Thursday, October 23, 2014

Infertile Myrtle

Well, fuck.  It did not work.  I mean, it did work, but then it stopped working.  Repeat beta 18dpo was 190.  It should have been at least double that.  The Dr’s office was like, “status quo, keep on your meds, but let’s get you in for another blood test.”  When she told me my numbers I was like, “well, fuck [see above], I’m having a glass of wine tonight.”  Of course third test confirmed it—beta of 151.  Dropping.  Not good.  (But at least it looks like it’s not ectopic!)
We have one frozen embryo left, but considering the poor quality, and that THREE better ones did not take, I am not holding my breath.  We might go for one more fresh cycle. I think science is on my side that it’s worth it to go for a second fresh round….  Although probably not a third fresh round (especially because we also went through two frozen):
This one says chances of having a kid--
·       after 1 round: 30.4%
·       after 2 rounds: 43.3%
·       after 3 rounds: 49.1%
·       after 4 rounds: 51.9%
·       after 5 rounds 53% (stays about here)
I’m unclear if my frozen cycles “count” against me.  That is, am I considered having done ONE cycle (because it was fresh) or am I counted as having done THREE cycles (one fresh, two frozen)?  I think the latter, which puts me into seriously screwed camp. 
Here’s another study from the same author with slightly different numbers with regards to lifetime success based on number of cycles (I think it has to do with the way cycles are counted):
See also:
Okay, one more interesting one:
The bad: “They concluded that both a major cardiovascular vulnerability to stress and working outside home are associated to a poor outcome of IVF-ET treatment.”  Gulp.  Yea, I work outside the home.  A lot.  In a relatively stressful job.
BUT: “Patients who have a biochemical pregnancy should be encouraged to go through another IVF cycle.”  Okay, I will!
Before we all start drinking, let’s inject some hope / good news into the mix:  “Young women who had a live birth and those who experienced an early miscarriage after IVF have a greater likelihood of achieving a live birth in a second cycle.”  See the full article here:
So, for me (and anyone who has had a miscarriage after IVF) there’s hope!  (As long as you’re under 40.  DAMN getting old is a bitch.) 
Okay, that was not bright enough.  I’m still depressed.  Here’s some REALLY good news.  IF you’re lucky enough to get pregnant via IVF, it does not appear that you kid will have cognitive issues AND in fact, they’re likely to do better in school:
This obviously does not prove that IVF makes smarter kids.  But it might indicate that when those desperate IVF parents are lucky enough to have kids, they’re mighty fine parents!

Wednesday, October 22, 2014

In the progesterone zone

Oh, did I mention I ALSO have low progesterone?  16dpo it was only at 8.8.  My doc assured me that because of my FET my body’s not producing much of its own yet (probably) so that’s (probably) all from the supplement.  (He basically said that the supplements make the progesterone measurement somewhat meaningless.)  I would freak out about my low numbers, and some of the articles above suggested low progesterone is not great, but progesterone is not nearly as important in predicting pregnancy outcome as the beta (  So I’ll continue to freak out about my low beta, thanks!
Along these lines, my doc likes the intramuscular progesterone, but has allowed me to use the suppositories.  (I’m on crinone now.)  Yes, my progesterone will be lower, but pregnancy rates are thought to be similar on between the shots and the gels (with the gels maybe slightly better?):

Tuesday, October 21, 2014

Making (mis)use of beta HCG measurements

Be prepared for a bit of stream of consciousness  below….

So, no surprise, I am pregnant.  BUT.  B.U.T.  But my beta HCG is low.  Not really low, but pretty concerning-ly low.  This time it’s at 131 10dp6dt [10 days post 6 day transfer] (or 16dpo [days post ovulation]).  Last time (miscarriage, early blighted ovum) it was 112 at 9dp6dt (or 15dpo).  With my first (and only) kid my HCG was 146 at 9dp5dt (or 14dpo).  So this embryo is TWO days more developed than my kid was, and its numbers are still not as good.  (I’m not sure how much we can hold the extra day of freezing against it hatching, but still.) Its numbers are not as good as my blighted ovum, either.  In fact, at 16dpo with my one successful pregnancy I was at 480!  Compare that to what I have now—131.  So it’s not good. 
Late implantation can account for an initial hCG level that's lower than the norm, BUT I had a fully hatched blasty that should have implanted the day of the procedure.  So not good at all.
I sensed from the doctor’s voice that he was thinking my HCG was low, but when I asked about it he said the odds were in my favor, and that I should be cautiously optimistic.

{see a later post on this with a chart here:}
Self-reported beta (all pregnancies, including natural)
Remember that handy chart I showed you all those years ago, showing beta HCG scores?  (I’m going to use beta and HCG interchangeably, just to make this even harder to follow.)  Well, here it is again:
It says for 16 days post ovulation I’m low (but not out!).  The average self-reported HCG for 16dpo was 278.  So roughly double where I am—or two days ahead.  (Betas are supposed to double every two days.)  Again, though, this collects ALL betas, and we know (or will know, when this post is over) that the in vitro process results in lower early betas.
Beta correlation study #1 – 16dpo (infertility treatments including, but not limited to, IVF)
No surprise, there’s a correlation between better beta scores and successful pregnancies:
(Information that makes crazy wanna-be moms like me totally nuts in early pregnancy.)  This medical study suggests an early low HGC means the pregnancy is less likely to continue.  (Again, no surprise there.)  The authors define the result as pregnancy “outcome,” which they define as progression to >20 weeks’ gestation.
It suggests that at 16 days post ovulation (me today!): “Low hCG levels between 25 and 50 IU/L are associated with a low probability of ongoing pregnancy (<35%), whereas levels of >500 IU/L predict a >95% chance of ongoing pregnancy.”  The authors include super helpful images of your chances of success based on your HCG measurement.  (Seriously, take a look at the article—very interesting.)
And here’s the info by category:
No. of women
Ongoing pregnancy rate (%)
Miscarriage rate (%)

The median HCG level for 16dpo was 193.  I’m 131—below average.  L  If you have an HCG of 131 16dpo (like me) you’re looking at around a 65-70% chance of success.  (I’m under 40, but I suspect because of my age—36—fertility issues, and use of FET, I might be on the low end of that range, if not actually a fair bit lower.)  Well, that’s certainly not terrible.  But it’s not great.  Oh how I’d like to be in the 500s!
Beta correlation study #2 – 13dpo and 15dpo (IVF)
Here’s another article about measurements 13 and 15 days after fertilization (ovulation):
Some highlights:
“Serum beta-hCG concentrations determined 13 and 15 days after fertilization in pregnancies established by transferring cleavage-stage embryos on day 3 or blastocysts on day 5.”
“In singleton pregnancies, serum beta-hCG concentrations were 75 +/- 54 (mean +/- SD, n = 203) or 62 +/- 41 (n = 109) IU/mL after day 3 or day 5 transfers, respectively. In twin pregnancies, the beta-hCG concentrations were 162 +/- 105 (n = 52) or 109 +/- 55 (n = 49) after day 3 or day 5 transfers, respectively. The percentage increases in beta-hCG concentrations between the first and second measurements were similar in the two groups (day 3: 144 +/- 109, day 5: 142 +/- 63, not statistically significant).”
“Initial beta-hCG concentrations in pregnancies resulting from day 5 transfers were lower than those from day 3 transfers when assessed at equivalent intervals from fertilization. This suggests that embryo development or implantation may be impaired by the additional 2 days in culture.”
These are 1999-2001 numbers, so a little older.  They measured HCG 13 and 15 days after egg retrieval and fertilization (ovulation) of day 3 and day 5 fresh (never tastes frozen!) embryos.  So the numbers for the day 3 and day 5 embryos should in theory be similar because the embryos are exactly the same ages, just transferred at different times, but as we see the ones that sat around in the lab a little longer are a little behind:

Day 3 embryo transfer
Day 5 embryo transfer
First test (13dpo)
75 ± 54
62 ± 41
Second test (15dpo)
173 ± 101
138 ± 105
[This is an excerpt from Table 2]
The authors explain, “Our data indicate that, at equivalent time intervals subsequent to fertilization, serum β-hCG concentrations are about 50% higher in pregnancies resulting from day 3 transfers in contrast to those resulting from day 5 transfers. . . . Serum β-hCG concentrations in early pregnancy roughly double every 2 days, corresponding to a 40% rise per day. The observed discrepancy therefore corresponds to slightly more than 1 day.”  The potential theories about why: “First, the observed discrepancy might result from a difference in the rate of very early, subclinical losses. Second, delaying transfer to day 5 might result in a gender bias, which in turn has been suggested to be related to the rate at which early embryos develop. Third, the additional 2 days of in vitro culture might directly, and adversely, affect the normal development of the embryo, resulting in subtle delay or reduction in hCG production.” 
The authors then go on to reject the first argument, reject the second, and accept the third, but with the caveat that it does not seem to impact pregnancy rates.  In other words, my slow-grower might do just fine, even though my numbers are low right now.
Interestingly, the authors note that “although our data did not reach statistical significance, they reflect a nearly 2:1 male to female bias after day 5 transfer.”  Uh, oh, we had a day 6 transfer, so we’re having another boy!  They suggest, “Delaying transfer to day 5 could potentially result in a gender bias that may contribute to the difference in β-hCG concentrations. However, our findings are inconsistent with this hypothesis. When β-hCG concentrations were compared by gender (combining singleton pregnancies with twin pregnancies with both newborns of the same gender), we found that male gestations were associated with significantly higher β-hCG concentrationsthan female gestations (data not shown). Because day 5 transfers appear to lead to the birth of more males, higher β-hCG concentrations would be expected in pregnancies after day 5 transfers, which is opposite our findings. Male embryos appear to develop faster than female embryos during the preimplantation period in mice and cattle. Therefore, male embryos are more likely to be selected for transfer when the cleavage rate or blastocyst formation on a fixed day after fertilization is used as the primary selection criterion, which is consistent with our observations.
If we treat my little 6 day embryo like a 5 day embryo (and we know culture impairs development, the authors tell us as much!) and thus treat me like 15dpo instead of 16dpo, maybe, just maybe it’s doing okay.  (Again, my 16dpo measurement was 131, and the averages measured in this study at 15dpo were 138.)  How do you like that optimism?! 
Beta correlation study #3 – 14dpt (IVF)
Another study (using data from 2007-12) talks about correlations between HCG on day 14 after embryo transfer and ongoing pregnancy:
Some tidbits: “Pregnancies achieved by in vitro fertilization (IVF) are at increased risk of adverse outcome as compared with natural pregnancies.”  Super.  Thanks for reminding me.
This study considered fresh day 3 and day 5 embys.  (And I have to keep reminding myself that frozen cycles have more adverse outcomes than fresh…  so I don’t know how much stock I can put in the fresh HCG numbers.)  In their study, of 139 pregnancies 39 did not make it to 12 weeks.  (So miscarriage/chemical pregnancy/ectopic rate of just under 30%.)  The average HCG rate for the 100 pregnancies that continued to 12 weeks was 600 14 days after embryo transfer.  The average HCG rate for the 100 pregnancies that did not continue was 178 on day 14 after embryo transfer.  It postulates, “initial serum β-HCG can be taken as the single best predictor of pregnancy outcome in patients undergoing IVF.”  It concludes: “The β-HCG level on day 14 of more than 347 mIU/ml has a sensitivity of 72.2% and specificity of 73.6% in prediction of pregnancy beyond 12 weeks period of gestation. Positive likelihood ratio (LR) is 2.74 and negative LR is 0.37, (receiver operating characteristic area = 0.79).”
Okay, well this one is hard to do anything with, as I am not yet 14dpt.  BUT, I’m having my beta retaken in two days.  (12dpt, 18dpo.)  It needs to double.  (So we’re looking for something over 260.)  If it doubles again 2 days later, it would be 520.  That’s still below the median 600 in this study, but it’s over the “more than 347 mIU/ml” threshold for pregnancies likely to go 12 weeks.
Also, this one is a little questionable because it lumps day 3 and day 5 transfers together for testing 14 days post transfer, even though the day 5s are “older” and should be more mature and have higher numbers.  (See more on this below.)
Beta correlation study #4 – 14dpt [IVF]
Here’s another one dealing with the same issue, with some different details:
Most interesting, the authors say that HCG levels for boys are lower than girls.  The authors state: “Although the mean beta-hCG value was higher in women who had female fetuses compared to males, it was not statistically significant in our study. Various other studies had quoted a higher value in woman with female fetus. Fetal gender has been shown to have a significant influence on maternal serum levels of hCG.”  (Remember the earlier study said more boys came out of 5 day transfers, and the authors suggested that was because boys developed faster and had higher earlier HCGs.  So maybe this one needs more thought.)  Also, the authors show mean HCG compared to outcome, 14 days after embryo transfer.  (Again, very interesting, read the article.)  The authors also suggest, again unsurprisingly, that a 6 day embryo should be much more developed 14 days after transfer than a 2, 3, 4, or 5 day transfer.  There is no way I’m going to be at close to 5000 (mean 6-day measurement) at 14 days post transfer.  (I was 131 10 days post transfer, so I’m very likely looking at under 1000.)  I’m just chalking that one up to small sample size.  One last chart that shows status of pregnancy at 6 weeks based on beta measurement 14 days post transfer.
This is a little silly to me, because it’s considering 14 days post-transfer whether a baby 2 day old embryo is used or a geriatric 6 day old embryo is used.  Especially because the authors just told us that the 6 day-ers should be a lot more developed than the 2 day-ers at the same time 14dpt.  So the “mean” doesn’t seem to have much value to me.  (I guess if you transfer a relatively sprite 2 or 3 day embryo and 14dpt you’re above 500, you can be feeling pretty good about things.)  But the numbers appear consistent with the study above.  If 14dpt you’re at 178 (the average bad number cited above), you seem pretty screwed here too.
Okay, I may have totally hacked my summaries of these articles (have I mentioned I’m not a doctor?), but I hope some of the charts and data provided (and links to the full articles) are interesting to you in case you’re fretting over your first beta.  (Who in the world would spend hours and hours researching initial beta results?  That’s crazy.)
As this all relates to me, I feel like I’ve got about a 50-50 shot.  Downside, we did FET, which has lower success rates.  Downside, we used a very poor quality embryo, which should have a lower success rate.  Downside, low HCG numbers.  Downside, we know that it was fully hatched, which means it should have implanted early.  (Low HCG numbers may be from late implanters.)  Downside, I’m 36, which is older than the averages of most of these patents and leads to more adverse outcomes.  Upside, we used a 6-day embryo, which may start with lower numbers because sitting in solution may arrest development.  Upside, using my HCG numbers alone, I have at least some chance.   We just have to wait until Thursday.
Final thoughts
What do I want?  Well, I want a healthy pregnancy that results in a healthy kid.  So, for a start, I want to see an HCG that is at least doubling.  (Preferably doing much more than that.)  But if this pregnancy is not going to work out, I want a super low level.  I want an early miscarriage.  I do not want to spend more time plodding along with a pointless pregnancy.  I do not want a late miscarriage, after I get my hopes up.  I do not want a D&C.  I don’t want to see a heartbeat, only to have it all taken away.  And I really, really, really do not want an ectopic pregnancy.  So, if I can’t have high numbers, I want low numbers.  If I can’t have high numbers, I want to mourn with a nice glass of wine.
Okay, one last (dark) thought.  Is anyone else wondering if pregnancies that continue from low HCG numbers are more likely to result in children with health issues?
Well, this study is pretty hard to follow (there’s a lot of math and statistics!), but I like at least this sentence: “Low levels of PAPP-A had a stronger association with adverse pregnancy outcomes than a low level of free β-hCG…. Studies investigating free β-hCG and adverse pregnancy outcomes have had mixed results.”
Another one says the same thing:
Low PAPP-A I no good, looks like not as much for low HCG.  What the hell is PAPP-A?  The last one says: “Low pregnancy-associated plasma protein A levels in the first trimester were associated strongly with a number of adverse pregnancy outcomes. Low free-beta subunit human chorionic gonadotropin levels and large nuchal translucency were both associated with early fetal loss.”  In other words, if you have early low HCG, you’re more likely to miscarry (see above, no surprise) but it does not appear to be linked to health issues if the kid makes it.  Whooh!

Monday, October 20, 2014

In defense of IVF and fertility treatments

Sometimes when I read articles about assisted reproductive technology I make the mistake of reading the comments.  While I shouldn’t find the judgment and hostility surprising—“trolls” make nasty little comments on a slew of topics—I still feel the need to offer some defense of the use of fertility treatments such as IVF.

Some of the comments focus on the obvious—fertility treatments are expensive.  They suggest that money could better be used elsewhere.  Fair enough, but that’s true of just about everything.  Do you have cable?  Go out to eat?  Go on vacation?  Fine, spend your money how you want.  Don’t judge how I spend mine.  (Although I must admit a portion of my treatments have been covered by insurance.  In that way I am lucky, but I would have made the exact same choices with my own money.)

Others make the argument that infertile couples should just adopt.  Again, fair enough, and many couples do make that choice.  But as anyone who has adopted, or looked into adopting, can tell you, it’s no cakewalk.  Like fertility treatments, adoption is expensive.  Like fertility treatments, adoption is stressful.  And like fertility treatments, adoption might not work out.  Adoption is not the right choice for everyone, and I don’t think it’s wrong to want to have biological children, be pregnant, be guaranteed a newborn, or any of the other reasons people choose to try to have biological children instead of adopting.  Also, I find the whole “there are so many kids looking for homes, so just adopt” argument a little hard to swallow coming from anyone who hasn’t made the choice to adopt.  The fact that there are lots of kids that need homes is true whether someone is dealing with infertility or not.  (Along these lines, I have no patience for the “world population is too large” arguments either.  Again, that’s true whether the parents are fertile or infertile.  And, see my comments below on fertility treatment parents being the best kinds of parents—ones who want kids.)

Likewise, I can’t engage with or take seriously anyone who goes on the rampage about fertility treatments being “unnatural.”  Yea, so is brushing your teeth. Vitamins.  Chemo.  Get over it.

Instead of attacking people who decide to use fertility treatments, we should be celebrating people who really, really want to be parents.  I believe most people who try this hard to be parents and ultimately succeed are really good parents….  Probably better parents than the judgmental assholes trolling articles and making anonymous mean comments.

Sunday, October 19, 2014


I pre-wrote this post.  As optimistic as I initially was about my hatchling, I was going to say I don’t think it worked.  No implantation bleeding.  (A very, very, very tiny amount of old brown dried blood a few days after the procedure, but I could have been because the doc accidentally pinched my inner lady bits during the procedure.)  My sore boobs do not appear in the morning until I take my estrogen.  No nausea.
BUT, I had one last pesky pregnancy test floating around in my bathroom.  A really nice one—a Clearblue digital.  And I thought, what the heck?  So 8dp6dt (8 days after my 6-day hatched embryo transfer) and two days before my scheduled blood test, I took the plunge.  PREGNANT!  I had to read the result (which says “PREGNANT”) three times before I believed it.  Yay!
BUT THEN the next day (24 hours after the test and 24 hours before my blood test) I started having very strange bleeding.  STOP READING NOW IF YOU DO NOT LIKE TMI.  I’ve had implantation bleeding before—it was like a really, really light period that just lasted half of a day.  And at least for the one kid who actually made it to the end, it was the day before my blood test confirming the pregnancy.  So the timing of this seems like it could be implantation bleeding.  But it’s not the same as last time.  It’s, frankly, gross.  Imagine a tablespoon of chocolate chips blended up into a tiny chunks slurried with someone’s snot.  That’s what it’s like.  Super dark (black/brown).  Snotty and clotty.  Seems a little gritty.  I actually had a small clot.  It lasted maybe a day and was about 2-3 tablespoons or so in volume.  But it was freakin’ gross. 
So, where does that leave us?  I guess it could be implantation bleeding.  (Especially if it stops.) The dark color suggests that it’s old blood (red is new blood).  So that’s good.  (Active miscarriages tend to be the red blood, not brown.  But the brown blood can also be a sign of an impending miscarriage or an ectopic pregnancy.  *Shudder.*)  I’ve also read that the kind of progesterone I am on—crinone (a change in protocol from my last FET cycle)—can cause some spotting/discharge.  If I hadn’t taken a pregnancy test, I would have taken it as a good sign—potential implantation bleeding.  But having had my BFP, it’s a little unnerving to see chunks.
So let’s not get too excited just yet.  I’ve been pregnant FIVE times and yet I only have one kid.  I know as much as anyone that getting pregnant is only the first step in the process.  And the miscarriage rate for frozen embryos is really high, with better quality embryos less likely to miscarry:
(Although this study is from 2006, based on data from 1997-2001, and I think freezing technology is getting better and better.)  So I just have to accept that I have a VERY good chance of miscarriage.  Whether it’s already started or whether this one is going all the way, only time will tell.

Saturday, October 18, 2014

Embryo reduction

One of the main reasons my husband and I have chosen (four times!) to do only a transfer of a single embryo is because we do not want to have twins.  And I obviously spent a significant amount of time yesterday going on and on about how risky twin pregnancies can be.  But if we ultimately do end up pregnant with twins, we would be very happy and we would make it work.
Many people undergoing fertility treatments welcome—or even want—twins.  But a very, very small number of people who use fertility treatments and get pregnant with twins choose to reduce the twin pregnancies to single pregnancies (ie. selectively abort one of the fetuses).  See a NY Times article on the subject:
I’m pro choice.  But there is something uncomfortable about going through all of this, purposefully getting pregnant, and terminating one half of a generally healthy twin pregnancy.*  Nevertheless, I can’t judge a person’s choice to reduce a twin pregnancy to a single pregnancy.  It is not the choice I think I would make for myself, but I’ve never been in that position.  And even if I were, and I made the choice to keep both (which I think I would), it’s not my job to tell other people how to live their lives. 
But for people—like us!—who do not twins, single embryo transfer is an option, and one I hope more and more potential IVF parents consider.  On that note, here’s a link to an article in support of selective single embryo transfer (from a success perspective and a financial perspective):
*I can completely understand reducing higher order pregnancies, as they are so very dangerous to the babies and mom.

Friday, October 17, 2014

Twice as nice?

As I’ve already mentioned, we decided to go with one embryo again.  It’s a very daring choice, as our embryos are all B3s and there is a less than 20% chance any individual embryo of that quality will result in a baby.  I suspect most couples would opt for two, as that increases the chance that you get a baby to about 40%.  Of course, the rate of twins with two B3s is about 15%. 
I’ve been very vocal about not wanting twins, but I would take twins over no kid at all.  On that point, there’s a nice article defending twin pregnancies from IVF:
I should also note that some women who do a single embryo transfer still manage to find themselves pregnant with twins.  And if that happens, you know it’s because the embryo split and you’re having identical twins.  OMG.
My doctor made an interesting comment that made me think about identical twins—he suggested that use of a “hatching” blastocyst is slightly more likely to result in identical twins.  Assisted hatching (using a laser to help it hatch) of day 5-6 blastys also has been associated with an increased risk of identical twins.  (I’ve read that is not necessarily true with 3 day implantations.)
For “natural” (non-IVF) identical twins, the rate is about 3/1000 births.  So 0.25-0.5%.  Pretty rare.  IVF increases the risk (or incidence, if we’re not being all anti-twin) of identical twins.  Specifically, I have seen suggestions that identical twins in IVF births are about 2%.
Identical twins do not “run in families” like fraternal twins do.  (I.e. there is no genetic component to egg splitting as opposed to producing extra eggs.)  There is an association with older mothers—the older the mom, the more likely there is to be egg splitting and thus identical twins.  The theory is that an older mom’s shell that the blasty hatches from is harder, making the inner mass break into clumps.  Poor older moms!  So maybe the increased identical twin risk in IVF relates to the population doing it (old moms) and maybe there really is something to the process of IVF (I’ve read articles that seem to think the latter is true).
Interestingly, the split can occur anytime in the early part of the process.  An “early” split (like before day 4) usually forms identical twins that will not share a placenta.  (That is good.  More on that later.)  Most twins split around day 4 or 5.  Interestingly, twins formed during this time can be “mirror images” of each other.  (So one has a mole on her right cheek, the other has the same mole in the same place on the left cheek.)  Twins that split later—days 9/10—mean that they will probably share the same sac.  (No good.)  That only happens about 1% of the time.  Even later splits (days 13-15) mean the twins might be conjoined.  Very rare, also no good.  [Fyi, I got all of my information from Wikipedia, so please feel free to give it as much weight as you feel is appropriate.]
Some thoughts on twins….  Okay, obviously many people (like us) who do IVF and opt for a single embryo transfer do it because we do not want twins.  I know what you’re saying, “twice as nice!”  Yes, but there are a lot of risks with twin births.  They are harder on mom.  Much harder on mom.  Mom gains a lot more weight, and is at greater risk for a host of health issues such as pre-eclampsia (30% in twin pregnancy, 2-10% in singleton pregnancy), gestational diabetes (12% versus 4%), and Caesarean-section.  They are also much harder on the babies.  Twins are usually not full term, tend to have a lower birth weight, often spend time in the NICU, and are at risk for more health issues such as cerebral palsy (affects 4-6 times as many twins compared to singletons).  And I cannot even imagine the terror of twin newborns, toddlers, teenagers, etc.  The horror, the horror.
And things only get worse with identical twins.  Not only are there the same risks with identical twins as there are with fraternal twins, but there are even more potential problems!  Identical twins that do not share the same placenta (early splitters) are just like fraternal twins.  That’s the safest kind.  But once they start sharing the placenta, there’s the risk of sharing blood, and that is dangerous and can lead to death.  Things only get worse if they share a sac, as their cords can get entangled, etc.
Links to articles about identical twin risks from IVF and dangers of those pregnancies:

Thursday, October 16, 2014

Time for sexy time?

So, as you know, once you go down the IVF path, sex no longer has any procreative value…. Or does it?  At least one study has suggested that semen can significantly promote embryo development and implantation:

“Intercourse during an IVF cycle has the potential to improve pregnancy rates since exposure to semen is reported to promote embryo development and implantation in animals. Conversely, coitus-induced uterine contractions or introduction of infection may have a detrimental effect.”

So have sex, just don’t like it, especially after your procedure.

IF we do this again, I’m going to make it a priority to have sex before the transfer….  Which is actually a bigger chore than it sounds because the gross progesterone suppositories start before transfer.  There is NOTHING is sexier than white, creamy, hormones coming out of your va-jay-jay, amIright ladies?

Wednesday, October 15, 2014

Mo’ aging, mo’ problems

Obviously I’m disappointed that our two B3s from our first round (when I was 32) did not survive.  (Have I mentioned that there was a lab issue that resulted in the frozen ones from our last cycle being ruined?)  So we’re doing a frozen cycle with our 35-year old guys.  Boooooo.  The rates of down syndrome DOUBLE from a 32 year old to a 35 year old mom.  There is nothing good about getting old when it comes to fertility.  Really, old hags like me should be shitting themselves when considering fertility statistics (handily collected for us from labs around the country):

Check out the national averages.  Okay, they’re not too bad for 36 year olds….  At the clinic we are using, about 40% of the women my age get pregnant and take home at least one kid, at least in any individual frozen or fresh cycle.  Not great, but not the kiss of death either.

At what I have read is one of the best lab/Dr. offices in the country, they have CRAZY good odds:

(Of course some offices patient shop or report numbers in a certain way, so they specifically warn you to take these with a grain of salt.  Still, SUPER interesting.)  Note that they are doing WAY more frozen cycles than fresh.  I bet they do pre-genetic testing on a lot of those.  But those stats! 43% of women over 42 doing a frozen cycle had a kid!  That’s insane!  (Of course these are women who managed to do a fresh cycle, have at least something reach blastocyst, presumably have those blastocysts tested and pass, and then have whatever they froze survive the thaw.  So those embryos went through the gauntlet.  I’m also going to guess that a fair number of those were frozen before the mom was 42.  But still, that’s amazing!)

What am I worried about?!  I’m a spring chicken.

Tuesday, October 14, 2014

Freezer burn

As I mentioned earlier, at my lab about 85% of the blastocysts that are frozen (they only freeze blastocysts) survive the thaw.  That’s pretty good.  Interestingly, they suggested that the blastys that survive the thaw have better odds than the fresh of the same rating, probably because the freezing process weeds out more of the weak ones. 

Unfortunately, the miscarriage rate tends to increase with the frozen embryos.

Monday, October 13, 2014

Many beautiful children have been born from ugly embryos

I’m a curious person.  (Can you tell?)  So I called the embryologist today to ask some questions about my recently transferred B3.  She confirmed what I thought I heard while relaxing on Vicodin—the “hatching” B3 was actually a “hatched” B3.  In other words, it had completely escaped from its zona pellucida and was ready to implant.  The embryologist confirmed that it would have likely implanted the day of my transfer, if it was going to happen. 
I asked her opinion of how often they see a “hatched” blastocyst.  She said maybe 1/50.  (So like I was told on transfer day, rare but not super rare.)  She also told me that if it was hatched when it was thawed, then it had frozen hatched.  I asked what she thought about that—i.e., was it better or worse to freeze it after it hatched.  She said it was rare enough that she had no idea, but if it thawed and survived, it’s probably fine.  I pressed for her opinion of whether it was more likely to be successful because it completely hatched, but she had no opinion.  She did tell me that they re-rated it after it thawed, and it was still a B3.  I pressed her—was it rough looking?—but her patience with me was waning, so all I got was, it had a lot of fragmentation (unclean division of the cells, not good), so it was a B3.  Here are some random links to info about rating blastocysts:
I tell you what, I’m looking at his/her picture right now, and he/she looks pretty darn good.  Round little ball with some small masses (cells?) around the edges and a very loose clump on the right side.  Not like the sad smashed butterfly we used last time!  Of course, it looks like a bit chaotic in there, hence the B3 rating.  (I think the more orderly things look, the higher the rating.)
Anyway, I’m taking the fact that it completely hatched as a good sign.  Every step further along the path is a good one!  And science is on my side! 
The authors of the linked article claim, “This is the first ever study involving exclusive transfer of spontaneously hatching/hatched blastocyst/s. Our results demonstrate that SHBT [spontaneously hatching/hatched blastocyst transfer] gives a distinct and significantly higher clinical pregnancy, embryo implantation, and live birth rate compared with EBT [expanded blastocyst transfer].”  Of course they found the pregnancy rates to be especially striking with the highest quality blastocysts.  (They called it “An extremely strong correlation of IR [implantation rate] with top-quality blastocysts in SHBT [spontaneously hatching/hatched blastocyst transfer] group….”)  So not super helpful to me.  Another interesting finding is that slightly higher than ¼ of day 5 blastocysts hatch on day 6.  The authors speculate that the blastocysts that fail to hatch by day 6 may also fail to hatch if implanted, which is obviously incompatible with pregnancy.
So, where does this leave us?  Who the hell knows?  I have some positive symptoms.  Namely really sore boobs.  Of course sore boobs are caused by elevated estrogen levels, which I am taking in pill form three times a day.  So it’s hard to read too much into that.  (Another reason IVF is a bitch—the drugs you take can make you feel pregnant even if you’re not.) 
What I WILL get excited about is implantation bleeding.  Sweet, sweet implantation bleeding.  Interestingly, there’s an implantation bleeding prediction calculator:
(What will they think of next?)  It says my most likely day for implantation bleeding is today.  Hmm….  Cross your fingers!

Sunday, October 12, 2014

Transfer day info

Our second B3 thawed successfully and was used on transfer day. It was the hatching blastocyst that I always thought (based on my extensive medical knowledge of embryology... Not...) should have been used. I was not quite lucid due to the Valium (which I thought was to help me relax--nope! To help my uterus relax!) so I can't recall if they said it was hatching or hatched. (Hatched would be very rare--the nurse said maybe 1% of their transfers are hatched embryos.) But it was at least hatching--beyond the "assisted hatching" they do--and I was told that was a good sign. Someone spitballed a 50% success rate based on that fact alone, and she thought it might even implant that day! Safe travels hatching B3.

We still have one more (the crappy one!) frozen. Sleep well crappy.

Saturday, October 11, 2014

Third time's the charm?

Okay, we're back on this crazy ride again! My husband and I have started having the "how much longer are we going to do this?" talk, but I'm hopeful we never have to resolve it. I'm feeling good about this one!! And so we begin yet another round of the two week wait....