The Superstar and The Underdog

Today was the big day....embryo transfer day!  Our appointment was scheduled for 9:00.  We headed out of the house on time, but as we were on the freeway, traffic all of a sudden came to a dead stop!  Apparently there had been a bad accident up ahead, and no one but ambulances and police cars were going anywhere.  As we sat there for a while it became obvious that we were going to miss our appointment.  So I called RCC to let them know.  Barbara answered and said, "Oh! That's too bad.  Thanks for letting us know.  But no worries, we are here and so are your embryos, so just get here safely when you can...Oh! And we got your PGD results in and they are awesome!  You have only one affected with CF, four that are carriers and four that are totally unaffected.  So we have some great embryos waiting for you -- see you when you get here!" And then she was gone.  I sort of just sat there for a moment and tried to process what she had said.  For one thing, I really didn't expect her to just sort of blurt out our PGD results.  But once my brain could wrap around those numbers, I got really excited!  That meant that we had eight embryos to pick from for transferring!  We have never had anywhere near that many to choose from before.

Eventually traffic got moving again and we arrived at RCC around 10:00.  We waiting in the waiting room for about 15 minutes before Barbara came to get us.  She took us to the consult room and told us that the doctor would be in when he could, but because the other scheduled patients had come when they were scheduled, we were going to have to wait a bit until they could "work us in."  But in the meantime, she gave us our PGD Report and our day 5 Embryo Report to look over.  So let's start with what the PGD Report said:

Embryo #1: Normal  (This one was the "superstar" from day 3...hooray!!)
Embryo #2: Normal
Embryo #3: Carrier (received gene from Mom)
Embryo #4: Normal
Embryo #5: Normal
Embryo #6: Carrier (received gene from Dad)
Embryo #7: CF AFFECTED (received gene from both)
Embryo #8: Carrier (received gene from Mom)
Embryo #9: Carrier (received gene from Dad)

Basically what this means is that we totally beat the odds again!  We have a 50% chance of contributing the mutated gene to our offspring, but we each only contributed it three times, and only one of those instances overlapped created an affected embryo, which is better than the odds! (And a lot better than our previous two cycles...)  So, so wonderful to be able to have eight choices, because it's not just CF status that matters, but also embryo quality.  So here is what the Embryo Report said Sunday morning:

(Embryos are rated according to stage of growth and quality.  By day 5 we need to see them advanced to Blastocyst stage.  Blastocyst 1 is okay, but they want to see Blastocyst 2 or 3 for the best chances of actually getting pregnant.  Then they rate the quality for Blastocyst 1 on the same Excellent-Good-Fair-Poor scale as day 3, but Blastocyst 2 also gets rated on outer cells and inner cell mass on a scale of A-B-C-D.)

Embryo #1: 2 BB Good  (Hooray! Again, this was the "superstar" from day 3, and not only was it not affected at all by CF, it also continued to grow really well and was a Blastocyst 2, rated BB and Good.  This is an excellent embryo!)
Embryo #2: B1 Fair  (not as good as hoped, but still this rating is a decent transfer candidate.)
Embryo #3: 2 CC Poor
Embryo #4: 3 BC Fair
Embryo #5: Stagnated (meaning stopped growing after day 3, was less than 30 cells when it should have been over 250, this type of embryo is essentially "dead.")
Embryo #6: B1 Fair
Embryo #7: B1 Fair (BUT CF affected, so not viable for transfer)
Embryo #8: Stagnated
Embryo #9: B1 Fair


So can you see how thrilled we were with our PGD results?  What if the only embryos without CF were number 8 and 5?  Or even 8, 5 and 3?  Our chances of getting pregnant with a 2 CC Poor would not be very good.  That is why starting with only four or five eggs is so awful.  But because we started with 10 mature eggs and had nine embryos and only one knocked out by CF, we had OPTIONS!! :)  And options, my friends, are a wonderful and amazing thing to an IVF/PGD patient.

We had already decided we would transfer the two best embryos on transfer day (if we were lucky enough to have two to transfer.)  So no matter what, we were transferring Embryo #1. (And I was very pleased about that, because I think that if genetic material is perfect enough to produce a "superstar" embryo, it stands to reason that the same genetic material is less likely to produce other congenital birth defects.  That's not coming from the doctor, that is coming from me and could be completely wrong.  But I like the thought just the same.)  But they weren't sure about what the second choice should be.  They told us that they were debating between Embryo #2 and Embryo #4.  They said that they would check them again right before our transfer to see which one looked best because they can change very quickly and even an hour can make a huge difference.  Then Barb left us alone in the consult room to wait for the doctor.

We waited probably 30 minutes more before the doctor was finally able to come consult with us.  He brought some consent forms (which we signed without even looking at them...so not like me!  I honestly have no idea what we signed, only that whatever it was they wouldn't go on without them so whatever.  But I am laughing at myself that I didn't even read anything on them.)  Then he gave me some valium to make my muscles relax.  This is because they don't want the uterus contracting when the catheter is inserted.  After only a few minutes of swallowing the pills I started feeling "fuzzy" in the head and heavy all over.  It was fascinating to me how quickly it took effect.  Then they led us (and my hubby was half-carrying me!) to a pre-op area to change our clothes.  Then it was time for the transfer!

The transfer room is a small "operating" room  joined by a secured door to the embryo lab.  And since our last time here they added something super cool -- a large flat-screen tv on the wall that is connected to cameras in the lab!  So they opened the door and Dr. Reggio (the supercool embryologist) was telling us what he was doing while we got to watch on the tv!  So we watched him take a circular "tray" that had little numbered indentations containing our embryos and he positioned the one labeled #1 under the microscope.  Then he scanned the medium for a small spot, zoomed in, and there was our embryo!  Then we got to watch him gently suck it up in a very, very small tube and transfer it to a holding indentation in the center of the tray.  (SO FASCINATING TO WATCH!!) Then we got some more amazing news.  Dr. Reggio explained to us that he had checked our other embryos right before we came in, and even though they had previously only been considering Embryo #2 or #4, in the past hour or so, Embryo #6 decided to have a "growth spurt" and was now upgraded from B1 Fair to 2 BB Good, the same as the "superstar"!! So even though that one was a CF carrier, it was now a really good looking embryo and our next best choice.  So we got to watch him find Embryo #6, gently suck it up and transfer it to the holding indentation with the other one.  Then we watched as he zoomed in the microscope, focused the camera and took the following picture for us:

My potential babies...aren't they cute? ;)

That, my friends, is what two great-looking embryos look like five days after conception.  And the "oozing" you see is them starting to hatch.  Yes, human embryos must hatch.  And once they do, the outer cells are what "burrow" into the endometrium and start forming a placenta.  And the inner mass of cells begins forming a fetus.  So even though this "oozing" is partially hatching and partially because there was a weakness in the shell from embryo biopsy, the result is the same: outer cells ready and waiting to burrow!

After taking the picture, Dr. Reggio very gently sucked them both into a catheter.  (All this time I was lying on the bed with my feet up in stirrups and the warm blankets over me...love those warm blankets! That plus the valium and I was feeling very heavy, and comfortable and kind of sleepy.) Then Dr. Reggio brought the catheter in to Dr. Heiner. While using ultrasound to guide him, he carefully and slowly inserted the catheter through my cervix and into my uterus. (You can't really feel much of anything, so it certainly is not uncomfortable or painful.) Then he pushes the contents of the catheter in and you see a little white "flash" on the ultrasound screen.  After that they all said "congratulations and good luck!" and left my hubby and I alone in the room.  They told me to lie still for about ten minutes and then slowly get up.  When it was time, my hubby had to help me up because I still felt like my limbs were filled with sand...strange feeling really!  Then we got dressed, and that was it!

So here is where it gets fun.  Unlike last time, this time I WILL KNOW which embryo (or both!) "took" (hopefully, hopefully!!) because #1 is unaffected and #6 is a carrier.  So when a baby (or babies?!) is born,   we will have them tested for CF to confirm the PGD results.  So if it is twins, I will know for sure if they are identical or fraternal (if same gender, otherwise it is pretty obvious!), because they will either have the same CF status (meaning an embryo split) or different, meaning both embryos implanted and grew.  Or if it is just a singleton, I will KNOW which embyro is his/her first baby picture!  Isn't that fun?!  And I can't help but smile when I think about Embryo #6.  Hopefully that one will "stick" and someday I will be able to tell my child that Heavenly Father knew he/she needed more time to grow so He had to delay my arrival to RCC! If I had been on time to my 9:00 appointment, Embryo #6 wouldn't have even been considered.  But because I was late, it was included!  I just think that could make a neat story to tell someday.

So now I just get to wait!  I have a pregnancy blood test scheduled for April 15th.  And right now, that day seems forever away!