F.E.T. # 4

The time has finally come... Our 4th FET cycle. We are doing a medicated FET cycle, meaning that we are using hormones to prepare the uterus. The first step is to suppress ovulation. At least 2 weeks of daily Lupron injections is used to suppress the pituitary gland, which in turn reduces the chances of ovulation occurring unexpectedly. The next step is to use hormones to duplicate the changes that normally occur in the uterus during a regular menstrual cycle. This requires the use of two hormone medications: estrogen and progesterone. During a normal menstrual cycle, estrogen is produced by the developing follicle. This estrogen acts on the uterus to thicken and mature the uterine lining. Estrogen is given in a FET cycle for the same reason. Once the uterine lining has been thickened sufficiently, progesterone is added and the Lupron injections are stopped. Progesterone matures the uterine lining and makes it receptive to an embryo to implant. Once the progesterone has begun, there is a certain “window of implantation” during which the embryo must be transferred. The stage of the embryo must match the stage of development of the uterus. Therefore, the only factor that locks the date of the embryo transfer is starting the progesterone. Once the progesterone has begun, if the embryo transfer is not performed on a certain day, the cycle must be cancelled and a new preparation with hormones must be begun after allowing a period to occur.

Now that I've explained about the general FET process, let's get a little more specific about my FET. My December period arrived on the exact date as predicted. Yay me! My nurse was even surprised when I called her that day. So she emailed me a tentative FET calendar; I will get an updated calendar when I get my next AF. In it showed the exact date I would need to have my P4 level checked. The P4 level needed to be greater than 5, indicative that ovulation had occurred. If it's one thing I can do, I can certainly ovulate. My P4 level was 7.7, so my nurse gave me the go-ahead to start the Lupron injections. Jerry has been giving me the shots in my lower abdomen for almost a week now.

Originally, I was supposed to be on 10 units of Lupron. But I was concerned that 10 units would not be enough to suppress my ovaries. I explained to my nurse that for my 1st FET here in Pensacola, I was on 10 units plus BCP and that didn't suppress me. So my 2nd and 3rd FET, my Pensacola RE put me on 20 units of Lupron plus BCP, and that seemed to do the trick. She brought my concerns to Dr. Schoolcraft, and he said that it was ok for me be on 20 units all the way. Because I'm taking 20 units, I will need to buy another Lupron kit. I guess I'd rather spend an extra $600 (remember, we're all out-of-pocket) than for this cycle to be canceled due to nonsupression. (Dr. Schoolcraft also said that if this was a fresh IVF cycle, he wouldn't put me on 20 units, as that much Lupron would oversuppress me. However, when I went through my 1st IVF cycle here in Pensacola, I was on 20 units and I still ended up with OHSS, even though I was on only 75 units Follistim and 75 units of Repronex. I shouldn't have developed OHSS but that's another story...)

I get another calendar once AF arrives. Estrogen replacement therapy will usually start on the 3rd day of the cycle. I am using the Vivelle patches for estrogen. Instead of reducing the Lupron injections by half, I will continue on the 20 units. I will replace the Vivelle patch(es), every other day. Before increasing the number of patches, I will have a blood test to check my E2 level. A doppler ultrasound and another E2 level check will be done before adding the progesterone (Prometrium vaginal suppositories) in addition to the Vivelle patches. Once progesterone is started, Lupron is stopped. As our embryos are frozen at the blast stage, the embryo transfer will take place on the 6th day of progesterone.

So the next step is to wait for AF to arrive. Let's just hope the hag shows on time so we can get this show on the road!


Clarification on the number of 'normal' embryos

My last post was a bit confusing, especially the part about the number of normal embryos. It's very difficult to gather my thoughts and type these days.

With my 1st IVF here in Pensacola, we had 18 embryos. 17 of which made it to Day 3 for the biopsy. Our RE told us that he will screen for 13 and 15 specifically, as DH has the Robertsonian Translocation 13;15. BTW, this RE was the one who had Jerry karyotyped in the first place. Anyway... As I developed severe OHSS, it was a freeze-all. So the 8 'normal' Day 5 embryos were frozen the old-fashioned way. (The reason I say Day 5 instead of blasts is because this RE didn't check if they were actually blasts and did any embryo grading. We didn't find this out until after our 3rd FET with him.) So we had 8 'normal' Day 5 embryos in the freezer waiting for us. There were 5 boys and 3 girls.

My 1st FET was canceled due to nonsuppression.

My 2nd FET, the RE transferred 1 embryo. Because we already knew the sex of the embryos, we were given a choice on which sex to transfer. We really didn't care as long as the embryo was healthy. So we did a eeni-meeni-miney-moe thing and chose a girl. We figured that the girl embryo might not survive the thaw, given the odds of the freeze-thaw process. He said that if the first embryo that they thaw didn't survive, he'd go back and thaw another one until he got one that he could transfer. We were pleasantly surprised when this RE told us that everything is A-OK for the transfer. We thought, wow, first one thawed and everything is ok. We thought we beat the odds. Before he actually transferred the girl embryo into my uterus, I asked him one last time if this embryo was a healthy one. He assured me that the embryo was healthy. The transfer took place, the embryologist popped his head in the room just long enough to practically throw us a picture of the embryo. BFN.

My 3rd FET, the RE transferred 2 embryos. This time, we picked 2 boys to transfer. Whoa, we lucked out again that the next two embryos made the thaw. We thought that we beat the odds on the thaw yet again. Again, I asked if the embryos were healthy. And again, he assured me that they were. After the transfer, the embryologist tossed us a pic of the embryos. BFN again.

I compared the pics of our embryos to the ones on the Internet. I am not an expert, but clearly our embryos didn't look like normal healthy embryos. I had so many questions. I asked the IVF coordinator if this RE ever had any success with FETs. She put me on hold for a couple of minutes to look it up. She said that there were no successes as of yet. Then I asked her questions about our embryos. But everytime I would ask her a question about the embryos, she would tell me that she had to ask the RE and would call me back. I never did get a call back. So I called and requested a re-group with the RE.

At this re-group, I specifically asked the RE about the embryos qualities. I even showed him the pictures of the embryos and asked him to tell me if he thought the embryos looked "healthy." His answer was that he couldn't tell by the pictures and that he'd have to talk with his embryologist and get back to us. I also asked him if he did assisted hatching. Again, he said that he'd have to ask the embryologist. Then I brought out the PGD-FISH report on the 17 embryos. I pointed out that 13, 18, 21, X, and Y chromosomes were tested and asked him why wasn't 15 tested, knowing that Jerry has a Robertsonian Translocation with both 13 & 15. He said something about the percentage of the sperm having both 13 & 15 is very low or something to that effect. His answer didn't make sense to me at all. Then I asked him what he would recommend as the next course of action, being that we had 5 'normal' embryos left. He said for us to do another FET, possibly transferring all of them. I also asked him if he's ever had any success with FETs. When he said yes, I told him that I asked his IVF coordinator the same question and that she told me no. We left the office numb.

That evening, the RE called me. By this time, I even had more questions for him. I asked him if the embryos that he transferred were expanded blasts. What he told me made my heart sink. He told me usually healthy embryos re-expand within 7 hours. However, ours didn't re-expand. But he decided to transfer them anyway; he hoped that they would do better in the uterus. I was thinking, how could he tell me (with a smile on his face) that they were "healthy"? Not once but twice, each time before transfer. I was so hurt that he basically didn't tell us the truth.

The next morning, the embryologist called me. I asked him about the embryo grading, and he said that they were very good quality. I tried to get him to pinpoint down a specific grade, but he couldn't tell me. He told me that he didn't have my chart in front of him. Um, then how could he remember that they were very good quality? Interesting. I asked about assisted hatching, and he told me that he always does assisted hatching on frozen embryos. I was confused, as I thought assisted hatching was already done before doing the biopsy. I mean, don't you have to poke a hole in the shell before removing any cells? So if that's the case, would doing it again be detrimental to the embryo? Ugh. It's been over two years, and I'm still thinking about our experience with the first RE here in FL. I've prayed about it many times, but I just can't get over the sorrow of our going to this RE and not giving our embryos the best chance at life.

About a week later, we had another question, so we called the IVF coordinator. Guess who's no longer working at that clinic? Yep, you guessed it. The IVF coordinator. So we decided that we didn't ever want to go back to this local fertility clinic. That left us in a predicament. What will become of our remaining 5 frozen embryos? Finding CCRM in Denver was a Godsend. We had the 5 frozen 'normal' embryos transferred to CCRM. They will be thawed in conjunction with my IVF #2 (July '08 at CCRM). Three of the 5 embryos didn't survive the thaw, so we never found out if they were normal for both 13 & 15. The two that survived the thaw were re-biopsied and sent with the 23 fresh Day 3 embryos from IVF #2. Of the two frozens, 1 came back normal for 13 & 15 and the other came back no result. Both were re-frozen (vitrified this time). Of the 23 fresh embryos from IVF #2, 7 came back normal for 13 & 15. Only 1 made it to blast to freeze and we transferred 2 grade AA blasts. BFN.

Then with this latest IVF cycle (#3), we had 22 embryos. However, 15 embryos made it to the blast stage for biopsy for CGH. Out of the 15, 8 came back abnormal and 7 were no results. So we had the 7 no results thawed and re-biopsied for FISH analysis. Out of the 7, only 1 came back normal for 13 & 15.

So to date, we have a total of 5 frozen blasts, 3 of which are normal for 13 & 15 and 2 no results.

Whew, that was a long story. But I felt the need to clarify.


FISH results

To re-cap, in November 2008 we had the cells from 15 blasts sent for CGH analysis. There were 8 that came back abnormal and 7 with no results. The 7 NR embryos were biopsied again and sent for FISH testing (13, 15, & 21). Only 1 came back normal. We didn't have any abnormalities with 21, but I wanted it screened anyway. The embryos that came back abnormal had something wrong with either 13, 15, or both.

So we have in the freezer three frozen blasts normal for chromosomes 13 & 15 and two no results (even after 2 different biopsies). The first normal blast is from the July 2006 IVF/ICSI/PGD-FISH cycle here in Pensacola. It's been through a lot, so we're not sure if it will survive the thaw. It went through its first biopsy (FISH 13, 18, 21, & sex chromosomes) on Day 3 here in Pensacola. Then it was grown to the blast stage and frozen the old-fashioned way (slow freezing process where the embryologist had to draw out fluid before freezing). The Pensacola RE didn't screen for chromosome 15, so we couldn't trust the FISH results, as we know that there is a known genetic issue with both 13 & 15. After almost 2 years in storage at the Pensacola RE's clinic, it was FedEx'ed to CCRM in a nitrogen container. Then it was thawed, re-biopsied (for FISH analysis #2 - 13 & 15), and re-frozen (via vitrification). So that blast is normal for 13, 15, 18, 21, and sex chromosomes. The second normal (FISH 13 & 15 only) blast is from the July 2008 IVF/ICSI/PGD-FISH cycle at CCRM. It only went through one biopsy (Day 3) and then vitrified on Day 5. Our third normal (for 13, 15, & 21) blast is from our latest cycle - the November 2008 IVF/ICSI/CGH/PGD-FISH cycle. It went through its first biopsy (Day 5 trophectoderm biopsy) for CGH (no result), vitrified, thawed, second trophectoderm biopsy (for FISH 13, 15, & 21), and then re-vitrified.

After 3 IVFs, we have 3 'normal' and 2 'no results' frozen blasts. I am saddened that after all we've gone through ... 3 IVFs (PGD-FISH & CGH), 3 FETs, ~190 injections, 1 8-day hospitalization (due to OHSS), 1 HSG, 2 hysteroscopies, 1 endometrial biopsy, 2 DNA karyotypes, Cystic Fibrosis screening, Fragile X screening, 1 transrectal ultrasound (DH is a trooper), ~35 dates with the dildo-cam, countless blood tests, 87 eggs retrieved, 69 mature eggs, 63 embryos that were created... now we have only 5 to work with. I am sure that we will be punished for that one day when we have "the talk" with God. But I am so desperate right now to have our genetic child(ren) that I am willing to risk extra time in purification in Purgatory or even going to Hell.


I'm back...

As you may know, I've taken a hiatus from blogging, as I haven't been "together" enough to post my thoughts and feelings coherently. Everytime I start to blog, I would bawl my eyes out. I find that this past cycle is so hard to "get over". However, I don't think one ever "gets over" a failed cycle. Instead, one finds a way to move on. I guess technically, my last cycle wasn't a failed cycle - but I feel so down in the dumps about it nonetheless. You would think that after 3 IVFs and 3 FETs, I'd be used to this by now. After each cycle, it gets harder and harder for me to cope with the reality of our situation.

My husband and I have been keeping to ourselves lately. It's just so hard, especially pretending that everything is ok and putting on a fake smile for everyone. Christmas was extremely hard. We forced ourselves to go to Mass on Christmas Day, where it seems like everyone has a little one or two or more or they are either expecting. It took everything I had not to cry in the middle of church.

I'll post details of the FISH analysis later, probably tonight if I can stop crying long enough. Right now, I just want to let you all know that I'm having a really, really rough time and to please forgive me for not updating sooner. And I thank you, from the bottom of my infertile heart, for your comments, emails, and PMs. I will get to each and everyone of your blogs and catch up.