Another round of IVF – do we even want to go there?

As I had expected, my latest pregnancy came to an end shortly after it began. My period brought both sadness and relief. Sadness that it wasn’t to be, again. But relief that I wouldn’t have to sit through weeks of not knowing whether this baby was chromosomally normal. Relief that there was no chance that I would have to go through that phone call again where I was told our baby had 100% trisomy chromosomes. It’s a pity that my thinking has changed so much over the years to automatically taking on negative slant on these things. But it is what it is, they say.

Despite barely having an opportunity to reflect on a failed embryo transfer due to parvovirus (a fucking virus!!), having the illness associated with parvovirus, and a second failed pregnancy all within six weeks, we believed that it was a good time to undertake a second round of IVF because I was off work until the end of the month. If we didn’t do the egg collection in November, we had to wait until January at least, perhaps February, given the Christmas holidays and our existing travel plans. So, November it was.

Until it wasn’t. I got my period and rang the clinic. They wanted my to take a blood test to ensure that the HcG was out of my system. I came back with a reading of six, and they wanted five or less. So I wasn’t allowed to start. I was not looking forward to the egg collection cycle but, equally, I was upset at the idea of having to wait and do the cycle while I was back at work. We talked to my gynaecologist and pressed our case, but at the same time stressing that we didn’t want to be pigheaded about it if it would impact on the number or quality of eggs.

So there we were, with permission to start our second round of IVF a day later than normal.

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IVF part 3: survival of the fittest

The IVF process from egg collection onwards is a real eye opener.

Our egg collection process retrieved 24 eggs. Then, at the party-in-a-petri-dish on day one  23 eggs were fertilised. 15 embryos “hatched” on day three. 13 embryos survived to blastocyst stage on day five. They were all biopsied for pre-genetic testing and then frozen.

They told us that 13 embryos was a ludicrously good result. I felt confident and happy, even if I was a little uneasy at the thought that we had a football team (and reserves) sitting on ice.

Our guys were biopsied on day five and those biopsied cells were sent away for testing, to see if there were any chromosomal abnormalities.  Given our history, it was the sensible thing to do. When I received the call from my gynaecologist exactly a month after the egg collection I realised just how sensible it was.

Only two out of the 13 embryos tested as “normal”. Embryo number 4 and embryo number 6. Three were “inconclusive”. The remainder were “abnormal”. I was shocked. What did this mean? We still do not really know, except they their cell division was not normal and the abnormalities appeared to be random. I called my husband straight away. As I heard his voice I started shaking and crying, and had to babble “it’s not as bad as it sounds!” quickly so that he wouldn’t worry. I told him the news. He was gobsmacked too.

It took a few days to come around from the shock of only two of our “guys” surviving to believing that two was a good result in the end and meant that we had a real chance of finally getting off the mouse wheel of infertility.

 

 

 

 

On the eve of IVF

It has been a long two months as I sit here on the eve of my first IVF cycle.

This month’s cycle is at an end. Clomid gave me migraine headaches, bloating, and some random sobbing, but unfortunately only one follicle. The previous month there were two follicles, and elation with a positive pregnancy test. That quickly turned to sheer disbelief and heartache as a week later I felt my underpants were wet and after quickly taking myself to the bathroom realised that it was blood. Lots of blood. Perhaps it was a chemical pregnancy, who knows. I felt myself drift into the familiar territory of grief and numbness, but the shortness of the pregnancy seems to have been mirrored in the shortness of my grief for loss #5.

The loss of another pregnancy hardened my resolve. I wasn’t prepared to let matters take their own course and wander on, and on, and on. I’m now 34 and we’ve been trying to have our second baby for two and a half years now. I’m sick of my relationship with my husband taking a back seat. The last two months we have had to wait for the hollow text message saying “it’s a good time to have intercourse for the next four days”. It’s been long enough.

Tonight I am completing consent forms. The questions ask, “do you want to dispose of any embryo with inconclusive pre-genetic screening results” and the like. It turns your mind to the possibility that we may have some difficult decisions ahead of us, or horrible things may happen to us again. It talks about CVS. I instantly think of my one and only CVS that led to a diagnosis of T21. I am doing my best to be positive. It is the best chance we have of conceiving a healthy baby.

On the bench sits a turquoise green cooler bag. Inside there are information sheets, a specimen collection jar for my husband, and two injection pens. I will need to inject myself in the stomach with two drugs, one to stimulate follicle development, the other to prevent ovulation. That’s what is making me the most nervous at this point. Stabbing my own stomach with a fine needle. Each injection costs around $300. What if I botch it up? Will it hurt a lot?

My poor husband has to deposit a specimen for semen analysis tomorrow. He said his voice quivered on the phone as he tried to say the words. I had to laugh at the sheer awkwardness of the situation, but I also feel genuinely sorry for him that he is now part of the medical hoop-jumping circus that I feel so familiar with.

Despite our history, my gynaecologist calls us his, ‘positive prognosis”, and he is confident we will get there. Fingers crossed that he’s right.

 

CVS (chorionic villus sampling)

A week ago I didn’t know what CVS was.

In a nutshell and from the perspective of a non-medical professional, it is a diagnostic  technique where a sample is collected from the placenta and used to test (at around 99% accuracy) for issues such as chromosomal abnormalities in a developing foetus.

I talked to BEP about my options following a high nuchal translucency reading. He recommended CVS, as the results are available in 48 hours. This was in comparison to our other option, a blood test, where the results would be available in around two weeks. The main downside of a CVS was a 1% risk of miscarriage. We decided that the risk was worth it for peace of mind. He also advised me that, even if the CVS came back clear we were far from being out of the woods. Apparently a high nuchal translucency reading is also related to other significant issues, like heart defects which could be fatal.

It was hard to take. I couldn’t face work on the Monday. My appointment was scheduled for 3.30pm that afternoon at the hospital. It was a similar feeling to sitting the most difficult exam of your life. I paced around the house, achieving absolutely nothing. My husband arrived home just before 3pm and together with our son we headed off.

I was crying by the time we reached the Fetal Monitoring Unit. The receptionist kept staring at me. I stared back. We were promptly called into a private room. I recognised the obstetrician there who would perform the procedure. He can be effectively summed up as Guy Smiley. Not really what you want on one of the more stressful days of your life. Guy Smiley advised us that my blood test results had come back. They weren’t good. Our risk was now one in ten. Guy Smiley irked my husband by repeatedly joking about, “sticking a needle in my belly” and nearly had his lights punched out by me when he said, “I had a one in two that was OK, you’ll be just fine!”

I had to stop crying when the CVS was performed. Guy Smiley placed some antiseptic on my tummy, and then a sterile sheet. He then used a needle to apply a local anaesthetic and then used another needle to gain the sample of placenta. I watched motionless on the ultrasound as he hacked away at the placenta. The midwife tried to talk to me about my son as though we were having a coffee together in a cafe. I didn’t respond.

It didn’t take long. Guy Smiley said I would know the result within 48 hours. The midwife said it might be slightly longer, as it was already 4pm. I recommenced my crying and toddled out to the waiting room with a fairly sensitive tummy. The receptionist stared at me again. And so began the excruciating wait for our results.

 

 

The world couldn’t be so cruel

It has been some time since my last post, three months or so in fact. About the time that it takes to fall pregnant and endure the first trimester of fatigue, morning sickness, hope and anxiety. And that’s no coincidence, because we’re pregnant.

It was only about a week after we were told by our obstetrician to “go forth and multiply” (his words not mine) that we conceived. Apart from the obvious, I barely know how it happened. I was still finding it difficult to decipher between withdrawal bleeding, a period and losing the last of the “products of conception” from our previous miscarriage to have any inkling about when I might be able to conceive again. But it happened. I was shocked, surprised, happy and nervous, but mainly glad that we didn’t have to endure months of anticipation. I wanted our son to have a little brother or sister before he was three.

I spent weeks going to bed early with tiredness and feeling nauseated morning, noon and night. My boobs hurt like crazy. My husband took our son to the pool, the beach, or the park almost every afternoon he could so that I could lie in bed, watching beautiful Autumn afternoons come and go through the window, but hopeful that it would soon all be worthwhile. The few friends I told I was pregnant crossed their toes and fingers for me. They asked if I was worried, “of course” I said, “but the world couldn’t be so cruel as to make this pregnancy third time unlucky.” They agreed. The world couldn’t be so cruel.

Our eight week scan went well. I was so nervous before hand that I paced around the sonographer’s office, checking over my shoulder every thirty seconds to check whether our appointment was ready. The sonographer confirmed a heartbeat probably within record time. It would have been obvious to anyone that I was a somewhat psychotic and deranged pregnant lady about to have a full blown meltdown. I proved her right somewhat by bawling uncontrollably at the sight of the heartbeat. Everything was going to be ok.

I then had a follow up appointment at BEP’s (my obstetrician) at around eleven weeks. I felt more confident than previously. I still felt sick, unlike my last pregnancy where my morning sickness had ended abruptly at around eight weeks. BEP said, “well let’s try and put your mind at ease”, and asked me to lie down so that he could perform an ultrasound. Before I could even ask whether he could see a heartbeat the baby moved! It was an incredible and unexpected moment. BEP even thought the baby measured at around twelve weeks. That magical twelve weeks.

BEP suggested that I undertake the standard twelve week nuchal translucency scan soon together with the blood test to test for issues including Down Syndrome. So I booked in at the sonographer’s that Thursday. I was slightly nervous, but nothing like the eight week scan. I’d seen the baby alive that Monday, and that had put me at ease.

The scan started well enough. The baby’s heartbeat could be seen, and the nasal bone, which apparently was a good sign. Then disaster. The sonographer began measuring the nuchal fluid. She loitered. I asked her if it was normal and she said no. The fluid measured at 3.8mm. Anything greater than 3.5mm was immediately referred to the Fetal Unit at the hospital. We asked what it meant. The sonographer said it meant it was likely that our baby had Down Syndrome. My husband asked, “what does that mean, does it mean more likely than not?” She seemed to agree. He asked again, “so is the risk, say, one in two?” She said, “it could be” and offered to enter the details into her computer to calculate our risk. One in thirteen. Lucky thirteen. Better than one in two, but one in thirteen! I’d only just turned 33 a few weeks earlier surely my risk wasn’t that high?

It was a day that, despite everything we’d been through, I hadn’t expected and it hit me hard. I cried. The midwife student shifted uncomfortably in her chair. The sonographer looked awkward and busied herself with preparing our report. “Why does this shit always happen to me?” I asked, “I don’t deserve this!” My beautiful son saw I was upset and gave me cuddles. My husband clutched my hand tightly.

We were moved into the staff room.  I cried there. Eventually we moved out to reception. I cried there too. I didn’t care that I was crying. They said I didn’t have to pay the $180 fee. I knew that must mean things were bad. And they were.

 

 

 

 

Trying again

After two miscarriages of three babies, two surgeries, and too many scans, we may well be ready to officially start trying once again. It’s been four months exactly since I had the devastating ultrasound that showed a perfect looking little guy with an inexplicable absence of life. My heart still aches, but it is not as acute. I still think about fertility, pregnancy and miscarriage every single day, but not for hours on end. And I’ve only cried perhaps a couple of times this last month. I try and convince myself that these four months have allowed me to heal somewhat, but I cannot help feeling somewhat cheated.

I’m lucky that I have had such a supportive husband. Although he sometimes struggles to understand the depths of my grief and preoccupation with what has happened and what the future holds, he has been incredible. I’ve been upset and withdrawn more often than not and for months on end. And he has at the same time dealt with his own grief. Support is so critical after a miscarriage, I cannot stress that enough. If you do not receive the support you need from family and friends, seek it from somewhere else.

My husband and I have yet to decide what to do with our little guys in my bedroom drawer and the kitchen freezer. In some ways I am loath to do anything that would see them leave me. In other ways, I know that my husband is right that we should look to honour and commemorate them. I think I’m now ready to face that. I’m thinking of getting a tattoo of three little birds, swallows, somewhere to provide a permanent reminder that they will always be loved.

What the heck is Asherman’s?

It was two months after my second surgery that I realized something was wrong. I hadn’t had a period, or anything resembling a period. I rang BEP (my obstetrician) and asked what might be causing this. He advised that it could be what I would later term “stubborn cervix syndrome” in that the cervix had reacted badly to the surgical procedure and remained tightly shut, or it could be hormonal, or there may be a few other explanations. He asked me to have a pelvic scan to rule out anything untoward, like Asherman’s Syndrome. I didn’t ask what Asherman’s Syndrome was.

The sonographer was pregnant I noticed. She was pleasant enough, and advised that she wanted to discuss what she had seen with the resident gynecologist. I waited for a few minutes and was then ushered into a separate room. They asked me to sit down. “We don’t really know what the situation is in your uterus, there are a few lumps that could be clots, and a lot of liquid that should be coming out but isn’t.” They seemed deliberately vague. It was a Friday afternoon, and my obstetrician rang and asked if I could please see him first thing on the Monday morning. Alarm bells were ringing. Once again I cried.

Don’t ever Google Asherman’s Syndrome. When I did it produced the most horrible results. Essentially, what was primarily discussed was a risk of the uterus scarring or even fusing together post-surgery, leading to a build up of blood inside the uterus and infertility. I totally flipped out when I read this.

BEP was great. He clearly saw the worry on my face. We read through the sonographer’s report line by line and he explained to me every aspect of it. “Asherman’s Sydrome covers such a broad range of conditions, from extreme to minor, that the term is effectively redundant,” he explained. “Thank God,” I thought, “hopefully we might fall into the minor category”. He suggested that he perform a procedure to dilate my cervix, and in the event that blood came out over the next few days and months that would indicate that there was no lasting issue, but rather a case of “stubborn cervix syndrome”.

It was certainly not glamorous and involved old-fashioned stirrups, but I didn’t care. The procedure appeared to be a success. A small amount of blood came out immediately. He prescribed me a contraceptive pill for a few months to “get things back on track”.

At my follow up scan, a different sonographer spent some time taking a variety of images. She advised that she wanted to discuss what she had seen with the resident gynecologist. I waited for a few minutes with my son, anxious as anything. The same gynecologist came into the room and said, “well it’s a different story today”. I didn’t know whether that was positive or not. “Is that a good thing or a bad thing?” I asked. “Good! Definitely good.” I think I had been holding my breath until that moment. What a massive relief. “There’s some blood remaining in your uterus but if I didn’t know your history I wouldn’t have thought twice about it. Compared to last time when it DEFINITELY WAS NOT NORMAL!” She mentioned something about “products of conception”. I was a bit taken aback at her forthrightness now that everything was seemingly OK. And this was the first time that anyone had suggested that perhaps some “products of conception” remained, that is, that the surgery had not been fully successful. I felt relieved, and confused, and sad.