Monday, 29 October 2012

Embryo Agony

No agony aunt post from me this week - turns out I've solved all your problems, which is smashing. So instead I am giving you the chance to answer MY problem

Dear Readers 

With four fresh rounds of IVF under my belt (that is a literal, locating, term - you'll probably find your Doctors use it too) I'm not keen on enlarging my aging ovaries to ostritch-egg proportions again to go through another round of IVF. 

 But I'm lucky, I don't have to. 

I have three embryos in the freezer, that is three potential babies right there. When I next do IVF it is going to be courtesy of the little frozen robot babies rather than battery-farming myself up for another crop of eggs. 

If the next three embryos fare no better than the 8 previous ones I've put back then there has to be a time when I admit defeat. Plus, depending on how long it takes to get through the remaining refrigerated batch, the eggs hanging out in my ovaries will be one or two year’s older than the previous ones and, having tipped over that magic mid-thirties mark, their quality is deteriorating faster than a student party with half-price shots and a foam machine. 

 Add to all that haemorrhaging savings and a desire to have a life beyond fertility treatments it feels like we are coming to the end of our attempts to breed. 

 So you've got the background - what is the question? (That was rhetorical - I'm getting there). 

Every IVF so far I've had two embryos put back in. Round one, two and three did nothing. I suspect that, as my womb lining is an inhospitable little bugger, you could have put eight back at once and rather than becoming a Octomom with my own TV series and I'd still be as childless as ... well, as I am now. 

The last round (four) was different. My womb was nurtured and plumped up. It was expertly scarred for added embryo-grabbability (another technical term for you there). 

And what happened? (Easy tiger, that was another rhetorical question - you'll know when I get to your question). 

Both embryos stuck around for a wee while but, I was scanned at 8 weeks and it became apparent that there was no heart beat that was the end of that. And the Doctor talked. A lot. I just wanted to get out of there whilst he went into verbal diarrhoea mode. I can't remember all he said. But I do recall him being quite insistent that the miscarriage was nothing to do with me. There was nothing I should have done in terms of my lifestyle, eating habits or exercise routine that could have increased my chances of a successful pregnancy. He was convinced that there were chromosomal issues with both embryos that prevented the pregnancy being sustained. 

I think about that all the time.

If these little ones had been chromosomally tip-top I'd be seven months pregnant with twins, or if only one could tick-off its full complement of chromosomes I'd have at least one bun in the oven - almost cooked. 

It is also a bit worrying. If two out of the five weren't Ok, how are the other three? Are they doomed before they even have a chance of life?

There is no way of telling. (Or at least there is, but the testing is beyond my budget or needs.)

 All I can do is carry on and assume that they are going to be OK. I don't have a choice.

So the question is:

*drum roll please*

How many embryo's should I put back in next time?

I'm not going to go for all three - I don't think I'd be allowed even if I wanted to. But my Doctor has given me the choice of one or two. And I can't make up my mind.

We have to assume that my womb lining will be a healthy as ever - it better be after my three pill a day ritual of the last few months. So there is a good chance that if one takes both will. Chromosomes allowing of course.  

But I have seen through T just how hard work twins can be - hell I've seen this weekend with the wombmate how hard one can be - I'm thinking one at a time would be best. 

But what if the one chosen is screwed? It'll be over before if begins and I'll be cursing the day I didn't have a back up in utero. 

But then if I put two in and neither takes I will just have one more embryo, and one more chance, left before we call it a day. 

If I put one back and it doesn't take I will still have two more bites at the birthing cherry. 

Oh I just can't work out what would be best. There clearly isn't a right answer. 

What would you do?

WFI



35 comments:

  1. I'd do one at a time. There are immune-related cases (and likely non-immune-related cases) where one bad embryo can ruin the environment for a good embryo. One at a time (if you can stomach the potential extra FETs) seems to remove at least some variables.



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  2. I dont know if surrogacy is on your radar but I think its a viable option to consider! BUT I'd give it probably one more shot with two in. Then if that didnt work then move onto surrogacy with the last one.

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  3. I've been following you for a long, long time now and am finally commenting. I think you should do what your gut tells you (my gut tells you to do one, so that's my vote). We had 3 cancelled transfers, 2 failed (2 embryos), 1 positive! (3 embryos), and then 1 more failed (3 thawed, 1 transferred). 47 eggs. none left now. The FET that gave us our daughter the docs were only going to transfer 2, the third was lagging and I had to demand they do all 3. The last (unsucessfull) transfer 1 was very good and another was lagging. Docs decided to transfer 1 and see if the other kept growing to freeze. I went along with it even though my heart said "put the slow poke in too"! and now....regret. So do what you feel is right. sounds hokey I know. also does your clinic always transfer day 5s? maybe see if they will do a 3-4 day transfer....that's my other regret. the sucess was a 4 day transfer and all the others were 5 day. the lab isn't as good as your own body (in my opinion). But enough about me ;-) Best of luck in whatever your decision is. I'm rooting for you 110%.

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  4. What Brave IVF girl said.

    I've heard of studies that show that the take-home baby rate is higher if you transfer one, and then another one, than if you transferred both at the same time. Sometimes miscarrying one causes the other to be lost too. Sometimes the reasons for a lack of implantation are due to factors that month rather than persistent ones.

    Ultimately, what motivated me to do single embryo transfers is knowing it's really really hard to deal with a loss knowing that you could have made the pregnancy lower-risk by being pregnant with a singleton instead.

    If your FETs are particularly expensive, then I could see wanting to try two rather than three. However, if you think that something like surrogacy might be an option, then I think I would definitely do a SET to have two left to try on the surrogate, since this is the end of the road.

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  5. Hi, this is tricky and I was in this situation a few months ago and regret my choices. I thawed 2 our of the 3 and put both in, failed FET. I then had another cycle (so I thought) for my last one and it didn't survive thaw and that was the end of my journey 3 failed IVF's three failed FET's and one that the embryo didn't survive. I always wished that I had only thawed one and put that one in. That way, if the one didn't survive the thaw, they would be able to thaw another one and I could still have one inside, leaving one for next time. If it does thaw, and stick them u still have 2 left for next go, or as siblings if you fall pregnant!
    All of my rambling a may have confused you! In short: thaw one, if it does not survive they can thaw another one on the day and you still have one left for another go.
    I found my last cycle the hardest as it was always going to be my last chance, but I felt so cheated out of my last go as had nothing to put back in. I am now adopting. Go with the path of least regrets is my advice. X

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  6. I'm not sure how prepared you are to keep going, but if it were me (and it's not, that's clear), I would do one at a time. The odds are that at least one of the embryos will not survive the thaw. If you go two now and the third single one last and - god forbid, the two round doesn't work and the single thaw embryo does not survive either, the regret could be (again, were it me) crushing. My clinic always believed in single embryo transfers at day 3. They have their best stats on it, being adamant that a single embryo has the best chances and day 3 is best as the embryo "wants" to be in the area that it is meant to be in. It's not an easy decision and it has to be whatever you feel you have in you.

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  7. Go with what your gut tells you. It also depends on on drawn out you are prepared for this to be. Say,one at a time and by the second or last one you fall pregnant. Or if you want to be done and move forward more quickly (no matter the outcome) put two back. That is of course a higher chance/risk of twins depending how you see it but you know all that.
    I was really torn our last round but did single transfers and our last embryo did survive but never implanted. But remember that every case is different. I guess it comes down to how many chances you want to have a shot at before you are done. It's tough.

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  8. I guess it depends on what your womb tells you. If you are plump and thick and the RE tells you it's a perfect embryo sticking environment I might try 2. But ultimately, I'd probably do one at a time so I could possibly have 2 more chances. My thoughts are with you! That's a tough decision.

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  9. If its really your last 3...then I say do 1 and then after you've gone through that, make a decision whether to double up or split the second/third but you don't need to make that decision now. You're my IVF hero so I've no doubt you'll make the right decision for you xx

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  10. Hello there,

    Two questions which might have a bearing: in the scenario where Embryo A is hunky dory and B is chromosomally challenged - do you know if putting them both back would create additional risk for Embryo A? (That would speak for one at a time - along the lines of Guinevere's comment).

    Another question - if FET 1 doesn't work, how long would you expect to have to leave before FET 2, to get the lining suitably primed? Might be a reason to put in 2 on the first try.

    That said, implantation remains such a mystery, even to the Doctors, that speculating about possible outcomes remains just that - speculation. In the end, as has been said already, I'd go with my gut, just because I would regret it all the more if I didn't.

    In your position I'd probably take the cautious route - one at a time. The only reason I put back two last year was because they were not brilliant quality, so I figured their chances were better fresh than frozen, and anyway I was convinced it would not work. The power of negative thinking...

    G xx

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  11. I think it depends on the quality of the embryos you have left. If they're good, I'd go one at a time. If they're only average, I'd probably do two.... Tough call for you though.

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  12. I was in this exact situation - 3 embryos left and we decided to back 2. As you now know, I am 39 weeks pregnant with a little boy. I still have one left that may one day (hopefully) be his sibling. Wishing you a ton of success no matter what you choose.

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  13. It's a tough call but I would probably do one at a time, for the reason Brave IVF Girl mentioned. By spreading out over months, you lower the risk of any one "off" cycle. A question, though - I know they did a womb scrape before the last cycle. Am assuming they will do more womb scrapes? How would that work? One before each FET? Or one at the start, and then going through the eggs, one by one, in successive months? I can understand how that might influence your decision, but I still lean towards one at a go.

    (And will be hoping that the first one takes).

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  14. I guess it depends on the quality of the embryos--if they are blasts do one at a time, if they are 8 cells or less do 2 at a time. Wishing and hoping that whatever you decide to do works!!

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  15. Don't they recommend 1 at a time, if possible?

    I can't tell you what to do, but I can wish you luck with the decision and the process.

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  16. Personally....I would do two. but you really need to go with your gut on this one.
    kd

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  17. I didn't do IVF. We got lucky with Clomid and herbs, but I had a rough pregnancy with life-threatening complications and cannot risk pregnancy ever again. Which is why I say go for two.

    I'm not saying it would happen to you too (though your luck seems atrocious!). If they both take and you get twins, yes, it'll be hard. But it'll also be hard if you want more children and can't have them, especially if you have leftover embryos.

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  18. As someone who just recently went through an FET, I'll tell you what I did. On our first IVF fresh cycle, we transferred a single embryo and we got lucky. We assumed since the frosties were just as good as the single embryo we transferred and had success we would transfer 1 again. We transferred one and that cycle failed. For any future FET's, we had to make a decision. The last 4 frosties are frozen in sets of 2 and my RE does NOT recommend re-freezing. So it was transfer 2 or discard.

    For you, I would recommend starting with the single embryo transfer. I'm a huge advocate for single embryo transfers. Hoping you don't have to be concerned about those other 2 embryos for a while. However, if you need to decide ahead of time, I would say take it slow and continue with the single transfers. I would do the same except I cannot think about discarding an embryo.

    You're in a hard place, but I say start slow and steady...it seems to be to be the best way...

    Good luck...Hoping and praying for you!

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  19. hello! I am in a similar position after 1 canclled IVF and 1 failed fresh transfer with a single embryo. I have 3 beautiful blasts frozen and convinced my RE to do 2 this time through. Yes, the increase in % success is marginal but I have had a nagging "what if" that I need to quelch. Howveer, if this is your last IVF ever, I would do one at a time..as the ladies pointed out, the uterine environment changes every cycle and who knows when it is ideal. Good luck. Know that we are rooting for you :)

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  20. Easy answer: one. I know I speak as a 'fertile' so what do I know about IVF? Answer: nothing.
    However, the natural order is to have one baby at a time - unless you are a sheep, twins are normally the exception... Presumably it is done this way to increase the chances of having at least one baby and save on the number of procedures? Sounds as if there is always a sacrificial embryo in that case ..With three, I'd like to think they were siblings with potentially unshared birthdays. Definitely take each of those precious eggs one at a time.
    Besides, I have friend who had fertility treatment and ended up with triplets when she had turned 40. They are now 11 and she admits that she is completely run ragged by them.

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  22. I would put one back at a time for no other reason than to give each one the best possible chance and no competition. Also, if the womb lining gives any issues with one cycle then there are more chances for it to work (sorry, I am no doctor, just working on a logical basis).

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  23. If it were me, I would put one back. Psychologically, that would be better for me to know that I had two more chances. I think I would be more relaxed through the process and, if I didn't achieve a pregnancy, while devastating, I'd have two more kicks at the can. I am throwing every positive thought your way. It's your turn! You've been through too much already.

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  24. I'd suggest you only do one at a time, maximise your chances and the health of baby-to-come. SET is recommended as it's safer for both mother and babies, results in only a slightly lowered birth rate (barely significant) and costs the healthcare system far far less. Babies from SET are healthier and have fewer medical complications in the 6 months post-birth than DET babies (usually due to complications associated with multiple-birth prematurity).
    Good luck!

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  25. How are they frozen?

    Mine have been frozen in lots of 3, so I have taken 3 when all 3 survived the thaw...if they are in 3's, I'd take at least 2....but if they are frozen individually, you can go for one at a time.

    Were you tested for clotting issues?

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  26. It's a pill you have to get from the doctor. You can't do it yourself.

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  27. Hrmm, I have been thinking about this, waiting for the "AHA! I know what I'd do" moment, that never came.

    Difficult one, needless to say. Just on gut instinct, I would do one at a time - but not if the womb scrape/prep time is not too long between tries. Maybe two and one if it is.

    For what it's worth.

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  28. Good luck! I agree with a lot of the uno votes, but do what you need! xo

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  29. Someone wrote some more about this, found it in Mel's roundup:
    http://missconception-ads.blogspot.nl/2012/10/an-honest-discussion-of-set.html?m=1

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  30. I will attempt my 2nd IVF next year 2013. I miscarried at 5 weeks from my 1st attempt (with 1 placed in) and said to hubby next time we are putting in two, I had none that could be frozen from the 1st attempt so we need to start over again. The thing is, I am beginning to think do I really want twins? I mean for the love of god 1 child seems a handful. I think I am putting the cart before the horse here as we have not even started again but the thought of twins scares the crap out of me quite frankly!

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  31. Before we had Baby Spouse I would have said 2. I didn't know about the stats on two versus one, but now I wonder how on earth anyone copes with twins.

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  32. I wanted you to know I read and re-read your story in the wee hours of the night last night. While I wish things were going better for you right now, I feel hopeful about what's ahead for you. My vote: definitely one embryo at a time. I think maintaining hope is the most important ingredient in this whole thing - the more you can do to breed that, the better. Thinking of you, and sending lots and lots of positive vibes your way. I'll be following along...

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  33. 2 . Put 2 in. That way maximising your chances against available embryos in the store. Why do it one by one when you can do it in two's and have equal effect. 1 may be rotten & 1 maybe the one but if you only put the rotten one in you've wasted a go.

    Well, that is my plan & I have the same dilemma

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  34. I'd vote for one at a time-- that way if you diagnose significant autoimmune factors or some other something, you'll have more data for the next attempts. I'm sorry that you're in this spot, and I wish you nothing but the best!

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