Day 10: Stims, U/S, No Trigger...

Day 10...I can't believe it! Yesterday's appointment was weird. I wasn't paying attention to the growth I had over the past day and left feeling very confused. I felt like I hadn't made any progress and that it was going to be forever until I was ready for retrieval. They had me order another days worth of meds (a precautionary $230) but when I went home to dose myself for the day I realized I had enough on one med to last me through Thursday. The injection pens have over-fill in them so I got a free dose and didn't have to pay for all of the meds. Pheww! I called the nurse to tell her this and also asked her to go over the numbers with since I left feeling confused. I actually had quite a growth spurt. I had 8 follicles over the 16mm range, 6 over the 11mm range, and 6 under 10mm.


Today.

I have 10 in the 16mm-22mm range, 6 in the 11mm-15mm range, and 6 still under 10mm. My RE said I had a 75% chance of triggering tonight but wanted to wait until the my E2 (estradiol, a form of estrogen) levels came back. My E2 level came back at 1800 which is good but the nurse said the doctor thinks I still have room to grow. I'm fine with that. One more day of growth is one more day of growth. She didn't have me order more meds so most likely my retrieval will be Saturday morning. This is good, I will not have to miss school or work next week since the transfer will be on Thursday instead of Wednesday. I go back again tomorrow morning for more blood work and another lovely ultrasound. I feel so bad for Michael. I've spent a week in his shoes having to drive the 30 miles to the U every morning and it totally blows. The traffic is horrible and the rising sun is blinding and it is SO early! I made our appointment for tomorrow a little later (8:30am instead of 7:45am) but Michael said with the time difference, the traffic is even worse so we will basically have to leave at the same time. Ugh.

Ahhhh! I'm getting super nervous. I hope my ovaries kick it into high gear!


Caution: Science ahead...ignore the information below if you don't care why the estrogen levels are so important.


Estradiol is a hormone that stimulates the lining of the uterus, causing the lining to grow, and to make itself ready for embryo arrival. (This is not estradiol's only function, but for us, it's the important one). Estradiol is tied into pregnancy by it's method of production: oocytes (eggs) contain follicles. These developing follicles contain 'granulosa cells'. These granulosa cells synthesize the estradiol and release it into the blood circulation.


 This means that more follicles produce more estradiol. This helps measure how many follicles are actively developing. The longer they continue to develop, the longer the estradiol level continues. As they develop, the level continues to rise. This rise can further indicate that the oocyte within the follicles is reaching its maturity.


 An example of the use of estradiol level is when it is measured during down-regulation cycles. In down-regulation we expect low levels of estradiol: below 30pg/ml. If levels are not this low, this suggests that the ovaries are not yet suppressed, and that the down-regulation should continue a little longer, until they actually are suppressed.


 Estradiol And Ultrasound Scans
Blood estradiol is also used in combination with ultrasound scans. Taken together they help indicate how (and if) the ovaries are responding to stimulation. Is there a response? Is it adequate? Is it excessive? To tell us this, the blood level has to be viewed in relation to the stage of pregnancy and the day in the cycle in which the level is being taken.

 For example, a level of 1500 pg/ml on day eleven might be considered acceptable in a stimulated cycle, as reflecting the presence of a reasonable number of mature follicles. However, if this level were present on day eight, it would be considered unacceptably high. It would almost certainly reflect the presence of an excess of follicles. At this stage (day eight) they would still be Immature ones. Their quantity, however, would suggest that continued stimulation would carry an unacceptable risk of developing OHSS-- ovarian hyperstimulation syndrome.

 Don't Expect Easy Comparison
Before we continue, one important point: levels of estradiol are not the same from person to person. They cannot simply be compared from one to another. People vary-- everyone is slightly different, and everyone responds to a different degree. Some more so than others. A level that is dangerously high in one person-- or dangerously low in a second-- might be normal and healthy for a third. This is why blood levels can't just simply be compared. It's also why blood levels can't always be interpreted with complete certainty in the first cycles. Without prior cycles to 'calibrate' the levels, the meaning of a level can only be determined as to what it usually means-- what it 'probably', or perhaps even 'almost certainly' means.

 Despite individual variation, estradiol level does provide very useful information.
 A Rough Rule-of-Thumb for Good Estradiol Levels.
Exact figures are not possible. As a rough guide, however, a level in the range of 150 to 500 pg/ml is generally considered reasonable for the eighth day of a stimulated cycle. An approximate doubling of this level every 48 hours is considered promising, as a sign of continued good follicle development.


48 needles! My belly gets a rest in a couple of days and then the butt gets all the abuse!