A poor quality embryo success story

Last week, after what has been a 5+ year battle with infertility culminating in a donor egg IVF pregnancy, we had our first ever ultrasound not at a fertility center. Instead, we went to a regular old midwife practice…like normal people. I know some IVF’ers who have felt out-of-place when they make this transition, as if they still don’t belong. I kind of felt the opposite, to be honest — like after the number of ultrasound wands I’ve had shoved up my hoo-ha to get here, they should present me with some sort of elite membership card.

With that said, we went into the appointment with significant trepidation. I’d had a non-negligible amount of red spotting/bleeding two days before, which left me completely panic-stricken. Combined with the strong cramps that started the next day, things weren’t looking so good. “I don’t think I’m strong enough to go through a miscarriage too” I cried pitifully to my husband from my perch on the toilet.

You see, what’s been in the back of my head this whole time is the knowledge that the embryo we transferred was not the best quality. It was rated a 3BC before freeze, and had developed into only a 5CB upon defrost. The number is the stage of development, and the letters (A–D) rate the appearance/quality of the inner cell mass (which becomes the baby) and trophectoderm (which becomes the placenta), respectively. Since both things are required to make a baby, both grades are important. For a 5-day blastocyst transfer, the ideal grade is therefore 5AA. Since D-grades (=poor) aren’t even frozen, this meant our embryo barely made the cut.

While you have a chance with any embryo, studies show that the quality of the embryo correlates strongly with both the chance of implantation and the ultimate live birth rate. The best quality (5AA) embryos have a pregnancy rate >60% and a live birth rate >50%. With the embryo I transferred, on the other hand, I had only a ~30% chance of a positive pregnancy test, and only a ~15% chance of a live birth. In other words, although I had managed to beat the odds and become pregnant, my chance of miscarriage was a whopping 50%.

To make matters worse, those statistics were compiled for ‘ideal’ 5-day blastocysts, but our little dude/dudette didn’t make it to blastocyst until day 6. That means it was growing at a slower-than-normal rate, and that our true chance was likely even more pessimistic. Combining these statistics with my sudden bleeding and cramping, my husband and I went into our first pregnancy ultrasound unsure of what we would find.

The 8-week ultrasound

After explaining our situation to the midwife and having her narrowly stop me from taking my pants off (…old habits…), I climbed onto the exam table for my abdominal ultrasound. I was in tears before the exam even started, so conditioned by our ‘journey’ to expect the worst. But almost immediately, she told us it was good news — she could see the growing embryo!

She then asked me to remove my pants for a trans-vaginal ultrasound (see!) and she told my husband he could get out his phone. (She had told him phones weren’t allowed earlier in case it was bad news…won’t fall for that twice.) The raspberry-sized embryo was measuring right on track for its age, and we could even see a heartbeat. Despite our worst fears, everything was progressing just fine.*

At this point, I should note that I’m still taking two different IVF medications: a form of estrogen (orally) and a form of progesterone (via vaginal suppositories). I assumed this was self-evident to the midwife, both because she knew it was a donor egg IVF pregnancy and because the progesterone leaks out in massive white chunks. I was therefore caught off-guard when she started delicately hinting that if I noticed any symptoms like discharge, itching, or redness, I should call my doctor. I smiled politely and tried to rack my brain (“Have I noticed any itching??”) when my husband piped up that I was on vaginal progesterone, to which she replied “Ahhhh, that’s what it is then.” From this, I learned two things: 1) They apparently don’t get many IVF patients, and 2) From the amount of white goo leaking out of me, she must have thought I had a vaginal infection to rival all vaginal infections. So that’s not embarrassing at all.

Success with a poor-quality embryo

Technically, our embryo wasn’t poor-quality, it was fair-quality. Still, this seemingly minor distinction didn’t ease my anxiety during the two-week-wait when confronted with the dozens of ‘Perfect 5AA!’ embryos that my fellow IVF’ers seemed to post about online. Perhaps there’s some bias where people only post about the grade if it’s good?

Since I had such a hard time finding success stories for anything less than BB, let me add our own small success story here for those still in the trenches. Our embryo was only a 3BC (and by day 6, at that), our donor (Marie) was a month shy of 37, and while we won’t stop worrying ’til the very end, here is the 8-week scan of our bean.

* When I called Ghent to share the good news, the midwife I spoke to thought I had used the eggs of ‘my partner’. So either known donations also aren’t that common, or Marie and I come off as an adorable lesbian couple.

A different kind of two-week-wait

Trigger warning: This post discusses a positive pregnancy test, which means that I’m now one of those annoying ‘pregnancy bloggers’ I used to avoid like the plague. My sincere apologies.

You’d think that after finally receiving our first ever positive pregnancy test, the anxiety would have subsided. After all, this is what we’ve been working toward all these years, right??

Wrong — what we’ve been working toward is a fully formed, living and breathing baby, and we’re still quite a ways from having that in the bag.

I’m not complaining, of course — a positive test is the first necessary step, and it’s one that eluded us cycle and after for >60 months (not that I’ve been counting). But after working so hard for it, and waiting for so long, the very real possibility of a miscarriage has not escaped my notice.

I realize, of course, that the odds are in our favor — which is definitely the first time I’ve been able to say that in this whole painful process. But while being a member of the online infertility community has been a HUGE support, I think I may have finally discovered one downside. In particular, seeing daily posts from other women having trouble getting (or staying) pregnant has given me a heightened awareness of everything — and I mean everything — that can possibly go wrong*. (Having severe cramps in the middle of the night on Wednesday didn’t help either.)

2nd blood test (‘beta’)

Luckily, one good thing about getting pregnant through (donor egg) IVF is that we’ll be followed fairly closely through the process. Our mythical Big Fat Positive (BFP) was originally confirmed via an HCG blood test (‘beta’) over a week ago now, and last week we had a second beta to see how things were coming along.

In a normal pregnancy, the level of HCG in the blood should double approximately every ~48 hours. With an initial beta of 160, and a second beta scheduled for 6 days later, I was therefore hoping for a number greater than 1,280. From the amount of dizziness I was experiencing, and from peeing on sticks like a madwoman, I was pretty sure my HCG was rising — I just didn’t know by how much.

Have you ever waited to hear if the only pregnancy you’ve ever achieved — a pregnancy which took multiple years and donated genetic material — was still viable? I can tell you that it’s not completely stress-free, no matter how much you want to ‘Just enjoy it!’. After a tense day of glaring at my silent phone, and multiple communication issues between my local clinic and Ghent (one involving a fax machine, because apparently it’s 1995…), I finally got word from the nurse: My second beta came back at 4,815. I’m definitely still pregnant – or at least I was as of last Thursday!

Another two-week-wait

What they don’t tell you is that after you get pregnant, the two-week waits don’t go away — they just change into a different form. Now that the clinic is satisfied with my HCG level, our next step is a 7-week ultrasound. That means another two-week-wait, which I’m finding nearly as nerve-wracking as the first one.

Part of the problem is that ever since that bout of bad cramps last week (which were the night before my 2nd beta), the dizziness I experienced in the first few days has mostly gone away. Since that was really my only symptom, that means that I no longer feel particularly pregnant. I’m really hoping that it’s just the normal ebb and flow of symptoms, but it’s hard to know so many women who have experienced losses and not be a little paranoid. I may come to regret having said this, but right now, I would really kill for some morning sickness.

xx

*For example, if you are in the very early stages of pregnancy, I highly recommend NOT — under any circumstances — googling ‘blighted ovum’.