Sunday, July 7, 2013

A tale of 2 ovaries, surrogacy, and the pitfalls of day 3 transfers

I've become aware, over my TTC journey so far, that my 2 ovaries may behave differently with respect to egg production. I think all 3 of my pregnancies (not sure about the first) came from eggs from my left ovary. The one time I had a BFN was when my right ovary was in play.  This IVF, when it became clear that my right ovary follicles were smaller than my left, I asked the embryologist to keep track of the eggs from the right and left. At egg collection and fertilization, it seemed, surprisingly, that the right did better than the left.But.....as things progressed,things changed.


Right Ovary
Day 1 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2PN
Day 2 4A 4A 4A 4A  4A 4B 4C 4C no data provided
Day 3 8A 8A 8A 8A 8A 6C 6C 4B 2A
Day 4 early
blast
early
blast
early
blast
morula morula 8C/B 8C/C fail fail
Day 5 4AA 4AA 3AA early
blast
early
blast
fail fail fail fail
Day 6 frozen  frozen frozen poor 
blast
poor 
blast
fail fail fail fail













Left Ovary
Day 1 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN
Day 2 4A 4A 4A 4B 4C 4C 2A
Day 3 8A 8A 8A 8A 6C 6C 5A
Day 4 Early
blast
Early
blast
morula 10 C/A comp 8 C/B 8C/B 5A
Day 5 4AA 4AA 4AA 2AA 1AA fail  fail
Day 6 frozen frozen frozen frozen frozen fail  fail


















If you plot the fate of each embryo to figure out where the blasts came from, its amazing how much better my left is than my right. I still can't understand why the mojo appears to be in the left and not in the right (70 % of my fertilized eggs from the left made it, as opposed to around 37% from my right). I'm sure such a dichotomy may also exist in other people, it may just be difficult to spot.

Another point I want to emphasize...sometimes the embryo you think has no chance on day 3 CAN actually make it to blastocyst, like my 6C  Day 3 embryo that became my 1AA blastocyst. I was reading a post from a lab who only does day 5 transfers and  the doctor commented on how often they are surprised by poor quality day 3 embryos actually go on to become Day 5 or Day 6 blasts and produce healthy children.

 I think a lot of people look at poor quality day 3 embryos and think that they may be saved if they go into the uterus and are certain that, if they wait till Day 5, they will end up with nothing. But I think a little faith is needed, because from all scientific and anecdotal accounts, that location seems to make no difference. Embryo cell culture is something that HAS been optimized, then tried and tested by many labs around the world. And while the uterus is a great place to be, there is definitely a body of studies that show that in a subset of women, the uterus may itself contain hostile factors. Basically, its a level playing field if you are comparing the petri dish to a uterus. If a day 3 embryo has the developmental potential to go the distance,  it will,  no matter where it is. And if it won't, it won't.

And this part is just pure idle speculation but I would think, technically,that a day 5 embryo may be able to hold its own better against the hostile uterus a touch better than a day 3 embryo...I'm saying this because a day 5 embryo would make more HCG, a hormone known to cause immune cell apoptosis, and possibly other factors that aid in implantation.

The issue with day 3 transfers (in addition to all the risks associated with multiples) that I see is that it puts you through a so much longer period of uncertainty- if none of the embryos will make it, it is actually easier on you to find that out after a phone call from your doctor, as opposed to going through a transfer, a 2WW, paying (monetarily and physically) for your progesterone, your blood test, all of it. Importantly, if your Day 3 embryo transfer fails, you remain in the dark as to what the issue was: was it embryo quality, or implantation issues? On the other hand, if a blastocyst transfer fails repeatedly, its a little bit more likely that the issue may lie in uterine receptivity or immune-related causes.

Anyway, moving away from preaching (I am sorry to be doing so much of it; I just can't bring myself to stop), my new surrogate is going through the preparations for transfer. I don't have a transfer date yet, but I HAVE decided to  be brave and only transfer 1 blast.

 The last time I picked a surrogate, I was hoping it would be somebody I was comfortable with. Now, I'm finding myself desensitized and starting to treat this the way surrogacy in India is meant to be treated: emotions should be left at the door. Obviously, this is a deeply different process compared to say, the one in the States. As a point I am thankful for, this is not her first rodeo, so to speak; this is the second time she is attempting surrogacy. The first time, she got pregnant on the first shot and had a natural delivery.

With so much possibility (in terms of embryo availability), I'm still not tempted to try to carry the baby myself. When I first got pregnant, and heck, even the second time, pregnancy was joyous. Now, the thought of getting pregnant, finding myself at the mercy of hormonal upheaval, of getting 50,000 blood tests and waking up 4 times a night--- I just don't want any of it. I know how much good stuff I am going to miss out on and I still don't want to do it. If my eggs don't work and adoption does not seem easy either, then I may have to go through donor embryo IVF (with PGS) in the States, and that thought makes my blood run cold---just because I'll have to go through pregnancy myself. I am aware that I am missing out on an incredible and important life experience  by choosing to avoid pregnancy---but I remain comfortably numb about it all.




























4 comments:

  1. I completely understand your feelings. At the beginning of this pregnancy I told my therapist that I wished I could send someone else to all the early ultrasounds and appointments and have them just call me with the results. The anxiety of early pregnancy is so overwhelming for those of us with losses. I hope that everything with your surrogate goes perfectly!

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  2. Good luck! I hope this surrogate and this embryo is the one!

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  3. Haha...would'nt that be awesome. I totally have ultrasound PTSD!

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  4. Thanks, hope it is for you too. Fingers crossed for the beta!

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