This morning we went in for another appointment to check my estrogen level (via the blood test) and see how the ovaries/follicles are doing. We made it to the lab around 8:30am - the nurse was very nice and gave me a Garfield bandaid. :) She commented on my scarf that I got from my parents for Christmas (Thanks, Mom & Dad!). Then we headed over to ORM for the ultrasound.
There were quite a few couples in the waiting room - lots of purple folders, one lesbian couple (we assume - maybe it was just a friend filling in), and even a lady that was deaf. Dr. Wiliams was still on vacation so we had Dr. Friedman today for the first time. During the ultrasound we saw that the lining of my uterus is still looking good - nice and thick to help the little embryos attach! :) Then he checked the first ovary. This time we saw a lot more dark circles within the ovary, all bunched together - which are the follicles. He counted about 12 follicles on that ovary! Then he moved to the other ovary and this one didn't have quite as many - which he said is nothing to worry about. It had about 8 follicles. As we looked at each ovary, he picked the biggest follicles and measured them - the biggest were about 12-13mm. So for me, it's still too early to schedule the egg retrieval date. They want to see a few at 18-20mm before they decide to schedule the egg retrieval and move forward with the ovulation trigger (HCG shot, aka Novarel). But it was definitely good news to see so many more follicles on the ovaries! He told me to come back on Monday for another blood test and ultrasound and that we'd go from there.
This may be TMI for some, so feel free to skip to the next paragraph - but I did tell him that ever since Thursday, I have been noticing the clear egg-white looking discharge when I go to the bathroom and wipe. (Based on my infertility reading, I know that this is typically the sign that you are about to ovulate - which is triggered by your estrogen levels increasing.) He said that this is normal and expected since they are taking my estrogen levels way up higher than one would normally experience without the stimulation shots. The Lupron shots are making sure that I don't ovulate - so it's all good!
We also asked him about our Gonal-F pens because we have been a little concerned that we were going to run out. We've been doing 75 units in the morning and 150 units in the evening. (We already used up one 900 pen on our evening shots and have started into the 300 pens - which will only give us 2 evening dosages per pen. The other 900 pen should last us fine for the mornings - since it's only 75.) Based on our calculations, we have enough for 5 more morning doses and 4 more evenings (including tonight). He said as long as we have enough for the weekend - we were good to go!
We met with one of the ART nurses, Penny, afterwards to just go through a few more questions. While we were talking to her, I was taking notes in my little notebook. I apologized for taking notes (I tend to over-apologize unnecessarily) and she said it was no problem but that no one has ever taken notes about what she says before. The other infertile women must have amazing memories- I need to write stuff down. Anyway, here's some of the questions we asked Penny:
- Dr. Friedman said that I should come back on Monday and that Tuesday we'd probably be ready. We asked Penny to help clarify what he meant by "ready." She explained that he meant that on Tuesday we'd be ready to trigger ovulation (HCG shot, aka Novarel) and then possibly do the egg retrieval on Thursday.
- My husband asked her if all 20 follicles that we saw today had an egg - I thought the answer to this question was "yes" - but I was wrong. She explained that although we hope that each follicle has an egg - not all of them do. When they do the egg retrieval they will take fluid from each of the follicles - but that doesn't guarantee an egg will be found by the embryologists for each follicle. She did say that before we leave their office on the day of the egg retrieval, we will know how many eggs they were able to get.
- I asked if we could find more follicles on Monday or if the 20 we saw today were it. She said that although we are really waiting for the other 20 to grow that others could show up by Monday. Since it is Saturday, they told us that we would not get a call with today's blood test results, unless the doctor decided to change my dosage based on the results.
- I mentioned that in a book I was reading, it said that they hope to get 20 eggs for in-vitro. She said that 20 is possible, but probably not typical. She said anywhere from 5-10 is good and that they then usually get a 70% fertilization rate of the eggs that they retrieve. I'm glad we mentioned this - so I can lower my expectations of how many eggs we get. Of course the more, the merrier - but I won't beat myself up if I don't produce 20 eggs. I feel like a hen with all of this egg talk. ;)
Earlier this afternoon, I got a call from Dr. Friedman on our home phone. He said that based on my blood test results that he needs us to change my Gonal-F dosages. He instructed me to drop my total daily dosage from 225 (75 AM + 150 PM) to 187. Since I already took 75 of Gonal-F this morning (before our appointment) he said to just take 112 tonight. Tomorrow (Sunday), he just wants me to skip the morning Gonal-F shot and do the full 187 in the evening. On Monday (before my next appointment), he also wants me to skip the Gonal-F. He said that there are no changes to the Lupron - we should continue those each morning. He mentioned that he also left a voicemail on my cell phone, so I listened to that voicemail after we got off the phone.
In the voicemail he said that my estrogen was too high - which was why he had to drop it down. I was curious as to what my estrogen level was today. When I was on the phone with him, I didn't think to ask how high my estrogen level was since I was just focused on making sure I got the dosage changes correct. So I decided to just call him back on the number which he called me - which ended up being his cell phone. He answered and I explained who I was and that I was just curious if as to what my estrogen level was if he was still at the office. Unfortunately, he wasn't at the office anymore. But after I explained how I was the one that he dropped down to 187, he thought for a minute and said he thought my level was at 1400 (I will validate on Monday when I go in, but at least it gave me a number for now). That's a big jump from the 433 that I was at on Wednesday. I haven't noticed my mood changing much sense Wednesday, but then again I don't know how much of a change would impact someone and think I'm somewhat out-of-touch with my hormones to begin with.
I don't think the high level of estrogen means that anything is going wrong with our in-vitro cycle- but really high levels of estrogen (3000+) could cause ovarian hyper-stimulation syndrome (OHSS - see link for more information). This condition is associated with in-vitro cycles and that's why they monitor us every couple of days to make sure that our levels don't get too high. If someone develops OHSS during in-vitro there is a chance they may cancel the cycle, so it's good that they monitor us for it. Hopefully after we adjust the dosage tonight and tomorrow, it will go back to more expected levels. I didn't think to ask what number he would've liked to see today - but I won't call him and ask him now as I think I can wait until Monday. :)
In closing I'd like to shout-out a "Happy Birthday" to my IVF Neighbor Buddy Friend!! She gets to start Gonal-F today - what else could a girl ask for on her birthday - I know you are all jealous of us!! =)