The KARMA Network – How to Understand Your Results

As part of the Investigative Cycle, you will have access to the KARMA Network, our online system of viewing your daily results. This is used as an aid to help you better understand your ultrasound and blood test monitoring. If you have any questions, please don’t hesitate to contact the nursing team for further clarification at 519-570-0090 x 2. The KARMA Network is complimentary for the first cycle and then $30 for 6 months of access.

When you first log in you can select Schedule to see all your upcoming appointments, Flowsheet to see your daily results, Messaging to contact the clinic, or Discussion Forum to chat with other patients.

 

Ultrasound

When you click on Flowsheet, the default view is the Ultrasound report.

In the Endometrium column, the ultrasound staff will record the thickness and brightness of the endometrial lining. The lining increases in thickness as you get closer to ovulation to prepare the lining for a potential pregnancy. The lining sheds every month with your menstruation when you are not pregnant. When you are pregnant, this is where the egg implants and the lining will remain complete.

The endometrium is hyper-echoic early in the cycle and is thin and brighter then the surrounding tissue. As the cycle progresses, it will become more hypo-echoic (darker than surroundings) on outer edges of the lining and after ovulation, the uterus will be mostly iso-echoic, or the same darkness as the other tissues as the lining prepares to shed. When assessing the uterus, we can determine if the appearance is typical at each stage of the cycle.

Uterine contractions are also measured. Early in the cycle, the entire uterus can contract from the cervix to the fundus (top of the uterus). This type of movement is beneficial as it can help draw sperm upwards and into the fallopian tubes. We may also identify the endometrium moving back and forth or “to and fro” as it prepares for implantation. If a pregnancy does not occur the endometrium tends to contract from the fundus toward the cervix as it prepares to be sloughed off.

“Ut art avg PI” measures the resistance to flow of the uterine artery that feeds blood to the uterus. A measurement less than 3 is optimal for this arterial pressure. If it is greater than 3, it could indicate decreased blood flow to the uterus, which may cause the endometrial lining to be affected for implantation of a fertilized egg. The doctor or nursing team will discuss treatment for this if the value remains to be greater than 3 through your investigative cycle.

Right and Left Side Follicle columns show the number of follicles each ovary has. At the beginning of the cycle, there will be small (<0.5cm) follicles called Antral Follicles, that are not currently growing but have the potential to begin maturing. The Antral Follicle Count (AFC) can vary with each cycle and the significance of how many are seen on Cycle Day 3 can be discussed with the nurse or doctor. Usually, one follicle will grow and mature each cycle; this follicle is usually detectable by Cycle Day 9 but may be variable depending on your average cycle length. The follicle tends to grow between 0.1 and 0.2cm daily, but this is variable as well. How the follicle develops will be discussed with the doctor at your review appointment.

There is also a column for Right and Left Cysts, if you have a measurable cyst it will be listed here. Cysts are quite common and usually unremarkable. If there is any concern, this will be discussed at your review appointment with the doctor.

Free Fluid refers to fluid that is within the pelvic cavity; a small amount of fluid in the pelvis can be normal. It has been documented that when ovulation occurs, a larger amount of fluid can be seen because when the follicle ruptures, the released follicular fluid accumulates in the pelvis. This can be helpful when trying to determine if ovulation has occurred.

 

Blood Results

Oocytes (eggs) are too small for ultrasound to see. The blood work we draw helps us determine the presence and the growth of an egg inside the follicle(s). To see your blood results on the Flowsheet, select “Lab” in the Cycle Type drop-down menu and click update view.

LH – Luteinizing Hormone – The final trigger for the maturation of a follicle. The level will generally be steady throughout the cycle and then “surge,” or approximately double in value, one day and the egg will mature and ovulate 36 - 42 hours later.

E2 – Estradiol – This is a type of estrogen that is produced by the follicle, this level can indicate if a growing follicle has a maturing egg inside. As a follicle grows larger or more follicles develop, the E2 level should rise and peak at ovulation where it will then drop after the egg(s) are released. If a pregnancy occurs, E2 will rise again and stay elevated, if no pregnancy occurs, the level drops and menstruation will occur.

Prog – Progesterone – This hormone is responsible for maintaining the lining of the uterus for implantation of the embryo. Like E2, it will rise after ovulation and stay high if you are pregnant but will drop if you are not pregnant.

FSH – Follicle stimulating hormone – Measured on Cycle Day 3, this hormone is sent from the brain to the ovaries, telling them to start producing oocytes. A higher number means that your body has to work harder to get eggs to develop; a value of less than 10 is ideal. This level will be discussed at your review appointment with the doctor.

PRL – Prolactin – This is the hormone that stimulates milk production during breastfeeding. It has fertility-inhibiting properties and can prevent ovulation. It can be elevated due to other reasons such as stress or a physical abnormality of the pituitary gland (where it is produced). If your level is high, treatment would be discussed at your review appointment.

 

Medication

To see your medication on the Flowsheet, select “Medication” from the Cycle Type drop-down menu and click update view.

Verbally Ordered and Ordered is the record of what the doctor instructed you to take that day (either told to the nurse or written down in your chart). Dispensed is the medication that was given to you by the nurse to take home. Administered is the medication that the nurse gave to you directly while you were at the clinic (usually an injection).

Depending on your daily ultrasound and blood work results, the doctor may order more or less medication each day. Depending on the treatment type, they may also trigger ovulation and schedule a procedure.

If you ever have any questions about the type of medication you are given or how much medication to take, call the nursing team at 519-570-0090 x 2.