Embryo Counts

This has got to be the most emotionally draining part of the whole experience. We have worked so hard and done everything we were supposed to do (and then some), and we have nothing left to do but sit and wait, and hear numbers that frankly make our stomachs drop. I have wanted to post on our embryo numbers, but I needed time to wrap my heart and brain around it myself before I could do it.

I thought we would have more. I started with more than what they hoped for from me with 22 eggs retrieved last week. Either way, this is the progression of where we have been the last few days:

Thursday, January 28, 2010

Of my 22 eggs:
16 were viable for fertilization (the others were discarded)
5 fertilized right away
5 are looking good - too early to say that it took. Tomorrow we will have the final answer on these.
6 didn't take and were discarded.

The biopsy will take place on Saturday (sucking a cell off to send to the lab in Detroit).

Friday, January 29, 2010

The 5 embryos that took right away are doing great. They are dividing now. Three of them are 4 cells big now. The other two are 6 cells big. They are right on schedule to do the biopsy tomorrow for the genetic testing. They are a little bit fragmented - as they divide, parts of the cell break off. A little bit of this is ok and normal, but if you get too much, the odds of success after implantation lower. They are watching this carefully.

Of the 5 that hadn't quite taken as of yesterday, 3 have fertilized successfully, but their development is slow. The doctor says that usually you start to see cells divide at the 12-20 hour mark. We are at 30 hours and they haven't started dividing yet. They can still come along and make it or not. They are watching these 3 very closely. (I joked with Chris that they are moving on Wilkerson Standard Time.)

Saturday, January 30, 2010

Of our 8 embryos, 2 didn't make it so we are down to 6. The 2 we lost each stayed at one cell big and never started dividing.

They did the biopsy on the remaining 6. Here's what we know about each one (remember the goal was to get the embryo to grow to be 8 cells big before the biopsy).

#1. Four cells big - This one has not divided past 4 cells since yesterday so the embryologist is concerned about it.
#2. Six cells big - This one has not divided past 6 cells since yesterday so the embryologist is concerned about it.
#3. Eight cells big - This one is by far the best looking one and grew completely on schedule. It is looking perfect.
#4. Seven cells big - Good growth, but a little slow. 7 cells is pretty good though.
#5. Five cells big - Slow, but hanging in there.
#6. Four cells big - Slow, but hanging in there.

They can only live outside my body for 6 days, so the timing of when they do the biopsy is pretty set. They can't wait for the ones growing slowly to catch up. We will get the results at 10am on Monday morning, and then they will implant shortly before noon. There will be not much in the way of news tomorrow - just simply to give a count of our embryos, and to comment on their growth.

This is an agonizing process. On one hand, I am not so comfortable with having a freezer crammed full of 20 embryos just waiting that I may use or not. The ethics of that are overwhelming. But on the other hand, it would be nice to have options, and to choose two stellar embryos to implant. It looks like we will just get what we get. Going through each day worrying about this is eating at us. Is it Monday yet???

Physically, I am recuperating. I didn’t expect the egg retrieval to be that hard to bounce back from. I had a bad reaction to the antibiotic that they prescribed, and spent much of the day after the surgery being sick to my stomach. Fortunately, it was an easy fix. I stopped taking the drug, and when it wore off, I felt a lot better. Today is the first day that I am moving around more and feeling like me again.

Chris and I are just going to try to keep ourselves busy today and tomorrow to try not to think about it so much. It is out of our hands at this point. There is nothing to do but wait. Obsessing about it only makes it worse. I know you guys probably have a million-and-five questions about it (this is crazy, how could you not!), and we would ordinarily love to talk about it, but for now we need to put it aside to try to relax. Once we have this leg of it over, it will be different. We are just trying to get through this part right now.

Thanks for reading along.

Retrieval

Here I am getting ready to go back to the operating room:

Today was the first of two big days (the other big day is the transfer). After a month of injections, and tons of doctor’s appointments to monitor my progress, my eggs are big and healthy and ready to be retrieved.

Last night I went and did one last treatment with my acupuncturist, and she began work to get my hormone levels back down again now that my body has released enough eggs and that they are the right size. My doctors gave me medication that helps with this, but acupuncture is great for this sort of thing too, and just walking out the door last night after her treatment I was already feeling more like my old self.

It was a bit of a scramble getting organized, making sure we grabbed everything that needed to go to Denver with us, hitting the grocery store for some last minute things, taking a shower since I won’t be able to tomorrow, and those sorts of things. Mom showed up to spend the night so we could all just roll out of bed and go since we had to get up really early to be in Denver at 6am (she had volunteered to drive us up there, since that drive can be stressful and Chris and I need to be as relaxed as possible through this).

I woke up this morning at 4am. I immediately panicked at what I had to do today. They were going to poke me with a needle a bunch of different times in a very delicate area of my body. Can I do this? Do we really want this? Why did I sign up for this? I was just so scared. I reached over and grabbed Chris’s hand for support. As I felt his hand, it reminded me of Noah. Noah had Chris’s hands. Suddenly I wasn’t scared anymore and reminded of why I am doing this. Yes this is worth it. Yes we absolutely want this. I knew I could do it.

We threw on clothes and were out the door by 4:45. I couldn’t have anything to eat or drink which was tough, but because it was so early, the roads were pretty clear and we made great time getting to Denver. We arrived at 6am on the nose. They have a pretty big outpatient surgery center at this hospital, and there were lots of folks there this morning checking in. At 6:30 they took me back, and had me change into the hospital gown, and started to work on getting my IV put in and doing the paperwork to get things started. Everyone was very nice, and the whole thing was a pleasant experience.

They took me back to the operating room, and helped me get situated on the bed. They administered the anesthesia, and I was out. Soon enough, they woke me back up in the operating room and were eager to tell me that they collected 22 eggs that they are sending straight to the lab. They were so excited because they had hoped to get 15-20 from me, and 22 gives them plenty to work with!

They moved me back to recovery, which was basically big lazy boy chairs, and wrapped me up in warm blankets. I was really sore. It felt like stabbing pain in my stomach. On their pain scale of 1-10, I rated it a 6, so it was bearable. Just uncomfortable mostly. They gave me some great pain medications through my IV that kicked in very quickly. Once we had that under control, they gave me some tea and crackers, which on my empty stomach tasted fabulous. All of the pressure that was on my lower belly from carrying around all those eggs was gone. Some of the swelling was gone too. I was thrilled about that. They found Chris and brought him back to me, and then the head embryologist for the practice came over to talk about next steps.

Two of the eggs were just a bit small, and so they were going to put them in their incubator for a couple of hours to see if they could get them to grow just a tad bit more. The remaining 20 were going straight on to the lab to be fertilized. They were going to do forced insemination, where they inject a sperm directly into the egg. We originally thought they were going to throw everything into petri dishes and see what happens. But, for the genetic testing we are doing, it has to be done the injection way. We were fine with this. It means we will likely have more embryos to work with. The head embryologist will be calling us daily from here on out to give us progress reports. And because of the nature of what needs to be done, he will personally be handling most of our case. We will continually lose embryos along the way. Some of my 22 eggs won’t fertilize. Some will, but will not mature and start dividing. Some will not survive the testing procedures, and then finally, some will be sick with MCADD. Each day when he calls us, he will give us a new count.

The implantation will take place on Monday. It will likely be in the afternoon, because the test results from the genetics lab in Detroit will come in sometime that morning. In the meantime, I am recuperating from the retrieval. I am sore and nauseous. I expected to bounce right back, but I definitely feel like I have been poked with a needle repeatedly today. I have been sleeping a lot which helps. Most moms who go through this have the implantation just a couple or three days after the retrieval. I am glad that I get 5 days because I think I need them to recover (patients doing genetic testing have to wait longer because of the extra procedures are thrown into their usual process). I am just so excited though. We are almost through this, and I am really looking forward to being pregnant again.

I had Chris dig out one of our baby books from when I was pregnant with Noah. It is a book with photography by Lennart Nilsson. He has done some incredible photos of all stages of development during conception and pregnancy. It is amazing to look at his pictures of eggs, sperm and newly created embryos and to think about our babies being created as I write this. What a miracle this whole process is!

I’ll keep you posted as I can on our counts as we go. Thanks for reading!

Videos of Our Nightly Injection Routine

I bought a Flip this last week. (A "Flip" is a device that records digital videos that are easy to post on blogs, Facebook and the like). We have so much going on, and will continue to have more to share as we go, so this seemed like another great way to share our news and updates.

To kick this whole thing off, we have recorded ourselves doing our nightly routine with the shots. Every evening at 9pm, Chris does a great job of getting all of the syringes loaded up and ready to go. He is the detail oriented one between the two of us, so he was the best candidate to fulfill this need every night. It is a load off my mind that all I have to do is inject them, and that's it. We make a good team!

Chris loading up the syringes #1:

Chris loading up the syringes #2:

Sarah doing the injections:

We’re getting close!!

I am uncomfortable! There is something strange about having children where pain is good. It means progress. When we go into labor, the more it hurts, the closer we are to seeing our children for the first time. Similarly, I am getting more and more uncomfortable, and it means that we are getting closer to having embryos!

I have spent the last 2-3 weeks or so injecting all sorts of things into me, and Wednesday I started to get crampy and bloated. It kind of freaked me about because they were so concerned about me hyper-ovulating (that I would respond too well to the hormones and end up releasing a ridiculous amount of eggs. WAY more than what we need.) But, I have a good doctor that has watched me like a hawk while I have been on these things, and assured me that what I am feeling is totally normal and to be expected for this stage of the process.

On Wednesday I went to the doctor for them to check my progress. What they discovered was that I had 12 follicles on my right ovary and 8 on my left. These “follicles” are pockets of fluid where an egg would likely be. So add that up, and we have 20 eggs!! They want me to end up with somewhere between 15-20 viable eggs so this is great news. Everything’s looking perfect.

Yesterday, I went again (I have to go every other day now for monitoring) and they did a new count of follicles and counted 14 on my right ovary and 16 on my left! That means 30 potential eggs, and 20 of them were definitely looking viable! My estrogen levels were where they wanted them to be, so they are backing my hormones down a bit. We were all so excited to hear this! I only have to do shots for a few more days, and it is looking like Tuesday or Wednesday will be the egg retrieval day. WOOT!! They will create the embryos as soon as possible after the retrieval, and then 5 days after their creation will be the implantation day. I think that works out to be February 1 or so.

In the mean time, my ovaries are really swollen carrying 30 eggs around (they are only designed to hold one or two), so life is a bit uncomfortable. Sitting is a little precarious because it puts pressure on my lower belly where all this is going on. It feels like just before I had Noah, when he had dropped down into my pelvis. Or some moms have described it by saying that it’s like someone inflated their ovaries with a bicycle pump. I am crampy and am bloated, and lying down feels the best. They say that by the time we get close to retrieval, walking will even be uncomfortable, and I can kind of see how that will be based on what I feel right now. I don’t mind it in the slightest because it is for my kids. I did natural childbirth, so I can do this no problem! I am going to spend the weekend doing as little as possible.

We are just so excited. It is scary too, thinking about all that is to come, but we have worked hard, and have such a great support system around us to help us face whatever grief issues come up along the way. We have told Noah from the beginning that since he is up there that he should pick out the perfect souls to join our family. I know that whatever comes will be sent from him. I look forward to meeting his choices for us soon!

Catching Up

I am catching up on blog posts tonight. I have written some things, but not gotten around to posting them yet. As it stands right now, I am a few weeks into the injections, and doing just great! I don’t feel any different, and I am attributing that to acupuncture. I have followed my acupuncturist’s plan for me religiously, and it has paid off. They keep bumping up the dosages on my medications, so I am taking each moment as it comes, and if I feel anything more than what I do right now, I am not going to be disappointed - just grateful that I have had it easy so far!

The doctors in this fertility practice we are using meet as a group to review cases, and because of Chris’s and my odds for creating sick embryos, they have bumped up my medications to try to get me to release more eggs than they would normally do. They are hoping they can get between 15-20 eggs. Not all of them will be mature enough to become embryos. Also, at least 25% of them will be sick with MCADD. We want to have options, so this seems like the right path.

If things go well, and we have enough healthy embryos to choose from, they are going to let us choose the sex of the babies that they implant! The plan is to implant two, and if possible, we would like a girl and a boy. Time will tell. We are certainly doing everything we can to relax and be healthy until the moment of truth arrives, and it is time to create embryos!

Without further ado, here are some of the things I have been writing in the last few weeks.

IVF and Acupuncture

My acupuncturist has made the switch from the treatment plan she has had me on to focus full board on the IVF. That means preparing my body to handle the drugs I will be on, and to help me be as fertile as possible.

I showed up today, and this time she had me lay on my stomach so she could do mostly points on my back and legs. The uterus attaches to the body at one point – the lower back. (This is why pregnant women have so much back pain. All that weight is concentrated on the one point!) This is why she did needles there today. Then – and get this – after she had the needles in my back and legs, she hooked up some electrodes to the needles themselves! I laid there while she turned up the juice until I could feel it! Oh my goodness!!! She said that I needed to be able to feel it, but not have it be so intense that I can't sleep. (After they stick you, they leave you with the needles in the dark, warm, quiet room for about 30 minutes. It is best if you can sleep, because it means you are totally relaxed and it gives the needles the best possible chance of doing it's thing). Adding in the electrodes made me completely nervous at first. I have to say that she did it very slowly, and when it went too high, it felt ticklish or like a light sting, depending on the point. I have done natural childbirth before, so really, this was nothing in comparison. It just scared me because it was electricity going through my body. When we settled on the proper dosages, it felt like of like a feather-light hum or vibration. And I did sleep.

After everything I have done with this woman so far, I trust her completely, and her odds with this particular therapy are good. 26% of her IVF patients never have to do multiple rounds of IVF treatments. They get pregnant on the first try. (Most women have to do on average 2.5 rounds of implantation before it takes!) They also experience far less of the side effects that all those hormones cause. That's worth it to me.

To add onto my hippie-earth-mama stuff, I have been contemplating hypnosis therapy to keep the stress hormones under control during all of this. My old pre-natal yoga teacher does it, and as much as the doctor at the genetics lab went on and on over how much stress can negatively impact your success rates, I think it is worth considering. This would just be once a week, and this is another person I think the world of and believe in. I want to give this the best possible chance that I can, so why not?

I love being a mom.

Oh wow, does this whole process push me outside my comfort zone, and make my head spin! I can’t believe all the steps involved. All of the drugs I have to inject into myself for example. They essentially have me going through menopause for two weeks, and then be so ridiculously fertile for another small stretch of time after that. Acupuncture. Hardcore diet and exercise. Hypnotherapy. Regular therapy. Support Groups. Why do I do it? Because I really truly love my kids and there is no such thing as half way when it comes to them. I know Noah - what he looked like, his little personality, his schedule and movements and such. I don’t yet know his siblings. I do know they are out there in the universe somewhere just waiting for the right time to come along into our family here on earth. I don’t know if they are girls or boys, look more like me or more like Chris, if they are Lester Type A, or Wilkerson Type B. It doesn’t matter. I am deeply in love with them and would do anything – ANYTHING – for them, no matter how uncomfortable or strange it makes me feel. I am going to great lengths to get them here and for them to be healthy, and I love doing every single step of it, because I know it is for them. I take the responsibility of being their mother very seriously, and refuse to take any short cuts. I am dying to get to the day that I get to actually see them and know first hand the payoff of all this hard work. And to make their brother proud to know that this love and energy is not wasted or lost. We were destined to do this with him, and with other children, and I just can’t wait.

PGD on NBC News

NBC Nightly News just recently did a segment on PGD (Pre-implantation Genetic Diagnosis) that Chris and I are are about to do later this month. It gives the Cliff's Note's version of what we will be going through. I have to say that most of the examples of couples that we have seen use it are more just like us - couples that are either living with a very sick child, or those that have lost a child like us. NBC interviewed a couple for this clip that had different issues. I have been trying to find an online video clip of a BBC documentary that was done specifically on our PGD clinic in Detroit and on a couple just like us. So far, no luck. In the mean time, check this out: PGD on NBC

I am a walking pharmacy...

Oh my goodness!!! I got this big box of fertility drugs today and am just amazed at all of the things I will be injecting, swallowing, mixing, absorbing and the like. For those of you that knew me as I was pregnant with Noah, and how much I was into doing things holistically and naturally, this is quite a departure! It just goes to show how badly I want this, and how I am pretty much willing to do just about anything for my children. Holy cow...

The first round of shots (the Lupran on the left side of the picture) are going well. I am so far not feeling any different. For some women, it has to build in you before you notice any side effects. For others, they never notice a difference. Who knows? I am just taking each day as it comes, and today I feel pretty normal.

Giving myself shots...

I did the first one last night! Scary!! I had to take a few breaths before I did it. The needle was so small, I really didn't even feel it. It was a little itchy afterwards until the medicine absorbed. I don't feel any different (granted, this is just the first dose of many). One down, 1,325,456 more to go before the month is out!!!

The first one is of me loading up the needle with the medicine, and the second one is where I am actually doing the shot. I have to pinch an inch of my gut and stick the needle in all the way (which on this medicine, the needle is maybe only one centimeter long thank God) and then push the medicine in.