PUPO! (Pregnant until proven otherwise)

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We are PUPO - pregnant until proven otherwise! ^^^ Hello there little baby!! Today this little friend came to stay in my uterus! Say some prayers that he/she is snuggling in tight!!

The expansion grade scale ranges from 1 (least expanded) to 6 (completely hatched).
Grade 1: the fluid-filled cavity takes up less than half the space of the embryo.
Grade 2: the fluid-filled cavity takes up more than half the space of the embryo.
Grade 3: the blastocyst cavity has expanded into the entire volume of the embryo, pressing the trophectoderm cells up tightly against the inside of the zona.
Grade 4: Expanded blastocyst, where the blastocyst has increased beyond the original volume of the embryo and caused the zona pellucida “shell” to become super thin.
Grade 5: Embryo has breached the zona and is hatching out of its shell
Grade 6: Embryo is completely hatched.
So the embryo is given a number grade (1-6), followed by a letter grade for the inner cell mass and then the trophectoderm (A,B or C).
For the inner cell mass:
A: Many cells, tightly packed
B: several cells, loosely packed
C:  very few cells
The trophectoderm grading goes like this:
A: many cells, forming a cohesive layer
B: Few cells, forming a loose layer
C: Very few large cells.
- See more at: http://fertilitylabinsider.com/2011/12/understanding-the-gardner-blastocyst-grading-scale/#sthash.xHvBQGol.dpuf

What you're seeing here is 1. the early beginnings of a baby and 2. More technically - an expanded blastocyst grade BA. Here's a little bit about that that means!

Expanded blastocyst - The fluid filled cavity volume is larger than that of the early embryo and the zona pellucida (outer shell) is thinning.

The ICM grading is as follows:
A ----- Tightly packed, many cells;
B ----- Loosely grouped, several cells;
C ----- Very few cells.

The trophectoderm (the inner shell) grading is as follows:
A ------ Many cells forming a tightly knit epithelium (layer of cells that make up the outer surface of your body);
B ------ Few cells;
C ------ Very few cells forming a loose epithelium.

So what? Welllll that means, basically, that it is in good shape, and a better quality than any of the embryos we have ever had!
We also have one to freeze for sure and maybe 3 more!! holy wow! That has never happened!! Frozen embryos means that if this doesn't take, or we want baby #3, then we don't have to do all the shots and procedures right away.

A little about the procedure - warning if you don't like mild gynecological talk don't read this, though it is a blog about making a baby after all!
I had to arrive an hour early to start drinking water and get checked in. You must have a super full bladder in order to do the procedure, it helps push your uterus down so its more accessible. (Here's the warning part) They brought me into the room to get set up, checked my arm band 2374634 times so I actually had my own embryo implanted then they get you in the stirrups. Now remember I have a TAC (transabdominal cerclage) this is tied at the top of my cervix, because of this my cervix doesn't "rise and fall" like most women. It just stays way way up high, which is fine b/c now it holds in a baby so I'll take that "pitfall".
My RE had to use like 4 different kinds speculums (this sounds like a Harry Potter word) and an extra long catheter to finally reach my cervix. OUCH! He then threaded the catheter through my cervix and into my uterus. The nurse yells "patient ready", embryologist yells "embryo ready" we see it on the screen above our heads and then she runs into the room with another catheter. The embryologist's bonnet was fabric with eggs and sperm on it, amazing. We watch the little white blip that is the embryo float into my uterus.
They took everything out and I went to lay back and settle in for my 15 minutes of laying flat when the nurse told me they don't do that anymore! My how things have changed, they also said I have no restrictions and can pick up Colin any time I want. I will have a blood test later to determine if the embryo "took" (if I am pregnant or not).
Then Bill and I went out for a nice lunch together! (Thanks Mom for watching Colin!)

At this point in the process Bill and I have decided that the blog should go dark for a while. Until we are ready to announce a pregnancy or until we begin another IVF cycle (both will take a while) Until then send some prayers our way!!

Grade 1: the fluid-filled cavity takes up less than half the space of the embryo.
Grade 2: the fluid-filled cavity takes up more than half the space of the embryo.
Grade 3: the blastocyst cavity has expanded into the entire volume of the embryo, pressing the trophectoderm cells up tightly against the inside of the zona.
Grade 4: Expanded blastocyst, where the blastocyst has increased beyond the original volume of the embryo and caused the zona pellucida “shell” to become super thin.
Grade 5: Embryo has breached the zona and is hatching out of its shell
Grade 6: Embryo is completely hatched.
So the embryo is given a number grade (1-6), followed by a letter grade for the inner cell mass and then the trophectoderm (A,B or C).
For the inner cell mass:
A: Many cells, tightly packed
B: several cells, loosely packed
C:  very few cells
The trophectoderm grading goes like this:
A: many cells, forming a cohesive layer
B: Few cells, forming a loose layer
C: Very few large cells.
- See more at: http://fertilitylabinsider.com/2011/12/understanding-the-gardner-blastocyst-grading-scale/#sthash.xHvBQGol.dpuf

Grade 4: Expanded blastocyst, where the blastocyst has increased beyond the original volume of the embryo and caused the zona pellucida “shell” to become super thin.
Grade 5: Embryo has breached the zona and is hatching out of its shell
Grade 6: Embryo is completely hatched.
So the embryo is given a number grade (1-6), followed by a letter grade for the inner cell mass and then the trophectoderm (A,B or C).
For the inner cell mass:
A: Many cells, tightly packed
B: several cells, loosely packed
C:  very few cells
The trophectoderm grading goes like this:
A: many cells, forming a cohesive layer
B: Few cells, forming a loose layer
C: Very few large cells.
- See more at: http://fertilitylabinsider.com/2011/12/understanding-the-gardner-blastocyst-grading-scale/#sthash.t16rla1O.dpuf

Grade 4: Expanded blastocyst, where the blastocyst has increased beyond the original volume of the embryo and caused the zona pellucida “shell” to become super thin.
Grade 5: Embryo has breached the zona and is hatching out of its shell
Grade 6: Embryo is completely hatched.
So the embryo is given a number grade (1-6), followed by a letter grade for the inner cell mass and then the trophectoderm (A,B or C).
For the inner cell mass:
A: Many cells, tightly packed
B: several cells, loosely packed
C:  very few cells
The trophectoderm grading goes like this:
A: many cells, forming a cohesive layer
B: Few cells, forming a loose layer
C: Very few large cells.
- See more at: http://fertilitylabinsider.com/2011/12/understanding-the-gardner-blastocyst-grading-scale/#sthash.t16rla1O.dpuf

On the docket for tonight

Some Ganarelix and of course my Follistim! Both injected subcutaneously into my abdomen by yours truly! I'm starting to feel more like a pin cushion, and my poor belly is bruising up.


So lets back up a tad, on Tuesday I went in for bw and an u/s. As we can see to the left, while 2 is better than 3 pokes, its still one to many! I had 4ish small follicles all measuring about 9-10mm (we need to get to 19-20ish mm).













Bill and I went to the Museum of Science in Boston to see the Pixar exhibit, so that was fun. And of course the 1 minute I was in a tunnel is when the Dr called. BOO. So more bw today, but no u/s, only one hand poke today! I said 'lets just cut to the chase, stab my hand' so she did. We have to watch my LH hormone to be sure it doesn't make me "lay my eggs" too early. Because it was at a 5.4 today they decided to have me introduce the Ganarelix. This will allow the Follistim to do its job but hold back the LH (oooOOooo science-y).
I head back in Friday for an u/s and more bw. Hopefully I have MY u/s tech that I love, and I can snap a few pics of my large ovaries starting to fill up!

So shall we start at the beginning?

When we started trying to have a baby we knew I didn't ovulate, I have PCOS (polycystic ovarian syndrome). It has a whole bunch of awesome side effects, one of them being anovulation. My amazing OB started me on Clomid. An awesome drug that made me throw dishes, cry, yell at Bill and have hot flashes. Bill calls it either "the clomid crazies" or "clomidia". As soon as I went off of my birth control, I started temping and charting. I had 90+ day cycles which ended in meds. Hence the need for the Clomid. This is my second cycle on clomid, what a chart should look like. Except mine kept ending in my period. 

 My OBGYN decided we needed to do some further testing, with the data that we had we knew there was more to this "problem". I had an HSG (hysterosalpingogram)  done. Basically a catheter with a balloon on the end is inserted into your cervix, it is then blown up to "block the hole" and dye in inserted into your uterus while xrays are being taken. They are looking for the dye to pass through your tubes. Basically it feels like a large man is standing on your uterus for about a minute. Fantastic. Along with the HSG we decided Bill needed to have a Semen Analysis (SA).
I received the call from my nurse at the OB's office in December. I can remember that moment like it was yesterday, standing outside in the cold listening to her say "sperm count is zero". Devastation. No other word for it. I couldn't even cry, my students had arrived. I looked at their little faces as I sang the circle time songs and just kept thinking "I will never get to have one of "these" with my husband" "I will never hear circle time songs from my kids, or sing to them". The only thing I have dreamed of since I was a little girl, ripped from me and it wasn't fair.
I went into "fix it" mode that day I called a local urologist who gave us the name of the top Male factor infertility (MFI) urologist in the NE area, Dr. Oates. We got an appointment with him in January, followed by an appointment with the Reproductive Science Center of New England (RSC). Dr. Oates did another SA, still zero, no obstructions. Genetic testing was done (we waited 7 weeks for the results) - nothing was found. We weren't sure if this was good news or bad news....it felt like no news. Our next step Testicular Sperm Extraction (TESE). A very invasive procedure Bill had to go through. After a long battle with the insurance we got it approved.

Here is Bill in his handsome surgery attire!

Bill went in for surgery and 30 min later Dr.Oates walked out into the lobby with this:

It was now my job to drive the sample from Boston Medical Center, to RSC in Lexington.  Most. Stressful. Drive. Ever. My mom came with me while Bill's mom stayed with him in recovery. I am so thankful to our families for being unbelievably supportive through all of this.
Bill and I went home and Bill got settled in bed with some good pain killers. and we waited. We thought our call from the Dr. to tell us whether or not sperm was found would come around 3ish. We arrive home around 11 we got our call at 12. SPERM WAS FOUND, 5 WHOLE VILES!! it was the best news we had heard in a very very long time. We just held each other and cried, we were going to get to have OUR baby. Something so many take for granted.

We then found out I was in such a place in my cycle to being with IVF right away. We were so happy to get things moving! I will update tomorrow on our IVF process, since I feel like this is plenty long enough!

-Nicole