WHOOOOOOOOOOOOOOOOOOOOOOOOOOOOSH!
A big choco-minty breath of relief at being home home home again. I like being home. I like my house and my normally sized, suitably firm bed (a double, my chickens, Steve and I have been sharing a squashy mushy DOUBLE bed for 15 days- good lord) and my books and my bathtub and the zillion little things we own that keep Patrick (and Steve) busy all day, which in turn allow me to spend my valuable time reading blogs in relative peace.
So this is my big IVF season finale, complete with the irritatingly long cliff-hanger as ShdGrv does not do beta pregnancy tests until 18 days after retrieval which is still 10 days from now. I just happened to find a few pregnancy tests lying around in the ol' pregnancy test drawer so I took one last night (faintest faintest faintest whispery trace of the shadow of the thought of a line) and another today (nothing) just to be more or less certain that the hcg from the trigger shot is out of my system. That way if I happen to accidentally take another home pregnancy test between now and the middle of February, well... it gives me a starting point.
Then There Were Two:
The reason I was so exuberantly excited about having six normal embryos on Thursday is that by Friday's transfer we were down to three, two growing blasts and a poky-but-still-growing-morula. Even using the New Math you can see that much less than six would have been problematic if the 50% decline between days 4 and 5 was to be expected.
My big fear from the moment we committed to doing this was that we would go through all of the shots and the money and the travel and the blood draws and the ultrasounds and find ourselves on transfer day with absolutely nothing to show for it. I would have been bitterly disappointed to come home without any hope at all and I am so grateful that this was not the case. Somehow it seems to me that putting some distance between ourselves and the process will make a negative easier to deal with. I mean, my god, yes I will be disappointed if this cycle does not turn into a baby but I am just so damned gleeful that it still MIGHT that I feel... lucky. Lucky to have gotten this far and fortunate to be hopeful.
My RE was half an hour late for the transfer which would have been fine if they had not instructed me to drink 32 ounces of water in preparation for The Big Event. By the time he was 20 minutes late I was actually in PAIN so the nurse let me use the bathroom provided I only peed "a little." In fact, she told me to count to 6 and then stop, a feat I accomplished but one for which I think I deserve some kind of medal. Perhaps a golden cameo of Mannekin-Pis... we can work on it.
Anyway I peed just enough but not too much and it helped some. I have to say, though, that I was still in no shape to be making critical decisions like how many embryos to transfer: "I DON'T CARE! I HAVE TO PEE! Put in 1! Put in 40! Put 'em in my purse for all I care but just for the love of god let me go to the bathroom!" They make such a big fuss about not making any important decisions for 24 hours after anesthesia and yet there is no AMA recommendation for women waiting for an abdominal ultrasound. Another glaring Failure of the System.
Anyway, our hope all along has been to transfer two nice healthy blastocysts and call it a day, so we were superthrilled to discover that we had two plump ones still in the cooler. As the doctor went over the embryo report, he praised their inner cell masses and cooed over the fact that their growth had not been slowed one iota by the biopsy for PGD (as is so often the case.) In short, these were dream blastocysts and both were duly issued passports to the Funland that is my uterus.
Great, I thought, now I can urinate without the added stress of counting.
Imagine my surprise when the RE wanted to talk about the possibility of transferring the third embryo as well, the morula* that looked good.
Which is when we got down to the statistical probabilities that make IVF what it is, a big old crapshoot. I believe the norm now (in the US) is to transfer 2 embryos to women aged less than 35 and 3 embryos for women older than that. This is not because women over 35 are better equipped to handle triplets, or their brains are softer so they are oblivious to the risks associated with high order multiples. No, it is because at 35 a woman's chance of having all three embryos implant crosses her chances of NOT having either of two embryos implant and it becomes statistically appropriate to err on the side of being more aggressive if pregnancy is desired. You dig?
People with balanced translocations (and/or the people who screw them) have IVF success rates that are half of what is seen for their age group, even after PGD. 50% chance of pregnancy? Try 25%. 1 in 5 chance of success? Make that 1 in 10. So I guess it was perfectly appropriate for him to say, "Let's talk about how many to transfer."
I was gritting my teeth and muttering "Need. To. Pee." so I merely stuck out two fingers like 'V' for Victory.
"Two?" he said, all surprised. "I'd like to put the possibility of three on the table."
But he promptly retracted that as he read through the embryology report and started talking to himself about it. For, you see, it turns out that I am an IVF superstar. A veritable Thackery of assisted reproduction. Of the 15 embryos that were biopsied, 11 made it to blastocyst**. I know! Granted, 5 of those were genetically abnormal and only half of the 6 that were good made it all the way through Day 5 but still... the medical conclusion was that I rock. He pointed out that this was quite possibly statistically one of the best balanced translocation cycles they had ever seen and he had no idea why he had suggested three. I told him, in complete sincerity, that I would rather wind up with the disappointment of not being pregnant than deal with the possibility of a triplet pregnancy. Besides, I said, that morula is probably skeevy. So he withdrew the suggestion and we agreed that if the morula made it to blast on Saturday we would freeze it. And they transferred two. And then I was allowed to go to the bathroom. And it was good.
Having said that about embryo transfer, I would like to add to anyone who was ever in the stirrups and chose to transfer more than 2 or 3 or 4 or 16 that I have complete and absolute faith that it was the right decision for you. It gets down to tiny probabilities and how this embryo looks and what that embryo did on Day 2 and what your periods were like at 15 and if I ever said, "I would NEVER transfer more than two" I am asschunder and I am sorry.
Anyway, they called a couple of hours ago to tell us that they were not able to freeze the third embryo after all. Since it was skeevy. So it all comes down to two. Which is pretty damn good, I think.
I have long since given up on the notion that I am psychic, that I can predict pregnancy outcome (or in this case pregnancy occurrence) on the strength of my intuition alone. Nor do I think that I am owed anything by the universe or, alternately, that it would be unfair for me to have a first IVF cycle succeed. I just don't believe the world works that way- why, the sun do shine on the just and unjust alike. So I have no idea what will happen with this.
Do You Speak The Language?
Harvest:
For the first week we were in DC everyone kept asking when they were going to "harvest" the eggs. I kept saying "retrieve" and they kept saying "harvest" and I cannot tell you why I found this so icky but man! I really really did. Particularly my mother-in-law asking, "Are you going to let them harvest all of your eggs?" and "When do you get harvested?"
It made me feel so... agricultural.
Implant:
About a billion years ago Lisa, the Brooklyn Girl, talked about a magazine article in which the author attempted to tackle IVF without bothering to first acquire a clue. She (Lisa) seethed over her (the author's) misuse of the word "implant" over and over again. At the time I clucked sympathetically and now it has become my own personal bete noir as well. They do not "implant" embryos, they "transfer" them. If they could "implant" them, you see, it would solve a whole fuckload of problems because, you know, the embryos would be implanted in the uterus and they would then just grow and ultimately become productive members of society. So the only people who were unfortunate enough to produce embryos and yet still have a failed IVF cycle would be the yumnuts whose REs' implanted the embryos in, like, their spleen or colon or something.
And if you made this mistake on my blog in the past few weeks I am sorry, I am not talking about you. My mother, whom I love dearly, just could not wrap herself around this concept and my mother-in-law.... yeeeesh.
Morals:
Are you a bioethicist? Do you have an advanced degree in bioethics from one of the few outstanding programs that exist in this country? Then shut the fucking fuck up about whether you think IVF "is morally the right thing to do." No one cares. You sound like an asshole. Oh, and, um, I still want in on the Christmas gift exchange. I am thinking a pashmina this year, my old one is sort of ratty.
In Toto
I have decided that, ultimately, an IVF cycle is not that big of a deal. I say this more to encourage my fellow translocatees standing on the water's edge than to disparage the very real suffering of my fellow IVF cyclists, but I suppose if you would like to take offense my comment button is there and my email link is there.
These were my concerns going in and here are my impressions at the end of it.
1. I was really worried about the injections but it is amazing how quickly getting shots in the ass or stomach simply become part of the landscape of your day.
2. The whole process seemed overwhelming on paper but the clinic, any clinic, does manage to shuffle you along somehow.
3. It costs an unconscionable amount of money, true. But either you decide you have it (or can find it) or you do not. Once you take the plunge there is no sense beating yourself up about how expensive it is. I found that the accounting principle of sunk cost worked nicely here. To wit:
Sunk Cost - Cost already incurred which cannot be recovered regardless of future events.
At first this seems a little depressing, right, but then you see how utterly liberating it is. That money is GONE, baby, so quit worrying about it.
4. The travel part was intensely unnerving ahead of time but we did somehow manage to travel on exactly the right dates.
5. I feel like this was a successful IVF cycle regardless of whether or not I get pregnant. We found out that about 1 in 5 of our embryos are normal and that is actually in keeping with what our experience has been. It gives us information to make future plans and I believe that we did everything we could to try to make this work. Que sera, etc. platitude, Gallic shrug.
So in conclusion: No regrets. Lots of bruises. Some hope.
*What is a morula? Someone is going to ask this and before Friday it would have been me, so here it is: Embryo development starts with a zygote. Four days after fertilization the zygote becomes a morula. The next day a morula becomes a blastocyst. After that they become teenagers. Something like that.
**Speaking of New Math, I just read this over and somehow these numbers leave us with one embryo unaccounted for but it is what he said and, you know, I REALLY had to go to the bathroom.... close enough.
