I mentioned the other night (Monday) that I gave Sarah an IM shot of hCG. Weirdly, after the shot she decided she was greatly disturbed by the fact that the shot --- wait for it --- didn't hurt enough. No, really; she was three-quarters convinced that the absence of pain from the shot meant I'd done it wrong. She wigged out all night, and didn't relax again until the positive pregnancy test on Tuesday morning.
So I mentioned this to the doctor on Wednesday, and he said "oh, we can fix that." And the fix is this: after the retrieval but before she got dressed, the nurses at the surgery center took a black magic marker and drew targets on Sarah's butt. The "targets" are circles and crosses: the crosses are supposed to roughly mark the track of a major nerve that runs through the area, while the circles are sort of drop-zones for the shots.
Saturday, June 19, 2010
Progesterone
Meanwhile, as of Thursday we started a new series of shots. This is progesterone, which you can think of as "pregnancy hormone"; it's primary role is to initiate all of the changes that a woman's body goes through during pregnancy. Now, a couple of things about that:
1. You should remember that in the normal course of business, Sarah would be pregnant right now; the 8-cell embryo would be somewhere in her fallopian tube or uterus, and her body would be beginning to respond to this reality. Because our 8-cell emrbyo(s) happens to be in a neighboring state, we have to make some of these changes to Sarah's body by hand. Hence, the injections of progesterone.
2. Because of the special circumstances of conception, it's imperative that we maximize the chance of successful implantation and pregnancy. This means, among other things, that we want "overkill" on a number of pro-pregnancy measures. Again, this is a case for injecting larger-than-strictly-natural doses of progesterone into Sarah.
The shot is IM. It goes in the hip, just like the hCG shot. It uses the same 25G 1.5in needle I used for hCG. The bad news is, the hormone comes dissolved in some kind of oil. Have you ever had a nice, viscous IM tetanus shot? No fun, right? Now imagine getting one very night for a few weeks. Suck. But it's got to be done.
1. You should remember that in the normal course of business, Sarah would be pregnant right now; the 8-cell embryo would be somewhere in her fallopian tube or uterus, and her body would be beginning to respond to this reality. Because our 8-cell emrbyo(s) happens to be in a neighboring state, we have to make some of these changes to Sarah's body by hand. Hence, the injections of progesterone.
2. Because of the special circumstances of conception, it's imperative that we maximize the chance of successful implantation and pregnancy. This means, among other things, that we want "overkill" on a number of pro-pregnancy measures. Again, this is a case for injecting larger-than-strictly-natural doses of progesterone into Sarah.
The shot is IM. It goes in the hip, just like the hCG shot. It uses the same 25G 1.5in needle I used for hCG. The bad news is, the hormone comes dissolved in some kind of oil. Have you ever had a nice, viscous IM tetanus shot? No fun, right? Now imagine getting one very night for a few weeks. Suck. But it's got to be done.
Day 4
Tomorrow will be Day 4. A lot will happen in the Petri dish, but nothing will happen in the Hopkins House. That is, we will not get a call from the embryologist, and will not learn anything new about the status of the embryos. In fact, as I understand it she won't even take the embryos out of their incubator.
Now, I know what you're thinking, but this has nothing to do with the fact that tomorrow's Sunday. Apparently cell division accelerates rapidly from here on out; where as we were seeing 1 to 2 division per day, the cells will undergo a number of cell divisions on Day 4 as they transition from an undifferentiated blob of 8 cells on Day 3 to a structured, 250+ cell blastocyst on Day 5. All this rapid change makes it difficult to make any assessments of their quality on Day 4.
On Monday, our transfer is scheduled for 9:15. We're supposed to be there at the clinic at 7:50, so that they can draw blood and do other prep in advance of the transfer. The transfer itself only lasts a few moments, so if everything goes off as scheduled we should be on the road home by 10. More on this as it happens.
Now, I know what you're thinking, but this has nothing to do with the fact that tomorrow's Sunday. Apparently cell division accelerates rapidly from here on out; where as we were seeing 1 to 2 division per day, the cells will undergo a number of cell divisions on Day 4 as they transition from an undifferentiated blob of 8 cells on Day 3 to a structured, 250+ cell blastocyst on Day 5. All this rapid change makes it difficult to make any assessments of their quality on Day 4.
On Monday, our transfer is scheduled for 9:15. We're supposed to be there at the clinic at 7:50, so that they can draw blood and do other prep in advance of the transfer. The transfer itself only lasts a few moments, so if everything goes off as scheduled we should be on the road home by 10. More on this as it happens.
Day 3
Today is Day 3. That means today was a possible transfer day, but it turns out that we're waiting for Day 5 to do the transfer. So, in the meantime we got a call with a status update on the embryos. Today it looks even better than yesterday:
6 embryos at Grade 1
7 embryos at Grade 2
1 embryo at Grade 3.
Note that this is an improvement from Friday, when only three of the embryos merited a 1. What's more, we're told that the Grade 3 has gotten this grade because it's straggling in term of number of cells --- they're now expected to be 8 cells --- but that some of the cells are multi-nucleated, which means they may be about to divide again. Apparently some embryos of this type will indeed make it through the next few days and become "transferrable" on Day 5.
6 embryos at Grade 1
7 embryos at Grade 2
1 embryo at Grade 3.
Note that this is an improvement from Friday, when only three of the embryos merited a 1. What's more, we're told that the Grade 3 has gotten this grade because it's straggling in term of number of cells --- they're now expected to be 8 cells --- but that some of the cells are multi-nucleated, which means they may be about to divide again. Apparently some embryos of this type will indeed make it through the next few days and become "transferrable" on Day 5.
Day 2
On Day 1 (Thursday) all we learn is the number of eggs that fertilized successfully. That number turned out to be big: 14. On Day 2 (Friday) we get more information: by then, the embryos have developed enough that they start to diverge in quality. So when the embryologist calls on Day 2, she reports not only how many embryos continue to develop, but a grade for each one.
For Days 2 and 3, the grading scale is a simple 1-5 overall grade where 1 is outstanding, 3 is average, and 5 is not likely to survive. On Day 2, they're looking for embryos to be 4 cells. The grade is based in part on whether there has been adequate division (ie, whether there are in fact 4 cells) and then in part on the subjective quality of the cells. The principle "quality" concern is with fragmentation: each time a cell divides, little pieces of cell break off and get loose. The less of this fragmentation you see in an embryo, the better it is. So each day the embryologist gets the embryos out of the incubator and puts them literally under a microscope, which she uses to give them a good once-over and assign each one a grade.
So, this is the way we graded out on Friday:
3 4-cell embryos at Grade 1
4 4-cell embryos at Grade 2
1 3-cell embryo at Grade 2
5 2-cell embryos at Grade 2
1 2-cell embryo at Grade 3
Recall that Grade 1 is Outstanding quality, Grade 2 is Good, and Grade 3 is Average. So as of Friday, we had 13 embryos of good-to-outstanding quality and 1 of average quality.
As a result, it was decided yesterday that we'll wait for a Day 5 transfer. This will allow the embryos time to differentiate themselves; that is, there will be more time for the differences between the best of them to become noticeable. As we understand it, this means each individual embryo transferred will have a better chance of implanting and growing into a baby.
For Days 2 and 3, the grading scale is a simple 1-5 overall grade where 1 is outstanding, 3 is average, and 5 is not likely to survive. On Day 2, they're looking for embryos to be 4 cells. The grade is based in part on whether there has been adequate division (ie, whether there are in fact 4 cells) and then in part on the subjective quality of the cells. The principle "quality" concern is with fragmentation: each time a cell divides, little pieces of cell break off and get loose. The less of this fragmentation you see in an embryo, the better it is. So each day the embryologist gets the embryos out of the incubator and puts them literally under a microscope, which she uses to give them a good once-over and assign each one a grade.
So, this is the way we graded out on Friday:
3 4-cell embryos at Grade 1
4 4-cell embryos at Grade 2
1 3-cell embryo at Grade 2
5 2-cell embryos at Grade 2
1 2-cell embryo at Grade 3
Recall that Grade 1 is Outstanding quality, Grade 2 is Good, and Grade 3 is Average. So as of Friday, we had 13 embryos of good-to-outstanding quality and 1 of average quality.
As a result, it was decided yesterday that we'll wait for a Day 5 transfer. This will allow the embryos time to differentiate themselves; that is, there will be more time for the differences between the best of them to become noticeable. As we understand it, this means each individual embryo transferred will have a better chance of implanting and growing into a baby.
Fertilization
Well, what we were told on Wednesday:
turned out to be spot on. Of the 21 total eggs retrieved, 14 fertilized successfully. As of Thursday afternoon, we had 14 one-cell embryos (ie, zygotes).
I'm told the doctor recovered 21 eggs, and that "at least 2/3 of them" look really good.
turned out to be spot on. Of the 21 total eggs retrieved, 14 fertilized successfully. As of Thursday afternoon, we had 14 one-cell embryos (ie, zygotes).
Wednesday, June 16, 2010
Retrieval
Retrieval went well today. We left home at 5:30, arrived at the clinic a little before 7:00, and were en route home by 11:00. I'm told the doctor recovered 21 eggs, and that "at least 2/3 of them" look really good.
The eggs were combined with sperm this afternoon, and will fertilize overnight. (Not all of them are likely to fertilize.) We'll get a call from the embryologist tomorrow afternoon, at which time we'll hear how many embryos we've got.
Transfer is either Day 3 or Day 5. Tomorrow is Day 1; that means transfer will be either Saturday or Monday.
The eggs were combined with sperm this afternoon, and will fertilize overnight. (Not all of them are likely to fertilize.) We'll get a call from the embryologist tomorrow afternoon, at which time we'll hear how many embryos we've got.
Transfer is either Day 3 or Day 5. Tomorrow is Day 1; that means transfer will be either Saturday or Monday.
Subscribe to:
Posts (Atom)