Primer to my ART History

I'm not artistic, so unfortunately, ART in my world stands for Assisted Reproductive Technology.

Pull up a chair and your beverage of choice, because here is the info you need to even begin to understand my ART history, which tells you a bit of where I am at.   For the record, through all this effort and the tens upon tens of thousands of dollars spent, I do not have any small human beings to call me "mom."

First, allow me to introduce you to some brief introduction on human reproduction.   Women are born with millions of eggs, right?   But what happens to all these guys?

Each cycle your ovaries recruit a set number of immature eggs to step their game up to be potential baby-making material.   For an average women of good baby-making age, which, for the record, is not me, they may recruit around 20 eggs per month.  In the two weeks of the cycle leading up to ovulation, a women's body produces follicle stimulating hormone (FSH) and lutenizing hormone (LH) to feed the one who usually wins the reproductive lottery and matures to be released for potential fertilizing at ovulation.   Occasionally more than one egg of the 20 or so becomes mature, and that contributes to fraternal twins.

ART provokes the ovaries to have more of those starting eggs become mature.  This can be done by either pumping LH and FSH into the women vial a needle in the gut (or their subcutaneous location of choice), taking a pill that tricks the pituitary gland to producing more of those hormones, or a combination of the two.

There are two main techniques in ART-IUI & IVF.   IUI stands for intrauterine insemination, and used to be referred to as artificial insemination.   It is also similar to turkey bastering that you may see jokingly in the media.

Sorry about putting that image in your head.

At absolutely best, IUIs only have a 15-20% success rate, but for most couples it is much lower.   It is often used first when couples do not have any discernible fertility problems that accelerate the jump to IVF.  It is also many times cheaper than IVF, so couples, fertility specialist, or, insurance providers, for the lucky few with insurance, may pursue this route first before investing the amount of a gently used Honda into IVF.

You've probably already heard the term IVF, or in vitro fertilization.   Tube tube babies is neither an accurate term or a fair one to the families going through the process.  With IVF, the women is usually hyper stimulated to mature as many eggs as possible and they are removed in a minor surgical procedure.   The eggs are then fertilized by placing each egg in a dish with a bunch of swimmers, and hopefully one of the sperm decides to get with the egg, hence the term in vitro fertilization.   Most IVF procedures in the US now use a method called ICSI instead of letting the the eggs try to woo the sperm in a petri dish and hoping for the best.   With ICSI, a winner-looking sperm is selected and injected into the egg.   ICSI has a much higher fertilization rate.

So, now we have a fertilized egg.   Congratulations!   Now what do we do with it?

Most labs will culture the embryo to either 3 days or 5 days.  Day 5 embryos are also called "blastocysts," or sometimes merely "blasts" to those in the know.

The embryologist will take a peak periodically at the embryos through their development.   For the first 3 days, a healthy embryo should be doubling its cells roughly every 24 hours.   A day 1 embryo should have 2 cells, a day 2 should have 4 cells, and the ideal day 3 embryo will have 8 cells.   On day 4, the cell division in the embryo, now called a morula for this stage only, starts to crazy accelerate, and by day 5, or sometimes 6 for the slackers, they will have many, many more cells.

For the record, the blastocyst stage lasts maybe 4-5 days, but once they reach the blast stage in a lab, they need to be transferred or frozen.  Frozen embryo transfers, in many clinics, have as a good if not better success rate than fresh transfers.

Once an embryo becomes a blast, you can pull a few cells out of the outer layer, which will become the placenta, and test to see if there are the correct number of chromosomes.   For me, this is a loaded factor that I can discuss at a later time, but an embryo that tests with the correct number of chromosomes has a higher chance of implanting and becoming a healthy baby.

Many clinics prefer to transfer blastocysts, but some will transfer day 2 or 3 embryos based on quality and quantity.

Overwhelmed yet?   Good!   Welcome to my life!   Tomorrow I will share my ART journey with you.