Bio Lesson: Cells the Grow into Human

January 5, 2019November 1, 2018 / Hilary / 2 Comments

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.

*Information from Fertility Smarts

Today is a New Day 1

January 3, 2019December 31, 2018 / Hilary / Leave a comment

It hurts to move.

I woke up a couple time last night to visit the bathroom and relieve the pressure on my ovaries. My body is not happy with me.

I am grateful that I am giving myself good nutrients to heal and space for my body to repair itself.

With light spotting of blood, I’m reminded that the doctor pierced through my lining into my ovaries and it will be more than just getting the hormones out of my system.

At 2:30am, I am awake. WIDE awake.

I spend some time reading and praying, thinking and praying and around 4am I drift back asleep.

With a slow start to my morning, I give myself permission to hunch over and shuffle.

We wait for the call from Dr. O’Brien to know the progress of our little ones.

Today is day 1– Fertilization check day

Approximately 16-20 hours after the insemination process takes place the embryologist will check to see if fertilization has occurred. The embryologist is looking for evidence of 2 nuclei (pn) – one from the egg and one from the sperm. This is how the embryologist determines if normal fertilization has occurred. Any more or any fewer nuclei present and the embryo is considered abnormally fertilized and is not kept in culture. Once normally fertilized, the embryos are placed back into the incubator and are not disturbed until day 3. The embryos are grown in a specially designed culture dish which contains a small drop of culture medium overlaid with oil.

This embryo culture medium contains the proteins, amino acids, and enzymes that mimic the fluid found in the fallopian tubes essential for embryo development. One factor (of many) that contributes to successful embryo development is the constant maintenance of temperature and pH level of this embryo culture medium. The temperature and culture medium pH level is dependent upon the CO₂ environment and the heat that is provided by the incubators. Since the embryos are grown in a very small drop of culture medium it does not take long for the temperature to drop and the pH level to change in that drop containing the embryo once the dish is removed from the incubator’s environment. Severe changes in the temperature and pH level of the culture medium can have potentially detrimental effects on the embryos. The embryologists are very protective of the embryos in the lab and this is the reason why the embryologists do not like to disturb the embryos too much and will not look at the embryos on a daily basis.*

We get a call from Dr. O’Brien around 9am, of the 20 eggs retrieved, 13 of them were mature. This is a little less than was expected but MORE than what we saw on the monitoring screen a few days ago (which was 8).

Of the 13 mature eggs, 12 of them were fertilized!!

Yippee! The statistic is that 75% of mature eggs will fertilize, we had a 92% fertilization rate!

This means we go into the next 4 days of waiting knowing we have 12 potentials for a baby (or babies) to grow.

Dr. O’Brien keeps my expectations low as she mentions it’s typical to have 1/3 or 1/2 of the eggs survive the next 4 days. She would expect for us to have 4-6 blastocysts on Day 5. Although she cannot see the future or know the strength of our little growing cells, I can trust in her experience and let 4-6 be a success.

Here’s to a weekend of waiting, healing, and praying!

*Information from Fertility Smarts

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.

The Future Begins Tomorrow

January 1, 2019January 1, 2019 / Hilary / Leave a comment

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!

Add the Trigger Meds!

December 31, 2018December 31, 2018 / Hilary / Leave a comment

Day 13– Waking up to what feels like a bowling ball resting on my stomach. Is this what it’s like to be pregnant and have to pee every 30-minutes?

The weight of carrying these full follicles is getting heavier and it’s as though gravity is pulling my belly button down to the ground.

My right ovary seems non-existent in my body as I move around but my left is as though there are water balloons squished up in there.

Is today the day we will pull the trigger?

It’s possible and yet I don’t want it to be too early if there is a chance the little ones will still grow to 17 or 18mm. Remember, 18mm is mature and anything smaller may not produce a healthy, viable egg.

I get a pinching prick into my arm. My poor vein is so yellow and bruised.

Into room 3 I go for another monitoring.

As the nurse closes the door for me to undress, I fall to my knees. “God, I surrender this outcome to you. Help me be calm and accepting of what you are doing inside my body.”

A delightful sonographer joins me in the room and we begin.

Sure enough, we have big black circles on the screen. She measures 11 follicles ranging from 9.6mm to 24.8mm, wahoo!! Then comes the left, a little smaller but that is not new information. Eleven follicles there too, measuring from 11mm to 20mm, yippee!

I have 22 follicles measured total with 8 follicles being of mature range (above 18mm).

There are 7 that are either 15-16mm and they ‘might’ grow to be 18mm by the time we retrieve, or they might just be too shy.

I give those over as I can’t do anything about it.

Ok, I’ll be honest, I really want to stick myself with some of the drugs I have at home, even just a little bit just to give that extra boost.

I tell on myself to Hubby so that I can see how insane that would be.

I’m not the doctor, I have never been through this before, and I don’t know what I’m talking about.

I just have to trust. Sit back and trust.

I bet we trigger tonight, so I’ll wait for the call from our nurse to confirm.

Oh my goodness… Thank you body for responding so well to these medications. I don’t know what the quality of my eggs is in there, but I have done everything I can to help them be healthy.

I’m so grateful to be at this point in this journey!

~~~~~~~~~~~~~~~~~~~~~

6 hours later

We receive a call from Nurse Christine. Wonderful news as she confirms 21 follicles with at least 15 of them being a mature size, yippee!!

Tonight, we will trigger!

She has our instructions for the medications.

Stopping all Gonal F, Menopur, and Cetrotide we turn towards the trigger shots.

Since I don’t have a period without medical intervention, Dr. O’Brien decides to use a dual trigger method. I will inject myself with Lupron and hCG tonight and visit the clinic in the morning for blood work to make sure it’s all absorbed and properly ‘triggering’.

There is a hesitation of using the hCG because it could cause the ovarian hyperstimulation syndrome (OHSS).

Dr. O’Brien decides to go with a small dose of hCG and will add more tomorrow if my blood work shows my body is not responding.

After a quick tutorial of how to mix the sterile water with the white powder medication, change the needles and draw just the exact amount prescribed, we say our goodbye.

We spend the next 2 hours waiting to hear from the scheduler to know what time to give the trigger shots tonight (which will be 36 hours from the retrieval time).

Trigger shot at midnight TONIGHT for a retrieval of noon in 2 days.

On we go!

~~~~~~~~~~~~~~~~

I fall asleep to help the time pass and wake up at 11:55pm to get ready for the shots. Hubby stayed up and mixed the solutions for me so all I have to do is prick and return to bed. (What a great Hubby, such support.)

The hormones rush through my body and it takes me an hour to fall back asleep. Finally, I do, one day closer.