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CCRM Regroup: Dumbfounded

Posted Aug 11 2009 9:42am
If you remember from a previous post, I dreamt that I couldn't dial my husband's cell phone number while I had Dr. Schoolcraft holding on the other line. That today, was not my problem.

In preparation for the call, I wrote out a ton of questions to pose to Dr. Schoolcraft and prior to the call reviewed them with Berilac:
  1. We transferred 3 embryos, what was the quality/grade of the remaining 7?
  2. What was the quality/grading of the remaining 7 on day 5/6?
  3. What was the overall quality of our eggs/embryos (anything look off/odd/weird)?
  4. The previous diagnosis you gave us was "egg quality," after completing a cycle with us, is it the same?
  5. This was my first fresh cycle, and it was successful, are we really a "tough case"?
  6. Yes we have a child that has made it this far into pregnancy, but some RE's don't consider that a successful cycle, was this a successful stimulation and cycle to you?
  7. What would you change about our protocol?
  8. My mom had early menopause at age 36, we don't feel like we should wait to TTC#2, how soon after giving birth can we take CD3 blood work to see where my AMH and FSH are at?
  9. How soon after birth can we cycle? How do we take breastfeeding weaning into consideration for the timing?
  10. How soon after a miscarriage can we cycle?
I felt very prepared. I felt like I was getting the entire rest of the story from our April cycle.

Then the call came, and like I said, I nervously dialed Berilac. I successfully got both men on the line and thanked Schooly for his involvement in our successful cycle, but that, before we forget, we wanted to know how he thought the cycle went down.

So I started with my first question:
  1. We transferred 3 embryos, what was the quality/grade of the remaining 7?

And I was SHOCKED at the result:

  • 1. 8-cell, grade 4 (transferred)
  • 2. 8-cell, grade 3 (transferred)
  • 3. 6-cell, grade 3+ (transferred)
  • 4. 5-cell ... poor fragmentation
  • 5. 2-cell
  • 6. 4-cell
  • 7. 4-cell
  • 8. 2-cell
  • 9. 4-cell
  • 10. 2-cell

I am shocked because the remaining 7 embryos ... were such bad quality, they weren't even graded on quality ... they were developmentally too far behind to get a grading (or he didn't tell us what they were) ... he did mention that the 5-cell had a lot of fragmentation :-( ... with each cell count he told us about I felt the breath go out of my chest. The feeling reminded me of infertility's heart ache and isolation.

At that point, a couple of my other questions went out the window ... did I need to ask what our overall embryo quality was at this point? No. Was this considered a successful cycle? I'd surely say No. So I modified the questions a bit, and below, I'll provide his answers:

2. What was the quality/grading of the remaining 7 on day 5/6?

None of the 7 remaining embryos made it to day 5 or day 6 - they ALL arrested prior to day 5, which is what he would have expected on day 3 ... hence the day 3 transfer. Ouch.

3. What was the overall quality of our eggs? (anything look off/odd/weird)? I didn't ask about the embryo quality b/c I thought that was obvious.

He indicated that look of the egg - graininess or darkness, really doesn't tell much about quality, he's had some weird looking eggs make beautiful embryos and vice versa.

4. The previous diagnosis you gave us was "egg quality issues," after completing a cycle with us, is our diagnosis the same?

Yes, he'd agree that it's the same, but we can't lose sight of the Sperm DNA fragmentation issues. But he believes that the overall problem is with the eggs. He would generically classify us as having an "egg issue."

5. This was my first fresh cycle, and it was successful, are we really a "tough case"?

I reminded him that this was my first real fresh cycle, so were we really "tough" enough to require cycling at CCRM? ... Basically I was asking him if I could cycle locally next time. I truly wondered if I brought out too big of guns by using CCRM and their lab and he said we are a tough case (even in his experience) and we are very fortunate that the cycle was successful.

I think this is where I was really shocked. After 4 miscarriages ... I could (even then) still tell myself that perhaps those 4 miscarriages were flukes ... and perhaps the monkey clinic in Sacramento caused the problems from the first two retrievals and the CGH vitrified oocytes transfer back in January ... but the results of the remaining 7 embryos and Schooly's affirmation that we ARE a tough case really threw me in a tailspin. I guess I was hopeful that somehow we'd been living in a nightmare these past 3 years and that we'd learn today that it was all just a bad dream ... but no, we really DO have fertility problems. I know, I know, many of you are like DUH POLLY ... but I've had ladies who have said to me, they just think I've been unlucky and that really I'm a better case than we think (because we've gotten pregnant so many times on our own) ... but really, this paints a picture of poor fertility - no matter how you dice it. Given that there is a baby in my belly, I really was optimistic that things would look different. This was just so unexpected.

6. Yes we have a child that has made it this far into pregnancy, but some RE's don't consider that a successful cycle, was this a successful stimulation and cycle to you?

I didn't even bother with this question ... for obvious reasons.

7. What would you change about our protocol?

Dr. Schoolcraft said that since I got about 5 eggs from each of my previous retrievals, and was able to generate 14 eggs with CCRM's EPP/Antagonist protocol ... he didn't think there was anything he would change about that.

8. My mom stopped having menses at age 36, we don't feel like we should wait to TTC#2, how soon after giving birth can we take CD3 blood work to see where my AMH and FSH are at?

He indicated that six months after birth is when the mom's hormones get back to normal.

9. How soon after birth can we cycle? How do we take breastfeeding weaning into consideration for the timing?

He indicated that six months would be the earliest time to cycle again and that we'd want to wean from breastfeeding at four months and then take two months off before starting a cycle at the six month point.

10. How soon after a miscarriage can we cycle?

I told him that we'd been considering possibly trying naturally one time before considering treatments again to TTC#2 and I indicated that there is a high likelihood that it will be another miscarriage, I asked him how long we'd have to wait after a miscarriage to cycle again, and the answer is two months.

So there you have it. All the details from the call. Where does this leave me? Incredibly grateful for the 'one little engine that could' in my belly. Grateful that I waited until after the first trimester, the genetic screening ultrasound and blood work, and after the 20 week level II ultrasound ... before hearing this news.

You are probably wondering if we're really considering treatments for #2 when we're only 1/2 way pregnant with #1 ... and the answer is yes. We're not getting serious about anything, but we do want to know our options.

I'm glad we had the call. I'm just not happy to hear the results.
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