A Whole New World
One of the comments I received on my post about our possible embryo adoption has got me thinking. (This isn’t a surprise to me as I often think about comments).
Having frozen embryos myself, I have to ask, do you know the grade/quality of each embryo? You don’t need to tell me, but I encourage you to ask that if you don’t know yet. If you’re going to give this serious thought, which it sounds like you are, that information will be helpful in setting realistic expectations Having gone through 8 “perfect” 4AA-BA and 5AA-AB embryos to get two kids, expectation setting is very important for your mind. Also, if you progress, if the embryos have not been screened yet, you can still do that with frozen ones. That helps whittle them down to just the chromosomally normal ones and makes embryo selection easier. Here in Iowa, it costs about $5000 to do that for the entire batch of embryos. If we were going to transfer again, we’d for sure screen them first. Screening increases success rates and when you’re using a carrier, you only want to do it once. – Courtney (for full quote please refer to the comment the actual post).
Honestly, this comment has brought up an entire perspective that Mr. MPB and I hadn’t even thought about.
Mr. MPB and I come from the perspective of having already gone through an open adoption to bring our son into our lives. In an open adoption the baby is already conceived and well past the point of viability, so, we were required to fill out a creepy “child desired form” in which we select boxes pertaining to what we are willing to accept or not. For example, we had to make decisions related to race, multiples, family mental health history (i.e. bi-polar, depression, etc.), substance exposure, birth defects (i.e. cleft pallet, club foot, down syndrome) and parent history (i.e. if the child was a product of rape or the mother was engaged in prostitution or if either parent have a criminal history), etc. We even had to make a decision about when in the pregnancy we would accept a match – second or third trimester.
But not once did we think about grade/quality or any type of genetic screening, in the same way that one would think about embryo quality because with open adoption the child is well past that stage. (I’m confident I’ll write on that topic separately soon enough). So, this just isn’t something that crossed our minds to even question.
So, what both Mr. MPB and I have realized is that we are completely and utterly new to the world of embryos, IVF and FETs. We never did IVF, so we just don’t know the details. As I follow other bloggers I have a vague idea of embryo grading and FET process, but that’s it. I also only have vague ideas of costs related to an FET and no idea (except what google tells me) about the costs of a gestational carrier or even how to find a gestational carrier (if we chose that route). But if you want to know all about the process and costs of international adoption, I’m basically an expert in that stuff now.
What this really means is that this is much more then an emotional decision. We really do need to educate ourselves of the practicalities of embryo adoption and in reality we have a whole new world to learn about it in the coming weeks/months as we make this decision. As Courtney made me realize, we need to be realistic in our expectations of this opportunity.
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Don’t. Seriously, just don’t. Pondering embryo quality will do your head in so fast. There is simply no predicting what embryo will become a baby. You might as well get a magic 8 ball and go with its responses. Since I am 40 and gay and in NYC I have about 7000 friends who have done IVF. I’ve babysat day three, fragmented embryos who doctors were convinced would never survive the freeze/thaw and comforted gay male friends who can’t understand why their perfect day 5 grade AA embryos don’t “take” in their nubile, perfect gestational carrier. (I am totally not exaggerating). Sure, embryologists do give grades and these grades do mean something I suppose but as far as any real predictive quality I think it’s a joke. And besides, will you really not accept a “lesser” embryo? My thought is, if it made the cut in therms of the doctor deciding to freeze it then it’s good enough.
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I sooooo appreciate this comment. I seriously know nothing about embryo quality and being told not to think about it (i.e obsess over it) is probably some very good advice for me. Thank you!
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This is soo true, what a wonderful comment!
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Actually, screening embryos increases success so much that many clinics across the country are going that route for almost all of their patients. And what one clinic freezes may have higher standards than other clinics – there are no regulations. Our clinic is strict, I’ve heard of others that freeze anything remaining on day 5. Grades tell only part of the story (I went through 8 perfect ones to get two kids), but it is part of the story and will help in expectation setting for someone like MPB who likes to know everything she can before doing it. If there are a bunch of 3BC’s, any embryologist would tell you not to get your hopes up.
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I get that there must be standards and cut offs. All the wondering about “good enough” should stop at the freezer door, though. Don’t you think? What good could possibly come from obsessing over whether the RE was right to freeze the embryo? If it’s shit it will not thaw. If it makes it to transfer there is a shot. Think about how many day 3 babies are currently in high school and college. Most of these teens wouldn’t have even make it out of the petri dish if todays grading/freezing standards had been applied.
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Please take a step back and realize that my entire intent was to suggest genetic screening if it hadn’t already been done. And yes, if it’s shit it won’t thaw, but wouldn’t you want to go in, if using a carrier, knowing that some may not thaw for good reasons (some just don’t survive, even when good. All of mine, though, have survived thaw)? I certainly would. Maybe you wouldn’t, buy I would. And that was my point. If you’re a person who likes to go in with informed expectations, then get the information. That’s all.
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My 3bc is nursing right now 😉
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Your 3bc nursing makes me smile! 😊❤
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😆
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I have 2 grade 17/18 embies terrorizing my house now. I get what Courtney is saying, good to weigh options and be informed but for me, I did two rounds of IVF wth drastically different outcomes, I had the shelve the logic once my feet were in the stirrups and embies were being transferred.
Are you going to carry them or are you using a surrogate? There’s some medical considerations we’ve discussed privately before to acknowledge and be aware of in terms of interventions.
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And that 3BC is proof that It’s more than how they look under the scope. Hence, screening if possible.
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I hear you Courtney. 🙂
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I’ve gotten a chuckle out of this conversation today because in all my years of IVF for myself, mentoring patients at the clinic we used, and reading IF blogs…. I have never heard of a situation where there were, say, 4 4AB embryos, a couple 3ABs, a 5BB and a 3BC and the RE and embryologist said, “meh, grades don’t matter! Let’s transfer that 3BC first!”. NEVER! 😉
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Side note, but I don’t think you can genetically screen frosties unless they’ve been ICSIed. That’s what my RE told me. I forget why, though!
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The interesting thing about embryo adoption is the legal aspects- there are no laws here in the US specifically for this. But many organisations tend to follow adoption laws…so it will be different depending on which healthcare provider and/or agency you choose to go with. So that is an added complexity. Of course, I have no idea about Canada!
I was going to reply to Courtney’s comment yest but I didn’t want to overwhelm you! I know it’s just the beginning 😊 But I will say briefly that quality and grade of embryo isn’t a good predictor of success. My Rocky is a good example of that 😊 We can talk about this more later! you are right that it’s a whole new world – but I reckon your experience of adoption will put you ahead of your class!!
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We’ve just started looking into it all in Canada and I really don’t know much about it yet. I do think embryo adoption itself will be easier then a gestational carrier laws. BUT, I’m not even confident about that. There is just so much to investing and learn about – it’s almost overwhelming (which is kind of funny because I remember when adoption was overwhelming to us and we managed to figure that out).
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I know how that overwhelming feels, when Chris and I seriously looked into both embryo adoption and surrogacy options so we could do some financial planning…I cried a lot at how confusing everything was. So…take little steps MPB!! X
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This is true, but when you’re paying a carrier, I’d think you’d want to know what you’re dealing with, and my original comment suggested genetic screening to get more info. I also added that I went through 8 perfect ones to get 2 kids, so screening would have been very helpful for us. What you see under the microscope is not the entire picture, buy any embryologist would tell you that in general, YES, grades are predictive to some extent to outcome. The perfect one can fizzle (believe me, I know 😞) but the 3CB making it to delivery even shocks the professionals.
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Before I get slaughtered here, everyone please note that my comment said we went through 8 “perfect” embryos to get 2 kids, so it is only PART of the story. But you can’t deny It’s part of the story. As RE’s and embryologists always say, “we wouldn’t grade them if it meant nothing.”. And my original comment suggested genetic screening because a gestational carrier would cost a lot of money, and it’s important to know what you’re dealing with before spending that kind of money. The bottom line of my comment was suggesting screening.
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I so did not intend for you to get slaughtered! I actually triglycerides appreciate your comment for showing me that there are so many things that we haven’t even thought about. Screening simply wasn’t something we thought about, because this is new to us. And I’ll be forever grateful that you made us realize this! Please, please know I didn’t intend anything but appreciation to you!!!
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I know you didn’t!
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I am somebody who is currently about to do a transfer of my DE embryos in a gestational carrier. I know that the grading is not everything, so I don’t care much about it. AA, AB, BB, whatever. But I could not for the life of me put an embryo in my GC without knowing whether or not it is genetically normal. I was told I have friends who have embryos graded BC and genetically normal and they got pregnant with them. So yes I agree that AA embryos may not be the best because AA could still be not normal. I care more about whether or not they have done PGS, especially when people are using a gestational carrier like me.
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Exactly!!! Thank you!
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And this, right here, is why I love community. I am not an expert in adoption or embryos. I learn so much just reading other blogs and comments!
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Yes!! I have learned so much since I shared this earlier this week!! It’s clear I have so much more to learn! And I’m thankful I have wonderful individuals helping me along the way 🙂
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When you’re looking at cost, 4 years ago (almost to the day!!!) in Iowa, a full frozen cycle cost $3900 without insurance, and $2800 with insurance. I have it line itemed in my blog if you want details.
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Isn’t it interesting (and sad) that in my mind anything under $5000 seems like pennies! I think from a cost perspective our issue with be a gestational carrier, and that cost seems as though it could be potentially as high as our international adoption.
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We were THRILLED with the “cheap” FET cost! Some people GC for free here. My friend setup a GC for a friend of hers (truly!) and she thinks it was $30k. Again.. Iowa. I remember the gal wanting to do it for free but legal said no. Ha! That’s the “Iowa nice” that is a real thing. If I didn’t have a bad uterus, I’d do it for someone for sure!
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To give you some perspective, our first round of IVF, we had 7 day 5 good/excellent grade embryos- 5BB, and while they all took, they all miscarried. This was because of our immune system issues though. This second round of IVF (different donor sperm), we got 7 day 5 good/excellent embryos 5BB (our clinic basically said it’s nearly impossible to get 5AA embryos- I think they’ve got high standards), and 2 out of 3 that were transferred became healthy babies. It seems that this batch turned out a lot better (or our immune protocol made the difference and both batches were equally good). All this to say that while quality ratings do give some information, there’s so much other stuff that can affect success too. As for costs, for us, the majority of the IVF cost was in the drugs and retrieval. The FET cost was quite low $1800 or something. Not sure if there’s additional costs with a surrogate transfer though. I know there would be costs for storage of the embryos beyond the coming January (we paid for a year already and it was $500), and a friend of ours used a surrogate privately (as opposed to through an agency), and paid her for her “costs and inconvenience” which was about $10000 all in. Legal fees I’m not sure about, but to write up something for my wife to carry Mochi was about $800 I think. I hope this helps ❤️
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Embryo quality is such a strange thing. We ended up doing pgs and some of the embryos we thought looked good were abnormal and vice versa. It’s such a crapshoot! That being said I do think pgs is worth consideration. We tested 15 embryos and seven were normal. Of course it’s not full proof. I miscarried my first baby at around 13 weeks. Even so it was a good decision for us. When I did it I read everything I could possibly find about PGS. I’m happy to share anything I learn.
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For what it’s worth, if I had it to do over again, I would have done genetic testing on my embryos. The grades mean nothing to me–like Elizabeth said, if they’re good enough to freeze and they survive the thaw, that’s about all you need to know there, but genetics is another story. My RE believes that Charlotte’s twin died due to a genetic issue, but of course we have no idea what actually happened. Still, it’s entirely possible that genetic testing could have spared us that loss. That said, testing frozen embryos is a lot more complicated than testing fresh embryos. There’s a lot more risk to the embryo. You would really have to discuss all of this with an embryologist to find out the feasibility. It might not be a bad idea to just schedule yourself some time with an embryologist so you can have your questions answered. Lots of love to you as you explore your options here.
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Thank you so much for sharing Molly! Another thing you made me realize is that if we do PSG it would clearly be on frozen embryos and I had no idea that would make a difference. Gosh, there is just so much to consider!!
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It’s my understanding (and don’t quote me on this as I’m no expert) that they would have to be thawed, tested, and then re-frozen while you await test results. Then you’d have to thaw them again for transfer. It’s a lot of stress for something so fragile.
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Ya. It may not even be something that would be recommended? I have no idea, but clearly I need to learn more.
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I forgot to mention, because we have so many (5) good ones (that’s where grades come in), they wanted to prep me for an FET, then thaw and TEST OVERNIGHT (this included shipping cells off -site), keep them thawed and re-expanding in the dish, then transfer immediately once results were in. Then they would re-freeze the remaining normal ones. So, if there are, indeed, enough good-looking ones, this would be an option. If there are a lot of good embryos, you can probably assume that there is a good one in there (because the donors have had successful pregnancies from their embryos). Be sure to discuss this with them if you do speak with ah embryologist.
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I had concerns about testing our frozen embryos after thaw and spoke with our embryologist. She said that if they survive the thaw for testing, that they’ll survive another freeze/thaw with the way they freeze now. I trust her, but we opted not to because our OB put the kabosh on more babies for us (bad uterus).
But – having even spoken with the embryologist, I share your concerns. Makes me nervous with frozen ones. But given the use of a GC, I’d do it. Heck, I’d do it even if transferring to my uterus, if it was worthy (it’s not!).
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I don’t know much about embryo quality and such since I didn’t do IVF either, but after my 4th loss I looked into the idea of a gestional carrier. From what I remember, in Canada, they cannot be paid. I would expect that someone you know would have to vounteer to carry if that’s the case. I’m not sure what the legalities are having someone from outside of the country carry for you and whether that would include another adoption of sorts (I believe that’s how it works in some US states).
Regardless, I’m sure you’ll learn all about this if you choose to go this route. Just thought I’d bring that up because it was something I was unaware of previously.
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I am glad you are getting so many thoughtful comments and insight. I will add my own. My one living son was a poorly graded day 3 embryo. Take the grading for what it is- an educated guess not a fool proof prediction. As far as testing for PGS- I see a lot of value in it for a surrogate ( assuming you are paying for a transfer not for a full pregnancy). If you didn’t want to test maybe you could make the contract for a pregnancy past a certain amount of weeks and try to build in multiple transfers of needed. My advice to you on this: decide in your heart if this feels like the right path then forge ahead and do what you need to make it happen. I think we should follow our gut and heart when we can in this unfairly clinical process. Xoxo
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Why dont you go for 1 ivf yourself, to get your own embryos which you can you use for a surrogate? Ivf isnt complicated, esp when using only basic drugs. Then, they can be genetically tested on day 5 or 6 in order to eliminate abnormal ones. There is avtest called New Generation Screening that has less false negatives, meaning it is more reliable. Your friends embryos arent going anywhere in case yours dont turn to be good.
As for the comment, i would agree with her thoughts. If the donor and her husband are young and with no family history of certain physical and mental abnormalities, then you may forget about genetic testing. However, if they were older (above 35) when the embryos were conceived, i wouldnt gamble.
Good luck with whatever you decide, but im optimistic your family will expand.
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There are so very many things to consider with this whole situation. Do your research, maybe talk to your Dr (or another RE, since I know you didn’t really like yours in the end.) Talk to friends who have gone through IVF/FET. Take your time with it, don’t try to rush your decision at all. Maybe put it on the back burner for the moment until you get the rest of your to-do list checked off (from your post the other day). We’ll all be here to give you advice and info if you want it! *hugs*
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Just to mention, you need to make sure about a surrogate the folllowing:
1.her immune condition
2. Thyroid health
3.blood clotting condition
This should be tested even if she has had successful pregnancies.
I know ladies who got pregnant naturally several times and delivered.then, their folowing pregnancies ended in mc gor the above readons that had developed in the meantime.
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We used two of our best grade embryos last cycle which did not work, we are lucky to have 11 remaining and this time will use two of our ‘best grade’. So I had been thinking about the remaining ones which are not as high grade, what if this cycle fails and how will their chances be. I have done lots of reading on the subject and so many woman had failed IVF with ‘perfect’ embryos only to go on and get pregnant with ‘low quality’ ones! I am no longer worrying about embryo grading, what will be will be I think. The fact that the person donating has gotten pregnant with the same eggs and sperm and presuming form same batch of embryos is the thing I would be most positive about and also that a gestational carrier has also had successful pregnancies and no miscarriages. So much to think about, I bet your head is spinning! Good luck.
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