Eight Weeks

Angie is 8 weeks pregnant today. Today is also the last day the embryo is considered an embryo. Tomorrow it will officially be a fetus. Crazy what info these online due date calculators can tell you now. I considered putting one of those baby ticker widgets on the sidebar of this blog and found a really cool one that has a picture of what the embryo/fetus looks like at the particular gestation its is at, but since it is still so early and our embryo still looks sort of like a jellybean-sized squid, I thought I would hold off on that for a month or two.

Thanks for voting in my poll to those that voted. Unfortunately the only way to find out the results seems to be to log in to my account, so I will just tell you that 9 people have voted to find out now, 2 voted for 20 weeks, and 3 of you have unbelievable patience and would not find out until birth. Looks like I side with the majority of you, and called the clinic yesterday to ask them to find out. Now, remember, they transferred two embryos, so if we had one of each gender transferred, then we will be forced to wait until the anatomy scan to find out which one implanted.

The clinic called me at 8 am this morning (of course, my only day off and Fletcher was still asleep until the phone rang...) and both embryos transferred were the same gender. And I am going to be coy and not post the results yet! I want you guys to comment with your guesses, and if you are feeling really talkative, let me know why you think it is the gender you think it is. I thought about being really mean and saying I would not post gender until I get at least 10 guesses in the comments but (1) I don't really think anyone but myself and my immediate family really care all that much and (2) I have already told my immediate family and most readers either fall into that category or speak on the regular basis to someone who falls into that category.

So, check back soon for the big reveal!

Angie is Pregnant!

This may not look like much to you, but it sure is beautiful to me. Angie had her first pregnancy ultrasound today and this is what we saw. One gestational sac, one yolk sac, one embryo, and one heartbeat. All measuring right on target. I think Trevor was initially a little sad that it is not twins. Me: 99% relieved and 1% disappointed. Truthfully, while we would love to have more kids, the logistics of having healthy full-term newborn twins plus Fletcher would probably have sent me over the edge (let alone all the potential complications of a multiple gestation).

Whoa, already talking about newborns, I am getting way ahead of myself. I, as much as anyone, know that there is a long road to go, with many obstacles, between a 7 week ultrasound and a full-term baby (EDD June 12, 2009, by the way).

After the scan (which was done in a full house with the RE, nurse, Angie, me, Trevor, Fletcher and Michael squeezed into the tiny ultrasound room) we discussed the next step, which is either another ultrasound at the clinic at 9 weeks, or, because everything looks really good, Angie could just be released to her regular OB right now. I am going to check Angie's insurance to see if having an additional scan now will limit the availability of future covered scans and if not, we'll probably do the 9 week ultrasound. May be a quirky thing about us "infertiles," we never turn down a peak at our hard-earned babies.

They also gave Angie instructions on gradually weening her estrogen and progesterone supplements and a list of approved medicines, including a few things that help with nausea as she has not been feeling her best.

Finally, the RE told me about a little option that I didn't know about during Fletcher's cycle. She said that the lab we used for the genetic testing (CPG) tests the sex chromosomes of the embryos, but only indicates on the original report whether or not they are normal. It does not indicate gender of the embryos (because they do not allow people to select which embryos to transfer based on gender). However, once a pregnancy is achieved, the fertility clinic can call CPG and find out the gender of the embryos we transferred. Honestly, if it were only up to me, I think I would want gender to remain a mystery until birth. But, if you know Angie, you know that is not an option. So, if we are going to find out at the 20 week anatomy ultrasound anyway, do you think we may as well find out now? Let me know what you would do if you were me by voting in my nifty little poll:

Third Beta

"Hope is one of my favorite emotions because of its humility. It's not like gladness or joy which stick around just for the good stuff. Hope is my heart's missionary. It humbly seeks fear and shame and hurt and befriends them. Hope enters the very dustiest parts of my heart, clears out the cobwebs, and whispers of the promise of eternal perfection. " --Maggie Lindley

Angie's third beta at 14dp5dt was 1109. More than double from Monday. Everything looks great. Check out the increase in graph form:

And, to compare, the same chart from the Fletcher cycle. Once again, Angie's numbers are much higher, but that is in part due to the fact that she has been testing later in the cycle.

Her pregnancy ultrasound is scheduled for Wednesday, October 29th. Wow, I can hardly believe this is happening. This news, and the fact that I got to wake up next to my sweet, sweet baby boy, have been the greatest birthday gifts I could ever imagine.

Second Beta

Angie's second beta at 12dp5dt came in at 463, so still going strong. As I mentioned in my last post, she will go in for her final beta on Wednesday, and assuming things look good, they will schedule the ultrasound to see how many embryos implanted and how everything looks (whether there is one or more gestational sacs and/or fetal poles, not sure if you can see the heart beat at this time). You can't definitively tell if there is multiples from hCG tests, but according to the chart I found online, her numbers indicate a strong singleton pregnancy.

Here is the same chart from the cycle in which I conceived Fletcher, not that it really makes any difference. I had my betas during the Fletcher cycle a little earlier, but it looks like it was on about the same curve.

I did see one website that indicated higher hCG numbers may mean it is a girl, but obviously, as Fletcher is a boy, that isn't always the case. Angie thinks it is a girl because she is feeling nauseous. I thought she felt sick with the boys, too, but maybe not this early. Who knows, all those drugs really do a number on your hormones.

I am still too afraid to get my hopes up too high, but I am really feeling good about this. You know, one thing I have learned in the past couple of years is that you should take every opportunity to be happy. Whether or not I enjoy this good news will not have a bearing on whether this pregnancy will develop or continue to term, so darn it, I will be happy about this. And yes, that last sentence was a pep talk to myself.

Beta Results

I thought about concocting a long post to wade through before getting to the results, but I changed my mind. Angie's first beta, at 8dp5dt (translation: eight days post five day transfer) is 90. It is a good solid number. I couldn't be happier, but it is only the beginning. She goes back to the lab next Monday and then again next Wednesday, and if her betas increase appropriately they will schedule an ultrasound probably around the end of the month. We still have a long way to go, but today's news is huge!

When I was going through my third IVF cycle I went to see an acupuncturist who was really into meditation and alternative medicine. She suggested I pick a phrase to meditate upon in preparation for the cycle, so I asked my mom if she knew of any good bible verses that would serve this purpose. She suggested the following verse from Romans 12:12: "Be joyful in hope, patient in affliction, faithful in prayer." Little did I know how often I would turn to that phrase for comfort and direction. I used this to meditate upon during that cycle, and then again during my next cycle, and again during my bed rest and Fletcher's NICU stay.

Today, I am definitely joyful in hope.

Flashback: IVF #4 "The Frozen Cycle"

I am doing a terrible job of putting tomorrow's Beta out of my mind. So, I was thinking, I did recaps of my IVF cycles that didn't work, maybe for karma's sake I should post about the one that did.

The cycle itself was pretty boring, no E2 levels to report, no follicles to count, no eggs to harvest, no dividing embryos to obsess over, no PGD. Well, that isn't totally true, they got a few E2 levels to check on my lining, to make sure the estrogen patches were working (they were), and I did have to worry about whether the two embryos would survive the thaw and start dividing again (they did). But it really lacked most of the drama involved in a fresh cycle.

I didn't keep a journal of the frozen cycle, but I did save some old emails. Below I have cut and pasted an excerpt from one I sent to my sister-in-law on July 6, 2006, sharing the good news. I would like nothing more than to post something similar on this blog very soon.

I started the usual cramping on Friday night and off and on throughout the weekend. I was feeling really bummed about everything. I even refused to do my PIO shot on Monday morning before my blood test, there was no way I was going to stick that huge needle in my own butt for nothing. Adding insult to injury if you ask me (did I tell you I have been doing my own PIO shots, it is really not that hard at all, I was surprised). I emailed my IVF nurse the night before to tell her that I knew I wasn't pregnant because of the typical cramping, etc, and that she didn't need to feel bad when she called me with the official results. She emailed me back and said I made her laugh and that I shouldn't give up hope so easily and she would love to be able to say "I told you so" with her call.

So I was running errands after my blood draw and the nurse calls me on my cell and said that she was not sad to call because she got to say "I told you so"... my beta at 7dp5dt was 57! Right in the average range for a singleton pregnancy. My hands are shaking just typing this!! I went back yesterday and it had increased to 109. Not quite double (91% increase) but with a doubling time of 51 hours (should be anywhere from 48 hours to 72 hours). I go back tomorrow to see if it is still rising properly and, if so, will schedule an u/s for the end of this month/beginning of next to see if there is a heartbeat. I have told my family, but that is it. There is still such a big chance that this won't actually develop into a full pregnancy, so I want to hold off at least until I get my third beta results tomorrow until I tell anybody else.

A Little More About PGD

To keep my mind off of tomorrow's impending Beta, I thought I would type out a quick post about PGD. I also wanted to document the fact that I am not as abnormal as some of you may think (well not in this way, at least).

Soon after the PGD results came in, Angie asked (and some of you may have wondered) why so many of my embryos were deemed abnormal. First off I want to clarify (as I have done in the past, but I think it bares repeating, because this is a confusing topic), when I say abnormal, I don't mean that the embryos have a propensity for some ailment. This isn't Gattica. These are chromosomally abnormal embryos which have too few or too many chromosomes and would probably not live past birth, or if they did, it would not be for long. In past cycles someone asked me how many of the abnormal embryos might somehow "grow out of it" and be healthy babies. The answer is none.

I asked Dr. Internet why so many of my embryos (60%) were chromosomally abnormal and if this is rare. Dr. Internet gave me this article. It talks about young egg donors (fertile women in their early 20's) and how they are finding even young, fertile women have a surprisingly high number of genetically abnormal embryos produced from an IVF cycle. For those of you who don't care to wade through the entire article, I have excerpted the relevant portions:

The present study indicates that young donors, presumably fertile, produce high rates of chromosomally abnormal embryos (57%). Nevertheless, because they produce many oocytes, there are enough chromosomally normal embryos to result in high pregnancy rates after IVF. The findings of this study suggest an unexpectedly wide range of chromosome abnormality rates between donors, but similar rates and variations are found in younger infertility patients.

The comparison group of infertile patients, 18–34 years old, undergoing PGD, produced 66% chromosomally abnormal embryos, higher than the egg donor group. However, considering that this comparison group was 5 years older, on average, than the egg donor group, one can assume very similar rates of chromosome abnormalities for the same age. This, if true, would mean that infertility in young couples (<35) may be attributed to other factors, and not to chromosome abnormalities in oocytes. One may also consider that it is certain aspects of follicular stimulation that could possibly cause aneuploidy in both donor and patients eggs. Whatever the reason, true controls such as analyses of eggs from donor and patient embryos in natural cycles are not available.>

So, it looks like my 60% rate is just about average. I don't know why, but this makes me feel a little better. I know most (all?) of you probably don't care, but for my purposes of making this a complete journal, I am summarizing the PGD results below. It is important to note that they don't test all chromosomes, just the 9 most commonly associated with miscarriages. For reference, a genetically normal embryo has two copies of each chromosome, trisomy means the embryo had three copies of that particular chromosome, and monosomy means it only had one.

Embryo 1: Trisomy 14 and 18.

Embryo 2: All tested chromosomes normal.

Embryo 3: Trisomy 14 and 17 and Triple X Chromosome.

Embryo 4: All tested chromosomes normal.

Embryo 5: Trisomy 13, 14, 15, 18, and 22 (this one they call "complex abnormal").

Most of these trisomies would have caused a first trimester miscarriage, had the embryo implanted at all (which is unlikely) but others commonly cause later term miscarriages. For those really interested in this topic, I found an interesting chart on wikipedia.