Sunday, February 9, 2014

Post Transfer Consult

This last few days has been pretty tough.  To add insult to injury, the night of my 3rd beta, my nose started running, and I have been down with a cold.

Thank you for the many kind comments here and from those on FB as well as texts from friends.  I've had a ton on thoughts running through my head, trying to process this and next steps.  But that will have to wait for a later post.

On Thursday, I had my post transfer consult with Dr. Keenan.  He actually called me earlier than our scheduled appointment time because he had some free time.  Since I was available, I spoke with him then.  In the end, he ran out of time to answer all my questions. 

This phone consult wasn't that much different from my first one from my November transfer.
  • Though not as great as my last transfer, embryos were good at 3AA, 2AB and 2BC (though 2BC was not expected to survive).  The embryos were not an issue.
  • The transfer went fine without any problems and my lining was good.
  • There was nothing after the transfer that would have cause this not to work.  I wasn't sick and was pretty relaxed.  
  • There was no reason why this transfer wouldn't have worked again.  
  • There is no reason medically why we can't try again.  It would be up to Babe and I if we are emotionally ready or want to try again. 
  • I asked about his thoughts about how my first beta was so high and it dropping after that, and he didn't know why that would happen either.
  • I said, based on my research, though no one really know for sure why it happens, chemical pregnancies are usually due to abnormalities in the chromosomes of the developing embryos.  I asked him if he thought this was true in our case since we have had embryos from two different set of donors so far.  He said it is usually true, but we can never be sure since they cannot test the embryos for abnormalities at transfer time.
  • I also asked for clarification about the quality of the embryo at transfer time (4AA, 6AA, etc), is that any way tied to abnormalities in the chromosomes of the embryo, and he said no.  He cannot tell if there are any abnormalities in the chromosomes in the embryos unless they were specifically tested for that.
  • I asked if for our next transfer, would we still only transfer 2 or would he consider 3 since it would be our last try and also I am over 40.  He said he would not transfer 3 unless they don't think a third one would not survive (like the last transfer in January).
  • I also asked about what the percentage is of women that have gone through a third transfer at NEDC and is still not successful.  He said he didn't have a number that he could provide, but it was very low.  I'm not really sure what I expected from him with this question.  I guess I was just curious... as I seem to alway seem to be one of those in the statistics.
He suggested that I do an endometrial biopsy before the start of the cycle for my next transfer.  He just wants to make sure there is nothing abnormal and make sure everything is good in the uterus.  

Since we have only 2 embryos left from our current donor family, we have to pick another donor family.  He suggested we consider picking a family with embryos that are at either the 2PN (2 day) or multicells (3 day) stage.  Our current 2 embryos are blastocysts (5 day).  If we pick new embryos from a different stage, we will not be able to use our current embryos for this next transfer as our primary as they embryos have to be at the same stage.  

Dr. Keenan said we should consider switching to 2PNs or multicells just to try something different for the next transfer.  There is no real medical reason to do so, but to try something different.  Having said that, he also suggested we consider the family that is right for us, and also to look at the age of the wife at the time the embryos were created.

After speaking with the doc, I found out that the March transfer calendar is fully booked.  So we will now have to wait till May for our next transfer.  Until then we have to:
  1. Pick a new donor family, including deciding what stage embryos we want to adopt, as it will determine how many donor families we can pick from
  2. Get an endometrial biopsy done before start of my cycle for the May transfer.

5 comments:

  1. I want to extend my condolences, and also emphasize that chromosomal abnormality really is very common even in younger women and even in very "pretty" embryos. I did an IVF cycle when I was 29 and had almost exclusively 5AA embryos resulting. Out of 25 fertilized embryos and more than a dozen embryos that made it to blastocyst, only 6 of them ended up being chromosomally normal when we tested them. That meant that there were a lot of really nice, perfect-looking embryos produced by a very young patient that were not viable and could not have produced a baby. My clinic was really surprised - they'd counseled us against doing the CGH testing because they felt there probably wasn't much of a point with my age. They ended up agreeing with us that it was an excellent idea once we got the results back - it saved us so many embryo transfers and so much heartbreak!

    My miscarriage and chemical pregnancy (of an untested embryo) were deemed very likely to be a result of chromosomal abnormality - I feel you how sad and heartbreaking that is.

    The literature data suggests that blastocysts are probably the best choice, as it means that a lot of not-viable chromosomally abnormal embryos have already been weeded out. Also, I think almost all the good labs in our area are doing blastocyst culture. I can understand the desire to shake things up, but I'd probably stick with picking donor families that match you the best.

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  2. First off, i'm so very sorry about your loss. The term "chemical" is a cruel one, minimizing the very real fact that you were pregnant and that this loss is a painful one. Please be kind to yourself as you go through the grieving process.

    Though there's a lot in the literature supporting the idea that miscarriages are caused by chromosomal abnormalities (and I do believe this is a cause), one thing that is not well understood is the uterine environment. I also had repeated miscarriages and was told is was likely to bad luck or chromosome abnormalities (though the karyotyping that was done showed that things were normal). It wasn't until much later that I found an RE who was willing to think outside the box and do some RPL testing. This was how we discovered that I had very low levels of APA antibodies. This resulted in me starting Lovenox for my final cycle on top of PIO. It's only now, after a diagnosis of HELLP syndrome that all my doctors believe that the APA syndrome diagnosis was correct and the cause for my infertility.

    I'm not saying that you have this or that this may be the cause of all your heartache, but after 2 losses with donor embryos I don't think asking for RPL testing is out of line.

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  3. praying for God's wisdom and leading as you make these decisions. (((((hugs))))) i'm praying every day for you and babe and my heart is so broken for you right now.

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  4. My embryos were always textbook perfect in all four transfers but it was only one that ever took. I think chromosomal testing is a good idea.

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  5. I'm so saddened to read this today, I was so hoping to hear doubling of numbers when I came back to blog...ugh, this is HARD and I am so sorry!!! Sending you virtual hugs!!!!!!

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