Sunday, September 4, 2011

Five Snowflakes

The thing about IVF is that it's relatively unpredictable. Most people who haven't been through it don't realize the combination of steps and gambles, twists and turns, along the way. We just had one of these happen to us. Fortunately, it may be a blessing in disguise.

First of all, I've mentioned before that I was overstimmed during my first IVF, which was likely the cause of my low egg maturity rate, and that my stim dosages were decreased this time, in an attempt to avoid overstimulation. Well, it seems to have worked! IVF #1: 21 sizeable follicles, 19 eggs retrieved, 8 mature, 5 embryos after fertilization with ICSI. IVF #2: 9 sizeable follicles, 11 eggs retrieved, 7 mature, 5 embryos after fertilization with ICSI. So you can see that the success rate at each step has been higher.

Today was the third day after egg retrieval (which by the way, was curiously more painful this time). We learned from the Embryologist that all 5 embryos are still growing, although one is slacking. A healthy embryo should be 6 or more cells by this point. Today we had a 9-cell, two 8-cells, a 7-cell, and a 5-cell. If my memory is correct, with IVF #1, we had an 8 cell, three 6-cells and a 5-cell. So the theme of higher success rates at each step of IVF #2 is continuing!

This IVF cycle has been more complicated because we want to do preimplantation genetic screening (PGS) at the day 5 stage, instead of day 3 like last time. In IVF #1, we had a single-cell biopsy done of our embryos at day 3, to test them for a severe chromosomal abnormality, and hopefully prevent another miscarriage. The results came back on day 5, and we had one competent embryo. Two tested as incompetent, and two were inconclusive. Unfortunately, the two that were inconclusive had already ceased growing on their own, or we would have given them a try.

A day 5 biopsy collects more than one cell for testing, and it takes longer to get the results. But it's also more accurate. However, it does require freezing. So our first plan for IVF #2 was to do a freeze-all cycle. But then, considering that we could easily end up with only 1 or 2 embryos to test at day 5, and that the 5-day growth process culls some of the genetically incompetent embryos anyway, we decided to have a back-up plan of preparing for an embryo transfer. In the case that we ended up with only 1 or 2 embryos at day 5, doing PGS seemed pretty pointless. But the result has been that I have had to prepare for both circumstances - a freeze-all, and a day 5 transfer. Having to explain this over and over again to confused nurses was no picnic.

Today, when the Embryologist called with our day 3 results, I was so relieved when she said we still have all five. If we had already been down to 1 or 2 poor-grade embryos, we would have gone in for a transfer today, and I am still in pain from my egg retrieval on Thursday, so I really don't feel ready to get pregnant. I was already getting worried about the very realistic possibility I would need to do a transfer on Tuesday, wondering if I would still be in pain. But, she also had some surprising news.

The Embryologist told me that they always grow a batch of mouse embryos to test the culture medium and lab environment, and that all her mouse embryos had just died. She needed to pull all embryos out of culture. In other words, they all had to be either transferred or frozen. So we froze all five of our embryos. The more accurate term would be "cryogenically preserved", but "froze" is easier to type.

Of course, the idea of something being seriously wrong in my embabies' first nursery concerns me, but I couldn't be happier with the Embryologist's response time, and her focus on saving them. The amazing part is this feels like a blessing. My body does not feel ready to become pregnant right now. This will give me a few weeks to feel completely healthy again.

So when will we get PUPO (pregnant until proven otherwise-describing my state after an embryo is transferred)? Probably anywhere from late September to late October. Vague enough for you? I'll write more about what that part will entail in a later post. For now, we have five snowflake babies resting peacefully. Please pray for them and for us!

As always, please feel free to ask any questions. This often seems like science-fiction to me, but at this point I've probably become so familiar with it, I brush over some points that need explained. No question is too simple.


  1. I'm sorry you are still hurting. That's no bueno. I am glad that you are giving your body time to rest before transferring...anything you can do to ensure a sticky baby is good :)

    OK, so they grow mouse embabies and freeze them? Does that mean someone could get mouse embabies implanted in them by mistake? Sorry, I had to ask.

    I'm praying that your embabies are safe and sound and are ready for you in September/October :)

  2. No and no. :) They grow the mouse embryos in culture in the lab, not frozen. And mouse embryos look different than human ones, on top of the fact that they have multiple levels of identification set up so they can't confuse anyone's embryos. We're even color coded, among other things. Our color is blue.

  3. I'm really excited that your embabies are growing and thriving. I hope more good news is coming in the next few weeks.

  4. I've been wanting to write a few questions but keep forgetting. Here goes.

    1. First off wow, 21 and 9 follicles? I didn't realize the medication could create so many. My question is how can you get more eggs then number of follicles? Maybe I don't understand the workings correctly.

    2. To do the testing, do they take one of the cells from the embryo? Do they put it back?

    3. How many embryos are usually implanted at a time? I know it's more than one (thus the higher rate on twins and triplets) but what is the average?

    Thanks in advance for answering my questions. I find the process fascinating and wonderful. I am so excited for you on the increased success rate this time.

  5. Thanks y'all. :-)

    Val - So glad you have great questions! Here are my answers:

    1. Keep in mind that you already have the start of all your eggs/follicles there in your ovaries. Normally several start to mature, then one takes the lead and becomes the dominant follicle/mature egg each menstrual cycle. (Except for women like me with PCOS-we'll usually have a group grow too much, and no dominant follicle emerge properly.) So the stims just force more of these to mature completely, and us with PCOS can be more sensitive to those stims. I was on a relatively low dose this time.
    Occasionally a follicle has more than one egg in it, and it's possible there was a follicle hiding during the ultrasound when they counted them.

    2. The testing we're doing this time,a day-5 biopsy (which is becoming the preferred method), takes a group of cells. At this point the embryo has hundreds, and no, they won't get put back. It's taken from a part of the cell mass that has been shown to not harm the baby.

    3. I don't know of an average, but standards depend on the patient - age, diagnosis, personal preference, and quality of the embryo(s), and usually range from 1 to 3.

    We currently opt for single embryo transfers, so we would only end up having multiples if the embryo divided and they were identical, or my meds failed to control my natural ovulation and I ended up with natural conception within a few days of an embryo transfer (extremely unlikely on several levels).

    Thanks for reading and for your questions!

  6. Hi! New reader here... I was wondering who your RE is that has the capability to do Day 5 PGS? I'm in the Bay Area, and was wondering if you are in my local area as well.


  7. Hi Linda! I am a couple hours from the Bay Area. I'm not going to name my RE or fertility clinic on this blog, but if you'd like to email me at thewombwarrior at live dot com, I'd be happy to email it to you privately. In my experience, most clinics in our areas have access to day 5 PGS/PGD. The most popular lab is GSN, which is based in the Bay Area. Their website is