The word from the Doc

*Alert*  This post talks in detail about my lady bits. I am posting it on the web for all to read but if you are uncomfortable with the biology of the human body then read no further.

The doctor I am seeing at Iscare is named Jaroslav Hulvert. He is the director of the clinic. His son, Jan (pronounced Yan - and the most popular boy name in Czech), also works for Iscare and he picked us up yesterday for our first appointment. Normally we would see Jaroslav at the main clinic (first name basis - Jan explained that you don't call your doctor Dr. So and so because you are already at the doctors office so why would you need to call the doctor Dr. So and so as you already know that he is a doctor - interesting!) but instead we saw him at his private office. Jan explained that there was construction to his office building so they moved him to an older building. As we walk down the dimly lit yellow hallway, we arrive at a door and Jan knocks. Jaroslav (which I have no idea how to pronounce) answers the door and smiles big and says, "Sorry I am not in white!" He is wearing a lime green polo shirt and black pants. The room has a desk and a table with an ultrasound machine that appears ready for me to hop up and put my legs in the stirrups (they are a bit different than the ones in the US).

We all sit at the table and talked for a bit. Jaroslav speaks english but his son is there to help when Jaroslav couldn't think of the english translation. After he looks over my chart again he says that he wants to see the anatomy of my uterus and cervix for himself. Jan leaves and Jaroslav says I can remove my bottoms behind the folding divider. I awkwardly remove my bottoms and hop up on the table. As you ladies know, we usually have something to cover ourselves in order to hold on to our modest notions. This was not the case. Naked from the waist down the doctor proceeds to start his examination - I have to say his bedside manor was superb and I totally felt comfortable. He examined my cervix and exclaimed with joy how beautiful it was  and discussed the consistency of my cervical mucous. He was very pleased. Then he performed a vaginal ultrasound. He was also ecstatic with the endometrial lining of my uterus. He then examined my ovaries and asked me what I saw on the monitor. And to his delight, I say that I see a follicle. I had one 19mm follicle on my right ovary that was in prime condition and he said I should ovulate soon (18-24mm is the ideal size for a healthy follicle). After, the exam was over and he said I could go clean up and then we would talk about our plan. As different as it was to an examination in the US, I felt pleased as he was pleased with his findings and had hope. Throughout the whole process he was very professional.

We all gathered around his desk and after a bit of conversation he suggested that we try a natural cycle this month as I am in the perfect spot in my cycle for it. He said that if it worked it would save us a lot of money. A natural cycle in IVF terms means that I allow my follicles to grow normally (versus stimulation medications) and then they extract the follicle and fertilize it and then implant it back into my uterus. Last night I gave myself a trigger shot to induce ovulation and the extraction happens 36 hours after the shot. That means that tomorrow morning at 7:30 am (12:30 am Colorado time) I will undergo the egg retrieval. Here is the process:

• A needle is passed through the top of the vagina under ultrasound guidance to get to the ovary and follicles.
• The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary.
• The oocyte-cumulus complex is pulled from the follicle wall when we aspirate the fluid through the needle.

Usually this happens under anesthesia, but as I only have one follicle it should be fast so I will be awake for the whole process. (OUCH!) A variety of situations could happen. First, they could discover I have already ovulated and there is no follicle to extract. In that case, we go home and start a medicated cycle on day 2 of my next cycle. Or they could extract the follicle and fertilize it, only to discover that it is not a viable egg. But if it is viable, then they will implant the egg and either I will be pregnant or it will not implant. If it does not implant then we go onto the medicated cycle. 

Our sleep has been all over the place and I am a bit nervous that I will not fall asleep again tonight until 4 am. Send us good thoughts for a restful night of sleep and a successful egg retrieval in the morning.  Off to bed we go (it is almost 10 pm here)

The trigger shot. Not many other photos I could take regarding this post!!!