Stimulus

So, as of last Friday (June 11th) we've entered the stimulation phase of the IVF process.  The basic idea is: hyper-stimulate Sarah's ovaries so that a large number of eggs begin maturing.  Over a span of 10 days or so, the eggs develop rapidly; then, when they're just about to be released, the doc goes in and "retrieves" them for fertilization in the Petri dish.  More on that later.

During the stimulation phase, Sarah takes a combination of hormone injections.  In the morning, she takes Menopur, a so-called "menotropin", meaning a mixture of follicle stimulating hormone (FSH) and luteinizing hormone (LH).  Together, these hormones stimulate the development of follicles, the structures that house eggs as they develop and prepare for fertilization.  In the evening she takes a larger dose of FSH in the form of Follistim, and a smaller dose of Lupron, which as we discussed before is an LH agonist.

The process is monitored in two ways.  The first is easy to understand: Sarah has ultrasounds exams, in which a technician uses the ultrasound machine to look at her ovaries and count the number of follicles.  As the follicles get larger, the tech will not only count them but measure their size.  The ideal result from one of these exams is a finding that:

1.  there are lots of follicles;
2.  they're bigger than they were in the previous exam; and
3.  they're all about the same size.

This is all very intuitive, right?  You want lots of eggs to fertilize; you want them to be growing and maturing; you want them all to be ready at the same time. So, what's ready?  Well, we're looking for the follicles to grow to somewhere right around 2.0cm in diameter.  If you're big like me, that's about the size of your thumbnail.  If you're small like Sarah, it's more like the size of you big toenail.

In addition to the ultrasounds, Sarah has blood drawn regularly.  The draw is for an estradiol (E2) assay.  The idea is, we want to see E2 levels going up and up and up.  The slope of this curve tells the medical team that the eggs are developing on schedule.

So what do the words "frequent" and "regular" mean in this context?  Well, we went for a "baseline" ultrasound and E2 test on June 1st.  This was the low point in Sarah's cycle; it tells the docs what her ovaries and hormone levels look like sans stimulation.  On Friday the 4th, we started the stimulation phase: Menopur in the morning, Lupron and Follistim in the evening.  We went for the first blood draw on Monday the 7th.  Then we went for blood tests on Wednesday and Friday, and we go again on Sunday.  The first ultrasound was on Wednesday the 9th; we had another Friday and will have a third on Sunday. All told, then, "frequent" means: at least every other day.  As retrieval gets closer, it may become every day; it won't surprise me if after Sundays tests we're scheduled to go for more tests on Monday.

More on the results of these tests momentarily.