Cycle Day 23

To obsess or not to obsess...Well, it's me so of course it's to obsess.  What's my latest bent?  Well 3-Day versus 5-Day transfer.  I'm debating with myself over how technical to get about this...hmmmm.  Fuck it.  I'll just see where it leads me.  As I understand it, if the fertilized eggs make it to good grade (1 or 2), and 8 cells by day 3, they will transfer it to another medium to grow to blastoycyst stage.

Numeric grading systems for multicell embryos usually have 4 levels:

Grade 1: even cell division, no fragmentation
Grade 2: even cell division, small fragmentation
Grade 3: uneven cell division, moderate fragmentation
Grade 4: uneven cell division, excessive fragmentation

Article by T. Timothy Smith, MD IVF Timetable and Embryo Grading

[wp_caption id="" align="alignnone" width="360" caption="3-Day 8 Cell Embryo"][/wp_caption]

[wp_caption id="" align="alignnone" width="360" caption="5-Day Blastocyst"][/wp_caption]

My question is, what if the cells don't make it to 8 by day 3 and they decide to transfer on day 3 anyway, who's to say that they would develop any further in my uterus?  The fertilized egg doesn't usually make it to the uterus until day 5.  On day 3 they are still in the fallopian tube.  So does putting them in a place they are not supposed to be in for another couple of days risk the eggs?  If you keep them in the new medium, which is more like a fallopian tube environment for the 5 day transfer, does it give you better odds?  If they are not developing after 3 days doesn't it mean that there is a genetic problem?  Is transferring them on day 3 just taking the emotional responsibility off the RE?  The embies don't make it to day 5 so the couple screams, "Your lab screwed up my embryos!!"  Or are they in a back room somewhere shaking their collective heads at the poorly developed cells snickering, "Well, lets just transfer them since they aren't gonna make it anyway that way she will think it's her fault and not ours."  Is the reason they predominately do a 3 Day transfer because of insurance companies.  Does the extra expense and time it takes to nurture to the blast stage make it a financial decision rather than a scientific one?  Are they too large a clinic for them to bring it to blast effectively because they do so many procedures?  I told you I was obsessing.

My next not so heated obsess?  Well I guess it's not really an obsess more of a query.  Why didn't they put me on Lupron this cycle?  Curious...

My third obsess, Assisted Hatching.  To hatch or not to hatch?  What is it?  The embryo is first placed in a petrie dish containing culture solution. A special pipette is then used to hold the embryo in place. The embryologist takes a hollow needle that contains an acidic solution and places it next to the zona pellicuda. A tiny bit of this acidic solution is released from the needle so that it comes into contact with the zona pellicuda. ( I understand they are beginning to use lasers, too)  This acidic solution begins to slowly digest the protective layering, creating a small hole. The embryo is then washed in a special solution and placed back inside an incubator until the embryo transfer can take place. It seems to me if assisted hatching increases pregnancy rates why wouldn't you do it all the time?

[wp_caption id="" align="alignnone" width="360" caption="Assisted Hatching"][/wp_caption]

[wp_caption id="" align="alignnone" width="350" caption="Hatched Blast - Go little blast GO!!!"][/wp_caption]

I was reading about the reasons to do assisted hatching:

1. Where the woman is over a certain age (37 ick!).  --OK. That's me...


2. Egg quality and quantity.  Where the woman's FSH (Follicle Stimulating Hormone: 1- Hormone produced by the pituitary gland responsible for stimulating the growth of the follicle that surrounds the egg. FSH on CD3 of menstrual cycle is important in evaluating ovarian reserve.) hormone is high.  --Not sure about that, I think mine was.


3. The Z factor.  Where the Zona Pellucida (the outer covering of the egg...the shell) is thick.  --I have no idea...


4. Previous failed IVF attemps. --This is IVF #3

So, when I checked my paperwork, they don't have me down for assisted hatching.  WELL WHY THE FUCK NOT!!!  The poor doctor is soooooooo gonna get an ear full from me tomorrow.

Last obsess, what if they don't like the size of my size 1 follicle?  I have never been a size 1 anything...maybe shoe...Now, I'm complaining because I have something that is a size 1 and it too freaking big.  How wrong is that!!!!!  This is not going to be a very good night...

In other related news...you notice we are on Cycle Day 23 and Cycle Day 1 again...I'm tired, crampy, headachy...but no CD1.  Maybe tomorrow.

I was just re-reading this post and can you please add PMS to my "In other related news" list?  Sheesh...maybe it's a good thing I'm not on Lupron.  I might start killing fools.  The doctor was probably afraid for his life!