It was the only day during the week after we lost our babies that I actually had to be somewhere: we had to visit the mortuary to arrange the cremation.* I got out of the shower in the middle of the day (don’t judge a grieving mother) a few minutes before we had to leave the house when my phone rang, indicating Palo Alto as the area code. That’s odd, I thought, I don’t know anyone from there who has my cell phone number… but picked up anyway. “Hi CC, this is Dr. RE” I recognized the voice and, even in my grief-addled state, was somewhat amused that she referred to herself as “Dr. RE”. I was surprised as I hadn’t expected this at all – she’s an MD/PhD and sees patients about once a week, if that; getting an appointment takes a month easily. She told that she had heard of our loss and was terribly sorry, and that both Dr. Head of RE (who did my retrieval) and Dr. Head of MFM (who saw us after C’s amniotic sac ruptured) had talked to her about me, and she had promised them to call me. Now, considering that I had sent an email to her nurse about whether I should to back on my drugs to prevent endometriosis earlier that week I cannot be entirely sure that they thought of me all by themselves, but regardless, it was nice to feel like an actual person and not just patient #1234567.
Dr. RE talked a bit about the psychological support systems the hospital offers, to make sure I knew that these were available to me, and proceeded to ask if we had frozen embryos (yes), how many (7), and which day (3). Given what had just happened, she said she’d definitely recommend single embryo transfer, and that of course there would be a lot more monitoring in any future pregnancy, and that the clinic had several excellent MFMs (it’s a big teaching hospital). I mentioned the doctor I had seen at my anatomy scan and selected for my follow-up appointment, and she immediately raved about how brilliant he was and where they had recruited him from. We also talked about whether I should take any medication to prevent endometriosis, but agreed that it might be better to give my body some time to recover and heal.
A few weeks later, I had my follow-up appointment with her. Given that the transfer part of my IVF had gone perfectly (we transferred 2 embryos and I got pregnant with twins), I didn’t expect there would much to talk about. Dr. RE was standing up when we entered the room, and declared that she’d first have to give me a hug. Another unexpected sweet gesture. She asked how we were doing, how I was doing (I think my poor husband felt a bit left out at times). We all agreed with trying single embryo transfer next, and worked out a timeline that would allow us to fit the FET in our contract to cover it. Then we learned that our embryos were frozen in pairs. I’m not sure this was ever mentioned before, but of course it was too late to change that now. Anyway, thawing two and re-freezing one seemed less than ideal. We essentially deferred that point for discussion with one of the embryologists when we got there. She also asked about Dr. MFM’s plan for the pregnancy (weekly progesterone shots starting at 16 weeks, biweekly monitoring, cerclage if cervix shortens below 2.5cm). “And perhaps bedrest, too?” she inquired, but I declined – there is no evidence that it actually improves outcomes. She nodded, but at the same time chuckled in what seems like a “young fools” way to me… that bit wasn’t particularly comforting, but I think we’ll cross that bridge when we get there.
Just a few days ago I had my lining check – the only appointment in this FET cycle, other than the transfer itself, much to my surprise. I had been worrying whether I’d been responding properly to the drugs (just because I tend to worry) but then started producing EWCM about a week ago, which seemed like a good sign. And indeed, my lining was trilaminar and 8.5mm, just perfect. Before getting started, the NP that does lining and pregnancy ultrasounds at my clinic commented how she’d seen us back in July and then now, how sorry she was for everything we had been through in the meantime, and that it must be hard for us to be back. While I appreciate the thought, and there is some truth to it, just minutes before I had mentioned to H how wonderful it had been to see our babies’ heartbeats in this room back then.
Then we met with the embryologist, who thinks that all our embryos are of similar quality – 8 to 10 cells, fragmentation and grades of 2-3. A & C had both been 822 and implanted and developed beautifully. According to the literature, she said, there isn’t much of a difference in pregnancy rates between grades 2 and 3, so we might as well thaw the lonely unpaired embryo to avoid having to re-freeze and thus potentially lose one. If a 10-cell embryo were to loose more than 2 cells in the thawing process, it’d be considered too damaged for transfer, and they’d thaw another (or a pair, in our case).
Long story short – my transfer is on Wednesday! I’ll take the day off to relax, go to acupuncture before and after if timing allows, and then I have a conference the following days to take my mind off things. Cell-division-and-implantation-supporting thoughts (however exactly these may look) will be much appreciated.
* A difficult task in an already difficult week, probably deserving its own blog post, but not today.