IVF#2: scheduled

Thank-you for all your advice yesterday.

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

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

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

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

FET#1: Cancelled

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

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

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

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

December 23
That's seven weeks from now. I have to wait seven weeks to have a 10 minute conversation in which The Professor tells us what we already know. Look, I enjoy talking with The Professor as he is quite knowledgeable and can answer some of our questions. But I am not willing to wait seven weeks for the privilege. Last time we had the appointment, he had already reviewed our chart and determined a protocol. Nothing that we said changed this protocol. It was a reassuring meeting, but hardly medically necessary.

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

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

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

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

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

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

The Chair

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

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

So. Surgery it is.

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

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

First infertility appointment

It's a good thing that am very happy about my life, because it turns out the infertility center works out of the gynecological department in the hospital. So we watched many pregnant bellies walk back and forth while we waited.

We were then interviewed by a younger woman about our medical histories. She did raise her eyes at my numerous graphs and statistics. She asked me for how long I had had a "baby wish", and my husband wryly noted that she did not ask him the same question when it was his turn. I thought I had prepared quite well, but when she asked me how often we had sex per month, that was not a ready figure that I had with me. I pulled out Fertility Friend's intercourse analyzer of my fertile periods over the past 12 months, and she asked "and outside of these times, you do not have sex?" I denied this statement, but now I am sure that she thinks we are celibate for 24 days out of the month.

Then suddenly she said to me, "and now we shall do an internal examination", and made some sort of gesture with her hands. Now? Did she want me to take off my skirt this moment? Yes, she did. She did not ask my husband to leave the room. She did not walk out of the room or give me a gown. She merely stood there, waiting for me to undress in front of her. I felt very shy, and removed my skirt without even thinking to remove my undies. It was only when I sat down on the paper that I realised my mistake. I removed my undies, hoisted my legs up on the stirrups, and in a few seconds she was in and out with a cervix spear.

This was all a little shocking for me. Why is it the act of undressing feels more weird than actually being naked? And what is wrong with draping a bit of fabric over the top to pretend otherwise?

Once I was dressed again, she called in the doctor came in. He looked at my temperature charts and told me that these were the best charts that he had ever seen, which was to be expected, he said, as I was a scientist. Usually, he said, they ask women to track two or three cycles, never... fourteen. I replied that you get a much better standard deviation with an increased N.

He said that the plan was to test my blood at CD21 and CD3 and do a basic internal ultrasound. In the meantime, my husband would be tested for "male factor" (he dislikes being reduced to that phrase) and if that came up normal, they would conduct further tests on me. They would also begin genetic tests immediately, as they take two months for the results to come through.

Today was my CD21 blood test, then I have my CD3 blood test, and then I come back for my ultrasound in a month. We meet with the doctor on August 12 to discuss our next strategy. I tried to ask my questions about donor gametes and embryos, but he said it was much too early for those sorts of questions. But now we are moving forward, and I feel accomplished. In 70 days we should have plenty to talk about.