Tuesday, April 13, 2010

He said, He said...tales from two REs on how to interpret wonky blasts

We now have opinions from two respected REs on what our normal (but strange) blastocyst results mean.

Doctor #1, from the NYC clinic said, and I quote, "We used to try culturing and transferring day 7s but we have never had a pregnancy result from a day seven blast, so we stopped." OUCH. Of course, my mind goes immediately to the key word "never." Do you mean NEVER never? Or rarely? Hmm...Mo..."never" sounds kind of like what it is...

He also said that he thought our chances of implantation with the invitro matured blast are "significantly reduced," but that it "could" work out.


On to RE #2 in Denver, Dr. Schl., not exactly known for being a ray of sunshine...

He seemed confused by the question initially. We said Day 7 blast, and he said, "You mean day 6?"

Um, Nope. We mean day 7.

"Err, really? We don't culture to day 7."

Well, we know. But your lab did this time...

I think he only started to believe us when I named the head embryologist and told him what he had said ("probably the two day 7s are abnormal and if they're normal, I wouldn't expect them to implant. But they will give you more data...").

Ultimately, Dr. Schl. basically shrugged and said the equivalent, of "I dunno..." Then said he'd pretty much count them out. "But you should transfer them" (well, duh!) "You never know."

As for the in vitro matured embryo, he said to consider it the same as if it had been retrieved mature. Which was relieving to hear.

And given our strange blastocyst situation, Dr. Schl. said he'd be willing to transfer all three at once.

Triplets, here we come! Ha ha. just kidding. We've tempted the fates for higher order multiples before, remember, longtime readers? And we got...nada.

So it kind of all sounds like we basically have one normal. Asked as to his thoughts on the likelihood of getting pregnant if we transfer all three, Dr. Schl. said, "Well, given your history, I'd give you about a 35% chance."

Not bad, considering we expected a 0% chance, but not exactly something we can lean back and relax about either.

So now we're left to try to figure out what to do. Transfer these three and as Dr. Schl. said, risk a miscarriage months down the line, which could mean losing almost a year of TTC at age 38 (he is SO cheery, that man)...

or cycle again while the going is hot and hope for another normal or two...

Because we love IVF!!!! (not)

But we are just crazy and desperate enough that we might cycle again, if you can believe it.

We did ask Dr. Sch. how finding the normals, even if they are wonky normals, changes his perspective on our prospects. He said he was surprised we'd had any normals (sometimes it helps to have rock bottom expectations) and that finding we can produce a euploid embryo definitely improved our chances for a positive outcome from what he'd thought before.

That's something.

We'll be writing more on our decision-making process in the coming days.

As always, would love to hear your thoughts.


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  1. Gosh, what a tough call (as always!). On the one hand, I suspect that in your situation I'd want those embryos back in my body ASAP. And yet...given that they're already frozen, it seems that you have nothing to lose (well, money, and the intangibles) and possibly much to gain by cycling and having a few more embryos to choose from, with the knowledge that you *can* produce normal embryos.

    The thing I've been thinking about with those day 7s? Isn't it entirely possibly that there are day 7 blasts from spontaneous pregnancies that REs don't know about? What's normal in the lab might not be normal in the body... Is that something either doctor has addressed?

    Thinking of you.

  2. what a rollercoaster. but i'm happy for you that you have at least one normal, normal. since these are already on ice, i think you should cycle again. think of it this way, if you cycle again, will you have any regrets about not transferring the frozen embies right away? how about if you go ahead with the transfer. might be doubts down the line about not having cycled again right away?

    this is tough, so i wish you mucho luck and sending *hugs* :o)

  3. We wanted to go to a day 5 blast, but never got there. Then we had lowish levels with our day 2 transfers so we just went with them & eventually it did the job.

    In regards to transferring multiples, I did it & although I would never give them back, I would never do it again. IMO you need the right embryo & it doesn't matter whether you transfer 1 or 51, if it's going to be the one it will or it wont work. And also, just because transferring multiples didn't work before, that doesn't mean it wont this time. Look at octomum.

    Sorry if I sound out there & ungrateful after finally winning the lottery, but living through possible losing everything, has changed my thinking on multiple transfers.

    Wishing you all the best with your decision & upcoming transfer.

  4. Love your recap!

    I cycled again before I transferred. I figured that time can only hurt the prognosis. And after waiting this long, what's a few more months?

  5. In Fall 2007, I was told by my first RE that I would NEVER get pregnant. My AMH had tested at .01 (point-zero-one) which he said told him that I had no true working follicles. Fast forward 2+ years, new RE, 3 pregnancies, 2 miscarriages, 3 lost babies and on healthy baby boy percolating in my tummy at 19 weeks. While my results clearly were correct in that I would have alot more problems than others, never say never.

    BTW, they gave me a 20% chance of getting pregnant this past IVF whn we transferrd 3 excellent-looking, 1 so-so embryos on Day 3. So, your odds are almost twice mine and I didn't do PGD, so had no idea if th other 3 embryos were normal or not.

  6. i know they are doctors and I am not but what about if your little embryos just take a little longer to get going (what if the healthy guys are busy repairing stuff so that it takes longer to get to the blast stage?). I don't mean to sing pollyana crap at you, but, everyone is different, and this may even make sense (at lesat to me).
    thanks for stopping by the blog - we're still cheering from you from across the lake.

  7. Me? I'd cycle again to see if I can build up more inventory. Because it seems like a relatively low cost (emotionally, that is) thing to do.

    One other thing -- remember that the REs, for all of their wisdom and experience, just don't know everything. A lot of this stuff is still a mystery and that means that all stats are just approximations. And furthermore, stats are practically irrelevant when it comes to an individual. But you know that.

    Good luck with whatever you choose.

  8. Ahhh, Schoolie, such a ray of sunshine! No really, I actually like his honesty, if I wanted touchy-feely, I'd not be at CCRM. But I want a baby, so I'm there.

    Anyways, I think I'd cycle again - oh wait, that is exactly what I did! So we had 2 euploids, one from a previous clinic and one (the only blast made) from my first CCRM cycle. So we cycled again, using a different protocol, and had much better results (5 blasts, 2 were euploid). So we doubled our euploids in one cycle.

    I vote to cycle again (my thinking is none of our eggs are getting any better with age!) and they can stay frozen til you need them. Your normal(s) will still be there, staying normal, and maybe you can add a frosty sibling or two or five!

    And when it comes time for transfer, I'm a big proponent for eSET. You clearly have no problems getting pregnant, and if you know its euploid, I'd try it on its own. That's just me though - the odds do go up slightly with transferring 2.

    Good luck as you make these tough decisions!

  9. If it were me, I think I would cycle again. For many of the same reasons the pp gave. More possible inventory, your normal one is still waiting for you, your eggs aren't getting any younger. And if you change your protocol a little, maybe you'll get even better results. In any case, I wish you luck making this decision. :-) No decision in IF is an easy one.

  10. Oh, man! Crazy hard stuff. Don't have any suggestions, but you know I'll be here for you whatever you decide. Although, 35% doesn't actually sound that bad. Hoping the in vitro matured embryo is the little embie that could.

  11. Oh wow. If I were you, I think I'd cycle again. I don't love IVF either, and I've not gone through nearly as much as you, BUT I think it's true that if something terrible were to happen, if you cycle again you won't have lost a full year of TTC. How soon could you start your IVF cycle, if that's what you choose? Will you do a short cycle or a long cycle? Gooooooooood luck with your tough decision. I eagerly await your entries every day!

  12. Since I am crazy and perhaps I subconsciously love pain I would totally cycle again to amass as many normal embies as possible. I've never had any embies on ice so it would be nice. Best of luck!

  13. Love all the cheer around here! Hmph. Anyway...I would cycle again to build up the numbers so you either have options for baby one or extras for a sibling (I know that seems crazy right now). However, at the same time, I don't think they know everything. Who knows what a day seven can do?

  14. My two cents Mo:

    It is a tricky question but emotionally I think it would be "less" hurtful to cycle again now that you know you CAN produce normal embryos -and actually have three frozen - than having another miscarriage and try cycling again after who knows how many more months when our eggs are not becoming any younger.

    I would cycle again but listen to your heart and your feelings and go with them :)

  15. Interesting information and definitely things to ponder.

    Given the expense of cycling again, it seems more financially feasible to me to do an FET and potentially save on doing another fresh cycle.

    That said, has anyone given you the odds of the day 7s thawing?

    I would thaw them all, but as Pie said, am a growing fan of eSET and that might be the ticket. So you could just thaw the one and see how it does.

    As my grandmother would say, "A bird in the hand..."

  16. Wow - so many supporters! You are loved. Anyway, at first I was thinking you should totally cycle again, to build up inventory. But you COULD just transfer now, and it MIGHT actually work! And if it doesn't, how long would that set you back (assuming a BFN), not that long...And you have been through so much I totally understand the urge to be DONE! But if you are even thinking of sibs, you should probably cycle first to get those eggies before they're gone!

  17. Wow. Lots of information as always.

    I think it depends on if you hope to have more than one (and no, I'm not kidding). If you transfer these and get pregnant (35% is not a bad shot), you would be at least 2 years from cycling again. Not sure if you would want to try at that point, but if you did, wouldn't you want 37 yo eggs as opposed to 39 yo eggs?

    The other thing is that now that CCRM has cycled with you once, they know more about you, and I would hope that a second cycle with them might be even better. (Wishful thinking!)

    Whatever you decide, though, total support from us :)

  18. I'm impatient. I'd transfer now, because I'm a one-step-at-a-time sort of gal, and to me, an embryo in the womb is worth three in the frozen vial of surfactant.

    But on reading others' comments and thinking about it more (and realizing that I don't know if you want sibs for this kid,) maybe it does make sense to cycle again to see if you can build up that healthy stock o' embryos before you start transferring.

    Whatever you do, I'm thinking 35% odds are nothing to sneeze at, and that I can't wait to hear what you decide to do.

  19. I think you did a great job with your recap, too! I am still so excited for you about your terrific three. :-)

    I am a glutton for punishment, so I'd cycle again...BUT, I think after retrieval, I'd try to talk the RE into continue going like I was doing a full fresh cycle and then just transfer the frozen embies on day 6/7 like usual. Is that crazy? It seems like the best of both worlds to me. You'd transfer AND possibly have more normal embies to freeze?

    I was just wondering if your RE has talked about how he would change your protocol considering that it took your "normals" a little longer to mature--maybe like sacrificing your larger follicles for some of the ones that are trailing?

  20. I started out without an opinion on cycling again before transfer, but I think I have been convinced by the majority here. It make sense to get as many embryos as possible whie you're younger- and, now that I have read all this commentary, I plan to do the same if our upcoming round of IVF is a bust.

    But what I actually planned to comment on was the 35% odds. From what I understand, 35% is pretty much the odds for ANY 38 year-old woman in a given cycle, and the average RE in this country would transfer 2 or 3 embryos for someone our age. So from where I sit, Dr Schl. is telling you that you have a fair shot with these. Not fair as in eh- fair as in pretty darned reasonable. So I hear that number as encouraging. And, as you said, infintely better than 0.

  21. Geesh, talk about between rock and a hard place...
    I think that given your history, and the normal ones you did produce, that I would cycle again...get as many as possible :)while you still can
    Besides which--email me for another idea
    Whatever you decide-cheering you on!

  22. Wow...you've been through so much; I don't know how you keep going. I think I would be looking into other ways to expand my family at this point (I used donor eggs and adopted eventually, which was the perfect choice for my family). If you have it in you, then I *think* I recommend cycling again. Best of luck.

  23. What's your gut instinct Mo?
    Try to make more?
    Get those babies inside NOW?

    I imagine if I were 38 and on a roll, I'd want to see if I could make more, you know, just in case. But I can also imagine being very ready to just do-this-thing.

    I'll support you no matter what, as you know.
    but shit
    35%?? better than any percentage I've ever had until the positive.


  24. Wow. I am totally floored that you are considering cycling again (and quite frankly a little jealous).

    I get it. I get wanting to collect some more normal embryos.

    Wowie wowie wow.

    I guess you just have to follow your heart/gut.

  25. I'm 38 as well and if it were me, I would cycle again now for the sake of time. It's worth a try since you do have these frozen embies that you can use later, if needed, and since these were shown to be normal maybe you will get lucky.
    Just my opinion. Good luck in whatever you choose!

  26. Wow! Such great responses. I'm being swayed. I really like Stacie's idea of cycling again, then transferring the frosties while waiting for the results on the new embies.

    Denver is probably lovely this time of year.

  27. If I knew I wanted more than one and had the money, I'd cyle again now for PGD. But I'd ask if I could thaw and transfer the ones you already have during the same cycle, unless they have evidence that it's better to transfer when you haven't just been on stims.

  28. What a tough decision to make. THinking of you as always! I'm no good at decisions I tell ya!

  29. Having done 5 miscarriages and 3 fresh ICSIs in the span of 3 years with no success, and I am currently almost 40, I'd say do another cycle (although it's not a clear choice, so each is a solid choice). As hard as IVF is, and with my crappy immune system which crashes during each cycle, a m/c for me is many times harder on my immune system and soul to recover from than a cycle. I'd rather up my odds. Even though 35% is good, I don't put too much weight into percentages any longer. There seems to be more unknown in what will really make it work, esp with more complicated situations like yours and mine. Hoping the best for you, partly b/c I want to believe there is still hope for me.

  30. This comment has been removed by the author.

  31. I'm rooting for you and myself. In fact, I'm doing a FET in May with my 2 day 6 and 5 day 7 frosties. Based on what I read or the lack there of, I didn't understand why my embryologist frozen 5 day 7 embies (4 of them are 3bb). I guess they felt anything is possible. I'll let you know how it turns out.

  32. Hi it's me from NYC going to ccrm again. I can't find what happened to ur ivf 6 results I only got to this part. U had a few euploids, why did u miscarry. I don't understand. I'm missing the rest of the story.


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