Decision Time

I'm having a hard time writing this post because my thoughts and emotions are all jumbled up and I feel scattered at the moment. I just got off the phone with Dr. Schoolcraft and he gave us a lot to think about. Although I had a bunch of questions written down to ask him, I still felt unprepared and of course, had a new question for him as soon as I got off the phone. That never seems to change! The high I carried with me through the weekend has now evapourated into the cold, stark reality of what we're facing.

The first thing we discussed was what the results indicated and if it could explain our past failures. My take on it was "isn't it great that I produce normal embryos?" and his take on it was more along the lines of "this confirms our poor egg quality theory". That's Dr. Sch - he always tells it like it is. I'm still digesting that tidbit of information...I've always been in denial that our IF was my issue, wanting to believe that it was more unexplained, but now it seems that CCRM is confirming what the doctors here have been telling me all along. That's a very bitter $30k pill for me to swallow.

How is this indicative of poor egg quality? Well, we've never had anything go to blast before and on day 3 of our CCRM cycle, it appeared that I was having (in his words) a perfect cycle, meaning that we had 6 embryos that were all 8 cells. The high attrition rate from day 3 to day 5 when we dropped from 6 embryos down to just two viable ones confirms for Dr. Sch that the poor egg quality is reflected by the poor embryo quality and the high number that arrested. In the past, we always did day 3 transfers so we never knew that we had such a high attrition rate between day 3 and day 5. I should have asked him about the 4CB poor quality blast that was normal - how come it was normal yet such poor quality? I suspect he would have said that quality and viability are not always directly correlated with the right number of chromosomes and make reference to my poor egg quality again. Again, should have asked him, but didn't think of the question until I hung up.

Interestingly enough, he was also in a bit of disbelief at my estimate of the success rates (65% for 1 normal transferred; 85% for 2 normals transferred). He was asking me where I had heard those numbers and I told him that it was from the genetic counselling session and based solely on my age. He was quick to correct my estimate and decreased it to a 40% chance if we transferred one normal embryo, taking into account my past history. He thought though that we could get as high as a 70% chance if we transferred two normals.

Dr. Sch also confirmed for me that the 4CB embryo is not normally one that they would have biopsied and he doesn't have a lot of past experience with the thawing of such poorly graded embryos. He doesn't know if it will make it through the thaw (the embryologist seemed to think that there was a good chance that it would not) but if it did, he would be okay transferring that one as well. However, he said again that this was a poor quality blast and that, in his opinion, we only have the one real contender here. Ouch.

As an aside, I asked him if the grading of the embryo could change from the time it was thawed to the time of transfer and he said that the freezing and thawing of embryos does not change embryo grading. What they were graded before the freeze is the grade that they are at thaw. They will tell us however, what percentage of the cells made it through the thaw but that's it. I was also wondering if we would be able to get a better idea of the grade of the inner cell mass and the trophectoderm cells of the normal 2/3 embryo after thawing and he said that the time between thawing and transfer is about an hour so there is not enough time for the blast to develop any further in culture.

So, it is decision time and I do not know what we're going to do. Part of me thinks that we should go down and hope for the best, that both will survive the thaw so we have two to transfer. The other part of me wants to cycle again in hopes of getting one or two more to transfer and therefore increase our chances as high as possible. I've even had the thought cross my mind to cycle again up here since it is cheaper and ask my doctor to follow CCRM's protocol but then I think about CCRM's top notch lab, which becomes even more important given the fragile nature of my eggs. Another option would be to try and treat this through TCM only because, after all, this is the only school of thought that believes that there is no such thing as poor egg quality.

In the end, lots to think about. Which way will we go? Don't know yet.