They managed to retrieve 10 eggs, 6-8 mature. I think this was possible because I got the sense that Dr N was only counting the largest follicles before. We are very lucky that they all yielded eggs. Still, the eggs from the smaller follicles of 8mm will most certainly die out very early.
It is very important to talk to your embryologist before you start. In our case, given our poor history, we have spoken to him repeatedly. According to the embryologist, the immature eggs continued to grow after staying 3-4 hours in the culture solution and amazingly, all 10 fertilized.
Dr N was so chuffed he kissed me on both cheeks. Although I had nothing to do with it, and I am well aware that fertilization is a mere hurdle, relevant for that moment, then completely irrelevant after, if many of them are going to expire along the way.
This confirms my view that IVF is a goddess of uncertainty and luck. There is no control. All they can do is apply medication and then your body does what your body does, and it has absolutely nothing to do with your mind. The only relative is the level of your own expectations.
If you compare this to the previous round, we had more antral follicles (7 versus 5), then fewer follicles (9 versus 15), then correlatedly, fewer follicles of mature size (4-6), and fewer eggs retrieved (10 versus 12), but more than you would think, then suddenly, more embryos (10 versus 8).
After the first-day fertilization report, they don't look at the embryos until Day 3 for assessment, leaving them undisturbed to divide on Day 2.
This is the day that ticks by in seconds of nervous trepidation, as I wait for the call from the embryologist. I've been unable to get much done, waiting fitfully by the phone since yesterday morning, to yesterday evening, to 9am, 10am, 11am today.
Basically, I just drive myself crazy, google-searching "egg quality", "embryo 5-day versus 3-day freeze". In any case, I know that when I get home, the house will be empty and I won't know what to do with myself, which has become a feature of most days.
This is the day that our embryos tend to fall over; some will arrest before Day 3, some will arrest between Day 3 and Day 5. I wish that most would keep going, but I fear that most will not. My stomach feels eaten with fear, remembering the last round, where out of 8 embryos, 5 were graded as poor and 3 as below average on Day 3. Would it have helped to do a Day 3 freeze? Yes, at that stage, I guess it would have preserved the three that remained.
Of course, as it turned out, the feedback was that (a) the embryos were poor and badly fragmented; (b) 6 out of 8 arrested before Day 3 and before Day 5; (c) the cell split overall was slow; (d) of the two that were still growing on Day 5, one had formed a blastocyte (separate cells merge to become a conglomerated organism) but the second was struggling to do so (a halfway merge on Day 4 is known as a morula). Most painfully, the blastocyte was judged to be of too poor quality to transfer, as it did not have enough inner cell matter (ICM), and looked like it did not have a fetal pole.
Without a fetal pole, which contains all the chromosomal information and metabolism to ensure proper development, the blastocyte might latch but it would grow as an empty sac and eventually miscarry. Even if it took, it could have chromosomal abnormalities.
So, as it turns out, perhaps freezing on Day 3, while allowing us to continue to transfer, would not have been sufficient for a healthy birth. The opposite side of the argument is that most people argue that the womb is a better incubator of embryos than the lab and there are countless successful and healthy transfers of lousy Day 3 embryos. Or is that just an urban forum myth?
Doctors agree that there is no inherent difference at Day 3 and Day 5; there is just more information at Day 5. You could, in other countries, also do a PGD screening for chromosomal abnormalities. This, in Singapore, is only done if you miscarry often and/or have blood-related diseases. Many reports also say that PGD, in and of itself, only screens for certain types of chromosomal abnormalities.
In Singapore, there is not a whole lot of quantitative advantage to doing a 5-Day freeze, though there are of course always qualitative advantages. This is balanced, on the other side, by the thinking that you must freeze on Day 3 if the embryos are dropping like flies. Even if the embryos make it past Day 3, they may not make it to freeze on Day 5. At this point, that is my biggest worry.
I am well aware of how ridiculous this is — an outcome that is determined in a petri dish. A couple of cells that have to fight their way to the possibility of being a child and life.
This is what I would like people who are morose about their third child, or their child's gender, or whining about doctor's offices and tuition, to remember — it is how desperate I feel. It is living with this uncertainty, held over you, badly on some days like this one, but silently in the shadow of all days. For these ten embryos, it is hanging on to the bare chance to experience life, a life, any life. It is the devastating heartbreak, if the result is that, it is again, not enough. If you have never experienced a sustained process that humbles you, then I'm not sure you even begin to understand the emptiness that I dread going back to.
I'm praying for something completely out of my control and binomial in result. This particular circumstantial feeling is one very few people in the world are ever going to understand. But the closest description I can give is that it is like the stomach-folding feeling the night before you buy or sell a house, or an asset that makes up the primary of your financial security or aspiration, and you are waiting to hear back as to whether the owner will actually go through. Either you get to continue, or you don't and someone will make a decision.
I guess in this case, God will make the decision. Either way, it will be above, below or at where we hope. I am trying to steel myself for a preposterously bad result, a call delivering "I'm sorry, it's bad news." I am trying to will myself to let it go, to ask Him to help me let it go, because I know that after you've been through so much, it is so hard, if not impossible, to pull yourself away from caring.
