There was a story--maybe a year ago?--where a husband allegedly put a pregnancy test in the toilet and was the one who broke the news to his wife that they were pregnant.
What a bunch of hippy dippy baloney. (I won't post a link to the story because I'm sure it's fake and also the people seem horrible.)
But I can imagine a scenario where a husband tells his wife she's pregnant. Maybe it's a situation where they've been trying to get pregnant for years. Maybe after 6 (or 5, depending on how you count) failed IVF attempts, she's not feeling very optimistic. Maybe this was the worst embryo they've ever used (or tied for last). Maybe she has no symptoms--no sore boobs, no implantation bleeding, absolutely nothing. Maybe she took an early pregnancy test and it was negative. Maybe she cried all day for two days and called her clinic to see if she could come in early just to get the inevitable bad news. (They probably said no.) Maybe she took one last pregnancy test the day before her missed period, just to be sure. Maybe she read it after two minutes and got back into bed, dejected. Only one line, as expected. Maybe when her husband went to brush his teeth half an hour later, the test was still on the floor, but this time there were two lines instead of one. Maybe he walked back into their room, holding the test, confused. Maybe she told him tests were not accurate after ten minutes... But decided to take a second test and wait the full three minutes like the instructions say, this time. Maybe after three minutes there were two lines--the second one was faint, but it was there. Maybe she knows that a measurable amount of HCG the day before her missed period is in no way a guarantee of a viable pregnancy, but she's excited that there's still a chance.
I could imagine that kind of a scenario, in which a husband tells his wife she's pregnant.
Friday, February 26, 2016
Thursday, February 25, 2016
Do you (I) have a good fertility clinic?
It can be hard to know if you have a good fertility clinic. So, where does one begin if they want to figure that out?
Take a look at this chart showing the national averages:
If your clinic has stats below the national averages (check here: http://www.sart.org/Find_A_Clinic/), find a new clinic.
(My clinic has stats that are way above the national average, and I still have some regret that we did not just pull the trigger and go to CCRM.)
Also, here’s some guidance on what the “best” labs do.
From what I know, my lab does almost all of these things.
Wednesday, February 24, 2016
When to take a home pregnancy test
For most of my cycles, I’ve “cheated” and taken home pregnancy tests. They’ve always been accurate.
The first question is whether it matters—the fact that you have HCG is less important than what the number is and whether it’s doubling. (Which is why fertility clinics want clients to wait for the blood tests.) But assuming you just want to know something as early as possible, well, you can use home pregnancy tests.
As I’ve written in the past, HCG rises during the pregnancy, but people can definitely have different measurements and still have successful pregnancies:
An embryo that implants later would be expected to have lower HCG than one that implanted earlier, and twins have higher HCG than singletons. Also, not all pregnancy tests are created equally. (I like the Clearblue Easy Earliest Result Pregnancy Test and First Response Early Result Pregnancy Test, both of which allegedly measure at 25 mIU/ml.)
I found an interesting article on the question of when to test….
So here are my thoughts on HPT testing:
Cycle day
|
Event / Thoughts on HPT
|
12
|
HCG trigger (for fresh cycle)
|
13
| |
14
|
Retrieval (“ovulation”)
|
15 (1dpo)
| |
16 (2dpo)
| |
17 (3dpo)
|
3-day transfer
|
18 (4dpo)
| |
19 (5dpo)
|
5-day transfer
(embryo could start to implant today)
|
20 (1dp5dt)
(6dpo)
|
(embryo could implant today)
|
21 (2dp5dt)
(7dpo)
|
(embryo could implant today)
|
22 (3dp5dt)
(8dpo)
|
Some women allegedly get a positive HPT on this day (early implantation, twins?)
|
23 (4dp5dt)
(9dpo)
|
The earliest high quality home pregnancy tests claim to start to be accurate (“5 days before missed period”)
|
24 (5dp5dt)
(10dpo)
| |
25 (6dp5dt)
(11dpo)
|
Generally the first day I would feel comfortable testing to get a reliable result
|
26 (7dp5dt)
(12dpo)
|
Would expect a sensitive HPT to work for most viable pregnancies
|
27 (8dp5dt)
(13dpo)
| |
28 (9dp5dt)
(14dpo)
|
Official blood test at doc’s office (“missed period”)
|
I guess this would be a good time to mention that I took a home pregnancy test this morning and it was negative.
Tuesday, February 23, 2016
Day 5 versus day 6 blastocysts
My doctor’s office has suggested it sees similar success rates with frozen day 5 and day 6 embryos, so I never really worried about the fact that many of our embryos were day 6.
I’m reconsidering. I have used three day 5 embryos. They have all “worked.” (My son, blighted ovum at 6 weeks, and anencephaly pregnancy.) Of course they were also B2s, so good quality. And they were also all fresh. So they were the best of the bunch—they should have been the best ones. I’ve also used four day 6 embryos. None of them have worked. (Chemical pregnancy, no pregnancy, and my last two with HCG of 2 and 1.) Of course 3 of the 4 were poor quality B3s. And all were frozen.
I mean, it makes sense that the more advanced the embryo, the more likely it is to work. Fully hatched > hatching > nothing. No surprise that the fastest embryo out of the gate is the most likely to work.
This article suggests that similarly developed frozen day 5 versus day 6 embryos have similar success rates (like my clinic suggests):
“[A]nalysis of those studies where the Day 5 and Day 6 blastocysts had the same morphological quality at the time of freezing showed no difference in clinical pregnancy and ongoing pregnancy/live birth rates.”
This article agrees:
However, the fresh results are not the same:
“Embryos that develop to the expanded blastocyst stage and are transferred on day 5 after retrieval are approximately twice as likely to implant compared to those for which expansion and transfer are delayed until day 6.”
Although, interestingly, day 5 embryos are more likely to survive the thaw than day 6 (maybe because they tend to be higher quality?):
“A total of 1,406 embryos were thawed with a survival of 90.7% for day 5, 83.7% for day 6, and 78.7% for day 7. Implantation rates were 43.3%, 28.9%, and 28.9%, respectively. Ongoing PRs were 43.9%, 32.9%, and 26.7%, respectively.”
This article makes no distinction between quality. I’m guessing that the day 5 embryos tended to be better quality than the day 6s (as has been our experience).
So I guess I should not fret over the day 5 v. day 6 issue… and just continue fretting over their poor quality.
Monday, February 22, 2016
Miscarriages... More likely with girls?
I can’t help but observe that I know the gender of 5 of my pregnancies. My son and the last four transfers we have done, which are all girls.
And only the boy made it. (So far, we’re still waiting on the last girl.)
I’ve been wondering—is that a sign? Am I not meant to be the mom of a daughter? Or is it possible there’s an unknown reason—like something genetic related only to girls? Or is it just dumb luck?
Maybe it’s because females are more likely to miscarry.
This article suggests that for women with recurrent miscarriages, 64% of the embryos were female:
“In total, 313 specimens were successfully karyotyped, with a median gestational age of 10 weeks at miscarriage (interquartile range 8–13); 199 (64%) were females and 114 (36%) were males. In total, 121 (39%) had abnormal karyotypes, the most prevalent of which were chromosome 21 and 16 trisomies, triploidy, and monosomy X.”
Because the minority of the miscarriages were related to chromosomal abnormalities… something else was going on. This article suggests that “In our opinion, during the first trimester of pregnancy, miscarried female POC may be partially due to imprinted paternal genes.”
I’m sorry—what now?
I had to go to Wikipedia. (https://en.wikipedia.org/wiki/Genomic_imprinting) It’s complicated, but from what I can gather from the article, some women’s bodies may just prefer male embryos. (We’ve all known that couple that decided for a third… or fourth… because they wanted a daughter, only to end up with yet another boy.)
This article also recognizes the fact that miscarriages are more likely to be female:
And here’s another article noting the same thing:
It suggests, “Female embryos could be at greater risk due to the way X chromosomes are inactivated in cells, scientists said. Females have two X chromosomes, but one is randomly switched off in each cell, leaving just one with active genes. However, sometimes this process becomes unbalanced and one X chromosome begins to dominate all the body’s cells. If there are genetic flaws on the dominant chromosome, it can lead to fatal health problems.”
Maybe my uterus wants boys. We’ll see if this girl makes it (I’m not feeling optimistic).
Sunday, February 21, 2016
Bootie shots
As I mentioned, we decided to change things up last time and use progesterone shots.
Boy, those suck.
My strategy (heat the butt, heat the oil-filled needle, ice the butt, change the needle, do the shot, rub the butt, heat the butt) generally worked. I had no knots, little bruising, and just some pain. EXCEPT ONE TIME. I think we got the shot just out of the perfect zone and got too close to a nerve. That spot hurt for MONTHS. It’s getting better every day, but it’s STILL SORE. Especially when I would exercise, it would just HURT. Yuck.
We’re doing the butt shots again this time. Same protocol as before, but we’re trying to be really careful with the placement of the shots. Interestingly, the needle gauge is smaller this round than my prior round. And yet, it hurts WORSE this time. The shot doesn’t hurt, but because the needle is so small it takes like 2 minutes to empty the syringe. And it’s two minutes of PAIN. Double yuck.
I feel bad for my poor husband too. As he confessed the other night, “I really hate this.” Me too, buddy.
Saturday, February 20, 2016
Choosing how many to implant
I’ve been pretty consistent with the opinion that we do not want twins / the health risks that accompany them, and for that reason we’ve done EIGHT single embryo transfers.
Studies suggest that, obviously, putting in more embryos increases the chance of success in any single cycle, but it also dramatically increases the risk of twins. On the other hand, if you are willing to serially implant embryos (ie. two single embryo transfers back-to-back), you end up with the same overall pregnancy rates, albeit with more cycles:
So that’s what we’ve been doing. I’m not going to lie, embryo transfers are a major, major drag, emotionally and physically. (And for people who don’t enjoy burning money like we obviously do, they’re expensive too!) So doubling the number of transfers one has to do… well, it’s not for the faint of heart. But, and I still believe this, it would be my biggest regret if we put two embryos in and then ended up with twins and something terrible happened to either me or the babies. Which is why, as much as I HATE this process, we continue down the SET road.
Everyone (my doc, the docs we talked to at CCRM, and my acupuncturist) agreed that twin pregnancies are not desirable, and too risky with chromosomally normal embryos. But, after six failed single embryo transfers in the past two years (or five, if we do not want to count the anencephaly one against us), it can be tempting just to say “fuck it, put two in!” I told my husband, I am CERTAIN that we are the only people in the world who would have six (or five, depending on how we want to count) failed SETs in a row and choose another SET for our seventh cycle. His response: “we don’t want twins.” I like his optimism!
So we stayed the course and implanted only one embryo—a bedraggled looking one, which looked particularly rough when I compared it to pictures of its smooth and hatching (or hatched!) failed siblings. I don’t think it was the ugliest embryo we ever used (there was a rough untested one in 2014…) but it’s definitely less cute than the other seven we’ve used.
If this one makes it, it will be like the ugly duckling turning into a swan.
I’ll admit that less than 12 hours after our transfer I started having regrets about choosing another SET. (Hell, when I looked at how rough the embryo looked before our transfer I started having regrets!) But if this one does not work, we’re going to thaw our last two embryos together. Chances are the chromosomally untested one—which we were told was a very early and rough looking blastocyst when it was frozen—will probably not survive the thaw or work. Even if it does, after as many failed cycles as we’ve had, many with chromosomally normal embryos, I think our chances of twins are approaching zero. (Famous last words?)
So, let’s hope this one works. Otherwise, for our last cycle we’re doing what most people would have done long ago… rolling the dice on two embryos.
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