Wednesday, April 30, 2008

Just call me Jen.nifer Ani.ston

So did anybody see the celebrity rag about Jennifer Aniston doing fertility preservation?

Ok, well she copied ME!!

I mentioned in a previous post about Dr. Danderfluff and his wonderful second opinions, well, we’ve decided to switch clinics to start fertility cycling with Dr. Danderfluff (hence our recent trips up to Sacto). Not because he has the lion’s share of fertility information but rather, because his clinic will do the types of treatments that address our moral concerns.

So I have been terrified of having another miscarriage. It wouldn’t be so bad for me if D&C’s were as benign as they are supposed to be, but for me both of my miscarriages requiring D&C’s were followed by complications – the first miscarriage/D&C was followed by a uterine blood clot and a second emergency D&C (one in which I was AWAKE!) in the emergency room five days following the first one! The second pregnancy brought with it a D&C followed by 10 ½ weeks of being severely ill – so much so that I was out of work for a month, was a terrible bridesmaid to a very dear friend, and nearly lost my job. My symptoms had the Stan.ford Univ.ersity doctors all wondering what the heck was wrong with me, on the list of possible ailments was brain tumor and leukemia … nice. So when I had chemical pregnancies for pregnancies 3 & 4 … to me they were answered prayers – literally. I prayed that if God wasn’t going to see these pregnancies to live birth, then I needed them to end sooner rather than later – and He answered those prayers. So yes, I’m more gun shy than most at having miscarriages … and hey, not to mention that I don’t enjoy the heartbreaking turmoil they cause emotionally.

Because of the adverseness to miscarriages and D&C’s and because of my tendency to have them both, all of the specialists that we’ve talked to have suggested that we use PGD – Pre.implantation Gen.etic Diag.nosis: embryo screening (chromosomal testing of embryos) in order to test and choose the most viable embryos/babies for tranfser.

Last year, I remember watching a Dis.covery H.ealth program about a couple whose child had an incurable genetic disease that was causing the rapidly approaching death of their child. The couple was going through IVF with PGD in hopes to create an embryo (or sibling for the ailing child) so that they could select the baby that was not a carrier of the disease, but that had the right blood type (or something like that) in order to donate stem cells or bone marrow to their diseased child. I remember my mouth dropping to the floor as I considered the gravity of the decision this couple had made to pursue IVF for a baby with the correct genetic makeup to help cure their already living child. My first impulse was to judge this woman for playing God and choosing which baby would live and which baby would die. But then they interviewed this woman and she said “don’t judge us until you’ve had to walk in our shoes” … and although I don’t agree with their actions, I was done judging them for making their decisions, my heart broke for them – I can’t even imagine being in their situation and I thank God that I’m not. So ten months after seeing the program on TV, here I sit, encouraged to use the same technology that this couple was using. Our doctors have told us that it makes sense for us to use PGD: because we have two miscarriages proven to be chromosomal issues in nature, and because the other two miscarriages were chemical (the medical industry indicates chromosomal issues for chemical pregnancies when progesterone levels and uterine competency can be shown to be adequate) – testing embryos and selecting the most chromosomally viable ones would highly reduce our chance of miscarriage.

Morally, this is a hard pill for us to swallow. We can’t choose to learn information about these embryos and use this information to decide which ones thrive and which ones get discarded. Basically this type of testing would tell us which embryos have Down’s Synodrome, Turner’s Syndrome, complex chromosomal issues, normal chromosomes, etc. Armed with that information, the couple (us!) … is supposed to be able to decide to only put back the embryos that are chromosomally normal. Now, this sounds logical enough, doesn’t it? I mean, who would want to put back a baby that could cause another miscarriage (95% of Turner’s Syndrome babies miscarry and never make it to live birth) … However, did I mention that I have a friend who is Turner’s Syndrome, like a real live girl that I mentored for a few years! If the doctors told me that one of my embryos was Turner’s Syndrome, they would not allow me to put it back in my womb. But could I let that baby die? I couldn’t.

So in order to take advantage of chromosomal testing I could really benefit from technology that tested the sperm and the egg separately, not the embryos. Well, as of last year they didn’t offer this to the general public, but in early 2008 they made this technique available. So that is what we are doing this cycle – chromosomal testing on my eggs (Polar Body Biopsy). If we find abnormal eggs – I’m fine tossing those out, but poor babies who might or might not live to child birth – I would not be ok making those decisions.

Polar body testing can be done in two ways:

  • PBB1: Polar body biopsy 1: they take the polar body from the mature eggs at ovulation (polar bodies are shed by the egg and represent a mirror image of the chromosomal make up of the egg)
  • PBB2: they take the polar body biopsy from the mature egg when the egg is ovulated (as above) and they take a second biopsy from the embryo following fertilization.

We are getting the PBB1 testing done. So last week when I did the retrieval, they tried to get as many eggs as possible. They biopsyed (sp?) those eggs (by taking their naturally shed polar body) and have cyto-preserved the eggs while we wait for the test results to come back. (It takes 4-6 weeks for the test results to come back – this is why they freeze the egg and why the procedure is called "fer.tility pre.servation"). I should know how many eggs are normal by June 2nd … mark your calendars and grab a bag of popcorn – that for sure will be an interesting post.

The IVF package that I signed up for at my new clinic is actually the fer.tility pre.servation package – not what I was looking to do (preserve my eggs for later use) cause I want to be pregnant sooner rather than later! But the testing was only offered in this package (*hence the title of this post – fer.tility pre.servation [putting her eggs on ice] is what Jen.nifer Ani.ston was recently reported to be doing – that’s how she’s copying me. Ok, you get it.) Otherwise they would have made me do the testing on the embryos – which I cannot do. It is kind of cool that I might actually benefit too from the preservation aspect of the package – given that I’m closer to menopause than most 38 year olds! But I really just want to have as many babies as possible, as soon as possible!

So there were three packages Berilac and I were trying to decide between:

  • Single cycle: One cycle of retrieval, egg testing, cyto preservation of any/all “normal” eggs.
  • Age-based cycle: (cost is based on your age, the younger you are the “cheaper” [if you could call it that] it is) One, two, or three cycles of retrieval, egg testing, cyto preservation of six “normal” eggs. You only do as many retrievals as you need to in order to get six normal eggs. If you get six normal eggs in retrieval one – you don’t have to go through the two other retrievals. Regardless, you have to stop after three retrievals – so if you don’t get six “normal” eggs in three rounds of stims – your loss.
  • Triple cycle: Three cycles of retrievals, egg testing, cyto preservation of all/any “normal” eggs that you retrieve during three retrievals – you could end up with two normal eggs, you could end up with sixty normal eggs.

… keep in mind that these are not how many total eggs get retrieved, but how many normal eggs get retrieved. Based on the trials that were conducted using this method, it is estimated that for women in their twenties, 70% of their eggs are not “normal” quality.

We decided to go with the age-based fertility preservation package. We will do one, two, or three egg retrievals in order to get six “normal” eggs. My hope and prayer was that we just had to do one – but given that we only got 5 mature eggs we need to do round 2 (yes we got 6 eggs, but 1 was immature – meaning it didn’t have the polar body to actually biopsy)! We shall soon find out what our next steps are. It’s also worth mentioning that if we get five “normal” eggs in our first retrieval – then by the rules of the package we go through a second round of retrieval to try and get one more normal egg (to make up a total of six normal eggs) however, if we get five more “normal” eggs in that cycle – we get to keep all ten eggs for the price of six!!

It’s most likely that we’ll get 0, 1, or 2 “normal” eggs. But my prayer is for five!! I’m trying to keep the hope alive. Keep it alive with me, will you?

All of this to say ... in case it's not obvious ... there will be no positive pregnancy test in the near future. So there will be no embryo tranfser update and no peeing on sticks to see if I'm pregnant. Not yet anyway ...

46 comments:

  1. Wow, Polly! You are a wealth of information. I thought I knew quite a bit about IF testing, but I had no idea that it's possible to test eggs separately. Polar Body Biopsies... crazy. Well, I hope your results are good and you end up with 5 very health, happy eggs. Please keep us posted on the outcome.

    ReplyDelete
  2. My thoughts are you with, Girl! Here's hoping for 5 good ones this time and many, many more next time!!

    ReplyDelete
  3. Hey Fortune Cookie: I've been missing you and updates on you, by my calc you're just over 30 weeks? How are you doing? Thanks for checking in.

    Thanks BB: I'm keeping an eye on you too and your first IVF!!!

    ReplyDelete
  4. I'm so glad this polar body biopsy is available to you. I am a carrier for an x linked genetic disorder and so wanted to consider pgd, but couldn't for the same reasons as you.

    It's wonderful when technology can assist us without our crossing moral boundaries. I'm excited for you, and I feel hopeful that this process is the answer to your prayers.

    I'm with you on the DnC's. Two is enough for me. I don't want to ever have another.

    Anyway, I look forward to hearing some good results come June!

    ReplyDelete
  5. Wow, I was fascinated reading this! Technology is amazing and I feel so lucky that we live in an age to do stuff like this. What a long waiting time to get the results back though, that part must be killing you.

    Thank you for your sweet posts on my page. I'm checking in on you regularly now - especially with all this cutting edge technology :) I'm praying for lucky number 5!

    ReplyDelete
  6. Wow, Polly! Amazing that this is an option now. You have had a rough go on this journey and I pray this is the answer to your prayers. Keep us posted on your eggs as well as your next retrieval. No more "in the closet starting IVF" stuff, okay? (:

    ReplyDelete
  7. I had the same issues as you with D&C. I almost had to go back in for a second after my m/c because of the uterine clot. They let me wait a week and it passed on its own. Gross, but better than another surgery. I had a second D&C with my lap surgery last Fall, but no complications from that one, thankfully. Sorry, that was random.

    Anyway, glad to hear you are getting the testing you want. I really hope insurance is helping you pay for it, because these infertility treatments don't come cheap! Either way, I'm glad you are able to get it done. I hope you find the answers you are looking for.

    ReplyDelete
  8. Polly,
    You and your DH have been through so much. I'm glad that your new clinic is going to be able to do some further testing for you.

    ReplyDelete
  9. Here from NCLM...

    Wow, that is all fascinating. We did IVF with ICSI so I am very familiar with how all that works, but not so much with PGD or PBB.

    Just in case you ever get to the point you want to look in to donor possibilities, our little boy is the result of donor embryos. It was the miracle we needed to complete our family.

    Am very much looking forward to reading more of your blog! Thinking positive thoughts for you as you find out the results of your PBB.

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