IVF#4 Follicle Check #2 (day 7 stimming)

Ultrasound and Blood work this morning. Had some follicle growth to start to measure today. My lining looked excellent it had a really nice 3 stripe layer going on which was missing in my FET's. I did get concerned when they mentioned we need to keep my progesterone under 2 and if over 2 on next check on Friday they would suggest freezing embryo's and doing a FET later. I kinda looked at them and was like we can't afford to go into Jan. Only reason we are doing this IVF is cause we could get it in this year and not go into a new deduct etc. It's like I understand freezing methods are better and they also talked and came up with a better FET plan for me going without Lupron and having me cycle where I would ovulate and use more of my natural hormones instead but I need to get to transfer this cycle this month we are so tapped out right now I can't see us coming up with another $6800 and travel to go again next year. Got really worried now about this all working out for us.

*My progesterone on my other IVF's 2yrs ago first one was above 2 it was 3.30, second one was 1.72, third IVF was 2.07on trigger day.

IVF#4
Left side follicles: 13.34, 12.82, 12.08, 11.76, 11.64, 11.08 < 10mm 0 to 2  
Right side follicles: 13.94, 12.58, 12.34, 10.14 < 10mm 0 to 2

Estrogen
IVF#4 - 316.3
Progesterone
IVF#4 - 0.69

This was my follicles on Day 7 from my other 3 cycles and my blood work. Is interesting to compare them. Not sure we will get as many eggs this time around will have to see.

Follicles
On Day 7
IVF#3
L - 14.75, 12.7, 12.22, 10.54 < 10mm 3 to 4
R - 13.24, 12.94, 12.57, 12.12, 12.05, 11.98, 11.27 < 10mm 5 to 7
IVF#2
L - 15.68, 13.92, 13.88, 13.58, 13.54, 12.49 < 10mm 3 to 4
R - 15, 13.74, 12.57, 12.36 < 10mm 5 to 7
IVF#1
L - < 10mm 5 to 7
R - 10.09 < 10mm 5 to 7

Blood work Day 7 
Estrogen
IVF#3 on day 7 - 147.5
IVF#2 on day 7 - 643.4
IVF#1 on day 7 - 200.6

Prayer request is that my progesterone stays below 2 and we get to transfer day with some good embryo's.

Plan for the rest of this week's IVF is Intralipids IV on Wed. Thurs. I have a apt. with my RI Dr. Kwak-Kim for a blood flow ultrasound but the weather is not looking good for that day snow, icy mix is forecast, not sure if we will make it to my apt. which sucks as I really need to know their opinion and if the Lovenox is doing the job. Hope the weather changes so we can make the 3hr one way trip there and home safe. Friday is my apt. with my RE for follicle check again and talk about when to trigger, egg retrieval. I did ask if we where going to use Lupron or the two Ovidril shots I have and sounds like we may go with the two Ovidril will know more next apt.

Stimming is going ok. I am starting to get really sore. Every bump on the road to the RE and cough or jerk I can feel my ovaries like they are going to explode already and I still have a few more days to go. Almost forgot how this felt and the over tiredness of it all. Have not had much time to get in extra sleep with getting ready for the holidays, running HBW and doing orders and taking care of my dh from his surgery. We had his second follow up apt today and he's doing well but still a ways to go for his shoulder to heal. Need to get some rest tomorrow in between wrapping gifts and house cleaning want to finish that as I know by this weekend I won't want to move with these follicles getting larger. I am sure I will be so ready to get the eggs out by this weekend. ER is looking to be Sun or Mon estimated so far. Nervous about that part going thru it all again and feeling ok to still see family for Christmas Eve. We have not really told anyone we are doing IVF again feel like it's just better to keep it to ourselves we get to may questions etc. so hope I feel up to traveling the day after ER or not sure what we will do.

Well will update again after Intralipids. Got a movie to watch for the 2hrs of sitting there on Wed.

Continued prayers that God finally blesses us!

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*Doing some research on why progesterone levels need to be lower before trigger as this is the first I've heard of it today:

1. The progesterone level needs to be below 1.5 (1.7-2 depending on the lab) before trigger (or ovulation). When you trigger (or ovulate in the natural cycle) the corpus luteum (or the follicle in the ovary) will start to produce progesterone. This progesterone tells the uterus to get ready and within 3 days it will be ready for an embryo to implant. There is really only a small 3 or 4 day window there for the environment in the uterus to be perfect! Higher amount of progesterone exposure to the uterus too early make for an undesirable environment for embryos to implant during a fresh cycle.

2. Progesterone is the hormone that creates the chemical balance in the uterus that makes it the perfect environment for implantation. You do need progesterone, but you need it only a certain amount and certain times.

You do need progesterone, but you need it only a certain amount and certain times. It is a bit confusing to read about progesterone level on the internet, because most places are from the US where they use the old British units and the levels are totally different from the Canadian numbers , where the SI metric system used. ( 1 ng/ml =3.18 nmol/L)
This is the normal ranges:

follicular phase (before ovulation) below 5.0 nmol/l in Canada( <1.5 or 2 ng/ml US)
luteral phase (after ovulation) between 15.00 and 90.00 nmol/l inCanada ( or between 2 and 28 ng/ml in the US)
1st trimester : 30-150 nmol/l in Canada ( or 9-48 ng/ml in the US) ( Here 1st trimester really refer to the time after you have your missed period)
2nd trimester: 50-450 nmol/ l in Canada ( 47-147 ng/ml in the Us)
3rd trimester: 175- 650 nmol/ l in Canada ( 55-200 ng/ml in the US)

Practically progesterone should drop almost to close to zero when the uterine lining sheds and you get your period. On the baseline (CD3) and during the stimulation it should be below 5 ( very often US sites refer to be below 2, but because of the different units used). Normally when we ovulate a single follicle release an egg and the follicle became a so called corpus luteum, which starts to produce progesterone at that point. Progesterone level increases at a fixed level per day ~ 2-5 nmol/ l. Normally progesterone is not produced before ovulation, and this timing ensures the perfect level at the time of implantation. Around 1 week after the ovulation the progesterone level peaks, and start to drop unless implantation occurred. When it drops to a very low level as a response the uterine lining shreads and you get your period. When implantation occurs the body keeps producing progesterone. 

During IVF women often get extra progesterone support, because the stimulation can mess up things and you may or may not produce enough progesterone on your own. Usually this level won't be too high even with the added support, UNLESS you already have high level before ovulation.

Usually the too low level of progesterone is the problem. If the progesterone is not high enough the lining starts to deteriorate and the women may miscarry.

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