Monday, June 29, 2009

Shutting down

I think I am done with the blogging for now. I appreciate everyone's kind words and I hope to be able to keep up with everyone's progress. It seems that everyone is doing very well. Plans are in place. Some seeds have been planted. Others are on their way to establishing a family. I wish everyone well and hope to update everyone once a cycle begins that has any promise. I am not shutting down the site until I get all my stats off it.

Wednesday, June 10, 2009

Waiting

Well, here I am. two days away from when I should be expecting my period. OK, I know others will think that I am totally insane, but I still hope that this cycle I conceived naturally. I always considered myself a realist, but no, I really think I am an optimist in disguise.

I felt cramps on day seven post ovulation. I know, why do I put myself through this. Well, if you think about it. It is all I have to do. There is absolutely nothing else I can do. So either I get my period or I am pregnant. I handle disappointment well.

I should quit drinking alcohol, shouldn't I? I gave up caffeine over 1.5 years ago. I try to take a vitamin every day. Boy, have I been bad at that. I eat veggies regularly, but for some reason I just can't stop drinking. I know I could lose weight and feel better about my eggies, but then how could I deal with the disappoinment. I know this sounds like I am an alcoholic, but maybe I just realize the whole futility of my situation. I know one good egg and all, but seriously it is beating me down. I just want to have it over with. I don't want to decide on a donor. I don't want to take the meds. I don't want to go through the tranfer. I don't want the two week wait . I just want it to be over.

Tuesday, June 2, 2009

Brief update

I thought I would provide a brief update to everyone. Thanks for all of your kind notes along the way. I was very sad to read about all the IF problems that everyone has had in the last few months. This stuff just stinks.

Because of a trip to Germany, we had to go the old fashioned route in May. I love doing the BBT because my cycle is so much like clockwork, except with the time changes. It is really difficult to try to get the right time when you are traveling. We may have missed the window but we gave it the old college try.

We went to Germany to see our new nephew. Ps sister got pregnant immediately after stopping BCP. Her biggest concern was that she could drink during Carnival. Sigh. Even funnier she rode her bike to the hospital to give birth. I love telling everyone that. It seems pretty amazing to me.

As I suspected, P was totally uncomfortable around the baby at first. He held it as if it were made of glass and contorted his body in weird ways to "make the baby more comfortable". The darn little guy really liked me, though. Every time I held him he fell asleep. Maybe it was because I cleverly let everyone man handle him for an hour or two, then took him when it was nap time again. I don't know.

Any way, we are debating about going in again for a baseline (iff this cycle is a bust). The hold back is that we would like to travel around the fourth of July and IVF could interfere with that. We will just have to see. I would just like to get it over with. I am still not excited about donor eggs, but I am hoping that would provide some closure. Until then, I think I will enjoy the life with only having a dog to worry about. After seeing Ps sister, it makes me appreciate my current life without child a little more.

Friday, April 24, 2009

Posted too soon

My ovaries looked like hell on the baseline sono. Nothing in lefty and a cyst and two follicles in righty. The worse baseline, yet. Hmmm so was it the....
Femara
Estradiol
or Gani*relix?

We'll never know. Yes, I almost cried on my way back, but the words of Nice Dr. were, "You are young and healthy." We can screen you every month. Once we find 5 follicles we will begin the stimulation.

On the bad side, I was being totally optimistic and bought all of the meds. Now they are just sitting there. Staring me in the face. If I do a donor cycle, they will probably be too many.

Monday, April 20, 2009

Bad at blogging

It has been a some time since I last blogged. I guess, I had many things to do and really I just couldn't face the fact that everyone around me was getting pregnant or having a baby. To summarize my last month.

Mekate my IF blog sister is pregnant and has graduated to an OB.
My coworker (40) just gave birth on Friday.
My second cousin just gave birth two weeks ago.
A good friend gave birth 10 days ago.

I, on the other hand, have had two months where my honey bun wasn't with me on the day I ovulated. Not that it would have done any good any way, but still heavy sigh!!

We have moved on to a new and very excited RE. Well, there are two in the practice. The one I saw (just so I could get an earlier appointment) was not my favorite person. He just didn't seem very personable. Mostly out to make the bucks. The other RE was fantastic. Very enthusiastic, informative, and positive. I am hoping all of my appointments can be surreptitiously scheduled through him.

What is the protocol? Luteal phase antagonist then agressive agonist, with a little antagonist thrown in at the end.
Dr. 1 forced me to ovulate (femara then ovidrel), which I thought, was overkill. I have ovulated every month according to every means readable (BBT, OPK, cervical mucus, progesterone levels, and cervix location) This was especially obvious this mont when he looked on Day 6 and I already had a 15mm follicle. Then one week after ovulation I had to have a progesterone test 24 (thank you very much). Then started 4 days of ganirelix. In addition, started estradiol patch to be switched every four days. Menses stared two days early. Very weird. I don't think I have ever been that early my entire life. I am already reading this is a bad sign. I have said that my body does not like to be manipulated with hormones.

So here we go. Oddly, I am not sure if I need to go in on day 2 or day 3. Clueless scheduling receptionist seemed to think that day 3 was ok, but I really think they said day 2. Will call them tomorrow morning.

Oddly, my dentist appt seem to always fall when I also have RE appt. Tomorrow I am supposed to get my teeth cleaned. Probably at the same time that they want to schedule my sono and blood work.

I think that is enough of an update for now.

Wishing all of the luck to my sisters in cyclesista. Lets get going!

Sunday, March 29, 2009

Inspiration

Mekate put her tarot reading on her site and I thought it was really cool so I will do the same. It looks really good, but I am not sure what to think about the hermit.

Opportunity
The Seeker-a new beginnig
You have the opportunity to start a new journey, with a beginner's mind. Is it time to hit the road, either metaphorically or literally? Every time you set out on a journey, even if it's only a one-day hike, you embark on a spiritual journey as well. Be open to all the twists and curves in the road ahead. Be ready for wonderful surprises. Be open-hearted, innocent, trusting and spontaneous. Take a risk! Before you is a brand new adventure — the chance for a fresh start and endless possibilities.




Challenge
The Gardener-sensuality,creativity, abundance
You are being challenged by overflowing abundance and fertility, to the point that it may feel overwhelming or chaotic. You may be pregnant with so many new creations that you are having trouble focusing on just one. Learn to plant, weed and nourish your garden in a sustainable manner; then you will be able to offer the best possible of all foods to those whom you love.







The Resolution
The Hermit-sacred solitude
Resolution comes as you spend time in sacred solitude. You need to withdraw from the world to focus on your inner life and spirituality. Perhaps you have been wounded in the "wars of the world," or perhaps you are fatigued and empty from putting out so much energy, especially if you are a caregiver. Your well is empty and it needs to be filled. Take some time out for a retreat. Go away to the mountains or the sea, by yourself, without partner or friends. Spend time outside in nature, observing the changes in your environment day by day. Your inner wisdom and sense of well-being will grow effortlessly the more time you spend outside. When you once again enter community life, others will be drawn to the light they see inside you and may come to you for guidance. For part of your purpose is to share what you've learned with others.



Doesn't sound too shabby to me. I guess as soon as I get through my parents visit, then it is time four our new beginning.







Tuesday, March 24, 2009

Waiting

I just returned from extended work travel. It was productive and the honbun met me up in Vancouver for a relaxing weekend. No thoughts about IVF just enjoying each others company and having fun together.

This weekend, we had an extremely productive couple of days. Cleaned the back yard, ordered a new door, organized some closets. And oh yeah, we listed all DE candidates in an excel spread sheet. The sad thing is that none of them are perfect. The one I like the most is 33 years old and not available until May. She has participated in 3 other cycles. Choice number 2 is available now, but she is slightly overweight and not a proven donor.

We have decided to go with a donor who will match our blood types. We plan to reveal the truth to the child when they are older, don't know what age, but I think it was confusing to me to find out when I was 12.

The plan is to find a new RE, try one more cycle with my own little eggies and then move to DE if we have to. I added up the costs recently, and they are frightening. The only other thing that I have spent more money on is the house. I think of all the vacations I could have gone on with that money.

Wednesday, March 4, 2009

Well the wait was over on Saturday

I was sure I was pregnant. My ovaries continued to hurt all the way through this weekend. Everything seemed right. We had copious amounts of enjoyable sex. The IUI was on Valentine's day. Forget the fact that it fell immediately after Friday the 13th. The follicles were not perfectly synchronized, but I figured with 3 we had an ok shot with IUI. I had a bbt dip on day 8. I was a little worried about my temps. They really weren't as high as they usually are. I don't know if that is the effect of the IVF drugs, but it really doesn't matter now.

Had to regroup. RE said he would prefer if I put time and energy into a DE cycle, but will try one more cycle with me if I beg and plead.

I am traveling again in March and my parents are visiting in April so I think all of this will be put on hold for now. I know I should forge ahead with the DE scenario, but that means I have to find another clinic. There are 5 to choose from and I have no way of deciding where to go. Then there is deciding on the donor. I hate making life altering decisions. That is probably why I am still in this job that I am not too excited about. Living in a city other than my darling, P. Life is comfortable, but I feel this need to contribute more to society.

Any way, I need a plan of attack. A time line, a good way to decide which clinic is ideal. There is one that is an easy choice, but thusfar I have not had the best experience with them. It took 3 emails to get them to send me the application. 4 phone calls to reach the donor egg coordinator. 3 weeks for them to return my call for an appointment with the psychologist. OK I know this sounds bad, but if I use this IVF clinic I can have all of my testing done at my existing clinic. Which I guess in the whole scheme of things doesn't mean that much. All they have to do is measure my uterine lining right? That won't take too many visits.

Sunday, February 15, 2009

Third IUI under my belt

I am such a horrible correspondent. No wonder I never kept a diary. Writing is very cathartic, but I often find that my writing is uninspired and boring. So to continue that trend I am writing a brief update about my progress.

On Valentine's Day had the IUI. I had Dr. M, my favorite fellow do the IUI. It hurt a little more with her, but she has such a positive attitude and I don't feel she makes things up as she goes along. Two of the other fellows are constantly feeding me BS and I really despise that. Inspired by one of the other posters, I wore Valentine's Day socks. It was fun, but P forgot the camera so there is no documentation. I am not even thinkng about the 2WW. I am just going to get the stuff I need done. I have grant due on Friday and I am traveling to Vancouver the following week. That should keep me occupied for the remaining time.

Today, my temperature rose so I definitely ovulated. Had 3 mature follicles, one smaller one, and one filled with debris. Whatever that means.

As I keep teasing my husband we had a weekend celebration of love. To be honest, the sex was great. I don't even care what the results are from this round of IUI. For the first time in a very long time, I had sexual desire. I was hot and bothered and had incredible egg whitey mucus. Everything feels right. And if this doesn't work I still believe I have a chance.

We will only probably do one more round with IVF/IUI. But after looking over our past cycles I am ok to be resigned to the old fashioned method. We will also pursue a DE cycle, but there are just too many other things to worry about now. For example, my clinic does not do DE so we will have to find yet another clinic. Also the donor profiles in the area aren't that great. I think we might have better chances in a college town. I know intelligence is not only genetic, but why not start off on the best foot? We want to have a donor with college grades better than a 3.5 and SAT scores of over 1250. Is this unreasonable? Our other main criteria is a healthy family history. Few allergies, cancers, and heart disease. We would also like our donor to be athletic. Just meaning that they find physical activity fun and healthy.

Thanks to everyone for your comments. They really mean a lot to me.

Wednesday, February 11, 2009

Brief update

I know I am trying to keep a positive attitude, and complaining does not fit that profile. But I really do not like the fellow who did my u/s this morning. She is the same one who overlooked a follicle that was 15mm. Saying it was too small to count. Making me think that I should go with an IUI last time. To top it off, I think she is pregnant, again. Just adding insult to injury.

We shall see what the E2 levels are. I am actually hoping for an IUI. I know it is lower in efficiency, but it also seems like less technical problems can arise. P. has great sperm counts, so if we give them a few more targets, maybe that will do the trick.

I should get back to work. Will update with the E2 levels later.

I am anxiously awaiting bb and Sarah beta. Crossing my fingers that all goes well with both. You guys give me great hope and inspiration.

Sunday, February 8, 2009

Egg donor cycle

I have been putting off writing this for awhile. I am completely torn about going with an egg donor. On top of the amazing expense and the hassle and all of the uncertainty, I also have a very personal reason for being undecided. You see, I was born from an anonymous sperm donor. Well, not exactly. My mom got pregnant by some guy. She knows who he is, but has never once mentioned him to me except on one mean occasion when I was teasing my brothers that I was not related to them. She then springs it on me, (when I was 11 or 12 years old).


"Mom, why is M. so much smarter then we are?" said my brother.

"Because I am not related to you," I said with a laugh.

"That's right. You kids have a different dad" my mom replied.


WHATTTTT???????????????!!!!!!!!!!!!!!!!!!

I have never been the same since. Nobody ever talks about it and I live in constant (well not constant) but occasional wonder if my "dad" will try to find me and give me a huge sum of money.

What does this have to do with egg donation. I just don't know if I would want to tell my child that they were not mine, genetically. Ever since that day, I have always felt kind of weird about the only man I have ever known as my dad. We really never have been close, and I wonder if somewhere back in the recesses of his mind he resents me. Will I resent my DE child? If s/he misbehaves will I blame it on my husband and not take any responsibility? Would I have been better off not knowning that I come from a different genetic stock than my brothers. Would I have felt closer to my whole family? I just don't know.

What if I do keep this whole donor egg thing a secret from my child? They will find out some day and then they will resent me. It would be a joint lie that my husband and I would have to share. Isn't that an incredible, painful burden. Is this one time when a lie is OK? Is there ever a time when any lie is OK. I just don't know. I don't know how to decide. I want statistics. I guess it is similar if you tell a child they are adopted. I just feel that the genetic bond does mean something and I don't want my kid to miss out on that.

I also don't want to miss out on the coolest genetic experiment of all. Mixing my DNA with my husband's to see what wonderful offspring can result from our love, respect, joy, friendship, and caring. Please, please let me get pregnant this time. Let me have one miracle. Let me experience first hand what I see happen in the lab every day.

I go in tomorrow morning for my day 5 sono and E2, but again isn't it really only like day 4.5 of stims. If I started on Thursday then I have only been stimming for 4 days. I am sure there is some time necessary for the uptake and the response. What am I hoping for. Something similar to last cycle. E2 around 200. I want 7 follicles over 10mm. Thats what I want. Lets see if I can get it.

Oh, for those wondering, I am not doing the day 3 stim, because I don't think my RE is concerned about OHSS.

Tuesday, February 3, 2009

Here we go again

After last months failed cycle...empty follicles. I thought that I might actually enjoy a break. I was able to get some physical activity in. I ran in a 15K, started going to spin class, and played some racquetball. I was hoping to lose some of the weight that I gained due to the multiple IUIs and IVF cycles. Everyone says that you can work out when you are pregnant, but apparently when you are trying to get pregnant and you are ancient like me, not so much.

I went in for the baseline ultrasound and there were 9 antral follicles. For someone of my advance reproductive age, that is supposedly the most you can expect. I wanted it to be 11 or 12 before we continued with another cycle. Maybe that is expecting a lot, but hey it is to be my last cycle. The doc says do or die. He would have stopped most people after the last cycle, but I guess I am too whiney to let that happen.

What is different this cycle? Well, we are going with the Lupron microdose flare protocol, but using 300 Follistim and 150 menopur. My guess is the change in drug dosage (less menopur, less LH) is due to the lost eggies. The plan is to find out how many follicles and if there are less than 5 I want to do IUI. The RE wants to do IVF, but after the last time, I am sure he understands my hesitation.

Thats the update. No news until next Monday. They don't seem to be worried about me and OHSS. Ha!

Wednesday, January 28, 2009

10 day later and a lor older

I feel bad about not writing in my blog for over 10 days, but I said I was going to be positive. I just felt that I couldn't be positive about what happened to me so I just kept quiet.

In a nutshell

Went in on January 19 and they told me to induce at 9PM. Just to recap I had 5 follicle 20.5,17,10.5, 21.5, 20 my E2 level was 1171 which has not increased much over the 1142 from Jan 17. Had HCG measure and it was 269 after 12 hours. Apparently as long as it is over 50 everything was good.

Went in for retrieval at 9. Got out at 11. 11? what the hey they told me 20 minutes. Then I learn that they found one egg after aspirating and flushing 6 follicles. Barely any granulosa cells and little cumulus cells Uno did not fertilize. The same day I found out about the failure to fertilize I found out I got tenure. Remember that I was actually out of town and my hubby had to talk to the embryologist. Haven't talked to my RE since then, though he cryptically released the HCG value on my patient chart. Weird because no other values have ever been released.

Now trying to figure out what we should do next. My negative, realistic side had already filed all of the paperwork necessary for DE. But my optimistic side wants another shot. Asked for a DHEA prescription. Asked RE if we might be able to screen for cycle with higher antral follicles. Also talked to fellow coworker who had a baby at 42. Turns out she did IUI on injectables, never had more than two follicles. Did IUI twice had chemical pregnancy first cycle then got pregnant second cycle. She gave me tremendous hope. Now, I wonder if we should have done IUI this cycle. I had no idea we wouldn't recover at least three eggs. I just didn't know it was even a possibility, but weirdly enough Mekate went through a very siimilar scenario one day later. Coincidence I think not. It was the woman who had 8 babies who stole our good mojo.

For now, I am setting up an appointment with the DE shrink to discuss all the psycological ramifications. I will talk about this more later, but that is all for now.

Hoping bb's ER went superbly today.

Monday, January 19, 2009

Low stress, only positive vibes

I am going to try a new approach. If I want my baby to be happy and well adjusted, I should be that as well. For the next two weeks (hey I don't know how long I can really pull it off), I am going to be filled with positivity, hope, joy, and love. I am going to be thankful for all of the good things and recognize that the bad things are not so bad. I will try to "not sweat the small stuff." Cortisol and norepinephrine can't be that beneficial for someone with hormones raging through their body so I am just going to relax. Go to be early. Enjoy my cup of decaf coffee every morning and pet the puppy butt.

Oh, about the puppy butt. I have a lab/greyhound mix that we got from the pound 6.5 years ago. She has been with me through thick and thin and she is a constant source of joy and amazement to me. OK, maybe I am laying it on a bit thick, but really she has always been there and she does make me smile every time I look at her. Any way, she loves to get her butt scratched. And she is so happy when it occurs. I now consider it a therapy for me. Scratching, petting, or even just touching the puppy butt makes me happy, because I know she is there and that she gives me unconditional love.

If you are having a bad day I recommend puppy butt therapy. It inexpensive, simple to use, and renewable.

Bless his heart

First, I need to complain a little about the failure of the fellow to really look at my follicles. As I said before I had 4 that were coming along nicely. Then on Saturday the fellow only counted 3. I asked about the other one. She said it was too small. I was heartbroken. I started crying in the little changing area. Then I left and cried at work. Then I left and cried at home. We were told to continue with the stimulation drugs so we had to go buy more. I decided it would be a good day for shopping and no more work. I bought some nice work clothes and while I was trying them on, Dr. B. called. We discussed everything and decided no immediate decisions had to be made on Saturday. Then he said that my E2 was 1150. I was suspicious that the "little" follicle was indeed still good and growing.

Go in this morning. We had a 21, 2X20, 17 and a 10. Because it is a holiday, only a skeleton crew was working and nobody really knew what I was supposed to do next (though the nurse said that I would stimulate for sure tonight). When the fellow called Dr. B. to get the scoop. He told him I only had 3 follicles. We decided that IUI was the way to go. All this time I was thinking, that I could have sworn I had 2X20 not one at 20 (which is what the fellow told Dr. B). Then the nurse again stopped the fellow and showed him that I had 4 mature not 3. With this in mind, now I felt there was more of a decision to be made. IUI or IVF. 2K vs 6K.

I called my honbun and we still couldn't decide. I decided to look up some data on women my age with IUI and IVF success rates. I found one really good review that said for women of advanced gestational age success rates of 3 hormone IUI cycles is equivalent to one IVF cycle. I thought wow this means the third time is a charm for us. My DH, on the other hand, said hmmm... that means IVF is three times more effective than IUI. I was all for leaving the darling eggies in their cozy sacs and letting the spermies get to them when they are ready. DH said lets do the IVF. We have lost more money in the stock market than we would spend on getting a baby. So I guess we are doing this. ER on Wednesday. Oddly, I have to fly out of town at 5pm. I sure hope that the ER is scheduled for early in the day.

I have always said I am not a gambler, but really if the only thing that is effecting my decision is the monetary costs then I guess that is not the best reason.

Thanks to everyone for the kind word. It really brightens my day.

Friday, January 16, 2009

Then hope floats away

Well, I almost broke down in tears at work today. 4 crummy follicles 14, 12.5, 12 and 11.5. E2 was 550. I don't know. Everyone seemed happy about this. I on the other hand feel like a broken women. Just crumble me up and throw me in the trash. Most likely I will do the HCG shot on Sunday (if they decide to continue with this cycle). Why couldn't it have been 6? then it would be a no brainer, but 4. I know it only takes one, but I do this for a living in mice and I know darn well it is a numbers game. The more you start with the more you get in the end.

Wednesday, January 14, 2009

It was worth getting up so early

Apparently my nurse isn't so good with writing down the appointments once they are made. It is kind of like the Seinfeld episode where they are good at "taking" reservations but not as good at "keeping" the reservation. Well, it wasn't so bad. When they realized they had double booked Dr. B said he would come in early and do the U/S himself. This required that I also come in early and do the U/S and b/w, but I thought it is better to get in early and then I don't have to take any time off work.

I really like it when I surprise the Drs. Last cycle was a complete bust. The highest my E2 levels reached was 52 and then they plummeted. (Hmm it really feels like there should be two t's there, but oh well). Any way this cycle is going better. I am really, really frightened about getting too excited about this. I feel like I am jinxing myself, but I can't help it. I am very happy about the results. (Maybe not as happy as Dr. B because I really don't quite have a full grasp on the E2 number game, yet)

What did the u/s reveal? 5 follicles greater than 10mm. (that seems pretty good considering it is only day 6 of stims (and I haven't done that injection yet). Even more suprisingly, there were 10 other follicles hanging out that were less than 10. Dr. B suggested that a few of them might get with the program and start growing. My nurse, K, told me that she heard I was very photogenic this morning. She has been doing this job for quite awhile and I have the feeling that she used that line before, but I appreciate the sentiment.

Then they call and give me the E2 levels......247. Now, I have read all of the info that says that E2 levels should be around 200/mature follicle at the time of harvest. So to me 247 doesn't sound that great, but again Dr. B. (or so I was told), was pleasantly surprised. I guess he was just a little tainted by my dismal failure during the last IVF cycle.

Anyway, I just wanted to say that I am thankful for my clinic, for all of the people there (I think they really do care), for my lovely husband who hasn't heard the good news yet, for my beautiful baby dog who will be the baby protector, and for all of the cyclesistas, who help put things in perspective. I don't know why I got all mushy, I just felt like I needed to say that I really do appreciate my life, and I felt that sometimes you just have to say these things.

Tuesday, January 13, 2009

Go estradiol go

Well I heard from the Drs office yesterday. I was prepared for the worst. Last time my day 3 E2 levels were 52. I really didn't know if it was good or bad. They called today and it was 106. I think that is quite good considering I am stimulating at night. Which means theoretically I had had only 2.5 days of stimulation. The resident said that Dr. B was quite happy and maybe a little surprised with that number. I have to admit my left ovary already hurt. I will have to look back and find out if it had the most antral follicles.

Maybe this time will be different. I was a little concerned because my temperature rose by 0.3 degrees this morning. Please don't let me ovulate too early.

I go in tomorrow for another E2 level and an U/S. Cross your fingers.

Monday, January 5, 2009

This time it is for real

Needless to say the two cycles of IUIs didn't work. Finally, after a holiday hiatus, I am back in the ring to take another swing. Come on hit me with your best shot.

Mysterious bleeding started on day 20 of OCP. Very unusual. Also tracked my BBT. It was over 98 for the past 20 days. Part of this may be due to illness. But then two days ago temperature dropped. Very strange. It is as if I went through an ovulation cycle (even though I know that is not possible). Granted I had a few days of antibiotics but I don't think it could have completely abrogated the OCP.

Went in today for a whole round of repeat tests. Yes, I have been doing this for over a year now. Got a pap, blood work for STDs, and an US. The little ovaries picked up their pace a bit. lefty had a least 5 antrals and righty had 4. Yippee! That is the most so far. Things are already looking up.

I am going to be on the Lupron flare protocol. Apparently, because I was totally suppressed last time, we will try a gentler, kinder approach. Remember last time I had zippo ER and had a cancelled cycle. Then 13 days later I had two huge follicles, and I underwent an IUI procedure. It obviously didn't work, but I think it just goes to show that I was over suppressed.

I start Lupron in two days. Only this time I am getting two injections a day. One in the morning and one at night. Then two days later I pull out the big guns.