6w2d: Waiting to see the heartbeat

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?

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

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.

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

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...

• 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

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

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

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

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

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

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

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.

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.