That extra time exposes information crucial to predicting a pregnancy's success. Having those extra days of growth, Behr said, "is like being able to judge marathon runners at mile 22 instead of mile 2. At the start of the race, you know the winner is someone in the group, but it's much easier to pick the winner toward the end of the race."
Beyond that better preview of the future, the extra days also gives assisted reproduction technicians, if a pre-implantation genetic diagnosis has been requested, the ability to remove an embryonic cell at a stage before all the cells begin to differentiate.
Engaging all elements
Stanford has always taken a comprehensive approach to treatment, Westphal said. The center's team includes embryologists, reproductive endocrinologists, clinical nurses, therapists and highly trained technicians. And all the lab technicians can do every step in the clinic's various procedures. "We have to be able to step in when needed," said the lab's manager and senior embryologist Janice Gebhardt, who has watched IVF/ART evolve since she began in the field almost 20 years ago. Most people, she said, "take pregnancy for granted."
In the clinic's phone center, voices murmur quietly as patients are given results of various tests or of pregnancy status. It's another part of the process that requires a delicate approach; the news can be bad as well as good. "But when they finally bring their babies in," said the clinic's nurse manager, Amanda Schwartz, RN, "that's the best part of my job."
Schwartz and her colleagues are an important part of the clinic, helping patients through loss, when necessary. That stress and emotions can affect fertility is a definite possibility, said the clinic's therapist, Penny Donnelly, RN, MFT. She runs groups and workshops for men and women to give them a safe place to talk about what they are going through, and to give them ideas about what they can do that pharmaceuticals and medical expertise cannot. "I use the analogy of a three-legged stool," Donnelly said. "The third leg is what you as an individual can do to create your best well-being by managing your diet, nutrition, stress and thinking patterns."
It took Michelson and Gardner four cycles of egg harvesting and seven cycles of implantation to have Joshua. As soon as he reached his first birthday, the couple tried again, using embryos left from one of their previous rounds of IVF. Although another cycle of retrieval was needed, the second pregnancy came much more quickly. Michelson's attitude with this IVF procedure was far different. "I knew I could be pregnant," she said. "My brain knew it. My body knew it. A lot of the anxiety wasn't there any more."
Michelson, like many parents, is keeping scrapbooks for her children, including the very first photograph of them, as embryos just before implantation. "They look like little flowers," she said. "As they get older they will say, 'Mom, what's that?' It'll be a fun part of their story. First they were flowers and then they were babies!"