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Mbre - January 24th, 2008 10:08 PM

hi Dr. Jacobs,

so i guess i have some good news, even after my day 3 u/s with only 8 antral follies in ovaries ( i am 27) re didnt think id make more than 7, and normal bloodowork, i am pleased to let you know i produced 13 follicules,
my protocol was
bcp 12/18-1/5
lupron 1/5-1/16
gonal f 450 1/16-1/23
menopur 1/18-1/23.
On my u/s on wednesday my follies measure
1-22c
2-21cm
2-20
cm
2-19cm
1-18cm
1-17cm r>2-16cm
1-15cm
1-14cm.
I
triggered yesterday and am scheduled for a 1030am transfer. My re has put me on estrace vaginal suppositories.
My questions are
1. given my antral follicue count on day 3 of u/s wsa 13 sufficient? I know in a perfect world some1 my age should have alteast 15-20.
2. Why estrace vagina suppositories? Re said to thicken the lining, but at other docs prior to my new one i was given progesterone to thicken lining. When i asked my re why the estrace he said its to thicken the lining and i will stay on it 2 weeks into pregnancy. The only reason i question it is because I am taking it 3 x a day vaginally 2mg. and it cost 450 buks( my local pharmacy does not compound) so had to pay out of pocket. If progesterone does the same thing which i already have ordered from my local pharmacy, why am i taking estrace? i keep askin him and i can tell hes gettin offended by me questioning him but i was told from others that estrogen is used for high fsh patients(which i am fsh of 6 on day 3). But my doc insist it is almost standard in protocols. Since using it my lining has increased from 6-9 and i am to continue using it until 2 weeks into a pregnancy. Why is that? I am grateful to the protocol he gave me as i yielded a good response, so i shldnt question is judement, i just wanted to know. especially since i paid out of pocket.

Sorry for the long questions.
Mbre

B. Jacobs, M. D. - January 24th, 2008 10:15 PM

After an IVF egg retrieval, I prescribe both estrogen and progesterone to help support the uterine lining. Both hormones are important. Both are made by the cells which line the follicles. When we perform an egg retrieval, a great many of the cells which make these hormones are removed with the eggs.
Good luck.


Mbre - January 25th, 2008 12:16 PM

Thanks soooo much for the clarification, i knew i could count on you for such,!

Today I had my retrieval and RE told me they got 17 eggs when on wednesday he saw only 13 follicules and said out of 13 i will robably have 9-10 eggs.
My question is this
1. OK so i have 17 eggs retrieved, that obviously means i had more follicules, am I right? Is it normal to missed follicules?
2. Out of the 17 eggs, statistically how many will fertilize?
3. Doc asked if i wanted to perform emet(embryo marker expression test). is this necassary? i mean is it a great benefit? How do you feel about it?

B. Jacobs, M. D. - January 25th, 2008 6:07 PM

1. When hCG is given, smaller follicles have a growth spurt. Prior to hCG, there were probably follicles too small to measure and record.
2. Ferttilizatioin rate will depend on the quality of eggs and sperm. We usually see most of our eggs fertilize.
3. I do not know which test your RE wishes to perform. There are some tests being investigated, which show peomice. There is a test called CGH, which will probably lead to discarding a number of good embryos.
Good luck.


Mbre - January 26th, 2008 1:44 PM

oh ok, I gotcha now..........another question then,

OK, out of the 17 eggs only 7 were mature and out of the 7 that were mature all fertilized.
What does that mean only 7 matured? I thought that once there is a follicules they determine if there is an egg, i know not all follies have eggs. But they got 17 eggs from my follies, so what does this mature thing mean? not all eggs are mature?
In either event all 7 mature eggs fertilized, so now i am waiting for day 3 results, for a day 5 transfer.

Thx so much

B. Jacobs, M. D. - January 26th, 2008 9:06 PM

Not all the eggs are mature when we retrivs them. We cannot determine if the eggs are mature, util we actually see them after reetrieval. Follicle measurements allow us to make a good estimate as to when most of the follicles will have mature eggs.
Good luck.


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