And the Wait Begins..

I haven’t posted much lately, and I never did write about the follow up appointment after our first transfer failed. As a result, I haven’t written much about this cycle, or the plan if it doesn’t work.

So, I’ll start with a brief synopsis of where we’re at. As I wrote about in most (all?) of my recent blog posts, I moved across the country in the middle of my two week wait from my first cycle. We had an appointment with a clinic here in Toronto lined up just in case the IVF did not take, which took place in early August.

A few days later, we had our WTF appointment with the RE in our old city. I did write a draft of a post describing in some detail how it went, but in a nutshell what came out of it is that we still don’t know why we’re not getting pregnant (via IVF or otherwise). So, the diagnostic aspect of IVF did not give us any answers, other than to say that both egg and sperm quality are great, and we make lots of very good looking embryos.

We decided that for this FET, we would do our monitoring appointment in Toronto, and fly back to our old clinic for the transfer. If this does not work, we are considering shipping some of our embryos to Toronto to do our next cycle here (probably 2 out of the 5 we have left – I’m still nervous about shipping them, as is my old clinic).

Our RE already pulled out most of his tricks on us with the first FET, so not much changed in the protocol this time around.

We did the intralipids and heparin again, but did add a steroid to the mix. These things should help us with any undiagnosed immune or otherwise weird implantation type issues, because that’s really all that’s left. And we decided that after only transferring one embryo last time that this time we would transfer two.

While overall, I would say my RE treats aggressively, he is conservative when it comes to the number of embryos to transfer. Wherever possible, he recommends a single embryo transfer, especially if it’s a day 5 transfer, and the blasts are high quality. As much as possible, he wants to avoid multiples, and I tend to agree with him.

I want my next pregnancy to go smoothly, with as few complications as possible. I’ve already had a pregnancy that did not go well (miscarriage), and one that never really started (chemical), so I want to do whatever I can to ensure that the next pregnancy makes it. While I understand that there is only so much you can do on that front, one guaranteed way to increase your risks across the board is through a twin (or higher) pregnancy.

Pretty much every possible risk, from incompetent cervix, to preeclampsia, to premature birth is magnified when you have are carrying more than one baby. Many women pregnant with multiples end up on bedrest for a significant portion of their pregnancy in order to try to manage these risks, which must just magnify the stress.

And the risks don’t end with pregnancy – babies born prematurely have more health issues, some of which can be lifelong problems. For example, cerebral palsy is ten times more common in twin pregnancies than in singletons. And lastly, there are what my RE described as the “psycho-social risks” once the babies are born, and the parents are overwhelmed dealing with two (or more) babies who both have the same needs at the same time.

Based on all of that, I was happy to transfer one embryo the first time around. But, when that didn’t work we had to decide whether to up the stakes this time. My husband was all for it, but it took me a while to come around.

I had been worried that if our first transfer did not work I would regret only putting one back in, but in the end I was at peace with our decision. I know that we did the right thing by only transferring one embryo, and if I had the chance to do it over, I would do the exact same thing.

However, the decision about how many to transfer second time around was much harder. I asked our RE what he recommended, and while he wouldn’t come out and recommend we do two, he did say he understood why we would want to try two this time around.

In the end, I did some crude math and decided I was willing to take my chances with two. Probably the biggest factor was thinking about the possibility that if we put one in this time around and it didn’t take, we’d be looking at another failed cycle and heading to a third transfer. If the third one took though, it’s a result we could have achieved earlier by transferring two this time around. And emotionally, I think there’s a big difference between being successful on the second transfer vs. having two failed transfers under your belt and having the stress mount that things aren’t going to work out. Yes, I’ll admit it, I’m getting impatient.

A related consideration was miscarriage risk. Again, if we put one back in and miscarried, it’s a very different story than putting two back in, having a vanishing twin, and still ending up with  a healthy baby. And this time around, my desire to get pregnant first and worry about the consequences later outweighed my desire to minimize pregnancy risk.

When we got to the clinic for our transfer today, our RE sat down with us to talk about our embryos. As in our first transfer, our embryos thawed perfectly. Once again, we heard that they looked like they had never been frozen, and once again both the RE and embryologist gushed about how they couldn’t look more perfect.

We went into the procedure room, where I changed and got ready for the transfer. The embryologist then told us that this morning when the embryos were thawed, our RE had started to wonder whether we should really be transferring two, since they looked so good and he felt they had a high chance of both implanting. Sure enough when he came into the room, he asked us whether we were sure we wanted to go ahead with two. He offered that we could transfer one and refreeze the other.

It was not an easy decision, but we talked it over and decided to stick with the plan. Hopefully no matter the outcome of this cycle, I’ll look back on this as the right decision. In the meantime, for the next twelve days I’m pregnant until proven otherwise.