And then there was one

One.

One normal blastocyst.

BUT, one is so many hundreds and thousands, of times better than none!  One is the difference between being parents and NOT being parents.  So we are happy.  And this one normal blastocyst is of good quality with a 75% chance of pregnancy.  Dr. A is very positive and confident that we'll get a pregnancy out of it.  But it also means if we want more than 1 child, we're sticking needles in my tummy again within just a few days here.

Sorry it's taken me so long to pick up where I left off.  I wasn't under a rock mourning our losses or anything since we've been very mentally prepared for whatever comes our way along this journey.  However there is a little something that got in the way of my posting prior to today: THE HOLIDAYS!  Sheesh...such a busy time.  But with our second round of stimulation and retrieval just a few days away, I'm somewhat astonished at how my body has been totally and perfectly navigating around all the important holiday milestones - our Thanksgiving travel, expensive tickets to a Broadway show we purchased MONTHS ago, multiple holiday parties and events, Christmas day AND New Years!  Essentially we got the month of December off while still avoiding Thanksgiving (retrieval was 2 days prior to it) and New Years (stimulation should begin a few days after it).  Thank you for that, Body.

Now let me get back to the info on our 2 embryos and how/why we went from 2 highly graded embryos - to only 1:

We met with Dr. A a few weeks ago and she gave us the news that our best looking embryo (the 4AA) was chromosomally abnormal.  It had a Trisomy 22 abnormality which meant there were 3 copies of chromosome 22 rather than a pair, as there should be.  Embryos with this abnormality would usually not even result in a pregnancy, however because ours was such a high graded embryo (AA is THE BEST) it likely would have for us and ultimately resulted in a miscarriage.  (On the odd chance that a person should be born with a genetic disorder associated with Trisomy 22, they would be greatly disabled mentally, physically or both.)  So while that was not what we wanted to hear, we were glad to be able to rule that embryo out and not waste time, money, physical energy and emotional turmoil going into a situation where I could become pregnant with a chomosomally abnormal fetus.

On the other hand - our 2nd best looking embryo, which was our only other embryo, (the 5BB) was chromosomally normal!!  This was wonderful news of course.  I can't imagine how devastating it'd be to go through this whole IVF process only to end up with nothing at the end.  So we celebrate our successes along the way - and this is certainly a success to celebrate!

oh, and Happy New Year too!

Dr. A also sent us out of her office with a paper which told us the genders of both embryos (the normal and the abnormal).  She gave us the info since it's ours to have, but suggested we not look at it, and I think I understand why.  I would guess it's less of an issue about knowing the gender of the normal embryo and more about knowing the gender of the abnormal one.  I think it feels like more of a loss when you know the gender.  But I repeat - it's not an embryo we want, so it never really felt like a loss to us.  As I've mentioned before, Hubby and I are planners and very practical people and knowing the gender of our embryos makes logical sense to us, so we did open the paper once we got home.  I won't be sharing the genders here, nor do we plan to share the genders with our family and friends (the few who know we're doing IVF).  It's something we want to keep to ourselves as we continue to plan our family.  But I will tell you that the gender of our normal embryo is a gender one of us has very much been hoping for.  You're right, that basically gives nothing away!  *evil laugh*

"muahahahahahahaha!!!!....."

Dr. A suggested we take a cycle off in between IVF stimulations which is why December was our month to relax and enjoy before January starts us over again.  But we're starting again with a lot of great information under our belt - and with a hearty, frozen embryo just a few miles from our house.  That's right - have I mentioned how close the infertility facility that houses our frozen embryo(s) is?  We drive by it all the time and sometimes we wave at our "kid".  :)  It IS truly incredible though, to think that someday that little embryo which is frozen and stored inside this medical building, could be walking around in the world and calling us Mom & Dad.

How are you kicking off 2014?  We're kicking it off with IVF Round #2...  In T-minus about 5 days.  2014 is going to be a great year for us, I can feel it.  If you'd like to keep following along with me - stay tuned!

Getting good grades

They're not even fetuses and we're worrying about the grades our kids are getting... it starts younger and younger each generation, doesn't it?

On Day 5 we started getting a different kind of report.  No more information on the cells and the grade, but instead since the embryos were becoming blastocysts, we were getting information on where they were in their overall development and expansion:

• 1 - Blastocoel cavity less than half the volume of the embryo
• 2 - Blastocoel cavity more than half the volume of the embryo
• 3 - Full blastocyst, cavity completely filling the embryo
• 4 - Expanded blastocyst, cavity larger than the embryo, with thinning of the shell
• 5 - Hatching out of the shell
• 6 - Hatched out of the shell

and then scores on the Inner Cell Mass which is the part of the blast that becomes the fetus:

• A - Many cells, tightly packed
• B - Several cells, loosely grouped
• C - Very few cells

and finally, scores on the Trophectoderm which is the part of the blast that becomes the placenta:

• A - Many cells, forming a cohesive layer
• B - Few cells, forming a loose epithelium
• C - Very few large cells

This is called the Gardner blastocyst grading system.  Here's a great page to help explain better.  So at this stage we started seeing embryos/blastocysts being labeled things like 2BC and 4AB and 5AA, following the grading you see above.

You'll hopefully remember where we left off with our little embryos at Day 4.  We had 4 morulas (stage between cleavage and blastocyst) that we were watching and hoping would grow into hearty blastocysts with excellent grades!

Day 5 (12/1)
Tracking 3 embryos!

Embryo Count	Blast Expansion Grade	Inner Cell Mass Score	Trophectoderm Score
1	4	A	A
1	early blast
1	morula

Day 5 brought us the above report card.  To decipher, this means we have a 4AA blastocyst, an early blastocyst (not yet graded) and a morula still in the running.  The last embryo (of the 4 morulas we had in my last post) did not continue to grow and divide so we'll stop watching it and continue to concentrate on the 3 good ones.

Our 4AA blastocyst was, as Dr. A put it - the best of the best!  It doesn't get better than this at this stage and as long as it's chromosomally normal it has a 90% chance of pregnancy.  The 4AA was frozen today and we'll wait for its 2 buddies to hopefully catch up.  Wonderful news on this 5th day!

Day 6 (12/2)

Tracking 2 embryos!

Embryo Count	Blast Expansion Grade	Inner Cell Mass Score	Trophectoderm Score	Freeze/ Biopsy Day
1	4	A	A	5
1	5	B	B	6
1	1	C	C	NA

Day 6 was the last day of watching our little embryos grow and the last day of the nerve-wracking yet simultaneously exciting emails.  It's hard to watch the numbers drop a little each day, but it's also interesting how our numbers dropped so subtly each day.  We never lost more than 1 per day, which made it a lot easier to go from 6 to 2.  Mother Nature may have been rough on us to put us in this IVF boat to begin with, but at least she was making seas a bit easier to navigate.

Today a 5BB joined our frozen 4AA from yesterday.  The 1CC didn't have pregnancy potential so we will stop watching that one and it was not frozen with its siblings.

It was around this day that I noticed almost all my bloating was gone.  It came on so subtly but also dissipated the same way.  And when I finally was home (from Thanksgiving travel) and able to weigh myself, I'd lost the 2-3 pounds I put on during stimulation, so THAT was a huge relief.  Even though I knew I was going to gain water weight - it doesn't make seeing those pounds on the scale any easier!

So our last and final stage before we truly know how we came out from this round is the genetic testing.  Specifically PGS with aCGH (Preimplantation Genetic Screening with array-Comparative Genomic Hybridization).  This is the newest step in the IVF process, and something most couples didn't even go through until just the last few years.  Knowing if an embryo is chromosomally normal or not is huge.  I mean HUUUUUUUUUUGE.  Typically it's the chromosomally abnormal embryos which do not implant, or if they do implant, will likely miscarry.  Plus, it also gives couples who do get pregnant, more peace of mind knowing the likelihood of those 2nd trimester chromosome and genetic screenings coming back with bad news is far less likely.  Sign me up!

Well, we did sign me up and we've sent a small collection of cells from each of our 2 embryos to IVIGEN to be biospied.  We'll get the results tomorrow when we go in for a consult with Dr. A.  She had the results late last week (only 4 days after our oldest embryo was frozen!) but wanted to review them with us in person tomorrow.  I'm a little nervous for the news - but she did give us a cryptic "It's good" in her email.  Good isn't great, but good isn't bad either.  My fingers are about to fall off from crossing them so much lately, but they're crossed again.  I'll be back soon with an update!

Another day, another number

Immediately following the egg retrieval day comes a daily update/status report from my doctor on how our little eggs/embryos are doing.  I found that each morning I was nervous/excited to see an email waiting from Dr. A.  Would it be bad news?  Good news?  Great news?  Thank God we were traveling for the holidays and highly distracted most of the time.  I can only imagine how that notorious "2WW" (two week window) waiting to take a pregnancy test after embryo transfer must feel, when I was anxious each day just for our embryo report!

For an explanation on embryo grading I like this page.  This is also a good page, but I noticed that their grading is backwards from the grading that was done for our embryos.  (For us, the lower the number, the better.)  As these fertilized eggs, aka. embryos age, they will have a grade and a cell count and that's the report we would get each day.  The grading refers to the even-ness of the cells size and lack of fragmentation (the more even-ness and less fragmentation, the better, and the lower the grade #).  We also want to see the number of cells increase each day from ~2 cells in the first day to ~10 by the 3rd day.  We would get these daily reports along this grading scale for the first 3 days.  Day 4 there is no report because they are morulas and Day 5 the report/rating changes since they are (hopefully) blastocysts by then.

Our Daily Reports

Day 1 (Day after retrieval):
Tracking 5 embryos!

Embryo Count	Cells Count	Grading
5	NA	NA

We got an email and a voicemail from Dr. A telling us that 5 of our 6 mature eggs fertilized which was GREAT.  At this point we got no information on quality since it was too early.  Quality and grading begin on Day 2.  I asked Dr. A what to expect from these little embryos.  What kind of success rate does she typically see?  Might we end up with 5 great embryos to send for genetic testing?  She said it's typically about 50% that make it to high quality blastocyst.  So we're keeping our fingers crossed for those 2-3!

I was still feelling bloated and very gassy, like that painful gas you get in your pelvic area, but can’t manage to release.  I thought about taking a Gas-X, but never got around to it (so that tells you how much it was truly bothering me).  Dr. A said it’s partly cuz of the anesthesia but mostly cuz my ovaries are recovering from the procedure.  It didn’t keep me from cooking all day for Thanksgiving the next day, though!

Day 2 (11/28):
Tracking 5 embryos!

Embryo Count	Cells Count	Grading
1	5	1
3	4	1
1	3	1

We got the morning report that all 5 embryos were Grade 1 which is the best quality!  Very excited to hear this.  6 eggs (from my retrieval) didn't seem like a big number to me, but we felt more positive when our first news about the embryos was that they were Top of Their Class (Go little embryos!  Go!)  Hubby and I commented on our drive to Thanksgiving how it's really crazy to think there are embryos that exist out there which are a combination of our DNA.  Like these little things could become our kids!  It was a very surreal, exciting and scary thought.

Physically I was feeling fine for the most part.  Still a little gassy and still couldn't release any of it (but still didn't take anything for it).  It wasn't as bas as the previous day though.

Day 3 (11/29):
Tracking 4 embryos!

Embryo Count	Cells Count	Grading
2	8	1
2	8	2
1	4	3

By Day 3 (which, I couldn't help but think to myself - is a day some IVF clinics do transfers, which means the embryos start to have enough information to speculate potential success) our number had dropped again.  But just by 1.  I'm so thankful that we never had a significant drop in numbers or some other heartbreaking shock.  4 embryos were continuing to divide well with little fragmentation, but the 5th wasn't looking so hot and so, while it would remain in culture - it would likely not come through for us.  We continued to stay positive - 4 is 4 more than a lot of people end up with.  We were thankful...

Today is probably the first day I felt just about fine.  The bloating was slowly starting to reduce and the gas pains were gone.  These side effects are almost not worth mentioning, they were so minor.  We flew to visit Hubby's relatives today which wasn't a problem for me at all.

Day 4 (11/30):
Tracking 4 embryos!

No change/no report

On Day 4, the embryos are "morulas".   (Kinda sounds like a character from The Addams Family, huh?)  Dr. A said that there is no new report today, so at least we got a day off from being anxious!  I found myself very hopeful that maybe these 4 embryos will be all we need to get our 2-3 kids.  Maybe I *won't* have to go through another round of stimulation/retrieval?!  But I know the hope is faint.  And to be honest, the stimulation/retrieval were really not that bad for me.  I'm just starting to get impatient about trying to get pregnant!

A Happy Little Blastocyst

The next news will be coming in for Day 5 and Day 6.  The hope is that the embryos will be at blastocyst stage and we should get (a new type of) grading report on them as well.

So far so good!