Two out of three ain't bad

Out of 22 eggs retrieved, 15 fertilized. I would have been thrilled if we'd had 10, so 15 is amazing.

They'll call me Tuesday morning to either give me a time for transfer that afternoon or to tell me that we're pushing to day 5 (Thursday). Since we're doing single embryo transfer, my doctor wants to do a blastocyst transfer if possible, so fingers crossed that there's still plenty growing and looking good on Tuesday morning.

CD7

Very quickly, since I've been up since the crack of dawn and had an exhausting all-day meeting: Everything basically fine at today's ultrasound. I'm assuming my E2 is up since I got a message today to drop Gonal-F dose down to 37.5 IU and come back tomorrow. My husband has observed that I'm starting to get bloated again (gee, thanks honey!). And, for your Phreaky Photo of the day, I give you this, an ultrasound image of my ovaries actually snuggled up together:
(The doctor doing today's ultrasound said, "Oh, they're kissing!") No, that is not normally what they do, they are normally one on either side like everyone else's. I assume this is just living proof of how everything kind of mushes around in there, which is why I'm told it would theoretically be possible for my one (right) tube to pick up an egg from the opposite (left, tubeless) ovary.

WEIRD SHIT.

Eek [UPDATED]

"How do you feel?" asked the doctor on monitoring duty this morning (CD 12).

"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)
E2: 1128

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.

and

Conclusions:
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.

Vax links

As it happens, right after I wrote my last post, a whole bunch of flu/vaccine/flu vax-related articles have popped up. So I thought I'd collect 'em all--they make for interesting reading.

On swine flu:

From Newsweek and factcheck.org: Inoculation Misinformation. An excellent article dispelling myths about the H1N1 vaccine. I guess I don't have the right kind of crazy email-forwarding friends, because I had NO IDEA the misinformation was this ridiculous.

From the NYTimes: Flu Story: A Pregnant Woman's Ordeal. Aubrey Opdyke was pregnant when she contracted H1N1. She spent four months in the hospital, five weeks of that in a coma, and had six collapsed lungs and a near-fatal seizure. Her baby had to be delivered at 27 weeks by emergency C-section and lived only seven minutes.

On vaccines in general:

From Wired: An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All. This was really interesting--it's the first article I've seen that states really clearly that by weakening herd immunity, parents who don't vaccinate don't just make their own children vulnerable, they endanger children and adults who have been vaccinated, because vaccines don't always "take":

The frightening implications of this kind of anecdote were illustrated by a 2002 study published in The Journal of Infectious Diseases. Looking at 3,292 cases of measles in the Netherlands, the study found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.

From Slate: My Son Has Cancer. He Can't Go Into Daycare Because of Unvaccinated Children. Less subtle, this one, but effective.

Oink

So I was moved to post about flu vaccines after reading this post. Except I just wrote the post in my head and didn't, you know, actually compose and post it. The post I wrote in my head was of course beautifully eloquent and masterfully argued. But here's what I'd like to say:

All three of us (me, husband, Bat Girl) have gotten the seasonal flu shot. We will be getting the H1N1 vaccine as soon as we are able. We got the seasonal shots at the beginning of October from BG's pediatrician (she only gets the thimerosal-free versions), and since she recommends spacing out all flu vaccines one month apart, BG will be getting the first dose of H1N1 in the beginning of November, and the second dose at the beginning of December. (Kids under 9 have to get 2 doses of H1N1 for it to be effective. Since she has had the seasonal flu shot before, she only needed one dose of that one.) Since she freaked out getting the seasonal shot and tried to rip the needle out of her leg, I decided to get her the nasal spray for H1N1.

I am a very big believer in flu shots. I have gotten one every year for as long as I can remember. Longtime readers may recall that I fretted a bit about whether to get a thimerosal-containing flu shot when pregnant with BG--but I went ahead and did it anyway. So there was never any question that we were getting the seasonal shot. I debated the H1N1 shot a bit, but considering that (a) I am hoping to get pregnant this flu season, (b) pregnant women and small children have had the highest fatality rates from H1N1 so far, (c) we are planning to put BG in day care, i.e. viral stewpot, 2 days a week this winter, and (d) given the demographics of our neighborhood (hippies, bobos, and non-English-speaking recent immigrants) the local vax rate will likely be quite low, I am not taking the risk of going unvaccinated. If I don't get pregnant this cycle, I will get the nasal spray when BG gets hers. If I do get pregnant (ha!) I will get the shot as soon as I possibly can.

If you are someone who has issues with vaccines in general, I totally respect that. What I have a hard time with is people who fear the H1N1 vaccine based on totally unfounded information that they picked up through rumor or on MDC. To wit:
-If you don't have a problem with seasonal flu vaccine, you shouldn't have a major problem with the H1N1 vaccine. They are made in exactly the same way--the only difference is the virus part.
-There are NO ADJUVANTS in any flu vaccines in the US. (If you're not in the US, your mileage may vary.)
-If you fear mercury in vaccines, you can get a thimerosal-free flu vaccine, either via a single-dose shot or the nasal spray (which is always mercury-free).

Here's a piece by Paul Offit (whom I know a lot of people have a problem with) explaining all of this in more detail. So if you decide not to get vaccinated--which you are totally within your rights to do--you will at least have the science straight. That is all.