Nope

Well, no surprise, it did not work. I've done IVF two times with fresh B2s, and it worked both times. Of course, one of those went on to be a blighted ovum, but still. This was a frozen with a B3, and did not work. And I have two more (lesser quality?) B3s on ice. Will history repeat, or is the second... or third... the charm? Only time will tell.

Countdown to...

Tomorrow's the big day--blood test at the clinic. Did it work? I don't think so. :(

Yes, I've been a pessimist before, but hear me out. I've had zero pregnancy symptoms. No implantation bleeding, no sore boobs and, the kiss of death, a negative pregnancy test 8dp6dt. (That's 8 days after transfer of a 6 day emby.)

Okay, I know what you're going to say. Those home pregnancy tests are not 100% accurate! Some people have pregnancy symptoms with one pregnancy and not another! And so on. Sure, sure, but there was only a 30% chance of success in the first place--and a really high miscarriage rate after that.   If, somehow, this worked (and things do not look good) what are the chances it's going to be a viable pregnancy?

I guess we have to wait until tomorrow, but I have a pretty good idea of where this is headed. :(

Post-transfer bed rest--unnecessary?

After my first IVF transfer, the clinic wanted me to be on (modified) bed rest (no working, just sitting around) for two days.  After the second round, they had changed the protocol to one day of rest.  I’ve actually read that studies suggest that bed rest is not needed, so we’ll see if this protocol goes away.

http://www.reuters.com/article/2013/06/28/us-bed-rest-after-ivf-idUSBRE95R10620130628

What the kids[’ wannabe moms] are talking about

To this day, sometimes I read fertility blogs and have absolutely no idea what people are talking about.  But here is a somewhat helpful guide to some of the more popular fertility blog abbreviations.

·       BFP – big fat positive, i.e. a positive pregnancy test (often used with a happy emoticon)

·       BFN – big fat negative, i.e. a negative pregnancy test (often used with a sad emoticon)

·       DH – darling/dear husband

·       DS – darling/dear son

·       DD – darling/dear daughter

·       TTC – trying to conceive

·       2ww – two week wait (aka the nerve-wracking period between when you ovulate and when you take a pregnancy test when you diagnose every twinge, hoping for your BFP)

·       LMP – last menstrual period

·       AF – aunt flow, i.e. period

·       MC – miscarriage

·       CP – chemical pregnancy

·       Rainbow baby – baby or pregnancy after pregnancy loss

·       D&C – dilation and curettage

·       D&E – dilation and evacuation

·       ART – assisted reproductive technology

·       HSG – hysterosalpingogram (x-ray of uterus and fallopian tubes)

·       HCG – human chorionic gonadotropin (in IVF, triggers ovulation; after pregnancy, hormone is measured to confirm pregnancy and confirm that pregnancy is developing—sometimes this is also called “beta HCG” or just “beta”)

·       LH – luteinizing hormone

·       FSH – follicle stimulation hormone

·       HRT – hormone replacement therapy

·       IUI – intrauterine insemination (using a “turkey baster”)

·       IVF – in vitro fertilization

·       ICSI – intra cytoplasmic sperm injection (a single sperm is injected into the egg after IVF)

·       PGS – preimplantation generic screening (screening frozen embryo for normal chromosome numbers)

·       PGD – preimplantation genetic diagnosis (screening frozen embryo for specific genetic issues)

·       OHSS – ovarian hyper stimulation syndrome (bad news)

·       SET – single embryo transfer

·       EC – embryo collection

·       ET – embryo transfer

·       DPT – days post transfer

·       DPO – days post ovulation

·       HPT – home pregnancy test

·       POAS – pee on a stick (do we really need abbreviations for all of these things?!)

·       Baby dust – well wishes for a pregnancy (if were actually a thing, infertile women would buy it and snort it)

There are lots of other abbreviations (some made up on the spot?), but this should be enough to get you going!

My snow babies

Okay, that one’s not mine.  When I read various infertility blogs, the ladies (it’s always ladies, right?) would refer to their frozen embryos as snow babies, frosties, snow flakes, etc.  So, about my snow babies….

After my last IVF attempt, we froze three day six blastocysts (none of them reached blastocyst at day five):

·       Day 3: 8 cell => Day 5: morula level 2, late cavitation => Day 6: blastocyst level 3, hatching

·       Day 3: 6 cell => Day 5: morula level 2, late cavitation => Day 6: blastocyst level 3

·       Day 3: 7 cell => Day 5: morula level 2, late cavitation => Day 6: early blastocyst level 3

It’s better for the embryos to reach blastocyst by day 5, and there is evidence that fresh day 5 blastocysts are significantly more likely to be successful than day 6.  (http://www.ncbi.nlm.nih.gov/pubmed/11384637)  But my lab says their pregnancy rates are the same with frozen day 5 blastocysts and frozen day 6 blastocysts.  (That is also supported by some medical literature: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03101.x/pdf)  So the fact that my guys did not make it until day 6 is not a further strike against them.

After my miscarriage, I discussed my frozen embys with one of the doctors at the office, lamenting that the “good one” didn’t take, so what was the chance one of the “crappy ones” would.  She looked at my chart and said that the hatching B3 had numbers that were basically the same as the B2 we ended up using, and that rating is not an exact science, and that she thought the chances could be similar to the B2.  She did look at the poor little early blastocyst level 3 and say, “I doubt they’d pick that one.”  Poor crappy early B3.

Interestingly, it is the LAB, and not the doctors, who pick the embryos to thaw.  The embryologist picks the one it thinks looks the best, starts thawing one embryo at a time until it finds one that looks good, and that’s the one used.  (If someone is using more than one emby for transfer, the lab will keep thawing until they have two good ones.)  The expected survival rate after thawing is about 85% at my lab.  (It used to be only 50%.)

On our transfer day, the lab chose the day 5 six cell B3.  (I.e. not the hatching one or the early “crappy” one.)  I asked a lot of questions about why that one was selected over any of the other ones, and was told that once they are frozen as B3s, they’re all kindof treated the same, and their background is less important.  But that particularly B3 had developed nice enough, so they thawed it, it survived, and bombs away. 

It’s still not clear to me why the “hatching” one was not selected.  One doctor I talked to seemed to think that was the best one, and I’ve read articles that suggest hatching blastocysts have better success rates: 

Hatching Day 6 
(Yoon HJ, Yoon SH, Son WY, Im KS, Lim JH., High implantation and pregnancy rates with transfer of human hatching day 6 blastocysts, Fertil Steril. 2001 Apr;75(4):832-3.)

My doctor did say for all of their frozen embryos, they do assisted hatching, so maybe that’s why.

They showed me a picture of my day 5 six cell B3.  It reminded me of a butterfly with injured/wet wings.  The doctor assured me that it would continue to unfold and look even better by the time it was implanted.  After an embryo is thawed, it is no longer possible to accurately rate it.  (Not that the ratings are so accurate when they are fresh.)  They can tell if it looks viable, but they can no longer say if, after the freeze, it’s a B1/B2/B3. 

Lucky for us, the first one the lab picked thawed, so “hatching” and “crappy” are still on ice.

P.S. In the Urban Dictionary, a “snow baby” is defined as a “a child born to a mother/father who was abusing either heroin or [cocaine]/crack/freebase at the time of [its] development in the womb/birth.”  Don’t look up how the Urban Dictionary defines “frostie.”  I’m scared to search the definition of “snow flake.”  Hmm.  Maybe we have to come up with another euphemism for our frozen embryos, ladies.

FET Protocol

The frozen embryo protocol is MUCH easier than the fresh cycle protocol.  You are not filling your body with hormones to grow tons of eggs, you’re just trying to over-prepare your fluffy lining to grab that thawed little embryo!

Here is the protocol we followed for our cycle:

(1) Birth control pills.  Easy.  Stopped them July 18.

(2) Lupron.  (Lupron suppresses ovulation.  No ovulation in this cycle.)  Started July 18.  20 units at first.  On the 10^th day (July 24), ultrasound and blood draw.  Then if all looks good (ovaries “quiet,” no eggs in site), move down to 5 units (starting July 25).  The Lupron is administered via shots, like last time.  But, like last time, the shots are not too bad—it’s just those tiny little insulin needles.

(3) Baby aspirin (81mg).  One time a day (starting July 25).  Apparently, the theory is that implantation is better with thinner blood.  They don’t do baby aspirin for a fresh cycle because of the risk of bleeding from the procedure.

(4) Hormone replacement (to build a big fluffy lining).  Best part about this—no shots!  The first day of this part is considered “day 1”.  (For me, July 25.)  Start with 2mg Estrace (estrogen) tablets one time a day.  After 5 days, move to 2mg two times a day.   After 4 more days, move to 2mg three times a day.  Easy peasy!  (Keep doing 5mg of Lupron for days 1-10.  Stop August 3.)

Day 14, there’s a follow-up ultrasound and blood draw.  (Only two doctor visits for the whole cycle until transfer!)

(5) Progesterone.  I started on day 18.  My clinic still prefers shots of progesterone, but they let me do suppositories instead.  Three times a day.  Oh yea.

(6) Antibiotics.  Four days.  Easy.

Transfer on day 23 of the cycle.  (August 12!)  One valium an hour before transfer. 

After the transfer, continue estrogen, progesterone, and baby aspirin. 

You down with FET (Yea you know me)

FET.  Frozen embryo transfer.  When I first started dealing with my infertility, I read lots and lots of blogs.  Many of them use infertility slang.  I had no idea what “FET” meant. 

Now I know.

And, once again, please join me on my (slightly less than) two week wait….