Wednesday, July 29, 2009

Mr. Sperm, please allow us to introduce you to Ms. Egg. Please skip the hanky panky, and just GET IT ON!

Wow. I don't know how else to sum up today.

We arrived at the Clinic at 11:00am, checked in, and met with our handsome Dr. (whom we will refer to as Dr. H). Dr. H is the Medical Director at the Clinic, and is "the" guy responsible for the technology behind the journey we are attempting. Personable, charming, able to talk to us at our level (without the mumbo jumbo so many doctors often spout), and committed to helping us have kids, Dr. H is really great, and we are excited to be working with him and his wonderful team!

Dr. H told us that Suzie's egg retrieval went well, and that the eggs were in the process of being prepped and reviewed, and he told us that "so far, everything looks great."

We wrapped up our individual appointments, in which we provided our sperm samples, and were later told by the folks in the Sperm Lab that they seemed "fine."

From there we did some paperwork, and Dr. H stopped by to see how we were doing and help with any additional questions we might have.

From what we understand, here is basically what happens next:
  • The embryologists are basically in control.
  • The eggs and sperm are allowed an opportunity to acclimate themselves to the environment they are now in. The eggs are quantified and qualified. Since we are conducting a "shared" cycle, we have contracted for a specific quantity of eggs, with the remainder going to the Clinic for use with other couples.
  • The eggs are stripped of surrounding cells and prepared for fertilization. In the meantime, the semen is prepared for fertilization by removing inactive cells and seminal fluid.
  • The eggs we are receiving will be separated into two batches; one for each of us potatoes' sperm to fertilize.
  • The eggs and sperm are reviewed to determine whether they will be allowed to naturally fertilize, or whether assisted fertilization is necessary. This will be determined today, as the goal is to fertilize ASAP with all of the fresh material.
  • The sperm and the egg are incubated together at a ratio that may vary from clinic to clinic, but is typically around 75,000:1 in the culture media for about 18 hours.
  • The eggs and sperm start to date. The rules are simple. No long-term dating. They need to get down to business and get some home runs going ASAP! We have asked for pictures, but understand they may be shy.
  • In most cases, the egg will be fertilized during this 18 hour period. This is not one of those long term relationships that go nowhere. The fertilized egg will show two pronuclei.
  • The fertilized egg is typically passed to a special growth medium and left for about 48 hours until the egg consists of 6-8 cells.
  • We should get a call tomorrow informing us of just how many embryos were fertilized and how they are doing.
  • Over the course of the next two days (Thursday and Friday), the embryos are checked, evaluated, and reviewed for "assisted hatching" as necessary.
  • By Saturday morning, the embryologists should know if they want to conduct the transfer of the embryos to Jane on Saturday (day 3) or on Monday (day 5).
  • I believe we will receive pictures of the embryos on transfer day. :)
  • The remaining embryos are frozen (through cryopreservation).
Jane's bloodwork will be regularly checked during the next 8 weeks to verify pregnancy and hormone levels, but most importantly to make sure she is doing okay. It is critical to point out that Jane's health is of foremost importance to us. She has a wonderful family, and beautiful kids. She is a really wonderful and amazing person, and the our appreciation for her help in making this possible for us is difficult to put into words.

That's basically today in a nutshell. Wow.

More as it develops!

Monday, July 27, 2009

Thirty Nine (39) Hours Until Fertilization!

According to "Baby Central" (the Clinic), we are now at 39 hours until fertilization, and everything is proceeding on schedule!

Suzie is scheduled for egg retrieval early Wednesday morning, and we are scheduled to provide our "samples" at 11:00am.

By 11:15am, the "samples" will be busy doing their thing.

We should know on Thursday morning how they did.

Let us all bow our heads and pray.

Saturday, July 25, 2009

Let the Egg Harvesting Begin!

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).

Embryo Culture
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!!


Saturday, July 18, 2009

Nine (9) Days Until Egg Retrieval!

NINE days and counting!

Throughout the past few weeks, the Clinic has been monitoring Susie and Jane. We've been advised that:
  • Suzie continues her Lupron treatments which are used to suppress the pituitary gland’s secretions of luteinizing hormone (LH). Normally LH is secreted in high amounts by the pituitary gland just before ovulation. In fact, it is this rapid release of LH (the “LH surge”) that triggers egg release (amazing!). Lupron suppresses the LH surge and prevents ovulation so that Suzie does not release the eggs prior to the retrieval (which would be BAD).
  • Suzie began her Gonadotropins (which stimulate the ovaries to produce multiple follicles) within the past two weeks. The Gonadotropins have been adjusted according to her hormone levels and ultrasound results, as her follicles have been produced.
  • Suzie's regular monitoring suggests that her ovaries are "plump" and that her eggs appear to be "maturing nicely." Suzie will be further monitored on Tuesday and Thursday of next week and into the weekend. This last portion of the monitoring is focused on determining when to "pull the trigger" by injecting the hormone that causes all of the eggs to be released. When the largest follicles reach a critical size (approximately 20 millimeters) the eggs within them should be mature. Human chorionic gonadotropin (hCG) is then given, which causes the egg to undergo a final stage of maturation. The retrieval then follows precisely 34-36 hours later.
  • Jane's "uterine lining is nice and thick and ready".
  • Us potatoes need to get the final FDA-required lab work (yes, from the FDA) completed on 7/24 (this is a follow up to the blood work taken over a month ago for comparison purposes). Since we are both essentially considered to be donors (according to the FDA), the FDA requires all sorts of analysis work be completed to ensure that we are healthy and don't carry any contagions that could be passed along to Jane (certainly reasonable enough).
Jane and the Potatoes are "on deck" for the week of 7/27.

The next steps include Fertilization, Embryo Development, Pre-Implantation Genetic Diagnosis (PGD), and Embryo Transfer - More on that later!!


Thursday, July 9, 2009

2 1/2 Weeks Until Egg Retrieval!

I know, I know, I know... I've been slacking... But there really ins't THAT much new to update everyone on...

At this point, we have 2 1/2 weeks left until the egg retrieval, insemination, and transfer. Suzie and Jane have been on their medications for a couple of weeks now. Suzie's drugs are stimulating fresh eggs for retrieval, while Jane's drugs are focused on making her eggs dormant and stimulating the lining of her uterus for pregnancy. Everyone is doing great, and seems to be "on track." Once Suzie's eggs are retrieved, they are inseminated, and "grown out" 3-5 days. The folks at the Clinic will determine when they are at ready for transfer to Jane. After two weeks (and several monitoring visits) we will know if the pregnancy "takes." Two to three weeks later, we should know how many heartbeats there are, and since we are hoping for twins, there should be two!!

Its amazing to think that we could be pregnant within 5 weeks - isn't technology just amazing?!?

Woo0Hoo!! :)