Category Archives: Life After IVF

Mosaic Embryos for the Win!

14 Wednesday Jul 2021

Posted by in Infertility Education, Life After IVF

≈ Leave a comment

Tags

, , ,

Photo by Anna Shvets on Pexels.com

Admittingly, it’s been a while since I’ve written here. My life has been filled with family, work, chaos, peace, and all the things life brings. I am grateful. I also want to occasionally run away screaming. But that’s normal, right? With two littles, and a husband starting up a new business, there’s never a dull moment. And I’m good with that (although I could use a few more ritual baths and date nights).

What caught my attention today is a new article from Embryoman. Side note: if you aren’t following him, you should be. He is a former embryologist who writes about the latest and greatest in infertility treatment technology from a scientific perspective. He has a knack for breaking down research papers, data, and outcomes with flair for everyone to understand. I appreciate his writing style and objective perspective. You can sign up for his free newsletter here, if you are so inclined, which is packed with accessible summaries of the most current infertility research. It really appeals to my research heart.

Back to the article in question. The headline read: No difference in euploid and mosaic embryo transfers! What’s that you say?! A recent study, that is pending publication, compares outcomes from transfers with euploid embryos (those are the “PSG normal” embryos you’ve heard so much about at the RE’s office and online support groups) versus mosaic embryos. Mosaic embryos are embryos where some of the biopsied cells come back “normal” and others are “abnormal” (meaning they have missing or duplicate chromosomes or parts of those). So there’s a mix of cells in the biopsy taken from the embryo, which leads doc’s to assume that the whole embryo is a mixed bag. Some mosaic embryos have a higher percentage of mosaicism, meaning that there are more abnormal cells present in the mix, and others have a lower percentage of mosaicism.

There’s been a lot of controversy surrounding mosaic embryos and PGS testing in and of itself. I must confess that I no longer have my finger on the current pulse of what common transfer practices are when it comes to PGS tested embryos. My most recent IVF baby is 2.5 years old (*gasp*) and I know how fast things change in the IVF world. When I was doing IVF, PGS testing was the norm, and, sadly, so was discarding PSG abnormal and mosaic embryos. I dove into every PSG-related article and study that I could find. I slowly came to the conclusion that PGS testing wasn’t right for me. I appreciated what PGS was trying to do, but I didn’t think that the science behind it adequately supported the treatment decisions that were being made. There was just too much they didn’t know. To ready more about my experience, the data I reviewed, and how I came to the decision that was right for me, check out this post. You can also read about how I ended up transferring an untested embryo and an abnormal embryo (*gasp again*) here and here, and the unexpected outcome of that transfer here.

Now back to that article. Embryoman explained that most of the studies that had been done previously looked at mosaic transfers after failed PGS normal transfers. The RE’s knew the PSG results of the embryos they were transferring, and when the mosaic’s failed, it was attributed to this flaw in chromosomes. But they were comparing PGS normal transfers (let’s call this group 1)  versus mosaic transfers after already having a failed PGS normal transfer (group 2). I’ve always said that the devil is in the interpretation when it comes to study results. It’s simply incorrect to attribute the failed mosaic transfer in group 2 to mosaicism with this study design. An alternative explanation is that there is a 3rd factor causing both the normal and mosaic transfers to fail in group 2 (remember the women had failed transfers with normal embryos before participating in those studies). So there may be something else going on that causes these women in group 2 to not have a successful pregnancy regardless of the PGS results of the embryo transferred.

In this new study, the RE’s transferred PGS normal and mosaic embryos without knowing which were which. This is called a blind study and reduces bias. It also means that they weren’t just transferring mosaic embryos to women who already failed with PGS normal embryos. The playing field was leveled. And the results are a big deal.

They found that there was no difference between the PGS normal group versus mosaic group in miscarriage or pregnancy rates, live birth rates, or prenatal outcomes. And if your jaw hasn’t dropped yet, they also found no difference between the groups when they further compared embryos with low (20-30%) or moderate (30-50%) mosaicism with the PGS normals. And of the babies born from mosaic embryos, none had any mosaic related abnormalities. Yes, that is a big, big deal.

Why is it such a big deal? Because for quite some time, and maybe still in some clinics, mosaic embryos were not transferred for fear of having a miscarriage or baby born with a disability. It’s a big deal because I know there are women out there who were told they would not be allowed to transfer mosaic embryos. There are women out there who, due to earlier testing methods, were only told that their embryo was either normal or abnormal, with mosaic embryos considered abnormal and cast aside. There are women who reached the end of their finances, emotional rope, or whatever the line may have been, who did not get to transfer embryos that could have brought them that baby they wanted so very badly with all their hearts. And for those women, I hold space. My heart breaks for them.   

For the women still in the trenches, I hope that this post gives you food for thought. Knowledge is power, and when it comes to infertility treatment we really do need to be our own best advocate. As I mentioned, I no longer know what is the most common practice in fertility clinics when it comes to PGS testing and transfers; and I know that in many medical fields, clinical practice tends to lag quite a bit behind scientific findings. But knowing that this research is currently being done gives me hope. Hope that clinics are keeping up to date on cutting edge research. Hope that they adjust their practices to be in line with new findings and recommendations. Hope that more women will have more chances with more embryos. Hope that you find you happy ending, whatever that may look like you for.

Life After IVF: 1 year after birth

13 Monday Jan 2020

Posted by in Life After IVF

≈ 3 Comments

Tags

, , ,

My second, and last, IVF baby turns one year old this week. And I’m feeling all the feels. It’s been a whirlwind of diaper changes, marathon nursing sessions, little sleep, cries, smiles, and firsts. I stare at my baby and my heart overflows with love. And as most say, I can’t believe it’s already been a year. Where has the time gone?

For once, my time has not gone to injections, doctor appointments, acupuncture sessions, or healing from surgeries and egg retrievals. Not once have I researched fertility supplements, ERA test implications,  methods for managing inflammation, or the merits and risks of PGS testing. I have not ordered, mixed, or recycled any medications or related paraphernalia. I have not lost sleep, nor daytime hours, to the all-consuming anxiety of pinning over the welfare of my embryos. I have not missed or rescheduled work meetings, or pretended that I knew what someone was saying when my mind was so very far away. I have not touched a pregnancy test.

My stomach and rear are free from bruises. My mornings do not involve intimate moments with an ultrasound wand and paper sheet. When I cry,  it’s from feeling overwhelmed in the moment – not from feeling like my heart has been ripped out of my chest once again. I think there are even whole days that go by where I don’t think about IVF even once.

How strange this is, given how much IVF used to consume my entire being?

So while I navigate being a mom of two littles, I’m also forging a new me. I know how lucky I am to be on the other side of IVF with two healthy daughters. So many don’t get here and my heart aches for them. Still, there is no denying how much my experience with infertility has changed me. I know I’m not the same person who decided to start trying for a baby nine years ago. And sure, who really is the same that they were almost a decade ago, infertility or not? But infertility took a spontaneous, fun-loving, spirited, energetic, somewhat naïve, newly minted Ph.D. graduate and changed the course of her path 180 degrees.

Now, I am more calculating, cautious, introverted, and serious. I have fewer friends. I miss parts of me that I’ve lost along the way, the parts that used to laugh more. I’m also braver, stronger, and a better advocate for myself. I know more about reproduction and the conditions that impact fertility than I ever thought I would. Likely more than my OB/GYN. I know I can handle more than I ever thought I could. I can ask for help, and I can help myself.

While the trauma of infertility is dulled now, having left most of it in the past, a touch of it lingers on. It will always be a part of who I am now. And that’s not necessarily a bad thing. Again, I know I’m one of the lucky ones that found the golden egg. Twice. And that also colors my perspective. So for me, I will always identify as “infertile with kids,” which I know will sound strange to many. But to those of us who have walked this path, we understand.

Happy birthday little one, from your Mom who loves you with her whole heart.

 

Age and Fertility

08 Thursday Aug 2019

Posted by in Life After IVF, Uncategorized

≈ Leave a comment

Tags

, , , ,

clear glass with red sand grainer

I was wasting some time awaiting a work meeting by perusing Facebook. I came across a post that I’ve seen in some variant countless times before. A woman asking about her fertility prospects based on age. Usually these post are in various infertility-related groups, but this one was in a mom group. The poster was asking what her chances were to get pregnant again naturally. She conceived her first without troubles, but is now 35 and feels like her biological clock is ticking. This question prompted a cascade of responses along the lines of “I got pregnant with no problems at age [something over 35].”

Well isn’t that nice. All the fertile myrtles giving “don’t worry about it” advice.

Now I could have kept scrolling,  but I just couldn’t resist. Because this irks me.

Obviously you’re going to get some pretty wildly different answers depending on the audience – you ask a mom group about getting pregnant and the answers will be rather different that what you find in an infertility group. But sampling bias aside, I’m bothered by the facts, or lack thereof, being doled out.

Because the thing is: age affects egg quality.

Regardless of how many celebrities over 40 are having babies. Regardless of how old your grandma was when she conceived your mom. Regardless of how healthy we are, how many miles we run, how clean we eat…fertility still declines with age.

Now that’s not to say that our lifestyles don’t matter. Our choices obviously impact our health and can work for or against us. But even the healthiest among us have aging ovaries, and this affects the quality of our eggs. On average, infertility begins a slow but significant decent around age 35 and take a steep hit around 40. Here’s another resource to help you be informed.

Yes, fertility declines with age. And we can’t escape it.

We do need to be educated about it. We need to be able to make informed decision about our fertility. We need to talk about the facts.

My niece is considering going to medical school. She’s in high school now and certainly things may change. But I was talking to my sister about it and brought up the fact that there’s a new trend in med school now where women are taking some fertility preservation means, like egg freezing. They’re doing this because med school, residency, and early careers tend to consume your most fertile years. My sister looked at me like I was talking crazy. She never considered the future of her daughter’s fertility, and has certainly never talked to her about it.

I’m no stranger to this concept, having spent my more fertile years as a doctoral student. While some of my infertility issues were not age related, age did become a major contributing factor and was the prime reason I endured so many rounds of IVF the second time around. I wish I would have known this way back when. Maybe I would have gone to the reproductive endocrinologist sooner rather than later. But hindsight, you know.

So there I was, staring at the computer screen, scrolling through all the “don’t worry about it” responses to that woman’s post. And I had to do it. I had to share the data. Not to scare or worry, but to inform. And so, among a long string of Polly Anna responses,  was my truthful response. Maybe someone noticed.

Life After IVF

26 Wednesday Jun 2019

Posted by in Life After IVF

≈ 2 Comments

Tags

, , , ,

art blur bright burn

Am I stuck in low-grade reaction mode?

I was reading a post recently by herbalist extraordinaire Maria Toll titled, “Reaction Mode, Yikes! Sit, Sip, Breathe.” She explains that in our fast paced modern life, where we operate under a multitude of pressures, it’s easy for our bodies to get stuck in a low-grade reaction mode. This reaction mode stems from the hard-wired fight-or-flight response (or more accurately called the fight-flight-or freeze response) controlled by our sympathetic nervous system. Basically, this response is how our bodies are built to react to significant stressors.  Like a lion attack. This nervous system response allows our bodies to shut down “unnecessary” functions and respond to the immediate threat in front of us. It’s what helped our ancestors survive.

It’s what helps us survive modern day traumas too, like rape, war, car crashes, fires. Like IVF. Because IVF and pregnancy loss are traumatic. This flight-fright-or freeze response helps us get through the pain as best as we can in the heat of it all. But what happens when the traumatic event isn’t an isolated incident? What happens when we deal with this stress day in and day out, for years?  That kind of prolonged stress response has a big impact on our bodies and emotions.

Now I’m on the other side of infertility. I have two daughters that are IVF miracles. I’m done. No more baby making for me. No. More. IVF. EVER. I’m lucky I made it to the other side. I exhale and think that everything is fine. Finally.

But as I was reading Ms. Toll’s post, I began to think…what if I am still stuck in low-grade reaction mode? As a psychologist, I know that that kind of prolonged stress does not simply vanish when you remove the person from the stressor. On the most severe end of the spectrum, people can develop Post-Traumatic Stress Disorder (PTSD) from their battle with infertility. Others may become depressed, anxious, or have other reactions. It changes us. We all walk away from IVF with a unique reaction, shaped in part by our own stories, outcomes, support system, and experiences. But without a doubt, all of us have been living under the pressure of isolating, heart-wrenching prolonged stress.

I still catch myself holding my breath. Tense and waiting for what will come. I’m still trying to find my way back to myself. I find my moments of calm – when I’m nursing my perfect baby and it’s just the two of us, when I light a candle and sip tea, when I walk barefoot in the grass, when I listen to the birds as I stroll my baby. These moments give my body a break from the tension that seems to hide in the background. In those moments I breathe deeply and exhale.