IVF for PGD: Egg retrieval and genetic testing results

6to10cells

Since my last post, we froze some embryos, ran the SportingLife 10K and redecorated our bedroom. For now, I’m back with the update on our IVF cycle.

In my last IVF update, I shared that I was getting set to take the trigger shot and go in for the egg retrieval. I wasn’t sure what to expect, but the egg retrieval was no big deal. I was given Fentanyl through an IV and then went in for the procedure. I was awake but slightly foggy. I didn’t feel much pain, just a bit of discomfort.

Leading up to the egg retrieval, we were told that we could expect getting around 10 eggs but they’d grab whatever they could. They managed to find 17! Knowing that they’d drop off at high rates, it felt good to start with that higher number. Every morning, the embryologist would give me a call with an update. It was kind of fun to wait for this call around 10 AM everyday. The downside is that they’re never going to call with an update that you’ve miraculously gotten more, you just hope they don’t drop off in large numbers.

The afternoon of the retrieval, they fertilized the eggs, and the next day I received a call that 16/17 of the eggs were mature, and 13/16 were successfully fertilized. By Day 2, there were 12/13. Those 12/13 also made it to Day 3. There was no update on Day 4. Since we were doing IVF for PGD, the objective was to biopsy and test Day 5 or 6 blastocysts. The number of fertilized eggs that make it to that stage can be pretty low, but I had youth on my side, so we were hopeful! The encouraging part is that those that make it to Day 5 or 6 are much more likely to result in successful pregnancy further down the line. It was still a bit of a bummer when these little tiny, 2-6 cell things stopped doing their cell division thing.

On Day 5, 5/12 were ready to be biopsied and on Day 6, 3/7 were biopsied. So of our initial 17 eggs, 13 were fertilized, and 8 made it to biopsy. The biopsy samples were sent off to a lab in the US, where they’d developed tests specific to us using genetic samples from Mike, me and my dad to screen for the BRCA 1 gene mutation that my mom passed on to me.

Each little blastocyst had a 50% chance of being positive for BRCA 1 mutation. On top of screening for BRCA 1, we also did PGS, which screens for a whole bunch of chromosomal abnormalities, including Down’s Syndrome. Since embryos with chromosomal abnormalities usually won’t result in a successful pregnancy, the idea was to find BRCA negative embryos that were also chromosomally normal. On average, they expect to detect chromosomal abnormalities among about 40% of those tested, with that risk increasing with age. Once you find out these stats…how few fertilized eggs make it past the first few days, even without any fertility issues, it’s a wonder that anyone manages to get pregnant at all. But with 7+ billion people on earth, I guess it somehow works out!

We had to wait about 2 weeks to get the PGD genetic testing results, and during that period I felt curious but not stressed or nervous. I had been feeling a bit stressed out before, wondering how many would make it to Day 5 or 6. If we didn’t have many, we’d have to consider doing an additional cycle first, since the cost of genetic testing is so high, so it makes sense to test as many as possible at once. So that’s the question I was mostly going back and forth on.

When we found out we had 8, we decided we were cool with sending those off for testing without getting another batch. Based on the 40% and 50%, I was anticipating that we’d find out there were 1-3 healthy (BRCA negative + chromosomally good) embryos depending on how much overlap there was between those two risks. So I was pretty happy when I got the call that we had 4. So now our potential future babies are chilling in the freezer. My friend pointed out that they’re quadruplets since technically they were all conceived at the same time! Haha. I bet they’re so cute with all their tiny cells.

Oh, by the way, IVF helped me quit coffee! On the day of my egg retrieval, I wasn’t allowed to eat or drink anything, including my morning coffee. Thanks to the Fentanyl they gave me, I didn’t experience the usual coffee withdrawal headache and just decided to go with it and haven’t had a drop of caffeine since (over 3 weeks now!). Want to quit coffee? Try Fentanyl. Just kidding. Please don’t.

IVF for PGD: Cycle protocol and update

Since I’ve been doing my own share of Googling other people’s IVF experiences over the last several weeks, I think it’s time that I document my protocol and experience with my current IVF cycle.

We’re doing IVF for PGD (pre-implantation genetic diagnosis) to screen embryos for the BRCA gene mutation. I inherited this gene mutation from my mom, and each of my eggs is 50% likely to be positive, too. BRCA 1 radically increases the risk of ovarian and breast cancer, so while I’m doing what I can to reduce my own cancer risks, we decided to pursue this option to try to avoid passing this on further. (Read more about our decision HERE)

So, my IVF protocol involved taking a birth control pill for 2 weeks. This ensures that my ovaries aren’t doing anything before we get started. After those two weeks, I started on Gonal F to stimulate follicle growth. I was to do that for 6 days before adding in Luveris and Cetrotide.

Ok, I actually totally messed up and thought I was supposed to take Luveris + Cetrotide instead of Gonal F instead of in addition to Gonal F. The next morning at my appointment, I was so devastated when I found out that I’d missed a dose because I was worried everything had been ruined and my cycle would be canceled. Fortunately, the nurse explained that my follicles had still grown so all was ok. Of all the meds to miss, the Gonal F was the least tragic at that point. So phew! I still was anxious about it for the rest of the day and just so upset that with all the uncertainty that already exists with this process even when you do everything 100% correctly, I hated to think an innocent mistake could mess up a cycle. When a cycle runs many thousands of dollars, eeek!IVF for PGD

Anyway, from then on I took them together. Luveris works with the Gonal F to stimulate follicle growth and the Cetrotide prevents ovulation to keep all those eggs up in there until they’re mature enough for retrieval. While Gonal F comes in an easy-to-use pen, the others required mixing dilutants and powders and swapping needles and instructions with 17 steps. I got the hang of it though and am now pretty much a doctor 😉

I’ve had to go to early morning monitoring appointments every couple days for ultrasounds and blood work. I’m so lucky that the clinic is a 5 minute walk from my office. I know there are other ladies that drive in from 2 hours away, and probably even further. With appointments between 7 and 8am every day or two, I really lucked out with being so close by!

My appointments showed that I had a decent number of follicles in each ovary and they were growing steadily although slightly slower than expected. This just meant that I had to “stim” longer (10 days total).

After so many injections, my belly is now feeling quite tender, but otherwise my only symptom has been major bloating, which results from big swollen ovaries full of growing follicles. The bloating started about 4 days in and has only gotten worse. I constantly feel like I’ve eaten a huge meal, and feel like I’m waddling around. I even have to undo my pants!

IVF for PGD

I’m also a bit more irritable, which isn’t surprising with the hormones flooding my system. Hearing people (Mike) making a noise while yawning has suddenly become the #1 most annoying thing ever. I have no idea why this of all things nearly triggers rage within me. So random. Fortunately I’ve managed to keep myself in check since I know that’s hormone-related craziness. Ok, so maybe I’ve become very irritable, but only a bit more than normal 😉 Otherwise I’ve been going about with business as usual for the most part. I’ve stopped running at my doctor’s recommendation, since swollen ovaries + vigorous activity can lead to twisted ovaries, which I guess is as awful as it sounds. I’ve been walking/waddling, but avoiding doing any more than that.

Tonight I’ll be taking Ovidrel to trigger ovulation, and then my eggs will be ready for harvesting in a couple days. I’m so happy that I only need to take one injection tonight instead of 3.

Since we’re doing IVF for PGD to try to find our healthiest, BRCA- embryos, it really is a numbers game and kind of crazy to consider how they drop off at each stage. Right now it looks like I have at least 10 good follicles, maybe more. Hopefully eggs can be retrieved from all of them. Even then, who knows if we’ll end up with any or one or two or more at the end. It goes something like: # follicles > # of eggs retrieved > # of eggs fertilized > # of embryos that grow into blastocysts > # of embryos that are BRCA- and chromosomally normal. And that still doesn’t guarantee anything when it comes to the success of the later frozen embryo transfer. For now I’m hoping for a successful egg retrieval in a few days and for the rest we will have to wait and see!

 

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