IVF #2: Snowflakes in Spring

Two weeks ago I answered the phone with a mix of dread and anticipation, hoping for the best but expecting the worst. The results, it turns out, were somewhere in the middle:  3 AA embryos with my name on them were tucked away in the freezer. As far as grading goes, each blastocyst (5-day-old embryo) receives two letter grades from the embryologist– one for the outer cells (which become the placenta) and one for the inner cells (the baby). The grades work the way you’d expect them to, with A being the best, B for “good,” and C for “fair.” However, even an embryo with an AA grading is not guaranteed to result in a pregnancy, nor is one with a lesser grade destined to be unsuccessful. During our first IVF cycle, both blastocysts were given AB gradings and transferred within 6 weeks of each other, but only one resulted in a baby.

Aside from the first three, there was another embryo that had failed to divided properly and four more that could go either way. My nurse said they would continue to monitor the rest and call the next day with an update. Immediately I told Kyle not to expect anything, that our final number was going to be three.

The next morning ticked by slowly. Despite trying to be realistic the day before, I had started to feel hopeful that we might get to keep just one more. I remembered back to getting the final update call in 2015, the morning of our fresh embryo transfer. In 48 hours we’d lost more than a dozen embryos, but we did have one blastocyst ready to transfer, as well as a few that might still pull through. A few hours later, as we sat waiting to be taken back to the surgical room, the embryologist had come to inform us of one last embryo– a straggler, who was now safe in the freezer. That straggler was Ross; the others failed to develop. As I went over the memory, I realized that I only knew about Ross that day because we had been physically present in the clinic, waiting to transfer his sibling. He was too late to be included in the update call that morning, and if we hadn’t happened to have been there, I wouldn’t have known about him until Day 6. I started to believe that we would have a straggler this time around, too.

Eventually the morning passed but the update never came. I called in and left a voicemail for the nurse, but two hours later, I was still waiting. By now, everything in me said that we had a fourth embryo, I just had to hear the confirmation for myself. The waiting started to get to me; the build up of pressure felt unbearable. I tried to reason with myself, arguing that nothing would change if I had to wait until tomorrow for the news, that another 24 hours of waiting would still be less than what I’d made it through already. But I couldn’t stay reasonable anymore. So when Kyle seemed unruffled by the delay, I texted Elle instead, knowing that she would be indignant on my behalf. Finally, in the late afternoon, the call came: we did have one more, our straggler. This one had a BB grading, and I felt a special affinity towards it as the underdog.

Four frozen embryos. We had snowflakes in May. I felt at peace with the results, especially since we’d started with far fewer embryos this cycle. We just had one last hurdle to get through yet. This cycle, because of my increased age, my poor results the first time around, and the time and money that go into the surrogacy process, my doctor recommended additional screening to test whether the embryos were normal and likely to result in a successful transfer. Prior to being frozen, each one of our blastocysts had been biopsied, and those cells would be sent to a lab. The results would take another week or so. Another week of waiting.

The remnants of an IVF stim cycle: several days and thousands of dollars.

IVF Cycle Results Comparison by the Numbers

IVF Cycle Results Comparison by Percentage

It was a busy week in the meantime. We weren’t just carrying the weight of our embryo testing, we had family staying in the area and multiple events surrounding Kyle’s graduation from his master’s program on Saturday. The weekend’s blur of festivities was followed by a few more somber days as we packed for a quick trip to Florida for my aunt’s internment. In the 48 hours between our flights we saw family from both sides who live in the area. There was very little downtime and never a moment our embryos were far from my mind; they clouded my thoughts and entered my dreams at night. Throughout the wait I tried to will three healthy embryos into being. Elle texted me on Wednesday to say that she was thinking of us ahead of the big day.

Then on Thursday, the call came. And I missed it, by seven minutes.

I fumbled through my contacts as I shut the door to block out sounds from the other room. The line rang, but rather than the expected voicemail message, my nurse answered. My heart started to race through the obligatory small talk– the most agonizing part of each call– and I tried to assess her tone to determine whether or not I was about to receive good news or bad. I couldn’t tell this time.

Well, we had one embryo. Out of four, nearly all of them were abnormal. It was a setback and not one I had been fully prepared for after the triumphant feeling of gaining that last embryo. I’d been warned that roughly half of our embryos would likely come back testing abnormal, but with four blastocysts, that still should’ve left us with two. One put me at a rate of 75% abnormal, well above the expectation. As someone who has been through a failed embryo transfer before, two was acceptable. Three was a miracle. One was not enough.

Back in early February, as we sat in our doctor’s office, having one or less at the end of treatment was the concern. One is not enough to start preparations for a much-needed hysterectomy. It’s not enough to be able to donate unused embryos to couples in need when we finally have a second child. One is not enough to move on in this process. If we were a normal IVF couple, we could schedule a frozen embryo transfer in a matter of weeks, and then, depending on the outcome, we’d move forward with any necessary treatment cycles.

But surrogacy changes everything. We are not a normal couple, and we don’t have the option of transferring this summer. For us, the hope is to simply transfer within the next year, and if that is unsuccessful, my body may be unable to produce another viable embryo to try again at that point. We need to do another cycle while we still can, and that means less time to focus on the next part of the process and more money spent on IVF when we desperately need it for other aspects of the surrogacy. We knew that all of this was a likelihood– from the beginning we were tentatively planning for another round of treatment sometime in August– but then I went and let myself hope that that fourth embryo was an indication that we’d finally found the missing key.

“Do you want to know the gender of your embryo?” my nurse asked, before ending the call.

“Yes,” I replied, wanting to know as much about this group of cells as was possible to know.

But as she told me, I didn’t know what to say in response. Here this potential future child is ready and waiting for us, but there is nothing I can do about it right now.