Almost exactly a year ago, in early September 2017, H and I were super egg-cited [sorry bad yoke 😂] to start our first IVF cycle. After a traumatic 11 months of the miscarriage (read my letter to my angel here), the discovery that I had Asherman’s Syndrome (more here), the uterus surgeries and the various hormone therapy treatments (HRTs), we were ready. It had to be our turn now, surely…
I’d received the drug delivery a week earlier. Not knowing what to expect, I ordered it to work. My office used to be located in one of London’s largest shopping centres, so the delivery guy got lost. He called me (from a withheld number) in the middle of the afternoon and asked that I meet him down a dark alley outside Zara Kids. (Shady AF, if you ask me.) I rushed out of the office, not knowing what he looked like. As it turned out, he wasn’t hard to spot – there was one guy standing next to a HUGE box (see picture on my Instagram). Et voilà, my first drug exchange was completed.
The fridge was stocked with drugs, the baseline scan confirmed there were at least 12 follicles, so my first injection took place on a Saturday evening. We happened to be at a wedding in the country, so H and I sneaked out for this momentous occasion and walked down a dark alley* (a “quickie” sure developed a new meaning!). I’d been so nervous about mixing the Menopur (300iu) solution that I’d restricted myself to one glass of Champagne all day (a tall order at a wedding). H kindly volunteered his nurse services, but he seemed A LOT more nervous and freaked out by the whole thing than I did. I love him dearly, but I realised quickly that this injection business was going to be a solo thing.
This cycle was on the NHS, so I had my first check-up scan on day 10 of stimulation (and no blood tests to check oestrogen levels). The scan showed that I already had three follicles that were 18mm or larger in diameter, which is the point when they say you’re ready to trigger. I also had another four follicles measuring between 14-17mm and one straggler at 11mm. I triggered with a shot of Ovitrelle at 2am that night. At egg collection (on day 12 of stimulation) the doctor retrieved seven eggs. Looking back at my notes, I see that six out of the seven eggs were mature (which is a good result – but no one informed me of this at the time when I could have done with the little “wins”).
We had been advised that we needed ICSI because of potential male factor – morphology was on the low side, but has since improved. As the eggs looked fine and dandy and the sperm sample top notch, the embryologist suggested we try normal IVF (i.e., let the egg and the sperm get cosy in a petri dish and hope they mate). Only one out of the seven eggs fertilised. Disappointing, to say the least.
Lesson #1: if ICSI has been recommended to start with, don’t be convinced otherwise while you’re a bit woozy post egg collection. As it turns out, my eggs and H’s sperm just don’t gel that well. This was (and still is) pretty evident, considering we have never fallen pregnant naturally.
With the one little embryo dividing itself in the lab, the embryologist informed us that the doctor would transfer it on day 2. H and I were both clad in the white paper lab coats and fish ‘n’ chip shop hairnets and I equipped with a full bladder (which if you ask me is the most uncomfortable part about embryo transfer). I lay down, put my legs in stirrups and a few minutes later, H and I watched the embryo shoot into my uterus via a syringe on a screen. It’s a little like watching your own personal baby Apollo 11 land on the Moon. Quite incredible really. And then for the next 16 days we crossed our fingers as hard as we could. This must be our turn, surely.
Lesson #2: the likelihood of success of a day 2 two-cell embryo transfer is much lower than a day 5 blastocyst embryo. If you only have the one embryo, the rationale for a day 2 transfer is that it is better for the embryo to be in the womb, its natural habitat, than in the lab. This may have been the case years’ ago, but technology and lab conditions have advanced, so I’m not convinced by this argument.
If an embryo fails to reach the blastocyst stage, it is almost unquestionably an incompetent embryo (an aneuploid). Not all blastocysts make healthy babies – in fact at my age, more than the majority don’t – but the chances that it does are higher than a two-cell embryo (simply because you have more information about the embryo’s early development). Interestingly, the embryologist at the IVF clinic where I did my fourth round said that “as a policy” they don’t do day 2 transfers. In addition, I am an Asherman’s case, which means my uterus lining has been damaged and isn’t as thick as it should be, so it may need more time to grow after egg retrieval – i.e. the “natural habitat” might not be the best possible environment on day 2.
I would rather have waited until day 5 to see if that single little embryo had developed into a blastocyst, rather than “winging it” on day 2. This, of course, means that we could have ended up with zero embryos to transfer and a cancelled cycle. We don’t know why that little embryo didn’t stick, but if we had waited until day 5 we would have had more information. Personally, I would rather have cut my losses after the first egg collection than walking around with false hope for two weeks. I could have avoided those yucky cyclogest pessaries that make me feel like a pregnant, moody cow.
In our case, the funding for each round of IVF was linked to transfer, which means that if there is no transfer you would do another egg collection (each CCG – Clinical Commissioning Group has different funding guidelines find yours here). We were extremely lucky to receive NHS funding for three rounds, but had they not transferred the day 2 embryo and that little embryo had degenerated before day 5, we would have had nothing to transfer and it would not have counted as a round. I’m not saying that the funding rules drive the clinical decision to transfer a day 2 embryo, but the cynic in me wonders if there is a tenuous link?
When I took the pregnancy test after the dreaded two-week-wait, I had (secretly) convinced myself that I’d be pregnant, but instead the Clearblue read: NOT PREGNANT. I felt crushed. It wasn’t our turn, yet…
I still feel a little crushed when thinking that almost a year has gone by since that first cycle – and our turn still hasn’t come…
* Just for clarity, I didn’t mix the Menopur in the dark alley.