Everyone's monitoring is continuing along smoothly!
Potato #2 and I went yesterday morning to get our second round of labwork completed. The young lady that did the bloodwork was very pleasant, and excited for us!
Suzie's follicles continue to grow, and folks at the Clinic tell me that they expect her eggs to be mature either this weekend or early next week, at which time they will inject her with Human chorionic gonadotropin (hCG) to cause the eggs to complete their maturation. Once hCG is administered, we are given our 48 hour notice to get to the Clinic to produce our sperm samples for fertilization, embryo culture, pre-implantation genetic diagnosis (PGD; only if necessary), transfer to the surrogate (Jane), bloodwork and follow-up.
Suzie's eggs will be divided in half, with half going to the Clinic (because we are doing a "shared donor"), and half being set aside for us. The half that go to the clinic are cryopreserved via oocyte (egg) freezing. Our half is further divided in half, with one half to be fertilized by Potato #1's sperm and the other half to be fertilized by Potato #2's sperm.
The sperm from both of us are added to the eggs on the day of the retrieval (typically within an hour or so). Oddly enough, the embryologists like to give the sperm an opportunity to fertilize the egg "naturally". If a problem with fertilization occurs, the embryologists then turn to intracytoplasmic sperm injection (ICSI), where a single sperm is chosen ("the chosen ones") and injected directly into each egg (of course, this would be done to each of our batches of eggs).
Once the eggs are fertilized, they are cultured for 2-4 days before the resulting embryos are considered ideal for transfer. During this period, the embryologists monitor the embryo development through several crucial cell division stages. One critical cell division stage may require the embryologist to "hatch" the cells in order to assist in implantation. Embryos may be graded based on their appearance or on PGD.
Pre-Implantation Genetic Diagnosis (PGD)
It has been determined that in our IVF case, PGD does NOT apply, so there isn't any need to perform PGD on our embryos, but because of the significant debate PGD presents, I thought worth writing about it to "make you think"... of course, if you would rather not think :) you can just skip ahead to the Transfer section!
PGD utilizes an embryo biopsy (where the embryologist separate one of the cells from each embryo) to evaluate the genetic composition of the growing embryo in order to determine the true genetics of each embryo prior to their transfer and subsequent pregnancy. The thought is that by using the results of the biopsy, the embryologist can identify the embryos that are "truly perfect" from others which may look good but may have chromosomal disorders which could lead to miscarriage or birth defects. Some argue that the mere process of biopsying an embryo may subject it to so much strain that it may impact its long term viability, or cause other issues. Others argue about the actual tests performed against the biopsy: (1) chromosomal testing (aka aneuploidy screening) and/or (2) genetic testing.
The chromosomal testing ensures that the embryo does not contain an abnormal number of chromosomes, which may lead to a failure of embryo growth, miscarriage, or birth abnormalities such as Down Syndrome. Women who may benefit from chromosomal testing include older women, women in whom embryo quality is a concern, and women who have experienced multiple miscarriages or prior births with genetic disorders.
The genetic testing is usually done for a specific disease by detecting a specific gene defect that can be inherited from one or both parents. These defects include ones that may lead to conditions such as cystic fibrosis, sickle-cell anemia, hemophilia, Duchenne muscular dystrophy, and Tay-Sach's disease. There are many other genetic disorders for which PGD can be used following proper genetic counseling with the intended parents and/or donors.
Needless to say, PGD raises many potentially ethical questions, and I think both of us are relieved that we don't have to deal with them. Coincidentally, I read in the NYTimes today that Yury Verlinsky, considered "the" expert in the field of Embryonics Screening, and credited with developing the techniques to detect genetic disorders in embryos through PGD just died recently in Chicago. I'm sure that his work has helped many families, and that his loss will be felt far and wide within the IVF community.
Embryos are generally transferred on either the third or fifth day after harvesting, in order to allow the embryologists to observe the way they develop and grade their quality. Based on experience, the embryologists select the embryos with the highest chances of pregnancy based on embryo quality. The number of embryos being transferred to Jane is anticipated to be two - one from each of our batches of fertilized eggs; the remaining embryos will be cryopreserved (frozen). Assuming all goes well, we wind up with twins that are genetically related to each through the egg donor, and genetically related to each of us through our sperm.
Bloodwork and Follow-Up
An initial blood pregnancy test is performed on Jane two weeks following the embryo transfer date, the Clinic will follow Jane closely for the next 8 weeks, with some visits and bloodwork. Within five weeks of the embryo transfer, they should know how many embryos remain viable.
Gosh, this is starting to get so damn technical - lets bring on some babies!!
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