photo of gynecologist sitting near medical equipment

Many of you are new to IVF, about to begin your cycle, or here to get some insight into what your friends or family are going through (some of you are my friends and family – probably many actually). There is so much you are left in the dark about on this adventure. One of those things is monitoring appointments. I’m going to break it down, since mine have begun again. (I said this post would be about supplements, but that will come next because I have some updates I want to share instead.

When you go an IVF cycle, as you may know by now, Wanda becomes your friend (as in the intravaginal ultrasound wand). What people don’t always know is how often you go, what happens when you get there, and the etiquette around being in your birthday suit in a doctors office.

Today was my first monitoring appointment for cycle 3. I am at my new clinic so things are a little different, so I thought I’d share.

So far in cycle 3, I have felt a LOT of different things physically. On about day 3 of stims (I am now on day 8), I started feeling a lot of ‘movement’ in my ovaries. When I say movement, some people may have not felt this sensation before, but since my very first miscarriage, I have always felt my ovaries doing every little thing. During a normal unmedicated cycle, during IVF especially, and as the follicles grow I can feel them almost pulsating in my abdomen. It’s super bizarre. It’s like a pressure and a twinge all at once.

So the movement began. I also started getting beyond exhausted from just about nothing at all, and any sort of sudden movement or compression/twisting of my torso felt super uncomfortable. This is perfectly normal, and the clinics generally ask that you avoid any strenuous activity during stims as a result. Doing so can risk ovarian torsion, which I can’t attest to, but I does not sound like something I’d like to feel for myself.

The ovaries can reach sizes of 4-5 inches each when you stimulate them via IVF, which is why your stomach expands, your bowels decide to stop working properly, and you are sometimes in discomfort as you lead up to the retrieval.

So monitoring appointment one. I went in today on day 8. I knew my body was responding to the meds simply from how I was feeling, but you go into these appointments so blindly regardless. It’s probably best that way, because you can speculate and fixate on so much during IVF. The appointments are always super early, and today on a Saturday it was at 8am. I am NOT a morning person, so these are always painful for me.

I arrived, got called into the changing area (at my clinic it is separate from the ultrasound room), and then once I was ready got called into the monitoring room. When you do these monitoring appointments you have to undress from the waist down, and a sheet is provided to cover up with, as well as booties at this clinic so you aren’t walking around in bare feet. I laid down on a bed next to the ultrasound machine, like any other ultrasound. The only difference is the stirrups you use, and well – you can picture the rest. Hello Wanda my old friend.

At this clinic I like it a lot because they don’t keep you in the dark about what is happening and what everything looks like. There’s a giant TV on the wall and you can observe exactly what the doctor is doing as they measure your follicles. Here’s what the screen might look like:

Follicles during IVF Monitoring Ultrasound

Each of those big black orbs are follicles, and in those follicles is where your eggs hopefully reside and grow. At each monitoring appointment they take precise measurements of each follicle. Sometimes clinics will do a preliminary count of these before you begin stims. Some don’t. Mine did not.

Today things looked really really good. We found a similar number of follicles to what I am used to getting, around 16 this time (normally I have had 14, but it’s possible some duplicates exist in there due to the challenges of identifying the individual ones. The doctor measured them as I watched.

In IVF it’s imperative that you don’t develop a ‘lead’ follicle. During a regular cycle outside of IVF, your body produces many follicles, but the largest wins. The rest don’t stand a chance, and the largest becomes the egg that gets released that cycle. The rest of the follicles change after ovulation to produce hormones to support a potential pregnancy. When we do IVF, we want all of the follicles to grow at a similar rate for ideal retrieval of similarly sized mature eggs. Usually one tries to take over but certain meds keep them growing steadily. Sometimes it takes a few tries to avoid a lead follicle. In the past, my lead follicles haven’t jumped too far ahead and haven’t hindered the overall collection of eggs. But what they can do is hinder egg quality. So slow and steady wins the race with IVF.

Today on day 8 of stims my follicle count was 16, and my follicles ranged in these sizes (in mm): 14, 13, 13, 13, 11, 11, 10, 10, 10, 9, 9, 9, 9, 8, 8, 8

In previous cycles by now I have had follicles 16-18mm with others as low as 5-6mm. My doctor seemed super pleased with this result today, as it showed I am responding to the meds in the way he had hoped, and they are slow and steady. Our hope is that keeping things even keel will help in our egg quality.

When I go in for these appointments I try to remind myself to hold back on talking too much during the measurements, because I can imagine keeping track of all the follicles – if you have more than a few growing (and it’s not always a numbers game, sometimes fewer follicles and eggs is better for quality) – can be frustrating for the doctors and nurses. Our doctor luckily gives us the time and space to ask questions once we finish up.

I got dressed and picked up my additional meds at the dispensary within the clinic. Ours dispenses enough medications for 9 days of stims, then goes from there day by day so you don’t over purchase medications. They aren’t cheap, averaging about $700+ Canadian Dollars a day (and of course most insurance does not cover fertility meds).

I skipped back to my car, happy that the different meds and protocol still yielded some good looking follicles. So much is still unknown, and that’s the hardest part of the journey. Whether they will continue to grow on track, whether they will be mature once retrieved, whether they will fertilize and whether they will reach blastocyst stage. Each step gets you closer to your baby, but the waits feel excruciating and the lack of control can be discouraging.

I head back on Monday for my next monitoring appointment, usually spaced just 1-2 days apart in case any big jumps in growth occur. Fingers crossed we stay on course!

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