Cryobank Checklist – the 411

Cryobank Checklist - the 411

CRYOBANK CHECKLIST:

Contact info for cryobank:
___________________________________

Name of person I spoke to: _____________________________________

Date of call: ______________________________________

Certifications? American Assoc of Tissue Banks? State Tissue Bank License? CLIA?

Genetic Testing
Sickle Cell
Hep B & C
HIV
HTLV I & II
Herpes
CMV
Cystic Fibrosis
Chlamydia
Mycoplasma
Syphilis
Canavan
Tay-Sachs
Familial Dysautonomia
Thalassemia
Fanconi
B-Strep
Gaucher’s Disease
Genital Warts
Niemann-Pick
Gonorrhea
Trichomoniasis
MS
Spinal Muscular Atrophy
SARS
West Nile
Cystic Fibrosis
Full genital culture (how frequently?)

List other testing:

How long specimens held? (min 180 days)

What other hidden/unexpected costs have I not asked about?

Min motility guaranteed? What happens if it is less than the minimum?

Refund policy?

Drug Screening

Family limit

How is family limit checked/verified?

How many are born in my geographic area?

How do you track conditions of donor/offspring in the future?

How would I be informed if a genetic problem appears years or decades down the line?

When should I call to order the tanks?

Online order/pay then.. ? What about weekends/holidays or overnight shipping?

How shipped?

Shipping costs?

Tank costs? (How quickly does the tank have to be returned and what is the cost if it is late? Or damaged?)

What other costs are there?

Do you ever run out of tanks?

IUI Cost

ICI Cost

Bulk rate or specials?

Storage fees?

Do you ask if donors contribute to multiple banks?

What if a donor has donated to other banks?

Has donating to multiple banks been an issue?

What other banks are in your geographic location?

Do you keep in contact with the donor over time? If so, how long?

Do you count on the donor keeping up with you or do you keep up with them?

Is the Donor Sibling Registry or other resources made known to donor

Open ID program?

How is Open ID info kept?

What happens if your facility closes?

What is your protocol for my child if he/she turns 18 and wants to contact the donor?

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IVF – The 411

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About the In Vitro Fertilization (IVF) Process

When medical conditions prevent the sperm from reaching the egg, the skilled physicians and laboratory staff are here to assist. Your eggs are retrieved, inseminated in the lab with semen from your partner or a donor, and then inserted back into your uterus as embryos. While every woman’s cycle is unique, the following is a general outline of the steps involved during a cycle of in vitro fertilization.

Step One: Ovulation Induction

Fertility drugs, taken through injections, are used to stimulate a woman’s ovaries to develop multiple mature eggs. This improves chances for fertilization and ultimately pregnancy. The most common medications are gonadotropins including Repronex, Follistim, Gonal F, and Menopur.

Step Two: Egg (Oocyte) Retrieval

When the eggs are mature, they are retrieved by an ultrasound-guided procedure that is performed under light anesthesia on an outpatient basis.  During the procedure a needle is placed through the vaginal opening and into the ovaries. There are no abdominal incisions or suturing. The eggs are then evaluated in the onsite embryology lab. Once there, they are fertilized with sperm from your partner or a donor. Risks are minimal and recovery takes an hour or two, although post-operative cramping is common.

Success rates vary depending on a woman’s age, her response to the medication and the quality of her embryos. Risks include increased chances of multiple births and ovarian hyperstimulation. The chances of infection or significant blood loss are very low.

Step Three: Fertilization in the Lab

Once the eggs arrive in the embryology lab, the skilled staff analyzes them for maturity and then incubates them. At this time, partners are asked to collect a fresh sperm sample, which is then analyzed and treated to isolate the best sperm for insemination. The sperm is then mixed with the eggs or injected directly into the eggs using intracytoplasmic sperm injection (ICSI).

It takes approximately 18 hours to determine if fertilization has occurred and 24 to 72 hours to establish if the embryo is growing. During a successful IVF process, the oocytes and embryos will stay in the laboratory for approximately 2 to 5 days.

Step Four: Embryo Transfer

A few days after the oocytes are retrieved and fertilized in the laboratory, you will come to the office for the embryo transfer procedure. Embryo transfer is a simple technique and anesthesia is not required. On the day of transfer, you, your partner, and our specialist will discuss the number of embryos being transferred, as well as their quality and grade.

During the actual procedure, a long, thin catheter containing the embryos and a small amount of fluid is passed through your cervix into your uterus, where the embryos are placed.

Conventional embryo transfer is performed three days after the donor’s egg retrieval when healthy embryos (Day 3 embryos) reach the 6-8 cell stage. Blastocysts are embryos that have advanced to 30-60 cells and are transferred five days after retrieval.

If you have a large number of good quality embryos on day 3, the doctor may recommend that you wait 2 days and have a blastocyst transfer on day 5. During the two additional days, some embryos will not progress and others should continue to develop. It is felt that the embryos that survive and progress during this time will be most likely to survive in the uterus. Thus, blastocyst culture is a tool that allows the embryologists and physicians to select the “best” embryos for transfer.

Additionally, blastocyst transfer allows the number of embryos transferred to be kept to a minimum, which reduces the chance for multiple births, while still giving you an excellent chance for conceiving. Transfer on day 3 is still recommended if there are a low number of “good” embryos on day 3.

Following the embryo transfer, you must limit certain activities and continue required medications. In five days, a blood test is done to monitor your hormone levels. A pregnancy test is taken 9 to 11 days after the embryo transfer, and will determine whether the procedure was successful.

Embryo Cryopreservation

Sometimes during the IVF process extra embryos develop during your cycle. If the embryos are of acceptable quality, they can be frozen and stored for future transfer. Since the IVF process can be difficult both physically and financially, cryopreservation helps facilitate treatment of infertility while also reducing the cost.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection, or ICSI, is a micromanipulation procedure that involves injecting a single sperm into the center of an egg. This method of fertilization can be particularly effective in cases of male infertility resulting from obstructive azoospermia (meaning cases where sperm cannot pass from the testis out the penis) or those where the semen has low sperm parameters such as low counts or low motility. For obstructive cases, microsurgical techniques and laboratory expertise combine to extract sperm directly from the testis or epididymus for use with ICSI,

Embryo Quality and Grading

The majority of embryos produced in the laboratory are cultured for 5 days after egg harvest. As embryos develop, they are closely watched by the embryologists and each is assigned a grade. Labs use the Gardner system to grade 5-day old blastocysts which uses the ranking AA-quality (considered the best and rarely seen in the laboratory) to DD-quality (those felt unsuitable for transfer). Day-3 embryos are ranked by the number of cells that are present along with a score from 1 to 4 (1-best, 4-worst). When you arrive for your embryo transfer, the physician will go over the number of embryos you have, the grade of each and make a recommendation, based on input from our embryologists, as to which embryos should be transferred and how many. The doctors try to adhere strictly to the American Society of Reproductive Medicine’s guidelines regarding the number of embryos transferred.

Please note that there is no standard classification system used by all fertility centers. Although most centers use the Gardner grading system for blastocysts, each center created their own system for grading day-2 and 3 embryos as the technology developed and, at this point, it would be too difficult for all centers to try and use a standard grading method.

Fragmentation

During cell division, little pieces may break off and result in a fragmented embryo. A small amount of fragmentation is normal, but as the degree of fragmentation increases the odds of successful implantation are diminished. In fact, significant fragmentation has been associated with chromosomally abnormal embryos. All embryos evaluated in the lab are assigned a fragmentation score by estimating the percentage of the embryo volume that is replaced by fragments. Up to 10% fragmentation is considered good quality, 10-20% is okay and embryos with more than 20% fragmentation are considered suboptimal. While a successful pregnancy can be achieved with a fragmented embryo, the odds decrease as fragmentation increases.

What Happens After an Embryo Transfer?

Once you complete your embryo transfer, you will have approximately 1½ weeks to wait before a pregnancy can be detected. The following tables outline an approximate timeline for what happens during a successful pregnancy after a 3-day transfer (3dt) and a 5-day transfer (5dt).

3-Day Transfer

Days Past
Transfer (DPT)
 Embryo Development
 One The embryo continues to grow and develop, turning from a 6-8 cell embryo into a morula
 Two The cells of the morula continue to divide, developing into a blastocyst
 Three The blastocyst begins to hatch out of its shell
 Four The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus
 Five The blastocyst attaches deeper into the uterine lining, beginning implantation
 Six Implantation continues
 Seven Implantation is complete, cells that will eventually become the placenta and fetus have begun to develop
 Eight Human chorionic gonadotropin (hCG) starts to enter the blood stream
 Nine Fetal development continues and hCG continues to be secreted
 Ten Fetal development continues and hCG continues to be secreted
 Eleven Levels of hCG are now high enough to detect a pregnancy

5-Day Transfer

Days Past
Transfer (DPT)
Embryo Development
One The blastocyst begins to hatch out of its shell
Two The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus
Three The blastocyst attaches deeper into the uterine lining, beginning implantation
Four Implantation continues
Five Implantation is complete, cells that will eventually become the placenta and fetus have begun to develop
Six Human chorionic gonadotropin (hCG) starts to enter the blood stream
Seven Fetal development continues and hCG continues to be secreted
Eight Fetal development continues and hCG continues to be secreted
Nine Levels of hCG are now high enough to detect a pregnancy

More Meds – The 411

I have no idea why I get so excited and overwhelmed every time Freedom Fertility Pharmacy sends a box via FedEx with medications for me !

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The Box !!

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The Meds !

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My Lovenox (blood thinners) !   YAY!!!

My dresser looks like I am starting a small pharmacy, but I know that in those boxes, bottles, and packs are my medications to help me get the twins I want.  Fear is starting to sink in that I will have problems giving myself injections and I almost want to go camp at my sister’s house.  She is an RN.  I am sure I will get it done, but I am excited and scared at the same time.  Today is CD 12 and on CD 21, it starts !

Time Is Ticking !

Time Is Ticking !

Today, I received some of my medications from Freedom Fertility Pharmacy ! My doctor and I discussed adding some meds to my protocol to increase the chances of my IVF taking.

In addition to Gonal F-450, Menopur-150, Lupron, and antibiotic, we added Femera (days 5-9), Prednisone, and Intralipids. After transfer I will be taking Crinone Gel.

I feel like a kid at Christmas receiving my meds because I know they will help me achieve my dreams of having twins ! I am feeling mixed emotions. I realize how much my life will change. Basically, my life will no longer be my own. I will be responsible for another PERSON ! I can not sleep when I want, not that I sleep that much anyway, but still…

I am excited about having a little person to nourish, love, and help shape. I am also excited to see the little persons personality emerge and see what their dreams and aspirations are…

Morning Sickness – the 411 (by babycentre.co.uk)

What causes nausea and vomiting in pregnancy?

Nausea is actually a good sign that your pregnancy hormone levels are high enough to allow your baby to develop and grow. But if you don’t feel sick, don’t worry, as you may just be one of the lucky ones. As many as eight out of 10 women feel nausea in pregnancy, with or without vomiting.

Now that you’re pregnant, your body is producing the hormone human chorionic gonadotrophin (hCG) in large quantities. Once your placenta takes over maintaining and nourishing your baby, hCG levels drop and your nausea should ease. Your sickness is likely to subside once you are between 12 weeks and 14 weeks.

But other hormones may also play a part in causing your sickness, including oestrogen and thyroxine. This is probably why some women’s symptoms last well beyond their first trimester.

If you’re tired, hungry, stressed or anxious, your nausea may be worse. And if you are expecting twins or triplets, you may vomit more often because you have higher levels of pregnancy hormones.

If you are vomiting several times a day and unable to eat and drink without vomiting, call your doctor or midwife immediately. Severe vomiting and sickness, hyperemesis gravidarum (HG), may lead to dehydration, which may require treatment in hospital.

How can I prevent nausea?

It is difficult to prevent sickness completely. It is a natural and normal part of pregnancy. However, you may be able stop it from becoming a major problem.

Relaxation and complementary therapies may help you to reduce your stress levels. Get plenty of rest and consider taking time off work. Eat little and often and work out which foods make your symptoms worse. Rich, fried, fatty or highly-spiced foods are regular culprits.

If you are feeling very sick, try not to worry about eating a balanced diet at this stage. You and your baby can catch up on the right amount of nutrients later in your pregnancy, when your nausea may have subsided.

Most importantly, keep well hydrated, sipping iced water, lemon juice, barley water, or whatever you can manage.

If you really can’t keep anything down, whether food or drink, see your midwife or doctor without delay.

What self-help tips can I try to ease nausea?

Ginger
Ginger is often claimed to be effective against pregnancy sickness. However ginger may make your symptoms worse or cause you to have heartburn.

Ginger is a common remedy in Chinese medicine. It’s based on the system of yin and yang and other opposing factors, including heat and cold. Ginger is a hot (yang) remedy and will make your sickness worse if you are already too hot. Ginger will suit you if you:

  • wrap yourself up in layers of clothing and blankets
  • feel miserable, introspective and disinterested in your surroundings
  • feel and look cold
  • need hot drinks

Try not to rely on ginger biscuits, as these contain a lot of sugar and not enough ginger to be effective.

Try making a tea from grated root ginger. Steep two teaspoons in boiled water, leave it to cool, and sip it throughout the day. Don’t take more than 3g of raw ginger (about three teaspoons) a day. Ginger capsules are an option if you don’t like the tea.

Ginger works in the same way as prescribed medicines and may have an adverse effect on your blood-clotting mechanism. If you take it for more than three weeks, ask your doctor to check your blood clotting. If you are taking prescribed anti-coagulant drugs, aspirin or other similar medicines, you should not take ginger.

Peppermint
This is a suitable cold (yin) alternative if you:

  • feel constantly hot and want to remove layers of clothing
  • want cool drinks
  • look hot and bothered and red-faced
  • feel irritable and hot tempered

However, if you are taking homeopathic remedies, the strong mint aroma may stop them from being effective.

Try sipping peppermint or spearmint tea. Sugar-free peppermint sweets or chewing gum may also help. Peppermint or spearmint essential oil will not suit everyone, as the strong smell could make you feel more sick.

Herbal remedies
Other herbal remedies worth trying include lemon balm tea, slippery elm lozenges, or small amounts of chamomile tea. The effects can be quite short-lived, so you may need to experiment and perhaps rotate the remedies to get the best effects.

Acupressure
Pressing an acupuncture point (pericardium point six) on your wrist may help to relieve your nausea. You can buy wristbands which help you to apply this pressure.

Make sure that the button in the band is placed on the acupuncture point. To locate this:

  • Use one hand on the inside of your opposite wrist, measuring up three finger widths from the crease between your hand and arm.
  • At the point where your third finger is, lift the pressure off until you are just touching the skin and feel lightly for a slight dip. Press into this dip quite deeply and it will feel bruised.
  • Place the button on the wristbands at this precise tender point on both wrists.

Put the bands on first thing in the morning before you get out of bed.

When you experience a wave of nausea, press on the button on each wrist about 20 to 30 times at one second intervals. If you forget your wristbands, you can simply press on these two points, or ask someone to do it for you on both wrists at the same time.

Other ideas
If movement, such as car motion, makes your sickness worse, try listening to music which contains underlying, frequent pulsations. This will recondition the balancing mechanism in your inner ear. Wear headphones to allow the music and pulsations to rebound against your ear.

Eating vitamin B6-rich foods, such as avocados and chicken, may relieve your symptoms. A vitamin B supplement may also reduce your nausea if you can swallow the pills, but they probably won’t prevent you from vomiting. Always talk to your midwife before taking supplements in pregnancy.

Which complementary therapies could help?

Choose a complementary practitioner who is trained and experienced in treating women in early pregnancy. Osteopathy and chiropractic can be effective, especially if you have had any problems with your joints or posture in the past.

Aromatherapy
Aromatherapy may relax you, but the smell of the oils may make your nausea worse. Essential oils which may relieve your nausea include:

  • peppermint
  • spearmint
  • lime
  • lemon
  • ginger (occasionally)

Reflexology
Reflexology that is not done correctly may make your symptoms worse, so only see a registered practitioner. After your first treatment, be ready for your symptoms to get worse before they get better. Your body may need to be kick-started into dealing with the symptoms.

Hypnotherapy
Hypnotherapy may be effective if your symptoms are made worse by stress, anxiety and fear, or ongoing emotional issues. But there isn’t much evidence that it is directly effective in combating pregnancy sickness.

Homeopathy
There’s no evidence that homeopathy works. But if you’d like to try it, make sure that you see a qualified, registered practitioner.

Today is Cycle Day One for me !!! Update…the 411

Today is Cycle Day One for me !!!   Update...the 411

I have mixed emotions since.. THIS IS IT ! Today is cycle day 1 for me. That means on day 21, I start taking the Estrace for seven days. After that, I wait for instructions on starting the injections !

After talking to some of the ladies on my forum who are using the same fertility center, I learned about some protocol add ons that may be helpful. I did some research and then sent a message to my doctor.

My doctor agreed to add femara on days 5-9 of stimming), prednisone (a steroid to help with implantation), intralipids (an IV med which helps if you have an autoimmune disorder in which your body has human killer cells which attack the embryo), and after retrieval, I will inject a blood thinner, Lovenox to also help my uterine lining and with implantation.

This entire process has been nerve wracking and exciting. It has been like a second job ! I have spent inordinate amounts of time researching and on blogs and forums learning everything I can to help put a baby or two in my arms.

I sometimes feel like a failure because I did not meet Mr. Right and will not be able to give my child(ren) a father. But I know in my heart and from experience that it is far better to give children ONE stable parent who is happy than to be in a marriage or relationship that is unstable and devoid of happiness. When God is ready, I will meet the person I am supposed to spend my life with, but if it doesn’t happen, I can not live the rest of my days NOT being a mother.

I am very much aware and very nervous about how much this is going to change my life and I can only pray that God gives me kids on the easier end of the spectrum and not brats ! I am devoted to being the best parent I can be and to giving all I have to this.

I am working on a new docu-series about my experience and to showcase all that we single women go through to get to motherhood.