We are still at 7-9 follicles and again, they have a large variation in size. The math is pretty simple, 7 or even 9 follicles is probably the least I've produced on any cycle, except the cancelled one. At this point, the chances are already pretty slim, and while there is always room for a miracle — and that's, of course, what I hope — I'm feeling a little silly and regretful that we may have rushed into it.
While I've successfully rid myself of questioning, should I have taken more supplements, should I have not drunk those Teh-Cs, should I have taken more folic acid, the only real differentiator is, perhaps, should I have rested longer and taken the DHEA for longer. So far, that has made the only real difference in any of the cycles.
On the other hand, I'm also pretty resigned that it is what it is and in fact, probably already is what it will be. By that I mean, between Sept and Nov last year — which is a pretty short gap — we jumped from 2 to 15 follicles, on a lower antral follicle count, on just a couple of additional months on DHEA and a different protocol.
My conclusion is, the whole thing can be a crapshoot. Each cycle really does differ on what nature has arranged. The Chinese word for ovulate, "*pai* luan", the first part meaning to arrange or line up but, more accurately, to order in rows, is hugely accurate. The IVF cycle orders in rows what your body has served up that month.
I guess I'm just slightly frustrated that our cycles have been a liturgy of what shouldn't happen in IVF. Our follicles always tend to separate in size, the large ones grow quickly, the small ones take a long time, and we always have dominant follicles. This ideal in IVF, of course, is to maximise the number of mature eggs. In our case, this never happens because some eggs will mature before all have a chance to catch up.
The hubby has been talking to the follicles, promising them anything from a dog to no music lessons, if they will just try their best to grow. But to no avail. The stronger but shorter dosages of meds have encouraged the larger follicles, while the small follicles had less reaction. The scattering effect remained as large, if not larger, by the end of stimulation.
The last scan showed that we have 4 already mature in size, but on the small and large end of being mature, 18mm and 20mm. There were another 2 that were 16.5mm, but Dr N was unwilling to sacrifice the two largest to wait for these two. So, that's that. We are down to maybe 4 eggs, if all of the follicles even yield.
We are retrieving on Day 12, which is pretty early; in previous cycles, it was as late as Day 15. With how poor the quality was in the past, we have no guarantee at all that the quality will be as poor, or better. Whether it would be enough to get over the line. Do we try to freeze at Day 3, or push on to Day 5 for a blastocyst, especially now we have lower numbers to begin with, and had 8 embryos all arrest or turn out unusable by Day 5 in the previous round.
I guess this is why IVF is so trying: all this effort and expense might easily, probably, be for nothing. I'm, of course, grumpy at having to go through sedation and day surgery for a smaller clutch. Is it worth building up your hope that there could be that miracle that we've been waiting for?
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I had a really funny question — how do they retrieve sperm. Well, for those interested, the guy goes in a plastic urine cup. He can do so at home, in the bathroom, or at the centre. The centre is annexed to a lab, an operating theatre, and it also has a comfortable, darkened little room where the guy can go and do his contribution to the whole process. His sole 3-minute contribution, I might add.
In some places, they have porn. Of course, my husband took it upon himself to check this out (of course). At NUH, they have just magazines, which he proclaimed useless, and an old VCR tape of Russian porn! Of course, my husband helpfully reported back to them feedback that this was not only ineffective, it was extremely ugly. Sometimes, I wonder why I jump through these hoops to perpetuate his genes into this world.
This sample in a urine cup is actually very hardy. In fact, it doesn't have to be a urine cup, it can be any vestibule, a paper teacup, a spoon — pretty much anything that is clean. Unlike eggs, they don't have to be kept in any culture solution. No, in fact, you can run with it out in the open air, and so long as it's within an hour or two of being produced, it is still fresh and usable. You can pipette it into anything via a turkey baster and impregnate just about anybody. I find this difference between the sexes absolutely incredible (and unfair).
In the public hospitals like NUH, the male gives a sample on the day of egg — or oocyte — retrieval. In private hospitals, they don't take the chance that he might not be able to produce anything, and they make the men do it once a few days before (this sample is then frozen) and then again on the day of. Despite the freezing costing $300, sensibly, they have never had anyone refuse this insurance. Can you imagine, if he can't do it on the day of, the entire stimulation process would have been for nothing! It also, on retrieval day, removes any pressure from the male. IVF, I have found, is designed to remove pressure from the male, while placing it squarely on the female.
This is also why, generally, if IVF does not work, it is an issue with the eggs. You are choosing a mere handful from two samples of over 19mn sperm each. The probability that it is a sperm issue, unless it is a cellular deficiency, is low. Taking more than one sample of sperm is a smart idea.
If your general quality is bad, just increase your sample size. That is a motto to live by.
From what the embryologist told us, further classification, while not fool-proof, is not terribly hard and is actually fairly common sense. You spin the sperm in a centrifuge, and after, all those that swim back to the top are the good ones, while those that remain at the bottom are dead or confused.
You can make doubly sure by inverting the test-tube, such that all the good ones now have to turn and swim back down to the bottom again. These are the strongest ones. Then, they look at them under the microscope and pick out those that are the most regularly shaped (don't laugh, if your morphology score is low, many have two heads, two tails or misshapen mid-sections) and active.
From what I have learnt about sperm over the last two years, and it is not a lot, there are three constants that women should be aware of. First, zinc and other supplements, including TCM, make very little difference to sperm analysis. It makes the least amount of difference to the morphology (% of normal shapes) of the sperm, and it makes the most difference to the sperm count (total number of sperm).
Second, if you are trying to conceive, doctors recommend that sperm be produced only every other day, to maximise the qualitative metrics. Third, the first release is likely to have a lot of immotile sperm. This is because they die as they are stored in the testes. So, for example, a first sample given after a period of sexual inactivity can have as much as 75% immotile sperm, and the rapid-moving percentage is likely to be very low. A second sample, three days after the first, will have a far higher rapid-moving percentage with immotile sperm dropping to a more regular 35%. This implies that if you are trying to conceive, the first production of sperm isn't your best bet.
