FET update, or In which I discover I have been laboring under a serious misapprehension

So. I had an ultrasound this afternoon to check my uterine lining. In a word it's a "beaut." (Specifically it measures 10.9 mm - the thickest yet - with a triple stripe and my Patent Pending Perfect Shape. But this post is so not about that.) And yes, my Swiss RE really used the word "beaut." He said, in fact, "It's always a beaut" (oh, you flatterer you) to which I replied, "For all the good it seems to do me" to which he replied "We just need to find a good embryo." Ah. And therein lies the rub; because let me tell you, I have been operating under a serious misapprehension concerning the process here in Switzerland. Very, very serious. So serious, and so misapprehended, that it's almost embarassing even to post this.

I have always known that doing an IVF and/or FET in Switzerland entailed more restrictions than the same procedures in the US, restrictions that generally work to lower your chances of a successful outcome. For example, pre-transfer genetic diagnostics are not permitted in Switzerland, although that should change some time before the last glacier melts; embryo grading is not permitted; no more than two embryos can be transfered; and all transfers are performed on day two, which is to say generally before one would discover if the embryo was going to stop dividing on its own. Because we wouldn't want to, you know, improve my chances or anything by weeding out the ones that were never going to make it anyway.* (And speaking of restrictions, let's say nothing of the fact that only heterosexual married couples under a certain age which I'm too lazy to verify right now but I think it's 41 for women and 55 for men can avail themselves of reproductive technology. Though to my knowledge Dr L's office never actually confirmed that R and I are married- a simple matter of requesting the Familienbuchlein - which given that R and I have different legal last names and different insurance carriers seems a bit odd.) Given the restrictions he's working under, Dr L's 33% success rate is downright astounding but compares unfavorably with many a US clinic.

I knew all this going in to the initial IVF and was more than willing to start here, especially given our relatively straightforward male factor diagnosis. In the back of my mind I did think that if things went repeatedly wrong I would consider travelling to the US for a cycle. But we cycled here. Let's refresh. In 2004 we did an IVF cycle in which 18 eggs were retreived. Twelve of those 18 eggs were successfully fertilized. From those twelve fertilized eggs, two were transferred to my uterus on day 2 and the remaining 10 were frozen. The unspoken end of that last sentence, in my mind, has always been "...on day two," meaning they were frozen at the two- or four-celled stage when at least some preliminary information could be gathered about them. Are they well-balanced? Do they exhibit fragmentation? Are they otherwise funky? So that, when it came time to defrost them for the FETs the lab would at least be able to select the better-looking ones, or the less funky ones, to the extent that making judgements like "better looking" or "not too funky" is even permitted in a Swiss lab (and really, it's not).

Um, no. No, no, no. No, they don't do that at all. They freeze the fertilized egg. They inject sperm into the egg, confirm that the egg has in fact fertilized, and freeze it bang! right then. For the IVF back in 2004 they just randomly selected which two of the 12 fertilized eggs they would not freeze and let those two divide until the day two transfer. (Which, when you think about it, makes the fact that it worked the first time all the more astounding.) The rest they froze. So now, when we're at the FET stage, they know nothing about the eggs they're selecting. They defrost two. No way of knowing which one might stop dividing anyway. No way of even beginning to select one that looks more promising than its slackard neighbor. Pick an egg, any egg. Eggs. They froze fertilized eggs. I can't believe I am only just now learning this. The FET is utterly and completely random. They're not permitted to do anything that might improve upon sheer luck.**

Now, I know it's utterly and completely random in nature, too, for you people who reproduce via sex and all and involves a great deal of sheer luck. But you're not paying 2,000 Swiss Francs, are you? Twelve bucks for a bottle of Chianti would pretty much cover it in nature, I'm guessing. I'm not sure what finally understanding this changes, if anything. Would I really have traveled to the US for that very first IVF cycle? Certainly not. Would I have skipped these FETs and done another fresh cycle? Well, yes, perhaps. Or so I thought until R pointed out to me the total randomness of a fresh cycle as well. Pick an egg, any egg. So coming belatedly to this full understanding changes nothing but this: now I can't help but think that, given my consistently beautiful uterus, if we were doing this if the US , if we lived in the US, where they could grade and select embryos, I'd be pregnant already.

How's that for an expat story?

* Yes, there is of course the theory that an embryo that stopped dividing in the lab may well have continued dividing in the more hospitable environment of the uterus. There are REs in the US who perform day 2 transfers because they believe it's better to transfer the embryos back to the uterus as early as possible. It may very well be true. It's all a crap-shoot in the end, isn't it?

** Aside from getting us twelve fertilized eggs, which is twelve more than we ever managed on our own, of course. I'm not completely unmindful of that.