Baby Bud Round Up

When last we spoke, I was mid-cycle on my IVF stimulation process.  All-in, the process lasted 12 days culminating in a nice dose of IV sedation (I do so love IV sedation) and the harvesting of my little egglets.

By my last ultrasound pre-retrieval they counted 10-12 follicles on each ovary.  Each follicle was about 20mm, give or take, and being the visual thinker I am I drew 12 20mm circles on a piece of paper and cut them out.

 Since I have two ovaries, I thought you should see it twice ;)

On the same day, they drew a blood sample as usual.  With IVF, there are generally two options for a trigger, Low-dose HCG and Lupron.  I had expected to be using the Lupron trigger because it is a good option under two conditions: when you are not planning a fresh transfer and when there's a risk of developing OHSS.  Since I have PCOS (a factor that increases the risk of OHSS) and planned to do PGS (preimplantation genetic screening), this made sense.  However when they got the blood results back and called me, they instructed me to use the more traditional HCG trigger.  I couldn't tell you the exact medical reason but as they explained it to me it had to do with my particular set of hormone levels which indicated I might not respond effectively to the Lupron trigger and a lack of warning signs for OHSS.  That's all fine and good, except that the Lupron would have been administered with more of the tiny needles I'd been sticking in my belly (and was now used to) whereas this is the needle used for the HCG trigger:

This is an IM (intramuscular) injection - yes, my husband had to stick this in my backside.  Yay.

As you can see, the HCG trigger shot needle is quite a bit longer, and thicker, than the subcutaneous ones.  On the other hand, that's a lot smaller than the needle that was going to be placed in a much more disturbing location two days later...but we'll come back to that.

Fun Fact:
The point of the trigger shot is not to rupture the follicles containing the eggs, it is to get the egg to release from the wall of the follicle - where it had been hanging out during development - and float freely in the follicular fluid.  How cool is that?!

Between the trigger shot and retrieval you get a day "off" from injections.  It's a nice little reprieve.  For retrieval I was going to be placed under IV sedation so I was going to need a day or two off from work, and with the effects of the meds and retrieval process affecting my ovaries I was encouraged to take a few days.  So in true sickie form, I took several vacation days to have this done.  On the up side, my husband was also able to take a few days so in addition to making sure I was taken care of we got to spend a little time together and do some day trips.  Gotta incorporate a little levity, right?

On the day of my retrieval, I arrived at the office and was placed under sedation.  While I was out, the doctor used a long needle placed through the vaginal wall to drain each follicle of its fluid, hopefully containing an egg.  Thank God I fall asleep from the sedation, I'm told some people don't.  I can't even imagine.

Anyway, one of the reasons I love IV sedation is how quickly and easily I recover from it, though apparently this time I did argue with my husband a little that I wanted to go back to sleep rather than really rouse myself.  I think this both annoyed and entertained him.  By the time I was with it, the embryologists had identified the eggs retrieved and within a few minutes more, knew how many were fully mature!  For some reason I thought it would take a couple hours to do that.  Even though there was a frozen sperm sample on hand for use as a back-up supply, my husband was asked to provide a fresh sample that morning, which he did.  This was also analyzed quickly and fresh sperm were selected for the ICSI fertilization process, where an individual sperm is selected and injected into an egg.  The day after retrieval you are told how many fertilized (this is day 1).  On day 3 we got an update on how many were still growing, and again on day 5 (my practice grows all embryos at least to day 5 hoping they reach blastocyst stage, and sometimes they are left for an additional 1-2 days).  At that point, we had to decide how many we would biopsy and send for testing.

As a point of order, not all follicles that are drained will necessarily contain and egg, not all eggs retrieved will be mature, and not all mature eggs will fertilize.  Additionally, the fertilization rate with ICSI is generally 75-85% and the proportion of fertilized eggs that will actually reach blastocyst is usually 60% or less.  With my age and stats we were pulling for the high end of those ranges.

That being said, I had 27 eggs retrieved, 21 of which were mature (this is considered an excellent response, and even moreso when you recall that I had used a low-dose stimulation protocol).  We gave the go-ahead to perform ICSI on all 21...and 19 fertilized.  On day 3, all 19 were still growing.  On day 5, ALL 19 WERE STILL GROWING.  A few didn't end up reaching blastocyst, but in the end we had 15 embryos eligible for biopsy!  Once we got past the initial shock of such high numbers we had to decide how many to biopsy.  For financial reasons we only sent 8 biopsies out for testing, but we did have the remaining 7 biopsied and the samples frozen for future testing.  I guess I have fairly hardy little eggs if they were only able to get through my damaged fallopian tubes!

For a woman my age, they expect 20-30% of the embyos to be chromosomally abnormal (non-viable), and this time I was right on target.  25% of my baby buds we tested (or 2 out of 8) were abnormal, leaving 6 chromosomally viable buggars to work with for now.  We chose to find out the genders, but this is a choice each couple can make.

The next step is generally to prepare for an FET (frozen embryo transfer).  In my case, they had identified one or more polyps hanging out in my uterus and it's best to remove them before transferring - which is where we can pick this up another day.

And that, dear future child, is the story of how you were made!