# My IVF EXPERIENCE



## Mimi37 (Apr 1, 2013)

Salut a tous,

One week ago I undertook an OVARIAN RESERVE TEST (ORT) at CRGH London. This is a combination of blood test (E2 - estradiol, FSH - follicle stimulating hormone and  AMH - anti-mullerian hormone test) and a transvaginal ovarian ultrasound (AFT/AFC- antra follicle test/count). ORT = a function test, used as a sensitive predictor of: ovarian reserve; your response to stimulation & can enable an individualised selection of the appropriate drug regime for treatment. The test is undertaken on Day 2/3/4. 

My result is due this afternoon, aggghhhh. Very nervous as DH sperm morphology decreased from 8% - 1% since our 2nd cycle - I am worried that my AMH may also have taken a battering since then as I am now 40!! I am due to undergo my third round of IVF & this is the first time this test has been recommended. Does anyone have experience of this test ? What were your outcomes?


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## magz1 (May 9, 2011)

hi mimi i`ve had AMH and AFC done but not the ORT test your having done, how were your results? hope they were ok for you to have another go at ivf
magz xxxxxx


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## Mimi37 (Apr 1, 2013)

Hi Magz,

There is a discrepancy between my AMH (which I am told is very good for my age - AMH  24.3 aged 40 years) & my AFT/AFC ( 8 follies on left ovary & 2 follies on the right). Accordingly,  this afternoon for repeat test as this discrepancy has left them befuddled as to what protocol is appropriate  &/or how to interpret my results !?! Has anyone had such divergent results? Anyone know what this might mean?


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## Mimi37 (Apr 1, 2013)

My results so far, are as follows:AMH: 24.3 --------- FSH: 7 ------- ACT/ACF: 8 follies on the left 9 on the right
The discrepancy referred to in my earlier message was due to a fibroid hiding part of the ovary. The repeat ACT/AFC scan was undertaken by a more experienced Dr. He manipulated  the right ovary by way of pressure: 9 (not 2) follies clearly visible.

PROBLEM!!! HELP!! In addition to my ovaries, clearly visible on the screen were not one, but 6 fibroids (begnin tumours). I now have to make a decision between:1) Egg collection (right ovary only), freeze, 2nd myomectomy  recovery, FET; or 2) Myomectomy, Egg collection, freeze, recovery, FET. Dr taken aback that two cycles were attempted with such a bulky uterus. Implantation is impossible in such circumstances. ANY THOUGHTS??


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## fififi (Mar 16, 2011)

mimi - firstly you've great hormone levels so am most jealous  
Not been in your situation but if I was I think your second option makes more sense as if you have the fibroids removed first then you can have EC on both ovaries and maximise your egg chances even more. That way you may even have enough to freeze for a back up cycle / siblings     in future.

Whatever you decide I'm sure it'll be a lot more promising than previous cycles where there was no space for implantation. Lots of luck and babydust


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## Mimi37 (Apr 1, 2013)

Hi Fififi, Love the babydust!!!!!! Thank you ever so much.

MYOMECTOMY My head says you are right option two, however, this being my 2nd myomectomy, there is an increased risk of a hysterectomy, my heart is saying, I'd love the privilege of carrying my own baby. God willing! So part of me wants the world to stop or the chance to look into the crystal ball just far  & long enough to see myself in the post operative recovery room. 1st myomectomy, hysterectomy negligible  - 2nd myomectomy slightly increased chance. Had they said 50/50 - for me that would be a NO!!!

Ordinarily I am definite in my approach to life, however, since I stepped into the 'infertile world' I procrastinate, avoid ladders/black cats (my neighbours black cat tortures me every morning in my back garden) wish I had the skill to read tea leaves ........ You get the picture!


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## fififi (Mar 16, 2011)

That does complicate things then. Poor you, I don't envy having to make choice when really and truly your preferred option is just get pg!
With that risk I think I'd probably err on edge of caution and have EC first so that there's definitely some eggs should the worst happen. But I'm not a good one for risk taking. Do wish that someone had a crystal ball as it's so hard making decisions based on possibilities rather than facts.

Have clinic given you any statistics as to how likely you are to be in position where they have to do hysterectomy? Do hope it doesn't come to that    

As for the loss of decision making ability and sudden belief in all things unlucky that must obviously be an little mentioned side effect of TX  I too suffer from this condition - though it's single magpies that plague my life rather than back cats!

Sorry I've not really been any help in the end. But I will be wishing you even more baby dust and hoping that whatever option you go for a short while after you've a big grin when you get that BFP


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## Mimi37 (Apr 1, 2013)

Hi Fififi,

Thank you for replying. On the contrary, you have helped. Just having someone else apply mind to matter, identify the challenge and give a view, is comforting! My husband and I will spend the weekend mulling over the decision. Isn't that the funny thing about infertility, swings and round arbouts. We all have a deficit. I may well have 'good hormone levels', however, my womb is what one may refer to as 'challenged'.

I have just received a further result: ........E2 - estradoil 287. That sounds high to me. The nurse would not give a view. I have to make an appointment to speak to the Dr about it ( a further £200). [ initial consultation £200, ORT £400]. Whilst I am waiting for my follow up, Does anyone know whether my E2 result is within normal bounds?


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## fififi (Mar 16, 2011)

The E2 is high I'm afraid. I'm seeing someone at end of April cos mines high at 155 - it should be below 75. On ipad now but when on laptop at weekend I'll send you link to info about levels. Just had mine all redone this month.

Hope you make a decision you're comfortable with


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## Mimi37 (Apr 1, 2013)

Hi I am confused. Dr  said my results are very good. 'An E2 result below 300 is good' were his exact words?? HELP Is it right that different clinics have different measures for E2?


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## fififi (Mar 16, 2011)

There may well be different scales used as remember when trying to find out what my level meant when I initially googled it that US websites had very different numbers for E2

Hope I've not worried you - am sure your consultant knows better than me. My info is only based on Google searches as my results came via GP who wasn't able to interpret the results. So I suggest ignoring my previous post.

Ps. Can't believe how cheeky your clinic is charging for an appointment to discuss results from test that's already expensive. Will your surgery be able to be done via NHS?


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## Mimi37 (Apr 1, 2013)

Dear Fififi,

Absolutely no no no you have not caused me any worry. Input is exactly what I was hoping for. The confusion is not caused by you. I too had been on websites and seen 75 as a 'cut off', accordingly I posed the question is my 287 too high. I  have not discussed with Consultant yet. junior Dr's did not feel that the  287 E2 skewed my ORT 

The ' optimal  scales' he gave me were as follows: FSH - below 10 - AMH - 10 is good, above 15 is excellent  - E2 - below 300 (I think below 30 is peri/menopausal ) - ACF/ACT - at least five follies on each ovary - Any information on scales would be most welcome ?Thankfully yes, I am on the NHS waiting list for my myomectomy.


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## fififi (Mar 16, 2011)

What day was your E2 tested on? That makes big difference. The standard info about below 75 is based on day 3 testing I think.

Glad you can at least have myomectomy on NHS. Will you get choice over surgeon? Don't know set up of your clinic but at mine most of the consultants work for NHS too so when I had my laproscopy & hysteroscopy in Feb I was able to have my consultant put me on his NHS list.

Enjoy sunshine today x


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## Mimi37 (Apr 1, 2013)

Dear Fififi,

I was indoors at a meeting all day, having just surfaced I was drenched in the space of two minutes, rain not sunshine for me   My E2 was a - Day 2 result. I dare say it makes little difference to a day 3 .


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## Mimi37 (Apr 1, 2013)

FIBROIDS DECISION:     Dr's view, myomectomy first. DH & I reluctantly concur.

MYOMECTOMY:  right ovary ( which is the only one accessible) was partially obscured by a fibroid during my initial ORT ( left ovary 8 follies, inaccessible due to fibroid - right ovary accessible only 2 of what turned out to be 9 follies observable due to fibroid obscuring).        there are three ways fibroids can be removed 1) keyhole surgery 2) through the vagina or 3) open surgery

FIBROIDS (   (leiomyoma/begnin tumours - 1) intramural - in the muscle lining of the uterus 2) subserosal - under the mucosal surface of the uterus can become pedunculated/on stalks and then twist degenerate and detatch from the uterus 3) submucosal - in the muscle beneath the endometrium 4) cervical - in the wall of the cervix* *** SYMPTOMS:    heavy periods, extreme abdominal pain, painful sexual intercourse, urinary frequency & urgency, impede implantation, failed/impaired egg collection due to lack of access - alternatively no effects what so ever ) Two very useful articles.   Source " DAILY MAIL". Yes I hear the collective groan, however, Google:" FIBROIDS, WHO IS THE SAFEST PAIR OF HANDS?"  & "IT TOOK JUST A WAVE OF A WAND". 

(hours of surgery, one week hospital, one month recovery- 1st time round for me). My current 6 fibroids have resulted in extreme pain, implantation failure & bilateral hydronephrosis. My first myo was undertaken at HAMPSTEAD Royal Free London Ms Reed, an excellent surgeon (unfortunately she is now a professor, specialises in the Vulva).  NB: fibroids can, very rarely be cancerous - leiomyosarcoma


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## Mimi37 (Apr 1, 2013)

Hi FiFifi,

Finally spoke to my Consultant. Yes Clinics do have different ESTRADOIL measures. Some measure E2-Estradoil in pmol/L= picomole/litre , others measure E2 in pg/mL= picogram/millilitre ( one should divide ones pmol result by 3.67 in order to get the correct pg/ml.) My E2 result is: 287 pmol/L= 78pg/mL - so only slightly higher than the  75 "cut off", noted in those tables I was looking at. Can you post the link to the table you were talking about. I am interested to see if the 75 cut off in your table is pmol/L or pg/mL.


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## fififi (Mar 16, 2011)

Mimi - so pleased you discovered that as I was getting really worried about my level (thinking perhaps I had a cyst growing due to DHEA I'm taking and fact I suffer with endo) and now had closer look at my results and delighted to see they're within limits after all   (Now I've just got to improve my progesterone levels!!!)

That's good news for you too - especially as these numbers can vary quite a bit month by month

The website I'd seen does measure in pg/ml so the magical 75 is based on a different measurement scale http://www.fertilityplus.com/faq/hormonelevels.html

Lots of relief all round    & you should be fantastically happy that your hormone levels are pretty much those of a much younger lady - wahooo.

Glad you were able to make decision re myomectomy (even if reluctant one) - hope you are able to sort out where to have the treatment soon. Good luck 

/links


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## Mimi37 (Apr 1, 2013)

Enormous relief all round.   .

OHSS      
Another matter resolved following the conversation with my Consultant: OHSS ( ovarian hyper stimulation syndrome).    = a potentially serious complication of fertility treatment especially  IVF.
A) MILD OHSS - mild abdominal swelling or bloating, abdominal discomfort and nausea
B) MODERATE OHSS - symptoms of mild ohss but the swelling or bloating is worse because fluid is building up in the abdomen, abdominal pain & vomiting
C) SeVERE OHSS: symptoms of moderate plus extreme thirst and dehydration, passing very little urine dark in colour,  difficulty breathing, red hot swollen tender leg or lungs. Blood clot. Hospitalisation. To drain the fluid.

As you can see from my signature, my first cycle I had suspected OHSS, the second moderate/severe OHSS. The symptoms included : rapid & dramatic weight gain, gross abdominal swelling (I looked 9 months pregnant)loose stool, difficulty in walking and breathing...     CAUSATION:  Fertility drugs stimulate the ovaries to produce many egg sacs (follies) . Sometimes there is an excessive response to these drugs which causes  OHSS. Overstimulated ovaries release chemicals into the blood stream that make blood vessels leak fluid into the body. Fluid leaks into the abdomen, in severe cases into the space around the heart & lungs. OHSS can affect kidney liver and lungs. A serious but rare case results in a blood clot. A small number of deaths have been reported. 

According to my consultant, the protocol he will prescribe (see pg 4) will specifically target the deficiencies in my previous cycles, such as OHSS. In particular the ovitrelle trigger has been replaced by a superfact subcutaneous injection. I am told that Ovitrelle can trigger OHSS particularly in those with a high AMH.


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## fififi (Mar 16, 2011)

That must be reassuring for you. Now to just sort out your op.
Lots of luck x


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## Mimi37 (Apr 1, 2013)

NHS waiting lists -surgery must take place within six months?  Im told the 6 month dead line runs from the date the surgeon makes the decision to operate & places you on the waiting list = Date of clinical decision. Which means referral, plus wait for consultation, plus investigation, plus clinical decision , then 6 months start ticking. The total can take a year. Mmmmmmm I have made it clear that  I am willing to step into any cancellation. PRAYERS NEEDED PRETTY PLEASE!!!!


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## Mimi37 (Apr 1, 2013)

OMG, Major surgery tomorrow!!!! A cancellation came up today. Please pray for me.


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## fififi (Mar 16, 2011)

Will be thinking of you - hope all goes to plan


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## Mimi37 (Apr 1, 2013)

God is Great!!!!Hours of surgery later, Eleven, yes you read right 11, tumours removed!!!!!! Back home safe & sound!!!!!!! FiFifi , thank you for th prayers/thoughts!!!!!!!!!!!! More news tmrw, I am shattered!!!


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## fififi (Mar 16, 2011)

Oh my, that sounds like pretty major surgery. Hope you aren't in too much pain


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## Me Myself and I (Dec 30, 2012)

Mimi73 said:


> Hi
> 
> I am confused.
> 
> ...


Good question.

I also had mine taken on day 3and was told it was high in the 400s. Yet have just received info that states:
follicular: 46-607
mid-cycle 315-1828
luteal: 161-774
Post-meno <201

Reading this, the level is within range, yet cons has suggested cysts/pcos.

Can anyone else shed any light?


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## Mimi37 (Apr 1, 2013)

Me Myself & I, there is a useful link provided on the previous page of this thread that will answer your question.

God Bless Mr Bell (Consultant - anaesthesiologist) who put me at ease before my surgery

Womb, ovaries, tubes all intact. I'm walking, eating,(tentatively)  bladder working, bowel lazy, Still bleeding (though i am told that is ok). The pain , well that is another story. No zoladex/chemo, no blood transfusion. No hysterectomy, the one thing that was haunting me! My husband & I sat down to dinner last night. I burst into tears, overwhelmed by it all!


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## Mimi37 (Apr 1, 2013)

Not such good news  The left side swelling is a pool of fluid in the abdomen. Post operative debris they think. Breeding ground for infections. I'd been having night sweats, pain such that sleeping on my left side was impossible. Tender to the touch. 11cm in length & 3.5cm in depth.I was hospitalised, placed on an antibiotic drip for 24hrs. Discharged with a one week course of medication  Two weeks to dissipate, if not, I notify the hospital. They Opted not to drain via a needle nor to open me up again. The plan is to allow plan A= antibiotics do its worst.   

Female registra  was so rude, pre scan she had already judged me as a time waster, questioned why I was admitted. i didnt admit myself, that was a clinical decision following triage & examination by both a Dr & Consultant. only to find that I wasn't imagining there was a problem with the left side. Irony, the male Dr's were thorough and professional. Dr Micheal Wong a total rock star, he could not have been more reassuring. I'd trust him with my life. As for the woman ......


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## fififi (Mar 16, 2011)

Mimi - all sounds very painful. Do hope medication acts fast for you. Never understood attitude of many staff at hospitals who lack of people skills is so extreme.
Thinking of you


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## Mimi37 (Apr 1, 2013)

Oats, who knew. 
Altered my diet to start the day with oats, bowel is finally moving without senna or lactulose. Not back to normal, but moving. The relief, I can't explain. Basic bodily functions , bring such joy. sad very sad. Walking with more confidence & increase in distance. Still can't run for the bus like I used or go on 2 hour treks yet, but progress 

.Still no resolution to delays (2nd BFN June '12, referred to hospitals gynea department Sep'12 - myomectomy May '13). My follow up appointment was due 6/8 weeks after surgery which would be end of June, instead I've been given end of July. IVF on hold until go ahead from surgeons. 

Anyone know how soon after surgery one can use Bio-oil?


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## Mimi37 (Apr 1, 2013)

Hoping to progress to IVF in August. 

Considering paying for  "TIME LAPSE EMBRYO MoNIORING"  to assist in selection of the embryo most likely to implant.

In the press ( Telegraph, BBC, Daily Mail) time lapse embryo monitoring is being heralded as a "new" technique, the greatest IVF break through in 35 years, which "could" triple ones chances of a successful IVF outcome. There are at least two methods of time lapse monitoring currently available in the Uk, namely EEVA (available since 2012) & EMBRYOSCOPE (available since 2011). What is the difference between the two, which is better? The two seem to be the same, to me? I'm just a philistine !

EEVA or EMBRYOSCOPE  are available at:

Auxogyn & Hweitt Fertility Centre - Eeva
CRGH London - Embryoscope 
CRM London - Eeva
CRM Glasgow - Eeva
CRGW Wales - Embryoscope
Liverpool Women's Hospital - Eeva
Care Fertility Manchester -Embryoscope?
PFC - Embryoscope 
Kings, Bourne Hall Wessex - Eeva
Southampton - Embryoscope
iVF Hammersmith - Embryoscope
Oxford Fertility Clinic - Embryoscope
The Bridge Centre - Embryoscope

(That's my research on the net, let me know if I've got any of the above wrong )
Guys & St Thomas' - Embryoscope

ARGC - DOES NOT OFFER EITHER - Does anyone know why??


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## fififi (Mar 16, 2011)

Mimi - glad you seem to be recovering now & hope you are able to have next tx in August.

My clinic now offer the service you talked about although at present they are reseaching it's usefulness  

Here's their summary of the differences:
Embryos grow slowly and the technology is perfect to observe them in a laboratory environment over two to five days. After much research into the various time-lapse systems currently available including the Embryoscope, we chose the PRIMO VISION TIME-LAPSE EMBRYO MONITORING SYSTEM because unlike Embryoscope it allows us to monitor embryos within our current culture system. This means we are still able to use our own incubators, which have given us such high success rates for the last few years. The camera sits inside the incubator and the embryos are not moved until absolutely required as part of your treatment. Clear images of the embryos are obtained with minimum light exposure. 
In contrast to other time-lapse systems, the dishes used to culture the embryos with the Primo Vision system are specifically designed to enable the individual identification of each embryo whilst still supporting group culture of all embryos. Nurture Fertility feel that group embryo culture is the best way to look after your embryos. There is good evidence that embryos develop better when grown together. Primo Vision allows us to culture up to 16 embryos at any one time which is not possible with the Embryoscope system.
It is important to stress that time-lapse monitoring is not a proven treatment and the benefits are still to be determined. The recent media coverage related to one study that involved a very small number of patients 69 in total and only 88 embryos.


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## Mimi37 (Apr 1, 2013)

The roller coaster ride goes on, In hospital again today, it turns out I have three pieces of bad news:

1) A pool of blood is sitting above the womb

2) Contrary to what I was told at UCH they did not remove all the tumours during my myomectomy in May. A few were clearly visible on the scan today.

3) My right ovary is now inaccessible. It's been pushed high up, such that it will be of no use, egg collection wise. Prior to the operation it was the left side that was problematic (large mass that was so troublesome has been removed).
Anything to cheer me up!!! Any one, any advice?


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## fififi (Mar 16, 2011)

Sorry to see you've yet more bad news - hope life smiles on you soon as you certainly have been through mill of late


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## Mimi37 (Apr 1, 2013)

Thankyou FiFifi,

Laparoscopic surgery is on the cards if the fertility consultant declines to undertake IVF with this 'little puddle' in situ. Chum invited me to rest  prior to Augusts Fertility appointment.


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## Mimi37 (Apr 1, 2013)

ASDA v Homecare 

DRUG                  QUANTITY      ASDA      HOMECARE.          ALCURA

Primolut 5mg            (30).            £2.26.        - £ 15.00
Merrional 75iu              (9).        £279.00.      - £207.00.      £288.81 (£32.09 each)
Doxycycline 100mg      (.            £0.42.      - £.  1.50
Gonal F 450IU              (3).        £423.00.    - £435.00
Zomacton. 4mg            (5).        £398.45.    - £650.00.    £398.45 (79.69 each)
Cetrotide. 0.25mg          (6).        £135.66.    - £138.00
Superfact inject.0.5mg    (1).        £28.64.    - £. 42.00
Deximethasone. 0.5mg  (2.        £39.43.    - £.  60.00

TOTAL:                                      £1306.86    -£1,548.50

ALCRA 01420543400


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## Mimi37 (Apr 1, 2013)

The wonderer returns!!

Six months post myomectomy, first attempt at IVF (three months later than predicted by gyny). Has anyone had high E2 blood results during IVF stimulation?

1st E2 result (after three days of stims): 2185
2nd E2 result (after four days of stims): 3400
3rd E2 result  (after five days of stims):4709
4th E2 result (after six days of stims ): 6740
5th E2 result (after seven days of stims): 7996
6th E2result (after eight days of stims): 13,432 aaaaaaaagggggggghhhhhhhh!!!!!

1st scan result 12 follies all small save for two at 10mm & 9mm
2nd Scan results: 7 follies on the left 10-14 mm 6 follies on the right 10-14mm (several smaller follies)
3rd scan result : follies now measure between 12-18 mm (aggggghhhhhhhhh, it's becoming more real!!!!!!)

Am I on track for my third bout of OHSS ?? What is the impact of these awfully high results? I read an article 150-500 = an acceptable E2 result for Day 8. Maximum4000 in a cycle. Another article says 200-600 per mature follie (18mm). Anyone know what the acceptable scale is


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## Mimi37 (Apr 1, 2013)

10 eggs, 7 fertilised!!!


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## fififi (Mar 16, 2011)

Great news - hope it all continues to go well for you


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## Mimi37 (Apr 1, 2013)

*Fifi*: Thankyou! How is your treatment progressing ? Donor selected or are you still hoping for a natural miracle?

ET today. Two grade 6bb+ hatching blasts on board. Two grade 6bb- hatching blasts frozen. Three embbies in the lab overnight.  

ET from hell, it was almost abandoned. Very traumatic , accordingly, only cautiously optimistic


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## fififi (Mar 16, 2011)

Sounds like you've good embies on board - just a shame ET was so horrible. Hope you are not in pain from ET and are able to start feeling positive soon. To have some frosties too sounds great            

AFM - well was matched & all set to go in Sept but then my body went nuts (delayed AF) and ended up too far behind donor so clinic pulled me out. Got matched again & should have started this month but new donor changed mind last week and wants to wait until after Xmas now. So feeling pretty frustrated.
Just hoping all these delays are for a reason


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## Mimi37 (Apr 1, 2013)

*Fififi*: Sorry to hear about the delays. However, on a positive side, everything in its time. A stress free Xmas lies ahead for you.More time to get your body into better shape. If intralipids have been prescribed, t'is highly recommend doing exercise and shedding a few pounds in advance of your ET.


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