Do I have it in me to write it again? Let's see.
On Monday, when we got the fantastic Day 3 report, Barb emailed me: "We’ll still take about #’s but right NOW DR H is thinking transfer of 2 …..unless there is an issue we are not anticipating –then he MAY consider a transfer of 3 embryos . Have to see what transpires."
M and I talked about it very briefly and agreed that, assuming there were at least two blastocysts on Day 5, we would not transfer more than 2. Dr. Hickman had earlier told M and N that he had never recommended three embryos be transferred to a surrogate. Well, turns out there's a first time for everything.
On our way to Houston yesterday morning, I got a text from M. "Barb says Hickman wants to transfer 3 because we have 1 stage 2 blast and 4 morulas. The morulas are sort of where we were last time, so he thinks three would be best. He says as long as everyone is ok that is what he wants to do. Just wanted to let you know beforehand so you could think of questions or whatnot. Talk to you soon."
Holy moly. Big decision. I went into this match preferring a single embryo transfer (SET), had agreed to transfer two, and now was being asked to do three? Yikes. I do know Dr. Hickman is very conservative and doesn't stray outside the guidelines-- but now he was. I texted Gayle who said she'd never known him to recommend three, and that with just one blast, she would do it. She said if Dr. Hickman recommended it, there was a reason.
Rick and I talked through a bunch of different scenarios. This was not a decision I considered lightly. I counsel clients against allowing for a 3-embryo transfer all the time-- I suggest limiting it to two in every contract. And I believe in that too. 3 is a risk. 3 can become triplets. Triplets = difficult pregnancies, premature babies, and possibly selective reduction.
Ultimately, I decided that with M and N's explicit agreement that they would support a difficult triplet pregnancy, should it occur, and that they would parent potentially premature triplets, should that occur, I would agree to transfer three. The stage 2 blast (reminder: developmental scale is 1-6, 3+ ideal to transfer, 6 is fully hatched) and 2 morulas. To be honest, I was still uneasy about the decision, and felt like a pretty big hypocrit. But I put my faith and trust in Dr. Hickman's judgment.
When we got to the clinic, I went straight back for labwork. Just one vial of blood, but she really got me-- my arm is red and beat-up-looking today. Later on, I found out both estrogen and progesterone levels looked good. No shots for now!
Then, I was supposed to be taken to acupuncture, but somehow got whisked back to pre-op instead. And then I sat around for a long time doing nothing (alone at first, but then I asked them to go get Rick). Here I am waiting (and looking a little anxious about 3, I think!):
Eventually they realized that I was supposed to be getting acupuncture (about 20 minutes past my appointment) and the acupuncturist popped in and got me needled up. In the meantime, M had arrived and Rick went out to the lobby to meet him (N has a cold and stayed away this time). Barb met them both out there, and talked through the information about the embryos and the risks and benefits of transferring three.
After the needles were out, the nurse told me they'd be back in a minute so I could sign consents. I figured I would be looped in on the conversation Barb and the guys had, but nope. The nurse popped in with a clipboard, said "You're transferring three. Looks like they're good quality. Sign here." I flipped through the chart to see the embryo report too see what quality she was talking about. It was what I already knew-- 1 stage 2 embryo, 4 morulas. I still had some misgivings. But I took a breath and signed.
Then Rick and I moved over to the procedure room, which had my name plastered on the door (we're in the right place!). They made me say my name and how many we were transferring. Then they checked out my bladder to be sure it was full. I had 60+ ounces of water, so it darn well should have been. It was.
M showed up. The put him and Rick at my left shoulder, close to the table. There needed to be enough room to wheel in the embryos in their incubator.
The embryos and Dr. Hickman all arrived at about the same time. He started getting things prepared and reviewed that we were transferring three. M asked something about why he'd recommended three and Dr. Hickman flipped through the chart and said it was based on embryo quality and our history. As he was talking, he was having me scooch down on the table, placing the speculum, and getting the outer catheter ready for embryo transfer.
Then the nurse with the embryos piped up "I have an updated condition on the embryos! 4AA and two Stage 1 blastocysts."
Wait. What?
Three blastocysts was never the plan. What was going on?
M, Rick, and I were all shellshocked. "Wait-- is it still your recommendation that we transfer all three?" asked M. Dr. Hickman said it was. Rick asked "What's the probability of triplets?" "Miniscule," replied Dr. Hickman. Rick pressed him to give us numbers. "Standing here today, I'd say 1%. If you get pregnant, 2-5%."
Had this conversation happened any sooner in the day-- or had I been asked to sign a consent at this point-- I would have stopped the train. No. Two blastocycsts was our agreement. Two. I only agreed to three because of quality issues. Now we had one perfect embryo (you can't really ask for better than 4AA) and two slow-going blasts.
But it didn't. It happened on the table, minutes before transfer. And for better or for worse, I stayed silent and we all just went with it. I took M's hand and said "Ok, let's do this," with a somewhat shaky voice. And I laid back and let it happen. I do have regrets. I should have spoken up. And I knew M was deferring to my judgment, so the decision really was mine. What's done is done.
After more jostling around than I remember from my first two transfers, we got going on the embryo transfer. The tube was inserted in the catheter through my cervix. They loaded up the embryos and then they were pushed into my uterus, as indicated on the ultrasound by two white spots that were air bubbles loaded before and after the embryos. Two little bursts of light, representing three potential new lives.
Here are the embryos, from a report at 9:11 that morning (not sure if that's when the pictures were taken, or just when they uploaded them to the report). Most developed on the left, then the two stragglers.
After the transfer, I had to lay on the table for 15 minutes. The acupuncturist gave me the option of placing needles right then or waiting until I had the chance to get up and pee-- I took option B, because I wanted to be able to relax and my bladder was not going to be able to do that! So I ended up going back to pre-op for my treatment, and got to enjoy the Muzak song stylings back there. Just like last time, she left me with two ear needles in each ear, to be removed on Saturday.
After transfer, like last time, we went to lunch at Pappadeaux. Like last time, I ordered ginger salmon (post-transfer ritual, I guess). We had lots of laughs and shared lots of nervous what-if scenarios. I do have every confidence that if we do end up with three, M and N will rise to the occasion more than anyone else could. It will be really, really, really hard. But we will get through it. If we have to.
We all agreed that for now, we'll stop panicking. There's really no use worrying until we get beta results at the very earliest. Our 9dp5dt beta last time was 302, so if it's 700+ this time, I reserve the right to flip out again.
After hugs goodbye, Rick and I had an easy drive home-- all 5 (deep breaths, deep breaths) of us arrived safely. I spent the rest of the evening lounging and gestating. Watched "Best of Show" again, which always makes me laugh.
I believe in the importance of positive thinking. I do very much hope that each embryo grows and develops the way it's supposed to and I'm sending those good intentions to them. We can work out the details later. For now, snuggle in, little ones. Follow those mysterious, magical, genetic blueprints and see where they take you. I'm trusting all of us have a safe and happy journey.
The short of it: I'm not really happy with the decision I/we made, and given ideal circumstances, I wouldn't have gone this way. But we're here now and everything will work out as it should.
And be proud of me. Here I sit at 1dp5dt with no urge to test. LOL. I've decided to take the first one Saturday afternoon, at exactly 3dp5dt, which should still be too early for a BFP. I do think I'll see one on Sunday, though!
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