Buliej - please don't worry about bombarding us with questions, that's what we are here for. You're right, in an ideal world everyone would share their expertise with other clinics to provide the best care available.
I am going to start writing letters to 'goddness knows who' regarding the fact that PGD is not covered at all on medicare. Considering the cost that a special needs child could put on the health system, you would think that the government would encourage PGD to be done in our circumstances, ultimately it would work out cheaper for them? In our case Brendan would have been institutionalised from day 1 so the cost of caring for him would have been thousands. But then when did the government ever do anything that made sense to the average person.
WTH, I am ing for you that the cramp is because you are pregnant! As the embie was well developed when put in and it might well implanted the next day or so, and I hope this is the symptoms that it is snuggling deeper and finding roots! I can totally understand having an action plan in place, I am exactly the same...
Sara, hope the higher dose will do the trick and fingers crossed this Friday.
AFM, still early days, they said estogen starts picking up ...need another b/t and u/s Saturday, which will be day 6 on FSH. I don't like to have internal early days of the cycle, yeeks! It was funny that clinic first called to ask me to do them on Monday and then changed to Saturday, I guess being 1st cycle with my new FS, he is precaucious of monitoring me closely. Good to know though but hate the early mornings...
Buliej, sorry I won't be able to help more as PGD is a very new concept to me too...I hope you find some answers in here and make an educated decision.
Last edited by Cuddlepie; November 26th, 2008 at 02:36 PM.
Buliej - Ask as many questions as you can... you need to be comfortable with the next plan of attack. And everything you ask is pretty much what I was asking prior to going for PGD. KMN and WTH have answered things every well but I will share what I have learned also.
I have always been wih Monash IVF in Melb and decided to stick with them for PGD, although did consider the prospect of going to Sydney for day 5 biopsy.
The crux of day3 vs day 5 chromosome screening is not so much about damage to embryos or but about the accuracy of the results. On day3, the embryo is only 6-8 cells and only 1 cell is taken for testing.
In some embryos, not all cells are the same (is called mosaicism). For example, a "normal" embryo may have 1-2 "abnormal" cells which would eventually be "weeded" out as it grew. Similarly, an "abnormal" embryo may have a couple of "normal" cells. By testing only 1 cell, there is chance of getting false negative or positive result. ie. a "normal" emby may test abnormal and be discarded or an "abnormal" embryo may test normal and potentially be transferred back. Monash IVF quote a 10% false result rate. The obvious benefit of day5 biopsy is that they can remove 5-6 cells and hence increase the accuracy of results (I think SIVF quote 2% inaccuracy). The downside as ohers have mentioned, is that you do need a reasonable number of embies to get some to day5 for testing. There is certainly a reasonable chance of not eve getting an embryo to test, let alone get a "normal" result. There are also more technical limitations to all this testing. When i spoke with the MonashIVF genetic councellor, I did ask why they are not doing day5 biopsy. She couldn't give me definitive aswer but did explain that its actually quite difficult to read results. The cells from a blast come out as a sheet and there may be some overlap of cells. When they are looking at the "tagged" chromosomes to count them, it can be ricky to work out which ones are i which cells. eg they may count 4 x copies of chromosome 15 and not be able to tell if there are 2 copies in 2 cells (normal) or 3 x copies in one cell and only 1 in the other.
I assume SIVF have basically worked out how to do this all fairly well but I know I have been warned of the chance of "inconclusive" results so I am sure this would also be the case in any lab. Sometimes in can be purely technical stuff that makes a test invalid.
I must admit, I do like the idea of increased accuracy of day % biopsy but I trust that Monash is good at the protocol they use and will take my 10% chance of a false result for perhaps the increased chance of actually haveing an embryo to transfer.
I also don't think there is any realissue about SIVF being "better" at growing embies to blast. Monash IVF does it A LOT for standard IVF. I think its purely about the actual testing technicalities
My embryos will (hopefully) be tested on day 3 and I then have the option of putting them back the next day (day4) or letting them grow on to blast, hence getting that "extra" screening for the "strongest" embryo. Our decision will be based on how many embies we get. I not many normals then we will not risk growing them on and put straight back.
Hope this helps and ask away if there is more we can help you with
WTH - symptoms sound good so far darl. Great that you have a "plan" bt hoping you don't need it
CP - good that you are being monitored closely. Personally, i like to know whats going on as often as possible
Sara - so sorry things are not going so well as yet. Just not the extra stress that anyone needs with all this. Its really hard having your first cycle as an "experiment". I am at least fortunate to have done many stimulated OI/IUI cycles so they had some idea of how my body responds to the drugs. Mind you, every cycle is totally different even when the drugs are the same (very frustrating the human body is!) Hoping the upped dose does the trick and Friday brings better news
AFM - Next scan and BT tomorrow so hoping we may know an EPU date afer this. Just praying all is doing what it should in there!
Last edited by MeredithD; November 26th, 2008 at 08:29 PM.
Thank you everyone. There's certainly a lot to think about...and I haven't even spoken to my FS yet - that's next week. A part of me is wondering if I should do another cycle without PGD. My reasoning is that this has only happened once (with my first BFP - but still once) and perhaps this won't be an ongoing issue (fingers-crossed) - on the flip side, I feel like I'd do almost anything to avoid another miscarriage. I have figure out where these feelings along with all this other information leaves me...Oh how I wish this was as easy as getting rid of my gray hairs!
Meredith - I hope your scan goes well.
CuddlePie - same for you - I hope it goes well
LisaK - I agree - no one seems to look at the big picture when costing out various approaches (of course, some others...not on bellybelly...would argue that none of this should be paid for - now that would be horrible)
Sara - I was also allowed to do back-to-back cycles - I had to push for it - but they let me
WTH - I hope your blast is fully on board and growing inside of you - when is your BT - do they have you want the same amount of time as they do for a 2 day transfer?
Buliej - Just remembered you had also asked re DNA test for you and DH. From my understanding, most trisomies are due to random egg issues ( increasing with age). Only a very small minority would be from parents DNA issues but yes, I would say defnitely worth testing for.
DH and I had the full testing after our 2nd m/c ( which was actually a normal girl) and no problems found. Is just a blood test but does take several weeks to get results.
Quick update from me.
Scan today shows my ovaries have gone crazy in the past 3 days. I now have total of 50 follies!!
Just over 20 were b/n 12-18mm with only a few in the "mature" range. E2 -10,786 ( no wonder I am feeling so blah!)
Had my thoughts set on a Mon EPU bt with such stimulation they won't let me go any longer so trigger tonight and EPU now set for sat at 12.30pm.
I am a bit worried that most of those eggs just won't be mature enough to be of any use but my nurse still thinks I could get close to 10 "useful" eggies - which i would be happy with. Guess its better than getting 25 but ending up in hosp with OHSS or having the cycle cancelled - this was probably a close call today so thankful they caught before I got to whatever their "cut off" point is.
A touch scared about the pain I might be in after EPU. They will be jabbing my ovaries for nearly ALL those follies, even if most of them only yield immaure eggs.Even the sonographer warned me I was likely to be pretty sore... eek! Ah well, will just be happy if we get a reasonable number of "good" eggs and subsequent embies.
Meredith, if it's any comfort... the cycle I didn't get OHSS on my levels were around 10000 at EPU. The cycles where I did, we were up over 15000. However, I did have it develop in a mild way after the embryo took. It was about the only thing that made me believe I was pregnant - sudden pain in my ovaries and bloating when I'd been fine for about a week... all worth it in the end, though! Good luck with EPU, and I'll be hoping and praying that you manage to avoid the dreaded OHSS.
Meredith, drink loads and loads of water, my 1st cycle E2 was just over 10,000 and FS gave me strict instructions of 2L of water a day and by TF day my level was back to normal and be able to do TF in the same cycle. Best of luck for Saturday and will be thinking of you! Hope you will get some surprise and get more eggs than you think...
Meredith: Really well done! Keeping fingers crossed for you for EPU on Saturday and to avoid OHSS. Take care, have some rest. There is another discussion about OHSS, they are talking about eating lots of protein....
Cuddlepie: Thanks for thinking of me, it helped!! Good luck with BT and Ultrasound tomorrow.
WTH: how are you going? Not long now till Monday, hope you're hanging in there.
AFM: It was as expected but in a lot of ways better than expected. Ultrasound now showed two Follicles at 6mm and 8mm, so at least there is one more and they have grown, this may mean that E number have gone up as well. Expect that the cycle will be cancelled but happy that the bigger dosage seems to have some effect. Really hoping that I can talk to my FS today and she tells me what the way forward is, hoping to start a new cycle as soon as possible.
Just wondering about something - can any of you help? The pill on which I was has the effect that you don't ovulate and that the lining gets thinner (mine has actually gone down from 3mm on Wednesday to 2mm today which was probably the effect from really rough ultrasound on Wednesday which had caused spotting) - my base line ultrasound in September which was done after I had been off the pill for 5 weeks showed 5 to 8 follicles, so I am thinking maybe the bad result is actually caused by aftereffects of the pill?
Meredith - wishing you all the best for your EPU. Your follies will continue to grow after trigger so you just may get a pretty decent amount. You might have mentioned this before, but are they putting you under? If they give you a choice it might be worth it if they are draining such a large number of follies. Looking forward to hearing how you go - I have a really good feeling about this for you
Buliej - I had a Day 6 transfer (the PGD results delayed things). It was almost fully hatched. BT on Monday. I think AF might be due Sunday.
Sara - thinking of you today
Cuddlepie - Goodluck with your first US tomorrow. I am really liking the sound of your FS - extra attentive is all the better
AFM - continuing to over-anaylise EVERYTHING. I am mostly very tired. Have had mild AF-like cramps since Wednesday. Would have been too late for implantation cramps, but is too early for AF (I hope!) so am hoping it means something else...
Sara - we posted at the same time. Sorry to learn you had a rough ultrasound operator that made you spot! I know they needed to look around a little, but that does not sound right to me at all! That is great news about the improvement in follicles. If it is any help I have had "several follicles" seen in just regular non-stimulated cycles and I ended up with 8 mature follicles (plus a couple of bonus smaller ones) in this IVF cycle so you could very well expect a simlar outcome. Maybe you need a more "aggressive" protocol, ie: more puregon. It may also suit you better not to take the pill or down reg (which really put the brakes on me in my first attempt). It will be interesting to hear what advice your FS gives from here. I will be all ears. But I am sorry about the cancellation. I know how excited you were about this cycle
Sara - I had a very different cycle so I don't know much about the drugs you are taking. However, for my first pickup they found 1 or 2 more follicles than they saw on the ultra sound - so there may be more there
WTH - fingers crossed that AF stays away and you get a bfp from your BT - I'll be checking in on Monday!
Meredith - good luck with the pick-up and take care of yourself
Cuddlepie - good luck with your scan - hope it goes well
I finally had a chance to look into DHEA a bit more. What I learned (I think) is that the drug itself is not legal in Australia - although I'm really not sure why - as it's legal in Europe and the US. Also, I found this article about a very, very small "study" - but it's fairly recent - neogenesis.gr - Content - and it offers a bit more info on form of DHEA (I gather from my reading that there are a few types and some are either more pure or more medically appropriate) as well as the amount to be taken.
Thank you WTH and Buliej for yoru advice and concern that really made me feel better.
Had a call from my FS now. She is happy to do a Flare cycle with me but says I can't start straight away again as my levels are just too low E2 was at 51 today.
She says I have two options either go on the pill for three weeks and then start again with a cycle where I start both the Lucrein and the FSH at the same time or to wait until I have my next period (she thinks that will take between 4 to 6 weeks and then start a flare cycle. Without the pill she says there is a chance that I will have too high levels of progesterone (spelling?) and she won't be able to put the embryos but freexe them ( She says if she freezes them there is a 85% chance for them to defrost fine). The natural cycle seems to have the advantage that they can check my FSH level at the start of the period and if it's less than 10 it means it might be a good month with and okay number of follicels for me to start. Anyone has any advice on this?
Sara, I am so very sorry that cycle has been cancelled. I wrote in the other thread as well, I hope you work out the best way for you...
WTH, hope you are keeping sane in the madness of TWW...when is the b/t?
Meredith, how are you feeling today with no drugs or injections? Best of luck for tomorrow, I will be thinking of you and hope you get good quality eggs, and a lot.
Buliej, thanks for the good wishes, I hope you are getting your head around all the fact, its quite overwhelming isn't? Sometimes I do surprise myself how much I absorb when I need to, I am hopeless with all the medical terms, but sometimes you just have to...
AFM, feeling tired, sore back, heavy around the ovaries, a bit nauseous too. Drove to Wollongong today and back, 1 and half hour each way, maybe that's why. Wore the wrong skirt too, I got a shock looking into the mirror, sideway, I look like I am 4 months pregnant, my tummy must be bloated because of the injections. I hope I am not OHSS....tomorrow's scan will reveal. Ah, joy of IVF journey...
Hope everyone is having a good night and fab weekend.
Last edited by Cuddlepie; November 28th, 2008 at 05:35 PM.
Sara - so sorry about the cycle cancellation. I would be devastated so I think you are coping very well!
Not exactly sure about all the in's and outs of the various protocols. Correct me if I am wrong but I thought a Flare cycle is just another name for the antagonist cycle which I am doing and that WTH has just done. Just on FSH and use a few days of orgalutron (antagonist) to prevent premature ovulation. Obviously our follie numbers were pretty good on this protocol so personally, I am all for it! I've never been told or ever heard anything about Prog levels being to high for transfer so not sure what your FS means by this? It does seem that some people are overly "down regulated" by the Pill/Lucrin so I guess maybe it would be worth trying something different next time.
WTH - How are you hanging in there? These last few days are a killer! All sounds very positive to me - I always get cramping when I'm pg and can usually tell that its a bit different to AF cramps. Are you going to test at home early?
Monash IVF does GA for all EPU which I am quite happy about!
CP - Hope you are growing some good follies in there. Tomorrow will be an exciting day for us both!
AFM - Not feeling to bad atm. Nagging headache which I presume is due to the high E2. Aching ovaries but not as bad as it felt few days ago so guess they have done most of their stretching!
very anxious about tomorrow but excited about being underway. Its going to be a long week!!!
Last edited by MeredithD; November 28th, 2008 at 08:09 PM.
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ing for you that the cramp is because you are pregnant! As the embie was well developed when put in and it might well implanted the next day or so, and I hope this is the symptoms that it is snuggling deeper and finding roots! I can totally understand having an action plan in place, I am exactly the same...
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