We had our final appointment before having the egg retrieval. Dr. Cass is very excited for us, and was happy with the growth on both ovaries. My Estrogen level yesterday was 1763, and today it is 1890. Doctors estimate that a mature follicle produces ~200 pg/ml of Estrogen. Meaning, that as of today I have about 9 follicles that would be considered mature. Personally, I was hoping for a higher number than that, but as I understand things, even after the trigger shot my follicles will continue to grow 1-3mm per day. Here’s to hoping that some of these smaller ones turn out to be late bloomers and we can get closer to that 15! What I have to keep reminding myself is that even if the retrieval number is lower than I hoped for – it only takes one fertilized embryo to lead to a pregnancy. So I am trying to keep cool about everything and not put any unnecessary pressure on myself.
As of today, here are my numbers:
2) 18 x 15
1) 20 x 18
2) 22 x 17
3) 13 x 12
4) 21 x 20
5) 18 x 12
6) 14 x 12
7) 21 x 11
8) 16 x 12
9) 18 x 14
1o) 17 x 15
11) 15 x 10
Dr. Cass went over the procedure with us, and told me what we should/could expect from the surgery. Pretty typical pre-op instructions: no food or drink past 12AM, no make up or jewelry, wear comfortable clothes etc. However, I was given some new protocol to follow. Yes, new protocol means more meds. These are mostly oral meds, and thankfully there are NO MORE INJECTIONS. I will do another post tomorrow with a copy of that protocol because it is a lot of information – including a 3 times daily vaginal progesterone suppository! Yaaaaaaaaaay!
Additionally, I have been instructed to maintain a high protein/low to no carbs diet to help avoid ovarian hyperstimulation syndrome. I have been instructed to up my salt and potassium intake as well, because this can help stave off the symptoms of OHSS. After receiving the trigger shot and having the egg retrieval, some women develop this issue and this is something that can lead to a “freeze all” cycle, rather than a fresh transfer. The way it was explained to me is that OHSS can develop in women who have higher insulin levels, so it is important to stay as low carb or carb-free as possible. If the insulin level raises, the risk of this issue developing increases drastically. This is not a problem for me, since this is pretty much how I eat anyway – unless I binge on a bunch of rice or some kind of potato….mmm potato…
Here’s symptoms I need to watch for post-retrieval:
- Rapid weight gain — such as 5 pounds (2.3 kilograms) in one day or 10 pounds (4.5 kilograms) in three days or more.
- Severe abdominal pain.
- Severe, persistent nausea and vomiting.
- Decreased urination.
- Dark urine.
- Shortness of breath.
- Tight or enlarged abdomen.
If these develop, we will freeze all my embryos and give my ovaries a chance to calm down and then do our first transfer next month. If all goes well (as we are hoping), then my transfer will either be scheduled for Wednesday June 1st, or Friday June 3. If the embryos aren’t developing very well, they will opt to transfer on day 3 and freeze the rest. Ideally, they would grow one to 5 days where it is no longer an embryo but a blastocyst. “On average, close to one-half of 4- to 8-cell embryos at day 2 or 3 are chromosomally abnormal. By culturing these embryos for an additional 2 to 3 days, more chromosomally normal embryos will be selected out naturally and develop to the blastocyst (5-day-old) stage in the laboratory. Usually, only the best embryos have the ability to grow to the blastocyst stage and the pregnancy rate per blastocyst transferred is better than 3-day-old embryos.”
Basically, when IVF used to be performed, Doctors would transfer several Day 3 embryos into women, with the hopes that one would survive, because the others may not be chromosomally normal. Many women would go on to have just one child because the other embryos would stop developing/ be absorbed. But of course, occasionally all the transferred eggs would survive and that is how women can end up with triplets/sets of multiples. So again, to avoid the whole twin possibility – one blastocyst only, please.
Tomorrow, my plan is to clean the house as much as my fatigue will permit and do some laundry. But we will see how much actually gets done 😉