Wednesday, 6 February 2013

The final countdown

Embryo Transfer and the dreaded two week wait

Tuesday was ET day, it was a very exciting day and it pretty much marked a conclusion to our IVF treatment; after waiting for so long and then diving headlong into it, and then feeling rubbish (but very upbeat) throughout, would you think it strange if I told you I found this a little sad? Probably!

We got the call from our embryologist around about 9:30am on Tuesday to tell us we had one ├╝ber top grade blastocyst for transfer and we have a few for freezing, all good quality blastos but the best with the highest possibility of implanting would be meeting me later. Whoop whoop. Despite having quite a few good quality embryos at the three day stage you always worry that they may not live - it has happened but I was ecstatic to hear that ours were still fighting. I gave verbal consent for them to be frozen - we have some babies in the bank so to speak.

Our appointment was at 2:30pm, you need to have a full bladder for ET as it helps the doctor place the embryo in the right section of the womb (the bladder helps flatten out the womb so when it comes to inserting the catheter into your womb - it practically goes in a straight line). Given the sheer amount of liquid I've been drinking to try and beat the OHSS this wasn't a problem, however - we didn't get seen until 3:30pm - I was full to bursting!!! Like egg collection (EC) day, you need to ensure that you're not wearing any makeup (including nail varnish), perfume - anything smelly and the same goes for your significant other - embryos don't like it so you need to make sure when you are going for EC and ET that you are there as God made you. 

ET doesn't hurt and is much like a smear test as it involves a speculum, unlike having a baseline scan you have an ultrasound - it's via the ultrasound the team can see where to transfer the embryo. There were a legion of people in the room with us: the doctor doing the transfer, two other doctors, a trainee doctor and the embryologist. Initially a lovely, petite Indian lady doctor was supposed to do the ET but when I walked into theatre fully gowned up, I was asked if I minded another doctor doing the ET as he wanted try a new softer catheter (a more senior doctor obviously pulled rank)? I didn't really care who did it, as long as they did it properly and got my mini-me in my womb safely - this doctor seemed like he knew how to do the job! You can't be shy if you're having IVF, your foof is on show for everyone to have a look at. As they were trialling a new catheter we had a mock transfer first, this is fine, do as many practice runs as you like as long as when it comes to the real thing - it's done correctly (I didn't doubt the doctor's competence at any time btw). Yes ladies - you can't be shy about this; imagine you are on a dentist like chair with you legs in stirrups, much like a smear there's a speculum and it's clamped in for a good while, your chair is then winched up and there is a bright yellow shining light beaming at your foof where both male and female doctors will be having a look, all to ensure the safe delivery of your mini-me. This is what ET is like! The bonus of all of this is we not only got to see our mini-me hatching out of it's shell in the petri dish on the big plasma screen just before transfer, but we also saw it being inserted into my womb (not very clearly, but you could see it). This was awesome (and it brings a tear to my eye when I think about it - absolutely amazing).

A day five hatching blastocyst - this is what our mini-me looked like before transfer, ripe for attaching and implanting (fingers crossed).



Kings ACU use the Gardener scale for grading Blastocysts, the stage of development of the blastocyst(s) is graded from 1 - 6, and the outer and inner cell masses are graded from A-C. The inner cell mass forms what will become the baby (this is what you can see hatching out of the picture above), the outer cell mass or trophectoderm will become the placenta. The stage of development and quality of the outer and inner cell masses is scored as per the tables below. I've included this technical shizzle as it can be hard to remember everything as and when you're told it due to adrenalin, and given how you are positioned in theatre.

The Gardener blastocyst grading system assigns three seperate quality scores to each blastocyst embryo:

  1. Blastocyst development stage - expansion and hatching status
  2. Inner cell mass (ICM) score, or quality
  3. Trophectoderm (TE) score, or quality


Expansion
grade
Blastocyst development and stage status
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


ICM grade
Inner cell mass quality
A
Many cells, tightly packed
B
Several cells, loosely grouped
C
Very few cells


TE grade
Trophectoderm quality
A
Many cells, forming a cohesive layer
B
Few cells, forming a loose epithelium
C
Very few large cells

What I am really pleased to say is that our mini-me is a grade 5AA - this is the best type of blastocyst that can be transferred, and from what I understand is a bit like gold dust in the murky world of IVF/ICSI. Grade 6 blastos need to hatch in the womb so I was pleased as punch to see that we now have the best possible chance of success, our mini-me was ripe for implantation, fingers and toes crossed.

Test day is Friday 15 February 2013: gulp. 

This is nine long days away. I am so looking forward to that day but it also scares the be-jesus out of me. It's REALLY hard not to dwell and over analyse every twinge (Google at times can be your own worst enemy). Those cramps I can feel, are they implantation cramps or is it my ovaries groaning with the last bit of OHSS or is it the progesterone pessaries? Questions, questions, questions. And it's because of all these questions, lack of activity and waiting that make the two week wait (or the 11 day wait for a five day transfer as in my case) the hardest part of IVF: am I pregnant or not - please somebody tell me!!! BUT one must wait patiently for the outcome of one's endeavours. There's no point in testing too early as you could get a big fat positive (BFP) due to residual HCG being in your system from the trigger shot done 36 hours prior to egg collection. I know of a friend who tested too early and got a BFP, and then ended up getting a big fat negative (BFN) when it came to test day. I can't put myself through that so I shall have to be patient and wait until the morning of 15 February.

I haven't worked out how I will tell people yet, what I do know, if its a BFN I'm not going to want to talk about it and I won't want to have to repeat the news, and I will crumble but for the minute the Hubster and I remain hopeful. Hopeful that our mini-me is bedding down for some VIP womb action and at the moment it feels like that might be happening but only time will tell, as I said - it could be anything. We have done everything humanly possible to make this work and we have a great chance of success but there are no guarantees.

So I'm signing off for now, the next nine days are going to be long but this is where my IVF Belief CD comes into it's own. The third and final message is about deep relaxation and positive visualisation and it really helps me chill and focus all my positive energy to my womb and our mini-me. I'm going to be listening to it lots. Please sprinkle oodles of baby dust our way and pray we get the result we so want.

Catch ya later :) x

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