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Hi Dr. Smith,
Here are my questions. At what size and E2 levels do you think is a good time to trigger? Eggs vary in size, but the largest one is approx 18-19. Also, how many days would you say is too long to be on stims and what may be the outcome of stimming for 13 days?
2nd question, I know your viewpoint on D5 transfers, my lab is willing to do a 5 day, although their standard of practice is a 3 day. I myself am nervous to do a day 5, I dont make many eggs-considered a "poor responder" and am concerned that I'll have nothing ever to transfer. How often does that happen? And a lab that usually does 3 days are they well equipted to do a 5 day?
I appreciate you taking the time to answer all these questions the way you do. It means a lot when you take the time to explain, educate and empower us to be our own advocates with your knowledge....
Carrie
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The general rule of thumb is around 200 pg/ml for each mature follicle (>16mm). As a matter of terminaology, it is the follicles containing the eggs that are visable on ultrasound, not the actual eggs The human egg measures about 130 micrometers in diameter and is invisable on ultrasound and to the naked eye.
The ideal stimulation length is 8-10 days. Some people take longer. Taking longer is better than shorter. It is not unusual for "poor responders" to take longer to reach follicular maturity. Don't wory too much about it.
In our patient population, about 5% do not make it to transfer. These patients are usually 38+ with fewer than 6 follicles. Keep in mind, if there are no embryos for transfer on Day 5, there wouldn't have been a pregnancy anyway. Would you rather get the news at the time of the scheduled transfer or after 14 days of progesterone shots and waiting on pins and needles (no pun intended)?
Most labs have the capacity to grow embryos to the blastocyst stage because many programs wait until the blastocyst stage for freezing. If they are willing to go to Day 5, go for it.
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