I am 35 years old, living with stage IV Endometriosis, possibly adenomyosis and struggled with infertility for almost 4 years. I also struggled with PPD and now struggle with PMDD. I am a mother to a son that was born at 18 weeks and too precious for this earth; and now a mother to a son born in August 2011. By journaling here, I hope to benefit both for myself and for others that are dealing with this disease and fertility struggles. Thanks for visiting!

Monday, July 13, 2009

It's all about supression

Well, here we are in the throws of IVF cycle#2. My last dose of Aygestin was Saturday evening. I was taking Aygestin for my endometriosis and to help ease into this cycle. I can't take birth control because I get migraines with aura's, so, this is how we start. Aygestin has been good to me since our last IVF cycle. I was in a good amount of pain from my period/miscarriage, and after I started taking the Aygestin the pain has been minimal to none. Being pain free is something unknown to me since my entire endo journey has begun. So, pain-free is a wonderful state!

Lupron is taken for a number of reasons. Being in the field of Oncology professionally, my first run in with Lupron was for the treatment of prostate cancer. Never had I thought of it in another manner until it was prescribed to me by my OBGYN after my first surgery and diagnosis of stage IV endometriosis. My opinion on it for the treatment of endometriosis isn't very high, but, that could be for a number of reasons. First, I didn't take it for it's full course (started having ocular migraines and decided to stop). Second, my endometriosis "came back" rather quickly once I was off. In my case, my second surgery was to remove an endometrioma that resurfaced only a few months off treatment. So, really, it was only a temporary "fix". The Dr.'s make you feel like the "fix" will be longer, so, I was pretty disappointed when I was back in surgery just months later after stopping. (NOTE, it is NOT a cure for endometriosis-don't let ANYONE tell you otherwise!)

So, when I heard of Lupron again for IVF, I was a little reluctant. It's in a MUCH smaller dose than in treatment, and it's side effects were minimal during my use for IVF. I'm still not 100% thrilled with having to take it because of everything that I experienced when using it to "treat" endometriosis, but, it seemed to work well the last cycle.

So, what does Lupron do in IVF?

Lupron Depot (leuprolide acetate for depot suspension) is a GnRH agonist - a hormone that works in two distinct phases. Phase one stimulates the ovaries causing them to produce more of the most potent of the three estrogens produced by women - estradiol. In phase two the messenger hormones that tell the ovaries to produce estrogen decline dramatically. This causes a significant reduction in estrogen levels, and results in the "pituitary suppression" phase.

Because of the initial surge in estrogen, it is usually given for a few weeks before starting the other fertility medications. This allows patients to “get past” the stimulation phase and into the suppression phase.

Pituitary suppression is important for recruitment of multiple follicles. By desensitizing the pituitary to signals from the brain, Lupron blocks the natural tendency of the brain to allow only one dominant follicle to grow in each cycle.

Tonight will be my 6th injection of Lupron this cycle. Seems today I have signs of spotting. This happened last cycle after I stopped the Aygestin as well, and, is considered "normal". I didn't have any particular side effects last cycle. This time I am having some local irritation at the injection site for about 30 minutes after injections. I've also noticed I'm bruising this time. So interesting how things differ from cycle to cycle. Hopefully the rest of the regimen will go well.

Sorry I've been MIA. It's been super busy in "normal everyday life" around here. I've been so pleased to go through some of my blogroll to find some of my fellow endo sufferers and infertility bloggers have found themselves with recent positive pregnancy tests and new adventures. Very exciting. It also seems I have new followers. I need to catch up!

My next apt is on Thursday and I am eager to see how things are going. Last time I had an endometrioma by my first ultrasound (it was luckily drained during my egg retrieval). I'm wondering if that right ovary will have another or, if it doesn't, will it be productive this time? So many unknowns ahead. Here we go!!!!


Kelly said...

Good Luck Thursday!

devon said...

Yay for being pain free!!! WOOHOO!

And thanks for explaining Lupron and it's various roles. That stuff still freaks me out!

Most importantly, good luck Thursday!

Benny said...
This comment has been removed by the author.
Benny said...

I also took Lupron for my endometriosis and short of growing a beard I had every side effect possible. Like yourself I was not remotely looking forward to having to deal with it again for IVF. I just started my BCP pills today and it appears my cycle cocktail is about six weeks so Lupron won't be administered for that long. Have you experienced any weight gain/bloat with your cycles? I ask as I seemed to balloon up with the Lupron before. Hope all goes well on Thursday I will be sending positive thoughts your way.

Sonja said...

Good luck! Great to hear that you're having some great pain free days!!

Thanks for all the info regarding Lupron during IVF!

Christa said...

This was a very interesting post. First, do you think you could tell me a little more about Aygestin? I would like to consider it for sometime in my future.

Second, your opinion on Lupron strikes my interest. Did you not have good luck with the results? I hated HATED it while I was on it with the hotflashes, headaches and depression, but afterwards, they did a lap (about 1.5 years later)after having DC and although I was still in pain, there was no new endo. So Lupron, while being on it sucked, is my savior. I'm sorry that it wasn't as good for you.
I hope this cycle works for you, I think about you often and hope things work out soon! You deserve it!

My Endo Journey said...

YES on the bloat/weight gain. BUT, not much. More bloat than weight gain. But, I think it was more the stims than the Lupron. I'm still a little puffy from the last cycle. It's so weird, because I really haven't gained weight, but, my clothes are tighter. So, who knows WHAT it is!

Aygestin (norethindrone acetate) is used in the "treatment" of endometriosis (says it right here on my bottle). Norethindrone is a type of female hormone (progestin). It is like the hormone progesterone that your body makes naturally. This medication works by stopping the normal growth of the uterus lining during the menstrual cycle and signaling hormone changes in the uterus to restore normal menstrual periods.

It's NOT a birth control...and, I don't have periods when I'm on it. But, apparently you still ovulate. I'm not 100% sure on that one. It's also used as add back with Lupron when used in treating endometriosis.

Lollipop Goldstein said...

This is such an interesting post--I've never heard of Aygestin and it sounds like...well...more people should know about it.

I love that your husband is reading the book--thank him for me!

Becky said...

Good Luck Thursday!!
I am very familiar with the pituitary stuff - though for different reasons of which I wish on no one! Praying for you & Weston that all goes wonderfully:)

Jeanne said...


You have such an awesome, positive attitude. I love the way you are so excited for your blogroll buddies. You are so sweet. Best of luck on Thursday!!


P.S. I left you a reply on my blog regarding that hummingbird feeder you are going to be purchasing. :)

Cathy said...

Here from L&F.

I've been on Aygestin continuously for 18 months now - and was on it for nearly 3 months prior to my IVF cycle (when I got pregnant).

Aygestin IS a miraculous little pill, isn't it? You DON'T ovulate - or shouldn't. If you are, it's not working as effectively as possible. I get checked every 3-4 months, and my ovaries are always dead as a doornail, which is how it's supposed to be. (Ovulation = estrogen = potential for endo growth)

Aygestin alone doesn't work for me anymore - I was up to 20 mg a day and still in pain, so we knocked it back to 10 mg and added Femara, which knocks out the estrogen from the adrenal (I think?) gland too. (I have particularly persistent endo.)

Glad to see more people using this drug - so few know about it!

kerri said...

Great info!

It's amazing how much different stuff Lupron is used for. I agree that it is not the most effective tx for Endo.

Here's to follie growth!