If there is one thing I have learned over the past three years trying to have another child it’s expect the unexpected! No matter how I may try to anticipate different scenarios or outcomes to a given situation, something always comes up that wasn’t on my radar.
I went for my monitoring appt. this morning and found out that one of my follicles is “pulling ahead” of the others. It is called a “dominant” follicle and despite two weeks of Lupron injections to attempt to keep my ovaries from ovulating before the follicle sizes, conditions and timing were right, it appears my stubborn body is still trying to ovulate on it’s own. There were 7 measurable follicles today, up from 5 on Wednesday, which was great! But one of them is 19.5 mm, which would be awesome if there were at least two others above 17mm, however the next biggest are 14mm, 13.5mm, 12mm, 11mm, 10mm and 9.5mm. So what it comes down to is the level of the progesterone in my body today will determine whether we can go forward with the IVF cycle as planned or if we need to convert this cycle to an Inter Uterine Insemination (IUI). I will get a call this afternoon letting me know what the level is and how we will proceed accordingly. There will be one of two scenarios as I understand it:
1) If the level is high, indicating that my ovary is ready to ovulate soon, I will cease the Lupron and Follistim injections, I will do the trigger shot tonight and then we will do two IUIs this weekend (one on Saturday and one on Sunday). After that instead of the Progesterone-In-Oil (PIO) injections prescribed for IVF, I would only have to do Progesterone suppositories each day for the next two weeks and then 14 days after the 2nd IUI (on Sunday) they would do a blood test to determine if it worked/if I was pregnant.
2) If the level low enough, indicating that my ovary isn’t quite ready to ovulate, I will continue with the Lupron (I was wrong last night when I thought I was done if we were continuing with IVF) and Follistim tonight and every night until at least three of the other follicles are able to develop past 17mm to qualify us for IVF. In this scenario we would be trying to overtake the dominant follicle with the Lupron by preventing it from ovulating in hopes that the others can catch up still allowing for this IVF cycle to play out. In this case the soonest I would trigger would be Sunday night, with an ER on Tuesday. But it could be as late as Monday (or later), with an ER on Wednesday (or later).
I certainly wasn’t expecting such a report this morning. When the u/s tech told me I had a follicle measuring 19.5mm she said “looks like you are ready to roll!” But it wasn’t until I debriefed with the nurses that they explained there were not two others ready for retrieval yet. My Endo Line was still at 5 (I have yet to look up what that means and forgot to ask today). The Thickness (of my uterine lining) was up to 8.3mm (the nurse said there is still time for it to get to where it needs to be for implantation, which is closer to 10mm). My E2 (estridol level) from Wednesday was 258 (up from 125 on Monday). The nurse explained that is suppose to double every two days, so that today it should be around 500. Finally, the u/s tech actually FOUND MIGHT RIGHT OVARY today! It was small and there was only one 5mm follicle she was able to measure on it, along with 4 itty bitty ones. But it was encouraging to know that it isn’t completely out of the picture for possible future cycles. She did clarify that it wouldn’t be a factor in this cycle, as the follicles are too small to produce retrievable eggs.
So now we wait for “the phone call” to find out which direction this cycle is going to go… We are trying to see the advantages to both scenarios, though we know it is out of our control at this point. If we end up doing IUI it is less invasive, I wouldn’t have to do any more injections this cycle after the trigger tonight, if it worked it would be closer to a natural conception on the spectrum of medically assisted fertility treatments and we wouldn’t have to be concerned with frozen embryos and such. However the odds of success, especially given our reproductive history, are much lower than with IVF. If we end up doing IVF the biggest advantage by far is that our success rate would be higher and if it doesn’t take we might have frozen embryos available for one or more Frozen Embryo Transfers (FET) in the future.
We appreciate your thoughts and prayers, especially over the next few hours as we wait to find out what will happen next.
Take care and God bless,
Kathy 🙂
PS – I just remembered that today is Friday the 13th! Not that I am superstitious or anything… But it is a bit ironic in light of our current situation! 😉
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