack of priming has made a big difference in the levels rising faster.

So back to the follicles, she started on the right, and measured 2 follicles at 11 and 12mm and one small one at 6. Then on to the left (I was holding my breath while she switched sides, hoping there would be something over there!), and there was! Two more, even larger follicles, measured at 13 and 15!! So we are looking at 4 good sized follicles here people– that is exciting! They asked me to do the orgalutran (ganirelix) shot once I got home, and I’m booked to come in on Saturday (2 days from now) for my next appointment, which will hopefully be trigger day, with retrieval Monday! We are still trying to catch the lead follicle in the 16-18mm range, the one that’s at 15 now might go slightly over that by Sat, since it seems to be growing not quite, but near 2mm per day. At first she said Sunday, but I’m not willing to risk that! I’m hoping that one will stay steady and the others will catch up a bit! So, 2 more nights of menopur and letrozole and hopefully last doses and trigger on Saturday!

For my reality check, I know this is only half of the number of follicles we were looking at compared to our original IVF, and only 1 of those worked… so I know the odds are still not in our favor. But this does feel like it’s about as good as we could hope for at this point. We just have to keep the faith that one will come through for us again this time!!

My little girl asked me on Tuesday, “will I ever have a sister? A real sister?” (She has many pretend sisters.) A hard question to answer, but we’re trying! Hopefully today’s progress is getting us one big step closer!

No photos of the follicles today… but here is a mom and baby sheep for some good vibes! Spring is in the air around here apparently!

Update: Estrogen level today was 1,028! Definitely higher than past cycles at this point!

Once Again, One Last Time: IVF Attempt #4

We’ve weathered one more lockdown and come out the other side. We also celebrated our 1 year anniversary of moving to New Zealand- the very day the new lockdown was announced! We had a phone call follow up appointment with the Dr. during level 3. She confirmed that we could do baseline scans to try to make sure we picked a good month to proceed. And we kind of discussed going back to just letrozole, but discussed a few other options.

During the lockdown, I slacked quite a bit on taking supplements, I ran out of several and put in an order, but of course it arrived just in time for my new cycle to start but not to take them in advance.

My cycle ended up coming about 3 days early so this morning I went in for a blood test and day 2 scan. I was a little surprised that she counted 3 follicles on each side, all about 4cm with one 5cm on the Left. So we decided to proceed, even without prepping with supplements and no priming. It will also be my last chance before yet another birthday next month. We were going to do just letrozole again (3 pills or 7.5mg for 5 days), but I was thinking that with 6 follicles, I want to make sure we maximize our chances while staying within the ‘natural IVF’ category. The 6 count struck me as similar to what we had at the baseline for our original IVF cycle. I don’t pretend the outcome will be as good, but hopefully better than the last attempts. She said we would be able to go up to 2 vials of menopur (150iu) plus one letrozole (2.5mg) every night and see if we can get more than 2 follicles to keep growing.

I do wish I could have taken the supplements that just arrived before starting this, but I am getting tired… and older. At some point, the desire to be done begins to outweigh the desire to be successful… I feel I am approaching that point. I do wish I hadn’t spent all of that money on the supplements I won’t be taking right now (some are not compatible with the stim meds (herbal tinctures and DHEA). It would be nice, for once, to feel prepared. But we just hope we can get an embryo or two to transfer this time. Fingers crossed!!

Sending love to wherever you are in your journey, thanks for reading.

A photo of our favorite lockdown weekend destination 🙂

A Shocking and Not so Shocking Twist

Spoiler alert: The IUI result was the not shocking part of tonight’s post… it was negative. It’s disappointing, but again, not a surprise. We had already booked an appointment to speak with the Dr. in a couple of weeks to see if there is any way forward that she would recommend at this point or if we should just call it.

The lack of baseline scans here is bothering me a little, if we are going to try again I want to make sure there are enough follicles to make it worth the effort. If they don’t agree to do that then I’m not sure any protocol is worth investing in. I am curious to see what she has to say.

Last night is what threw us for a loop. We’d spent the day on a bit of a high celebrating the anniversary of the day we arrived in NZ 1 year ago. Then, for the first time in over 100 days, there were new cases of COVID 19 announced in New Zealand of unknown origin. And they are here in Auckland, so we have all of the sudden gone back into level 3 lockdown. We are definitely less prepared than last time in the sense that we didn’t have advanced warning to start stocking up on things, but on the other hand, we’ve done it before so have a much better grasp on what we’re in for. So far they’ve announced it as only 3 days, though many expect that will be extended.

I knew we were getting too comfortable in our easy breezy COVID-free lifestyle! It was wonderful while it lasted, I hope we will be back to it soon. Hopefully these cases will be quickly tracked, traced and isolated and there has not been (and will not be) much spread.

So, the status of our appointment is a bit unknown. We shall see if it will have to be cancelled or not, but either way, it’s too late to start anything for this cycle. We shall see what the days and weeks ahead will bring. Hang on for the next wild ride!

 

 

IUI #5

So instead of IVF we decided to go ahead and do the IUI this cycle. The blood tests did not show a natural LH surge so I had one more scan on Wednesday (follicle measured at 19mm and lining at 10mm). We got the Ovidrel trigger to do at 10pm. On Friday my husband had to be there at 8am, then I was supposed to show up at 10am (36 hours post-trigger). Of course there was insane traffic which caused me to be about 20 minutes late. I tried not to totally freak out, but definitely not the most stress free of mornings! The IUI itself went smoothly, no problems and took about 5 minutes.

I decided to get some extra progesterone suppositories (or pessaries as they call them here), since I already had most of the box left from our previous IVF attempt. I teeter on the edge of feeling like it’s a waste of time and effort vs. trying not to totally give up and at least go through the motions of trying to help facilitate success.

But instead of taking the day easy, we had decided to pack up and go away for a ski weekend, so shortly after I got back home, we headed out again for a ~4.5 hour drive to the mountains. It was good to get out, but the temptation of the apres-ski hot tub was great. The person who did my IUI (I’m not sure if she was a Dr or nurse) had said not to apply direct heat to any part of my body, which I thought was a little strange as a lot of people emphasize keeping feet warm, encouraging blood flow etc. I did put my legs in and even dipped in briefly, because it really wasn’t that hot, but then instantly felt like I’d sabotaged it all! Of course, the night before we had cranked up the heat in the hotel and I’d woken up boiling hot in the middle of the night, which was probably worse… but really, neither are great. Ugh, what can ya do.

I started using the progesterone Sunday night, doing it in the morning and at night (2x Utrogestan each time). It is what it is. Next steps are a blood test to check progesterone Friday and a blood pregnancy test Monday a week after. Implantation should have been yesterday/today. I did an acupuncture appointment the day before the IUI and today (Wednesday). I hope there’s some tiny glimmer of a chance that things worked out how they should, but I don’t have a lot of confidence in IUIs.

Trying to send some love to my body, and love to all of you reading. I leave you with a photo from our snowy weekend! I’m one of those little person dots riding up the Tbar 🙂

The IVF That Wasn’t…

Our second scan was last Friday, and as expected, there was just 1 follicle still. They measured it at 11mm. We decided to stop doing the Menopur and switch to IUI. They also mentioned that they measured my LH level on the day 7 blood test (I guess accidentally? As they don’t usually measure it apparently…) and it was quite high (over 19- I need to check the units, but it should be under 10). It went down on the day 10 test and they asked me to do another blood test Sunday (day 12) and come in for another scan on Monday (day 13). The estrogen was also a bit low, but increasing (185 to 338).

At the follicle scan this morning they measured it at 15mm, so growing, but not big enough yet. They told me I’d need to do blood tests every day to see when my LH surge starts to schedule the IUI. My arm is already bruised from the latest rounds of tests and I’m so frustrated that this cycle has been such a let down… I’m feeling so angry that our last IVF attempt was ruined just because of the bad retrieval timing. I mean it is not unlikely that it wouldn’t have worked anyway, but it sucks feeling like we didn’t get our solid last try.

I’ve done some reading about elevated LH during the follicular phase of the cycle, and it’s not good. This article reviews several studies and cites one where ‘A higher likelihood of pregnancy was observed when the LH level was <10 IU/L and the miscarriage rate was significantly higher in women with LH levels >10 IU/L’. So generally, higher LH at the beginning of the cycle leads to less chance of pregnancy and if you do somehow get pregnant your more likely to loose it. Not encouraging for even continuing with the IUI at all…

We debated just throwing in the towel on this cycle altogether and saving the $ for the IUI and possibly trying IVF one more time IF (and that’s a very big IF) our Dr. thinks there’s something different we can do that might actually make a difference. I’m not sure there is at this point. From reading, it sounds like there are things we could do if the high LH is part of what caused this cycle to be so bad. This article mentioned some potential treatments in the last paragraph. I’m not sure what we’d do differently for the stim medications though… go back to only letrozole? Do letrozole alone, then menopure? Increase doses? A different priming protocol? I don’t know. And unfortunately we can’t talk to our Dr. about it because I found out today that she’s gone on vacation for 2 weeks.

So, we’ve somewhat settled on continuing for now, in case there isn’t anything worth trying for another IVF. We’d rather end with the IUI than with nothing. Ugh. Not feeling hopeful. I was/am ready to be done, just hate going out without a good-feeling effort. But starting to wonder if we’ll even get that at this point.

As always, thanks for reading. Here’s a lovely view from our NZ adventures over the weekend.

First Scan, Last IVF

So, first, the protocol. My Dr. suggested we alternate Letrozole (3×2.5mg), with Menopur (1 vial, 75mg), for 5 days starting on cycle day 2. This meant 3 nights of Letrozole, 2 of Menopur before the first blood test and scan. We decided it felt strange not taking the Letrozole on the Menopur nights, and since I have plenty of extra we figured we’d go for it and I took 2 Letrozole tablets on those nights. Even with all of this, and feeling rather positive going in to the appointment, the scan was disappointing. They found just one follicle to measure (8mm). In all of the cycles we’ve done with Letrozole, (I’ve lost count how many now), we’ve always had more than one, so this is definitely a let down for our last try ever, especially with the addition of the shots. On top of that unfortunate news I got a headache and felt pretty crappy for the rest of the day.

While I attempted to process the unexpected news, I was a little tempted to throw in the towel then and there, but they proposed taking Menopur every night for 3 more nights and check again on Friday. If there is still just one follicle on Friday we’ll cancel the IVF and maybe do an IUI- just to do something. I certainly didn’t go into this without preparing for either outcome, so I’m not feeling blindsided by the bad news. Just disappointed that we won’t really get a real last try. I keep thinking about how we should have pushed harder to do an earlier retrieval last time… Alas, the past cannot be changed.

I am interpreting this response as my body just being done with this s%*#! So this will, no matter what happens, really be our last IVF attempt, and we’ll have to say goodbye to our hope for another little one. I’m not optimistic about Friday’s scan, but we’ll finish up the shots as planned. They’re pretty much the same as what we’ve done before, with the exception of the liquid to mix with the Menopur powder. Here it comes in a little glass narrow tipped bottle that has a special tool to break off the top to get the liquid out. It seems kind of crazy, but I guess it works! Hopefully no little shards of glass will get in there! Side effects so far are headaches and hot flashes.

Here are all of the shot items, the yellow thing is the glass breaking tool. They aren’t big on the alcohol to sterilize things here, but out of habit (and the fact that I have a box of them still), I’m using it on the top of the Menopur vial and on my skin before the injection.

Thanks for following along. Best of luck wherever you are as you read this.