Egg Collection 24th Sept

I'm gobsmacked! They collected 12 eggs! Turned out there were 12 follicles, and all of them contained an egg. This good number has to improve our odds, so I'm really pleased. Of course we now need to see how many fertilise. Last time it was 50%. Hoping better this time. But at least of it is 50%, then we'll still have the 10 we need.

This Egg collection was fine, like the second one. Went to theatre a little early. Was back in ward about 30 mins later, and walking out just over an hour after that after a much welcomed cuppa and custard creme biscuits !!

Another drug regime now starts ....

• Crinone Gel (progesterone) morning and night (vaginally - lovely!)
• Progynova (oestrogen) tablet three times a day,
• 75mg Asprin in the evening
• Clexane (blood thinning) injection in the evening.

Waiting for that all important phonecall ...

Some good news and some bad news

The good news is that my LH is back within the safe limits. The bad news is one follicle is out of the picture. It is still 10mm which means, I think, that it is empty. Either way it isn't counted, so we are left with five.

The largest is 17.5mm and I think the smallest two are 14.5mm. The doctor, Malini this time (yes, it does sound a bit like Melanie, we didn't hear wrong) told me they measure two ways, and take the average to give the overall size. Hubby took a picture of the screen while she was doing the measurements and you can see the measuring lines across the follicle.

When we then saw the nurse (Kiwi Kate today), we were told I needed to have an extra Menopur 375, Gonal F 75 and Zomacton (growth hormone) right away. Talk about pressure! I am used to being able to take my time, but I now had to do it there and then! Another blood test, and we were on our way. We'll get a call later, and it is likely I will be told to take the Pregnyl, and another dose of Cetrotide. The injections I had just done could not be done at the same time as the Pregnyl, hence doing them immediately.

I think there was some question about whether to continue, due to the low number of follicles. I am disappointed, yes, I know you only need one, but of course the lower the number at this stage, the lower the odds are of you having one at the last stage!

Its seems a lot to go through for just 5, but having done this much, I don't want to stop now.

Egg Retrieval likely to be Monday.

I think today is the first day I am feeling anxious. Not sure whether it is because egg retrieval is near ("Fear of the Unknown"), or if it is concern about the low number of follicles, or if it's excitement. Probably a mixture of all the above.

Physically I still feel fine, although my stomach is starting to get sore where I have had so many injections.

I have just had 'the phonecall' as I type this. Another Cetrotide shot today and tomorrow and I need to do the Pregnyl injection tonight (well, tomorrow morning) 1am. Egg Collection will be Monday between midday and 2pm, so I need to arrive at the hospital 10am. I will be 'put to sleep' (isn't that what you do to a sick animal?!). It is a deep drug induced sleep and I wont be aware or feel anything, but is not as deep as a general anaethetic.

Human pin cushion

Today's appointment was at 12:45. I took an appointment as late as possible as I was on a course this morning. As it was I had to leave 15 minutes before the end to get there on time. Just made it! Then sat for 50 minutes waiting !! I wonder if I turn up late for appointments will I wait less ? :)

Scan and tests all done. Lynn said I have 6 follicles now (I lost one ?!) and there were two smaller ones, but they were about 10mm. The larger ones were 14mm which is much more what they need to be. Seems the growth hormone is working.

There is a chance egg collection (EC) might be Monday rather than Sunday. I asked whether they try to aim for ER at a certain time of day, and tell you when to take that final Pregnyl shot to aim for that. This is not the case, the timing is based on your cycle and follicles.

Another blood test, I'm getting the hang of this! And a scan booked for 12:15 tomorrow.

Got a phonecall at 5pm. Start Cetrotide this evening and Gonal F and Menopur to stay the same. Second dose of Zomacton to do tonight also. FOUR injections!! That's 5 needles all in one day, who'd have thought I would be choosing to do this ?! :)

I have also been told to do a Cetrotide injection in the morning, and another tomorrow night.

I think this means I am at the stage now where they want to prevent the natural ovulation. I think this is good and things are progressing OK. I am disappointed with the low follicle count, and just hoping they continue to grow.

After finishing the four injections I asked Hubby for a reward, a cup of tea. He replied "I don't think you should drink tea, it might just leak out of all of the holes!!"  :)

Ickle Follicles & Frustration

Scan booked for 11 am today. The way the trains worked out, we'd either be 5 mins late or 25 mins early! We opted for early and arrived cold and soaked about 10:40.

Scan happened about 11:15. Follicles are a little small, the doctor, Lynn said some of the measurements, but I can't remember them! She suggested that they give me a growth hormone, a dose today and a dose Thursday, which sometimes helps. My blood test was done while Lynn was getting ready to do the scan, so I thought great, we're out of here quick! Lynn said she would now be seeing me every day, so I needed to book a scan for tomorrow. We had to wait in the waiting room to see the nurse to get the extra drug. We waited an hour and 20 minutes. The nurse was about to do a blood test and I mentioned it had already been done. I am starting to wonder whether things are being written in my notes! They didn't have the drug in stock so we had to go to a pharmacy to collect it. We waited 10 minutes for a prescription to be signed, then headed off to a pharmacy in Warren Street, by now a little frustrated at all the waiting as it was 13:30! We had to pay, and we'll claim it back; £260 for two doses of Zomacton! As I guessed, it's an injection! ...

Scan booked for tomorrow, although they were fully booked so it's a double booking! I got a text later in the day to confirm Menopur and Gonal F doses to remain the same. The text also said next scan Thurs. so it looks like they don't want to see me tomorrow after all. I expect I will have to go in Friday as its getting close to egg collection day, which made me wonder why they didn't book me in for a scan Friday at the time. Three injections done. I was given syringes and needles for the Zomacton and was relieved to see it was a small needle, like the ones I am using for Menopur.

The Zomacton, like Cetrotide and Menopur has to be mixed. The solution comes in a small ampule. The top has to be snapped off, the liquid (at least 1.3ml of it) drawn into the syringe with a mixing needle attached and added to the vial of powder. You then change the needle (given the size of the mixing needle you're not likely to forget this step!)

A text message confirmed my doses at 17:42 .. "The dr has reviewed your bloods and would like you to take 225 Gonal F and 225 Menopur tonight and tomorrow night, and Zomacton on alternate days. Please come for a scan on Thursday. CRGH"

I have follicles and he has working bollickles!!

Hubby laughed when I said that. I guess a sense of humour is going to be vital through this :)

Today I was seen by Lynn (doctor) and Nathalie (nurse) and I had an ORT (Ovarian Reserve Test). The description on the CRGH website is:

"The ORT (Ovarian Reserve Test) is performed between days 2-5 of the period. It involves a transvaginal scan and baseline blood hormone profile (E2, FSH and AMH)."

So they tell you what it is, but not what they are looking for or why they do the test. The scan (see blog dated 4th November 2011) was to count the follicles. I had five one side and four the other. This is a good number, a relief given my age. The number of follicles is a good indicator of how many eggs a woman has left (remember we're born with all our eggs, once they're gone, they're gone!)

While I was having my scan, the nurse said "I'm just going to take some blood while you are having that done". Hang on a minute! One thing at a time, I'm busy! Oh, I don't think I have a choice in this. I guess might as well get it all over at the same time! I'm a woman, I can multitask. There was of course the advantage that I was laying down, no chance of passing out :)

I was reading a CRGH brochure that I'd kept from a visit about 3 years ago. It describes how they used to just test the FSH hormone levels, but that it was possible that a woman can still have normal FSH levels even though their egg reserve is low. Hence they now do the scan and use the number of follicles as an additional indicator.

Blood test over and done with very quickly, and I was told to phone Karen next Tuesday as the results will take about 1 week.

I found a useful diagram:

I also found a few videos, I'll evaluate them and post a link to the ones I think are best.

More detailed information for those who want to know ......

First day of period flow is counted as day one.

A follicle is an anatomical structure in which the primary oocyte (mature egg) develops. Typically around 20 follicles mature each month and only a single follicle is ovulated (an oocyte is released). The rest undergo atresia. That single dominant follicle becomes a corpus luteum following ovulation.

The blood test checks for three hormone levels:

AMH (Anti-Mullerian Hormone) is a hormone that is produced by the ovaries and is strongly correlated with the egg follicle pool. This hormone does not fluctuate month to month like other hormones, and is a strong predictor of ovarian reserve.

E2 - Estradiol (also known as Oestradiol). From Wikipedia: estradiol acts as a growth hormone for tissue of the reproductive organs, supporting the lining of the vagina, the cervical glands, the endometrium, and the lining of the fallopian tubes. It enhances growth of the myometrium. Estradiol appears necessary to maintain oocytes in the ovary. During the menstrual cycle, estradiol produced by the growing follicle triggers, via a positive feedback system, the hypothalamic-pituitary events that lead to the luteinizing hormone surge, inducing ovulation. In the luteal phase, estradiol, in conjunction with progesterone, prepares the endometrium for implantation

FSH - Follicle Stimulating Hormone, produced by the pituitary gland and directly stimulates the ovaries to recruit and support ovarian follicles, each containing one egg. The hypothalamus adjusts the production of FSH depending upon the levels of other hormones such as estrogen.

Healthy day 3 FSH levels are generally less than 10. Values of 10 to 18 are generally intermediate and are sometimes associated with lower fertility and higher miscarriage rates. Pregnancies are rare and miscarriages increase with high FSH values more than 18. This hormone level needs to be considered along with the E2 level, to check that the FSH level was tested whilst the E2 level was low (which it will be on days 3/4). A high FSH level can be an indicator of low ovarian reserve in older women, less so in younger woman, hence the additional Antral follicle count.