Transfer (the real story)

Ok I am back, I know it has been awhile and you all have been stuck getting the updates from Erin Nye the science guy. I thought I would update you all on the true story of the transfer.

First off Erin gets the call just like she said, one great embryo one "slow" embryo. She cried and worried, going over every single scenario (like she always does), while Trevor continuously repeated (including telling the RE and the embryologist) that he beat me in poker last night and we had a bet that he would then decide how many to transfer and he chooses two. I bet he said it four times, I started feeling as if I were dealing with Rain Man. Also, to clarify things, he beat me in the first session but I was victorious in the second, which is a tie in my book. We discussed the different options, while ignoring Trevor, and I left the decision up to Erin. Ultimately we all decided to transfer both embryo's. Both the RE and the Embryologist agreed with this decision, because it was very questionable if the second embryo would freeze.

Next we were off to the transfer area, I think it is located in a holding area for same day surgery, but I had my own room. This was nice because all the other patients were lined up on cots only separated by thin curtains, reminding me of some kind of psych ward. I was told to undress from the waist down and hop up on the stirrup table and cover with a blanket. The nurse must have noticed my distress with this because the table was chest high and there would be no hopping up, it would be a climb and with no pants on, holding a blanket, it might get embarrassing. She kindly pointed out a step stool in the corner. Thank goodness, I had visions of Erin hoisting me up on that table and they were not pretty.

Next, the RE comes in and puts pictures of the embryos up on a tv screen. I thought this was strange and pointless but Erin gets very excited and busts out her camera phone to take pictures, as I pull my blanket up a little tighter. I don't want her getting any ideas about that camera phone. She was quite the proud momma staring at those two blobs. I kindly, in my opinion, told her that they had her features. Next they perform the transfer, and thankfully Erin put away the camera phone.

After the transfer was complete, the RE hangs around answering any questions we may have. I must clarify this, by hanging around I mean snuggling up between my legs and draping her arms over the side of my thighs, kinda like a kid hangs on monkey bars. She had done this once before with my initial exam and although I do have a blanket on it is very awkward. Erin witnessed the first time she did this and it has been a running joke since then but neither one of us could believe it was happening again. She is dying trying to hold back her laughter and I am trying to signal to her to get her camera phone back out and get a picture of it. She never got the message and as soon as the RE left the room she busts out laughing. We are both very disappointed we have no picture to show all of you because it would have been a great one. We thought about calling her back in for some random questions but I was already getting dressed so it wouldn't be the same.

Well that is about it, we left, Trevor was waiting for us in the car with some chick-fil-a, which was delicious and now I am home, sleeping off the Valium.

Transfer

I still had not heard from the Lab and needed to leave to head down there no later than 10:30, so I gave them a call around 10:00 and left a message for the Embryologist. He called back shortly and the we had the following conversation (of course this is the abridged version):

Me: Are the results in?

Embryologist: We have yet to get the PGD results in, but as far as morphology goes, all five are fit for transfer.

Me: Did you say FIVE? But, what about the one that "didn't do much" after biopsy?

Embryologist: It is still a little behind, but has progressed to an early blastocyst.

Me: Oh. But none of this matters until PGD is in.

Embryologist: Exactly. So, why don't you come on down and, worst case scenario, they are all bad and you wasted a trip.

Me: If all of the embryos are abnormal the last thing I will be mad about wasting is my half-hour drive to the clinic.

Embryologist: Good point.

So, that was that. On my way down the results came in and he called my cell phone to let me know. Remember the scenario I described in my prior entry which would be the ONLY way we might transfer more than one embryo? You guessed it. Out of the five embryos, three were genetically abnormal for one or more of the chromosomes tested and two were normal. Of the two genetically normal embryos, one looked great and one did not. So, obviously I wanted to transfer the good looking embryo. The question remained of what to do with the other.

I agonized (and I will admit it, called my mom (who was at bible study and didn't answer) and cried) over this decision for the remaining 20 minute drive to the clinic. Once there Trevor, Angie and I (and Fletcher and Michael) sat down with the RE and the Embryologist to go over all the facts. It was a really hard decision. Transferring two embryos "significantly" improves pregnancy rates, and even transferring two, given my (you guessed it) diminished ovarian reserve, the RE still only gave us a 50% chance of getting pregnant. Only transferring one would decrease that percentage, plus, essentially, we would be more or less throwing away the other genetically normal embryo, as there was "a good chance" that it would not meet the clinic's criteria to freeze. On the other hand, transferring two increases the chances of multiples, and all of the associated risks, to Angie and the potential fetuses. And believe me, I take none of that lightly.

In the end, we decided to transfer them both. Neither Angie nor I could bear the thought of discarding a genetically viable embryo, which was a very real possibility had we only transferred one. I will do a post a little later on this week with more details about the PGD report, in case anyone is interested. And I am hoping, since she has to just lay around for the next couple of days, that Angie will do a post about the actual transfer, so stay tuned.

Stood Up

The Lab stood me up for our morning chat. I held off as long as I could, but finally left for work at 9. Maybe they decided to only call once, after the PGD results came in. I slept well last night (as did Fletcher... we had to wake him up for his 8:30 vision therapy appointment, which never happens). Now, however, I am super nervous and anxious, as is apparently my mom and Angie (with good reason), as I have already gotten calls from them this morning, well, twice from Angie.

I guess I will call the clinic if I haven't heard from them in about an hour. I would love to be an optimist and just head on down there for the 11:15 transfer assuming there will be one, even if I never hear affirmatively that we have viable blastocysts, but I'm just not that person anymore.

Day Four Embryo Report

Lab called this morning (starting to seem like groundhog day to you, too?). The embryologist informed me that one of our embryos "hasn't done much" since biopsy yesterday, so it looks like we have our first casualty. The other four are still going strong and are all 12 to 16 cells (morula stage) at this point, which is good. Day four is tricky though, so he had no predictions for tomorrow. I have found that smart docs avoid predictions anyway. Plus, it doesn't matter how pretty they look tomorrow if they are genetically abnormal and will not progress, so no use in trying to figure everything out today.

The embryologist and I will have our final morning chat tomorrow to confirm that there are still viable embryos fit for transfer at that time, and hopefully there will be at least one or two blastocysts on the all-important day 5. He confirmed that we still only wanted to transfer one embryo, and I explained that I was very confident about that throughout the cycle, only now I am starting to freak out about the odds and a tiny part of me is considering transferring two. I guess it just depends on how the embryos look tomorrow. Assuming there is more than one that is genetically viable, if both look great and are aggressively dividing, I will no doubt choose to have one transferred and one frozen for a possible future frozen cycle (my door is open to accept any applicants for future surrogates, ha). But, if only one looks good and one looks marginal (and not good enough to freeze, because freezing and thawing takes a toll and they only do it with grade-A blastocysts), we may, and I mean MAY, transfer two. After spending as much time in the NICU as I have, the term high-risk pregnancy takes on a different meaning, and I have had my fill of high-risk. Not to mention I am not the one taking the risk.

Anyway, that is all useless speculation at this point. What will be tomorrow will be. Angie has to report to the clinic tomorrow at 11:15, Valium in hand. I think I will drive her while Trevor watches Michael. So, around 11 to 12 tomorrow, please say an extra prayer for us!

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.