Yesterday I had my fifth ultrasound. The doctor said he was actually considering having me do a trigger shot that night. My follicles had grown some from about 14mm to 16mm. I asked him why he would do it then if originally he wanted them to be around 19mm for ICSI (Intracytoplasmic Sperm Injection – where they surgically put the sperm inside the egg to create the embryo). He said that it is still ok to have them smaller, he just prefers them to be more mature because they have to do something to the cells on the outside (he told me and I forgot) so it’s better if they are more mature. He said it would also depend on my estrogen level and that too high of an estrogen level can compromise the uterine lining. Lastly, he also has to take into account that I have been on stimulation meds for almost 14 days (far longer than anticipated). He said that being on them for too long can compromise things and is not good for your heart, etc. I said, “So what you’re saying is…it’s not an exact science.” He said, “No. That is why they call it an art.”After my US, he took me into his office to discuss some new technology that has become available. He said there is something called “Pre-implantation Genetic Screening.” He said ideally, you want to put a good embryo into a good uterus. Typically the uterus is not the problem and in most cases, if it is a good embryo, it will implant. A “good embryo” is determined by its genetic make-up. Most of them are not so great – which is nature’s way of making sure you aren’t pregnant every month. He said there is usually a 1 in 5 chance that your egg will be good. However, the best eggs come to the forefront.
When a female is in utero, she has as many as 4 million eggs or more. Once she is born, she loses half of them and only has about 2 million. By the time she reaches puberty (or around 12 years old), she has only about 400,000 eggs left. Each month, a woman loses about 150 eggs. The follicles sit there, but only one of them actually grows to maturation and that is the egg that is released during her cycle. The rest of them die away and are absorbed. CRAZY, right?! I knew that you lose eggs each month, but I just thought it was one. (Here is an article that is a good, brief review of what I just said.) I had asked him about it because I wondered if we didn’t get as many this time because I’m getting older, I’ve done a lot of IVF cycles and maybe I don’t have as many. He said that as you age, it gets harder to stimulate them, but that it also just could have been a slower batch of follicles this month to respond to the medications.
Ok, back to the Pre-Implantation Genetic Screening. So…you want the best embryos. Currently, they have some ways of assessing which are best, but it’s not a perfect science. (I am so grateful I don’t have to have the pressure of making that determination!) However, now they can do an actual biopsy on the embryo, test the cells and see if it is genetically good. Yes. I just said they can BIOPSY a microscopic, growing, living organism and still use it for implantation and growth into a human being. WHAT?!?! And this is cool too – sometimes they might test an embryo on day-3 that the tests show is not a good embryo. However, on day-5 it might grow out to be good. Why? Because they happen to biopsy a bad cell that was preventing it from growing properly, and then the good cells move in and grow in its place to create a good embryo. I’m not gonna lie. My mind was kinda blown by this whole conversation. He said, “Of course, in 50 years from now, they will have developed new technology that only requires a simple scan to determine which are best and they will look back at what we are doing now and think it is so archaic.” Amen. I 100% believe that. Technology is SO incredible!
So, that being said…technology is also dang expensive! The thought of doing this to increase chances of pregnancy to 80% is awesome! However, it would require quite a bit of commitment – both time and money. He said typically when you do this, you want to do it over maybe four different egg retrievals. Then you test each batch, freeze them, and finally use the very best ones you get. While it sounds enticing, and maybe if my circumstances were different and I felt like this was my only chance at having children (having none before), and if money grew on trees (ha!) then I might consider it. For now…I think I’ll stick with my few eggs that have come forward and hope they are the very best ones that would have made it to maturation above the other 149 in any given month….
I left the office thinking I might do my trigger shot that night, but got a call stating that my estrogen had gone from around 900 to 1100 (He had said he would trigger if it was around 1200. He is looking for it to be around 200 per egg follicle, and wanted to give it one more day.) and to continue for one more day. I went in this morning for another US. The eggs grew from around 16mm to 18mm. So they are much closer to the goal he had been looking for initially. He said he was 100% sure we’d do the trigger shot tonight, but then quickly changed it to 95% sure since “nothing is 100%.” 🙂 I finally got a call around 5:45 PM confirming that we were ready to move forward.
So tonight I will do the HCG trigger shot. This “triggers” my body to go into ovulation. That releases the follicles so that they are ready for them to “harvest” or retrieve them. It’s all very precise and I have to do the shot at exactly 8:30 PM tonight for my egg retrieval a day and a half later on Sunday morning at 7:30 AM. Tomorrow, (exactly 12 hours after doing the shot) I’m supposed to take a pregnancy test, which should show positive. (If only that were the end and the true results…) That is just to make sure that the HCG went into my bloodstream as it should have. Then I’ll head in Sunday morning and see what we get! Sadly, my doc won’t be doing the retrieval. I said, “But I thought this was your cycle?” (Each of the doctors at the office have a time when they are specifically on-call.) He said, “It was. But you went too long.” Dang this slow responding body! Oh well, I’m sure the other doctor will do just fine. But I’m guessing I won’t get a donut from him like I did with my doc last time. 😉