We finally made it past the waiting period, and had our appointment with Dr. Greene for the trial embryo transfer, as well as the consultation appointment. We were told to drink 32 ounces of water, within 15 minutes, 1 hour before the trial transfer. It was important to have a full bladder so the ultrasound tech could see everything. We sat in the waiting room for a bit after checking in, and my eyeballs were swimming by the time we were called back. The nurse told me I looked pretty uncomfortable, and began the ultrasound on my bladder. After seeing a massive black mass on the screen, she said I must be a very good water drinker because I was too full. She asked me to empty two full cups of liquid and then one half cup. I thought to myself, “great, I get to torture myself by opening the flood gates, and then have to have enough self control to lock it down mid-stream”.  I came back and waited for Dr. Greene to come perform the practice transfer. He came in and I asked him, “why the practice embryo transfer?” Dr. Greene explained that the embryos’s are extremely sensitive to light, smell, temperature, etc., and they want to make sure they don’t run into any unforeseen issues with inserting the catheter, so they could transfer quickly and efficiently. I nodded my head, laid down and prayed I wouldn’t pee. Everything went very smoothly, and when it was all over, I got to use the restroom, then meet Dr. Greene in his office for our transfer discussion.

Rick and I walked into Dr. Greene’s office, and I’ll never forget his massive desk, with one large Apple computer, and two enormous brown leather chairs for the couples to sit in during consultations and meetings. I remember the chair being too big for me. I either had to sit all the way forward, almost leaning in towards Dr. Greene, or I had to sit all the way back to utilize the back rest, which made my feet dangle. Perhaps this was just an uncomfortable conversation, or maybe it was literally just that big chair. We had a list of questions to review with Dr. Greene, so I brought out my phone with my notes app. Our list included the following:

1. Should we get the flu shot? (I am personally not one who gets a flu shot, but I wasn’t willing to take a chance during pregnancy)
2. Do we need to worry about the Zika Virus (this was at a time when the Zika virus had made it’s way to the United States, and every pregnant, or about to be pregnant woman was terrified of contracting it)
3. Can we transfer more than one embryo?
4. Diet
   1. What to avoid
   2. Calcium
   3. Caloric intake
   4. I was a pescatarian at the time – did I need to change this

But before I could begin with my list, Dr. Greene started with his. He asked first if we wanted to know the sex of the embryo’s. We told him that we had that discussion with our nurse, and we did know the sex of all five embryos. He said he liked to ask first, because if we said “no” he would not look at the results either. He had a piece of paper on his desk that was turned over, so the blank back was facing up at him. I then understood that the results of our embryo’s were on the face of that piece of paper. We initially began talking about the transfer of one embryo. If we transferred one embryo, we did not want to know the sex of the embryo that would be transferred. We wanted the healthiest embryo transferred. Dr. Greene said all of our embryo’s were in excellent condition, and he put the word, “healthiest” into perspective. He explained that it would be as if Rick or I went to the bakery and wanted to pick out a chocolate glazed donut. They are all the same, but as individuals, we select based off our own desires (more chocolate, less chocolate, fluffy, crispy, etc.). It was quite the analogy in putting us at ease, that all our embryo’s were healthy.

The next question was, “how many embryo’s do you want to transfer?” Rick and I looked at each other and smiled, then looked back at Dr. Greene. I told Dr. Greene that we really wanted to transfer two…I waited for his disapproval and his laundry list of reasons why we should only transfer one, but that never came. He said he could absolutely do that for us, he only cautioned that we really needed to be in love with the concept of having twins. He told us a story of a colleague he used to study with who said, “you should not have any more babies at one time, than the amount of nipples you have. A dog has many nipples and can have a litter of puppies, humans have two nipples and should have no more than two babies at one time.” Makes sense.

Once Rick and I had the go ahead to have twins, we explained that our dream was to have one boy and one girl. Dr. Greene crossed out the previous note of not knowing the sex, and took out a purple pen from his drawer to make the new notes. He told us that he would send the request in to the lab for a boy and a girl embryo to be transferred. I felt my heart skip a beat…I would be pregnant with twins in a few short weeks.

It was our turn to share our questions and get some insight. The flu shot was recommended because flu season was approaching and there was no reason not to get it. Calcium was not as important as I suspected. Dr. Greene expressed that prenatal vitamins were vital, and if I needed a bit extra calcium, I could take a chewable tablet each day. The Zika virus was a surprising topic. Dr. Greene expressed that this was truly a topic that was being greatly blown out of proportion. Fear was being instilled in the minds of women in America and it was not necessary to get worked up about it. We hadn’t traveled out of the country prior to our IVF journey, and we should not be concerned. Lastly, my diet…my husband was a firm believer that I needed to return to eating chicken and red meat prior to getting pregnant. I had no desire to start eating meat again, but I was going to do what was necessary for our babies. Dr. Greene himself was a pescatarian and informed Rick and I that sources of protein can actually be more significant in plant based sources. No need to change my diet.

After leaving the office I felt so full of hope, joy and love. Love for these babies that were going to finally be with me again. It was a time that I could relish in my excitement, and leave the worry out of my mind and my heart.

Trial Transfer – What, Why, How, and When…Oh and Does it Hurt?

Many of you may be reading this post wondering why on earth would you go through a trial transfer? Why not just get off to the races and transfer. Here is a little run down on the what, why, how and when for the mock embryo transfer.

What.

The “mock” embryo transfer, or trial transfer, is the procedure done with your doctor that assists in determining the ideal location to implant the embryo in the uterus, measures the length from the cervix to the placement location, and rules out any unforeseen issues, like cysts, scar tissue, a blockage, etc.

Why.

Embryo’s are also extremely sensitive to light, temperature, and odor. By having a trial transfer, doctors are limiting the amount of exposure, and minimizing the risk of damage during the moments that an embryo is no longer incubated and being transferred to the uterus via catheter.

How.

You will be asked to arrive to your appointment with a full bladder, this not only helps move the uterus into a position that makes the transfer easier, and it helps with the visual quality on the ultrasound machine.

You’ll then lay back in a chair, similar to those in an OBGYN practice. The chair will have stir-ups for your feet, and a speculum will be used to assist the doctor with placing the catheter into and through your cervix to the uterus.

Your doctor will measure the distance between cervix and uterus,  and plan the best placement for transferring the embryo. Each uterus is different and could have elements that affect the placement (tilt and position).

When.

Depending on the type of embryo transfer you have selected, whether fresh or frozen, as well as your doctors preference, there are a few options for when the mock transfer occurs.

The mock transfer can occur as early as a month before the actual IVF process begins. The initial testing procedures include, but are not limited to, HSG, hysterography with saline, and hysteroscopy.

Another option is one month before the FET cycle. This is a time period where the reproductive system is quieted down a bit due to being on birth control pills. This would is common for those IVF patients going with a frozen embryo transfer. On the other hand those patients going forward with a fresh transfer, may commonly have their mock transfer performed a month before the IVF cycle. Again, this is a time period when the system is quieted down from birth control pills.

A mock transfer can also be performed during the egg retrieval procedure. You will be under anesthesia during this process, so you won’t even be aware of it happening.

Lastly, the mock transfer can be performed on the same day as the actual embryo transfer. The doctor can do a trial run, and then immediately implant the embryo after the trial run.

Does It Hurt?

Luckily, the catheter used for the embryo transfer is smaller and more flexible than those used during procedures like the hysterography and hysteroscopy, resulting in the pain level being minimal. You may experience a slight feeling of cramping or discomfort when the catheter is being placed.

Commonly women are so distracted by their full bladder, that they are unable to focus on anything other than not peeing on the table and their doctor. So, there’s the silver lining.

Photo credit to https://www.ivfbabble.com/2017/11/10-tips-preparing-body-embryo-transfer/