and I'm back...

It's been a few days over a year since I last posted and I am ready to start this up again. We started TTC again in March 2014. I weaned N around that time for fertility reasons, which was a difficult choice.

In early June we thawed our four frozen day 3 embryos. Our hope was to thaw them on day 3 and try to grow them to day 5 and then do SET if any of them made it blastocyst. We knew the embryos weren't great quality and we didn't want to transfer more than one because we were explicitly trying to avoid twins because of what happened with our first twin pregnancy. We figured growing to day 5 would be a good selection device.

I guess it was too good of a selection device, because after preparing a fluffy lining with a couple of weeks of estrogen, none of the embryos progressed to day 5 after thawing. It was disappointing to have nothing to transfer, but I guess it also wasn't shocking since we knew the embryos weren't great and I didn't regret that we chose to attempt a day 5 transfer.

After the transfer that never was, I had a meeting with my RE to decide where to go from there. I knew that I wanted to get pregnant soon and never having had a spontaneous pregnancy, I knew that I wanted to continue with treatment. I was uncertain whether I wanted to start with something less invasive and emotionally consuming like Clomid IUI or whether I wanted to dive right back into a fresh IVF cycle. I also didn't know what our health fund would cover based on our circumstances at the moment.

Our RE advised that he would support me in whatever treatment that I wanted to do and in whatever order or combination I wanted, but that he still thought IVF was our most efficient path to pregnancy. Fair enough. After talking it over with Y and some soul-searching, we decided to proceed with our fourth fresh IVF in July 2014.

We did the antagonist protocol and the stimulation went fine. We got 10 eggs, which is pretty standard for me. Unfortunately, only 5 fertilized with ICSI which is a pretty low fertilization rate for us. Our embryos were in an incubator with an embryoscope, a time lapse imaging system that takes video of the developing embryos. It is a pretty cool recent invention that is supposed to help in embryo selection and gives the embryologist and RE real-time info about the embryos without disturbing them in the incubator.

Our hope was still to do a day 5 SET but based on our lower fertilization rate and underwhelming embryo quality, my RE advised we do a day 3 transfer. We weren't so psyched about this, both because day 3 hadn't brought us success in the past and because suddenly it made the question of how many embryos to transfer much more confusing, since day 3 SET doesn't have such great results.

The day of the embryo transfer, the embryologist and our RE reviewed the video clips from the embryoscope. Our RE told us none of the embryos were more than 6-cell, all had significant fragmentation, and none of them met the freezing criteria. He and the embryologist recommended that we transfer three (!) We decided to settle for two, even though Y had significant reservations since we were (and are) still both traumatized from the pregnancy with Aminadav and Naava.

Needless to say, much to the shock of our RE and myself (and not to Y), we got pregnant with twins again. I am now 17w3d pregnant with a boy and a girl, and it's been a challenging and scary road so far. I had light bleeding from weeks 5-7 due to a subchorionic hematoma. At the NT scan I was diagnosed with partial placenta previa, and during week 13 I was hospitalized due to a major bleed. This was really scary since chronic bleeding is what we believed caused PPROM (premature rupture of membranes) with Aminadav and Naava -- basically due to blood wearing down the amniotic sac like sandpaper. I rested at home for a week and then returned to work.

I also had a worrisome cervical length ultrasound about a week ago. It shortened significantly based on that measurement but then when another technician measured it a few days later, all was good. I am not sure whether my cervix is dynamic or whether maybe the first measurement was incorrect or what, but I will ask my doctor what she thinks when I have my regular appointment next week.

This whole ride is very scary for us....every day I just feel thankful to wake up still pregnant. The only way through this is to make it to each new day as uneventfully as possible -- 10.5 weeks til our first big goal. Meanwhile, N fills our lives with so much joy (and activity!). We are so blessed to have her here with us.

the embryo transfer blues

Despite my best attempts at apathy, TTC again is really hard. I so desperately want to be pregnant again, but everything I've been doing to try to make it happen feels like a form of punishment. I think constantly about how if the twins were to arrive now they would most likely be alive and well, and that causes me a lot of pain.

Every action we take to make a new baby is a reminder of the babies who were supposed to be here with us right now. Sometimes it is just too cruel. I do still think this was the right choice for us -- to jump back into IVF again so soon after, but it is hard and lonely.

Today we transferred one day 3 8-celled embryo with some fragmentation. I really only want to do SET because I am terrified of conceiving another set of twins, but I still have very complicated feelings about it. In some sense "needing" to do SET and the lowered chance of pregnancy with each transfer that comes with it feels like a punishment, like I am being reprimanded for something really horrible that I did.

And in a sense that's completely accurate -- I am being reprimanded for something really horrible that I did, it is just something that my body did that I had no conscious control over.

Honestly, part of me also would still really like twins. I am okay now with admitting that, but at the same time it is a very theoretical type of want, because another twin pregnancy, at least before proving that I can successfully carry a full-term singleton pregnancy, would just be too terrifying and too unfair to the babies (so despite my complicated feelings, no need to lecture me on what a bad idea it would be to transfer more than one embryo).

Anyhow, all of this talk of singletons vs. multiples is pretty moot at this point. Due to the premature rise in progesterone, Dr. T. thinks my chances of conceiving with this transfer are low. Of course this makes me feel pretty bleak. Actually, this really sucks.

I have been giving this little 8-celled soap bubble a lot of pep-talking, and of course anything at this point is possible -- if I have been on the wrong side of the unlikely statistics more than my fair share, isn't it possible to end up on the right side of the unlikely statistics this time?

I even promised this pretty little 8-celled soap bubble a ridiculously overpriced stroller and a loving home (you will not be surprised to know Y rolled his eyes at the ridiculously overpriced stroller part). Still, I am not very hopeful and it's bringing me to a sadder place than I imagined because I am bringing so much additional grief along with me.

The interesting news is that we still have four remaining embryos. This morning, one was 4 cells and the other three were 6 cells. All of them had some fragmentation. This doesn't sound stellar, but Naava and Aminadav both came from blasts that were fragmented 6-cell embryos on day 3.

Our lab isn't so good at freezing and thawing blasts (though they do use vitrification), so the current plan is to freeze the remaining embryos today on day 3 and then thaw them next month and attempt to see if we can grow one of them to blastocyst. Then we would attempt a day 5 SET, which is what we initially wanted to do with this transfer and we would have, but since my RE thinks our chances of implantation are lower due to the premature progesterone rise, we didn't want to…wait for it…put all of our eggs in one basket.

This plan is ok but puts a serious cramp in my style given that we were supposed to move to Canada on June 15! If this transfer is unsuccessful, the new plan is for me to stay behind in Israel solo to do the transfer after we've packed up all our stuff and moved out of our place. This would pretty much suck (goes right back to the feeling of being punished), but since I am a glutton both for punishment and opportunities to get pregnant, we all know that I will end up doing it. Clearly, what would suck even more is if I hang around for the additional couple of weeks only for none of the embryos to make it to day 5.

Between the move, TTC, and my work situation I feel like everything is in total limbo right now and nothing about this year is unraveling the way I hoped and anticipated (most notably the part where my twins were supposed to live and I was supposed to be totally overwhelmed with two infants this summer). Sorry if I am starting to sound angry, sad, and bitter, but right now, I think that's pretty much where I'm at.

embryo update :(

I just got a call from Dr. T. He said that this morning (day 3) two of our embryos were looking good at 8 cells, 5 were 'okay' or fair at 6 cells with some fragmentation, and 1 had arrested. He wanted to update me in case I wanted to see whether they could squeeze me in for a day 3 transfer today, especially since 2 embryos are clearly looking better than the rest right now. He did say that he felt the outcome of the cycle would be the same regardless of when we transfer (or if we transfer - meaning that if there is nothing on day 5, it probably wouldn't have resulted in a positive cycle anyway had it been transferred on day 3), but he wanted me to be prepared for the possibility of having nothing to transfer if we press on to blastocyst and he knew that would be very disappointing.

I thought about it, and I guess I feel that if we truly trust in the assumption that what doesn't survive in the lab won't survive in my uterus, it makes sense in my mind to still press on to day 5. The reason being that if the outcome of this cycle will be the same no matter what, I think I would rather start another fresh cycle in a few weeks and have the opportunity to create new embryos than transfer frozen embryos that wouldn't have made it to blastocyst anyway.

I also feel like the disappointment of having nothing to transfer would not be greater than the disappointment of a failed cycle, though I am sure if this happens I will feel regret for not having transferred the 2 higher quality embryos and given them a chance when there was the option…tough choices. Y said he will go along with whatever I decide, so we are pressing on to day 5 for better or worse. I am starting to get the sinking feeling that there is more IVF in our very near future.

FET #2: craziness ensues!

First off, I have been pretty horrible commenting this ICLW (and actually in general over the past few weeks). For someone reason, reading blogs lately has been stressing me out a little, so I apologize. I hope I will be back in full blog commenting gear soon.

Here is the craziness I shared with my message board buddies earlier today:

Yesterday was our 2nd FET. I was told to arrive at 10:30 am. When I arrived, the nurse told me that there were many transfers today and to expect a long wait. I figured I must be last on the list, because I noticed that they were having both the women who came in before me and the women who came in after me change into gowns but not me.

Around noon, Y decided to speak with the nurses and as usual, he got more information than me. They told him that it wasn't that I was last on the list, but that they were putting my transfer on hold because the thawing had been problematic and the lab was waiting for the doctor to make a call on whether we would proceed or not.

According to the fertilization report, we had 2 frozen embryos remaining in a straw together: a 5-cell BC grade and an 8-cell B grade (my clinic uses an A-D scheme to rate fragmentation, with A being the best). My RE had told me not to expect much from the 5BC, it was not such a good embryo and would be likely to not survive thawing.

Anyhow, the RE doing the transfers comes out and tells us that our embryos were initially a 9-cell BC grade and an 8-cell B grade and that after thawing, the 8B only had one surviving cell and wasn't viable (this was supposedly our good embryo) and that the 9BC had 7 surviving cells and was viable to transfer.

Objectively, none of this information added up at all to the original information we had about these embryos: a 5-cell BC and an 8-cell B were supposed to be in a straw together but it turns out that it was actually a 9BC and 8B and that now they are 7BC and 1B? It just didn't make very much sense and I guess that is why the lab was waiting for the RE to make the final call about whether to proceed with the transfer of the one remaining mystery embryo. I saw in marker on the updated report print-out where someone had crossed out "5 BC" and written "9 BC."

The RE told us that it's possible that the 5 BC just "grew a lot" (almost 2x?) in the time between the final grading report and being frozen. This explanation really doesn't make much sense biologically, and all of our other embryos remained the same in cell number, so it doesn't seem that a lot of time elapsed between the final grading and the freeze.

We went ahead and transferred the one remaining mystery embryo at the RE's urging but I am still so confused. In other news, I got a horrible migraine yesterday after the transfer and spent the night vomiting (sorry for the TMI). It seems like there are 3 possibilities here:

1) They got confused between the 5 BC and 8B in the same straw - it makes a lot more sense that the 5 BC wouldn't survive and only 1 cell would remain viable and that the 8B would remain viable but lose 1 cell, making it a 7-cell embryo. I think this is the most attractive and reassuring explanation, even though it's not the one they were offering us.

2) The 5BC miraculously almost doubled in cell number between the final grading and the freezing although during that same time period, every other embryo remained the same in cell number.

3) The 2 embryos in the straw didn't resemble the original embryos we froze because they weren't our embryos (this is the most horrifying explanation but also the most unlikely). I know this is probably almost impossible but the thought crossed both Y's mind and my mind independently.

Thank goodness we have our long-awaited appointment next week with the new RE. I am ready to run, not walk to a new clinic. I am curious, in this situation, what would you guys have done? Would you have still gone ahead with the transfer? I like to believe I would have at least asked to speak to the embryologist and the lab directly and see what they have to say, but in the pressure of the moment, when everyone was trying to work quickly and there were still several women waiting behind us, I guess it was hard to press for more info or reassurance.

moving on to FET #2

Today I went in for my clinic appointment. We have two frozen embryos left in a single straw at this point - a 5-cell BC grade and an 8-cell B grade. I saw the youngest RE in the practice today and I must say that I found his no bullshit responses refreshing.

He basically said what I thought all along - that the 5-cell BC is basically junk and while it is technically possible to get pregnant from an embryo of that grade since the classification schemes we have now are imperfect predictors of an embryo's potential, it would be very usual. Since all of my embryos lost cells last time in the freezing/thawing process, it is very possible the 5-cell embryo will lose too many cells in the thaw to remain viable anyway.

However, the 8-cell B grade embryo is a good embryo and if it thaws well, it has a chance just like any good day 3 embryo. We are going to clean out the freezer and do another medicated FET this month.

I also asked whether the fact that all of my embryos lost cells last time during the thaw was in any way a reflection of the quality or competence of the embryos and he said that it is really a technical issue with the lab and not any embryo-specific problem. I guess that was reassuring in some sense, but it also reaffirmed my feeling that our current clinic is not so up to par in its lab.

I have an appointment in 2 weeks with another RE for a second opinion as we contemplate moving clinics for our next fresh cycle if this FET doesn't pan out. I guess I have mixed feelings about this - I am used to the way things work at my current clinic and I feel a certain sense of loyalty to them. It is also by far the most convenient option for me and I feel like I have a good relationship with the nurses.

On the other hand, I have been at the same clinic for 13 months now with no viable pregnancy (ironically despite what everyone keeps assuring me is an amazing prognosis), I have serious doubts about the practices and quality of the lab, and the institutional attitude is just not so proactive.

It is maddening constantly wondering whether I have just been really unlucky with the last 5 embryos transferred (but do indeed have a great prognosis) or whether there is something major going on that just hasn't been uncovered. Of course, the truth of my situation could certainly lie somewhere in between those 2 possibilities but I have a little trouble sometimes with the many shades of gray:) I also oftentimes wonder whether during many of those IUIs, we also had eggs that fertilized and became embryos but never implanted.

AF arrived full-force late this afternoon so tomorrow it's back to the clinic for baseline and assuming all is clear, back to little blue pills and estrogen headaches...yum.

Lastly, thank you so, so much for all of the support over the past week. Your comments mean so much to me and truly brighten my day when I am feeling down.

18 cells heavier

Today was our embryo transfer for our FET. We put back three 3-day embryos, a 5B, 6B, and 7B and now all there is really left to do is hope and pray that 1 or 2 (or 3?!?! eek) will stick and thrive and blossom into souls we will have the privilege of meeting again come spring.

I wrote before how the original plan was to thaw the straw with the 2 embryos that remained from those that were fertilized by regular IVF, an 8B and 5BC. It seemed really questionable, though, whether the 5BC would even have a decent chance of surviving thaw. I still find it odd that they bothered to freeze the 5BC at all. Instead, they decide to thaw all 3 of our ICSI embryos, which were originally rated 8B, 9B, and 9B. All three survived thaw, but not without sustaining battle wounds: one 9B became a 5B, one 9B became a 7B, and the 8B became a 6B. Since none of them survived fully intact, we decided to transfer 3.

To be honest, I had a pretty naive and uninformed view of the thawing process - I thought the embryo would either thaw intact (a viable embryo) or not (a non-viable embryo). I was oblivious to all of the shades of gray in the thawing process - that some of the cells could die, but that if over 50% of the cells remained alive, the embryo would still be considered viable.

No one told us the embryos looked good or said we had an excellent chance or anything like that. Honestly, I don't think our chances of a live baby from this cycle are that great but I always have to keep hoping that this is the time that things will be different...