Embryo Transfer

The eve of my embryo transfer my husband brought me home a beautiful bouquet of dahlias.

The appointed time for my arrival for the embryo transfer was 8:45 AM today. The embryo transfer was scheduled for 9:00 AM. I dreaded the requirement for a full bladder during the procedure. I had nightmares last night about not being able to go the washroom. I woke up several times, because I had stomach cramps from the Endometrin (progesterone- this seems to be the most troubling of my current medications) plus, fittingly, a full bladder. Finally, the clear and sunny morning dawned.

Since there was no anaesthesia, there was no fasting. And since there was no fasting, I was required to take all of my medications as usual this morning, except for the Endometrin, which is intravaginal and therefore might interfere in the whole embryo transfer process. They recommended drinking 32 ounces of fluid an hour before the appointment time. I told my nurse coordinator to relax, if there's one thing I'm good at, it's almost always having a full bladder.

This morning, I had my protein shake, a cup of tea, a glass of lemon water, then took a cup of tea and a travel mug of water with me for the drive to the Victoria Fertility Clinic.

Squinting in the sun in the car.

My husband was able to join me (I was allowed to drive myself this time if I needed to, but it's always nicer to have someone else with you I think). As before, no scents may be worn (embryos don't like it).

It was a bright an sunny morning as we entered the lobby of the building where the VFC is located.

We arrived a few minutes early and since I couldn't go to the washroom like I normally would before my VFC appointments, we just sat awkwardly in the waiting area of the lab (after checking in down the hall at the regular VFC reception). We were both nervous, wondering if any of the embryos had made it, if we would have one to transfer of a good grade, and if we'd have any to freeze.

We waited in the lab section of the VFC for our embryo transfer.

Old fashioned love in the waiting room of the VFC, where making a baby doesn't happen the traditional way.

An embryologist came out to  see us first. She told us that all eight embryos had survived (this is against the odds they quoted us and what we've read). She told us that since they only freeze grade 17 or higher, we would have a grade 20 blastocyst to use today and five to freeze for future use (two grade 19, one grade 18+, and two grade 18- the 15 and 16 will not be frozen)! She said that this was an excellent result. We felt very blessed and relieved by this news. We then were told to continue waiting in the reception area.

Our embryo worksheet showing the number of embryos that survived, 8, and their grades.

I could feel my bladder filling more and more, my kidneys working furiously to process all of those fluids that I had drank recently. I felt sick to the stomach from too much fluid, too fast, first thing in the morning, the hormones, and the nerves, but they need a full bladder to use the ultrasound externally to guide the catheter into the uterus to put the blastocyst into a prime location in the uterus to give it the best chance possible of implanting.

My original nurse coordinator at the VFC was assisting in the transfer and she took me down to a procedure room to get ready. I had to take off everything from the waist down and lie down on the procedure table. She first checked to see if my bladder was full enough for the ultrasound machine. No problems there. Dr. Hudson and another reproductive endocrinologist, who had been visiting from another clinic, but who would be apparently joining the practice, came into the room.

In the treatment room waiting for the embryo transfer.

Apparently, a full bladder is required for two reason. Firstly, when using an ultrasound externally, it helps the image be clearer (Dr. Hudson pointed out the dark mass at the top that was my bladder and then the greyish mass under which was my uterus. He said "I know it all looks like clouds, but we know how to interpret it." To which I responded "well, thank God for that."). Secondly, a full bladder can help weight down the uterus and make it lie flat, because apparently sometimes uteruses just like to sit up on their heads when a full bladder isn't on top of them to make them behave. So, while they had used an internal ultrasound for past procedures like imaging the follicles in the ovaries and the uterus' lining, the endometrium, they were using it externally today (ie. running it over my abdomen that was covered in goo), so that the catheter that they inserted into my uterus, wouldn't be blocked or interfered with.

The full bladder was easy to distinguish, the black mass at the top, everything else was kind of vague (to us at least).

The dark mass at the top is my full bladder, below is the uterus or clouds.

They put an image of the beautiful little blastocyst that they would be transferring today up on the screen for us to gaze upon. This was a lovely image to be able to focus on while Dr. Hudson inserted a speculum into me and my nurse pushed down on my full bladder with the ultrasound on my abdomen. It was not comfortable at all.

Dr. Hudson pointed out how the outside cells of the blastocyst become the placenta should implantation occur and the inside cells become the fetus.

Our glimmering blastocyst.

They flushed my uterus out with saline first. This is where the cramping on top of the sensation of a full and compressed bladder started. I breathed deeply and stared at the ultrasound screen and at the other screen with our beautiful blastocyst on it. The cramping felt like bad menstrual cramps. Dr. Hudson spent some time trying to line up the catheter just so.

The catheter was long and scary looking.

Dr. Hudson finally asked if my uterus had some sort of a secret password. Yes, it does and I'm not telling. When he had the catheter lined up just right in the uterus, the embryologist brought the blastocyst into the procedure room from next door to put into the catheter. Then Dr. Hudson shot the embryo up there and said "perfect!" The embryologist then flushed out the catheter and looked under a microscope to make sure that the blastocyst hadn't sneakily held on and refused to go into my uterus (a blastocyst is microscopic, so you couldn't tell from looking with the naked eye). The catheter was clear and they showed us on the image on the ultrasound the air bubble that is created by the blastocyst being shot from the catheter into the uterus.

Two thirds down on the left of the screen a whitish area is the air bubble created by the embryo being shot into the uterus. Or it's just all clouds . . .

The process had taken about 15 minutes. I was then told to lie still on the table for 10 minutes. I was told after this time I could fully empty my bladder (thank God!!!!). My husband and I gazed at the image of the blastocyst that had been left on the screen, glimmering like a beautiful fiery opal.

Like a fiery opal our blastocyst glimmered from the screen in the procedure room.

Passing the agonizing ten minutes until I could empty my bladder.

After I went to the washroom, I went to one of the other rooms, where I could put a heating pad on my cramping abdomen. My nurse coordinator brought in a sheet of discharge instructions and the date I need to get my blood test (HCG level) to check if I have become pregnant or not (12 days from now on October 17th). She said that I could go to any Life Labs. I booked an appointment for 8:50 AM on the 17th when I arrived home (if it's done before 10:00 AM they get the results that same day at the VFC, otherwise, you have to wait till the next day). She gave me a requisition for the blood test.

Waiting for acupuncture in a different treatment room.

Then Dr. Hudson came in to give me some acupuncture. He put some needles in my feet and lower legs and one in the top of my head and told me to relax for 30 minutes. I told him that I had booked an appointment for Friday morning to have more acupuncture done at Elements of Health (which specializes in infertility and fertility treatments- see previous posts) and I asked if this was a good interval. He said that it was perfect. He said that there's no guarantee that the embryo transfer will work. The misinformation out there about doctors "implanting" embryos is all over the place, but really all they can do is an embryo transfer. It's up to the embryo whether or not it implants into the uterus and thus become a pregnancy. He says in the next 24 to 36 hours is when the embryo will implant if it implants. It can either be chance that causes an embryo not to implant or a genetic flaw in the embryo that they just can't detect at this stage (nature's way of wiping things clean as he put it).

An acupuncture needle in the top of my head.

He told us that nowadays intercourse and even a bit of walking are allowed post embryo transfer (nothing the day of the embryo transfer though, I have to take it easy and move as little as possible), but 30 years ago when he was first doing IVF, they used to have patients admitted to the hospital post embryo transfer. They would be hooked up to catheters and have to use bed pans to try to minimize them from moving really at all. It's now thought that that level of inactivity doesn't improve the odds. But too much activity ie. anything other than a walk around the block or basic day to day activities and some intercourse is thought to be deleterious to the odds of having the embryo implant and survive the early stages (interestingly, the materials handed out by the clinic prohibit intercourse, but perhaps this is because some patients have more restrictions than us). But really, there's not much we can do at this point other than wait for the nail-biting 12 days and then get that blood test done to see if it worked or not. He told us though that there is definitely a chance that it will work and he told us that it all went well today.

I asked Dr. Hudson if I could use a heating pad and he said that that was fine. He said the only thing that is dangerous for an embryo or fetus is if my entire body temperature elevates (a fever for instance). He said a heating pad would be fine, but avoid things like a hot tub. I told him I thought hot tubs were gross and he told me that he agrees. Incidentally, he also loves tabby cats, so I've decided that he's good people.

While I rested with the acupuncture needles in me and meditated, my husband went to the reception area over at the main office and paid for the freezing of our remaining embryos and their first year of storage. This was $700.00 and $200.00 respectively (with the addition of $900.00 our outlay is hovering around $14,000 and we're not sure how much we might get back from insurance for drugs that we have purchased). We hope that this means that we won't have to do another cycle of IVF in the future if this embryo transfer doesn't work (we'd do a frozen embryo transfer instead) and/or to have a second child. It's $200.00 a year thereafter to keep our embryos frozen at the VFC.

Acupuncture needles in my feet and lower calves.

I've got a needle sticking out of the top of my head. Dr. Hudson said I might be able to pick up the CBC on it.

My husband returned and I babbled nervously. I was having trouble meditating/ relaxing for the 30 minutes as my overwhelmed bladder filled steadily again and my uterus continued cramping. Plus the morning had been momentous.

My nurse coordinator came and took the needles out and told me to take it easy for the rest of the day. I wouldn't have to go to bed, but sit down and put my feet up and move around as little as possible. Then low activity for the rest of the 12 day wait (ie. no beast mode weight lifting or long or vigorous walks or lifting anything over 10 pounds, just bare minimum life). She told me to take the dose of Endometrin that I had to miss this morning before the embryo transfer when I arrived home and then resume the schedule as before.

Other restrictions besides activities include no baths, hot tubs, saunas, and public swimming pools until pregnancy test, then further instructions depending on the result. If I come down with a fever, I need to treat it will acetaminophen, as elevated body temperature is harmful at this stage. If I need to treat any pain it must be with Tylenol/ acetaminophen, no NSAIDs (except the low dose aspirin that I take every day).

The materials state that it's not unusual to have cramping or spotting. These symptoms can occur during pregnancy are usually of no significance. They say that I MUST (their emphasis, not mine) continue with my medications as directed until the pregnancy test. If I experience difficulties I can of course call the clinic or if after hours, I as usual have the afterhours nurse cell phone number to call.

My husband and I stopped at a nearby restaurant and had a late breakfast/early lunch before I dropped him off downtown at the office and drove straight home to relax and write. My uterus had stopped cramping, but my stomach, bowels, and bladder were in a testy sort of a state into the afternoon. My body just doesn't know what/who had hit it this morning.

I have eggs on the mind.

My drugs/vitamins continue as follows:

1. Endometrin- one 100 mg intravaginal tablet in the morning, then one in the evening until the pregnancy test. If the pregnancy test is positive, this is continued until 9 weeks gestation. If the test is negative, this will be discontinued.

Yeah, some marketing genius thought women would feel special if they called the intravaginal tablets effervescent.

2. Doxycycline- the antibiotic is finished with tonight's dose. I have one extra left which I'll have to recycle at a pharmacy.

One of the prettiest coloured pills I've had- Doxycycline.

3. Estrace- I continue taking one 2 mg tablet three times per day until the pregnancy test. If the test is positive, this continues until 9 weeks gestation. If the test is negative, it is discontinued.

Pretty colour, tiny, and dainty, but they pack a punch.

4. Low Dose Aspirin- 81 mg- This is taken once daily until the pregnancy test.

Low dose aspirin is content being plain.

5. Dexamethasone- 1 mg is taken every morning until the pregnancy test, then I will be given instructions for weaning off of this whether the pregnancy test results are negative or positive.

Dexamethasone refuses to be a boring shape.

6. Prenatal vitamins- these continue as before.

7. Extra Folic Acid- continues are before (an extra 4 mg per day on top of the 1 mg in the prenatal vitamins)

8. Vitamin D- 2000 IU daily continues as before.

Tylenol (I just can't shake this horrible headache), Doxycycline, Dexamethasone, low dose aspirin, Estrace, prenatal vitamin, fish oil, and two extra folic acids make up the morning.

The reason why the medications, in particular, the hormones are so important, is because we are trying to trick my body into believing that it is pregnant/could be pregnant/make it more receptive to the blastocyst that is being put into the body from an external location where it was created, make implantation more likely, and miscarriage less likely. I am currently on day 21 of my cycle. Given my regular 29 day cycle, I would normally have ovulated around day 14.5 or so and then if the egg was fertilized, it would have implanted about nine days after ovulation give or take (if it managed that feat), so on about day 23 or 24. I'm on a weird schedule where my eggs were retrieved, fertilized externally, allowed to grow for five days, and one blastocyst has now been shot directly into my uterus (instead of meandering down the fallopian tube to the uterus on its own). They have to give my body as much support as possible with building and maintaining the endometrium for the embryo to snuggle into (estradiol/Estrace) and maintaining hormones like progesterone (Endometrin) at a level where my body might have more of a hope of creating/maintaining a pregnancy against all odds.

In any event, my husband and I are both feeling shell shocked this afternoon. It's amazing that anyone figured out so complex of a process as IVF and that so many people have succeeded in becoming parents using this marvel of modern medical technology. We only hope that one day we get to experience parenthood.

We've done all that we can do, so now we wait.

As soon as I arrived home, the cat jumped up on my lap and put his paws over my uterus and wouldn't leave.

I'm guarding the blastocyst.

Making a baby is hard work, but don't worry, I'm here to help.