Attrition is something they somewhat prepare you for.
After the egg retrieval, you begin to play a new waiting game. You’ve done your part, and now it’s time for the eggs and sperm to do their’s.
Immediately after the retrieval, they look at how many eggs are mature. We got lucky and 13/13 were mature. Usually the attrition for this is around 60-80%, meaning on average, people with 13 eggs would end up with 8-11 mature eggs.
From there, the eggs are fertilized. They use one of two methods (there are other methods that are much less common), either standard IVF or ICSI (I described this in an earlier post, but in short standard lets the sperm decide to fertilize, and ICSI is an injection of sperm INTO the egg itself). On day 1 post retrieval, so the day after, you get your fertilization results.
Usual attrition for fertilization is also 60-80%. By now, most people will have 5-8 fertilized eggs. We miraculously got 13.
The next part is the hardest wait so far. If you’re doing a fresh transfer, you find out on 4 days post transfer whether any embryos made it to the blastocyst stage. The blastocyst stage requires a certain number of cells and for the cells to arrange in a particular way. We were lucky to have all embryos growing as hoped on day 4, so we got scheduled to come back for our embryo transfer the next day on day 5. We were hoping to PGT-A test our remaining embryos for genetic abnormalities (an additional cost, and involving a biopsy on day 5-6 before freezing).
From here, the wait can get tangly. Lots of embryos make it to day 3-4. We in the infertility community fittingly call the next few days the hunger games.
We went in for our embryo transfer feeling so very hopeful. We got a photo of our little embryo that would be transferred and it was so cool to see a picture of it. It was of one of the highest possible grades (grading takes into account the ‘look’ of the embryo, and in lieu of genetic testing it is the one marker they use to decide which embryos to keep and which to discard).
The transfer itself is a lot easier than the retrieval. Following the retrieval you immediately switch gears and start on progesterone suppositories (in my protocol anyhow), and you come back on day 5 for the transfer. This involved another trip across on the ferry for us and another night in hotel that same night. You really don’t get much notice, but for us it was the ‘off-season’ from tourist season so not too difficult to find a spot affordably or to get on the ferry.
We arrived and usually the transfers themselves are completely unmedicated. They had me take Ativan one more time just to ease my muscles in case I reacted to the catheter due to some cervical pain/cramping I had previously with my Saline Sonohistogram.
This appointment was a piece of cake. I donned my hospital attire, and my husband was allowed to be present for this procedure so he donned his own set of whites over his clothes. I wore my socks again for good measure. He, of course didn’t even have to take off his shoes. He just put some booties over them and went on his way.
They walked me into the same OR I had my retrieval in, and it was just sheer luck that it was the same doctor (I still had never met my own RE doctor at this point. More on that later.). I laid on the same bed, had the nurses lift my gown – and my husband got a wonderful show.
This is where I point out that I am NOT comfortable with my body. We joke that I am a never nude like Tobias on Arrested Development. I have always had issues with body confidence and being comfortable in front of others. I changed under my bed coverings until I was 10 years old (no abuse, just paranoia), I refused to change for gym class with other classmates for many many years, often going so far as to leaving my clothes at home and getting detention because I was uncooperative. I wouldn’t shower when we went swimming unless there was a private shower stall. This was never addressed in a healthy way, because teachers and parents don’t talk about that stuff. Not in our generation anyway (Millennials). After some tragic experiences as a teen regarding consent, I reverted even further into my cave of discomfort with my body.
Let’s just say the IVF journey has taken all the fear and dignity I have when it comes to my body. There is was, out there for a room full of strangers and my husband to see. Not to mention his first experience seeing people poke and prod between my legs. I can only imagine how uncomfortable that is for a partner. He had never been present for my other exams, and there were many, so by this point I was used to it. It got to a point where I didn’t even try to cover myself anymore. What was the frigging point.
The transfer went off without a hitch. The catheter and the speculum didn’t hurt, and when they inserted the embryo into my uterus, a little flicker showed up on the ultrasound screen. This is NOT the embryo, but an air bubble that accompanies the embryo to confirm placement. An embryo at this stage is microscopic (.1-.2mm), but they print off a little picture of your “flicker” for you to hold on to.
It was done in a flash and I walked out with the strangest feeling. I was now Pregnant unless Proven Otherwise (PUPO! – I’ll note that the fertility community says “Pregnant until proven otherwise” which I don’t love, because there’s almost an expectation of it being proven otherwise, so I prefer my saying).
Now the next most excruciating wait of my life was to come. The “Two Week Wait”. This is a bit of a misnomer for IVF though because technically the two weeks starts the day after your retrieval. At this point on day 5, I was already 5 days into that wait. So we awaited our bloodwork 9 days after retrieval to tell us if this little blob decided to stick around or not.
The only solace we got in that time was that we would be getting our final blast update on day 6-7, telling us how many made it to biopsy & freezing.
All in all these 9 days have tended to be THE most hopeful and ignorantly blissful part of IVF. We got to pretend we were pregnant, we got to feel all the myriad of emotions that come with maybe having a baby. We got to imagine a future with our little 4AA embryo. Finally we had hope.