Friday, 24 February 2017
A little lap
It's been a while since my last post. My due date came and went, and it was coincidentally also the day that I had a diagnostic laparoscopy. I had a few tears about it, but the bigger challenge has been the lasting impact of the ectopic itself. Not every month, but most months, I would continue to test after the bleeding came and went. I wasn't sleeping. I was afraid to plan a trip because it could happen again. Scheduling the lap was such a relief. Then low and behold, the lap showed that only one tube was mangled and posed a risk, and the other looked fine. Was the HSG test wrong? Did the pain of the procedure cause cramping that made it look worse than it was? Did something I've done over the past three years (caster oil packs, acupuncture, Chinese herbs) actually work? I'll never know. What I do know is that I'm rapidly approaching 42, and I don't have many good eggs left. So, I'll carry on with my vitamins and charting for a few more months, and then it will be time to move on. Again.
Thursday, 12 May 2016
And then this happened...
There I was, minding my own business, having accepted my infertility and moving on with my life, and this happened:
That was three weeks ago today. After one day of complete shock, and two days of joy, everything spiralled out of control. Because of my history and because I had been bleeding, blood tests and a scan were ordered. It was a holiday long weekend though, so I had to wait. It was the happiest I had been in a long time. I had two professional failures back to back just two weeks previous and I was in a funk. Infertility is such a deep personal failure, and I coped by throwing myself back into work, so failure there too really hits hard. The two little pink lines rescued me.
I went to my scan with so much excitement. I'd even had visions of twins, given my age, so when the scan found nothing - really nothing - I felt crazy and embarrassed. No signs of pregnancy, those were the sonographer's words. In fact, to my untrained but IVF-savvy eye, it looked like my body was gearing up for ovulation as the calendar would have suggested. As I walked home, I thought the test was wrong. Of course the test was wrong, I have no functional tubes, how silly of me to think I could actually be pregnant. I'd had the blood draw in the morning, but my doctor wouldn't have the results for a few days.
That night, I woke up in pain. It started as just a burning sensation across my pelvis, but then it felt like my uterus was being wrung like a sponge. And I was bleeding again. Off I went to the hospital. Luckily it was quiet and when you say the word ectopic you are treated as seriously as a heart attack. Five hours later they let me go home. My hcg was lower than it should be and they were putting their money on a miscarriage, but because ectopic hadn't been ruled out, I was referred to the Early Pregnancy Assessment clinic for follow-up. It also became clear that potential ectopics aren't allowed to stray far from the hospital and if I didn't live so close to the hospital they would have kept me there for observation.
I returned for my follow up blood draw and appointment two days later. The results weren't good. I had not had a miscarriage (my number crunching over the previous two days suggested that my heavy bleeding two weeks earlier could not have been a miscarriage anyway, given the timing, my numbers never would have gotten high enough). Rather than doubling on schedule, I only had a 20% rise in hcg. All signs were pointing to ectopic. Next draw showed a 40% increase. So did the fourth, but before I could attend my appointment, I nearly blacked out at work and was rushed back to hospital. This time they kept me. I should have been seven weeks, but still no pregnancy could be located on scans. My hcg started to falter, dropping during the day and only showing a 10% rise over 48 hours. The decision was made to treat medically with a shot of methotrexate. I was sent home, but remained on high alert. Until my levels reach zero, the risk of rupture remains.
Barely 24 hours home, I started having pain. I thought it was just gas and I laid down. But it didn't improve. Four hours later it became intense and off I went for the third time to hospital. Again, I was admitted and stayed three nights. The first 24 hours I was fully prepped for surgery even more than I had been on my previous admission. I didn't eat for 36 hours. I had id tags on my wrist and ankle. I signed consent forms for surgery, my jewelry was removed or taped, and surgical stockings were brought to my bed. But no signs of rupture were found, so they let me eat, and monitored, and eventually everything settled down and they sent me home again.
It's still not over. I still have monitoring. Technically I'm miscarrying, but it's hard to grieve when your life is at risk. If it was just a miscarriage, I could just bleed at home, in my own bed, and distract myself with Netflix. Instead, I have to wonder if every cramp is normal or life-threatening. I had a few tears in the hospital. I also had a lot of panic and self-doubt. It's replaced the hope and joy.
It's very surreal to dust off this old womb. I really thought that chapter of my life was over. But it's not. The hope is replaced with fear now, fear of another ectopic. I can't try again without that hanging over me. Trying to conceive consumed me completely for years. I had finally moved on. Now I'm dragged back and I don't know why my life has to be such torture. Nothing good came out of any of it.
I wish I could end this on a more positive note.
Thursday, 19 March 2015
Stages of Infertility
It occurred to me today that an infertility diagnosis has some things in common with other more serious medical diagnoses. No, I won't die, but my hopes and dreams certainly got a terminal blow. Nearly 50 years ago, Elizabeth Kubler-Ross developed a theory of death and dying, describing the stages she observed in terminal patients. You might be familiar with these five stages. They are more commonly known as stages of grief, although they were never based on grief and grieving in general, but they work well, so long as you don't expect them to follow in strict sequence:
Denial
I still have a lot of denial. It's the shred of hope that my diagnosis was one of "err on the side of treatment" - meaning where I lived at the time, a bilateral blockage would get me approved for IVF and a unilateral blockage would leave me with nothing. I saw my tubal patency test live, I saw ambiguous spillage from one side, as did my OB who performed my test, so I was pretty shocked when she delivered the official diagnosis - the radiologist had signed off "no spillage". That was it, end of story, off you go for IVF. I still hold on to that denial. If I accepted it, then knowing I'm not going to have any further IVF rounds, I really should get rid of ALL the maternity items. But I can't seem to do that. Denial.
Anger
I have been angry at times with various people, particularly those I might hold responsible for the delay in diagnosis. Most of these are doctors, a system in which there is a 5-6 month wait to see an OBGYN, male GPs who don't know seem to know anything about reproduction or female anatomy, and of course my husband for wanting to wait. The simple reality though is that no one caught the infection, I delayed seeking treatment when I had pain, and I took a job and moved before I could get in to see another OBGYN about it. Then I spent 3 years living somewhere that the diagnosis wouldn't have mattered because IVF would not have been an option. The fact that we weren't really trying during those three years didn't matter, and when I moved again, at most it would have sped things up by six months. So not a lot of time is spent on Anger, but it pops up now and then.
Bargaining
I haven't done this recently, but I made all kinds of strange bargains, especially during the IVF cycles. Like when I committed to flossing my teeth every day, without fail, if it would work. And I did, every day, until the day it was officially a bust. It gives a sense of control, even if it's false.
Depression
Oh there are loads of days when the depression comes back. You have to be ready for them, before they suck you down that hole.
Acceptance
I'm not here yet. In Kubler-Ross' stages of dying theory, acceptance wasn't about giving up, but if you've been bargaining or trying things that won't work because you're in denial, then acceptance can be understood as simply that, you accept the reality of the situation, it is what it is. At some point I will have to accept that my tubes are useless, my uterus might even be a scarred mess, and my eggs are all old and stale and useless. But I'm back taking CoQ10 for my eggs, Chinese herbs for the one ambiguous tube, prenatal vitamins "just incase" and considering finding a new doctor for a more thorough investigation of my insides. Clearly I've looped back around to Denial.
Denial
I still have a lot of denial. It's the shred of hope that my diagnosis was one of "err on the side of treatment" - meaning where I lived at the time, a bilateral blockage would get me approved for IVF and a unilateral blockage would leave me with nothing. I saw my tubal patency test live, I saw ambiguous spillage from one side, as did my OB who performed my test, so I was pretty shocked when she delivered the official diagnosis - the radiologist had signed off "no spillage". That was it, end of story, off you go for IVF. I still hold on to that denial. If I accepted it, then knowing I'm not going to have any further IVF rounds, I really should get rid of ALL the maternity items. But I can't seem to do that. Denial.
Anger
I have been angry at times with various people, particularly those I might hold responsible for the delay in diagnosis. Most of these are doctors, a system in which there is a 5-6 month wait to see an OBGYN, male GPs who don't know seem to know anything about reproduction or female anatomy, and of course my husband for wanting to wait. The simple reality though is that no one caught the infection, I delayed seeking treatment when I had pain, and I took a job and moved before I could get in to see another OBGYN about it. Then I spent 3 years living somewhere that the diagnosis wouldn't have mattered because IVF would not have been an option. The fact that we weren't really trying during those three years didn't matter, and when I moved again, at most it would have sped things up by six months. So not a lot of time is spent on Anger, but it pops up now and then.
Bargaining
I haven't done this recently, but I made all kinds of strange bargains, especially during the IVF cycles. Like when I committed to flossing my teeth every day, without fail, if it would work. And I did, every day, until the day it was officially a bust. It gives a sense of control, even if it's false.
Depression
Oh there are loads of days when the depression comes back. You have to be ready for them, before they suck you down that hole.
Acceptance
I'm not here yet. In Kubler-Ross' stages of dying theory, acceptance wasn't about giving up, but if you've been bargaining or trying things that won't work because you're in denial, then acceptance can be understood as simply that, you accept the reality of the situation, it is what it is. At some point I will have to accept that my tubes are useless, my uterus might even be a scarred mess, and my eggs are all old and stale and useless. But I'm back taking CoQ10 for my eggs, Chinese herbs for the one ambiguous tube, prenatal vitamins "just incase" and considering finding a new doctor for a more thorough investigation of my insides. Clearly I've looped back around to Denial.
Tuesday, 17 February 2015
Eastern Medicine
I had my first consult and began treatment - combination acupuncture and herbs. I didn't feel most of the needles at all (it's nothing after all the injections of IVF) and the herbs didn't taste nearly as awful as she made it sound (maybe she just says that so we aren't expecting a nice herbal tea).
My expectations for clearing blockage are low, as I suspected, she said mucus plugs are readily targeted by herbs but scar tissue, especially given how old and bad mine likely is, is a long shot and I shouldn't expect much. However, since I went in with those same low expectations, I will be happy to just get my digestive and hormonal balance back, as these are areas Western medicine has failed me for years.
Despite my low expectations, and rapid decent towards 40, I still don't quite feel ready to "let it all go" just yet. Having spent the better part of the past 6 years dreaming of another pregnancy, I can't just shut if off, but days go by now where I am more focused on other things. It does get a bit easier, and maybe by the time I'm 45 I'll be ready to let go of the maternity clothes and admit that I'll never wear them again. For now, I'm going to give Eastern medicine a go for a few months, and then maybe in June I'll revisit the idea of repeating my tubal patency test (horrible as it was, but this time I will request benzodiazapines to get me through it) or more invasive investigation or surgery to remove the scar tissue. Or maybe by June I'll be that much closer to moving on. After more than a year of saving every penny for IVF, I now have new goals for every penny I save, the enjoyable things I put on hold like travel.
I think the key to moving on will be to rediscover and enjoy diaper-free freedoms.
My expectations for clearing blockage are low, as I suspected, she said mucus plugs are readily targeted by herbs but scar tissue, especially given how old and bad mine likely is, is a long shot and I shouldn't expect much. However, since I went in with those same low expectations, I will be happy to just get my digestive and hormonal balance back, as these are areas Western medicine has failed me for years.
Despite my low expectations, and rapid decent towards 40, I still don't quite feel ready to "let it all go" just yet. Having spent the better part of the past 6 years dreaming of another pregnancy, I can't just shut if off, but days go by now where I am more focused on other things. It does get a bit easier, and maybe by the time I'm 45 I'll be ready to let go of the maternity clothes and admit that I'll never wear them again. For now, I'm going to give Eastern medicine a go for a few months, and then maybe in June I'll revisit the idea of repeating my tubal patency test (horrible as it was, but this time I will request benzodiazapines to get me through it) or more invasive investigation or surgery to remove the scar tissue. Or maybe by June I'll be that much closer to moving on. After more than a year of saving every penny for IVF, I now have new goals for every penny I save, the enjoyable things I put on hold like travel.
I think the key to moving on will be to rediscover and enjoy diaper-free freedoms.
Tuesday, 16 December 2014
The lies we tell ourselves.
For months I have prepared myself that regardless of the outcome, this was the end of my road, nothing more to do. But unlike Forrest Gump, I've reached the end but I find I can't just turn around and go home and declare the whole thing over.
I know I'm done with IVF. We threw the kitchen sink at that last round and still nothing. I don't regret trying, had I not I would always wonder "what if" because until I went through it I thought it would be my magic cure, and given my age, wasting time wasn't an option. Donors and surrogates - I don't think that's for me. Instead I find myself entertaining two options: Traditional Chinese Medicine and Laproscopic Surgery. Both long-shots, but what do I have to lose? The journey continues in 2015 when I will schedule my first consultation with a specialist in gynaecological TCM.
I know I'm done with IVF. We threw the kitchen sink at that last round and still nothing. I don't regret trying, had I not I would always wonder "what if" because until I went through it I thought it would be my magic cure, and given my age, wasting time wasn't an option. Donors and surrogates - I don't think that's for me. Instead I find myself entertaining two options: Traditional Chinese Medicine and Laproscopic Surgery. Both long-shots, but what do I have to lose? The journey continues in 2015 when I will schedule my first consultation with a specialist in gynaecological TCM.
Sunday, 14 December 2014
IVF symptoms
If there is any "pro" to having IVF, it's that you get the fun of symptoms before the embryos are even back in your body. It makes it a bit easier to ignore symptoms and say "it's just the progesterone" - which is the cause of most symptoms. If you can keep telling yourself that, you will maintain your sanity much better during the dreaded wait until you know if it worked or not.
So for my sanity, I'm documenting all my symptoms of this frozen transfer cycle. Medications are estrace (6mg/day until transfer, 4mg after) and prometrium (600mg/day)
Progesterone (before transfer): sleepy, lethargic, unmotivated, depressed, breast swelling, IBS aggravated, insomnia, acne.
day 5: mild cramping (6 hrs after transfer)
day 6: mild burning, fluttering (36 hrs after transfer)
day 9: headache, bloating
day 10: cramps (from increased activity & lifting), bloating
day 11: bloating
day 19: still just bloating and cramps from too much walking
beta drawn: less than 6 (negative).
5-6 weeks: just bloating, extra weight in hips, bum, thighs (despite scale remaining stable), breast swelling, everything else has eased. There is no good reason to be taking the hormones now, this is more of an experiment (in denial). Lasted just over six week mark when spotting began, so that answers that question.
As disappointed as I am in the negative result, part of me is eager to get off the meds, drink some coffee and get back to my usual self (after a month of progesterone-induced and caffeine-lacking drowsiness). I'd rather be pregnant, but there isn't much worse than feeling pregnant for no good reason.
So for my sanity, I'm documenting all my symptoms of this frozen transfer cycle. Medications are estrace (6mg/day until transfer, 4mg after) and prometrium (600mg/day)
Progesterone (before transfer): sleepy, lethargic, unmotivated, depressed, breast swelling, IBS aggravated, insomnia, acne.
day 5: mild cramping (6 hrs after transfer)
day 6: mild burning, fluttering (36 hrs after transfer)
day 9: headache, bloating
day 10: cramps (from increased activity & lifting), bloating
day 11: bloating
day 19: still just bloating and cramps from too much walking
beta drawn: less than 6 (negative).
5-6 weeks: just bloating, extra weight in hips, bum, thighs (despite scale remaining stable), breast swelling, everything else has eased. There is no good reason to be taking the hormones now, this is more of an experiment (in denial). Lasted just over six week mark when spotting began, so that answers that question.
As disappointed as I am in the negative result, part of me is eager to get off the meds, drink some coffee and get back to my usual self (after a month of progesterone-induced and caffeine-lacking drowsiness). I'd rather be pregnant, but there isn't much worse than feeling pregnant for no good reason.
Sunday, 16 November 2014
Last chance
After a good long break (there were other things going on that made me wait this long), today I transferred my one frozen blastocyst from March. The frozen cycle was a lot easier than a fresh cycle - no injections, just oral estrogen and progesterone suppositories, no blood tests, and only one vaginal ultrasound to check my lining. The most stressful part about it was worrying that it wouldn't survive the thaw.
But it did. The lab thawed it yesterday afternoon and it was still growing strong this morning before transfer. Everything went well during the transfer (I forgot how uncomfortable are speculums, but the catheter was smooth and no cramping). I've been resting for the past 6 hours, and while it's hard to ignore "symptoms" I'm going to try and just remain optimistic that this one is the one.
But it did. The lab thawed it yesterday afternoon and it was still growing strong this morning before transfer. Everything went well during the transfer (I forgot how uncomfortable are speculums, but the catheter was smooth and no cramping). I've been resting for the past 6 hours, and while it's hard to ignore "symptoms" I'm going to try and just remain optimistic that this one is the one.
Monday, 29 September 2014
Day 1 again
It's not the day 1 that counts, I'm not starting my frozen transfer cycle this month, but it's planned for next month. For several months now I've looked ahead trying to predict the timing, and now that it's only a month out, the dates are looking a little more reliable. So it's time to start preparing.
I've been reading various sources (not necessarily reliable) to make a plan. I'm going to make some minor dietary changes. The coffee plan is just the start. I've cut back down to 1-2. That's manageable. I'll get it down to only 1 in two weeks, and then maybe just half for a week, and none by the start of the next cycle (estimated 29 days from today).
I'm also going to cut out the sweets. This is my weakness. I love chocolate (who doesn't) and the killer is that chocolate loves me! Fries, chips, pastries, they all go straight to my hips, but chocolate doesn't, I seem to tolerate it very well. Too well. But I know that all that processed and refined sugar is not good for me. So that's it, I'm off sweets. Fruit is nature's candy! So that's two massive changes. And I think that will be enough for this month. Otherwise we eat pretty well, and I'll be more conscientious about the whole grains, the full-fat dairy, and the nuts and seeds (because we have been slipping and buying white pastas, processed convenience foods, and lazily skipping our veggies).
Day 1 - yet another countdown begins. Estimated transfer date Nov 16. I'm starting to get excited!
I've been reading various sources (not necessarily reliable) to make a plan. I'm going to make some minor dietary changes. The coffee plan is just the start. I've cut back down to 1-2. That's manageable. I'll get it down to only 1 in two weeks, and then maybe just half for a week, and none by the start of the next cycle (estimated 29 days from today).
I'm also going to cut out the sweets. This is my weakness. I love chocolate (who doesn't) and the killer is that chocolate loves me! Fries, chips, pastries, they all go straight to my hips, but chocolate doesn't, I seem to tolerate it very well. Too well. But I know that all that processed and refined sugar is not good for me. So that's it, I'm off sweets. Fruit is nature's candy! So that's two massive changes. And I think that will be enough for this month. Otherwise we eat pretty well, and I'll be more conscientious about the whole grains, the full-fat dairy, and the nuts and seeds (because we have been slipping and buying white pastas, processed convenience foods, and lazily skipping our veggies).
Day 1 - yet another countdown begins. Estimated transfer date Nov 16. I'm starting to get excited!
Thursday, 25 September 2014
One of those days
Ever get those days, you know, when it seems everyone is driving you crazy. Your husband's count of "infractions" is up to three (today - that you know), your former assistant didn't keep a certain record you told her to keep so now you have to go redo her work, and you can't find a moment's peace to even get through your emails. One of those days when you just want to hide away somewhere, alone.
Today is one of those days.
I don't know if it hurts or hinders matters that upon realizing that I had six coffees yesterday (really, it was the realization that the large was a triple espresso and counts as three), I've decided that as I'm roughly 5 weeks out from my last chance frozen embryo transfer cycle, perhaps I should prepare to wean again. This is the third time I will give up my precious coffee, but unlike the last two attempts, I won't even replace it with decaf. This morning I had only one cup, but then my blood pressure was a bit low so I'm having a cup of chai tea too since Dr. Google tells me that caffeine withdrawal can lower blood pressure (since the caffeine raises it in the first place). I want to do this gradually, and two cups in the morning is my norm, but all week I've been grabbing that triple espresso while out and about without even thinking about it, and I've been out and about more this week than usual.
So, goodbye coffee, parting will be such sweet sorrow (as I drag it out over the next 5 weeks).
Today is one of those days.
I don't know if it hurts or hinders matters that upon realizing that I had six coffees yesterday (really, it was the realization that the large was a triple espresso and counts as three), I've decided that as I'm roughly 5 weeks out from my last chance frozen embryo transfer cycle, perhaps I should prepare to wean again. This is the third time I will give up my precious coffee, but unlike the last two attempts, I won't even replace it with decaf. This morning I had only one cup, but then my blood pressure was a bit low so I'm having a cup of chai tea too since Dr. Google tells me that caffeine withdrawal can lower blood pressure (since the caffeine raises it in the first place). I want to do this gradually, and two cups in the morning is my norm, but all week I've been grabbing that triple espresso while out and about without even thinking about it, and I've been out and about more this week than usual.
So, goodbye coffee, parting will be such sweet sorrow (as I drag it out over the next 5 weeks).
Monday, 11 August 2014
Egg v embryo donation
Am I being pessimistic? I have one embryo, just one, and I'm planning to transfer it in a few months (the wait is an insurance thing, but I'm ok with it, the embryo isn't getting any older). But I can't stop thinking beyond that one. Like I assume it will fail. Is it the two massive disappointments that makes me feel this way? Is it because I always wanted more? I can't imagine doing a third fresh cycle. The lengths we had to go to for these three embryos just makes me say no more - we can't possibly expect anything better and the drugs alone cost upwards of $6000. I still can't believe I spent and injected that much money in a two week period. So I start considering egg and embryo donation. How did I even get to this point?
Just a year ago, my partner and I were on the same page, we considered it ethically more responsible to give a child who already exists a home rather than use vast medical resources to create new lives in a lab. But for bureaucratic reasons (based on where we live), we aren't eligible to adopt. We were, however, offered "free" IVF due to my diagnosis. This "free" IVF quickly snowballed into "not so free" but more like heavily discounted, and my biggest expense on both cycles was the drugs. Still nothing compared to what my American peers are paying, and I know plenty of couples who can't afford IVF at all, so I shouldn't complain. It was my foot in the door, I never would have considered it if it hadn't been presented as "free". So down the rabbit hole I went. No baby (yet).
If I want to try beyond this frozen embryo, my more realistic options seem to be egg or embryo donation. Egg donation seems to be the more "available" option, but I would prefer embryo donation for the same reason I would prefer adoption - why put someone through another fresh cycle to procure eggs, when there are potentially viable embryos in a cryo bank somewhere that could be adopted. The answer of course is that there are very very few embryos in cryo banks that are "put up for adoption" just as there are very very few infants put up for adoption these days. We destroy. We terminate. Don't get me wrong, I'm pro-choice. If there was a way to transplant a 7 week fetus to a new uterus, I'd be on board, but I imagine there would be a lot of people creeped out or bothered by the idea of someone else raising their child. 30 years ago the culture was different, but today we are very anti-adoption. I'm not sure we will ever go back either. It's a lot to ask a woman to reluctantly carry a baby to term. It's a lot to ask her to give her child to someone else to raise after she's done so. The simple fact is that we have much better supports in place to allow her to raise her child than we did in the past. And that's a good thing. It just leaves a hole in the hearts of couples with fertility challenges. And you would think that couples that have been down that road would be more open to sharing their surplus, if any. However, a recent study of patients from my own clinic showed that there is a high tendency to change intentions for unused embryos over time, particularly towards destruction. It should be noted though, that donation to another couple isn't an option at my clinic, they are hoping more people will donate for stem cell research.
I don't know if we will have the conversation. I don't know if we will schedule an appointment at a new clinic to discuss egg or embryo donation. I don't know what we will do if this frozen transfer fails. All I can do is keep looking at the calendar, waiting for the time to schedule the frozen transfer cycle.
Just a year ago, my partner and I were on the same page, we considered it ethically more responsible to give a child who already exists a home rather than use vast medical resources to create new lives in a lab. But for bureaucratic reasons (based on where we live), we aren't eligible to adopt. We were, however, offered "free" IVF due to my diagnosis. This "free" IVF quickly snowballed into "not so free" but more like heavily discounted, and my biggest expense on both cycles was the drugs. Still nothing compared to what my American peers are paying, and I know plenty of couples who can't afford IVF at all, so I shouldn't complain. It was my foot in the door, I never would have considered it if it hadn't been presented as "free". So down the rabbit hole I went. No baby (yet).
If I want to try beyond this frozen embryo, my more realistic options seem to be egg or embryo donation. Egg donation seems to be the more "available" option, but I would prefer embryo donation for the same reason I would prefer adoption - why put someone through another fresh cycle to procure eggs, when there are potentially viable embryos in a cryo bank somewhere that could be adopted. The answer of course is that there are very very few embryos in cryo banks that are "put up for adoption" just as there are very very few infants put up for adoption these days. We destroy. We terminate. Don't get me wrong, I'm pro-choice. If there was a way to transplant a 7 week fetus to a new uterus, I'd be on board, but I imagine there would be a lot of people creeped out or bothered by the idea of someone else raising their child. 30 years ago the culture was different, but today we are very anti-adoption. I'm not sure we will ever go back either. It's a lot to ask a woman to reluctantly carry a baby to term. It's a lot to ask her to give her child to someone else to raise after she's done so. The simple fact is that we have much better supports in place to allow her to raise her child than we did in the past. And that's a good thing. It just leaves a hole in the hearts of couples with fertility challenges. And you would think that couples that have been down that road would be more open to sharing their surplus, if any. However, a recent study of patients from my own clinic showed that there is a high tendency to change intentions for unused embryos over time, particularly towards destruction. It should be noted though, that donation to another couple isn't an option at my clinic, they are hoping more people will donate for stem cell research.
I don't know if we will have the conversation. I don't know if we will schedule an appointment at a new clinic to discuss egg or embryo donation. I don't know what we will do if this frozen transfer fails. All I can do is keep looking at the calendar, waiting for the time to schedule the frozen transfer cycle.
Monday, 14 July 2014
Top 3 strategies to keep your mind off fertility.
Everyone with fertility challenges, and frankly all women who are beyond the three month mark in trying to get pregnant, knows that there is a lot of hurry-up-and-wait. Whether you are trying naturally (or with assistance) and waiting until you can test, or whether you are waiting for a treatment cycle to begin, you are looking for coping strategies to get you through. Here are my top 3, tried and true, after two years of serious trying:
1. Work. If you can work in an environment with other people around so you don't find yourself drifting over to googling anything fertility, all the better. No one I worked with knew what I was going through, so reading anything pregnancy was off-limits at work. Having my assistant come and work IN MY OFFICE right next to me really kept me focused on actual work. Working at home, by myself, is more challenging and requires a lot of self-discipline. My self-discipline tends to be strong in the morning, but deteriorates in the afternoon. Non-work projects can also be good distractions, but they tend to be short-lived. One lady was shopping for a new car - it only occupied a couple of weeks in researching and then test-driving. Then she had her new car and was back to thinking about the baby she hoped to put in it. I'm shopping for a new car, but it only took me a day to do the research, and every day after that the information online is the same, so it isn't enough distraction for me. But I suppose any project you do with others that prevents you from discussing your fertility challenges will keep your mind off it and help pass the time.
2. Movies. You might be able to lose yourself in a good book, and often times I can too, but I found reading never quieted the voices in my head, the ones that spoke fertility non-stop, as well as movies or television. There were things I couldn't watch - every show this spring seemed to be full of unplanned pregnancies, kudos to Grey's Anatomy for at least balancing that one out with an unrealistically quick diagnosis of sorry, no more babies for you. I watched endless pregnancy shows when I was pregnant, but when you're dealing with infertility you want to get as far away from that as possible, so be careful in your selections and keep the tissues nearby incase you're caught off-guard.
3. Exercise. This works in several ways. First, there is the general stress-relief and mood-enhancing benefits of exercise. Second, my hormone levels were all in a better place after a few months of regular exercise. Third, it gives you a project with a longer-term goal. Fourth, when I'm at the gym I like to watch a video, which is a good mental distraction for me, but if all I have available is my iPod and a run outdoors, the music can clear my mind too. I'm not one to sing while running, but I found singing in the car very beneficial, so if you're confident, go ahead and sing while you work out!
1. Work. If you can work in an environment with other people around so you don't find yourself drifting over to googling anything fertility, all the better. No one I worked with knew what I was going through, so reading anything pregnancy was off-limits at work. Having my assistant come and work IN MY OFFICE right next to me really kept me focused on actual work. Working at home, by myself, is more challenging and requires a lot of self-discipline. My self-discipline tends to be strong in the morning, but deteriorates in the afternoon. Non-work projects can also be good distractions, but they tend to be short-lived. One lady was shopping for a new car - it only occupied a couple of weeks in researching and then test-driving. Then she had her new car and was back to thinking about the baby she hoped to put in it. I'm shopping for a new car, but it only took me a day to do the research, and every day after that the information online is the same, so it isn't enough distraction for me. But I suppose any project you do with others that prevents you from discussing your fertility challenges will keep your mind off it and help pass the time.
2. Movies. You might be able to lose yourself in a good book, and often times I can too, but I found reading never quieted the voices in my head, the ones that spoke fertility non-stop, as well as movies or television. There were things I couldn't watch - every show this spring seemed to be full of unplanned pregnancies, kudos to Grey's Anatomy for at least balancing that one out with an unrealistically quick diagnosis of sorry, no more babies for you. I watched endless pregnancy shows when I was pregnant, but when you're dealing with infertility you want to get as far away from that as possible, so be careful in your selections and keep the tissues nearby incase you're caught off-guard.
3. Exercise. This works in several ways. First, there is the general stress-relief and mood-enhancing benefits of exercise. Second, my hormone levels were all in a better place after a few months of regular exercise. Third, it gives you a project with a longer-term goal. Fourth, when I'm at the gym I like to watch a video, which is a good mental distraction for me, but if all I have available is my iPod and a run outdoors, the music can clear my mind too. I'm not one to sing while running, but I found singing in the car very beneficial, so if you're confident, go ahead and sing while you work out!
Sunday, 13 July 2014
How to keep your sanity during fertility treatment
The chaos of moving house kept me pretty distracted these past couple of months, but then out of the blue, I'll just have a very bad day.
In the more than two years now of actively trying to conceive, waiting, diagnostic testing, more waiting, treatments, and more waiting, I know how trying and stressful this process is. I know that when you are in a cycle, or approaching a cycle, time seems to stand still.
But I can also promise you that distraction makes the down time, the long waits, pass - with less agony.
Yes, every celebrity baby post will eat away at your heart, and real friends with real babies will hurt even more, but it gets easier. I'm now enough cycles out from my last failed transfer to stop counting, and didn't even visit my fertility board for two or three weeks. Yes, I'm out of touch with how my ladies are doing, but I've also kept my mind occupied with other things and poof, time flies! It felt like forever when I made the decision to wait six months to try my frozen transfer, but now I'm half-way there! I have reached out to a new clinic, making inquiries about shipping my embryo, and I could drive myself nuts waiting for a reply, and waiting for an appointment, while checking expedia for airfares back to my old clinic and guestimating how long I would have to stay, and then start stressing about the physical stress of travel... it's a vicious cycle you see. So instead, I am better off keeping my mind busy with work (now that I work at home though, much more opportunity for mind-wandering) or online browsing for new dining chairs. Or figuring out how to reset the clock on my oven...
The hardest part about the move was giving away baby things. Each time was like ripping off a band-aid and often involved tears. Giving to someone in need made it easier - at least I knew it was going to get used. Some things were sold. Some things were put out at the curb but never by me as that is not something I could do. Somethings were smuggled aside, sorted later in private, and a few things even smuggled into my suitcase and into the back of the closet with the "out of season" clothes so my partner doesn't know I kept them. The brusk efficient manner of the movers made me think some days I could have smuggled a little more, a few more baby clothes or maternity clothes, but it's done, it's gone - a basement full of things for baby number two, never to be used again by me anyway. And it made me very sad at the time, but I try not to think about it. Back to new dining chairs and resetting the oven clock. Before I know it, I'll be popping estrace pills in preparation for my frozen transfer.
In the more than two years now of actively trying to conceive, waiting, diagnostic testing, more waiting, treatments, and more waiting, I know how trying and stressful this process is. I know that when you are in a cycle, or approaching a cycle, time seems to stand still.
But I can also promise you that distraction makes the down time, the long waits, pass - with less agony.
Yes, every celebrity baby post will eat away at your heart, and real friends with real babies will hurt even more, but it gets easier. I'm now enough cycles out from my last failed transfer to stop counting, and didn't even visit my fertility board for two or three weeks. Yes, I'm out of touch with how my ladies are doing, but I've also kept my mind occupied with other things and poof, time flies! It felt like forever when I made the decision to wait six months to try my frozen transfer, but now I'm half-way there! I have reached out to a new clinic, making inquiries about shipping my embryo, and I could drive myself nuts waiting for a reply, and waiting for an appointment, while checking expedia for airfares back to my old clinic and guestimating how long I would have to stay, and then start stressing about the physical stress of travel... it's a vicious cycle you see. So instead, I am better off keeping my mind busy with work (now that I work at home though, much more opportunity for mind-wandering) or online browsing for new dining chairs. Or figuring out how to reset the clock on my oven...
The hardest part about the move was giving away baby things. Each time was like ripping off a band-aid and often involved tears. Giving to someone in need made it easier - at least I knew it was going to get used. Some things were sold. Some things were put out at the curb but never by me as that is not something I could do. Somethings were smuggled aside, sorted later in private, and a few things even smuggled into my suitcase and into the back of the closet with the "out of season" clothes so my partner doesn't know I kept them. The brusk efficient manner of the movers made me think some days I could have smuggled a little more, a few more baby clothes or maternity clothes, but it's done, it's gone - a basement full of things for baby number two, never to be used again by me anyway. And it made me very sad at the time, but I try not to think about it. Back to new dining chairs and resetting the oven clock. Before I know it, I'll be popping estrace pills in preparation for my frozen transfer.
Wednesday, 18 June 2014
On ovulation spotting...
I haven't posted in a while because it's "break time" but something strange happened, and I felt the need to get an answer and share what I learned...
For the second month in a row I had "ovulation spotting" - mid-cycle bleeding to some of you. In the general sequence of cycle events, it was exactly the same both months, but after two years of steady charting, it came as a surprise. I know about the prevailing theory circulating online that it comes from the actual follicle rupture - but that theory just wasn't working for me because of the timing and because of my gummed up tubes. How would such a tiny amount of blood manage to get out through my cervix if larger quantities of fluids under pressure can't get in or out (sperm, imaging fluid from diagnostic tests, the much larger amount of blood that was found in my abdomen when my cyst ruptured two years ago). So I turned to my friend Pubmed and, eventually, found my answer:
259 women contributed data from 470 cycles to this study of menstrual bleeding patterns, and very few experienced mid-cycle bleeding. It was actually only 12 women, and for 11 of them it only happened on one of the two cycles recorded. So the chance of it happening twice in a row is roughly 0.4%. Lucky me, but still way more likely than winning the lotto.
They also took regular hormone levels from the women, and compared the hormone profiles of the spotters and non-spotters. I love numbers, so this was like candy to me, and I know it's hard to make a good prediction on the basis of only 12 women. But the data suggests that mid-cycle bleeding, what we call "ovulation spotting", coincides with higher estradiol levels, higher lutenizing hormone spikes, and higher progesterone levels. They aren't big differences though, and looking at the levels, it's nothing compared to the levels reached during ovarian hyper stimulation (40x higher). Just a subtle increase. But it also supports the lesser discussed theory I found during my googling, that it's a bit of leakage from a slightly enhanced uterine lining when the cervix opens up in the days leading up to ovulation. Some have taken this to mean "stronger ovulation" - I'm not sure that is completely accurate, or at the very least meaningful. Heightened estradiol may or may not reflect egg quality, and I don't know that a higher lutenizing hormone spike makes a difference, it's a threshold thing, and the increased progesterone doesn't look high enough to suggest multiple follicles or anything helpful.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299419
Unfortunately I can't link directly to the figures, but click on the link, go to figure 3, and you'll see.
So that basically brings me back where so many websites started me off - it happens, but it may not mean anything when and if it does. But it's nice to know.
Happy ovulating ladies!
For the second month in a row I had "ovulation spotting" - mid-cycle bleeding to some of you. In the general sequence of cycle events, it was exactly the same both months, but after two years of steady charting, it came as a surprise. I know about the prevailing theory circulating online that it comes from the actual follicle rupture - but that theory just wasn't working for me because of the timing and because of my gummed up tubes. How would such a tiny amount of blood manage to get out through my cervix if larger quantities of fluids under pressure can't get in or out (sperm, imaging fluid from diagnostic tests, the much larger amount of blood that was found in my abdomen when my cyst ruptured two years ago). So I turned to my friend Pubmed and, eventually, found my answer:
259 women contributed data from 470 cycles to this study of menstrual bleeding patterns, and very few experienced mid-cycle bleeding. It was actually only 12 women, and for 11 of them it only happened on one of the two cycles recorded. So the chance of it happening twice in a row is roughly 0.4%. Lucky me, but still way more likely than winning the lotto.
They also took regular hormone levels from the women, and compared the hormone profiles of the spotters and non-spotters. I love numbers, so this was like candy to me, and I know it's hard to make a good prediction on the basis of only 12 women. But the data suggests that mid-cycle bleeding, what we call "ovulation spotting", coincides with higher estradiol levels, higher lutenizing hormone spikes, and higher progesterone levels. They aren't big differences though, and looking at the levels, it's nothing compared to the levels reached during ovarian hyper stimulation (40x higher). Just a subtle increase. But it also supports the lesser discussed theory I found during my googling, that it's a bit of leakage from a slightly enhanced uterine lining when the cervix opens up in the days leading up to ovulation. Some have taken this to mean "stronger ovulation" - I'm not sure that is completely accurate, or at the very least meaningful. Heightened estradiol may or may not reflect egg quality, and I don't know that a higher lutenizing hormone spike makes a difference, it's a threshold thing, and the increased progesterone doesn't look high enough to suggest multiple follicles or anything helpful.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299419
Unfortunately I can't link directly to the figures, but click on the link, go to figure 3, and you'll see.
So that basically brings me back where so many websites started me off - it happens, but it may not mean anything when and if it does. But it's nice to know.
Happy ovulating ladies!
Friday, 25 April 2014
When everything comes crumbling down...
If you've read my blog you know that entering into the IVF world wasn't easy. So having it fail not once, but twice now... let's just say devastation is an understatement. After the first failed cycle, I cried for a while and then focused my energy on whether there was any hope of a second cycle being more successful (there is always hope for a second cycle). I obsessed about it while I waited for our follow-up appointment, and my doctor confirmed my worst fear but at least she had a plan. And that plan was effective, just not enough. But I do have one lonely blastocyst, and I'm not rushing into transferring it. In fact I'm terrified that it will fail too. It's my last shot, but worse than that, is the knowledge that it really is the very last one, that there will not be any siblings even if it does work, GAME OVER.
So now I cry a lot. And get angry and bitter. And cry some more. I can't watch television - every damn show has babies or pregnancies or actresses that either look like they're concealing a pregnancy or maybe it's all in my head... I can't go on any social media either, it's the same thing, babies everywhere. Friends. Celebrities. Women I know are older than I am. This started as "just" blocked tubes and I thought easy-peasy. But no, egg quality issues too, I'm past my best-before-date, and we've tried all we can to get a viable embryo. On average, a 40 year old has 1 good egg for every 10. I've retrieved 27 eggs in total now, and only three made it to blastocyst stage, and two have already failed. 1 in 27 is pretty shit odds. I might as well be 40!
So yes, I'm angry and bitter and hate everyone with their effortless pregnancies. I also feel so powerless. So lost. So sad. The why not me thoughts just lead back to anger again. And more tears. And running out of tissues. And runny nose - where is the GD kleenex!
It has been nearly two weeks. Two weeks that I could only cry about it, I couldn't even write about it. I still don't know what to say about it. What to do with all these emotions, all this anger and sadness. I try to find ways to pass the time, but it confronts me all the time. And I want to scream. Two weeks ago, while I was actively bleeding and fearing the worst, I was also getting the annoying questions from family about if we will have another baby, and oh, I thought you wanted more, blah blah go fuck yourself... all I could say was that sometimes it doesn't work out that way. I wanted to say more. I wanted to say the first one broke me, caused permanent scarring, and we've exhausted our treatment options. I want to tell the world, but I can't. Because all I can do is cry. For five years I've wanted to have another baby. For two years I've thrown everything at it, and failed. FAILED. It isn't the first time I've encountered a challenge that no matter what I do, I just can't achieve my goal. And it hurts. It hurts to put so much effort into anything and fail. It hurts even more to see others achieve your goal effortlessly. And there is nothing you can do about it.
So now I cry a lot. And get angry and bitter. And cry some more. I can't watch television - every damn show has babies or pregnancies or actresses that either look like they're concealing a pregnancy or maybe it's all in my head... I can't go on any social media either, it's the same thing, babies everywhere. Friends. Celebrities. Women I know are older than I am. This started as "just" blocked tubes and I thought easy-peasy. But no, egg quality issues too, I'm past my best-before-date, and we've tried all we can to get a viable embryo. On average, a 40 year old has 1 good egg for every 10. I've retrieved 27 eggs in total now, and only three made it to blastocyst stage, and two have already failed. 1 in 27 is pretty shit odds. I might as well be 40!
So yes, I'm angry and bitter and hate everyone with their effortless pregnancies. I also feel so powerless. So lost. So sad. The why not me thoughts just lead back to anger again. And more tears. And running out of tissues. And runny nose - where is the GD kleenex!
It has been nearly two weeks. Two weeks that I could only cry about it, I couldn't even write about it. I still don't know what to say about it. What to do with all these emotions, all this anger and sadness. I try to find ways to pass the time, but it confronts me all the time. And I want to scream. Two weeks ago, while I was actively bleeding and fearing the worst, I was also getting the annoying questions from family about if we will have another baby, and oh, I thought you wanted more, blah blah go fuck yourself... all I could say was that sometimes it doesn't work out that way. I wanted to say more. I wanted to say the first one broke me, caused permanent scarring, and we've exhausted our treatment options. I want to tell the world, but I can't. Because all I can do is cry. For five years I've wanted to have another baby. For two years I've thrown everything at it, and failed. FAILED. It isn't the first time I've encountered a challenge that no matter what I do, I just can't achieve my goal. And it hurts. It hurts to put so much effort into anything and fail. It hurts even more to see others achieve your goal effortlessly. And there is nothing you can do about it.
Monday, 7 April 2014
A day by day guide to IVF - After retrieval
Before retrieval, you started to slow down, you felt heavier and more bloated and you just wanted to sit. Tip - pregnancy will be much the same, times 10.
After retrieval ladies feel various things. Some were overstimulated and are really swollen and watching for OHSS. I felt pretty good, although taking it easy, resting, but not bed-rest, were in order for the first 24 hours. Then it slowly started to improve.
Day 2 - feeling better, but taking it easy. I spent most of the day with my feet up, but got up and moved around about every hour. Drinking water and gatorade constantly and then having to pee all the time helps with that.
Day 3 - felt even better, but should have taken it easy. I spent a little too much time on my feet, so I was extra tired and a little sore, but nothing a good rest and tylenol couldn't fix.
Day 4 - feeling almost back to normal, with one exception - accidental twisting. this is the point at which I have to be careful when sitting up, rolling over, or accidentally reaching across my body for something. I don't know exactly what's going on inside, but it feels like the swelling went down leaving my ovaries unsupported all of a sudden. So no sudden moves. I have to remember that... Also, progesterone is really kicking in, and symptoms are fatigue and boobs feel bigger (but not sore). Luckily my embryos are still safely tucked in the lab, so I have no illusions of "pregnancy symptoms"
Day 5 - transfer day is an exciting day, and since the news was good this time, it was psychologically a feel very good day. Physically, it's still a "no sudden moves" and progesterone-fuelled (which is a misnomer, because what I lack is fuel) day. I can barely stay awake long enough to take my 10pm dose.
Day 6 - 8 - more of the same. On the bright side, if you can call it that, my daily test strips are stark white now, so now I just have to keep peeing until the strip turns pink again. All the cramping is on both ovaries, no where else. Despite not watching what I eat for the past week (and on activity restrictions), my weight is remarkably stable.
Day 9 - Woke up at 5am for unknown reasons, and was ready for a nap at noon. This was a problem as I had a lot of work to do, all of which involved sitting quietly, reading, and writing. Not the best day. On top of the extreme fatigue I had a heavy feeling in my uterus, and my first ever charley horse!
Day 10 - Also woke up at 5am, but managed to fall back asleep so the day wasn't as bad as yesterday. Heavy feeling, cramps continue. I'm pretty sure that on my first (failed) cycle that I was feeling "better" by now, not worse, so this fills me with optimism.
Day 11 - Woke up at 4am! Headache since 10pm last night. Tried to nap at 11am, but no luck.
Day 12 - Feeling like my ovaries have healed. Pretty sure I felt this way on day 9 during the first cycle, so that's my estimate 9+ days for ovaries to heal. Obviously it will depend on how stimulated you were (I retrieved 13 and 14 on my two cycles), and if the cycle is successful, the hcg from pregnancy will complicate matters.
Day 13 - 14 - Despite progesterone, I always start bleeding. I asked my nurse about it - it doesn't mean it isn't working, some women's bodies don't need the progesterone drop to begin. As if progesterone suppositories weren't gross enough... My clinic schedules a blood pregnancy test on day 18, but I always call when I start bleeding to put myself out of my misery (ok, so it is misery either way, but at least I can stop the progesterone). A home pregnancy test is likely to be accurate by this point, but my my estimates as many as 10% will still be false negatives - keep hope alive, ladies!
After retrieval ladies feel various things. Some were overstimulated and are really swollen and watching for OHSS. I felt pretty good, although taking it easy, resting, but not bed-rest, were in order for the first 24 hours. Then it slowly started to improve.
Day 2 - feeling better, but taking it easy. I spent most of the day with my feet up, but got up and moved around about every hour. Drinking water and gatorade constantly and then having to pee all the time helps with that.
Day 3 - felt even better, but should have taken it easy. I spent a little too much time on my feet, so I was extra tired and a little sore, but nothing a good rest and tylenol couldn't fix.
Day 4 - feeling almost back to normal, with one exception - accidental twisting. this is the point at which I have to be careful when sitting up, rolling over, or accidentally reaching across my body for something. I don't know exactly what's going on inside, but it feels like the swelling went down leaving my ovaries unsupported all of a sudden. So no sudden moves. I have to remember that... Also, progesterone is really kicking in, and symptoms are fatigue and boobs feel bigger (but not sore). Luckily my embryos are still safely tucked in the lab, so I have no illusions of "pregnancy symptoms"
Day 5 - transfer day is an exciting day, and since the news was good this time, it was psychologically a feel very good day. Physically, it's still a "no sudden moves" and progesterone-fuelled (which is a misnomer, because what I lack is fuel) day. I can barely stay awake long enough to take my 10pm dose.
Day 6 - 8 - more of the same. On the bright side, if you can call it that, my daily test strips are stark white now, so now I just have to keep peeing until the strip turns pink again. All the cramping is on both ovaries, no where else. Despite not watching what I eat for the past week (and on activity restrictions), my weight is remarkably stable.
Day 9 - Woke up at 5am for unknown reasons, and was ready for a nap at noon. This was a problem as I had a lot of work to do, all of which involved sitting quietly, reading, and writing. Not the best day. On top of the extreme fatigue I had a heavy feeling in my uterus, and my first ever charley horse!
Day 10 - Also woke up at 5am, but managed to fall back asleep so the day wasn't as bad as yesterday. Heavy feeling, cramps continue. I'm pretty sure that on my first (failed) cycle that I was feeling "better" by now, not worse, so this fills me with optimism.
Day 11 - Woke up at 4am! Headache since 10pm last night. Tried to nap at 11am, but no luck.
Day 12 - Feeling like my ovaries have healed. Pretty sure I felt this way on day 9 during the first cycle, so that's my estimate 9+ days for ovaries to heal. Obviously it will depend on how stimulated you were (I retrieved 13 and 14 on my two cycles), and if the cycle is successful, the hcg from pregnancy will complicate matters.
Day 13 - 14 - Despite progesterone, I always start bleeding. I asked my nurse about it - it doesn't mean it isn't working, some women's bodies don't need the progesterone drop to begin. As if progesterone suppositories weren't gross enough... My clinic schedules a blood pregnancy test on day 18, but I always call when I start bleeding to put myself out of my misery (ok, so it is misery either way, but at least I can stop the progesterone). A home pregnancy test is likely to be accurate by this point, but my my estimates as many as 10% will still be false negatives - keep hope alive, ladies!
Thursday, 3 April 2014
Introducing, the twins!
Introducing, my two blastocysts! Transferred today to my happy warm sticky uterus! I'm calling the smaller but slightly more advanced blast (on the right) Amelia, and the larger, earlier blast on the left Linus. Why did I decide one is a boy and one is a girl? I'm not sure, I guess because they are slightly different sizes. And if I do end up giving birth to boy-girl twins, there is no way of knowing of course which is which, but since girls are slightly ahead in all aspects of development (it's true), if they are one boy one girl, I think the ever-so-slightly-more-advanced one is a girl.
So it's a very good day in my world! If some of the others that were bringing up the rear make it too, and can be frozen, even better, but I am happy with this result! Time for daily visualization exercises. Next step for them will be hatching (great video here), then burrowing in (great illustrations here), and a great timeline to help me maintain sanity here.
And I guess that's all there is to say. My husband was a little freaked out and didn't want to see the picture, but some day I will insist on putting this in the front page of the baby book, ahead of baby's first ultrasound picture!
*update - another unsuccessful transfer, neither one was strong enough. Insert tears here.
Monday, 31 March 2014
A day by day guide to IVF - Pre-retrieval.
A lady asked for a breakdown on a message board, so I thought I'd post my response here as well. The bottom line is that every IVF cycle is different - clinic to clinic, woman to woman, and cycle to cycle. Here is the general schedule of events, based on my two IVF rounds:
Once you have the green light from your clinic (which involved endless testing, some quite invasive and uncomfortable, and may have taken months), then you wait for a new cycle to begin. This is the down regulation part of the cycle, and involves roughly 3 weeks of birth control pills. There is a fair bit of flexibility in this portion, but mine always started with blood tests and ultrasound on day 3, and starting pills that night. On the 18th day of taking pills, I had another ultrasound to make sure the pills were doing their job of "quiet ovaries and thin lining", which they were, so then with some flexibility the decision is made as to when to stop the pills. There is some unpredictability as to when bleeding will occur after stopping pills, so I was more involved in my second cycle planning dates with my clinic, based entirely on my first cycle. Symptoms of pills are much more pronounced when you just take it one cycle after 10 years off, and they suck. For me, it's headaches & irritability. No wonder I didn't have any long-term relationships when I was young and on the pill, makes me wonder why I was on it in the first place ;)
Cycle 2, again, on day 3 go for blood tests and ultrasound. this day 3, coming off the pill, I was not as actively bleeding when I went for my ultrasound, which is pretty awkward for me but old hat to them. It's not something you think about until you're standing in the change room, sheet wrapped around you like a skirt, hoping you don't start bleeding down your leg while you wait for them to call you in. Oh, and internal ultrasounds (aka vaginal ultrasounds) are sometimes uncomfortable, sometimes not, and you get used to them. I've had days when I was quite tender and it's very uncomfortable, but other days when it was fine. During my first cycle I got more tender as the days went on. During my second cycle I was tender on the left only two occasions early on, but then it got better. On the basis of this day's "monitoring", the decision is usually made to start injections. This day 3 now becomes day 1 of injections.
You're left alone to inject yourself daily until day 5 (of injections), when you return for monitoring. At this point, estradiol is starting to get pretty high so this is when I start leaking extreme amounts of cervical fluid. This is also the day when, depending on monitoring results, a GnRH antagonist is added to the injection routine, to prevent the high estradiol from prompting a lutenizing hormone surge. It was at this point in my second round that we discovered I was responding a bit slower than the first time, so I knew my perfectly planned schedule was in jeopardy. I was a day behind at this point.
Day 8 (of injections), more monitoring. After this point, it really could go day by day. This is also when my boobs became really sore. On my first round, growth was progressing nicely and they had me back on day 10, when I was instructed to take a partial dose of injections at my usual time, my trigger injection at a specific later time, and given the appointment time for my retrieval. On my second round, I was back on day 10, 12, and finally on day 13 they said I was ready to go. My schedule wasn't completely shot, in fact it worked out pretty well for the most part.
My clinic requires you to take 7-10 days off work after retrieval, and 14 days restricted activity, so put your feet up and relax!
Once you have the green light from your clinic (which involved endless testing, some quite invasive and uncomfortable, and may have taken months), then you wait for a new cycle to begin. This is the down regulation part of the cycle, and involves roughly 3 weeks of birth control pills. There is a fair bit of flexibility in this portion, but mine always started with blood tests and ultrasound on day 3, and starting pills that night. On the 18th day of taking pills, I had another ultrasound to make sure the pills were doing their job of "quiet ovaries and thin lining", which they were, so then with some flexibility the decision is made as to when to stop the pills. There is some unpredictability as to when bleeding will occur after stopping pills, so I was more involved in my second cycle planning dates with my clinic, based entirely on my first cycle. Symptoms of pills are much more pronounced when you just take it one cycle after 10 years off, and they suck. For me, it's headaches & irritability. No wonder I didn't have any long-term relationships when I was young and on the pill, makes me wonder why I was on it in the first place ;)
Cycle 2, again, on day 3 go for blood tests and ultrasound. this day 3, coming off the pill, I was not as actively bleeding when I went for my ultrasound, which is pretty awkward for me but old hat to them. It's not something you think about until you're standing in the change room, sheet wrapped around you like a skirt, hoping you don't start bleeding down your leg while you wait for them to call you in. Oh, and internal ultrasounds (aka vaginal ultrasounds) are sometimes uncomfortable, sometimes not, and you get used to them. I've had days when I was quite tender and it's very uncomfortable, but other days when it was fine. During my first cycle I got more tender as the days went on. During my second cycle I was tender on the left only two occasions early on, but then it got better. On the basis of this day's "monitoring", the decision is usually made to start injections. This day 3 now becomes day 1 of injections.
You're left alone to inject yourself daily until day 5 (of injections), when you return for monitoring. At this point, estradiol is starting to get pretty high so this is when I start leaking extreme amounts of cervical fluid. This is also the day when, depending on monitoring results, a GnRH antagonist is added to the injection routine, to prevent the high estradiol from prompting a lutenizing hormone surge. It was at this point in my second round that we discovered I was responding a bit slower than the first time, so I knew my perfectly planned schedule was in jeopardy. I was a day behind at this point.
Day 8 (of injections), more monitoring. After this point, it really could go day by day. This is also when my boobs became really sore. On my first round, growth was progressing nicely and they had me back on day 10, when I was instructed to take a partial dose of injections at my usual time, my trigger injection at a specific later time, and given the appointment time for my retrieval. On my second round, I was back on day 10, 12, and finally on day 13 they said I was ready to go. My schedule wasn't completely shot, in fact it worked out pretty well for the most part.
My clinic requires you to take 7-10 days off work after retrieval, and 14 days restricted activity, so put your feet up and relax!
Sunday, 16 March 2014
One month decaf
Nine more days of injections
Three more uncomfortable ovary scans
Three more days of injections until I see the progress!
Antral follicle count: 13
The kit - three injections. The dial-a-dose pens are great! Mixing Menopur, not so much fun but easy when you get the hang of it. No one should have to get the hang of it.
Monday, 10 March 2014
Caffeine free me
I've been caffeine free for a few weeks now. By which I mean I switched to decaf. The most caffeine I ingest comes from an occasional green tea, a rare afternoon pick-me-up (not often enough). So it should not come as a surprise, that when I made chocolate peanut butter cookies yesterday, and ate a few extra chocolate chips left in the bowl, I had a really hard time falling asleep. It's funny how the body adjusts. The bigger pick-me-up comes from the gym. I'm loving my cardio workouts, and they are loving me. I finally hit my long aspired target weight (only to eat the cookies), and so now that I've officially had the last birth control pill before my IVF cycle, which starts in FIVE DAYS, no more scales, it's just about feeling good, stress relief, and eating well.
And with that, I'm off to the gym to spend 30 minutes on my favourite elliptical, followed by some arms.
And with that, I'm off to the gym to spend 30 minutes on my favourite elliptical, followed by some arms.
Wednesday, 5 March 2014
Dear Visa
Dear Visa,
Yes I did just spend $6K at the hospital. I know this is unusual activity on my card. Thanks for giving me that gold card all those years ago, it really came in handy today.
Sincerely,
Loyal customer with a very valuable fridge.
Yes I did just spend $6K at the hospital. I know this is unusual activity on my card. Thanks for giving me that gold card all those years ago, it really came in handy today.
Sincerely,
Loyal customer with a very valuable fridge.
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