Day Three Embryo Report

The embryologist called again this morning and I think I may amuse him. And by amuse I mean annoy. Not really. Or maybe. You see, I can't let any decision be simple. It is just how I am made. I have to analyze things over and over, and then usually just go with my original gut feeling. I just can't leave anything unsaid (or more accurately, unasked). On a number of occasions I said, I know there is no clear answer, or, alternatively, I know the answer is obvious, but I just need to ask this question... I know from experience with Fletcher in the NICU, it is the things left unsaid that will haunt you.

Our five embryos are still progressing (thank the Lord). All are eight cell and looking good (however, and I learned this just today from this link about blastocyst transfer, "during the first few days, the embryo relies on the mother's egg for all its nutrients, however, in order to survive past day three or four, the embryo must activate its own genes. Not all embryos are successful. In fact, only about one-third of the embryos become blastocysts"). So, looking good at this point--while, well, good--doesn't necessarily mean that the embryo will progress to day 5 (blastocyst stage, when my clinic does the transfer). The status of the embryos tomorrow will be a better predictor.

And already, before they are even fetuses, let alone born, I have to make the hard decisions. Because all five are still progressing, we have decided to pursue PGD, which means today, if not already this morning, one of the eight cells of each little embryo will be biopsied and federal expressed cross country for evaluation. How weird is that. If we don't do it, transfer a defective embryo, and then do a frozen transfer, we have effectively spent the same amount of money (PGD and frozen cycles are roughly, plus or minus a couple hundred of dollars, the same cost) and have reduced our chances while at the same time put Angie through a possible miscarriage or failed cycle. If we do PGD, and transfer an embryo that is proven (although not 100%, there is always room for error) to be genetically viable, then we have maximized (although not guaranteed) our chances of success, especially considering we are only transferring one embryo, instead of the usual two (which is a whole separate topic of discussion). Of course the best case scenario would be to not do the PGD and still transfer one genetically viable embryo that implants and grows to a full-term pregnancy; but, alas, I have no crystal ball, and reproductively speaking, who am I kidding, the odds are never on my side.

I have to add that I am, obviously, very happy that all five are progressing and look good. Last cycle at this time we had seven, but one was already falling behind at this point. Check back for day four report tomorrow (but don't expect any genetic testing results... those come in at the eleventh-hour, just prior to transfer, you know, to add a little drama to this boring process).

Day Two Embryo Report

Lab called again this morning. Trevor answered because he was up with Fletcher and I was trying to get another hour or so of sleep (I seem to not be recovering as well after this retrieval… still lots of soreness, which doesn’t translate into the most restful nights).

I heard the phone ring and Trevor starting up the stairs. He knew that I had wanted to talk to the embryologist and didn’t want to take the chance of missing any important info. The embryologist said exactly what I thought he would say. Typically they like to have at least 5 embryos to send out (the testing is done off site at a lab in Maryland or somewhere), reason being is that by day 5 usually about 40% of the embryos that fertilized are still alive and dividing, so there is a good chance that if you start with, say, three embryos on day three (the day they biopsy for PGD) there is a real possibility that you may end up at day 5 with no viable embryos and you have just wasted all that money for nothing (and as you can imagine, as with everything else related to IVF, the genetic testing is not covered by our insurance, and it is not cheap). That said, they will send out less than 5 (and we actually did in the past, with cycle two we sent four); it is ultimately our call.

My lovely friend Sara, who also happens to be a comment-leaving rockstar (thanks, Sara!) had a good question. She asks, what exactly is PGD. Having been indoctrinated and living in this crazy infertility/IVF subculture for over four years now, I sometimes forget that there are certain things that all you “normal” (ha) people know nothing about. So I will link to a little more information here and here (the second link has a helpful FAQ section). Basically, PGD stands for preimplantation genetic diagnosis. The first link, above, lists a number of reasons why people may be candidates, and we fit many. This is a process that screens the embryos for genetic defects before they are transferred. I must clarify that we do NOT use it for gender selection (in fact, they won’t even test our embryos for that, or at least will not include those results in the report we see). What they test for are by and large conditions that are incompatible with life, and, even if we didn’t test these embryos, chances are the ones with genetic defects would not survive to day five, or if they did, would not implant, or if they did, would likely miscarry in the first few weeks (or, as the doc explained, nature usually does a pretty good job of doing its own genetic screening). And, if this process only involved me, I am not sure I would do PGD.

There is a really long explanation that I started to type out, but it is just not making any sense. So the short of it is that many times the genetic testing doesn’t increase the chance of live birth, rather, it decreases the chance of miscarriage, and I want to minimize the chance of miscarriage, in general, and specifically because it is not me that would have to go through it… it is Angie. She is already subjecting her body to so much for me, if we can do something to minimize the chance of her miscarrying, I am all for it.

The embryologist will call tomorrow to discuss how the embryos are looking, and we will make the PGD decision at that time, so check back tomorrow for that news.

And, in case you were wondering, our fab five are still going strong. Five little 4-cell embryos– right where they are supposed to be.

Five

Lab called this morning around 9:30 (and see how fast I am posting the results, I am such a conscientious blogger). Seems like they called earlier the last few times around, but back then we didn't have a baby who gets up at 7:00, so 9:30 probably just seemed a lot earlier back then.

Out of the seven eggs collected, five were mature and all five fertilized and are at 2pn, right where they should be. A nurse called, not the embryologist, and she was pretty much just reading from a report so she couldn't answer my questions, the primary one being whether or not we are still candidates for PGD, because I know they really like to have higher numbers before they send them out. It may depend on how the embryos look on day 3 (Monday). I also want to know if the two that couldn't be fertilized were over or under mature and also what was up with the lower-than-expected egg yield. I am sure the response will include the words diminished reserve somewhere, but if you know me, you know I like to ask questions.

I have mixed feelings about the five. Even though it does no good to compare to prior cycles, I can't help but do it. This was actually the fewest eggs I have gotten during a retrieval. It was the second fewest amount of mature eggs, and now it is the third fewest (or second largest) number of eggs that fertilized. The cycle is improving with each step. So, while it started off disappointing, I am really liking this trend and hopefully it will continue and by day 5 I will have the most healthy blastocysts of any prior cycle.

Seven

Retrieval was this morning. I had to be at One Day Surgery at 7 am, but unfortunately that is not the reason behind this post's title. They only retrieved 7 eggs. The doc told Trevor the count while I was still in recovery, so I don't know if the other follicles were empty (they don't always contain eggs) or if they couldn't reach my left ovary or what. Who knows, maybe that stupid cyst affected things. All I know is that I am disappointed. To compare, with my first cycle they retrieved 9 eggs, only 4 of which were mature, second cycle retrieved 12 eggs, 11 of which were mature, and third cycle, retrieved 17 eggs, 14 of which were mature. So, even best case scenario, all 7 of the eggs are mature, that is still half as good as my last cycle. Darn it.

The good news is that the procedure went well (other than the fact that the nurse took my weight (with my shoes on I must add) and then said, oh, you don't look THAT heavy... you carry it well. Um, thanks?). It took a different nurse two sticks to get a good vein for the IV, which wasn't pleasant, but the lovely versed they gave me made up for it. The anesthesiologist was actually the same one who attended Fletcher's birth. He was really happy to see Fletcher and was pleased at how great he looks, and couldn't believe it has been almost two years since he was born (and neither can I).

I wanted to post a quick update before going back to sleep for a few hours. I am feeling pretty sore, but not too bad. They should know by now how many of the 7 are mature, but the lab probably won't call until tomorrow morning to give us a fertilization report. Trevor and I (and Fletch) are heading down to my Aunt's house for the day tomorrow, but I will try to post the fertilization report before we leave, as I know you all will be waiting with bated breath. Ha.

In the meantime, for all you secret science geeks out there, here is a video describing the ICSI process. Hopefully all 7 of my eggs fertilized through this method mere hours ago.

Tired, Nervous, Distracted, Frustrated, Hopeful, but Mostly Grateful

That about sums up how I am feeling right about now.

Tired from the drugs; nervous about how many eggs will be retrieved, fertilize, pass PGD and grow to day five; distracted from my work; frustrated that conceiving a child has to be so darn complicated for Trevor and me; hopeful that this will actually, somehow, all work out; and grateful that the technology is available and that Angie has agreed to do this for us.

I edited the last sentence of my last post for clarity, based on Angie's comment, to acknowledge that she isn't just about to begin, but has been in the trenches since April doing shots of the crazy-inducing Lupron and subjecting herself to other humiliating procedures, all for me. I have always been thankful for what she is doing, but I have to admit at times (although rare) it was kind of a bitter-type of thankful in that I thought, "why shouldn't she do this for me, she has been lucky enough to have a few "easy" full term pregnancies, and I have had such misfortune in this area, poor me." But after seeing her pull out her Lupron shot just before dinner the other night at my mom's house, and having to put her crying toddler down, essentially putting her life on hold, to inject herself with menopausal simulating hormones, well, it just really hit home how selfless she is being in all of this.

So, thank you Angie. No matter what happens with transfer, whether the embryo implants or not, I will always be eternally grateful for your sacrifices to help me build my family. And, no, I am not just saying this so you don't smoke crack while you're carrying around my kid.

Surrogacy Cards and Retrieval Preparation

I ran across this post (scroll down for some creative surrogacy and infertility card suggestions) and thought it was funny enough to share (by the way, for you readers with little blog experience, you can click on the purple colored text... they are hyperlinks to another site and I use them to direct readers to more information, or pictures, or in this case, a funny blog post from someone else because, as my dear sister told me a number of times, my recent posts are so boring they put her to sleep).

I can't believe I took my last shots this morning. This cycle just flew by, once it actually started, that is. I am getting increasingly "full" and slightly sore in the ovary area. I have been dealing with last minute retrieval details all day. I finalized the surrogacy contract, pre-registered and prepaid for the hospital (retrieval is done at one-day surgery) and the anesthesia, and completed the PGD paperwork. I had to give my medical history during pre-registration, and instead of sailing through my minimal medical history or problems, as I did in my past few retrievals, I had to stop and think about how my severe preeclampsia/HELLP syndrome played into any of her questions. I still answered no to mostly everything (except the blood pressure questions, which aren't currently a problem, but I still think worth mentioning). I successfully fought the urge to tell the woman that "I am fine until I am about half-way through a pregnancy, and then the baby and I try to kill each other."

Angie had to go in for a last minute blood test to test for CMV exposure, but I think it is a legal requirement more than a practical necessity. She also tested a little low on her estrogen levels (just barely, they want her over 300 and she is at 290), and will need to add an oral estrogen pill to supplement the patches (I think I had to do that for my frozen cycle as well).

That's about it. Trigger tonight at 9 sharp. Report to one day surgery at 7 am on Friday. No food or drink after midnight on Thursday, no jewelery, no lotion or makeup, etc. The typical surgical stuff. The end is in sight (at least my part of it is... hopefully Angie's has a little over 9 months to go*).

_________

* Edited for clarity, see my next post.

Second Scan

For some reason I made this morning's appointment for 7:30, why I have no idea, as I am not a morning person and it just made my return trip (going with the flow of rush hour) that much longer. Fletcher was snuggled up next to me sleeping soundly when the alarm went off (yes, he still sleeps in our bed) and the last thing I wanted to do was head down to the lab to get my blood drawn and be violated (as Angie described it) by the "magic wand."

The appointment went well. Had a number of good-sized follicles on the right, and only 3 decent ones on the left. Diameters ranging from 19mm to 10mm, but quite a few in the 17mm to 19mm range. Marge was happy, but she thought I better come in tomorrow morning for one last look and then do my trigger shot on either Wednesday, for a Friday retrieval, or Thursday, for a Saturday retrieval. This shot is done as an intramuscular injection, so it is a little more tricky (and the needle much larger) than all my sub-q injections up until then, but I gave myself intramuscular injections of progesterone every day for about 13 weeks when I was pregnant with Fletcher, so I think I can handle this one (and yes, if you were wondering, if Angie does get pregnant, she will have to give herself the same type of shots every day for 13 weeks... have I mentioned how much I love my sister lately?).

Marge just called with my lab results. Estrodial is 2499. I wish I could compare to my last cycles (which were 2254 and 2235 at the second scan) but I have been stimming for an extra day at this cycles blood draw relative to the last cycles, so they aren't an accurate comparison. I tried to ask Marge about relative estrodial levels, and she saw through me to what I was really getting at and said that she is hoping to get roughly 9 mature eggs this cycle. Turns out the RE was happy enough with my E2 level that she didn't feel like I needed to come in tomorrow. I am going to just stay on my typical shot doses for tonight and tomorrow morning, and she will call me tomorrow afternoon and give me the exact time I need to trigger.

Okay, I am officially starting to get nervous.