Much to our surprise, they managed to retrieve six eggs yesterday.
The embryologist has just phoned. Three were immature, one was damaged as a result of the ICSI procedure, one showed initial signs of fertilisation but did not develop overnight, but one fertilised. The resulting embryo will be frozen, and put back in a later cycle, once we have dealt with the polyp. She also said that she did not think that there were any major problems with the quality of the eggs retrieved.
Obviously, there is still a long way to go - there is a chance that our one embryo may not survive the freezing process, let alone implant. But today I am going to allow myself to feel hopeful that we have this one chance, and grateful that I am part of this community: I went into retrieval knowing that you were all there with me, willing this to work out. I like to think that all those waves of positive energy made the difference!
Showing posts with label ivf1 take2. Show all posts
Showing posts with label ivf1 take2. Show all posts
Wednesday, 7 May 2008
Monday, 5 May 2008
A kick in the guts
I feel - literally and metaphorically - as though I have been kicked in the stomach.
As I continued on with the meno.pur injections over the course of last week, my abdomen grew progressively more tender. I interpreted that pain and discomfort as a sign that the drugs were working as they should. With every twinge, I visualised the follicles appearing on my ovaries. I imagined them growing to a good size. I attended Saturday's scan feeling optimistic. I was expecting a better response than last time round.
Since our first attempt at IVF was cancelled, I have trod that fine line between hope and caution. I have listened to those who told me that there was every reason to expect that I would have a better response on a shorter protocol, and with an increased dose of drugs. I have done everything I possibly could to try and ensure that this cycle worked. I have given up alcohol and caffeine. I have eaten as healthily as I possibly could. And nothing - not the weekly acupuncture sessions nor the expensive anti-natal vitamins - appears to have made any difference. The polyp is just the final fucking straw.
Yesterday, we toyed with the possibility of simply cutting our losses, of not going ahead with the retrieval. After my lap & dye test three years ago, I suffered a particularly bad reaction to the anaesthetic. I am exhausted by the prospect of having to undergo two sedations, and two unpleasant and uncomfortable gynaecological procedures in a short space of time: one to retrieve the eggs, another to get rid of the polyp. Neither of us are optimistic that this cycle will result in viable embryos. I have only two follicles, either or both of which may turn out not to contain a fully mature egg. Even if we get two eggs, they may not fertilise, or may be damaged as a result of the ICSI procedure. Any embryos we do get may not survive the freezing process.
I suspect that there may well be a problem with the quality of my eggs, as well as with the quantity. I have reached the point where I need to know whether there is any point in us continuing treatment; I'm not sure whether I can go through all this again. If we go ahead with the retrieval, then at least they will be able to give us some indication as to whether we have any chance of having a child that is genetically related to both of us. And so, at exactly midnight last night, I stabbed one final needle into my bruised, aching and swollen belly and administered the HCG shot. We will return to the Great Big Infertility Clinic for retrieval tomorrow morning.
Right now, I just want this to be over. I feel angry, let down and betrayed by my body, empty, barren.
As I continued on with the meno.pur injections over the course of last week, my abdomen grew progressively more tender. I interpreted that pain and discomfort as a sign that the drugs were working as they should. With every twinge, I visualised the follicles appearing on my ovaries. I imagined them growing to a good size. I attended Saturday's scan feeling optimistic. I was expecting a better response than last time round.
Since our first attempt at IVF was cancelled, I have trod that fine line between hope and caution. I have listened to those who told me that there was every reason to expect that I would have a better response on a shorter protocol, and with an increased dose of drugs. I have done everything I possibly could to try and ensure that this cycle worked. I have given up alcohol and caffeine. I have eaten as healthily as I possibly could. And nothing - not the weekly acupuncture sessions nor the expensive anti-natal vitamins - appears to have made any difference. The polyp is just the final fucking straw.
Yesterday, we toyed with the possibility of simply cutting our losses, of not going ahead with the retrieval. After my lap & dye test three years ago, I suffered a particularly bad reaction to the anaesthetic. I am exhausted by the prospect of having to undergo two sedations, and two unpleasant and uncomfortable gynaecological procedures in a short space of time: one to retrieve the eggs, another to get rid of the polyp. Neither of us are optimistic that this cycle will result in viable embryos. I have only two follicles, either or both of which may turn out not to contain a fully mature egg. Even if we get two eggs, they may not fertilise, or may be damaged as a result of the ICSI procedure. Any embryos we do get may not survive the freezing process.
I suspect that there may well be a problem with the quality of my eggs, as well as with the quantity. I have reached the point where I need to know whether there is any point in us continuing treatment; I'm not sure whether I can go through all this again. If we go ahead with the retrieval, then at least they will be able to give us some indication as to whether we have any chance of having a child that is genetically related to both of us. And so, at exactly midnight last night, I stabbed one final needle into my bruised, aching and swollen belly and administered the HCG shot. We will return to the Great Big Infertility Clinic for retrieval tomorrow morning.
Right now, I just want this to be over. I feel angry, let down and betrayed by my body, empty, barren.
Saturday, 3 May 2008
In which things go from bad to worse
For the past week, I have been taking the maximum recommended dose of 450iu meno.pur per day. Today, we went back to the Great Big Infertility Clinic, where the dildo cam revealed that I have precisely two viable follicles, each measuring 16mm. There is another one currently limping along at 11mm, and a number of smaller ones which will not catch up in time for retrieval.
As if that was not bad enough, a polyp has suddenly appeared on the wall of my uterus.
We are going ahead with retrieval on Tuesday. Even if the two viable follicles do both contain fully mature eggs, and even if those eggs then fertilise, any resulting embryo(s) will have to be frozen until the polyp has either been shed with my next period, or surgically removed.
Crap. Crap. Crap. Crap.
Dr Approachable tells me that I should not give up all hope. He is not willing definitively to diagnose diminished ovarian reserve until after retrieval, at which point they will be able to assess the quality of my eggs. There is still a chance that the two follicles may yet yield two high quality eggs, which may well go on to fertilise. He reassured me that, if this is the case, our chances of a successful pregnancy will not be substantially reduced if we do have to freeze the resulting embryos. But I am not getting my hopes up. It seems that more and more obstacles are being placed in our way. And so, on the way home in the car, we had our first serious conversation about what we will do if we cannot have a child through IVF/ICSI: do we go down the donor egg route, do we begin to explore adoption, or do we start trying to come to terms with involuntary childlessness?
As if that was not bad enough, a polyp has suddenly appeared on the wall of my uterus.
We are going ahead with retrieval on Tuesday. Even if the two viable follicles do both contain fully mature eggs, and even if those eggs then fertilise, any resulting embryo(s) will have to be frozen until the polyp has either been shed with my next period, or surgically removed.
Crap. Crap. Crap. Crap.
Dr Approachable tells me that I should not give up all hope. He is not willing definitively to diagnose diminished ovarian reserve until after retrieval, at which point they will be able to assess the quality of my eggs. There is still a chance that the two follicles may yet yield two high quality eggs, which may well go on to fertilise. He reassured me that, if this is the case, our chances of a successful pregnancy will not be substantially reduced if we do have to freeze the resulting embryos. But I am not getting my hopes up. It seems that more and more obstacles are being placed in our way. And so, on the way home in the car, we had our first serious conversation about what we will do if we cannot have a child through IVF/ICSI: do we go down the donor egg route, do we begin to explore adoption, or do we start trying to come to terms with involuntary childlessness?
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!
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.
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.
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.
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.
Thursday, 6 March 2008
Plan of action
Yesterday, we returned to the Great Big Fertility Clinic for our review appointment with Dr Abrupt.
Dr Abrupt, I am now beginning to appreciate, responds better when confronted with specific questions, as long as they are not overly emotive, and are couched in relatively scientific language. 'Are my ovaries on their last legs?', for example, will not meet with a good response. If, on the other hand, this same question is rephrased as, 'How worried should I be at this stage about diminished ovarian reserve, or could my poor response to the last cycle simply be down to either over-suppression or under-stimulation?', he is more willing to engage in dialogue.
His answer to the above was that, at this stage, we simply don't know. Once again, he reiterated that my FSH levels (7.6 in March 2007, 5.6 in September 2007) did not appear to indicate any underlying problem which could have been anticipated before we started treatment in December; we simply have to try a different protocol and see what happens this time round.
He recommended that we wait another month before trying another cycle. This time round, we will do a shorter, 'flare' protocol, and will triple the dose of Menopur from 150iu to 450iu. I did ask why he thought Menopur was the best option - would I perhaps respond better to a recombinant? He referred to an unspecified meta-analysis (as anyone who has read of my prior dealings with Dr A will know, he is very keen on statistics and meta-analyses) which suggested that the choice of either a recombinant or a urinary based stimulant did not appear to have any major impact on success rates. Having had such a poor response to the Menopur last time round, I do feel a little bit iffy about taking it again, and will perhaps raise this particular concern with him at our next appointment.
He also suggested that, this time round, we would definitely proceed to retrieval, whatever my response. We are now at the stage where he feels it necessary to have a sense of the quality of any eggs I do produce - that way, he will be able to advise us on whether he feels that there is any point in us continuing treatment.
Such a lot is riding on this next cycle. Although there is a tiny voice inside me telling me not to panic, that I could well be OK on this new, more aggressive protocol, there is a far larger part of me that is trying to begin to find a way of processing the fact that this cycle could possibly mark the end of the road for us.
Dr Abrupt, I am now beginning to appreciate, responds better when confronted with specific questions, as long as they are not overly emotive, and are couched in relatively scientific language. 'Are my ovaries on their last legs?', for example, will not meet with a good response. If, on the other hand, this same question is rephrased as, 'How worried should I be at this stage about diminished ovarian reserve, or could my poor response to the last cycle simply be down to either over-suppression or under-stimulation?', he is more willing to engage in dialogue.
His answer to the above was that, at this stage, we simply don't know. Once again, he reiterated that my FSH levels (7.6 in March 2007, 5.6 in September 2007) did not appear to indicate any underlying problem which could have been anticipated before we started treatment in December; we simply have to try a different protocol and see what happens this time round.
He recommended that we wait another month before trying another cycle. This time round, we will do a shorter, 'flare' protocol, and will triple the dose of Menopur from 150iu to 450iu. I did ask why he thought Menopur was the best option - would I perhaps respond better to a recombinant? He referred to an unspecified meta-analysis (as anyone who has read of my prior dealings with Dr A will know, he is very keen on statistics and meta-analyses) which suggested that the choice of either a recombinant or a urinary based stimulant did not appear to have any major impact on success rates. Having had such a poor response to the Menopur last time round, I do feel a little bit iffy about taking it again, and will perhaps raise this particular concern with him at our next appointment.
He also suggested that, this time round, we would definitely proceed to retrieval, whatever my response. We are now at the stage where he feels it necessary to have a sense of the quality of any eggs I do produce - that way, he will be able to advise us on whether he feels that there is any point in us continuing treatment.
Such a lot is riding on this next cycle. Although there is a tiny voice inside me telling me not to panic, that I could well be OK on this new, more aggressive protocol, there is a far larger part of me that is trying to begin to find a way of processing the fact that this cycle could possibly mark the end of the road for us.
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