Today was embryo transfer day! I thought the embryo transfer wouldn’t be much more than what an IUI involved, but it was kind of a much bigger deal.
We arrived at the fertility center around 9:00 am for a 10:00 am transfer. Leading up to today, they had repeatedly instructed Molly to keep from emptying her bladder once at the center and before the transfer, which would provide a good window for the ultrasound during the transfer, but when we were still sitting in the waiting room at 10:15 am, we had both become quite irritated (me: for having to wait so long; Molly: for having to pee so badly). Finally, they OK’ed Molly to go ahead and go, because what they had really meant was don’t empty between admission and transfer. Relief. Then, of course, we were called back less than 10 minutes later.
Back in the pre-op/recovery area, we waited while another person was having their transfer done. Our reproductive endocrinologist was the one on duty that day so she is the one who did the transfer. She came in before the procedure to tell us how our embryos had done since Day 3. 12 of the 19 3-day embryos had made it to Day 5! They gave us a microscope photo of the single, grade 4AA 5-day embryo (blastocyst) to be transferred:
A good description of blastocyst grading is here. In short, the number refers to the blastocyst development stage (expansion/hatching status), and 4 (expanded blastocyst) is the most ideal for a Day 5 transfer. The first letter refers to to the inner cell mass (which will become the baby) score, with “A” being the most ideal score indicating many cells tightly packed together. The second letter refers to the trophectoderm (which will become part of the placenta), with “A” being the most ideal score indicating many cells forming a cohesive layer.
We had one “perfect” 4AA in the bunch of 12, and that is the one they transferred today. We signed paperwork that said they would freeze the remaining embryos, which I assume are all 11 others, that varied in score from 4AB to 3BC (“lower score” embryos are not associated with “lower quality” babies, just less babies). Then we waited some more.
Finally, around 11:00 am, it was our turn. Unlike the egg retrieval procedure, I got to accompany Molly into the procedure room for the transfer. Have you ever seen surgical-style stirrups? Wow, they are no joke. After all of the straps and velcro and clamps, I was just waiting for them to slap some padlocks on! They did a little bit of prep, including a quick general abdominal ultrasound. There was a moderate amount of free fluid in Molly’s abdomen, which may be a very mild form of Ovarian Hyperstimulation Syndrome. They didn’t seem too worried about it and just recommended monitoring for weight gain and increased abdominal distension every morning as we have been since the egg retrieval.
Then another person came in with the magic insemination catheter and handed it to our reproductive endocrinologist to go to it. They continued doing a simultaneous abdominal ultrasound to see where the catheter was in the uterus, and that was kind of fun to watch. The trial transfer at the IVF orientation was so fast and apparently “easy” that I was expecting the real transfer to go like an IUI insemination. I don’t know exactly how long the actual transfer took, but it felt like it a very long time (seemed like more than 5 minutes, which is long compared to what I was expecting when a typical IUI insemination takes all of 30 seconds or less). On the ultrasound, I could see that once the catheter was in, it took longer than I expected to position it in exactly the right place, as there was a lot of discussion between the reproductive endocrinologist doing the transfer and the other person doing the abdominal ultrasound about being able to see it clearly. I’m pretty sure, or at least hopeful, that it was less than 2 minutes or so, because I believe previously they had said they only have 90 seconds between taking it out of the incubator and getting it into the body before chances of success drop dramatically. What made it mostly seem to take forever was having to watch it make Molly so uncomfortable.
After the procedure, Molly mentioned she was having quite a lot of pain and cramping. Again, something I’m not sure is “normal” or often experienced or not but was definitely a surprise to me, and I tried to not let it worry me. Stress is probably the worst thing for this whole process so I’m really attempting to just go with the flow this time and not let my anxiety and over-analyzing take over. So far, so (pretty) good.
Because the transfer happened to fall on a Sunday, it was easier to secure a babysitter. It’s a good thing, too, because we ended up spending the whole morning there, getting home right before the girls’ afternoon nap time. In a few days, they’ll check Molly’s progesterone level to make sure we’re injecting the right dose every night. Otherwise, so begins the two-week wait!