dandle dreams

The birth story

2011-08-17T18:04:00.002+02:00

Email me at doctordandle at gmail dot com for photos.

We visited my gynaecologist a day after my due date. She asked how I was, and I replied “still pregnant”. She decided to schedule us for an induction two days later, which was fine with us. She wrote out a prescription which looked a lot like “1 baby, 8h30, 29 July 2010”.

On Friday morning, we got everything ready. It was weird knowing that (hopefully) next time I returned to our home, it would be with a baby. It was a beautiful summer day as we took the ten minute walk through the park to the hospital. My husband tried to meander, but I was feeling very mission oriented.

Once we got there, we were asked to wait on the chairs by the entrance until a room became available. I was seated next to a young girl, her boyfriend, and her mother. Her mother couldn’t stop crying and said that her 22 year old daughter was too young to have a baby. I didn’t see them again - I hope everything is going well with them.

The midwife called me in and gave me an internal exam. I asked if I was going to be induced with oxytocin, and she said that she had to calculate a score first. I asked her if she was talking about the Bishop score, and she asked me if I worked in the field or just read a lot. I told her that I just read a lot.

It turns out I had a bad Bishop score, so they were going to induce me with oral Prostaglandin 1 tablets instead of a drip. They would monitor me for an hour, give me some tablets, monitor me for another two hours, another tablets, etc, until something happened.

They set me up in the delivery room around 10am, where we were to spend the next day and a half. There was an uncomfortable padded shelf for my husband and a bed for me. I got changed into my “I dream of sushi” delivery outfit, complete with belly hole for monitoring. The midwife said that in all her 11 years of work, she had never seen anything like it. I showed her the low back for the epidural, and she said that she hoped I got an epidural so we could make use of her. I assured her that I would certainly be getting an epidural.

For the next ten hours, it was a little like we were on a long haul flight. I couldn’t feel anything, but we could watch the irregular and small contractions on the monitor, and listen to the baby’s heartbeat. We could see the baby’s transition from wake to sleep every hour or so.

They served me meals but didn’t have anything for my husband, so he popped out for ten minutes to grab a quick dinner. While my husband was out, at 8:02pm, I felt this little pop and then this extreme gushing. It took a few moments for me to realise that my water has just broken. I send my husband a text message saying “Water just broke.” My husband rushes back and is there almost before the nurse.

The nurse comes in and I tell her the news, feeling somewhat alarmed. There is now a huge quantity of liquid gushing out of me and I’m starting to panic. I am astonished by her response - perfect, fantastic! She tells me that she was worried that she would have to send me home. Now she can finish her shift happy, knowing I will have this baby tomorrow. I ask her about the colour of the fluid, and she tells me that it is clear, that everything looks good. She is sad that I have gotten my dress dirty, but I tell her that it was sort of a single-use outfit, and I change into my spare one.

The midwife asks us for our baby clothes, and it starts to hit me that they are actually expecting a baby to arrive. We give her the outfit, and she asks us "is this all you brought?". Apparently over here, babies don't just wear a nappy and a onesie, they also wear baby underwear, which is weird. Throughout our stay all the healthcare professionals are puzzled by the lack of underwear we dress our baby in, even though it is summer and the hospital does not have air conditioning.

At around 10pm, the contractions become painful, and I ask for an epidural 10pm. The next midwife seems rushed, sad, and distracted. We sense that it has been a difficult night on the ward, with perhaps an unhappy story. She says that I am only 2cm dilated, and the minimum was 3cm. She gave me some more oral prostaglandin 1 to help with the contractions. At 11pm, I ask again, but my contractions are not regular enough.

The contractions are getting more and more painful. I remember reading that one should visualise the baby through each contraction, but for me this isn’t very useful, as I realise that I am terrified of being responsible for a baby, and thinking about this just sends me into a panic. The common mantra “labour pain is good pain” is also not very helpful. I end up sitting on a Swiss ball, and having my husband massage my back. I repeatedly tell him that I really like the bits in between contractions. As I feel each contraction begin, I feel ambivalent. As they get stronger and closer together, I become a better epidural candidate, but they still hurt a lot.

At midnight, I ask for an epidural again, and she checked me, and very kindly announced I was “3 very small centimetres”, and confirmed I wanted an epidural. “Yes”, I answered immediately, without pause or hesitation. She called the anaesthetist, who explained the procedure.

I start shaking from fear, as I sat on the edge of the bed with my back curled over. I tell myself that the pain of the procedure will be less than the contractions, but I am still really scared. They ask me to tell them when I was having contractions and they would stop their work, and luckily they weren’t so close together yet so they only had to stop a couple of times. The doctor explained what she was doing each step of the process, and my husband and then the midwife held me steady. I remember the anaesthetist saying to me “now you must not move for any reason”, as she entered the epidural space.

She gives me some great advice - if I feel pain on one side, simply lie on that side and press the button for an extra dose of anaesthetic. They add oxytocin to my drip to ensure my contractions continue, and leave us to get a bit of rest. I need to switch sides every hour or so, otherwise my thigh muscles tense up like a terrible cramp.

From midnight to 8am, I manage to get a bit of sleep, though I max out the boosting button on the epidural. I can hear our baby’s heartbeat on the monitor, and I can relax due to the constant galloping noise that fills the room. I have to keep on moving the heartbeat sensor lower down, so I know that he is progressing. I am still really scared about everything - labour, birth, looking after a baby, so I try to just focus on the moment without thinking about the future.

Just before she leaves her shift at 8am, I tell her that the contractions are feeling lower and more painful. She checks me, smiles, and gets my husband. Shows him that the head has dropped, and he gets his first glimpse at our son. He holds a mirror up so that I can also see the head, and I think to myself that maybe I can do this after all. He seems so close to the exit that I feel like he’ll be here in no time. She asks me to stop pushing on the “extra” button of the epidural so that I’m able to feel each contraction.

At 10am, I call the next midwife and tell her that the contractions are now frequent and painful, and that I think the baby is ready. She agrees, and we do a few practice pushes. She tells me to push with each contraction, holding my breath and pushing with all my strength. She then gets into position between my legs. With each contraction she yells “allez allez go go go push push push like you have to go to the bathroom”. If it’s a strong push she yells “more more like that keep on going yes yes yes”. If it’s a poor push she tells me afterwards that I have to try harder. Surprisingly, one of the most difficult aspects is that my thighs start to cramp up with each contraction, and the pain of that blocks my ability to push with any strength. I find that stretching out my legs by placing them on the midwife’s shoulder offers some temporary relief. She gives me a strange look, but I don’t care.

After an hour of pushing, they tell me that they have to call in the doctor to use a vacuum, but they will give me ten more minutes first if I feel strong enough. I try for another ten minutes, but I feel defeated, I don’t feel like the baby has moved at all, and that all my pushing is for nothing. My husband is great, telling me that I’m doing a fantastic job, but I don’t really believe him. I only feel strong enough to push with every second contraction, and I can hear the disappointment in the midwife’s voice when I fail to be strong enough.

As the midwife is French, she often pokes my belly and announces “she’s still there” when checking for my contractions. In between contractions we have a conversation about the gender of French nouns, my husband comments that it makes sense that contractions are feminine, then I tell him that the gender of “vagina” is male - le vagin. Usually I’m too shy to bring up this example, but I figure it was appropriate in this context.

Another ten minutes of pushing, he’s still not out, it’s time for the vacuum. The doctor and the paediatrician arrive, and the vacuum is prepped. The midwife steps out of the way and is replaced by the doctor and her contraption. She attaches the vacuum, and helps me with each push. I am exhausted, and I feel like giving up. I don’t feel like I’m getting anywhere. I am tired, and I don’t want to push anymore, but the doctor tells me that I don’t have a choice at this stage, I have to keep on going. Suddenly I hear my husband’s voice telling me that he can see the head, that it’s coming out, and I get a new sense of energy. Only my husband’s voice keeps me going “I can see the head, he’s coming out, keep on going, there’s an arm, nearly there, great job sweetie”.

At 11:53 am, all of a sudden they plop this enormous purple bloody wriggling baby on my chest. I am astonished that something like that just came out of me. He had a very pointy head, though my husband tells me that by the time I saw him, it had already shrunk.

The then lifted him up to weigh him, and I watched him being checked by the paediatrician to ensure that he had not been overly harmed by the vacuum extraction. They told us that he was 4.4 kg and 54 cm. We later learn he has an APGAR score of 9 after 1 minute (white hand), and then 10 after 5 minutes. I watch as the midwife gave me an injection in my leg to encourage the delivery of the placenta and the doctor extracted cord blood for anonymous donation.

Somehow an hour past, and they told me that I had not yet delivered the placenta. They asked me to push a bit more, but that achieved nothing. The doctor told me that she would have to manually extract the placenta - reach inside my uterus and scrape it off by hand. They called an anaesthetist who injected several doses of anaesthetic straight into my epidural drip. He also told me that he likes to plan for the worst case scenario, and attached a second trip to my right arm, in addition to the drip on my left arm.

The manual extraction was by far the most painful part of the process, I don’t know how unbearable it would have been without the epidural. I called out in pain, and I was touched that the anaesthetist kept on apologising, saying he had given me the maximum dose, and he was so sorry it wasn’t working. No one ever said to me that this was childbirth, and pain was part of the process.

The doctor waited for me to get my breath, but she said it was critical that she finish the process as soon as possible. A few more minutes, and the process was complete. However, they told me that I had lost 2.5 litres of blood by then, and I needed a transfusion. My husband later told me that the bucket underneath me was filled with blood and tissue, the floor was a mess of red, and the sink was full of bloodied instruments. They ask him to sit down while holding the baby as they don’t want him to faint. Luckily he is very good with blood.

I start shaking uncontrollably, and they cover me with blankets and bring the overhead heater to beam down on me. I look up and see that I’m hooked up to four different bags of liquid on my left arm, including a bag of blood. On my left arm I have a saline drip. They ask me to take some tablets, the side effect being that my temperature will be raised. Now I am the one hooked up to a heart-rate monitor. They tell me I must stay here until I have received two bags of blood, one bag of plasma, and my heart-rate drops below 100. Everyone seems calm, though, and I am impressed by their quick response.

I am so glad that my husband was there to hold our baby, while I am laying there, my legs propped up on a block of foam. While we were waiting for all the infusions to finish, we try nursing Our baby for the first time. This was not very easy as I was laying flat on my back. Our baby made snuffling piglet noises that made us laugh, and he eventually found the nipple. The midwife squeezed my other nipple to show me that I was indeed making colostrum, which our baby seemed to enjoy.

Many hours later, at 8pm, I had stabilised and they announced I was ready to be wheeled into the maternity ward. We arrived into our room with a small single bed, no food, no bed for my husband, and down here the midwives only seem to speak French. I feel quite lost. After several requests, they finally bring a meal for me and a bed for my husband. It was the start of four unpleasant nights, with the night nurses barging in constantly and bringing criticism for whatever we were doing with Our baby at the time.

Four days later, our baby and I passed our medical tests, he started to regain weight, and we were permitted to leave the hospital. We walked through the park with him in his stroller, and arrived home, ready to start our new life with a child.

The past two weeks have been harder than I imagined. Thankfully the breastfeeding has been going very well, and I am so grateful that my husband does the majority of the work during the day, leaving me to rest and relax. Still, I am not yet feeling very attached to our baby as our interactions seem to be this three-hour cycle of feeding, changing, and soothing. He hates sleeping in his cot, which means that often during the day he rests in our arms, then spends the nights swaddled and complaining as we try to get him used to sleeping alone on his back.

I am so thankful that he is healthy and growing and thriving. I realise that I am so lucky, that there are so many people out there who would give anything to have what I have right now, but at the moment, honestly, it is not very rewarding. They say the first social smiles will start in another three weeks, to which I am desperately looking forward.

He's here

2011-08-01T08:26:00.003+02:00

I have a sleepy little boy in my arms. Born 9.7 lbs after a vaginal vacuum extraction. Three stitches. Two liters of blood lost during manual placenta extraction. Apgar 9/10/10 - one white hand. He is exhausting work, looks a little like Churchill. Feeling accomplished. Husband marvellous during labour and also now. I have yet to change a diaper in his 48 hours of life.

40w2d

2011-07-28T21:48:00.002+02:00

Dear Belly Bump,

Very soon you will no longer be there when I look down. I have treasured these last nine months of pregnancy. I love resting my hand on my bump and feeling the wiggles inside. I loved the chance to buy a whole new wardrobe to show you off to the world. I love the feeling of being pregnant, of growing life inside me. Though it has sometimes been disturbing to see my body change so dramatically, I feel so truly lucky to have had this experience.

I think that soon I will have a very lonely belly. But a very full heart.

40w0d: Due date

2011-07-26T07:04:00.005+02:00

According to Franz Naegele's 1812 calculations, today is my due date. It has been 266 days since conception.

I can still feel the little guy wiggling around inside, but no painful contractions or other signs of labour.

My docgtor says that as my gestational diabetes is under control, she won't induce for another 10 days. So we still don't know if he'll be a July or August baby.

Truth be told, I'm a bit terrified of the next stage. Not so much the birth, but the whole being responsible for a new human being thing. It seems like such a huge responsibility, and I've never even held a newborn before. Now I'm supposed to be a mother? There are so many unknowns - soothing, breastfeeding, playing, nurturing...

After everything we've gone through, I really hope that I'm good at this.

New bump photos here.

39w0d: Full term

2011-07-19T21:57:00.002+02:00

Still pregnant, no signs of labour yet. Feeling so thankful that we have made it so far with relatively few problems.

My maternity leave started today, and as I can barely walk for 5 minutes without discomfort, I am spending a great deal of time on the couch.

I have another fetal monitoring session tomorrow - 30 minutes of listening to the heartbeat and watching my painless Braxton-Hicks contractions that are coming every 10 minutes or so.

We have a big, posterior baby, so labour is not going to be short or easy. I am planning on taking as many drugs as possible to get me through.

All in all, very happy and thankful, still in disbelief that a child will be joining our family and we are soon to be parents. We both feel that it is much more likely that I will just remain pregnant forever.

36w0d: Still moving along

2011-06-28T10:59:00.003+02:00

And here I am, one week away from being considered full term, one month away from my estimated due date.

Firstly, I'll get my complaining out of the way. I managed to stay vegan for about 24 hours before I resorted back to the deliciousness of eggs, cheese, and meat. I am still unable to resist cake, even though I know it is bad for both me and the baby in my gestational diabetic state.

My feet and ankles are terribly swollen, my belly and hips have erupted into a swarm of stretch marks, and I get a painful sharp cramp/round ligament pain sensation whenever I have to walk for more than 10 minutes. Turning over in bed is an effort, and the heat is not helping. We are still on the waiting list for all our creches, and they have yet to confirm availability for 2012.

However, apart from all that, things are pretty good. I am feeling really happy most of the time, finally starting to embrace and celebrate this pregnancy. I had a wonderful baby shower and felt very spoiled by all our friends who brought beautiful gifts for the little guy.

He seems to be doing very well - still measuring one week ahead, and my gestational diabetes doesn't seem to be affecting him too much. His head is down and the placenta has moved up, so it is likely that we will try for a vaginal birth.

I have a feeling the baby will come early as he is measuring ahead, my husband has statistics on his side when he says the baby will come late as he is our first. Either way, I can't wait to meet our son and see my husband holding him in his arms.

30w3d: Gestational diabetes

2011-05-20T11:42:00.006+02:00

The good news is that the little guy is doing well. He is moving a lot, the placenta is moving away from my cervix, and my fundal height is on track.

The bad news is that I have gestational diabetes. I am diabetic. I rang my doctor to confirm my "no news is good news" theory, and she told me that I had failed the one hour test. Then I failed the fasting two hour test. They took another 7 vials of blood from me this morning, and I have my first meeting with an endocrinologist on Monday.

As soon as I got my diagnosis I went to the shop and bought three books on diabetes, and I have spent this morning reading the literature on randomized trials of diet and diabetes.

From the studies that I have read, it seems that the quickest way to get my diabetes under control is to follow a low-fat low-GI vegan diet. What is the evidence for this?

After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use, and BMI, an observational study found that vegans (OR 0.51 [95% CI 0.40–0.66]), lacto-ovo vegetarians (0.54 [0.49–0.60]), pesco-vegetarians (0.70 [0.61–0.80]), and semi-vegetarians (0.76 [0.65–0.90]) had a lower risk of type 2 diabetes than nonvegetarians. N = 60,903 ¹
A prospective cohort study (N = 3,158) and a case-control study (N = 596) found that compared to no egg consumption, adjusted relative risks for gestational diabetes were 0.94, 1.01, 1.12, 1.54, and 2.52 for consumption of ≤1, 2–3, 4–6, 7–9, and ≥10 eggs/week, respectively (P for trend = 0.008) ²
A randomised trial (N = 99) found that type 2 diabetics allocated to a low-fat low-GI vegan diet (rather than the 2003 American Diabetes Association diet) had significantly lower HbA1c and cholesterol levels ³

I had always thought that the vegan diet was only suitable for self-righteous stinky hippies, but it looks like this is what my plate will look like for the next ten weeks:

1. Tonstad S, et al. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care May 2009 vol. 32 no. 5 791-796
2. Qui, et al. Risk of Gestational Diabetes Mellitus in Relation to Maternal Egg and Cholesterol Intake. Am. J. Epidemiol. (2011) 173 (6): 649-658.
3. Bardard, ND, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment
of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009;89(suppl):1588S–96S

28w5d: Third Trimester

2011-05-08T13:59:00.002+02:00

I have finally arrived in the third trimester, and things are still going well. I have puffy ankles and constant heartburn, and the occasional backache, but no major problems.

Last week I had my glucose test. I know that a lot of women complain about it, but for me it felt like a right of passage. It's an experience that I had read about so many times, it seemed surreal to be sitting there with all the other pregnant ladies, drinking my sugar drink and waiting the hour for my test. I haven't heard back from my doctor, so I'm figuring that no news is good news.

The little guy is wriggling all around, so reassuring to get a little poke every hour or so to let me know that he's doing okay. I love sitting on the couch with my hand on my belly, feeling him press against my skin. It is so difficult to refrain from doing so while in business meetings when I can feel him bouncing around in there.

The nursery is finished - cot, rocking bassinet, changing table. Some friends are throwing me a small baby shower next month, which is very unusual in Europe - many people consider it bad luck to give gifts before a birth. Sometimes I feel a little presumptuous too, decorating a room for a person who has yet to arrive in this world, and it's hard to believe that in less than three months we could be parents.

Ye every day his chances of survival increase if he were born prematurely, every day his kicks feel stronger, ad every day I can feel my womb expand as he grows.

Eleven weeks to go.

26w2d: All is still good

2011-04-21T18:13:00.003+02:00

We had our first check-up at our new hospital today. It was a bit daunting moving from our IVF hospital to the one closer to home, but after today I feel a lot more confident. There didn't seem to be many differences between the two places, and I feel a lot better knowing that we are now so close to our chosen labour and delivery ward.

My fundal measurement is 27 cm, right on track. She did a quick ultra-sound - the little guy is head down, but the placenta is still a little low. If it stays low, then they will do a cesarean, but won't make that decision for another 10 weeks.

My feet are enormous, but I my urine and blood pressure are normal, so my fears of pre-eclampsia were unfounded at this stage.

Next week: glucose test and the start of the third trimester.

So thankful that everything looks good so far.

24w1d: Viability

2011-04-06T13:52:00.004+02:00

So we have reached viability, with a theoretical 50% survival rate if the fetus was born today. Happily, he doesn't look like he's going anywhere anytime soon. I'm still feeling pretty good. I have a lot of heartburn, and I can't really bend over any more, but I am still able to sleep reasonably well.

We've even started doing some shopping. There was a special at the supermarket last week, so I bit the bullet and even bought some diapers. We have started talking about names, and looking at cribs. With every day that passes, I am feeling less terrified of disaster, and more excited about the future.

22w0d: Overwhelmed but happy

2011-03-22T11:01:00.003+01:00

So, I think that I may finally be accepting the fact that I am pregnant. This is helped by everyone around me pointing out that fact. The guy that served my lunch on Friday said "Had a great weekend. Both of you". Neighbours are stopping me to wish me congratulations. Honestly, I'm amazed at how brave people are to comment on my bump this early on. But it is nice to know that all those extra kilos have been collecting at the right places.

The fluttering has turned into kicking, and it is so reassuring. As I have an anterior placenta, the doppler is quite difficult to use, but with all those kicks throughout the day, I usually feel pretty certain that everything is okay.

I am trying to read some baby books, but will often feel overwhelmed with how much there is to learn, and how much we have to do before the end of July. I am excited too, though. Every day I am reminded how lucky we are to be in this situation, and how if everything continues to go well, what an extraordinary summer we will have.

Scan and bump photos here.

20w0d: Anomaly scan

2011-03-08T11:53:00.000+01:00

This morning we had our 20 week ultrasound. Before the scan, my husband was talking to me, saying that today is the day that we find out whether we're having a son or a daughter. I told him that I didn't want to think about it and made him talk about other things. However, they called us up right on time, and soon got down to business. Everything looked great, and the sonographer couldn't find a single thing for me to worry about. They counted the fingers and the toes, looked at all the internal organs, checked the placement of the placenta and the fluid, and took a bunch of measurements. The baby weighs 377 grams, and we found out today that I am carrying a boy. It is strangely wonderful to be able to say "he" rather than "it". My husband has told me that I now have to start facing up to the fact that we are most probably going to have a son in less than 5 months.

18w6d: Babymoon

2011-02-28T17:33:00.003+01:00

We are having a wonderful time on our babymoon. It is so luxurious to get away from the daily stresses of life, and just kick back and relax. I am loving our two weeks by the sea, soaking in the sunshine and spending long hours with my husband. I now feel the little one wiggling away every day, which is so reassuring and delightful. We are both feeling very hopeful for the future, and I love the way that my husband rubs my belly when we sit side-by-side.

Now only over a week until our 20 week scan. If we can, I would like to find out the sex, but most of all I am hoping for a perfect bill of health for this little one.

17w6d: Quickening

2011-02-21T19:05:00.003+01:00

On 10:30am on Valentines Day, I was sitting in front of my computer focusing on a Word document, when I felt a tiny little *something* in my lower belly. At first I didn't pay it much attention, and then, when I realised what it could be, the rest of the world suddenly disappeared.

All I could focus on was these soft little flutters above my pubic bone. Flutters the like of which I had never felt before. This was the day I first felt our little one move inside me. Now, about twice a day, after I have been sitting quietly for an hour or so, I feel these little wiggles and tickles and pokes that are delightful and charming.

Each day, it is starting to feel more real.

Now, we are off for a two-week babymoon to pass the time until our 20 week scan. Fourteen quiet days near the sea (and a world class hospital) to celebrate what will hopefully be our last vacation as a family of two.

16w1d: Up to speed

2011-02-09T10:11:00.002+01:00

I had a great check-up yesterday. The doctor kindly explained that they couldn't do a routine 16 week ultrasound for everyone, but she would do a uterus palpatation, fundal height measurement, and a doppler check. If any of those looked off, then she would send me for a scan.

She said that she could feel my uterus sitting just underneath my belly button, and showed me how to feel it myself. My fundal height was 14 cm (at 16 weeks it should be 16cm +/- 2cm). She had a great deal of difficulty finding the heartbeat, which made me feel better about having trouble with my home doppler. She found the soft wooshing of the ubilical cord pulse quite easily, and some sporadic sloshes of the fetus moving, and finally about 20 seconds of the loud galloping fetal heartbeat at 160 bpm, before the fetus swam away again.

I know that we didn't get an ultrasound, but all in all I felt very reassured. The doctor seemed so calm and confident that I felt like any other pregnant woman in for a routine check-up.

And now only four weeks to go until we reach the half-way point and our big 20 week morphology scan.

15w6d: Check-up tomorrow

2011-02-07T16:38:00.003+01:00

Since the 12 week scan, my emotions have varied from relief to happiness to fear to worry. Relief that nothing bad was detected, happy that I graduated from the first trimester, fear that bad things will happen, and worry that the heartbeat was in the bottom 1% for gestational age.

I now have a noticeable bump (latest photo here), and my pregnancy was publicly announced during the last departmental meeting. Most of our friends in this city have not experienced fertility or loss, however they seem understanding of my "let's wait and see" attitude. A few of them have said to me "can I be excited for you, on your behalf?", which is sweet.

While I have heartburn, round ligament pain, a runny nose, frequent urination, headaches, and breathlessness, there is nothing unbearable. I am surprised every time I see myself in the mirror.

I individually emailed the people in my IVF support group to tell them my news, starting with "I know that it can be difficult to hear this...". Some of them have replied with congratulations, others have remained silent, which I understand perfectly.

My next check-up is tomorrow. They told me that they will do a Doppler heartbeat check, but no ultrasound. I would really love a reassuring glimpse to know that the fetus is measuring properly. Does anyone know of any secret phrases that will convince them to do an ultrasound, without having to lie about my symptoms?

14w3d: Out

2011-01-28T18:03:00.003+01:00

My belly and the word are both out. I have told my close friends, family, and my boss. I have booked childcare. Random colleagues are coming up to me to wish me congratulations. Presents are starting to appear in the mail.

Apart from the few moments of terror and fear, I am mostly starting to feel a little bit excited. Cautiously optimistic, sometimes. I am now officially in my second trimester.

Frustratingly, I am still having trouble finding a consistent heartbeat with my cheap eBay doppler. I am trying not to worry too much, as even the tech couldn't get a good abdominal scan at my last ultrasound with her fancy-pants machine. I have my next check-up in 11 days.

Finally, I will not be able to make it to my next IVF support group dinner. I have not yet told any of the ladies my news, as I do not see any of them outside these events. Should I send an email? Should it be individual or reply-all? What should it say?

The NT scan

2011-01-18T13:39:00.003+01:00

This Tuesday last week I was anxiously counting down the hours until my NT test. I was a bundle of nerves, and had to break down the activity into tiny steps so that I could get through it (get dressed, leave house, get to hospital, walk through front doors, etc). My doppler still hasn’t arrived, so I had no idea if the foetus was even alive.

I arrived 30 minutes early and impatiently waited for my husband to arrive, as he left it to the last minute and only arrived 5 minutes early. Twenty minutes after that, they called us in. My first transabdominal ultrasound, I didn’t even have to take off my pants.

The technician pressed down on my belly and a grainy picture appeared. At first glance, it didn’t look that different from the scan three weeks ago, and my heart froze. But she pointed out the heartbeat and I started to relax. I thought that I had been a responsible patient by drinking a litre of water an hour beforehand, but the technician said that all I was doing was forcing my uterus further towards my spine. She sent me to the bathroom to empty my bladder, and then got down to business.

Everything looked great. The foetus was measuring 6.5 cm (12w6d) at 12w0d with a femur length of 0.68 cm and a NT thickness of 1.49mm (photo of the fetus with a hand on its nose here). I was so relieved when I saw that NT measurement. Then the technician went on to check all the organs, pointing them out as she went along: brain, stomach, kidneys, spine, fingers, feet, even the four chambers of the heart. Due to the position of my uterus, she switched to a transvaginal probe for some of the measurements, so I got a visit from my old friend too. All in all, she concluded “it is a good baby”.

The foetus waved its hands in front of its head, occasionally wiggling and kicking. Although the print outs were a bit poor, seeing the live-action movement on the screen was incredible. With my husband by my side, holding my hand and smiling at me, we could have watched that little thing for hours.

After she had finished, the supervising doctor came in to double-check the measurements. I was a little concerned that the heart rate was a little low (151 bpm) – (the mean rate is 159 +/- 3 bpm at 13 weeks). She did something where she did four different types of doppler heartbeat measurements and said that everything looked fine.

My urine, weight, and blood pressure looked good, so they printed out an official certificate of pregnancy that I need for my work and for securing a childcare position. A few days later I heard that my combined trisomy risk is 1:11 600 for T13 and 1:20 000 for the others.

So, there we are. So far, things look good. Now another three weeks until my next check-up, and another seven weeks until the big anomaly scan.

12w0d

2011-01-11T22:17:00.001+01:00

Everything looks great. We have a wriggling 6.5 cm fetus with a 1.5 mm NT measurement. Arms, legs, brain, heart, etc all look good Details and pictures to follow.

11w3d: Exhausted

2011-01-07T15:16:00.006+01:00

In exactly four days time I will be making my way to the hospital for my NT scan. I am scared of all the things that can go wrong, and excited about what a milestone it will be if everything looks good.

So in order to get me into the spirit of the occasion, I have been doing what any good scientist would do, and reading through the literature surrounding the tests that will be conducted at this appointment, mainly, the NT scan and the blood tests.

The nuchal translucency (NT) test measures the thickness of the sack of fluid behind the neck of the fetus. In general, a fetus with a trisomy (three copies of a chromosome, rather than two) has a thicker NT than a chromosomally normal fetus.

The first figure below illustrates this observation. Each black dot represents two measurements (the crown-rump length and the NT thickness) of a single fetus that was subsequently found to have trisomy 21 (Down's Syndrome). The dark grey rainbow is the distribution of 90% of chromosomally normal fetuses. As you can see, in normal fetuses the NT thickness gradually gets thicker as the fetus gets larger. However, in trisomy 21 fetuses, the thickness remains relatively constant during this gestational period, with a mean thickness of 3.4 mm.

(from Kagan, et al., Ultrasound Obstet Gynecol 2008; 31: 618-624)

The second test is a blood test of the mother to measure our old friend beta-human chorionic gonadotropin (beta-hCG) as well as pregnancy-associated plasma protein-A (PAPP-A). The values on the axis are multiples of the median (MoM), that is, by how many-fold does a result differ from the median value from all normal women. By definition, the median beta-hCG for unaffected pregnancies is 1.0, and the median PAPP-A for unaffected pregnancies is also 1.0.

This second figure below shows how the blood tests from women with trisomy 21 fetuses varies from women with chromasomally normal fetuses. Each dot represents the values from a single patient with a trisomy 21 fetus. The unfilled oval represents the lab values of 90% of women with chromasomally normal fetuses. The median beta-hCG values were 2-fold higher and the the PAPP-A values were 2-fold lower in women with trisomy 21 fetuses.

(from Kagan, et. al., 2008, Ultrasound Obstet Gynecol, 31: 618-624)

So here's hoping that all my dots fall in the normal range, and I can pass this test and start to look forward to moving into the second trimester. It is still feeling unreal, so I hope that seeing a wiggling little fetus on the ultrasound next Tuesday will put some of my anxiety to rest.

References:

Kagan, K.O., Wright, D., Baker, A., Sahota., D., & Nicolaides, K.H. 2008. Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol., 31: 618-624

10w2d Anxious

2010-12-30T17:29:00.002+01:00

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.

9w2d: Happy

2010-12-23T13:57:00.005+01:00

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.

8w0d Everything looks perfect

2010-12-14T11:21:00.003+01:00

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.

7w6d Tomorrow

2010-12-13T20:16:00.003+01:00

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.

7w0d Waiting

2010-12-07T17:21:00.002+01:00

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.

Grateful

2010-12-02T15:56:00.004+01:00

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.

Unbelievable

2010-11-30T09:53:00.006+01:00

-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).

To thecrazycatwoman

2010-11-17T15:03:00.003+01:00

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.

Happiness today, Hope tomorrow

2010-11-10T10:56:00.002+01:00

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.

IVF#2: scheduled

2010-11-05T16:58:00.005+01:00

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.

FET#1: Cancelled

2010-11-04T12:19:00.005+01:00

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?

Endometrium thickness

2010-11-03T17:49:00.003+01:00

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

FET#1: CD14

2010-11-01T17:55:00.002+01:00

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.

FET#1: CD11

2010-10-29T11:25:00.003+02:00

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.

FET#1: CD8

2010-10-26T09:45:00.004+02:00

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.

FET#1: CD2

2010-10-20T14:35:00.003+02:00

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?

CD27: Here today, gone tomorrow

2010-10-16T17:50:00.001+02:00

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.

IVF#1: Post-failure consultation

2010-09-24T05:59:00.005+02:00

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!

IVF#1: BFN

2010-09-20T16:17:00.004+02:00

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?

IVF#1: 11dp3dt: One pink line

2010-09-17T09:26:00.004+02:00

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.

IVF#1: 9dp3dt: Single line

2010-09-15T15:06:00.004+02:00

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

IVF#1: 5dp3dt: Waiting

2010-09-11T08:14:00.010+02:00

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.

Home Pregnancy Tests during the Two Week Wait

2010-09-08T11:28:00.001+02:00

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.

IVF#1: Transfer: One 7-cell embryo

2010-09-06T19:53:00.005+02:00

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.

IVF#1: Fertilisation report: 7 embryos

2010-09-04T13:53:00.004+02:00

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.

IVF#1: Egg retreival: 9 eggs

2010-09-03T18:25:00.003+02:00

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.

Fertiles and Infertiles

2010-09-01T16:09:00.001+02:00

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.}

IVF#1: Day 12 of Stims

2010-08-30T23:00:00.004+02:00

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.

IVF#1: Day 9 of Stims

2010-08-27T15:18:00.003+02:00

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.

The Drawer of Hope

2010-08-26T10:41:00.004+02:00

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.

IVF#1: Day 7 of stims

2010-08-25T10:50:00.007+02:00

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.

The Chair

2010-08-23T09:52:00.000+02:00

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.

Welcome ICLW

2010-08-21T17:40:00.005+02:00

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.

Cleared for take-off

2010-08-19T11:23:00.005+02:00

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?

Hot Flashes or Hot Flushes?

2010-08-18T09:48:00.002+02:00

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.

My Dream Cycle

2010-08-16T15:33:00.011+02:00

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.

Bye bye birth control

2010-08-14T16:49:00.003+02:00

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.

The Pregnancy Announcement that Broke the Camel's Back

2010-08-13T10:35:00.004+02:00

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.

The Miscarriage Club

2010-08-11T16:18:00.005+02:00

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.

Nasal pulverization

2010-08-08T14:37:00.002+02:00

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...

Amazon

2010-08-07T14:34:00.000+02:00

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?

It’s about to begin

2010-08-06T14:33:00.001+02:00

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.

Back on birth control.

2010-06-28T14:32:00.002+02:00

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.

Ectopic ruled out

2010-06-02T14:06:00.005+02:00

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.

6w4d Miscarriage

2010-06-01T13:56:00.005+02:00

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.

6w2d: Waiting to see the heartbeat

2010-05-27T06:41:00.004+02:00

If I am pregnant, then I am 6 weeks and 2 days today. The brown spotting seems to have gone away for the moment, which is great. Five days until the ultrasound. My husband keeps on reminding me that I must still be pregnant because I haven't had my period. But what if I had my period without noticing, or it's ectopic, or I reabsorbed it like a rabbit?

The ultrasound is scheduled for Tuesday. My IVF intake appointment is scheduled for Monday. I still haven't cancelled my IVF intake appointment. I will do this today, and hope that it doesn't jinx me.

My stomach is churning this morning. Morning sickness or anxiety?

5w4d: Not not pregnant?

2010-05-22T08:32:00.003+02:00

Still another ten days to go until the ultrasound. I really do not feel pregnant at all. I know a lot of women feel like this around this stage, but I also know that a lot of non-pregnant women feel non-pregnant, too. I like to think that my breasts are a little sore and my appetite is a little off, but that might all be psychosomatic. A few days ago my abdomen felt like I had done too many sit-ups, but that sensation has also disappeared.

Still, no red spotting and no cramping. I'm going to take this as a good sign.

I am so impatient to see the scan. Is there something inside me, or is this just going to be a sad little line on my history bar?

If it were up to me, I would be measuring my blood hCG daily and searching for a gestational sac. I am not very good at not-knowing how things are going inside of me.

20dpo: Beta #1

2010-05-17T13:08:00.008+02:00

Well, the lines on the pregnancy tests have been getting darker and darker. The one this morning was almost as dark as the control line. So I figured it was time to bite the bullet.

I rocked up to my fertility clinic as soon as it opened. As quietly as I could, I explained to the receptionist that I didn't have an appointment, but I had gotten a positive result on a home pregnancy test. She told me that it was probably too early, and I should just wait until my Beta appointment. I told her that I was in between treatments. She looked surprised, but booked me in.

About ten minutes later they called me in for the blood test. Funny how now I can now calmly watch them poke a needle into me and collect a vial of blood. The nurse asked me if this was a pregnancy test, and I told her yes. She asked me what I felt about it, and I told her the home urine test came back positive. She smiled, and asked me if I had used IUI or IVF. I sheepishly told her that I was on a break between treatments, and that I had just had sex. She immediately began quizzing me about symptoms: nausea, sore breasts, etc. When I told her that I didn't really feel any different, I could see the doubt in her eyes.

I am sure we were both thinking the same thing: Hysterical pregnancy

Then I had a day of work to get through. I knew that they would call me between noon and 5pm. I called my phone a few times to make sure it was working (then freaked out 5 minutes later at seeing a missed call on my screen). I set myself up in a meeting room for the afternoon, segregated from our open-plan office. At this stage, I need a beta of at least 111.

Noon. No phone call.

1pm. No phone call.

2pm. No phone call.

3pm. No phone call. Give 30 minute presentation in 17 minutes and scoot everyone away.

4pm. No phone call.

4:15. Call the clinic. My beta is:

477!

They wash their hands of me and give me an appointment with gynecology/ obstetrics next door on the 1st of June for an ultrasound. The nurse starts asking me who I have picked to monitor my pregnancy, and I tell her that I haven't even started thinking about it.

I still can't believe that I am pregnant. I am so happy. So thankful.

17dpo: Not darker. Not lighter.

2010-05-14T12:50:00.007+02:00

What does the "1-2" on the Digital Pregnancy Test I showed yesterday mean? No, not the number of babies. It is the estimated weeks since conception - either "1-2" or "3-4", based on whether both strips inside the test change colour, or just the super-sensitive one.

Well, according to my computer this line has gone from a density of 42% to 44%. I guess we'll just have to see what the weekend brings.

I would really like to have a baby in January, though.

Break cycle: 16dpo: BFP

2010-05-13T06:25:00.013+02:00

I have over 25 IU/L of HCG in my urine. It's not due to a trigger shot. I guess that means I'm pregnant.

I was going to enjoy this break before IVF. To not worry about trying to conceive and just appreciate all the wonderful things I had in my life. I did not renew my VIP Fertility Friend membership. I was going to go back to my lifestyle when I was back on the pill. In fact, I would have gone back on the pill but my RE said that 40 days is the maximum length of time for their long IVF protocol. So my new crazy lifestyle included:

Drinking three glasses of wine a week
Sleeping with the electric blanket on
Skipping my pre-natal vitamins
Skipping my omega-3 capsules
Drinking coffee
Drinking tea
Eating McDonalds

I kept an eye on my temperatures because my ovulation date fluctuates wildly, and I wanted to know when my period arrives.

But when it reached 14 days past ovulation, and my temperature was still high, I was puzzled. I looked back at my chart, and my thermal shift was very clear. Is it crazy to take a pregnancy test? Yes, I thought, but, no, 14 days post ovulation is a perfectly normal time to test. So I pulled out a Digital Test, glad it would give me a definitive answer. This way I would know that it was safe to drink at my friend's birthday party that evening.

But three minutes later, it said

Of course, not having the VIP Fertility Friend membership, it took me a few minutes to find somewhere that would calculate my due date. Due date. How odd.

I started to shake, and quickly wrote out a little card for my husband saying "I am pregnant. I am due January 18 2011.". He took forever to get out of the shower, but when I gave him the card he said "Wow." then "1-2 babies?" and then pointed out that they should have a small advantage due to their date of birth, as a child born at the beginning of the year is slightly more mature than their peers. Which is one of the reasons why I love my husband very much.

But I had yet to see those two pink lines. How dark was this second line? I went to the pharmacy and asked for four "tests de grossesses", because they keep them behind the counter here. The guy gave me a strange look. "Four?", but slowly opened up a new box and handed them over.

All night I dreamed that I was taking that test, but I could never see the result, and ended up going through hundreds of sticks. Finally, it was 6am. I took the test.

It is faint. But it is there.

Now I need to wait until tomorrow.

Last time I was pregnant it lasted for 19 days post ovulation. The line never got darker.

Is this going to be another chemical pregnancy? Or is this one going to stick?

What if...

2010-05-02T01:47:00.005+02:00

What if IVF was available and accessible and cheap for all of those who needed it?
What if we could reduce the rates of stillbirth and premature birth in IVF patients?
What if we could achieve both of these goals and decrease the burden on the healthcare system?

What if IVF didn't cost US$12,000 per attempt? What if it was available to all patients in need, without needing to sacrifice a chunk of their wealth to gamble on a few blastocysts?

In many countries, double embryo transfer is routinely performed to increase the success rate and to decrease the financial impact on patients. Around one third of double embryo transfers result in twins and higher order multiples.

However, the burden of multiples is great - on the babies, the mother's body, their parents, and the health care system. It seems unfair that a woman who spends so much emotional and material wealth on achieving a pregnancy should have to face higher rates of misfortune compared to a fertile woman.

In Belgium, the cost to the healthcare system for each singleton up to three months old is 3,400 euro. The cost to the healthcare system for each twin child up to the age of three months is 13,000 euro.

The cost to the Belgian healthcare system for a single IVF/ICSI cycle is 2,426 euro.

In European countries such as Finland, Sweden, Norway, and Belgium, IVF is available to all patients under the universal health care scheme. However, in women under 36 in their first or second IVF attempt, only a single embryo may be transferred. The mean pregnancy rate after single embryo transfer is now around 34% with 1% twins, compared to 35% with double embryo transfer with 33% multiple pregnancies.

This permits the Belgian healthcare system to offer six IVF cycles (technically six oocyte retrievals) to every woman who needs it, reduce the rates of pregnancy complications, and reduce the overall healthcare budget.

It is not only compassionate to offer IVF to all patients in need, it is also financially prudent. What if all countries could recognise this?

Gerris J, De Sutter P, De Neubourg D, Van Royen E, Vander Elst J, Mangelschots K, Vercruyssen M, Kok P, Elseviers M, Annemans L, Pauwels P, Dhont M. A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. Hum Reprod. 2004 Apr;19(4):917-23.

Gerris JM. Hum Reprod Update. 2005 Mar-Apr;11(2):105-21. Epub 2004 Oct 28.
Single embryo transfer and IVF/ICSI outcome: a balanced appraisal.
Hum Reprod Update. 2005 Mar-Apr;11(2):105-21.

This post is part of Mel's Project IF, supported by RESOLVE for National Infertility Awareness Week.

IVF in July/August

2010-04-27T11:43:00.001+02:00

We had to wait three months for the appointment, and then an additional 70 minutes in the waiting room, but the Professor has now officially granted us permission to begin IVF. The meeting itself was a bit pointless and anti-climactic, as it was basically an appointment to make another appointment for the end of May, once my insurance has approved IVF. Over here, six egg retrievals and all subsequent fresh and frozen transfers are covered for all female patients under 43 years, after three unsuccessful IUIs. I am so thankful for this.

The midwife talked to us about the process, and mentioned that I can choose between twilight anesthesia and local anesthetic for the egg retrieval. When describing twilight anesthesia to me, she said “so during the procedure you are in pain and are telling us, and asking for help, but afterwards when we ask you if you were in pain, you have no memory of being in pain”. At this description I visible paled and started to panic, my husband trying to comfort me. In this panicked state, it didn’t even occur to me to confirm that they do actually give their patients pain-relief during twilight anesthesia. However, as English is her third or forth language, I am going to put it down to a translation error.

The professor said that our main infertility issues are partly blocked tubes, spontaneous premature ovulation during IUI, thin endometrial lining, and a slightly lower sperm count. Happily, these are all issues that are likely to be circumvented by IVF.

Plus, I get to use a new orifice for medication delivery – over here in Europe, the IVF patients inhale their lupron through a nasal spray four times a day. Fewer injections are just fine with me.

I am on the long protocol. When I get my period in June, I go on the pill for 17-40 days, overlap the suppression medication, then begin Menopur injections. If it all goes to plan, we’ll know the result of our first IVF in August. If that doesn’t work, we’ll have a break cycle and then, if we can, a frozen cycle in October.

IUI#4 14DPO Not Pregnant

2010-04-10T17:45:00.000+02:00

Not Pregnant. Those were the words that greeted me this morning. I’ve bought a bunch of digital pregnancy tests from eBay. I much prefer the definitive answer. No examining the strip under a bright light, or scooping it out of the bin to see if a line has subsequently appeared. No room for doubt or error. Not Pregnant.

The worst day of this cycle was the day of the trigger, when I discovered that I had spontaneously started to ovulate while my lining was too thin. I “knew” then that this cycle would be no different from the others. My belly full of holes was for nothing, and I even had to inject myself with the drugs for the first time, as my husband was due home late that night. I demolished an entire jar of Nutella.

This was our last IUI, which means that the next time my belly is attacked with needles, it will be for IVF. We will have a 40% success rate instead of 10%. For the first time, my adhesions and blockages will not interfere. If nothing else, we might even be able to see the result of our combined genetic material, even if it is just a small blob of cells.

Consultation appointment in two weeks, procedure in July/August.

IUI#4 CD13

2010-03-26T16:15:00.003+01:00

This morning it looking like things were moving along well, with a "beautiful" lining of 6.5 and a follicle at 16.2 mm. However, the phone call this afternoon announced that I would not be coming in for another ultrasound tomorrow, but for my IUI. "Already?" I said. "Already", they confirmed. My HCG Pregnyl shot tonight at 8pm, and then the IUI tomorrow at 12:30.

Now I know my ovulation date, I can take a look at how my response stacks up against the other IUIs. And my endometrium measurements fit right over the other ones. No matter if I ovulate at day 9 or day 16, my lining is always around 7 mm, one standard deviation below my clinic's average of 8.7 mm ± 1.59. My lining is a consistent under-achiever.

IUI#4 CD10

2010-03-24T10:39:00.004+01:00

I was able to check in on my ovaries again this morning. My lining is looking good at 5.5 mm (triple stripe), there are no large follicles on my right ovary, and my left ovary has a single follicle at 12.1 mm. This is good, if we can take things nice and slow, there will hopefully be time for my lining to thicken up a bit before we trigger. My estrogen was only 80 on Monday (CD8), so everything is just cruising along gently, which is fine with me. I'm guessing the IUI will happen around CD15. Now I just wait for the nurse to call and tell me when to come back again. (Edit: E of 121).

IUI#4 CD8

2010-03-22T10:53:00.004+01:00

I woke up very excited this morning. I love the chance to spy in on my ovaries and see exactly what they are up to. I had my first ultrasound of the cycle today, and everything looks great. My lining is already at 4.4 mm (red dotted line) with a triple stripe pattern, and for once my follicles are not racing ahead. I have a sub-dominant follicle on my right ovary at 7.1 mm, and a dominant follicle on my left ovary at 10.1 mm (red unbroken line). It looks like 37 units of Menopur per day is a good dose for me. Looking at this, I guess that we'll probably do the IUI around Sunday on day 14 - must more respectable than day 9 with the first injectables attempt.

IUI#4 CD3

2010-03-17T10:35:00.003+01:00

Yesterday was the first day of Menopur shots. Considering that I ovulated on day 9 last time, they have cut my dose in half. So I take half an ampule each night, keeping the other half in the fridge until the next night. My husband is doing a wonderful job mixing everything together and giving me the injections.

Protocol:
CD2-CD7: ~37.5 IU Menopur
CD8: Ultrasound and bloodwork - Menopur dose as advised
CD9-17: Possible ultrasounds and bloodwork - Menopur dose as advised

It has now been two years since I started ovulating again after eleven years of hormonal contraception. Twenty six cycles, twenty six ovulations, twenty six thermal shifts. Fertility friend tells me that my second year-long VIP membership will expire next month. Do I sign up for another twelve months?

IUI#4 CD1

2010-03-15T16:47:00.004+01:00

Our insurance approved the injectables for IUI#4, so we start with low doses of Menipur tomorrow. I go in next week for my first scan.

It has now been over five months since my laparoscopy, and the surgeon said that the adhesions start to grow back after six months. After this cycle, we will not be attempting any more IUIs, and will start preparing for IVF.

Our lives have really settled down recently, we both have stable jobs, and we have a spare room that would look perfect as a nursery. For so long I have been able to tell myself that it wasn't really the bset time to have a child anyway, but now I think that this December might be an excellent month for us. I am very glad, however, that we started trying two years ago when our lives were all over the place, so we're not starting at square one today.

Yes, I would like a child, please.

2010-02-26T16:26:00.003+01:00

After some serious contemplation, I have decided that, yes, I really truly want to raise a child with my husband. These are the sort of events that I would love to experience in my life:

Dressing our baby up like a bear.
Seeing them asleep in my arms.
Helping them assemble a rock/stick/leaf/shell/etc collection.
Make them laugh.
Reading to them and seeing their imagination soar.
Listening in awe as they speak a second language.
Seeing their faces as they discover new places.
Creating new family traditions together.
Involving them in making family decisions.
Helping them figure out how the world works.
Doing my best to answer the question "why?".
Making a train-shaped birthday cake.
Watching the private world that they create with other children.
Learning from their unique insight and experiences.
Watching their personality develop into a whole new person.

Even if we do have a child, there is no guarantee that we will experience any of these moments. How do you decide to welcome a new person into your home that you have never met? How do you decide that the benefits outweigh the risks? Mel wrote about this leap into darkness a few days ago:

I think it’s brave to put your heart out there, to want something so badly, to allow your entire being to get wrapped up in the potential life of another person. If we make that leap to love a partner or family member or friend, we do so knowing that person, having met them, knowing our compatibility or history. But when we put our entire heart into the idea of a child, we do that bravely. Without answers or information or sometimes even a true understanding of what it will be like to parent.

With this confirmed desire, I called the fertility clinic to schedule our next IUI. However, I learned that this cycle needs to be pre-approved by our health insurance, which means a delay of at least another month. So more waiting and day dreaming for me.

Will we be happier with a child?

2010-02-17T15:25:00.006+01:00

Having children is a life changing event. Suddenly, there will be this new person in our family. My husband asked me to take a moment to stop and really think about if I truly want a child, or if I am just getting mission-orientated.

Julie addressed the question of "is it worth it?", and one commenter wrote:

This one is tough for me, too. And it's tough because, as much as I truly, madly, deeply love my children, I now realize how much of my own life--a life I really loved--I gave up in being a parent. I miss that life. And I sometimes think that if I didn't get the diagnosis "Infertile," if it had felt like a free choice and not a need to prove something to myself (I'm classic overachiever; having children was the one thing I couldn't 'get right'), maybe I would have made the decision to be childless. And maybe I would have been equally happy, or even happier. That's a hard truth to face.

So I am taking a few days to line up the pros and the cons of bringing a child into our family. Here are the most commonly cited reasons for having children or being childfree:

Reasons to have children	Reasons to be childfree
An additional way to express love for spouse	Less global overpopulation
Increased closeness with friends with children	More energy and fewer illnesses
More fulfillment and meaning to life	More freedom and spontaneity
The experience of parenthood	More money
The opportunity to provide and receive love	More privacy
The pleasure and pride of raising children	More sleep
To develop personally by interacting with children	More time for hobbies
To have a relationship with children	More time to develop career
To transmit ones own ideals and beliefs	More time with adult friends
	More time with spouse
	No problems associated with children

I also ploughed through the literature on happiness, marital satisfaction, and freedom in parents, the involuntary childless, and the voluntarily childfree. It appears that parents and voluntarily childfree couples are as happy as each other, and are both happier than the involuntary childless. Some studies suggest that marital satisfaction may be slightly lower for parents than for voluntarily childfree couples. Mothers state that they have less relaxation, independence, and freedom than voluntary childfree couples.

Outcome	Sex	Parents	Involuntarily childless	Voluntarily childfree	Ref
Well-being	M	47.8	not included	45.0	1
Life satisfaction	both		not included	3.5	2
Global well-being (1-9)	F	6.44	6.28	7.06	3
My life is disappointing (1) to rewarding (7)	F	5.42	4.68	5.18	3
Satisfaction with personal success (1-9)	F	5.94	5.50	6.37	3
Life satisfaction	both	23.7	not included	25.2	4
Happiness	both	0 (a)	-0.17	-0.14	5
Happiness	both	-0.18 (b)	-0.17	-0.14	5
Depression	both	0 (a) 0.05 (b)	0.09	0.07	5
Life satisfaction	both	0 (a) -0.30 (b)	-0.46	-0.22	5
Depression	F	1.68	1.73	not included	6
Life satisfaction	F	3.18	2.89	not included	6

Marital satisfaction	M	33.0	not included	31.7	1
Marital satisfaction	both	5.95	not included	6.00	7
Positive marital interactions	both	3.49	not included	4.32	7
Unhappy with marriage	both	7.4%	not included	0%	8
Marital satisfaction (1-5.7)	both	4.50	not included	4.75	2
Satisfaction with marriage (1-9)	F	6.96	7.84	7.37	3
Marital satisfaction	both	91.9	not included	93.6	4
Marital satisfaction (6-45)	F	38.2	not included	40.0	9
Marital satisfaction (6-45)	M	37.6	not included	38.8	9

Amount of relaxation in life (1-9)	F	4.26	5.81	5.28	3
Amount of independence and freedom (1-9)	F	4.90	6.69	6.46	3
Amount of friendship and love in life (1-9)	F	6.72	7.43	6.90	3

Satisfied with childbearing decision	both	3.87	not included	3.73	2

(a) = close ties to their adult children (standardized to 0)
(b) = distant ties to their adult children

1. Magarick, RH & Brown, RA. 1981. Social and emotional aspects of voluntary childlessness in vasectomized childless men. J. biosoc. Sci.13, 157-167
2. Burman, B & de Anda, D. 1986. Parenthood or Nonparenthood: A Comparison of Intentional Families. Lifestyles: A Journal of Changing Patterns. 8, 2, pp. 69-84
3. Callan, VJ. 1987. The Personal and Marital Adjustment of Mothers and of Voluntarily and Involuntarily Childless Wives. Journal of Marriage and Family, Vol. 49, No. 4, pp. 847-856
4. Somers, MD. 1993. A Comparison of Voluntarily Childfree Adults and Parents. Journal of Marriage and Family, 55, pp. 643-650
5. Connidis, Arnet I., McMullin, JA. 1993. To have or have not: Parent status and the subjective well-being of older men and women. The Gerontologist; 33, 5; pp. 630-640
6. Schwerdtfeger, Kami L. and Shreffler, Karina M.(2009) 'Trauma of Pregnancy Loss and Infertility Among Mothers and Involuntarily Childless Women in the United States', Journal of Loss and Trauma, 14: 3, 211 — 227
7. Feldman, H. 1981. A Comparison of Intentional Parents and Intentionally Childless Couples Journal of Marriage and Family, Vol. 43, No. 3, pp. 593-600
8. Ramu, GN. 1984. Family Background and Perceived Marital Happiness: A Comparison of Voluntary Childless Couples and Parents The Canadian Journal of Sociology / Cahiers canadiens de sociologie, Vol. 9, No. 1, pp. 47-67
9. Lawrence, E, Rothman, AD, Cobb, RJ, Rothman, MT, Bradbury, TN
2008. Marital satisfaction across the transition to parenthood. Journal of Family Psychology. Vol 22(1), Feb 2008, 41-50.

Not pregnant, but alive

2010-02-15T13:52:00.003+01:00

I caught two trains in Belgium today to get to the fertility clinic - one at 7:30, the other at 9:30. On my way back, the train was travelling very slowly, and I noticed several men in bright yellow vests walking along the other tracks. As it was snowing quite heavily, I thought nothing of it.

Then on I saw the news item "25 dead in train crash outside Brussels" flash across my desktop. My husband was also due to catch a train that morning, and I had not heard from him since I left the house. My hands were shaking as I called his work, and I was so happy to hear his voice on the other end. He had not heard about the crash, and once I told him the news, he was so glad that I was okay, too.

While I was on the phone with him, I got the call from the clinic telling me that I was not pregnant, and they suggest one last shot at IUI with injectable Menopur.

But all in all, I feel extremely lucky today.

Endometrium thickness

2010-02-01T09:21:00.010+01:00

Does clomid really thin out the lining more than injectables? The literature says that it only does this when taken on its own, but not when supplemented with estrogen.
From Dickey and Holtkamp, Human Reproduction Update 1996, Vol. 2, No. 6 pp. 483–506

Does endometrium thickness affect IUI outcome? Yes, significantly (p < 0.01). IUI birth rates per cycle for endometrium thickness at time of HCG trigger:

Regimen	6 mm or less	6 to 8 mm	8 mm or greater
Clomid	0%	7.0%	14.0%

From Dickey and Holtkamp, Human Reproduction Update 1996, Vol. 2, No. 6 pp. 483–506

At my scan yesterday (CD14) my endometrium thickness was 6.9 and my dominant follicle measured 19.6. We triggered last night, and the IUI is today. Looking over my last three cycles, I analysed my data and saw that, while Menopur thickened my lining more quickly, I also ovulated earlier at CD9. For all three cycles, my lining is around the same thickness right before ovulation, and it is far below average. At least this time it's above 6, which means we have a shot.

IUI#3 CD12

2010-01-29T11:23:00.011+01:00

I do love having my cycles monitored. I love graphs and tracking my numbers and knowing exactly what is happening. I like knowing what my ovaries are up to and how everything is progressing.

However, our clinic is not very empowering in that respect. They never tell me my hormone levels, and I have to quickly memories my ultrasound numbers as they appear on the screen. Today I asked the midwife what the procedure is, if we decide to move onto IVF. Her response was "you do not decide to move onto IVF, the professor will decide." She went on the explain that for IVF to be covered by the Belgian health care system, patients generally must try three IUIs first.

We are lucky to live in one of the few countries that provides six cycles of IVF to most residents. It pays for this cost by mandating that many of these must be single embryo transfers, which decreases the number of multiples born, and thus lowers the higher costs associated with multiples. The savings made on decreased newborn intensive care usage pays for the cost of providing IVF.

IVF coverage in Belgium:

age	IVF 1 to 2	IVF 3 to 6
Less than 36 years	single embryo transfer	two embryo transfer
36 to 39 years	two embryo transfer	three embryo transfer
More than 39 years	three embryo transfer	three embryo transfer

As for me, my dominant left follicle is still only at 13 mm, and my lining is still only 5.3 mm. Moving very slowly this time around. I'm guessing the IUI might be on Wednesday? We shall see.

IUI#3 CD10

2010-01-27T11:03:00.003+01:00

I was randomised to clomid this cycle (clomiphene citrate CD3 to CD7, estrogen CD8 to CD12), and as I had some at home that meant that I didn't have to go into the clinic until today. The midwife who was taking my blood looked so young that I was worried that she would be incompetent. I think however the problem was that I am getting old, because she was fabulous. In fact, she coaxed out so much of my blood that I didn't realise that I was continuing to leave little drops of the stuff over the chair and floor of the waiting room. I was so embarrassed to have to get one of the midwives to clean it up for me. Still, better that than leaving human blood around the place.

My follicles seem to be ripening more slowly this time around. Last CD10 with clomid my dominant follicle was at 16 mm, but this time around it is only 11.7 mm. This is great, because I need time for my endometrial lining to thicken up. My lining is only 3.7 mm, the thinnest it has ever been at CD10 - it's gone from 7.6 mm (IUI#1 Menopur) to 4.8 mm (IUI#2 Clomid) to 3.7 mm (IUI#3 Clomid). I have been reading through the literature, and it really needs to be at least 7 mm on the day of the HCG trigger for a good chance of success.

The good news is that the dominant follicle is on my left ovary with the good tube. I should know more when I hear from the midwife this afternoon, but my guess is that I will have another scan in two days (CD12) and that the IUI will be on Monday (CD15).

IUI#3

2010-01-18T08:37:00.003+01:00

New year, new IUI cycle. After a lovely vacation and break, it will soon be time to get back on the Assisted Reproductive Technology horse. Yes, I am still involved in the clinical trial, and yes, we have two more IUIs planned before we move on. The plan is:

February: IUI #3
March: IUI #4
April: Break and vacation
May/June: IVF #1
July: Break
August/September: FET/IVF#2

By this time, the theoretical success rate will be over 50%, and hopefully we will be part of that proportion.

Otherwise, we are just taking things month by month. We do not make any long term plans that we would have to change in the event of pregnancy. I try to schedule as many meetings at work in the afternoon, just in case I have to spend the morning at the fertility clinic. My calendar is divided into 28-day increments. I take my daily pre-natal tablet, as I have been doing for the past two years.

As long my husband and I have each other, we will be okay. For the moment, I am his baby and he takes care of me. He makes sure that I am taking care of myself, and that I have plenty of indulgences.

2009 and 2010

2010-01-04T09:42:00.003+01:00

Well, our second IUI did not result in a pregnancy. Even though 2009 we may not have succeeded in getting pregnant in 2009, it was still a wonderful year. In my opinion it is much harder to find the perfect spouse than the perfect baby. As long as I have my husband by my side, I am content to wait for a bit longer to expand our family.

Last year we got the ball rolling, started our journey into assisted reproductive technology. We are now in the system, and hopefully a series of injections and probes this year will finally flip the odds in our favour.

IUI #2 insemination

2009-12-07T18:33:00.004+01:00

We had our second artificial insemination yesterday. I was sitting in the procedure room, half naked with a towel draped over me for modesty, hoping that my bladder was just full enough. A well dressed woman comes into the room, wearing a short black dress, black stockings, and long black boots. She is holding a tube of sperm, and wants us to read the label to make sure it is correct. We confirm that those are our names, and then she asks me to put my legs up in the stirrups. I realise that she is the doctor!

I suddenly feel very embarrassed and nervous. I am getting accustomed to medical people in scrubs seeing me half naked, but this woman doesn't look a bit like a doctor. Here I am, legs splayed with everything on display, in front of a woman who looks like she's about to go out on a dinner date. I am so flummoxed I forget to ask any questions about sperm numbers or quality.

The IUI itself was a bit painful, but it was over very quickly. Happily, they did not play any love ballads for us while we rested for 15 minutes. They even let me keep an ultrasound picture of the sperm cells entering my uterus (the white dot in the center-right of the picture).

I must say, I am really glad that I have a break from the three-hour round trip to the hospital, the blood draws, and anxiously waiting for the phone to ring between 2pm and 5pm each day. We are taking a break cycle after this one, so we have six weeks of rest and relaxation.

IUI#2 CD12

2009-12-05T10:38:00.006+01:00

CD3-CD7 50mg Clomid
CD8-CD11 Estrogen
CD8 Disappointingly, the dominant follicle is on my right ovary, the one with the partly blocked tube. The follicle is 12.7 mm, and my lining is very thin at 3.4 mm, only 0.35 more than at CD3.
CD10 Dominant follicle at 16mm, lining at 4.8 mm (compared to 7.6mm when I was on Menopur)
CD11 Dominant follicle now ripe at 19mm, but lining only 5.78mm (triple stripe pattern). We trigger with HCG at 11pm. The needle injection hurts.

I have been extremely irritable lately, and my poor husband has had to bare the brunt of it all. He also has this thing about me taking personal responsbility for my actions, so I can't get away with just yelling at him and then blaming it on the drugs. Perhaps they could also percscribe some valium so that I could glide serenely through the days, instead of feeling my blood boil at every minor hindrance.

If this cycle doesn't work, then we will take a month break over Christmas, and then one to two more IUI cycles. If I am still not pregnant, we will move onto IVF. I am ambivilent towards IVF. On the one hand, there will be more medications and drugs and operations. On the other hand, I no longer have to worry about adhesions and blocked tubes, and our chances of success go from 10% to 40% per cycle.

These past IUI cycles have been odd. After so many months of privately monitoring my cycles with temperatures and LH cycles, I am surprised to find a team of midwives now working with me, and wishing me "good luck". I do appreciate the support, and the extra monitoring and knowledge, but the endless blood draws and commuting to the hospital are exhausting. And these area just the IUIs - we haven't even gotten to the hard stuff yet. I hope that all this does not last for longer than it has to.

We go in for the IUI tomorrow at noon. Either way, no injections for at least six weeks. Fingers crossed.

IUI#2 Day 3

2009-11-26T16:50:00.003+01:00

Three days ago.

"An exciting day today, yes?" The nurse asked me while taking my blood.
"Well, it is a rainy day" I answered. I didn't have the heart to tell he that I had already taken a home pregnancy test and recieved a negative result. She just seemed so excited, and then so disappointed when she called me at 4:02pm to tell me the result.

But the good thing is we can sneak in another IUI before everything closes for Christmas. This time I was randomised to Clomid, so fewer injections but perhaps more side-effects.

They are going to start monitoring me earlier, as I responded very quickly to the stimulation last time. My first ultrasound is next Tuesday, December 1.

Today.
Today is day 3, my endometrium is at 3.05mm, I have no ovarian cysts, my bloodwork looks good, so we have the green light.

We have one last chance for a positive pregnancy result in 2009.

12dp IUI

2009-11-18T21:21:00.002+01:00

Here's how my first IUI cycle went down:

CD2-CD7: 75 IU Menopur. Despite having my wonderful husband to do the injections, they get slightly more painful every day. I am grateful that Mel's book recommends a warm compress, which is a great comfort to my sore belly. Frustratingly, both the Menopur and Pregnyl here in Europe come in these fragile glass ampules that need to be snapped in half to access the powder or solution. This makes the mixing process even more fiddly and difficult.

CD8: Right ovary: several small follicles around 8mm. Left ovary, one large follicle at 15.5mm. I am very happy that the dominant follicle turned up on the side with my good tube. We continue with 75 IU Menopur. They call me to come in again the next day.

CD9: Left ovary follicle now measures 18.6mm, my endometrium measures 7.6mm. It is still strange to see my uterus clammed shut, so used to seeing open pictures on the web. They call me that afternoon, want me to do the trigger that night and come in the next morning for the IUI, which means that I must have started ovulating too soon. Trigger at 11pm.

CD10: Our IUI is scheduled for noon, but doesn't happen until 12:40. My poor bladder is so close to bursting it is all I can think about. The midwives leave us waiting in the room to the sounds of "Eternal Flame" and "My Heart will go On". I lay there, trying not to pee on myself, while being forced to listen to Celine Dion. It is not a very romantic insemination.

CD21: Today, 12 days into the two week wait, with my blood test having to wait until CD29. Fertility friend gives me a score of 35/100 for early pregnancy signs.

~~~~

So, the timing was off, and my endometrium was thin, but at least we will have IUI number 1 under our belts soon. One more 'n' for the clinical trial, either way. If it's negative, then we'll set up the next IUI, and in the mean time I will get my hair dyed and eat lots of soft French cheeses.

IUI #1

2009-10-30T19:07:00.005+01:00

Today is Day 2 in our very first IUI cycle.

The lab tests from the laparoscopy came back clear, so I do not have endometriosis. However, with only my left tube completely clear, the odds of pregnancy are slightly lower. The professor estimated that we have a 10-20% chance of success per cycle, with a 40% chance of success over three IUI cycles. Interestingly, he recommends a rest cycle in between each IUI cycle for both psychological and biological reasons.

I have joined the university's head-to-head randomised trial comparing Clomid with Menopur for IUI. Now no matter what the outcome of this cycle, I am increasing scientific knowledge that will help subsequent people with infertility make more informed decisions. They gave me a selection of brown envelopes to choose from, and I chose one that means I will be taking Menopur this cycle. This is my protocol:

CD1:
CD2-CD7: 75 IU Menopur
CD8: Ultrasound and bloodwork - Menopur dose as advised
CD9-17: Possible ultrasounds and bloodwork - Menopur dose as advised

Once the follicles look ripe:

Day -2: Trigger with Pregnyl
Day 0: IUI
Days 0-15: Progesterone suppositories
Day 15: Blood pregnancy test #1
Day 27: Blood pregnancy test #2 and ultrasound, if #1 positive

I am very thankful that I have my dear husband to do my injections. He is an expert at these things, while I can't even bear to watch the instructional video. I am also very glad that I only have one injection per day, it is subcutaneous, and the post-IUI progesterone is not an injection.

The hardest thing will be to try to keep everything in perspective. I am a very goal-oriented person, so if this IUI doesn't end in pregnancy I will feel as if I have personally failed. So my main mission this cycle is to focus on staying happy, to enjoy my time doing the things I love, and to remember that I already have a wonderful life.

Laparoscopy / hysteroscopy

2009-10-04T19:49:00.009+02:00

It has now been one week since my laporoscopy / hysteroscopy. I am recovering well, and they found a cause of our subfertility. I had intrapelvic adhesions between my uterus and abdominal wall, as well as on my fallopean tubes and ovaries. The methyl blue test showed that my left tube is unblocked, but my right tube is partly blocked. The doctor thinks that the adhesions will return in about six months, so we have a few months to try IUI, then on to IVF. The adhesions should not affect our chances of success with IVF.

The surgery really wasn't as bad as I thought it would be. For the previous five days I was on a low-fibre diet, with a bowel prep the night before. On day day of surgery I wore a dress and felt strange without my wedding ring. All the staff were great, especially the nurse who looked after me all day. My husband and I checked in at 8:30, and we had our own private room by 9:30. I got changed into a dashing blue gown with press-studs, sad that they wouldn't let me keep my socks on. I hunkered down under the blanket and started watching TV on my iPhone to distract me. The nurse could see that I was a bit nervous, and offered me "something for the pain" and "something for the anxiety". She looked at my belly and told me it was "good". The nurse took my blood pressure, and did a pregnancy test. At 7 days post ovulation it seemed a bit pointless, especially as abstinence was ordered by the doctor. The funny thing was, I was a bit afraid that it would come up positive, and I would be sent home in disgrace for wasting their time. However, it was negative.

In no time at all it was time for surgery. They even let me hold my toy dog that I had brought with me for moral support (yes, I am 29 years old). The wheeled me until just outside the doors of the operating room. There was a small boy of about 10 who was being wheeled through too, crying and vomiting and sounding terrified. I, on the other hand, was feeling quite mellow. Exactly like myself, but not at all worried or nervous. Yay for tranquilizers. A while later, they had me get off my bed and walk into the operating room.

I lay down, and started to shake. My mind might not have been nervous, but my body was cold and apprehensive. One nurse started sticking all these heart rate monitors all over me, while the anesthesiologist was prepping my drip, strangely in my wrist and not in my hand like in the movies. Everyone was moving very quickly, and they all seemed to know exactly what they were doing. The drip was in quickly, and the anesthesiologist told me that I would feel a bit of discomfort when the medication started flowing. The nurse held an oxygen mask above my nose. I asked them if they wanted me to count backwards from 100, and they said no. The infusion started, felt unpleasant, and within seconds I was feeling very sleepy. I wanted to tell them that I wasn't completely asleep, because I could still hear the beeping, but after that I fell completely asleep.

The doctor's notes say that they first conducted a hysteroscopy, and that my uterus looked normal from the inside. It measures 7 cm. A small biopsy was taken to double-check for endometriosis.

For the laparoscopy, a 12 mm incision was made just underneath my belly-button, and my abdomen was inflated. Three more incisions of 5 mm were then made lower down. From the outside, the uterus looked normal. There were adhesions in the vesico-uterine fold, in the pouch of Douglas between the sigmoid and peritoneum, on the right fossa ovarica (depression that lodges the ovary), and on end of the left fallopian tube. The adhesions were blocking the fimbriae that collect the egg from the ovary and pull it into the fallopian tubes. My corpus luteum was still bleeding. It was coagulated, and a cystectomy was conducted and sent off for further tests.

Methyl blue die flowed quickly through my left tube, but very slowly through my right fallopian tube. The adhesions were removed, my abdomen is deflated, and my catheter and breathing tube were removed.

I remember dreaming about wandering through the cobblestone streets of the city, but the next thing I new two hours had passed, and I was in the recovery room, with my toy dog on my pillow. I was so worried that I would never wake up again that I was just so thankful to be conscious. I started shaking, and the forced warm air under my blanket. I told them I was in pain, and they added something to my drip.

They wheeled me back into my room, and there was my wonderful husband, who hadn't left the room for even an instant. My throat was sore, and they wouldn't let me use my soothers because they had lidocaine in them. But they gave me something else to suck on to relieve my throat. I spent the afternoon dozing and recovering, getting some more infusion of "something for the pain" in my drip, and after that "something for the pain" to put under my tongue. The doctor came over in the afternoon to tell us the results. She said that the adhesions are most likely due to "an infection in the pelvis", which the internet tells me is most likely clamydia, which is very surprising.

I have taken the next week off work. The first 24 hours were difficult. It hurt every time I moved, and I could not lie on my side or sit up without intense pain in my shoulder, due to the residual gas pressing on a nerve. But I was still able to lay on the couch and have a Mad Men marathon, so it wasn't so bad. Every day got easier, and I am surprised how quickly I am recovering. The incisions are tiny, and the stitches are going to be removed tomorrow.

I am so glad that we now have an answer, and I have some neat photos of my uterus to boot. So now that the cobwebs have been cleared away, I am hoping for some good news in the next twelve months.

Laparoscopy next week

2009-09-22T15:36:00.001+02:00

The midwife called me back last week, saying that she had heard that I had some “not so good” news. She was really kind and gentle, and she has me booked in for a laparoscopy next Monday. At first I was really frightened, but then I had a long talk with my husband and he was very pragmatic and thoughtful.

He said that if I was too worried about the procedure, then I should cancel it. If I thought that the benefits outweighed the risks, then I should go ahead but stop worrying. He also gently reminded me that the best possible outcome will result in childbirth, which is much more risky and more painful. And then it hardly gets easier after that.

So, I thought to myself, am I in, or am I out?

I’m in. Now I’m focussing on the short term and long term positives. A low fibre diet the week before means lots of rice bubbles, white bread, and peanut butter. After the surgery I get a week at home with the cats and a pile of DVDs. We also get an answer to the question of endometriosis. And then our first IUI in December.

Raising a child brings joy and delight, but it also involves dealing with crises, disappointments, and pain. It is messy and complicated and stressful. So I am viewing this process as an educational experience. I need to learn how to communicate my thoughts, fears, and needs. To avoid panic attacks, and to act calmly and rationally. To enjoy the delights of each day, and aim directly for happiness and not for proxies.

Empty

2009-09-07T18:14:00.005+02:00

"How was your weekend?" my colleagues ask.
"Great!" I answer, thinking I had my first miscarriage.

I told myself that I would think in all the appropriate terms. Zygote, blastocyst, embryo. I know all the statistics. I know that I had a 20-50% chance that it would end too soon. I wouldn't skip ahead. I would take each day as it comes.

But as I felt those twinges inside me, I got attached far too quickly. I imagined being pregnant during the Winter holidays, and the baby being born in Spring. We would have our first child before I turned thirty.

I should be happy, that I know that we can now at least get pregnant, that somewhere inside me a sperm can meet an egg. Objective: fertilisation - achieved. This should be a good sign.

However, I can't help but feel a little empty.

Chemical pregnancy

2009-09-06T20:49:00.005+02:00

I started bleeding today. Chemical pregnancy. Four weeks and six days since my last menstrual period. Twenty one days post ovulation.

We have a houseguest with us, so I must act normal inside the house. So this morning I sat out on the fire escape, freezing in my pyjamas, quietly sobbing while I watched the people down below. Then I logged onto Fertility Friend and ticked 'miscarriage', and was informed that my status had been changed from "pregnant" to "waiting for ovulation".

I don't know where we go from here. I would like to hope that it is a positive sign, that it means that at least one of my tubes is not blocked and the sperm can swim. But why has it taken us this long to even get to this point? Do I still need a laparoscopy? Do we move straight to IUI?

As I look down at all the blood, I can't help wondering where the little poppy seed is, and how it failed to find a foothold in the dark.

Fading

2009-09-06T07:32:00.001+02:00

Friday: The midwife at my infertility clinic called me to schedule my laparoscopy. I told her that I had a positive pregnancy test, so I probably should cancel the appointment. She congratulated me, and I asked her to pass the news onto the professor.

Saturday: I went for a walk through the park in the sunshine. I felt happy and full of hope. My womb felt like it was tugging and stretching. As I fell asleep I had to sleep on my back, because my breasts were so sore.

Today: In the absence of a blood test, I took another pregnancy test. I was hoping that the line would be twice as dark as the one that I took 48 hours ago.

Instead, the line is fading, and my spotting is increasing. Things are not looking good for the little poppy seed.

Zwanger

2009-09-04T09:49:00.002+02:00

Yesterday afternoon, I picked up a digital pregnancy test, or a "test de grossesse / zwangerschapstest"" as they are known here in Belgium. Sixteen euros. Sheesh. Luckily, instead of trying to fit "enciente/ pas enciente; zwanger / niet zwanger; gravid / ikke er gravid" into the tiny window, there is simply a plus or a minus. So I come home, and use the fancy test. The hour glass flashes, and I put it down to wait. Three minutes later, I return, and I think that I catch a glimpse of a minus sign. Yep, I think, that's more like it.

But then I pick it up, and this is what I see:

It still feels very academic to me. Like this stick that I'm holding is referring to someone else. I still don't feel any difference - just some very mild pre-period cramping.

Still, I know I have to tell my husband. Maybe that will make it real. I pop out to a local baby store. It takes me a long time to walk in. Once in, I feel as if everyone is looking at me. After a long deliberation, I pick up a cute bear onsie for newborns. It looks disturbingly large. I come home, wrap it up, write a note, and order pizza.

Over dinner, my husband tells me about his day. I am terrified of telling him. I still don't feel like it's true, and that I am jumping the gun or making it up. So I give him the gift, and a card that says "I am pregnant. I am due on the 9th of May, 2010. I love you". He looks at me with wonder and amazement, and pulls me over to the couch. "Wow", he says, as we touch noses. I can't stop holding the positive pregnancy test. It is the only evidence that anything is difference. We spend the rest of the evening discussing wills and life insurance and maternity leave and childcare. It still doesn't seem real.

Pale pink line

2009-09-03T09:48:00.001+02:00

So, this cycle I ovulated sometime after cycle day 13. I had a positive luteinizing hormone rise at day 12, but no temperature rise until day 18. If I did ovulate at day 13, then today I am 18 days into my luteal phase. I took a pregnancy test 14 days past my LH surge, when my period was due, but it was completely negative, as usual. I also noticed I had some spotting and cramping, and thus had a few glasses of wine and a cup of coffee, and waited for my period to show up. Today, four days later, it still isn't here. My pregnancy tests will expire in two months, so I figured, why not use another one, even though my temperature is falling.

I remember reading that usually the second line shows up straight away. But mine, as usual, fades to white. I put it down, but then a few minutes pick it back up again. If I look very, very carefully, there appears to be an extremely faint second line. So faint, I must be hallucinating. I pull up the Fertility Friend gallery of very faint positive pregnancy tests, and they all look darker than mine. I pull it out again. It's more than a shadow than a line. The test strip cost a dollar from the internet, is over a year old, and has been shipped over two continents. It's probably not very accurate.

I have had no other signs. No nausea or sore breasts or anything. I feel completely normal.

If it is positive and I had a healthy pregnancy, I would give birth on the 9th of May 2010. That is far too soon and too real and too scary. My hands shake at the thought. It's all too soon. I'm not ready.

So I will test again this afternoon, and we shall see then. But I might pick up the strip and look at it again.

Hmmm...

So. Surgery it is.

2009-08-13T15:51:00.001+02:00

We had our second infertility meeting yesterday. It is mostly good news. All our genetic tests came back normal, which means that we both have the right number of chromosomes, and aren't carriers for any major monogenic diseases. Our blood hormones also look normal. We found out that my husband's sperm morphology is 4%-7%, which is sub-normal, but not really that bad.

Thanks to Fertility Friend, I know that we have had well-timed intercourse for over 14 ovulatory cycles with no pregnancy.

So the next suspected culprit is endometriosis on my side. This is tricky to diagnose externally. I never suspected this, though when I think back my periods do seem to be getting worse with time since I went off the pill. So the professor recommends a laparoscopy/hysteroscopy.

While it is keyhole surgery, it is still surgery. General anesthetic, filling my abdomen and uterus full of gas, and three keyhole cuts - one for the camera, and two for the robot arms. They say that in 50% of cases like ours, they find mild endometriosis, which they repair with a laser during the same operation. After treatment, they move onto IUIs and notice a doubling in success rates compared to women who do not have their endometriosis fixed. We will then have a 10-20% chance of success for the first IUI cycle.

So the expected timeline would be something like:
October: Hysteroscopy
November: Stimulated IUI #1
December: Stimulated IUI #2
January: Stimulated IUI #3
February: Meeting to discuss options

Now I am waiting for the nurse to call me to schedule my first ever operation. I am quite worried and nervous. They say there is <1% chance of complications and that they do around 10 of these operations a week, but I am still frightened of catheters and drips and anesthetic and incisions. Still, I suppose pregnancy and childbirth is no walk in the park either, so I might as well start to get used to strange things happening to my uterus.

I am not looking forward to the pain.

Internal Ultrasound

2009-07-17T17:01:00.001+02:00

Yesterday I had my internal ultrasound. Again, it was at the gynaecology ward of the hospital, so I was surrounded by large bellies and excited couples. I imagine this would be very difficult for many.

It was a little bit disconcerting, sitting there half naked with my legs hoisted up to the ceiling while the doctor was asking me about my medical history. It also didn’t help that the technician was new and couldn’t find my uterus or my ovaries. For a while there I was convinced I didn’t even have a uterus, which had me shaking with nerves on the cold chair.

But in the end, my uterus and my ovaries passed this superficial test. They exist, there is no endometriosis visible, and my left ovary has a bunch of immature follicles that are competing for dominance on this CD6.

I asked the doctor if I could get a copy of the images. He looked completely baffled. He said “why, to show your family?”, like I was going to post my grandmother a photo of my empty uterus. So I just told him that I liked to keep a copy of all my medical records. He didn’t give me any images, but I did manage to wrangle a copy of the report.

As for the results of all our other tests? We do not find out until August 12. I called up the Fertility Centre and they only discuss the results in person, during the consultation appointment. They do not release the results before then.

This is very frustrating. I like to do my own research on the implications of the data, but instead we have a single meeting with the head of the centre to discuss strategy where he is holding all the cards. I know that all the information we need about our own bodily fluids is just sitting in a file someone, and I am unable to access it.

So more waiting and waiting for us.

My insides:
Uterus:
Position: ante
Dimensions: L:53 A-P:26 T:32

Endometrium:
Imaging: clear division
Structure: intact

Right Ovary
Imaging: visible
Morphology: Normal
Limitation: Regular
Size: 31
x 23
x 18
Volume 6.7

Left Ovary:
Imaging: visible
Morphology: Normal
Limitation: Regular
Size: 30
x 30
x 17
Volume 8.0