New Insight

I had an appointment today with Dr. Glatstein, my reproductive endocrinologist. I wanted to have a checkup with him to see what our plan would be for future kids and to go over what happened in the cycle with the twins. And now I know what happened...

First of all, of my eight eggs, here is what happened to them. One of them did not fertilize, two of them divided before being fertilized (it's a meiosis thing), three of them fertilized and then became multinucleated (this means that there is more than one nucleus in a cell, and the doctor will not transfer or freeze these type of embryos because of the high rate of miscarriage and abnormality), the last two are the ones that continued to divide and are now The Twinners. The doctor suspects that I have an egg quality issue which has been causing our problems. Why a perfectly healthy 26 year old should have egg quality issues, I don't know. But it is what it is and the doctor would not change our protocol at all (except for a minor change in medication because of what my insurance covers). He does not recommend doing any other kinds of treatments first (like IUI or clomid), since IVF is what worked and we think that there may be this minor egg quality problem. Also, he doesn't recommend ICSI or PGD because the eggs didn't seem to have problems fertilizing...only one of the available eggs didn't fertilize (the two that divided early weren't available so they don't count). Also, we don't have any known genetic issues, so there's no reason to do PGD. Also, we both agreed that we're only transferring one embryo at a time since I'm not allowed to have twins again. In order to make me feel better, though, we're going to freeze anything that's still cleaving (growing) on day 3 and I'll get to help choose which embryo to transfer based on how all of them are growing. Of course then I asked him if it would be possible for us to get pregnant on our own, and the doctor reiterated that it would be possible. It's a statistical thing...if I have decreased egg quality, there's just less of a chance of me getting pregnant in any given month (say 5% instead of 20%), and there's a higher chance of miscarriage if I develop one of these multinucleated embryos. That may explain my miscarriage on my first IUI! Anyways, I like now having some type of diagnosis and knowing what my next steps are. I need to have all of my testing done again (blood tests, semen analysis, SHG), and then I can start a cycle whenever I want. It most likely won't be for a while since we want to put about 3 years in between the twins and another baby and I'll want to try to plan for a delivery when it won't interfere too badly with school, and we'll get a chance to try on our own for a while. Then, if the statistics just don't go in our favor, we can start in on an IVF cycle when we're ready.

In other news, in case you hadn't noticed, TODAY IS THE TWINS' BIRTHDAY!!!! HAPPY 1st BIRTHDAY!!!!!!!!!!!!!!!!!!!

Transfer

So, we had the transfer today! As it turns out, 4 of the 8 eggs did not fertilize and 2 of the eggs that did fertilize did not continue to divide. This isn't so bad...if we do need to try again, with ICSI we can get the fertilization rate up and hope for the best. As for the two embryos that made it to transfer....one of them is 5 cells, grade C, with fair symmetry and the other is 10 cells, grade B, also with fair symmetry.


Aren't they cute? I have no idea which is which--they both look similar to me, which is why I'm not an Embryologist. :-) I dunno what the black splotch is, but it has nothing to do with my babies.

For those of you who don't know about embryo grading, I will give you a crash course.

Number of cells: At a day 3 transfer, the embryo should have between 6 and 8 cells...less than this isn't so good, but more is great!

Letter grade: This refers to the amount of fragmentation present in the embryo. As the cells divide, cellular material may break off and end up between the newly formed cells. An A grade means that there's less than 5% fragmentation, B means that there's between 5 and 25%, C means there's 25-50% and D means that there's more than 50% fragmentation. Obviously, you want less fragmentation--A and B grades are normal.

Symmetry: Cell symmetry describes the evenness of size and distribution of cells in the embryo. This is graded as either good, fair or poor--with good and fair being normal.

Basically, this means we transferred 1 real winner embryo and 1 not so good embryo that still has a chance (and we love them both the same).

Trying to be Positive

Well, on the bright side, we've taken care of more of my "worst case scenario" questions from Tuesday morning. Here goes:

2) What happens if they get in there and none of the eggs I have are mature?

• Well, at least 2 of them were mature (and even fertilized)...we don't yet know about the other 6, but the answer to this question is still "didn't happen".

4) What happens if they get a whole bunch of great eggs but none of them fertilize?

• Well, at least 2 of them were fertilized...again, we don't yet know about the other 6, but the answer to this question is also "didn't happen".

Only 2 questions left to answer, and one will be answered tomorrow...the other will take a little while.

*sigh*

2 embryos...8 eggs, and only 2 are still around. I'm in total shock and completely devastated. They wouldn't tell me the grade or what happened to the other 6, but I'm so scared that they'll say they all fertilized and then they all died... I'd rather them say that the 6 were immature (because that can be fixed with holding off on the hCG shot and/or giving a higher dose of Follistim) or that 6 didn't fertilize at all (because that can be fixed with ICSI).

Please G-d...just give me a baby! Please watch over these 2 remaining embryos because they are my children. Please help them to grow properly and have either one or both of them implant into my uterus so that they can continue to grow. Please...I really don't want to go through this again next month!!

IVF #1 S/A

I literally just got the call from my clinic about my hubby's sperm numbers from his sample given before my retrieval, so here goes.

Before washing:
Concentration: 85 million (normal = more than 20 million; best = more than 90 million)
Motility: 51% (normal = more than 50%; best = more than 60%)
Morphology: 29% abnormal (normal = less than 70% abnormal)
Forward Progression: 3 (It's a scale from 1 to 4 with 4 being the best and 2.5 being average)

After washing:
Concentration: 17.6 million
Motility: 95%
Morphology: 9% abnormal
Forward Progression: 4 (That's amazing!)

It's not as amazing as some of his others, but the fact that it's IVF and not IUI makes me happy--you really only need one per egg and they're put together in a very small space. So I'd say 15 million sperm to fertilize 8 eggs is pretty good odds. LOL

Wheeeew!

Ok, it's over so now I can breathe. The retrieval went great and I wasn't even freaking out or anything. It was actually kind of funny--when I got into the OR I knew the anesthesiologist was messing around with my IV while the nurses were keeping my attention and having me get on the bed, legs in stirrups, lie down, etc. Once I was almost situated I said, "Did the Dr already start the drip? I'm feeling kinda tired." The nurse smiled and said, "yes". The next thing I remember is waking up in recovery with my hubby just arriving and me thinking "gee, that was quick and easy". LOL

As for my freak out questions this morning, we've already taken care of some of them:

1) What happens if they get in there and see that I've already ovulated all of my eggs?

• Well, that just didn't happen...

3) What happens if they get in there and find nothing in my follicles?

• This also didn't happen...they aspirated 8 follicles and found 8 eggs. :-)

7) What if something goes wrong during the retrieval and I just don't wake up CV"S?!?

• Fact is, I'm writing this post and don't feel any more bizarre than I did this morning or yesterday (yeah I'm tired, but I was tired yesterday too). And I obviously woke up. :-)

There you have it, 8 eggs and we'll see what happens to them on Thursday.

Terrified

I am soooo nervous about my retrieval. Only 3 and a half hours to go and I'm already freaking out.

1) What happens if they get in there and see that I've already ovulated all of my eggs?
2) What happens if they get in there and none of the eggs I have are mature?
3) What happens if they get in there and find nothing in my follicles?
4) What happens if they get a whole bunch of great eggs but none of them fertilize?
5) What happens if they get a whole bunch of great eggs that fertilize, but they all die before the transfer?
(this is starting to remind me of the Passover song "Dayenu"...)
6) What if everything goes well (even the transfer and freezing), but I just don't get pregnant?
7) What if something goes wrong during the retrieval and I just don't wake up CV"S?!? (I know that sounds completely rediculous...it's a 15 minute procedure, it's not even general anesthesia, I'll be breathing on my own and even be monitored the whole time, and I don't believe ANYONE has ever died during an egg retrieval...plus the fact that these guys have done THOUSANDS of egg retrievals and I'm not even their first today...)

I'm just praying that everything goes swimmingly and that at the very least I wake up normally sometime within 15 mins or so after the retrieval. :-)

P.S. If you're curious about the song "Dayenu" go look it up or I can explain further on another post if you're stuck.
P.P.S. CV"S stands for chas v'shalom and basically means G-d forbid.

Woo hoo!!!

So, I actually had the same ultrasound tech today as on Friday, but I guess she was more on the ball this morning. Here are the results:

estradiol: 2579 pg/ml
endometrium: 13.3mm
left ovary: 19mm, 18.5mm, 17mm, 16.5mm, 16mm, 15mm, 12mm, 11.5mm (total of 8)
right ovary: 16.5mm, 15.5mm, 14.5mm, 14mm, 13.5mm (total of 5)

Grand total: 13 follicles (which will all hopefully be mature by Tuesday!)

So the doc is having me trigger tonight at midnight and I'm having the retrieval on Tuesday at noon (eep!). I'm really nervous about the sedation for the retrieval, because I've never been put to sleep before...if anyone has any comforting words about it, please send them!!

Waiting

I really hate this waiting... I started my stims for IVF on Friday, so I've done 3 doses of 125IU Follistim, and I just want to know how many eggs I'm going to have. I know it sounds silly, but I don't like to be kept in suspense! And I have to wait until Tuesday morning for my follie scan to find out...and I'm terrified that I'm only going to have 1 or 2 nice ones--even though they nearly doubled my dose from before. I'm also scared that my endometrium lining will suck. I'm just terrified that they're going to cancel the cycle and I REALLY don't want that to happen. I just want a baby already!!!!