Friday, June 5, 2009

It's Like DeJaVu All Over Again

The phone call from SuperDoc on Day 4 explaining the outlook and the options. The apologetic tone in his voice. The determination to push forward. The sense that maybe things aren't quite as perfect as he'd like them to be. I feel like I've lived this life before. I've been down this path, I know where it leads, and it doesn't lead to the perfect single embryo transfer on Day 5.

In fact, that's pretty much what SuperDoc told me this morning. Things looked "great" on Day 2, but apparently not so great on Day 3, and even less so on Day 4 (today).


Embryo #: Day 2 Report: Day 3 Report: Day 4 Report:
1 2 cell, no fragmentation 4 cell, no fragmentation 6 cell
2 2 cell, no fragmentation 4 cell, no fragmentation 4 cell, no change
3 2 cell, no fragmentation 4 cell, no fragmentation 6 cell
4 2 cell, no fragmentation 3 cell, 15% fragmentation 8 cell
5 4 cell, no fragmenation 4 cell, no change 4 cell, no change
6 4 cell, no fragmentation 4 cell, no change 7 cell
7 4 cell, no fragmentation 4 cell, no change 4 cell, no change
8 4 cell, no fragmentation 6 cell, uneven growth compacting embryo


Note, SuperDoc gave me no information about fragmentation - but said that the embryo quality today wasn't nearly as promising as he'd hoped. He believes that we'll likely have a [singular] good quality blastocyst to transfer - but he thinks it is unlikely that we will have it by tomorrow and that I'll more likely be pushed to a Day 6 transfer.

This seems to be a chronic problem of mine - the slow growing embryos. This is the same thing that happened to me last time, essentially. By Day 4, I should pretty much be looking at morulas. I should have had 6-8 cells on Day 3. The reason that clinics don't do Day 4 transfers (usually) is that it's difficult to differentiate quality between morulas, so they let the morulas mature to blastocysts by Day 5. But it's unlikely that my almost-morula (Embryo #8) is going to be a blast by tomorrow (Day 5). It'll need the extra day. This is the same thing that happened last time. I did end up with two blasts on Day 6 (none on Day 5), but one was clearly the winner. None of my 9 embryos in IVF#1 made it to freeze. None. It is unlikely that any of these 8 will either.

So what do you do about slow-growing embryos? Not much. According to Dr. Licciardi, from NYU Fertility Center, they really don't know what to do about it. They'll try different things in the protocol to see if it fixes anything, but they never know whether it was the change in protocol that fixed the slow growth issue, or whether it was just luck. Probably just luck.

Since we've always known that PCOS isn't my sole issue with getting (and staying) pregnant, it makes me wonder whether my slow-growing embryos contribute to the issue. But then again, maybe they're only slow growing in a lab. This is one of those places where the science is simply too immature to help answer these questions. We just don't know. So we keep trying.

I have long said that I am grateful to live in a time when the science and the medicine have reached a point that I know, with a reasonable degree of certainty that I can get pregnant with assistance. I went through five years of infertility, countless monitored cycles, 11 medicated cycles, 6 IUIS, and a late miscarriage before having my beautiful babies. But a hundred years ago, even fifty years ago, I wouldn't have been able to push through all of that knowing that there was always a next step available to me. There just wouldn't have been options (regarding getting pregnant, that is), period.

I am incredibly grateful that I live in a time where the science and medicine are so advanced. But I think it bears noting that we are still in the (pardon the pun) infant stages of this research. We have so far to go before we really understand how a lot of the embryo development works. How and why certain embryos are more likely to implant than others. Why, in the absence of chromosomal abnormalities, killer cells, a clotting disorder, etc., recurrent miscarriages occur. It is important to recognize and appreciate how far we have come ... but also to recognize how far we have to go to ensure that our sons and daughters, grandsons and grandaughters, friends and families have less heartache and more hope.

I have hope that we'll have a little George, Jr. on Day 6 this cycle. And that George, Jr. will want to cozy on up and stick around until 40 weeks gestation and make his or her appearance into the world. I have hope that this will be the case.

But I am also making plans. A girl needs to make plans, you know. I'm making plans to start my next cycle in August. It will be my last covered at YOFC. I wonder whether I'll need to use the category, "IVF#3" in my blog posts. I hope not, but I'm making my plans, just in case, because that's what I do.

9 comments:

Meghan said...

Sorry those little embies aren't growing like we'd all like. Hoping that #8 makes it and those other 8 cells are just late bloomers and step up.

I so hear you about the science and research of all this. I had such a hard time with the unexplained dx but then I realized that it wasn't so much unexplainable, it was that there aren't the means to explain it yet. Years ago the unexplained category was much bigger. There is so much farther to go.

Thinking of you and we'll miss you this weekend! Good luck

Anonymous said...

I hope that you won't need IVF # 3 as a category.

Hoping for you and your embryos.

Erin said...

And Blogger finally posted 19 updates...sheesh.

I'm sorry that the embryo growth is so slow, and that Embryo #8 is a George, Jr.-40-weeker. And I'm also grateful that we live in a time when we have options. I've thought about that myself and wondered how I would have handled it if I were in the same situation 40 years ago. I would probably not have P, I would probably not have K, and who knows if I ever would have gotten to be a mom. We are indeed lucky to have options. I hope, though, that IVF #3 isn't an option you need to use!

Jody said...

Yes, Blogger caught me off-guard, too (and it seems to have been 19 updates at a time lately, hmmm).

I will send good thoughts and prayers your way, knowing that there's only so much that can do. Here's hoping that they decide to flaunt the sabbath by forgoing rest in favor of super growth. Come on, George Jr.

nishkanu said...

I am sorry things are so hard for you right now. I hope for you despite everything that the cycle still turns out successfully.

I hear you on the "science does not know everything" front. On our most recent cycle (DE, young donor), we got 23 eggs!! Woo-hoo!! And ended up with 1 good and 1 crappy blastocyst to transfer, none to freeze. This from a donor where the previous couple had had plenty to freeze, i.e. this was likely not an egg factor thing. "They" say that male factor is over once there is fertilization, but this made me think once again they don't know squat about male factor and how it subsequently affects embryos. Among the many, many things science can't tell us about why things do or don't work.

Beth said...

Thinking of you and those little embies...

Adventures in Glass said...

oh, i'm sorry these are so slow growing embryos.. You're right about the medical advancements we've made.. yet, there is so much we don't know.. why do the grow slowly? what can we change? why do some grow differently than others?

I really hope that you get that embryo for your SET and that it sticks around for 36 more weeks after your beautiful high (but not too high) beta!

But if not, you and me girl.. August, we WILL get pregnant!

Emily said...

I am sorry about the slow growers. I am a fan of Day 6 transfers myself - I had a hatched rockstar on Day 6 that looked crappy earlier on, so you never know!
The power of medicine and miracles where the hand of God meets the hand of science...Praying for your miracle.

Carol said...

oh gosh, sorry that wasn't the news you were hoping for. I've definitely been there, that's basically why I ended up with the direction that we did - not that I'm saying that you will have the same diagnosis as me. Just that I can empathize with how it feels to get these less than stellar progress reports.

I will be hoping with all my might that you have at least one super duper blast to transfer - and stick around for 38 weeks!