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

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Egg Harvest Day!

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.

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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).

UNADJUSTEDNONRAW_thumb_8705.jpgI 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 0Retrieval 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.

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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.

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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.

 

 

 

The Future Begins Tomorrow

Day 14- The final prick of my arm to see if the trigger medications worked. I check out of the clinic and am grateful to not need to make another monitoring appointment.

Nope, the next time I step into the clinic will be for egg ‘harvesting’.

I like that word better than retrieval. Time to gather all these wonderful, healthy, vibrant, abundant eggs!

My final acupuncture appointment focuses on balancing my body and rejuvenating my system. It’s time to love on my body and let the eggs release as they are supposed to.

I spend the rest of the day enjoying this process and relishing the growth of these wonderful follicles.

The sunshine greets us as we enjoy a brisk walk around our ‘home’. I feel as though I’m waddling and anxious to have this pressure released from my body.

Dr. O’Brien said the bloated feeling may last up to a week after the ‘harvest’ because of the trigger shots, but I’m hopeful my body will flush these toxins (is that what there are?) out of my system and I’ll be able to return to a normal body.

  • When will I be able to move without feeling this pressure?
  • When will I be able to work out my body again?

Only time will tell.

For today, I am focusing on giving my body good healthy nutrients.

I took the final medication tonight at dinner. It will be my last meal until after the ‘harvest’ tomorrow at noon.

I’m scared of what the ‘harvest’ will be like for my body.

  • What will the aftermath feel like?
  • Will I bleed?
  • How will I be able to walk?
  • What will the flight be like back home?

The only way to know these answers is to walk through this night… and tomorrow morning… and walk into the clinic at 10:30am and put my trust in the doctors…. And God.

See you on the other side!download.jpg

Wiping Tears

This week started out hopeful. After 10 days of the mega dose of Letrozole, I’m feeling as though there will be lots of little black circles staring at me on the ultrasound screen. I went to my OBGYN for the follicle check and there we have it folks, bundles of black circles! We have follicles!

None of them are large enough to force an ovulation so they put me on a low dose of Letrozole for 2 more days and ask me to return.


Two days later, I am hopeful there has been growth. Yet, when she checked, it was only slight. Take two more days of low dose Letrozole and return. The nurse also talked with us about planning for an Inter Uterine Insemination (IUI) a few days after this next check. An IUI involves placing sperm inside a woman’s uterus, by way of a catheter, to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. To me, it’s like a turkey baster, squirting those swimmers up nice and close to where the egg should be.

I am getting excited and hopeful that my body is getting ready for this next step!


Here I am 2 days later, and I can’t believe that the follicles have decreased and my lining has thinned out.

What’s wrong with me that I can’t produce what I need to?

Why is this happening to me?
I have been concentrating so hard on eating the foods people say to eat, not working out too much, but still getting my blood going and circulation throughout my system. I have been napping almost every other day and taking things slow. Reading has become my new hobby and praying that God will bring us a miracle.

My eyes are leaking.c0224595b355ac7bc4b6c1b73cf08ad4--crying-eyes-sad-eyes.jpg

I can’t stop the overwhelm of emotion and the tightness in my chest.

I am just so sad that this is so hard for us.

Why God? What are you doing in this?

How am I supposed to learn from this and when will I grow stronger?

Isn’t that what people always say. It’s through the trials and hardships- the storms of life- that resilience and character are refined.

I’m all about learning life lessons, so what is this all about? Patience? Learning that I don’t always get what I want? Believing there is a bigger picture?

The pain is so strong; it overcomes my thoughts like a wave crashing over the rocks.

I have to let my tears roll down my face. No use trying to stop them.

I just want this pain and heartache to be over.

Why can’t we just get pregnant? Why does this have to be so hard?

I don’t know how many more cycles I can go through. This is hard on my body and my emotions.

I don’t want to give up now out of fear that we are quitting too early in the process.

I really thought this time would work. We amped up the dose of medication and the days that I was to take them, how could my follicles not have grown?

I just don’t understand and trying to make sense of any of it is too exhausting.

Tonight, I have to accept what is. There is no other way around it. I can’t change it.

I pray our doctor is learning more about my body through this and I also pray that I might see God and how he is working in and through me with this heartache.

As I have been writing, I get a call. “CCRM”.

Hello, I answer.

Hi, this is Gina from CCRM. I have some next steps for you.

“What?” I’m thinking. I thought we have missed the chance for this go around.

We are going to have you do 3 more days of Letrozole at the highest dose and have you check through an Ultrasound in 4 days.

I am relieved, overjoyed. This cycle is not too late!

I go skipping to the pharmacy to pick up the medication.

We are still in the game!

Showing up is all we can do.

One remains…

I thought this cycle was a bust a few days ago and I felt it in my heart. Disappointment.

Here I sit with one wonderful, large follicle and Dr. G is happy.

He sends me home with an HCG trigger shot to give myself in 2 days.

This time it’s a shot in my stomach and I can give it to myself– Hubby is off the hook.

We also get clear instructions on when we are to be together.

These instructions are different than what our OBGYN said so I’m a bit confused and my brain gets activated.

Wait a second?

My OBGYN said to be together every other day leading up to the day of Ovulation and then once the smiley is solid then be together that day and one more day following…

This time I’m hearing NOT to be together until 2 days after the shot and then again the following.

Which one is right?

I don’t know. As much as I want to Google search all the different ways that are recommended.

I surrender.

I don’t know what’s best and we are paying the CCRM clinic a lot of money for their expertise on this so I decided to let go of all the ‘figuring it out’ and just follow along with what they said.

I’m a bit scared. I am grateful for the opportunity to have another chance at having our own biological child and am praying I can relax into these next few days.


Two days ago, I gave myself the trigger shot. It actually wasn’t as bad as I thought. Just grabbed a bit of skin and stuck it in there.

Here we are- the two days Dr. G said to enjoy and I’m scared.

What if this doesn’t work?

What if we have to go through another round of all these tests and medications?

My face hurt with acne from the large dose this time around and I don’t want to go through it again… God, please work in us in these next 2 days. I am praying for a miracle and for the opportunity to be pregnant and give birth and have stretch marks

(Do I even know what I’m asking for right now?)

I know I will be ok if this is not Gods will and not the right timing for us to become parents, but at the same time, I do pray that we are able to and that my body responds and Hubby’s swimmers are strong and ready and that it all comes together.

I have a painful/weird feeling in my right ovary area this morning along with a weird sensation and my body feels ‘off’.

I take it as a sign that I’m ovulating.

Our time together hurts a bit but I keep focusing on what this could mean for us and pray that this is the beginning of our growing family.

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God, your will be done. May we receive whatever it is you have for us knowing your desires are good.

 

We’ve shown up and done what we can and again we wait. We’ve been here before.

What’s new is this time we will go in for a progesterone level test in a week to make sure my levels are where they are supposed to be to welcome the beginning stages of our baby.

God, we surrender.