Showing posts with label ivf1 take1. Show all posts
Showing posts with label ivf1 take1. Show all posts

Monday, 4 February 2008

Big. Fat. Negative.

The title pretty much says it all. The IUI didn't work - AF arrived with a vengeance at the weekend.

I knew it was a long shot, and yet I hoped. After all the unrelenting shittiness we've experienced so far, I thought that maybe, just maybe, we deserved a bit of a break - a bit of good luck, for a change.

But I was wrong. We're not even back to square one - it feels that we've slipped even further back than that. Now we have to deal with my poor response, as well as Mr H's wonky sperm. Our dreams of becoming parents seem further away than ever before.

Sunday, 27 January 2008

On not counting your eggs before they're retrieved

Over at Just One Bean, the lovely Katarina recently shared a story about a woman she had encountered on a message board. This woman was due to start an IVF cycle in March, and wanted to know if it would be OK to take a trip to Disneyland the following month, since by then she would be six weeks' pregnant. My own obsessive Googling has recently unearthed a similar post from a woman who was just beginning her first cycle of IVF here in the UK. She was overjoyed to report that she had managed to get all of her maternity wear for less than half price in the January sales.

I've been thinking a lot about these women over the past ten days or so. When I read Katarina's post, I prided myself in not sharing what I considered to be the Disneyland woman's misplaced optimism. I was not nearly so naive, I told myself. I was not jumping ahead of myself and making plans that very probably would not come to fruition. When I started IVF, I was daunted by the enormity of what I was about to put myself through, physically and emotionally. The only way I could make sense of it all was by breaking the cycle down into a series of smaller stages. I was, I wrote on Katarina's blog, focusing on getting to the next stage - on making it through the next injection, the next scan. I could not, I suggested, project myself forward even to the point where I might take a pregnancy test, let alone imagine myself six weeks' pregnant.

Yet now I wonder, am I really so different from those women on the message boards? It never crossed my mind that this first cycle would have to be cancelled because I did not respond to the drugs. All the tests I had had led me to believe that everything was OK - my FSH levels were good, I ovulate regularly. There was no sign of any underlying problem. And so I presumed that IVF was an option for us. I presumed that, if I did not get pregnant this time round, we would be able to try again - perhaps initially with a FET, and then with a second, or even a third, cycle. I suppose that, deep down, I was presuming that this would all work out for us and that we would one day have a child.

But now I realise that there may not be a happy ending. Maybe the IUI will work. If it doesn't, then maybe I will have a better response on a different protocol. But maybe I won't. Maybe, just maybe, this could be it.

Tuesday, 22 January 2008

On being a 'good' patient

Thank you all for your supportive comments about my difficulties with Dr Abrupt - his ears must have been burning over the weekend!

Hekateris mentioned that she had had similar problems at another UK clinic, but didn't say whether she was being treated as a private or an NHS (National Health Service - i.e. state funded) patient. We are paying to have private treatment in an NHS clinic, which I think may go at least some way to explaining Dr Abrupt's attitude. I don't want this to turn into a lengthy post about the shortcomings of the NHS, so will only say that there is huge pressure on resources, and the impetus seems to be to get people in and out as quickly as possible. We were aware of this when we chose this particular clinic, as opposed to the fancy private one fifty miles further away; we decided that it was more important to be treated in a research-led clinic, rather than somewhere that offered fluffy dressing gowns and up to date magazines in the waiting room.

This does not, however, entirely excuse Dr Abrupt's behaviour on Saturday. I left the clinic feeling profoundly infantilised. Obviously, this may say rather more about me than it does Dr Abrupt - I was, after all, brought up to be a good little girl, and not to bother the grown ups. And yet it also says something about the authority patterns that continue to subtend our dealings with our doctors: however well-informed we may be, we are still led to believe that the Doctor Knows Best. As many others have already stated far more eloquently than I ever could, one of the most difficult things about infertility is the loss of control. In our bid to have a child, we hand our bodies over to the medical profession; we obediently take the drugs they prescribe, drugs which disrupt the cycles we have so painstakingly learnt to chart (one of the most difficult things about the last few weeks has been the feeling that I no longer understand what is going on inside my own body). We are rendered not only emotionally but also physically vulnerable, as we lie on their couches with our most intimate parts exposed. One of the ways in which I have tried to claw back some control is by finding out as much as I can about my own condition. I am an academic, and I approach infertility in the same way as I do any other unfamiliar topic: I read around the subject, and then I ask what I hope are intelligent and informed questions. And that is precisely why I do not like being patronised and dismissed.

We returned to the clinic yesterday for the IUI, still prickling with resentment towards Dr Abrupt. Despite some anxieties in the car on the way over, Mr H rose to the occasion and came up with the goods, and then at 1pm sharp we were called in for the treatment itself.

The whole thing felt a little perfunctory. I thought that they might do another scan to confirm that we were all ready to go, but no-one even asked if I had done the trigger shot on Saturday evening. We were both asked to confirm our full names and dates of birth, then Dr Abrupt got busy with the speculum. The procedure itself was over really quickly, and was far less uncomfortable than a smear test. From behind the curtain, I heard the sound of Dr Abrupt removing his latex gloves. I should lie there for about five minutes, and then I could leave, he said. I then heard the door opening. 'Dr Abrupt?' I called. He stuck his head round the curtain. I took a deep breath. 'I feel that our appointment on Saturday raised more questions than it answered, and I just wanted to make sure that we would have chance to talk through some of those issues in more detail before we started another cycle of IVF.'

'If the IUI doesn't work, then of course we will arrange a longer appointment in a few weeks time to talk about what we learnt from this cycle, and to think about what we'll do differently next time. But for the time being, try and think positively.' He even managed a reassuring smile.

Obviously, he does have something resembling a bedside manner!

Five minutes later the nurse came in. If I hadn't had a period in a couple of weeks, I should probably do a home pregnancy test, she informed me. Would I not have to come into the clinic for a beta, I asked. 'Oh no,' she replied, 'that's only if you were doing IVF.' Should I start using the progesterone pessaries, I asked. She did not know, but would go and ask Dr Abrupt. She returned a few minutes later. 'Oh no,' she answered - you've guessed it - 'those are only if you're doing IVF.'

So now we wait.

Saturday, 19 January 2008

Fourth appointment - at which more questions are asked than answered

We got up early this morning, and reluctantly drove the 25 miles to the Great Big Fertility Clinic for our appointment with Dr Abrupt.

Afterwards, we conducted a lengthy postmortem over lunch. Was I being unnecessarily pushy and demanding, I asked Mr H. 'No,' he replied, 'but Dr Abrupt did a pretty good job of making you feel that you were.'

Mr H has up to this point been a major apologist for Dr Abrupt. Dr Abrupt has, Mr H has consistently pointed out, an excellent reputation. He runs one of the largest and most successful IVF units in the UK outside London. For those who set store by such things, he was last year listed as one of the seven best fertility experts in the country by Tatler magazine. More importantly, Mr H recognises in Dr Abrupt a fellow man of science. Like Dr Abrupt, Mr H does not deal in what ifs or maybes; he prefers cold, hard statistics.

But today, Mr H came away from our appointment feeling as non plussed as I did.

The dildo cam revealed that three of the follicles on my right ovary had grown to 19mm, 14mm and 13mm respectively. The remaining two follicles hadn't grown beyond the 10mm stage. 'We have seen this sort of thing before,' Dr Abrupt blithely commented. 'Some couples like to go ahead with egg retrieval, but others prefer to cancel and start treatment again in a few months. What would you like to do?' 'What would you recommend we do?' I asked. He did look pretty shocked to have been asked such a direct question, but eventually conceded that it would probably be best to cancel, given that I only had one fully mature follicle. At this point, I raised the possibility of an IUI. He went along with the suggestion, but does feel that the chances of success are pretty slim given Mr H's swim up analysis. Dr Abrupt would, we decided over lunch, have made an excellent politician, given his seeming inability to respond to any question directly, but instead to quote statistics or to else draw graphs on the back of patients' charts.

'Can you give me some reason as to why this might have happened?' I persisted. 'Is a poor response always indicative of a diminished ovarian reserve?' He replied that a first cycle of IVF was as much a test as a treatment, that they had gained some important information about our fertility levels as a couple, that they had put me on a standard protocol based on my Day 3 FSH levels, that they could safely increase the dose of the stimulant drugs next time, and that they had many different protocols they could use. At this point, I saw my chance and asked him whether those different protocols included a shorter, 'flare' one.

By this stage, it was becoming apparent that I was beginning to get on his nerves. Dr Abrupt, I think, looks at his patients and sees only a set of reproductive organs which will or will not do what they are supposed to. He does not realise that those organs are housed in an individual, an individual who has endured years of heartache before she winds up in his clinic and who will, in all likelihood, have spent some of that time finding out as much as she possibly can about her own condition. He retorted that he had a waiting room full of other couples and so was not willing at this stage to get into discussions about my next cycle, that we would have to wait a couple of months at least before resuming treatment, and that he would explain the short protocol to me nearer the time.

My many questions will evidently have to wait until Dr Abrupt is ready to answer them. But I am not going to be intimidated: I will store them up, and keep asking until I get a satisfactory response. You've all been so helpful with your comments and suggestions, and I'm reassured to learn that several of you have bounced back from a similar situation. Based on some of your comnments, I'm quite reluctant simply to go with an increased dose of Menopur next time round, and will be pushing for a different stimulant.

In the meantime, however, we are going ahead with an IUI - I will do the trigger shot at 10pm this evening, and then we will return to the clinic on Monday morning.

Friday, 18 January 2008

Thank you

After spending much of yesterday crying, and cursing my lousy fucking ovaries & the lousy fucking doctors, I went to bed at 10pm with a splitting headache. I logged on this morning to find all your fantastic messages of support. I want to thank each and every one of you for your kind words - it means a great deal to know that there are so many of you out there rooting for me.

Luna asked about Mr H's SA. Based on the tests we've had done so far, his count ranges from between 17 & 19 million, and motility between 54% & 76%. The main problem seems to be with morphology (the results have consistently showed around 75% abnormal forms). They also do not appear to hang around for that long - when we switched to this particular clinic, they performed a swim up test which showed that, two hours later, most of them are dead in the water.

And yet, in spite of Mr H's wonky sperm and my now seemingly recalcitrant ovaries, we did manage to conceive without medical assistance (I then lost the baby at seven weeks) - which is what led me to think that IUI might be a way of salvaging something from this cycle.

I've spent the morning obsessively googling such cheering phrases as 'IVF poor response' and 'diminished ovarian reserve', and have come up with a list of questions ready to ask Dr Abrupt tomorrow:

Is it possible for us to convert this cycle into an IUI? And secondly, what are the costs involved in doing this? As Claire so rightly acknowledges, money is an issue in all of this. If we cancel this cycle prior to retrieval, we still have to pay £1,000 plus £500 for the drugs (the bulk of which I have now taken). If we go ahead, we are looking at £3,000 for a complete cycle plus the £500 for the drugs. Working on the assumption that we are unlikely to get a positive result with this first cycle, then it makes financial sense to cancel & focus our efforts on the next cycle, rather than paying out for something that probably will not work.

Other questions for Dr Abrupt:

Why did I have such a poor response to the Menopur? Is this an indication that my eggs are in fact past their sell by date, or do they simply need to adjust the meds?

And finally, leading on from this last one, do they have a protocol in mind for next time? As both Mel and Luna asked, is there a particular reason why they seem so intent on Menopur? Would a shorter, 'flare' protocol perhaps produce better results?

From what I read, it seemed that acupuncture may help - does anyone have any thoughts, positive or negative, on this one?

Dr Approachable said that I should in the meantime carry on with the Menopur injections, which I have been doing. But all we can do now is to wait - tomorrow's appointment will presumably resolve things one way or another.

Thursday, 17 January 2008

Third appointment - at which I am proved right, shit does happen

This morning, I headed back to the Great Big Fertility Clinic for another scan.

After a full week on the Menopur injections, I have managed to produce a sum total of five follicles. On my right ovary, I have two follicles measuring 10-13mm, plus another two measuring 8-10mm. On my left ovary, I have one follicle that is well under 10mm.

We are to go back to the clinic on Saturday morning for another scan, however at the moment our options - as outlined by Dr Approachable, who was wielding the dildo cam this morning - are as follows:

1. They go ahead and retrieve the eggs from the two largest follicles early next week. Given that we were scheduled to do ICSI, which requires fully mature eggs, and there is a further chance that the ICSI process may itself damage a certain percentage of those eggs, the chances of fertilisation look fairly slim.

2. We cancel this cycle owing to my poor response to the stims, and start all over again with a more aggressive protocol in a couple of months.

I did suggest a third option, that we turn this cycle into an IUI, but Dr Approachable pretty much ruled this out owing to Mr H's poor swimmers.

While I sobbed into a tissue, he made all sorts of reassuring noises - my most recent bloodwork showed that my FSH levels were 5.6, which he considers good for my age (I've just turned 36). Based on those results, he told me that there was no need for me to panic about having a diminished ovarian reserve. It was, he suggested, by no means the end of the road for us; next time round, they would simply increase the dose of Menopur.

But I still don't understand why this has happened. Did I do something wrong? Did I administer the injections incorrectly? I've spent the last three and a half weeks pumping myself full of drugs - why didn't my stupid, fucking ovaries respond?

I thought that starting IVF would take us one step closer to having a baby, but that now seems further away than ever. Before today, our problems never seemed insurmountable. I checked out fine; all our difficulties seemed to lie in Mr H's wonky sperm. ICSI would, we thought, enable us to bypass that particular problem. We weren't naive enough to think that it would work first time round, but we did think that eventually it would. 'Maybe it'll take us two or three cycles,' we told ourselves, 'but we'll get there in the end.'

But now we're facing an entirely new and unexpected problem. The door hasn't exactly been slammed in our face, but I do have a sense that it's drawing slowly shut, and right now it seems that there is very little I can do to stop it.



Tuesday, 15 January 2008

Caring and sharing

In bed this morning, Mr H had the temerity to complain that I had not shaved my legs. 'Please don't cuddle me,' he implored. 'When you wrap your legs around mine, it feels like you're stabbing me with hundreds of tiny needles.'

I managed to resist the temptation to load up a syringe of saline solution and stick him there and then. Instead, I brandished my IVF goody bag at him and shrieked, 'How would you like to find out how it REALLY feels to be stabbed with hundreds of tiny needles?'

I guess I can now add irritability to the list of side effects from which I am suffering.

Friday, 11 January 2008

Over the next hurdle...

This morning, I got all psyched up to inject myself for the first time. I unpacked my IVF goody bag, assembled my sharps bin (just the IKEA bookcase to go, then), read through Melissa's fabulous advice, snapped the top of the little vial, drew up the solution, mixed it with the powder, switched needles, got rid of the air in the syringe, loaded up the Autoinject pen, took a deep breath... and fired!

Using the Autoinject pen made the process a lot easier: I'm sure I would have been even more freaked out had I actually had to watch the needle going in...

But that first injection really did feel like a rite of passage - I'm half hoping that I may now be invited to join some secret IF society that no one has told me about before!

Thursday, 10 January 2008

Second appointment

This morning saw our second visit to the Great Big Fertility Clinic. Dr Abrupt wasn't on duty this time, so we got to see Dr Approachable instead, which meant that I had a chance to raise some of the questions I didn't feel able to ask during our last appointment. The scan confirmed that I was ready to start the stims, and the nurse taught us how to administer the Menopur injections. Having shown us how to prepare the shots, she then did the first one for me, so I have still to get over the hurdle of injecting myself - I'm sure tomorrow morning will find me dithering anxiously in the bathroom, syringe in hand!

Our next scan is scheduled for a week today, with the retrieval tentatively planned for 21 January - gulp!

We were done at the clinic by just after 9am, and I then popped into work to collect a pile of marking. Because Mr H had taken the whole morning off work to come with me, we decided that we had time for a quick trip to IKEA to purchase an extra bookcase to house our ever-burgeoning book collection. Two years ago, we bought a new kitchen from IKEA. I will not re-hash the whole sorry tale again, but suffice it so say that I made so many trips backwards and forwards from IKEA at that time to choose the kitchen, order the kitchen, pick up extra pieces of the kitchen that were not delivered at the time, and to return bits of the kitchen that we did not order, that I am now like Pavlov's dog - as soon as I draw into the carpark, I start salivating because I think I am going to get a hotdog soon!

My aim is to get my marking done before I go back for my next scan. Am now accordingly eyeing up the pile of essays with trepidation - did I actually manage to teach the students anything at all last semester?

Tuesday, 8 January 2008

Forward planning

Normally, when I get to the end of a box of tampons, I buy another box – that way, I won’t get caught short the following month.

This month, however, I paused and thought about it some more. If I get a period next month, it will be because this cycle of IVF has failed. Should I remain optimistic, and work on the assumption that I may not need said tampons? If I buy the tampons, am I admitting to myself that I won’t get pregnant as a result of the treatment? Will this then become a self-fulfilling prophecy?

I want – no, I need – to believe that this will work. I do not want to think about how I will feel if I get a negative result. I am terrified by the thought that I could put myself through all this, and still be left with nothing at the end of it. And yet I know that, statistically speaking, a negative is a more likely outcome than a positive. Obviously, there are plenty of stories with a happy ending out there. But there are lots of others that don’t end so well: I am not naïve enough to think that this will definitely work out for me.

Mr H tells me that I am a born pessimist - that I could make Eeyore look cheerful. But experience has taught me that shit does happen, and that it’s best to be prepared. And so I bought the box of tampons.

Thursday, 3 January 2008

Is it me, or is it hot in here?

I am now - hopefully - past the half-way point in the down regulation phase. I've been taking the Nafarelin spray for ten days now, and the side effects seem to be kicking in nicely.

I'm getting a lot of headaches and hot flushes (hence the title of this post!). I also feel terribly depressed, and I cry at the least thing. I don't know whether this is because I AM depressed, or whether it's because of the meds - somehow I feel horribly out of control, both of my body and my emotions.

This first phase of the treatment seems to be really dragging - I still have another week to go before our next appointment at the clinic. Hopefully then they will confirm that it's OK to start the stims - maybe then I will start to feel like a bit more is happening.

Monday, 24 December 2007

First appointment

When I was three, Father Christmas brought me a doll's cot. It was painted lemon yellow, and was made up with teeny-tiny sheets and pillows, and a patchwork quilt (I later learnt that my grandmother had made all of these, and had sent them up to Lapland for Santa to deliver). When I peeked under the quilt, I found a ragdoll lying there fast asleep. I immediately named her LoobyLoo, and she remained one of my most stalwart companions over the next few years.

A few years ago, when my father moved house, my doll's cot was unearthed in one of the farthest corners of the loft. My father and stepmother insisted on packing it up and taking it with them to their new house, 'for when we have our grandchildren over to play'. It now sits, empty and reproachful, in their garage. Unfortunately, LoobyLoo has gone forever; she did not come to light in the move.

Thirty-three years later, the doll's cot remains My Best Christmas Present Ever. This morning's IVF goody bag does not come close: unpacking my very own miniature sharps bin does not fill me with anything like the same sense of wonder and excitement. I thought I would feel more gung-ho about finally starting treatment, but have to say that the whole thing felt like a bit of an anti-climax. We had been told that the appointment would take about an hour, and I'd assumed that the consultant would spend the time talking us through the protocol he had prescribed for us, and that we would have time to ask any lingering questions. In fact, we were in and out in fifteen minutes: a quick probe with the dildo cam confirmed that I had ovulated this month, and was OK to start treatment, and then the rest of the time was taken up signing various consent forms.

For the down reg phase, I was given a choice between Buserelin injections, or Nafarelin nasal spray. Because I'm still a little freaked out by the thought of injecting myself, I elected to go for the Nafarelin (3 sprays a day, eight hours apart). Have taken my first spray, and am now waiting for the first of the long list of side effects listed in the information leaflet to appear!

Friday, 21 December 2007

What my unconscious is telling me

In waking life, our impeding cycle of IVF continues to have a vague air of unreality about it: I still cannot quite believe that our first appointment is on Monday morning.

In my dreams, however, the anxieties come thick and fast. I dream that I am in the bathroom, syringe in hand, but that I cannot bring myself to inject myself. I dream that I do not fully understand what medication I am to take when, and that I inadvertently miss an injection, thereby screwing up the whole cycle and sending us back to the very bottom of a six-month waiting list. I dream that I am to give a lecture on my experiences of infertility: the lights in the lecture hall go down, I open my mouth to speak, but no words will come out.

I suppose that what all these dreams are telling me is that I'm scared: I'm scared of the injections, I'm scared of the egg retrieval, I'm scared it won't work, and I'm scared that if it does work, I may miscarry. I thought I'd feel ready to do this, but I don't.

Thursday, 13 December 2007

Countdown to Christmas

Christmas is a difficult time for those struggling with infertility - somehow it reminds you of all the things you can't have. A while ago, Loribeth had a great post which neatly captured all poignancy of a Christmas without children, which I went back and read as I began to think about our own plans for the holiday season.

Over the years, Mr H and I have created our own Christmas routine. We try not to get caught up in the relentless consumerism that appears to grip the entire country at this time of year. Going round the supermarket yesterday, I was faintly sickened by the excess of it all - the shelves were groaning with processed, over-packaged, fat-laden, Christmas-themed goodies (stilton & cranberry flavoured crisp anyone, or perhaps a white chocolate topped mince pie?). People were already beginning to stockpile loaves of bread, and a couple were having a bitter exchange of words next to the packets of bread sauce mix. Looking around at the overflowing trolleys in the queues for the checkouts, I couldn't help but wonder: how much of this food will go uneaten into landfill sites when people clear out their fridges and cupboards in the new year?

We don't bother with turkey and all the trimmings; for the last couple of years, we have instead had a shellfish platter from the fabulous Ramus Seafood Emporium. We generally treat ourselves to a bottle of champagne, or else a really good dry white wine, and buy each other one small gift each. We spend most of the day lazing in front of an open fire, reading, chatting or watching the television (if I have my way, we will also play board games, although Mr H is not as keen as I am!) If the weather is nice, we may go for a walk in the afternoon.

This year, however, I am counting down to Christmas for a very different reason: our Day 21 appointment is scheduled for 8.20am on Christmas Eve.

Thursday, 15 November 2007

Preparations

We are starting to gear up for IVF next month. Last week, I went to have my Day 3 bloodwork done. This week, it was Mr H's turn. On Tuesday, he went off to the clinic for an up to date semen analysis. He tells me that they operate a queueing system akin to the deli counter at the supermarket - i.e. you turn up & take a number. When that number is called, you are then ushered into a small room & expected to do the business.

Not for the first time, I am struck by how very different male sexuality is to female sexuality!

Friday, 9 November 2007

The next step?

AF arrived bang on time this month, and so I took a deep breath and phoned the clinic to confirm that we would be proceeding with a cycle of IVF/ICSI next month (my first appointment will be on Day 21 of my December cycle, so a few days before Christmas).

I'm finding it difficult to see this as the next step in our journey through infertility - somehow it seems more like the end of something: as though we're now officially giving up on the idea that we might manage to conceive without medical assistance. It feels like we're admitting that we've failed, and that we can't do what seemingly everyone else out there can.

Infertility has taught me a great deal about my body; I have learnt to respect its rhythms and chart its cycles. Now I feel that I am going to have to give up control of that body, and hand it over to the medical profession. It is hard to accept that conceiving a child, which should be a private and intimate act between me and my husband, is going to be such an intensely medicalised and public process.

Perhaps as the IVF draws closer, I will be able to cling on to the feeling that at least we are actually doing something that will take us closer to our dream of having a baby. At the moment though, it feels more like we've come to the end of a particular road.