Hypothetical of a hypothetical

So we’re moving along with Plan D – completing our IVF homework. Here’s what I’ve accomplished in the last week:

  1. Repeated my day 3 bloodwork. This revealed virtually the same bad numbers as before. Actually, to be fair, they were a smidge better…but probably not statistically significant; FSH went from 13.7 to 13.5, E2 went from 24.6 to 27.2; AMH went from 0.17 to 0.22. More importantly, they didn’t get worse in the past 4 months, which I’ll take as good news. (Funny story about the blood draw: after so many IF-related blood draws, I decided that I was now a needle badass and would therefore watch as the phlebotomist drew my blood…naturally, that was the first time ever that someone missed the vein and had to stick me a second time! I did NOT watch the second stick. So much for being a badass.)
  2. Took blood pregnancy test. No surprises here. This test was a liability necessity before they’d do #4.
  3. Start Zithromax with C. Apparently they want to make sure neither of us has any infections prior to IVF (not sure why this isn’t required for IUI…) I’ll write about the chemistry of Zithromax below…
  4. Saline sonogram & mock transfer. Dr. Y filled my uterus with saltwater and observed it by ultrasound to make sure there were no obstructions that might pose a problem for an embryo. (Kind of like the HSG, except with saltwater in place of the dye and ultrasound instead of x-rays.) He also practiced inserting a catheter to get the ‘lay of the land’ for the real transfer. The whole thing was very anticlimactic. The most uncomfortable part was that I had to do it with a full bladder. (I have a very small bladder and practically live in the bathroom…) I would have asked C to take a picture of this, but it didn’t really look like anything. My HSG photo was much cooler.
  5. Sign & initial 9-page informed consent document. The first 6 1/2 pages of the thing discussed various aspects of the medical interventions involved. Yes, I understand that there may be side-effects of drugs, complications of surgery, that I may have multiples, and that the whole procedure may fail miserably…The unsettling part was the other 2 1/2 pages, which consisted of depressing hypothetical scenarios and our decisions about what we would want to do with our hypothetical embryos. For example, what should happen to our hypothetical embryos…
  • if we fail to pay our embryo storage bill?
  • if one of us dies?
  • if both of us dies?
  • if we are legally separated or get a divorce?
  • after I exceed my “normal reproductive life”? (defined as age 50; phew!)

C was no help at all, and I struggled with how seriously to take the whole thing. On the one hand, I was making a decision about what would happen to our precious embryos – C’s and my potential children (and the only that I might ever have). On the other hand, we were planning for a doomsday hypothetical of a hypothetical. Given my antral follicle count, we’ll be lucky to get one or two ‘good’ embryos to transfer. What are the chances that we’ll have ‘extras’ to store and worry about in the event of further hypothetical catastrophes? In the end, I tried my best to take the questions seriously…If we stop paying our bill or don’t use the hypothetical embryos by the time I’m 50, we’ll donate them to research; if one of us dies or we get divorced, they’ll be made available to the partner who wants them (probably only pertains to me, since if I die or we get divorced, C can make cheaper babies with his new wife!), and if we both die, they can be donated to another couple. Gosh I hope this post is the last time I have to think about such bummer scenarios!

 Still on our ‘To Do before IVF’ list:

  1. Submit C’s semen culture (after we finish the Zithromax course) to confirm no infection.
  2. Attend a ‘teach class’ with the nurse to learn how to do our new injections.
  3. Call the finance lady at the IVF clinic to work out arrangements for payment.
  4. Start taking estrogen (estrace) and testosterone gel.
  5. Do a blood draw (including a progesterone test, and others?) to confirm that my hormones are ‘turned off’ before officially beginning our cycle.

And finally, here’s your IF chemistry lesson for the day:

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Azithromycin (aka Zithromax) is a macrolide antibiotic. That just means that it contains a large (15-member, in the case of azithromycin) lactone ring (shown in blue). Actually, a lactone is defined as a cyclic ester, so “lactone ring” is redundant…kind of like “ATM machine”. Anyway, azithromycin is a synthetic analog of the natural product 🙂 erythromycin, produced by the soil bacterium Saccharopolyspora erythraea. Like erythromycin and other macrolide antibiotics, azithromycin has a sugar part (technically, two sugar parts, shown in green) that dangle off of the lactone ring.

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Plan D

I made a mistake in my post about progesterone… Despite the suppositories, AF showed up a few hours after my last post. So yesterday morning I snuck out during my students’ final to call the clinic right when they opened.

C and I had decided our plan was to do a baseline ultrasound on cycle day 2 or 3, and see how many antral follicles were visible – if it was 3 or fewer, we would do medicated IUI again; if there were more, we would try for IVF. But when the advice nurse called me back, she said that Dr. Y wanted me to come in on Tuesday – too late for medicated IUI.

When I explained our ‘plan’, she said that upon further reflection, Dr. Y really felt that IVF was our best option and we should just go ahead with that. At this unexpected disruption in the plan – and to my complete surprise – I burst into tears on the phone. (I should probably mention that I have never been a very emotional person. For our first year together, C teasingly referred to me as ‘The Robot’. But infertility is doing its damnedest to change that.) Anyway, the nurse ultimately relented and said they could squeeze me in at 4:30.

The ultrasound showed 6 follicles (lame by most standards, but tied for my best count). It also showed a small cyst (Dr. Y said that wasn’t surprising after coming off a medicated IUI cycle), which means we couldn’t do medicated IUI this cycle anyway. We all agreed to move ahead with IVF, assuming the cyst goes away before next month. (We need a month to do our IVF ‘homework’ anyway.)

Once again, it feels good to have a plan, and to feel like we are moving forward (to what, I don’t know, but I’ll settle for movement toward anything at this point). I would title this post ‘Plan B’, except IVF was certainly not our plan B. By my count, we are on Plan D. Here’s a summary of our plan/backup plan/backup to the backup plan, etc:

Plan A: Pull the goalie and get pregnant “the old fashioned way.”

Plan B: Timed intercourse, using charting (phase 1), charting + OPKs (phase 2), and charting + OPKs + Clearblue Easy Fertility Monitor (phase 3)

Plan C: Medicated IUI with Menopur

Plan D: IVF with my (scarce, presumably crap) eggs

Plan E: IVF with donor eggs

Plan F: Adoption

Plan G: Wait for Guy on a Buffalo to drop off a prairie orphan. (If you don’t know what I’m talking about, click below.)

Plan H: No idea. Suggestions?

Rookie mistake

I made a rookie mistake this week. Since I was feeling so optimistic about this cycle, I decided to test early – at 8 dpo (that’s 8 days past ovulation, for the non IFers). I saw the faintest second line, and woke C. to tell him that we were pregnant. I tried not to get TOO excited (after all, C. and I know all too well that a BFP is a far cry from a live baby…), but in my head, I had calculated the due date, lamented the end of my blog (okay, not much of a lament, but I thought about it nonetheless), and imagined how quickly all this ‘infertility stuff’ would be a distant memory. Not wanting to burst my bubble, C. gently asked “What’s the chance that it could still be due to the trigger shot?” to which I replied, “It’s been 10 days. There is no way that protein could still be detectable in my pee after 10 days!!!) I fantasized about our rainbow baby all the way to work, and then decided to Google it. And guess what?

hCG can totally remain at detectable levels…for up to 14 days following a trigger shot!

Ugh. I’m sure all the seasoned IFers out there are like “Duh!”

So what did I do? I tested again at 9dpo, 10dpo, and 11dpo. And the second line was like faint, fainter, gone. 😦

So today C. and I went to meet with Dr. Y. to plan our our next step. (One ‘perk’ from the accident: C. is available to go with me to all my appointments!) I found this meeting super depressing, which is to say, it was exactly like every other meeting at that office… “Yadda yadda yadda, diminished ovarian reserve, yadda yadda, born with all the eggs you’ll ever have, yadda, let’s do another day 3 blood test and antral follicle count, yadda yadda, we can try IVF but you’ll be lucky to get 5 eggs out, yadda yadda yadda…” You get the idea.

Rather than rehash the rest of the conversation, or the tear-filled ride home, I’d prefer to learn and then write about the biochemistry behind how home pregnancy tests work.

Here’s a nifty image I found online. I’ll attempt to caption it in my own words.

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(A) So the purple blobs are hCG, which is present in the urine of pregnant women (and of wannabe pregnant women who had a trigger shot 10 days ago…)

Capillary action carries hCG along the stick (or down in this particular figure; nevermind that HPT instructions definitely do not say to hold the test with pee end up like that…) Anyway, capillary action carries hCG toward where the action is.

(B) The reddish things that look kind of like lobsters holding a blue balloon are the anti-α-hCG antibodies which were pre-deposited on the stick (between the pee end and the viewing end). The antibodies have a pigment attached (in the case of the test I used – FRER – the pigment is pink, not blue). They will grab the hCG (specifically the alpha subunit of hCG – for more about the structure of hCG, see this post) and hold on tight…and be pink.

Now, capillary action will carry the bound-to-hCG anti-α-hCG antibodies, and the free anti-α-hCG antibodies (there are extras that don’t get any hCG) along the stick.

(C) At the ‘test line’, there is a line of anti-β-hCG antibodies (blue lobsters in the figure, although they are actually colorless) that are fixed to the stick. These antibodies also grab onto hCG (specifically, the beta-subunit) and hold tight…and don’t go anywhere. Everybody holds on tight, and the resulting group of anti-β-hCG—hCG—anti-α-hCG sandwiches appear as a pink line on the stick.

Meanwhile, the free anti-α-hCG antibodies (that is, the ones that didn’t get any hCG) continue to be carried by capillary action along the stick.

(D) Finally, the free anti-α-hCG antibodies reach the ‘control’ line, where there is a line of antibodies that specifically bind to the anti-α-hCG antibodies (no hCG needed). These antibodies are the green turtle-heads in the figure, and are themselves fixed to the stick. The resulting antibody—anti-α-hCG complex appears as the pink control line.

I go in for a blood pregnancy test (which works a bit differently; but I’m too lazy to figure out how right now…) on Saturday, but with a negative HPT at 11dpo, I’m decidedly not optimistic about it. I’m also not optimistic about moving forward with IVF, but I’m sure that will pass. In the mean time, I think I’ll console myself with a glass of wine tonight.

Progesterone

Yesterday I went in for my progesterone blood test, and then started progesterone suppositories last night. I’m supposed to continue with these twice daily until I get a negative pregnancy test or make it past 10 weeks pregnant…

First, the test results: my blood progesterone was 24.49 ng/mL. I think the purpose of this blood test was to confirm that I had indeed ovulated. Normally you expect your progesterone levels to be near zero prior to ovulation, and to rise after ovulation. From what I can tell, 24 ng/mL is on the high side, but within expected variability (and who knows what ‘normal’ is for women pumping themselves full of hormones), so I’ll assume that this is a ‘good’ result.

Next were the suppositories. Here’s what they looked like:

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For some reason, I found the packaging very entertaining. The top view makes me think of a petri dish with a bunch of bacterial colonies – or a disk diffusion assay. The bottom view looks like a bunch of perfectly arranged raspberries! I use the ‘key’ thing to push one suppository out of the packaging morning and night.

After getting over the goofy packaging, I casually mentioned to C. that I wasn’t totally sure how to use them. His reply: “Just put it in your butt!” I laughed and told him that I’m pretty sure it doesn’t go in my butt. C. again: “Where else would it go?” After repeating that it doesn’t go in my butt, he thought for a minute and eventually figured it out…

So, what’s interesting about progesterone?

Well, like estradiol, testosterone, cholesterol, cortisol, etc., progesterone is a steroid. Being a steroid gets a bad rap, but really all that means is that it has the four-ring carbon backbone shown above. The name progesterone is short for progestational (preceding pregnancy) steroid (four-ring carbon backbone above) ketone (functional group consisting of a carbon double bonded to oxygen, and attached to carbons on both sides; highlighted in blue above). Testosterone is also a ketone, while estradiol is an alcohol (highlighted in red).

Fun facts about progesterone:

  • Progesterone (secreted after ovulation to prep the uterus for implantation) is responsible for the ‘thermal shift’ observed by those weirdos (myself included) who go to the trouble of charting their basal body temperature (BBT). For this reason, I’m kind of bummed that I didn’t bother to chart this month…I wonder how big the effect of the suppositories will be on my BBT…
  • In cycles that don’t result in pregnancy (like all the ones in recent memory), progesterone levels naturally drop off after 12-16 days, signalling Aunt Flo (AF) to visit. Since I will be taking progesterone suppositories, this drop won’t happen, and my period won’t start. Instead, I’ll have to go in for a blood pregnancy test. If I’m not pregnant, then the doctor will tell me to stop the suppositories, which will prompt AF. So, no checking the toilet paper for unpleasant surprises this month. (Actually, there have been no surprises from AF since I started charting…one of the few perks of being a weirdo data-junkie!)

The progesterone suppositories are a nice safety net, just in case I wasn’t producing enough progesterone on my own to support implantation (something I had worried about a bit, since my temperature shift is sometimes subtle).

And now, we hurry up and wait! Since this is the last week of classes, you can probably expect a fair number of ‘making sense of it all’ posts coming up. Apologies in advance for that! (Although my non-chemist friends will probably appreciate the break from all the science talk…) Also, I’d like to apologize to any biochemists reading my blog. A molecular biologist friend asked me to ‘lay off the biochemists’, and I will try to oblige! Truth be told, I have the utmost respect for biochemists!

Trigger shot

I had my estradiol and follicles checked today. Two looked like they could drop any minute, so the nurse practitioner – D. – administered the hCG trigger shot while I was there. (Poor C. didn’t get to “stick me” after all!)

For all the data monkeys (like me) out there, here’s a summary of my test results:

Estradiol (E2):

  • baseline estradiol (taken during infertility workup 1/26) = 25 pg/mL
  • estradiol on 4/17 (after 4 days of injections) = 281 pg/mL
  • estradiol today (4/19, after 6 days of injections) = 572 pg/mL

According to this FAQ (http://www.fertilityplus.com/faq/iui.html), the target is 200-600 pg/mL per big follicle; since I only have two big follicles, I think this means I’m good.

Follicle size & count:

  • On Wednesday (4/17) I had three visible follicles, measuring 14.5 mm, 13 mm, and 11 mm.
  • Today (4/19) the same follicles measured 18.5 mm, 16.6 mm, and 11.5 mm. Below is a picture of my biggest follicle, viewed on ultrasound. (The follicle is the black oval just left of center with the dotted cross through it). 18.5 millimeters sounded huge to me, so I posed a penny (also 18.5 mm in diameter) in the photo for reference!

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According to that same FAQ above, it looks like 16-18 mm is a good range for Menopur-stimulated follicles, which is consistent with what nurse D. said. She expects that the smaller one will probably not release, so we’re looking at two follicles this cycle.

Things are slightly less than ideal. For our best chances of pregnancy, our target would have been 3-4 big follicles (to increase the odds of at least one ‘good’ egg taking). But 2 is better than 1, and better than 5+ (in which case we would’ve had to cancel the cycle or risk a multiple pregnancy). In addition, it would have been better to inseminate 36 hours after the trigger shot, but since the clinic is closed on Sunday, 24 hours will have to do! Nurse D. pointed out that it’s better to inseminate early than late, since the sperm can “wait for the egg”, while the egg can’t do the same. (I’m sure there’s a sexist joke to be made there…) She also suggested BDing on Sunday to be sure…

So I’ll be back tomorrow for the insemination. Wish me luck!

Looking good!

So today I had a blood estradiol (E2) test, and ultrasound to see how I’m responding to the Menopur, and all looks good. 🙂

The annoying part is that they only do the estradiol test at the hospital lab across town, and only from 7-7:30 am. So I had to wake up at 5:30 this morning to get ready and drive east to the hospital, and then drive back west in rush-hour traffic to teach my 8:30 class. Fortunately, the infertility clinic is on this side of town, so making it to my 10:30 ultrasound appointment was no problem.

Anyway, the result is that I have two decent-sized follicles, and one smaller one. This is good news, since our target is 2-3 follicles for IUI. Based on the size of the follicles and on my estradiol (281 pg/mL), the nurse practitioner recommended upping my dose of Menopur from 300 IU to 375 IU per injection, and repeating the blood draw (5:30 am wakeup – Boo!) and ultrasound on Friday. Depending on those results, we may do the insemination as early as Saturday!

IUI cycle start

So despite C.’s valiant effort, we are definitely not pregnant. 😦

I suspected as much this morning, and it was confirmed during my ‘Menopur Teach Class’ (a required class for informed consent before medicated IUI).

Anyway, as I mentioned before, I needed to schedule a ‘baseline ultrasound’ during the first 3 days of my cycle if I wanted to do IUI this cycle. Since C. and I were already at the infertility clinic for the class, the staff at the clinic was very accommodating and got me in this afternoon for the ultrasound, and for the one-on-one session to teach us how to prep and administer the shots.

Because of the short notice, a different RE at the clinic – Dr. L. – performed the ultrasound. Upon entering her exam room and taking stock of the decor, C. and I appreciated what we assume is Dr. L’s subtle sense of humor:ImageUnfortunately, the decor was the highlight of the visit. Not that we didn’t like Dr. L – we did! But the ultrasound revealed even fewer antral follicles than last time – only 3. And Dr. L. was less equivocal than Dr. Y. Among other things, she said that I would probably hit menopause before age 40. 😦

But the ultrasound did not reveal any ovarian or uterine cysts, which was good news for moving ahead with medicated IUI, and we had our one-on-one meeting with the nurse. Starting on Saturday, I’ll be giving myself subcutaneous injections of Menopur every night, and when the doctor says it’s time, a one-time intramuscular HCG ‘trigger’ injection, which I very much hope C. will give me. I’m strangely proud to say that I gave my first shot today (just saline solution for practice), and it wasn’t so bad. C. (who loves to tease me for my fear of needles) was especially impressed!

The bottom line

After writing that last post, I realized that I had omitted any sort of conclusion from all that data. I started to edit it to fix the problem, and then stopped – that post was too long anyway – and decided my “diagnosis” was deserving of its own post!

So what is my diagnosis? According to my online medical records at kp.org, it’s “female infertility” – not vague at all! Of course, Dr. Y. never actually said that to my face. He said something more like “low ovarian reserve” (i.e. reduced number of remaining eggs). When talking to close friends and family, I prefer the technical term “ovaries of a 45-year-old”.

All joking aside, I’m not really sure what the results of all those tests actually mean. And, frankly, I’m not sure experts know what those test results mean… Dr. Y. was very cautious in his choice of words, and from what I’ve been able to read about it, I can see why.

What I know (or, what I think I know, based on what I’ve read in infertility books and online):

  • My test results are atypical for 34-year old women who have taken these tests (that is, women with infertility). They are more typical of women in their 40s who have taken these tests.
  • Women with low ovarian reserve (i.e. with test results like mine) tend to respond poorly to ovarian stimulation drugs. This means that IVF patients with this condition are less likely to produce lots of eggs at once (a prerequisite for IVF), and thus have higher rates of cancellation, and lower success rates overall for IVF.

What I don’t know (and, from what I can tell, nobody really knows):

  • What impact does low ovarian reserve have on women trying to conceive naturally (who only need to drop one egg at a time)?
  • What are the ranges of test values for women in the general population (that is, not just women experiencing infertility, which currently seems to be the only people this data is available for)?
  • How many eggs do I actually have left? (Or, put differently, how many years do I have until menopause?)
  • What is the quality of my remaining eggs?

As far as we know, I could still get pregnant naturally – after all, it happened once! Then again, 45-year old women get pregnant sometimes too…

So, why am I pursuing treatment, especially given that my test results seem to suggest that I am not the best candidate for IVF?

Two reasons:

  1. IVF is the ‘gold standard’ infertility treatment, offering C. and me the greatest chance for a biological child (still true despite my low ovarian reserve).
  2. Every month that we delay treatment, our odds of success with IVF go down (especially true given my low ovarian reserve).

For me, these two facts are enough to propel me forward, ignoring such ‘helpful’ advice as: ‘It’s in God’s Hands’ (Of course it is, but so is cancer; should folks not seek treatment for that?); ‘Just Wait, It’ll Happen’ (Wait for what? Menopause?); ‘Try this Diet/Potion/Lube’ (The fact that it worked for your sister-in-law’s aunt’s cousin’s daughter is so much more compelling than scientific data!); and the classic ‘Just relax!’ (Oh, why didn’t I think of that? [snapping fingers] I’m relaxed now!)

Actually, I don’t mind the well-meaning advice (for the most part), but that’s where we stand!

Test results

First, another update: I picked up C. in San Jose last weekend and flew home to San Diego with him yesterday. The flight was uneventful (a bit of turbulence, but smooth landing), but he was pretty tuckered out from the trip. Nice to have him home, though. The doggies and I missed him!

Back to the IF world. Now that I’m firmly in the two-week wait, I don’t actually have any news, but figured this would be a good time to fill in some of the holes in my earlier posts…starting with my pre-HSG test results.

I won’t share C.’s sperm test results, for the simple reason that I don’t have the values. (Due to HIPAA or whatever, I never got a copy of the results.) I will say (again) that I hear they were awesome. The best our IF nurse has seen, or so she claimed. C. is happy to believe her, and so am I.

So below are the results of my tests:

1) Antral follicle count. At my first visit with Dr. Y., he performed a transvaginal ultrasound and counted the number of antral follicles (maturing pre-eggs, visible under ultrasound). The idea here is that you can’t actually count the number of eggs a woman has left, so you assume that the number of partially-mature eggs your RE can see under ultrasound will give some indication of how many immature eggs (which your RE can’t see) are there. In general, more antral follicles = good, with ‘normal’ (in other words, ‘fertile’) levels being 16-30. My antral follicle count = 5.

The remaining three are all tests of blood hormone levels, determined from a blood draw on day 3 of my menstrual cycle. The structures of these hormones are shown below:

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Now, despite what my dad said in pretty much every Christmas letter throughout six years of grad school, I am not a biochemist. I’m an organic chemist, which means that I love to look at little chemical structures like the one of estradiol above. I start to get uncomfortable looking at any molecules bigger than about 1000 atomic mass units. Forget about proteins and nucleic acids! Both AMH and FSH (discussed in detail below) are protein hormones, which means that they are long chains of amino acids (AMH is composed of 560 amino acids; FSH is smaller*). If I tried to draw them using the same style of line drawing as estradiol, the drawings would be ridiculously large, indicipherable, or both. Instead, biochemists like to use other representations, such as the ribbon drawings above. The space-filling model is a compromise that makes me a little less uncomfortable, because I can at least see that there are carbons and hydrogens and oxygens, etc. Anyway, back to the tests:

2) Anti-Mullerian hormone (AMH). AMH is named for its role in preventing the ‘default’ development of female plumbing (“Mullerian ducts”…like uterus, vagina, and fallopian tubes) in male embryos. Its significance for infertility testing arises because AMH is released by egg-associated cells (“granulosa cells”) in the ovary, and – like antral follicles – is used as an indirect measurement of how many eggs are left. So, high AMH (>1 ng/mL) = good; low AMH = bad. My AMH = 0.17 ng/mL.

3) Follicle-stimulating hormone (FSH). As the name suggests, FSH stimulates the development of follicles (i.e. eggs) in the ovaries. My RE describes it as being like the gasoline that revs up the engine and gets your ovaries to develop and drop an egg. In young, nubile women, it doesn’t take much FSH (“gas”) to get the egg to drop. In women approaching menopause, you have to push the pedal to the floor to get enough gas for the egg to drop. In other words, low FSH (<9 mIU/mL) = good; high FSH = bad. My FSH = 13.7 mIU/mL.

4. Estradiol (a type of estrogen) is the main female sex hormone. In terms of predicting fertility, estradiol behaves a bit like FSH, in that your body may produce higher levels of estradiol (turning up the gas) as the number of remaining eggs decreases. Moreover, estradiol suppresses FSH production, so someone who has low FSH might actually still be in trouble if high levels of estradiol are ‘masking’ what would otherwise be high FSH. For this reason, REs like Dr. Y. typically order FSH and estradiol tests together… I can’t seem to find ‘normal’ values for estradiol, but since my high FSH levels already indicate very low fertility, I don’t think it matters! My estradiol = 24.6 pg/mL.

A side note about units:

As a scientist, I find it a little strange that every medical test seems to have its own units of measure. A cynical explanation is that perhaps physicians aren’t big fans of scientific notation, and prefer to choose a unit of measure for each test that gives normal ranges with values from 0.1-100 or so…even if it means learning dozens of different units. A more generous explanation is that maybe each of these molecules are being detected in different ways, and the units used might be determined by the detection method and sensitivity.

Regardless of the reason, here’s my guide to units for the tests above:

  • mIU/mL (milli-International Units per milliliter of blood). From what I can tell, the ‘International Unit’ is a biologist’s invention. (Is my bias showing?) It’s sort of like an ‘effective concentration’ that doesn’t translate to anything that a chemist would understand as concentration (like molarity, molalilty, normality, ppm, ppb, mg/mL, % by volume, etc.)
  • ng/mL (nanograms/milliliter of blood) For non-scientist types, a nanogram is one billionth of a gram.
  • pg/mL (picograms/milliliter of blood) A picogram is one trillionth of a gram, or one thousandth of a nanogram.

*For more about the structure of FSH, see: https://infertilechemist.wordpress.com/2013/04/16/injections/

HSG

The HSG took about 5 minutes (excluding time for me to strip from the waist down) and was virtually painless. (I had a few cramps on the drive afterward, but less even than a bad menstrual cramp – not that I ever get bad menstrual cramps…) To the utter bewilderment of my radiologist, I asked to take a photo of the screen. For your viewing pleasure, here’s my uterus and Fallopian tubes:

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I think the fact that you can see the white hair-like projections (my Fallopian tubes) coming out of the white triangle in the middle (my uterus) shows that everything is flowing freely. So plumbing doesn’t appear to be the problem (which we pretty much already knew). Now all I have left for my IUI homework is my injections class next week. Should be fun!

For today’s chemistry lesson, I tried to figure out the likely structure of the dye that they put in my uterus to appear all pretty and white on the x-ray above. I didn’t actually check what they used, but from what I can tell the vast majority of these dyes are small, iodinated organic molecules like the ones shown below. The iodine atoms are the most important part, and are what makes it show up white on the x-ray. There are two classes of iodinated contrast media: ionic (which contain a carboxylic acid group – shown in blue below – somewhere in their structure), and non-ionic (that don’t have a carboxylic acid). For imaging the digestive tract, they often use an inorganic compound – barium sulfate – but I’m going to assume that’s not what they used for my HSG.

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