We finally got our embryo grading report! We hadn’t received any information on how the embryos were developing, and it was great to finally get a look. This embryo grading report is a lot different from the ones we’ve received in the US; but it was pretty easy to figure it out. To summarize, we had 18 mature eggs, which were fertilized and grown to day 3. One of the embryos didn’t make it, so we ended up having 17 embryos. 14 embryos were frozen after making it to day 3 as 8 celled, as you can see below (they are marked as 8bl,l). 7 embryos made it to day 5 as blastocysts, and the best three were transferred to the surrogate, while the other 4 were frozen. We were a bit surprised, because our original plan was to only grow 3 to the blastocysts stage without doing the preimplantation genetic diagnosis (PGD), as the process involves taking out a cell from the embryo, which can cause the embryo to fail, as any disturbance to the embryo can cause damage. Embryos of bad quality does not result in a baby that has issues of some sort; rather, it results in no pregnancy at all.
According to the report below, they actually grew out another 4 to blastocysts stage before freezing them. When I emailed my case manager about this, she assured me that if the transfer should fail, that we could take any of the day 3 embryos and have PGD completed, which determines if there are any genetic issues in the embryo, and also what sex the embryos are. I’m guessing that the clinic wanted to freeze a few more blastocysts in case we changed our mind about doing the PGD. Either way, we’re happy to know that we have plenty of backup embryos just in case we need to try again, or if we decide to have another child in the future.
I find it interesting that we had so many embryos from this round of IVF, where in the past, we had about 10 day 5 blastocysts, which isn’t a bad haul either. We wondered why we had so many this time, and came to the conclusion that maybe the eggs were in better shape because they let them grow out to past the usual threshold that we’ve had in the past, where they would trigger when the follicles were around the 16 – 18mm range. The last ultrasound we had showed the follicles being size 12mm – 19mm, and I had another day of stimming and the Lupron trigger, before coasting to the egg retrieval. In theory, that means the 19mm could have grown to 25mm, although I have no idea what size the follicles were at retrieval. So this is just a theory that we came up with, and we might be completely wrong, so take this with a grain of salt.
I hope you enjoyed the picture of this very pregnant guinea pig, because that is the best way I can describe my current mood. Today’s last and final scan (thank God!) began with the doctor checking out the follicle count and size. Again, I winced as she scanned my orange-sized ovaries to see our progress, and apparently, I have approximately 34 follices ranging from 12 – 19mm, so I am more than ready for the egg retrieval! In fact, I’m a bit nervous because in the US, we would usually stop the stimming after a follicle reached 16 – 18mm, but I am still going to be doing another round of injectibles tomorrow, followed by a Lupron trigger at 1130pm. Part of me is afraid of how much pain I will be come Tuesday morning, when the follicles could have possibly expanded by 2 – 6mm, but it’s all about taking it day by day. I’m scheduled to go in at 1030am for the egg retrieval, which involves going under general anesthesia for the procedure. Usually, I wake up and have a lot of pain and nausea, which in the US, they would give me some good meds for, so I have been busy trying to learn some Russian and plan to ask my case manager to make sure that I get some Zofran mixed in with whatever pain drugs they usually give thereafter. The doctor also prescribed some suppositories to reduce the inflammation, so hopefully that will give me some relief when I start on them tomorrow.
Usually when I hit the stage of few days before egg retrieval, I’m in a wonderful combo of abdominal pain, nausea, and unrelenting hot flashes, and so I’ve decided to impose upon myself some good old-fashioned bedrest until next Tuesday. When driving to the clinic, K and I sat in the third row of the van, and after a few minutes, I frantically asked K to have the driver turn on the air conditioning. I had to mentally zen myself out so that I wouldn’t throw up or bash out the side window, and decided that I would sit in the front seat of any vehicle that I rode in from this point on. Also, our hotel room is on the fourth floor, and the elevator (or “lift”, as the sign says) is broken, so we’ve had some built-in cardio for most of our time here. I honestly didn’t mind it very much until today, when I was huffing and puffing my way up the 76 stairs, and made the decision that this was going to be the last time I was going to be walking up these stairs until Tuesday, haha! Overall, though, I have to say that medically speaking, I feel like I haven’t responded to well and quickly on the injectibles in the US as I have here, so we are happy with our progress, and hope that we will have a lot of the follicles make it to day 5, so that we have a good number of embryos as a back-ups!
Today was our fourth scan, and man, did it hurt! When she started the ultrasound today, I winced in pain because I could feel that my ovaries were swollen from the follicles that are growing inside. I might’ve also been just hangry because I had to fast this morning so they could run some blood tests and a urine analysis for the anesthesiologist. By the time we got to the clinic by 1030am, I was pretty ravenous and asked Anna if I could get the blood and urine work done pronto so I could eat something, and she helped set it up right away.
Then we got called in for the doctor, and K stood by as she started measuring, and the largest one is 15.8mm, which is great! In the past cycles, I would usually trigger around 16 – 18mm, and wondered if this would speed up my egg retrieval, but instead she changed my protocol to decrease Gonal-f to 150, and upped the Merional to 225. She also started to put me on Cetrotide so that I wouldn’t ovulate early, which is what I was concerned about.
Next scan is this Saturday, but in the meantime, I’m hoping my ovaries will behave and relax so that the next ultrasound won’t be super painful. I am starting to look like a bloated fish, so I know the time is pretty near. She is still estimating next Tuesday, which seems far and close at the same time, haha.
We also asked if they would do ICSI, and they said they would. I also asked how long it would delay the embryo transfer to do PGD on all of the embryos. She recommended that we should do a fresh transfer with the first 3 blasts without PGD first, and if that failed, we could do PGD on the rest of the embryos that they would freeze on day 3. The doctor said that she wants to attempt doing a fresh cycle at least once before moving onto the frozen embryos. In this clinic, they really are big believers in fresh over frozen, and since we’ve never had a fresh embryo transfer because I always had OHSS, we thought this plan was a good idea.
This morning was quite a rush! We were told by Yaryna that we would be coming back to the clinic today for our third scan, but we didn’t know which time, and figured that someone would get us when the time came. Unfortunately, this particular morning, we had gotten up a bit late, so much so that Kyle went to grab some breakfast and bring some back to the room for me, as I could not get up for the life of me. As I was munching on the scrambled eggs and veggies, we got a knock on our door, and the receptionist said our driver had been waiting 10 minutes, eeek! I scrambled to put on some clothes and off we went. We basically decided that pretty much anytime we are going back to the clinic, we should be ready to go at 945 – 1015, so we won’t have anymore surprises!
So we went again to meet our doctor, and I got back onto the crazy ultrasound machine that kind of looks like a torture device, which you can see below. It is not like any other ultrasound machines I’ve ever been on – the seat is super high, and what can be uncomfortable is that when you put your feet in the stirrups, you’re basically just sitting there wide open to the world, and they don’t give you a courtesy sheet or anything, which can be awkward! By now, I am used to it, but I remember the first time, I felt really strange. What makes it more uncomfortable is that there is a desk with a computer for one of the nurses right in viewsight, so I thought to myself, please don’t look up! Hahaha I was told that in Europe, a lot of the clinics are not like the ones in the US, where they give you a ton more privacy, so not to be too shocked with being exposed more than usual.
The picture above illustrates what type of image the doctor is looking at – basically each round circle is a follicle, and they measure how big they are. Note that this is not my actual ultrasound picture – they do not distribute them. Usually, they like to see each follicle grow to around 16 – 18mm before they give you an HCG trigger, shot, which ripens the eggs for release. Again, K stood in the background while the doctor was taking a look – and she murmured with approval, and even pointed out to K that the follicles were growing well. She measured some of the larger ones, and it looked like they were at 12mm, which she was satisfied with. The doctor told us that we are going to keep the same protocol, and that we should return on Thursday for our final scan. I am to fast that morning as well, so they can run some blood tests for the anesthesiologist to view for our possible egg retrieval date for next Tuesday.
This is all very exciting, because stim cycles in the past have been soooo long! But the doctor did listen to my request to start with high medications, and I think this why our progress has been pretty good so far. Our next update will be when we go for final scan this Thursday, so stay tuned!
Today we came in for our second scan at the clinic, and I was a bit nervous to see whether my follicles were developing. I have already been feeling the heaviness that comes with the stimulation, but since it had only been 4 days of stimming, it wasn’t too bad. We met with our doctor, and she took a look and told me that she could see a ton of little follicles, but since we’re so early in our cycle, that she wanted to see me again the following Tuesday. Before she took a look, I made sure to have K stand next to the ultrasound machine and look at the screen, because the more information, the better! He said he could see a bunch of them, but they were still tiny. I’m guessing in American standards, they were all less than 10mm.
The doctor decided to up my stims so that I’m now taking 200 Gonal-F and 150 Merional, and since I had already had my shots that day, had me go downstairs in the clinic to get the additional 75 Merional from the nurse. In general, our trip was really quick, although the clinic was very busy, and full of surrogates and clients waiting for appointments. I’m realizing more and more that the long wait in the clinic that I’ve read about from other reviews are solely dependent on which package you choose.
After meeting some other nice folks in our hotel, I’ve also come to realize that there is some confusion about the room size at the Venice hotel. Apparently, on the website, the pictures that they have are of bigger rooms, which is not like the rooms that most of us stay in at the hotel. Also, all the rooms are a little bit different in the fact that the bathroom might have a completely different decorating scheme.
One of my personal goals while being here is to lose the weight that I gained while doing fertility treatments in the past 5 years. I would say that I’ve gained about 40 pounds from start to finish, so I have been focusing on eating low carb and doing some sort of exercise everyday. Ever since the pool opened up, I told myself that I would do 10 laps every day, but on some days, it has been too cold to go in the water, so I try to walk instead. Also, since we’re on the 4th floor and the elevator is currently not working, we get some built-in cardio every time we leave our room to go anywhere :)!