Testing, testing, one two three

I finally managed to get a print-out of my negative, ooh-lovely-healthy-lady-garden chlamydia result, by visiting the GP receptionists twice and phoning the nurse once. Yet another hurdle May the IVF Ox eventually managed to plough through. The next step is to commence menstruating, then call Riverside Clinic and announce Day One, and book the Initial Scan And Nurse Appointment, which will happen on day two or three or four (and knowing my tendency to be horribly unwell on day two and even three, we’re hoping to wrangle a day four appointment), and then, we frogmarch Satsuma into gleeful overproduction. Hopefully. Needles up the cooter!

(Period still hasn’t started, but I have cramps severe enough to make me feel a little sick, so any minute now. Any minute. Am wearing black underpants).

(Also, 14 day luteal phase? What the actual fuck, Satsuma? Is this the buserelin? It can’t be pregnancy, because H and I didn’t have sex this month before ovulation, and I am very much not the Virgin Mary).

So, on Thursday last H and I went to see the embryologists at Riverside. We were met by an extremely nice young person with a very sweet smile. We sat in an office with a myriad bits of paper and Had Things Explained To Us. I do not know if I can therefore Explain Things To You, Gentle Reader, but I will give it a go.

Because we have had up to nine misarriages (nine. Good God Almighty, I hate chemical pregnancies. I hate them so much. Too pathetic and brief to mourn, too fucking infuriating and miserable to ignore. And here on Infertility Island, they’re data, so I cannot ignore them even if every professional assvisor in Western Europe is telling me to) – where was I? That parenthesis rather took over.

Because we have had so very many early miscarriages, there is a strong possibility that H and I, for whatever reason, are incapable of creating a normal embryo. Basically, for those of you who did not do Embryology 101, every human cell contains 23 pairs of chromosomes, and in each pair, one was inherited from the mother, and one from the father. The only human cells therefore not to have 46 chromosomes are sperm and egg, and when they get together to make sweet sweet love embryo, the embryo ends up with a full set of 46. We know we, May and H, both have normal chromosomes ourselves, but in the fun and games of sperm and egg, it is not uncommon for the sperm, or the egg, to have lost a vital bit somewhere, or to be bringing an extra bit with them. This results in embryos with aneuploidy, which is fancy Greek for ‘not an ideal number of chromosomes’ or ‘oh, fuck, oops’. An anuploid embryo, which has too many or too few chromosomes, usually entirely fails to live until implantation. Of the rest, most die within a few days or weeks of implantation. And of those that survive until birth, many poor babies will have lethal deformities and health issues. And some few luckier ones will live, with varying degrees of problems and life-limitations, for varying amounts of time. But, basically, aneuploidy is not a good thing at all. And there is a marked possibility, given our history, that we produce many, possibly nothing but, aneuploid embryos.

So CGH is a (expensive) test that checks the number of chromosomes in each embryo. This means we can make sure we’re putting back an euploid embryo, so whatever the hell else happens to it in there under the care of Cute Ute The Despoiler, at least it won’t be genetic malfeasance at the gross level (fine detail arse-pantsery is still a possibility – not all birth defects are caused by aneuploidy. On the plus side, we neither of us come from genetic stock that runs to such matters, which lowers our risk of it being something of that sort (and of course, Cute Ute and The Immune System Of Angry could just wilfully kill it anyway because they are shitweasels like that)).

Our options (we did flow-charts to work this out. I will spare you) are as follows -

  • If we only have one or two embryos on day three (day 0 being retrieval), Riverside will just whang the prettiest (or onliest) back in there ASAP and fill May up with steroids and heparin and progesterone and intralipids and HOPE LIKE HELL.
  • If we have several embryos on day 3, we could take a cell from each and do CGH on them all then, and know on day 5 which if any to stick back (plus all the drugs and the HOPING LIKE HELL). However, as most abnormal embryos never make it to day 5, we could be testing a lot of embryos for no good reason, as the results’d come back ‘abnormal, but you knew that; abnormal, but you knew that; abnormal, but, yeah, anyway, let’s just talk about the ones that are still alive…’
  • Because the lab Riverside uses for this can do CGH in 24 hours, there’s the option to do assisted hatching on day 3, and then test the extruded (‘hatched’) material on day 5, which has the bonus of not poking the embryo directly (while it is rare, poking the embryos directly on day 3 can sometimes (I think she said in 5% of cases?) [edit by H - I cannot find any stats to corroborate this; my recollection is that it's not really possible to provide an accurate damage rate, because of no way to take account of the natural attrition rate] ‘arrest’ them (or, ‘kill’ them, if you’re feeling cynical and grumpy). Day 5 testing reduces this risk to less than 1%. Also, on day 5, you’ll be testing survivors, and won’t be wasting time (it is all time consuming, poking embryos) testing ones that were going to die anyway.
  • The prettiest (or onliest) ‘normal’ can then be transferred at dawn on day 6, fill May with drugs, HOPE LIKE HELL, etc.
  • HOWEVER. Because of lab times and logistics, we can only do day 5 testing if we retrieve Wednesday through Saturday. And we can only do day 3 testing on Friday through Tuesday. So we can ask Riverside for a Friday or Saturday retrieval for maximum options, and they will tweak medications if possible, but gonads are ornery and Satsuma is definitely ornery, bless her. So while we (based on my fabulous AMH levels and apparent youthfulness (most women at Riverside doing CGH are in their 40s. I am a kitten at 38)) are expecting a few eggs (Dr George was talking in terms of 10-12 eggs at retrieval (remember I am MONO-OVARIED)), and are therefore planning on day 5 testing, we are very aware we will have to take what we get.
  • And, as a further complication, if we go for day 5 testing, and the embryos are a bit slow to grow, we can still do the testing, but then the blastocysts will have to be frozen at once, because by the time the results come back we’ll’ve missed the transfer window. So we could accidentally bounce ourselves into a FET in August or September. Eh. Ah. Oh.

So, there you have it. We’re leaning towards day 5 testing and a dawn-of-day-6 transfer. We may not have enough embryos to do that. We may not have any normal embryos at all. We may end up missing the transfer window and dragging out the whole saga into yet another few months of Epic Stressing. All is subject to change and confusion without warning or explanation.

Excuse me, my uterus is calling me. She requires medication and heat. And possibly a sharp slap.

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37 responses to “Testing, testing, one two three

  • Jo

    Hoping like hell that this is the one that sticks. FWIW, I think your plans make a shitload of sense and I want nothing more than for Satsuma to cooperate. Keep us posted.

    • May

      Thank you. I’m glad it makes sense. I’m not sure I make sense at all sometimes! (Satsuma, the internets are WATCHING you. OK? OK).

  • Anonymous

    Good luck.

  • Mina

    Hope like hell that EVERYTHING works for once AT THE SAME TIME, and the result is what we all hope like hell it is. Hear, hear, Satsuma!

  • H

    Another factor that for me pushes it to Day 5 testing is Mosaicism. A mosaic embryo is one that contains both normal and abnormal cells. At day 3 this is up to 1 in 20 (5%), at day 5 less than 1% (they also take more cells at day 5 (5-10)). So there is a greater risk of a false negative/positive at day 3.

    It’s certainly not going to give us absolute guarantees, but it will, I hope, give us some indications of whether there are serious problems or not. There is a 5% chance the result will be ‘no result’… So it’s all a numbers game.

    Another slight risk of day 5 testing (in addition to slow growth) is that if there are a lot of embryos still to test we may not get the results back in 24 hours, in time to do a fresh day 6 ET, in which case they will then need to be frozen too.

    We’ve been warned we need to be awake and able to take 8am phone calls on day 3 and day 5 to make decisions based on the number/quality of embryos – neither of us are morning people…

    • Hairy Farmer Family

      H, I know caffeine is very much not your pollutant of choice, so can I confess to being awfully curious as to how your system might react to a judicious double espresso at 7.30am…? I have visions of you sprinting to Riverside to peer over the lab rats’ shoulders!

    • May

      Yeah. And mosaicism. I forgot about the mosaicism.

  • Hairy Farmer Family

    Hmmm. Lots of options. Mind-boggling, bewildering options. Striving for balance between Needing To Test For Stuff and Put Them Back Into The Warm, Quick! seems a Judgement-Of-Solomon job. Lacking a crystal ball, I suppose the best you can do is make a call on the day, faced with whatever/how many you have/have not.

    God, how I want you to be one of the Haves. IT IS YOUR TURN.

    • May

      I am pretending this is all an Interesting Science Experiment for the purposes of Data, and not about babies at all, in case I FREAK THE HELL OUT about leaving them to fizzle out in petri dishes.

  • kylie

    good luck. times about a thousand

    And on the FET, some women actually respond better to FET than doing a fresh ivf cycle (something to do with the hormones mucking up the uterine environment). So even if it happens, it may be a good thing.

    • May

      That’s a good point about FET. So while it’ll be a drag from one point of view, it at least won’t be a set-back.

  • Blanche

    Very best of wishes to you both as this process proceeds, especially for Satsuma to be compliant and all timing and results to be exceptionally convenient and only positive in the most wonderful and lovely of ways. .

  • a

    I am hoping that things progress in a nice, reasonable, non-ornery manner. That you are presented with your best days, and your best options, so you can make the most reasonable decision. (But things being what they are with the two of you – I’ll assume the opposite will happen.) Much luck – here’s to a good number of happily dividing embryos who have the required number of chromosomes in the right places with the right lengths.

  • marion

    Just as a comparison: Most of the places I’ve heard of that do full day-5 chromosomal testing in the U.S. freeze all of the embryos as a matter of course and transfer the euploid ones back as FETs. FETs tend to have a higher success rate anyway, presumably because there’s no tradeoff between pumping the body full of the perfect mix of hormones to encourage egg production and pumping the body full of the perfect mix of hormones to encourage ideal uterine conditions. That having been said, the U.S. clinics offering that as an option tend to be very effective at freezing embryos for later use (i.e. they use vitrification rather than slow freezing and have thawing survival rates in the 90+ percent range), so there’s not a perceived tradeoff between fresh and frozen in that regards.

    Don’t think that was very helpful, but there you go.

    My hope is that (as may have been the case with us) you are perfectly capable of producing euploid embryos together, but that May’s rebellious reproductive system doesn’t want to provide them with the ideal hormonal environment left up to its own devices, and/or that the eggs that are naturally dying off every month are of better quality than the ones being selected by the natural process to grow to maturity. My pair of rugrats is evidence that modern medicine can, in fact, kick Mother Nature’s arse at times; may the same hold true for you. May you, a year from now, be nudging each other in bed saying, “No, it’s YOUR turn to get up with her.”

    • May

      Riverside Clinic has a… a THING about fresh blastocysts, I think. Possibly because they don’t do vitrification. At least, no one has mentioned vitrification. Oy. But it’s a good point about an FET being done with a cuddlier, friendlier uterus.

      Hurrah for your rugrats! Science for the win!

      • marion

        Thank you! May science fill your home with high-pitched screeches (of delight) soon! And little fingers attempting to steal your computer. Sticking out one’s tongue at fickle Mother Nature is great fun.

        I know in some circles vitrification is considered so matter of course that it’s not even discussed; others, not so much. (Might also be described as “flash freezing.” Anything but “slow freezing,” which is the old-fashioned way.) But it sounds as though you have plans to cover every contingency, which is good. Best of luck!!!

    • H

      It may also be that they cannot turn the results around in less than 24 hours for a fresh day 6 ET. We have been warned that if there are too many embryos to complete all the testing in time then they will have to freeze the lot. Another scenario is that they mature a little too slowly and don’t reach blastocyst stage early enough on day 5 then they can take sample on day 6, freeze, and wait for results for a FET.

  • Valery Valentina

    Dear Satsuma,
    this is an important month for you. You are gently being nudged to do what you love to do, except this month you don’t have to choose an egg: you can have them all! Let’s say, all 10 of them. There is no need to overdo this. A dozen is ok too if you like that number better. Don’t be modest, not just 1 or two, that is in the past now.
    Love from across the small pond,
    VV

  • Anonymous

    Best of luck with it all xx.

  • Emily Erin

    Wishing you luck and hoping that everything works beautifully. BTW, what’s the difference between microarray testing and CGH testing? I’ve seen both discussed on the interwebs (as well as FISH, but that’s just for sex chromosomes, I think). I hope that whatever testing is required that Samsuma, the dear gonad that she is feels the call to be extra productive and makes you both quite proud with her production (without producing OHSS). Wishing you nothing but good things, great timing and all of the things that will make this go as smoothly as possible.

    • May

      I think CGH is a particular microarray technique, that requires only a tiny initial sample to produce an accurate result (which makes it extra suitable for very small embryos who don’t have that many cells to spare), so they’re more or less the same thing in terms of results.

      Thank you for your good wishes.

  • Melissa

    Wowza, that’s a lot of information! I will be “hoping like hell” for you! I love the way you write, btw!

  • minichessemouse

    Wishing you the very bestest of good luck. It’s surely your turn. Go satsuma Go!

  • Shannon

    I think – I hope – I never, ever leave assvice. No one likes assvice. But you seem to be debating, and one thing that my clinic said stuck with me (apart from their total lack of warm cuddly feelings. That stuck with me, too), and that is when I was keen on a day 5 due to all the reasons listed above, my IVF doctor (one of those pioneering ones involved in the start of IVF) said that they have a simply philosophy – they do day 3 embryos because the body is the one place where embryos are meant to be, and where according to their statistics, they do better. They were also very heavily against putting more than one back due to the increase twinning rate (they have very high rates of twins, of which I am but another statistic). I don’t know why the day 3 thing stuck with me, but it did. Not sure if it’s something to consider or not and I apologise for the assvicery, I really do, just wanted to put that out there. Muddy the water. Insert appropriate metaphor of choice. Acupuncture anyone? G&T?

    • May

      You can give me assvice anyday, dear heart. You’ve earned it.

      We can’t do day 3 transfer AND testing, because day 3 is the earliest the embryos can be tested and the results take 24 hours to come back, so we’d have to do day 4 transfer at the very earliest, and in my case Riverside would like to put blastocysts back, because blastocysts have at least proved they can do the ‘divide into fetal mass and placental/gestational sac’ bit correctly. Which is a thing, given my constant chemical pregnancies. They are also being very anti putting two back. Given the horrible state of my uterus, this is probably a good idea, as will the damn thing even stretch properly? Oh God, the water’s so muddy now I can’t see my feet. G&T. Definitely. Make mine a triple.

  • Twangy

    Excellent plan, May and H. You have certainly done your part. GOOD, GOOD LUCK, the kind that makes things synchronise in a fortuitous way!

    (Wait, though. You’re NOT the Virgin Mary? There’s me thinking you were! And Womb4Improvement was the Pope. Huh!)

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