Tuesday, November 22, 2011

Limited Fert and sET Consult

I had a consult with the another clinic in our area that does frozen oocyte (egg) cycles last Friday. The point of the consult was to find out what a frozen egg cycle would look like and what it would mean in terms of a limited fert and sET cycles. The RE there was great and informative and (surprisingly) all but convinced me to stay at my current clinic.

Basically he said that frozen eggs are are relatively new procedure and he had no statistics and data to back up their success. He explained that eggs don't freeze as well as embryos (due to their higher water content) and that they don't provide as big of a "confidence level" for cycles as they are an unknown.

If we went with that clinic, we would ICSI three eggs for a frozen egg cycle with an sET. The remaining eggs would be frozen for later use. They'd watch my ICSI'd eggs for fertilization and then push the embryos out to day 5 to let nature pick the strongest one and that would be what we'd transfer. Obviously, with three eggs, we risk having nothing to transfer at day 5.

The RE explained that frozen egg FETs could be a lengthy process should that become our next steps (i.e. if we don't make it to transfer with our fresh embryos or the sET doesn't implant) and here's why. When they thaw eggs, their goal is to get one that survives the thaw. The clinic then ICSI's that egg, watches it in the fertilized drop and checks on it 24 hours later to see if it continued to develop. If that one egg doesn't fertilize they can try to thaw and ICSI more eggs the next day, watch the second round of ICSI'd eggs for 24 hours and see if they develop. If after two days of thaw and ICSI nothing fertilizes the cycle is over and you have to wait another month and start all over again. After sticking e2v needles in my arse intramuscularly for 4 weeks, I can say without hesitation that I would lose my mind if I prepped for a month to not even make it to transfer (and I would lose it even further if that happened multiple times).

This RE seemed to indicate that frozen egg cycles are much more volatile and they may mean a lot of cancelled cycles because you are playing with an unknown. Will the egg(s) survive the thaw, will they fertilize, will they continue to thrive beyond the first 24-48 hours? The timeline with a frozen egg cycle is also very sensitive since the eggs start on day 0 on a medicated FET cycle (essentially the day you would have an ER for a fresh cycle) and then you only have so many days to create a successful embryo and transfer it before it's game over.

The conversation kept coming back to the fact that with embryos you have a known entity, that is graded, it has statistics to back up the success and that the only what if (once an embryo is frozen) is whether that embryo will survive the thaw.

The RE gave me a test case scenario taking frozen eggs out of the equation and focusing instead on limited fertilization. He suggested fertilizing six eggs and discarding the rest of my eggs from the next fresh cycle. Explaining that, statistically speaking, someone my age with our Dx (Unexplained IF) should have 2-3 embryos strong embryos from 6 ICSI'd eggs. With an sET we'd transfer one (obviously) and freeze all that remain on day 5 in separate straws.

He said we should focus on how many embryos we can live with having and what we'd do with them if we were done making a family and we had snowbabies left. It seems as though a limited fertilization with more embryos created would up our chance of success and lower the number of cycles we'd have to do/length of time we'd be TTC for.

In the end he said if we're comfortable with our current clinic and they are willing to do a limited fert, sET and separately freeze of all our remaining embryos on day 5, then there's really no reason we should leave them given the success we've had there. Our current clinic is $2000 cheaper for a fresh cycle, so if we take out the notion of frozen eggs, then he's right, we probably are better off sitting tight.

My consult with my clinic for our next cycle is the first week in December. If all goes well, I'll start BCP mid-December and start stims on January 8 with a retrieval around Jan. 18.

Depending on what my RE says at my consult and consent review, we'll move forward with fertilizing 6. It's a number we're comfortable with, and given my clinic's success rates with FETs (13%) and the fact that they don't vitrify, 6 probably gives us the best chance of conceiving #3 without doing a fourth fresh cycle again in the future.

Now that I'm armed with a little more knowledge and a plan, I'm actually excited to cycle again. I have a lot of hope for our next IVF. January has always been a good month for us (I cycled for my first IVF and got KU in January 2009 and I gave birth to our amazing twins in January 2010) so hopefully we can continue the January streak.

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