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.}