Cycle Day 5: I Finally See My Doctor and Learn about the 10:1 ratio

After my morning Gonal-F injection, I went in for my Day 5 ultrasound and bloodwork.

Today was not as crazy as Friday at the office, so I was seen pretty quickly, and I had my bloodwork done and went in for my ultrasound immediately thereafter.

I was mildly surprised to see my doctor come in to perform the ultrasound.  He was not great at wielding the pelvic ultrasound wand (maybe I don't want him doing my egg retrieval after all...), and he said that he saw five follicles on the right side and six on the left.  Say what?  I thought there were 12 the other day?  I asked him if it was possible for us to grow more, and he reassured me that I was doing fine, but that he didn't think we'd grow more.  I asked him flat out what this means, probing him on what this might mean for me.  This is basically what he said, "If we retrieve ten eggs, let's say eight of them are mature eggs.  Among those, at least six or seven should survive freezing and thawing.  And then let's say about four of them fertilize, and we get two good embryos out of it.  That gives you a great chance of pregnancy.  So it's the same as IVF-- ten eggs usually results in one pregnancy."

???

He acted like I had heard that stat before.  I was bummed.  Even if I got pregnant off of these numbers, carrying a baby to term is another matter, and I really wished I had more chances...

So when I got home tonight, I started researching follicle count some more and learned a few things.

Antral Follicle Count (AFC) refers to the number of antral follicles detected by ultrasound.  AFC is a good indicator of ovarian reserve, and the more you have, the more likely you are to respond well to hormones during hormone stimulation.  I thought that the Chicago Fertility Clinic had a really good explanation of AFC (specifically for IVF, but one can extrapolate a lot of the results for egg freezing), and what you might expect from your cycle depending on your AFC count.  Unfortunately for me, according to this resource, I am a normal-to-low responder...

I began to wonder if my doctor is taking a conservative approach to stimulation.  No judgments, because I've read that sometimes lower hormone stimulation can lead to better quality eggs, but at the same time, I wish I produced more eggs!

I also wonder if it's possible to get an accurate and meaningful antral follicle count during your initial consultation.  Ladies, if I knew then what I know now, I'd drill down on the follicle count during the consultation, ask how many follicles the doctor sees, and corner him or her on what this might mean for your chances of pregnancy.  During my consultation, my doctor said, "You look like you've still got a lot of eggs, and you'd be a great candidate for egg freezing."   Sales pitch.

The thing is that AFC is somewhat subjective-- different doctors and technicians might interpret the same ultrasound slightly differently.  Also, while a good AFC is an indicator that the patient is likely to respond well to hormones, follicles don't grow uniformly.  As ovulation nears, certain follicles will grow more dominant, so even if you started out with, say, 17 follicles at the very start of your cycle, it is possible that by the time you go to retrieve the eggs, there are only 12 dominant follicles (the remaining follicles being smaller and immature).  It is also possible for some that more follicles will sprout up out of seemingly nowhere as the cycle advances (too small to count at the start but caught up with the bigger ones later), but I don't think this usually happens.

Anyway, I'm trying to remain positive because I know that no good will come of fretting about this.  It is what it is, and all I can do at this point is focus positive energies on producing good quality eggs!  I can hope that I beat the odds on subsequent stages of this process (freezing, thawing, fertilization, good embryos, transfer, full term pregnancy).  The number of eggs retrieved is but one factor.

Meds Update:

Gonal-F this morning was slightly painful, but OK.

I got the call from the nurse post ultrasound/bloodwork to say that I should stay at the current hormone levels-- 150 IU of Gonal-F, 150 IU of Menopur.  I asked the nurse if it was normal for the Menopur to sting, and she suggested that I inject in my thigh instead because she's heard that it hurts less.

She lies.  It hurts about as much, and now my left leg is pretty tingly as if it's been asleep.  Nothing to be alarmed about, but I think I'm sticking to injections in the ab area.

I couldn't help it-- I asked the nurse if bubbles in the Menopur syringe was OK.  She said yes.  Fine.