Thursday, 30 December 2010

10w2d Anxious

It is a long slow wait until my next ultrasound in mid-January. I have ordered a doppler, but it seems to be making its way to my home on foot, and is not due here for another week. Although the queasiness, fatigue, back-pain, and swollen breasts continue, it is not the concrete proof that I would like that everything is progressing well with this pregnancy.

My husband, on the other side, seems to have accepted the fact that our family will welcome another member in August next year. He is busy reading "First Time Parent" and making a long list of all the tasks that must be completed before then. He wants to start painting the nursery and buying furniture. The other day he started asking me questions like if we should alternate bottle with breast at night to allow me to get more sleep, and if we should use a crib in the nursery rather than a co-sleeper in our bedroom.

I responded to his thoughtful questions by bursting into tears. For me, it is all I can do to get through the next two weeks until the Week 12 scan. For him, he figures I've got the pregnancy handled, and his job starts in August. I am thinking fetus, and he is thinking newborn. I am so thankful that he realises that he is an equal partner in the upbringing of our child, but sometimes his go-go attitude is a little intimidating, especially when I can barely muster the energy to get off the couch.

Thursday, 23 December 2010

9w2d: Happy

Today was supposed to be the day of my post-failure consultation with my RE. We were going to discuss strategies to improve my endometrium thickness during the next round of stimulation. I was going to be leaving today with a cooler full of medication, ready to start my suppression injections.

Instead, here I am, pregnant, and less than three weeks away from my week 12 scan. I don't know how one can be in shock for more than a month, but I still feel blown away by our luck.

On Tuesday we had our first appointment with an obstetrician. I had expected just a quick interview with a few routine questions, but they were very thorough. Full medical history, weight, height, blood pressure, urine test, and six vials of blood. They tested for anti-RBC Abs, STIs (syphilis, HIV, hepatitis, chlamydia ), infections (rubella, toxoplasmosis, CMV), blood type, hormones (TSF), and did a full RBC and WBC. I smiled as she said that since it had been over three months since my last SDI screen at the fertility clinic, they had better run it again. I guess they figure I must have gotten pregnant somehow.

Best of all, before she started the consultation, she gave us a quick peak at the embryo with an ultrasound. I whipped off my pants before she had time to realise that we had already had a scan last week, and we were greeted with a happy looking blob on the screen. I was a bit worried at first, as I couldn't see the heart beating and it looked the same size as last week. However, she she pointed out the heartbeat and measuring the embryo as measuring 9w3d, three days ahead of schedule.

Ultrasound and belly photos here.

Overall, I am feeling fantastic. I feel nauseous unless I am constantly nibbling on simple carbohydrates, which might explain the 4 kg increase in weight over the past two months. I however like to think that I am just growing the most comfortable womb ever. I have back pain if I twist or bend down, and heart palpitations keep me awake during the night. I am always thirsty, and I love pineapple and orange juice. My breasts are larger and slightly sore.

I love being pregnant. I was never convinced that this would happen for me, and I love every day that this little embryo grows inside me.

Tuesday, 14 December 2010

8w0d Everything looks perfect

We walked into the shiny new ultrasound department of the hospital, just unveiled a few weeks ago. Lots of space, new machines, and they even called us in 5 minutes early. The doctor was great. She quickly went through our history and confirmed that I had previously miscarried, and then moved immediately to the ultrasound. She delicately stated that at this stage, they get better resolutions with a vaginal scan, and I told her that wasn't a problem, I was used to those.

Pants off and then I was sitting up in the chair, watching my uterus pop up on the TV screen on the wall. A few seconds in, and she said "and there is the heartbeat", and I saw a cute little bean in a gestational sac, with a flicker inside. My poor husband was just confused, I guess he hasn't been watching as many ultrasound YouTube videos as I have, so it took him a bit longer to understand what he was seeing. At one stage he thought he saw whiskers.

She then spent a while measuring everything and checking my ovaries for cysts. She measured the heartbeat at 140 bpm, and told us that they switch the sound on the machine after about 10 weeks. The estimated gestational age was 8w1d, one day ahead. Photo can be found here.

She went away to check the measurements with her supervisor, then came back and said everything looks fine. She said congratulations, enjoy your pregnancy. I said Thank-you. Then we went and made an appointment with a gynecologist for next week, and for a NT scan at 12 weeks.

Afterwards I sat outside in the waiting area with my husband in shock. What a surprise. I am supposed to be starting my Gonal-F injections next week, yet somehow I am already half-way through the first trimester. I am so, so, thankful that we received such wonderful news today.

Monday, 13 December 2010

7w6d Tomorrow

I have seen a lot of scans of my uterus over the past few years. I even have a few photos from my laparoscopy. Yet I have no idea what I will see tomorrow.

One one hand, the queasiness, fatigue, sore breasts and lower back pain suggests that I might be gestating something. On the other hand, these symptoms are all psychosomatic, and I know of plenty of women who have received terrible news at their first ultrasound scan.

Seeing a heartbeat tomorrow is both imaginable and completely impossible.

Tomorrow, we open Schrodinger's box, and hope he didn't share it with Pandora.

Tuesday, 7 December 2010

7w0d Waiting

Today marks my seventh week of pregnancy, if indeed that is what I am. My husband likes to remind me that I can only claim five weeks of this as the true post-conception period. It has been three weeks since I saw those two pink lines. One more week until our first ultrasound.

During our last pregnancy, we had our ultrasound at seven weeks and received the news that I had already miscarried, like we suspected. This time around, I am feeling a little more hopeful. My betas were strong and doubling, I am feeling constantly queasy and tired, and I have not even had a single spot of spotting.

I am trying not to think about what any of this means until after the ultrasound. I keep imagining alternative scenarios - will we see a thriving little bouncing bean, or will we see nothing but a still and silent sorrow?

Seven days to go.

Thursday, 2 December 2010

Grateful

Thank-you all for your excited comments and congratulations. There were over 100 exclamation points in your replies. I was really moved to read such excitement, especially as many of you have been through so much more than we have, and you are still waiting for your own good news.

Many of you asked why I didn't announce this sooner. There were two main reasons.

1. I wanted to wait for my husband to come back home so that I could share this news with him in person.

2. I am still skeptical that this all means what everyone think it means. Sure, I have an exponentially increasing amount of hCG in my serum, and I feel a little queasy and tired, and I haven't seen my period for over 6 weeks, but still, I don't know.

I look at those pictures of month-old fish-like embryos and read phrases like "the neural tube closes" and "small buds will soon become arms" and "heart contractions start", and they all sound preposterous. I bought a pregnancy book but then put it away because it seemed completely irrelevant.

I find myself remembering all over again 100 times a day, and every time it surprises me. I have spent so many years day-dreaming about getting pregnant that this feels like just another fantasy.

As I said before, pregnancy is what happens to other people. Not me. And especially not without an embryologist.

Twelve days until my first ultrasound. I hope to see some wonderful sights that day that change my mind.

Tuesday, 30 November 2010

Unbelievable

-1 dpo (days post ovulation)
I have my final Menopur injection, and a Pregnyl shot to trigger the release from a single 16.1 mm follicle. It is on my right ovary, the one with the partly blocked tube. My endometrium is a very thin 6.7 mm. It looks gloomy.

0 dpo
I have a romantic evening with my husband.

2 dpo
I get a call from the clinic telling me that our frozen embryo didn't make it, and our FET is cancelled. They tell me they can't book me in for a follow-up consultation for another seven weeks.

9 dpo
My husband leaves for a conference in a developing country with no phone contact and sporadic dial-up internet.

14 dpo
I am alone in the house. I figure there's no one there to laugh at me when I pee on a stick. This way it won't be such a shock when I get my period today. However, I look down, and I see the strangest thing:

A spectacular positive test. I had to blink several times, I was sure I was dreaming or hallucinating. No squinting, no colour correction (unlike all the other times). Two very strong lines. Then I remember the 5,000 U Pregnyl trigger 14 days ago. Is it just the trigger? No, it's too strong, and a 10,000 U Pregnyl shot was out of my system by 12 days during my last IVF. So then it must be real.

My husband doesn't respond to any of my text messages. I email a picture to him, but it is a long eight hours until I get his excited reply. He tells me that he secretly had his hopes up for this cycle.

I should make an appointment to get a blood test, but it feels too surreal. I tell myself I'll test again tomorrow and see how that looks.

15 dpo
Well, there's no mistaking this test for anything else:

It still doesn't seem real, and it takes me nine hours to psych myself up to call up the fertility clinic and tell them the news. I was sure that they were going to yell at me for being delusional and making up stories, but instead I hear a smile in her voice as she books me in for a blood test.

16 dpo
I go in for my blood test, so nervous as I watch my blood fill the tube. It looks like the same old blood that I've always had. I can't see any hCG antigens floating around. I make the poor nurse check three times that the tube has my name on it and that they are going to check for hCG, not just LH and FSH.

The clinic surprises me by calling at 11:13 AM. I didn't even have time to get nervous. She tells me that I have a beta of:

1,097

I am in shock. Last time I was pregnant we had a beta of 477 at 20 dpo. A beta of 1097 falls in the top 4% of singleton betas at 16 days post ovulation. My progestrone is great at 31.0. She books me in for another test in a week.

19 dpo
I am tired and sleepy, but then again I am always tired and sleepy. No spotting, no sore breasts, no nausea. Apart from the lack of a period, I do not feel any different. I suspect this is some sort of trickery. I take another pregnancy test at 2 weeks, 5 days post ovulation. I believe it for about 5 minutes.




23 dpo
I go in for my blood test, and again make the nurse triple-check that the label is correct on my tube is blood. I work from home because I can't imagine taking this call in an open office, plus I am too nervous to concentrate properly on anything else. By 12:30 they still haven't called. The later they call in the day, the worse the news, right? At 12:37 my phone rings. I pick it up with shaking hands.

Calmly the nurse tells me that everything looks good, and I am graduating from the clinic. I need to make an appointment with gynecology for an 8 week scan. I am in shock. I ask her for my beta number. "The gynecology number?", she asks. No, the hCG number. She tells me it is:

13,843

Which works out to a very respectable doubling time of 45.93 hours. My progesterone still looks good at 31.4. I beg her to let me pop in for a quick search for a heartbeat, but she says that their work is done.

After sharing the news with my husband, I sit and stare at the screen for about an hour. Then I pick up the phone and ring the gynecology department and book an 8 week scan like any other normal woman would.

28 dpo
Today. I still don't know what to think. I always thought that pregnancy was what happened to other women. I still don't quite understand how we got this fortunate. The embryo failed to thaw. The follicle was on the wrong side. My endometrium was too thin. This is just so unbelievable.

So how do I feel? Tremendously excited. Hopeful. Thankful. Lucky. Worried. Happy.

(If you somehow know me in real life, please keep this information to yourself).

Wednesday, 17 November 2010

To thecrazycatwoman

Dear Crazy Cat Woman,

I am so sorry that your sixth IVF failed, just days after you mourned an unfulfilled due date. You deleted your blog before I had time to leave a comment. Please know that I am so sorry for your loss, and still thinking of you and the babies you never met.

I know that sometimes you have to step away from it all, to get some distance and try to heal. Please know that this community will be waiting for you if you choose to return.

Thank-you for all your support and comments during the year.

Dandle.

Wednesday, 10 November 2010

Happiness today, Hope tomorrow

No Baby Ruth was kind enough to nominate me for the "happiness today, hope tomorrow" award, created by Miss Ruby. Her instructions are to acknowledge something that's making you smile and a hope for one amazing thing to bring you even more happiness. Then pass this award on to anyone who would benefit from looking at their life now and finding happiness in it..



Previous recipients of this award include:
non geordie mum
The life and times of KitVonD
All In One Basket
one donor. one husband. one month at a time.
Adventures in Infertility-Land
My Cheap Version of Therapy
Blawnde's Blawg
The Elusive Embryo
Little Looman Log
My words fly up, my thoughts remain below
Our Fertility Journey
Mommy-in-waiting...
Half as Many Chances
The Road Less Travelled
And Baby WILL Make 3!
Going For It
Time Well Wasted
phoebe gone wilde
Serenity in Chaos
No Baby Ruth: Playing Baseball Without a Bat

I enjoyed reading through their entries and learning about their current joys and wishes for the future. Common themes included

Things that make us happy...
Job
Community
Beauty
Friends
Family
Food
Pets
Travel
Rest
Autumn
Vacation
Play
Sports
Body
Health
Home

Our hopes for the future...
Pregnancy
Birth
Adoption
Travel
Relationships
Friends
Family
Home
Relocation


As for me, I am so happy to be married to such a wonderful person. My husband is the best part of my life, and makes me smile with joy. I am hopefully that I never lose perspective, and that I remember that no matter where life takes us, as long as we have each other we will make a beautiful family.

I am passing this award along to anyone who wants a bit of hope and happiness in their life.

Friday, 5 November 2010

IVF#2: scheduled

Thank-you for all your advice yesterday.

I called the clinic today and spoke with a lovely midwife. She said The Professor had very recently put a big note on my file saying that he must meet with us before we proceed with our next cycle. My husband suspects that The Professor wants to talk to us about my thin endometrium and suggest some further tweaks to our protocol.

However, I managed to convince her to let me start BCPs before the consultation, and schedule me to put me into the system to start injections a few days after the consultation. So this is my tentative calendar:

November 16: Start BCPs
December 23: Consultation with The Professor
December 27: Start suppression with decapeptyl
January 6: Start Gonal-F stimulation
January 24: Tentative transfer
February 4: Tentative beta

I am so happy that I can ring in the New Year while in the midst of an IVF cycle, full of hope and excitement for the year ahead.

Thursday, 4 November 2010

FET#1: Cancelled

Oh yes, that word that is heard far too often in the Land of IF: "Cancelled".

Our poor little 6-celled embryo did not survive the thaw.

When the clinic rang this morning, I could tell by the tone of her voice that it wasn't good news. Then she confirmed this by saying "I am afraid that I don't have good news". I knew that we had a 40% chance of cancellation, as we only had one embryo to defrost. So this was not entirely unexpected.

But then she surprised me. She said that I had to have a meeting with The Professor before we started our next fresh cycle. I told her that, no, we just had a meeting with The Professor, and we had agreed on a new protocol for the fresh cycle. She told me, no, my file said that I had to have another meeting first. I told her that wasn't necessary. She told me it was. Fine, I said, and asked her when the next appointment was available.

December 23

That's seven weeks from now. I have to wait seven weeks to have a 10 minute conversation in which The Professor tells us what we already know. Look, I enjoy talking with The Professor as he is quite knowledgeable and can answer some of our questions. But I am not willing to wait seven weeks for the privilege. Last time we had the appointment, he had already reviewed our chart and determined a protocol. Nothing that we said changed this protocol. It was a reassuring meeting, but hardly medically necessary.

I am thinking of sending the clinic an email like this:

On September 23 we met with [The Professor] to discuss our treatment options. He told us that there was a 40% chance that our upcoming FET cycle would be cancelled due to the embryo failing to survive the thaw. We discussed our treatment options for the next fresh cycle if the FET cycle was unsuccessful. [The Professor] recommended an injectable GnRH-agonist instead of nasal buserelin, and the use of recombinant Gonal-F instead of urine-derived Menopur.

Today we learned that our FET cycle was cancelled because the embryo did not survive the thaw. However, I was told that we were required to wait another seven weeks for another meeting with [The Professor] before we can begin our next fresh cycle.

I understand that [Fertility Clinic] is a large and busy practise that deals with hundreds of patients every month. [The Professor] works many hours as an academic, a researcher, and a clinician. We appreciate the fact that he is very willing to take the time to meet with all of his patients one-on-one, and we understand that he meets with a large number of patients.

However, we do not feel that this appointment is strictly necessary, and we would love to be able to begin another fresh cycle as soon as possible. Is there any way that we could commence the next cycle earlier without having this appointment first? Or if a consultation appointment is essential, could we meet with another doctor in the clinic if they have an earlier slot available? We are also open to consultations via email or telephone.


What do you think? Am I over-reacting to a seven week wait? And how do I tell them that I don't want to wait for a consultation appointment, but I do want to ask them to add estrogen and sildenafil to my next cycle?

Wednesday, 3 November 2010

Endometrium thickness

For every single cycle, my final endometrium thickness has been 7 mm or below. For this last cycle it reached a maximum of 6.7 mm. I know this is bad, but how bad is it? I did some research for myself today, and wrote up my findings.

Endometrium Thickness
During the follicular stage of the cycle, estradiol released by the developing follicles to stimulate endometrial proliferation. In general, the greater the proliferation, the thicker the endometrium.

In both fresh and frozen IVF cycles, a thinner endometrium is associated with lower pregnancy rates. In one study of 1382 fresh IVF cycles, endometrial thickness of less than 10 mm on the day of transfer was significantly associated with lower pregnancy rates (Kovacs et al., 2003). One study of 768 FET cycles found that live birth rates were 1.9-fold lower in women with endometrial thickness of 7-8 mm compared to women with thickness of 9-14 mm, after adjusting for confounding variables. The lowest pregnancy rates were found in women with endometrial thickness less than 7 mm (El-Toukhy, et al., 2008). Biochemical pregnancies have been associated with a thinner endometrium (Dickey, et al., 1992).

Association or causation?
Of course these studies are not saying that a thin endometrium is causing implantation failure. It may be a proxy for another factor. However, in one study logistical regression found no association between endometrial thickness and embryo quality or age (Kovacs et al., 2003).

Multivariate analysis has concluded that endometrial development is one of the factors that play a significant role in IVF outcome. Other variables such as age, embryo quality, number of embryos transferred and stimulation protocol were also shown to have a significant impact on treatment outcome.

Does increasing endometrial thickness improve pregnancy outcome?
Numerous possible treatments for increasing endometrial thickness have been proposed. These include aspirin, tamoxifen, sildenafil, and estrogen.


Low-dose aspirin
Aspirin (acetylsalicylic acid) has anti-inflammatory, vasodilatory and platelet aggregation inhibition properties, and may promote uterine blood flow. Randomized clinical trials have produced conflicting results on the beneficial effects of aspirin in IVF.

One meta-analysis of 10 randomised clinical studies of fresh and frozen IVF cycles found that clinical pregnancies were 1.15-fold higher in low dose aspirin groups than placebo groups (Ruopp, et al, 2007). However, aspirin does not appear to improve endometrial thickness (Haapsamo, et al., 2009), and subsequent randomised placebo-controlled trials have failed to find a significant difference in pregnancy rates between aspirin-treated and non-aspirin treated groups (Dirckx, et al., 2009).

So if there is a positive effect of aspirin on the success of IVF cycles, it is very small, and not associated with changes in endometrial thickness.

Tamoxifen
I was only able to find a single study that examined tamoxifen and the endometrium. This study compared the use of supplemental Clomid or Tamoxifen in addition to injectable gonadotrophins in IUI cycles, and found that patients taking tamoxifen had increased endometrial thickness and improved ongoing pregnancy rates (Wang, et al., 2008). Tamoxifen is generally only used in IVF cycles in cancer patients.

Sildenafil
This magic blue pill has been found to improve blood flow by enhancing the release of nitric oxide and thus relaxing vascular smooth muscle. Does it also affect womens’ reproductive organs in a similar manner?

One randomised placebo-controlled study of 15 non-pregnant, nulliparous women found that sildenafil improved uterine volumetric flow during the luteal phase of their cycle (Hale, et al., 2010).

In a pilot study, 105 infertile women were recruited with prior IVF failures attributed to poor endometrial thickness

Estrogen
Estrogen supplementation during stimulation with Clomid during IUI cycles has been shown to improve endometrial development and to result in thicker endometria and improved morphology (Gerli et al., 2000; Elkind‐Hirsch et al., 2002).

Similarly, a placebo-controlled randomised trial of 81 women demonstrated that oral estrogen supplementation throughout a fresh IVF cycle was associated with increased pregnancy rates. The estrogren group had significantly thicker endometrial thickness and a 1.9-fold higher pregnancy rate (Jung and Roh, 1999). Supplementing progestrone with estrogen purely in the luteal phase has also been shown to increase pregnancy rates compared to progestrone-only supplementation during the luteal phase (Var, et al., 2010)

Conclusions
Supplemental sildenafil and estrogen may improve endometrial thickness and pregnancy rates in women with prior IVF failures due to thin endometriums. The evidence for estrogen is currently stronger than that for sildenafil.

Personal Implications
I am going to contact my clinic and ask them about the possibility of adding estrogen (and perhaps sildenafil) to my next fresh IVF cycle.

References

P. Kovacs, Sz. Matyas, K. Boda, and S.G. Kaali. The effect of endometrial thickness on IVF/ICSI outcome Hum. Reprod. (2003) 18(11): 2337-2341

Geoffrey Sher and Jeffrey D. Fisch. Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF Hum. Reprod. (2000) 15(4): 806-809.

Geoffrey Sher and Jeffrey D. Fisch. Effect of vaginal sildenafil on the outcome of in vitrofertilization (IVF) after multiple IVF failures attributed to poor endometrial development. Fertility and Sterility. Volume 78, Issue 5, November 2002, Pages 1073-1076.

Sarah A. Hale, Cresta W. Jones, George Osol, Adrienne Schonberg, Gary J. Badger, and Ira M. Bernstein. Sildenafil Increases Uterine Blood Flow in Nonpregnant Nulliparous Women. Reproductive Sciences April 2010 17:358-365

Marcus D. Ruopp, Tara C. Collins, Brian W. Whitcomb,and Enrique F. Schisterman. Evidence of Absence or Absence of Evidence? A Re-analysis of the Effects of Low-Dose Aspirin in IVF. Fertil Steril. 2008 July; 90(1): 71–76.

Mervi Haapsamo, Hannu Martikainen, and Juha Räsänen. Low-dose aspirin and uterine haemodynamics on the day of embryo transfer in women undergoing IVF/ICSI: a randomized, placebo-controlled, double-blind study. Hum. Reprod. (2009) 24(4): 861-866

K. Dirckx, P. Cabri, A. Merien, L. Galajdova, J. Gerris, M. Dhont, and P. De Sutter
Does low-dose aspirin improve pregnancy rate in IVF/ICSI? A randomized double-blind placebo controlled trialHum. Reprod. (2009) 24(4): 856-860


Tarek El-Toukhy, Arri Coomarasamy, Mohammed Khairy, Kamal Sunkara, Paul Seed, Yacoub Khalaf, Peter Braude, The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles, Fertility and Sterility, Volume 89, Issue 4, April 2008, Pages 832-839

Hyuk Jung and Hyoung Kyun Roh. The Effects of E2 Supplementation from the Early Proliferative Phase to the Late Secretory Phase of the Endometrium in hMG-Stimulated IVF-ET. JOURNAL OF ASSISTED REPRODUCTION AND GENETICS. Volume 17, Number 1, 28-33

Turgut Var, Esra Aysin Tonguc, Melike Doganay, Cavidan Gulerman, Tayfun Gungor, Leyla Mollamahmutoglu, A comparison of the effects of three different luteal phase support protocols on in vitro fertilization outcomes: a randomized clinical trial, Fertility and Sterility, In Press, Corrected Proof, Available online 2 August 2010

Monday, 1 November 2010

FET#1: CD14

No more injections! We trigger tonight.

Right ovary: follicle 16.1 mm
Left ovary: nothing big here
Endometrium: disappointing 6.7 mm

Transfer is scheduled for Friday.

Friday, 29 October 2010

FET#1: CD11

Lining: 5.9 mm
Right ovary: 12.1 mm
Left ovary: 9.5 mm

So it looks like I am progressing very similarly to my last IUI, not surprisingly because I am on the same Menopur dose. If things go the same way, I will probably trigger on CD13 (Sunday), ovulate on CD14 (Monday), and transfer on CD17 (Thursday).

We asked the Professor about the chance of multiples, as we are stimulating ovulation as well as transferring an embryo. He said that it is theoretically possible, but they have never seen it in practise. He also said that animal studies have shown that simply the act of intercourse before embryo transfer can increase the rates of pregnancy.

Feeling much better today. I need to remind myself that the best cure, for me, is just to knuckle down and attack all the work that is stressing me out.

The sun is shining over the soft falling leaves. This might be our last autumn as a family of two (plus two furballs). This is a time to celebrate our love for each other, for cherishing all the wonderful joys already in our life together.

Tuesday, 26 October 2010

FET#1: CD8

I am participating in a clinical trial for this FET, which involves me injecting half a vial of menopur each night, much like I did for my last IUI. This means that they are monitoring my follicles too, even though we have a little embryo that we prepared earlier.

Stats:
Lining 4.7 mm
Right ovary: One large follicle at 9.7 mm
Left ovary: One large follicle at 8.4 mm

Perhaps another week until trigger? Next check-up on Friday.

Things that are currently stressing me out:
* The hours of sunlight are decreasing, so I am waking up in the dark every morning
* More people are catching the metro, so I now have to stand for 30 minutes to get to work
* My boss is off sick, so I am doing the work of two people
* All projects need to be completed by the end of the year, so we are extra busy
* My mother is coming to stay for a whole week
* I am putting on weight
* Blood tests in the morning, waiting for phone call during the day, injections in the evening

Things that I should be doing to decrease this stress:
* Working hard at work
* Cleaning the house
* Going to the gym
* Eating lots of fruit and vegetables

Things that I am actually doing instead:
* Spending hours on the web looking at pictures of cute animals
* Napping
* Eating chocolate and biscuits
* Worrying
* Feeling guilty

Argh.

Wednesday, 20 October 2010

FET#1: CD2

I don't know what's wrong with me.

We were at a dinner party over the weekend, filled with strangers. I had my first inkling that there could be a problem when the hostess said to me "I hope you like children, because there will be plenty of them here tonight". I blink and suddenly the house is full of them, running and playing and babbling and crawling. Then one of the fathers comes over to me and says loudly "Are kids in your future? You can have our two if you want!".

I get a sudden sinking feeling when I realise that I am going to burst into tears, right in the middle of the party. I walk away from the father, leaving my husband to reply, and stumble into the first room that I find. Luckily it was the bathroom, and I let myself have a few big sobs before trying to pull myself together. I was so mortified that someone would see my swollen eyes and I would ruin the evening.

I manage to make it through the rest of the party with the help of a few glasses of wine, and just ignoring anyone who probed into our childlessness. I even offered mock sympathy to one woman who said to me "It's been so long since I could drink wine, unfortunately I got pregnant with our second child as soon as I stopped breastfeeding our first".

~~~


When we first went to our fertility clinic, they told us that they had psychologists on staff if we ever needed counselling. I smiled at them, thinking that I wasn't one of "those" women with the Baby Crazies. I knew how lucky I was already and I wasn't going to let a short delay in procreation ruin my day.

My life is wonderful. I have so much for which to be thankful.

Yet I just burst into tears in public.

Is there something wrong with me?

Saturday, 16 October 2010

CD27: Here today, gone tomorrow

On Friday night before a night out on the town, I figured I may as well take a home pregnancy test. I told myself that I had a special feeling about this cycle. There is something so anxiety-inducing about that 10 minute wait for the test to develop. I had an argument with myself - was I foolish for holding out hope during a natural cycle, or could I feel that something was different?

I looked down at the test, and caught my breath. Was it there? Was it not there? Perhaps there was perhaps a very tiny second line. The smallest, thinnest positive I have ever seen. I took a photo, and popped it in my purse to show my husband. Yes, I carry around urine-stained antibody tests in my handbag.

I added 36 weeks to get the date of June 24 2011. I wandered into the spare room and imagined it as a nursery. I showed my husband and eventually convinced him there was a second line. But there was no card this time, no talk of maternity leave or childcare. We both agreed to wait it out and see what had happened. After a chemical pregnancy and a miscarriage, we have been bitten by two lines before.





This morning, I woke up early full of excitement. All night I had been dreaming of a June baby, and so happy that I didn't have any more injections, follicle counts, or embryo transfers ahead of me. No waiting by the phone each afternoon for the results, no hoping that our frozen embryo defrosts, no two week wait. I was already one month into my nine month pregnancy.

My pregnancy test was waiting for me, and I watched it develop with anticipation, waiting for that second line to burst into colour. Three minutes past - no second line. And then ten minutes past, and there was still no second line.

I was no longer pregnant.

Once again, we have seen two pink lines only to have our hopes dashed.



Friday, 24 September 2010

IVF#1: Post-failure consultation

We had a fabulous consultation yesterday. We left the appointment feeling like our clinic has a great understanding of IVF and is really tweaking out next cycle to give us the best chance of success. These are some of the answers to our questions:

FET cycle
• How fragmented was our 6-cell embryo at freeze?
They gave it a score of 2 (with 0 best and 6 worst). The symmetry was 1 (with 0 best and 2 worst)
• What are the chances that this embryo will survive the thaw?
There is a 60% chance that it will survive the thaw, and then a 10% chance it will result in a live birth. By law, I must use up all my frozen embryos if I want my next fresh cycle to be funded by health insurance. They quickly signed me up for a clinical trial of Menopur-versus-no stimulation for my FET cycle. I am in the Menopur arm, but I can opt-out and just go the no stimulation with monitoring route instead. I am not sure which option I will take.

Next fresh cycle
• Given my poor response, and that no embryo reached the 8-cell stage, what are our chances of success in future fresh cycles?
At my clinic, 9 eggs is not a poor response - they only aim for 10 eggs retrieved. I guess as 6 fresh cycles are funded, they prefer to have fewer patients with OHSS. They said 6-cell and 7-cell is not that far off from 8-cell, and that we have a very good chance of success in future fresh cycles, especially with a change of drug regime (see below).
o Does our history of a chemical pregnancy and miscarriage influence this?
One chemical and one miscarriage, sadly, falls within the 'normal' range and doesn't tell us anything.
• Will I be on a different drug regime next time around
?
Absolutely. My LH was too high throughout the whole cycle, indicating that I was not properly suppressed. He even asked me if I had trouble using the nasal spray. So instead of Suprefact nasal spray for suppression, I will be taking an injectable lupron-like drug instead. Then, instead of urine-derived Menopur I will be taking the recombinant Gonal-F. He said that in order to reduce costs, they put first-time IVFers on the cheaper Menopur, but then after that keep them on Gonal-F, which has a better quality control and is easier for the patient to use.
• How many eggs should we transfer next time?
By law I am now permitted to transfer two embryos, but I am leaning towards elective single embryo transfer. The increased risks associated with twins makes me uncomfortable.
• Can we squeeze in another fresh cycle before New Year's?
Probably. I need to ask them if they want me to have a break cycle after my Menopur-FET.

Donor embryos
• Can you tell us about your frozen embryo program?
They were very unwilling to talk with us about this program. They said that they usually suggest it as a last resort, and no on has ever asked so early on in the process. The process is completely closed, even if the child turns 18, and even if the child requires a bone-marrow transfer.
o Does the six month waiting period apply for every frozen donor embryo transfer?
No. It takes six months for the psychological tests, and after that, we are permitted a 'virtually unlimited' number of donor embryos.
o What criteria do you use to match couples with embryos?
I couldn't get much information on this. From the web, it appears that no matching is conducted (I'm not sure about blood-type).
• Can we sign up for donor embryos now while still attempting our own cycles?
Not yet. They suggest we try a few more time with our own gametes first.
• Will they transfer in donor embryos shipped from abroad?
This question really confused the guy. To clarify, I said, if we had a frozen embryo shipped from the Czech Republic (thinking of Reprofit's bank of cheapish embryos), would you conduct the transfer? He then looked really confused, asking me if I wanted a Czech baby? I laughed, and said, no, we just want one good embryo. We don't care where from. My husband said that we'd even be happy to take a baby if they have any of those laying around. The poor guy just looked more confused and I had to tell him that my husband was joking.

So that's that. Most of my questions answered, and a shiny new drug regime waiting for me for our next fresh IVF cycle. I feel hopeful and happy.

Now it's off to the UK for a week!

Monday, 20 September 2010

IVF#1: BFN

Well, it's official. After getting my period yesterday, I was expecting a zero on my beta today, and that's what I got: Not pregnant. I was quite sad yesterday, which worried my husband. He doesn't like seeing me so down, and just wants me to be happy. But I can tell that he will make a wonderful father, so I think it is appropriate for me to be disappointed that I won't get to see him in that role just yet.

The nurse told me that I could start my FET cycle right away if I wanted, but annoyingly I will be away for work next week, so it will have to wait another month. We are always waiting, aren't we?

We have my follow-up consultation with the head of the clinic on Thursday. To summarise this cycle: BCPs, Suprefact supression, 14 days 150u Menopur, 9 eggs retrieved, 7 mature, 7 fertilised (without ICSI), a Day 3 transfer of a 7-celled embryo, and a single 6-celled embryo frozen.

These are my questions for the Professor:

FET cycle
• How fragmented was our 6-cell embryo at freeze?
• What are the chances that this embryo will survive the thaw?

Next fresh cycle
• Given that no embryo reached the 8-cell stage, what are our chances of success in future fresh cycles?
    o Does our history of a chemical pregnancy and miscarriage influence this?
• Will I be on a different drug regime next time around?

Donor embryos
• Can you tell us about your frozen embryo program?
    o Does the six month waiting period apply for every frozen donor embryo transfer?
    o What criteria do you use to match couples with embryos?
• Can we sign up for donor embryos now while still attempting our own cycles?

Thank-you all for your support during this difficult process. Can you guys suggest any other questions that you think might be appropriate to ask?

Friday, 17 September 2010

IVF#1: 11dp3dt: One pink line



I tested this morning and I got a single pink line. We're going to wait until my Beta on Monday for the official announcement, but it looks like this cycle is a bust. I am sad and disappointed, but if something is going to go badly, I would rather it happen early rather than late.

My friend Emma sent me an email yesterday. One month ago she told me she was 18 weeks pregnant, and I felt like she had betrayed me by conceiving as soon as she started trying, and stealing my due date in January. Two weeks ago I heard that things didn’t look good on the ultrasound. And yesterday she told me that she delivered her beautiful baby girl at 22 weeks. They held her, said farewell, and then left the maternity ward empty handed.

I feel guilty at the anger I felt after her pregnancy announcement. How I said that I wanted both of us to be part of this Infertility and Loss community. How I wanted her to understand that the road to that first birthday is long and hard for so many of us. Well, now she understands it better than most. She’s part of the club now, just like I wanted (though my husband reminds me I never would have wished this on her).

My heart aches for her. Although I can’t imagine what she is going through, I am thankful for the blogs of women like Busted Babymaker and Awful but Functioning who have so graciously documented their grieving and opened their hearts to the world. Through their words, I am able to get a better understanding of what Emma is experiencing, and understand that this grief may be part of her forever. I sent her a letter of condolences, a candle, and gave her the address of Glow in the Woods . I wish that there was more that I could do.

Wednesday, 15 September 2010

IVF#1: 9dp3dt: Single line

To Anonymous: Thank-you for your comment. I am so glad that you found my blog and excited to hear that you are starting your first cycle. Send me an email if you would like an invitation to the next IVF Support Group dinner in three weeks.

Yesterday, at 8dp3dt, I saw my first single pink line of this cycle. I thought I was fine. It was still too early to know for sure. And even if this was a true negative, I thought I was okay. I knew the success rate. I knew that our low egg yield lowered our odds. I knew that slow embryo growth lowered our odds. I had been expecting this.

I told myself that even though each individual cycle only had a 25% success rate, the overall process of IVF in this country has a 51% chance of success over three cycles, and a 58% chance over six cycles (1).

I started planning the questions that I would ask at our follow-up appointment. What are the chances our 6-cell embryo would survive the thaw? Given no embryo reached the 8-cell stage, what are our chances of success in future fresh cycles? What are the waiting times to receive donor gametes? Can we sign up for donor gametes now while still attempting our own cycles? Can we source donor embryos from abroad? Suddenly I was overwhelmed by all these questions.

Then it was time to join my husband and two friends for a dinner out. They were discussing what bottle of wine to order, and one of them asked me if I liked champagne. I had no idea what to say. I couldn’t say “yes”, because then it would be odd when I didn’t drink any. I couldn’t say “no”, because that’s not true and they’d just order something else anyway. And I couldn’t say “I’m not drinking alcohol tonight”, because then everyone would think that I was pregnant. I just looked at my husband in desperation. He said something like “I don’t think she feels like drinking any wine tonight”.

And then, because I am paranoid and imaginative, I felt like I had just announced to our friends that I was pregnant. They didn’t say anything, but I thought that I could see their secret smiles. For some reason, I felt so awful. Like I was a fraud, pretending to the world that there was still hope.

And I feel guilty, when later as I confess all of this to my husband through tears, and I see the pain in his eyes. When he quietly suggests that maybe we should stop trying, because I take the negatives so badly. He has told me that I am all the family that he needs, and that my happiness is the only thing that is important to him. I feel like my sadness in this moment says to him that he is not enough for me. This is not true - I just get so mission orientated.

*****


Today is a new day, and when I saw the single line on the test this morning, I was okay. I think I will be okay no matter what the final verdict is. The point is to be happy, and right now, when I think about our little family, all I can do is smile.



1) Cumulative live-birth delivery after IVF/ICSI since the progressive introduction of single-embryo transfer
Reproductive BioMedicine Online, Volume 20, Issue 6, June 2010, Pages 836-842
D. De Neubourg, C. Daels, M. Elseviers, K. Mangelschots, M. Vercruyssen, E. Van Royen

Saturday, 11 September 2010

IVF#1: 5dp3dt: Waiting

I looked at a calendar today to figure out how many days past transfer I was. Eight? Ten? No, five. It feels like my transfer was months ago, not just last Monday.

Physically, I am starting to feel much better. It took me a full week post egg retrieval to feel fully healed and back to my old self.

My new hobby is peeing on sticks every morning and watching my trigger disappear. Today is ten days past trigger, and I can still see a tiny bit of a line when I look at it just right. I'm guessing that by tomorrow it should be completely clear, and then I can start the more exciting process of waiting for the line to re-appear.


I think it's really mean of the pharma companies to make us trigger with hCG. Can't they just put a patch over the bit of the molecule that the home pregnancy test detects? I have even written this on my two-line tests (just in case a burglar breaks into the house and misinterprets them and sends me a premature 'congratulations'):



So glad it's the weekend! Even though I only had a four day week, it really seemed to drag on forever. I am looking forward to two relaxing days with my husband - catching up with friends and relaxing around the house.

Wednesday, 8 September 2010

Home Pregnancy Tests during the Two Week Wait



I know that many people warn against home pregnancy tests (HPTs) during the two week wait, but as my stash above indicates, I am not one of them. The last peer-reviewed head-to-head comparison of HPTs was by Cole and colleagues in 2005, so I picked the top brands from that study and then used the the manufacturers' own data on early sensitivity. I don't know the extent to which these results are directly comparable, as they were tested in different laboratories on different women. From these data, the First Response Early Result test came out looking the best, although all are equal by Day 0.



What about false positives? Cole and colleagues (2005) found no false positives in their lab test tests. Clearblue Digital reports a 0.49% rate of false positives on Day 0. First Response state that women over 41 years old could expect a 4% false positive rate on Day 0 due to high levels of pituitary hCG.

So here is my plan:

Thursday (3dp3dt): Daily tests until I get a negative result to ensure that the trigger is out of my system, then:

Sunday (6dp3dt): Daily tests until Friday 17th (11dp3dt).

Monday 20th (14dp3dt): Blood test.

Sources:
First Response Early Result true positives
First Response Early Result false positives
Clearblue Digital

Clearblue analogue colour change tip

Cole, LA et al., 2005.
Sensitivity of Over-the-Counter Pregnancy Tests: Comparison of Utility and Marketing Messages. Journal of the American Pharmacists Association.
Echner, SF and Timpe, EM. 2003.
Urinary-Based Ovulation and Pregnancy: Point-of-Care Testing. The Annals of Pharmacotherapy.
Cole, LA. 2004.
Accuracy of home pregnancy tests at the time of missed menses. American Journal of Obstetrics and Gynecology.
Butler, SA. 2001.
Detection of Early Pregnancy Forms of Human Chorionic Gonadotropin by Home Pregnancy Test Devices. Clinical Chemistry.

Monday, 6 September 2010

IVF#1: Transfer: One 7-cell embryo



Thank-you all for your wishes of good luck. The transfer went really well today. Sadly my husband was abroad on business, but I kept him updated with photos throughout the process. Once at the clinic I drank one litre of water then got dressed for the procedure, including my lucky socks.

The nurse wheeled me into the procedure room, and the doctor told me that two embryos had survived to Day 3. Today they were transferring a 7-cell embryo, and they were freezing a single 6-cell embryo. While I was a little sad that none of them were 8-celled, I am so happy that we have one for now and one for a FET.

I asked for a photo, and they said that they didn't do that there. How disappointing. I really wanted something to visualise over the next two weeks, and to maybe stick in a baby book one day. However, I did get to see the end of the catheter where the embryo was waiting, and I whispered it a quiet hello. Then I watched the ultrasound and saw this bright little star travel from right to left all the way through my womb until it found its home in the snug spot at the end.

As I sit here now, it is such a rare experience to know that there is a twinkle inside me that is stretching out, testing itself and its environment. Each cell division brings new challenges and checkpoints. I wonder if this tiny little thing has what's needed to keep on keeping on.

Saturday, 4 September 2010

IVF#1: Fertilisation report: 7 embryos

The report is in - of my 9 eggs, 7 were mature, and all 7 fertilised (100%). Plus my husband had a personal best of 38 million total motile sperm (compared to 7 million from our last IUI). We are really happy about these results. I am booked in for a Day 3 transfer on Monday for a single embryo transfer. Fingers crossed we might even have one to freeze too.

I am healing quickly and my husband is taking extra special care of me. He went out shopping and came back with hot chips for appetizers, made a fresh baguette for lunch, and now I have a selection of cupcakes waiting for me for dessert.

It's a pretty good weekend.

Friday, 3 September 2010

IVF#1: Egg retreival: 9 eggs

As I type, 9 of my eggs are on a steamy first date with a few million of my husbands sperm. We, on the other hand, are lazing around on separate couches and letting conception occur in a very different manner to our usual style.

The day started a little bit stressfully. The fertility clinic is in the basement of the hospital and thus has no cell phone reception. My husband hadn't turned up yet, so I sent him a quick text to let him know they were prepping me in a few minutes. To do this I popped upstairs quickly, then down again, where a nurse found me and took me to my bed. My husband arrived, and the receptionist said that she saw me leave with a phone in my hand, and I had not returned. So the poor thing spent 20 minutes wandering round the hospital trying to find me, while I sat there on the hospital bed, trying to fasten a hospital gown behind me and failing miserably. Finally we were reunited and I cranked at him for being late and told him the Xanax had done nothing.

Then the very young looking guy cam in and told me that he would be part of my anesthetist team, and he would take some blood and get my drip going. He seemed very nervous, picking instruments up and then putting them down again and fastening my tourniquet too tight. He then inserted this impossibly long needle into the crook of my elbow, and pulled off the end, so I, predictably, began to bleed everywhere before he could attach a tube for blood collection. His incompetence was frightening me, so I just lay back on the bed and quietly cried while I waited to finish. After he had two tubes of blood in the vials and another two tubes on my skin, he asked me for a favour and if I could press down really hard on the impossibly long needle inside my vein. I said, no, I could not, and my husband kindly did it for me. He then asked me to lie very very still while he got some more tape. Finally he taped it all up and left us alone.

My husband comforted me as best he could, but I was not feeling very safe. He asked me what I was afraid of, and I told him I was afraid of the pain.

Soon it was time to go, and they wheeled me into the room while my husband had to stay behind. I then walked over to the chair with very leg rests. While they were putting on the heart-rate stickers, I started to shake with cold and anxiety. Once they gave me some oxygen and some meds in my IV, I started feeling a lot better. I became drowsy and then very sleepy, and I don't remember any pain, but I do remember every now and again them telling me to breathe deeply. I think I replied "sorry" or "thank-you" to this, but I'm not sure. I then told the guy that I was starting to feel more awake, and he told me that they had finished. I carefully moved onto my bed and I was rolled back to my room.

My husband said that I was very loud at this point, telling him that I was fine and it didn't hurt a bit and that I was okay. They also told me that they had gotten 9 eggs, and I was very happy with that number (my original goal had been 11).

After about 15 minutes the drugs wore off, and I was in a bit of pain. I told the nurse, and she said she would look for the doctor who knew what I'd had in the surgery and could tell her what she could give me now. We waited and waited, and no one showed up. The pain was getting much worse - severe cramps and sharp pains - and all I could do was wait. By this time I was crying with pain, and when the nurse came to see me next, she said it was probably just my full bladder. She told me to go to the bathroom, and once I had emptied my bladder she would give me something if it still hurt.

I hobble to the bathroom, and then sit there, in a great deal of pain, and unable to pee. I am sitting there crying and crying. Finally the nurse comes back and says that she will give me something anyway. About time.

Once she injects something into my drip, I start feeling a lot better. A few minutes later she comes back and brings me some chicken soup and some crispbread with apricot jam and Nutella. Even though my husband hasn't eaten himself yet, he helps me eat my soup and prepares my crispbread for me. Now I was feeling much more sprightly.

A while later, I pass their urination exam and note that my bladder was hardly bursting in the first place. We gingerly make our way home, and I am now camped out on the couch for the next three days.

I feel happy. We got more eggs than we had expected. I am in no pain, and the most physically grueling aspect of all this is over (apart from that little thing called childbirth if all goes perfectly). No more injections or blood draws for another two weeks.

Fertilitsation report tomorrow.

Wednesday, 1 September 2010

Fertiles and Infertiles

About two weeks ago I was upset that Emma had got herself pregnant before I did. Now I have just heard that her latest ultrasound indicates that there might be something wrong. My heart breaks for her in this stressful situation, and I feel so ashamed that it took a misfortune such as this to knock some sense into me.

I had been reading a lot of infertility blogs, and it instilled into me a sense of “Me versus Them”. There were Infertiles, battling with conception, and then there were the Fertiles, walking through life as though it was a field of daisies.

My thinking was foolish and narrow minded. I had been discriminating against people based on their reproductive history. I was saying to people “you do not deserve to be happy because you had sex to get pregnant”. What an arbitrary way to distinguish between allies and enemies.

I am so glad that I found this fantastic community of Stirrup Queens. The understanding and support that has been given to me has been astonishing and nourishing. However, I realised that I had been replanting these seeds of compassion in a very small circle.

I see now that my infertility means that I can also empathise more with the exhausted single parent, the teacher diagnosed with diabetes, the anxious teen on their first day of school, the postman about to go into surgery, the dentist who is losing her hair.

We are not a world divided into Fertiles and Infertiles. We are a community of people who strive to cope. No one walks through this life unscathed. I have been so lucky to have wonderful people to listen to my story and offer encouragement. Hopefully one day I can return the favour, and show someone else that they are not alone in their struggle against the odds, whatever it happens to be.


{Day 14 of Stims: Lining 7.07mm. 7 follicles 14-20mm. E2 2395. Trigger 1:15 AM. Retrieval on Friday.}

Monday, 30 August 2010

IVF#1: Day 12 of Stims

Lining: 6.9mm
Right ovary: 6 follicles, largest 13.9mm
Left ovary: 3 follicles, largest 16.3mm
E2: 1218
Drugs: 150u Menopur 1xday, Suprefact 3xday


"Well that's bizarre"

These were the words that the midwife greeted with us this morning before my scan. My husband and I shared a worried look. She said that apparently my plasma hormones seem to be racing ahead of my follicles. i.e., my blood is responding correctly to the medication, but my ovaries are not as active as they should be. She said that this is especially odd considering how quickly I responded to the Menopur during my IUIs.

Also, my lining is still below 7mm. In all my monitored cycles I have never managed to break the 7mm barrier. So this cycle looks like it will feature a thin lining and low egg count, both predictors of failure. I don't think I'll be at the top of the class for this assignment.

We go back on Wednesday for another checkup, with a possible retrieval on Friday.

I calculated that a retrieval on Friday would put my due date near my birthday, and this led to daydreams of joint birthday celebrations in Disneyland with matching mouse ears. I would really like that.

Friday, 27 August 2010

IVF#1: Day 9 of Stims

Lining: 6.4mm
Right ovary: 4 follicles, largest ~8mm
Left ovary: 4 or 5 follicles, largest ~10mm
E2: 461
Drugs: 150u Menopur 1xday, Suprefact 3xday

My midwife seemed fairly happy with my scan today. She said that things were growing "not too fast and not too slow". They are keeping me on the same dose of stims, and they don't want to see me until Monday. She estimates my retrieval will be at the end of next week, maybe Friday.

I am really happy with my lining. One of the great things about a slow cycle is that it is giving my endometrium a lot more time to mature, compared to my premature response during IUIs.

Thank-you so much for all your comments, I am reminding myself that we only want one baby, so we just need one good embryo. It's about quality, not quantity.

And my lovely husband (who came with me to the appointment and held my hand throughout) was even thoughtful enough to ask the midwife for a print-out of my follicles because he knew I would be too shy to ask. So here they are - let's hope they're the beginning of something wonderful.

Thursday, 26 August 2010

The Drawer of Hope

If you took a quick glance looked around our home, it would look like that of any other child-free couple - holiday photos, thick novels, delicate glass ornaments on display. Open a few cupboard doors, though, and you would find some clues as to our hopes for the future. The shelf containing books like "The Land of IF". The pre-natal vitamins in the kitchen. The Pregnyl in the fridge. The needles and sharps container in the bedroom.

And if you were to open the very bottom drawer in my husband's wardrobe, you would find our Drawer of Hope. The outfit I bought to tell my husband I was pregnant the first time. The hat we bought before our last IUI.The onesie we picked out when I was pregnant the second time. The clock that would be perfect for the nursery.

We don't open the drawer very often, but I am glad that we have it.

Wednesday, 25 August 2010

IVF#1: Day 7 of stims

Ultrasound report:
Lining: 4.5mm
Right ovary: 3 or 4 follicles, largest ~7mm
Left ovary: 4 follicles, largest ~9mm

So it appears here in my European clinic they like to stim us long and slow (150u Menopur / day), rather than the quick and fast stim protocols in the US. The midwife told me that she expects me to stim for another 7 days.

Once again, I guess I just have to trust that they know what they're doing. Their live birth/cycle rate (25% for < 36) is lower than the US average (41% for < 35), but that could be for many factors, I guess (like compulsory SET). On the up side these cycles are funded by our universal healthcare.

It is hard to give up control - to let someone else make all the decisions. Part of me wishes that we were at the Colorado Center for Reproductive Medicine with their crazy 66.5% live birth/cycle rate, but then again I am glad that our clinic has an 11% rate of twins rather than their 39%.

How am I feeling? I am disappointed with my thin lining and my low number of follicles. I wanted to get 11 eggs at retrieval, so hoped to see around 14 follicles this morning. Instead I only have 7 or 8. I am constantly terrified that I'm going to forget an injection - or I'll forget my Suprefact and the suppression will wear off and I'll lose all my eggs. I am exhausted from constantly worrying about everything that could go wrong with this cycle.

Edit: My clinic called, and my estradiol is only at 139. They said not to worry that things were really quiet on the scan, this is my first IVF so they are taking things slow. They want to see me again in two days (Friday), and they'll increase my dose then if my follicles still aren't growing.

Monday, 23 August 2010

The Chair



This is one of the chairs in the waiting room of my clinic. It is filled with Gonal-F pens. I have no idea what the story is behind it. Did one lone infertile decide to make a monument to her years of injections? Did she want something tangible for all those cycles of hope and disappointment? Is this a donation from Merck to thank the clinic for all their orders?

I have never seen anyone actually sit in the chair. Perhaps it is a Wishing Chair? Maybe if I sit in it, the chair will sprout wings and take me away from the Land of IF.

Saturday, 21 August 2010

Welcome ICLW

If you have found your way over here from ICLW, then welcome. This is my first time participating.

Our reproductive history
1. My husband and I have been trying to have a baby for 26 months.
2. Many things about our reproductive systems seem a little bit off - my tubes are slightly blocked, I have too many intrapelvic adhesions, I ovulate a little bit early, my lining is a little bit thin, his sperm count is a little bit low.
4. All four of our IUIs were unsuccessful.
5. We have had two spontaneous conceptions that ended too soon. We do not know why.
6. We are currently in the middle of our first IVF cycle.

My dreams and wishes
1. It was my new year's resolution to be pregnant by the end of the year. Next year I will be more specific, and resolve to get and stay pregnant.
2. I am very hopeful IVF will be our answer.
3. I dream of reading Winnie the Pooh and Matilda to our child.

About me
1. I haven't really bought any clothes for two years, because I always hope to be pregnant next month.
2. I love Disney but I feel terribly guilty about it because I think the Princesses are terrible role-models.
3. My favourite Starbucks drink is a non-fat white hot chocolate with sugar-free caramel syrup.
4. My favourite ice-cream is Ben & Jerry's Cookie Dough.
5. I am terrified of driving.
6. I don't really like my belly, so I am so looking forward to having a baby bump instead.
7. My current favourite TV shows are Glee, Gossip Girl, and The Big Bang Theory.
8. I love graphs and statistics. I seem to think that if I can chart it, then I can predict it, and if I can predict it, then I can control it.
9. I hate olives.

Thursday, 19 August 2010

Cleared for take-off

I had my baseline check today, and we are cleared for stimulation.

I was a little put-off by the midwife who did the scan for me this morning. She wasn't very gentle with the wand, and she couldn't even find my left ovary. She just told me that it would stand out if there was a cyst on it, so it must be okay if she can't see it. Nor did she do a blood test.

I told her that I responded very quickly to Menopur, so she booked me an appointment for Tuesday (day 6 of stims), only to call me and move it to Wednesday (day 7 of stims).

I am not very good about standing up for myself. I don't know what is normal and what is not. Should I have requested a baseline blood test? Should I have insisted on a Day 6 scan? Or do I just need to relax and trust that this clinic knows what they're doing?

Wednesday, 18 August 2010

Hot Flashes or Hot Flushes?

I always thought that they were called "hot flushes" because you became flushed, but it turns out that the more common term in the scientific literature is "hot flashes". Whatever they're called, I have them in spades.

If you see a woman standing in the rain who is stripping down to a t-shirt, it might be me.

CD1 was yesterday, so now I get to simultaneously experience the symptoms of both menstruation and menopause.

Suppression check tomorrow - hoping everything is quiet on the southern front.

Monday, 16 August 2010

My Dream Cycle

I was inspired by Ms Egghunt today. She wrote about her flowchart for a perfect cycle, and said that she stuck it in on her door for inspiration, ticking off each milestone as it comes.

I think that this is a really positive and energising act, so I too have created my own flowchart for the next few months. Here's hoping that the Chief of the Universe gets the memo, and we both get to tick the boxes all the way to the end.

Saturday, 14 August 2010

Bye bye birth control

Yesterday was the last day of my oral contraceptive regime. I should get my period in a few days, and then I am officially beginning my first IVF protocol.

Naturally, all my worries are still there - stim too fast/ stim too slow/ lining too thing/ eggs not mature enough/ no fertilisation/ no division/ no implantation - but I am so excited that things are moving forward.


Friday, 13 August 2010

The Pregnancy Announcement that Broke the Camel's Back

I have a friend. We shall call her Emma. She is 36. She lives in a different country, but we visit each other occasionally.

For the past two years we have been talking getting pregnant. While we have been trying to conceive, she has been holding off, waiting for everything to be perfect. I warned her about waiting. I told her that at our age, it can take a very long time to get pregnant. "Or for some people it can happen straight away" Emma told me. I sighed, and figured that she would have to learn the hard way.

Last time I saw Emma was March, when she told me that they had just "sort of" started trying. I sent her an invitation to fertility friend. I told her that we were planning to start IVF this year. "What's IVF?" she asked me. I sighed again, and figured at her age there was a chance that she might soon have a very good understanding of what it was.

As it was nearing Emma's six month mark of trying to conceive mark , and I was about to send her an email suggesting that she see an infertility specialist without delay. I could pass on my advice on laparoscopies and blood tests and sperm counts. We could commiserate together on the difficulties of falling pregnant, and I would have a good friend with whom I could share stories and complaints.

Then, I get this email from her yesterday. Four paragraphs in, I read:

"I am 18 weeks pregnant, due in January 2011".

I realised that Emma and I fell pregnant around the same time in May, only two months since they started trying. While my pregnancy ended in miscarriage, hers ended up in a baby bump and pregnancy announcements and decorating a nursery. Which is wonderful. Which is the way that all desired pregnancies should progress.

So of course, I promptly burst into tears. At work. In front of my computer.

I felt so betrayed. She was supposed to be my infertility buddy. I know so much more about ovulation, conception, fertilization, blastocyst formation, and implantation than she does. And yet she just had sex with her partner for a few months, and now Emma is the one who gets to have a baby in January.

Wednesday, 11 August 2010

The Miscarriage Club

A few months ago, I heard about an English-speaking IVF support group in my area. It was organised by this wonderful woman who, despite six unsuccessful IVFs, is willing to host monthly get-togethers of women involved in IVF.

Four of us met for dinner last night to share war stories and offer support. It was very liberating to talk about injections and ultrasounds, blood tests and urine tests. We all had miscarriage stories to tell, so many stories of hope and worry and disappointment.

We talked about anxiety, and about how there is no magical point at which one can stop worrying. The second beta, the second trimester, even birth - each milestone acheived brings with it new dangers and concerns.

Realising this, I am trying to remind myself that either everything will go well, or it won't. It is unlikely that worrying about an issue will change the outcome. So I am trying to enjoy the journey, treasure all the gifts that each day brings, and know that if something bad happens we will deal with it as best we can.

It is a great comfort of me to find this support network, to know that I am part of a wonderful supportive network of women who live nearby. I am looking forward to the next meeting in September.

Sunday, 8 August 2010

Nasal pulverization

I started my suppression today. How exciting. I went to sleep last night like it was the day before my birthday. Then I managed to sleep through my alarm for my first dose.

I will not be taking one shot of Lupron in the belly each night. I will be squirting Suprefact (buserelin) four times a day up my nose (7am, noon, 5pm 10pm). Over here in Europe, they love their nasal sprays. Lupron and Suprefact are both gonadotropin-releasing hormone (GnR) agonists that interact with the GnR receptor. As they both act on the pituitary gland, I suppose that it has a shorter distance to travel if it starts in my nostrils. This will be especially fun at work, when I have to sneak into the bathroom with my handbag several times a day and secretly sniff up my drugs. I hope no-one thinks that I’ve developed a cocain habit.

I don’t even know if I’m doing it right - It feels so weird to inhale it, but at least it’s not another daily injection. Though by the end of this, I wonder if I will prefer one small jab to multiple daily puffs.

Here we go...

Saturday, 7 August 2010

Amazon

In preparation for this cycle, I wanted to make sure that I had plenty of home pregnancy tests to use during the two week wait. Over here they keep them behind the counter, and I can still remember the look on the pharmacist’s face when I asked for four at once.

I decided to go with Amazon, they are a lot less judgemental about such things. Or so I thought. Once I navigated to the “First Response” page, I was greeted with these options:



Thank-you Amazon . Do you know something that I do not? Or do you tell all women that they may as well save 15% and have these things shipped monthly, because they’re going to be using them for a while? Or just for the women who have also bought “The Fertility Diet” and “IVF: A Patient’s Guide” in their purchase history?

Friday, 6 August 2010

It’s about to begin

I start my suppression on Sunday, and I go in for my suppression check on the 19th of August. I can’t believe that our first IVF cycle is finally here.

The past few months have been a wonderful month. No worrying about temperature or cervical mucus, no urinating on strips to test for LH of hCG. No hour-long trips to the clinic to get jabbed and probed. No supersensivity to any feelings of nausea or sore breasts.

We were able to take a nice long summer vacation, and focus on relaxation and togetherness. It was traquil and very enjoyable.

Now, however, I am in mission mode.

Monday, 28 June 2010

Back on birth control.

As of today, I am back on the pill, and starting my first IVF cycle, using the standard long suppression protocol. However, my clinic is closed over the summer, so I don’t start Menopur injections until Thursday August 19, which is another seven weeks away.

I am so excited that the time has finally arrived for us to start this cycle. After two clomid IUIs and two injectable IUIs, I am hoping that the process will be familiar, though hopefully with a different outcome.

With my IUIs, I always spontaneously ovulated before my lining had time to thicken. Hopefully the supression from Suprefact will hold everything back a bit so my endometrium has time to mature, if not with a fresh cycle, then maybe a frozen cycle.

I am hoping that work is not too busy around that time, that I don’t have too many early morning meetings, and that there isn’t anything critical when I suddenly have to take a few days off. Once again, I will begin the familiar pattern of trips to the clinic in the morning, anxious afternoons waiting by the phone, and then injections in the evening.

I am still a bit nervous about the retrieval. The nurse assured me that they administer plenty of pain relief during the procedure, and even put a special note in my file that I can have a Xanax before the procedure. I took something like that before my laparoscopy, and it made the world of difference. Funnily enough, knowing that I won’t be feeling anxious before the procedure is enough in itself to substantially decrease my worries.

So it is time for me to make my way twice around the circle of birth control pills, and then the real adventure will start to begin.

Wednesday, 2 June 2010

Ectopic ruled out

The doctor called me today, and told me that my hCG level was 19.

While this is good, in terms of no-emergency-surgery-for-an-ectopic, it is the final confirmation that this is indeed the end of this chapter.

Strange to think that I'd probably still produce a positive result on a home urine test.

I wonder how high my hCG levels got. Did they break 1500? Would we have been able to see a sac if we had gone in a week earlier?

It's funny, but this week is actually easier for me than last week. Those days of seeing all that blood, not knowing what was happening, and feeling so helpless were really tough. My heart would sore or dive depending on my symptoms. So much anxiety. Now that it is over, I don't need to worry any more. What's done is done.

In just over a week, I will be submitting my paperwork and picking up my medication for our first IVF cycle.

Tuesday, 1 June 2010

6w4d Miscarriage

For the first week after my beta, I was very optimistic – looking at dopplers and imagining how to tell my mum. Thinking about a January birth, signing us up for a pregnancy information evening.

From 5 weeks 6 days, the brown spotting became heavier. My husband would look at me and call me his “beautiful pregnant wife”, but I asked him to stop. I still don’t feel comfortable saying that word out loud. Every day was a mixture of hope and anxiety. The days ticked slowly past.

By 6 weeks 3 days, there was tissue, and by 6 weeks 4 days, there was a great deal of bright red blood. I didn’t feel any pain, but I knew that this was not a very good sign.

Today was the day of my scan, and I woke up today a bundle of nerves, pushing my husband out of the house so that we ended up arriving at the hospital half an hour early. They had me down for a 12 week NT scan, and as I corrected the receptionist, I felt like such a sham. I hated hearing myself say “I am seven weeks pregnant”. We turned the corner to the waiting room, and I was confronted with a long line of baby bumps. That was really hard for me, watching them walk out with smiles and little print outs of hands and feet. The wait was excruciating, but eventually my name was called.

I dumped my coat and bag on the floor in the corner, and the nurse chastised me, telling me to hang up my beautiful coat. Seriously, my coat. I threw it on a chair, anxious to just get to the scan. They asked me to pop up on the chair fully clothed, like I was getting an abdominal scan. I tried to tell them that I needed an internal scan, but first they started firing all these questions at me. Last menstrual period. 17th April, ovulation 9 days after that. Name of my family doctor? I told them that I don’t have one. Name of my gynaecologist? I told them that I don’t have one. “But you need one!”, the nurse explained “Who is going to follow you through this pregnancy?” This is when I lost it.

With my eyes full of tears, I said to them “There has been a lot of bleeding, let’s just make sure that there is a pregnancy first, then I can answer these questions”. I could barely stand or speak after that, and my husband gently took over, telling them about our reproductive history. They asked me to take my pants off, and I sat on the table half naked and shaking.

My uterus came into focus, and it was the same as I have always seen it – tight as a clam. The doctor was called quickly. They interrogated me – what made me think I was pregnant? Just a urine test at home? No, I told them, I had a blood test of 477 at 21 days post ovulation. I am so glad I got that blood test. I am glad that the system has some sort of concrete record that I was pregnant, that I wasn’t just mad.

The doctor was quite kind, gently explaining that she could not see anything in the uterus, and now her job was to search for something outside the uterus. She carefully looked along my ovaries and checked for extra fluid in my abdomen. There were no signs of an ectopic pregnancy. She tried to tell me that “at least you can get pregnant”, but I told her that after two years of trying, a miscarriage isn’t that much comfort.

They sent me off to get a blood test to completely rule out an ectopic, and told me they would send a copy of everything to the fertility centre for their records.

I then walked down the hall to the fertility centre to make another IVF intake appointment, and I was glad to hear that they can fit me in next week.

So how am I now?

I am comforted that I don’t have an ectopic, and I am reassured that I should be able to start my IVF cycle with my next cycle.

I am relieved that the worrying and anxiety are over.

I am thankful that I have a wonderful husband who held my hand through the whole ordeal, and who manages to make me smile every day.

But I am very sad that I am no longer pregnant.

I am so disappointed that we will never have a January 2011 baby.

I am worried that even if I manage to get pregnant again, I will not stay that way.

I am bitter than two pink lines will never mean the same thing again.

I am exhausted.