Thanks for the reassurance and support ladies. I'm feeling much better today and yesterday was a good day too. The injections have been easier, so either I'm getting better at doing them or I'm getting used to them!! Dh has been unbelievably supportive and is keen to talk about what's next. With his meds, he sometimes forgets what we've talked about, so I've been repeating myself quite a bit... which has actually been useful for me because I can get things straight in my mind too. I'm nervous about my ultrasound tomorrow - am I over stimulated? Am I under stimulated? How much longer will I need to stim for? How many more ultrasounds? What if DH's sample isn't good? Regular IVF or ICSI? When will egg collection be? How many egg? How many will fertilize? What is the quality of the embryos? When will transfer happen? How many embryos? Risk of multiples (could probably deal with twins but triplets would be too much! We have a set of magnificent triplets at school who are adorable - identical twin boys and a girl, but still not enough to convince me that I could handle that or a triplet pregnancy)?? What about freezing embryos (if there's extra - hopefully!)? What's next in the process? When will I trigger? Will I need progesterone supplements? Injections, tablets or suppositories? Too many questions! Good thing I've now written them down, so I can go back and ask the doc
to you all!!
I've been around the assisted conception world long enough that I can sort of answer some of these for you (keeping in mind everyone is a little different, as are each clinics procedures) - also a little surprised they didn't go over this with you, because most places basically use the same schedule.
Am I over stimulated? Am I under stimulated? How much longer will I need to stim for? How many more ultrasounds?
Based on your testing results (FSH, AMH, antral follicle count, etc.) they can usually guess what dose is appropriate for stimulation, once they start U/S around CD 7-9 (then usually 2-4 day intervals for U/S, which decrease until your scheduled for trigger/ retrieval). They base the stim dosing off what activity they observe. Depending on the protocol it varies, but *most* protocols with expected response stim for 8-10 days - some can be MUCH longer - don't worry if you are in the longer group, as the time it takes to mature a pool of eggs doesn't really have a predictive effect on whether or not a cycle will be successful. They also monitor estradiol (E2), a type of estrogen, and check the lining thickness of your uterus.
What if DH's sample isn't good? Regular IVF or ICSI?
I can only suggest not worrying about that which you cannot control - encourage him to take any recommended supplements, eat well, sleep well, make sure he's not letting things sit in the system more then 3-4 days without ejaculation (this is generally true, unless he has specific issues with different instructions). If the sample is less than ideal, that's usually when they recommend ICSI, which absolutely still gets people pregnant!
When will egg collection be? How many egg? How many will fertilize? What is the quality of the embryos? When will transfer happen?
Egg collection will be when you are ready! Definitely cannot help with speculating the number of eggs, how many will fertilize, or their quality. I can say that transfer usually happens 3-5 days after collection, usually they already have a plan for that. I do know someone who was scheduled for a fresh, 5 day transfer and they put her off a month to improve her lining with a frozen transfer instead and she's now almost 20 weeks along, so keep that in the back of your mind that they can get creative, if their experience sees a way to improve your odds! Frozen actually has a bit of a statistical advantage: https://www.cdc.gov/art/pdf/2013-na.../art_2013_graphs_and_charts_final_figure5.pdf
Main data page from CDC here: https://www.cdc.gov/art/reports/2013/national-summary-figures.html
How many embryos? Risk of multiples (could probably deal with twins but triplets would be too much! We have a set of magnificent triplets at school who are adorable - identical twin boys and a girl, but still not enough to convince me that I could handle that or a triplet pregnancy)??
Any embryo has about a 1% chance of splitting. Most REs stick to single embryo transfer, though in some cases or if you really push for it they will transfer two. Very few will transfer more than two. Data does NOT show a statistically significant increase in live births by increasing the number of embryos, but there is an increased risk of multiples. Most of the time when multiple embryos are transferred, only one takes anyway. Most of the twins and triplets from assisted conception are from ovulation induction and not from IVF. IVF is like the ultimate level of control for REs. If you do get more than one viable embryo, it's totally fair to ask if your chances are better transferring two in one cycle or doing two cycles with one each. The data I've read, would suggest you would be better off doing one fresh cycle with one and failing that, doing a frozen cycle with the other - but fair question to ask that particular facility, as their specific protocols may alter those generalities.
What about freezing embryos (if there's extra - hopefully!)?
Whether or not you freeze is up to you, make sure you understand the costs and what your options are for the fate of any unused embryos after you have completed your family. Some states/ countries have restrictions regarding donation to other couples, donation for scientific research, indefinite storage requirements (and fees), and/or destruction.
What's next in the process?
My clinic did a 12 DPO hCG blood test (though I tested out my triggers and then tested daily with internet cheapies because I'm a shameless POAS-aholic).
When will I trigger?
Triggers are once there are the maximum number of eggs that can be matured in a pool of them based on U/S. They have to balance quantity over "ripeness" - making sure they are making as many ripe enough, but not too ripe, in one pass. Trust yourself for choosing that clinic and their judgement. It's your first cycle, but sure isn't theirs! They usually instruct you to trigger the day/ night before retrieval.
Will I need progesterone supplements? Injections, tablets or suppositories?
You will almost definitely need progesterone supplements. There is something about the chemical process of induction that doesn't cause the same level of progesterone output that you would get in a natural cycle. Tablets have the lowest absorption, where suppositories have been developed as an alternative to injections and found to have comparable absorption. Both have their advantages and disadvantages, and chances are your provider will have their preference. I would be sure to ask them about side effects and ways to deal in advance.
I hope some of that helped ease your mind! I would still ask your clinic all of those questions because the exact answer for your case and their procedures may be different. I did a TON of research (LOL, in case you can't tell), because I honestly fully expected to be doing this next year - I don't think I believed I could get a viable pregnancy without it.
