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Quantity verses Quality - Elizabeth Unexplained
Lots of data but no answers
greyautumnrain
greyautumnrain
Quantity verses Quality
What's the fastest you've ever gone from happy to depressed?

For me it was this morning, shortly after 11 am when the embryologists had us sign off on the embryos we would be transferring. I took one look at the grades and that's when it happened.

"I thought we had five," was the only protest I managed to make at the time. (You must understand that I had to have a full bladder for the procedure and was mostly concentrating on not spraying the room with an amount of liquid that impressed both the nurse and the sonagram tech.) Oh yes, we did have five, but it turns out that they all.... well, lets say they don't test very well.

As planned we did indeed transfer the three best one. Unfortunately the three best were an 8CF and two 4CFs. The C is the part that worries me, that's the fragmentation. You may recall my best embryo last time around was a 7BF. The other two we were told had been discarded, they were a 4DP and a 3DP, not suitable for transfer or freezing. At the debrief last time Jedi Master Grace Wendo said she would consider that first cycle to be effectively a single embryo transfer, that the 5CF didn't really count. It doesn't take much to extrapolate that probably two and maybe all three of these shouldn't really count by that measure. Warren and I didn't need to say anything to each other at the time, we were both thinking the same thing; we could do the math.

We'd been so happy when we heard we had five embryos, because we'd assumed that there would be a range in quality. I was kind of assuming that at least two of the embryos would be as good as the good one last time. I was assuming that it meant we had a better chance this time around. I am not assuming that anymore, quite the opposite. I will of course do all I can for the next two weeks to make sure that they have the best chance possible, but I can't say that I'm really hopeful.
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Comments
chenoameg From: chenoameg Date: March 2nd, 2007 01:38 am (UTC) (Link)
I'm very sorry to hear that.
merastra From: merastra Date: March 2nd, 2007 07:52 am (UTC) (Link)
Oh, that's hard news. :-(
twe From: twe Date: March 2nd, 2007 03:36 pm (UTC) (Link)

Oh no!

That's hard news. I'm very sorry to hear that. I'll keep my fingers crossed anyway.
enugent From: enugent Date: March 2nd, 2007 05:48 pm (UTC) (Link)
That is tough news. I was under the (possibly mistaken) impression that an 8 was really quite a bit better than a 7, though, so even though the fragmentation was greater, that one might have a decent chance. I'll at least hold onto that hope.

Does the change in insurance with your new job have any effect on how many transfers are covered?

And finally, are you sure that Nurse Ditzy really didn't know what the quality was when she talked to you? Whether or not she did, it seems to me that in your followup meeting with Grace Wendo you should discuss the appropriateness of getting your hopes up like that and then dashing them. (Even if this one works and you are pregnant, I would have that conversation so they can consider whether they need to change their policies for others.)
psychohist From: psychohist Date: March 2nd, 2007 07:29 pm (UTC) (Link)
I'm curious as to where you got your impression about 8 cells versus 7 cells? There's some theoretical justification - if the cells are dividing on a schedule that's approximately synchronized, 8 cells means they're all still dividing, and 7 cells may mean that one of the cells at the 4 cell stage quit - but our clinic doesn't differentiate, considering the best embryos to be "7 or 8 cells", as well as A or B on their fragmentation scale. Of course different clinics use completely different embryo grading schemes.

I don't think we can really blame nurse Ditzy, since at the time she called, they were probably all still at the 2 or 4 cell stage and dividing normally as far as anyone knew.
enugent From: enugent Date: March 2nd, 2007 07:43 pm (UTC) (Link)
I actually can't remember where I formed that impression, and as I said, it was probably mistaken. I did, however, find one very recent paper that said that "degree of fragmentation did not predict outcome nearly as well as blastomere number" (but it found that 6-8 cell embryos are all good). The women studied had low ovarian reserves, though, which I think does not apply.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17207795&query_hl=2&itool=pubmed_docsum
jaedian From: jaedian Date: March 2nd, 2007 10:24 pm (UTC) (Link)

ICSI

Did you have the intracytoplasmic sperm injection? I was looking around for info on the embryo grading system. (not much luck on that, everyone grades them differently) But I came across a paper that says that ICSI increases the fragmentation of the embryos. This paper says it didn't affect the clinical outcome though. So I was wondering if that was a factor since your mentioned last time that you might use that.

I guess I could see why the ICSI would increase fragmentation, although it is encouraging if it didn't affect the clinical outcome.

Anyway, I am still hoping for the best this time.

http://www.springerlink.com/content/u564778v68h5683r/
greyautumnrain From: greyautumnrain Date: March 3rd, 2007 06:39 pm (UTC) (Link)

Re: ICSI

We did not do ICSI, so that wasn't a factor. We felt that it wasn't necessary, and given that we had 5 embryos out of 9 eggs, I think we were right about that.

Everyplace does seem to have its own grading system. I guess we just have to hope for the best, but I'd have been a lot happier with better grades.
(Deleted comment)
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