Back on the mouse-wheel of infertility

My colleague that sits next to me in the office is pregnant. Again. Unless something goes drastically wrong she will have two kids in the time we have been unable to have one. She’s so happy. I overhear her making  telephone appointments for scans, pregnancy yoga classes, “babymoon” holidays, and buying a bigger car. It really gets me down and that bothers me.

It was one of the reasons I’ve decided to take time away from work. I’m taking three months off. In part, this time is to repair some of the damage done to my mental state over the last two and half years. When our first embryo transfer failed, it hit me in a different way than I expected. It has been like a thick fog descended on me overnight and has barely lifted. My senses have been dulled and I don’t feel happiness like I usually do. I grump at my husband and cry way too much. It’s no good for anyone.

So I’m trying to take charge. I also want to do the best that I can for our second guy in the freezer, embryo number six. I was so anxious prior to and in the weeks following our first embryo transfer that I believe it may have affected implantation. It was unhealthy and unhelpful, and given the stakes are so high I feel a bit stupid in hindsight that I didn’t prioritise my health and sanity more by taking time off work then. Not that I can do anything about that now.

My boss was amazing actually. When I raised with him taking time off it was as if he had figured it out before I had. He said that he realised that the alternative to me taking leave was that I’d probably quit, which was true. This was more important than my job and he agreed. I don’t know how he convinced himself and management in barely 24 hours to approve my proposal, but here I am, on leave now for three months.

Fingers crossed that its productive in more ways than one.

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.

 

 

 

 

IVF part 2: egg collection

I opted to work from home the morning of my egg collection. It proved a good distraction from egg collection, but a bad distraction from my ban on any food or drink before the procedure. I became pretty nervous in the half hour or so before I had to get in the car. I checked I had everything I needed, which was basically nothing, about five times.

My husband was there when I walked in the doors of the clinic. We sat on the couch and waited. I was too distracted to read any of the trashy magazines, or to even really talk.

We were called into our own small room. Two nurses came in. They asked all the usual questions, “are you allergic to anything?” “have you eaten anything today” “when did you last drink anything?” They explained the procedure in brief. An embryologist joined the conversation. My gynaecologist joined the conversation. It felt like there were thirty people in a room meant for one. My poor husband slunk back from providing his “sample” to a room of chaos.

I was walked into theatre. Almost immediately I noticed a tiny little window with the embryologist sitting on the other side of it. It looked like a little coffee bar, or a service kitchen. I almost expected to see a little moustached barista with an apron pop out with a smile and an espresso. I think what really was going to happen was that my gynaecologist would pass fluid containing eggs through the window so that they could examine the eggs immediately.

I sat down on the theatre bed and was promptly hooked up to various machines. An IV drip. A blood pressure monitor. Something in my nose with some gas passing through it, probably to zap any fears away. Then the nurses passed my gynaecologist drugs and even before I had my legs in the delightful stirrups I felt myself going fairly floppy.

The procedure itself was pretty painful. With 26 follicles my gynaecologist had to make a number of incisions directly into the ovaries. I cringed and let out a little squeak with each one. I tried to focus on my breathing. Soon enough they were finished, and I was out of theatre just like that, back in my little room.

I was given some toast, and I suspect about then the effect of the drugs really kicked in. I can’t remember what was on the toast, but I do remember that I offered some to my husband. The next thing that I remember was my gynaecologist advising me that they had managed to retrieve 24 eggs. “Wow!” I exclaimed. I was so stoked. My husband laughed and said, “you do realise that is about the sixth time they’ve told you that?” I had no recollection whatsoever.

I was discharged fairly quickly. We had a prescription for some codeine and we drove around the building to the pharmacy on the other side. I waited in the car while my husband went inside. Pretty quickly things went really downhill. I realised that I was going to either throw up or pass out, or both. I shifted uncomfortably around in the car, put the seat back, but to no avail. My mind told me that I had to escape the car and lie down on the cold concrete of the car park. So out I flopped. I began sweating and my head was spinning. I frantically told myself not to spew, to breathe, to focus on lying still.

I don’t know how much time had passed. I heard my husband say my name in shock. He later said he felt like he had an out of body experience seeing me lying with my head on the curb amongst some dead leaves and cigarette butts. I heard a lady say, “is she alright?” and my husband replied, “yeah, she’s ok, she’s just nauseous.” Poor guy.  I refused to move for a while, until I was able to get myself into the car and stay as still as possible on the reclined seat. Off we drove.

At home I rushed myself to bed and basically conked out for the rest of the afternoon. Occasionally I would get enough will and hunger to have some food and drink, but mostly I just slept. Neither of us had expected it would be such an ordeal, or that I would basically spend the next five days in and out of bed with nausea and a feeling like my insides were pumped full of concrete and squeezed. But we had done it. Now the wait to see if any of our guys would make it began.

 

 

 

IVF part 1: the human pin cushion

We started IVF a little over two weeks ago. It was Mothers Day (the irony of this is was not lost on me). I sat nervously on the couch, dialled up 200 on the Puregon pen, screwed a needle into the end and just sat there. It’s not something that came naturally to me, stabbing yourself in your abdomen. Perhaps that is a good thing.

I think I administered the first injection a bit too fast, some residue was left on my skin. It left me feeling worried and anxious – what if I had just stuffed up our entire cycle, all on the first night?! I called my gynaecologist, he wasn’t bothered but wanted me to talk to the nurses the next day. It turns out that injecting yourself can take a bit of practice and patience.

In addition to injecting myself every evening with Puregon, to stimulate follicle (and hopefully egg) development, from day six of my cycle I also had to inject myself in the mornings with another drug called Orgalutran to prevent ovulation. Initially, the only real side effect was a heinous lump of uncomfortable breast tissue sprung up almost overnight. An ultrasound later and thankfully it was confirmed as drugs and hormones messing with me rather than anything too sinister. Probably could have done without that additional stress though.

My first scan and blood test was on the following Saturday. I went in with the expectation that we would see maybe five or so follicles. The gynaecologist used an ultrasound to start measuring the follicles she could see. “Sixteen” she’d call out to the nurse sitting at the computer. The nurse typed the measurement into the computer. “Fourteen”. “Ten”. “Ten”. “Fourteen” and so it went. I counted in my head with my heart in my mouth, “one, two, three, four, five, six…”

“OK”, said the gynaecologist, “now we’re going to move onto the other ovary”. The OTHER ovary? It seems obvious that this would be the case in hindsight, but at the time I thought that only one ovary would be producing follicles. I stopped counting after that, content that we must be on the right track.

My results showed that we had 22 follicles and I was scheduled to have another blood test and scan on the Monday morning. Things were definitely progressing, and fast. On the Monday, we went through the same follicle counting process as before. 26 follicles!! The nurses seemed nervous about the number of follicles and advised me that I would have to take an injection of Buserelin at 12.30am the following morning to “trigger” the ovulation process.

My egg collection was scheduled for 12.30pm on Wednesday, no food that morning, no water after 10.30am, bring your used needles, instruction after instruction after instruction. It was only day 10 of my cycle and it felt like I suddenly lost control over what was happening.

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.