Case of the month Mar '08: Episode #7
For Terra who was now undergoing her first IVF cycle, the anticipation and uncertainty of starting something new was offset by the excitement and hope that maybe finally, her years of sadness were soon to be over.
"If you would like, let’s review the big picture for you two," I said to Miles and Terra on the day of their trial transfer. "You came to see me because of three years of failing to get pregnant on your own. We did your basic testing and found no obvious problems, except maybe for the issue with the cervical mucus. We started off conservatively by trying IUI. We tried it twice and failed both times. Now, as I said before, most couples try three cycles of IUI and can expect about a 50% chance of success overall. You two have done only two IUI cycles, but have chosen to skip the third and go ahead with IVF. Is this correct?" They both nodded enthusiastically.
I went on. "Today, we’re going to do something that hopefully turns out to be unnecessary. I’m going to map out your cervix in anticipation of the day when I will be transferring your precious embryos for implantation. Of course, we have no embryos today, but we are going to go through the motions. If we get surprised by a cervix that is too tight, we will try and loosen up the scar tissue. If we find a cervix that is too twisted, we will map out each turn for future reference."
What followed was one of the easiest trial transfers I did that week. Terra’s cervix was readily accessible. The catheter went in smoothly with a 12:00 curve (directly upwards) and no resistance. I used ultrasound, visualized the exact tip of my catheter and took a picture. "Your actual transfer is most likely going to be a breeze", I said.
The next step was to ultrasound her ovaries to see if there were any cysts. You would think that by taking birth control pills, we could prevent any cysts from forming, but it’s not that perfect. True, taking birth control pills ahead of time, as part of the IVF protocol can MINIMIZE the chance of cyst formation. However, it is not 100% foolproof. Fortunately for Terra, it worked and she had no cysts. Everything was perfect to go and she was started on Lupron with instructions to quit taking the birth control pills according to her schedule.
Without going into extreme detail, Lupron is a drug used to start most IVF cycles. The Lupron shuts down the ovaries and gives us full control over the stimulation. By continuing the Lupron until we are ready to harvest the eggs, we protect Terra from the risk of premature ovulation. Terra got her period about a week after starting the Lupron, so we were all set to go.
Just as she did with her 2 IUI cycles, Terra faithfully gave herself the ovulation medication. By doing ultrasounds and checking the estradiol level every 2-3 days we were able to track the progress and adjust her doasge accordingly. After 10 days of stimluation, this is what we saw.
Right ovary: (22×15) (19×14) (17×17) (16×15)
Left ovary: (22×20) (22×19) (17×15) (17×12) (21×13) (18×16) (24×18)
The lining was a beautiful triple layer appearance, measuring 8mm.
Estradiol = 3402. Progesterone = 1.2.
"This is it perfect!", I exclaimed. "The follicles are at their optimal size. The lining is fantastic. Your blood tests are good. Today, you stop the ovarian stimulation. We’re all done with that. Tonight you will take the most important injection of the cycle. You will take your shot of hCG at a precise time exactly 35 hours before your egg retrieval surgery in 2 days."
After my nursing staff reviewed the exact instructions with Terra, I came back to answer any final questions. There were none. The next time I would see her would be two days from now for the big day of her egg retrieval.
