IVF#2: Embryo Development Day 3

So last year, we had 14 fertilized embryos on day 1, 11 of which survived to day 3.

Today, I got an update that all of our embryos are at the appropriate 6-8 cell stage, with one embryo having 10 cells already. Normal for day three is anywhere from 4-10 cells, ideally 8 cells by the end of the day, so we’re good there.

Now, of the entire batch of embryos:
6 are grade 2 (good quality, minimal fragmentation)
5 are grade 3 (average quality, moderate fragmentation)
2 are grade 3-4 (poor quality, a lot of fragmentation)

Judging by the total count of embryos here (13), I’m guessing that the single slow grower from yesterday caught up to the group.

The grading made me a bit nervous though, as I wonder why I don’t have any perfect grade 1 embryos. Is the grade 1 embryo just super rare? Is my egg quality not great, or is the grade 1 embryo a mythical creature like the unicorn?

Everything that I have read says that both the grade 2 and 3 embryos have good implantation potential. And a greater indicator of making it to the blastocyst stage is the embryo making the expected number of cells for its developmental day.

OHSS Watch:

Weight: down 1 pound
Umbilicus circumference: down 1 cm

I got out of bed today, and had minimal problems dressing myself (yesterday, DW had to help me put on my pants and socks- which was actually quite enjoyable). Peeing and pooping still hurt, but changing positions is accompanied by only mild pain now. My ovaries are still sore on palpation, but more like a sore muscle than active inflammation. The bloating is still there, much worse at night, but sleeping and peeing lots overnight seems to bring me back to a less bloated baseline.

DW and I started watching this show called “Transparent”, which has been really fantastic. It’s about a Jewish Patriarch who comes out as transgender to her family of quirky adult children. It’s got this really interesting tone to it. A humorous backdrop, with really deeply somber and tender moments. I’m loving it, and have to try hard to savour each episode rather than binge watch it.

Tonight though, is the Bachelor, and while I object to the whole premise of the show, I can’t seem to look away. Why is there always so much crying?

PS- embryo transfer is happening in T-minus 48 hours!!

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To ICSI or Not to ICSI?

During IVF#1, we went in blind, not knowing what the outcome would be for fertilization. The embryologist recommended we fertilize 2/3 of our eggs using ICSI and 1/3 via conventional IVF.

For those of you who aren’t familiar with these terms, conventional IVF is when they place the eggs and sperm together in the Petri dish and let fertilization happen on its own.
This allows the stronger sperm to fertilize, and the normal eggs to be fertilized.

ICSI, which stands for intracytoplasmic sperm injection is when the embryologist selects which sperm he/she deems to be the “the best”, and then manually injects that single sperm into the egg to fertilize it. There is a different kind of selection here, as it is based purely on the embryologist’s observations of morphology and motility. Less natural selection here, as the race to the egg and process of penetrating the zona pellucida (shell of the egg) is bypassed. Potentially, crappy sperm and crappy egg can fertilize and be fertilized by ICSI, however, if you suffer from fertilization failure (hard to penetrate eggs or sperm that can’t dissolve the shell) ICSI can make a positive difference.

These were our results from last year’s IVF:

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Now, the grades of these embryos were all very good, except for one which was fair. The “best looking” embryos were ICSI fertilized. We don’t know which ones were chromosomally normal, but know that the pregnancy (and subsequent miscarriage) in July/August/September was of a chromosomally normal female embryo.

Since egg retrieval is coming up next week, we have to decide how we want to fertilize our eggs. I want last year’s IVF to be a learning opportunity. The embryologist thinks we could do all conventional IVF since we did have fertilization occur properly this way. Conventional IVF also allows natural selection of normal eggs and normal sperm as well. Overall live birth outcomes are the same whether you do IVF or ICSI, even if IVF yields less embryos.

This compares the use of ICSI over Conventional IVF in several different causes of infertility, and finds that ICSI is only beneficial in cases of male factor infertility.

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Right now we’re leaning toward 100% IVF, but our RE thinks we should still do some ICSI, without giving a real reason. He says it depends on our numbers on retrieval day. We are not naive to the fact that doing ICSI means they can charge $1250 more.

And then there’s this, which seems to say that there’s little to no risk from doing ICSI, so why not do it.

Another factor is that we are not using the same anonymous sperm donor as last IVF, so it is unknown how well this sperm will fertilize our new batch of eggs. But seeing as how our sperm is coming from a sperm bank, we can assume the motility counts are decent.

I would love your feedback and experience as we make this decision.

IVF#2: After 5 Days of Stims

Just a quickie today, but I wanted to update y’all after today’s monitoring appointment.

Yesterday, I went in for my intralipid infusion, which took about two hours, and involved me being hooked up via IV to a bag of what DW calls the “special mayonnaise”. At $750 a pop, out of pocket, it is also an expensive mayonnaise. I have very few superficial veins, and it took the nurses four tries to tap a live one. They eventually had to go for one in my hand, which hurt a lot, and with the Aspirin that I’m taking, bled a lot afterwards.

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Yesterday, I also noticed globs of egg white cervical mucus, which tells me my estrogen levels are high. Each of the little follicles in my ovaries release estrogen as they mature, contributing to the clusterglobs in my underpants. I anticipate that it is bound to get messier by the day. Lucky for you, I did not take pictures of this, as I might have been tempted to post them.

Today, I ran from appointment to appointment. I had really bad insomnia last night (probably due to high estrogen levels, which messes up my sleep every cycle), and took 50mg of diphenhydramine hydrochloride (Benedryl) at 11pm. Benedryl makes me super groggy and I was laying in bed like a zombie this morning, almost missing my monitoring appointment at the fertility clinic. Over the course of 15 minutes, I managed to shower and dress, set up the crockpot for pulled pork, fry some eggs (sunny side up), butter some gluten-free toast, and make myself a protein shake. I also made it to my appointment only 4 minutes late. Phew!

At the clinic, I had blood work and ultrasound done, which revealed 10 follicles on each side (20 in total!), 4 of which are 10mm or larger. They still have a ways to grow, so I go back in on Friday for my next monitoring.

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I’m happy with this number, and now just want them to grow into big fat juicy follicles. Last IVF, I ended up with 36 follicles, with only 19 being mature. This time, since we are doing a fresh transfer back into me, I hope I am not overstimulated, but still have a good number of mature eggs to make good quality embryos. *Fingers and toes crossed*

After monitoring, I rushed downtown to my acupuncture appointment. I’ve got a whole bunch of herbs that I need to take to increase my kidney yang, as my pulse was a bit slow and weak. I also had an acupuncture treatment, which was nice. My TCM doc is a bit of an odd duck, so it’s always an interesting treatment.

Next update on Friday!