One great thing I love about the fertility center we’re going to (and went to last time when we got pregnant with the twins) is that they do a baseline ultrasound on Cycle Day 1 or 2. This allows them to see if there are any follicles or cysts left over from the previous cycle that may interfere with the current cycle. In fact, it was their more intensive ultrasound monitoring that allowed us to figure out that Molly does indeed have a paratubal cyst on the right side that measures almost the same size as a mature follicle and could have caused us to mis-time the Clomid inseminations last go-around. I wasn’t able to attend the baseline ultrasound appointment today with Molly, but the doctor who did it was not our normal doctor, and he said he saw a cyst inside the ovary. They checked the estradiol level, just to be sure, and it came back normal, meaning most likely what he saw was actually the paratubal cyst. This is actually a relief because it means we can go ahead and proceed with this cycle, and again now we know it is there, where to look for it, and to hopefully not mistake it for an almost-mature follicle again.
They saw many very small follicles just waiting to be stimulated by the medication so we decided to follow the same plan that worked for us last time: the conservative, low-dose, slow protocol of injecting 112.5 IU of Gonal-F for 3 days, then dropping to 75 IU. Ultrasounds and the estradiol level will be used to assess response, and they will either keep the dose at 75 IU or increase it back to 112.5 IU based on the number and size of the developing follicles and the estradiol value.
As rewarding (and challenging) as twins have been, I must admit that we (and I realize I should be saying “I” here as I can only speak for myself, but Molly and I have talked about it, and she agrees) that a singleton would be nice this time. Of course, it goes without saying that we would be overjoyed with twins as well, but our goal is one. We have both close friends and family who have gotten pregnant with triplets or more and have faced the very difficult decision of reduction. My heart goes out to the families who have faced such a difficult issue, and we want to do what we can to try to prevent ourselves from ending up there. Molly and I have talked extensively about our thresholds for when we would choose to continue with the insemination and when we would opt to skip insemination and abandon the cycle altogether: going into this cycle, we would be comfortable inseminating if two follicles are present, and if there are more than two present, we will opt for follicular reduction. We didn’t even know follicular reduction was an option last time, and it is good to know that is one of the tools at our disposal should we end up with three mature follicles this time.