Empty Sac education

I think you are catching the drift that I enjoy the science behind things and I like to go in search of "answers" about things. I try to drive life instead of life driving me. Sometimes that's a good thing and sometimes it's not. Anyway, for what it's worth, here's some information on Blighted Ovum which is the term used for an empty gestational sac.

From American Pregnancy Association:

What is a blighted ovum?

A blighted ovum (also known as “anembryonic pregnancy”) happens when a fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself. A blighted ovum usually occurs within the first trimester before a woman knows she is pregnant. A high level of chromosome abnormalities usually causes a woman’s body to naturally miscarry.

Many women assume their pregnancies are on track because their hCG levels are increasing. The placenta can continue to grow and support itself without a baby for a short time, and pregnancy hormones can continue to rise, which would lead a woman to believe she is still pregnant. A diagnosis is usually not made until an ultrasound test shows either an empty womb or an empty birth sac.

What causes a blighted ovum?

A blighted ovum is the cause of about 50% of first trimester miscarriages and is usually the result of chromosomal problems. A woman’s body recognizes abnormal chromosomes in a fetus and naturally does not try to continue the pregnancy because the fetus will not develop into a normal, healthy baby. This can be caused by abnormal cell division, or poor quality sperm or egg.

How can a blighted ovum be prevented?

Unfortunately, in most cases a blighted ovum cannot be prevented. Some couples will seek out genetic testing if multiple early pregnancy loss occurs. A blighted ovum is often a one time occurrence, and rarely will a woman experience more than one. 

The chance of this happening to K&M was probably higher than most, simply because with age comes more risk of chromosomal abnormalities.  I have to believe that if this embryo truly did have a chromosomal abnormality, this might have been a blessing in disguise, knowing that they intend to terminate a pregnancy resulting in chromosomal defects. Better to miscarry now, I would think, (As if there's EVER a good time to miscarry - There's not.) than to carry the baby longer and go through the hell of making a conscious decision to terminate a baby with a beating heart. Every day you carry that baby is another day that you love it even more. Others might not agree and I understand that.

So... what are the chances of this happening to the last 4 frozen embryos? I don't know. That question echoes in my mind. They've not done genetic testing on them as their RE believes the risk of damaging one or more of the embryos is greater than the risk of an abnormality. (??) It's also costly. So, who knows?

Not your typical Mother’s Day post

Sunday, as almost everyone knows, is Mother’s Day. Moms my age, you know… it’s the day where you run around like a nut trying to celebrate “his” Mom equally with “your” Mom.  If you just get to sleep in a little with the noise below 300 decibels, and get some sweet snuggles from your babies, you can consider it a win.

But then there’s the other group of special women who know this day is coming and they approach it with dread.  Infertility affects about 1 in 8 couples.  Do you know someone who has struggled or continues to? Chances are you do. Maybe you are one of them. We are, and the intended parents obviously are. 

Would you have guessed it by looking at us? Of course not. Not everyone is open about their personal struggles and so it’s especially important, at the very least on Mother’s Day, to be aware that your well meaning words could touch a friend or family member in a very emotional way.

I’d like to share a few pieces of a fairly humorous article that CNN recently published, written from Nia Vardalos’ view, looking back on her struggle with infertility.

For years, at Spring social gatherings, some women would innocently ask why we didn’t have children. Others would overhear and exclaim what a great father my husband would be, so why on earth didn’t we have kids? When I would give a tight-lipped answer: “we’re trying,” they would not go silent.
They meant well, but they would loudly persist with up-beat advice: stories of this sister or that friend who had tried forever, and then a “miracle” had happened. All I’d wanted was a snack. Now, crudité in hand, I was up against the food table, being advised by pretty, chipper moms bouncing beautiful, pudgy babies on their hips.
A lot of “You Should” advice came my way. From the “latest technique in Europe,” to “just adopt from China” – everyone weighed in. I understood it all came from them wanting to help. It was meant with goodwill. But it was a painful, overwhelming subject for me. I just wanted to throw dip in the air and run. Those were the nice women. Some women were, um, well… they were turds.
No matter where I went on this day, I was an easy target. If I drank anything non-alcoholic, there were women who would pat my tummy and say “when are you due?” A small social guideline: don’t ask a woman if she is pregnant, unless her water breaks on your flip-flops, a baby arm dangles out of her vagina and she asks you to cut the cord. Then, and only then, may you ask if she is having a baby. Otherwise, shut up.
Please, on Mother’s Day, have some compassion. If you see someone without kids, do not ask them why they don’t have children, why they don’t just adopt, or if they are pregnant. Please be kind. Be quiet and pass the dip.
I am writing this for the friends and family who listened, didn’t pry, and above all stuck with me on my quest to be a mom. If I am happy on May 9th, it’s largely because of these people’s quiet empathy and unending encouragement. And, if I am happy on this day, it’s because I am in love with being a mom and so grateful for the circumstances, as painful as they were, that led me to my wonderful daughter.   - CNN ac360 blog

If I can leave you with anything, then let me leave you with the thought that you never know what a person’s struggles are. Be thoughtful, encourage others, and band together as women instead of judging without understand their circumstances.  
 
I’m so incredibly fortunate to be a mom, and the challenges to get there make it all that much sweeter. That is why I feel so passionately about making this couple’s dream a reality. I want them to experience the joy that I do, and that millions of others do without as much effort.

A great question!

I began to write my response to Jenn's question in the comments section, but realized others might also have the same question, so it gets its own post.  :)

Jenn asked:
Did your doctors mention whether or not they can aid in avoiding placenta previa? Are they able to "shoot" the egg up high in your uterus, hoping it will attach in a higher location? (I know "shooting" the egg is not proper medical terminology. lol.) 


That's a really good question Jenn!

On Thursday when I went in for the final blood work and ultrasound, they mapped my uterus very carefully. I watched as the ultrasound tech highlighted the curve and basic "geography," including markers for both the cervix opening (mine points toward my back as opposed to most that point downward) and also the opening of the fallopian tubes.

When the RE begins the transfer, they insert a catheter into the uterus, placing the open end of the tube very close to the place where the fallopian tubes meet the uterus. This simulates exactly where an embryo at that stage of development would naturally be after fertilizing and completing the trip out of the tubes. Generally speaking, because of the placement, actually the risk of an ectopic pregnancy is greater than the risk of placenta previa.

Placenta previa is more often associated with women who have some sort of uterine irregularity, whether that's an abnormal shape, fibroids, scarring from surgery/csection/abortion/infection/previous pregnancies (especially multiples), or advanced maternal age.

So you might ask how IVF results in an increased risk of an ectopic pregnancy if it bypasses the tubes all together. :) The answer is that sometimes the male  embryos forget to ask directions before leaving the petri dish and start wondering around after they're placed. If the RE placed the embryo too high in the uterine cavity, or if they are injected too forcefully it encourages that risk. That is why the uterine mapping was so specific and why some RE prefer to place the embryo with ultrasound guidance.

The risk is generally only about 2-5% though. Most RE's do enough IVF procedures that it's second nature to them.

So that's probably a longer answer than you might have expected, but it's kind of fascinating, don't you think?  :)

Uterine health may be more important than egg quality...

An article just came out regarding a study where Texas Children's Hospital determined that uterine health may be more important than egg quality, with regard to birth weight and gestational maturity, for mothers who use IVF. Here is the link to the article: http://www.texaschildrens.org/allabout/news/2011/Uterine_health_IVF.aspx

Some of the highlights:

• The study explored several scenarios and found that the birth weight associated with standard IVF, where the mother is carrying and embryo created with her own egg, was higher than those with donor egg cycles, but less than that in gestational carrier cycles. 

• ...In standard IVF, an embryo is transferred to a woman who has just undergone controlled ovarian hyperstimulation, while using a gestational carrier IVF, the embryo is transferred to a “natural” or unstimulated uterus. Then, the researchers looked at IVF utilizing frozen embryo transfer in which an embryo created with a patient’s own egg is transferred to her own unstimulated uterus. In the cases where the uterus was unstimulated, they found the transfer cycles had markedly greater birth weights than those born as a result of standard IVF.

 

• The complete study, called “Toward understanding obstetrical outcome in advanced assisted reproduction: varying sperm, oocyte and uterine source and diagnosis,” can be found at Fertility and Sterility at www.fertstert.org.

FAQ

I certainly welcome questions that people have for me. I'm a pretty open book and the more we talk about surrogacy and infertility, the less foreign it seems to people, right?

So here are some that I get asked most often. Feel free to add to the list. I'll answer them.

• Do you have any hormone treatments for the ivf? 

Sometimes people are put on birth control or Lupron to suppress the cycle and help time the IVF for the convenience of the intended mother's cycle and/or the fertility clinic. However, I am doing a very un-invasive hormone prep which is quite nice. I will be placed on estrogen (probably a patch) until right before the transfer. After the transfer I will be placed on progesterone which helps in some cases to sustain the pregnancy.

• What about the possibility of multiples? 

In an effort to reduce the risk of multiples, we will be limiting the amount of embryos transferred. The great thing about IVF as opposed to IUI is that you can better control the number of fertilized eggs, thus reducing the risk of high order multiples. 

• Who makes prenatal decisions (such as ultrasounds, testing, etc)? 

 Tests relating to the baby will be determined by my OB, their RE, and the intended parents. Testing related to my personal health is decided by me.

• Who makes decisions during labor and birth?

Same - they make decisions related to baby's health. I make decisions related to my health. Both in cooperation with the appropriate Dr's and specialists. I've chosen to give birth med free and the parents are on board with that. They've also agreed to allow me the space I need during labor. They will join me once I start to push.

• What will the parents do as far as immediate bonding? 

The parents will receive the baby as soon as he or she is born. I've not discussed in detail their plans for bonding though. I have no doubts that the parents have thought about this though and do have a plan.

• Breastfeeding? 

This is really cool. The intended mother is planning to attempt lactation. It will mean a lot of effort on her part, several months in advance but I think it's a neat thing for her to do, and it will provide an amazing bonding experience. I will plan to pump the milk that I produce and send it to them as a supplement. 

• What will you do to care for yourself during that emotional rollercoaster called postpartum?

I feel like I'm perfect for this because I'm  not a hugely emotional person. I have no desire for a newborn at this stage in the game and I think, after all of the testing and 9 mos of carrying a child, I'll just be glad to have my body back again. People ask me how I could possibly give up my baby that I carried all that time. My answer is simple. It's not MY baby. I'm just carrying it and then giving it back. It's really that simple.

• What will you tell your kids?

I had a wonderful opportunity to explain it to my 3 year old after the intended parents had visited us. She'd asked, "Where are their kids?" I told her that they didn't have any and that mommy would help them so that they had a baby. I reminded her that sometimes I would carry her dolly down the stairs for her, but that when we got to the bottom, I'd give it back because it wasn't mine. It was still hers. In the same way, I'd carry this couple's baby and then give it back after I was done helping them.

My youngest child won't really understand or remember any of it.

• Where will you give birth?

I'll be giving birth in my home city. The intended mother will be here for the last month of the pregnancy and the intended father hopes to join us for the last two weeks. They will attend the birth.