Monday, September 24, 2007
I'll jump ahead because otherwise this could take years. After the frozen embryo transfer cycle and the short-lived pregnancy we had a longer break then got back on the horse in Spring. Another fresh IVF cycle this time as there are only two frozen embryos and because I was so productive egg-wise, the clinic suggested I add to the frozen pot. In brief, the third cycle yielded only nine eggs – the clinic slowed me right down so as not to over stimulate me and in my oppinion went too far the other way. Not that nine is poor by any means. Anyway, it looked briefly like I might not even get any embryos which is when I lost the plot. I became like a wounded animal, standing sobbing in one corner of the garden with Sue and my mum trying to reach out to me. I could only lash out at them, literally, physically, verbally. I was inconsolable. To go through all that again and potentially not even get the chance to fail, cruel. But we got three good embryos, the best two were chosen and put back in and I got to do my two week wait again. Only to fail again. Once again, my periods come bang on time. You could set Breitling watches by my menstrual cycle.
That was probably the worst crash. But I didn't allow myself too much time to think, I waited the obligatory three months then went for number four. Summer now. And I'm thinking - surely this time it's a definite. I was convinced. I'd looked after myself, been at yoga, etc etc. Surely it was my time...? I mean, fourth, it was a definite. I became quite high at the prospect. I hated the injections by this time, even though needles had never bothered me before. My arms were ravaged from the blood tests, I looked like a bad junkie. My veins seemed to disappear every time the clinic nurses came near me. One time it took three nurses, five attempts before finally successfully getting blood out of me. They even had to go into my hands and that hurt.
But it would all be worth it when it worked.
But it didn't. And then I really crashed. I won't go through the next six months in much detail because I don't have the energy right now, but suffice to say it was a very dark time. I have always managed to be quite blindly optimistic about life, but this ability had now left me. I was in a dark tunnel and there was certainly no light at the end of it. I wasn't suicidal. I was just stuck. I couldn't go backwards and I couldn't go forwards. I was just stuck in this hell of turning 40, not being a mother, and the prospect of being a mother looking more distant than ever. Of course it seemed during this time, more than usual, that new pregnancies were being announced every week. I had to keep being pleased for other people. Which gets very draining. It's not that you're not pleased for them, but you want to join in. Desperately. And it's so confusing and incomprehensible to know that your body doesn't do what most women's bodies do so easily. I would look at pregnant women, stare even, as if I could absorb by osmosis their ability to reproduce.
Those six months were hellish. My relationship with Sue hit an all time low. I turned 40. We bought a house. Life seemed in chaos. Here I am trying to have a kid whilst my relationship falls apart. Here we are buying a three bedroom house when there are no kids to fill the bedrooms. How did life go upside down like this. I'd had enough dramas in the past, that I won't even go into, but certainly enough to think that it was my turn to have the good things. The time crawled by. I put one foot in front of the other and hoped that I could keep my head above water. But it was bloody hard. I hated someone at work who was young and carefree. She seemed to me to be everything I wasn't - light and fun. I don't hate her, she's sweet. I hated me and what was happening. It's horrible finding yourself feeling so hateful to people who have nothing to do with your predicament. I don't like resenting other people, and I don't like wanting what others have because as we all know really, nothing is what it seems. I just wanted my version of family. I was having to undo 35 years or so of belief that of course I would have kids by now. I remember laughing about how I wouldn't be forty and having my first kid. I was right but not in the way I thought.
For one who had never enjoyed Christmas, this time, the new year brought relief for some reason. I had never been so relieved to say goodbye to a year.
Wednesday, August 15, 2007
With the minimum amount of time between cycles, we moved swiftly onto preparing for a frozen embryo transfer cycle. This is a much much simpler procedure than IVF – no needles, fewer visits, and only a few hormones taken orally. I think it was relatively simple for me because my cycle is very regular. You can even do FET with no intervention whatsoever if you want to go natural and your cycle is regular. Anyway, compared to growing 20+ eggs and having them painfully removed (did I mention I was shuffling for the best part of a week after that first egg collection?), FET is a walk in the park. Practically nothing.
Physically speaking that is. Emotionally it's the same old journey of optimism, fear, anxiety and patience. The two week wait is as the first, initially happy descending into your own personal hellish waiting room a la Huit Clos.
As with IVF number one, I started bleeding a day or so before the pregnancy test was due. My spirits fell, although I had tried really hard not to raise our expectations at all. I felt defeated again. Why couldn't I just be one of the lucky ones. Why were my dam periods so irrepressible. It made mockery of all the times in my 20s + early 30s that I worried about being pregnant. I took it easy, again. I went to the clinic for the blood test I knew would be negative, again. I sat there pretending to be light hearted while they took the most important blood test of my life, again. I probably even listened to the chirpy 'you gotta be in it to win it", again. And I went off home to put my feet up, again. At lunchtime, I put in the progesterone suppositories and thought, what's the point, I'm about to get the confirmation that it's negative, what a waste.
And the call came. And she said – it's positive. Very positive. You are most definitely pregnant.
What? Sorry? I'm pregnant? Are you serious? What's my score?
My score was very high, indicating twin pregnancy. Jesus, thank god I was lying down. I called Sue to tell him. I barely got the words out and he said I'm coming home. He came home. Cried. Had a cup of tea. And went back to work. I'm still lying down cos I'm still bleeding.
To jump forward three weeks: the pregnancy didn't take. However I spent three weeks feeling quite blissful. Shoving suppositories up my bum regularly and lying down didn't bother me. I felt special, I felt content. It was Christmas, what a great Christmas present. But deep deep down I think I knew the pregnancy wasn't developing. You're tricked by the effects of the progesterone, but deep down I knew. It's amazing how much you know your own body even during a process where you're in the hands of people who supposedly know more than you.
Sure enough, come the 7 week scan – nothing there.
How low can you go? Oh, much much lower.
Sunday, August 12, 2007
The waiting in between IVF cycles is quite something. Although you are not actually doing IVF at this time, you are thinking about it, planning the next one, so you're not clear of it for the intervening months that's for sure. You pretend to yourself that you're resting, but you're not. For me at this stage, every day that passed was a day closer to becoming pregnant, and another day lost to not being pregnant. But it's a good way to distract yourself from the crushing feelings of the previous failure, so it's useful in one sense....
The waiting during IVF is quite something too. The daily anticipation of needles determined by the almost daily blood tests to check hormone levels. Waiting for the phone call to let you know whether to up or lower the dose, or coast. Waiting to get more injections out the way so you can put a big inky cross through another day on your IVF schedule. Waiting to hear how many eggs they got, waiting to hear how many embryos they got, waiting to hear how many of those are actually viable and waiting for the confirmation that embryo transfer can go ahead. And then the mother of all waits, the two week wait. Aaaaaarrrrggghhh!
The first of those two weeks is strangely pleasant. The culmination of all that hard work is there, in your belly, you know they're there cos they show them to you going in. And for one sweet week you can pretend to yourself that you're carrying babies. It's quite a delightful feeling to those of us that need help with it and have never experienced pregnancy officially. I spent the first week on my first cycle slightly floating, never feeling quite alone. And feeling instantly protective of my belly. It was a lovely feeling, brief though it was.
The second week is hellish. You start anticipating the period. You are constantly evaluating how you're feeling – are my boobs swollen, do they hurt, do I feel crampy etc etc. But you forget that the progesterone makes you feel like that anyway so it's probably all pointless analysis. Nearly every minute that passed I was thinking I could feel my period coming on.
Then it did and my wait was over.
But anyway, onward march to IVF number two which as previously mentioned was to be far easier as it was a frozen embryo cycle. Almost not IVF at all really, hardly worth worrying about...
Wednesday, August 8, 2007
Where was I? Oh yes: sat in park having lunch with colleagues. See lone magpie. Salute it, say good morning to it, nod three times (etc etc). Then feel my period hit. Go to loo. Blood. Dammit.
Phone clinic who tell me it's not necessarily bad news and to go home + put my feet up. Deep down I know my period is here to stay, but I opt to go with their opinion that it may be ok, and I go home to put the feel up as instructed. The feet stay up for two days, but the period keeps on coming. I go to the clinic two days later for the pregnancy test, knowing by now it's a negative, but somehow there's an optimistic bit of me that's saying - don't worry, it might be ok, you might get a nice surprise. But I don't. It's negative. I find this out in a phone call a couple of hours after test. The nurses deliver this news god knows how many times each day and they are used to being sensitive to the recipient. However they do still say bland things like "You gotta be in it, to win it".
... I have no response to that other than a feable nod.
I take a few days to crumble upon failure of IVF number one. I was so optimistic. I was so sure I'd be lucky and get it right first time. I'm slightly numb at the news that my body has failed me. Then almost immediately I shift into looking forward, planning the next round, letting go of the disappointment in favour of forward movement. Well, hardly anyone gets pregnant first time do they, it's usually 2nd or 3rd time because the clinic knows how you respond to the treatment better. I presume they will alter my hormone doses next time as I responded so quickly to the stimulation. I can't wait to book the follow up appointment in order to make my plan with the doctor. I am now officially on a mission. And I say 'I' on purpose. What about Sue? He is pretty much just caught up in my back draught from here on in. Despite being told "Don't put your life on hold, Don't become obsessed, Pay attention to your partner, There is life beyond having babies" and other helpful advice, I do of course put OUR life on hold no matter what husband wants, I do become obsessed despite thinking I am not and as far as I am concerned if I don't become a mother, I am nothing.
At this point there is a two month hiatus while I have the period, have another period, excercise, "get myself back" and vaguely focus on work. I am still firmly fixed on the next cycle of IVF, which will be much easier as we have some frozen embryos. Oh yeah, here's the summary of IVF number one: 25 eggs collected under anaesthetic. 10 embryos fertilised. 2 discarded within a day. 2 put back at embryo transfer and 6 frozen.
Thursday, August 2, 2007
When will the pain stop?
That's the first I say when I come to, a bit groggy, but I don't come to enough. My husband is there with me and the nurse looks a little concerned that I am still very woozy. Suddenly my pulse and my blood pressure drop considerably and she has to give me something to pep me up. I pep but I stay there a couple of hours recovering. We're told the doctor collected 25 eggs. Apparently that's a lot. My belly tells me it is a lot. The taxi ride home is painful, London is full of speed bumps.
I spend the next couple of days before embryo transfer shuffling around, mainly to the loo. Any pressure on my bladder is killer so I am peeing constantly. Turning over in bed hurts. It all hurt. But I didn't care, I had ten embryos busy hatching.
The embryo transfer (ET) is easy. I was still very tender from the egg collection, but the ET is fine. It's quick, the doctor gets a good view of the uterus and pops in the two selected embryos without complication. Before they go in, the embryologist shows them to me on a screen. How wierd. I imagine them with little faces. And from that moment on, for most of the next two weeks I never feel that I am alone, and it's a lovely feeling. I immediately felt protective of my belly, not wanting anyone to bang into it, not wanting to move too much, stretch, or make any sudden moves in case I disturbed them. That's the problem with knowing the embryos are there, you feel more fragile than you probably do if getting pregnant naturally.
The first week of the two week wait is fine, I feel optimistic and I enjoy the sensation of wondering what they're up to, imagining them implanting. However the second week, that's hellish. Every day that passes brings you one day closer to your due date for the period, you scrutinise how you are feeling all the time - do the boobs hurt, do you feel premenstrual, can you feel the arrival of your period, it's endless. It becomes a minute by minute watch, time crawls by.
Then I'm having lunch in the park the day before I'm due to go the pregnancy test and I feel my period come on. You know instantly don't you. Bugger.
Wednesday, August 1, 2007
On Monday this week, 30 July, Sue and I made a very important decision. I won't share it with you just yet because it would mean revealing the outcome of all this fertility lark (to date) and I kind of want to avoid that because part of the slog of fertility treatment is not knowing what the outcome will be, so I would like this blog to be read without the reader knowing too. I hope that makes sense...?
Ok, back to the story – no doubt very good, but personality defficient private doctor number 1 is now out the window. No way am I going to pay someone to treat me like that, there are far too many emotions involved already for that sort of messing around.
A bit of research with the HFEA's clinic guide and a personal recommendation or two later, we make an appointment with another private clinic in London. We go, doctor is lovely. He even has a book on the shelves behind him with a title something along the lines of "The Emotional Side of Infertility". I'm sold. Even if he's pretending and hasn't opened the stupid book. The whole question of Hydrosalpinx is raised again and although Doctor No. 2 knows Doctor No. 1 and Scan Man, and has no reason no doubt either of their findings, he decides to scan me himself to verify the condition of my tubes. Hydrosalpinx is very visible (I believe) even with a 2d scan. He sees no evidence of Hydrosalpinx. To be sure however, he asks me to come back a week or so later at a different point in my cycle, to double check that it is not present. I do. It isn't.
Your first cycle of IVF (or ICSI or whatever) is almost great. Because finally, after months of tests, results and appointments to discuss things, you are doing something that may result in a baby. You discuss the protocol with the doctor, you get your schedule, you collect the hormones, they show you how to inject yourself with a fake belly, you stick the timetable on your fridge and you start marking off the days, one by one.
The first injections are terrifying. I was obsessed with the air bubbles and making sure the syringes were bubble-free (almost impossible especially when with sweaty nervous fumbly palms you drop them on the floor a few times) in order not to die from an air bubble making it's way to my heart. Dramatic, yes. But those are the places the mind goes when suddenly you are immersed in a medical world. But I was also surprised, pleasantly, at how thin the needles are and how easily they slide into your flesh. Like a hot knife into butter. For the next 2-3 weeks this is what your life is about: injections, scans and blood tests. Work is something you do along the way. I was very VERY lucky to have incredibly understanding bosses (one of whom had experienced infertility therefore knew directly what I was undergoing) which meant I didn't have to lie and cover up why I might be behaving oddly, and why I was coming and going every other day.
At this point, cycle number one, you are filled with hope and that hope carries you a long way. It carries you through the pain of sticking needles in yourself every day and having little bruises all over your legs and belly, of going for appointments, of having your life governed by this medical procedure when other people just get to have a shag. In my case, having been told by all doctors that I was a great candidate for IVF, I was brimming with hope and optimism, certain that I was on the path to having a baby, that it was now in my reach. I specifically waited to do it during August so that it was warm and life felt more relaxed.
I responded well to the hormones, very well in fact, to the point where toward the end of the hormonal stimulation phase (and I was on the short protocol anyway) they had to coast me to avoid Ovarian Hyperstimulation. I apparently had a 'beautiful' uterus and ovaries that looked like the surface of the moon, follicles a-go-go. I was drinking enough Evian to pee pure mineral water and I was feeling frankly good all things considered. They told me I was ready for the egg collection, the final injection was given to me with strict instructions on what time to have it, and told me to bring myself in on Sunday morning 7am, food and drink-free from midnight.
LESSON No. 3
Apparently drinking lots of water helps during the hormonal stimulation, especially when you have lots of follicles. It's something to do with pockets of fluid left behind when the eggs are harvested, being well irrigated means you are less likely to suffer ovarian hyperstimulation following the egg collection. Drink 2-3 litres per day. Treat yourself, buy in Evian from the supermarket to make it easier.
Saturday felt like a national holiday. A day without drugs. No blood test, no internal scan, no toing and froing between the clinic and work, no needles. But it was the calm before the storm. I had never been under general anasthetic, but because I had so many follicles they would have to knock me out completely as egg collection would take while, too long to be kept conscious. I arrived with Sue, we're both incredibly nervous, you kind of don't know what to do with yourself. At this point you realise how important it is that you trust the clinic in whose care you are, it's imperative.
I get called, I say bye to Sue as he goes upstairs to have his special moment. I go to the room attached to the surgery room, I undress, go in, lie on the bed and see nothing but the shiny metal stirrups staring at me. You start lying flat on your back but you know that very soon, your feet will be up there... it's a very wierd thought that you will be unconscious and someone will whip your legs up and be fiddling around, down there, with your mimsy. I'm a strange mixture of calm and terrified. The anasthetist chats inanely and I feel the cold curtain of blackness descend.
... Next: post-egg collection and all that goes with it.
Wednesday, July 25, 2007
So, there I am with Husband, let's call him Sue. We're in a little room at local NHS hospital, just been told we need to have IVF to have a baby, and I'm simultaneously numb and crying a bit while Sue does his husbandly duty and provides a shoulder. I don't really think we realise the full ramifications of what it means, not in that instant. I very quickly went into thinking, ok, I've not been told I can't have a baby at all, I just need some help. The lady doctor tells us that blocked tubes are a very mechanical error, that IVF is very successful in such cases and that really, pull myself together and get on that (year-long) waiting list for my one free go, and we'll have a baby in no time.
LESSON NO. 1: IVF is a postcode lottery. Where I was originally treated, you get one measly free go (as long as you're under 40). Elsewhere in London, I know some areas that give three cycles of treatment free on NHS. What I didn't know then is that you're not obliged to stay at your local hospital, I think you can pick a hospital you like and get referred there for the actual treatment, once it's established that you need it.
We decide, as I am 38 at this point, not to bother waiting for our one free go at depressing local hospital with rubbish success rates, we decide to go private.
LESSON NO. 2: success rates must be interpreted. Don't be fooled by ridiculously high success rates. Look at the 'live birth' rates as this is number of babies born, not pregancies, as they can fail of course. And somewhere like our local hospital had low success rates because the general population they serve are extremely unhealthy, overweight etc.
CHOOSING THE CLINIC
Deciding on which private clinic to go to was the next challenge. Luckily it was made a little easier by two things: we live in London and we know people who have had fertility treatment who gave us their recommendations. We visited the first clinic, a very reputable doctor who works both privately and on the NHS. He was stern, but I felt like he would give us what we wanted. We went armed with all test results from the NHS hospital and he decided to send me for a 3d scan at a Harley Street scanning specialist so he could see better what's going on with my tubes. Hydrosalpinx is a common side effect of blocked tubes and he wanted to check for its presence before proceeding with IVF. When we attended the private scan man, he didn't seem to find anything conclusive, he certainly didn't say "yes, I see hydrosalpinx on the right tube". So back we went to the IVF doctor. But he hadn't received the results yet. £400 for a scan and they hadn't managed to fax or send the results a week later... slack. IVF doctor asked how the scan went, we said we thought it had gone ok, that scan man had not seen anything untoward. IVF doctor said ok then, let's proceed with IVF. Although we were excited, we said - shouldn't you wait to see the scan results for yourself...? After a little persuasion from us, he called his colleague scan man, and the result was faxed through.
Everything then changed. He decided that there was a possibility of hydrosalpinx and his next offer was an operation to remove my fallopian tubes. Coincidentally, the NHS folk had mentioned a laparoscopy too, but instantly dismissed it saying - don't bother with that, go straight to IVF.
LESSON NO. 3: don't assume the doctors are always right or give you the space to question what they say. You may have to be strong willed and determined. You may have to go away and look things up. It's entirely possible that in not questioning this laparoscopy there and then, I proceeded to waste two years, twenty grand and pump my body so full of hormones I went a bit mental.
We came out of that appointment confused to say the least, and I in floods of tears. The doctors may know the physiognomy of fertility treatment, but they don't necessarily care about the psychology of it.
One NHS and one private clinic down... where to next? Stay tuned for next instalment. God almighty, it's exhausting reliving all this stuff!