IVF: Phase 2… preparing the 9-month “home”

The start of phase two of IVF has begun. Once we set a transfer date, Dr. O’Brien counted the days leading up to the transfer by going backward. Eighteen days from ending birth control, 17 days from my first ultrasound after all the waiting. Everything looks clear and we are set to go.

I begin with Estrace, an estrogen pill, which I will take 3 times a day. Fortunately for me, this same estrogen pill was what I used earlier in my fertility journey as a suppository so I am grateful to be ingesting it this time. I will do this for 11 days and then go in for another ultrasound.

The side effects aren’t horrible, and in fact, I can hardly notice a change in my being. Might this be because I am comparing it to the ridiculous amount of hormones I just rid my body of over these past weeks, possibly?

It feels good to be on medication that is helping without making me into a witch.

The goal is to grow my uterine lining so that it’s nice and ready for little Maxwell Bean to nestle in.

My days continue as normal, not thinking too much about the transfer date, which is less than 2 weeks away!

I am grateful to not be consumed with thoughts about what the transfer will be like or if it will take. Instead, I am happily practicing living in this moment, as my body prepares a little home.

Image result for pills and shotsOn day 11 of this routine, I go in for what I hope is my final ultrasound before we fly.

The lining needs to be at least 8mm thick with no major follicles growing.

My doctor didn’t even prescribe me Lupron (an ovulation suppressant drug). My theory is because it took major dosage for me to produce follicles in the first place that she is not concerned about my body deciding to produce follicles now.

She is correct, no follicles and my lining is just shy of 8mm, sitting at 7.25mm. The little home is getting ready!

Dr O gives the green light to proceed!

I am so excited and we move forward to book our car rental and hotel for the night we will be staying in Maryland.

Yet, what’s next is not enjoyable.

I always imagined IVF to be full of shots in the rear-end, but up until this point, it has been in my abdomen or pills… not bad and not too painful.

That is about to change.

Starting tomorrow, I (ok Hubby) will shoot 1ml of progesterone oil into the intermuscular area of my buttock every morning precisely at 7:15am. If I falter 10-15 minutes, it could cancel the transfer!

Nurse Christine gives me some pointers on how to help this not be as painful. I wasn’t worried about a shot until she began to explain how it’s ok to use a heating pad after and to be sure to switch sides eatery day so as to not completely hurt one side.

She explains this is an oil-based liquid so it’s a little thicker so it may burn a tinge.

Uh… what is about to happen to me?

She also shares it’s best if Hubby administers the shot for a better angle and then jokes, “unless you like to inflict pain on yourself”.

Eek! What is this going to be like?

She also gives me instructions for the day of transfer.

The transfer is set for noon, arrive at the clinic at 11:30 with a photo ID. Be sure to empty my bladder completely at 10:45am and then proceed to drink 16oz of water before 11am. Don’t use the bathroom after 11am. A fuller bladder helps Dr. O position the catheter more precisely as to release the embryo in the correct location.

I have my marching orders.

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Do we want to know the gender?

The PGS testing came back a week earlier than expected. On my voicemail, nurse Christine stated we have 1 healthy viable embryo.

She even offered to share the gender since that is a part of the chromosome testing.

Woah, I am overwhelmed with emotions.

It’s been 8 days since our two little embryos went for testing and the results are said to take up to 14 days.

I check the message and before I know, nurse Christine is sharing the results of our PGS testing.

No time to gear up for the truth, I simply take a breath.

“You have one genetically normal embryo and so we will be able to proceed with this”.

My heart drops.

I know, I know. I should be happy to have one.

I’m still mourning the loss of fertilized eggs from 12 to 2 (which to me is a huge drop off rate).

We have 1.

We went from 20 eggs retrieved, to 13 mature eggs, to 12 fertilized eggs, to 2 blastocysts, to 1 genetically normal.

I would be lying if I said I was overjoyed to learn we have 1.

Unfortunately, my excitement has been mounting over the weeks and months of preparation for IVF. I have heard people who have ended up with 1 in the end of their cycle.

But not me.

I thought I was going to be different.
I had my hopes set on multiple embryos that we would be able to implant over the next few years to make our family complete.

The truth is, I’m a little sad and disappointed.

I had my hopes on having more and had set myself with higher expectations based on what ‘could be’.

I know, I know.

Everyone says, you just need one. Which is true.

Let me explain.

We are apart of the Shared Risk Program at Shady Grove. This was one of the reasons we chose them.

They give a soft guarantee for a live baby birth at the end of 6 IVF cycles, or your money back. Everything (except the medications) are wrapped up into one price.

If you don’t have a successful egg retrieval to embryo process, you can do another egg retrieval for ‘free’ (except for the medications), and you can do this up to 6 times for no additional cost to the clinic.

What is ‘successful’? Good question.

One embryo at the end of an IVF cycle is successful.

So since we have one, then we need to implant this one before we would be able to do another retrieval.

The caveat is, if you have a successful/ live birth, the package goes away.

Any future egg retrievals would need to be paid for by us.

Pretty incredible, huh?

So here’s the ‘issue’.

We want to have more than one child and if we get a live beautiful baby out of this embryo then in order for us to have more children, we would need to pay the full price of IVF, again.

If we would have had more embryos that made it to this stage, then we would have some more frozen and in the waiting.

If we had no embryos make it to this stage we would go back into the egg retrieval stage and have the opportunity for more embryos.

I’m not not grateful for the one.

I’m just pouting because I’m scared that we won’t be able to have more children in the future.

I know, I know… we can always adopt or do another egg retrieval… it just prolongs the process.

It’s just not what I had created to be the story to be.


If our goal was 1, I would be happy.

I guess I shouldn’t have set my sights so high as to have all our kids frozen and at the ready for us to implant when we want.

That would be too easy.

That would give me too much say in the timing, too much control over my family.

Nope, God has other plans.

It’s true, I don’t really know what the future holds for me and I know that God always pulls things together in a way that I could have never imagined.

I’m just letting myself be bummed.

I lean into the tears and let myself feel the disappointment.

I don’t really want to have an only child and the thought of adopting seems so daunting at this point.

Maybe I won’t like being pregnant and having 1 embryo/pregnancy is a gift.

If we transfer now, I will be 36 when I give birth and that puts my eggs a year older than now, which only means fewer quality eggs and less of a chance for more healthy embryos.

I feel like my chances aren’t great at 35, after this retrieval, so the thought of 36 or 37 is a bit uninspiring.

Maybe a pregnancy will kick my body into gear and I will get pregnant naturally the second time around.

I don’t want to have to spend more (outrageous) amounts of money to try this again. If this one embryo does result in a live baby, then our Shared Risk package with Shady Grove goes away and we will have to pay for a full retrieval again.

Maybe this little embryo will divide and we will have identical twins.

The chances of this are single-digit percent, but God is big. He knows the story.

So I just sit here. Trying to allow my head knowledge of what God can do seep into my heart.

It’s not happening in the way that I wanted.

I thought I was surrendered to the process, but I made one mistake in my mental preparation.

I got too fixated on the idea of having multiple embryos that set the bar too high and now my expectations have not been met.

Before I get too ahead of myself, I still need to actually GET pregnant.

Something I have not been able to do in the past.

There is no guarantee that this 1 embryo will nestle in and grow.

I am very well aware that this may result in a miscarriage and we will be back to square 1 (a 2nd’s egg retrieval) with more information about my body.

There are so many unknowns at this point and the thought of all the various options of how this can play out exhausts me.

Yet again, I learn I’m not in control, I don’t have control over the outcome of these experiences and all I can do is put forth my best effort and trust that God knows what is to be the unraveling of this story.

God, help me accept the plans you have for me. Help my heart be overflowing with gratitude that we have this little embryo and appropriately excited at the thought that I could actually have a biological baby (something I wasn’t sure would happen).

Help me be joy-filled and prayerful about this little embryo (who does have a gender which nurse Christine knows!!)

God, help me to change my thinking around this news and shift my heart so I can exude positive thoughts and love for what you have done so far in me through this journey.

So here we sit, with one lovely, wonderfully healthy embryo.

WE HAVE ONE!!!!


Next steps you ask?

Well, I got my period a couple days ago and since we are wanting to do a transfer when it works with our schedule, I will go back on birth control to time the correct days leading up to the transfer date.

Day 6. How Many Embry-babies?

I have butterflies in my stomach. Today is our call with Dr. O to find out how many of our remaining 11 are still growing and are viable blastocysts. Although we have 1 confirmed, we still have another layer to get through before we can move towards the transfer, genetic testing.

We have no reason to believe we will have any genetic abnormalities, but we also never know what’s going on in these genes and dividing cells.

I am so scared that the results will be so small that in the end we won’t have any to work with. I have to turn my thinking around.

My body is hot as I think about the call (in 10 minutes).

We have waited and prayed and although my prayers were for 7 blastocysts, I have come to peace that no number will guarantee a baby.

Instead, I turn my thinking to accepting what is and letting it be the story of faith that even if we just have the one that goes into genetic testing, that all will be exactly as it is supposed to be.

I want to control the outcome.                                                                  I can’t.

I want to protect my emotions.                                                                 I can’t.

I choose to feel with a healthy openness to being vulnerable to the desire of my own biological babies balanced with low expectations of the outcome.

Regardless of the number, God is in control.

Not me.

~~~~~~

We get the call.

Dr. O’Brien first asked how I was feeling and was sensitive to hearing how my recovery has been over the past 6 days. She hesitated to give me both the Lupron and HCG shots as my trigger shots for this very reason, it makes the bloating and swelling worst.

This discomfort is worth it to me if we are able to have babies.

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Then she let us know, we had one more egg make it to the blastocyst stage and was biopsied and frozen this morning.

There is a possibility for us to have one more, which we will have confirmed tomorrow.

All others did not progress and in a sense ‘died’.

My heart sank.

From 11, there are 2. Maybe 3. (Just confirmed we have 2, 1.9.19).

These are not the final embryos we will use to transfer.

We have one more stage, on more hurdle, to get through, which is the PGS- genetic testing.

We will know in two weeks what our final number of embry-babies will be.

Until then, I just have to keep waiting and trusting that God knows what he’s doing in all of this.

My heart feels quiet. I have no words.

 

Here’s some more information from Fertility Smarts about Day 6:

Day 6 in the IVF lab – Final Number of Embryos Known

On Day 6 we know the final number of embryos suitable for freezing. Day 6 is the final day in the lab for the embryos at most clinics. The embryologists will assess the remaining embryos and if they have continued to grow overnight they will freeze all that are of good quality. Embryos that have not made a blastocyst by this day are not viable and will not be frozen. Most labs do not grow embryos longer than Day 6 because they need to either be frozen or to be in a uterus after Day 6.

Chromosome Screening

If you choose to undergo chromosome screening on your embryos, a single cell called a blastomere can be taken from each embryo on Day 3, or a small group of 4 to 5 cells can be taken at the blastocyst stage around Day 5/6. This is called embryo biopsy and is done before the embryos are frozen.

Chromosome screening allows the lab to select and thaw only genetically normal embryos for transfer in a frozen embryo transfer cycle. This type of screening is recommended for women who have had multiple failed IVF cycles or are of advanced maternal age (38 or older). The pregnancy rates are very good for all ages of women when the embryos have been screened before transfer.

 

 

Day 5 is here!

My heart is calm. I have been patiently waiting for the call from the doctor to let us know how many of our little cells have turned into blastocysts and are ready for biopsy and being frozen.

I try not to read all the different experiences people share online of how many eggs retrieved, how many fertilized, how many make it to day 5 & 6, etc… but it’s hard not to look.

These last few days have felt deflating. In my mind, I have obtained a goal (of sorts), something I was focused on for many weeks, and now I just sit and wait.

My body is recovering, but still not back to normal. I continue to reheat the rice-hot pack in the microwave and melt into the couch.o-GIRL-WAITING-BY-PHONE-facebook.jpg

We receive a call, today is day 5. It’s nurse Christine calling to report 1 of our eggs have reached blastocyst stage so they have biopsied it and put it in the freezer (my heart drops… only 1).

The remaining 11 are still under observation and they will call us tomorrow with the final count.

Oh, my nerves!

I continue to trust in this process… the process I cannot control and have to simply accept.

The following is taken from Fertility Smarts to help explain the process:

On Day 5, embryos that have continued to grow to become blastocysts will have formed a fluid-filled cavity in the center of the embryo surrounded by a flat layer of cells called the trophectoderm (the part that makes the placenta). These embryos should also have a clump of cells called the inner cell mass (the part that makes the baby). Blastocyst embryos have a more complicated grading system based on 3 factors:

  1. The size of the embryo – based on the degree of expansion of the cavity (graded 2-6)
  2. Appearance of the inner cell mass cells (graded A-C)
  3. Appearance of the trophectoderm layer of cells (graded A-C)

Therefore an embryo with a grade of 4AA would be classed as a good quality embryo. Anything with a B grade is classed as average and a C grade would be quite poor quality.

Embryo grading is not an exact science and it just helps us to get an overall picture of the appearance of an embryo. Grading helps the embryologist to choose which embryo to transfer within your group of embryos.

Embryos with a higher grade are more likely to implant with the uterine lining, most likely because these embryos have a higher chance of being chromosomally normal. In other words, not all embryos are created equally and it is possible to select the genetically normal embryos that are more likely to grow.

What if my embryos have a poor grading?

Most people have a range of grades within their group of embryos from an IVF cycle and the embryologist will pick the best ones out of that particular group. We have seen babies born from different grades of embryos, so try not to focus on the numbers too much.

Although lower grade embryos have a less of a chance of implanting than their more handsome counterparts, it’s still possible to achieve a pregnancy from embryos that are not ideal when viewed under a microscope.

Try not to over analyze the exact grade of your embryos as we have seen babies born from all grades of viable embryos.

On Day 5 we know:

  • The number of embryos that have continued to grow and the quality of these embryos.
  • On average, only half of all Day 3 embryos will continue to grow to the blastocyst stage and the other half will stop growing after Day 3. Embryos usually stop growing because there is something wrong with their chromosomes. If an embryo stops growing in the lab it would most likely not have made a baby if we had transferred it.
  • Not all embryos grow at the same rate. Some will grow faster and be ready for transfer or freezing by Day 5 and some will need another day’s growth to get to an advanced stage. This is a normal growth pattern.
  • The best embryos are either transferred or frozen on Day 5 according to your clinic’s policy. In general, pregnancy rates are better when blastocyst stage embryos are transferred rather than Day 2-3 stage embryos.

Any embryos that are frozen are kept in the lab storage tanks until you need them. Any remaining slower growing embryos are kept in the lab overnight and there may or may not be more embryos to freeze Day 6.

Bio Lesson: Cells the Grow into Human

Here’s what will be happening with our little cells while we wait:

*Day 2 in the IVF Lab – Embryo Divides

On Day 2 the embryos start to divide and should have 2-4 cells. The embryo itself does not grow bigger; the single cell that was the fertilized egg divides to become 2 cells and then 4 cells with each cell being half the size of its predecessor.

They can start to see slight variations between the embryos in the group and they could be graded at this stage. Most clinics do not look at the embryos on this day but it is possible to do an embryo transfer or freeze the embryos if that is the clinic’s policy. It is usually better to wait as long as possible for transfer and freezing as this allows more diversity within the group and enables the embryologist to more easily select the best embryos. The splitting of cells to create identical twins happens on day 2 or 4.

Day 3 in the IVF Lab – Embryo Grading and Potential Transfer

On Day 3 the embryos should be around 8 cells. This is the day when some clinics move them into a new Petri dish with different media (solution to support growth) that is similar to uterine fluid for their next stage of growth. They grade the embryos but still do not know how many will continue to grow to the blastocyst stage (Day 5 and 6).

Some clinics perform embryo transfers and freezing on Day 3 and some clinics wait until Day 5. This depends on the number and quality of embryos that you have available and also the clinic policy. From what I understand, Shady Grove does not touch the cells until day 5 to let them grow in a healthy, untouched environment.

On Day 3 we know:

  • How many cells the embryos have
  • If the embryos are of good appearance up to this point
  • An average of 95% of fertilized eggs will grow to the Day 3 stage
  • The appearance on Day 3 does not tell us how many embryos will continue to grow

Day 4 in the IVF Lab – From Cleavage Stage to Blastocyst

Day 4 is a transformation day where the embryos are in between the cleavage stage and blastocyst stage.

What is a blastocyst?

  • A blastocyst is a fertilized egg that has developed for five to six days and contains 3 distinct features. These features include a fluid-filled cavity and two distinct types of cells:
    • Trophectoderm (T) cells – T cells consist of a single layer of cells around the circumference of the embryo that become the placenta and embryonic sac.
    • Inner cell mass (ICM) – The ICM is a distinct clump of cells that form the actual baby

The clinic usually does not look at the embryos on this day, but if they did they would see that some of them would be making the transition from a multi-celled embryo with clear cell outlines to what is called a morula which is the stage before an embryo becomes a blastocyst. Sometimes embryos do not reach the morula stage until Day 5.

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*Information from Fertility Smarts