Transfer: Close to Perfect

One 3 day old embryo.

5 cells.

Grade 2A.

And....absolutely no fragmentation whatsoever!! :-)

Is this the embryo of one turning 46 this month? Holy crap.

I am stunned. I had 3 with very little fragmentation my my last cycle at CWRC in May, but this little bean is even better.

I am thrilled ... and best of all, hopeful.

3 on board

Today was transfer day. Full bladder I laid on the table and waited for the transfer crew to arrive. Dr. Indian wasn't there but I had the nice Italian or Spanish doctor that did my retrieval.

He said they had two embryos of very good quality to transfer (my heart literally did backflips with the words "very good"). I asked what happened to the 3rd. He said it only had 5 cells but I said "Let's just put it back. No sense freezing it or anything." And so they agreed. All 3 went back in.

Stats:
2 8-celled embryos, grade BB (very little or no fragmentation!! Yay!!!)
1 5-celled embryo, unknown grade

I told the doc I'd done an ultra low carb diet for two months prior to this cycle and he said that there is an insulin pathway in oogenesis that might have been helped in my case by cutting out carbs. I think it's the same path/reason that they put PCOS patients on metformin. I've always wondered if I was a wee bit PCOS because I used to make loads of follicles and I've got excessive chin hair (which is really odd since I'm blond). I'm not heavy, but I'm not svelte either at 5'10" and 170 lbs (I'm usually 155 - 160 but I'm carrying loads of steroid weight from these last 4 cycles that I've done since October, oy!)

Off to ride the couch for the day. I hope they're firmly planted in that uterus of mine and snuggling in for the next 8-8.5 months!

And Then There Were None

On day 3 I had two grade 2 embryos: 1 at 6 cells, 1 at 7 cells. Anything over 6 is considered "good enough" to progress onto a 5 day transfer.

Today, is day 5. Transfer was due for today at 3:30PM. It's 6:00PM. You can see where this story is going, can't you?

I was at a conference in NYC when the email and call came through from Dr. Italian's office.

Neither embryo divided further. Both arrested at 6 and 7 cells. Transfer was canceled.

The nurse actually told me, "Call me at 10AM tomorrow (Thursday) morning and we'll let you know if anything has changed." I said to her, "Even if both divide and double their cells, they'll be at 12 and 14 cells on DAY SIX. They're still not viable." Let's not even talk about endometrium lining, which would be totally out of sync with a embryo that hasn't even gone morula. Could they do anything to keep my lining squared away until a late transfer? I seriously doubt it. I also doubt that I will subject myself to another fucking shot of PIO in my ass tonight just because the nurse wants to torment me with such silly nonsense.

I canceled my acupuncture appointment. Maybe I should have gone for a stress treatment? I then left my conference early - I'd already told my manager and coworkers that I was leaving for "minor outpatient surgery" and handed off my pass to another coworker who wanted to attend.

I don't know what to think. It's just another fucked up cycle at this clinic. I've had a string of them. For this particular failure, I don't know if I can blame the laboratory, the Dr. Italian for triggering me too early, or what.

But I am done ladies.

I am taking my IVF insurance back to the last clinic to cycle with Dr. Indian at the other famous clinic here in the Big Apple. In October of last year, this other clinic found 4 follicles, retrieved 4 mature eggs, all fertilized, and 3 transferred. This was just six months ago.

Great numbers IMHO. Granted they did a 3 day transfer. Maybe they ALL died on day 4 at the last clinic and I wouldn't be any wiser for it if that was the case. But I'm going back there and I'll ask for 5 day transfers and we'll see. If I do three cycles there and they're as dismal as this, then I'll quit for good. I'll know it's just hopeless. But if my cycles are back to normal with near 100% numbers across the board, then I will know that Dr. Italian's clinic is seriously lacking.

I know my #1 problem is age. I know this. But I'm still making so many good follicles. My FSH is normally quite fine and hovers around 9 save for this cycle when it hit 33, probably due to my doing back to back cycles. (Repeat: I know it's my age).

Outside of my age are bonafide issues though: I do believe without a doubt that Dr. Italian's measurements with the U/S are questionable. 14mm lining cycle after cycle? Maybe. But in October at the other clinic they didn't see that. I also got triggered too early 2 out of 3 cycles and lost ALL of my follicles in one cycle, and 4 in this cycle (2 unretrievable, 2 immature).

So, I'll be swinging by the clinic in a few days to get a full packet of my records and we'll just call it a day. Insanity is doing the same thing over and over and expecting a different result. I'll call Dr. Persian in California tomorrow or on Friday to see if I can squeeze in a Da Vinci lap in the next two weeks or so, too.

I hate how I watch myself planning on "what to do next" (eg, cut out dairy/gluten, lose weight, see Dr. Persian, cycle again). In the last hour, I've cried, I've hugged my cats and have covered them with my tears, but I don't feel like I've emptied myself of this terrible feeling of loss. In the back of my mind I find myself thinking that I should be screaming and pounding on the walls. I should be having a fit of the highest order. It reminds of the feeling of having eaten too full a dinner the night before and you feel full for days afterward, carrying a bloated stomach with you. I feel like I'm literally bloated with pain from this ceaseless cycling and failing. A purge is due.

And Then There Was One

Yesterday was transfer day. I arrived early to inquire about a $517 bill from the clinic for services that should have been paid, to do a progesterone test, and for my pre-transfer acupuncture session.

It was my first meeting with the acupuncturist. He was charming and really quite good placing the needles. I really appreciated being able to do my acupuncture session inside my RE's office - a huge stress reducer.

As I laid there with my needles in, I tried to visualize myself in a safe place, white light, and becoming pregnant. It was strange but something about the experience brought forth lots of really vivid visuals. I found myself wiping a unexpected few tears away.

He took the needles out at 4:45, which is when my transfer was due to happen. I guzzled down a bunch of water since I'd forgotten to drink anything but luckily my bladder was already moderately full. I was whisked into the transfer room and waited just a few minutes until Dr. Italian came in.

"We have one embryo today."

My heart sank. We had two blasts earlier in the day. What happened? He explained that the one that was "non expanding" was doing quite well (a grade 3 in terms of "blast" grading, not embryo grading - so very very good). The other one was not compacting well and hadn't formed the appropriate junctions between the cells. He said that they would watch it til the next evening. If it came around they'd freeze it for me. I suggested why not just put it in? But he said, "Well, that would defeat the purpose of doing a 5 day transfer."\

True. But it DID make it to blast. It's past that 3 day mark. So why not just put in back

I guess one thing is that it's safer in the lab under constant conditions if it's fragile. My uterus is a fairly hostile environment given how many embryos HAVEN'T made it there.

But he did say something that made my heart jump:

"This one may very well get you a baby."

So they washed my insides with water, blotted, and then rinsed out my cervix with blast culture so that there wouldn't be anything to "shock" the blast.

And in went the one little blast.

My post-transfer acupuncture would be done in the same room, so I just laid back and relaxed as best I could with a bladder that was near to popping. I really get freaked out peeing after transfer - worrying that I'll push out the embryos. The nurse could tell I didn't really want to get up and when I joked about getting a bedpan, she dashed off and brought me one. She is an angel. OMG. All I know is that with the bedpan and the acupuncture being done ON THE TRANSFER TABLE I was able to stay stationary for about an hour and a half before getting dressed to leave. That, in my book, makes me feel a LOT better about transfer than just about anything. (Well, that and the lovely valium that they gave me before I went in! ;-)

Progesterone levels are at 68 which they said was good. They said they want it to be over 17 or 18. They asked if I was taking extra on the side. Hell no. I wouldn't dare mess with my lining. There are somethings that I will tweak: antibiotic duration, lupron/ganirelix dosaging...but progesterone before transfer is definitely NOT among them. I would add in extra progesterone well after transfer (maybe 4 or 5 days out to support a potential pregnancy, but not before).

Anyways. That's it. 1 very good blast, one is struggling in the lab today.

Taking it easy today...riding the couch with the cats.

Beta is on March 2nd, but I'll be POAS with abandon the entire time.

POAS

I'm one of those infertiles that has absolutely no issue with POAS from the day of transfer. My reproductive endocrinologist (who has passed away) told his patients that it was actually a good thing to POAS every day starting with transfer.

Yes, you'll have some residual hCG in your urine from your trigger. But that's fine. You POAS every day. You watch the trigger disappear. THEN if anything REAPPEARS, you are nearly 100% certain that it is because of implantation and NOT the damned trigger.

Why is this important to know?

Well, for an immune patient such as myself, I'm supposed to get an infusion of intralipds the first second I know I'm pregnant. I'm also supposed to double my lovenox injections. Both help to support the attached embryo. The sooner you know, the sooner you can act. Also, from an insurance standpoint, some benefits are better once you are pregnant. So if you test +, then get immediate blood test confirmation, many prescription drugs that aren't covered for the infertile might suddenly be covered for the pregnancy. One such drug that comes to mind is IVIg. $2500 for a cash payer without coverage. Reason enough in my book.

So knowledge is power in the hand of an infertile immune patient.

I've done a bit of reading online about which POAS are the best. Many seem to test at 25mIU of hCG. Some require as much as 50 or 100, which is crazy in my book. There used to be some POAS made by Inverness labs (So Cal) which measured amounts as low as 10mIU but they only seem to be available in the UK or EU these days.

One I found that has great reviews is made by WondFo of China. It says that it measures to 20mIU of hCG but tests have shown that they pick up hCH as low as 10 to 12mIU.

I bought a lot of 50 on Amazon for less than $12 and will be POAS with abandon.

Day 5 Embryo Report

I was a bit nervous this morning as I only had Saturday's day 3 report to go on. I sent in an email to the office. A prompt reply came back:

"You have one non-expanded and one compacted, both grade 3. There will be one last update right before transfer"

OK. I've not been to a day 5 transfer before. I'm in the dark on these things. I found this great description of how blasts are graded here which helped a lot but I still asked for a bit of clarification. She wrote back right away. Thank god. As I am a bit nervous.

"The best case is an expanded blastocyst, the non expanded and compacted. The non and compacted are just embryos that haven’t totally expanded. You will be able to get a better explanation at transfer from Dr Italian or our embryologist."

So I am wondering about the grading now. I had 2 7-celled grade 2 embryos on day 3. But now they are blasts. Blasts tend to have their own rating scale (esp if you look at the link above). Are my blasts still being graded on an embryo scale (and have thereby slipped from grade 2 to grade 3) or are they onto the Gardner blast grading scale which makes them a 3 and is actually quite good?

Well, I guess I'll have to wait til I get to the lab to know for sure.

All I know is that I am grateful, elated beyond belief, that this 45 year old has produced two living blasts for my 5 day transfer. I know that I have beat the odds: only 50% of embryos apparently make it to day 5.

This can happen. I believe this can happen.

Touch wood. Throw salt. Spit. Make sign against evil eye. Anything I'm missing in my ritual?

I'm doing pre and post acupuncture at the clinic (thank god it's all done in house) which should bump my odds a bit higher.

Now if I can just remember to breathe!!!!