Getting closer

So we have been moving forward with getting all our ducks lined up for the cycle we want to do this fall.  We have all our bloodwork done.  We just needed to get hubby's semen analysis done and have my uterus looked at.

Hubby did his analysis a couple weeks ago.  We had them freeze a sample in case there is nothing on retrieval day or if hubby cannot come with me for some reason.  His count and motility came back slightly lower than normal, but his morphology was 0%.  This is pretty much the same as last time.  Good thing is that he has "homies".  They are just shaped in such a way that would require ICSI (intracytoplasmic sperm injection - where they inject a sperm in to one of my eggs and see if the sperm fertilizes the egg).  The bad morph number doesn't mean his sperm are carrying defective genetic material - it just means that they cannot effectively penetrate the eggs' shell in order to fertilize it.  Because we are doing ICSI, this in essence increases our chances of conceiving a boy since the sperm are hand picked by the embryologist.  The male sperm tend to be the fastest, most progressive sperm but die sooner while the female sperm tend to be slower but live the longest.  During ICSI, the embryologist chooses the healthiest sperm which tend to be faster, robust sperm (the males).  Of course there are plenty of female ICSI babies too - it's just that there is an increase in male babies.  

I went up to visit my RE this past Monday and had my uterus and ovaries looked at.  I had the hysteroscopy and an ultrasound to look at the ovaries.  Originally I had thought I was going to have an HSG, but I guess not.  I get them mixed up sometimes.  It was laughable how painless it was this time!  They asked me right before the procedure whether my son was delivered vaginally or via c-section.  After I said 'vaginally and he had a big head', they ensured me that the procedure would not hurt one bit.  They were right.  It just felt like a pap smear - slightly uncomfortable, some pressure and faint cramping, but that was it.  They looked around my uterus and saw that everything was normal - no polyps, fibroids, etc.  Then they looked at my ovaries.  They looked good.  They counted the number of antral follicles as well.  This gives the AFC number (antral follicle count).  3 years ago I had 20-22.  But now, I only have 11.  I'm slightly worried about this, but trust my doctor.  This just means that my response might be a bit sluggish and I might not produce as many eggs as last time.  However, since my other levels are all fine, the doc doesn't have concerns and is keeping me on the same protocol.  The silver lining I guess is that I might not become over-stimulated as easily this time which may mean that I can have an HCG trigger and won't have to be on PIO for 16 weeks (or however long it was - I have blocked that out from my memory:)).  It is strange that I have a normal AMH level but a slightly low AFC.  Usually the AMH and AFC are in sync with each other as they are both considered to be a measure of the ovarian egg volume.  I did some googling of course after getting my AFC count and found this interesting link: http://www.posters2view.eu/eshre2014/data/500.pdf
It is a study of the outcome of IVF cycles where women had either low AFC and normal AMH or had normal AFC and low AMH.  Seems like it is not so bad to have what I have - but a bit worse to have the opposite.  At least I don't have both.  Then I would be diagnosed with "Diminished Ovarian Reserve" (DOR).  For now, I'm reading up on it but I'm not too worried about it.  The AFC number is also somewhat objective and no two ultrasound techs will count the same number.  At my clinic a good range of AFCs fall between 14-21.  Mine falls in the somewhat reduced range between 9-13.  During stims, other follicles tend to pop up as well.  So we'll just have to see what happens.

I also sat down with the nurse and got more of an idea regarding dates.  I am to call them on day 1 of my next period (should be mid-September).  Then I will go on birth control for ~2 weeks.  They will have me go off of it around 10/1, have a bleed, and then start stims a couple days after for an egg retrieval somewhere around the week of Oct 11th.  The goal is to have enough embryos make it to day 5.  Then if we have enough, they will do PGS (preimplantation genetic screening) and freeze the embryos.  I think it takes 2 weeks to find out the results.  This is testing for chromosomal abnormalities so we don't transfer embryos that might result in a miscarriage or a baby with a defect.  I think it would determine gender too but not sure if we will do that.  So if we have normal embryos, we will wait until mid-November and do a frozen embryo transfer (FET).  If we do not have normal embryos then sadly the cycle was a bust, but at least we don't go thru the embryo transfer and 2 week wait only to end up with a BFN or m/c.  If we do not have enough embryos on day 5 though, then we will just go straight to embryo transfer and see what happens.  The good thing about doing PGS/FET is that we would only transfer a single embryo since we would know that it is genetically normal.  Whereas with the fresh IVF cycle we would probably want to do 2 just in case 1 is abnormal.

Anyway, things are really starting to get close.  I'm still undecided on whether or not I want to do acupuncture.  It is relaxing and studies have been done that shows that it helps.  But it is just so dang expensive and things are pretty hectic at work right now.  So we'll see.  But less than a month from now, I will likely be shooting up again!  Oh the joys of IVF!!