Embyro, Meet Womb

                                                                                                                                                                                                                                                                                                                           

This morning we went to Dr D's for our scheduled embryo transfer. We were anxious because we didn't know how many embryos we would have remaining and still hadn't made a final decision on how many we would transfer. Once we arrived we got very good news. Of our 8 fertilized embryos, 6 were still viable. The cute grey blob you see above was the best one. The others are looking good but were not quite as advanced (likely because they weren't fertilized as quickly). Dr. D recommended based on our age and the quality of our embryos that we transfer only 1 but ultimately the decision was ours to do 1 or 2. Drum roll please....

We quickly decided we would only transfer 1 embryo. Dr. D said that he expects most of the 5 remaining will continue developing and be able to be frozen for later use. We will hear tomorrow how many fully developed and were frozen. If this cycle doesn't work we will skip a cycle and then be able to thaw an embryo for another shot in 2 months. Dr D's success rates suggest that we have a 53% chance that this cycle work. If it doesn't his success rate after thawing our frozen embryos is 50% per cycle.

After deciding on a single embryo we moved along to the procedure room as the staff prepared for our transfer. They did a test run with the catheter to make sure everything was in the right place and avoid any surprises. Then they loaded the catheter with our little embryo and injected it into my uterus. Once the catheter is removed, the walls of the uterus collapse around the embryo preventing it from escaping. If all goes well, the embryo will hatch from its protective shell today and implant into the uterine lining as early as tomorrow.

After the procedure we had a quick meeting with Dr D. He told us that he didn't like to give anyone false hope, but that hope was important and so far everything had gone as well as possible. It is a little surreal at this point to think we could finally be pregnant but we are excited and hopeful. We return in 8 days for a pregnancy test. Thank you for all the calls, texts and good wishes this past week. Keep hoping for the best this week!

Now We Wait

Our doctor called this morning to update us on our eggs. We were excited to hear that 8 out of the 10 eggs fertilized. The other 2 were not mature eggs, so it wasn't surprising that they didn't fertilize. We were also excited to learn that my eggs fertilized naturally when mixed with Jeff's sperm and they didn't have to use ICSI, which is a procedure where they manually insert the sperm into the egg.

Now we wait. We wait for our embryo transfer on Sunday morning at 9:00. Then we wait 8 long days for my pregnancy test on February 6th. And in the words of Tom Petty, "The waiting is the hardest part."

Retrieve and Conceive

Laura is still under the influence of sedatives and not permitted to blog.  This message is brought to you by her sperm donor.

Today's procedure went well and was quicker than expected.  We arrived at Dr D's at 8:00 and were at home with chick-fila biscuits in our stomach and the real housewives of beverly hills on the tv by 10:30.  Laura has had a little bit of cramping and is a bit drowsy but otherwise is doing well.

During the procedure Dr D. was able to reach both ovaries and managed to retrieve 10 eggs.  There were 14 follicles that appeared to be mature but 4 didn't make it.  3 things could have happened with those 4 follicles 1) they never actually had an egg inside  2) the egg escaped into Laura's body when they drained the follicular fluid away  3) The egg was destroyed during the retrieval process. 

We were a little disappointed with the number of eggs because only a third of successfully retrieved eggs are likely to make it through the fertilization process and the next 5 days to become a blastocyst and be available for transfer.  Dr D was slightly disappointed (they usually get around 80% of mature follicles which would have given us 12) but still expects we will have several blastocysts and maybe even enough to freeze 1 or 2 for later use.

We will get a call tomorrow morning letting us know how many eggs were successfully fertilized.  Dr D said the number of fertilized eggs is a better predictor of how many healthy embryos we will ultimately have so hopefully what we lost in the retrieval will be made up in the fertilization stage.  We most likely will transfer our embryo(s) Sunday morning.  Keep us and our growing embryos in your thoughts and prayers this week.

No More Shots!

I had my final ultrasound and blood work done this morning and everything looked good. My follicles are definitely growing. Most of them were in the 15-19 mm range, so they scheduled my egg retrieval for Tuesday morning at 8:30 am. That means I'm done with all of my follicle stimulating medications (injections)! I do have one final shot to take tonight at 8:30 pm. It's an HCG trigger shot that induces ovulation and is taken 36 hours prior to retrieval. After that, NO MORE SHOTS!

I will be under IV sedation for the retrieval, which is pretty quick procedure. While I'm having the retrieval done, Jeff will go back and collect a "sample." :) They'll fertilize my eggs with his sperm and we should get a call the next day telling us how many of the eggs they collected were able to be fertilized. Our embryo transfer will be 5 days later on Sunday, January 29.

We would appreciate your prayers over the next week. Please pray that the egg retrieval goes smoothly, that my eggs can be fertilized, and that they develop into healthy embryos in the days that follow.

Quick Update: Round 2

I went back to the doctor for another round of blood work and an ultrasound today. I had 19 measureable follicles in all. Everything continues to look good! Most of my follciles were between 13-15mm, so they still need a few more days before my eggs will be mature enough to retrieve. My estradiol level was close to 1,000 so I'm cutting back on my medicine from 4 vials to 3.

I'll go back on Sunday morning for another quick ultrasound and more blood work, and possibly again on Monday. Right now I know that I'll take my HCG trigger shot to induce ovulation either on Sunday or Monday night and will have my egg retrieval 36 hours later, on Tuesday or Wednesday. It all depends on how things look on Sunday morning.

I'm still feeling pretty good--no mood swings, headaches, or hot flashes, but I'm very bloated and feeling lots of pressure in my abdomen. It kind of feels like someone is blowing up a balloon inside me. This is a normal side effect from the medication, since my ovaries are swollen from growing so many follicles. It doesn't feel great, but I really can't complain!

Quick Update

The shots are going well so far. I'm not really experiencing any side effects, other than a little soreness around the injection site. I went in to my doctor's office this morning for a quick check up. They did some blood work and I had my first ultrasound. The ultrasound showed about 12-14 follicles on each ovary, 7-8 of which were measurable (between 6-10mm). According to my IVF coordinator, everything looked good! I got the results of my blood work back this afternoon and my Estradiol level was good, so the doctor is going to keep my dosage of Bravelle and Menopur (injections) the same. No need to cut back or add more--I'm right where I should be. My progesterone level was 0.8, which was perfect since they like it to be below 2. That means my body is not trying to ovulate. For now we'll just keep doing what we've been doing and I'll head back to the doctor on Friday morning for my next check-up.

One Car Seat or Two?

We knew when we started this process that we would have to make lots of tough decisions. The one we're wrestling with right now is whether to transfer one or two embryos.  When IVF became a real possibility for us, we talked about how many babies we were comfortable having. We both agreed that we felt comfortable transferring two embryos. The possibility of twins became very real for us. We kind of just assumed that if you had more than one to transfer, that's what you did. It makes sense, right? If you're taking on the financial burden of IVF and putting yourself through so much physical and emotional stress, why not make sure you have the best chances possible? One would think that two embryos versus one would double your pregnancy chances. But that's where we were wrong. It's just not that cut and dry.

At Dr. D's office, there is a 53% pregnancy success rate from transferring one embryo. (Our pregnancy chances are closer to 65% based on our ages and my AMH level). If he transfers two, the couple's chances for pregnancy is about 60%, with a 44% chance for twins. A 7% difference in pregnancy rates? That's all? We were really surprised.It seems to us like this data means that either IVF will work for you, or it won't. Transferring more than one embryo doesn't really make much difference (if you're under 40).

The hardest part about all of this, is that we don't get to consult with our doctors about their recommendations until the day of the embryo transfer. There are only 5 days between the egg retrieval and the transfer, and during those 5 days our embryos will change every day. Some of the eggs they retrieve won't be mature enough to fertilize. After fertilization, some may grow and develop beautifully, while others may not. It's impossible to know how many embryos you have, and of the ones that you have, how many are high quality until day 5. Our IVF counselor told us that it's like playing a game of "What If?" to try to decide now. The scenarios are endless. We'll just have to wait and see.

The one thing we do need to consider, is that our doctor thinks we will have more embryos than we'll need for one cycle. When showing his chart of statistics at our orientation, we learned that we fall into the category of patients that have an average of 16 eggs retrieved, 11 that become embryos, and 5-6 that make it to the blastocyst stage (day 5). That means it is likely that we will have some left for freezing, which makes the decision even harder. If we only have two, the decision's easy--put them both in and hope for twins. But if we have 5, do we really need to transfer more than one? Is it worth the chance of a high-risk, multiple birth pregnancy for only 7%, if you have embryos left that can be frozen and used later.

Right now I change my mind daily, maybe even hourly. It's such an overwhelming decision. How will we decide? I'm hoping the right choice is obvious when we go in for our transfer, but Jeff says that's wishful thinking. We've still got a few weeks to think about it and my prayer is that we'll know what to do when the time comes.

Let's Get It Started

It's a busy week for us! Last night we had our orientation at Dr. D's office with the other couples who are doing IVF this month. Today I had my baseline ultrasound, mock transfer and medicine teaching class. Friday we start stimulation via injections!

Our orientation last night was very interesting. Dr. D took us through an IVF cycle from start to finish, explaining each of the steps and procedures. He talked for about 45 minutes and shared a few videos with us. We got to watch an egg retrieval, see how the eggs are fertilized though ICSI (intracytoplasmic sperm injection--a fancy way of saying they insert the sperm into the egg) and view an embryo transfer. All of the videos showed our doctors and were shot in our office, which I thought was neat. He showed us lots of statistics and pregnancy rates based on AMH levels. You may remember that I had my AMH level checked when I did blood work at my first appointment. AMH is an indicator of egg quality and egg reserve. Mine was 2.96, which according to our doctor is very good. This put us in the category with the highest pregnancy rates, which made us feel really good!  After Dr. D's presentation we "signed on the dotted line" so to speak, and hit the road to go watch the Tar Heels play basketball!

Today I had my baseline ultrasound, which went well. Dr. D said my uterus and ovaries looked good! While I was in the exam room, he did a mock embryo transfer. Basically he just wanted to use the speculum and catheter that he'll use the day of the transfer to make sure that there were no problems inserting it into my cervix. The mock transfer gives them information about the shape and size of my cervix to ensure the real transfer goes smoothly. It took about 5 minutes. When I finished up in the exam room, I went down the hall to meet with our IVF coordinator to go over all of my medications and how to use them. Since we've done injections before, it was mostly review. However, I'm taking more medications than last time, so it was good to learn about the ones that are new to me.

As far as my injections go, I have 4 vials of medicine that I'll have to inject each night.  The good news is that all 4 vials can go into one syringe, so I'll only have to get one shot a day! My next appointment will be for an ultrasound next Tuesday, January 17 to check in on my follicle growth.

Thank you for continuing to check in our progress and for all of the love and support you send our way! We're so blessed to have such wonderful friends and family.