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.