All Systems Go!

I've just returned from my meeting at the clinic.  Had an ultrasound scan of my ovary to see if it's good to go, and it is!  So had a chat with the doctor to answer some of my questions, he prescribed the drugs, I met with the nurse to collect my drugs and learn all about how to inject myself.  Got a blood test for sexually transmitted diseases and so now it's just a matter of waiting for my period to start.  Last norethisterone is tonight!  I start injecting on day 2 of my period, and need to go in for a scan and possible blood work on the 4th day of the drugs.  I'm nervous, but I'm actually really excited.  I felt really positive about it today!

So I'll do another post with all my drugs but I wanted to also record here some of my questions and answers, in part so I won't forget, and also because maybe it might help other people.  So in no particular order:

• How am I supposed to understand AMH numbers against having one ovary?
• The doctor told me this is a two part answer.  He said if I want to know how many eggs I have left, I should stick with the number as it stands.  But if I'm trying to understand how my ovary might respond to medication, then I should consider the number to be doubled.  Of course I will only get half of what one would expect from the doubled number, so again, tempering my expectation.  But this is kind of great news because it bumps up my AMH to a better bracket.  So that was good news.  Actually, he said my one ovary was actually very promising.  So I felt really good about that (I may regret these words later!)

•  If I think I'm going to need two cycles, how much time should I prepare to leave between cycles (if any)?
• The doctor said they recommend to take a two or three month break in between cycles.  Now on the way home I realized I still didn't understand this perfectly.  I'm having a February cycle now.  March would be one month off.  Then is April possible?  Or does a two month break mean not to do it in March or April?  May won't be any good for me as I'm traveling to the States to see family for the annual trip home so I guess I'm looking at June.  If I want to do a third cycle, and need to take a break, that means my third cycle will happen when I'm 39.  I'll cross that bridge when I come to it, it depends on a number of other factors.

• Is there a way for them to know if an ovary has twisted?
• I was reading up about how you shouldn't do any impact activities or twisting activities while stimulating.  Because when I lost my other ovary, it had twisted 3x, I'm a little worried about it happening to this one.  Twisting cuts off the blood supply and is pretty much bad.  I mean, why does it twist??  So apparently there is no actual way for them to 'see' if it's twisted and the only way for them to know would be if it was very painful.  He said that as the ovary gets larger, that's what might make it twist.  Now my cyst, that was large- around 15cm.  He said under stimulation, the ovary will grow to between 7-8cm so hopefully not so large to make it twist, but large enough that I need to be careful.  That's fine.  I plan on being very careful.  They said to call of course if I had any pain or worries during the treatment.

• How many eggs should a woman freeze to have a very good chance at one future baby?
• Okay, this one has been bothering me because a lot of the egg freezing stuff I'm reading have women talking about freezing 10 or 11 eggs.  When I met with the doctor the first time he said ideally I would really want around 20.  I saw a different doctor today who will be managing my process and he actually said 20-30!!  But that 20 was probably a good number to have a very good chance at one successful baby.  His rationale was because the clinic results (see chart below for 2011) show a 33% success for clinical pregnancies with women 38-39.  So because I am 38, the eggs I am freezing now will give me about a 1 in 3 chance of a successful pregnancy.  He said that one IVF cycle will use about 7 eggs. So 20 frozen eggs accounts for 3 cycles and the odds show one of those would be likely positive.  It's important to note that for live birth the number drops slightly.

Patients age	<35	35-37	38-39	40-42	43-44	>44
% clinical pregnancies*	44%	37%	33%	13%	6%	-
Clinical pregnancies per cycle commenced	72/165	27/73	20/60	11/84	2/32	0/12

(Not) Understanding Numbers

I look around a few IVF/egg freezing places and of course everyone wants to compare their numbers.  Follicle Count, AMH, and FSH.  Here's the problem.  All of the numbers and charts provided are based on a woman with two ovaries.  I have no idea what the numbers mean with my one little ovary.

In my quest to find information, I found something else of use that is not so easy to find- a comparison of US to UK AMH readings and brackets for what they mean: http://www.drmalpani.com/amh.htm.

Based on this, my AMH at 9.4 pmol/l would put me in a low fertility bracket.  Although if it was doubled, I'd be in a satisfactory fertility bracket.  Of course, following that logic, even if I was satisfactory, I'd only betting half of what a satisfactory person would be getting, but I still think it makes a difference based on how many eggs you might be able to get from a single ovary in terms of trying to temper my expectation.

Similarly, I found this: http://www.advancedfertility.com/antralfollicles.htm regarding Antral Follicle Counts.  Now my count was 9- in one ovary and here there is an even bigger difference.  As a single ovary I'm looking at a reduced count but if that were doubled, I'd be skipping a bracket right into a normal or good count.

These will be questions for my meeting on the 5th.  Unfortunately however, UK doctors are just not as forthcoming as American ones.  By the way, if anyone comes across this post and knows the answer, even if it's months from now, please feel free to illuminate.  I will update the blog if I find an answer.

Blood Work is Back

So now we're catching up to where I'm at and why I started this blog.  I got my results back, and a letter from the doctor.  So here's the deal:

• Age: 38
• Height: 5'3"
• Weight: 185 lb
• Antral Follicle Count: 9 (one ovary)
• Anti-Mullerian Hormone (AMH): 9.4 pmol/l

The letter from the doctor used the phrase "reasonably good" when describing my follicle count and AMH result.  He went on to say that, I am still at an age where, "there is moderately good prospects of successful outcome following the thawing and fertilization of these eggs."

It's all very careful language isn't it?  I mean, I know they can't promise anything.  And I'll tell you what else, looking at IVF blogs is disheartening.  Even for example, when I think about my good friend who went through 8(!) rounds.  Yes, she just had babies from the last round, but all of those other eggs, they weren't good enough.  I know egg freezing is not anything close to a guarantee that these eggs will work out.  It's a lot of money.

However.... it's not my money.  Is that terrible?  I'll be honest here.  If it was my own money, I'm not sure that I'd spend it on this.  But since my mom is paying for it, I'm willing to take the risk.  I'm willing to let myself be hopeful.  And put myself through what will not be a particularly pleasant experience.  All for the chance of maybe having something.  But it's something I would really like to have.  At some point.

I do wish I'd done this when I was younger.  I'd have less angst if I still had both ovaries.  If I knew that a good cycle would produce a lot of potential eggs.  But I have to stay focused on my reality.  And I have learned this from the IVF blogs- my reality isn't the end of the world either.  It seems a lot of people trying to get pregnant have worse results than I do and they're going through and getting pregnant.  And I don't believe the doctor would have told me that I had "reasonably good" chances if I didn't.

I am going to go ahead with this.  Probably in February seeing as it's mid December and I'm about to go away for three weeks and will probably be getting my January period right before I come back.  So I'm going to get in touch with the clinic and find out what needs to happen in February.  Then I'll document everything as it happens here.

Stay tuned.