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.

How we got to IVF & Current Status

Last year, after going through two miscarriages at about 8 weeks, I had a bazillion tests done to see what could be wrong. We found nothing. No uterine factors, no immunology issues, no clotting factors, no infection. The Wacky Wicketeer and I were both karyotyped after the first miscarriage, which showed that we, ourselves, had no major chromosome defect that might be contributing to the loss. My general practitioner did find that I had a severe vitamin D deficiency. However, my Reproductive Endocrinologists (REs) would not attribute my losses to this factor. (Despite the fact that there are recent studies coming out showing a possible relationship between uterine lining and vitamin D.) Go here for more information on causes of Recurrent Pregnancy Loss (RPL): http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/recurrent_preg_loss.pdf)

We were very disappointed in the attention and lack of customer service we were receiving at our first clinic. So, we went to a new one last fall.

Our new RE, Dr. "Analytical", diagnosed me with a mild form of Polycystic Ovarian Syndrome (PCOS). You can learn more about PCOS here: http://haveababy.com/infertility-education/causes-of-infertility/pcos.html. PCOS is a syndrome, thus it occurs on a spectrum. At my end of the spectrum, I still ovulate regularly, but my eggs are immature and/or poor quality.

Dr. Analytical has a theory that, between poor-quality eggs caused by PCOS, and abnormal sperm, as exemplified by the Wacky Wicketeer's abnormal sperm morphology, we end up with a non-viable embryo on the rare occasions that sperm actually fertilizes egg. This then results in a pregnancy loss.

Dr. Analytical has explained to us that our best chance at having a biological child is through In Vitro Fertilization (IVF) with Intra-cytoplasmic Sperm Injection (ICSI) and genetic screening. In this way, we are the most likely to become pregnant with a viable embryo.

So, here we are. We decided to do IVF with ICSI and genetic screening, and are now in the midst of treatment. It is a trying process, and we are attempting to approach it with grace, with respect for our marriage, and with love for the embryos conceived in the process. I'll explain more of the details in another post, but for now, know that we have five, maybe six, embryos in their first home at the clinic, each fighting to grow. Please send them, and us, your prayers, hope, love, luck, and well-wishes. Thanks in advance, and lots of babydust to those looking for it!

Our New TTC Protocol, Part One: Yes, Women ARE Complicated!

I’ve often heard men say that women are complicated. Men, you have no idea! So read on.

There are basically four levels of assisted reproductive therapy ("ART"): (1) a medicated cycle, (2) intra-uterine insemination (“IUI”), (3) in-vitro fertilization (“IVF”), and (4) intra-cytoplasmic sperm injection (“ICSI”). Because timing, and everything after intercourse, relies so much on the woman’s body, medicated cycles alone can help women who have unexplained infertility, irregular, or unpredictable cycles. The medication also has a higher occurrence of more then one egg being released, increasing the opportunity for a sperm to fertilize an egg.

The average woman’s menstrual cycle is 28 days long, and she will ovulate (“O”) usually on cycle day (“CD”) 14. Ovulation refers to the release of a mature egg from an ovary. Cycle day one is the first day of a woman’s full-flow menstruation. These are the dates that conception, and therefore assisted reproductive therapies, are based on.

My cycles are rather predictable, with O arriving on CD 14 like clockwork (unless I get sick earlier in my cycle). They are a little on the shorter end, at 24-25 days long, but this is not short enough to be diagnosed with a defect because of it. Since we have moderate male-factor infertility (“MFI”), the least-invasive step that could help for my husband and I is IUI. In proceeding with IUI, many fertility specialists like to have the woman on medications also to make her cycle extremely predictable, stable, increase the number of eggs released to increase the odds, and make her as fertile as possible. It made me feel like a bionic baby-making machine!

Anyhow, I liken IUI to the turkey-baster method. This seems to be a working metaphor, and it sticks in my friends’ and family members’ heads so I don’t have to repeat the descriptions over and over again! It also contrasts nicely with the next step, which is IVF, or what I refer to as the petrie dish method. A quick description of IVF and ICSI: For IVF, the sperm are donated and treated as in an IUI, and mature eggs are extracted from the woman’s body, then the two are put in a container together, and hopefully, sperm meets egg there. ICSI is IVF with the sperm being injected into the egg(s). We have been told that if IUI doesn’t work for us after about three times, ICSI would be the next step.

So, back to our current cycle, new protocol and IUI. It all starts with me taking Clomid on CDs 3-7. As it was explained to me, Clomid acts like a little general in your brain telling it to stop listening to certain hormones and to listen to the Clomid instead, which mainly tells it to mature extra follicles (in which eggs are maturing). Side effects that I had from it included hot flashes, bloating, headaches, and blind spots (like stars you see when you get a concussion or a migraine). I have heard from other gals that modd swings are also very common, and the doctor warned me that the Clomid could thin out the uterine lining and decrease cervical mucus (which is an important fluid present around O that helps the sperm swim through the cervix and into the uterus). Because of the last couple of side effects from Clomid, the next drug is Estrogen, or Estradiol, which I took on CDs 8-12. The bloating continued, but the other side effects subsided. Starting on CD 11, I had to use an ovulation predictor kit (“OPK”) first thing in the morning, and as soon as we had a positive, call the clinic and go in for an intra-vaginal ultrasound (“IVUS”) to see how big my mature follicles are and how thick my uterine lining is, and from that, predict how close I am to O. We also had to abstain starting on CD 9 until the insemination, so that my husband could build up a good store of soldiers before making his deposit! They start you on CD 9 in case you have to get the IUI on CD 12, so that you have three days of storage, but I didn’t O until CD 14 (as usual), so it was a long time, I tell ya! And mind you, those days are your most fertile, so for the last two years, that’s been baby-dancing time! What a switch…

Next post will continue at CD 13 when we went in for my IVUS to check out the follies. Make sure to check back!

-J