It only takes one...

Although we strive for multiple embryos in stimulated IVF, sometimes we loose track of the concept that it really takes just a single embryo to make a baby. I have a current patient who went through IVF with PGS (preimplantation genetic screening) and had multiple grade AAA blastocysts for embryo biopsy on day 5. Interestingly, only a single embryo of all these normal looking blasts was genetically normal. We transferred that single embryo and now she has an ongoing pregnancy. Would we have found that single normal embryo eventually? Yes. Would the patient have become emotionally drained, frustrated and financially strapped by the repeated transfers... Possibly...

So as we revise our approach to stimulated IVF, PGS may become more and more common. In the end, it still just takes a single good embryo to make a baby. Does Natural Cycle IVF create a higher percentage of normal embryos compared with stimulated IVF? We don't really know but this could explain the higher implantation rate that we see in NC IVF....

Last weekend I was in Boston cleaning out my parent's home as my Dad prepared to move into an apartment. I ended up with a minivan full of thousands and thousands of slides. Many of these were photos of yours truly that I had never seen. (These photos would serve to undercut my brother Steve's assertion that I was found in the gutter one night and raised in my parents' home under the mistaken impression that I was actually a Gordon born and bred....).

The photo on the right is me with my dog Karma. Although not evident in the photo, Karma was actually missing her right front leg which was amputated after she was struck by a car early in her life. She lived to be about 13 years old and it never slowed her down. In her case it took only 3 legs to live a full and happy life and in your case remember it only takes a single good embryo!

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Crazy Twin Stories #2

Here is another one that leaves you scratching your head....

RL is a 32 year old fertility patient who had failed to conceive with less invasive therapies and elected to pursue stimulated IVF. At the time of egg collection we anticipated around 12 eggs but only got 4 eggs plus a couple of empty zona (egg shell only with no egg inside). From those 4 eggs we ended up with only a single embryo. However, it was a beautiful blastocyst and we had high hopes for success in spite of the relative inefficiency of the cycle...In fact, she did conceive and her betas were very high....really high.

At the first ultrasound visit I saw two sacs. At the next visit both sacs had embryos with heartbeats. I was very concerned about her ability to carry twins but she and her husband were ecstatic. She had an uneventful pregnancy and delivered at 38 weeks. Both babies were healthy and went home with Mom after delivery. So what, the informed reader may declare...another case of identical twins...ho hum. Yes indeed....except that the babies were a boy and a girl...clearly not identical.

So the explanation is that her fallopian tubes did catch at least one egg that we failed to retrieve and they had sex prior to retrieval and voila....bonus baby. This happened to me previously in a case where I froze all embryos because of OHSS and then the patient failed to get a period and was actually pregnant. She had been intimate with her husband 5 days prior to retrieval and I got 28 eggs in that case...but apparently I left one behind. That was a tough case to enter into our statistics....retrieval, no transfer but pregnancy and delivery...go figure.

Mark Hughes (smartest doctor I know) reported a case where he was comparing the results of PGD/PGS with pregnancy outcomes once the babies were delivered. In one patient, the baby was definitely the genetic child of the couple but did not match any of the embryos that were transferred. Another case of slipping one past the goalie I guess...

So the take home message is that if you have sex during stimulation then once in a great while you may see outcomes that defy the odds....

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