Well, I just got back from my ultrasound appointment and things are interesting. Let's start with the positive:
The other day my uterine lining measured at 3.97, and today it measured at 7.94, which is great! It must be above 7 to be "ready", and 8 is actually optimal. So that aspect of things is perfect. :) (This means that an embryo would have the best chances possible to implant or "stick" and actually perpetuate a solid pregnancy, so that is very, very important!) However, of the nine or so follicles he measured, he thinks we can expect only FIVE eggs. He said anything over 14mm has a good chance of containing an egg, and he likes to trigger when one or two have reached 17mm. (Today the two on the left were 14.83 and 13.8. The seven on the left were 17.02, 15.66, 11.04, 9.34, 16.4, 15.33 and 10.43.) Now, there are still a couple of days to follicles to grow, so I still have hope that I will again have some "late bloomers" pop up and give us an egg. (After all, on Wednesday my estradiol level was 174, and today it was 686, so who knows what could happen in a couple more days!) We won't really know until all is said and done at egg retrieval day. I am going back in the morning. He is going to decide whether I will take my trigger shot tomorrow or Monday. Personally I am hoping for Monday just to give my potential eggs that much more time to mature.
So why does number of eggs really matter? Because for persons in my circumstances especially (meaning not fertility issues, but genetics,) it really is a "numbers game." Meaning that for many women who have fertility issues like recurrent miscarriages, etc., they often have no problem creating embryos, just getting them to "stick." But for me, my greatest challenge is getting something to transfer! If I can get that far, my chances of a solid pregnancy are higher than a woman who has other fertility issues. Here is how the numbers work:
1) You take meds to stimulate as many follicles as possible....ones 14mm or bigger have a good chance of containing an egg.
2) Of all the eggs collected, only some will be mature.
3) Of all the mature eggs, only some will fertilize.
4) Of all the fertilized eggs, only some will fertilize normally.
5) Of all the normally fertilized eggs, only some will grow to a solid 7 or 8 cells by day 3. (This is when many IVF patients choose the best-looking embryos to transfer and freeze any others.) But for us PGDers, it continues:
6) The embryos then are subjected to the embryo biopsy procedure. They use either a teensy drop of acid or a tiny laser to create a hole in the zona pellucida (the "shell" that hardens around a human egg once it has been fertilized) and use a very tiny needle to remove one of the cells. (The other seven cells then go on to compensate for the loss and a normal baby develops. That's why embryonic stem cells are such a hot debate right now -- in theory each one of those cells could be turned into a new heart, lungs, liver, whatever.) The embryologist does this as carefully as possible, but it can cause the embryo to stagnate, or stop growing.
7) The embryos that survive biopsy must then grow and develop for two more days. This may not sound like a big deal, but keep in mind that this whole process is NOT supposed to happen outside the human body. So when you are doing it in a petri dish, (or whatever medium they use) instead, not all embryos are strong enough to make it.
8) During those last two days our biopsied embryonic cells are overnighted to RGI so their DNA can be extracted and analyzed using our personal test. So we go to RCC five days after egg retrieval and sit down with the doctor to review the report from RGI. Our biggest fear is that by the time we get there, the only surviving embryos will have CF. If that were to occur, we would have nothing to transfer and this process would be over for us. Or, as what happened last time, we had four embryos alive by day 5, and two of them were only carriers for CF, so we transferred both and I became pregnant with our daughter. :) We literally will not know until the very last moment whether or not we have an embryo to transfer.
So can you see why there is not a ton of confidence in starting with only five eggs? (I have a friend who just went through IVF, and she got 20 eggs from only one ovary! What would I give for those starting numbers?!) Again, though, last time I had a few things in my favor. My fertilization rates tend to be higher than average (I can't kick out quantity, but I seem to produce quality....) and they all survived the biopsy. And all I need is ONE strong embryo without CF at day 5. So I am back to what I said before: IF I am supposed to have another baby than my Heavenly Father will see to it that it works. And IF I am not, then it won't and I can close this door. And mercifully this process takes a matter of weeks, not months to find out.
4 comments:
Even reading this 5 years after we set out on this process ourselves the whole concept of PGD really blows me away. Modern medicine is just so amazing. Having the opportunity to NOT implant an embryo with a serious genetic condition is just huge. And the biopsy - flying a single cell across the country to run tests for like 40 hours straight...just fills me with awe. I don't mean to minimize how you feel about whatever outcome comes of this...It IS a numbers game. I hope you do get some late bloomers if that is what you want. In the meantime, I hope you're not too sore.
Sarah,
I think the most interesting thing about the whole IVF world is how every person can react so differently to what is available. I have had many people find out what I am doing and accuse me of trying to create "designer babies," etc. I have had other people think I am crazy for going through the expense and hassle and not just have a baby and if they have CF just "deal with it." Then there are most people who are amazed that the technology exists and very happy for me that I have this opportunity to save the life of my child before it is born. Because I am very vocal about things, it has been interesting to see which people hold which views.
For me, bottom line is this: I am also in total AWE that I have this choice! I am able to still have my own children and yet have the power to avoid a terminal disease (and awful suffering) for my child. No matter what my outcome may be, the sheer awesomeness of having this CHOICE is not lost on me...
(As for you, did you find adoption to be an easier road? That's one path I don't know that I could take...)
I still find it mind boggling that your blog is the only one I can find out there of somewhere else going through this process. Are we really the only ones to choose IVF/PGD to avoid CF? Or is no one else wanting to talk about it? (To be fair, I won’t talk about it on my blog!)
Wow, big question on is adoption “easier?” I can’t say yes or no, it is just different. It was hard in a lot of ways but so was IVF. There were miscarriages, a lost twin, a failed cycle, and lots and lots of money (we got zero assistance from insurance) spent along the way to our biological child. Oh, and huge therapy bills that got me through my pregnancy! Things were more raw with IVF somehow, it was very life or death all growing inside my body, and so many bizarre medical ethical decisions I never thought I’d have to make. Given the choice of more uncertainty with future cycles and all the money involved vs adoption, which also filled a need for a child that already existed, we chose adoption. I consider myself lucky that I get to do both, honestly. I’ve met so many wonderful adoptive families and having a connection to another culture and an alternative family building makes our life richer. That isn’t to say that we will have to work things that other families don’t, but biological families have their issues too.
Anyway, if you ever want to chat over email or facebook about this, I’m at sarahblossom@hotmail.com. You seem pretty well-adjusted though I think it’s awesome that you have the choice to do IVF/PGD and weren’t scarred by the process. I still find myself haunting the fertility blogs looking for someone like me, someone faced with having to build their family the non-conventional way. Thanks for writing about your experiences and putting yourself out there.
Sarah,
I have enjoyed your openness in your thoughts about everything. You are the only other PGDer I have ever "spoken" with about IVF/PGD. Thanks for all your comments! And yes, I can totally see what you mean about IVF being more raw. And you're absolutely right, we do end up having to make decisions about things that would never have crossed our minds otherwise. (For example, having to designate what to do with the embryos that are viable on day 5, but that have CF. My hubby and I had to really ponder that one. Ultimately we decided that they are just a conglomerate of cells that have the POTENTIAL to become a baby, but that they aren't "babies." So we agreed to donate any CF-affected embryos to science--so that an embryologist can practice biopsies or something, and hopefully benefit others in our situation.) Not to mention the unfortunate fact that with IVF you pay all the money for the CHANCE of a baby, no guarantees that you will ever take one home. So I can certainly see how adoption would be a much different journey. I do think it is neat that you have done both -- you are now part of two very special "clubs"!
As for the lack of blogs, I wonder if it is just because it is too emotionally difficult for many to discuss. I couldn't blog about it my first two cycles. It's only because I am truly okay with any outcome (because I am already so very blessed with TWO healthy children!) that I am able to "put it out there" this time.
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