Moving forward with FET#1!

We had our long awaited follow-up consultation with our RE yesterday afternoon. Overall, it went well and we continue to be impressed with our RE!

We found out that the grade of three embryos that were frozen from this cycle are: one 2bb (the one we already knew about the day of the ET, as the RE almost transferred it along with the other 2bb that he did transfer), one 2aa (which didn’t become that quality until day 6 after the ER, or as with IVF#1, our RE would have chosen that one to be transferred) and one 2ba. So we now have four frozen embryos: 2 – 2aa, 1 – 2ba and 1 – 2bb. As it turns out the 2aa and the 2ba from this cycle were frozen together, which is frustrating since we only plan to use one at a time. It probably happened because routinely two embryos are transferred during an FET and unfortunately they must not have realized that we only intend to put back one with each try. We are unsure whether the technology is advanced enough to allow one to be refrozen if need be and thus when the time comes to try to use the 2aa, we may have to sacrifice the 2ba. However, we are trying to focus on the fact that we have as many frozen embryos as we do and be positive about that!

We also found out that our RE’s embryology lab has a 97% thaw rate!!! That was so wonderful hear, as I had read online that the average thaw rate is more like 60% (that’s what I get for doing my own research and believing what I read). But apparently the vitrification process that our RE’s lab uses is much more effective than traditional cryopreservation methods?! 🙂 So we also found that news VERY ENCOURAGING, as on our way to the appointment I had been telling Bob that odds are all of our frozen embryos might not even make it to the thaw and thus we might only get one or two tries from them. Now it looks like odds are we might get to try as many as three or four FETs before we would either move onto another fresh IVF cycle or call it quits with Assisted Reproductive Technology (ART).

Some other details our RE shared about our embryos were that three of the four did not develop into blastocysts until day 6 after our ER (as opposed to day 5 when the ET takes place). He said that in those cases, the success rates for FET are slightly lower 40% vs. 50% for my age group (under 35). Though since we are only transferring one, the rates may be closer to 20 – 25% for us, as those rates may take into account primarily FET cycles in which two embryos are transferred. All along, the success rate he gave us, though he said it was a conservative one, has been 25%, so by that logic, it seems like our rate in this instance would be around 20%, though I may be wrong, it might be higher, if I miss understood how to interpret the data. He also said that it was frustrating for him that one of our day 6 blastocysts ending up being of higher quality (2aa), than the day 5 one that we actually transferred this cycle (2bb). You may recall the same thing happened with our 1st IVF cycle, the day of ET our best bet was only a 3bb embryo (they like to see between 1aa-2bb) and the next day one became a 2aa! 🙁 That said, we are pleased that we will be moving forward with this, our first FET cycle, using the grade 2aa embryo that was frozen from our 1st IVF cycle.

As far as why our RE thinks that our 2nd IVF cycle was not successful, though he does’t know forsure, he explained the two main reasons that IVF cycles tend to fail (more specifically why embryos do not “stick” or implant into the uterus). First, though embryos may look good, in terms of the grade the receive, they can still have abnormal chromosomes in them, that can’t be seen and that can lead to them not surviving in the uterus. He said that my history of having two miscarriages and my somewhat poor egg quality speak to that possibility in our case, in which case outside of doing Pre-implantation Genetic Diagnosis (PGD), there is really nothing we can do about that. As you may know, PGD is expensive ($3,000-$5,000), it is not covered by our insurance and it is not typically recommended, for those in our age group, unless one or both parents are known to be carriers of genes for things like cystic fibrosis. Also, the PGD procedure can, at times, damage the embryo itself, which then regardless of the findings, often deems the embryo not viable. Sometimes when couples repeatedly have embryos fail to implant from IVF and FET cycles, PGD is recommended to be able to only transfer embryos with normal chromosomes. Though we won’t rule PGD out for the future, at this point in the process we still don’t think it is worth it for us to do.

The second reason our RE gave to us for why he thinks that many IVF and FET cycles fail, is because the actual embryo transfer procedure is an imperfect science. Though REs who do ETs try their best to place the embryo(s) toward the top of a woman’s uterus, using the catheter to guide where they want them to go interally and the ultrasound monitor to observe the procedure externally, it is not possible for them to know forsure, if the embryo(s) in question are going where they think they are in the uterus. Uteruses aren’t perfect either, especially mine post-ectopic pregnancy removal, and thus if the embryo isn’t placed in just the right area, it can also contribute to lack of success in implantation.

Our RE was very sensative to our not having had success after 3 ART cycles and seemed somewhat frustrated himself that after two IVF cycles we had not conceived. He did remind us, and himself, that since we have only been transferring one embryo, as opposed to two (which he typically does and really increases success rates for patients), that it is almost as if each one of our IVF cycles counts as half of a cycle, since our odds of success he considers to be almost half that of couples who are able to transfer two embryos. So I guess that is sort of encouraging in that it many couples don’t conceive on their 1st try at IVF and many more do on their 2nd or 3rd and thus if it is more like we have only had one try, then maybe we still will have success with this?! I know, I am reaching here… 😉 We also reflected that our 1st IVF ET used a 3bb embryo and though women have conceived and delivered healthy babies from embryos with that low of a grade, it is not very common. So again it points us back to really only having had one good chance at success this far (with our 2bb embryo during our most recent 3rd ART/2nd IVF cycle) and when I look at it that way, I feel compelled to try my hardest to remain optimistic.

Some further debriefing of this last/our 2nd IVF cycle, led us to find out that again my egg quality was considered poor (the polar bodies were fragmented and there was debris around them) and Bob’s sperm was actually rated fair this time (with 78 million and low motility). That said, somehow our eggs and sperm managed to yield pretty decent embryos (I am sure the ISCI helped) that appeared to be doing very well after the ER on day 2, when they like to see them at the 4 cell stage, and day 3, when they like to see them at the 6-8 cell stage. Apparently on day 3, we had 3 “perfect” 8 celled embryos. When I asked if there was anything about my uterus at the time of the ET that would lead our RE to believe that it wasn’t ready to accept an embryo for implanation, he said no. The thickness of my lining was 9.5 (they like it to be between 6 – 20 and he said the number doesn’t matter) and my pattern was 5 line.

On a side note, unlike other times that we have been at our RE’s office for consultations, they were not very busy, we didn’t have to wait long to get in to meet with him and he didn’t seem rushed, all of which was very nice. Our RE was a little under the weather, which I felt bad for him, but he still seemed pretty on top of things. One funny thing though, when we started to discuss this last cycle, he was reviewing the data and I was comparing it to my notes and they didn’t seem to match up. When I looked more closely at the computer screen and saw the dates he was looking at, I realized that he was talking about our 1st ART/1st IVF cycle, as opposed to this last 3rd ART/2nd IVF cycle. I pointed that out to him, he apoligized, he switched to the appropriate dates/information and we continued! 🙂 It was even more interesting/funny, as our 2nd IVF cycle was a lot more successful overall (even though the embryo didn’t implant) than our 1st one and his tone quickly changed when he reviewed the data from that cycle, as he found it to be a lot more encouraging in terms of our potential for success!

After going over in great detail, as you can see by how long this post is already, what happened with our 2nd IVF cycle, we moved on to discussing the plan for our future. As we suspected, our RE recommended our next step to be a Frozen Embryo Transfer (FET). He reviewed the general schedule, which I was already somewhat aware of, and the variety of medications I will be using throughout the process. I will share more of those details shortly. He also pointed out that a FET cycle is an easier process, especially on my body, since there is no ovarian stimulation involved and not as many high horomones.

Our RE also plans to do procedure called cervical dialation, sometime next week, in effort to do anything that might increase our chances for success with this cycle! 🙂 He will strech my cervix to make it easier to allow the catheter to pass through at the time of the ET. Though it may not make a difference, he explained that sometimes it can and he would like to give it a try. Works for us! He was willing to do it after our consultation yesterday, while we were at the office, but unfortunately our insurance company needs 48 hours to approve any requests for procedures and thus, I will need to go back sometime this coming week, after they get the okay, to have it done. Our RE said that I may feel pretty crampy after the procedure, but that it shouldn’t feel too bad. One of the nurses who did one of my IUIs, said that it won’t feel much different than that procedure did and she recalled that I did well with that one.

As we were discussing the plan for our FET#1, our RE proposed putting back two embryos this time, to increase our chances for success. He did so knowing the risks involved with my uterus not potentially being able to handle multiples, which could lead to uterine rupture and recognizing that we are not willing to consider selective reduction if we were to conceive twins. We were shocked and confused by him suggesting this plan. We talked with him at length about it. We reviewed that uterine rupture can lead to a hysterectomey and/or worse maternal death. Bob and I both agree, with having an almost four year old child at home and wanting to have a long life together as a married couple, increasing our chances of success with FET by transferring two embryos is SO NOT worth the risk of having no mother/wife in the end. Even though all of our guts tell us that odds are we wouldn’t conceive twins and if we did, things would probably be fine, it still just doesn’t make sense to us, if there is any risk involved, not matter how minor. We also asked for clarifcation of how selective reduction works, just in case. However, after hearing graphically what is involved and the time table during which it happens (not until the fetuses are 8 – 10 weeks along in the pregnancy), we retitterated that it was something that neither of us could ever do to babies growing inside me. So once again we are back to being as patient as we possibly can be, knowing that the odds of success are less, and plan to go forward transferring one, and ONLY ONE, embryo this time around!

The tentative schedule for this FET cycle is as follows:

Friday, September 14 – Finish the pill (after being on it for 21 days). I think I may have an appt. at our RE’s office that day for bloodwork and ultrasound and it might even work out to also have my cervical dialation that day too, to save having to go twice that week.

Saturday, September 15 – Start Lupron injections (5 units) daily in the PM, in my thigh or stomach, to keep me from ovulating.

Saturday, September 22 – Begin to build my uterine lining (by wearing 2 Estraderm patches on the trunk of my body, that I will change every 3 days and by taking 1 Estridol vaginal pill in the AM and 1 in the PM). This is considered cycle day 1 for our FET cycle.

Wednesday, September 26 – Appointment at our RE’s local office for bloodwork (cycle day 5).

Sunday, September 30 – Up the number of Estraderm patches I wear from 2, to 4. Continue with Lupron and Estridol vaginal pills (cycle day 9).

Friday, October 5 – Lining check at our RE’s downtown office. This appointment will include bloodwork and ultrasound (cycle day 14).

Saturday, October 6 – Begin Progesterone-in-Oil (PIO) injections in my rear end and Progesterone vaginal suppositories, 1 in the AM and 1 in the PM (cycle day 15).

Wednesday, October 10 – Final Lupron injection, as it will be the night before the ET (cycle day 19).

Thursday, October 11 – Embryo Transfer (ET) preformed by our RE (and not another one in his practice). Our RE said that, when possible, he prefers to do ETs for his patients, as he feels responsible for them and though he trusts his collegues, he still prefers to do his own patients’ procedures. Especially in light of what he shared with us about one of the two main reasons he believes embryos don’t implant being transfer error (not placing it in the right part of the uterus) on the part of the person doing the procedure (though it may not have been possible for them to do it any better, in light of exhisting technology). So this tentative schedule is somewhat based on the fact that he is scheduled to do procedures on this date and thus would be available to do ours! 🙂

Friday, October 19 or Monday, October 22 – Beta blood test to determine if the embryo implanted and we are pregnant! 🙂

Sunday, June 28, 2008 – Estimated Due Date (EDD) if our embryos sticks! 🙂 Though the baby would likely be born at least 7 – 10 days earlier, since I would be having a scheduled c-section.

I know this was a VERY LONG post with A LOT of details! As I have said before, these types of posts I do as much for me to be able to review in the future, as to inform you. So thank you for reading (if you actually made it this far) and for humoring me! Thank you also for your continued support, thoughts and prayers. After three failed ART cycles, it is getting harder for us to keep our spirits up and our hope alive, but we have not given up. We intend to at a minimum see through our remaining frozen embryos and God willing maybe one of them will be able to stick around! If not Bob and I will take it from there as to whether or not we do more fresh IVF cycles (we have two left that are covered by our insurance and we would want our RE’s honest opinion as to whether it was worth continuing to try and to take stock of if I was up to doing it all again). If not, we would either choose to start the adoption process or move on with our lives being ever greatful for each other and our amazing son Sean!

I will check in on Monday when I have a better idea of when my cervical dialation will take place next week and when I get confirmation of the schedule I shared or if and how it might change. The rest of our weekend is going to be pretty busy, but hopefully a lot of fun, as we are having dinner at a friend’s house this evening and tomorrow is our nephew’s baptism and his older brother’s 4th birthday party! Sean also starts preschool on Monday, which is hard for me to believe and bittersweet! He is very excited though and I am happy for him! Until next time…