Wednesday, 30 April 2008

In which Ms Heathen feels sorry for herself (it may well be the meno.pur talking)

I am now on Day 4 of the meno.pur injections, Mr H is still in Rome, and the cat is ill.

I started the nafa.relin nasal spray on Saturday, and the meno.pur injections on Sunday. Because I am taking such a high dose of the meno.pur, the nurse at the Great Big Infertility Clinic recommended that I do two separate injections - each with three vials of powder diluted in one ampoule of solvent. If I did a single injection containing all six vials of powder, I ran the risk of boils at the injection site, she explained. Superstitiously, I aim one injection in the general direction of each ovary. The increased dose does seem to be bringing with it increased side effects - nausea, an angry rash at the injection site, and tenderness in my abdomen (not ovulation pain, more a feeling of soreness), but only time will tell if it also results in more follicles.

Mr H phoned yesterday afternoon to say that the new firm was asking him to commit for a minimum of three years. How did I feel about that? I explained once again that I was concerned about how it would affect our relationship, particularly our plans for a family. He said that he would talk things over again with his new boss. When he rang back again, he said that he had told his boss that we were currently undergoing fertility treatment, and that we were very much hoping to have a baby. His boss had reassured him that family was the most important thing, and that, providing he gave them notice, his schedule could be adjusted to fit around treatments.

As several of you said in your comments, a potential move down south may well bring new opportunities. I've felt for some time that, once I've submitted my thesis, I would like to make a clean break from the Shit Hot Critical Theory Department. The Shit Hot Critical Theory Department seems to be full of recently qualified PhDs, who hang around like dogs at dinner time fighting over any scraps of teaching that are handed out, hoping against hope that they will be offered a permanent contract. The longer they stay, the more bitter they become. I'd far rather submit, and move on to somewhere where I may be seen as an academic in my own right, rather than 'Professor So-and-So's student'. A move down south would take me closer not only to a number of other universities, but also to the major museums and galleries, which would open up a whole range of new career opportunities. As shinejil says, it would also mean that I could look for a more responsive clinic. I also quite liked Luna's suggestion that I could possibly accompany Mr H on some of his trips so that we can keep trying naturally - but knowing my luck, I wouldn't get to go to Paris or Rome, but would probably end up trying to plan a romantic tryst in a Travel Lodge somewhere near Milton Keynes!

The decision has now been made, for better or worse: we talked it through again yesterday afternoon, and came to the conclusion that Mr H should take the job. He has now signed the contract, and is flying home later this afternoon.

Amongst everything else, the cat is ill. She seems to be spending an inordinate amount of time in her litter box, but doesn't appear to be peeing. I'm assuming that she may have a urinary infection, and so have booked an appointment at the vet's later on today. She is currently asleep in a small patch of sun at the end of the bed, unaware of the trauma that awaits!

Monday, 28 April 2008

The times they are a-changin

Mr H and I both work from home. Every morning, he goes off to the dining room to do his mysterious job in IT, while I retreat to my study, where I pretend to write my PhD. We break for lunch at around 1pm, and occasionally knock off early to go to the gym.

Today, however, I am Home Alone. Mr H is in Rome (once again, I seem to have drawn the short straw). He has been head hunted, and so has been flown out to Italy to meet his new boss and to finalise the details of his contract of employment. This new job is a fantastic career opportunity for him; it is with a small and progressive company, and offers both more responsibility and more money.

The downside? He will be required to travel extensively throughout Europe and the Middle East. He will be away on business for an average of 17 days out of every month. Although we have agreed not to make any decisions in this respect until after I have submitted my PhD, in the longer term, it may well make sense for us to relocate down south - the company's HQ is situated on the outskirts of London, and the chances are that a fair proportion of their UK work will be in the capital. It would also make things easier if we were within commuting distance of an international airport. Proximity to Heathrow also, however, means proximity to his mother and to his endlessly and effortlessly reproducing friends.

Although it is undoubtedly a great opportunity for him, I am also worried about the effect that all of this will have on our relationship. We are in many ways quite a self-contained couple; even before infertility led us to retreat in on ourselves, we preferred time spent together to endless hours socialising with other people. I'm not sure how either of us will cope with spending a lot of time apart - on the one hand, it may encourage us to make the most of what time we do have together; on the other hand, we may end up leading increasingly separate lives.

My major concern, however, is how it will effect our plans to have a child. Having conceived 'spontaneously' before, I still hang on to the hope - however remote - that I may do so again. Our odds will be considerably reduced if Mr H is going to be away much on business much of the time. How will we manage even to fit in another cycle of IVF around his work schedule?

More to the point, what will happen if we do have a baby? I will effectively be a single parent for much of the time. When I'm struggling to cope with little sleep and a crying baby, will I wind up resenting him? Will he feel that he's missing out? Will I unconsciously shut him out?

We have talked and talked about this, and both of us feel that he should take this job - it really is too good an opportunity to turn down. Our relationship is - we hope - strong enough to survive. I am trying to look on the bright side - when he is away, I can have time for all my little projects around the house and garden. I may well sign up for an evening class - I quite fancy learning to sew. Plus, of course, there is the small matter of the PhD - perhaps it will encourage me to knuckle down and get the last chapter finished.

Infertility makes it extraordinarily difficult to make other plans. I feel like we've been living in limbo for the past five years. We've talked about moving house on several occasions, but have always decided that it wasn't the right time. There is, after all, not much point in buying a much bigger house if it's just going to be the two of us. Now, however, Mr H's new job is making some of these decisions for us. I can only hope that some other pieces of the jigsaw also begin to fall into place.

Thursday, 24 April 2008

A small scratch?

The Great Big Infertility Clinic requires all couples to have an HIV & hepatitis test before starting a cycle of treatment. After our unfruitful meeting with Dr Knows Best on Monday, we duly trooped off for our blood tests.

I drew the short straw, and got the evil, stabby nurse, who took two attempts to find a vein. By Tuesday morning, I had a huge bruise on my left arm. If you factor in the additional bruise I have on my right wrist after one of the students hit a nerve in yesterday's acupuncture session, I look like I've already been through the IVF mill - and all this before I even draw up a syringe of Menopur!

Mr H, on the other hand, got Nurse Small Scratch. There is not a mark on him.

While I don't want to wish unnecessary pain and suffering on my husband, this does strike me as somewhat unfair!

Monday, 21 April 2008

Doctor Knows Best

Now here's a sentence I thought I'd never write: I miss Dr Abrupt. His secretary called on Friday afternoon: Dr Abrupt is away at a conference all this week, but he had asked her to telephone me to let me know that he had received the results of my Day 3 bloodwork, and that everything looked fine. He had passed my file over to his colleague Dr Knows Best, who would be seeing us for our Day 21 appointment.

This morning, we got up bright and early for our appointment at the Great Big Infertility Clinic. After waiting over half an hour, eventually we were called in to see Dr Knows Best. I renewed my acquaintance with the dildo cam, which revealed that I had ovulated from my right ovary this month (so still no confirmation that my left ovary is in fact functioning as it should). After some prompting on my behalf, Dr Knows Best volunteered the information that I had 9 follicles on my right ovary, and 5 on my left ovary. I said I thought that, given my anxieties about diminished ovarian reserve, this was a good sign. 'Not necessarily,' said Dr Knows Best. 'It doesn't matter how many follicles you have, if they don't respond to stimulation.'

After I'd put my knickers back on, we then sat down to discuss my protocol.

Dr Knows Best explained that I would start taking the nafarelin nasal spray on the first day of my next period. The dose would be 3 sniffs per day. At this point I interrupted. Did that mean I was doing a regular dose, rather than a micro dose, flare? 'You've obviously been spending too much time on the internet,' replied Dr Knows Best. 'Why don't you let me worry about what protocol we're doing? All you really need to know is what dose of drugs to take, and when to take it.'

He proceeded on with his explanation. I would start the Menopur injections on day 2 of my period, and would come in for a scan eight days later. I explained that, given my poor response last time round, I didn't feel terribly comfortable about being left to stim for eight days; I would prefer to be more closely monitored on this cycle. Dr Knows Best informed me that the Great Big Infertility Clinic no longer performed scans earlier in the stimulation phase; they did not feel that they were of any use in monitoring patients' response (they also don't appear to check E2 levels either). I was on the maximum dose of Menopur, and after eight days they would know whether I had responded or not. If I hadn't responded, then there really was very little more they could do for me. He then smiled, and asked us whether we had any further questions.

Why are you such a pompous and patronising ass? What the fuck are we doing here? Instead, I asked him about my day 3 bloodwork. What were my FSH levels this time round? 'I really don't think it would be helpful for you to know these,' he replied. I disagreed. I said I thought that knowing as much as I could about my treatment was very helpful. Grudgingly, he told me that my FSH was 6.

On the way home in the car, we decided that this is very probably the last cycle of treatment we will undergo at the Great Big Fertility Clinic. Neither of us can escape the feeling that we are paying vast amounts of money for what seems to be very cursory treatment. I have no sense that I have been given a protocol that has been tailored to my individual needs; instead Drs Abrupt & Knows Best appear to be trying a series of default options. Possibly my feelings about them both may change if I get a positive result from this cycle - it's just, at the moment, that feels a fairly remote possibility.

Tuesday, 15 April 2008

Displacement activity

It is a truth universally acknowledged, that a woman about to undergo a cycle of fertility treatment, must be in want of distraction.

Over the weekend, I attended a 'learn to knit' workshop. I can now cast on, knit, purl, cast off and read a simple pattern. Armed with this new knowledge, I plan to make a scarf. Secretly, I imagine myself as Madame Defarge from Charles Dickens's French Revolutionary novel A Tale of Two Cities. Madame Defarge was one of those strong, revolutionary women who so fascinated and appalled nineteenth-century commentators such as Dickens. She incorporates into her knitting the names of those whom she considers to be enemies of the revolution, but as I click slowly away with my needles, I think of all those who have offered me their unsolicited assvice on the topic of my infertility - were I to include all of their names in my knitting, it would be a very long scarf!

Mr H is claiming a sudden allergy to anything made out of wool (my new-found hobby has uncovered some hitherto repressed memories of being forced as a child to wear a succession of misshapen, stratchy tank tops knitted for him by his grandmother). He is, however, currently re-reading the final Harry Potter novel, and so has taken to appropriating my knitting needles to use in the manner of a wand. 'Pregnum!' he exclaimed optimistically after dinner last night, pointing his makeshift wand in the direction of my abdomen. 'Prrrrregnum!'

Would that were all it took!

Monday, 7 April 2008

Lost for words

Out here in the blogosphere, all we have is words. And yet there are times when that doesn't seem nearly enough.

At the weekend, Mr H came into my study and found me in tears. What was wrong, he asked. I explained that I had just found out that Luna had received a negative from her final cycle. Luna has been through so much over the past six years, she has been so generous in her support of others in the blogosphere, and this FET was her last chance for a baby. I had been hoping and willing with every ounce of my being that this cycle would work for her. Mr H could not understand why I was so upset. 'But you've never even met this woman,' he reminded me, gently. 'You live on opposite sides of the Atlantic. You very probably don't even know each other's real names.'

Mr H is, of course, right. I have never met Luna, or indeed any of my other blogging friends. And yet I feel a deep connection with you. In many cases, we have shared interests that extend beyond the common thread of infertility - we would, I like to imagine, get on well if we were to meet in Real Life.

You have all been a tremendous source of support to me over the past few months - not only through your kind comments here, but through your own posts. I have in particular learnt a great deal from Luna's wise and astute writing. And this is why, at this particular moment, I feel so powerless. I can find no words of comfort to offer her.

It strikes me that society in general isn't particularly comfortable with grief. Mourning is seen as something that should be hurried through as quickly as possible - 'coming to terms' and 'moving on' are seen as the ultimate goals for the recently bereaved.

And yet in our little community, it seems that grief is always just around the corner. And so perhaps all any of us can do is to acknowledge each individual loss, and to sit and mourn quietly with those whose hopes and dreams are not now going to come to fruition. Phrases like 'I'm sorry' and 'I'm thinking of you' may not seem much, but out here in the blogosphere, all we have is words.

Wednesday, 2 April 2008

Back on the treadmill

Today, I went to have my Day 3 bloodwork taken. At our review appointment, Dr Abrupt reassured me this was nothing to worry about - repeating the test was standard procedure for anyone about to embark upon a new cycle of IVF. In one of his rare flashes of bedside manner, he informed that it was, 'statistically speaking', highly unlikely that my FSH levels would have risen dramatically since they were last checked in November.

And yet I am worried. Since my first cycle was cancelled, I have been searching for a reason as to my poor response. There is a small part of me that accepts that this may have been because I was either over-suppressed or under-stimulated, in which case I may do better on a shorter protocol/higher dosage. And yet, from the reading I've done, there does seem to be a clear correlation between poor response and diminished ovarian reserve. And so, lying awake at night, I have managed to persuade myself that my ovaries are on their last legs (last week, I was even convinced that I was suffering from perimenopausal hot flushes, until Mr H confessed to having turned the central heating thermostat up!) I am worried that the lab may have made a mistake with my previous tests, thereby lulling me into a false sense of security. I am worried that this test will reveal that my FSH levels have shot up over the past few months. I am worried that, even if my hormone levels are within the prescribed range, I still won't respond to the stims. I am worried about the longer-term effects of taking such high doses of fertility drugs.

When I started out on this process just before Christmas, I was scared at what I was about to put my body through, but I was also relieved finally to be doing something that might actually have brought us closer to having a baby. I wasn't banking on it working first time round, but I was banking on IVF at least being an option for us. But now, I've lost my IVF innocence. I'm going into this cycle with my eyes wide open. Fertilisation reports, transfer, 2wws - at the moment, all of these seem like things that happen to other people. I'm just focussing on making it to retrieval this time round - a few good follicles, two or three mature eggs would do me fine.

My baseline ultrasound is scheduled for 21 April. If everything looks OK then, and my bloodwork is within the normal range, I will begin the treatment itself when I get my next period.