When you have repeat failure to conceive there are lots of weird things that start to become triggers – and now that I’ve been through it, rightfully so. Here are a few things to never say to someone struggling with infertility or loss:

⁃ “But at least…” – sure, there are silver linings. It’s easy to want to look for them when talking to someone about infertility, but nothing fills the void in your heart that not having a wanted child of your own does.

⁃ “Just relax…” – followed by anecdotes about how xyz person got pregnant only when they stopped trying. (Here’s a secret, you never truly stop trying, or thinking about it every time you await your period). If relaxing was the cure for this medical condition, doctors would be out of work.

⁃ “Try to enjoy the process…” – especially during trying to conceive the old fashioned way. Nothing kills your libido and the mood more than timed intercourse and the pressure that comes with that. It’s the last thing you want to do when you’ve been timing it for 15 months+.

⁃ “Your time will come” – I sure frickin hope so! But it’s not guaranteed whatsoever.

⁃ “Congrats on doing IVF!” – the number of people who have congratulated me on my infertility journey and the need to spend tens of thousands of dollars on treatment is astounding.

⁃ Following miscarriage, “at least you know you can get pregnant!”… sure, but it’s not working. Something is clearly not working and I might never carry a baby to live birth.

I’ve had a close friend tell me that they really don’t know what the proper thing TO say to me is, as I experience the ups and downs over and over again. And to be honest, there isn’t really anything right to say. It’s a crapshoot that I wouldn’t wish on my worse enemy.

What helps me, is knowing I still have people in my corner. Still being invited to things, despite sometimes having to bail due to IVF commitments or a medication schedule. Having people simply ask how I’m doing and being open to a potential not so great response. Hearing me out when I need someone to talk to about how much the process sucks or hurts or is unfair. Just don’t stop checking in with your people. Don’t leave them to suffer through it alone. I’ve had a number of friends disappear through this journey and it’s hard. People stopped inviting us out, asking how life is going, shooting the shit. But I have also had people I never expected come out of the woodwork to pick me up and help me keep going when it feels like the universe is not on my side. A big thank you to all of you. We don’t feel like ourselves when we go through the rollercoaster of infertility. It’s not easy to be our support. But we will remember your kindness for a lifetime.

This third transfer preparation was aided by some gracious humans who offered to transport donated meds and who drove miles and miles to make it happen, who offered a place to stay or a ride to and from the ferry if we needed it. My heart felt full going into the FET prep.

Transfers after a miscarriage are a bit of a pain. You have to wait for your cycle to come and go, so it’s about a month waiting from your loss until your next cycle day 1. From March 10 until April 16. Then, priming began. More Estradiol, more visits with Wanda. More progesterone up the hooha.

Lots of things can happen in a frozen transfer to delay your cycle. From ovulating through the meds to thin endometrial lining issues. I suffer from the latter, and every time I try to grow my lining using medication, it takes its sweet time. More delays. Woohoo.

The first baseline ultrasound happens generally 2-3 weeks following priming beginning. Mine was May 5 on CD20. Too thin. I went a few more times around 2-3 days apart, and then finally on May 12, cycle day 27, I was finally ready.

They ask for a minimum lining thickness of 7-8mm before proceeding. Sometimes, you don’t get there and the cycle gets cancelled. But I got there. My frozen transfer would be scheduled a week later on May 19. We would finally get to meet our last normal embryo.

May long weekend was chaos for travelling from our island to our clinic – they had recently stopped offering transfers at our local clinic, so now we’d have to travel for any procedure larger than monitoring. Booking a ferry was nearly impossible and I had to work the following day, but we somehow managed to get on it that very morning at 7am. We anxiously anticipated our last shot from this retrieval.

The transfer went as expected, short and sweet. A new doctor we hadn’t met did the procedure (no meds this time whatsoever but no pain), and we were sent off again to suffer through the two week wait (9 days for us technically). That very day I had mild cramps, and in the days to follow they continued. My fingers and toes were crossed. The symptom spotting ramped up. Nausea, headache, back ache, fatigue, twinges, tender breasts. The whole gamut. I was 95% sure this was it for us. I had a feeling in my gut, again.

Earlier that month we decided to take a vacation – it had been about a year since we got the chance to relax and explore. Yolo. Especially during fertility treatment when so much gets pushed to the back burner – both time wise, mentally and financially. We booked a 9 day trip to NYC and we couldn’t be more excited.

Our significant transfer delays due to my lining were unexpected, so my beta tests fell on the days I’d be out of the country. Because of this I decided to test on May 26. 7 days post transfer, or 12dpo. This would give us a fairly definitive result. We left for the ferry and drive to the city where we’d overnight until our morning flight the next day. So I could test that day and the morning before we departed (8dpt by then). I packed all my injection meds, suppositories and supplies just in case. Then I took the pregnancy test.

It was negative.

I tested the next morning in a frenzy. It had to be wrong. Too early. Something. Stark white.

Our last normal embryo failed to implant. My body failed me. My symptoms failed me (I read into this further and apparently the high doses of progesterone I was on can mimic pregnancy symptoms 100%, great to know). I was angry, and I’d be stuck on a plane for 6 hours to stew in my thoughts. The idea of a relaxing vacation was out the window. Now WTF were we going to do? By this point, 30k in the hole with nothing but pain and suffering to show for it. A failed egg retrieval cycle, 3 failed transfers of 2 normal embryos. 7 total embryos gone.

I heard those phrases I knew all too well echoing in my mind. “Try to relax”, “At least…”, “your time will come…”. All I wanted to do was cry on that plane.

Lost was an understatement – but damn was I glad I had 8000 distractions in NY to take my mind off of it. At least to an extent.

We had the trip of our lives. I connected with family randomly in NYC that I hadn’t seen in many years (they just happened to be there the same week as us from the UAE). We ate at a 3 Michelin star restaurant, we saw Ray Ramano perform at the comedy cellar, we went to two wonderful broadway shows.

All I can say is book the damn vacation. Nothing is guaranteed. Life is too short. We can always make more money, but time is finite. Living our lives, finally, was the best medicine for the loss we felt deep in our hearts. It brought back our connection we felt got buried during all the trauma and all the loss. It healed us just enough to keep moving forward.

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On day 6 the clinic called to tell us that they had biopsied and frozen 6 embryos, in addition to the one 4AA they inserted into my uterus. I jumped for frigging joy. 6 embryos out of 13 eggs retrieved is unheard of. There were others, too, but they didn’t meat the grading requirements to freeze. Every lab is a bit different on how they grade and what they believe it’s worth keeping. 6 was amazing. They biopsied them and mailed the samples off to Igenomix, a genetics lab that tests for chromosomal abnormalities.

PGT-A Chromosomal testing is helpful in some ways. The unfortunate thing is that most clinics make you decide whether to PGTA test before you even begin your cycle. There’s an increased cost to set this up, so if you don’t get embryos you’re out that money. In addition to this, for each embryo you send out, you pay a testing fee per embryo. At the time, ours was $550 per embryo, so an addition $3300 after our cycle. It’s not chump change.

PGT-A testing doesn’t find everything though. It tests for the most common genetic abnormalities, such as common trisomies. There other types of PGT tests too, but this is the most common. Skip the next section if you don’t care to read about the specifics…

– Preimplantation genetic testing for aneuploidy (PGT-A): This type of PGT screens embryos for certain chromosome abnormalities. Human embryos typically have 23 pairs of chromosomes (46 total) in each cell.  One chromosome in each pair is contributed by the egg, and the other is contributed by the sperm.  It is common for embryos to have random chromosome abnormalities such as a missing or extra chromosome, which is called aneuploidy.  In the majority of cases, these chromosome abnormalities happen by chance and are not inherited from a parent or donor.  Embryos with aneuploidy are more likely to result in miscarriage or a failed transfer.  Some types of aneuploidy may result in the birth of a baby with a chromosome condition such as Down syndrome or Turner syndrome.
– Preimplantation genetic testing for monogenic disorders (PGT-M): This type of PGT is performed when a patient has an increased risk for a specific genetic condition to occur in their embryos.  PGT-M is appropriate when an individual is affected with a genetic condition that could be passed on to their children, for individuals who are carriers for an X-linked condition, or when an individual and their partner or donor are both carriers for the same autosomal recessive condition.
– Preimplantation genetic testing for structural rearrangements (PGT-SR): This type of PGT is performed when a patient or their partner has a rearrangement of their own chromosomes such as a translocation or inversion.  A person with a translocation or inversion is at increased risk to produce embryos with missing or extra pieces of chromosomes.  Embryos with missing or extra pieces of chromosomes are more likely to result in miscarriage, stillbirth, or a child with serious health issues.
(Source)

If you have suspected monogenic disorders, sometimes they will send you for IVF not because of infertility, but so they can test for these disorders. For PGT-A, its for people who have a need to do IVF otherwise, and it gives them peace of mind. The results can come back either Euploid, Aneuploid, Mosaic, or No Data.

I’ll also note, when testing for chromosomal abnormalities in blastocysts, it is done by taking a miniscule sample from the embryo. This sample will ideally contain all the data needed to say whether the inner and outer portions of the embyro are chromosomally normal, however the data is taken from the outer portions which will eventually form the placenta (not the fetus). The inside portion will form the fetus and is usually left untouched.

Euploid Embryos are embryos with normal chromosomes. People often say your fertility shits the bed at 35 and it drops off a cliff. For some it does, but Euploidy and Aneuploidy are the reason they state this. You may be able to make lots of eggs and fertilize those eggs, and they may make it to blasts, but they might all be aneuploid.

Here’s a chart showing the probability of Euploidy at different ages:

Aneuploidy is when an embryo comes back with one or more extra or missing chromosomes. This can result in either a nonviable pregnancy, babies that may not survive after birth, or a surviving newborn with congenital birth defects and functional abnormalities. Most aneuploid embryos won’t implant, but at times they do, and it can be the main cause of early miscarriage. When getting pregnant ‘the old fashioned way’, we have know way of knowing whether our embryos are euploid or aneuploid, and this can sometimes be why a cycle isn’t working.

Mosaic results are a different beast. No tests are perfect. A mosaic outcome *could* result in a live birth – it’s heavily debated in the fertility community, so some clinics will implant Mosaics while others will not. In PGT-A, mosaicism is defined as a mixture of 20% to 80% aneuploid and euploid DNA content, with some euploid content.

No Data embryos occur when there is not enough genetic material in the biopsied sample to provide a picture of the genetic makeup of the embryo. These are often given the option to retest, or to transfer blindly. Re-testing requires thawing the embryo, re-biopsying it, refreezing it and sending it off again. This can damage the embryo so some people choose to forgo additional testing.

PGT-A testing can help you select the embryo that is most likely to end in a successful pregnancy/live birth. However, having a PGT-A normal embryo does not guarantee a successful transfer cycle.

The 3 embryo rule
Many doctors will say it takes 3 Euploid tested embryos to achieve a 95% chance of pregnancy in most individuals. Many first transfers of PGTA-Normal embryos will result in a pregnancy. Those who take more than 3 transfers likely have other underlying issues at play which may or may not be evident.

Now that you’ve had a science lesson!

We sent out embryos off for testing and waited a painful two weeks over Christmas 2022 for our results.

In the meantime, I was still PUPO. They encourage you not to test at home during IVF due to a variety of factors. You go in for your beta bloodwork usually 9-14 days after your transfer, depending on the clinic. I went on day 9. I was feeling good until a few days before. We had a bunch of embryos and so much hope. I caved and tested at home.

Stark White.

I went for my betas on December 19, and the result came back as <1, which means you are not pregnant. Our first perfect little embryo (pictured in the last post) didn’t make it. I was sad. But I was still hopeful.

On December 26 I got a call and voicemail with my PGT-A results. Then logged into my portal – the portal is where they keep all of your communications, docs, med schedule and results. It’s like a beast of a database from the year 2000. I logged in and the embryologist had sent me SOMEONE ELSES RESULTS. I was super confused. Not to mention the concern I had that someone also got my results, and all of my personal information to boot.

I tried to reach the embryologist but as the clinic wasn’t open officially until Jan 3, I was left in the dark. The results in the voicemail differed from the results in my portal for the other couple. So I went with what was in the voicemail (which turned out to be correct).

13 Eggs Collected
13 Eggs Mature
13 Eggs Fertilized
7 Blasts (6 tested, 1 failed transfer)
We found out 2/6 were Euploid, 2 were Aneuploid and 2 were No Data.

I was pretty happy, considering we had been lucky with attrition at that time. 2 Euploids meant two more shots at this thing. and 2 No Data could be more hope!

I’ll fast forward to February, when we decided we’d retest the No Data embryos. We thought for sure one would be Euploid. Tragically, neither embryo survived the thaw. We lost 5/7 embryos in two months due to attrition, aneuploidy and failed implantation.

Our goal was one child, and we felt pretty damn positive about our two normal embryos and got to work on preparing for another embryo transfer.

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