Rinse, repeat

And so we pick ourselves up again.

Thank you for all the love and kind thoughts, both here and on twitter.

Emailed with my RE. We can do a natural FET immediately. Meaning we wait for AF, and then I use OPKs to watch for my surge, and then I go in for bloodwork and an ultrasound to confirm things look ok for transfer.

Of course, my body will have to cooperate and ovulate, which it normally does (ovulates, not cooperates, obviously). Sometimes after my previous IVFs, I've had a wonky cycle that may have been anovulatory (we think this happened in in March), but I'm hoping that it was caused by stims.

My last progesterone was Saturday night, so hopefully AF will have started by the end of Thanksgiving weekend. I usually (ha!) don't ovulate until CD17-20, which would put us around December 14-17.

So amazingly, it's not impossible that we could do another transfer before Christmas.

Cruel

It's so cruel that progesterone side effects mimic pregnancy symptoms. Even knowing that, it's hard not to be hopeful after twinges, sleepiness, queasiness in the morning...

Beta was negative.

The Hamster Wheel

Tomorrow is my beta.

It's hard to imagine it being positive. And I say that with full ownership of the fact that I've felt symptoms that could be pregnancy symptoms all week: twinges, exhausted in the afternoons, queasy this morning...

It's hard to imagine that after 4.5 years of TTC, we could be close to getting off this hamster wheel.

You know what that's like. Rinse, repeat. You do your shots, go in for your monitoring appointments, do the bloodwork, go through retrieval (or IUI), go through transfer, deal with suppositories. And then have to start all over again, due to bad luck (cancelled cycle), bad luck (BFN), or bad luck (miscarriage). Back at square one.

The first time we got pregnant, we thought we were there. I was a little cautious, because I'd joined twitter and the blog world when I started IVF1, and I'd heard a lot of sad stories in my brief time in the online TTC community. But then we had a good ultrasound at 6.5 weeks and saw a heartbeat. And then at 9 weeks there was no heartbeat and our world (and our optimism) came crashing down.

Pregnancy #2, we were much more guarded. Pleased, certainly, to have made that milestone, but we were oh so aware that it was just a milestone and not the goal. And then at our 6.5 week ultrasound the heartbeat was just a little slow. And at our 7.5 week ultrasound it had slowed to 50, and at 8 weeks it was gone.

IVF4, knowing our two miscarriages were due chromosomal abnormalities, we transferred a (FISH-normal) embryo, and got a BFN. We managed to make it all the way through the various hurdles, and then the embryo didn't take. (Of course now we know it had a 40-50% chance of still being abnormal...)

IVF5, we switched doctors so we could try a new protocol. Dismal failure - no embryos made it to testing.

After so much bad news, it's hard to be hopeful that this time is going to be THE time. It's hard to imagine  that we might be able to step off the hamster wheel.

Logically, we have made changes that make a difference - mostly using a donor so we could get a genetically and physically perfect embryo to transfer. But is it enough? It's still rolling the dice.

I will be disappointed if it's a BFN tomorrow, but I won't be surprised.

Roulette, anyone?

The genesis for this post came from my thinking about our recent DE cycle, and our decision to do another cycle immediately with the same donor so we have a better chance of having multiple children who are all full genetic siblings.

I've been wanting to do a post for awhile on the financial side of infertility. Occasionally I see bloggers post a total of their IF-related costs, but it's rare as a stand-alone topic and rarely as detailed as I think a post needs to be to be helpful.

Let me start with how lucky my husband and I are that we can afford to pay for treatment. I know that, and I know this post may rub some people the wrong way. Despite the fact that the costs are breathtaking, we've never had to consider forgoing treatment because of the price. And after all, what would we be more willing to spend money on...

It breaks my heart when I read bloggers talk about how they can't afford the next step, or when they consider using all their savings for one try. It's awful that those of us dealing with IF can't rely on insurance coverage, and that even when we have insurance coverage, it's almost always paltry compared to the costs involved, or doesn't cover IVF.

Onward to actual numbers...

Our donor cycle cost about $45,000. That's $25,000 for the IVF cycle (her costs/meds + my costs, including CGH), $2,500 for my meds, $13,850 for the donor (her fee + agency fee + escrow fee), and about $4,500 for her travel costs. (We didn't get to take advantage of a shared risk cycle because I'm recommended to transfer one embryo at a time due to the DQ Alpha partial match.)

A repeat cycle is going to cost less, because we will only pay for her IVF cycle and then the testing/freezing of the embryos, but the donor fees and travel costs will be pretty similar (agency fee drops a bit, donor fee goes up a bit). My guess is ~$37,000-$38,000.

This first donor cycle produced 3 perfect embryos. $15,000 each. Isn't that nuts? It's like walking into a casino and putting a giant stack of bills on red on the roulette wheel.

Since the beginning of 2010, we've spent about $140,000 on infertility treatments across our 5 IVFs with my eggs and the 1 DEIVF. Prior to that, we spent 2 years doing IUIs. I had some med coverage through insurance at the time ($5,000 lifetime max), but it ran out during our last IUI with injectables.

When we were looking into gestational surrogacy, after learning about our DQ Alpha partial match, I found out that it costs about $100,000 to engage a surrogate. About $25,000 goes to the surrogate, $20,000 goes to the agency, $25,000 pays for the insurance for the surrogate, and the rest covers expenses. Crazy.

It's unfair that some of us have to spend thousands, tens of thousands, or hundreds of thousands of dollars to have the children we want.  IF is unfair.

I don't know what the answers are.

What CGH results look like

(Edit: Added PGD results to the bottom of this post.)

I thought some people might be curious about what sort of information you get when you have your embryos tested with CGH, so I scanned in my reports.

Here's the report from the lab that did the CGH (click the image to zoom in).

The embryos are numbered down the left, 1-12, the second column notes how many cells were tested (1 each, in our case), and then there are 22 columns for the 22 chromosomes, and another column for the sex. Then a summary of the data - if everything is a 2, and the sex chromosome is normal, then the embryo is declared normal.

It's noteworthy that every embryo was declared either normal or abnormal. It is possible to get "no result", because the biopsied cell fails to grow and thus there's not enough DNA to get test results. That's one downside of CGH, although we were completely ok with it - worst case we would have thrown out the known abnormals, transferred the known normals one at a time, and then moved on to the unknowns if necessary.

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Here's the report from my clinic that tabulates the CGH data (diagnosis column) with the physical grade at Day 3 and Day 5.

You can see that egg #1 produced a genetically normal embryo, but it fragmented by Day 5 and wasn't looking great at Day 3 (grade III).

Embryos #4, #7, and #8 are our good ones. They're genetically normal, and they are Grade 1 expanded blastocysts. We transferred #8, which was as good as embryo as you can get (5AA). Those following along closely can figure out what gender we transferred... #4 and #7 are frozen for future transfers - they're both graded 5AB which is only slightly below a 5AA, still awesome embryos.

We really lucked out that we had 3 genetically normal and physically perfect embryos. They don't always line up so nicely. (see egg #1)

#5 was the laggard that we were hoping would keep growing. It was genetically normal, but was 9-cells at Day 5 and needed to reach blastocyst stage by Day 6 to be frozen. Alas it stopped growing (or didn't grow fast enough).

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For comparison, here's the FISH report that we got on IVF4 earlier this year. My clinic used to only offer FISH (tests 9 chromosomes), but recently started working with another lab to offer CGH for patients who want/need it.

You can see that the report is much less complete - only certain chromosomes are tested (including sex). It also turns out that the FISH report is less reliable - it's possible for a normal pair of chromosomes to be situated so that the lab analyst can't tell if there's one or two. So there's about a 5% chance that an embryo showing one monosomy is actually normal. However, with FISH, unless the sample is degraded for some weird reason, you'll always get a result, so you don't risk the 'no result' that is possible with CGH.

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And here's the egg report from that cycle.

Slightly more information than for our recent cycle - the embryos were graded at Day 2. You can see that the best looking embryo at Day 3 (#2 with a Grade 1) was not normal. And by Day 5, our "normal" embryo had only reached early blastocyst stage.

Dr. Sher has an interesting blog about CGH compared to FISH. (Note that SIRM does a different type of CGH that requires that the embryos be frozen since it takes a few weeks for the analysis to come back.) Since FISH only looks at a subset of chromosomes, a "normal" FISH embryo is actually abnormal 40-50% of the time.  I found that out only after our failed IVF4, and it's likely the reason that IVF didn't work - that the 'normal' embryo we transferred wasn't actually normal.

It's infuriating, actually, since the cost for the two types of genetic analysis are comparable, and one only identifies about half of the abnormal embryos. It's still better than nothing, so if it's all your clinic offers, you may still want to do it, but it's why I insisted that my local RE do CGH on our donor egg-derived embryos.

Hopefully this is helpful and of interest. I know I would have loved to have seen what a CGH report looks like before I actually had one run on my own embryos. If you have other questions, leave them in the comments and I'll continue to flesh out this post if I have the answers.

Planning ahead

Our fourth embryo didn't make it, so we have 2 genetically perfect frosties, both 5AB.

With 3 embryos from this cycle, we're reasonably optimistic we'll be able to have one kid, but it's unlikely we'd get lucky and have 2.

So yesterday I reached out to our donor egg agency and asked them to contact our donor to see if she'll donate for us again.

Despite the breathtaking cost (post to come soon about the financial side of IVF...), given we want more than one kid - meaning we'd need to do another donor cycle eventually - and given we'd like for our kids to be full genetic siblings, there's no better time to ask her to do another cycle for us.

And she said yes.

We're figuring out exact fees with the agency. Her fees go up since she's a repeat donor, but obviously there are a lot of agency costs that won't recur: genetic consult, therapist consult, and medical screening (and related trip up here) with the clinic. We should also be able to minimize legal costs since we can either duplicate our first contract, or simply add an addendum that the second cycle follows the same rules as the first cycle.

She'll need about 3 months in between, so the cycle would be February-ish, and then we'll test and freeze the embryos.

I've been low key at home since transfer. Suppositories started last night - joy! - and I found out on Thursday that I keep with the 2x weekly estradiol valerate shots through the first trimester. Since this is my first transfer without having a retrieval (not sure what to call it - it's like prepping for a FET, but it wasn't frozen), I hadn't realized that would be necessary. Those shots use the 22g needle and are a lot less pleasant than the progesterone in ethyl oleate shots which use a 25g needle that I barely feel. Ah well, at least it's only 2x weekly.

Fast forward to transfer

So I left you all with the news that we had 12 eggs fertilize normally. That was Sunday.

We found out on Tuesday night (Day 3) that all 12 made it to biopsy, which was great news!

The CGH results didn't arrive until this morning at 9am so our transfer appt was moved to 10am for the consult, with transfer right after.

5 of the 12 embryos are genetically normal. Of those 5, 1 is a fragmented blast and will be discarded. 1 is a 9-cell embryo that's still growing. And 3 are grade 1 blasts (5AA, 5AB, 5AB). Two XY and 1 XX, and the still-growing embryo is XX.

We transferred the 5AA perfect embryo today and froze the other two. Transfer was easy but I overcompensated for my not-full-enough bladder last time and had a super full bladder - ugh! At least my clinic lets me pee right after transfer.

Did my Intralipid infusion after and then came home to rest on the couch.

Beta in 10 days, on November 20. And we'll know tomorrow if #4 made it to blast and can be frozen. I'm hoping we get that 4th - 3 makes me nervous and the chances of getting two kids out of 3 embryos is slim. We may ask our donor to consider doing another cycle for us...

Less wow

Still good, but not the fabulous update we hoped to get.

Of the 30 eggs, 16 were mature and 12 fertilized normally. None matured overnight, so we're on for a Thursday transfer.

12 is good - we know that the ones that don't progress to Day 3 are abnormal, so we're hoping of the ones that do make it, we end up with a handful of genetically normal ones so we have a few chances at transferring them.

Started Lovenox last night, and progesterone. All done with Lupron, at least. :)

Wow

So in my last post I mentioned we were tracking 18 follicles for our donor.

Two days later that was updated to 19.

Two days later than was updated to 20.

Today, when we arrived at the clinic for our monitoring appointment, we ran into our RE, who had just done the retrieval for our donor. He hugged us (we haven't seen him since April), and said "We got way more than 20."

Twenty minutes later, when he came into the exam room for my ultrasound, he told us they'd confirmed they got 30 eggs.

30!

I can't imagine what it feels like to have 30 follicles in there - I felt bloated with <10.

It's likely that a higher proportion of the extra 10 are immature, so we'll see how many mature overnight. If it's three or more, we'll plan to do a Day 6 transfer. The regular embryos will get biopsied on their Day 3, which will be Tuesday, the overnight-matured embryos will get biopsied on their Day 3, which will be Wednesday, and then we'd have CGH results back for a Friday transfer.

I'm not counting my chickens, since there are a lot of steps to go, but it's the best possible news we could have gotten today.

We also learned that our RE loves our donor. He sees a strong physical resemblance, and thinks she's smart and lovely. She's apparently feeling good (the clinic uses a Lupron trigger to help avoid OHSS), and has been easy for them to work with.

My monitoring went well - lining is good, and my estradiol is where it should be. I did an Intralipid infusion today as my TNF levels are still elevated despite the Humira (mid 30s for those of you who know what to look for), and will do another with transfer.

#hope