My frozen embryo cycle has finally started. I had to go in for blood work last Friday to make sure my progesterone level was above five, indicating that I’d ovulated. It was 9.8, so I started the daily Lupron shots in alternating thighs on Friday evening. Next week I’ll start estrogen patches. They’re stuck onto the stomach, gradually increasing from one to four over a period of two weeks. At the same time as the patches, I’ll start the daily Lovenox blood thinner shots. My stomach will be a high traffic area….
Then five days before the transfer I add progesterone in oil (PIO) shots in the bum, antibiotics and a steroid drug. The latter two are only for a few days, but the PIO could be for twelve weeks or so, depending on the outcome of the transfer. I made the grave mistake of looking at the needle I’ll be using for the PIO shots – it’s huge. A 1.5” intramuscular needle just like the trigger shot, but it looks much thicker than the one we used for those shots. I’ve never done this by injection before, having opted for suppositories for the other two transfers. But, hopefully not to my great regret, I decided it would be easier to do one shot a day than three messy suppositories with the need to lie down for half an hour for each one.
This cycle involves quite a few doctors’ visits as well. In addition to the usual blood work and endometrial lining checks that'll need to happen a week before the transfer date, I’ll have to have my blood platelets checked three times, four days apart, once I start the Lovenox. We need to make sure I’m absorbing the blood thinner appropriately and that the viscosity of my blood is correct. But the pièce de résistance of all appointments will take place tomorrow with the insertion of a so-called Laminaria, which I understand is some sort of sea algae used to dilate your cervix with for twenty-four hours. It apparently expands with time, similar to those natural bath sponge things, I imagine. Lovely! The Laminaria is intended to widen my cervical opening and make the passage of the transfer catheter easier. As documented in a previous post, this was the problem at my first transfer last March and was the likely cause for the failure of that cycle. I’m not sure how the treatment will last for more than a month, but my doctor in Denver wanted me to do it this week prior to the start of estrogen patches. I’m going to make a wild guess: this will not be a pleasant twenty-four hours. My OB told me he would need to “pack your vagina with other stuff” to keep the Laminaria in place. I can hardly wait.
If all goes well, the transfer of our two embryos will be on Monday, April 27th. We’re very excited with a small side order of terrified.
Monday, March 23, 2009
Thursday, March 5, 2009
Honesty
I’ve been tagged by the lovely Sue and the lovely KayJay to share ten honest things about me. In no particular order, here they are:
1. I’m a walking identity crisis. I’m English but grew up in Germany from age five and am not sure where I belong more. On the upside, I’m extremely punctual.
2. There’s something weird in my personality: I’m terrified of flying, but all the jobs I’ve chosen have involved a lot of global travel. I’ve flown on all sorts of airlines, some more dodgy than others. My fear of flying developed before any of the four “overshoots” happened (landings cancelled at the last minute), but they certainly didn’t facilitate the recovery process.
3. Despite the chocolate and beer, I’m not a huge fan of Belgium. I was robbed once for each year I lived there (three). The first robbery was in Gent and I was held up at gunpoint in a corner shop when someone walked in to clean out the cash registers; I happened to be standing there paying. The second time was when I was mugged late at night in the parking garage at Brussels airport coming back from a business trip to Australia. The third time I was in my car in Brussels at a red light with the doors locked and someone put an axe through the passenger window and grabbed my handbag from the seat. I took the hint and moved to the US soon after.
4. I constantly feel guilty about the fact that my career drive has slowed over the last few years. I used to be a real go-getter with a lot of responsibility at work, but my work ego has mellowed since then. I’m still very keen on my job and working hard, but not at the expense of my personal goals. One of my biggest stress factors in the IVF process is making all the doctor’s appointments work with the business trips.
5. I had a beautiful little brother called Patrick who died in an accident when he was five and I was sixteen. It’s the worst thing that’s ever happened to me.
6. J the Elder and I met on eHarmony. After staying in several bad relationships for far too long, I finally realised that I wasn’t very good at finding the right kind of person on my own. It took me about two weeks to fill in all the questionnaires, but within three weeks of joining we were matched up in August 06. We were engaged in Paris in May 07 and married in January 08. First marriage for both of us. I admit to still cringing over how we met, but it worked. Two friends joined after they saw what happened to us, one of them is getting married this July and the other is also very happy.
7. When I married J the Elder I went from having one sister-in-law to having eight. My DH has seven siblings, all of them fabulous. Once I’d perfected the names of his seven siblings and their spouses, I went on to memorise the names of his seventeen nieces and nephews and two great-nieces and nephews. Before meeting his parents for the first time, I’d nailed it. I think I liked him.
8. I’m neurotic and paranoid about losing my two cats and probably should seek therapy for it. I live in constant fear that they’ll get out of the house and be attacked by coyotes (very common where we live). When I moved in with J the Elder, I went on and on about the need to be really careful with the doors and windows. Within two weeks of moving in, however, it was his beloved dog that got out on my watch when an air conditioning service person left the garden gate open. I had to call him to come home from work and we found her about three hours later. I was sure that was the end of the relationship…..
9. I really miss the running lifestyle. Because of our fertility issues, I haven’t run more than a mile since July 07. I only started running in 05 but took to it like a fish to water. Between 05 and 07 I ran several 5Ks, 10Ks and half marathons, as well as the Marine Corps Marathon in DC. Ironically, I wasn’t able to run the Boston Marathon due to an injury I sustained qualifying for it in DC.
10. I’d be utterly heartbroken if I wasn’t able to make a Daddy of my DH. He’s unbelievable with children, they all just gravitate towards him. Watching the amazing bond that’s developed between him and his nearly 3-year-old nephew is wonderful and very touching.
1. I’m a walking identity crisis. I’m English but grew up in Germany from age five and am not sure where I belong more. On the upside, I’m extremely punctual.
2. There’s something weird in my personality: I’m terrified of flying, but all the jobs I’ve chosen have involved a lot of global travel. I’ve flown on all sorts of airlines, some more dodgy than others. My fear of flying developed before any of the four “overshoots” happened (landings cancelled at the last minute), but they certainly didn’t facilitate the recovery process.
3. Despite the chocolate and beer, I’m not a huge fan of Belgium. I was robbed once for each year I lived there (three). The first robbery was in Gent and I was held up at gunpoint in a corner shop when someone walked in to clean out the cash registers; I happened to be standing there paying. The second time was when I was mugged late at night in the parking garage at Brussels airport coming back from a business trip to Australia. The third time I was in my car in Brussels at a red light with the doors locked and someone put an axe through the passenger window and grabbed my handbag from the seat. I took the hint and moved to the US soon after.
4. I constantly feel guilty about the fact that my career drive has slowed over the last few years. I used to be a real go-getter with a lot of responsibility at work, but my work ego has mellowed since then. I’m still very keen on my job and working hard, but not at the expense of my personal goals. One of my biggest stress factors in the IVF process is making all the doctor’s appointments work with the business trips.
5. I had a beautiful little brother called Patrick who died in an accident when he was five and I was sixteen. It’s the worst thing that’s ever happened to me.
6. J the Elder and I met on eHarmony. After staying in several bad relationships for far too long, I finally realised that I wasn’t very good at finding the right kind of person on my own. It took me about two weeks to fill in all the questionnaires, but within three weeks of joining we were matched up in August 06. We were engaged in Paris in May 07 and married in January 08. First marriage for both of us. I admit to still cringing over how we met, but it worked. Two friends joined after they saw what happened to us, one of them is getting married this July and the other is also very happy.
7. When I married J the Elder I went from having one sister-in-law to having eight. My DH has seven siblings, all of them fabulous. Once I’d perfected the names of his seven siblings and their spouses, I went on to memorise the names of his seventeen nieces and nephews and two great-nieces and nephews. Before meeting his parents for the first time, I’d nailed it. I think I liked him.
8. I’m neurotic and paranoid about losing my two cats and probably should seek therapy for it. I live in constant fear that they’ll get out of the house and be attacked by coyotes (very common where we live). When I moved in with J the Elder, I went on and on about the need to be really careful with the doors and windows. Within two weeks of moving in, however, it was his beloved dog that got out on my watch when an air conditioning service person left the garden gate open. I had to call him to come home from work and we found her about three hours later. I was sure that was the end of the relationship…..
9. I really miss the running lifestyle. Because of our fertility issues, I haven’t run more than a mile since July 07. I only started running in 05 but took to it like a fish to water. Between 05 and 07 I ran several 5Ks, 10Ks and half marathons, as well as the Marine Corps Marathon in DC. Ironically, I wasn’t able to run the Boston Marathon due to an injury I sustained qualifying for it in DC.
10. I’d be utterly heartbroken if I wasn’t able to make a Daddy of my DH. He’s unbelievable with children, they all just gravitate towards him. Watching the amazing bond that’s developed between him and his nearly 3-year-old nephew is wonderful and very touching.
Saturday, February 21, 2009
Microarray Results
After a five week and four day wait, we got the big call from Denver yesterday afternoon. We have one viable embryo from the batch of three that were biopsied. We're unbelievably happy and relieved. Our normal embryo's grade is 4BB. The 4BA and 3BB embryos were abnormal and, in my happy fog, I forgot to ask what errors they contained. I’ll get this information - I find it very interesting indeed.
Now we have two normal embryos waiting for us in icy isolation, one 4AB and one 4BB.
To get to this point has taken almost exactly one year of IVF treatments, 146 shots, 51 eggs retrieved, 3 trips to Denver adding up to almost a month spent there, a total of just under 14 weeks of waiting for microarray results and untold expense (if the number's not written down, perhaps it simply didn't happen). There are still no guarantees, but this is certainly the closest we’ve come to potential success.
Shortly after the major attack of gluttony documented in my last, embarrassingly long-ago post, I went back to my life in black and white. No sugar, wheat, dairy, caffeine, lots of Chinese herbs and other supplements and no running or other strenuous exercising, in case we had no normals in this batch and had to do yet another cycle. The call came in while we were out and we made an immediate detour to buy a bottle of lovely Italian prosecco to celebrate. I used to think it was better not to celebrate anything in case we jinxed it, but have learned that good news is so rare on this journey, each victory must be celebrated along the way. And so we did.
Having walked around for many weeks with my cell phone practically strapped to my body lest I miss their call, CCRM called just as we’d sat down in the attorney’s office to sign the papers for our mortgage refinance. I’d forgotten to turn the phone off and made the huge mistake of looking at the caller ID as it was ringing. Of course I had to let it go to voicemail. As a result, it’s quite likely that we’ve bought an entirely different house, will have a payment twice what we expected or otherwise messed up, since anything we did after seeing the caller ID is a blur. It fleetingly crossed my mind that it would be very wise not to reveal to J the Elder (sorry, honey, I meant J the Studly) who’d just called so that he could concentrate on the papers, but my brain/mouth coordination failed as I whispered the information to him. I suppose we’ll find out soon enough whether we’re still the rightful owners of our own house, either when our mortgage statement comes in or when we’re served with eviction papers. Whichever comes first.
No sooner had we stumbled out of the closing did I call the nurses’ line back. Luckily our nurse then called within about thirty seconds of the message I left to put us out of our misery.
The next step is putting a frozen embryo transfer (FET) calendar in place. I’ll need to call my nurse when my next cycle starts this week and we’ll put a tentative calendar together. My doctor’s not allowing birth control pills due to my Protein S deficiency (blood clotting) and BCPs help with the timing of everything since you can stay on them for a planned set of days. Without them, we’ll have to rely on a natural cycle so we won’t be able to set an exact date for the transfer for another three or four weeks. However, if my body co-operates and does what it usually does, I expect it will be around April 21st. Then the serious nail-biting starts again.
Now we have two normal embryos waiting for us in icy isolation, one 4AB and one 4BB.
To get to this point has taken almost exactly one year of IVF treatments, 146 shots, 51 eggs retrieved, 3 trips to Denver adding up to almost a month spent there, a total of just under 14 weeks of waiting for microarray results and untold expense (if the number's not written down, perhaps it simply didn't happen). There are still no guarantees, but this is certainly the closest we’ve come to potential success.
Shortly after the major attack of gluttony documented in my last, embarrassingly long-ago post, I went back to my life in black and white. No sugar, wheat, dairy, caffeine, lots of Chinese herbs and other supplements and no running or other strenuous exercising, in case we had no normals in this batch and had to do yet another cycle. The call came in while we were out and we made an immediate detour to buy a bottle of lovely Italian prosecco to celebrate. I used to think it was better not to celebrate anything in case we jinxed it, but have learned that good news is so rare on this journey, each victory must be celebrated along the way. And so we did.
Having walked around for many weeks with my cell phone practically strapped to my body lest I miss their call, CCRM called just as we’d sat down in the attorney’s office to sign the papers for our mortgage refinance. I’d forgotten to turn the phone off and made the huge mistake of looking at the caller ID as it was ringing. Of course I had to let it go to voicemail. As a result, it’s quite likely that we’ve bought an entirely different house, will have a payment twice what we expected or otherwise messed up, since anything we did after seeing the caller ID is a blur. It fleetingly crossed my mind that it would be very wise not to reveal to J the Elder (sorry, honey, I meant J the Studly) who’d just called so that he could concentrate on the papers, but my brain/mouth coordination failed as I whispered the information to him. I suppose we’ll find out soon enough whether we’re still the rightful owners of our own house, either when our mortgage statement comes in or when we’re served with eviction papers. Whichever comes first.
No sooner had we stumbled out of the closing did I call the nurses’ line back. Luckily our nurse then called within about thirty seconds of the message I left to put us out of our misery.
The next step is putting a frozen embryo transfer (FET) calendar in place. I’ll need to call my nurse when my next cycle starts this week and we’ll put a tentative calendar together. My doctor’s not allowing birth control pills due to my Protein S deficiency (blood clotting) and BCPs help with the timing of everything since you can stay on them for a planned set of days. Without them, we’ll have to rely on a natural cycle so we won’t be able to set an exact date for the transfer for another three or four weeks. However, if my body co-operates and does what it usually does, I expect it will be around April 21st. Then the serious nail-biting starts again.
Sunday, January 25, 2009
Unhealthy Living
I haven’t had time to blog. I’ve been too busy making up for a year of consumptive abstinence by gorging on treat after delicious and unhealthy treat. On Sunday, the eve of our first anniversary, J the Elder impressed me to no end by disappearing into the kitchen after dinner and emerging twenty minutes later with Nutella crepes he’d just made. I showed immense restraint by having just three of them. On our anniversary the next day we went to our favourite sushi restaurant for dinner. It just so happens that there’s a Krispy Kreme right next door to it and it seemed like a splendid idea to get in line at the drive-through (why do they make it so easy?) and pick up one or two small doughnuts on the way home (well, four actually). On Tuesday I was back at work in my office at home when there was a knock on the door and a nice man from UPS handed over a box containing nine cupcakes, sent from California to our door by a friend of J the Elder’s who lives in Oklahoma and had lost a bet with J over the outcome of the Florida/Oklahoma championship game. Since there was a three-day freshness guarantee, we were obliged to consume these cupcakes by Friday and did so very stoically and without grumbling, ending our dinner with them every evening from Tuesday to Friday. Does putting on running clothes count? If it does, I did get a great workout yesterday without ever going outside or breaking into a sweat. I did intend to run, but it just didn’t seem to happen. Then last night we went out to meet an old colleague and friend of mine from Australia who was in town on business. It would’ve been extremely rude of me not to have those four vodka and cranberry juice drinks. I’ve often heard that the early pregnancy feeling is very similar to a hangover. If that really is so, I feel pregnant this morning. Very pregnant.
We had a telephone regroup with the doctor at CCRM earlier this week. Unfortunately it didn’t have the desired effect of making us feel any better. We were given a 35-40% chance of a successful pregnancy if we only have the one existing normal embryo from last cycle to transfer. Those don’t seem like very good odds, after all we’ve done to get to this point. Obviously we’re still trying to be hopeful about the three embryos that are being tested from this cycle, but it remains difficult to be too hopeful. The dilemma now is whether, if we don’t get another normal embryo to transfer, we should go ahead and transfer the one we have or whether we should somehow try to do another cycle, locally or at CCRM. It’s not only about increasing our chances of getting pregnant with one healthy baby with the transfer of two embryos. At this point we’ve got nothing and we don’t want to be greedy, but strategically, if we think we’d want to do another cycle for a sibling after one baby was born, then it would be much better to retrieve eggs now than next year.
It’s not immediately clear how we would afford a fourth out-of-pocket cycle, but if we could and went back to Denver, CCRM wouldn’t put me on birth control pills again, because of my Protein S deficiency and the resulting risk of blood clotting. They would also try Gonal-F only, rather than a combination of Gonal-F and Menopur. I did far better locally without birth control pills and without Menopur. In terms of protocol, they would either use Long Lupron again, or Antagonist. I need to read up on the Antagonist protocol before I can form a preference. The doctor didn’t seem to push one over the other and I’d always rather see a clear choice, since it would just make me feel as though the solution is obvious, rather than this being the Russian Roulette it really is.
If we decided to do another local cycle, it would cost us somewhat less, mostly in travel and hotel costs, but we wouldn’t be able to do CGH or microarray testing of all 23 chromosomes, because the local clinic doesn’t offer it. Instead we’d ask for a five-day biopsy and traditional PGS (pre-implantation genetic screening) on the blasts, to at least test for nine chromosomes. Usually this test is done on three-day embryos and then the normal ones are transferred two days later, but we wouldn’t want to put our three-day embryos through that, since they only have six to ten cells at that point and by taking out one or two of those cells for testing, you’re removing a high percentage of their genetic material. Also, it’s recently been reported that there are many false positives with this technique, meaning that some embryos might test positive for chromosomal abnormalities, but are, in fact, normal. Doing a five-day biopsy would mean vitrifying the embryos and transferring them in a subsequent cycle, which, while adding more time, does have the advantage of the body getting rid of all the stimulation drugs. If we did the local cycle, we’d probably arrange for any normal embryo/s to be shipped to CCRM so that we’d be able to transfer two together.
Of course this discussion is entirely academic until we get our results, because if we do have one more normal embryo, we’ll transfer the two at the earliest opportunity. However, as anyone who is going through fertility treatments knows, it helps to have a plan in place so that you’re not floundering and too upset to make a well thought-out decision should bad news come in.
We had a telephone regroup with the doctor at CCRM earlier this week. Unfortunately it didn’t have the desired effect of making us feel any better. We were given a 35-40% chance of a successful pregnancy if we only have the one existing normal embryo from last cycle to transfer. Those don’t seem like very good odds, after all we’ve done to get to this point. Obviously we’re still trying to be hopeful about the three embryos that are being tested from this cycle, but it remains difficult to be too hopeful. The dilemma now is whether, if we don’t get another normal embryo to transfer, we should go ahead and transfer the one we have or whether we should somehow try to do another cycle, locally or at CCRM. It’s not only about increasing our chances of getting pregnant with one healthy baby with the transfer of two embryos. At this point we’ve got nothing and we don’t want to be greedy, but strategically, if we think we’d want to do another cycle for a sibling after one baby was born, then it would be much better to retrieve eggs now than next year.
It’s not immediately clear how we would afford a fourth out-of-pocket cycle, but if we could and went back to Denver, CCRM wouldn’t put me on birth control pills again, because of my Protein S deficiency and the resulting risk of blood clotting. They would also try Gonal-F only, rather than a combination of Gonal-F and Menopur. I did far better locally without birth control pills and without Menopur. In terms of protocol, they would either use Long Lupron again, or Antagonist. I need to read up on the Antagonist protocol before I can form a preference. The doctor didn’t seem to push one over the other and I’d always rather see a clear choice, since it would just make me feel as though the solution is obvious, rather than this being the Russian Roulette it really is.
If we decided to do another local cycle, it would cost us somewhat less, mostly in travel and hotel costs, but we wouldn’t be able to do CGH or microarray testing of all 23 chromosomes, because the local clinic doesn’t offer it. Instead we’d ask for a five-day biopsy and traditional PGS (pre-implantation genetic screening) on the blasts, to at least test for nine chromosomes. Usually this test is done on three-day embryos and then the normal ones are transferred two days later, but we wouldn’t want to put our three-day embryos through that, since they only have six to ten cells at that point and by taking out one or two of those cells for testing, you’re removing a high percentage of their genetic material. Also, it’s recently been reported that there are many false positives with this technique, meaning that some embryos might test positive for chromosomal abnormalities, but are, in fact, normal. Doing a five-day biopsy would mean vitrifying the embryos and transferring them in a subsequent cycle, which, while adding more time, does have the advantage of the body getting rid of all the stimulation drugs. If we did the local cycle, we’d probably arrange for any normal embryo/s to be shipped to CCRM so that we’d be able to transfer two together.
Of course this discussion is entirely academic until we get our results, because if we do have one more normal embryo, we’ll transfer the two at the earliest opportunity. However, as anyone who is going through fertility treatments knows, it helps to have a plan in place so that you’re not floundering and too upset to make a well thought-out decision should bad news come in.
Saturday, January 17, 2009
From The Frozen Tundra That Is Atlanta, Georgia
As I write this, I’m sitting in our office wearing Ugg boots, a red puffer jacket (yes, very 80s) and a woolly scarf. No gloves. I should hastily clarify by saying that I’m wearing these items in addition to my normal clothes. It just had to be the coldest weekend in the past year for the heat to go out on our ground floor and in the basement. Luckily, the upstairs furnace is still working but the cold downstairs is starting to affect the temperature upstairs, too. For reference, it was 71°F (21°C) upstairs this morning and a very refreshing 46°F (7°C ) downstairs. We’re off work for MLK Day on Monday, which is also our first wedding anniversary, and we’ll be spending it freezing in the morning and in the company of a nice technician called Antonio in the afternoon. Antonio promises that warmth will be restored by Monday evening.
Having spent the week since we heard the news about our three blasts in a state of utter doom and gloom, I’m starting to feel a bit better now. If I really try, I can be quite good at doom and gloom. Here’s how CCRM very accurately summarises the emotional impact of infertility:
• feelings of loss of control are common and sometimes uncomfortable
• the emotional roller coaster of hope and despair, either with each treatment or on a monthly basis
• feelings of failure and low self-esteem are normal as are feelings of guilt, blame, shame and embarrassment
• the process erodes and consumes time and energy
• financial issues - loss of other dreams in exchange for treatment
• changes within your relationship - pull together or apart - infertility brings most couples closer together but changes in intimacy are often associated with treatment regimens
• impact on employment and performance at work
• feelings of injustice are reality based
We know we’re old and trying to beat the odds, so I do sometimes wonder why we’re even expecting this to work, but we’re still convinced it will work for us soon. I’m mainly feeling better because, as drummed into me by my wonderful, less doomy and gloomy DH, we already have one viable embryo waiting for us; and not only because of that basic fact alone, but also because it means that we can produce them generally. Statistically we really ought to have one more normal embryo in the new batch, but with just three it’s hard to count on the stats. We decided to organise a phone regroup with the doctor this coming week to get his view on the cycle and any ideas he might have on improving our blast development, in the unlikely event we were able to do another cycle. We’re aware of the possibility that he’ll simply put it down to age; he did tell us before egg retrieval that I was doing spectacularly for my age, but I suspect it may just not have extended to blast development.
I’ve been going over the differences between our local cycle (seven blasts from ten embryos) and our CCRM cycles (four and now three blasts from two sets of eleven embryos). Other than several months between them and, therefore, just older eggs, the two major differences were that the local protocol didn’t include birth control pills and that we only used Gonal-F to stim, rather than a combination of Gonal-F and Menopur. Perhaps my eggs just don’t like Menopur. In the end, it’s hard to pinpoint it with so many variables at play, but talking to the doctor may give us more perspective.
Having spent the week since we heard the news about our three blasts in a state of utter doom and gloom, I’m starting to feel a bit better now. If I really try, I can be quite good at doom and gloom. Here’s how CCRM very accurately summarises the emotional impact of infertility:
• feelings of loss of control are common and sometimes uncomfortable
• the emotional roller coaster of hope and despair, either with each treatment or on a monthly basis
• feelings of failure and low self-esteem are normal as are feelings of guilt, blame, shame and embarrassment
• the process erodes and consumes time and energy
• financial issues - loss of other dreams in exchange for treatment
• changes within your relationship - pull together or apart - infertility brings most couples closer together but changes in intimacy are often associated with treatment regimens
• impact on employment and performance at work
• feelings of injustice are reality based
We know we’re old and trying to beat the odds, so I do sometimes wonder why we’re even expecting this to work, but we’re still convinced it will work for us soon. I’m mainly feeling better because, as drummed into me by my wonderful, less doomy and gloomy DH, we already have one viable embryo waiting for us; and not only because of that basic fact alone, but also because it means that we can produce them generally. Statistically we really ought to have one more normal embryo in the new batch, but with just three it’s hard to count on the stats. We decided to organise a phone regroup with the doctor this coming week to get his view on the cycle and any ideas he might have on improving our blast development, in the unlikely event we were able to do another cycle. We’re aware of the possibility that he’ll simply put it down to age; he did tell us before egg retrieval that I was doing spectacularly for my age, but I suspect it may just not have extended to blast development.
I’ve been going over the differences between our local cycle (seven blasts from ten embryos) and our CCRM cycles (four and now three blasts from two sets of eleven embryos). Other than several months between them and, therefore, just older eggs, the two major differences were that the local protocol didn’t include birth control pills and that we only used Gonal-F to stim, rather than a combination of Gonal-F and Menopur. Perhaps my eggs just don’t like Menopur. In the end, it’s hard to pinpoint it with so many variables at play, but talking to the doctor may give us more perspective.
Tuesday, January 13, 2009
Day Six Report
Unfortunately our hopes for more blasts than last time were dashed today. In fact, we’ve ended up with fewer. The embryologist called to let us know that only three of the nine good-looking embryos developed to the blastocyst stage. One of them was biopsied and vitrified (flash frozen) yesterday at day five and the other two today because they took longer to develop into blasts. Their grades are as follows:
1. 4BA
2. 4BB
3. 3BB
The number refers to the stage of blast development, 3 being a full blastocyst and 4 an expanded blastocyst – I was told that this is not as important as the letters. The first letter refers to the cells that will become the embryo and the second letter to the cells that will form into the placenta. The embryologist told me that the 4BA embryo is near-perfect and the BBs are very decent quality. Our one chromosomally normal embryo from last cycle is a 4AB, also close to perfect. However, the embryo quality has nothing to do with their chromosomal make-up, which is what we’re testing for. A perfectly graded embryo can be abnormal and very often is. It’s the embryo grade, combined with its chromosomal viability that leads to success, so long as the uterus is also receptive. We know the grades, but we must now wait two months to find out if any of them are chromosomally viable.
Needless to say, we’re extremely upset by this news. While things could always be worse and we could have had even fewer or, heaven forbid, none at all, this leaves us with an agonisingly long and terrifying wait for our results from the biopsies. The statistics for our age group leave us with, at most, one normal embryo to hope for. However, we know that it’s touch and go whether there’s a normal one among them. Last time we had one normal embryo among four blasts. At this point, we’d be over the moon with one normal in this group of three, because that would give us two embryos in total to transfer together sometime in late March or so. Transferring two would significantly increase our chances of one implanting and developing into a healthy baby.
How we’ve developed this problem of growing embryos to blast, I just don’t know. In our local cycle last March, we had seven blasts out of ten fertilised embryos, a much higher percentage. Of course, that cycle didn’t result in a healthy pregnancy so we can’t class it as a success. Our fresh transfer failed because of a mechanical issue at transfer and the frozen one ended in miscarriage. We didn’t have the embryos tested so we have no idea how many of the seven were chromosomally normal. CCRM are stricter about the quality of blasts, but the seven we had locally were of a decent quality and would most likely have passed at CCRM as well. Since the laboratories at CCRM are known to be fantastic, this situation is even more of a mystery to us. CCRM expect about 50% of fertilised embryos to grow to the blast stage and this should have given us five or six. We have to face the fact that our ages are really going against us and that this could be a contributing factor, even between last March and now. Mercifully my ovarian reserve, meaning the number of eggs still remaining, is far above average for my age group, so at least we start with a lot of eggs. Thank goodness for that, since otherwise we really may have had none at all to biopsy. But to go from twenty one eggs retrieved to just three blasts is a devastating blow.
1. 4BA
2. 4BB
3. 3BB
The number refers to the stage of blast development, 3 being a full blastocyst and 4 an expanded blastocyst – I was told that this is not as important as the letters. The first letter refers to the cells that will become the embryo and the second letter to the cells that will form into the placenta. The embryologist told me that the 4BA embryo is near-perfect and the BBs are very decent quality. Our one chromosomally normal embryo from last cycle is a 4AB, also close to perfect. However, the embryo quality has nothing to do with their chromosomal make-up, which is what we’re testing for. A perfectly graded embryo can be abnormal and very often is. It’s the embryo grade, combined with its chromosomal viability that leads to success, so long as the uterus is also receptive. We know the grades, but we must now wait two months to find out if any of them are chromosomally viable.
Needless to say, we’re extremely upset by this news. While things could always be worse and we could have had even fewer or, heaven forbid, none at all, this leaves us with an agonisingly long and terrifying wait for our results from the biopsies. The statistics for our age group leave us with, at most, one normal embryo to hope for. However, we know that it’s touch and go whether there’s a normal one among them. Last time we had one normal embryo among four blasts. At this point, we’d be over the moon with one normal in this group of three, because that would give us two embryos in total to transfer together sometime in late March or so. Transferring two would significantly increase our chances of one implanting and developing into a healthy baby.
How we’ve developed this problem of growing embryos to blast, I just don’t know. In our local cycle last March, we had seven blasts out of ten fertilised embryos, a much higher percentage. Of course, that cycle didn’t result in a healthy pregnancy so we can’t class it as a success. Our fresh transfer failed because of a mechanical issue at transfer and the frozen one ended in miscarriage. We didn’t have the embryos tested so we have no idea how many of the seven were chromosomally normal. CCRM are stricter about the quality of blasts, but the seven we had locally were of a decent quality and would most likely have passed at CCRM as well. Since the laboratories at CCRM are known to be fantastic, this situation is even more of a mystery to us. CCRM expect about 50% of fertilised embryos to grow to the blast stage and this should have given us five or six. We have to face the fact that our ages are really going against us and that this could be a contributing factor, even between last March and now. Mercifully my ovarian reserve, meaning the number of eggs still remaining, is far above average for my age group, so at least we start with a lot of eggs. Thank goodness for that, since otherwise we really may have had none at all to biopsy. But to go from twenty one eggs retrieved to just three blasts is a devastating blow.
Saturday, January 10, 2009
Day Three Report
Our Day Three Report is in. Of the eleven embryos that fertilised normally, all are still hanging in there, but nine of them are within the range of cells they like to see at this point. Three-day embryos should contain between six and ten cells, eight being ideal. Here's the breakdown:
2 at 10 cells
4 at 8 cells
2 at 7 cells
1 at 6 cells
2 at 4 cells
The four-cell embryos haven't reached the appropriate milestone for three days, so they only have a 15% chance of developing further. The other nine, on top of being within the necessary range, also have very little fragmentation, which is positive.
I asked for a comparison of last cycle's embryos; according to the embryologist, it looks as though these ones are slightly better, both on cell-count and quality, but we really just don't know how well they'll continue to grow. Anything could happen between now and Monday/Tuesday. We'll get the big call on Tuesday with news of how many made it to the blastocyst stage and were biopsied. A blast contains between sixty and one hundred cells. CCRM wait until Day Six to call because some embryos take six days, rather than five, to develop into blasts. The agonising wait continues, but we're happy with today's report.
Thanks to everyone for their lovely comments and for sending good vibes to our hard-working embies. Please keep the vibes coming.....
2 at 10 cells
4 at 8 cells
2 at 7 cells
1 at 6 cells
2 at 4 cells
The four-cell embryos haven't reached the appropriate milestone for three days, so they only have a 15% chance of developing further. The other nine, on top of being within the necessary range, also have very little fragmentation, which is positive.
I asked for a comparison of last cycle's embryos; according to the embryologist, it looks as though these ones are slightly better, both on cell-count and quality, but we really just don't know how well they'll continue to grow. Anything could happen between now and Monday/Tuesday. We'll get the big call on Tuesday with news of how many made it to the blastocyst stage and were biopsied. A blast contains between sixty and one hundred cells. CCRM wait until Day Six to call because some embryos take six days, rather than five, to develop into blasts. The agonising wait continues, but we're happy with today's report.
Thanks to everyone for their lovely comments and for sending good vibes to our hard-working embies. Please keep the vibes coming.....
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