We set up a call with our doctor, who might I add now feels like a member of our family more than a member of our clinical team, to review the results. I can’t stress enough how having continuity of care impacts how I have felt about treatment. I feel supported in such a different way, where my doctor knows my face and my situation.

Anyway, the results you’ve all been waiting for (hah, I feel like I am the only one anxiously awaiting these)…

EndomeTrio:

ERA Test:
We have found out that I am “pre-receptive”. Here’s an excerpt from my clinic on what the receptivity test does:

“The rationale for the test is based on the fact that the endometrium will only allow the implantation during a finite time frame known as the window of implantation (WOI). If the embryo is delivered to the uterus too early or too late, when the window is closed, implantation cannot occur […] However, until the ERA test was developed, there was no meaningful way to measure it in any given individual. More importantly, the ERA was actionable: if the endometrium was found to be non-receptive a plan to optimize receptivity was provided.” (Source)

Pregnancy can’t occur if:

• the window of receptivity is missed
• the embryo isn’t mature enough
• the endometrium is not expressing the correct genes or is not in a receptive state

The idea of a window of receptivity exists in both natural conception and IVF.

In my particular case, a very specific window of transfer/implantation has been recommended – between 141-147 hours of progesterone. This means my endometrium wasn’t ready on the day of biopsy, and additional progesterone is recommended (so an ideal transfer would take place approx a day after the normal transfer date of day 5 for most frozen embryos).

Here’s a really good article that explains receptivity and how to interpret your results if you do the ERA: https://en.e-stork.com.tw/article/view/71

EMMA Test:
The EMMA test came back recommending vaginal probiotics for 10 days prior to FET. I have taken these before, but not every time. The recommended probiotic is Flora SAP.

ALICE Test:
Nothing found

UtimPRO
This test was the beast. This one is not done routinely, but due to my implantation failure and recurrent miscarriages, my doctor recommended I give it a shot. I don’t know anyone else personally who has had this test, but the findings were very interesting. Once again, I am happy to try anything and everything at this point in my journey.

I didn’t see the report directly, but given the recommendations I was able to draw a few conclusions.

1. Heparin was recommended for my FET. This likely indicates that a clotting disorder may be a factor in my repeat failure. Here’s a good study on use of Heparin in Assisted Reproductive Technology (ART): https://academic.oup.com/humupd/article/14/6/623/631770

2. Endometrial biopsy prior to FET was recommended (AKA scratching). SUPER excited to do that again (sarcasm). Scratching can enhance the receptivity of the uterus to the embryo. It’s not a guarantee, but it ‘can’ assist. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294834/

3. Addition of HCG – HCG can aid in the implantation of the embyro,

Experiments have indicated that hCG influences the level of hormones in the uterus and even within the embryo itself around the time of implantation. hCG may also influence cells involved in the immune response of the uterus to the embryo, allowing the uterus to accept the embryo.

Here are two good studies on adding HCG during FET and the outcomes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289495/
https://www.fertstert.org/article/S0015-0282(19)31176-8/fulltext

4. Addition of Seminal Plasma (basically intercourse one day prior to and one day after transfer)

“Seminal fluid contains several proteins that interact with cervical and uterine epithelial cells inducing active immune tolerance.” (source)

Studies are conflicted, but here are two that demonstrate benefits:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9979547/
https://www.iris.unina.it/retrieve/handle/11588/698105/212311/Saccone_et_al-2019-BJOG__An_International_Journal_of_Obstetrics_%26_Gynaecology.pdf


After reading all of the above, I am assuming that there’s a suspected immune response happening during implantation of an embryo in my uterus.

So how do I feel about this? Relieved to be honest. For the first time in our IVF journey, something actionable has come about that gives us hope. So many people have success in IVF during the first or second retrievals, and although my egg quality and our blastocyst production has taken a hit recently, this testing has made me feel more in control of my outcomes. Will it work? Who the hell knows.

The moral of the story here is that embryos are precious and everything should be done to ensure the ones we have actually implant. I am not sure why these tests aren’t offered more often before transfer, especially after subsequent failed implantation or miscarriage. I feel that I was over confident after our first egg retrieval, thinking “we made 7, we can make more easily!”. That wasn’t the case.

Going forward I feel more confident that any embryos we do create (fingers crossed), will have the BEST shot of survival. That we’re doing all we can on our end to make this dream a reality. I always tell my IVF friends, ADVOCATE ADVOCATE ADVOCATE for yourself in this process. Be it in asking for a test, pushing for a second opinion, making your wishes known. So many of us pay out of pocket for this, and we should use that power to do everything we can to achieve the outcomes we can for our future. You’re in the drivers seat, so don’t just sit there in the parking lot waiting for change to happen.

PS – I’ll be adding all of the studies I link to in my blog in my Resources page, once I have some time to organize them! If you know of a study that is informative that should be included, feel free to comment below!

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I went into stims with enthusiasm and I brought that same vibe to my second egg retrieval. I basically hopped and skipped into that procedure, knowing what to expect now. I had the same number of follicles as last time, similar sizes and I was on a so-called miracle drug called saizen/omnitrope which I was sure would bode well for us given our previous outcome). We just needed a bit better quality and we’d be golden.

As before, my husband dropped me off, waiting with me until it was my turn to go into the procedure area. He stuck around for his part, did the job and left. I took my ativan since I’d be having another IV placed. I was in a nice daze as I awaited the okay to head into the operating room. Things were light and easy this time. My nerves were low, and we chatted about the hoopla of the Taylor Swift Eras tour, even getting the doctor in on the chatter. It was another doctor I hadn’t met before. But all was well. I was ready to do the damn thing.

I faded out a bit – didn’t quite fall asleep, but remember time warping slightly and we were done (thanks meds!). They walked me out and the embryologist came shortly after to give me my news.

We had 13 eggs retrieved (same as last time!), 12 were mature and would be fertilized using ICSI. I was over the moon.

I received a call the next day at 8am sharp. Out of the 12 mature eggs, 10 fertilized normally.

Looking back, I felt a little sad about this. Our first cycle just 9 months earlier was:

13 retrieved, 13 mature, 13 fertilized, 7 made it to blast on day 5/6. I was still super hopeful. Quality over quantity I kept saying! Our first cycle yielded just the two normal embryos after testing, so I wanted this cycle to be better quality even if it meant fewer embryos.

The wait until day 4 after transfer was painful, but we had friends visiting and I took every opportunity to enjoy myself. We went to a music festival two days after my retrieval. We celebrated my best friends birthday. We came home and I caught up on work. Doing a retrieval mid wedding season is no joke!

Day 4 I got a call. We had embryos!!! I’d be heading back for a fresh transfer that next day. I booked the ferry, we left at 6am and we’re ready to meet our embryos! This time we had planned to transfer two, in lieu of testing. Due to the added cost, we didn’t want to bother and discard anything. We decided each untested transfer would be a double transfer.

I arrived at the clinic with so much excitement. I was so damn ready. So damn positive. My husband donned his hazmat suit and I changed into my hospital attire. We were sent to the little waiting room we’d been in countless times before and we sat for a bit and waited for the embryologist to come give us a report before we did the transfer.

After about ten minutes she entered. She was so hard to understand, with a very thick Eastern European accent. I had to clarify a few things because it was hard to hear every word. She told us we were ready to go, and we’d be transferring 2 embryos – a 3BA and a 2AB….

Say what? I was confused. Last time we had a myriad of 4-5s (further along basically I’m growth with more cells), and some AAs. These were the two they wanted to transfer? She said yes, and proceeded to tell us how the others were doing. I barely understood her, but from what I gathered, a few were growing normally, just behind, and the others were trying to catch up.

Okay… so we had two, and that’s all we knew so far. Last time we had 6 full on blastocysts by this stage on day 5. I was worried.

While my legs were splayed and my drapery open, I asked the doctor if we should transfer two after all given this news. What if they were our only shot? She assured me that embryos do much better in our bodies than in the lab, so yes we should! (I found out later that the 2BA was something they wouldn’t even normally freeze, so this is likely why she urged us to transfer).

We went ahead with the transfer but the mood had changed. I was scared. Another 20 thousand dollars was on the line. I was told to stay hopeful, to keep positive. We had two embryos on board and that’s all that mattered. We travelled home immediately after the transfer – went to the ferry early and waited. I had a slice of pizza and an egg salad sandwich for dinner.

The next morning at around 9am I got the final call. Day 6 report. None of our embryos had made it. None. Not one. It was the same embryologist who delivered the news the day before. Her bedside manner was lacking, the way the news that we lost everything except the two embryos in me came across was appalling to be honest. She said “they are all discarded, ok? Anything else?” when I asked for clarification. I held back tears.

I hung up the phone and texted my husband from bed. I couldn’t handle speaking the words out loud. He came rushing into the bedroom and found me sobbing in a puddle of tears. I was hysterical. I couldn’t stop crying. My world stopped in that moment. Hearing every single embryo had either arrested or was such poor quality that they couldn’t be frozen was one of the most upsetting moments in my life to date. This moment was harder than the miscarriage news. It was almost as hard as hearing my little sister died in a car crash, over the phone nearly ten years prior (that one takes the cake). It broke me in some deep way. All the hope. All the positivity. All the parts of my that had convinced myself that I deserved a family of my own were fractured into a million shards. I began to spiral, and I wondered why me. Why the hell couldn’t I just have anything without fighting so damn hard for it and suffering so much over it.

I’d love to say this had some silver lining, but for once it just didn’t. Maybe that’s why it hurt so unimaginably.

People kept saying “but you still have two!”, “be positive for those embryos inside you!”. I couldn’t. I was convinced it was over.

We waited 8 more days until our beta test. To be honest though, I tested every damn day from my transfer onward. I did a HCG trigger again, like the first retrieval. So my tests were positive for many days. I wanted to test that trigger out. The tests got lighter almost every day, until they didn’t. They kind of went stagnant, with a faint little pink line for about 4 days straight. It was beta time and I actually thought, despite my pessimism that I might be pregnant. That they were slow to grow and probably slow to implant. I went for my beta and I got my results.

<1. I was not pregnant.

20k. 8 weeks of my life. Pain. Bloating. Excruciating waiting. For nothing. Absolutely nothing.

It was September 2. We had been trying for 1 year and 9 months with nothing but heartache and loss.

I called my clinic to make a follow up appointment with my doctor to find out how, why… they couldn’t get me in for a phone call for 6 weeks. 6 WEEKS. 6 weeks to ponder my failure, 6 weeks in the dark. 6 weeks of doing nothing to move forward. They didn’t seem to see the problem with this. They had made their money and that’s all that mattered to them.

I made a very crucial decision that day. I decided to leave my clinic. The clinic where I only ever spoke to my doctor 4 times in over a year. The clinic that screwed up and gave me someone else’s PGTA results and all their personal information. The clinic who I had to babysit at every damn turn. We only have two clinics regionally where we live, and I decided I was burning the bridge and jumping ship. Nothing can change if you do the same old things over and over. I wasn’t about to risk more money down the drain, it was mother effing go time. I wasn’t getting any younger.

Exactly 3 months before my 39th birthday I got my period and I got myself a new doctor.

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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.

The post “Just relax” – The last euploid embryo appeared first on .

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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