The Lives of Others – Donor Egg cycle August/Sept/Oct 2014

The initial preparations for our first donor egg cycle began back in July when I had to notify the Prague clinic about the onset of my period and submit the completed donor request form. This form asked us to specify basic details about ourselves- height, weight, eye, hair and skin colour. There was a box at the bottom of the form for any other requests so we included a request for a proven donor (one who has had children already), a blood group match ( we are both O+) and level of education although I put these in as preferences rather than must haves. I also had an endometrial scratch performed at my local clinic.
During August my husband attended the local clinic on 3 occasions to provide samples. These were subsequently frozen and shipped to Prague. This meant that all going well, no fresh sample would be needed and we could travel to Prague for 2 nights instead of 7. A test thaw was carried out on the samples and 10 straws in total were shipped.
I was instructed to take a single Decapetryl injection on 7th August and also to start 5mg folic acid. This was to down regulate me. As this was an intramuscular injection I went to the local clinic to have it done. I was asked to advise the Prague clinic of my August period which arrived on the 16th. I was then told to start estrogen tablets from the 20th, 3 tablets or 6mg daily. As an addition I also started 25mg daily of prednisolone with my local clinic to keep my immune system quiet. This also had the happy side effect of calming my annual August asthma. My first scan was scheduled for August 29th.
I attended for the scan and a nurse I had not seen before completed it. She measured the lining at 6.06mm which was too thin as yet. The Prague clinic wanted a minimum of 7mm. I was advised to increase my tablet dose to 8mg daily, taking an extra evening tablet. Another scan was scheduled for 1st September. At this second scan the usual nurse was back and she measured the lining at 5.7mm with a triple line pattern starting to form. The ovaries were quiet with no cysts. Some time later the Prague clinic rang to advise me to add estrogen patches along to my 8mg tablets daily. As I couldn’t collect the patches until the following day I took a risk and took two extra estrogen tablets that night. The following morning I collected the patches and applied the first one. These are to be changed every second day. Another scan was scheduled for 4th September.
Also on 4th September I had booked an intralipid appointment. In a previous clinic I had found that my NK cells are very slightly raised and they offered the treatment at that time. I’ve had it subsequently but have to arrange it privately as my local clinic or the Prague clinic don’t offer it as routine treatment. Ideally the first intralipid appointment is meant to take place a week before transfer. However, I remembered the intralipid nurse saying the last time that the intralipid lasts several weeks to a month so I figured I should be covered.
I found the slow lining issue stressful and it made me worry about the cycle. I didn’t even enquire as to what was happening with the donor as part of me was afraid to know and I have no control over any of it. I did think about her though and what she was doing for me and hoped that she wasn’t having any problems or feeling too unwell. I got myself some pomegranate juice as I read that it helps with lining. I also tried to increase protein intake, avocados etc and kept a full regimen of vitamins and omega 3 on the go. I also got a class plan from my fertility yoga teacher and started doing some of those poses at home as they are also meant to help with blood flow. I did the poses to the accompaniment of a canine relaxation CD given to me by a now pregnant IVF friend who used it both on herself and her anxious dog! It was full of gentle piano classical music. I also listened to a Circle and Bloom relaxation CD for donor recipients and attempted to do this in the yoga ‘legs up the wall’ pose. Just as well you couldn’t see in my window!!
I reattended for a further scan on the 4th September and there was no change. The triple line pattern was there but there was no further thickening. This concerned me greatly. The nurse seemed unsure as to whether the Prague clinic would increase medications again or postpone the cycle or simply keep me on the medications a bit longer. I left the clinic and went to the nearby shopping centre where I was due to have the intralipids. I rang to cancel them.
At a loss at what to do and tearful I wandered around the shopping centre until my husband came to collect me. He had been off sick from work all week with bad migraines but was feeling relatively ok on this day. We wandered around the shops together and bought one or two things. I had a call from the Prague clinic to say that my transfer would proceed on the 15th September and to stay on the same medications. They seemed to think the 11 days further on medications would be enough. No further scans were requested although my understanding was that I would be scanned when I got to the clinic in Prague. I rang to reschedule the intralipid appointment.
I was a little naughty and added in the occasional extra estrogen tablet here and there but I didn’t stray too far from the plan. Once the Clexane and Cyclogest were added in I stuck firmly to the plan. Before starting the Clexane and Cyclogest I had to take an Ovitrelle injection, not entirely sure why. The clinic said it was to do with the balance of leutinising hormone. I had two further Ovitrelle shots to take, one the day before transfer and one a few days after. I usually associate this shot as being a trigger shot in an own egg cycle.
I booked acupuncture appointments and had 3 in the week before transfer. I had no opportunity to have any in Prague but I had ear acupuncture points in place that I could use. It was suggested that I schedule one 3 days after transfer as well. I have had pre/post transfer acupuncture in the cycles I have not travelled for but my acupuncturist said not to worry if I cannot arrange this abroad as most of the work of acupuncture is done in the run up to the transfer. The effects don’t suddenly ‘vanish.’
Meanwhile I discovered that our donor had her retrieval on Wednesday 10th September. The clinic called me the next day with the fertilisation report. 15 donor eggs were retrieved and 14 fertilised using my husband’s frozen and shipped sperm. We paid extra to have IMSI, PICSI, embryoscope and embryo glue. The clinic preferred to do a 5 day transfer so it was again confirmed for Monday 15th.
I opted to get a GP note and be signed off for 2 weeks from transfer day. This was my 6th attempt in just over 2 years and I have kept working through all of them with about a week’s leave on average each time. My body and mind was tired and I really needed to step back.
We made our arrangements to travel for 2 nights to Prague. Luckily we were able to fly out on a Sunday which helped the annual leave situation. It was a rainy evening in Prague on our arrival but we went for a nice meal in a favourite restaurant and took it easy at the hotel. On Monday we got a taxi to the clinic for the transfer. In the end it happened an hour late- not good for the bladder! Before the transfer we met the doctor who advised that there were two hatching blastocysts ready for transfer that day and 4 others being assessed for freezing. We were given a picture of the embryos from the embryoscope report and some basic details about the donor. She is 23, a whopping 19 years my junior! The doctor said to just continue normal activities after transfer as ‘it is not a disease!’ I was brought to the transfer room then, set up and ready, a few security questions asked.
The same doctor arrived to do the transfer. He scanned my lining which was now 8mm. On the screen I could see the embryos being taken into the catheter. The transfer was super quick and painless- in fact I nearly missed it as some of my transfers in the past have been quite uncomfortable. The doctor alerted me to the white flashes of light on the opposite screen to show our embryos being placed in the uterus. Once transfer was completed I was advised to rest where I was for 30 minutes which I did, and then had a much needed bathroom break. I got a letter of instructions for post-transfer, date of testing, what to do if positive/negative etc. We got a taxi back to the hotel and took it easy for the afternoon, reading and watching TV with a few snacks. Later that evening we went to the hotel restaurant for dinner. The following day we flew back home around lunchtime after I gave myself another decapetryl shot supplied by the clinic. Before we left for the airport and after we checked out from the hotel, we sat on a bench and people watched for an hour. I couldn’t help wondering when any petite dark haired Czech girl passed by, if she was my donor. I felt immensely grateful for the generosity of this unknown young woman who has given myself and my husband such an amazing gift, a much better chance of possibly achieving a much wanted pregnancy.
Travel home was uneventful and it was nice to be back and surrounded by my own things. Now was the commencement of the infamous 2ww. Always stressful, this one proved no different but at least I did not have work on top of it. I opted to get plenty of rest for the first few days but after that continued a low level of normal activities- met friends for lunch, went to the supermarket (no lifting bags) etc. I took out my picture of the embryos and tried to focus on them. I listened to relaxation recordings and music. Monday 29th September was my designated test date. Some time in the second week of the 2ww I noticed some red blood when I inserted a progesterone pessary. I contacted the clinic who got me to take an extra ovitrelle shot and add an extra Cyclogest pessary to my regime. By Sunday 28th I had had enough and tested and was shocked to see a positive result. I brought the two tests down to my husband in the kitchen and asked him to confirm what I saw. I think we were both shaking. I repeated the test on Monday to find the same result. Could this be real? Could this be happening? We notified the local clinic and Prague clinic and a scan was booked at the local clinic for the 15th of October to confirm if a viable pregnancy was present- more waiting and worrying….
As it turned out we found out this information before the 15th as in the early hours of the morning on October 10th, which happened to be the 8th anniversary of my mother’s death, I went to the bathroom and saw a small amount of red bleeding. I didn’t sleep any more and by morning decided I would go to the EPU of the maternity hospital I was planning to attend. My husband drove us and we arrived before 8am. I went to Outpatients and filled out a form and then went to a waiting area with a lot of other pregnant women. However, I was seated in a special part and a nurse explained that I would be seen quickly and not to worry about anyone else there as they were attending for routine check ups and tests. Another nurse took me into a room and took some details and my blood pressure. I also had to give a urine sample. Within the hour I was brought into a consultation room and a nurse did an abdominal scan. As at this point I was only 6 weeks 2 days pregnant, there was little to be seen but the presence of two intrauterine gestational sacs was noted. The nurse was very kind and noted that this information was of little use to me. She rang the Fetal Medicine Department upstairs and arranged for me to go up to them as they had more elaborate scanning equipment and would be able to do a transvaginal scan. We were warned that we might have a bit of a wait.
We made our way up and were shown to a waiting room. As it turned out we were not waiting that long. We were brought to a scanning room and a nurse conducted a transvaginal scan. She had obviously been alerted to the fact that there were two sacs as once she got a view she announced casually ‘there’s the two heartbeats.’ Our mouths practically dropped to the floor. The only response I could come up with was ‘are there?’ The nurse took time to show us each sac and the position of the flickering heartbeats. She also printed off scan pictures and a report to take away and suggested another scan appointment for 3 weeks time. I asked about the bleeding and she had a close look but could see no source for it.
With the timing of this momentous news coinciding with my late Mum’s anniversary, I wonder if she engineered it somehow that we would see a scan picture on this day. I’d like to think so.
Still somewhat shellshocked my husband and I parted company to go to work. I was at my desk by 10.30am but not sure it was the most productive day I ever put in. We had seen our first ever heartbeats and some special unknown young woman had helped us to achieve this. I remained very cautious and scared but it was a memorable day for multiple reasons.
All I can hope now is that we can get these little babies over the line. It’s going to be a long nerve-wracking journey of a different kind. I hope we all make it. Wish us luck!

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Posted in Donor eggs, Egg Donation, ICSI, IMSI, IVF | Tagged , , , , , , | 9 Comments

The road to donor: May-August 2014

After our failed cycle it became inevitable that I would have to seriously consider egg donation. In fact the prospect of double donation was put to us after both of our last cycles but my husband was finding it hard to accept. It seemed more pressing to start with egg donation in view of my age. I had been reading and thinking about this option for some time so it wasn’t a huge surprise. There were of course moments of grieving that I would never have my own genetic child who could be the ‘image’ of me. There was also the resentment at the fact that having already lost my own mother, I could apparently not have a child from the same genetic lineage. There is no reason for this. My own infertility has always seemed to come under the category of ‘unexplained’. Now being the ripe old age of 42, age plays a more significant part. The only issue I have been diagnosed with is antithyroid antibodies and I take a thyroid medication daily. It is still a process but I have come around to acceptance of the idea of donor eggs and indeed double donation if it comes to it. Reading about epigenetics and how the carrying mother influences the switching on of genes in the developing embryo and foetus helps greatly. The carrying mother creates the placenta which nourishes the baby. I know somehow that if my baby was placed in my arms after this struggle, I don’t think I would be overly concerned at the provenance of the eggs. Having said that, I do have that fear that maybe I won’t bond in the same way with the baby or that I will resent him/her for all the suffering and hardship we have been though. I also worry sometimes that as the donor conceived child gets older and will wonder about the egg donor, that they will resent the fact that I have no information to share and that the anonymous donor can never be found. I pray that they won’t hate me for it.

There is the whole argument of telling and not telling in the case of anonymous donors. Some say what good will it do? I fear though that it would come out at some stage so I think I may be inclined to be honest with the child from an early age rather than have it potentially sprung at them at an older and perhaps more delicate age. I guess there is no right or wrong as such with this and it is for every parent to decide what they feel is best for their circumstances. There are support groups that I link in with and they have useful information too and plan further activities in the future for donor receiving families in much the same way as adoption support groups do for those families. I suppose a happy balance of creating normality for donor conceived children as well as an outlet for them to meet others like them is what is sought here. It strikes me that in 18 years time as today’s donor-conceived babies reach maturity, the whole concept may have become quite commonplace in a more open way than is perhaps the case now.
However, despite my worries, having spoken to or otherwise been in contact with several donor mothers, not one of them has regretted it and all of them love their children. Some did confess to having a ‘moment’ every now and then, but I can imagine that is natural. I had a ‘moment’ myself recently while watching ‘Who do you think you are?’ a genealogy TV programme that traces the family trees of celebrities and others. Having to use donor eggs is not what you dream of but how amazing that the option exists and that the world has generous altruistic women who are prepared to donate to give others a chance at having a baby when otherwise they cannot.
I decided to get more information on donor programmes so emailed about 9 foreign clinics in Spain, Greece and the Czech Republic. All of them got back to me and it was a little overwhelming having all the information and wondering which was best, even though I knew we would probably try again with our current Prague clinic. I asked one clinic about the sperm FISH test and they said that an abnormal reading would probably only affect 10% of the sperm and that it was possible to have a child with such a result. Another clinic commented that they had seen worse results than my husband’s 0.49% diploidy result in successful pregnancy. Maybe a young strong healthy egg can compensate for less than perfect sperm. I sure hope so. At the moment I am relying on this.
I had my phone review with the Prague clinic and unsurprisingly I was recommended to proceed with donor eggs but they suggested I could still use my husband’s sperm. It is possible to freeze more than one batch of it and send over thus avoiding him having to travel over or to have backup in case the fresh sample if provided was insufficient. The clinic emailed consent forms and a donor selection form which asked for basic information about us- height, weight, eye colour, hair colour, skin colour. It felt a little strange reading it.
A few days later we had a review consultation in the local satellite clinic. I brought my paperwork and the specialist had a look and commented on some of the clinics listed as well as my current clinic. We had a frank discussion about what to do next, if anything. I said that I was finished trying with my own eggs and wanted to move onto donor eggs. However, it became clear that my husband was definitely not ready yet to move on to donor sperm. In the end the specialist agreed that a reasonable course of action would be to try donor egg only as although my husband’s sperm count is poor, his other parameters are reasonably good and we have always got decent fertilisation and blastocysts. The local clinic advised of a new programme they have with the Prague clinic which allows sperm to be frozen and sent over, embryos to be created in Prague and those shipped over for transfer in the local clinic, avoiding the need for any travel at all. The freezing process is vitrification which is very safe for the embryos (indeed my only brief pregnancy was from an embryo that had been vitrified). More than one sperm sample could be frozen. This approach appealed to my husband who can find it very difficult and stressful to get time off work at short notice. It is a little more expensive but then the package included more preliminary scans and tests that were charged separately before. It would also avoid the panic of booking flights and accommodation last minute. We considered going for this option initially though I sought further information before making a decision. The success rate is the same as for donor egg cycles generally. However, on looking into it further we opted to freeze the sperm and travel to Prague for transfer as the local clinic are only in the early stages of running this particular programme and I feel that I am too far down this road to be a guinea pig for it right now.
We decided to defer cycling until around August and the clinic agreed that this was best. Now that I have switched to donor eggs, the time pressure is not as great. For now the focus is on seriously healthy living and getting fitter and healthier, losing a few pounds along the way. I have to focus now on uterine health rather than egg health. I changed acupuncturist for a fresh approach and also found a reflexologist and healer who works with fertility patients. The biggest threat to me now is my overwrought, overactive and over anxious mind. These therapies along with my yoga, walks, mindfulness and other meditations will be my arsenal to keep the waves of anxiety at bay. It’s easier said than done though. I have a lovingly created vision board of babies, families and children to try and focus me. I read ‘The Secret’ and am trying to tell the universe that this is what I really desire.
I am mid cycle now and close to transfer. It hasn’t been smooth sailing and I am anxious and scared while trying to be hopeful. I will document the cycle in another blog post.
I really hope that we might get somewhere this time. I am surrounded by pregnant people including long standing IVF people and I am feeling very left behind even though I am completely happy for them. I just want to get there so badly it hurts! It REALLY hurts!

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My Prague Spring – April/May 2014

I started my Prague cycle in April and this cycle was co-ordinated between my new local satellite clinic and a clinic in Prague. I had registered with the satellite clinic but as it turned out I communicated mostly by email with a co-ordinator in Prague. I also had a phone consultation with the head doctor there which was very helpful. I was put on a flare protocol with no prior down regulation. Instead I took a Suprefact (buserelin) injection at the same time as the stimulation medications. I was on 300 Menopur reducing to 225 after 3 days. I was also on the delightful bruise-inducing Clexane.  So 1 morning jab and 2 night-time ones.  This allowed 7 follicles to wake up. My lining was 7.3mm at the final scan in my local clinic. I was put on Cyclogest as the progesterone supplement. This was a vaginal suppository but solid unlike the gel of Crinone. Still quite leaky all the same with panty liners again my new best friend.  Each time I had a scan the results were emailed to Prague and they emailed back an updated treatment plan. Although I had paid the local clinic for the basic cost of the cycle, I opted for IMSI, PICSI and embryo glue in Prague which meant I had to bank transfer an additional amount to them directly. This had to be done quite late soon before departure to Prague.  I also opted to have immunology treatment (steroids and intralipids). These were not provided by my local clinic or particularly favoured by the clinic in Prague. However, my local clinic wrote the prescriptions for me to get the intralipids privately (as it happened in a venue 5 minutes from the clinic) and they also prescribed the steroids. Both clinics accepted my use of these.  I had one intralipid infusion about a week before transfer and another one around a week after.  I was on 25mg prednisolone steroid from before transfer. The hardest part of this cycle was not knowing when exactly I would need to travel to Prague and not being able to book flights or accommodation until quite late. Once my follicles were deemed ready I was instructed to take the trigger shot Ovitrelle which was in a pre-filled pen.  Thankfully this was at 9pm rather than the post-midnight experience with fiddly bottles I had on an earlier cycle.

It was on a Tuesday afternoon that I was instructed to be in Prague for retrieval at 9am on Friday morning. I was mid intralipid when I got the call and managed to book my hotel on the iPhone with my non-dominant hand! I detoured by the office on my way home from that and booked the flight there. I felt a little relieved once that was done. I left the logistics of getting to the airport and parking to my husband. I arranged taxi pickups through the clinic as they used a firm with a cheaper rate than the general taxi firms.  There were no problems bringing my medications including Clexane through the airport security, it was useful having the explanatory letter from my clinic even though it was barely glanced at. Travel was uneventful thankfully and we were met by our taxi driver on arrival. He helped us get change at the reception desk as our Czech currency had been given to us in rather large notes. The hotel was simple enough but comfortable and we had a nice view of the city from the 8th floor and more English language TV channels than I was expecting. The room had a mini bar fridge too so I stored all my little extras I had brought to assist my attempts to stay gluten and dairy free as much as possible- dairy free milk, some gf protein bars and some dark chocolate. We found a local restaurant nearby which had plenty of menu options and I chose a chicken and vegetable dish which was very tasty. Once midnight came I could not eat or drink any more in preparation for retrieval.

The following morning we were up early and I made my husband go and eat a good breakfast as I knew we would be away for some hours. I sat with him but could have nothing but I took some fruit to have later and packed a protein bar in my bag. The taxi was early so off we went. We had spotted the clinic en route from the airport the previous night so recognised it immediately after the 25 minute drive. The taxi driver brought us right in and we filled out some forms in English and took a seat. We met with a doctor and were brought by a very friendly nurse  to a private cubicle where I was given a lovely paper gown with pockets to dress in. I was brought into theatre and my husband led away to do his part. In theatre, there was a little bit of difficulty getting a vein for the canula but they got there in the end. Everyone spoke to me in English except for one person who spoke to me in Czech anyway in a very friendly tone. Once the sedation was given I remembered no more. I woke up back in the cubicle in a bed, covered by a blanket and with my underwear back on (it had been in the pocket of the gown on their instructions). A nurse came in every so often to check my blood pressure monitor and my husband was brought in. After an hour or two I was allowed get up and dressed and we were brought back to the waiting room to await the doctor. After a time we were brought into his office and he explained that they had retrieved 7 eggs and 5 of those were suitable for injection. He told us we would get the fertilisation report call in the morning.  He said also not to eat a heavy meal for a few hours including the infamous Czech dumplings!! The retrieval went smoothly from their perspective. We got a taxi back to the hotel and I spent the afternoon resting in bed and eating various snacks. Later on that evening and for convenience we went back to the same restaurant as the previous night and I tried a different dish.

The following morning I got the fertilisation report while we were at breakfast. It was good news as of the 5 eggs collected, all 5 had fertilised. There would be no more communication now until transfer day in 4 days time. At this point there was nothing to do but go out and about and enjoy Prague. That is exactly what we did, making the most of a beautiful city, nice weather and decent food. We fitted in a three hour WW2 history tour as well. I recovered quickly from the retrieval. I guess a 7 egg haul was not too taxing on the body, unlike the 17 I got in my very first cycle in 2012. However, I did have to take little rests from all the walking every so often. We found a large shopping centre too and over the course of the 7 nights we spent in Prague I managed to get myself both a scarf and a handbag as mementos. There have to be some little treats!!  I listened to my Circle and Bloom cds nightly. I actually found these few days quite relaxing and didn’t fret too much about the progress of my embryos.

On the night before transfer as we relaxed in our room, the tv options seemed to be a choice of rather bad disaster movies! Transfer day was a Wednesday and we again got a taxi to the clinic, this time for midday. As I have had some difficult transfers in the past, I was allowed take a Czech version of Valium half an hour beforehand to relax me. A female doctor met us and explained that we had 2 early blastocysts for transfer but there were none suitable to freeze. Although I was grateful to have anything for transfer I was sad that there were none to freeze. It reminded me all too much of my previous cycle which ended in tears and which distressed me greatly afterwards. I was brought into a room outside the transfer room and given a paper gown again. My husband was allowed in this time. I got into place and in the moments that my husband and I were left alone, I couldn’t help but shed a tear as I found it hard to believe what could be different this time. We were shown the 2 embryos magnified onto a screen and the transfer itself went smoothly. I had to lay still for 30 minutes and then I was able to leave and use the bathroom. We got a taxi back to the hotel and I spent the afternoon relaxing in bed. Later that evening we went to the hotel’s own restaurant for dinner so that I would not have to walk very far.

The following morning was our last day in Prague, we had a relaxing breakfast, checked out, left the luggage and spent the morning looking around the modern art gallery beside our hotel. It was quite a relaxing thing to do. I had to take an injection (decapetryl?) that the clinic had given me at 1pm so managed to find a Ladies in the gallery to do this.  We went for lunch in the same local restaurant and got out taxi to the airport. I let poor hubby lift all the cases.

I had taken a few days off work so took it pretty easy after I got home. As usual I was fine for the first few days and then the doubt started to set in. I attended for my second intralipid appointment just over a week after transfer.  The following weekend I was visiting my father some hours away by car. On the Sunday I started spotting. This was 3 days before my official test date. I had brought some tests with me and took one which was negative. The hardest part was that as my father did not know I had even done the cycle I could not let on. I was devastated as was my husband, and he had to return home that night whereas I had to stay on for a work meeting the next day in the area. I visited my sister in law who did know, and she was very kind without saying too much. I was terrified I would crash in the same way as I did after my last cycle. I put it aside for that evening and had a rare quiet evening with Dad on my own. The next day I went to my work meeting and stayed calm although I did get fined by speed camera on my way home- I didn’t know this until about a week later mind you. In my approximately 18 years of driving I have never got a speed ticket. Lesson learned.

I continued with the meds and increased Cyclogest on the clinic instructions but the spotting turned in to bleeding. By the time test day came it was still a negative and I reported it to both clinics. My local clinic also did a beta HCG which was also negative. I stopped all the medications and weaned off the steroid. At the start of the cycle I had decided that this was my last attempt with my own eggs. Part of me had hoped that somewhere an embie would pull though. But after 32 eggs, 9 blastocysts transferred over 5 transfers, I think there is no point trying again with my own, especially as I am now 42. Most clinics would run a mile!

So deflated doesn’t even begin to describe it. I took a week or two off my diet regime to eat and drink all round me and set up a phone consultation with Prague and an in-person consultation with my local clinic for early June to decide on next options. I know now that donor egg will definitely be involved. I just feel so bruised by this process that I am not confident that even donor eggs will work for me. Perhaps 5 cycles in under 2 years have taken their toll. I need to find my hope again and my will to go on. I will find it somehow with a little time. I’m THAT stubborn!

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From Hero to Zero- test results and next steps- Jan/Feb 2013

We attended an appointment back at our clinic in January to get the results of the endometrial function test (Yale test) I had done and the FISH test my husband had done in the never ending quest to find a reason why our cycles with blastocysts keep failing or, in the case of one, ended in miscarriage.

The Yale EFT involved completing a dummy FET cycle so basically I took the same medications as if I was doing a frozen cycle. This meant that most of December and Christmas was taken up with this. I had the biopsy for the test on 6th January, what a lovely way to start the New Year! This followed much the same procedure as for an endometrial scratch. However, although I got through the (short lived) discomfort, I did find this more painful than the endometrial scratches. Afterwards I felt very dizzy and lightheaded and had to be given some oxygen and chocolate to recover myself. Luckily my husband had come in to collect me. The Yale EFT looks for certain markers in the endometrium that may indicate a lack of receptivity to implantation. The biopsy is sent to Yale University for analysis.

The FISH (Fluorescent in-situ hybridization) test looks more deeply at certain chromosomes in the sperm. It looks at the X and Y chromosomes, chromosomes 13,18 ,21 and the level of diploid sperm (sperm with 2 sets of chromosomes instead of one). All that was required for this was just a semen sample.

My Yale EFT came back normal. My husbands FISH test was fine for the chromosomes X, Y, 13, 18, 21 but it noted a higher presence than average of diploid sperm, 0.49% instead of 0.24% for the control population. Our consultant seemed to point the finger at this as a possible reason for our failed cycles. This news was devastating for my husband who remained silent for the rest of the consultation, processing it all. The talk moved to our options. The consultant suggested that if we had another attempt using our own eggs/sperm, that PGD/PGS (pre implantation diagnosis/screening) would be an option. However, he didn’t recommend it on grounds of our age, the cost and the likelihood that we would not produce large numbers of embryos to select from. It would really only be for diagnosis to prove that the embryo was abnormal or otherwise. He suggested that we take some time to think about it all, but pointed out that our best chance would probably be with double donation, using donated sperm and eggs, or possibly donated sperm on its own. Sperm donation could be done in the clinic as could egg donation, but double donation would require going to a clinic abroad as no Irish clinic has a licence for it. PGD/PGS would require going to a different clinic as well.

The consultant suggested another specialist to whom we could talk in order to discuss other options. This specialist works with many different clinics including those abroad. We came away from our consultation  feeling somewhat deflated as it felt like clinic 2 have run out of options for us unless we do either egg or sperm donation on their own. The consultant did suggest arranging a follow up phone consultation when we had time to process the news but we haven’t so far.  When we got home, my husband cried his eyes out. I’d never seen him cry like that in the whole time we have been together. There was nothing really that I could do except comfort him and reassure him that it was not his fault, that he had done everything to help his situation and agree that yes this was highly unfair and unfortunate.

After a few days of licking our wounds I arranged a counselling appointment for my husband with his agreement. He found the session beneficial and started to get back to his usual self.  I made an appointment with the other specialist who had been recommended at clinic no 3. This person is an embryologist who works as a fertility consultant and runs a practice that provides support services for people undertaking treatment abroad, but which also has a clinic attached for standard IUI/IVF locally. Our appointment was scheduled romantically enough on the afternoon of Valentine’s Day. This was a very lengthy appointment. I had brought copies of all my results and the specialist went through various suggested options. The double donation option was mentioned again but he did not rule out cycling again using our own sperm/eggs just on the understanding that the chances of success would be greatly reduced (about 10%). He did not put as much emphasis on the FISH diploidy result as he said that these sperm would be unlikely to fertilise an egg in the first place and if this test was so crucial, why is it not provided as standard in all clinics? My husband hadn’t been feeling well all day (he had a viral bowel infection we found out later) and actually blacked out briefly in the consultation. This was nearly a repeat of what had happened to him at our very first fertility consultation back in March 2012. He said afterwards it was like a form of PTSD, it just brought him back to that experience. He was revived with tea and Oreos. The specialist suggested that it might be worth while taking a fresh approach and cycling abroad, the cost would work out much the same as cycling here even with travel. He suggested a clinic in Prague and said he could send our notes there and get an opinion. He considered a change in protocol would also be worthwhile, maybe one with less suppression than previously and a different stimulation drug, possibly Menopur. My husband was clear that he would like us to try one more own egg/sperm cycle before moving onto a donor path.  The specialist could see that he was not there on the donor issue yet and that I was nearly there but not quite. Part of me wants to see if the months on DHEA and high dose Co-Enzyme Q10 have made any difference.

An information pack was provided which included a list of basic tests to be repeated. It was stated we would not be asked to repeat any major tests as these had already been done at previous clinics and provided to this clinic no 3. The tests for me included a repeat antral follicle count scan, day 3 bloods, thyroid profile, dhea, amh and for him, just a semen analysis.

The following week I happened to be on the right part of the cycle so I got the scan and bloods done. These proved to be a bit depressing for me. My antral follicle count which had been 14 in 2012 (7+7) and 12 in mid 2013 (6+6) had dropped to 6 (4+2). My right side had always been the better performing side and now it has only 2 follicles. Equally gloomy was the fact that my amh which had been a higher than average (for my age) 34.87pmol in 2012 had now dropped to 6.7pmol.  The sad fact is that my biological clock is starting to tick out. I feel it is like the little clock that appears in the corner of the screen on Jools Holland’s New Year’s Eve TV show in the last minute before midnight. My FSH though had oddly improved. It was 6.8 in 2012, 6.2 last year and is now 5.6.  My mind is already thinking towards donor eggs even though I will give this one last try with my own my best shot. It’s just the sad fact of getting closer to 42. To think that I had good fertility less than 2 years ago and now it is low makes me sad, especially as my husband managed to get his count to 10mil from a low of 400,000 over the same time period but yet got hit with the news of this FISH diploidy result.

At least we can say we are both broken I guess. I feel like I have come from hero to zero in this timeframe and hubby probably feels the same.

I can’t generate any excitement about a final own egg/sperm cycle. In one way I want to get it over with so that I can move on from it. I am trying to read more about donor conception and both my husband and I attended a donor conception meeting recently which was very helpful. It was good to meet and talk with others who have either embarked on the donor path, are thinking about it or have had success with it. It’s nice to feel that our situation is not unique, that we are not ‘defective’ and that lots of perfectly ordinary normal people have travelled a donor path for whatever reason.

My husband had a repeat semen analysis in clinic 3 and this ended up being better news insofar as his count is now 20 million which is the minimum of normal. Motility and Morphology were also ok. He didn’t feel ready to go down the donor route and after some soul searching  and a meeting with the new gynaecologist we decided to give one last own egg/sperm cycle a try in a clinic in Prague recommended by our new satellite clinic. I am concerned that I won’t get enough eggs or that the quality will be poor even with all my DHEA and co enzyme Q10 supplementation. But we will give it our best shot and if it doesn’t work out I think I can move on to donor egg and maybe there will be a chance for my husband’s sperm yet. If not we will have to think long and hard about double donation.

We applied for international adoption but this process is essentially stalled in Ireland at the moment with wait times exceeding 8 years and no guarantees. This is heartbreaking when we think of the children in need of homes and unable to be placed with a loving family here.

For now though I will do my best to try and keep positive. The protocol suggested by the Prague clinic is quite different to the long protocols I’ve had before. It is a flare protocol that avoids down regulation and over-suppression of the ovaries. I will have Menopur as the stims drug and Cyclogest is the progesterone. IMSI, PICSI, embryo glue and embryoscope are available options if needed. Maybe it will help having a completely different protocol. I am lucky to have lots of support on Twitter, my fertility yoga class and other support groups through which I have a number of email contacts and couples I now know in person. I’m getting counselling in advance too as I want to go into this with a better frame of mind than the title of this blog post might suggest.

I’ll be back to update on my Prague adventure….

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Remembering Hope- Miscarriage Remembrance Service and EDD Nov/Dec 2013

Never to have seen but to have dreamed

Never to have held but to have felt

Never to have known but to have loved

(Reflection from Miscarriage Remembrance Service)

We marked 6 December 2013 as my EDD (Estimated Due Date) for our lost angel. Although we have no idea whether she was a boy or a girl and we never saw a heartbeat, my instinct made her a girl and we called her Hope. That was my husband’s idea and it seemed appropriate as it was our only bfp and pregnancy and was a miracle while it lasted. Up until then I had started to doubt if it was ever possible. Of course, now I am back to doubting if it will ever happen again but that’s another story.

I pondered all sorts of ideas as to how we would spend this day, how we would mark the occasion. As it turns out the decision was taken out of my hands as I was away on an overnight work trip to London and was returning home on the day in question. Perhaps to some degree that was not a bad thing, keeping busy and occupied. It was mid afternoon by the time I got back, my husband collected me from the airport, we went home, had a takeaway and a quiet night in, just us in our own little bubble. It was surprising how many people in the know just suggested I brush myself off and get on with things, the baby is gone, just move on. Others, however, were gentle and sensitive. I didn’t say it to a lot of people, not even to my Dad, about the EDD. I am not sure if people who have never experienced this can ever fully understand the significance of the day. If I am honest, I probably never fully did myself until now. I hope I am a more compassionate person as a result. However, I know everyone will have their own way of dealing with a similar loss. There is no right way in general, only a right way for each person I think.

Possibly one reason we had a very low key EDD day was that I had the opportunity to become involved in more specific remembrance activities during November. The Miscarriage Association here hold an annual remembrance service for all lost angels and we decided to go. Although the service was held in a Catholic church, it was non-denominational and not affiliated to any particular religion. In fact a female Minister from another Church spoke movingly in a layperson capacity about her own loss after IVF.  On arrival at the church we were invited to take candles.  I took a seat beside a much older lady who had 3 candles in front of her. Loss can be remembered at any time in life. The service opened with a self-penned song from a man whose wife had experienced miscarriage. Later on a woman sang the Sarah McLachlan song ‘In the Arms of the Angels’ which makes me cry for a number of reasons. There were several readings and a number of short reflections.

I particularly liked this one:

When some great sorrow like a mighty river

Flows through your life with peace destroying power

And the deepest things are swept from sight forever

Say to your heart each trying hour:

“This too shall pass.”

(Reflection, Miscarriage Remembrance Service)

The Miscarriage Association’s memorial books were brought to the altar in procession. I had entered Hope’s name in this back at a meeting in the summer. I got a record of the entry and it can be used for a family tree. It felt good to ‘register’ her somewhere.  There was then a procession by a group of children carrying lit candles which were to represent those angels who no longer have anyone alive to remember them. Then the entire congregation was invited to proceed to have their candles lit. The lights were dimmed and we all went in procession and left our candles at the front of the altar. It looked very beautiful. On our way back from the altar each family was given a silver Christmas decoration showing 3 candles. There was also a memorial ‘tree’ inside the church and paper leaves. I wrote our message to Hope and hung it on the tree. We had the option of taking home our candles from the altar or leaving them there and allowing the Miscarriage Association to take them to light at meetings. We opted to leave them as I had brought home my candle from the meeting I attended in the summer. After the service we were invited to remain for tea and snacks but we opted to go home. It was quite an emotional service but healing too and it felt nice to be in the presence of others all grieving their losses and eager to remember their angels. All ages were present too, babies to the elderly.

I can’t claim to be very religious and my faith has taken a hard knock during this IVF process. The unfairness of it all rankles and a lot of my anger gets directed at God. I no longer attend Mass regularly although I do pop into church from time to time to light a candle for my late mother and for my lost baby. Sometimes I like the serenity of an empty church. November in the Catholic church is always a time to remember the dead and the departed souls. I usually fill out a remembrance list of the dead for the November masses and make a financial contribution. This time I included Hope on the list.  At least I feel that she and the other dearly departed will be prayed for even if I cannot manage the praying myself right now.

Although the EDD was hard in many respects, in other ways the passing of the date was a relief. I stopped figuring out where in the pregnancy I would have been ( I had noted the various milestones throughout, 12 weeks, 16 weeks, 20 weeks, 24 weeks, 37 weeks, 40 weeks). About a week or two after the EDD I finally managed to delete the pregnancy app off my mobile phone.  I hung the silver decoration we had got from the Miscarriage Association on our Christmas tree. A twitter friend had sent me a lovely hanging sign reading ‘Hope’ after the miscarriage and I hung it up in my bedroom in a location where I can see it every time I get up in the morning. In this way I can remember my lost little one but also remember why we gave her that name and what it meant and continues to mean.

If there is an afterlife, and for all my faith struggles I like to think that there is, I imagine Hope is there sitting in my mother’s arms and they are smiling, happy, laughing and full of joy. I could not ask for a better guardian for her. I hope in this New Year that they will watch over my husband and I with love and care as we continue our journey and as we make decisions on what steps to take next.

Hope, you will never be forgotten by your Mammy and Daddy. Ever. You are remembered with so much love. So much xxx

Lives that touched our lives tenderly, briefly

Now in the one light living always

Named in our hearts now safe from all harm

We will remember them all of our days.

(Reflection, Miscarriage Remembrance Service)

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The ‘Kitchen Sink’ Cycle- IVF2- August/September 2013

I am writing this a week after finding out the outcome of this cycle which was negative. This has been the first day I could even contemplate looking at my blog as I took this particular failure very badly. However, to get things up to date I will summarise the cycle and my feelings on it as best I can. I nicknamed it the kitchen sink cycle as we really threw everything at it both in terms of our own preparation, alternative therapies etc which were the subject of earlier blog posts, and the clinic’s programme which included  medications for immunes issues, thyroid and potential PCOS tendencies. We thought we had all bases covered in as far as was possible.

Down Regulation

This part of the cycle was largely uneventful. I felt rather tired and moody on Buserelin nasal spray but hot flushes were minor. Unlike my previous clinic, I had been put on birth control for this cycle and had to stop it for a withdrawal bleed. I found this part the worst as I had incredibly bad PMS and really felt in irritable form. I took the Buserlin spray three times daily. In addition I also took my thyroid medication (Eltroxin) and the Metformin drug.

Stimulation

My baseline scan after 12 days indicated that I was ready to proceed to the next stage. For stimulation I had a combination of 3 nightly injections. Puregon (Follitropin beta) the FSH agent at 150 dose, Luveris at 75 dose- this is a touch of luteinising hormone which is meant to help egg quality I was told. I also had a nightly shot of Clexane which is a blood thinner. I don’t have blood issues but it was given as a precautionary measure. I had used Puregon before so I was comfortable enough with that. The Clexane was in a pre-filled syringe and was straightforward also except that it made me bruise, the advice was not to rub the area after injecting as this would make any bruises worse. The Luveris required mixing of a vial of powder with a vial of solution which made me a little nervous as there were mixing needles and injecting needles supplied. However, the clinic nurse had gone through everything in detail and I looked up videos on You Tube as well. I got used to it as the days went by. I felt reasonably ok on stims just a little bruised and bloated and a bit tired from the heavy regime of medications and trying to fit them  all around my life. I went for a scan after about 6 days and it showed 3 follicles on the left and 5 on the right. This was a little disappointing as I had been told at my last clinic that my antral follicle count was now 12 (6+6) and as my AMH was quite high last year, it was hoped I would respond well again now. The Puregon dose was increased to 225, with the rest remaining the same.

During the stims stage I also attended the clinic for an intralipid infusion. This is a treatment given to quieten the immune system and especially Natural Killer cells. Mine were only found to be very slightly elevated in tests but the clinic decided to treat me anyway. The infusion involved me sitting in a comfy leather recliner chair, having a drip inserted into my arm and a white liquid fed in. It took about an hour and 2 other girls were also being treated at the same time. We had magazines to read and a TV to watch and various nurses came in and out to check on us. It wasn’t uncomfortable at all though I was a little tired afterwards. I just went to work for the afternoon as normal.

At my second stims scan the follicles had grown but the overall number had not increased. I felt that I was not responding as well as I should have. The Puregon dose was kept at 225. At my final scan the overall number remained at 8 and I nicknamed them the 8-Team. It was decided to delay my retrieval by a day to give extra growing time. My retrieval was scheduled for the following Tuesday. I had to take my trigger shot at quarter past midnight on Sunday. The trigger shot I was to use, Pregnyl, made me nervous as it was in little glass phials and required the mixing of 2 powders with one saline solution. I looked up You Tube videos again and remembered the clinic nurse stressing the importance of breaking off the caps at the black dot marked on them as they would snap off cleanly (they did). I assembled everything in plenty of time, put the phials in my lipstick holder tray to stop them falling over and managed it all.

I had to start antibiotics for the period from EC to ET and my husband had to take them for the duration of my stims. I also had to start steroid tablets, 25mg Prednisolone.

Egg Collection

I arrived as requested an hour before the time, fasting from the previous midnight. I was brought to a cubicle and given a paper gown to wear and was instructed to take two Solpadol tablets (painkillers with codeine). These made me feel a little lightheaded on an empty stomach. I handed over the Flagyl pessary to the nurse- that would be inserted while I was under sedation. One of the doctors came in to see me to go through everything and to sign consents. A nurse also called in to go through the printed sheet of aftercare instructions. I was brought down to the theatre and my husband presumably was dispatched off to fulfil his part of proceedings. In theatre there was some further confirmation of identity and a canula was inserted into my arm. After this I remembered nothing further though I did wake while still in theatre and could see the doctor still working, but I felt nothing and drifted out again. I found out later that a mock transfer had been done on this occasion as I had mentioned past difficulties with transfer. It seems they opted to do it on retrieval day rather than transfer day. I think I might have woken when they were doing this.

When I woke again I was back in the cubicle feeling slightly sore but not too bad. I was told they had retrieved 8 eggs. After a while I drank some hot chocolate and ate a couple of plain biscuits. After a rest period I was allowed home with instructions regarding starting progesterone. Once home I went to bed to rest and took some more Solpadol.

I did feel a bit uncomfortable for a few days after, some bloating and a feeling of pressure on my stomach and under my chest. It did ease off though after about 3 days.

Fertilisation

I had been told that it could be 4pm next day before I got a call about fertilisation but thankfully the call came though around 11. Of the 8 eggs, 7 were suitable for injection and 6 fertilised using IMSI, a highly magnified form of ICSI. My husband’s sperm count was 6 million (his best yet) with 1 million usable post-wash. My consultant wanted to go for a 5 day transfer using EEVA so the embryologist explained this and the risks involved. I would not get a call again until day 4, Saturday. This was the longest wait as every day I feared the embryos would be lost. This fear was especially bad on day 3. It seems day 4 is a critical stage as the embryo works off egg energy up to then but then switches to its own combined energy and often the embryo can fail at this point. Day 4 arrived and I got the call to say that 3 embryos had reached compact morula stage and the others were at 4, 5, and 9 cell. The smallest two were not  expected to progress. Egg transfer was scheduled for the next day, Sunday. I was the 4th transfer of 4 that morning for midday but had to arrive 2 hours before as there are no reception staff on duty on Sundays, so everyone has to be admitted together.

Egg Transfer

I had a pre transfer acupuncture session that morning and then we went to the clinic. I was admitted to a cubicle and given a paper gown to put on though I was allowed leave my upper clothing on. I also wore knee high socks. I had a very full bladder and a long wait. In hindsight I am sorry I did not empty and refill it but it was hard to judge the timing. As it was by the time I got to transfer I was quite uncomfortable and found the transfer a bit uncomfortable. My consultant did the transfer at my request and there seemed to be no issue as such with it. I could not see it happening on screen because of where the nurse had to stand but she showed me the images afterwards. My husband could see it though. Two of the embryos had reached blastocyst and both of these were transferred. I nicknamed them the Roses as we had two in bloom in our garden. Two others were at compact morula stage and were being grown another day to see if suitable for freezing. The smallest two had not grown any further. After the transfer I was wheeled back to the cubicle and allowed rest. I held out for 15-20 minutes and then emptied the bladder. Soon after we got ready to leave and I went for a post-transfer acupuncture session. Following that I went home and went to bed for a couple of hours. Drank some pineapple juice and had a light fish dinner.

2ww

I took the first week of the 2ww off work and rested at home though not in bed. I watched lots of films and box sets including Harry Potter, Mad Men and various others.  I listened to a Circle and Bloom recording daily (as I had done throughout the cycle) to help me meditate and relax. I was feeling relatively ok for the first couple of days though not hugely optimistic as I just felt it had not been a great cycle. By day 4 the worries and doubts set in. I felt nothing, no bloating, no cramps of any significance, no spotting. I felt the pressure of having 2 embryos on board with none having made it to freeze, unlike last year. I felt the pressure of my age. I went for an acupuncture session and also a hypnotherapy session and I attended for a second intralipid infusion. By week 2 I went back to work, convinced it was not working out. As the week went on I slept less and less at night.  Our 2nd anniversary came and went on the 17th and we decided to go for dinner at the weekend. Test day was Friday 20th September and I was awake that morning at 5. I took a cheap internet test and a First Response, both negative. Although I was expecting it to some degree, it really felt like the biggest kick. My husband and I had taken the day off work as he wanted to attend with me for my beta at the clinic, I had not had these at my previous clinic. I didn’t have the heart to wake him, I left the tests on the toilet and he came to find me downstairs an hour or so later. We cried. We went to the clinic and a nurse took the blood test. I told her about my negative test. A very nice nurse rang back with the result later that afternoon and unsurprisingly it was negative. She advised me to stop all medications except Metformin and Eltroxin and reduce the steroid gradually. A counsellor also rang me. I left a message to make a review appointment which is scheduled for 30th September. We spent the day a bit shell shocked but managed to dress up and go out for our belated anniversary dinner. We had the nicest steak and a good bottle of wine and a musician in the restaurant sang songs that appealed. If nothing else we figured we should celebrate our 2 years of marriage and surviving all the heartache and loss we had been through. That night we sat up with more wine until 3am, each picking 5 songs from our ipods in turn, songs that had some meaning for us. We usually turn to music for all the good and bad things in our lives.

Crash and Burn

After the negative result, as the days went on I started to feel worse and worse, I could not sleep more than 3 hours a night, I was constantly on a hyper nervous edge, unable to relax, snappy and prone to crying fits at any moment. My heart felt like it was racing and I felt panicked. The weight on my chest was unbearable, it felt like physical pain. I could get no rest or relief, asleep or awake. I had to attend a family event that weekend and as the night wore on I found myself unable to interact properly and kept having to go outside for air. I saw a photo of myself at this event and I looked how I felt, sad, tired and stricken. After all the hopes (and money) invested into this new clinic and treatment, for it not to work was devastating. I won’t be pregnant by my EDD for my lost baby as I had secretly hoped. Another season has turned, another wedding anniversary (our 2nd) has passed in the shadow of another BFN like last year.  Christmas looms. It was an exact repeat of last year. Even my county team lost their final match just as they did last year, except this year it was to my husband’s county team. I railed bitterly against life, fate, God, nature, for dealing us this miserable hand. Why us? Why are we always left behind? What have we done wrong? I wondered what awful thing I had done in a past life to deserve this. Had I not suffered enough having had other major bereavements in my life? I felt sorry for my husband, he had tried so hard, diet, acupuncture, everything. He deserved better.

By Monday I went into work but was unable to contemplate it. I managed to get an early doctor’s appointment with my GP. I explained the situation and she signed me off work for the rest of the week, gave me a short course of low dose sleeping tablets and Xanax to help re-establish my sleep pattern. I went straight home and took 3 Xanax throughout the day and napped. I took a sleeping tablet and got 7 hours that night. I took one Xanax and one sleeping tablet over the next 2 days. As of yesterday I stopped the Xanax but am still taking the sleeping tablet for another few days.  I rested as much as I could, watched gentle TV, read, went for walks, cried.

I attended a counselling session on Thursday at my clinic which was helpful as the counsellor made me feel normal for how I was feeling based on all that has happened. She said that it was ok to feel as sad/angry/bitter/hopeless as I did in view of what my experiences had been but that I was carrying around a lot of unwarranted guilt and self-blame that I needed to let go of. She said I needed to be compassionate to myself and give myself a big hug and also to find a part of me that existed before IVF. Losing my faith was understandable and not to pressure myself about it, it may return later. Failed cycles are like bereavements but less tangible in a sense as there isn’t an actual death (unless you consider it embryo death) that can be processed in the mind, it is more the loss of the assumption that I can have a child. Also the process doesn’t have an end unless I call an end to it, or my biology does. She said that this will resolve itself in time and I won’t always feel this way. The nature of the resolution will depend of course, I may end up with or without a child, but a reconciliation to whatever the resolution will be will come eventually. I have survived major bereavement and a miscarriage before and I have the resources to survive this. She suggested to let the feelings flow but perhaps set a time limit on them daily and then find something, anything that can lift me a little. Also she said to acknowledge negative thoughts if they happen but just let them happen, don’t add another 20 negative thoughts to plump out the original one. I have another session next week but it is a joint one with my husband and with a different counsellor. I was distressed that I could not come up with a plan of what to do next and she said not to fret about that now, the plan will come when I am ready.

Recovery?

So now I have to find the road to recovery. This has been a really difficult week, there have been many tears, many moments of wondering is it all over for me and will I never be a mother and should I stop. I am trying to find a little of the old me again, I started back my yoga and zumba classes this week and it felt good. I have more classes next week. Starting to sleep better is helping.  Today I decided I would bake, and I made blondies (white chocolate brownies with pecan nuts) and vanilla cupcakes. I put on uplifting 80s music while I baked and let the delicious smells soothe me. A friend phoned and a group of us plan to attend a college reunion in a couple of weeks’ time. I think I am even looking forward to it although may need a ‘fit in a dress’ crash diet between now and then. I am staying with another friend on Tuesday, we will drink wine and complain about our useless reproductive organs and life in general and then eat chocolate.  I am not sure of my next plan. I will attend the review on Monday, I may research donor egg, I may send in my adoption application  papers. Right now, I just don’t know. The bruises on my stomach from the injections are nearly healed now. I just need the bruises in my mind to heal the same way.

Wish me luck my friends. I really need it.

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Hysteroscopy, Endometrial Scratch and a big bag of drugs- Starting IVF2 (with IMSI & EEVA) August 2013.

Hysteroscopy

My new clinic had recommended a hysteroscopy before my cycle and this was scheduled for August 2nd. It was carried out in a private maternity hospital by referral rather than at the clinic itself. A few days beforehand I had to attend for an ultrasound scan at the hospital just to make sure there were no issues that would cause a surprise on the day. This was an abdominal rather than a transvaginal unltrasound which took me by surprise as I am so used to having the others now. No issues were detected.

On the day of the hysteroscopy I was dropped off at the hospital at 7.30am having fasted since midnight the night before. The only exception to this was one sip of water that morning in order to take the two Cytotec tablets I had been given to ‘loosen the cervix’. These tablets caused a bit of cramping but luckily nothing too bad. On arrival at the hospital I had to fill out some paperwork for my medical insurance and was then admitted and brought to a ward, there were 3 other girls in the ward but I wasn’t speaking to anyone as we were all curtained off from each other. I think we were all there for the same or similar procedures. I got dressed into the hospital gown and paper knickers provided and put on my own dressing gown and slippers. Various nurses and doctors came to see me to take blood pressure and to note other details and I ticked my preferences on a menu for a light meal later.

The consultant who would be doing the procedure came in to discuss it.  I had already signed  a consent form at a previous consultation with her a week before. She explained that a camera would be inserted and the inside of the uterus would be viewed to check for any issues such as fibroids, polyps, scarring, blockage of tubes etc and that she would do a light and very gentle D&C. I had some reservations about the D&C but she explained it would be very gentle and would be of benefit. After the consultant left there was quite a long period of waiting so I just read a book and tweeted. Eventually, around midday, a nurse came for me and brought me towards the theatre. I sat in an outside room initially where the anaesthetist and one of the surgical team came out to introduce themselves to me. Then I went in, handed over my dressing gown and slippers and lay flat on the bed. There was a lot of good humoured chatting, and the nurse said that a pain relieving pessary would be inserted while I was under anaesthetic. The canula was inserted in my right hand and a mask placed over my mouth, it felt a bit weird initially but 3 breaths and I was gone…

I woke up some time later in a recovery room with a mask still over my mouth. I wasn’t sure if I was alone but later noticed it was a very large room and there were 4 others there. One girl’s alarm kept beeping so there was a lot of activity around her. A nurse came over to me a couple of times, I started to cough and she removed the mask. She also brought a cup of water and straw so that I could take some painkillers as I had some cramping. After a while I was wheeled back to the ward and told to sleep for a couple of hours if I could. The girl opposite me was snoring quite loudly so I couldn’t sleep but put on my headphones and rested instead. A nurse came in to check every now and then and around 3.30pm I was brought some food which I gratefully accepted, brown toast, tea, cranberry juice and a bowl of icecream. The consultant came around and said that the procedure had gone well, no fibroids, polyps or other issues were detected inside the uterus, the bit of scar tissue on the cervix was unimportant. The only issue she had in fact was an excess of thick cervical mucus that made access difficult but which was cleared out. She said she would note this in her letter to the clinic consultant as any transfer I have should be by guided ultrasound (they usually are). After that I got up to use the bathroom and noticed I had a large wad of cotton wool, like a thick pad between my legs as I had some bleeding. My husband arrived soon after and before I was allowed leave I had to use the bathroom (where I changed into my own pad and underwear) and had a final blood pressure check.

The post procedure instructions were to take it easy for a few days, no heavy lifting. No sexual activity or tampon use for 2 weeks. I went home and went to bed for a while as the next day I was flying out to London for a few days. I had some spotting and bleeding like a light period with some clots for about 4 days after to varying degrees. Maybe this was because although I was on holiday, I was doing a huge amount of walking. An acupuncture treatment on my return seemed to help with this. I also had a sore throat for a few days, possibly following the insertion of a tube while under anaesthetic. Some lozenges helped.

Endometrial Scratch- the third one!

Next up was the endometrial scratch on August 8th. This was to be done by the clinic and without any sedation. I was dreading it as I had this procedure twice in my old clinic and found it very painful both times even though it is a quick procedure. I had an acupuncture session that morning and arrived at the clinic rather early for my allocated slot of 1.30pm. I sat in the waiting room with DH and considered when to take the painkillers I had brought, I was aiming for 20 minutes before the procedure. However, we were called in before I could decide so ended up taking them just minutes before the procedure. I explained to the nurse that I had been for a hysteroscopy a few days before. She instructed me to get ready and gave me a plastic squeezy toy to use when I explained my nerves about the procedure. She said squeezing  the toy would actually distract the brain from the procedure. I hadn’t tried this before but I think it definitely helped and having DH there did too. The doctor arrived in to do the procedure, I had not met this doctor before but she was very nice. She explained what she was doing and got down to business quickly. I felt the discomfort and used the squeezy toy but it never got unbearable. Next thing I saw her calling the nurse over and a ‘very good sample’ (her words) being put into a container, then she said I was done and that I could get ready, she advised I take one of the sanitary pads to put on in case of spotting. After that I got ready, was given some post procedure care instructions (no heavy lifting, strenuous activity for 24 hours, no sex or tampon use for 1-2 weeks, take the prescribed antibiotics). I settled my bill (this procedure was a separate cost at this clinic unlike my old one) and we left. I was given a prescription for 5 days of antibiotics, to prevent any infection, so we collected those. Once home I got into bed for a nap as I was feeling a bit queasy. I have a little spotting still, some days later, but it’s very little.

Collecting the Drugs

The day before my endometrial scratch, I had arranged with the pharmacy that I would collect my drugs. They had my prescription on file from the clinic so I was not entirely sure what I was going to be given. When I was handed a huge paper carrier bag filled with drugs I was quite taken aback! I was immediately glad I had both DH and the car with me as I wouldn’t have enjoyed trying to sneak these into work without being noticed! I signed some paperwork and paid the capped fee for the drugs of €144.

When I got home I spread the lot on the floor to have a look. Here’s what was in the bag (not including the Eltroxin for thyroid, Metformin and contraceptive pill which I got previously). The new clinic were not joking when they said that they were putting me on ‘everything’.

  • Suprecur- buserelin- nasal spray for down regulation.
  • Clexane- enoxaparin sodium- to prevent blood clotting.
  • Deltracortil- prednisolone- a steroid.
  • Folic acid 5mg tablets
  • B- Complex ( I opted not to take the pack as I already have a B complex supplement and it was just a general supplement not a specialised dose and it was an extra cost).
  • Puregon-  Follitropin beta- the FSH (follicle stimulating hormone) drug to grow follicles in stims, this drug stays in the fridge. The Puregon pen was also included in the pack.
  • Luveris- lutropin alfa- a hormone that supports FSH therapy, a gonadotrophin that contains LH or Luteinising hormone.
  • Cetrotide- cetrorelix acetate, a GnRH that prevents premature surge of LH.
  • Estrofem- estradiol, presumably to help with the lining or with the hormone levels of estradiol.
  • Pregynl- chorionic gonadotrophin or HCG, the trigger shot, also stays in the fridge.
  • Crinone- vaginal progesterone gel for luteal support (alas I know you well!).
  • Flagyl pessary and By-Mycin- these are antibiotics so might be used to prevent infection after perhaps EC or at transfer?
  • Solpadol- paracetamol and codeine- think may be used on EC day.
  • Hypnovel- this wasn’t in the bag but supplied directly to the clinic, it’s a sedative used for EC.
  • One pack of By-Mycin was also included for DH, no idea when he needs to take that.
  • Needles and swabs. Still have a sharps container from my old clinic so will use it but it is small so may need to come back for the one offered by the pharmacy.

I have to take all of these drugs to my appointment on 20th August when a nurse will explain everything to me and give instructions for the injections. From what I can see, Puregon, Luveris, Clexane, Cetrotide and Pregnyl are all injectable medications. So that’s going to be fun!  I have used Puregon before so am not worried about that one, but some of the others require mixing so am a little worried about that. The 20th August will also be my baseline scan to see if I have down regulated.

I started my down regulation spray on 10th August. On looking at an earlier blog post I noticed that I started the down regulation for my very first cycle last year also on 10th August. It feels a bit déjà vu. I really hope we have a happier outcome than we had after the same process (though much less drugs) this time last year. I hope somewhere in all of these extra drugs is something that makes the difference.

Time for another sniff of buserelin so better sign off….

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