Day 6. How Many Embry-babies?

January 9, 2019December 31, 2018 / Hilary / Leave a comment

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!

January 7, 2019November 6, 2018 / Hilary / 1 Comment

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.

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:

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

Egg Harvest Day!

January 2, 2019January 2, 2019 / Hilary / 2 Comments

Today is the day! We have been waiting a long time for this opportunity to come and here it is.

Since I will be going under anesthesia, I am not able to have anything for breakfast. So instead, I shower, pack my luggage, and we drive to the clinic around 10:15am for our 10:30am report time.

I am nervous. My stomach feels less bloated today and I fear that the trigger shot already forced ovulation to occur and my eggs flushed out of me.

Oh, the mind games I play.

We are quickly taken back to room 11 where I redress with my blue smock and booties. The bruised vein gets one more prick and the saline begins to drip into my body. It takes an hour before it’s my turn to go into the operating room. At 12 noon, I kiss Hubby goodbye and shuffle into the OR.

It’s cold and the bench I lay on is short, just long enough for my head and torso. I lift my legs into the leg rests and I feel the vulnerability overwhelm me. The nurse straps my legs into the rests and asks me to move down to practically hanging off the edge of the bench.

I mention the chill and Steve, my anesthesiologist, quickly responds with, “let me give you a hot totty to warm you up”. He hooks me up to the ‘goods’ and the nurse flips my blue gown up over my stomach. Complete vulnerability. Pure humiliation.

That was my last thought.

The IVF process is pretty amazing. We are still in the first part of it all as we need to get the eggs and put the sperm inside and then let the cells grow.

In order to get the eggs, they need to drain the liquid from the follicles. The eggs will come with the liquid into the doctors care. They will pierce the vagina wall and go through the ovaries. I am going into this procedure with just over 20 follicles (that were seen on the monitoring screen).

I wake up about 12:45 in a drugged haze. I am in and out of coherent thought and I am crying. I’m so happy this part is over and so scared there were no eggs to retrieve. Hubby handles the blubbering sentiments and random thoughts like a champ. I even asked if Hubby could go into the OR and take a picture so we had a memory of it. (not an option).

Dr. O’Brien was by my side and shared they were able to harvest 20 eggs from my body!

Oh, what a joy! Great work body, I’m so grateful!

She was very pleased with the outcome and warned me of how sore I would feel. I could already feel the tenderness in my stomach.

Before I am released, I walk up and down the hall with a nurse. I can barely pull my legs out of bed before I feel a shooting pain up my bum.

I comment to the nurse and she says this is a normal pain as my ovaries are so enlarged. I get home and do some googling. This is what I find out:

It’s normal to feel this way since my ovaries were so enlarged that they could be pushing against my rectum. Apparently, the more eggs they retrieve, the more uncomfortable you feel. The reason is that they remove the eggs from the follicles, but the follicles still remain inside you and fill up with fluid after the retrieval, hence the bloating and my engorged ovaries.

Today is day 0– Retrieval day

After I am released, 4-6 hours following the time of the egg retrieval the embryologist will initiate the fertilization process of the eggs. Fertilization is attempted using one of two methods, standard insemination or ICSI.

Standard insemination involves placing a required number of washed, motile sperm into the culture drop containing an egg. Although many may decide to do this, modern science has progressed to the ability to insert a single sperm into a single egg.

ICSI is a more involved process where the embryologist uses a specialized needle and microscope to catch a single sperm to inject directly into the cytoplasm of the mature egg.

Once insemination or ICSI occurs the eggs are placed back into the incubator to allow time for fertilization to occur.

We decided to do the ICSI.

For the remainder of the evening, I rest and move gingerly, giving my body enough space to heal. We will learn more about how many of the 20 eggs were mature and fertilized tomorrow.