Watching our embryo garden grow

Days 1-4 of our embryo watch – from Zygote to Morula.

Day 1

The clinic regarded the actual day of egg retrieval as “Day 0”, so Day 1 was the following day. We had been promised that they would contact us before midday with the news of how many of our (eight) eggs had successfully fertilised overnight.

They did not prolong the agony too much, just before 10am we received the news. They also attached a nice little infographic:

This was as good a result as we could hope for. We knew from our previous attempt at IVF (using my eggs) that successful fertilisation was only the beginning and that failure could happen at any stage. However even my pessimism could not detract from the fact that this was a promising start.

We were surprised to see from the infographic however that ICSI had been used to fertilise all the eggs – David’s sperm analysis had been normal. I emailed the clinic to ask why. Their response was short:

“We always use ICSI method for fertilization donor’s eggs, except the cases when poor sperm quality is and it is recommended by doctor or when the clients wish to use another kind of method of fertilization such as PICSI or IMSI“.

During normal fertilisation, sperm compete to be the one which finally fertilises the egg. With ICSI however, one sperm is picked up and forcibly injected into the egg, therefore reducing the likelihood that only the fittest would make it. Our understanding from previous discussions with fertility personnel in other clinics was that ICSI was generally only used in cases where previous fertilisation had been poor, or where there were problems with sperm quality or physical access (e.g. in the case of a blockage or a vasectomy). ICSI is also suspected of increasing the incidence of genetic abnormalities. While the exact risk is still debated (and is thankfully thought to be low), we had already had multiple miscarriages and one failed IVF cycle because of chromosomal problems. Our priority was to have a healthy child, not just achieve the maximum amount of fertilized eggs. I simply would not have opted for this added intervention had the choice been presented to us and was really unhappy that the clinic had not discussed this with us first. But there could be no going back. The donor had performed her part, so had David. We had eight fertilized eggs now. All we could do was hope that for once, luck might actually be on our side.

My protocol had also changed slightly to accommodate some new medications. I was already on Aspirin (for it’s blood-thinning properties) and Estradiol (a form of oestrogen). Three days prior to our egg retrieval I had started on a low dose of a synthetic steroid called Prednisolone to dampen down my immune response (immune issues are believed to be a contributing factor in many cases of recurrent miscarriage). Then on the day of egg-retrieval itself, two more new drugs were introduced to my regimen. Duphaston, a synthetic progesterone in tablet form, and Cyclogest, also progesterone, but in the form of a pessary. Both were supposed to increase the receptivity of the endometrium to allow implantation of the embryo.

Unfortunately for me, the Cyclogest pessaries were only available in the Czech Republic in doses of 200mg, but I had been prescribed 400mg doses. This would mean taking two of them at a time. I knew from taking them in the past what kind of “leakage” to expect, and taking two at a time did unfortunately add to the misery proportionately. But then not a lot about the IVF process is pleasant.

Day 3

We did not receive any update from the laboratory on Day 2 as it was a Sunday, so we were particularly anxious to hear from the clinic this morning. Just before 11am we received the following email:

We had started with eight embryos. Now were were down to four. I emailed the lab to ask if it was normal to loose such a high proportion so quickly. They responded with:

“This is quite common as about 25-30% of embryos reach the blastocyst stage on day 5.”

We tried to keep ourselves busy and not stress too much. It worried us that we had lost 50% of our embryos and we still had two days to go, but what could we do? Absolutely and entirely nothing.

Day 4

Just before 9:30 am we received our update:

…so now we were down to three.

The clinic asked us to confirm how many embryos we wanted to transfer the following day. I replied to say probably one, but that we wanted to talk to the embryologist before making a decision. They also sent me the following instructions:

We spent the rest of the day playing mini golf nearby and basically trying to keep ourselves occupied any way we could. And we talked more about whether to transfer one or two embryos, assuming that we would even have that choice at the rate we were loosing them.

Only the morning would tell.

Here are some links and articles related to this post:

 

1. Aspirin. Wikipedia.
2. Cyclogest. Medicines.org.uk.
3. Differences between zygote, embryo and fetus. Invitra.
4. Duphaston.
5. Embryo Grading and Success Rates. Embryoman at Remembryo.com.
6. Estradiol. Wikipedia.
7. Estrogen – why do fertility patients need it? Your IVF Journey Ltd.
8. Frequently Asked Questions on IVF treatment answered by Dr. Charles MPL. Ivf-treatment.com.
9. Intracytoplasmic sperm injection. Wikipedia.
10. Intracytoplasmic Sperm Injection (ICSI). Health Day.
11. IVF treatment used by 23,000 women in turmoil as shock report reveals that birth abnormalities have DOUBLED. Mail online.
12. Morula. Wikipedia.
13. Neonatal health including congenital malformation risk of 1072 children born after vitrified embryo transfer. Human Reproduction.
14. PICSI. Prague Fertility Centre.
15. Risks of infertility treatments ‘overhyped’. NHS Choices.
16. The risk of birth defects after assisted reproduction. Journal of Assisted Reproduction and Genetics.
17. Perinatal Outcomes by Mode of Assisted Conception and Sub-Fertility in an Australian Data Linkage Cohort. PLOS ONE (open access).
18. Prednisolone – the fertility wonder drug? Your IVF Journey Ltd.
19. Weighing ICSI Risks and Benefits. Attain Fertility.
20. What is IMSI (Intra-Cytoplasmic Morphologically Selected Sperm Injection)? UK Health Centre.
21. What is intra-cytoplasmic sperm injection (ICSI) and how does it work?. Human Fertilisation and Embryology Authority.
22. Zygote. Wikipedia.