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.

Two Week Wait

Sorry for the prolonged silence (a big change from the daily updates last week). Basically, it is because I don't really have anything to say. We are in the phase of the cycle typically known as the "two week wait." I suppose if you have a day 3 transfer you used to have to wait two weeks before you found out if it worked. However, since we did a day 5 transfer and my clinic tests a bit on the early side, we only have an eight day wait. Which means Angie is to go into the lab this Thursday to have blood drawn for her beta. This tests for hcg levels in the blood. If there is a measurable number, that means an embryo did implant, but that is about all it tells you. In that case, she would go back for another beta to see if the hcg levels are rising appropriately, which would indicate an early pregnancy has been achieved.

I used to OBSESS during my prior two week waits, and wonder if this cramp or that ache meant that it did or didn't work. For some reason I am a little more ambivalent about this 2ww. An obvious reason is that I am not the one who may or may not be pregnant. I think it is also because I have Fletcher to look after. And he likes when the focus is all on him (and I am usually happy to oblige).

I'm so bored

I am posting again because it is 6 am and I have a full day of semi bed rest ahead of me and I am already bored. Those of you that know me, know that although I am extremely lazy, I can not stand to sit around and do nothing. I get this from my dad. I guess I should not have given in to the Valium and slept for 4 hours yesterday. I have already devoured the whole box of doughnuts meant for my kids breakfast, played two games of online poker, ordered High School Musical on Ice tickets (which is a big deal because I had to figure out the presale code), and called up to my job and bothered them for an hour. I guess I have time for one more poker tournament before my boys wake up to entertain me. By entertain I mean run around the house making messes, that they will have to clean up before Theresa the girl that cleans my house gets here later today. Told ya I am lazy.

Also some of you astute blog readers may have noticed my last entry has a few touches of Erin in it well your hunch is correct, I made the mistake of giving her my password so now she fixes my spacing and changes the Doctor's names to their titles. Fortunately she did not delete any of the embarrassing things I have recapped. That would have forced me to change my password. She also hates that I change the color but she left that alone as well.

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!