Houston, We Have a Problem

As you may have guessed from my estradiol-induced grumpiness in my last post, Matt and Ellie decided to go ahead with the October transfer, so meds were started on September 16. I was very happy to hear from the nurse coordinator that we would not have to do Lupron in this cycle because it's a frozen transfer and we are starting so close to my own cycle day 1. I quickly learned that Estrace alone with no Lupron to balance it out did not love me. I have been irritable for the past 3 weeks straight - God bless Scott for putting up with me! But I can certainly put up with some irritability to get to our transfer and find the success that we've been waiting for in this stork adventure.

My first monitoring appointment to gather baseline information was on September 15. Ideally, we want to see a somewhat thin lining (2-5 mm) and little or no ovarian activity. My baseline for the August transfer was perfect, so I was hoping to hear the same at this one. Unfortunately, the ultrasound technician pointed out a follicle on my left ovary that was developing quite well, already 13 mm. A mature follicle will ovulate when it's grown to somewhere between 20-30 mm, so this one was well on it's way. As I've said before, this is a problem because we want to make sure that Matt and Ellie's bun is the only one baking in this oven. The number one rule of being the stork and not the mommy: DO NOT OVULATE (unless you do natural cycles and are into that kind of thing). The RE looked over the lab results later in the day, noted that the follicle wasn't producing high-enough amounts of estrogen on its own, and reassured me that the high-dose estradiol would stop that little booger from getting any bigger. So, like the first round, we all kept busy with work and kids while the days passed.

My final monitoring appointment before transfer was on October 1. Ideally, we would like to see a thick lining (8-12 mm) and little or no ovarian activity. However, based on the previous ultrasound, I knew that we would have some ovarian activity, so we hoped for at least no growth. I watched intently as the ultrasound technician did the lining measurements: 7.74 mm. Hmm, that isn't quite what we were looking for. Although she rounded it to 8 mm, my final lining check before the August transfer was 10.24 mm, so this one is considerably less, and borderline for what the RE wants prior to transfer. She then panned over my right ovary; nothing there, as expected, so on to the left one. I literally held my breath until she moved the transducer to the right spot, and the image was undeniable. She hadn't measured it yet, but that was one of the biggest follicles I've ever seen in real-time.
I started to ask questions so quickly that the words were getting jumbled. I knew that nothing good could come from this. It measured 25 mm, and she pointed out the haze on top of it that is indicative of imminent ovulation. So much for the estradiol stopping it from growing. Un-freaking-believable.

I called the nurse coordinator on my way out of the clinic to see what our options were. She didn't answer so I left her a message. I also sent Ellie an email of the findings. She had been worried about this exact scenario. We played arm-chair MD all morning and afternoon looking up all of the possibilities. We were both hoping that the RE would allow the follicle to ovulate and then transfer 5 days later in a quasi-natural transfer. I warned Scott about this; We have a live round in the chamber so he must not even make loving gestures in my general direction. When the nurse coordinator finally called back just before 5 pm, she told us that the RE had looked over the labs and found that my circulating hormone levels didn't match up with what they would expect for pre-ovulation, and that it was likely that the lining had already begun to breakdown. Not wanting to take any risks with the one embryo that Ellie and Matt have frozen, we had to cancel the October transfer and look ahead to the next opportunity. I stopped taking the estradiol that same day, and depending on when my cycle occurs naturally, we'll be able to put together a new medication plan for the next transfer. Without a doubt, the next one will include Lupron. That was the long, expensive, painful lesson that we all learned with this round.