The Future of Our Frosties

When it comes to the future of our 3 frosties, should we…

• Do all Single Embryo transfers (SET’s) meaning transfer only 1 embryo at a time, for a total of 3 possible transfers?
• Do a Double Embryo transfer (DET) the next time, meaning transfer 2 embryos at once, and if that doesn’t work do an SET with our last embryo?
• Do a SET next time, and if that doesn’t work, do a DET with the 2 remaining embryos?

Sounds like enough to give you a headache, I know.  According to ASRM, SET’s are generally the way to go if the embryos are blastocysts of “good” grade and you are a healthy woman under the age of 35 ( How many embies to transfer according to ASRM )

We have now done 1 SET and 2 DET’s, all ending in miscarriages. In our minds, there are both pros and cons to SET and DET.

Pros to SET:

• Better chance of carrying to full term (especially with my RPL history)
• Usually healthier mom & healthier baby

Pros to DET:

• It’s like a BOGO transfer (2 for the price of 1 deal). Sounds bad, but trust me, once you have dropped 30 grand you would consider it too.
• Do not have to worry about the sibling factor down the road (we already know we would like more than 1 child)

Cons to SET:

• More expensive if it doesn’t work (more transfers=$)
• Sibling factor down the road

Cons to DET:

• High risk pregnancy
• More money all at once being spent on the babies (makes up for those extra SET’s!)

Tough decision.  We were just as elated when we got pregnant off our SET as when we got pregnant off our DET’s.  We were just as thrilled to have 1 baby as 2 babies.  All we want is a healthy, full term pregnancy.  Right now, my hubs is leaning more towards the SET for our next time, while our current RE says we should do another DET.  I’m curious to see what the RE we are getting a second opinion from will say.  I really have no idea what to think at this point.

Since we didn’t do PGD testing, we really don’t know with certainty that any of our embryos are truly of “good” grade. Yes, they made it to day 6 so that says something positive about them.  But when it boils down to it, our embryos were graded by their looks. I like to think of it as a beauty contest that the embryologists were judging. Unfortunately, anyone who did not have PGD done for an additional 7 or 8 grand is in the same boat as us technically speaking.

Here are the judges scores from the beauty contest for our remaining 3 embryos:

• 1 6AB (same grading as the embryo we transferred the 3rd FET)
• 2 6AC’s (the lowest grade we had out of all 8 of our embryos, have not transferred any of this grade yet)

From my understanding, based on the Gardener blastocyst grading system (what our clinic uses, some clinics use different systems), there are 3 separate quality scores assigned to each embryo. 1 number, and 2 letters, like above.

 

As you can see, the number represents the expansion grade, with a 6 meaning the embryos have hatched out of their shell. This was the best number we could receive & we paid for assisted hatching so it only makes sense!

The first letter following the number represents the inner cell mass quality (baby component), with an “A” meaning there are many cells, tightly packed. This was the best letter we could receive in this category. This is also supposed to be the most important category, but I would argue they are all equally important.

The second letter represents the Trophectoderm quality (this is the placenta component) with a “B” grade meaning there are few cells, forming a loose epithelium and a “C” grade meaning there are very few large cells.   

All of this only matters if you believe in the beauty contest ratings they received anyways. The first embryo we transferred from our fresh cycle was rated a 6AA, the highest they come, & we miscarried right away. After that we transferred another 6AA & a 6AB & still miscarried early on. The third transfer we lost 2 6AB’s, one being baby Isaiah.

Supposedly, there is a minimal decrease in pregnancy rates when the placenta component (2nd letter) is not rated an “A” like our embryos from the last transfer, which were 6AB’s. Well obviously these statistics didn’t apply to us; it was the furthest along we ever got in any pregnancy.

That being said, we aren’t really too concerned that our remaining embies are not 100% beautiful to the embryologists because so far their system hasn’t held much weight.  I think the biggest decision we will end up having to make is how we want to transfer these precious little embies.  Whatever God leads us to decide, I sure do hope at some point 1 of them can sport this hilarious shirt!