As you know, we doubled the dosage of Bravelle starting Tuesday night after seeing a less than 20 point bump in my estradiol level from Saturday the 17th (E2 = 49) to Tuesday the 20th (E2 = 65). From last Tuesday through Friday, I still had not really noticed any of the potential side effects of the hormone injections. Despite the encouragement from Mindy and Dr. Fritz that everything was on track and not to worry, I added worry over my body’s ability to produce eggs to the myriad of worries in my mind. I worried that because over the 12+ years that I’ve taken birth control and told (eh, maybe threatened) my ovaries not to work, because I was focused on school and then my career and was not personally ready to have children, that they would not work now when I need them functioning very well and quickly. Finally, last Friday morning, I went back for another ultrasound and estradiol level check. During the ultrasound, I mentioned to Mindy and Dr. Young (one of Dr. Fritz’s associates) some of the fears running through my head over the past few days, and Dr. Young responded by telling me not to worry and to understand that although I was behind where I would otherwise be if I were not on such a rushed timeline, but that we would get my levels up and see production by next week. I held my breath in response as he started the ultrasound. As I lay on the examination table watching both Dr. Young’s face for a reaction and the screen for something other than indistinguishable black and grey blobs and lines, I was finally able to breathe as I saw Dr. Young look at me and turn the screen toward me. He pointed out that he was seeing a nice response in my uterine wall, and then proceeded to look at my ovaries. On Friday, we saw 9 follicles in my right ovary and 7 in my left, which Dr. Young predicted should provide a yield of at least 12 eggs during retrieval, and my estradiol level had risen to 212 (up from 65 on Tuesday).
I left the clinic with the same feelings of relief and exhilaration that I had when Dr. Gorsuch told me it was limited stage. This felt like a huge triumph and allowed for me to feel more normal and confident. It was a departure from the recent emotion of feeling “broken”, which I had felt after finding out that I had cancer and then again after finding out that my baseline *AMH level was a bit low for someone my age and health. (*AMH Level: This is the Anti-Mullerian Hormone Level, which is used to predict the size of the remaining egg supply aka: the ovarian reserve…the pesky ticking biological clock) I have been making the conscious effort each day since starting this journey to celebrate each bit of good news and to make them my focal points, instead of allowing myself to succumb to darker thoughts and completely losing my sense of self and optimism.
My next check-up was set for Sunday. I started feeling a bit bloated and tightness in my abdomen on Saturday, which I thought was due to the large dinner I had Friday night. By Sunday when I was back for another ultrasound and estradiol check, I realized that it was not just my overindulgence on Friday that was causing me to feel like all of my organs in my lower abdomen had been turned into very full water balloons. The ultrasound Sunday morning was more uncomfortable than the others I had experienced. The doctor was very nice, but lacked that gentle touch that I espcially needed at that point, so I found myself wanting to grab the extra ultrasound wand and poke the doctor every time I felt him moving the ultrasound wand, just to even the playing field and boost his bedside manner and gentleness. Fortunately, I used my better judgment and decided against inflicting pain on him, and instead was distracted by his descriptions of the number and sizes of my follicles. I still had about 16 follicles that he could see and the larger ones ranged from about 8mm-14mm, and my estradiol level had risen to 643. On Tuesday, I went back again for another ultrasound and more blood work. Dr. Hoff greeted me with a wonderfully cheery demeanor and gave me great encouragement as she noted that my follicles had grown to 12-18mm and that they were “beautiful and looking perfect for fertilization”. We had to wait for the results of my blood test to determine whether Tuesday would be “trigger” shot night. The trigger shot is a dose of Human Chorionic Gonadotropin (hCG), which causes ovulation. Once this shot is give, it starts the clock for egg retrieval, which occurs exactly 35 hours later in order to ensure the eggs are retrieved at the optimal time to support fertilization.
My estradiol level Tuesday was only 1,046, so we decided to take one more day for hormone stimulation to help raise my estradiol levels more and allow the follicles to increase in size. This morning (Wednesday the 28th), I went back for another ultrasound and level check. Again, Dr. Hoff bounced into the room, performed my ultrasound, and made me feel as if I was the best egg making machine in the world. She noted that since yesterday, my 16 follicles had all increased to the optimal 18mm range and that she thought today was the trigger day. By mid-afternoon, Mindy emailed to inform me that my estrdiol level had increased to 1,214 and my progesterone was 0.591, which meant tonight is trigger night. At midnight, I gave myself the Novarel shot, causing ovulation to start. On Friday at 11:00am, I will have my eggs retrieved and Jason will do his part in the “comfortable facilities” (again, I get the short end of this stick), so our doctors can create our little embryos to be frozen and saved for a future happy day.
Although I have spent the past eleven days mastering the art of giving myself injections and had fears of my ability to produce eggs, it has been a pretty neat process seeing my body go from my ovaries essentially being turned off to working in overdrive. I am also thankful that the only side effect I had through stimulation was feeling like a human water balloon for a few days, and that I was in such capable hands throughout it. The doctors and staff at UNC Fertility take a collaborative approach to treatment, which provided me with extra peace of mind knowing that on a daily basis multiple experts were reviewing my results and discussing my treatment. They also are collectively the most charismatic and caring medical team that I have met and worked with, which I think can only increase the outcomes in such an emotional process. I’m excited to find out how many eggs are retrieved Friday and to find out how many of those have turned into viable embryos five days later. Then, the embryo babies will just have to wait patiently until I’m done with treatment, and until Jason and I decided to turn one of them into Annabelle and Layla’s human sibling. I think teaching our future child patience from a very early (non)age will hopefully prevent us ever dealing with the terrible two’s 🙂