Relax; This Is Not What It Appears To Be

Well, it sort of is. It appears to be a positive pregnancy test. And it is. But it doesn't mean Sarah is pregnant. Allow me to explain.

The predictions made on Sunday held up. On Monday we went in for a blood draw (no ultrasound). The results of this E2 test told our doc that Sarah's eggs were mature and ready to harvest. So, yesterday afternoon they called and scheduled retrieval.

Put in the broadest terms, woman's cycle looks like this:

1. End menstruation.
2. Begin building up a new uterine lining while egg matures.
3. Ovulate.
4. Wait to see if egg is fertilized.
6. Begin menstruation.

Now, imagine that during step 4, the egg is in fact fertilized and embeds in the uterine lining. The last thing you want is for the uterine lining to be shed; it would take the developing embryo with it. So you need some signal from the developing embryo to the rest of the body --- something that says:

HOLD EVERYTHING, I AM HERE!

That signal comes in the form of human chorionic gonadotropin, or hCG. This is a hormone that is only produced in the event of pregnancy, and when present it brings the woman's menstrual cycle to a screeching halt. In other words, hCG is a kind of switch that works to shift a woman's hormonal system from "normal" to "pregnant".

(It's also been in the news lately, as the compound that got linebacker Brian Cushing suspended from the Texans and nearly cost him his Defensive Rookie of the Year award. Its presence in a man indicates one of two things: he either has testicular cancer, or has injected the hormone as part of a program of steroid use. Cushing maintains that he is a medical marvel whose body must somehow be producing hCG in the absence of any cancer. He is lying.)

Produced in a laboratory and packed into a kit, it looks like this:

It's one of those binary jobs like the Menopur: the big vial on the left is sterile water; the smaller vial on the right contains crystalline hCG. To prepare the injection, you take the syringe, stick it in the vial of water, and draw 1mL. Then you pull the syringe out of the water vial, stick it in the vial of powdered hCG, and inject the water into the medicine. In this case, the amount of medicine to be dissolved (look closely: it's 10,000 units) is large enough that dissolution is slower and takes a little more agitation. Once dissolved, the solution is drawn back up into the syringe, and the broad needle swapped out for a 27 guage, 1.5in needle. The prepared shot looks like this:

So this looks a lot like the prepared Menopur shot --- except that in this case, that long needle is going to go all the way in.  The shot is meant for intra-muscular (IM) delivery, meaning the needle goes all the way through the skin and underlying fat and into the muscle.  We do this in Sarah's upper hip, where the muscle is big and thick. 

The technique is simple: wipe the injection site with a sterile alcohol pad, press it flat, stick the needle all the way in, pull back slightly (to check for blood, and thereby ensure you haven't inadvertently stuck the needle into a vein; you don't want to accidentally deliver the shot intravenously), and then press the plunger and deliver the med.  It's over lickety-split.

The pregnancy test is a check to make sure the injection worked.  Over-the-counter pregnancy tests are yes-or-no checks for the presence of hCG; the positive test indicates that she's got a good dose of hCG in her blood.  In other words, that means I correctly administered the shot and her cycle is safely halted for egg retrieval, embryo transfer and early pregnancy.