We also talked about my embryo transfer - which was "difficult" per their standards. But he reassured us that even though it took a little longer for Dr. Schmidt to find the right place - since they use the ultrasound-guided transfer, they do know that the embryos got to the right place. So that isn't a concern from their perspective. He said that for future transfers, they will just plan to have the extra tool (that he referred to as a "pincher") handy to make it go smoother.
We then talked about the Frozen Embryo Transfer (FET) protocol that Dr. Williams recommends. There is a natural FET process that doesn't involve any hormonal changes (no shots/drugs) - but it costs more, requires more visits to the doctor's office, and has a 5% success rate. The other FET protocol that uses hormones (which is the one that Dr. Williams recommends) is cheaper, requires less visits and has a 27% success rate. We are going to move forward with the FET protocol with hormones. Part of the process is very similar to the IVF cycle - we just get to skip and/or replace a few steps. Just as a quick refresher, let's go through the major steps of our past IVF cycle:
- Birth control pills for 3 weeks to "reset" my cycle and took antibiotics for a week.
- Daily shots of Lupron in the morning (overlapping with the birth control) to suppress ovulation. This continued right up until the embryo transfer.
- Daily injections of Gonal-F to start follicle growth and egg maturation. (Required ultrasounds to monitor follicle growth and blood tests to monitor estrogen levels). The follicles produced estrogen - which made my lining thicken.
- Received one shot of Novarel (HCG) to complete egg maturation & prepare the follicles for rupture.
- My hubby had to give a sperm collection and the egg retrieval was done to retrieve my 18 eggs. Progesterone shots began that night.
- Fertilization in the lab (via ICSI) with my hubby's sperm resulted in 12 fertilized embryos. Our embryos were monitored and graded each day up until the transfer.
- Embryo transfer was done to transfer two embryos back into me.
For the FET, I will again do steps 1 & 2 to start the cycle by taking birth control, antibiotics, and the Lupron shots. We will be skipping the Gonal-F (step 3) - because we aren't trying to get more follicles to produce lots of eggs this time around. Since I won't have a lot of follicles producing estrogen (which is what is needed to thicken the lining), they will have me take shots of estrogen (twice a week) during the cycle instead. It won't require as many ultrasounds or blood tests as it did in the IVF cycle. We will also be skipping step 4 as there is no need to trigger ovulation - since there is no egg retrieval this time around. For step 5, we obviously will not have the egg retrieval or need the sperm - but they will have me start progesterone shots when the egg retrieval would've taken place, to get me ready for the transfer. We will skip step 6 as we already have our fertilized embryos waiting. And then we will finish things up again with step 7, the embryo transfer. Here are the major steps to FET, definitely not quite as intense as the full IVF cycle:
- Birth control pills for 3 weeks to "reset" my cycle and antibiotics for a week.
- Daily shots of Lupron in the morning (overlapping with the birth control) to suppress ovulation.
- Shots of estrogen twice a week on Mon/Thurs. (Requires fewer ultrasounds to monitor follicle growth and blood tests to monitor estrogen levels). The estrogen will make my lining thicken.
- Nightly shots of progesterone shots (which will start a few days before the transfer).
- Embryo transfer with the thawed embryos.
I read online that not all embryos survive the freezing/thawing process, so we asked about the lab's success rate for thawing embryos. Their success rate is about 90%. Dr. Williams said the lab will thaw however many embryos are requested - but if any of the embryos don't survive, then they will thaw another one if available. So even though we have 6 embryos, it doesn't necessarily mean that all of them will be available to be transferred. We are lucky to have 6 to play with - but let's hope they all make it through the thawing!
We also talked about how many embryos we would transfer during the FET. Dr. Williams said this is typically when patients want to increase the number of embryos. But he still recommends two embryos for our FET cycle. When you start transferring three embryos, that's when you get into the higher risk of triplets or more. We agreed that doing two would be best!
Our next question was, "When can we start?" :) Dr. Williams said it depends on when my body is physically ready and when we are emotionally/mentally ready to try again. Physically speaking, they said we could start as soon as my next cycle. This was the response I was expecting to hear - but it was still disappointing to hear that we have to wait for my next period to start. It should arrive around March 15th - 22nd so it's not really that long to wait. I do think that we are both emotionally and mentally ready to try again - we are ready to get this show on the road again. Dr. Williams did say that he'd like to do the transfer this time around if possible - which we would love as well. :) It does sound like the FET cycle is much more flexible than the IVF cycle. We won't be at the mercy of the follicles' growth this time around. It will still take the same amount of time - so we're probably looking at another 6 week timeframe from the start of my next cycle. When my period arrives next, I'll call in to the doctor's office and they will create our calendar. Unlike the IVF cycle which is very unpredictable based on the egg retrieval and embryo development, the FET cycle is more predictable and I think they will actually give me the embryo transfer date at the beginning.
In the meantime, of course we will do our best to prevent my next period from arriving (wink, wink) - but if it does, we will just get our FET ball rolling. Like my husband always reminds me, "Everything will be okay in the end. If it's not okay, then it's not the end." :)