Surrey with the Gene on Top

Two weeks later, on April 13, I had my phone consult with Dr. Surrey of the Colorado Center for Reproductive Technology. He had a very frank but reassuring manner. He did not mention donor egg OR advanced maternal age once. I really appreciated this. Perhaps he realizes that if you've come this far, you already understand how being over 35 leads to fertility issues, and that you don't need to hear it any more.

He said I am the perfect candidate for genetic testing. He said, most doctors don't like to talk about bad luck, but it is possible that my three miscarriages are the result of that very thing. He said that it is also possible that we are producing a greater number than usual of abnormal embryos, (his nice way of talking about the dreaded Advanced Maternal Age) and so CCS/CGH genetic testing would help us select the right ones.

He said, "Now if we do test the embyros, and all of them turn out to be abnormal, then you will be two very unhappy people, but you will be two very unhappy people with a lot more information."

Again, I really appreciated that he acknowledged that finding that out might actually cause those things we humans like to call e-mo-tions. Maybe these CCRM doctors take some sort of class on human/fertility patient interaction. Maybe that's the next big money-making thing--training your medical professionals to talk to patients. It sounds crazy, but it just… might… work.

But I digress.

As soon as I could, I asked about the chances of a woman my age not producing any normal embryos.

They have done CCS/CGH testing on 49 women in my age group 35-37. Of those, 1 out of 49 has had zero normal embryos. Now, I would not be surprised if my particular brand of bad luck caused me to be patient #2, but I guess that number is lower than I actually expected, so that might be considered good.

At this clinic, they do the CCS/CGH testing of Day 5 blasts, which enables them to biopsy a 60-70 cell blast instead of an 8 cell embryo. (At OHSU, for example, they take one cell out of an eight cell day-three embryo.) Because there are more cells, and they can take more than one cell per embryo, they avoid the risks of mosaicism. In fact, they are actually biopsing the trophectoderm, which becomes the placenta, instead of the part of the blast that actually becomes the baby. I still don't understand why this method takes six weeks, but whatever--- these people seem to know what they are doing. He said that actually, they've been getting their results back a little faster lately. There is a thorough explanation of this testing method in the Schoolcraft book, If at First You Don't Conceive.

He also really made the argument to get all the embryos vitrified and let my body get back to normal before any transfer. He talked about some study that showed a much higher rate of implantation for a uterus that has been properly prepared and has not gone through stimulation and retrieval that cycle. It was something to do with egg donors and egg recipients. It was like 70 % implantation in the egg donors themselves, and 85% implantation in the egg recipients who had not gone through controlled hyperstimulation in the same cycle as the transfer.

Here is the only statistic that stuck in my husband's head--
For those who transfer a CCS-tested blast, the miscarriage rate is 4.5%

Tests for me:
FSH
AMH
Antral Follicle Count
hysteroscopy (the kind where you are awake)
doppler blood flow analysis

Tests for DH:
Sperm Chromatin Assay
Karyotype
screen for Ashkenazi genetic diseases

Sadly, none of this information was conveyed in song.

But a girl can dream.