"Like I'm about to ovulate!" I chirped.
As the dildocam slid home, the doctor said, "Well, you've got a lot of eggs here, so I can definitely see that you'd feel bloated." (Bloated, yes, but there have also been more...um...personal symptoms suggesting imminent ovulation. Fellow veterans of the TTC wars, I trust you know what I mean.)
I watched, squinting at the screen as he clicked and measured...18...15...15...right...left...then it was over and I wasn't sure what had happened, but I had a pretty strong suspicion that there was a LOT going on. I'm used to seeing perhaps two large follicles on an ovary, and there were definitely more than two.
He told me that most likely I would trigger tonight for a Sunday IUI, bloodwork pending. Nurse called a few hours later to confirm that yes, I should take Ovidrel tonight and schedule my Sunday morning IUI. I asked her what my follicle count and E2 were. She told me:
Right side (where I have a tube): 5 @ 15 mm, 3 @ 17 mm, 1 @ 19 mm (and a bunch of littler ones)
Left side (no tube so not so much of a factor): 2 @ 17 mm, 1 @ 19 mm (and a bunch of littler ones)
Yikes. Even if we assume the left ovary is not really in play (which isn't totally guaranteed), that is DEFINITELY more follicles than I have ever triggered with in the past. (Cycle I got pregnant I had one lead follicle and two close behind; last year I had three cycles and never had more than two over 16 mm a day before trigger.) Granted, I never had this level of detail about the follicle counts before, and I usually had my final ultrasound the day before trigger, not day of, so it's likely that I had some 15 mm guys hanging out at trigger in the past too.
But still. 1 19mm and 3 17mm follicles seems like a lot for someone who really, really does not want to have multiples. And we all know those 15mm follicles could decide to join the party at any minute.
Here's the thing: My doctor isn't actually in the office today. So the call to go ahead was made by one of his partners, who doesn't know me and my history. The nurse said she would email Dr. SF and he would call me back this afternoon so I could talk it over with him. If I was 32 and on my first cycle, I would almost certainly pull the plug and cancel the IUI. Too scary. But I'm 37, which while not ancient is old in fertility terms, and I had 3 unsuccessful IUIs last year with average 2 mature follicles on the right side each. And I once again reread this, which, while 10 years old, had this to say (emphasis mine):
For patients age 35 and older, pregnancy rates in HMG and clomiphene + HMG cycles were doubled when six or more follicles were > or = 12mm without a significant increase in twin or higher order implantations.
Withholding HCG or IUI in clomiphene, HMG, and clomiphene + HMG cycles when six or more follicles are 12 mm or more in diameter may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.
For patients age 35 and older, withholding HCG under the same circumstances may decrease pregnancy rates by half without significantly reducing multiple implantations.
Clearly more follicles does improve the chance of pregnancy; considering that I'm 37, and thus far have not been successful with fewer follicles, do we go for it and consider that the risk of multiples is probably less than for someone 10 years younger with the exact same numbers?
On one hand: I'm tired. I hate this shit, the needles and the slog. I don't want to do IVF, and I barely want to do another IUI. I want to just go for it and take home a baby.
On the other hand: THIS IS HOW PEOPLE END UP WITH SEXTUPLETS.
Nurse promised that Dr. SF would call me back later this afternoon. I will of course update then.
UPDATE: Dr. SF called right as I hit "publish" on this post. He talked me down. While of course, he said, we cannot avoid the risk of multiples with IUI, this cycle is actually pretty equivalent to the cycle I got pregnant on, maybe actually safer from an avoiding-multiples standpoitn. Apparently that cycle I had 3 follicles hovering around 17 mm the day before trigger with an E2 of 1074, so I most likely had a much higher E2 the day of trigger, and probably a bunch of 15mm follicles too. He thinks that we're not going to get a cycle much better than this, and recommended going forward.
So we're going forward. And you can all laugh at me when I end up pregnant with sextuplets.