I sat on the bed, just staring at the syringe in my hand.  I sat there for like an hour.  Hoping, wondering, praying.

The syringe contained one-hundred and seven dollars worth of hCG, and is commonly referred to as a trigger shot.  It was prescribed by a fertility specialist.

I finally just told myself to breathe and have a little courage.  I gave myself the injection like I would any other patient, I was deft and swift.  It wasn't the injection itself that was making me nervous, but my inability to see a glimpse of the future, and what this needle might bring - maybe happiness, maybe not...

I've been in to the fertility clinic twice recently.

On Feb 15th I went in for a hysterosalpingogram (HSG), where they were unable to confirm whether or not my fallopian tubes were already open, or whether the contrast dye had just pushed them open right then and there. I felt like they should be able to tell them if my tubes were okay or not before this super expensive intervention, but they couldn't.  I also felt like they should've been able to tell me how long my tubes are likely to stay open... hours, days, weeks, months... but they couldn't tell me that either.  What they did tell me is that my left fallopian tube is three times longer than my right.

Weird.  

They printed off a picture so that I can keep it forever.  

I attribute this anomaly to the fact that my mom used some kind of herbicide to kill weeds in our backyard while she was pregnant with me.

Apparently it may or may not effect my ability to get pregnant.

Maybe if the fertility clinic was able to answer some of these questions they would have a higher success rate - but you can't really point that out to them, because you need their help, and you don't want them to inseminate you with the wrong sperm as retaliation.  That would be bad.

My second time at the fertility clinic was this week. This time it was to measure my follicles.   I had like nine of them that measured 14-20 mm.  Apparently that's pretty good because they told me I could go ahead and take my hCG trigger shot, and they will plan on inseminating me at the end of the week... this definitive announcement is what started making me so nervous though, and my brain started swimming with questions.  What is a good size for a follicle?  How many should there be?  If I normally ovulate on the 14th day of my cycle is it really best for me to take the trigger shot on Thursday? I ended up calling the clinic fifteen minutes after driving out of the parking lot.  I had to start the conversation by apologizing for my weirdness.  They were very kind and answered all of my questions, and thought maybe it would be better if we did the trigger shot today.

This made me more nervous.  I mean, it's a whole day different - they should know the exact timing of these things, shouldn't they?

Apparently nervous Bonnie is someone who spends a great deal of time reading information on the internet.  This is what I've gathered in the past hour:

Follicles grow 2 mm per day toward the end of your cycle

Follicles should be 18-20 mm (or larger) before taking your trigger shot

IUI should take place 24-48 hours after the trigger shot

5-10 million (or more) motile sperm are needed for IUI to work

STUDY 1: Eight percent of patients (n = 87) were excluded because their leading follicle was less than 18 mm by days 11 to 13. Pregnancy was recorded as clinical pregnancy with fetal heart activity seen at 6- to 7-week transvaginal ultrasound. For both CC and letrozole, higher pregnancy rates were achieved when the leading follicles were in the 23 to 28 mm range. The optimal size of the leading follicle was not statistically significantly different between cycles using CC or letrozole. However, for each endometrial thickness, the optimal follicular size of the leading follicle was different. Each additional millimeter of endometrial thickness increased the optimal follicular size by 0.5 mm. Thicker endometrial lining led to a higher probability of pregnancy.

STUDY 2: In this study, intrauterine insemination timing did not affect the cycle outcomes whether the procedure has been performed 24 or 36 h later following ovulation trigger with exogenous hCG utilization. The longer period of treatment cycle during ovulation induction with clomiphene citrate resulted with higher clinical pregnancy rate. Intrauterine insemination can be done successfully at either 24 or 36 h after hCG in clomiphene citrate stimulated cycles. This will allow more flexibility and convenience for both physicians and patients, especially during weekends.

STUDY 3: Study showed a statistically significant increase in pregnancy rate up to 22.6% in patients performing IUI 48 h after hCG trigger, compared to the 10.6% in the patients having the procedure done 12 h earlier.

STUDY COMPARISON: They reported a 2.3% pregnancy rate per IUI cycle when fewer than 10 million total motile sperm were initially available, compared to 8.4% for 10 to 30 million total motile sperm and 9.9% for ≥30 million total motile sperm. We reported an 8.4% pregnancy rate when 5 to 10 million total motile sperm were initially available, 8.7% pregnancy rate for 10 to 40 million total motile sperm, and 12.8% for ≥40 million total motile sperm, compared to 2.3% pregnancy rate when there were fewer than 5 million total motile sperm.