Monday, December 29, 2008

Choosing CCRM

This is the current home of our precious embryo, as it awaits us, cryopreserved and suspended in time. Soppy though it sounds, both of us were overcome with a strange and powerful feeling as we approached the CCRM building for the first time yesterday.

We chose CCRM based on a number of factors, though there were many things to like about our local clinic too. We loved our RE there, who is warm and chatty and just generally made us feel as though this was all definitely going to work. He also got to know us a great deal over the ten or eleven months he worked with us, as was succinctly and pointedly verbalised shortly before my frozen transfer in June, when, as I was leaving his office, he called after me “don’t worry, remember, I know your cervix very well”. And he did. I was worrying, because my cervix is a stubborn beast that tries to resist the insertion of a soft catheter containing embryos, which was almost certainly the reason for our unsuccessful first transfer.

My nurse there was also very entertaining. Shortly after we first started working with them and we were on our first (and last) month of the ovulation stimulating pill Clomid, she called to enquire as to whether we favoured an IUI that month (turkey baster) or whether we were going to try the old fashioned way first. She must have been in a terrible hurry because she chose to ask this, admittedly, simple question by barking down the phone “insemination or timed intercourse?”. Reminded of the “crucifixion or freedom” scene in Monty Python’s “Life of Brian”, I burst out laughing. For what it’s worth, we went with the latter.

But during my research over the months, I became aware of the incredible success rates at CCRM. In 2006 for women between 38 and 40, the live birth rate was 25.4% at my local clinic and 44.4% at CCRM. That’s a remarkable difference. CCRM’s success rates are unbeaten anywhere in the world, particularly for older women, and I started wondering what it was about them that made them so unbelievably successful. Following our devastating early miscarriage in June, we decided to book a phone consultation with the leading doctor there and it became immediately clear what their success was all about. Before the phone consultation could take place, we were asked to fill in a huge form listing every tiny detail of our medical history, particularly our history of infertility. The consultation itself gave us a great deal of confidence in our possible new doctor, especially when we heard about the intense “one-day-workup” they perform on every couple before they start treatments on anything. Off we went in August, to be poked, prodded, questioned and educated for a full day. As our results trickled in over the next couple of weeks, many previous mysteries fell into place for us and we knew that, if anyone could help us, it was CCRM. Unlike many other clinics that assume that it’s “just old age”, they left absolutely no stone unturned and even asked me to do some more tests locally to ensure my uterine lining was receptive to the successful implantation of an embryo, lest we find the “golden egg” and mess it all up with an unreceptive uterus. Luckily I passed those last tests.

An additional and extremely compelling push towards CCRM was the fact that, in collaboration with a laboratory in New Jersey, they perform a brand new type of genetic testing on five-day embryos (blastocysts). Now, we’d hitherto been uncomfortable with the concept of genetic testing, because it seemed somehow unethical and, without further investigation, smacked of “designer babies”. However, we’d learned that, coupled with ovarian reserve itself, meaning how many eggs a woman has left, the main reason for low pregnancy and high miscarriage rates in older women is a high occurrence in their embryos’ chromosomal defects. In fact, once you reach your late 30s and early 40s you can only expect about 15-20% of your embryos to be chromosomally normal and, hence, viable. This is because the eggs have been sitting around in the body since birth and the chromosomes have been stuck together for so long that they have difficulty separating, which they must do to reduce the number of chromosomes from forty six to twenty three. So, when combined with the man’s half, there's either one chromosome too many or one too few. In the vast majority of cases, this will lead to non-implantation, in some cases it will lead to implantation but loss of the pregnancy and in extremely rare cases it will lead to a child with birth defects that will only live for a few weeks. The exception is babies born with Down’s Syndrome – otherwise known as Trisomy 21, a third 21st chromosome.

Once we learned of the high number of chromosomally abnormal embryos we are likely to be producing each cycle and we’d already experienced a loss, we felt that genetic testing was a good way for us to move forward with a reduced risk of having to go through many more failed cycles or losses. At our age time is of the essence, not to mention our increasingly fragile emotional state and the heavy financial burden of repeated IVF cycles.

Traditionally available pre-implantation genetic screening (PGS) is performed on three-day embryos which are at the six to ten cell stage and can only be tested for nine of the twenty three chromosomes. Obviously taking one or two cells from an embryo that only has six to ten is a very risky matter, since you are removing a high percentage of the overall genetic material within that embryo. It has also been reported lately that this traditional method of genetic testing is not as accurate as once thought and can lead to both false negatives and positives.

By contrast, the new test looks at all twenty three chromosomes and is therefore much more comprehensive. What’s more, it’s performed on five-day embryos with sixty to one hundred cells so it’s a great deal less risky to remove a couple of cells. Since the latest an embryo can be transferred back into the woman’s body is five days after fertilisation and the cells are sent to a laboratory in New Jersey for testing, the embryos are vitrified (flash frozen) after the cells are removed and any embryos that tested normal are then transferred in a subsequent cycle. Although it’s difficult to wait, this has the advantage of giving the body a chance to rid itself of the high-powered stimulation medicines that were given during the retrieval cycle so it’s in a better position to successfully implant the embryo once it’s transferred.

The first baby tested in this way was born in June 2008 and so far 75-80% of transfers with two normal embryos have led to healthy, viable pregnancies. Currently there are only two centers that offer this test, but it’s thought that, ultimately, this method will change the way IVF is performed world-wide.

Having said all that, in the end it was this view from outside CCRM that clinched it for us.

1 comment:

  1. Jim and Jess,

    It sounds like things are progressing well for you. I can't get over how far this technology has come since I went through it 12 years ago. They have learned a lot since then and it sounds like odds have increased significantly, particulary with the group you have chosen. Fingers and toes crossed!

    I must say, it's very brave of you both to create this blog, but we do all appreciate it. It's great to know what's going on.

    I'm sending positive thoughts your way every day....good luck!