Excerpt from The Doctor and the Stork book
Part 3: It takes a village to make a child
The procedure had yielded 12 eggs, a perfect dozen. Of those, seven had been fertilized. Now the next big event had arrived. We stepped through the door on the left into the transfer room. Maybe it was the Valium, but for the first time since I had begun IVF, I felt awed by the process. We were so close to where the embryos were stored, to the secret forces of fate and biology that could turn those little cocktails of human DNA into breathing babies. Behind a second door, marked LAB, our 120-micron whippersnappers were enjoying the most expensive daycare they would ever experience.
After some moments, the room filled—Ken, No-Name nurse, Dr. Marion, and I were joined by two more women, who appeared together as a pair, mysteriously, from the back-room lab. The all-female makeup of the medical team seemed suddenly significant. It was like the Isle of Wonder Woman with fertility maenads.
I felt grateful to see smiles all around. We were not making love to conceive a baby. We were not two bodies in heat, twisting in unity towards an orgasm that would give new life. We were six people in a sterile room, and it meant a lot to me that the mood was upbeat—almost festive—if slightly strange. We were trying to make a baby, no matter how clinical, no matter the crowd. Forget it takes a village to raise a child. It takes a village to make a child.
-K. K. Goldberg
Dr. Hinckley on game day decisions during embryo transfer
The embryo transfer is the culmination of all the heart and soul you have put into an in vitro fertilization (IVF) cycle. Often the embryo transfer occurs in a fresh cycle, usually at the blastocyst stage of embryo development. This is day 5 after the egg retrieval. If a patient only has one or two embryos, it is possible to perform the embryo transfer on day 3, since the uterus can culture embryos until they naturally implant on day 5 or so.
The benefits of transferring the embryo on day 5 are that we have learned more about the embryo’s potential. It is larger and less likely to become an ectopic pregnancy, and the embryologist is better able to sort the embryos based on quality and likelihood of becoming a baby. At RSC we also freeze embryos at the blastocyst stage on day 5 or 6, as they can withstand the freeze and thaw better (98 percent survival).
About 50 percent of patients choose to freeze all their embryos from the fresh cycle in order to test them for chromosomal problems or to transfer them to a gestational carrier. Sometimes the doctors recommend freezing all of the embryos to prevent OHSS (ovarian hyperstimulation syndrome), or over responding to the medicine. This means that the embryo transfer will take place in another cycle a month or more later.
Most of the time, the decision of how many embryos to transfer has been made ahead of time and is based upon the age of the female patient. However, sometimes there is a game day decision based upon the quality of the embryos, weighing the increased chance of getting pregnant with at least one baby versus getting “too” pregnant with twins or triplets. If the embryos have undergone genetic testing, the results of these tests are reviewed ahead of time and the patient is allowed to choose the embryo to transfer (sometimes getting to choose boy or girl.)
The transfer is not unlike a Pap smear exam at the gynecologist’s office. The difference is that your bladder is full and there is an ultrasonographer performing an ultrasound over your belly while the doctor is working below. Your partner (or a friend) can be in the room with you.
While it may seem like a routine exam, the excitement of seeing the picture of your embryo and witnessing the moment it lands in your uterus never gets boring. It truly is an amazing field of medicine!