Deja vu

(Or: When hope and hopelessness collide)

This morning was my first follicle check since starting the Follistim. For those of you who haven't needed a bunch of people in labcoats present when you conceive (but I highly recommend it... sexy!), the doc was looking at two main things during this ultrasound: the thickness of my lining, to make sure it is substantial enough to support implantation; and what size my follicles are. When the follicles are big enough, they will have me give myself a trigger shot of HcG in order to force ovulation. Then the IUI is timed 34ish hours later, which is when ovulation should be occurring based on the trigger shot timing. And then, wham bam thank-you-ma'am, I am with child.

Or that's the theory, anyway.

So on to the appointment. The doc was pleased to find that my lining is measuring 13.1 mm. This, my friends, is impressive. For reference, 10 mm is the point considered more than adequate by most REs, so clearly mine is kicking some major ass. I am thinking of having my uterus host a seminar on growing such an impressively cozy home for potential embryos. Just to help offset the cost of the medication.

Now, drumroll please.... the follicles.

Right side: 14 mm

Left side: 15 mm and 13 mm

Some of you are nodding appreciatively, while some of you are thinking that this makes about as much sense as that bizarre fog beast thing on Lost. For the latter, a bit more explanation. (About my follicles, of course. You are on your own with the fog beast.) The doc saw three dominant follicles doing their thang in my ovaries. One on the right side, two on the left. Those are their measurements.

On the generic clinic paperwork I have, it says that the doctor will have me take the ovulation trigger shot when a follie hits 17-18 mm. Which is right in line with what my previous RE had me do. However, Dr. Downtown has noted specifically that he wants me to trigger at 16 mm. Unfortunately I didn't see him today so I couldn't ask him why so early. But his partner (who read this in Dr. Downtown's notes) said that I should come back tomorrow for another check, and if we hit the magic number, it's trigger time.

It also means: the possibility of triplets. In fact, the doc specifically stopped to discuss with me that each follicle is a potential baby. I loved that he did this. One of my biggest pet peeves about infertility is when doctors DO NOT monitor the follicle development and DO NOT inform the couple of how many eggs could potentially be fertilized by the IUI. I find it extremely unethical and sloppy. (This is what I believe happened with Jon & Kate Plus Eight, by the way.) Before DH and I started injectible treatments two years ago, we sat down and discussed what our opinions were on this subject. Because we didn't want to face the possibility of higher order multiples -- and selective reduction is not an option we'd personally consider -- we agreed that if I had four or more follicles, we would not proceed with the IUI. I realize all too well that it is costly and inconvenient to have follicle checks during treatment, but the consequences are just too severe for the parents and the children when the "off chance" occurs and there is a basketball team in there. I'm sorry for going off like that, but it's obviously a subject that hits a nerve for me. (And yes, I realize that triplets would still be higher order multiples and a risky pregnancy. And yes, one embryo can split into identical twins naturally and unexpectedly anyway. I'm just talking about being informed and carefully weighing these life-sized decisions.)

*stepping off soapbox*

So we will be going ahead with the IUI. Personally I'd be surprised if all three follies make it to ovulation, especially based on this questionably early trigger. I have to go to the office tomorrow for another follicle check. The doc expects them to be big enough for a trigger shot late on Friday, with an IUI early on Sunday. Which happens to be our wedding anniversary. Harry Potter, out. Turkey baster, in. Romance, anyone?

And just for fun, let's remember our first Follistim + IUI cycle back in May 2007, shall we?

Outstanding lining, three ripe follies, Olympic Gold swimmers, a perfectly timed IUI.

And?

BFN.


Edited to add: I emailed Dr. Downtown as the brilliant Martha suggested. He explained he was concerned that waiting an extra day would give time for a fourth follicle to mature, which is definitely too many. Excellent point! Ideally I would like 2-3 follies between 16-18 mm tomorrow morning, then I would be happy to trigger tomorrow night.