Predictions

Okay, my blood test is tomorrow—16dpo.  (It should have been 14dpo—2 days ago—but no blood testing at my clinic on the weekend.)  I know I had enough HCG in my blood test to get a positive pregnancy result on a pregnancy test 13dpo.  But, that’s just the first of many steps.  I’ve had enough HCG in my blood to have a positive pregnancy result at least six times—my ectopic pregnancy, my first (pre-IVF) miscarriage, my son, my blighted ovum, my post-IVF miscarriage (chemical pregnancy), and my anencephaly pregnancy.  And only one of those resulted in a healthy child.  Sooooo, yea, getting a positive pregnancy test is just the first step for me.

NOW, if I get a good HCG number tomorrow, we’re on to something.  I’ve only had 2-3 strong HCG numbers—my son, my blighted ovum (and it was not that strong of a number), and my anencephaly pregnancy.  My pregnancy losses have tended to be very early, with low HCG numbers, so if we pass THAT hurdle we’ll be cooking.  I already have in my mind a number I’d like to see (my son was 480 on 16dpo—I’d be THRILLED to see that number), although because I had a slow-developing frozen embryo I recognize that its numbers could be a little lower and it could still be viable.  

I know I did not have measureable HCG in my urine on 11dpo… or do I?  I’ve proven I’m incapable of following the directions for HPTs.  After my 13dpo debacle, I fished the 11dpo pregnancy test out of the garbage.  There were two lines.  (The second one was faint, but there.)  Since you’re not supposed to read the results after 10 minutes…. I suspect that means you’re REALLY not supposed to read the lines after 5 days.  So who knows.  (I’ve read that “Some kits improve in detection when read after a wait of 10 minutes, but waiting longer than that may produce a negative result that looks faintly, misleadingly positive” http://www.cbsnews.com/news/the-best-pregnancy-tests/)

I still don’t FEEL pregnant, regardless of whether I have some measurable amount of HCG.  (Still no sore boobs, dammit!)  But, on the evening of 13dpo, I did have some spotting.  At first I freaked out until I remembered—implantation bleeding!  So that was a good sign.  

A friend said something very kind recently.  After I told her that my doc thinks we produce a large number of genetically abnormal (though chromosomally normal) embryos, she suggested that meant that my lower quality embryos might have the same chance of success as my better quality ones.  That was a good point.  And, indeed, now it appears that my lower quality one is doing better than the better quality ones.  (Although maybe that’s because of my thicker lining or Medrol?)  BUT, I have to keep reminding myself, if it’s true that we produce a large number of genetically abnormal embryos, the fact that we have a chromosomally normal embryo that is implanting does not insulate us from failure.  In other words, I might still be fucked.

Anyway, what are my predictions?  It’s VERY hard to be optimistic in this situation, but the fact that I have gotten a positive HPT result and had some implantation bleeding is encouraging.  Right now I give this a 50/50 shot at best.  If I get a good number tomorrow… well depending on how good… I’ll revise my prediction.  If I get a bad number, well, depending on how bad that might answer the question.

There IS a silver lining, whether this fails or succeeds.  I was fretting last week that maybe something happened to the frozen embryos and that it was a lab issue—what are the chances that I would have so many failures??  But now that this seems to be at least progressing a little bit, it’s hard to believe it’s been caused by my lab.  It’s just my shit embryos.  I won’t have to look back and worry that I should have done something else.

The steroid of choice: methylprednisolone

Did I mention that (for the first time) I am on a steroid this time around?  After our conversation about “Hail Mary” protocols, my doctor agreed to use a steroid.  Initially he wanted to proscribe dexamethasone, but I’d read a lot more good things about prednisone. 

http://3yearwait.blogspot.com/2015/10/switching-horse-mid-race.html

http://3yearwait.blogspot.com/2015/10/cheating-on-my-fertility-doctor.html

http://3yearwait.blogspot.com/2016/01/the-other-corticosteroid-dexamethasone.html

http://3yearwait.blogspot.com/2016/02/its-not-meits-you-embryos.html

We split the difference (?) and went with methylprednisolone (Medrol).  I’m on a 16mg oral tablet once a day at night, right before bed.  I started on day 10 of my cycle (so before my transfer) and will be on it… well, we’ll see.  If this does not work I’ll go off of it right away.  Otherwise I think he was thinking I’d be on it sometime through the first trimester.

Via blogs, I’ve read about a lot of IVF clinics putting patients on Medtrol around their transfer, especially in situations where the patients used ICSI/assisted hatching.  It seems that many patients only go on it for a handful of days before transfer. 

The side effects sound similar to other corticosteroids, although I’ve read some may be more minor.  A friend who was on a similar dosage (during her egg retrieval) said she had insomnia, so started taking it during the day.  I have not had any problems falling asleep, but I have been waking up a little early recently…. Maybe just a coincidence. 

Other than it’s a corticosteroid (like prednisone/prednisolone/dexamethasone), I don’t know much about methylprednisolone.  I just don’t have the energy to read about methylprednisolone versus prednisone (or prednisolone) versus dexamethasone right now.  If this does not work, I’ll look into it some more.

In which a husband tells his wife she's pregnant

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. 

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:

http://nccd.cdc.gov/DRH_ART/Apps/NationalSummaryReport.aspx

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.  

http://fertilitylabinsider.com/2010/09/common-practices-of-the-best-ivf-programs/ 

From what I know, my lab does almost all of these things.  

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:

http://3yearwait.blogspot.com/2015/11/beta-hcg-measurements-part-ii.html

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.)

http://3yearwait.blogspot.com/2015/10/to-pee-on-hpt-or-not-to-pee-that-is.html

I found an interesting article on the question of when to test…. 

http://www.ivfconnections.com/forums/content.php/673-The-IVF-Two-Week-Wait-%282WW%29-If-and-When-to-Do-a-Home-Pregnancy-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.

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. 

(http://3yearwait.blogspot.com/2014/08/my-snow-babies.html)

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):

http://humrep.oxfordjournals.org/content/early/2010/06/11/humrep.deq143.full

“[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:

http://link.springer.com/article/10.1111%2Fj.1447-0578.2008.00203.x

However, the fresh results are not the same:

http://www.ncbi.nlm.nih.gov/pubmed/11384637

“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?):

http://fertstertforum.com/kovalevskyg-blastocyst-frozen-embryo-transfer/

“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.

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.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150206/

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:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130929/

And here’s another article noting the same thing:

https://www.theguardian.com/science/2015/mar/30/female-embryos-more-likely-to-die-in-pregnancy-than-males-study-claims

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).