transfer: 1 or 2 or…..?

So the debate in our household at the moment is how many do we transfer. This debate comes up randomly at any time and it never seems to be far away from the top of either of our minds. We are incredibly fortunate to have this option and while you think the “two for one” option of twins would be good, here are some chilling stats to think about:

(1) At the gourmet, mountain side, baby making retreat we hang with the chance of getting pregnant with a single transfer (post microarray) is 65%. No stats yet on going full term. For dual transfers, pregnancy success is 77% with 73% going full term (so a 4% loss rate)

more general stats from some surfing….

(2) 60% of twins are pre term (<37 week) and av 35 weeks and weight 1.5 – 2 lbs less that a singleton on average which can cause all sorts of issue particularly if you are below the 35 week av.

(3) twice the rate of gestational diabetes as a single pregnancy

(4) higher placental problems, heart problems (for mum and bub), blood pressure problems etc

(5) “vanishing twin” – 20% chance that one of the twins will miscarry

(6) Still birth  (1-2% chance vs 0.5% chance)

(7) twin to twin transfusion – one bub gets more blood that the other

(8) IVF twins twice as likely to be admitted to neonatal care in the 1st three years of life

(9) twice as likely to die just before or after birth

(10) Twice the risk of postnatal depression for Mrs IVF

(11) bed rest etc etc for Mrs IVF and the risk we trash her ute for future attempts

(12) just about anything they talk about in the infamous NY times report:

http://www.nytimes.com/2009/10/11/health/11fertility.html?scp=1&sq=ivf&st=cse

(13) one year post birth, twin parents are more likely to experience severe parenting distress (22% vs 5% for singletons)

(14) 1st trimester risks. Increased risk of: bleeding, loss of one or more kiddies, increased nausea / vomiting  (“that may require medical intervention”), a stitch in your cervix (that just freaks Mr IVF out no end)

(15) Trimester numero deux / trois: really the diabetes, maternal anemia and exaggeration of most common complaints of discomfort etc. Risk of pre term labour.

(16) our background read pack from the baby factory had some very interesting articles about this and advising against twins. A Perinatologist who is a guru at such twin things wrote an article and used phrases such as the following:

– “…most twin gestations in fact do reasonably well. However, there are many many additional risks to both the mother and babies that come with a twin pregnancy that, in my opinion, suggests that twins should be avoided when possible.”

– “Maternal death (no more Mrs IVF!!!) 6 times more likely with twins”

(17) the occasionally blogged thought that one embryo that doesn’t grow can wipe out the other one out, (bad ju ju in the ute I believe )

So.. what to do. We are speaking with the chief baby maker next week but will take any thoughts on the topic if you have ’em. In one corners Mrs IVF is thinking of doing the solo transfer and then 2 if not successful. Mr IVF, even after reading all of this, is thinking two then who knows what next. (77/ 73% is a great stats while 65 / ? – is significantly lower in my book)

So appreciate any thoughts you have, just to recap:

1st cycle: Day 3 transfer. No genetic testing. transferred 3 – pregnant with a single. Miscarried at 8 weeks with trisomy 13

2nd cycle:  PGD genetic testing: no transfer

3rd cycle: Day 4 transfer. PGD genetic testing: 3 passed and 3 transferred. Chemical

4th cycle: Day 3 transfer, No PGD. 4 transferred. Negative pregnancy result.

5th cycle: day 5/6 transfer coming on 12/14, 6 passed microarray. transfer?????

So you could say 1 (maybe 2) out of 3 cycle success rate in terms of getting pregnant OR you could say 10 transfers and only one (maybe sort of 2 – the chemical) embryos stuck. You could also argue that none of the advanced sperm analysis was done on our previous cycle embryos (PICSI, IMSI) and that best of all these 6 this cycle have passed the complete genetic checkout (whereas PGD only test 9 chromosomes). So you could say, we are completely confused..

vote in the poll as well if you like (don’t worry – your decision wont be binding but I am interested to see what you are thinking dear reader)

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Got my head around this a bit better

I think a good nights sleep helps. I am sure I had some outlandish dreams last night, (who knows what goes on in that head of mind when I am not awake to keep an eye on it) but woke up this am, thought about the situation, pinged Mrs IVF when I got to work and declared that, you know what, we are very lucky to be where we are and apologised for coming to the party a day late.

Jen – you bet one more step. Thanks for standing in and being chipper while I was off making up disaster scenarios in my head. Much appreciated.

Murgdan – yeah it does seem fast, but the stress in your head over that time does weigh on you (like crap golf scores on Monday… well that’s my excuse)

Pie – you win the word of the day with “destruction”. That nails exactly the fear I think I was trying to get my head around last night. Some form of pure destruction that I have no idea how we will come back from.

Well – who knows, but today the sun came back out in  Mr IVF’s head, (people who speak in the 3rd person generally freak me out by the way) … so life goes on and we’ll take it as it comes.

Murg ..(oh – Australian men have a habit of shortening names – it’s a sign of respect and friendship, so all is good), in answer to your question: Next steps:

– supreme lining building post Mrs IVF’s next period

– decision on 1 or 2 to transfer (ah, that reminds me to cancel my NY Times subscription – thanks)

– transfer booked in at the baby factory on 12/14

– pregnancy test on 12/23 and backup on 12/25 (ho ho ho, or no no no?)

One last thing. I ran a decision tree / stats model last night (ok yes – bloke blogs on IVF are different aren’t they!) and if my calcs are right (which  I doubt) from what the baby factory told me,  (i.e. we have a 73% success rate per cycle of going full term if two kidsicles are transferred) then with the 6 kidsicles we have (and assuming we lose none in the thaw) we have a 98.8% of one of these six kids turning into a fully grown wiggles watching nugget. Now that kind of blew my mind, and made me check the math over and over. Theoretical stats are one thing, Mother nature and her bricks are another and we have had some sort of netflix type subscription with her of late.

One very last thing: I realise there are lots of folks out there having a harder day than us at the moment, but I guess in the past, Mrs IVF and I have had hard days as well. I hope nothing in here comes across as gloating. I think that is why sometimes I feel bad being positive. I mean nothing at all in a gloat way, its more just relief and maybe a bit of hope for some of you, as it is hope for us. If we can get this far after 2-3 years and our 5th cycle I hope we can keep going to show others that this can work.

We need to see the mouse

We are all well versed at waiting. You can tell the IVF person at a bus stop, or at the station if a train breaks down, they don’t care, it’s just another wait. However –  don’t get in the way of an IVF person when their glacial IVF existence is shifting fwd with an elf appointment or a trigger, nothing will stop them. Still, for 99% of the time it’s all about waiting, so whats the rush if the bus is late, it’s not like you need to get home to tuck the kids in.

So as we wait for the Bingo gang to come back with results, we see others ahead of us getting around 50% success and getting their results right on 4 weeks, so I guess that is our expectation on both fronts. Mrs IVF pings me at work during the day on updates from numerous boards she is tracking if one of our bingo predecessors has come back with results. She is like my own home built IVF google (with legs), which is great and one of those nice freebies you get when you get married and didn’t realise this was part of the order you put in. Kind of like the warm bread you get at a nice restaurant and you didnt even order it.

So while there is a little bit of tension building around results I have decided to tackle this head on and we’re off to Orlando. We need some fun. We need a break. We need to get away for a few days over the long weekend and just chill out. We need an injection of laughter. We need a fairytale, a castle and some tangible, touchable make believe.We need to see the mouse.  According to Mrs IVF’s calculations we should hear from the elves at the baby factory just after the Columbus day weekend, so that will be the day after we get back from the House of Mouse, so perfect timing to have our own world turned upside down again.

So this clicked off a rather bizarre thought in that rather overactive mind of mine and I blurted it out to Mrs IVF before I could catch it. ” Maybe I dont want a result at all. We could stay like this”…. how messed up is that. Prima facie this is a poor tortured head that just doesn’t want a bad result. At the IVF casino we have had a great run this cycle and just want to take our chips off the table and go and buy a nice steak dinner. Maybe deeper down we just want off this overall roller coaster and are fed up with the process.Mrs IVF landed the clear common sense in one line “… then we never get to transfer… you really want to stay here?”

I think our expectations are low enough. If we really strike low / no goodies then we are really screwed. How can you do better than this cycle and WTF do we do next? and if its good? My first reaction is “whats the next hurdle?” I hope the mouse can help with a bit of short term escapism.

2 more quick thoughts:

– thanks for the poll votes and thanks also for all of your posts. They are quite long and well thought through, so I really appreciate that. Mrs IVF loves your comments as well. I am working on responses to your poll answers and additional questions.

– a mate of mine at work today (who has a really nice 5 bedroom house) was complaining and wants to sell it and go find work somewhere else. “want to buy it?” he blurts, and my knee jerk response was ” I can’t produce enough people to fill it”…I need to get these sort of things out of my head, but how, the pain and exhaustion of 3 years has saturated my soul I think. Ok – yes we’ll see, but I guess this things is just a slog. IVF is like a session at Ben and Jerry’s – so many different flavors – but deep down it’s the same product. I just wish it tasted as good.

To those out there having a wonderful result today – good on you! For those who have been hit by one of mother Nature’s random bricks, oh man, I hate those days, and those that are just watching or waiting – hang in there, and keep the faith!! Just google google google and see how many frikkin people get pregnant on this path.

Dealing with my brain

Back from the baby factory and nice to be home. A 500 sq ft hotel room can be really fun for well, 5 mins, but 2 weeks. well. So bit of an update:

– a final push on the chicken nugget front at the airport before leaving babyland seems to have cured Mrs IVF of her dreaded nugget curse. The crap food now ceases and we are back into behaving well on the eating front.

– we walk around all day saying “11′ to each other and smiling, knowing full well mother nature can king hit us with one of her random brick throws at any time, but fck it, 11 is awesome, so why not feel good for once. Lets watch this implode from here.

– as we roared down the runway heading back to gotham city Mrs IVF looks at me and say “bye kids, see you soon” with a really nice big sweet smile on her dial.

– according to the genetic elf 50% good is the success rate back from microarray testing so if that comes off we get 5-6 to play with. They wont transfer more than 2. If we go 2, then there is a 77% chance of pregnancy and 73% chance of it going full term. Thats the baby factor stats

– thinking ahead to the results. So if we score..

zero – we are screwed. There is no way they will every stim Mrs IVF that much again, so we have a choice as to weather this was just a bad roll of the dice and try again, or if we give up and go donor etc

1-2 – do we transfer now, or do we hold off and stim again? Here is Mrs IVF’s theory. If we go trf and get pregnant it will be 2 years before we get to probably go again and by then we will probably have a birthday starting with a 4. So do we farm a bit now, or are we kidding ourselves and just go for one, shut up and be happy. Another stim cycle could be over by christmas… hmmm.

2-4.. see 1-2 or see 5-6

5-6. Probably transfer

7-8. Write a book  on how we manager to get this far.

8+ probably hit the daytime TV shows, starting with Oprah. Book a slot in US weekly and ring a few TV producers (even though of course none of these have turned into a bloody child that has been any more than a 5 day olds blob of cells)

So , no idea why  I wrote that out, but I guess there is nothing else to do on this front, (now the nugget addiction has been licked) for another 3 weeks 5 days and 12 hrs, (not that we are watching a clock or are anxious at all)

– Work has been a real haul the last few days. I worked a lot remotely while in babyland (which thankfully my job has that flexibility to allow that), but I came back feeling useless, some what emotionally exhausted and just tired. One part of me was sort of yelling at me to get my shit together as I have been out of the office for 2 weeks and the other part of my brain was telling the pushy side it can stick itself where the sun done shine (to which the pushy side said ” I am already where the “sun dont shine”  as when was the last time the sun shone inside your head – moron”)….. hmm interesting day in my brain today.. anyway – the more lenient side of the brain was saying “chill out dude – you have been back on the emotional roller coaster and you know what – it aint easy and you know what, you work to hard anyway and you know what, you need a holiday and you know what – cut yourself some frikkin slack. You are going through an incredibly hard time in your life, so how about a little bit less on beating yourself up.”

“nice work” says the brain referee (somewhere between the two) … lets go for a drink, so I headed out with a mate who is in town from Tokyo and slammed down 6 rather tasty no alcoholic nojitis.

Thankyou all for your posts. I really appreciate it and Mrs IVF loves to read them as well. I recognize there is a world of lurkers out there (or Mrs IVF has just been spamming the site to get the dashboard stats up), either of which is cool I guess, but we do appreciate all posts, so thanks. Click the poll and let me know what you want to hear about so I can keep my mind active for the next few weeks!

Final biopsy results

So yesterday I left you feeling a bit flat with 5/17 biopsied and a promise f rom the elf that they’ll see if any more made blast today.

Mrs IVF was stoked with the 5 and I guess I was flat thinking that our stellar run had hit a wall with 12 dropping away. I did some research last night and found out that 30-35%, max 40% of day 3 kids make full blast. So 5 is actually pretty good and I realised after hitting the running machine in the gym for an hr I was foolish not doing some research and setting my expectations better. Also, we might get another 1 or 2 today and that would be nice, but we’ll take the 5 and remember that our old clinic didnt think we could make blast.

The call comes in this morning and Mrs IVF was showering so I answered it. On the other end was a lovely elf who was warming me up like you see in reality TV shows just after a TV ad break “now if you recall before the break, you had 25 eggs, 23 mature, 17 fertilize and we biopsied 5 yesterday…” “yep, I recall that” “…. and we promised to call you today to see if any more made it to blast….” “yep, got it”, “…well this is that call..” “great ok” “…and I’m about to tell you if we got any others…” “yep, yep , sure, yes” … it wasnt anywhere near that bad but it felt like it. Time stopped. Heart sank a bit, you new it was a big call, but we had 5 in the bag so anything else was a bonus….

“we biopsied  6”

“thats great”

“on top of the 5 we did yesterday”

Whoa.(and dare I use my catch phrase again). Holy shit.

So 11/17 got biopsied in the end – 69%! Unbelievable result

“You should be very happy with that, we dont often see results like that” says the elf.  We were ecstatic. Mrs IVF enters the room and I am frantically writing down grades and asking heaps of questions and she is looking at me with the “so, how many?” look. I continue my chat with the elf “yes, hmm, wow, interesting, thanks” with a somewhat cheeky grin on my head that gets a rolled eye response.

We dropped in to see the genetic elf this AM and ask some questions. She hadnt heard about the 11, and in fact thought we had dropped in as something had gone bad. When we told her she was very excited.. “it has been a very long time since we have biopised 11, we normally do 3, 4 or 5”

So 3 didn’t make blast and 3 were lower quality. (a 3DC, a 4CC and a “too poor”)… they think these 3 poor guys wont survive a freeze / thaw so didnt biopsy them.  So actually thats 14/17 made blast – which is an even more ridiculous success %

So a bit about the scoring (in non technical, Mr IVF speak):

3 = fat outershell , 4 thin outershell, 5 hatching (higher # the better) ; 1st letter: quality of baby bit of embryo: A  – top rating, lots of cells, neatly packed will grow up to star on baywatch, B: lots of cells but not as dense (very fine distinction between these two “but we are picky” says the elf – so probably more a game show host) 2nd letter: quality of the trifectadermbloganodulethingo that will form to be the placenta bits: A and B as per the before. So we got:

2X 5AA (bursting out and “we need to watch them if we put them back in as they are a little sticky” – we like sticky), 2 x 5 AB, 1x 5BA, 1 x 5BB, 1 x 4AA, 3 x 4 BB and I wrote 6BA but have no idea what 6 means now, so that could just have been a blur from the moment.. so some very nice results in there with 6 hatching.

Our genetic elf says that they normally get 50% good back from testing so hopefully we can keep this strong run up.

Still – they were buzzing in the clinic this AM but Mrs IVF and I remain cautious as ever. I think we will remain this way until these kids graduate from college.

Murgdan: I asked a few questions around speedy kids. It appears that some speedies  have issues but others are …. well.. boys. (Our 12 cell day 3 zippy turned into a nice 4AA – which makes him / her sound like a type of battery), but I asked our genetic elf if more boys or girls are products of the baby factory and she said its very very even but ever so slightly favors boys as boys have been noticed to develop faster very early in embryo development so often get picked more often (but not necessarily through CGH). So she said it’s a fine line between turbo’s that have genetic problems and turbos that are well, just boys. Thought you’d appreciate that.

So results back in 4 weeks or so and back to NY tomorrow. One remaining issue is Mrs IVF’s nugget addiction but we’re working on that.

Dancing on eggshells

The elf just called. We had 5 reach blast today and were biopsied and others that are in early blast stage and hope make it tomorrow so can be biopsied. Mrs IVF didnt ask anymore than that, this is all out of our hands now anyway, so maybe we should just forget about it for 4-6 weeks and wait for another phone call to see how we go after mircoarray. Mrs IVF was very happy with her 5 blasts and reminded me how big a deal that was (and that the old clinic didnt think we could hit blast at all). I think I am just fed up with all of this. At the end of the day we have been incredibly fortunate to have such large numbers to play with but it always just seems to come down to a few embryos and living with minced nerves, (oh, and I am not the one who has had their body treated like a lab rat who has developed a nasty nugget addiction, so what do I have to complain about.)

We’ll see how we go I guess. We are still taking steps forward and for that I need to get out of my huff and remember that we are still in the game and that, to be fair, is huge.

Day 3 update

We didnt get a call on day three yesterday so we popped down to the baby factory to see if they can give us an update (they dont really answer the phones on weekends and Mrs IVF, after sleeping 70 of the last 72 hrs, really needed some fresh air). They were busy prepping for morning retrievals, so promised to call us later..

We headed out of the baby factory and just drove around for a while. Within an hr we got the call and Mrs IVF, even though she promised that this time she would quote numbers, all Mr IVF got was the “good, oh, ah thanks” routing again, but she did have her notebook and pen out and managed to write down “good news!” so again, the confidence went up.

Mrs IVF hangs up the phone, looks up and says..

“hey whats that?” as she points out the car. I look around and see some small little groundhog like thing that stands up on its hind legs. Very cute, we look around and see 4 or 5 of the in their burrows…

“how about the results?” I politely nudge. “oh yeah, sorry, damn this will go in the blog” says Mrs IVF. So….

they are expecting to see them at a 6-8 cell stage growth. Out of 17 embryos, all are still going!! 3 are a little slow and a little bit delayed / fragmented, (but that is normal the elf tells us and they may catch up). 2 are a 10 cells and 1 is powering along at 12 cells. The elf thinks that the 12 and maybe 10  cell ones are bad genetically as its common that the bad ones go a bit nuts before imploding (and here we were at the last clinic thinking these turbo ones were preferable.)

So assuming these all keep going well we hit biopsy tomorrow.

We continue to be blown away at our progress so the fall from here will be large and painful. Very painful. You also think that you have 17 kids out there. As Mrs IVF said (who is far more chatty these days now she is awake for more than 3 mins) – “geez – we have enough kids for our own reality TV show”. See how this thing seeps optimism into your brain… its very very dangerous. Still – as my mate says – enjoy it while you can. We can go and pick up the pieces later.

For those of you reading this thinking “wow I want that sort of success” I dont know if it’s the baby factory or if we just got lucky, but we have been reading blogs for 2 years and seeing heaps of success. So if it can happen to us, shit, it really can happen to anyone, but lets see, We have such a long way to go.

Mrs IVF is eating again but her sweet tooth has completely left her but has developed a nasty taste for Mc Donalds nuggets. She is still in a lot  of pain and doesnt want to walk far, but she is on the mend.