A New Calendar, Two Embryos and Twins

We talked to the IVF nurses and got on the schedule for our next embryo transfer. I will start birth control pills in a couple of days then Lupron (tummy injections) on July 13th. I will have to get another endometrial biopsy the week I start Lupron, then our embryo transfer will take place on August 11.

Calendar for IVF cycle # 3

After talking to our doctor earlier this week, we knew it would be 6-8 weeks out, but we were hoping we would only have to wait 6 weeks. Considering we have been at this for almost a year now, 8 weeks really isn't too bad. With the help of some friends I have come up with some reasons to look on the bright side of getting pregnant (hopefully) in August:

1. I will be hormone free (except for birth control) for the next month.
2. I have the rest of the summer to have fun while I feel good.
3. I should be over the morning sickness portion of the pregnancy in time for the holidays.
4. Getting pregnant in August would mean an April/May baby (or babies), and spring is a lovely season.
5. I would be at my fattest when it is still relatively cool outside and would have the baby (or babies) before summer (in other words, before it gets too hot).
6. We will not be bringing a baby home in the middle of RSV, cold and flu season.
7. Summer birthday parties are so much fun (double the fun if we end up with twins)!

Really, getting pregnant in August would be pretty great. Getting pregnant ANY time would be pretty great!

 

The Embryos 

The main reasons an embryo does not implant are problems with the uterus and problems with the embryo. Our doctor said that we know my uterus is good (thanks to the recent procedures) so likely it is just a matter of getting the right embryo. An embryo will not implant for the same reason a miscarriage occurs: there is some sort of chromosomal abnormality with the embryo. An embryo can be excellent quality and look perfect under the microscope, but that does not mean there is not something wrong with it.  Our doctor said sometimes it is just a matter of trying until you get just the right embryo.

We have 5 good quality embryos left. One is a 5-day blastocyst and the other four are 6-day blastocysts (meaning that they took an extra day to make it to the blastocyst stage). Studies have shown that 6-day blastocysts have about a 10% lower chance of resulting in a live birth than a 5-day. Our embryos are also of different grades. The embryos are graded on a scale of 1 to 6 (I think). Our 5-day embryo is a B2- (B is for blastocyst), two of the 6-days are B2- and the other two are B3. Our doctor said that a 2 is near perfect (both of our previously transferred embryos were 5-day B2) and the difference between a 2 and a 2- is ever so slight. A perfect blastocyst would be a B1, but those are very rare; so rare that our doctor has not seen a single one in the two years he has been with the clinic. Basically when it comes to a thawed frozen embryo, a 2 is about as good as it gets.

 

Twins

We are definitely doing TWO embryos this time. The only decision we have left to make is which two. We are planning to use our last 5-day embryo for sure but need to decide if we want to use it with a 6-day 2- or 3. Using our 5-day B2- with a 6-day B2-, our chance of twins would be about 30-35%, with the 6-day B3 it would be about 25-30%. We have decided we are fine with the possibility of twins 5% or 10% difference in our chances of getting twins is not an issue. The decision as to which embryos to use depends on what we want to have left to try again if needed or keep on ice for pregnancy/baby #2 someday.

When I was younger I wanted twins. Then I grew up and had several friends give birth to twins (and friends who had singletons)...suddenly twins looked like a lot of work. The more I think about it though, the more I think it would not be so bad. One of my friends said that it was just normal for her because she did not know any different (she had not had any children before the twins). I think twins for our first time around would be the way to do it. For a second pregnancy, after already knowing what it was like to have a singleton, twins would probably seem much more overwhelming.

In reading up on twins I discovered there are several different kinds (and not all of them are nice). I have always known about Fraternal (2 eggs develop into 2 embryos) and Identical twins (1 embryo splits into two), but a few others are Mirror twins (which look identical, but with opposite features), Parasitic twins (where one twin acts as a parasite to the other, sometimes even absorbing their own twin) and Vanishing twins (where one twin fails to develop and disintegrates-or vanishes). In reading about IVF pregnancies I have found that vanishing twins are actually pretty common. I think they are viewed as more common in IVF cases just because pregnancy is detected so early and IVF patients usually get earlier ultrasounds than those who conceive naturally, so they know they are pregnant with twins before one of them vanishes. There are also three different ways identical twins develop.

• Dichorionic/Diamniotic: each twin has own placenta, chorion and amniotic sac
• Monochorionic/Diamniotic: twins share placenta and chorionic sac but have own amniotic sac
• Monoamniotic/Monochorionic: twins share placenta, chorionic and amniotic sac

Which type of twin depends on how late in the pregnancy the embryo splits; the later the split the more they are likely to share things. For example Conjoined (Siamese) twins are a result of a really late split, where they don't fully separate. With monoamniotic/monochorionic twins there is a greater risk of complications. About HALF of these types of twins die because their umbilical cords become entangled during the pregnancy, which can cut off blood supply to one or both of them.

Which brings me to my fear in transferring two embryos: Doing IVF already puts us at a higher risk of the embryo splitting into two, meaning twins. The risk of it splitting more than once (triplets) is VERY rare. But with two embryos, if just one of them splits then we could end up with TRIPLETS-which would be odd because two of them would be identical. Even scarier is the risk that they would both split and we would end up with TWO sets of identical twins-QUADRUPLETS! Either of these scenarios happening would be very rare though because really there is only around a 30% chance that both embryos will even implant to begin with, but I can't help but freak myself out. Since I am trying to keep looking on the bright side, one advantage to having triplets or quadruplets (or maybe even twins) would be that we would get all of out kids in one shot, which would mean we would not have to worry about trying to get me pregnant again!