Blighted ovum

I'm ready to talk about it. A blighted ovum. I'd never even heard of that before last week, and yet it's the most common cause (~50%) of first trimester miscarriages. Apparently the sac continues to develop, so your body thinks you are pregnant. But the baby stops developing. So really you're not. :(

Anyway, at my checkup last week there was no heartbeat, and no evidence of a fetus. Just an empty sac. A blighted ovum. A fetus that, most likely, had genetic issues and ceased developing a while ago.

It was a surprise. I'd passed the big hurdle--I'd managed to get pregnant. I never thought I would fail the smaller hurdle of staying pregnant... Especially because I FELT pregnant the whole time.

But I wasn't. My body just did not realize. I stopped my meds (progesterone, estrogen) and waited for my body to figure it out.

From what I read, I was pretty scared about the miscarriage process. It can happen at any time. Some women have said it is very painful. And it can involve copious amounts of blood. Or nothing at all, requiring a D&C. Yuck.

In this regard, I was lucky. No heartbeat / off meds Tuesday. Very light spotting Friday and Saturday.  Heavy, heavy period-like bleeding (very, very heavy) Sunday and Monday. Tapering off today. No cramping.

I'm not allowed to try to get pregnant for at least a full cycle, so I'm going to try to regroup over the summer and figure out a new plan this fall. We will probably try to use our frozen ones next.

While blighted ovums ar common, apparently they are not necessarily things that reoccur--most women who have one only have one. Of course, they are more common with older moms-to-be, and I am now an older mom. (35, soon to be 36!)

It feels a little unfair that I started trying to get pregnant when I was in my late 20s, and have been pregnant (at least) 5 times, and somehow only have one child.

And yet, I feel so incredibly lucky to have that one wonderful kid. I would love to have another, but it'd I can't it will be okay. He's more than enough.

No heartbeat

There's nothing else to say, right?

Feelin fine

Things are still going well. Beta is 453. (It was 112 14 DPO [days post ovulation] and 453 18 DPO. They want to see it double in 72 hours. Of course I did not have a 72 hr blood draw (stupid Sunday), but it is clearly going up at least as much as it should.

Side note, this is an interesting website that collects self-reported beta measurements. Like anything self reported, take it with a grain of salt. (It says my betas are slightly lower than average. Boo!)

http://www.betabase.info/chart/basic/single

One hurdle... Hurdled....

Well, my pessimism was misplaced. Yesterday I read that not any individual pregnancy is the same, and that starts with implantation bleeding. In other words, some ladies have it with one but not another.

Then last night my acupuncturist asked if I "cheated" with a home pregnancy test. I said, no, should I?! So of course I went home and cheated--positive!

Test this AM confirmed it. Beta 112. Going back for a second test next week.

Wish me luck!!!

Countdown

One day left until pregnancy test.

I hate to say it, but I don't think this one worked. :( I'm not trying to be pessimistic--I understand how important optimism is through this whole process. I also remember last time I didn't think it worked... Right away....  But a day before the test, I had spotting. In fact, I've had spotting every single time I've been pregnant--ectopic, miscarriages, and the last time I did IVF.

I have not had any spotting this time.

I do have slightly sore boobs, which I would take as a good sign, but they've been sore since the transfer. So I can't do much with that. Actually, I had very different side effects this time. No real lupron headaches, and no acne until recently. I had horrible cramps after retrieval. Last time (especially because of OHSS) I took it easy. This time I was working really hard, getting our house ready to sell, packing, and chasing a toddler. I doubt all the activity helped.

I'm preparing myself that it's not going to work. If it doesn't, we'll try again. We do have a bunch of B3s on ice....

Get out your calculator--it's time for fun with numbers!

I asked my fertility clinic for their implantation data, just to get a sense of what we would do if this time doesn’t work and we end up trying again with one of our B3s…  It was really interesting.  (Ask your clinic for their stats!)

As expected, for a single egg transfer, B1 has the highest implantation success rate—about 70%.  B2s are less successful—around 50%.  B3s really drop off—less than 20%.  They also rate the morulas.  For a single embryo transfer, M2s have about a 30% chance, and M3s have about a 20% chance.  (They don’t rate M1s—probably if you’re perfect, you make it to a blastocyst!) 

They also rate success of two-embryo transfer, depending on the exact quality of the two embryos.  For example, the rates of implantation for TWO B1s is also about 70% (actually a hair lower than the implantation rate for a single B1).  BUT the chance is 50% that the resulting implantation is twins.  In other words, if you implant two B1s, you have about a 1/3 chance of no implantation, 1/3 chance of 1 embryo implanting, and 1/3 chance of two embryos implanting.  BUT, if you just implant a single B1, you have the same chance of implantation (about 2/3) but no risk of fraternal twins. 

The stats are similar when “lesser quality” embryos are implanted along with a B1.  The chance of implantation does not increase significantly if you move from one B1 to a B1+B2/B3/M2/M3, but the chance of twins rises dramatically.  So if you’re lucky enough to have a B1, it seems like you should just implant the B1.  Implanting a second embryo does not appear to make pregnancy more likely, but it dramatically increases the incidence of twins.

Things do get a little dicier for people (most of us!) who don’t have a B1 to choose from.  For people with two B2s (still a good result!), if both are implanted the implantation rate rises from 50% to almost 70%.  BUT the chance of twins also rises dramatically—from almost zero (only identical twins) to about 1/3.  In other words, if you implant two B2s, just like the B1s you have about a 1/3 chance of no implantation, 1/3 chance of 1 embryo implanting, and 1/3 chance of two embryos implanting.  Not that we had two B2s to choose from, but if we did we still would have only implanted one—the risk of success with a single B2 is good enough (50%) and the risk of twins implanting from two (30%) is too high considering the implantation rate only rises from 50% to 70%.

Where I think the decision gets really hard is if you don’t have a B1 or B2, or even a blastocyst at all.  Like I said, with a single B3 your odds are only around 20%.  (And some of these are very small sample sizes—so take these numbers with a grain of salt.)  But if you implant two B3s, your chance of implantation rises to 50%, and of that 50% the risk of twins is about 1/3.  In other words, if you implant two B2s, you have a ½ chance of no implantation, a 1/3 chance of implantation of 1 embryo, and about a 15% chance of twins.  Those numbers start to look like odds I would take—that is, the risk of twins with a double implant (15%) does not outweigh the risk of not getting pregnant with a single implant (20% success rate).  The rates of success with a B3+morula are similar to the rates of success for B3+B3.  So again, if I had a B3 and anything, I’d seriously consider adding the other one as well.

Another thing I found interesting—my lab did not break this data out, but I was able to calculate it—the percent of each kind (B1, B2, B3, M2, M3) they use in their transfers.  About 10% of the embryos transferred are B1, about 50% are B2, and the remaining are split pretty evenly between B3, M2, and M3 (about 15% each).  Obviously the ones they use are, on average, better than what they retrieve.  I.e. I got a B2, which I used, and three B3s, which I may or may not use.  So on average women are not obtaining 10% B1s, they’re just picking their best ones.  Like I mentioned, the lab told me about 5% of what they retrieve is a B1, so it’s still pretty rare.  But because people tend to USE the best embryo they have, 10% of the embryos transferred are B1s, and because people often transfer more than 1 embryo, about 15% of transfers involve at least a B1.

These are just averages observed based on a relatively small group, and not all factors can or have been taken into consideration.  (Also, I don’t know if these include frozen transfers or if they are just fresh transfers.)  As an example, I am sure very few women would choose to only implant a B3 if they had another B3 or morula to choose from.  So it’s likely that many of the women implanting a single B3 were doing it because that’s all they had, not because it was choice.  And if you do IVF and end up with only a single B3, that might suggest there are other issues (less quality egg/sperm) making that B3 less likely to survive.  Compare the woman who has only a B3 to choose from to the woman who has several B3s.  You’d think even if they both implanted a single B3, the woman who had more B3s might have a better chance of success.  But in the real world, the multiple B3 lady probably implanted two B3s, so the multiple B3 numbers look even better when compared to the single B3 numbers….  Does any of this make sense??

Also keep in mind that these are just implantation rates—not pregnancy rates.  There’s still about a 10-15% risk of miscarriage even after implantation, similar to the rate of miscarriage after a normal pregnancy.

Wow, this is a lot of math!  Does anyone else’s head hurt??  I know this is a lot of math to follow without actually seeing the numbers.  But if you’re thinking about how many embryos you might want to transfer, take a look at your clinic’s numbers and figure out what makes sense for you.

Ice Ice Baby

The day after our transfer (day 6) we got a call that three more of our embryos reached the blastocyst stage. (So two more pooped out.) They were all B3, which means not great quality.

Oh well. 

We decided to freeze all 3. When I asked, I was told a majority (2 out of 3) would probably survive the thaw, should we need to use them. When I asked if the success rates were lower with frozen than fresh, the tech told me actually they are higher--probably because the ones that thaw are so much hardier. 

Good to know.