Content note: I’m going to discuss our final two embryos and decisions related to them.
Over the last few months, Arthur and I have an ongoing conversation that sounds something like this:
“If we were three or four years younger…”
“If we hadn’t had the infertility issues or the miscarriages or NICU…”
“But we did.”
It’s easy for me sometimes to focus on the good parts, those final easy months of my pregnancy with M that culminated in a term birth and a beautiful newborn and think, “oh, I could do that again”. And if that was what was guaranteed, the answer would be easy. Both of us had always assumed that if we hit the lottery (aka got pregnant and had a live birth on our own), we’d just be excited to try for a third child. What – as the dust settles – we’re only now truly starting to account for in a meaningful way is how much the whole journey has taken out of us.
This isn’t a complaint. We are fortunate beyond all belief in so many ways. With some distance, all the infertility, IVF, miscarriage, and premature birth has ceased to be the constant it once was and has slowly begun to sublimate into the normal fabric of our life. There are moments, of course, but there’s no doubt that it’s better.
Recently, however, I was reading a book where the miscarriage scene triggered a strong, painful memory of sitting in a darkened ultrasound room, pregnant, but not really any longer. “I can’t keep putting myself through this,” I told my husband. “I just can’t go through everything and then hold my breath for months.”
We met with the RE last week to discuss what to do with our final two embryos. It’s truly a conversation I never thought we’d need to have. When I went through the transfer that ultimately resulted in E, it was not a good day. I’d had 22 mature eggs retrieved, 18 fertilized, and plenty of embryos growing beautifully on day 3, which pushed the transfer to day 5. On the appointed day, we arrived at the clinic, got prepped and then handed a photo that I expected to contain our perfect blastocysts for transfer. Instead, the photo showed two cavitating morulae. Our best embryos out of 18 fertilized eggs were a full day behind. Let’s just say there were a lot of tears that day.
I didn’t even think about the last few embryos the clinic had decided to continue growing to day 6 and see if there was anything to freeze. A day or so later, I got the call that the lab had frozen two day-6 blastocysts. Truthfully, I was so disheartened by infertility and circumstances I just sighed. It was too much at the time to get excited. We were more or less broke, emotionally and financially.
As the infertility cliché goes, though, you only need one good one (and in our case, a bizarre, stressful, high risk pregnancy), and E came into our lives. At the advice of the perinatologist and my OB, we decided to try on our own for a year when we were ready for a second child. Much to our immense surprise and joy, M came to us. Which left us having the conversation I recounted above.
Like I said, none of this is a complaint. We’re lucky and I don’t discount that in any way.
Neither of us feel as though we can discard the embryos. The embryos have a form of dual existence for me. They are somehow both not fully human and also, simultaneously, my babies. I’m aware other people have different feelings about embryos, and that’s absolutely their prerogative. I’m certainly not going to judge anyone for their feelings or what they choose to do with their embryos – it is such a difficult, personal decision. This is just what works for us.
We finally determined that our best course is to find out, as much as possible, what we have frozen. We know we have two day-6 expanded blastocysts with a “b” grade inner cell mass and a “c” grade trophectoderm. The biologist at the lab described them to us as “average” – certainly high enough quality to potentially create a baby, but not top rated. Due to my high-risk pregnancy with E (and the increasing trend towards single embryo transfers regardless of pregnancy history), the embryos have to be transferred one at a time, meaning we would potentially need to go through two FETs.
We don’t have the energy (or finances) to put into treatment that we once did. The idea of going through another miscarriage (or worse) scares me. Doing two FETs means a good bit of logistics to make them work just in terms of getting to the clinic as required, not to mention the expense and the two week waits.
This led us to genetically testing the embryos, which is a little cheaper than a single FET at our clinic by the time we add in medications and everything else that goes into an FET. It means thawing, growing the embryos out overnight, having them biopsied, and then refreezing. It’s not without some risks, but in return, we’ll have some idea of whether or not the embryos are euploid, and the refreezing will be done with a newer, better form of vitrification. If one or both of the embryos turns out to be euploid, we’ll have a higher chance of implantation and a lower risk of miscarriage once we transfer. If one or both of the embryos turn out to be aneuploid, well, we’ll save ourselves the cost of one or two FET cycles, the two-week-wait, and potentially a miscarriage.
It’s not an easy decision. I’m aware that there’s definitely some controversy right now in the world of embryo genetic testing. A couple of days after Arthur and I made the decision to go ahead with genetic testing, this landed on our doorstep:
Not the most helpful coincidence. I mean, I’m glad doctors and scientists are considering these variables, just sort of strange timing for us…
I’d be lying if I said that the idea of a lab making a mistake about whether or not the embryos are good doesn’t scare me. However, given all of our particular variables, genetic testing is still our best option going forward. We’re working on getting the consents signed currently.
And then…we’ll see.