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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Results, Set up and Schedule- Getting ready for IVF2 (with IMSI and EEVA) July 2013

I have had numerous tests undertaken at my new clinic which I listed out in an earlier blog post. I attended a consultation in June with my husband to discuss the results. The outcome of these was as follows:

For husband-

Sperm DNA fragmentation was normal at 5%. Motility now at normal range for the first time. Morphology ok. Count at an all time high of 5 million, still very low but vastly better than before and over twice what it was when we did ICSI last year. He was feeling quite good after this. Endocrinology and karyotyping tests had been carried out in our previous clinic and the new clinic did not require them to be repeated.

For me-

Karyotyping- normal female karyotype

Thrombophilia/Blood clotting- no issues

Chlamydia- negative

Fasting insulin/glucose- normal, in fact low

Chicago Bloods (Immunes tests)- mostly normal but slight elevation on one (CD56) which will be treated with intralipids during my cycle, with possibly steroids added also.

Anti-Thyroid Antibodies- the presence of these was the main finding.

I tested postive for the presence of both anti-TG (9.29 IU/mL on a scale of 0.01-4.11) and more particularly anti-TPO antibodies (71.20 IU/mL on a scale of 0.01-5.61). I don’t fully understand the significance of these but it seems they can have an impact on fertility if unchecked and on a person’s likelihood of developing a thyroid disorder if they don’t have one already. My TSH (thyroid stimulating hormone) had come back as 3 in the GP’s tests which is normal in their book but the clinic prefer to see it between 1 and 2 for fertility purposes. My Free T4 was just barely in normal range, erring on the low side.

The clinic explained that I have a sub-optimal thyroid function for fertility with a tendency towards having a slightly underactive thyroid. The presence of the anti thyroid antibodies means that when my thyroid is required to work harder, for example in pregnancy, the anti-thyroid antibodies attack it. It seems the antibodies cannot be eliminated but if the TSH is kept low, they will be quiet. Accordingly I was placed on a drug called Eltroxin (levothyroxine sodium) at 50 mcg daily. I had a repeat test of TSH and Free T4 at the GP a couple of weeks later and the TSH is now down to 1.9 and the Free T4 has risen a little more so hopefully that will help.

The consultant also put me on Metformin which is actually a diabetes drug often given to girls with PCOS. I don’t have PCOS (or diabetes) but the consultant thinks I may have slight polycystic tendencies due to a high amh for my age (was 34.87 pmol at just before age 40 last year) and retrieving 17 eggs last year. Perhaps he is aiming for less but better eggs and this is part of that process. I am not really enjoying this drug as it makes me feel a bit queasy sometimes though it helps if I take it with food. I am currently on 3 x 500mg daily and will soon switch to 850mg twice daily.

I received a cycle outline from the clinic with a list of dates on when to stop/start drugs and prompts to schedule scans, intralipid infusions etc. A provisional date of 2nd September was posted for egg retrieval with a 5 day transfer recommended with IMSI and EEVA. The main determining factor was when I could get a hysteroscopy scheduled which the consultant arranged to be done at an external private maternity hospital rather than within the clinic- perhaps because it was my first one. As the gynaecologist I was now to see was on holiday I had a little wait but the initial consultation was scheduled for Friday 26th July and the hysteroscopy for 2nd August. I also had to schedule an endometrial scratch at a certain point. I had hoped to lump this in with the hysteroscopy and be sedated but as the clinic prefer to do the scratch themselves, I will have to go there and experience it in full consciousness. I have had two of these scratches already in my previous clinic and found them very painful, if short. It has been scheduled for August 8th.

At my previous clinic I had to collect medications in the attached hospital pharmacy. However as this new clinic does not have a hospital attached, my script was faxed to one of the designated pharmacies of my choosing. I just ring them 2 days in advance of when I want to collect them.

I am now scheduled to start down regulation on 10th August. Unlike my previous clinic, I have been put on the pill as part of my down regulation, so it will be a slightly different experience this time round even though the core down regulation and stimulation drugs are the same [Suprecur nasal spray (buserelin) and Puregon (Follitropin beta)]

I had a little trouble initially with the schedule as we have been designated for IMSI (Intracytoplasmic Morphologically-Selected Sperm Injection) and the clinic only do one IMSI per day- it’s an extremely magnified version of ICSI- the difference between 500 and 5000 times magnification I believe. It is designed for couples with severe male factor issues (who may not have had luck with ICSI). We also had to get scheduled for EEVA (Early Embryo Viability Assessment) which is a time lapse video system to monitor embryo development in hopes of choosing the one(s) most likely to have potential to develop into a baby. I guess with our aging eggs and problem sperm we need all the help we can get. It doesn’t come cheap though. That overdue house painting job might have to be put off another while yet. A house move is currently out of the question as my bank balance dwindles rapidly….

Whatever happens, I want us to feel we have tried everything and I think we are certainly getting there, if not yet in outcome, then certainly in effort! I realise as the clock ticks ever more loudly that we are hoping for miracles.

I just don’t want to have regrets that we did not try whatever was available to us. I really hope that somewhere in all of this will be the key to unlock the door to the realisation of our dream of a child. Part of me is excited and hopeful at our new start in a new place with a new regime but part of me is also completely and utterly terrified.

I guess the well known phrase ‘Feel the Fear and do it anyway’ really applies now! I’ll just go and grab my parachute…

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Embracing Alternative Therapies- Preparation for IVF2 (with IMSI and EEVA)- July 2013

I’ve neglected my blog for a while, not deliberately though. I’ve just been pretty busy. We had a review meeting after the miscarriage which was a bit upsetting as it was with a doctor we had not met before and who did not seem to have read our file. We had already decided to move clinics so I wasn’t too concerned about hearing their new plan. As it turned out I think there was no new plan except to just repeat the same process again. I left it there and sent in a request for a copy of my file.  We took a week’s holiday in the sun which was very therapeutic for us. Time to just be ourselves. A final scan after the holiday confirmed all remaining pregnancy tissue had completely passed but that there was a cyst on my right ovary. I was told this would likely resolve itself on my next period which turned up after a surprisingly short (for me) 26 day cycle.

After the trauma of the last cycle and miscarriage it became time to take stock and to see what else I could try that might help my situation for a future attempt. If nothing else, I need to get my mind in the right place and my alternative therapies help me with this. The new clinic can look after the medical side of things but I have to look after my own mind and spirit. They can’t do that for me. My husband has also selected a few therapies for himself, his mindset is equally important especially as we have male factor issues.

Acupuncture

I decided to stick with my acupuncture. I have been doing acupuncture for over a year now.  I find it relaxing and I do feel healthier with it. At the moment my acupuncturist is just working on my general health, in particular keeping summer allergies, asthma and sinus problems at bay and working on my kidney and liver energy. As I have been placed on the pill by my new clinic, there is little that can be done for my cycles at the moment. When I start the actual IVF cycle, the treatments will be adjusted accordingly depending on what stage of the cycle I am at. My husband had been attending general acupuncture but has since moved to a new acupuncturist specialising in fertility. He is currently attending once a week but may go more frequently during the treatment cycle. The acupuncturist will work on his sperm motility, morphology and count. She recommended that he takes Royal Jelly which I already take myself. He is finding the sessions very relaxing.

Nutritional advice

We have also both been to see a nutritionist who has looked at our eating habits, exercise habits and supplements regime and made certain recommendations based on blood tests we had done at our GPs and hair mineral analysis she arranged for us. She also provided meal plans, food suggestions and recipies. The main recommendations in terms of supplements were a good Omega 3 fish oil with a high EPA/DHA ratio ( we are using Eskimo oil which is a liquid but it is ok and only a teaspoon a day is needed), Co enzyme Q10 for both of us (200mg daily), Vitamin C and a good prenatal multivitamin. I was also recommended a good probiotic to help my sluggish digestion as well as a low wheat/dairy diet to help my allergies/asthma/sinus issues. We were recommended to eat plenty of good proteins and increase our fish intake as well as lots of vegetables and salads (which we were trying to do already) and whole fruit rather than fruit juice. Small regular protein containing meals were recommended instead of fewer large meals. Caffeine and alcohol were to be avoided which we had already been doing. However, she did note that an 80/20 rule applies, in that we should try to follow this healthier regime as much as possible but not deny ourselves all treats. In terms of exercise more gentle forms were recommended such as long country walks, swimming, yoga- anything that would calm the mind. I do most of these already but also threw in some more vigorous activity such as exercise DVDs and Zumba as I can find these stress relieving. I had attempted some running but was advised against that on hard surfaces for the moment as it can be hard on the ligaments around the womb if you are not used to it. Probably if you are a runner already, this is perfectly fine as your body will be accustomed to it, but for me it would seem now is not the best time to take it up.

Mayan Abdominal Massage

After reading about the benefits, I went for a couple of sessions of Mayan abdominal massage also. This was quite a novel experience for me. After a detailed discussion of my cycles and general health, I got ready for the actual massage. I was laid out flat on the table, wearing only underwear but covered by a sheet. The therapist was careful to only uncover whatever part of the body needed to be accessed at a given time so all modesty was preserved. The massage itself consisted of firm short upward strokes from the pubic bone to hip bone height, the strokes were also repeated from each side. Apparently this helps gently reposition the uterus into its correct place, over time it can move slightly. My left side was very sensitive which the therapist thought might be due to lymphatic congestion in that area. There was other massage carried out on the upper abdominal area to help with digestion. Some pulling and shaking of the legs also to loosen joints, some shoulder massage. I had to turn over onto my back and the therapist warned me that one particular massage point of benefit was in the lower buttocks, basically the tailbone. That was a slightly odd experience! All in all the whole thing was pretty relaxing. From time to time I would be asked how certain areas felt, where there was any tenderness etc.

I was also taught how to administer the abdominal massage to myself and recommended to do so several times a week. This involves repetition of the upward strokes from public bone to hip bone and from each side, but also upper abdominal massage from chest to navel and on points around the navel. I am using almond oil for the massage.  I was given two different types of flower essences to try- Mallow for calm and Reindeer Lichen (Findhorn Essence) for releasing buried emotions. The self care sheet I was given also recommended other general good health practices, much in keeping with what the nutritionist said. One recommendation was to apply castor oil packs to the lower abdomen to ease any congestion in the pelvic and abdominal area. To make a castor oil pack I took a sheet of cotton wool, applied some castor oil liberally (I used Pukka brand) to it and covered the top in cling film. I placed a towel on the bed (castor oil is a bit messy), lay down and placed the soaked cotton wool sheet on my lower abdomen, cling film side up. I then put a hot water bottle over the cling filmed top to heat up the oil. I covered myself with half the towel under me wrapped around, and a light blanket over that. The recommendation is to rest for 30-60 minutes so I generally put on a relaxation recording at this time. There’s quite a lot of information on castor oil packs on both Google and You Tube. Whatever the benefits, it certainly is relaxing. The cotton wool pad can be re-used about 4 times.

I was also given a herb mix to use on Cycle Day 1 or first day of period. These are known as Vaginal Steam Baths or ‘Bajos’ in Spanish and are used for cleansing of the uterus. This was a slightly bizarre experience. I had to boil the herbs and let them simmer for 10 mins, then pour into a bowl that could sit in the toilet bowl. I then had to seat myself on the toilet without underwear but with my lower half completely wrapped in a light blanket to keep the steam in. I could wear socks and clothes on my upper half. I had to sit thus for 20 minutes. Apparently the purpose of this vaginal steam bath is to gently draw out old blood and act in a cleansing way. I have very light periods so it was not difficult for me but not sure how it would be for someone with heavy flow. My husband excused himself to go to the cinema which was probably a wise move!! After the bath I had to lie and rest in the blanket and keep nice  and warm in a resting state for another 20 minutes. During the night I had some cramps and dark clotting so maybe it did have an effect.

I have had 2 sessions of Mayan abdominal massage so far. I will probably go for one more prior to the stimulation phase of my new cycle.

Fertility Hypnotherapy

I have always found the hypnotherapy cds and recordings I have very useful during cycles. However, after the last upsetting experience I decided to actually attend some hypnotherapy sessions with someone dealing with fertility issues. I felt I needed a body and mind reset after 2 failed cycles and a third ending in miscarriage with no remaining frosties. It seemed like a good time for this computer to have a reboot.

I have had three sessions so far, the first one required me to fill out a detailed questionnaire. The therapist explained that in the first few sessions she would work on my fears and negative thoughts and that later sessions would switch to positive thinking about my upcoming cycle. She got me to start the session with deep breathing and tapping (Emotional Freedom Technique). The hypnotherapy part of the sessions required me to lay back in a large armchair with foot stool and wear large headphones so that outside noise could be eliminated and only the therapist’s voice could be heard. In that first session there was a lot of imagery of fallen leaves and of sweeping these up from an otherwise bountiful garden, these fallen leaves were to represent fears, disappointments and loss and I was to visualise burning them.  Lots of positive affirmations were fed into the voice stream about my ability to conceive and carry a baby to full term. I didn’t ‘go under’ or anything (apparently you don’t need to) but I did find it very relaxing and hopefully the positive ideas are bedding in to my subconscious. The next two sessions dealt more specifically with major single issues that I had identified, grief over the loss of my mother to cancer nearly 7 years ago and fear of loss generally.  At each session after the negative messages were challenged and released, more and more positive messages were fed into the voice stream and repeated over and over. The therapist said that she will record a session for me for my IVF cycle in one of the upcoming sessions and she had emailed me 4 general recordings for a natural menstrual cycle to listen to at home. My husband went for one single session also, not quite sure what transpired at it but I imagine it was to boost his subconscious regarding his ability to produce enough good healthy sperm. He actually ‘went under’ he said.

Yoga and Fertility Yoga

I have attended yoga classes on and off for the last 18 years or so as I really enjoy it and find it calms me. My husband had also practiced yoga on and off before we met. At the moment we both attend a Hatha Yoga class on Wednesday evenings and both of us really find it stress relieving. The only inconvenience for me is that at various points in the cycles (post transfer) I have to stop the classes as some of the poses are no longer suitable if pregnant. However our yoga teacher has referred me to a colleague who does fertility yoga on Saturdays so we are going to give this a go starting in early August. The fertility yoga will be a slow paced class and it involves lots of visualisation, meditation and forward bends to increase blood flow to the reproductive organs. The focus will be on using restorative yoga to tackle the stress that accompanies a fertility journey and the high levels of cortisol that can result. There will be a lot of breathing exercises to calm the sympathetic nervous system. The good news for me is that I can do the classes up to embryo transfer and beyond.

My mini pre-cycle bootcamp

I decided to fit in as many higher energy activities as I could in an effort to regain my fitness and lose some weight before my new cycle.

I’ve done a couple of hot yoga classes, which I will stop once I start my IVF cycle properly. This involves doing yoga at a quicker pace in a hot room. It’s a different kind of yoga experience, this will make you sweat!

I’ve been doing a few exercise DVDs including the 30 Day Shred and others to try and tone up.

I also attended Zumba for the first time and discovered I love it and being a well co-ordinated dancer is not required thankfully. It’s a high energy dance workout to music but it’s so much fun!  However, I’ll stop these higher intensity activities once I start down regulating. Gentle walks in nature and my yoga will be the order of the day then.

None of this may give me a baby alas, but it may preserve my sanity.

I’m pretty much willing to try anything at this stage and my husband is not far off. They say God loves a trier. Well, God, if you are listening, I am ready for a bit of that love.

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Loved and Lost- ‘Missed’ Miscarriage- May 2013

After the dismal 8w scan I spent another week in miserable half denial. I had made up my mind that I would request another scan and then decide my management options from there. I went to the GP to request another beta HCG test but she said there would be no point doing it as the scan would be more informative. She said if it made me feel better, to have the additional scan and stay on the meds until then. During that week one of the clinic counsellors called me and I explained my predicament and that I had not taken myself off my medications. She helped me to arrange a repeat scan for that Friday (9 weeks). On that day I met a good friend for lunch and then went for the scan afterwards. As I sat in the waiting room a couple returned to the reception desk and I could tell from the conversation that they had just had a successful 8w scan. I felt a pain for me, but in my head I wished them well, while simultaneously wishing that it could have been me.

9w repeat scan

This scan followed much the same process as the scan of the previous week. I had a different doctor though, a woman. She was very nice and completely understood why I wanted this extra scan and said that they often did these repeat scans in hope that the outcome would be different. I could see for myself once the image appeared on screen, that things had disimproved from the previous week even with remaining on the medications. The doctor pointed out that the sac had shrunken a bit more and was in a lower postion in the uterus, it was even harder to make out what was inside, compared to the relatively clear scan of the previous week. She said she could see where the placenta was starting to detach. This scan, though beyond tragic, was the finality and closure I needed. I could see there was absolutely no hope for this pregnancy, no way back. I knew now I could stop my medications with a clear conscience. I got dressed and met the doctor in an adjacent room. She went through the management options again- await natural miscarriage, take medication to bring it on or have a d&c. She explained that  the d&c would be done in the main hospital and that generally no testing of ‘products of conception’  would be done in this case. She said that as everything was quite small, I could chance allowing nature to take its course. I agreed to try this. She prescribed some strong anti-inflammatories (Ponstan) and painkillers (Tylex) in case I needed them. She also told me to make a scan appointment for 10-14 days to check that the miscarriage was complete. Before I left she gave me a hug and I told her and the nurse also present that I would probably go home and have a glass of wine.

Before I went home I bought a couple of items for our upcoming holiday. This was the May bank holiday weekend and for once the weather was nice. I spent time with my husband sorting out our garden for the summer and it was quite therapeutic. We did some shopping the next day and generally had quiet time. I had that wine.

I wondered how long it would take for the miscarriage to start and how it would manifest itself.

(warning: miscarriage description)

Late on the bank holiday afternoon (Monday) I started feeling some minor cramps and noticed a bit of spotting. As the day went on the cramps got stronger and I took some painkillers, more red bleeding started, not especially heavy. The cramps got even stronger again later and I could not really take more medication so made a hot water bottle as I was quite uncomfortable. After a time I felt I had passed something so I went to check. Aside from more red blood, some small clots and masses of surplus lumps of Crinone, there was one other small orangey coloured but clear fluid-filled bubble  with a thread like attachment and a bright red clot. I assumed this was the sac. It was tiny, maybe grape sized. I picked it up, wrapped it in tissue and put it into a container. However, by next day it had deflated. After this I only had some red bleeding, some clotting and lesser cramps, progressing as the week went on to more brown coloured discharge. None of this was heavy, I didn’t soak pads.

(end miscarriage description)

I rang the GP on the Tuesday morning and requested a sick note for the rest of the week. There was no way I felt I could work through this. I was surprised how quickly it happened, given that I had been told it could take a few weeks. I guess when I gave my body permission to let go, it simply did. My emotions were very variable for the week. At one stage I listened to the lyrics of Katie Melua’s song ‘I cried for You’ and they really hit home and I could not stop crying that day, some of the words are reproduced below.

You’re beautiful, so silently/It lies beneath a shade of blue/It struck me so violently/When I looked at you.

But others pass/They never pause/To feel that magic in your hand/To me you’re like a wild rose/They never understand why..

I cried for you/When the sky cried for you/And when you went I became a hopeless drifter/But this life was not for you/Though I learned from you/That beauty need only be a whisper.

I’ll cross the sea for a different world/With your treasure/ A secret for me to hold.

In many years they may forget/This love of ours or that we met/They may not know how much you meant to me.

Without you now I see/How fragile the world can be/And I know you’ve gone away/But in my heart you’ll always stay.

The thing is I had a connection to this little one, I had a visualisation of myself waving to him/her and she/he waving back to me from in utero. A mischievous wave too. A little character. I imagine our little angel Hope is with my Mum now but that makes me sad too, a double loss.

To help with grieving we decided to do two things. Both my husband and I attended an infertility support group, which was very helpful. It was nice to meet others who are in the same position and struggling and to share our experiences. There were men there too which was great for my husband.  We will also attend a miscarriage support meeting in early June. I have good support in real life from 3 colleagues, two who have experienced miscarriage and the other a stillbirth. There is grief and pain  and I know there will be more to come as we process this. Our holiday in late May will give us some much needed space and time to reflect.

I have great support on Twitter also, many ladies there who have been through miscarriage and even if they haven’t been, who are there with support and friendship. I even received a lovely teddy for comfort thanks to two special ladies there.

I returned for a repeat scan last week to check that the miscarriage was complete. The same lady doctor did this scan. It confirmed that all pregnancy tissue had passed and that the uterus was empty. However, a small pool of blood remained pooled at the cervix. The doctor said that this would pass itself without intervention and possibly as clots. She recommended that I have a further repeat scan after my holiday to make sure all was clear so I booked this for 5th June. I also have to book a review meeting to discuss the failed cycle/pregnancy, which I might do for the same week.

In terms of next steps, my husband has already been for his sperm DNA fragmentation test at the new clinic and was happy to see that his months of supplements have increased his count more and that the sperm fragmentation at 5% was considered normal. I had a phone consultation on the 21st  May with the new clinic to schedule my own tests after a suitable interval, ie after a natural period. The new consultant saw positives in the fact that a positive test and pregnancy had occurred even if it had ended in miscarriage. We both had a nutritional consultation and are making changes to our diet. In my case I am drastically reducing dairy and wheat and eating more protein foods. We already have a high vegetable intake and will add more fruit.  I plan to start a course of fertility hypnotherapy in early June and am thinking of doing a session of Mayan womb massage. I will also resume my yoga class. I’ve ordered some more books and relaxation cds to help. I also want to lose some weight and get a bit fitter and healthier. I have about a stone of weight on since last summer after 3 cycles so am not feeling very comfortable right now.

I finally started a fitness DVD in the last couple of days and I think the activity has helped that last bit of dark clotting/blood to pass, hopefully the spotting will soon end, now that just over 2 weeks have passed since the miscarriage.

I will start packing for my holiday tomorrow- actually knowing me, I will probably pack on the morning of departure…

We are still working on our garden, planting flowers and maintaining shrubs and finding solace in it. 2 plants are very sickly though, they are ones that my late Mum had bought for me and I had transplanted to this house from my previous one. Despite surviving 2 harsh winters, I think the wet summer last year finished them. It seemed a little cruel to lose these particular plants right now but my husband is valiantly trying to save them. I know one is definitely lost. I want to plant snowdrops later in the year, they flower like little beacons of hope in the depths of winter. They seem appropriate.

But as we take these tentative steps forward I know that I will carry our little Hope with me always, sometimes I get moments of deep sadness when I think of the lost future and lost possibilities for our little one and rage against the unfairness  of it all. I hope I can recover the strength and optimism to move forward and give our new cycle and treatment our absolute best shot.

Posted in Fertility, FET, IVF, Miscarriage | Tagged , , , , , , | 6 Comments

Surprise, Stress and Sorrow-A Missing Page?- April 2013

After the initial high of finally getting the positive test and briefly allowing ourselves to contemplate due dates (6th December 2013), possible names, maternity leave etc it was not long before the worries set in. In the early pregnant days I had some minor cramping and twinges but was told that this was normal, that it was the uterus stretching etc. I had minimal symptoms, a need to drink more water and a hearty appetite. I had arranged on the day I was to notify my clinic of the positive result (16dp5dt or 5w) to also have a beta blood test done at the GP to measure the level of the pregnancy hormone HCG as my clinic does not do this test. The test was done that morning but because the result had to be sent to an external lab, it was a number of days before this came back. The 16dp5dt result was 1051. The number on its own did not mean very much as with HCG it is not so much the number but the way that it rises which is important. The following week I felt very little symptom wise and was a bit concerned. Then began Beta Hell. I had the 2nd blood test 6 days after the first and when this result came back it was 1775. This immediately set alarm bells ringing in my head as the number remained very low and was not in any way doubling in the 2-3 days generally expected at this stage. The GP tried to reassure me and said HCG is massively variable from one person to another and once it hasn’t stalled or started to fall we should keep hopeful. I had another test 5 or 6 days later again and this one came back at 3498.

6w5d Scan

On the same Wednesday  as this third test was taken I attended for a private  early pregnancy scan at a nearby medical centre. The GP had cautioned me against going for a private scan too early as sometimes not much is seen but I could not wait. The day I went for this scan I was technically 6w5d pregnant. The sonographer initially did an abdominal scan and located a single pregnancy sac. She then got me to empty my bladder and return for a transvaginal scan so that we could get a better look. She spent a bit of time positioning the probe and trying to get a clear picture. She said that to be honest she wasn’t very happy with what she was seeing. The sac appeared small for where I should be and there was little evidence of much else. A mass inside the sac was pointed out as possibly where the embryo had grown for a while but had possibly arrested. No heartbeat was detected. She called this an anembryonic pregnancy or what used to be known as a blighted ovum.  She said however, that I should remain on all medications and hold out for my clinic scan on 26th April (8w). Of course the tears started to fall even though I was half expecting this result from the poor blood results. The sonographer was very kind, told me there would be no charge for the scan and before I left, said she hoped that I would be back another time for a happier scan. If the scan had been a positive one I would have got pictures and a dvd it seems. I went to the bathroom at the medical centre on my way out and bawled my eyes out.  I texted my husband, who had been unable to come to this scan due to work, and then texted a couple of close colleagues who knew I was going for the scan. My husband rang me back and made arrangements with work so that he could drive in to collect me.  As I left the medical centre into the afternoon sunshine, it was like walking in a daze, people were going about their day talking and laughing and it felt like I was looking at them through a window or from a distance. I passed a lone busker playing ‘My Way’ on the saxophone and the tears started to fall. I didn’t care who was looking. To be honest, nobody was.

I waited at an agreed place to meet my husband and after a hug we made the journey home in near silence, with tears running down my face periodically. Once at home I changed into comfy clothes and we sat on the sofa and I cried and he looked thoroughly sad. I opened the large Easter Egg that I hadn’t touched due to being cautious with my caffeine intake and demolished half of it. We then put on a few episodes of ‘Last of the Summer Wine’ which was probably the most gentle and inoffensive comedy I could find. I texted some close friends to update them as they knew my situation. We updated the small number of family who knew our circumstances, this was the hardest part. I updated my twitter account and got lots and lots of lovely messages of support from people there. I wasn’t able to respond individually as I was just so crushed but posted general replies later. My husband’s boss gave him the option of taking the next day off but I decided to go in and so did he. I did not want to be alone with my thoughts. I have two colleagues in my section at work who know my situation and they were tremendously supportive. Having to tell people this gloomy news was gut-wrenchingly painful.

The following Monday I went back to the GP for a 4th blood test and updated her on my scan. We discussed the possibility of a ‘missed miscarriage’ whereby the baby arrests early but the body doesn’t recognise it and the support structures are still there and HCG continues to be produced. This would account for the fact that I had no bleeding or spotting whatsoever (though maybe the FET medications I am on also prevent this) and the HCG levels continued to rise, although slowly. I raised this myself and the GP said she had experienced it. It’s apparently relatively common. The GP offered to give me a note for work but I declined. I preferred to keep busy and save the note for later if needed. The final blood test came back at 5784. The GP conceded that it was a bit lower than where they would like it to be in the 7th week. There was nothing to do now but wait for the clinic scan on the 26th.

The waiting of these 3 weeks since notifying the clinic of the positive  test was even worse than the 2ww itself. I had decided to get the blood tests done and the early scan to help me cope and to give me reassurance but they made me more stressed in the end as they signalled that something was wrong. If I hadn’t gone for these I would have wandered into my scan on the 26th thinking everything was fine and then possibly be faced with devastating and unexpected news, as opposed to devastating but expected news. Which is worse?

I found I could no longer join in with my twitter cyclebuddies on early pregnancy chat as I had no symptoms to share and felt that I had a failing pregnancy. As they moved on to their own scans with happy results, a little bit more of my heart was broken every day. I was completely delighted for all of them but just so devastated for me, after being through all this and coming so far, for nothing but more heartbreak. The usual ‘Why Me?’ question was asked.  I just found this whole period an incredibly lonely time.

As Friday the 26th approached I actually got a bit calmer. It had got to the stage where I was no longer able to cope with being in limbo and I needed to know an outcome, even a negative one, so that I could move forward in some way. After struggling to sleep and having weird dreams, I finally started to sleep a little better. I still felt very tired, probably a combination of emotional exhaustion and pregnancy hormone related. How ironic.

On the morning of my clinic scan I rang one of the clinic counsellors and discussed my situation with her. She was very compassionate and said that she would be on standby that afternoon if either or both my husband and I wanted to talk to her after the scan. I said if this has failed, I would love to know a reason, though often there will be no reason. I said that I know a lot of the time it is simply a chromosomal or genetic issue. The counsellor said one of the doctors had compared it to a book. If you have a book but there is a missing page, you don’t have the complete story. Sometimes the embryo has a ‘missing page’ and it is crucial enough to not allow it to develop.

I am just perplexed that in my fresh and two frozen cycles, after having 5 good blastocysts, all of which thawed, 3 of which were naturally expanding at the time of transfer, why 4 did not stick and the one that did immediately ran into trouble. Is it me? Is it an egg quality issue, a sperm quality issue. Who knows?

8w Clinic Scan

As the time approached for the clinic scan my stomach was in knots. I walked the 30 minutes or so to the clinic from my office and had arranged to meet my husband there as he was further away and travelling by car. I arrived a bit early and checked in. The receptionist gave me a beaming smile and wished me good luck. I said I wasn’t expecting good news. I visited the bathroom to empty the bladder as this was to be a transvaginal scan. A nurse came to get me after 5 minutes or so and I followed her, not quite able to catch her to let her know my husband  had not arrived yet. However, in the scan room I told her and she said that we would wait for him. I told her my concerns about not expecting good news and why and gave her a copy of my blood HCG results for my file. She took that on board and  went out to look for my husband, after a time both arrived back in and she left us to get ready. I burst into tears and said I didn’t want to do the scan and my husband looked like he was about to cry as well. I got ready and waited for the nurse. She arrived back in and we proceeded with the scan. She explained that they were looking for the gestational sac, yolk sac and fetal pole and a heartbeat, this being an 8 week scan. She pointed out each of the items but noted that they were not looking as they should, too small and that she could find no heartbeat. She asked us to wait there and said that she would get a doctor to repeat the scan and confirm this. I sat up again with my knee-socked legs dangling over the edge and my husband stroking my back. We could hardly look at each other in case we burst into tears but he rested his head against mine.

The nurse arrived back with one of the doctors and he introduced himself and explained what he was going to do and why and asked if we wanted to be told everything as he conducted the scan, I said yes. He scanned even more thoroughly than the nurse had, it was slightly uncomfortable at points. He took various measurements and pointed out the various elements again on the monitor, noting that they were smaller than would be expected and that there was no trace of any cardiac activity. He said that this was indicative of a miscarriage. He took some printouts of the scan. I was asked if I had any bleeding or spotting but I said no, none at all. When the scan was finished, I was told I could get dressed again and to wait as he would speak to us privately.

The doctor brought us into another room and took our file in. I asked several questions, was it egg quality, was it a missed miscarriage, did the baby live long at all, was there any particular reason? He explained that this type of miscarriage is very common both in assisted and regular pregnancies, it is generally down to an issue with the embryo itself when it continues to divide, something in its coding simply goes wrong and it doesn’t have the necessary information within itself to keep going. It is nobody’s fault. Egg and sperm quality may be an issue and egg quality can be an issue in older women but it is not always predictable. He said there were a number of ways to manage the miscarriage, I could wait naturally for it to happen, though this could take quite some time. I could be given a medication to expedite things or I could have a d&c procedure whereby the womb contents would be removed under anaesthetic. He said I did not have to decide immediately, I could take a few days and contact the clinic then. He said although they were satisfied with the diagnosis, I could have a repeat scan. I said for the moment I would like to wait and see. He drew up a letter for me for the main hospital attached to the clinic in the event a natural miscarriage became problematic. I asked should I stop all my FET medicationss and he said yes. He asked if I would like to have a copy of the scan photographs and I said yes. He then went through my file and tried to pick out the positives from the situation, my good response to stimulation, the 5 good blastocysts which was an above average number, the fact that I got pregnant which puts me into a different category of IVF patient. He said from their point of view it was a very good cycle (the IVF1 and 2 FETS combined). Maybe so, but I still have no baby though maybe I should not lose all hope of it.

We left then and went home, ordered in a very unhealthy takeaway and raided even more chocolate, just sat together and were sad and cried. I updated those friends/family who knew the situation and my twitter friends. That night I told my Dad, who had no idea I was even pregnant. He was so sweet and was genuinely sorry and sad for us and deeply concerned. He said he had been praying for us as we did the treatments. Again the having to update people with the sad news was profoundly painful and made me consider keeping future cycles a secret.

Since then I’ve been ok at times and then start getting teary, or panicky or angry or just darkly blue at other times. I have been touched though by the kindness and support I have got. I am still a bit in denial, not quite off all my FET medications and thinking of getting a repeat scan before I decide on ‘management options’.

What next?

So what next? Well it’s totally back to the drawing board. I guess we proceed with our plan b, a move to another clinic where I will have the following tests: immunes, endometrial function test, vitamin d, chromosome test, hysteroscopy. My husband will have a DNA sperm fragmentation test. IMSI and EEVA may be considered depending on the outcome. I will have to start a new fresh cycle now at the age of 41. Not a happy place to be.

I will also request the adoption information/application pack and start the initial paperwork. The application has to be paused if we cycle but at least we wouldn’t have to start all over again with this part of it.

Before all this I need to grieve, and we have booked a short holiday abroad for late May. We hope to also get some overdue painting work done in the house. We will have an enforced break anyway as my body will have to recover it’s normal cycle before I can have the new tests, let alone cycle although the new clinic said they will proceed as quickly as possible. Time is not on my side. I might have mentioned that…

This whole process is so wearing, so full of hope,  anguish and disappointment. After the initial joy of the positive test to the crashing despair of losing our much wanted baby, I feel like a shell, a shadow of my former self. I need to recover a bit of that before we can move on.

As for our lost baby, I tweeted the following, ‘I am sorry tiny angel,  that we could not get to keep you. We would have loved you so much, more than life itself. RIP and hope my Mum is minding you x.’

I asked my husband if we should give our lost baby a name and he suggested Hope. Maybe when we can emerge from these dark days we will be able to take some positives from this experience. But for now, these are dark days.

I will wish that our Hope will be by our side as we pick ourselves up, dust ourselves off and move on somehow…

Posted in Fertility, FET, IVF, Miscarriage | Tagged , , , , , , , | 8 Comments

Manic March Part 3- FET no 2- The Agony, the Ecstacy and the Fear

After a bit of confusion with an AF that started and then stopped, I finally started my medication for FET2 on 28th February. The clinic wanted me to start on Cycle Day 1 but my AF started and then stopped and on their advice I waited until CD2 for a better flow to be established. I had already started taking the 75mg of baby aspirin that the clinic had prescribed me but they said that was ok, a day or two extra would not matter. The purpose of the aspirin was to prevent any blood clotting and act as an anti-inflammatory. I started my 4 tablets or 8mg  of Fematab (like Prognyova) nightly. On day 12 I attended the clinic for a scan which showed the lining had grown to 8.6mm. A blood test was also taken and I was told I would get the result of this in a phonecall that afternoon. If all was well, my transfer would be scheduled. As I was down to have assisted hatching, I was given a prescription for an antibiotic which would be taken once daily for 3 days before transfer to prevent any infection from the procedure.

That afternoon the call came and all was well. The following weekend was a bank holiday and national feast day, St Patrick’s Day so my transfer was scheduled for Wednesday 20th of March, some 8 days after my scan. I was told to start the Crinone Progesterone gel on the previous Friday, 5 days before transfer, one in the morning and one in the evening. I was told to start the antibiotic on the Sunday before transfer and continue until the night before transfer. I was to continue the Fematab and Aspirin as before. The Crinone gel was not to be taken on the morning of transfer.

I had the week off work so organised myself to have healthy food on hand and a dinner that would be simple for my husband to prepare on transfer day. I had pre-booked a hotel break that weekend by coincidence so we went along and enjoyed it, though I was, of course, not drinking. I had booked a facial too and explained to the therapist about my situation and asked to have a treatment appropriate for pregnancy. She took this on board and advised that she would be careful of the massage element of the treatment. I enjoyed the downtime in the relaxation room afterwards. It made a change from running around the place at work which happened before my previous FET in December. Again, as happened with my last cycle, a couple of days before transfer my allergies flared up and I could not stop sneezing!

On the afternoon before the transfer I attended for a pre-transfer acupuncture session, apparently it is fine to have the pre-transfer session up to 24 hours before the transfer. I went home that evening and tried to relax.

On transfer day we went to the clinic for our 12 noon appointment. I was a little nervous as I hoped that our last 2 embryos had thawed. I had opted not to receive a phonecall if they had not. My doctor met us at the clinic and advised that both embryos had thawed but she said there was a new culture available called ‘embryo glue’ that might give a 10% increased chance of implantation. The only thing was that this would push our transfer out to 4pm as the embryos needed to be cultured in it for 4 hours. We decided to take this option and took ourselves off to wander around Dublin for the afternoon, it was not really worth our while going home and coming back. The doctor had given me a prescription for Prednisolone to take (5x5mg per day for 2 weeks, then gradually reducing over 2 weeks) and I collected the prescription. This steroid is given to reduce any inflammation and hopefully give the embryos a better chance to attach. I rang my acupuncturist as I needed to reschedule the post-transfer acupuncture to about 5pm. Unfortunately he was unable to do it himself due to a teaching commitment elsewhere but made arrangements for his girlfriend who is also an acupuncturist and familiar with the points used for the session, to come and do the treatment instead.

We returned at 4 for the transfer and I was brought into the smaller transfer room along with my husband. Our doctor actually came in to do the transfer herself. A nurse helped me get set up and an embryologist came in to confirm our identities and to provide information about our embryos. Both blastocysts had thawed and one had started to expand itself so assisted hatching was not performed on that one but was on the other embryo. A scan was done (across the tummy) and the speculum was inserted. The doctor asked if I had ever been diagnosed with endometriosis- not sure why she asked this unless she saw the bit of scar tissue that had been seen at the first transfer. The embryologist checked our identities again. The catheter was inserted and then the embryos were passed into the womb. Both my husband and I got a clear view of the bright white blob entering the uterus on the screen. The old excitement returned. Maybe these would be the ones to stay!

The doctor stayed for a few moments to answer any questions and said to start on the Prednisolone that night. The nurse remained on to go through the other medications, advise when to do the home pregnancy test (16 days after transfer) and gave other general advice. This advice included avoiding alcohol and caffeine, soft cheeses, swimming and baths, lifting and hoovering. After another 10 minutes or so I got up and left and we made our way to the acupuncture appointment, with me swallowing the 5 steroid tablets on the way in the car. The acupuncture session was relaxing. After this I went home, got into bed and took my delayed Crinone gel while my husband made dinner (fish). After dinner I went back to bed and listened to some post transfer relaxation recordings.

I had booked some days off work and spent them relaxing, reading and watching tv. I rested in bed a good deal but did get up and potter about also. I had home made soups defrosted so that feeding myself while my husband was at work would not be taxing. I was in pretty good form the first few days as I felt that this transfer had gone the best of all 3, I had practically no cramping at all. I felt a few twinges now and then and some bloating but nothing in particular.  As the days moved on though, my old fear from my previous two failed cycles returned and I got more paranoid that the cycle had failed. I kept looking for spotting but there was none. The weekend was easier as my husband was there to distract me. By the following Tuesday I went back to work and it was almost a welcome distraction. On the following Wednesday I attended an adoption information meeting. I went back to work again then and travelled to my father’s house for the Easter weekend which was also a welcome distraction. It was nice to enjoy some time in the country and catch up with my nephews.  My time was occupied with getting replacement flowers for my mother’s grave which we placed there before Mass on Easter Sunday. I felt very emotional and stressed on Easter Sunday, the whole loss of Mum was hitting me hard and I was utterly convinced that the cycle had failed. I tackled an Easter egg with gusto in the afternoon and made up my mind that I had had enough of this and would test in the morning, at this stage the not knowing was becoming worse than knowing. I knew I could not live like this until the following Friday (16dp5dt).

After a restless night (and a dream that I got a positive) I got up on Easter Monday morning at about 6am and lined up an internet cheapie test and a First Response one, got my little pot ready and produced my sample. I dipped the cheapie test first and saw it soak through highlighting the control line. I thought to myself, here we go again. I left it aside and dipped the First Response and left it to develop. I looked at the cheapie and did a double take as I saw the beginnings of a second line. I looked across at the First Response and saw a second line appearing on that. I was totally floored. I have never had a positive test. I thought can this be real. After a moment I went back to the bedroom.

Me: Are you awake?

Him: mmmmph

Me: Are you awake???

Him: Huh, yeah, what?

Me: There’s 2 lines.

Him: What?

Me: There’s 2 lines!!!!

Him: What!

Whereupon he leapt up and went in to consult the tests and said yes he could see the two lines.

We stood there not knowing quite how to react. I had not expected this after nothing but failure. I said in the end that this is great news but we must not get too excited, we don’t know anything yet, the risks are so high of losing it. My husband went back to sleep for a time but that was the end of sleep for me.

This was 12dp5dt and I was not to notify the clinic until 16dp5dt, the following Friday. Over the next few days I proceeded to repeat the tests each morning, usually around 4am as I could not sleep properly at all. Each test came up positive. I tried a Clear Blue Digital with conception indicator on the Wednesday (14dp5dt) and it came up with Pregnant, 2-3 weeks. It was so nice to see it in words. I rang the clinic that day and told them, they accepted it as a cautious positive but said repeat the test on Friday anyway. HCG can show up and a woman can still miscarry, they gloomily advised. My clinic don’t do pregnancy blood tests so I decided to ring my GP and request one, which was scheduled for the Friday morning.

By the time Friday came around I was tired from the several nights of broken sleep. I did a cheapie test and a Clear Blue Digital which had the same result as Wednesday. My GP appointment was early so I went there before work. The GP seemed as shocked as me when I told her. She was very cautious about it in view of my age and treatment although said she did have a baby at 41 herself (not her first and not with ivf). She understood my need for the reassurance with blood tests so did the test but said the result may not be back until Monday. She said she would do a second one later in the week to see how the levels were rising. She pointed out that HCG results are not an exact science and greatly vary from woman to woman. However, we might like to see a reasonably high number for now. I said the clinic would scan me in 3 weeks. We agreed to proceed with caution, do the bloods and see how things are after another week before making any further plans regarding referrals to obstetricians etc. As I was, and still am, finding it hard to believe the positive, this suited me fine.

After the appointment I rang the clinic and informed them of the result. They booked me in for a scan for 3 weeks (26th April)- it seems so far away! I pray I make it and that there is something to see. I also had to call to the clinic that afternoon to collect another prescription for my Fematab (estrogen) and Crinone (progesterone) medications as I will be staying on these for another month, as well as baby aspirin. I will be phasing out my steroid over the coming fortnight and am slightly worried about that.

I have not had very many symptoms. I had quite a bit of cramping,  a bit like period cramping, some shooting pains and aches, bloating, constipation, a bit gassy and a heavy feeling after eating sometimes. No reactions to smells, food aversions, sickness or sore breasts so far. The cramps sometimes worry me but there is no spotting or bleeding at present, touch wood, so I hope it is normal. As I have never been pregnant before, I don’t know what is normal and I am very scared.

I am still very afraid that it is not real or lasting but am trying to keep positive. Every day I see with no bleeding I count as a bonus. I fear miscarriage or ectopic pregnancy greatly. I worry that the embryo is ok. This will be a very long and anxious 3 weeks to the scan. I am sure that day, if I make it that far, will be utterly nervewracking. I suppose no matter what happens I should take it as positive that I managed to get a positive test, that my body can become pregnant, as I was beginning to doubt this. I still have my plans b and c in reserve if needed but I so desperately hope they are not for the moment and that maybe I can keep this little miracle.

I allowed myself to download one phone app with a pregnancy tracker which puts me now at 5 weeks and 2 days. So scary and such a long way to go. All I can do now is take one day at a time and wait. Yes even more waiting!!! And more fear. I have stepped away from the pregnancy tests for the moment, though maybe I will take one or 2 next week.

I turn 41 next week and all I want is for this little one to stick with me. I have waited such a long long time….

Your thoughts and prayers are so very welcome and appreciated. I have never been so scared.

Posted in Fertility, FET, IVF | Tagged , , , , , , , , , | 9 Comments

Manic March Part 2: Adoption Information Meeting 27th March 2013

My husband and I were invited to this meeting following on from a general enquiry we had made to our health authority about adoption. The meeting took place in a hospital conference room on an unusally snowy day. There were about 100 persons present, mostly couples but also single persons. We were asked to both sign in on arrival and took a seat. A slideshow presentation was set up. The meeting was chaired by two social workers and an administrator in the adoption services. This meeting focused on adoption services for the particular region of the country in which I live (Ireland).

A number of points were mentioned at the outset of the meeting. Firstly it was stated that adoption is a service for children, not for prospective parents. Everyone has the right to an assessment of suitability but not necessarily the right to a child. Adoption is a permanent legal process which establishes a new legal relationship with the adoptive parents and child and terminates the pre-existing legal relationship.  Adoption Services also deal with domestic adoptions including step family, family and the small number of non-family adoptions processed. Intercountry adoption was the main focus of this meeting.

Background was given to the legislation currently underpinning adoption in Ireland. This was originally the Adoption Act 1991 which allowed a statutory right to assessment. An official Adoption Board grants a Declaration of Eligibility and Suitability to approved applicants. Section 42 of the Act noted that it is illegal for money to be exchanged. This is to prevent trafficking. The Adoption Act 2010 is the most recent legislation on this matter. This ratifies the Hague Convention into Irish Law and repeals all previous acts. It consolidates the legislation governing adoption. It is now only possible to seek to adopt from a country that has ratified the Hague Convention. This tightening up has meant that there are fewer children available for adoptions with many of the referring countries operating quotas.

Section 33 of the Act deals with the Criteria for Eligibility.

  • married couple living together
  • married person living alone (spouse consent needed unless legally separated/divorced/deserted)
  • mother/father or relative of the child
  • widow/widower
  • sole applicant

The position is complicated in law for cohabitees.

The minium age limit is 21. Although there is no upper age limit as such, this is a factor that is considered and the referring country may itself have a preferred upper age limit. In reality the upper age limit would appear to be about 55 for married persons and 50 for a single person with state of health being a key issue.

There are also ‘Suitability Criteria’ based on 5 standards.

  1. Capacity to Safeguard the Child throughout his/her childhood

Here the age and health issues will be taken into account as well as financial status, experience minding children and the referee’s report.

2. The capacity to provide the child with family life that will promote his or her development and well being and have due regard to the physical, emotional, social, health, educational, cultural, spiritual and other dimensions.

Here the presence of social and support networks, relationships and friendships will be considered as well as lifestyle and domestic arrangements. It is expected that one half of a couple should be prepared to give up work for a year to help an adoptive child settle. Placing a child in crèche is not favoured thereafter, but rather having a childminder in the home or placing a child with a dedicated childminder. A crèche environment is not seen as attentive enough to the particular needs of an adopted child.

3. The capacity to provide an environment where the child’s original nationality, race, culture, language and religion will be valued and appropriately promoted throughout childhood.

Here some of the issues that we were asked to consider were those of bullying or racism and how we might deal with this should our child encounter it.

4. The capacity to recognise and understand the impact of being an adopted child from an overseas country on the development of the child’s identity throughout their childhood and beyond.

Here the importance of being sensitive to your child’s losses to date was stressed. We were asked to consider how we would maintain links to the child’s past.

5. The capacity to recognise the need for and to arrange for appropriate support and intervention from health, social services, educational, and other services throughout childhood.

Here we were told that we have to be prepared to actively advocate for our child to ensure that they get whatever resources and support they need.

Stages of the Adoption Process (Intercountry)

The meeting then outlined the steps involved in applying to be assessed. These are:

  • Initial Enquiry
  • Information Meeting
  • Follow up request for Information Pack
  • Completion of documents within Information Pack and return to Adoption Service
  • Processing of Information Pack documents
  • Social Work Management Review of your documents (invitation to meet with Social Worker if any issues arise)
  • Placed on waiting list for Group Preparation Course (adult education)
  • Attendance at Group Preparation Course
  • Homework tasks arising from Course
  • Homework returned to assigned Social Worker
  • Assessment/Home Study
  • 30 page Home Study report prepared by Social Worker.
  • Social Worker makes recommendation
  • Local Adoption Committee screen this and endorse or seek further information.
  • Material forwarded to Adoption Authority who grant Declaration of Eligibility and Suitability.
  • Appeals process exists if needed
  • Apply to your chosen Country and go on waiting list

The Information Pack

This Pack contains all the forms and documents to be completed in order to apply to be assessed. These include:

  • Application form (all questions must be answered, even with ‘not applicable’)
  • Documents to be supplied include original civil birth certificate, civil marriage certificate (or divorce/separation documents), up to date photos, Certificate of income.
  • A GP medical form to be completed is included.
  • Consent forms for consultant/counsellor’s report
  • Consent form for police clearance
  • Consent form for child protection/social service clearance
  • Consent form for post placement visits and reports

In the event that an applicant has lived abroad for more than 6 months foreign police clearance and foreign social service/child protection clearance is also required.

Type of Issues that Arise for applicants

  • Age- especially if they are in their late 40s and early 50s.
  • Health- physical and mental. Proof that a condition is being well managed is required.
  • Convictions- the nature of the conviction is important. The nature of the conviction as well as when it happened will be taken into account. A minor conviction many years ago will be recognised as such. The potential safety of the child is the concern here.
  • Area clearance
  • Age of children (if any) in applicant’s care
  • Bereavements- you can ask to put your application on hold for a time, some time out is expected for major bereavements.
  • Infertility Investigations- these will tend to be highlighted in medicals. A couple is not required to undergo IVF to prove their infertility but it is expected that they will have had basic medical investigations.  Before a couple attends the Group Preparation Course, they must have completed all IVF treatment. All frozen embryos must be used up.
  • Cohabiting Relationships- these are complicated regarding adoption as only one of the partnership can adopt at present.
  • Other Issues

Deferrals- it is possible to defer an application for a maximum of 2 years, it is essentially ‘frozen’, you do not have to go back to the start and repeat it again, although depending on the time lapse you may have to repeat the Group Preparation Course.

Group Preparation Course

This is an adult education courses specifically designed for prospective adoptive parents. It takes place over 6 sessions once every 2 weeks for 3 months in total. As it is a morning session, arrangements would need to be made with work.

A Social Worker is assigned to the prospective adoptive parents. They will receive the homework that the couple must do following the Group Preparation Course.  The homework tasks deal with attachment and identity and looks at drawing up a Child Care Plan.

Assessment/Home Study

This takes place over 7 sessions (once every 2 weeks, one or two of which will be in the family home). The Social Worker will meet the referee also.

A 30 page typed report will be prepared by the Social Worker- the Home Study report.

Changes in Circumstances to be notified to Adoption Services

  • Health
  • House Move
  • Criminal Conviction
  • Employment
  • Pregnancy- if you become pregnant the application is deferred until the child is 9 months old, there is a preference for a 2 year gap between the child and adopted child.
  • Change in relationship
  • New Relationship
  • Any other relevant information

Non disclosure will be taken very seriously.

When choosing a referee, it is necessary to choose someone who knows you well. Often in the past a clergy person or similar would do it.

Question and Answer Session

Timeframes for Processing Applications

The completed Information Pack takes about 6 months to process.

Police clearance can take 3-4 months

From 8 weeks of the Group Preparation Meeting, a social worker will be appointed to you. It takes about 4 months to do the Home Study stage and about 4 weeks for the report to be written.

It takes about 13-14 months in all to reach the declaration of Eligibility and Suitability, the biggest wait is then for your chosen country to make a referral. There are waiting lists for all countries. This could be a wait of 3-5 years. It is only possible to choose one country. If the country you choose ‘closes’, you can have your documents returned and reapply to another country.

Dual assessment for domestic and intercountry adoption is possible but you cannot apply for both. There are very few non family domestic adoptions in Ireland today. The waiting list is so long that anyone over their early 30s is advised against it. There is no waiting list for fostering children. Legislation is not yet in place to allow the adoption by foster parents of foster children, though a referendum on this matter was recently passed. Ironically it is technically possible to adopt children from the foster system in the USA though it is an extremely expensive process.

Adoption of Special Needs Children, Older Children, Sibling Groups- these may or may not result in shorter waiting lists but the adoption authority will require evidence to know that you can support children in these circumstances and that you are aware of the additional challenges such children may present. There may be more requirement for you to take time of work for a longer period for example.

Advice Given

  • Check out international adoption association support groups and the official adoption authority websites for your own country.
  • Learn more about the Countries that are signatory to the Hague convention and which are open for adoption.
  • Gain more experience with children, with nieces/nephews, babysitting etc
  • Start saving – the whole process can cost from 16k-40k depending on the country.
  • From my own point of view I think it would be good to read some books on the subject as well and perhaps books and blogs about other people’s experiences. If you know someone who has been through the process and can talk to them that would also be great. Twitter may also help here if you can interact with those who have been through the process.

So there was plenty of food for thought at this meeting. It was quite sobering. Certainly if you came into the meeting thinking that adoption was an easy option (I didn’t) you would have had your eyes opened. It is a long tough journey too with lots of waiting and waiting and hoping also. I would love to corral the ‘just adopt’ brigade in here to show them the reality!! Although I could have picked up an information pack before I left the meeting, I opted not to but to go home and reflect on it. I am mid 2ww of my last FET with my current clinic so I will at least wait for the outcome of that. Requesting the pack only involves the sending of an email so another week will make little difference. This is a big decision too and not one to be rushed. I wasn’t sure what my husband was thinking but on speaking to him I discovered he was reflecting more deeply on the whole thing than I had thought and was quite in tune with the particular challenges that may be faced in raising an adopted child of another nationality.

It feels like being at a crossroads and sometimes it is so hard to know which way to turn, which avenue to pursue. I really could do with a Crystal Ball!!

Posted in Adoption, Fertility | Tagged , , | 3 Comments