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.

Hormone concern

I am now on CD12 (Cycle Day 12)

Today's scan was on time! New (male) doctor who I had not seen before did the scan. He mentioned my hormone levels from the blood test yesterday. My LH is too high. I believe the LH causes ovulation. This would explain why I had to take a Cetrotide this morning as well as last night. I think the risk is if the LH level does not come down ovulation could happen and they don't want it to happen naturally.

Follicles have grown. Two are 16mm, two are 14mm and two are 10mm (let's hope those little ones catch up!) Another blood test, and wait for instructions on drug doses tonight. The original schedule would have been no Menopur and Gonal F tonight, but I think things are going for an extra day. I was asked if I had enough of the drugs for tonight, and I said I had enough to do one more dose. The instructions came via text message at 6:30pm. Gonal F 75 and Menopur 375! My response to the 'do you have enough drugs' was assuming the same dose as usual (225). I only just about have enough Menopur left! The instructions also say 'Take Cetrotide' ... Yes, but when? Just tonight, or should I take in the morning again too? Not clear at all.

My scan is booked for 10am tomorrow. I think I'll opt for not taking Cetrotide in the morning. At least if I should have taken it, I can then take it at 10am when I check. If I take it and shouldn't have, there's no going back. I did call the clinic when the text message arrived, but they were closed.

A day of stimulation !

First day of injections has arrived.
We decided to start with the pen first (Gonal F) as it seemed the easier one
The pen already contains the medication, so we turned the dial on the end to the correct dose (225 in my case), took a needle out of the packaging and fitted it on. A pinch of the skin in the stomach to lift it, needle in at 90 degree angle and pressed the end of then pen. It clicked about 5 times then would not go any further. It was harder to push than expected. Hubby did it for me, and it was fine!

Next the Menopur. The two syringes of liquid had to be added to the vial of powder and mixed. This will now be used for several doses. One new syringe fill it to 225 from the vial, and then inject same as the pen.

Hubby found this easier, as the syringe was easier to hold, the pen seems to slip a little as you dont have anything to grip. I felt the needle slightly more with this one, but again, it was fine. I was relieved to get the first one out of the way. Now we've done it once I know we can do it again. ... Phew  Perhaps I am not such a wuss afterall. It's amazing what your mind can overcome when it is important enough.

Potentially huge setback

Just had a call from Karen Fordham. Looks like my biggest fear may have come true. I've waited so long for the funding, I might have waited too long.

My blood test results are back already. Nice of Karen to call so late in the day, it was 7:30 pm and she was still working!

Results were:

E2: 152 ... Fine
FSH: 6 ... Fine (needs to be less than 9)
AMH: 2 ... NOT fine, ideally should be 10

Seems this could be a potential show stopper. I feel a bit sick, just the injustice of it. Still, they haven't said no, yet. The biggest problem is that the PGD test takes months, possibly a year, so if my level is low now, it's likely to be even lower at treatment start time. There's a meeting next Tuesday evening, my case will be discussed then to see if there's anything can be done.

So now we wait a few days, feeling deflated, but trying not to give up hope.

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.