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Fertility Stimulation Protocol (1st RE Visit)

Various medications in pill and liquid forms

The doctors explains that once she is done with me, blood will be drawn to test for my AMH and other hormones results are due on 5/23. I was expecting this, based on my consultation with Dr. Google prior to arriving. Anti-Müllerian hormone (AMH) levels give a snapshot of ovarian supply and the test is a more accurate marker of female fertility and reproductive lifespan. Damn, science is so cool!

The docs asks if we “tried” this cycle. I told her yes (I mean we had unprotected sex) and that I had started charting. Based on the chart ovulation was around the 13/14th. Doc says I may be pregnant or may have a period. Time will tell. I'm doing cartwheels inside. Could it really be that simple??

If I am not pregnant and have my period, I am meant to call RMA on 'day 1' and then return on day 3 or cycle day 3 (CD3) for blood work. If all my levels look good from the blood work, I'll start the Letrozole.

(When she said this, I had to pick my chin up off the floor. I’m going to call into your office and tell a total stranger that I started my period?? Yes. Check. Damn, I must really want a baby.)

After getting my blood drawn, I was shuffled off to the nurse who explained my protocol to me in more detail. I would take the Letrozole for five consecutive days (CD3-7). My prescription would be 5 mg, so that would be two pills each dose. I am to take it at the exact same time each day. She recommended that I set an alarm on my iPhone.

I think it is interesting that this is called a natural cycle, even though I am being given the Letrozole to help strengthen ovulation (and possible increase the number of follicles that mature and release during the cycle). I am also prescribed Ovidrel, to help release the mature eggs. I ask the nurse why it is called a natural cycle. She explains that is natural because we'll let my body take the lead. We will follow my natural cycle as opposed to using medication, such as birth control, to alter my natural cycle.

She goes on to explain how to fill the prescription for Ovidrel. It has to be handled by a speciality pharmacy that will deliver it. It will be delivered via overnight courier in a cooler surrounded by ice and delivery of the package can only be executed if someone over the age of 21 is present to sign and receive the package. I will be injected with the Ovidrel on or about CD 12.

Must have sex within 36 hours of the Ovidrel shot. The Ovidrel is usually referred to as a trigger, because it triggers ovulation.

The timing thing has me nervous, one our schedules are a bit crazy and timed sex? That sounds SUPER ROMANTIC. I must admit this all felt very clinical. There was something almost magical about the prior pregnancy. After the shock and disbelief passed, of course. There was something so beautiful in knowing that we had created a human being. Leaving the Baby Factory I knew it was going to take more than magic to make the next one and carry it to full term. It was going to take modern medicine, magic and the hand of God to once again achieve that 1%. I just need one good egg. I have to focus on doing everything I can to make the best egg possible. (Yes, I know I was born with all the eggs I’ll ever have, but that last three months before maturation of the egg is what I am going to focus on…)

(Blood tests results from today, E2 Level 35.1; HCG Level 5.45; P4 Level: 2.4. Anything over a 5 on the hCG is considered a positive pregnancy test, but this is the last of the miscarriage passing. P4 is progesterone. It will be less than 1 once everything has passed and I'm ready to start a new cycle.)

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