Posts

23
Aug

Becoming an Egg Donor: Stimulating!

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Diane (not her real name) has embarked on the journey of becoming an egg donor at CNY Fertility Center and will share her thoughts during the process in her blog here. If Diane’s journey and stories that she shares compels you to look in to becoming an egg donor we would love to get you started. The first step is to fill out our Donor Eligibility Questionnaire – click here to begin.
Stimulating!
Since my last appointment I have started taking the Follicle Stimulating Hormones.  I am currently on Day 3 and had another appointment today.  Let me first tell you about taking the FSHs.
The nurse explained how to give myself an injection at my last appointment.  I don’t think of myself as a squeamish person so I thought this would be no problem.   But I have to admit, giving myself that first injection was more challenging (mentally!) than I had anticipated.  When a nurse gives you a shot, they chat with you, and usually I look away so I don’t see what she’s doing.   They can distract you and it’s usually over before you even realize they’ve done it.  It’s impossible, I quickly realized, to distract yourself when you are the one giving the injection, to yourself.  The anticipation was worse than anything.  I had to psyche myself up way more than I thought.  After a deep breath and a big ONE, TWO, THREE! I realized the injection itself was painless.  As I said, the mental anguish and anticipation was way worse than the actual shot.  I felt sort of foolish afterwards for making such a big deal out of, what turned out to be, nothing!  The area of the injection (right around my belly button) was just a tad tender for a few minutes afterwards, but as of yet I am not experiencing any side effects.  So, now that I’m on Day 3, I fancy myself the injection expert and no longer torture myself with anticipation beforehand.
I felt quite proud of that as I walked into my check up today.  The nurse drew blood again.  But just one vial today instead of 4, which was what they drew the previous two visits.  She told me that depending on the results of the blood test today they may increase or decrease the dosage of FSH that I’m currently taking.  Then the second nurse came in to do the ultra sound.  The ultra sound showed that there were indeed follicles and she said they looked good.  Then we set up appointments for two days out, four days out, and seven days out.
The nurse did end up calling me a couple of hours later to tell me that we did need to increase the dosage of FSH by 75 units.  Although the follicles did look good my estrogen levels were still a bit low.  I would take the new increased dosage and see how things looked at my next check up in two days.
This entire experience is so educational.  I feel as if I’m taking an advanced biology course; learning about estrogen levels, follicles, injections, dosages of hormones, etc. and all within my own body!  Each day is a new fun experience and I eagerly await each new part of becoming an egg donor!
Sincerely,
Diane

16
Aug

Becoming an Egg Donor: The Recipient is Ready

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Diane (not her real name) has embarked on the journey of becoming an egg donor at CNY Fertility Center and will share her thoughts during the process in her blog here. If Diane’s journey and stories that she shares compels you to look in to becoming an egg donor we would love to get you started. The first step is to fill out our Donor Eligibility Questionnaire – click here to begin.
The Recipient is Ready:
Today I took another step forward in the process of becoming an egg donor.  Upon arrival today, the visit began much like my last visit.  I first had to once again provide a urine sample and they also had to draw blood again.  We also had to do another ultra sound.  This time the ultra sound was done to determine if my follicles were ready to start the medications that I would be on for the next couple of weeks.  Happily, my follicles looked ready to go and my ovaries were symmetrical in size which meant there were no cysts present.  The presence of a cyst would, evidently, complicate the process a bit.  Luckily everything looked great and the nurses stepped out to determine the exact treatment plan.
A couple of minutes later the nurse returned with a typed up plan and a bag with the medication enclosed.  The nurses decided that I would be starting the follicle stimulating hormones on Saturday and that my next appointment would be Monday.  Monday’s appointment would consist of another blood draw and ultra sound.
The process of starting the medication was simple.  Once a day I would give myself a small injection in my abdomen about one inch away from my belly button.  The nurse had the “pen” (which is basically an apparatus that already contains the medication, a system for dosing it appropriately for each day, and a place for a fresh needle to attach each day).  We went over how to put a clean needle on each day (which was very easy, each needle is in its own small package and just twists into place onto the pen), then how to set the dosage (again, this was very easy; all you have to do is click the appropriate number so it lines up with the big arrow), then she explained where the injection goes, and how to put it in (at a 90 degree angle).  I will be giving myself this particular medicine at this particular dosage for one week.  This medicine will stimulate my body to produce eggs, then I will switch to taking a medicine that will tell my body not to ovulate (as this needs to be timed perfectly with the recipient), and finally I will take a medicine that will tell my body to ovulate at the ideal time.
I came away from today’s appointment armed with new information and a bag of follicle stimulating hormones.  The process, although made easy and as straight forward as possible by the fertility team, is a complex one.  I have to say, I give a lot of credit to couples who endure this process.  I am only getting a tiny glimpse into this as an egg donor.  I can now begin to appreciate the tenacity it takes for couples to go through fertility treatments.  And I also have to give the entire staff at the fertility center a lot of credit as well.  Their jobs are not only to deal with the technical side of hormone levels and lab tests but also the emotional side of this very personal journey.  Bravo to both the families that have gone through fertility treatments and to the fertility teams for making this difficult process as effortless as possible for the couples.
Sincerely,
Diane

12
Nov

IVF and Antral Follicle Count

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This information is provided for patients interested in their prognosis for infertility treatment. CNY Fertility Center in Syracuse NY, Albany, NY and Rochester, NY provide consultations, and treatments for couples trying to conceive.
The number of follicles, each containing one egg, which are available in the ovarian pool relates to the chance of success of In Vitro Fertilization (IVF). These numbers decline with age, and in some women decline abnormally fast. For couples who are trying to conceive and their care givers, methods of predicting the potential outcome of IVF can be important in making medical decisions.

One important tool for measuring the ovarian pool is a direct measure of the follicles as they emerge in a given month. The number of small follicles in the ovary during a menstrual period are observed using ultrasound. At this point there are no large follicles, and the pool of follicles which will emerge that month are beginning to grow. As the fluid accumulates, even a few milliliters (a teaspoonful is 5 ml) of fluid in the antral follicle can produce a measurable echo on the highly sensitive ultrasound machines used for transvaginal evaluation of the ovaries. Follicles between 2 and 5 mm can be visualized and counted. The antral follicle count (AFC) must be done when the follicles have not begun to grow. Thus it is scheduled day 2, 3 or 4 of the cycle prior to considering IUI or IVF therapy. Since there is not a huge variation from month to month, this test can give a good idea of the prognosis for the future.
antral follicle
Antral Follicle from www.DKImages.com
antral follicle ultrasound
Ultrasound image of antral follicles from www.healthline.com
Because not all of the follicles can be visualized , after stimulation by clomiphene or injectable gonadotropins, the number of follicles which eventually develop may be higher that the number of antral follicles in that particular cycle.

In a review of studies, Verkagen has concluded that the AFC is as good as any of the biochemical tests to determine ovarian reserve. In IVF treatment, if the AFC is less than 4, there is a much lower rate of successful pregnancies. Since this cut off is so low, this limits the value of the test. How high can it go? Egg donors or young infertility patients might have an antral follicle count of 17 or more. The typical mid-30 year old infertility patient will have 5-10 antral follicles. Sometimes in women with low ovarian reserve it is tempting to try to find a cycle with more antral follicles in order to get a slightly better result. However, there is low variability of the AFC from month to month (Jayaprakasan 2008) so waiting for another month is not likely to change much.

More indirect biomarkers of ovarian reserve include serum FSH, day 3 estradiol levels, inhibin B and anti-Mullarian hormone. These tests of ovarian reserve are covered in the section on IVF prognosis on this web site. In practice all available information is used for prognosis. Thus, the AFC is used in conjunction with the indirect tests of ovarian reserve.
For additional information and opportunities to get involved in infertility chat rooms, visit CNY Fertility Center’s patient discussion forums for medical questions or support.

Selected References
Verkagen et al Fertil Steril 2008
Jayaprakasan, K et al. Establishing the intercycle variability of ultrasonographic predictors of ovarian reserve. Fertil Steril 2008;90:2126-2151.
Edited by JBM on 9-26-09

IVF and antral follicle count.

This information is provided for patients interested in their prognosis for infertility treatment. CNY Fertility Center in Syracuse NY, Albany, NY and Rochester, NY provide consultations, and treatments for couples trying to conceive. For a glossary of terms please refer to www.fertilitylifelines.com

The number of follicles, each containing one egg, which are available in the ovarian pool relates to the chance of success of in vitro fertilization (IVF). These numbers decline with age, and in some women decline abnormally fast. For couples who are trying to conceive and their care givers, methods of predicting the potential outcome of IVF can be important in making medical decisions.

One important tool for measuring the ovarian pool is a direct measure of the follicles as they emerge in a given month. The number of small follicles in the ovary during a menstrual period are observed using ultrasound. At this point there are no large follicles, and the pool of follicles which will emerge that month are beginning to grow. As the fluid accumulates, even a few milliliters (a teaspoonful is 5 ml) of fluid in the antral follicle can produce a measurable echo on the highly sensitive ultrasound machines used for transvaginal evaluation of the ovaries. Follicles between 2 and 5 mm can be visualized and counted. The antral follicle count (AFC) must be done when the follicles have not begun to grow. Thus it is scheduled day 2, 3 or 4 of the cycle prior to considering IUI or IVF therapy. Since there is not a huge variation from month to month, this test can give a good idea of the prognosis for the future.

secondaryFollicle-thumb.jpg

Antral Follicle from www.DKImages.com

antral healthline .com

Ultrasound image of antral follicles from www.healthline.com

Because not all of the follicles can be visualized , after stimulation by clomiphene or injectable gonadotropins, the number of follicles which eventually develop may be higher that the number of antral follicles in that particular cycle.

In a review of studies, Verkagen has concluded that the AFC is as good as any of the biochemical tests to determine ovarian reserve. In IVF treatment, if the AFC is less than 4, there is a much lower rate of successful pregnancies. Since this cut off is so low, this limits the value of the test. How high can it go? Egg donors or young infertility patients might have an antral follicle count of 17 or more. The typical mid-30 year old infertility patient will have 5-10 antral follicles. Sometimes in women with low ovarian reserve it is tempting to try to find a cycle with more antral follicles in order to get a slightly better result. However there is low variability of the AFC from month to month (Jayaprakasan 2008) so waiting for another month is not likely to change much.

More indirect biomarkers of ovarian reserve include serum FSH, day 3 estradiol levels, inhibin B and anti-Mullarian hormone. These tests of ovarian reserve are covered in the section on IVF prognosis on this web site. In practice all available information is used for prognosis. Thus, the AFC is used in conjunction with the indirect tests of ovarian reserve.

For additional information and opportunities to get involved in infertility chat rooms, visit CNY Fertility Center’s patient discussion forums for medical questions or support.

Selected References

Verkagen et al Fertil Steril 2008

Jayaprakasan, K et al. Establishing the intercycle variability of ultrasonographic predictors of ovarian reserve. Fertil Steril 2008;90:2126-2151.

Edited by JBM on 9-26-09