Thursday, February 21, 2013

Lets do this thing.

So, just to get you all up to speed, my progesterone at 6 dpo last cycle was only 6.5.  That's kinda low.  No big deal, really.  I was only at a 9 when I (successfully) was pregnant with my son.  And, they were going to supplement me anyways, so it's ok. 

I went in today for my cd 3 check.  My antral follicle count (AFC) was 15 which is pretty good.  I that in your twenties 10-15 is an average number, in the mid 30's it's 5-10 and in your 40's it's less than 5.  AFC has also been shown to have a strong correlation with pregnancy rates despite age.  Since I'm 37, I'm pretty happy with this number. 

My next appointment is 3/6 in which Jim will give a sample for the SA and to freeze in case somehow he can't make the retrieval day.  He also gets a bunch of bloodwork done to show he doesn't have any infectious diseases.  I have to do a class on how to give myself a shot and they go over any questions I have. 

So, I started birth control pills (BCP) yesterday and the dexamethasomne at 0.5 mg.  I'm hesitant on the Dex (it's a low dose steroid).  Some studies show no difference, some studies show a better response.  So, I think I'll take it during stims and stop after retrieval.  I know the doc will recommend I keep it through the early pregnancy, but I'm not comfortable with that.  Every study sees no benefit of taking it after implantation and there's a study in which it was given to premature babies to help them with their breathing.  It did that, but also caused long term lower IQ scores.  ....  I'm off track... 

************Insert caveat***********

I should warn everyone. I tend to take my medical care into my own hands.  So I listen to the docs, research their advice and make my own decisions.  Please don't send me a message saying that I should "just listen to my doctor."  Doctors aren't gods.  They don't know everything and they certainly don't know you like you know you.  It takes a smart doc and an informed patient to make the best medical decisions for you. 

*************Caveat finished************

On that thought, I'm supposed to stop taking the BCP on Sunday, 3/10 and get my period Wednesday - Friday.  But, I'll stop taking it Saturday and get my period Tuesday - Thursday.  Let's get this show on the road.  (For the finicky ones out there, I started taking the BCP yesterday which was a day early, so the total number of days will work out to be the same.) 

The next week, 3/18, will be the busy week of bloodwork, ultrasounds and stims. 

The procedure week should be 3/25. 

And then hopefully, we'll have some answers.... 


My cd3 bloodwork came in from this morning.  (I like how fast they are!) 

FSH - 5
E2 - 21
LH - 7.2

(I don't like how my lh is always a little higher than it should be.  I'm going to have to research that.) 

Wednesday, February 6, 2013

A test cycle

So, to pick up where we left off.  I did in fact cancel the 2nd RE appointment because I liked the 1st RE so much.  He was very much on booard with the plan.  So the first step for him is to see what one of my cycles looks like.  So, we run all the tests for the a normal cycle and see how it looks. 

The first step is CD 3 (CD=cycle day).  This can actually happen anywhere from cd 2-4 and since 3 wouldve been a Saturday I came in on CD 2.  They do an ultrasound and bloodwork.  The ultrasound showed that my uterus and ovaries look good.  No cysts, no malformations or anything like that.  No surprises.  The bloodwork was as follows: 

Estrogen - 27           This should be 25-75 with lower being better. 
LH - 4.3                  Should be less than 7. 
FSH - 4.8                Under 6 is excellent, 6-9 is good, 9-10 is fair, 10-13 is poor, over 13 is very bad. 
Progesterone - 1.8   Should be less than 1.5.  hhmmmm

Now for anyone who knows what all that means you'll notice that the FSH is excellent.  Really all the numbers are excellent especially for a 37 year old!  But, any FSH under 6 is considered excellent if I was 20 years old.  I was hoping for anything under 10 which would be only OK.  So, I was pleasantly surprised with such a great number.  It's also important to note that my estrogen was low and my LH was similar and slightly lower than my FSH.  All good signs.  The progesterone may have still been falling form the end of my last cycle, so I'm not too worried about that. 

The next step was a HSG on CD 7-10.  I went in on CD 9.  I'm kinda annoyed that the doc wanted this test since it was clear there was nothing wrong with my ability to get pregnant, only stay pregnant.  Anyways, this (as you all know) looks at the shape of the uterus and if the fallopian tubes are open.  Perfect and yes.  Moving right along...

Next is the "CD 14" tests.  CD 14 should be about ovulation day.  Since my cycles are pretty regular cd 14 does, in fact, tend to be ovulation day.  I had not had an LH surge by CD 14 so the office had me come in anyways for an ultrasound and bloodwork.  The ultrasound showed a perfect lining of 10.5 and one dominant follicle measuring 20x21 with fuzzy edges, which means it's about to ovulate or in the process of ovulating.  This is slightly odd since the OPK was negative that morning.  But, I guess the LH just hadn't made it to my urine yet because.... they also did bloodwork:

Estrogen - 258          Should be 200-600 per mature follicle
LH - 27.8                 Over 20 is considered the LH surge
Progesterone - 2.8    The nurse said this shows I ovulated. 

The last bit seems odd to me.  Maybe it's just rising as I ovulate?  But, honestly, this all seemed to happen too fast.  Shouldn't the LH surge first and then ovulation happen 24-48 hours later?  Yes, it should.  So, did this whole testing moment just catch the moment of ovulation?  I think the nurse was a little confused.  I think progesterone was only starting to rise.  Since the follicle hadn't collapsed yet and the surge was still occuring, I think ovulation will actually happen tonight or tomorrow. 

One annoying thing is that I guess they're used to speaking to the lowest common denominator.  I get that, but that's not me.  Today the nurse (different nurse) said as she measuring the endometrium, "That's the uterus - it's the place where the baby's going to be."  Um, yeah.  I think I got that part.  I just laughed and asked the exact measurement of my endometrium.  The I think she understood then she wasn't talking to a rookie. 

So, anyways, the next step is the "cd 21" testing.  It's really 7 dpo, but since my ovulation date is going to be almost "perfect" at cd 14, cd 21 is close enough.  By then they want to see the progesteorne at about a 15.  This is where I may not meet their standards.  My progesteorne tends to be a little low.  But, that's fine.  I really want to be supplemented with progesterone (which I think they'd do no matter what anyways).  There's some evidence that progesteorne helps the body not over react to an implanting embryo, so it's a good thing anyways. 

Well, the most interesting thing about this latest bout of information was that the IVF nurse said that if it all checks out (and it does) the doc could easily start the IVF cycle right away.  Like as in next cycle!!!!!  ARGH!!!  All this was only talk, but now it could actually happen!!!!!