Happily Ever After

Archive for April 2008

Here is a study I found. I don’t know why I sit here and do this to myself. I guess it’s because I’m obsessed with having to know everything. I can’t wait to talk to my embryologist on Monday. I’m going to pick her brain. They have done lots of their own studies over the years so she can tell me what my odds of pregnancy are. Thank goodness we finally got at least 1 perfect embryo. I’ve been doing IVF for 1 year and that has never happened. Boston IVF did say that I had a perfect 8 cell (day 3) embryo with my first IVF but their criteria is not nearly as strict as my current Re’s office so I don’t have much faith in them.

I guess judging by the research I’ve done that my embryo’s are considered chromosomally abnormal. There are tests we can do to check if that is the case however in order to do those tests my embryo’s have got to make it to day 3 (which they normally do) on day 3 they take some cells and do a biopsy on them to see if they are abnormal or not. However it takes a few weeks for the results to come back so they would grow the embryo’s to day 5 and freeze them. My embryo’s never make it to day 5. So essentially I could get the test done but odds are I’d have no embryo’s to freeze. I suppose then at least we’d have an answer.

I believe this study was done back in 1996 so I’m sure there have been new developments. Which is one reason I want to talk to my embryologist. She said she could email me some of her studies so I might take her up on that offer.

Titre du document / Document title

The presence of multinucleated blastomeres in human embryos is correlated with chromosomal abnormalities

Auteur(s) / Author(s)

KLIGMAN I. (1) ; BENADIVA C. (1) ; ALIKANI M. (1) ; MUNNE S. (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) The Center for Reproductive Medicine and Infertility, The New York Hospital-Cornell Medical Center, New York, NY, ETATS-UNIS

Résumé / Abstract

The purpose of the present study was to determine whether the presence of one or more multinucleated blastomeres during early embryonic development is associated with chromosomal abnormalities in sibling blastomeres of that embryo. Embryos with multinucleated cells (n = 47) detected on day 2 or 3 of development were compared to dividing embryos without multinucleation. Arrested embryos were excluded from this study. Chromosome abnormalities were detected using fluorescent in-situ hybridization (FISH) with X, Y, 18 and 13/21 chromosome-specific probes. Of 47 embryos included in this study, 76.6% were chromosomally abnormal, compared to 50.9% in the control group (P

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I had my 2 day transfer today.

at ER we had 9 eggs retrieved which is exactly how many my RE thought we’d get based on my E2 levels.
Out of the 9 7 fertilized with ICSI.

We did a 2 day transfer of our 3 best embryo’s however only 1 looked promising.

Embryo #1 was 4 cells and had even cells (meaning all the same size) and 1 nucleus in each cell. This embryo is a high quality.
Embryo #2 had slightly uneven cells but was a 4 cell embryo. 2 of the cells had 1 nucleus but the other 2 cells had multiple nucleus.
Embryo #3 was a 4-5 cell embryo. they said it was cleaving and starting to divide. I can’t remember what the cells had for nuclei but I am pretty sure this was the lowest grade of the 3.

I’m not sure of the quality of the rest of my embryo’s. I had a 2 cell and I think the rest were 4 cells but I’m pretty positive that the rest were abnormal in one way or another. I tend to get embryo’s that are multinucleated (which is poor quality and leads to decreased pregnancy rates. These embryo’s often don’t survive)

here is what I found on the internet that might help explain how my clinic grades embryo’s:

quote:

Eggs retrieved from the ovaries are inseminated with sperm during therapeutic in vitro fertilization (IVF). Fertilization must be confirmed by the embryologist and embryo development carefully monitored thereafter. On the first, second and third days of development, embryo quality is evaluated based on key morphological markers, including the number of cells, cell size and symmetry, multinucleation (more than one nucleus in each cell) and the presence of cytoplasmic fragmentation. The thickness of the zona pellucida, the protective shell surrounding the developing embryo, is also a consideration for embryologists as they select the “best” embryos for replacement in the uterus.

The rate of cleavage (cell division) is an important predictor of an embryo’s developmental potential. Evidence indicates that early cleavage, embryos with four cells on day 2, and embryos with seven to nine cells on day 3 result in higher implantation rates and establish more pregnancies than those with fewer or more cells at those time-points. Based on this, we preferentially replace seven to nine cell embryos on day 3 and consider others for cryopreservation if they meet additional quality standards.

Uneven cleavage is common among human embryos developing in-vitro and there is general agreement that replacement of embryos with this characteristic results in lowered pregnancy and implantation rates. This may be due to an unequal distribution of cellular components among uneven cells or the occurrence of more nuclear abnormalities among them. As a result, these embryos generally are not selected if others are available.

A. A normally fertilized egg showing two pronuclei

B. An uneven 6-cell embryo with one multinucleated cell

C. An 8-cell embryo with minor cytoplasmic fragmentation

Following the first division, some blastomeres in human embryos show multiple nuclei rather than the normal single nucleus. Possible causes are the lack of appropriate oxygen levels during follicular development or a rapid response to hormones during ovarian stimulation. Regardless of the cause, implantation and pregnancy rates decrease with increasing proportion of embryos with multinucleated cells replaced in the uterus. These embryos also have a considerably reduced ability to reach the blastocyst stage in extended culture. The selection of such embryos for replacement is avoided if at all possible.

end quote:

I wish I had pictures of my embryo’s to share but I forgot to ask for them. I’ll call on Monday and when I talk to the embryologist I’ll see if they took some but I doubt it. At my old clinic I was used to them automatically taking the picture and giving it to me.

As you can tell from reading the above criteria only one of my embryo’s is promising. However that’s more then I’ve had in a year so I’m over the moon that I have a perfect embryo. Granted I am still holding out hope for my other two. I guess you never know…but an embryo with multiple nucleus is chromosomally abnormal.

I bolded a part I thought was important. I just assumed that meant that I had crappy eggs, when in reality maybe it means that all this time my eggs/body didn’t respond well to the medications. I do tend to respond a tad quicker. and lots of my embryo’s grew with in the last few days of my stim’s. most of my cycle I had 7 embryo’s, it wasn’t till the last few days where the other 6 showed up so they grew rather rapidly.

This does give me a slight hope that I can conceive naturally. however the abnormal embryo’s could just be becuase I have poor quality eggs. it’s possible that we just have a high number of chromosomally abnormal eggs. Some of the eggs we have are abnormal and will NOT make a baby. Which is why almost no one gets pregnant right away. It’s why it can take up to a year for perfectly healthy people to get pregnant. Unfortunately I guess I just have a high number of abnormal eggs.

All in all this batch did look better then the last batch I think. Most were “even” as in they were 2 or 4 cells. Unlike last time where I had mostly 3 cell embryo’s and some 4-5 cell’s that were extremely abnormal.

I’m going to talk to the embryologist on Monday for 2 reasons. 1 is to get an update on if my embryo’s survived the weekdend (by Monday they should be at the day 4 stage, morula. My embryo’s have NEVER made it this far. But i also want to pick her brain about my embryo’s. What the chances are of a multinucleated embryo making a baby. I’d kind of like to know what my chances are. I’m not sure switching clinics will help me at this point. This RE has proven that he can get double or triple the eggs my last RE did.

Side note. The RE today asked me what I did for a job. He thought I was in the medical field because I knew what I was talking about. I chuckled and said “nope I’m just obsessed with having to know every single detail, I’ve spent hours on the internet researching.” My husband then replied “those hours have probably added up to days and weeks by now.” LOL

It’s a miracle. I think I’ll be stimming for a full 10 days! This has never ever happened. The only thing different (other then increased dosage of meds) Is the following:

-Taking Whey protein to try to help egg quality
-Doing my shots at 9 pm instead of 5:30
-Starting my cetrotide (antagonist) at 2:30 rather then in the evening like they told me too.

I’m very excited!

Here’s my stats:

Saturdays results:

CD 9 (7 days of stims)
E2= 632 Lining= 10.1
Right: 1@16mm 2@12mm, 3@13mm
Left: 1@13mm

Instructions:

4/19-4/20 Same dosage
300 Gonal F, 150 Repronex
Total FSH = 450, total LH = 150
Add Cetrotide

Todays results:

4/21 (9 days of stims) b/w and u/s
E2=waiting on results
Lining 13mm
Right side: 1@16mm, 1@17mm 5 between 13 & 15mm
Left: 6 around 13/15mm!

I’m very excited that I’ll probably be stimming for 10 full days! That makes my ER on Thursday and my ET on Saturday! That works out best for Jon and I too! I’m over the moon.

*******************update**********************

E2 was 1,432 Just a hair under what it was last time. I’m sure not all 13 follies will be mature but I’m fine with that. I do one more round of shots tonight and trigger tomorrow. I’m excited that I made it to 10 days of stims!

I’m really exhausted so this will be quick.

Today is day 5 of stims. my E2 was 306 and I had 4 follies, 1 at 12mm and 3 at 11mm. It’s still early so I’m sure I’ll get more. My E2 is very low though compared to what it usually is. It could mean that I’m just stimming slower (that is what I’m hoping) or it could mean I’m just going to get less eggs this time. I’m on more meds then I’ve ever been on and the side effects are really starting to get to me. Headache, achy all over, nausea, and the runs. I didn’t have the energy to cook so I went to KFC and got a bucket of chicken and some potatoes.

anyhow, I am on a total of 450 FSH and 150 LH now. I go back on Saturday morning at 7 am for blood work and another ultrasound.

I’m hoping ER will be Thursday.

Ok I went to ok a comment and I can’t find it. I have no idea who it was from or what the whole message said but it was something about “my re okayed 5-6” or something like that…

E2 on 4/12 (baseline) was under 20 (CD2)

I did -4/12-4/14 225 Gonal F

today: CD 6-4/15 E2 was only 75 icon_sad.gif that is after 3 days of 225

my instructions:

keep gonal F at 225 but ad 150 repronex (total FSH = 375 total LH = 150)

do that for tonight and tomorrow. return on 4/17-Thursday for more b/w and u/s

I didn’t have an u/s today and I’m fine with that.

I’m kind of scared right now…quality over quantity…all I want is 2-3 perfect 4 cell day 2 embryo’s for transfer…that and a nice thick lining.

I’m trying to be optimistic. icon_mrgreen.gif

My fear however is the BCP’s over supressed me. Honestly I shouldn’t have been on them at all but that is JMO

Maybe this is a GOOD thing. I mean maybe I’ll stim for 10 days *holds breath* I have NEVER stimmed for more then 9. Heck stimming for 9 is a miracle for me. LOL

Maybe I”m just up to a slow start. I”m 100% ok with stimming for 10 + days, all it will do is improve my egg quality. Stimming to fast is bad for egg quality. So this is good right? I refuse to give in to the fear that I might be over supressed.

My E2 has NEVER been that low. Heck it’s usually over 400 by now. HAHA. My last IVF it was around 200 I think and even that was low (I attribute that to the fact that I’m at a different RE so different lab)

anyhow, I’m hoping this means I’m stimming slower…what do you think? He increased my FSH to 375 and adding 150 of LH (225 Gonal F and 150 repronex)

I wonder if I’ll *gasp* actually stim for 10+ days? I’d LOVE to stim for even 10 days!!! Maybe it will help with my egg quality. I’m grasping at straws here and trying to be positive rather then give in to the fear that I may be over supressed.

All I need is 2-3 perfect 4 cell embryo’s for a 2 day transfer. LOL

My embryo’s however are very poor quality and barely even make it to the day 3 stage. I’ve added whey protein to my diet and gotten my hypothyroid fixed.

The only change I made this time was taking my shots t 8:30 pm instead of 5:30pm. I wouldn’t think that would make that HUGE of a difference.

my last IVF I was E2 of 257 after 3 days of stims (and even that is low for me)

I forgot to ask my numbers but I got the go ahead to start stims today. I do know this:
Lining was 4.2 (CD 2)
Left ovary less then 10
Right ovary less then 10

My RE already told me that based on my past IVF’s I probably have a reduced count. Ok he didn’t flat out tell me that but he eluded to the fact. normal antral count is 15-26. So I could have a normal count but my guess is my count is just below normal since I have had a so so response to stims. Who knows. Numbers don’t really matter to me any more. All I care about is getting some good quality embryo’s one way or another. Unfortunately my odds are better if I have more eggs retrieved. If we can get 12 eggs again this time I’ll be happy. Last time 8 were mature so my guess is he will push me an extra day with stims but who knows.

Today through Monday I do 225 Gonal F. Tuesday I go in for blood work but no ultrasound. I already have been told he will most likely (per him) increase FSH to total of 300 per day and ad LH of 150 per day So 150 Gonal F and 150 Repronex.