Tuesday, August 13, 2013

SET and Thawing Questions: A Followup

To follow up on my last post on Single Embryo Transfer, I had a conversation with my clinic yesterday about my plan -- the changes, ordering medications, scheduling, etc. Everything seemed to be going well, until I received a quick call back right after hanging up.

"It says here in your plan you only want to transfer one?"

"Yup. We are electing for single embryo transfer for this FET."

"Hmmm." (Immediately feel like everyone there thinks we are ill advised to do things this way given our history of crap implantation and limited success. Immediately feel a little second-guessed.)
"So, do you want to thaw one, transfer one, or thaw two and transfer one?"

HUH? Why on earth would I want to thaw BOTH my precious blastocysts and only transfer one? Once they are thawed it's not like you can stick them back in the freezer. I felt badly, but I think I said more aggressively than I intended, "Why would we EVER thaw two and transfer ONE?"

"Well, in case one doesn't make it." (We have been told that the thaw success rate is really really high at our clinic, and in doing 2 frozen transfers with 5 embryos all 5 of them thawed just fine, minus one still viable but ugly blast that was thrown in on the triad transfer. So why all of a sudden is it seeming like we are doing the riskiest thing ever?)

"Ok, well what if you thaw one and it isn't viable, can you thaw the second one on the same day, separately?"

"Yes, we can do that. So you want to thaw one, transfer one, but thaw the second if the first isn't viable."

"Yes. Only if the first one ISN'T VIABLE do I want the second one thawed."

HOLY CHRISTMAS. Am I being sensitive here? Does it seem like the most logical choice was the one I brought up, NOT having a sacrificial blastocyst (or, in my highly paranoid mind, a push to have us do a double embryo transfer anyway because what sane person would say, "oh, they both thawed great? Well, let's just put one in. Sorry little precious blast, not your time to get a shot at implantation." WHO WOULD EVER DO THAT???). I left the conversation a little unsettled. I feel like while they will do the SET, my clinic is not really on board with the whole thing but are humoring our crazy. I tried to explain, "We are looking to have two chances with these two blastocysts. We don't have a lot of chances left." I think that made it a little clearer, but wow.

I felt like we are asking for something incredibly risky, like saying, "Yeah, I need to run a marathon right after transfer, so uh, that's ok, right?" It makes me uneasy. I was very clear about our wishes and if needed I can bring printouts of my research to back our decision up, but I kind of feel like I SHOULDN'T HAVE TO. I shouldn't have to justify a decision that is all over the literature as a good choice, a viable choice. I am now worried about thawing--what if they don't thaw right? What if now is the time when the freeze and thaw process fails us? This is a chance we take regardless, but now it seems amplified since our goal is JUST ONE. I know "what-if-ing" is not a productive train of thought, but I can't help it in this case. I was kind of hoping for more of a positive response for our SET, more of a "look how responsible you are, taking a (very measured) risk to set yourself up for the healthiest pregnancy, birth, and baby possible!" instead of a "if that's really what you want, ok." Even a clinic that I know has transferred anywhere between FOUR and EIGHT embryos at a time has been giving SET its due when people ask how many to transfer or express no desire for twins or have health concerns that make SET the only viable choice. I have many friends who were successful with SET, either because they chose one embryo or because one embryo was the only choice they had as the outcome of their cycles. I feel like choosing this shouldn't make me feel like I'm making a strange choice.

Maybe some of my angst is projecting my own fears onto the nurses and doctors. But it's not all of it. I do worry. What if they don't thaw? What if we have nothing? What if one embryo isn't a good idea for me based on my implantation history? What if? What if? What if? Why do we "only" have two blasts from our fresh donor egg IVF? Why out of 15 embryos left to culture to day 5 did only 4 of them make it to blast? We have those 6 Day One embryos and I don't want to discount them, but they scare the pants off me. How many viable embryos will we actually get from them? Will we end up needing to use those? And then, the scariest question of all, WHAT HAPPENS IF WE USE THEM ALL TO NO AVAIL???

I can't focus on these questions, I want to pour all my energies into this one beautiful blastocyst that will hopefully make me a momma. They are seeping in, though, the fears and the anxieties that infertility has given me. I have a really hard time not catastrophizing. (Is that even a word?) I have a really hard time not worrying about things that haven't happened yet, and I am trying really hard to just let go. To not worry about my clinic's apparent dubious support of our SET choice, because that is their problem and not mine. To not worry about the Embryos of Christmas Future, because their time in the sun isn't here yet. To not worry about what our next steps might be if this all fails, because it could very well succeed on this next try. I want to put all my hopes and energies and dreams into this frozen single embryo transfer, without worrying and fearing the result if things go south. I want to believe that this is it, this is the final countdown. But I am so scarred and damaged by all the NOs that it is hard for me to fully believe in a YES. And now that we've changed so much, I want to feel that that YES is even more possible, so I am not all that excited that now I am worried about thawing and any possible mix ups there may be about thawing JUST ONE. And I am worried that my team thinks we are making a mistake. Things that I didn't really have to worry about until yesterday. Argh.

Do you worry about thawing? Do you feel that your team has questioned your decisions? Am I being sensitive?


  1. I can't even describe how nervous- ok, terrified- I was after the frozen eggs had been thawed, mixed with the sperm, and left to fertilize via ICSI. Those 24 hours were the hardest. So I totally understand. I have never had embryos thawed yet, but it's a similar thing where you have no control over what will happen in that petri dish.

    I support your plan to have two chances. Of course if you really have doubts, you can change your mind that day, but try not to worry about it too much once you have made that decision. I know, easier said than done. But you are making other important changes in your protocol, and with great-quality embryos, this seems to be a smart, well-thought out plan.

  2. Thank you! So many decisions, so many scary alternate scenarios to envision. I think reminding myself that really, as much as I try, I have no control over what actually will happen in that dish and in my uterus, is so helpful. I also have to remember that I did actually get pregnant from a FET once, so I have faith in the frostie embryos. There are so many beautiful once-frozen babies out there who were also SETs, so I just have to get over these jitters and ignore second guessing and go for the gusto. These are times when I wish there was a fast-forward button on life! (and then a pause for the good stuff.)

  3. Oh Jess! The "what ifs" are the worst! I think you have done your research and have a solid plan. Of course you are going to worry and second guess your decisions! This is a big deal. I'm rallying for you, Bryce and that precious embryo!

    1. Thanks, lady! ugh, I wish there was an "off" switch for the "what ifs." Thanks for the support!

  4. I am a big fan of eset. Yes, it can be more costly if you have to do 2 FETs. But compared to all the costs to get where you are, I think it makes a lot more sense. Do everything to give yourself the best chance of a healthy pregnancy. And clincs seem to often have their own favorite way. And typically this is based on what the RE has the most experience doing, not on best current research. My only question is whether the embryos are frozen seperately. This could explain why the clinic is talking about thawing both. My clinic would have frozen my embryos in groups of 2 and 3 (!!!) had I not insisted on speaking directly to the embryologist and heard about this plan.

    1. Oh, wow. That's crazy that they would freeze them in groups. Mine are frozen singly. I feel like the cost of two FETs is way less than the cost of a fresh cycle, especially a DE fresh cycle, plus all the health benefits and risks avoided... But you're totally right, there is a "this is the way we've always done it" kind of thing with clinics. I'm happy that they are doing the SET and that it's possible to thaw my blasts singly! Jeez that would make me mad if that wasn't an option. Good for you, speaking directly with the embryologist to get the option you wanted.

  5. I do not think that you're being overly sensitive at all. I think that your thought process makes complete sense. I don't even understand where they're coming from.

    1. Me either--although I guess it's probably that they think we have a better chance with two embryos, and maybe part is business that they want us to be successful sooner, so maybe that's it? I haven't heard anything further about it, so I guess I just let it go! Thanks for helping me feel not crazy. :)