Don't count your chickens before they've hatched

Two days post six day embryo transfer (2dp6dt)

'Having a baby is like getting a tattoo on your face. You really need to be certain it's what you want before you commit.' 
Elizabeth Gilbert 

From my last post up until 8:45am on Wednesday 9 April 2014 everything had been going tickety-boo. I've actually got three blog drafts saved that I'll never publish - they're going to remain drafts. In these drafts I've babbled on about The Lister hospital experience and compared it to a stay in a 5* hotel, with room service, great food, Molton Brown goodies and Sky TV. The only difference is you do actually have to go down to theatre and have a general anaesthetic and the nurses check in on you every 30 minutes afterwards. Below is a photo of me a few hours after egg collection, my blood pressure was very low at that point but I was overcome with joy when the food arrived - I was very hungry and I inhaled the lot. It was delicious!

Egg collection via general is FAR more civilised and I thoroughly recommend it. They managed to get 13 eggs, 10 were mature, six fertilised. Yep - we had six mini-mes and apparently fertilisation was easy - to quote the embryologist I spoke to three days post egg collection: 'Very easy fertilisation, in fact so easy I'm surprised you went for IMSI, from what I could see you would have been fine with straightforward IVF - the sample was grade 1 sperm. Your eggs were also top quality.' 

All six of our mini-mes were going strong on day three so we enthusiastically agreed to go for a day five / blastocyst transfer. We got a call on Tuesday from one of the embryologists telling us that four of our mini-mes hadn't reached blastocyst stage - they were what they called morulas - the other two were a wee bit behind but we should give it another day and give them a chance to develop a wee bit more. Again this was fine, day six transfers are perfectly normal. So when I got a No Caller ID phone call at 8:45am on Wednesday morning I answered the phone with dread - I knew instantly that it wasn't going to be good news. Four had arrested in development and two were developing slowly but were showing signs of becoming blastocysts, they were at the cavitating morula stage of development. We were advised that we may have to cancel the cycle.

NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 

HOW CAN THIS BE?

OUR EGGS AND SWIMMERS ARE GOOD? TOP QUALITY YOU SAID.

WHAT WENT WRONG?

The room started spinning and I felt sick. I immediately got on the phone to my Bessie who is travelling in Europe (what would we do without Apple and FaceTime/Viber/WhatsApp? We are in the age of the smart phone and I would be 100% lost without mine).

My Bessie calmed me down, so I could calm my wonderful Hubster down. We were going to go to the clinic, talk to Dr Wren, and I was positive that we were going to transfer. Just because our mini-mes were a bit slow doesn't mean they won't stick. But the journey there was the longest its ever been and it was the most quiet we've ever been. We were supposed to be excited but we were scared.

I was hoping to see my consultant James Nicopoullos but he was on holiday so we saw Dr Wren instead. She was in the main nice but my god she was also VERY blunt. To cut a long story short she said: 'you didn't get pregnant with a 5AA blastocyst so you're not going to get pregnant with these.'

BOOOOOOM - kick me us both in the teeth when we're down why don't you? Up until that morning as far as we were concerned we were on track for a single embryo transfer and hoping to be able to freeze two or three embies for later, but now you tell us four have died and we will need a miracle for the others to progress. A little sensitivity wouldn't go a miss eh? I appreciate that you are a scientist and see everything in black and white but look after your patient's emotions, you work in the field of infertility - by the time ladies have come to you they have been through years of trying for a baby - they're desperate - you're their last hope - your patients have invested EVERYTHING into this process so be mindful of their hearts. You should know better than to say something like that, especially someone in your position. Our mini-mes weren't dead, they were slow, so whilst they are still growing (albeit slowly), there is still hope (even if it is only a glimmer and a miracle is needed).

We took five minutes, we went outside, I called my Bessie on Viber. I didn't know what to do. I felt like I was drowning. On the one hand I have this doctor who I had never met before telling me in no uncertain terms that there is no point in transferring our last two mini-mes (but she'd do it if I wanted her to, the choice was mine), on the other hand I wanted my mini-mes in my womb. I wanted them with me, they'd be better with me than in a petri dish, they belong with me. 

To be told that the only way forward was to abandon your cycle is a million times worse than getting to test day and having a negative. Trust me - I know. I've had a cycle not even let me get to test day and end in a very heavy, painful bleed. I've gotten to test day and got a negative and now I've been told that my cycle is being abandoned and there's not much hope in your remaining embryos progressing - in fact there's no point in transferring. Out of the three scenarios the third is the worst - take my word for it, it sucks.

I felt winded. 
My legs felt weak. 
I was confused. 

I cried and cried and cried. My Bessie cried. My Hubster cried. We all cried.

But you know what? My mini-mes were still going. They might be slow but they are still growing so what did we have to lose? So we transferred them and they are now with me where they belong. Here they are - the one on the left is a bit more developed than the one on the right. They are called cavitating morulas - the stage right before blastocyst.

I've read of day five and day six cavitating morulas resulting in pregnancy. Apparently they usually result in girls? I'm not getting ahead of myself and believing that next week I'll have a positive pregnancy test and I'll be carrying a baby girl - I'm not that silly. I know I need to be positive but not at the expense of dealing with the here and now and the range of emotions that comes with that. I'm being realistic. The opportunity to be cautiously optimistic was taken away from me the moment I was told there's not much point in transferring as I won't get pregnant. They took away my hope. Ladies on the Fertility Friends forum have helped give me a bit of hope, whilst you have an embryo there is always hope (but let's keep that hope in check shall we and not run away with ourselves).

Today my boobs are like rockets, they are swollen and they hurt, so much so I had to wear a sports top to bed with an in-built bra to try and stop them hurting as much. Today I have mild cramping. The hopeful part of my brain tells me that this is a good sign - my embryos would be eight days old (if they are still going), as they were a little slow off the mark the mild cramping could be implantation cramps. But I doubt it. It's the cyclogest pessaries Johanna - YOU KNOW THIS - it's the progesterone, nothing else so stop imagining you're pregnant.

We have a lot of questions.

Why in our cycle at Kings were we able to get five blastocysts but not at The Lister? Why when we were focusing on quality and not quantity were we unable to get the quality we got in our previous cycle? You told us we didn't need IMSI so why did our embryos not develop? What about sperm DNA fragmentation? Did the awful family bust-up a few weeks ago affect the quality of my eggs? Was the stress partly to blame? What went wrong in the lab? How could this happen? 

Questions. Questions. Questions.

We need a miracle. Please let our mini-mes fight and stick and prove everyone wrong.

I started this post with a quote and I'm ending with a different quote. Repressing your emotions is bad for you, and imposing positivity when you are sad is bad. Don't get me wrong - I am a positive kinda girl, but even people who are naturally positive and reject negativity have their sad days. Being sad and being negative are very different things. I'm finding the strength to acknowledge how the past few days have made me feel and I'm dealing with the tough emotions - I'm allowing myself to feel happy believe it or not. In my acknowledgment of my sorrow I can truly be happy as happiness and sorrow are two sides of the same coin. To be truly happy you must be at one with all of your emotions and you must have the strength to live in the here and now. I may be feeling sad, but I'm ok with that - as it's our emotions that makes us human. 

'Joy and sorrow are inseparable…together they come and when one sits alone with you…remember that the other is asleep upon your bed.' 
Khalil Gibran

Laters xx

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 über 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

My own harvest festival

Egg collection and after affects round up

Egg collection was on Wednesday 30 January 2013, its now Friday 1 February and I'm spending another day in bed - oh what I'm going through to get a mini-me - but I'd do it all again - in a heartbeat.

So on EC day I was super calm, chilled and if anything not nervous but EXCITED - really excited. This was the day that the Hubster's DNA and my DNA were going to join to make mini-mes - what's not to be excited about?!

I got told off for admitting to taking a sip of water by the embryologist but we were still allowed to go ahead with the procedure. I won't lie to you - it hurt like a MoFo but I was out of it at the same time so I only remember snippets. The Hubster stayed with me throughout, I have vague recollections of him stroking my hair throughout the whole process. I had a heartbeat monitor and not at any point did it increase, it was a nice constant 70bpm, even when I was told to "take a deep breath in" and then I felt a hot, sharp stabbing pain around my womb / ovaries. The hypnotherapy CDs are obviously working - being relaxed and positive is the name of the game so if you are going through IVF yourself, please chill (and if all else fails, listen to The Orb's little fluffy clouds - works every time - you're allowed to take your iPod in with you if need be, if it helps - do it!!!) I know I bled as I felt them clean me up. I don't recall saying this but every time the embryologist said "deep breath in" I said "no pain, no gain." I winced but I wasn't a pansy and I breathed. This was after all one of the most exciting days of my life. What I'm really chuffed that I remembered was seeing MY EGGS on the big fat plasma screen - I am soooooo glad I was with it for that as it was 100% awesome - there were loads of them! Screw the pain - this is so worth it.

Anyhow, in recovery I zonked out and slept on and off for about an hour. I could hear a lady in the neighbouring cubicle crying her eyes out prior to her EC - if my head wasn't as woozy and my legs worked I would've gone in there, given her a big hug and would've tried to change her fear to excitement. I can't see how getting yourself in such a tizz is going to help matters? Anyhow - I hope the sedative helped her chill - it most certainly did me and I felt the after affects of it for the rest of the day.

The long and short of it is: I had far more than 26 follicles by the time the embryologist started having a rummage (my ovaries obviously went into overdrive last weekend), they got 18, yes 18 eggs (woo hoo) and Hubster's swimmers stood up to the test and did us proud. Another embryologist came to see us once I'd come round from the sedative in recovery and told us that at least 9 of my eggs would be fertilised via ICSI and 6 via conventional IVF. As per the most recent swimmer analysis, the Hubster's swimmers were on the cusp of ICSI/IVF so why not treat them like that and do a combo? Brilliant, the staff at King's really are amazing and I am in awe of them. How cool would it be to tell people that you're an embryologist? Far more exciting than saying you work in Marketing - I really wish science had been made a lot more appealing when I was at school as I now find it all fascinating. I'm going to make it my mission to get my mini-me(s) interested in science and with a bit of luck they'll go one to do something as amazing as this.

Anyhow, I digress, do you want to know what the different is between ICSI and IVF? ICSI stands for: Intra-cytoplasmic sperm injection. This involves injecting a single swimmer directly into the egg to fertilise it - so the swimmer is given a helping hand. Here's a picture to show you the science bit - seriously - these guys are amazing for being able to do this:

Conventional IVF stands for in-vitro fertilisation, this literally means fertilisation in a glass - here's another picture for the science bit:

I am very chuffed that we are having both, the staff at Kings are keen to keep the whole process of baby-making as natural as possible so we have been lucky enough to have the best of both worlds. This however is where my frank honesty of how many eggs and swimmers successfully fertilised ends; I want to keep this private and don't really want the amount of embryos we have currently dividing away out there on the internet (you can understand that hey?) What I can tell you is that we have mini-mes growing in a petri dish and the embryologist called saying "I have amazing news" and it was amazing - lockdown was worth it and I am so excited about everything (despite feeling like a big fat pile of steaming poo). We're booked in for embryo transfer (ET) at 10:30am tomorrow morning (Saturday 2 February 2013). This would be a three day transfer, I'm hoping our little mini-mes stay strong and keep dividing evenly so they can get to blastocyst stage and we can have a five day transfer.

Here's a bit more science: check the image below to see how embryos develop. If you look at the very first embryo picture that has just two small circles in it - these circles represent the DNA from the mother and the father - how cool is that?! I figure that our mini-mes are currently at the eight cell stage, awesome, awesome, awesome. With a bit of luck the progesterone pessaries I'm now on will help one of my mini-mes implant in my nice, think womb - a blastocyst implantation is the aim.

Since my EC I have been feeling rough. The bloating I had with the HCG trigger shot has increased, I look about six months pregnant. It seems I have mild OHSS, it's quite uncomfortable and painful, I've felt queasy and have had some terrible trapped wind! Kings are checking up on me daily, I have a jug I need to pee in and I need to drink at least two litres of water / juice / tea  etc a day, and I need to monitor my pee output. If my output declines rapidly I need to get myself to Kings quick sharp, if I start to feel breathless I need to get to A&E. I feel like crap but I'm still über optimistic - it is what it is and it will go soon enough - its just one of those things. I had yesterday off sick and I'm off sick again today - I was supposed to work form home but sitting up at a laptop for long periods of time is very uncomfortable (this post has been written in segments). Kings are calling me daily and they are concerned and keeping a close eye on me but I figure it'll be gone soon enough and I'll have a mini-me inside me :)

So that's it from me today, despite feeling like poo this is quite possibly the most exciting time of my life.

Catch ya later :) x