Wednesday, February 17, 2010

ivf - day 37 - all about the follicles

Let me start with a disclaimer: These are not my follicles, but they look like mine.

Today was my first monitoring appointment post-stimulation meds. If you remember my earlier post, I've been on follicle stimulating hormones (FSH) since Saturday. The purpose of those is exactly that: make my follicles grow. You might be thinking, "Why would you want all those follicles to grow to be eggs? You can't possibly want 20 kids." But, the fact of the matter is, IVF is a numbers game from the outset. Conception (in general) is a numbers game.
  • Age: less than 35, you've got a great prognosis Greater than 35, the clock's a-ticking
  • Number of Follicles: almost 100% related to age, although this can be affected by chemotherapy and other drugs, and genetics.
  • Number of Eggs Harvested: Of the eggs harvested only about half to 2/3rds will be mature.
  • Number of Eggs Fertilized: About 1/2 of the mature eggs will become fertilized (possible more if ICSI is used, but more on that later)
  • Number of Embryos: About 1/2 will make it to transfer.
  • Number of Implanted Embryos: About 50% chance of implantation.
So, let's do the math. Let's say we have 20 follicles. 12 are harvested as mature eggs. 6 will become fertilized. 3 will make it to transfer (or freezing). 1 or 2 will implant.

I'll talk more on that later, but it's very important that I get lots of follicles and good quality ones at that.

My monitoring appointments are standard. The clinic runs on a very strict schedule, so I never have to wait long. This morning, I checked in at 8:02 and was called for bloodwork at 8:05. Sandy and Mandy are the phlebotomists. Mandy, the UT fan, has a harder time getting my veins, so I always give her my right arm, otherwise, she just fishes around on the left side before ultimately going to the right. So, Mandy drew my blood to check Estradiol levels (called E2 for short).

Because I'm inquisitive in nature, I asked why "estradiol" is abbreviated "E2." The clinic didn't know. So, I came home and researched it online, and couldn't find anything either. Inquiring minds want to know answers to questions like these, so if you know the answer, please speak up!!!

Sorry about that rant.

Here's what I did find out:

Estradiol is the most important form of estrogen found in the body. Most of it is made in and released from the ovaries, adrenal cortex, and the placenta, which forms during pregnancy to feed a developing baby.

It's used in IVF to determine how I'm responding to the FSH.

Normal levels are 30-400 pg/mL in a premenopausal woman, not taking FSH.

My level today was 469.

But that's considered well within normal for 5 days of FSH. Trust me, it'll be in the 1000s before I'm done. The reason is the number of follicles. Normal women pick 1 or 2 follicles to grow each month, hence the 30-400 number. For me, I picked about 15 to grow this month. Yes, I told my ovaries which ones to grow.

To be honest, my husband would probably believe it. He thinks I can control my ovaries like I control my appendages. I tell him "autonomic system" but I think he skipped science class.

After my blood was drawn at 8:05, I was told to empty my bladder for the ultrasound. I didn't have to empty my bladder because mine's the size of Texas and it generally fills up only once per day, so I went straight to the ultrasound room.

8:10, Patty the ultrasound tech came in. When I first met Patty, she was a blond. Now, I know Patty quite well. She's a brunette now and I love that her teenage daughter is basically a golf pro. Smartest sport for a teenager to take up if you ask me. Non-contact, play for free through the golf team, and carry the skills with you through retirement.

Patty handed me my clipboard and I knew exactly what to do. Lay down, feet in stirrups, and she started calling out numbers for my right ovary then my left. These were measurements for the follicles. Most of them today were around 10 (mm I think), and they grow about 2mm each day. When they hit 18-20mm it's time for retrieval.

8:20, time to take my ticket to the desk and check-out.

8:30, in the car headed to work.

3:30, my IVF nurse, Jennifer, called with good news. She said my cycle is looking great, even better than my first cycle at this point back in June/July 2009.

One last thing to report: I got my first bruise last night from my injections. First ever. It's not pretty.


Sheila H said...

Hi April,

This is so exciting for you I'm sure! Estradiol has 2 -OHs(or hydroxyl units) attached to its steroid back bone- hence E2. I used to work in an IVF lab as an embryologist for 13 yrs so I am rooting for you!

Kimberly said...

Oh April,

How exciting this is and the fact you are journaling about it. I keep you and Greg on my TAWG list daily and I just know...that you will be a MOM for sure!

Thank you for sharing your journey.

mommy2alex said...

Ouch, sorry about the bruise, but YAY, great news. Keeping my fingers crossed and prayers lifted! :)

AnilĂș Magloire said...

Do you keep your meds in the fridge? Nati used to get bruises from her insulin shots cause it was too cold.
Maybe that's why you're getting them?

Lately I warm the syringe a little between my hands before injecting her.

Lynn Ghahary said...

love the play by play! my clinic was the same way - a well oiled machine i tell ya! thrilled to hear your cycle is going so well. you know i've got my fingers and toes (and everything else) crossed for you guys! hugs my dear!

jill marie barrett said...

i know you must get alot of advise, but i used to put the meds in the bottle, before i put them in their surenge, in my bra, between my girls. i did this for 10 min. it warms it up a bit...
my bruses were really small, if any at all.
jill b

Kimber-Leigh said...

i'm glad that the office keeps such a tight scheduled...especially since you have to go so very often. continuing to pray for you guys in this. and i'm sorry about the bruise...not fun. although my 4yr.old would be very interested in what color it is :) he is very attune to bruises lately!

Karen said...

so glad to hear everything is going so well!

Anonymous said...

Injection bruises suck, sorry! As for your follicle count, don't be too pessimistic! I've known of more then a few intended mothers and egg donors to have numbers like 15, 18 at their monitoring scan, and end up with 15-18 in their fertilization report! Fingers crossed, this is the last leg of this journey!

Sasha Farina said...

you're doing good.. so glad to hear that. *hugs*

nat2377 said...

We're all cheering for you, April! Best wishes for great results! You deserve it!