Sometimes a girl needs her Viagra

I am honestly amazed that someone even thought to take a pill that was created to help with erectile dysfunction and found a use for it in boosting the success of IVF for those with thin lining issues. I also find it very amusing that between my husband and myself, I am the first one to take Viagra.

The Science

The science behind it makes sense though. In order to have a successful implantation, the uterine lining needs to be thick. In the range of 9mm thick is considered ideal. A thick lining is grown with the use of estrogen (estrogen induced endometrial proliferation to be exact). However another factor is blood flow. If there is inadequate blood flow, the estrogen can only do so much.

Enter Nitric Oxide (NO). The actual chemical reaction that occurs to cause the blood to flow is over my head (I am not a scientist by any stretch), the study does go into the details if anyone is interested. Essentially, NO causes smooth muscle to relax  which in turn causes blood to flow more freely. Viagra (generic name Sildenafil) is basically NO in pill form.

The most effective way to deliver the NO with limited side effects is through vaginal suppositories (apparently just shoving a little blue pill up there will not have the same effect, and taking it orally had nasty side effects). The suppositories are made by grinding up a pill and mixing it with the suppository materials (basically looks like white wax that melts at body temperature) to turn it into a little bullet shaped suppository that can be easily inserted in the vagina. Daily dosage is 25mg, which needs to be taken 4 times a day in order to keep the effects even throughout the day. So 4 suppositories are made out of 1 pill (I need a 21 day supply, so total of 84 suppositories). I will post a picture of the suppositories soon in case anyone is interested. This is what they look like:


Because Viagra normally comes in pill form, these suppositories need to be specially made (compounded) for this use. Only a compounding pharmacy (I never knew they existed until last week) has the skills and equipment to do this. (FYI: your neighborhood pharmacy/grocery store is probably not a compounding pharmacy, but they can direct you to one in your area).

The sildenafil treatment is stopped a few days before transfer to ensure that the drug is out of the body and will not affect the embryo. It is not clear what impact this will have on any embryo and it is understandable why no one has conducted this research yet.

The Hunt for a Compounding Pharmacy

I asked my regular pharmacist for a recommendation and did a quick google search of my area for ‘compounding pharmacy’. I called 3 places that showed up in my neighborhood on google. One place refused and said they could not do it. The other two said they would have to look into it and call me back. Both places provided quotes that were within a few dollars of each other. Both said it would take a few days to compound after I dropped off the prescription.

The pharmacist that I did end up going with was very nice. He said this was the first time he had to compound viagra/sildenafil into suppository form so he did some research about its use and provided me with a printout of his research too. He even asked if I needed an applicator and provided me one (no charge). I wish I had asked for 2 applicators so I can keep one at work. I might go back and ask for one next time I am in the area.

The Game Plan

So now I wait for CD1 so I can start this next cycle.

A few things I have learnt so far, and will need to keep in mind for this cycle:

  • The suppositories need to be refrigerated. This is going to be a challenge, as I will need to insert 2 doses every day I am at work. I need to find a discreet way to store the correct number of doses at work, and discreetly walk with my little package to the bathroom (located in a publicly accessible hallway) insert a suppository and walk back. Still haven’t worked out the logistics of this. I am also travelling for 3 days in the middle of this cycle. So I will need to figure out an icepack/cooler bag situation for my travels as well.
  • Use the applicator. This will help. Since the suppositories are designed to melt at body temperature, it can get messy when trying to insert it with just your fingers. I find pushing 2 tiny estrace pills up my vagina very messy (I wish I had the applicator for the pills on my last cycle!), so I can only imagine what something cold, melting and slippery will be like.
  • Use an ice pack to transport the suppositories. The pharmacist was helpful in providing me a small ice pack to transport the suppositories back home. These are expensive pills to loose to something as silly as melting. I will be using the ice pack to transport them to my work fridge (1 hour commute). And for my travels.
  • Sildenafil/Viagra is not covered by my drug plan. I also made sure to check with my drug benefits insurance plan to see if the cost of the suppositories would be covered. They are not. I believe that most drug plans don’t cover drugs used to treat infertility.
  • Stock up on panty liners. Some people have mentioned that there is some messy discharge that occurs as it melts inside the vagina. So I will be stocking up on, and probably will need to change, panty liners frequently. I might also buy some cheap granny panties if things get really messy.

The Hope

In this study  70% of 105 women were able to achieve an endometrial thickness of >=9mm. None of them had been able to achieve this thickness in their prior cycles. This group of women also had higher implantation and ongoing pregnancy rates compared to the women who could not achieve that thickness. I hope that I am one of the 70% that this works for.

Now we wait for Day 1 of this, my last mock cycle, redux, part 3.

 

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