Saturday, September 12, 2009


Sorry to keep so long with the report on our consult (if anyone was on the edge of their seat ;-) I wasn't home yesterday evening so I couldn't write it up.
Sure, mobile internet connections exist, but I don't have a subscription since they're frightfully expensive here.

The consult went very well. I had given my RE a heads-up of what I wanted to talk about a few weeks ago, and not only had he remembered but he was prepared!
I had a note with my questions, and he had a note with the essentials of my file. Another reason I like this doctor.

The statistics:
About 30 out of 100 of women get PG if they transfer a single embryo in a fresh IVF cycle.
About 40 out of 100 get PG with 2 fresh embryos transferred. Of these 40, on average 1 in 4 will have twins.
I forgot to ask, but I think these are successful pregnancies, with take-home babies.

We talked about complications with twin PG, but I didn't press for statistics. The reason being that my husband and I consider the odds of 1 in 4 rather steep.
Given my age (early thirties), the top quality embryos we had in previous cycle and the fact that we already had a successful PG after IVF, the doctor thinks our odds of having twins would in fact be higher than 1 in 4.

The doctor remarked that FETs don't appear to be our thing, before I even asked, and that he understands the temptation to do a double embryo transfer next time. He would support our decision either way, but generally he would advise doing one more single embryo transfer first. After all, our stats our one successful and one failed SET, which is pretty fabulous.

About FETs, I asked about freezing at day 2 or day 5 in stead.
As I thought, the problem with day 2 is that they can't really tell the quality of each embryo yet, and therefor can't select which would be the top embryo to transfer. Since our best chance is with the fresh transfer, we should make sure we transfer the best one(s).

Day 5 is another option, which they have ample experience with. By day 5, they can really tell which embryos are of the highest quality and straight after transfer the embryo is ready to burrow itself into the womb. The problem is that far less embryos make it to day 5 in vitro. Generally, they propose this option to patients who have 8 good embryos or more on day 3. We had 2 and 3 good embryos on day 3 in our respective IVF cycles. We could ask to attempt a day 5 transfer anyway, but unless we were to have significantly more good embryos on day 3, I'm not keen to take the risk. Having nothing to transfer after all the effort is pretty depressing.

In conclusion, we're doing one more single embryo transfer (if given the chance, knock on wood). After that, it's double or nothing!
If next time there are only medium quality embryos, we transfer two. I didn't ask about transferring one good and one medium (not-freezing quality). I'll ask that at the next blood draw or u/s.

So, I've been swayed, not because transferring two would be a wrong decision, it just isn't right for us. Not yet.

Thanks for your support and helpful suggestions. We didn't discuss changing the protocol, perhaps we should have.
A vitamin boost for my husband can never hurt (or me), but aren't we too late to improve semen quality? It takes about 2 months to make them, if memory serves, and I hope our retrieval will be at the end of Octobre. Hm, maybe still just in time. I'll have to make smoothies every day though (yum!), my husband never eats fruit on his own (feel free to roll your eyes). And then there's his smoking ... (strictly outside and against my known disapproval).

Thanks for the comments and tips! Next step is picking up my meds at the clinic. Baseline u/s is scheduled for mid Octobre.

Tuesday, September 08, 2009

We interrupt the waiting for a brief burst of activity

This Thursday I have a consult with my RE, for a Q&A session (I hope).

When I walk out of his office, I want to know whether or not to do a double embryo transfer (if two are available) in our next fresh cycle.
I'm leaning towards "yes, definitely!". But I'd like to know the twin rate and associated risks, if only to keep me awake at night fretting.
To be honest, I don't know if knowing any of this leads to better decisions. Either I go ahead with it, and naively assume it won't happen to me (twins, complications). Or I don't, and regret it later if/when another fresh cycle fails and the FETs crashland.

I also want to know if there's any point in changing the freezing protocol. What if we freeze at day 2 or try to make it to day 5?
3 frozen embryos failing to thaw is not enough to draw conclusions. However, at our current rate, we're never going to make near enough to do so. I've lost my belief in FETs working for us.

Which brings me back to DET. Yes, definitely.

I don't know what DH is thinking though. He's the quiet type, and usually clams shut tighter if prodded. Which is why I'm insisting he comes tot he consult with me.

Having twins is a daunting idea to me. It's daunting like driving my car in morning rush hour on the highway, I don't know where to look first and in the corner of my eye I see one near-collision after another (real or imagined). Experienced twin parents may feel I'm overreacting, and I sure hope I am, but that's how I feel.
I'm also concerned whether it would push my husband and me over the edge.

Any tips on what I could ask our RE?