Pass!

I had my first of many rendezvous with the trusty ultrasound wand (crudely nicknamed dildo-cam) and a small, flimsy paper rectangle whose - clearly misguided - vocation was to cover up my modesty as I make idle small talk with the ultrasound tech about her forthcoming holiday plans and other diversions. The stirrups and, may I say, disgusting stirrup covers were also present. I kept my socks on. I also had my first blood draw. During this cycle I estimate that I will have ten or eleven such encounters before it’s decided that my eggs are ready to be retrieved. This first one took place at the local RE’s office, but all the rest will be in Denver. Our local RE was very gracious when we came clean in July about our plans to defect to the competition. He actually told us that he was more concerned with our success than his being the one to “get you pregnant”. This makes things alot less awkward on days like today when we needed their services. They faxed the results of my ultrasound and bloodwork to CCRM. CCRM then called me to let me know that we have the go-ahead to move forward with the cycle. Phew, good news.

The purpose of the suppression check is to look for any cysts that may interfere with follicle stimulation (each follicle generally contains an egg) and to measure the level of E2 (estradiol) in the blood to make sure the baseline is low at this point (they want it below 50). They also count the antral follicles visible in the ovaries.

As for cysts, my two resident endometriomas (chocolate cysts) are still hanging out in my ovaries, as expected. They’ve both shrunk by a couple of millimeters. But there are no active cysts lurking in there, so that’s good news. An active cyst would generate E2 of its own, expressed by a level greater than 50 at this point in the cycle, and could basically interfere with the stimulation of the follicles by stealing the hormones for itself and leaving none for them to gorge on.

E2 is the hormone that rises as the follicles grow – each mature follicle generates about 150-200pg/ml. E2 levels need to be carefully monitored to ensure there’s no risk of hyper-stimulation which is a condition that would, after one ER (egg retrieval), swiftly land you in the other ER (emergency room); that’s if your cycle wasn’t cancelled before egg retrieval. You’re getting into the danger zone if your E2 starts to move towards 5000pg/ml. Mine was less than 20 today, pre-stims. They’ll use this number as a baseline from which to measure my follicle growth.

And my antral follicle count (AFC) was good today. The AFC is always the most fear-inducing part for me, because antral follicles are an indication of ovarian reserve, in other words of how many eggs you have left before menopause sets in. Each woman is born will all the eggs she will ever have and as a teenager she has approximately three or four hundred thousand of them. From then on, about a thousand eggs die off each month. As we age, not only do we have fewer and fewer of them left, but their quality declines sharply as well. Antral follicles are those follicles that are resting in the ovaries at any one time, of which, in a natural cycle, one will become dominant and ovulate but which, in a medicated cycle, can all be stimulated for possible retrieval and fertilisation. The “trick” here is to try to get as many of them as possible within the mature range at retrieval. Some may be too small to be mature and others may be allowed to become post-mature if there’s the potential for more smaller ones to become mature instead. Only mature eggs will fertilise. In the end, it’s a numbers game. We will lose some along each step of the way so the more you start with, the better. I might add that quality is always better than quantity.

So this was the first hurdle with more hurdles to come: Will I respond well to the stim drugs, meaning will my follicles grow nicely, will my E2 show a steady increase, will I have enough follicles around the same size, how many will be retrieved, how many will be mature, how many will fertilise normally, how many will stick around and develop into 5-day blastocysts (they need to be at that stage to be biopsied) and, finally, most importantly, how many will the tests reveal to be viable? A cycle can take a turn for the horrible at any time and be cancelled. We’re holding on to our hats. The first shots start tomorrow morning.