IVF 15: One egg in Dr Jekyll's basket

There's no reason for the hiatus in updates except the obvious one, that during my mandatory 48-hour bed rest I went on a Colin Firth marathon, and have only just finished the second DVD of the BBC miniseries version of Pride & Prejudice. (Because some people who know me read this blog, I categorically deny the rumor that other Firth-related rentals included "Bridget Jones 2.")

The embryo transfer on Monday was not traumatic. If anything it tended towards the unintentionally silly. The two assistants who prepped me were new to me (a pity, because I've grown comfortable with all the staff I've met). The older one looked about 21, and the other--a trainee--had such a baby face that I wondered if it was legal for her to see the sort of adult entertainment I was going to provide.

I'm not sure why no one told these young ladies that they should probably do a dry run-through of the procedure before bringing the patient into it, but it was rather comic. First of all, the embryo transfer is treated as a sacred ritual in this fertility clinic, with advice like, "You may bring a copy of your favorite CD if you like," (who in hell would want their go-to album to turn into a IVF soundtrack? And what if I brought in death metal?)

In the event, we decided that there was no music we wanted forever associated with the special, special moment of us, our potential baby, and five other strangers in one room together, which was just as well because I doubt we could have replaced the soft New Age tunes that were already playing. And in any case, given the relative importance of my role (don't twitch), Dr Hyde's role (don't talk), and the doctor's role (everything else), we preferred for him to have the music that he wanted.

Anyhow, the assistants brought me in and laid me on the bed and took a preliminary ultrasound to make sure my bladder was full enough to push the uterus into better alignment with the cervix (in most women, it's tipped forward above the cervix like an empty upside-down hot water bottle). Check. Then the "older" assistant had me put my legs up. She showed the other one how to wrap my legs with a towel and then a warm sheet (yay!) so that I didn't get cold.

The younger assistant proceeded to completely biff it. There was some unwrapping and some re-wrapping, followed by, "It looked so easy when you did it!" Similar antics followed the height adjustment of the leg supports ("Which mark were you lining it up with again?") and then the removal of the lower half of the bed, where my legs had previously rested ("Wow, your knee must be stronger than mine because when I push in there it just doesn't unlatch!")

The doctor's office, wisely, had already given me a tab of Valium.

Finally, they turned off all the room lights except for the ultrasound monitor and one surgery lamp, which I thought of as the Twat Spot. "The doctor should be in any minute." Oh good, because this isn't weird.

More music, more waiting, and finally the doctor, the embryologist, the two assistants, and Dr Earnest Resident appear. "Hello!" I chirped, oblivious that this was Quiet Time. "Good morning," Dr Big Shot whispered in my ear reprovingly.

And then the big moment. Dr Hyde, who had a seat near my head, was invited to look through the microscope at the lone blastocyst that had been selected. I almost unwrapped my legs to go join him, I was so jealous. But he returned and said that it looked terrific, just like tissue he would want to see under his own microscope ("Patchable!"), and furthermore that it took after him.

After that, Dr Earnest Resident took over the ultrasound, my nether regions were unveiled and the Twat Spot reangled, and the whole procedure began. The doctor swabbed out my cervix, which didn't hurt--it wasn't the sort of scrub brush they use for Pap smears--and then did a trial run with the catheter, trying to get the measurements and angles just right.

It turns out that Dr Big Shot has written a recent review on embryo transfer optimization, so I can tell you quite a lot about what he was trying to do. First, multiple studies show that if there is any trace of cervical mucus, blood, or other drippy bits on the catheter tip, the pregnancy rate is decreased significantly. It's not clear precisely why this is, but keeping things clean is a priority.

Second, proper placement of the catheter is critical. Ideally the embryo will be ejected into the middle third of the uterus. It must not be ejected into the uterine lining itself, which sounds trivial until you see your uterus under an ultrasound: at this phase in the cycle, for obvious reasons, it's pretty much all lining. (In women who have given birth previously there may be more space, but in us nulliparous types the uterus is a deflated balloon.) So the doctor has to thread the catheter through the cervix and into the uterus, taking care to touch neither mucus, blood, nor endometrium along the way.

Who knew that Operation was really training up little doctors?

So we watched while the thin white line of the catheter snaked up through my cervix into the uterus, shooting straight down the middle of the space defined by the uterine lining. After the trial run, it was time for the real thing. They load the catheter with 20 uL of culture medium, with the embryo about one-third of the way in from the tip.

We watched again as it snaked up my lady parts. The culture medium must have a different density than water or for some other reason is distinctly visible on ultrasound. Dr Big Shot pushed it out and we saw a white streak shaped like a comet exit the catheter and take up residence. After a pause the catheter was out, the doctor was cleaning up, and everything was over. But they took an ultrasound picture of our little comet, and it is now at home, right next to his report card.

"How do you feel?" murmured Dr Earnest Resident. "That was much better than sex," I replied loyally.

Then I was wrapped in more warm blankets, kept supine for a half-hour, and eventually allowed to dress and be wheeled out to the car. The "older" assistant said, "It's so nice when they go so smoothly like that." I immediately revised my opinion of her upwards.

I doubt I need to tell you that my thought process for the last five days has gone something like this: "Hey, did I feel something? Was that a little cramp? Is that a sign? If so, is it a good sign or a bad one? Wait, has it stopped? Is that good? Is it next Friday yet?" Repeat this, with small variations, every ten seconds or so and you will have a good representation of my state of mind.