Introducing Icsi & Dicsi

As promised, here's picture of Icsi and Dicsi.  We are not sure which is which, but here they are anyways.  My first picture ever of my embryos.

They were both at 4-cell stage at day-3 transfer.  Even though we had less eggs retrieved, and only 2 fertilized, Dr. Hopeful noted that the quality of the eggs seem to be better, with no fragmentation.  Icsi seems to be slow for being only 4-cell at day-3, but Dicsi seem to be on target, so I am optimistic.

Here's a picture of the actual transfer.  The dark area in the top of the screen is my bladder.  The little white arrow (sorry it's so tiny!  Click on the picture to view a larger picture) is pointing to a white circle where the little 2 embryos were just placed into the uterus.

Please continue to pray that the embryos will continue to grow and implant successfully!

Transfer Day

I started of today with an appointment with AcuGirl at 9 am this morning.  I always enjoy my acu sessions, and pray each time she walks near my door that the session isn't over yet.   I had previously asked about doing a session after the transfer too, but she said based on their experience at her clinic, the success rate is the same as just doing it prior to.  So I won't see her again until I hear my pregnancy test result.

My transfer was at 11:30 am, but at 10:30, I had to empty my bladder, take my valium and start drinking water.  I had to make sure that I had a full bladder by 11:30.  I was worried about how much water I needed to drink because during my first IVF transfer, my bladder was SO full.  I desperately needed to pee during and after the transfer, but I had to lay there for 10 minute before I was allowed to go pee.

So this time, I was very cautious about how much water I would take in.  We checked in at 11 am, and by then, the valium had started to take effect.  I was starting to feel woozy and needed help from Babe to walk into the IVF suite.  I changed into my gown, cap and booties, and Babe changed into scrubs, cap and booties.  Amy, the nurse (the same nurse from retrieval day) gave us our discharge instructions - bed rest for 48 hours, no exercise, no showering for 48 hours (eww!), no sex still pregnancy test, etc.  She also put my ID tag on my right ankle, not my wrist.  This was different.  I guess it makes it easier for the doctor and the embryologist to confirm the tags since it is closer to them at my ankle instead of my hand.  Then I asked the nurse a question (probably a "dumb" question), I asked the nurse would I have to worry about sneezing or coughing too hard (I do tend to sneeze really hard).  She said not to worry.  She gave me an illustration:  Imagine a pea sandwiched between 2 pieces of bread.  If you sneeze or cough, it may move a bit, but it would not fall out.  That made me feel better.

Then Dr. Hopeful came in.  I was glad she was the one doing the transfer too.  As of this morning, both the embryos have grown to 4-cells.  Embryo #1 was a bit slow at 4-cell ( I think they like to see it at 8-cell by now), but Embryo #2 seemed to be on target at 4-cell, considering that was ICSI'd one day later.  It made me feel better that there was at least one embryo that was on target for growth.  She also gave us pictures of our 2 embryos and some other eggs that didn't fertilize.  I was so excited that I actually got photos of my embryos.  Proof that they exists!  I'll post those pictures later.

We then went into procedure room.  I'm pretty sure it was the same room my egg retrieval was done it, but this was the first time I noticed a large sliding window that joined to the embryology lab.  I laid on the examination table and the ultrasound tech put some gel over my belly and did and ultrasound of my uterus and bladder.  I made the comment that this was the first time I've had and external ultrasound, I'm so used to the vaginal ultrasound wand.  A new experience for me.  So, this is what if feels like to have an ultrasound done if you are pregnant!

My bladder looked good, so I did a good job drinking water.  I was glad because I felt comfortable, and not like I really had to pee.  I was also happy that I was able to look at the ultrasound screen from where I was laying.  Then Dr. Hopeful came in.  She put in a speculum (my least favorite part!), cleaned the cervix, and did a trial transfer.  I think this is done just so she knows exactly where to put the catheter.  Then she put in another catheter with the embryos in it and said 'here comes the embryos".
The ultrasound tech pointed out a little white circle indicated by an arrow on screen.  It's a little air bubble where the 2 little embryos are.  Then the catheter was pulled out, and the embryologist checked to make sure that nothing was left behind in the catheter.  And we were done!

I asked Dr. Hopeful about what "delayed ICSI" was.  I thought delayed ICSI was doing ICSI on the eggs that didn't fertilize naturally the first day.  I was wrong.  Dr. Hopeful explained that delayed ICSI meant they did ICSI on the 3 mature eggs on the first day.  Only 1 of the mature eggs ICSI'd fertilized.  Then they waited one day for the other immature eggs to mature a little more and they ICSI'd those.  Out of those immature egg, one more egg fertilized.

Dr. Hopeful said, yup, it's ICSI and DICSI (delayed ICSI).  Of course Babe, being the funny guy he is, named our embryos Icsi (embryo #1) and Dicsi (Embryo #2, from delayed ICSI).  So now we have names for our embryos!

After Dr. Hopeful left, I was left to rest for 10 minutes on the examination table before being allowed to go pee again.  Then it was off to the recovery room to rest/nap for another 30 minutes.  It was quite nice actually.  I was pretty relaxed, thanks to the va.lium.  I had Babe turn off the lights while I tried to nap, and he sat there playing on the iPad.  When the 30 minutes was up, I got dressed, Babe changed out of his scrubs, and I had to pee again before leaving.

We picked up lunch on the way home, and I have been relaxing in the recliner all day.  Spend the afternoon watching daytime TV - Rachel Ray, Dr. Oz, The Doctors, Oprah, etc.  I'm now watching "Julie and Julia".  It's nice to just bum around for a while, and letting Babe take care of me.

Though Icsi is a bit slow in growth, I'm optimistic that Dicsi is at least on target for growth size.  I'm praying that both will continue to grow inside of me and implant.  We are praying for either one or two babies!

So for now, I'm PUPO - pregnant until proven otherwise!

Delayed ICSI

I googled "delayed ICSI" and I think it is the same thing as a "rescue ICSI".  It is ICSI done the next day after finding none or very few eggs have fertilized naturally.  Sound just like my scenario.  Unfortunately, the research findings is not very positive.  Success rates for rescue ICSI is pretty low.

Gosh, this is hard.  I need to stay away for Dr. Google!

(**Updated: I found out during transfer that delayed ICSI meant the mature eggs were ICSI'd right away, and then they let the immature ones mature one more day before they were ICSI'd the next day.)

TWO Phone Consults

Yesterday, I mentioned that I was supposed to have a nurse's consult on Tuesday for our next round of IVF but I cancelled.  I wanted to talk to Dr. Hopeful first about trying to access the eggs in my right ovary.

So yesterday, I was finally able to talk to Dr. Hopeful over the phone.  I again told her about my concern that we can only access my left ovary.  Was there any other way to access the right ovary that was located high and behind the uterus?  It feels like such a waste to not be able to access the eggs on my right ovary, cutting down the number of eggs to 50% for my next cycle.  This is what I found out:

• She will not try to retrieve eggs from my right ovary by going through the uterus unless it looks like the position of the ovary has changed.  This is unlikely, but it is possible.  She does not want to risk going through my uterus with a needle, jeopardizing the condition of uterus which may impact implantation of the embryos.
• Many people have successful IVFs even though they only have one ovary.  This of course, is no comfort to me, knowing the crappy quality of my eggs.  Also it's not the same thing having only one ovary, versus having 2 good ovaries and knowing that your eggs from the right ovary is just being wasted!
• She will not be able to do a laparoscopic surgery to remove the eggs during the IVF retrieval process.  In the past, egg retrieval was done via laparoscopic surgery, but that procedure is no longer used for IVF.  They have found that it is inefficient and have low pregnancy rates.  
• Dr. Hopeful's clinic is not set up to do laparoscopic surgery.  It totally makes sense.  She is not trained for laparoscopy, and I wouldn't want her perform it on me!
• Most IVF clinics do not do laparoscopic egg retrieval for IVF anymore.  According to her, there are no clinics in MN that do that anymore.  I would have to go out of state to have it done.  Today I called another IVF clinic here in the Twin Cities asking about laparoscopic egg retrieval.  They don't offer that in their clinic either.  I will try to call another clinic next week to see if they do it.  Just out of curiosity.
• If I wanted, I can consider doing a laparoscopy surgery to try to move my ovary to better position, making it more accessible for egg retrieval.  But there are no guarantees.  It would mean postponing my IVF cycle for a few months.
• For our next cycle, we will be doing 100% ICSI.  From my first IVF cycle overseas, I didn't seem to have any issues with fertilization, and therefore, ICSI was not considered.  But we will do it this next time around.

During my conversation with Dr. Hopeful, I mentioned that I had not been able to get a hold of the andrology lab director.  She had suggested I go over my lab results with him.  However, I had left multiple messages for his admin, but she never got back to me.  So I gave up on trying to reach him.  Well she said she would email him (he is based in Utah) asking him to call me.  

Less than an hour after I hung up the phone with Dr. Hopeful, he called!  So I had my second phone consult of the day, with Dr. Lab Director.  I was very surprised that he called me back so quickly.  He's what he told me:

• Based on my first IVF cycle overseas, he didn't expect the outcome of my last cycle at the clinic.
• My last cycle here, 8 eggs were retrieved, and 6 were mature.  3 of the 6 were mature but had vacuoles (similar to bubbles) in them, indicating that there were some issues with the egg.  According to him, this is very unusual.
• According to Dr. Lab Director, in IVF cycles that have bad outcomes (like mine), in the next cycles, if nothing is done differently, 40% - 50% of the time they get a different outcome.  Possibly just a fluke.  The other 50% of the time, they get the same result.  So I guess, it sounds like we have a 50-50 chance of it working the next cycle?
• So the question is, is the issue the egg or the sperm?  According to Dr. Lab Director, Babe's sperm seems to be fine, based on previous IUIs and IVFs.  Generally sperm tends to be more consistent.  It seems like the issue is with my eggs (no surprise here!).  Unfortunately, there is no good test for eggs.
• His guess is, my body may have responded differently to the drugs or protocol of my last cycle versus the one overseas.  It's a possibility, but we will never know.
• Doing ICSI is a good idea for the next cycle since we had such a low fertilization rate (only 2 out of 6). This will increase the odds of our eggs fertilizing. 

Based on the 2 phone consults I had, I have decided to continue with our original plan of doing our next IVF cycle in July.  We now have a nurse's consult next Wednesday, June 23rd.  I am praying that acupuncture and herbs will help improve the quality of my eggs.  I can sure use all the help I can get.

Tick Tock

We met up with Dr. Hopeful for our post-IVF conference yesterday.  Overall it was a good meeting.  There wasn't anything shockingly new that I didn't expect already.  Overall, Dr. Hopeful thinks the reason why this cycle failed was due to egg quality issue.

Surprise, surprise.... NOT.

(image from http://www.stupid.com/fun/BCLK.html)

Tick tock, tick tock ..... can you hear the biological clock ticking?

See this earlier post for a recap of this cycle, and some answers I was looking for at this post-IVF conference.

This is what I found out from Dr. Hopeful at our meeting:

• Dr. Hopeful was surprised that no one had mentioned about my right ovary being in a difficult position.  It is high and posterior (behind) my uterus, or other organ.  It would have required a needle to go through the uterine cavity to access it for egg retrieval.  She thinks the location of the ovary will remain and will not change in the future.
• It is possible to fix the ovary but it would require surgery to fix or retrieve eggs from it.  Did you know that in the past, laparoscopic surgery was used to retrieve eggs for IVF?  Dr. Hopeful does not recommend surgery to fix this.  She thinks that based on my body's response to the meds, I should be able to produce a decent amount of eggs in the left ovary.  However, this also means that I probably will only have ONE ovary to work with in the future.
• A day-3 transfer was not considered since my embryos were not at a 7 or 8 cell stage.  If there were, they would have a day-3 transfer.  My embryos arrested at 2-cells and 4-cells stage on day-5.
• Assisted hatching is only done for day-3 embryo transfers, and are not done for day-5 blastocyst transfers.
• There were no issues with my Babe's sperm numbers.
• There were an increased number of vacuoles (fluid or bubbles) in my eggs/embryos, indicating that they may not be healthy (signs of post maturity or degeneration).
• ICSI could be an option in the future.  However, ICSI does not help a compromised (low quality) egg.  She would rather not do ICSI if there is an egg issue.  Performing ICSI is performing surgery on an egg, so she would rather not do it.
• It is an option to do half ICSI and half natural fertilization, or all ICSI in the future, assuming egg quality is not a factor.
• I asked Dr. Hopeful if one year would make that much of a difference in the quality of eggs.  She said no one really knows, but she doubts it.
• If we did a future cycle (which we will), we will switch our protocol and do an Antagonist protocol, meaning I won't be using any Lu.pron.
• I asked about additional testing and Dr. Hopeful suggested doing Karotype testing for me to determine if there are any issues with chromosomes.  It will check for 46XX chromosomes, to see if there would be issues with chromosome imbalance in my embryos (not me).  I still have to research more about this.  She will test me first since she suspects the issue is with my eggs.  Karotype testing is not cheap, about $900 a pop!  I will have to find out if our insurance will cover at least part of it.  It will take about a month for the results to come back.
• According to Dr. Hopeful, there is an 8% chance of chromosomal imbalance.  The other 92% chance is egg quality, i.e. my biological clock is ticking.  If the test comes back and I fall into the 8% chromosome imbalance, then she would suggest donor eggs (my Babe and I have never even discussed DEs yet) since it would mean that our embryos would arrest, fail to implant or we would miscarry.  If we do not have chromosomal imbalance, then it is a matter of finding good quality eggs.  
• Based on my hormone levels this cycle, it looks like I do not have diminished ovarian reserve, i.e. I still have some eggs to work with.  We just have to find the good ones!
• Dr. Hopeful wants to try again. My uterus was "perfect".  I responded well to the meds.
• If I wish, Dr. Hopeful would consult with one of her other RE partners about my case and see if there is something else that she missed, or something different that could be done for the next cycle.
• I will be scheduling a phone consultation with the IVF lab director to go over the outcome of this cycle.  Hopefully this will give me an idea about what happened to my eggs/embryos.  

Overall, we had a good discussion at this meeting.  I think Dr. Hopeful was impressed with the questions  we had for her, and we had a good hour long discussion.  She took her time and read through my list of typed up questions to make sure we got everything answered (she did that the last time too).

She said when we were ready, we should take the Karotype test, and then come back for another try when the test results were in.  Before we left, Babe and I decided that we would take the test anyway, so I had my blood drawn for the Karotype test before I left the clinic.  Since the results won't come back for a month, it would probably be June before anything else happens.

So now we wait.  Again.

Obviously, we hope the Karotype test come back normal so we can try again.  If not, we will need to have a discussion about donor eggs. I don't think we will do donor eggs, but we have never even considered it or discussed it.  We'll have to at least talk about it.  We'll have to see how things go.

We've all heard the cliche of the biological clock ticking.  Well it's ticking REALLY LOUDLY for me.  With each tick, it feel like my eggs are getting crappier and crappier.  With less than 4 months to my 37th birthday, it feels like a time bomb!