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.

2 blasts on board

Just a quick update to say that we had two blastocysts to transfer today. They weren't amazing quality, but still, I'll take it! There is a 3rd embryo that was a morula today that may be frozen tomorrow based on whether it has continued to progress and how it looks. I am so happy and relieved we had something to transfer. I was quite anxious that we might end up with nothing.

Today was really beautiful outside - a clear, cloudless blue sky and a crisp chill in the air that made me nostalgic for New England fall days. "What a beautiful day to become pregnant," my acupuncturist said. I hope, hope, hope.

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.

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...

Welcome home!

Today was our embryo transfer. We were told to arrive at 10:30am and the transfer didn't happen until 2pm, so that was pretty annoying! The day would definitely have been more pleasant if we arrived later, had lunch first, brought some entertainment with us, and if I didn't start chugging water until right before the transfer! In the end, the transfer went super smoothly, though, and that's what is most important!

Of our 8 embryos, 1 was blatantly abnormal (the outer shell was missing entirely) so it will be discarded, and the other 7 were continuing to grow and do their thing. We transferred 2 embryos, an 8-cell grade AB and a 10-cell grade B. The remaining 5 which will be frozen were grade B with respect to degree of fragmentation (it is possible that 1 of them was actually grade C or BC). We weren't sure if we were going to transfer 1 or 2, but my gut was to go with 2 and Y felt it was ultimately up to me, so that's what we ended up doing.

It was really one of the most amazing experiences of my life to see those 2 embryos on the screen and watch them get sucked up by the glass straw and then to watch by ultrasound the little flicker as they went inside my uterus...pretty incredible. I really hope and pray to be blessed enough to meet one or both of those little guys again this coming winter. Y made a video on my iPhone of the embryos on the screen, but I don't think that the quality is so good.

The real kicker is this: my former boss performed the transfer! Before grad school, I worked in a stem cell research lab for a couple of years as a research technician. The head of the lab was a MD/PhD whose training was as a RE. Anyhow, he does 1 day a week in IVF and today was his day! He was really friendly and professional about it and he offered to get someone else if I was uncomfortable. We were already in the OR, though, and by acknowledging the situation, it actually made me feel okay with him doing it. In truth, I really only run into him once a year or so, and I trust him very much, so I figured I'd just go with it. Obviously, if he was someone I was still working with currently, it would be totally different. Still, crazy, right?

They brought me on a gurney to the ob/gyn ward afterwards to lie totally still for an hour, which seemed like total overkill to me. Once that hour was over, I was just so ridiculously happy to get up and PEE. Finally, we got out of there a little before 3:30. I am still feeling pretty crummy but I am beginning to walk like a normal person now, thank goodness, so I think I am on the mend. Now I am just thinking happy thoughts for my 2 embryos and hoping and praying for the best.

I am excited to have gotten this far - when my E2 wasn't rising and with the stress of not responding as well as they had hoped transfer seemed so far-off and built upon so many what-ifs. Now I just feel relieved and filled with gratitude to have just made it to this point. Seeing those 2 beautiful embryos inspired me and now I am doing my best to put my faith in them and in my body (though true to my usual form, I am still planning ahead for The Worst Case Scenario).