Increasing Efficiency

At the end of our initial consultation, my RE explained that he likes to review the mechanics of reproduction with every patient, regardless of their education level or prior experience with infertility treatments. I turned and gazed at the window to conceal my eye roll, although Husband listened intently. He summarised his birds and bees lecture by noting that human reproduction is very inefficient. Despite the reputation of rabbits, mice are actually one of the most efficient reproducing species (fortunately, he didn't go into further detail...) The female human only has a few brief fertile opportunities each year, while the human male wastes millions of gametes (sometimes recreationally). "Maybe from a standpoint of population control it is very effective, given that humans consume the most resources" I replied, truly intending to make a good point, while enjoying the added bonus of coming off as a smart ass.

When I first had the IVF talk  with my RE, he pointed out that IVF provided a more efficient means of human reproduction. I felt that he was trying to be somewhat consoling; 'I'm sorry that infertility has dropped you in the bottom of the heap'. Yet he did have a point, after you get past the injections, retrieval and fertilisation in a Petri dish , IVF does offer a lot more opportunity than the average romp in the sack. Of course, that thinking is presuming you have a good retrieval, good fertilisation rate, good embryo development and enough embabies to stick on ice.

To a certain extent, we have achieved the goal of increased efficiency. In one cycle, I produced eight mature eggs. Five fertilised. To our knowledge we only had one other episode of fertilisation, and we all know that didn't work out too well. Yes, we're way ahead of where we would be without intervention, but is it far enough? It's so interesting how quickly your perspective can change. Eight mature eggs seemed meek compared to twelve oocytes retrieved. The number eight seemed robust compared to five fertilised eggs. I had the feeling that by my day 3 report, I would be longing for the number five. A week ago, my RE was looking at our number of follicles and at my E2 levels and described that things looked "good". Now our prognosis seems anything but good. I shared some of my concerns with him just before my retrieval. Six to eight mature oocytes meant we'd be working within narrow margins. "When you're pregnant, you won't remember these details" he replied with a hand patting my thigh. I wondered if he was just trying to shut me up before the anesthesiologist did it for him.

I commented to Co-worker that if all five (realistically, at least four) of our embryos made it to day 5 and we could complete our intention for a freeze all cycle, I would consider this attempt to be a success from an efficiency standpoint. She reminded me that my goal with this treatment is to have a baby, not necessarily to have a collection of embryos. She is correct, we only need one to work as we only want to have one child. If we succeed, we really don't need to have any embabies on ice, so maybe this cycle could be deemed efficient in that respect. However, if we only end up with one (or two) embryos to work with, then it's hard to argue that IVF is increasing efficiency, but rather compensating for a defect.

After reading my initial fertilisation report, my RE thought a day 3 transfer was less likely and he seemed confident that we'd make it to day 5. I couldn't escape feeling that the entire process seemed like a long shot. More so, I started to fear that if we couldn't produce a decent yield of embryos would it even be worthwhile to consider pursuing a second IVF cycle? I projected that if at least four embryos survived to day 3, we could proceed with our Day 5 freeze-all. If there were three or less, we would need to do a day 3 transfer. Then I remembered these are our embryos! They have our genetic material. They have Husband's stubbornness and my determination. Progress to day 5? Challenge accepted! Bring it on Bitches! It was the first time I acknowledged any attachment to them. Is it odd that I felt a sense of pride?

My RE called with my embryo update while I had two patients waiting in rooms and I was on the phone reviewing a stat report with our radiologist. As soon as I spoke with him, he wasted no time giving the report and recommendations. Embryo quality wasn't bad, but wasn't good. He was advising transferring two embryos now. If we decided to wait until day 5, we may only have one or two, or worse case, none. I quickly rationalised, that if I were going to lose some embryos anyway, it was better to put some in my uterus. I felt really defeated. It was frustrating enough to acknowledge that we were pathetic at trying to conceive on our own, now we sucked at IVF too.

Here was the situation I desperately wanted to avoid. Transferring more than one embryo and potentially facing twins. Although I was also questioning if our possibility for pregnancy was so low, was I being daft for even fretting about twins? My RE had noted that based on my age, I nearly fell into the 'poor prognosis' category when it would be recommended to transfer three embryos. At the same time, I couldn't deny my fears. I don't want to be another IVF twins statistic. I don't want to have people look at me and think to themselves, 'she should have known better.'

I spoke with my lead physician. She suggested that if he was advising transferring three, than I should at least go with two. Very reluctantly, I agreed. It would increase the efficiency of the transfer. My RE revealed that if he were talking to me about one of my patients [with our details] he would recommend two. If I were a member of his family, he would recommend transferring two embryos. Nearly every REI clinic would advise a transfer with two embies on board. It's so hard to go against such strong recommendations, but at the same time, no one making such suggestions has to live with the consequences. I do. He discussed the potential for regret if I elected to transfer one and it didn't work. Would I wonder what may have happened if we transferred two? Perhaps. I just hope I don't come to regret transferring two.

It turns out that our embryos weren't too bad. We had six that contained seven or more cells (we picked up a straggler!). Three actually had nine cells and one had ten. Yes, those are my over-achieving embryos. However, only three received a grade of 'good', two were 'fair' and one was 'poor'. I think they transferred my good nine and ten cell ones. I have one 'good' embie, two 'fair' ones and another 'poor embie that will try to make it to day 5 and to the freezer. The embryologist noted that if we just had a few more in the 'good' category, we could held out for a day 5 transfer. That was reassuring to hear.

I signed up to participate in Risa's  sock exchange, as I wanted to have socks from another infertile for my frozen embryo transfer in a month or two; but as we all discover, things don't go according to plan. Socks are a little bit of a sensitive topic for me, as that was one of Myrtle's conception tips. "If you wear socks after sex, it will help blood flow to the uterus and will help make things stick" Um, it's all about the boys and their swimming ability at that time. Implantation doesn't take place until 5-8 days after fertilisation, but thanks for trying to apply some scientific theory! I decided that it couldn't hurt, but I wanted to put my own twist on it and went with my compression calf sleeves.