29 May 2009

secret decoder ring

Hey Pa,

Because you asked:

The language we use to talk about IF (infertility), TTC (trying to conceive) and the treatments is like this secret code-- and so here is the brief secret decoder ring for my stuff-- not comprehensive at all-- just the stuff you are likely to hear from me.

cd1 or 2 or... : refers to cycle day (menstrual cycle day starting with day 1 which is real red blood, aren't you glad you asked?)

Some folks refer to their periods as AF, "aunt flow", but I cannot stand it. I just say I got my period.

2dpo...or 10dpo: number of days past ovulation... ovulation is the be all and end all of some types of cycles

IUI: intrauterine insemination-- good old artificial insemination, but up through the cervix and into the uterus. Timed with ovulation.

D&C-- or D&E-- the thing I just had done where they mechanically remove the contents of the uterus via the cervix-- in "C" (curettage) they scrape, in "E" (evacuation) they vacuum.

IVF: in vitro fertilization-- they take his stuff and my stuff and put in a petrie dish and pray.

So, you may ask yourself, how do they get my stuff?
ok, here's where things get interesting: in the first half of a cycle they try to make as many follicles as possible using stimulation drugs ("stim")-- follicles are little sacs in the ovaries that with luck, will contain eggs. The stim drugs are things like follistim (get it?) and menopur... sometimes they try to balance the GO GO GO drugs with some WAIT WAIT drugs so that ovulation does not just happen-- the WAIT WAIT drugs are called supression drugs or antagonists depending on which way they decide to go.

They monitor these little follicles with ultrasound (up the twozzle) and blood tests (looking at a hormone called estradiol, also known as E2)-- and they look for both # of follicles and their sizes and E2 numbers to assess how things are going and how long to stim. Different clinics have different criteria, but when things are ready, they "trigger" egg maturation with a trigger shot of hCG (human chorionic gonadotropin). And about 36 hours later if they left everything alone, some number of follicles would rupture, and fling an egg down a falliopian tube. In IVF, about 35 hours later, just before ovulation would occur, they go in and suck them out (no kidding, through the vaginal wall and via an ultrasound guided hollow needle/probe thingy)-- and put them in a petrie dish. Unless, of course, you are me and they go in and they suction nothing out and call it quits. They tell you how many eggs were retrieved that day.

OK then, so then they put his contribution in with mine and pray. Sometimes they do something called ICSI (intracytoplasmic sperm injection) where they take a sperm and inject it into the egg, sort of a forced date. The next day they call with the initial fertilization report--how many were mature, how many fertilized. And if all is well, there is something to put back a few days later at "transfer". (If there are more than you can use they freeze them).
Transfer just means they put some embryos back in, but the embryos then need to decide to implant (make a nice cozy home in the uterine lining). No one can make them implant.

Ok-- so far we have:

ER-- egg retrieval, that moment where they harvest eggs from those stimulated follicles
ET: embryo transfer, then they put some back 3 to 5 days later.

In the meantime, since the stim and multiple follicle process totally messes with inherent hormone balances, the woman person is usually on some sort of progesterone supplementation via suppositories or injection (progesterone in oil, also known as PIO). In an ordinary cycle, our bodies make enough so all is well, in an IVF cycle, all is crazy so it is necessary.

Once the ET (egg transfer) happens a new vernacular pops up-- folks refer to the number of days past their transfer like this:
3dp3dt -- 3 days past 3 day transfer (which is different than, say, 3dp5dt-- 3 days past 5 day transfer).

Since the ER day (retrieval) is reallly the "ovulation" day, add the first number and the second to get the number of days past "ovulation", so 3dp5dt is 3+ 5 = 8 so it is 8 days past mechanical ovulation...

And about 9 or 10 or 11 or 12 days after ovulation, one pees on a stick (POAS) to see if one is currently pregnant.


The other likely option is IUI (the artifical insemination option)-- this can be medicated (stim drugs like in IVF, trigger like in IVF, but insemination at 36 hours instead of egg retrieval ER), triggered (monitored and then a hCG shot and then IUI) , or just an IUI based on at-home hormone monitoring with ovulation predictor kits (OPK)-- in which two lines appear only when there is an LH surge (lutenizing hormone which indicates imminent ovulation), then IUI is done the next day.

If medications are used (and sometimes even if they are not) progesterone supplementation is used here too.

Other options?
Timed intercourse (sorry)-- use the OPK (ovulation predictor kit), look for the surge (lutenizing hormone surge indicating imminent ovulation), have sex, pray. At my age this is a fine idea, a nice end to a nice day, but is highly unlikely to result in a baby.

2ww: No matter what, the time between the act of egg retrieval, or IUI or timed intercourse and the time when one can reasonably expect to see a positive pregnancy test result is called the dreaded two week wait-- 2ww.

Other things we folks who are TTC do to amuse ourselves-- BBT, basal body temperature-- checking my temperature each morning with a special thermometer (with hundredths places)-- before I get up, before moving. Pre ovulation temps are low, post ovulation temps are higher, and would remain high in pregnancy. Drop just before period comes.

And then there is cervical mucus (CM). No kidding. It changes throughout the cycle but gets very eggwhite-like around ovulation to faciliate sperm swimming upstream... so we can get a sense of what is happening by paying attention to that too. But fertility medications often mess up temperature taking, and mess up mucus. So, sometimes this is futile.

The most likely scenarios for me since I responded so poorly to the stim medications, made only a few follicles, and had that empty egg retrieval-- we will probably do medicated (stim and triggered) IUIs-- and if enough follicles materialize we can convert to IVF. By far IVF has the highest rate of success, but clinics have a minimum amount of follicles they want to work with, since not all will result in an egg, not all eggs will be mature, and not all will fertilize, and then not all will make it to day 3 or 5.

And just because it is possible in the future- DE means donor eggs (doing IVF with eggs retrieved from a young and healthy egg donor), it can also mean donor embryos which means someone made more than they are going to use, they've been frozen, and are available for a FET (frozen embryo transfer).

Oh and the whole hCG thing I am dealing with now-- since I was pregnant, that little embryo created a whole shitload of hCG-- when one is first pregnant and pees on a stick, that stick is meant to sense the amount of hCG in the system caused by the embryo-- if you have two lines, you have hCG being created inside for some reason-- so, then they follow with a blood test to quantify that hCG-- called a beta test-- and that number, ideally, needs to double within each 72 hour period. It if is really low, and/or if it does not double well, it may mean that something started, but is not going to last. This used to be called a chemical pregnancy, but is now considered an early miscarriage.

hCG takes time to build up, and it takes time to come down.

So right now, I still have enough in my system to turn a pregnancy test pee stick "positive"-- but it is on its way down and soon be back down to normal for a non pregnant person, somewhere under 5.

So, there we have it.
ART (assisted reproductive technology) TLAs (two or three letter acronyms)-- WTF.

Love you,
your very own Kate


daves51 said...

for nice job Kate.

I think you should consider a change of careers. Seriously. A clinic somewhere? You have the knowledge, the empathy and the passion.

Have a great weekend.


Anonymous said...

You are really something, Kate! Thanks (mostly) for the decoder ring info. I'm still "here" for you, whatever that entails. I love you, Pa

Searching for Serenity said...

Bravo! And an extra standing ovation for the humor you stuck in.

What IF? said...

Where were you when I started this journey?! This is one comprehensive, easy-to-understand (not to mention witty) TTC 101 course. Love it!

Anonymous said...

OMG - I love your decoder ring; and that it was actually requested (and read!) by your Pa! That makes me wish my dad was in on the secret (our whole ttc thing) but my mom really couldn't handle it. She is not a stress-handler type. *sigh*

Thinking of you - hope the hcg is coming down (I'm finally "there"). Good luck.

Sarah and Family said...

LOL! Oh, Dad is so brave to even ask. xoxoxo s