Thursday, 9 January 2014

A long winter's nap

Is what I need to get through this wait. Follow-up appointment isn't until

Am I making it worse, counting down the days? For a little more than a week it's all I could think about. I was sad and teary for a couple of days, then back to reading studies trying to understand how seven great embryos all arrested at about the same point. And I won't get a clear answer, it could be any of three factors.

First, is the culture medium. It seems that after day 3, the embryo needs a different culture medium in the lab. This change can be difficult for some embryos and they don't adjust well. The nutritional needs of the cleavage stage and the blastocyst stage are very different this is one reason why embryos arrest at day 4 in the lab.

Second and third, are egg quality and sperm quality, respectively. Each are contributing equally to the growth of the embryo and poor quality of either can be the cause of embryos not making the leap from morula to blastocyst. I know my egg quality is potentially suspect due to my age. I'm 38 and I can expect rapid decline in the number of suitable quality eggs I have left, regardless of how many were retrieved and fertilized. The rapidly increasing rate of miscarriage in older women is directly linked to the quality of eggs, and especially chromosomal problems like trisomies. But there is also reason to suspect the embryo arrest could be due to egg quality. An important aspect of the leap from morula to blastocyst is the quality of the mitochondria (the nuclear power plant of the cell if you will) as well as the cytoplasm (the fluid in the cell, which is very important because among its functions it has all the enzymes, sugars, amino acids, and fatty acids that the cell needs to function properly). So very very important. This might be the level at which supplements like DHEA and CoenzymeQ10 might be effective in supporting healthy eggs in older women, so long as they are taken from the onset of the maturation of a given egg (roughly 70 days from primordial oocyte sitting around since you were in your mother's womb to ovulation-ready).

So that's the egg end, and at this point it won't hurt to start taking supplements now, while I wait to see if my Reproductive Endocrinologist thinks, based on all her expertise and my various test results, if egg quality was a factor. But then there is also the sperm. Our sperm was also compromised on two levels. First, it was frozen because my other half was undergoing surgery to remove a brain tumour which could have left him permanently infertile. Frozen sperm doesn't leave a lot of good quality sperm after the thaw, resulting in the need for ICSI, which also means it's not the top sperm winning the race in quite the same way. But on top of that, due to the extended period of time he had the tumour and the stress it was causing on his system, maybe his sperm were not as high quality as they could be. His age would only matter if he was five years older than me, which he isn't, my age matters more. So when we have our appointment I will be asking about retesting his sperm as he will be sufficiently post surgery by the time we do our next cycle, and hopefully we can use fresh instead.

So I feel very optimistic about a second cycle if we transfer multiple embryos on day 3, use fresh sperm, and I take supplements for egg quality for the next 12 weeks. But am I making it worse fixating on the countdown? Am I ruminating? I'm making a pledge. The appointment is in 31 days from today. I pledge to make the next 31 days a period of maximum productivity at work. I arrive early, I stay late, I go to the gym when I need a boost, and I challenge myself to get as much done as I possibly can in the next 31 days. Then when I have my appointment, I can fixate on the calendar again and become obsessed with the whole IVF process again, and feel good about it knowing I had a very productive January!

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