| AFC | 4 follicles. Dr. Filková said “unexpected” — she anticipated more based on prior AMH of 1.3. Confirms diminished ovarian reserve. |
| Uterus | Good size and shape. Confirmed ovulation this cycle. |
| Endometrium | 6.5 mm — improved from ~4 mm measured at Grace Fertility previously. |
| Blocked tubes | HSG showed blocked tubes. Dr. raised hydrosalpinx risk (fluid dripping into uterus affects implantation). Ruled out based on ultrasound — no fluid visible. |
| Adam spermiogram | All parameters very good. No male factor. Done at 1 PM, results back by 2:30 PM consult. |
| Test | Result | Ref. Range | Unit |
|---|---|---|---|
| TSH | 1.96 | 0.38–3.50 | mIU/l |
| Free T4 | 15 | 9–25 | pmol/l |
| Free T3 | 4.3 | 3.10–6.80 | pmol/l |
| Prolactin | 210 | 102–496 | mIU/l |
| Estradiol | 598 | varies by phase | pmol/l |
| Progesterone | 29.3 | luteal: 13.1–46.3 | nmol/l |
| Testosterone | 0.61 | 0.29–1.67 | nmol/l |
| Vitamin D | 96.4 | 75–250 | nmol/l |
| AMH | 0.9 | 0.06–4.44 | ng/ml |
All values within range. TSH 1.96 is under the 2.5 IVF threshold — no thyroid adjustment needed. AMH 0.9 is the key number: down from 1.3, consistent with AFC 4. Luteal-phase draw may account for 10–15% of the drop.
| Drug | Role | Dose / Qty |
|---|---|---|
| Pergoveris | FSH + LH stimulation | 150 IU/daily · 2 pens |
| Gonal-F | Additional FSH | 300 IU/daily · 3 pens |
| Cetrotide | GnRH antagonist (prevents premature ovulation) | 0.25 mg · 5 doses |
| Diphereline | GnRH agonist trigger | 0.1 mg · 2 packs (14 vials) |
| Ovitrelle | hCG trigger | 250 mcg · 1 unit |
Total daily stim: 450 IU FSH + 75 IU LH. High-dose, appropriate for AFC 4 / AMH 0.9. Doctor may adjust after reviewing bloods — confirmed on CD1.
Dual trigger (Diphereline + Ovitrelle) confirmed.
Andrea raised the uneven development from Grace (one dominant follicle, others small). Dr. Filková noted it but wants to observe cycle 1 under her protocol first. If uneven growth recurs: cycle 2 switches to long protocol with priming (testosterone or estrogen).
Dr. raised testosterone supplementation for cycle 1 unprompted. Not prescribed — testosterone came back normal (0.61 nmol/l). Clarification pending from Adéla: was it dropped because levels were normal, or is it reserved for cycle 2 priming if needed?
| beReady | Endometrial microbiome test. Checks endometrium readiness for transfer. Especially valuable if embryo count is low — maximizes each transfer attempt. |
| KIR genotyping | NK cell receptor test. If Andrea has KIR AA genotype (“lazy” receptors), it won’t reject any embryo HLA-C type. If not AA, specific embryo selection matters for implantation. Affects transfer strategy. |
~5 oocytes per retrieval → 1–2 embryos after cultivation. “Sometimes the ovary can surprise us” — no guarantee on follicle count per cycle.
1,500 EUR paid for baseline (ultrasound + blood draws + spermiogram). Deducted from total package — already included in both All-Inclusive and Sperm Packet options.
Package decision deadline: 2nd ultrasound (CD 8–10).
| Brno | Pick up at clinic. Default option, confirmed available. |
| Hungary | Fill CZ prescription locally. Requires exploring HU pharmacy process. Andrea does not yet have a TAJ card (Hungarian health insurance). Prices may be cheaper — unconfirmed. |
| DHL from Brno | ~100–150 EUR shipping. Meds should be refrigerated; OK at room temp briefly but current weather is 31°C. |
ECG + blood panel: total bilirubin, conjugated bilirubin, ALT, AST, alkaline phosphatase, GGT, urea, creatinine, glucose, sodium, potassium, chloride, blood count, prothrombin test, APTT ratio, fibrinogen, D-dimers, total protein, albumin, CRP.
If uneven follicle development recurs in cycle 1: long protocol + priming for cycle 2.