At long last, the embryo banking chapter of our journey came to an end today with the final re-biopsy result: one more euploid girl.
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| You're reading this right, we actually had a single cycle with 4 whole euploid embryos. Way to go out with a bang! |
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Our final banked embryo roster
Scoring overview
Embryos are graded based on looks. They get a score based on 3 physical features:
1. The "blastocyst expansion" stage (3-6).
2. The quality of the bundle of cells that would mature into a body, called the inner cell mass (A-C). 3. The quality of the outer layer of cells that would mature into a placenta, called the trophectoderm (A-C).
Embryos are graded based on speed. It can take 5, 6, or 7 days for an embryo to mature into a blastocyst that can be cryopreserved.
What matters? Embryo morphology score: - The most important is the first letter, with A being best and C being worst.
- Next most important is the second letter, again with A being best and C being worst.
- Lastly, look at the expansion number, from 3 to 6. Counterintuitively, a 4 or 5 are generally best. An embryo at stage 3 is a bit of a slower grower, and an embryo at stage 6 has already hatched from its protective outer layer (zona pellucida), which makes it more vulnerable during the cryo freeze/thaw cycle.
Embryo maturation speed: - Day 5 embryos are best. These have a strong, robust metabolism and matured most quickly, in just 5 days in the lab.
- Day 6 embryos are almost equally good in modern labs.
- Historically, when an embryo got implanted during the same menstrual cycle that the egg was retrieved, the day 6's didn't do as well because they fell out of sync with the uterine lining, but these days egg retrievals and implantations are generally done in different cycles.
- This gives time to genetically test the embryos.
- Decoupling retrievals and implantations allows doctors to optimize for egg maturation during the retrieval cycle, and then fully focus on the uterine lining growth during the implantation cycle.
- Among women under 38, day 5's are more likely to be genetically normal. That held up for us: our day 5 euploid rate was 100%, whereas our day 6 euploid rate was just 50%.
- Day 7 embryos, on the other hand, are significantly worse. We don't have any: Spring will not culture through day 7 due to the low odds of live birth, though word is they may start allowing it for women 38+.
Overall, Spring's data indicates that a day 5 3AB and a day 6 6AA have about equally likely chances of a successful live birth. So voilà, a handful of embryos from our May, November, and December cycles are teed up for the first shot at joining our family.
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Our final count stands at 15 implantable embryos, of varying degrees of quality, from the excellent embryos with odds of live birth at Spring surpassing 65%, to the back-ups with slightly worse than 50/50 odds. This was a journey of so many things: a recognition of my own mortality, a deepening awareness of the inescapable realities of existing in a female body, a total redirection of life plans, an exploration of the limits of biotechnology, and a numbers game. And there were so many numbers.
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| The entire process was some weird medical March Madness. Throughout monitoring appointments, hope rose alongside the follicle count and estrogen levels. Then, from retrieval onward, we watched hopes slashed with the numbers at every check-in point. |
The numbers weren't all data points coming from labs. I lived them too:
- 279 fertility-related injections
- 40 blood draws:
- 38 at fertility cycle monitoring or FDA-screening appointments
- 1 genetic carrier screen
- 1 for general health
- 8 IVs (ugh)
- 7 egg retrieval surgeries (after 37 years with zero surgeries!)
Forgive me for not being up for the ultimate number: 1 pregnancy. It's a privileged journey to biological motherhood, but it didn't come without physical sacrifice.
It's amazing how quickly I've blocked out those numbers. But for the residual fertility-related acne haunting my bare shoulders, I'm back to my normal over-worked, under-rested, circus-loving, tea-sipping self. It's hard to believe I wrapped up a whole year as a human pin cushion just a few months long ago. And it's mind boggling to think how last year's actions stand to change the course of our lives.
Now here's to hoping and praying that the world doesn't collapse before we can cash out the funds to turn these embryos into somebodies we can really love.
