Another Episode of: You've Got Questions - I've Got Answers!

I know, I know, ever since my recent media appearances, it's been hard to escape my adoring fans, the ruthless paparazzi, the constant phone calls, the text messages, the overflowing mailbox, the neverending emails... It's a hard life, but someone has to live it, right? At least I can say that stardom has most definitely NOT gone to my head.

So you, my adoring fans, have questions. And, it turns out, I have a couple of answers. . .

Q: What time will your transfer be tomorrow?
Well, I'm glad you asked. Because I just got a call from my nurse answering that very question! I'm scheduled for 11:15 tomorrow morning. Be there at 10:45 with a "moderately" full bladder and instructions not to use the bathroom upon arriving at the office. Now, I find this incredibly hilarious. Have you ever tried to exactly provide a "moderately" full bladder? Yeah, it doesn't happen. Either you end up with an empty bladder, or you're sitting in the waiting room absolutely DYING and eventually a nurse says, "Okay, you can pee, but only THIS much." And really, have you ever tried to pee just, say 30ccs with a completely overflowing bladder?? Yeah, it doesn't actually work that way. So good luck with that. (I will say that the serious advantage of having had HOMs is that I never had to have bladder-filled ultrasounds in my pregnancy... that would have been sheer misery)

Q: But what about Shabbos preparations? How will you manage?
Fortunately, I'm not the only super-hero in my household. My husband, darling man that he is (see? I can say that now that I'm not on Lupron!), can totally handle Shabbos prep all on his own. That, and I'm going to cook as much as I can tonight so that it doesn't ALL fall on him.

Q: How long will you be on bed rest?
My clinic, apparently, is "East Coast Conservative" on this issue. There have been several studies done on the benefits of no bed rest after transfer vs. 24 hours vs. 48 vs. 72 etc. So there's some benefit to bed rest, but 72 hours seems to (maybe) be overkill. So we're a 24-hour clinic. Look at me, referring to the clinic staff as "we". Yeah, I'm there so much I feel like I work there. I assure you, I don't. Though for all the free press I give them, I ought to be on the payroll.

Q: If you have 3 good embryos and they implant 1 and you freeze the other two and the first embryo takes and results in a successful pregnancy what do you do with the other two embryos?
Well, first I'm going to nitpick here a little - Doctors can't implant embryos. They can only transfer embryos into the uterus and hope that it implants into the uterine wall. Implantation = pregnancy (though no guarantee of ongoing pregnancy). If doctors could implant embryos (and who knows? Maybe someday they will be able to!), they would always implant a single embryo in all IVF cycles - because it would be a 100% initial pregnancy rate. The media, for WHATEVER reason has never been able to keep these terms straight. For crying out loud, the frickin' New York Times can't even get the term right. If they can't, who can we expect to get the term right? The problem with getting the term wrong is that it causes the general public to have a skewed view of the reality of fertility treatment. It makes the general public believe that IVF is more of a sure thing than it is. While IVF success rates have skyrocketed in the last several years, it is still not a guarantee. And when the general public perceives that every cycle is a guarantee that each embryo transferred equals a guaranteed baby, they think that women who come out of fertility treatment with multiple babies had it coming. And frankly? That's unfair. So I'm on a mission to blot out the misuse of the term implant.

But I digress, because I didn't actually get to the heart of your question, did I? You want to know what I'll do with any leftover embryos should I have any frozen and should I get pregnant on my first go-round.

Well, I imagine the author of this article would have you believe that having any frozen embryos from this cycle would be an irresponsible consequence and rather poor planning on my part. And, further that the only morally acceptable choice for any remaining embryos that we have would be to enter into an embryo adoption program. But... that author probably never went through IVF himself. I daresay he actually never spoke with an actual IVF patient. And, further, probably never actually spoke with a reproductive endocrinologist or fertility science researcher. No, I'd guess that he never read beyond the abstracts of the studies he cited or the party lines of the political think tanks he references. Instead, he proudly waves the banner of prochoice moralism and dismisses any opinion other than his own, woefully uneducated one.

Right. Off soapbox now (but for a brilliantly written soapbox on this very article - I highly recommend Akeeyu's post!)

Clearly, I didn't have the luxury of telling my doctor to make sure to only create one embryo and make sure there were no others that survived. (I mean, that very well may still happen - but if it does, that's Darwinism in action, not anything pre-planned). I certainly wasn't going to tell him only to fertilize one egg and hope THAT one was the one that lived. (Don't worry, I don't think you, my reader, were suggesting that I should have done so. I'm just still so pissed off at that article... which, by the way, I read over a MONTH ago and my blood is still boiling). So, sure, I ran the risk that I would make more embryos than I needed for my planned single embryo transfer.

But, then again, we also knew that I wasn't *quite* the ideal candidate for eSET... and so we knew that I wasn't looking at the standard 67% odds on an eSET cycle that my clinic has. I was looking at 40-45% odds going in, which SuperDoc revised to...oh, 30% about halfway through my cycle. So clearly, having some back ups? Good thing. (again, still don't know that I'll have any back ups...)

So what if I get 3 blasts by tomorrow? We transfer one, freeze 2. And then, let's say, I get a BFP? (Hah! I can't say that with a straight face yet. But for the sake of argument...) What then?

Well, we'll start with the knowledge that I've already had one late miscarriage, so a BFP for me does not necessarily equal an ongoing pregnancy. So I'm not holding my breath, first of all. But... if I do get and stay pregnant and deliver my (healthy? Please God) singleton baby (9? Please?) months later... what then?

Well, I'm not promising our family is complete with one more baby. Maybe it is. But I don't know yet. We know that right now, we want at least one more baby. And that probably is it for us. But not because we want to be done, but because of the financial hardship of having more after that point... we're already stretched financially, so one more? Sure. But two more? Probably more than we can handle. But option one is we hang out for a while until we are certain our family is complete. And that IS the current plan.

After that, our choices are between my husband and myself, and those decisions are up to us for the moment. We do have a plan, and they are documented in our consent forms with Ye Olde Fertility Clinic (though they'll have to be revisited at the end of a specified period of time). But it's our plan, and ours alone. (I will say that Jewish law is pretty complex in this area, so there isn't a lot of choice involved, but regardless, our plan is documented)

Sorry for the long answer to a seemingly simple question.

Q: What happens to those embryos that don't make it to freezing or transfer but are still considered viable?
This question came from an anonymous commenter. I'm not entirely certain that I understand this question. Honestly, if by Day 6 the embryos haven't made it to a stage suitable to freeze, they aren't really all that viable any more. I'll check with Ye Olde Fertility Clinic, but I assume any non-suitable embryos are discarded in a respectful manner.

Q: All this fine-tuning seems sensible and makes me wonder how the Hatchery does those batches when obviously tailoring to individual response is needed.
This is from the same anonymous commenter. Yes, YOFC has been doing very sensible fine-tuning, which is fantastic considering that YOFC is an enormous clinic. Other clinics in the area accuse my clinic (without naming names, of course) of being a "revolving door of doctors" and tout themselves as being able to individualize care in a way that the "bigger clinics cannot". I'm here to tell you - YOFC individualizes every patient's care and treatment plan. They don't just have one set protocol and squeeze each patient into it. They have been extraordinarily flexible with my protocol, recognizing that the fine tuning is where the success will come from.

As for The Hatchery - they do batch their patients for the start of their cycles (every two weeks), but they almost have to do so because they have one doctor and one doctor only. This gives him the ability to have one retrieval weekend and one transfer weekend per month on average according to his nurse. But he, too, has built in flexibility. And because he sees fewer patients, he's able to individualize care plans very easily as well. For example - though they have never done an elective Single Embryo Transfer, and he wasn't totally comfortable with the idea of having his hands tied on that issue (me saying that under no circumstances would I allow him to transfer two), he was willing to work with me on that. He never takes his patients to blast and always transfers on Day 3. Why? Because when he was doing blastocyst transfers, he found that he had a much higher pregnancy rate, but no more babies. His ongoing pregnancy rate didn't change with blastocyst transfer. He couldn't figure out why, either. However what he did say was that with me and me alone he was thinking that to do an eSET, what he'd probably do would be to take me to blastocyst before transferring. So he was definitely flexible in terms of the protocol and the timing, etc.

Obviously, with the batching, there is occasionally some overlap of patients, but it is kept to a minimum for him this way.

Any other questions??