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!