This post is to demonstrate what is involved in a cycle. Some people have expressed curiosity about what is involved. It's in no way meant to be a "look what we had to do" post....there are many who go through a heck of a lot more to have a child. This is just to explain the IUI (intrauterine insemination) process. Here is a "brief" primer.
Disclaimer: This may be too much information for some. If you continue reading, you agree not be all strange and weird if you read something you think is gross or embarrassing.
FSH: Follicle Stimulating Hormone. The injections that I give myself are FSH. Because I have PCOS, I am at a higher risk of overstimulating and creating too many follicles. The Follistim Pen allows for fine tuning the doseage (in increments of roughly 8 units), however my insurance covers Gonal F which comes in a vial and is drawn up in syringes that are marked in 37.5 increments. So if you're reading this and have used either of these medications...this is why the total doses may look a little funky! It means that I usually have to give myself 2 injections rather than 1, but it saves a LOT of money so I'm up for it!
LH: Luetenizing Hormone
E2: Estradiol level. This is used to monitor whether or not I am being overstimulated. They're also looking for the level to correspond with a mature follicle.
Follicle: Cyst-like part of an ovary which contains an egg. As the follicle grows, the egg matures. Ovulation occurs when the mature follicle ruptures and relases the egg. The doctor with have me give myself a "trigger" injection once a follicle is mature (between 18-22 mm). This will cause ovulation. In a "natural" cycle, the LH level surges. This is mimicked by the trigger injection (hCG, the pregnancy hormone, which acts like LH...details, details).
CD#: Cycle Day #. You know when you're trying to conceive and/or dealing with infertility when you measure time in cycle days, or when you schedule around certain cycle days!
Now, onto the cycle details. It's a bit long. Each cycle is different. I never respond the same way. This is an example of our 4th injectable cycle, first intrauterine insemination (IUI).
CD 1 1st day of period. Called the office to set up my baseline ultrasound (u/s) and bloodwork (BW)for CD3. This is to look for any cysts that could become a problem if I were to start treatment. If they see a cyst, the cycle is canceled and I take birth control pills for 3 weeks to calm the ovaries down and shrink the cyst. This has happened once so far and I didn't enjoy the break!
CD3 Ultrasound looks great. Start 120 units of FSH every night, return on CD7 for u/s and BW.
CD 7 Ultrasound shows that there are about 4 follicles at the starting gate (right around 10mm). Lining is thickening up. Estrogen (E2) level is slightly higher than they’d like at this stage, however. We aren’t trying to have high order multiples…one or two mature follicles is the goal. Any more and we’d have to cancel the cycle. Dose of FSH is decreased to 83 units tonight, and I come back tomorrow morning for BW and u/s.
CD 8 Two follicles slightly larger than 10 mm, E2 level is back down. Increasing dose of FSH to 100 units for the next 2 nights and returning on CD 10 for u/s and BW.
CD 10 I was expecting to have 1 or 2 follicles that had taken the lead and were 13-15 mm….but instead I have 8 right around 10 mm, and my E2 level didn't move much (112) So…we’re increasing the dose to 112 units for 2 days and I’m back into the office on CD 12.
CD 12 My E2 level shot up to 300. I have one follie at 13 mm and one at 11. Everything else is 10 or less. Hopefully that 13 (and maybe the 11) will be the only two which keep growing and the others hold off. They decreased my dose to 75 units and I come back again in the morning.
CD 13 We've got a follie at 17.1! Likely triggering tomorrow. I assume my E2 level is down somewhat as the doctor wants me to increase the dose to 150 units. My usual nurse was out and the one covering didn't leave details in the message. I'm back yet again tomorrow.
CD 14 Goodness gracious....these follicles aren't reading the textbooks! They're supposed to grow 1-2 mm per day. Instead, the lead follicle jumped from 13mm to 17mm in one day and then decided to slow down. It only grew from 17.1 to 17.8 today. The measurements are estimates based on the ultrasound, though. My E2 levels look good, so we're triggering!!
CD16 IUI today. I'll make a separate post about this.
CD 17-29 The dreaded two week wait (2WW). Honestly...this is the hardest part. While I do have to take progesterone in a manner that I prefer not to share, I don't have to give myself any shots. There are no visits for bloodwork or ultrasounds. At the same time, I have 2 weeks to wait until I know anything. At least during the "stim" period I only had to wait 1-4 days to know whether things were progressing as they should.
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