Glad to hear you’re feeling good, EmAnJ. 
Since this IS an “Ask the” thread, maybe you could fight some ignorance and explain a little bit about linings and follicles.
Is it simply, “the more the better”?
Hey EmAnJ, just wanted to let you know that I’m over here on the sidelines, wishing you well!
Sure!
Your lining is created through the secretion of estrogen from your developing follicles. Ideal lining for IVF at the time of embryo transfer is over 9mm (but less then about 16mm) and triple stripe (trilaminar). A trilaminar lining is the pattern of the endometrium, and is ideal for implantation. After ovulation (and after they take my eggs), the ruptrued follicles create progesterone, which helps to support a pregnancy until the umbilical cord takes over. I will be on progesterone supplements (suppositories).
Every woman responds differently to the stims, so you can never really tell if she’ll produce a high amount of follicles or not, unless she has some other indicators of diminished ovarian reserve (such as high Day 3 FSH and low antral follicle count). I was expected to be a high responder, which is why they started me on a lower dose of Gonal-F. Turns out I’m a bit of a slow responder (but am starting to respond well now), so they increased my dose quite a bit.
You don’t want too many follicles or you are at increased risk for ovarian hyperstimulation syndrome (OHSS). OHSS can be life threatening, and presents with large amounts of fluid in the abdomen - some women gain up to 30 lbs. in a couple of days. They track this risk via the ultrasounds to check number of follies, and testing estrogen. Very high estrogen numbers are problematic, as are high numbers of follies. If you are at risk, your cycle could be cancelled, or they will go ahead with retrieval and fertilization, but freeze all embryos for transfer later. OHSS severity increases if a woman becomes pregnant from the same cycle.
Follicles have to be a certain size to contain likely mature eggs. Generally, in an IVF cycle, they look for 16mm to 20mm at trigger time. Follicles grow 1mm to 3mm per day, so based on that, having me on stims for two more nights makes sense.
My clinic aims for 8 to 12 eggs, of which about 70% will be mature enough to fertilize. Of those, about 70% will fertlize properly and become embryos. So, we’re hoping for about five embryos when all is said and done.
Hope that helps!
The clinic just called with my E2 numbers from this morning: up from 501 on Saturday to 3879 today (1057 in US terms)! This is a huge jump that I’m very, very pleased with!
In really simple terms, the better the better. As in, having lots of sub-par eggs is not as ideal as a few really good quality ones, particularly in the first few cycles when they are still trying to work out how a woman will respond to treatment and implantation of an embie.
So they usually try to be conservative with stimulation (to avoid hyperstimulation, which in rare cases can cause hospitalisation or death), and also to ensure that a bracket of eggs are all within a couple of mm of each other. If you have one large follie as an outlier, this can sometimes trigger early, cancelling the cycle. Instead, they try to monitor the dosage to allow a cluster of follies to all develop at the same time, and try to grow these to a suitable ~20 mm size for trigger. They generally say the longer it takes to grow the eggs (i.e. longer cycle), the better the quality of eggs produced. Although there are obviously other factors too, including age, hormone levels, basic DNA, diet etc.
Which brings me to a heads up for EmAnJ - as you get closer to the time, your formerly little ovaries are carrying 10+ follies each 2cm+ across, filled with fluid. They will begin to bounce around you in an uncomfortable way. Even something as simple as walking can become pretty uncomfy! I tended to keep exercise to low impact at that point, partially for comfort, and also to prevent the risk of ovarian torsion - where 'yow, I twisted my ovary" is not something you want to be saying.
I’ll give you my stats as well, which I hope can show there is hope even if you don’t get textbook results like that (it’s not uncommon for follies to be empty):
Cycle 1 at 33 - 10 follies/4 eggs/4 fertilised/1 blast - 1 marvelously happy 2 year old.
Cycle 2 at 35 - 19 follicles/10 eggs/3 fertilised/1 day 3 embryo - BFN
Cycle 3 at 35 - 10 follicles/6 eggs/4 fertilised/2 blastocysts/1 frostie and 1 gorgeous 6 week old bubba
Thanks Girl From Mars! I see you had success the first go-round. I am hoping for the same!
Do you remember what your protocol was?
To answer your question, I don’t remember the HCG injection being any different from the other injections. I would just do it in a oner and get it over with.
As you know, the most important thing is timing - my first on had to be done at midnight, which necessitated an alarm to make sure we didn’t fall asleep and miss the injection time!
To add to Girl from Mars stats, here are mine (although can’t remember follicle count)
Cycle 1 (at 33): Antagonist: 7 eggs / 5 fertilised / 5 embryos of varing quality at day 3 / best two transferred (nothing good enough quality to freeze) - one cheeky almost-2 year old
Cycle 2 (at 35): Agonist: 7 eggs / 1 fertilised / 1 embryo of really qood quality transfered on day 2 - one wriggly 14 week fetus
As you see, it’s almost impossible to predict how it’s going to go, even by the time you get to transfer. It’s very frustrating, but also should give you hope that even when things look dire, you can have success!
Cycle 1 was a long down-reg ICSI, taking almost 2 months - birth control pill + Synarel + 100IU Puregon + trigger
Cycle 2 and 3 were antagonist, which I much preferred - quicker, and no Synarel which was the only drug which seemed to affect me:
ICSI#2 - 300IU Puregon + 0.25mg Orgalutran (trigger)
ICSI#3 + HA - 350IU Puregon + 0.25mg Orgalutran (trigger) - this cycle we used a new technique called HA-ICSI(pdf), as our FS reckoned our low fert results from cycle 2 were due to low sperm quality (which is why we were doing the ICSI in the first place). Was only an extra $250 and I’m really glad we did it, as I think it gave us noticably better results.
Wow, interesting, thanks ladies! We will try to fertilize naturally and only use rescue ICSI if needed. DH has always had great SA’s, so the doc didn’t recommend ICSI out of the gate.
I am getting a cold, which sucks a lot, but I don’t think it’ll affect anything one way or another. Just sucks that I can’t take anything for it.
And one more time, how times change! You women are so much better educated about the whole process than I was 17 years ago. You posts are greek to me. I do, however, wish you the best of luck.
I think we’re similar in that we all want information. It gives us some semblance of ‘control’, I guess. I find that I look forward to my injects every night, simply because I’m doing something and have a bit of control over the whole thing. And I bet that 17 years ago you probably didn’t even have access to this type of information!
Thanks again!
Did the trigger shot last night, but I spilled some! It was mixed for me on Thursday by the nurse and I had to withdraw in to two syringes from the vial. For some stupid reason, I pulled the syringe out when I still has it upside down.
I ended up with just over 1mL in one shot and about 7.5mL in the other (supposed to have 1mL in each). I called the clinic this morning to let them know but they haven’t called back yet. I honestly don’t think it’s a huge deal because I know some people trigger the same amount, or even less (only 1 mL), so I’m not super concerned. Hubby freaked out a bit though!
ER is tomorrow morning at 10 am. They gave me some Valium for a good sleep tonight as I’m sure I’ll be stressing! Wish us luck!
Sending you all the luck I can muster!
Gah, totally what you didn’t need. Fingers crossed it’s all fine, and will be thinking of you tomorrow.
Thanks! The clinic hasn’t called back and they’re nearly closed for the day, so I guess they aren’t worried. Based on the research I’ve been obsessively googling today, a lot of doctors use 5,000 units and it works just as well. I think the 10,000 units is just my clinics standard procedure and most women are fine with less. I’m not too stressed.
Turns out the spilled trigger shot wasn’t a huge deal! We got 17 eggs this morning.
Now it’s a waiting game. We’ll hear from the embryologist tomorrow morning and he’ll let us know how many fertilized.
The ER itself wasn’t bad. The set up an IV and gave me a drug to relax me, and a drug for pain, but I was awake for it. I was able to watch him suck out the follicles on the ultrasound, and they also had a TV screen set up so I could see what the embryologist saw through his microscope. It was really neat to see all those little eggs!
I’m sore and crampy now, and pretty tired, but overall pretty decent…and very excited! We’ll know Tuesday if it’ll be a three day or five day transfer.
Fingers, toes and teeth crossed for you!
Hm, crossed teeth, eh? That must make it difficult to eat! Thanks!
Seventeen? Wowzers!