Fert Report In - Input, please? D3 Update

chucktgirl · June 2014

8 Retrieved, 8 Mature, 5 Fertilized naturally

I was shocked that they didn't do ICSI, since we discussed it and agreed to it. I am happy that we have five to work with, but can't help thinking that ICSI might have brought those other three along as well. This is our lowest fertilization percentage of all five IVFs. In any case, this is what we're working with.

We've been planning since our initial consultation to do a 3dt, as part of the protocol changes, with the theory that maybe my embryos will be happier developing in my uterus than in a lab. So, it was a big surprise to us this morning when my RE told us that she would let us know Saturday morning if we're doing a 3dt or a 5dt. Huh?! I thought we already made that decision. As this option was never even discussed, my DH and I were very confused and put a call in to have her call us back to explain. Her explanation? "Well, I never expected you to have 5 fertilize." Seriously? Based on my history, that is very possible. So now we have lots more decisions to make.

We now have two scenarios:
1. If there are 4 or 5 developing embryos on day 3, we can choose to A) Wait until day 5 and send all still in play for PGS testing, freeze, and plan a FET for next month. Hope that there are 1-3 embryos still developing to do a fresh 5dt, and freeze any over 3 without testing. C) Transfer random 3 as 3dt, then hope the remaining 1 or 2 make it to day 5 freeze.

2. If there are only 1-3 still progressing on day 3, we can choose to A) Transfer all as 3dt. Wait until Monday and do a 5dt on any still in play.

The RE seems to not like the option of PGS, as she doesn't want to risk injuring the embryos by the test sampling or risk a freeze and thaw on my fragile old eggs. That seems reasonable, but it's also not exciting to think of the possibility of carrying a non-viable pregnancy around for several months and the horrible result that will inevitably bring.
We are also surprised that she is recommending a 5dt, when in our initial consult, she sold us on specifically aiming for a 3dt with hopes of a better growing environment for the embryos. We are more confused now than ever. This is crazy.

Please give me your input and what YOU would choose. I know we all make our own decisions, mostly based on our guts and trust in our RE's expertise, but maybe your insight will help me clarify my own thoughts.

Food for thought, here is my past fert history:
IVF #1 12R, 7M, 6F. Five made it to PGS; all had abnormalities
IVF #2 9R, 5M, 5F. Two made it to PGS; all had abnormalities
IVF #3 6R, 2M, 2F. No testing, 1 made it to 5dt (I was severely under-stimmed, IMHO), BFN
IVF #4 5R, 3M, 3F. No testing, 2 made it to 5dt, BFN
IVF #5 8R, 8M, 5F. ???

Edited to add: I strongly doubt there will be more than 3 in play by Saturday. We're just trying to cover our bases to be prepared for the remote possibility of more. I'd rather have us discuss our options now and decide over two days rather than have to make a snap decision in 5 minutes prior to a potential transfer.

*****DAY 3 UPDATE: 1 eight cell, 1 seven cell, 1 six cell, 1 three cell, and 1 two cell. Decided to wait for a 5dt on Monday.

Grateful&Thankful · June 2014

This is tough. I hate when a plan is agreed on & then you have to make last minute calls. I'm sorry! I think I would do choice #1, C. So I would transfer 2-3 (only 3 if the quality of 1 or more is questionable. I'm personally terrified of any chance of triplets) & hope that the remaining 2 or 3 make it to freeze. I'm the type of person that likes to do different things each cycle. It just makes me feel like I'm being productive, for lack of a better word. Since you've never did a 3dt, I think it would be worth a shot. GL with whatever you decide hun! (((HUGS)))

I do have one questiom though-what was your quality like for your past day 5 transferred embryos?

chucktgirl · June 2014

Grateful&Thankful said:

This is tough. I hate when a plan is agreed on & then you have to make last minute calls. I'm sorry! I think I would do choice #1, C. So I would transfer 2-3 (only 3 if the quality of 1 or more is questionable. I'm personally terrified of any chance of triplets) & hope that the remaining 2 or 3 make it to freeze. I'm the type of person that likes to do different things each cycle. It just makes me feel like I'm being productive, for lack of a better word. Since you've never did a 3dt, I think it would be worth a shot. GL with whatever you decide hun! (((HUGS)))

I do have one questiom though-what was your quality like for your past day 5 transferred embryos?

@Grateful&Thankful, thanks for your input! I guess I should have said that I believe strongly that there will be no more than 3 in play by Saturday. We're simply hedging our bets to be prepared for the remote possibility. I'd rather have us discuss and decide over two days rather than have to make a snap decision in 5 minutes prior to a potential transfer. (I will edit my original to include this!)

In IVF#3 I had one eight cell grade 0 (best) on day 3, rated Fair on day 5
In IVF#4 I had two eight cell grade 0, one eight cell grade 2 (out of 0-3), by day 5 I had two blasts that I think were rated Good. All failed regardless.

Mrs.McIrish · June 2014

Paif warning---

Fwiw, I'm a fan of pushing to day 5 and see what you have for transfer. I'd love to tell you to test them but I'm not sure you want to. I don't want you to experience another loss due to an abnormality.. Just my 2cents: you can't always tell which are the strongest embryos by day 3. Even though they look good, 8 cells/no frag-- they could be bad... Just for story-telling, one of my twins was a crappy 4 cell "C" graded (d is the worst) on day 3. We never would have chosen her on day 3 yet she's still here. She made it to blast on day 6. However if you are down to 3 on day 3, I'd prob just put them all back. I think I'd wait for a game day decision to see who is still growing. Sending T&Ps!

J&D2007 · June 2014

I hate these decisions. If you would have asked me a year ago, I would have said push to day 5 and PGS them. Now I think genetic testing isn't worth it to me anyway. For me, I'd plan a 3 day transfer and make the call on the morning of. One one of my Ivfs, we had 4R, all fertilized and all were still going on day 3. I showed up for transfer and talked with the RE and embryologist and we made the call to wait for day 5. If you were to do this, I'd say if there are 3 on day 3 then go ahead and transfer. If there are 4 or 5 growing well, then wait and see what's left on day 5 and transfer then. HTH!

hmz819 · June 2014

Awesome fert report!!! It's such a tough decision. I think if there were only 2-3 left on day 3 I'd transfer them back in see what happens. If there were more and you are ok with the possibility of not having a transfer on day 5 should they all stop growing push to day 5. I'm sure my answer was no help. I am jaded by my miscarriage history and think I would rather not do a transfer than do a transfer and go through another miscarriage.

violetmarie61516 · June 2014

Oh gosh! I don't know how to advise you on this one. There are a few scenarios playing in my head but I just don't know what my call would be. I know you want to discuss it and make tentative decisions but I think this is going to have to be a game day call. But, I would really question the RE's new plan. I think a lot of times doctors slip back to old ways without always factoring in an individual. I've had this happen all the time. I have to review my case all the time to remind the doctors of who I am and what we discussed. Even if you get them on the phone and question them, they don't always read through your chart. I would really pin point discussions and ask the RE why she is changing her mind, other than "I wasn't expecting 5." That just doesn't sound positive from the start. I'm sorry I'm not much help.

sorrellam30 · June 2014

I would see what I had left on day three and go from there. A lot of times the embryos make the decision for us. I agree that I'd personally try to wait for day 5 but I also understand you wanting to try something new. Whatever happens I hope you are comfortable and find success of course. GL

mm29 · June 2014

(((Huge Hugs))) These are such hard decisions to make.

I'm personally a fan of 5dts as well. It gives your medical team a lot of information about the embryos, and a really good idea of what embryos should be transferred and frozen. I think either way if you decide to do PGD or not, I would ask you RE about doing Immunological therapy, such as an intralipids to help prevent miscarriage due to immunologic issues.

((More Hugs))

hmz819 · June 2014

I was thinking more about this, did they say they didn't do ICSI? I dont think you could test embryos that were not ICSId. Reason being if they are not ICSI there's tons of sperm around the embryo and one could pluck a sperm cell instead of an embryo cell. I'd ask your clinic to be sure.

pblge · June 2014

I'm assuming since you linked from the June Bugs page you're okay with us commenting here--apologies if not!! I hope you don't mind me throwing my two cents in, since you know I gave testing a LOT of thought for this cycle. I had definitely decided that testing didn't make sense unless I had a lot of embryos to choose from, but this is in part because I would keep a Down's baby, and I know a lot of women around here would have trouble with that decision. It's likely that both of my losses were normal karyotype (the ectopic wasn't tested, obviously), so I also have less faith than most people about the power of CCS to prevent m/cs. Since testing carries risks, and costs a lot of $$, regardless of the number of embryos, I think I agree with your RE. And my clinic definitely said that ICSI was necessary if you want to do CCS, so I think @hmz819 is correct.

I would be asking some stern questions about why they didn't ICSI. Did they forget?!?! If that was the plan it seems inexcusable to me that they didn't do it.

I don't know if embryos are better off in or out of you between days 3-5, and I don't know how you'd feel about having embryos that are unlikely to make it transferred even if there wasn't a lot of hope. In your shoes I would probably just transfer everything on day three (unless all five looked perfect!) and pray to whatever higher power you believe in for success, but I feel like this is a gut decision that only you can make. Given your history, higher order multiples seem very unlikely, but perhaps it's still too much of a risk for you.

Sending you big ((hugs)). All of this is awful, particularly when things don't go according to plan!

luvboston · June 2014

I would do day 3 and see what you have. I would put back 3 if that's what was left.

chucktgirl · June 2014

Thanks to all who responded! You truly are an amazing sounding board!

@Mrs.McIrish, situations like your story of how one of your embryos looked like crap on d3 but became a healthy fetus are exactly why I don't want to rule out any stragglers or further stress them by taking a sample from them. (I am still so thrilled for you, btw! You give me hope!)

@J&D2007, I felt exactly the same a year ago! Now, my desperation is starting to make choices for me. Not sure that's smart, but it is what it is.

@hmz819, That's why I'm torn. I don't want to go through another several months of thinking I'm pregnant and then deal with a third sucky MC. Regarding the ICSI, yes she specifically said they did NOT do it, that my 5 fertilized naturally. I said, but it was part of our plan to do it! We signed the paperwork! She just said that the fertilization rate is higher when fertilizing naturally. I couldn't argue with her over the phone; it was just too much to process at that moment. I specifically asked her if I could choose to send my five to PGS, since she went off the plan to transfer on d3, and she said yes, absolutely, and then we'd set it up for a FET next month. She was very clear about it. She warned me that she didn't think it was a good idea because the sampling, freezing and thawing all cause stress on my already fragile eggs. She never once said I couldn't do it because SHE failed to do our agreed upon ICSI.

@Love4Labs326, You are exactly right! I hate being just a cog in their IVF machine. I need more oiling than the rest!!!

@geordie314, Yes, we were in shock and couldn't really respond, especially since we were mad and we didn't want to anger the woman who is going to potentially put embryos back in me! We totally bought her initial "plan" for us. That's why we proceeded... enough was different that we thought it might be worth a try. This is all turning out too familiar, which is NOT a good thing.

@sorrellem30, I agree the embryos often make our choices for us. In fact, I fully expect to only have few still in play tomorrow. But, if they are, the RE said she can't really determine a good one from a bad one on d3, so it would be luck of the draw.

@mm29, thanks for the suggestion. I don't know anything about it, so I quickly googled it. I honestly don't think I have it in me to sit attached to a needle for two hours. I am so over this process! I have to stop torturing myself. It also said the first one needed to be done before ER, so I'm past that point. But who knows... maybe that's why I can't sustain a pregnancy.

@pblge, I probably broke a rule, I don't know! It just seemed easiest to update anyone who was interested enough to read more. I do know that I personally do welcome your opinion, so thanks for responding. I don't know the stats on a 3dt vs 5dt for an AMA gal, but the theory made sense to me, that my embryo might prefer to grow inside me more than in a lab, especially since I've gotten pregnant twice on my own (they were perfectly happy growing inside me... until 8-10 weeks!) I also think multiples are a slim chance, but it worries me just the same.

DH and I will discuss tonight. Re said to expect a call around 8AM tomorrow. We shall see...

STL34 · June 2014

**SAIF Response**

I hope you don't mind me posting. I previously was in the if it doesn't make it to day 5 it won't work camp. My first two cycles I only had 3 embryos and both cycles I did blast transfers. But, I had a second opinion with another RE after my second failed IVF cycle. He said that some women (especially older women using OE or DOR women) have eggs that make embryos that may not do as well in the lab. He also recommended that I give assisted hatching a try (but none of my blasts ever started hatching before transfer and I had never been pregnant before, so they thought this could be part of my problem). My third cycle, the only one with an early transfer and assisted hatching (I also had some different immune treatments that cycle) worked. I know it could have been luck of the draw. But, I am glad I gave it a chance.

My thought is if you only have 2-3 and you would transfer them if they made it to blast, you might as well transfer them on day 3 and see if trying something different works for you.

Best of luck with whatever you do! Grow embies, grow!!

Km672 · June 2014

I'll be thinking of you!!! Best of luck!!

kflynn81 · June 2014

I don't think this is an easy choice to make but with your scenarios there I'd go with A. Those that make it to 5 day, survive a biopsy, come back normal, survive the thaw you've got yourself quite the embryo there. Honestly, reading the past testing results if they were coming back abnormal then why put yourself through the stress of wondering if you've transferred an embryo that has a shot to begin with? IMO of course speaking only but I'd rather lose the embryo because it failed to grow or it was found to be chromosomally abnormal than transfer it and have that form of disappointment. (((Hugs))) to you though this is a very difficult choice either rway

Mrs.McIrish · June 2014

Stalking for an update!!

mm29 · June 2014

Mrs.McIrish said:

Stalking for an update!!

Ditto!

J&D2007 · June 2014

mm29 said:

Mrs.McIrish said:

Stalking for an update!!

Ditto!

Me too!

Grateful&Thankful · June 2014

Thinking of you!!!

hmz819 · June 2014

No update yet? Thinking of you!

chucktgirl · June 2014

Hi all! thanks for thinking of me this weekend. My d3 results were 1 eight cell, 1 seven cell, 1 six cell, 1 three cell, and 1 two cell. I maybe should have transferred the three leading embryos yesterday, but I didn't. It was a very difficult decision. I took a nap, and when I woke up, my mind was clear and I thought, I made clear, educated decisions about my IVF path two years ago and I shouldn't let desperation change that. I don't believe in faith and hope to determine outcomes; I believe in science. And finally, I had to recognize that I don't want multiples, nor do I want to endure a third failed pregnancy and the resulting disaster that is miscarriage. There's a decent chance there will be nothing to transfer tomorrow (RE said 10%) but if there is even one surviving embryo, I have to believe it is the best chance for our take home baby. And I've been comfortable with that decision since I woke up from that nap. Whew. Now let's see how I feel tomorrow!

hmz819 · June 2014

So happy you have 3 dividing right as they should!! Good luck tomorrow.

Mrs.McIrish · June 2014

Good luck tomorrow:-)

mm29 · June 2014

I love this update!!! Wishing you so much luck tomorrow!!!

kflynn81 · June 2014

FX for you tomorrow!

LeggyJeggy · June 2014

Amazing day 3 report!!!

Good luck today!

hmz819 · July 2014

Just checking in. I hope everything went well today.

chucktgirl · July 2014

Thanks @hmz819, it did. We were lucky enough that three were still developing. One reached blast, and the other two were on the cusp of blast. Two stopped developing, as expected. We transferred all 3. RE felt VERY strongly (too strongly) that there is no way more than one will stick. That was a little disheartening (not because I want triplets, but because I would love to pretend we created three viable embryos!). But I am relieved that everything is in its place. I'm not even dreading the 2ww. As far as I'm concerned, I'm pregnant, so I'm just going to quietly enjoy the next 9 days. Thanks for asking!

mm29 · July 2014

Hooray!! You are definitely pregnant until proven otherwise!!!

hmz819 · July 2014

Yay! I'm so happy for you.

Snuggle in lil embies.

Mrs.McIrish · July 2014

Glad you had a good transfer. Sending T&Ps that your THB is happily burrowing in for a long winter's nap.

LeggyJeggy · July 2014

I'm glad it went well! I hope the next 8 days are enjoyable

RunCC37 · July 2014

Alright!! FX and lots of good vibes headed your way!

zazu13 · July 2014

yay for 5dt!!~

Fert Report In - Input, please? D3 Update

Re: Fert Report In - Input, please? D3 Update

NTNP 2009-2012 TTC since 2012:

NTNP 2009-2012 TTC since 2012:

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