Saturday, January 10, 2015

Monitoring appointment 3

1/9: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
1/10: 1 vial Menopur bid, 75 Follistim am only, and 10 units micro dose Lupron bid
Ultrasound 10 measured follicles on right 13-20 mm + several smaller, 6 measured on left 13-19 mm. Estrogen 3249.

I had my monitoring ultrasound and the doctor said the follicles looked packed in! (I believe in a good way, as in there were many.) She said I might be ready to trigger tonight, but was also willing to let me stim one more day based on my estrogen result. I saw quite a few 13 mm sized follicles on my ultrasound today, and I want to give them a chance to reach 15 mm - the minimum size for maturity - so I asked to stim for one more day. Since follicles grow about 2 mm per day one more day should be perfect for us to hopefully get a few extra eggs. The largest follicle was only 20, so it would only reach 22, and follicles don't get over mature till over 24 mm, so we should still be safe there. I voiced this to the doctor, who agreed. Even though my Estrogen ended up coming back at 3249, she said it's ok to stim one more day, but we will hold Follistim tonight and tomorrow and just do Menopur. She thinks that's enough hormone not to deprive the follicles, but decrease my chances of OHSS. My estrogen will likely be above 4000 at trigger tomorrow, which they like to keep it below due to OHSS, but she is ok with that since we are not doing a fresh transfer (getting pregnant with a fresh transfer worsens OHSS due to beta-hcg.) So our plan for the next few days is:

1/11: 1 vial Menopur and 10 units micro dose Lupron in am, HCG trigger at 7 pm
1/12: Blood draw to check HCG level to ensure adequate level
1/13: Retrieval. Show up at 6 am.

Thursday, January 8, 2015

Monitoring appointments 1 & 2

1/2: 10 units micro dose Lupron bid
1/3: 150 Follistim bid and 10 units micro dose Lupron bid
1/4: 150 Follistim bid and 10 units micro dose Lupron bid
1/5: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
1/6: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
First monitoring ultrasound: lining 2.5 (was just finishing my period), all follicles under 10 mm, ~30 on right, ~20 on left. Estrogen 411.
1/7: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid + Humira in pm
1/8: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
Second monitoring ultrasound: lining 9, R ovary: 13, 12, 12, 11, 11, 10, many under 10, L ovary: 10, 10, 10, 10, several under 10. Estrogen 1338.

It looks like things are going well this round. I'm much happier with my estrogen. I think it might get pretty high by retrieval, but hopeful that will be in indication of many follicles, and many mature follicles. I am going to continue the same dose of meds and return for an ultrasound on Saturday. The follicles are still small but they all are growing, so hopefully it will be a nice, slow, steady increase. There is still time for those under 10 to catch up.

On Estrogen levels I've done a bit of reading, since I was worried with my low levels last cycle. From what I've read the goal is for Estrogen to reach 2000-4000 before retrieval (though I'm not sure if that is the level on day of trigger vs day of actual retrieval). Also there is a handy dandy equation that reflects expected Estrogen levels and number and size of follicles:

E2 = 291 pg/ml + 180 (x) + 64 (y) + 18.7 (z) 
where x, y and z represent follicles measuring >17 mm, 15 to 16 mm, and <14 mm respectively

I've also heard on average a mature follicle will produce ~200 pg/ml of estrogen. So far I'm just feeling a little uncomfortable in my lower abdomen already and had a little GI upset today. Otherwise, I'm feeling pretty happy and hopeful today.

Sunday, January 4, 2015

Trying again

I went in for my baseline ultrasound last Friday and everything looked good (lining ~4 mm, 30 antral follicles on R, 20 on L) so I started microdose Lupron that morning (10 units bid). Saturday morning I added in Follistim 150 mg bid, and tomorrow I add in 1 vial or Menopur bid and reduce Follistim to 75 mg bid. I go in for my first ultrasound to check how things are going on Tuesday morning. The main changes this cycle are doing microdose Lupron instead of antagonist, and doing just Follistim for two days before adding Menopur, which is what I did for my first IVF cycle.

I feel hopeful but also like there is so much standing between me and another baby. In my head I will do this round and if we can at least get to the point of having blasts to test, I would be willing to do it again if there aren't any that are normal. If we don't get any blasts then we will have to seriously think about what to do next. We would likely try going to a clinic that is well known for PGD, which would include traveling... but I know I'm getting ahead of myself. I need to give this cycle a full try, I just feel better having a contingency plan. I was hopeful enough (or more likely concerned about finances enough) that I had them send me the FET meds with my fresh IVF meds all before 1/1/15, since I had met my deducible last year and by some miracle my current plan covered my medications. So hopefully I will get a chance to use those FET meds in the next few months.