Waiting

We were supposed to hear from SCI today, but this is the first time they have not emailed on the expected date.  With the 11.5 hour time difference between New Delhi and Dallas, the clinic is presently closed.  So we have to wait and keep our minds from racing.

It's hard not to dwell on the history of prior failures and speculate about the worst.  We received an email from SCI last week that made us realize we are actually on our fourth attempt.  You see, last month we started all over with a new donor, but when the eggs were collected and fertilized, the surrogate was not deemed suitable for transfer, so the cycle was cancelled.  There were no surrogates for back-up that could take her place, which was what had happened in the past.  So no 2WW, no pregnancy test with a BFN (big fat no), just upfront failure. 

Margarida, one of the excellent SCI case managers, explained that this happens in a few rare cases, and that had the transfer gone ahead, our chances of success would have been very poor.  We trust Dr. Shivani's judgment, and on the positive side, we did not lose our best quality embyos in the attempt.  But we were crushed that we did not get an attempt with a fresh cycle, since your odds are higher when the embryos do not have to undergo cyropreservation.  Unfortunately, all of our embryos had to be frozen and we would have to wait to try again.

So while we wait for news on this recent attempt, I figured we would share our embryology report.  Perhaps it will help other IP (intended parents) know what to expect.  Our 2WW is somewhat shorter, since this attempt was an FET (Frozen Embryo Transfer) where the previously frozen embryos were thawed and cultured to 5 days (counted from the time of fertilization), versus the usual 3 days for a fresh cycle.  Allowing the embryos to grow to this more advanced "blastocyst" stage can aid in selecting the best/strongest embryos for transfer.  However, when we were in New Delhi and asked her, Dr. Shivani was very clear that the best environment for the embryos was the womb, which makes perfect sense, so it's a risk to freeze and then culture to 5 days, since some of the embryos will not survive the thaw or will just fail to mature outside.   In our case, four embryos were thawed, and four (in various stages of development) were transferred.

The report uses the Gardner blastocyst grading system, which assigns 3 separate quality scores to each embryo:
     1. Blastocyst development stage - expansion and hatching status
     2. Inner cell mass (ICM) score, or quality
     3. Trophectoderm (TE) score, or quality

Pictures and information taken from the following website: http://www.advancedfertility.com/blastocystimages.htm

The inner cell mass (ICM) will become the fetus
The trophectoderm cells (TE) will form the placenta

 

So the embryo is given a number grade (1-6), followed by a letter grade for the inner cell mass and then the trophectoderm (A,B or C).

The expansion grade scale ranges from 1 (least expanded) to 6 (completely hatched).

     Grade 1: The fluid-filled cavity takes up less than half the space of the embryo.

     Grade 2: The fluid-filled cavity takes up more than half the space of the embryo.

     Grade 3: The blastocyst cavity has expanded into the entire volume of the embryo,

     pressing the trophectoderm cells up tightly against the inside of the zona.

     Grade 4: Expanded blastocyst, where the blastocyst has increased beyond the

     original volume and caused the zona pellucida “shell” to become super thin.

     Grade 5: Embryo has breached the zona and is hatching out of its shell

     Grade 6: Embryo is completely hatched.

For the inner cell mass:

     A: Many cells, tightly packed

     B: Several cells, loosely packed

     C: Very few cells

The trophectoderm grading goes like this:

     A: Many cells, forming a cohesive layer

     B: Few cells, forming a loose layer

     C: Very few large cells.



As noted in the report, laser assisted hatching was performed.  The zona pellucida "shell" surrounds embryos and the embryo must escape or "hatch" in order to implant in the wall of the uterus. Some embryos in which the shell is thickened or hardened make it difficult or impossible for the embryo to implant.  Assisted laser hatching uses a laser to create a hole in the shell to aid the embryo in the hatching process.  Apparently this is a safe procedure, and if it helps increase our chances, I'm all for it!

The report notes that our pregnancy (bHCG) test was to be performed today, 2/17/13.  Looking at the treatment summary, I'm worried that we only had two blastocysts.  The other two were slower developmentally, so I'm not hopeful they will grow/implant.  I know, everyone always says "you only need one!"  And I would prefer not to have to undergo a selective reduction for multiples, but in this case, isn't it better to have too many than not enough (or any at all)?

I hope the delay isn't an omen or due to an issue.  Realizing this is our fourth attempt and we are three-time losers, I'm much less optimistic than when I thought we were on our third try (three strikes and you're out).  Crossing our fingers anyway.