Category: IVF preparation

A discovery – How far are we willing to go?

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Whilst on our epic South West USA road trip, Chris and I had lots of time to talk to each other.  You could almost say we lived in each others pockets for two weeks…some couples might break…but for Chris and I we kind of thrive on it, and it brings us closer together.  I think we only had one small ‘argument’ on this trip, but you could probably describe it as more of a strongly heated debate rather than an argument as such.  Anyway, the point is, we had lots of time to talk about some of the bigger things in life.  Surprisingly, we didn’t talk about our future as prospective parents for several days.  It wasn’t until I received a phone call from our fertility clinic that we got around to talking about it again.

The topic of conversation was how much more can we deal with all the infertility treatment?  Can we deal with another miscarriage or ectopic pregnancy?  The likelihood for another ectopic pregnancy almost doubles after you have had one.  What about dealing with a negative result?  We discussed whether to transfer our one frozen blastocyst or to go for another round of IVF/ICSI.  Yes, a frozen transfer would require injections, but I would avoid the egg stimulation and egg retrieval process which, for me, was very painful the last time around.  Chris wants to avoid me being in pain as much as possible.  He hates seeing me in that way.

I understand his point of view, it is hard for a partner to see their loved ones in pain over which they have no control.  But I feel differently, I feel like I know what to expect, how to better deal with the symptoms and feel overall less anxious (although I think I was pretty cool in my attitude about the first IVF cycle).  I feel ready to get some embryos frozen into reserve.

I am 32 about to turn 33.  If we go for the frozen transfer and we succeed in a pregnancy (!!!!! That would be awesome!!!) then I will be 35 by the time we are ready to have a second go at it for child #2 – my egg quality is likely to reduce and we could be facing an additional factor to our unexplained infertility.  So I figure it is best to do one more IVF/ICSI cycle now and we have one in reserve.  Perhaps I sound a little greedy in this respect – we are lucky to have one frozen right now!  I don’t mean to be – but I am an operational analyst after all, so I can’t but help try to figure out the optimal solution to a problem.

I explained to Chris my reasoning for going ahead with another round, and he gets it.  He admitted he hadn’t thought about age related factors for the future.  So we have both agreed that tomorrow we will ask our doctor about going ahead with a new round of IVF/ICSI.

But this isn’t really where the story ends.  I think Chris and I have different ‘lines’ to draw under how far we are generally willing to go to get our own baby in our arms.  How many times is enough to say we gave it our best shot?  How many times can we deal with sadness?  Will we ever become numb to it?  Depending on the nature of the outcome for round 2 will create different visionary paths in our heads for each of us, we discovered that they are not aligned at the moment.

This isn’t an easy topic to talk about without accidentally hurting each other with words that first come to mind…. so we are going to try writing down our feelings on paper and swapping our ideas so that we can understand each other’s perspectives.  I don’t know whether it will work, I hope it will help us at least gain a respect for each other’s feelings.  Love and marriage is unconditional, but feelings can easily get hurt when we are talking about something so passionate as becoming parents and how to do it.  Infertility knocks you for six when you discover that you can’t become a parent the ‘normal’ way.  So I think it is healthy to have this exploration of feelings and keep things open between each other.

Perhaps we will share these letters to each other on the blog at a later date, but for now we just need to focus on getting to the same place together.

The healing power of Stockholm and my Nobel Prize

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As I return from my work travels in Stockholm, I have some down time to reflect upon our recent failed first round of IVF.  I say ‘failed’…it’s actually quite difficult to say with any confidence that it was actually the IVF that failed us.  It is possible I suffered an ectopic pregnancy, but the doctors were unable to confirm it, although they treated me for it with methotrexate to terminate the pregnancy to be on the safe side.  Something was growing, they just could see it.  If my pregnancy was truly ectopic, then it wasn’t the IVF that caused the demise of my pregnancy….the IVF treatment managed to get me pregnant, but my body decided it wasn’t going to succeed; my body simply decided that this wasn’t my time to join the pudding club.

Or it could all simply be described as just terrible bad luck.  Sometimes, there is just no reason known to man why Mother Nature can be so cruel.

Of course, it is natural to blame oneself.  There are several potential causal links to an increased risk of ectopic pregnancy: tubal damage, smoking, age, IVF – all of these increase the risk: approximately 1-2% of pregnancies are ectopic.  But mostly there is just the plain and simple element of unfortunate luck.  You can find on the web doctors who speculate that the risks are higher with IVF because either:

  • a) With a 3-day transfer, the embryo that would ordinarily be in Fallopian tube at this stage, seeks out the more fluffy warm tubes because that is where it thinks it should be, then gets completely lost and doesn’t ask for directions.
  • Or b) the doctor who performs the embryo transfer procedure places the embryos too high up in the uterus; or they are transferred too quickly and end up in the wrong place.

However, my doctor explained to me that statistically speaking, the risk of ectopic pregnancy doubles with IVF because generally there are two embryos being transferred and so that risk doubles from 1% to 2%.    This makes a whole lot of sense to me.  I was just unlucky.

I am thinking through all of this right now because I need to take away something positive from this failed cycle.  I’ve got to get my cup half full again….and so the positive could be that we just needed that extra help from ICSI or the hormones, and I was just one of the really unlucky ones to not stay pregnant this time.  Next time might just be our time.  There is still no reason why it shouldn’t be.

I was feeling a little sorry for myself in my last post.  But the last couple of days have been an improvement, and it is starting to look like our path is finally beginning to flatten out, allowing us to take a breather.

Time to catch a breather before heading off on to the foggy path called infertility.

Time to catch a breather before heading off on to the foggy path called infertility.

I have been kept mentally busy with work, socialising and networking with my colleagues, so I have had little time to think emotionally about the failed round of treatment.  Physically, the pain has dissipated, the bleeding continues (seriously, where does it all come from?!!?), but it is a very small amount that it has barely bothered me.  I still feel exhausted, but jet lag most likely lays claim to the cause of that.  I miss my pre-natal multi-vitamins, I really hope to be allowed to take them again soon.  They help keep my bowels in shape and my energy up.

And I will grow back my positivity because over the next 3 months as we have a plan to get us to our next IVF cycle (hopefully if I get the all clear from my repeat HSG!!).  In short – we have our 2 week, 2000 miles, road trip starting from Las Vegas, visiting various amazing places like Grand Canyon, Zion national park, Bryce Canyon, Monument Valley, Santa Fe, Albuquerque, Petrified Forest, Painted Desert, Hoover Dam and a whole lot more.  I have another 3 work trips to Europe to fit in – Munich, Berlin and Brussels/Mons (I haven’t been to Berlin yet so that is exciting!).  We have a consult with our doctor scheduled for late October to discuss the plan for the next cycle.  I need to find some time to fit in a HSG once my period returns (seriously NOT looking forward to that).  I am hoping my body is going to play nice and we can get an IVF cycle in just before Christmas.  It’s also Chris’s Birthday soon and I want to organise a small party for him.  And amongst all that we are going to try and fit in a weekend away to Shenandoah National Park to see the beautiful colours of autumn.  No time for stopping over the next 3 months!!

Stockholm has done me a lot of good (despite the jet lag), I’m feeling mentally refreshed and excited to be moving forward.  However, I was very disappointed to discover that my invitation to pick up my Nobel Prize must have got lost in the post.

No Nobel Prize for me.....But it was beautiful!

No Nobel Prize for me…..But it was beautiful!

But I did get a chance to scope out the building they award them in, the museum my name would be listed in, and the best restaurants to celebrate at….May be someday I’ll be back 😉 bahahahahaha – Keep dreaming Dani!

The Nobel Museum, Stockholm

The Nobel Museum, Stockholm – Something to reach high for 🙂

How to get the most out of your doctor

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It took me about 24hrs after it was confirmed that I am pregnant to realise I do not know how to be pregnant.  This might seem very weird considering we have been talking about this moment for more than two years now.  Once we started trying to conceive I just of buried my head in the sand.  I didn’t want to jinx our chances by buying a book about it, and I started to avoid all pregnancy related websites and apps after 6 months of failing to succeed in our quest to make a baby.  I know the basics, like smoking is a big no-no, drugs are dangerous, avoid raw meat and reduce caffeine, but really, that is the limits of my knowledge.  So yesterday we went to the book store and bought two books on pregnancy.  One was the standard text book “Great expectations: Your all in one resource for pregnancy”, and the second was “Expecting Better”, beautifully demonstrated in this picture by Sushi:

Sushi, my book keeper

Sushi, my book keeper

This second book interested me because I have always wondered whether Japanese women stop eating sushi, or French women stop eating brie when they are pregnant.  Really?  I don’t think so.  I hope that this book will enlighten me to what the conventional wisdom really means.  But when I started reading the first chapter I didn’t need to go much further with it to be completely satisfied with my purchase.  Why?  Well the author, Emily Oster, is not so different from me, she was not happy with what her doctor was telling her.  I realised that my experience with my fertility clinic’s doctors and the feeling I had that there was a poor lack of communication.  All of this was because I was not asking the right questions.  I didn’t know I needed to ask them.  And this is silly because all along I had the key questions in the back of my mind…I use them everyday at work!!!

In my job I help leaders make decisions every day…I do this by presenting the evidence, the facts – for and against a decision – I do some analysis on the data that supports the decision, I try to be unbiased and objective in my analysis, and then I present a recommendation to the leader on the best course of action.  The leader doesn’t always go with my recommendation, but I have presented them with the facts and figures to make their own mind up.  Sometimes I feel a bit hurt, but then I remember, I am not the one taking the risk.  So when it comes to our healthcare and doctors, WE are the decision makers.  We need to be presented with the arguments for and against, and be told what the supporting evidence is.  WE are unique in many different ways and the decisions we make will be unique, blanket guidelines are not always appropriate for everyone.

I think a good example of this is when we were told we should do ‘ICSI’ because of our unexplained infertility.  We didn’t ask the questions:  What are the pros of ICSI?  What are the cons of ICSI?  What are the improved success rates with people like us? (i.e. what’s the supporting evidence/data?)   We were not armed to make a decision, we just went with what the doctor said, and in the back of my mind I felt like I had not been given a chance to make a decision.  I did actually do a lot of this research myself, but it would have been better if my doctor would have told me – after all I am not the medical professional, I just have the fortunate ability to interpret statistics from studies and experiments.  So although I was finally happy with the decision to do ICSI after my research, something inside me was niggling about our doctor’s communication.

Another example is when it came to our embryo transfer.  We were told that it is the standard practice at the clinic to transfer 2 embryos on day 3, unless there were over 6 fertilised embryos then maybe we would be a candidate for waiting to Day 5 to transfer 2 blastocysts.  We did not ask the questions: what are the pros of us waiting to Day 5? What are the cons of us waiting to Day 5?  What are our personal chance of success with 4 fertilised embryos compared to if we had had 6? (i.e. what’s the supporting evidence/data?).  Again, I did a lot of this research myself.

I could go on with other opportunities throughout our infertility treatment where I could have asked these three simple questions that would have revealed the knowledge I needed to feel like I was in control of making a decision.  We rely on doctors to make the decisions for us…and most of the time I am happy with that fact, but there were times that I felt like we should hold that responsibility for a decision.  When it comes to my pregnancy I want to be able to ask these questions to my doctors and nurses so I can take the responsibility for making some of the big decisions such as prenatal testing or birthing plans.

Emily Oster suggests reading the book “Our medical mind: How to decide what is right for you” by Jerome Groopman and Pamela Hartzband.  I think I might try it, and I’ll let you know how it goes.  Has anyone read this one?

In the meantime my friends, next time you are in a consult with your doctor, remember these three simple questions to help you make the best decision, for you, and get the most out of your doctor….

  • What are the pros (for me)?
  • What are the cons (for me)?
  • What is the evidence/what are the chances (for me in particular)?

What does it all mean? Pt 2: Drugs & Hormones

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Hormones, hormones, hormones…why am I injecting all these hormones and what do they do??  This is a good question – apart from doing as I am told by the doctor, I thought I should be able to at least answer this question to my friends and family  who ask: What does each drug do and why I am taking it?  So I am going to have to go back to school with this, I hope I am not patronising.  I am sure I could recant all of this from my biology classes if they weren’t almost 20 years ago!!!

There are several ways a doctor can choose to stimulate ovaries for IVF treatment, these are called protocols and they can vary in dosage, type and timings.  My doctor has chosen the antagonist protocol for me.

Back to basics...so let’s take it back to school…there are four major hormones involved in the menstrual cycle: FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone), Estrogen and Progesterone.  Today I am going to focus only on the first two weeks of the menstrual cycle, also known as the follicular phase.

During the folliclar phase, in a normal menstrual cycle the following events occur:

  • FSH and LH are released from the brain and travel into the blood to the ovaries.
  • These hormones stimulate 15-20 eggs in the ovaries, each in its own “shell”, called a follicle.
  • These hormones (FSH and LH) also trigger an increase in the production of estrogen.
  • As estrogen levels rise, like a switch, it turns off the production of FSH.  This careful balance of hormones allows the body to limit the number of follicles that mature to just one.

So what does this mean for IVF?  The goal of IVF is to produce as many mature eggs as possible to create conditions for the greatest chance of successful conception, to do this doctors use injectible hormones to control this phase of the mentrual cycle and stimulate the growth and maturation of the eggs, ready to be fertilised.

So we know that FSH stimulates the growth and number of small follicles, for small follicles FSH is the major survival factor that enables them to develop beyond 5mm in diameter and to avoid apoptosis, i.e. the programmed death of a follicle and egg.  In a normal menstrual cycle, multiple small follicles produce inhibin-B to lower FSH levels so that only one follicle will mature.  In an IVF cycle, artificially increased FSH overides the inhibin-B levels and therefore allows multiple follicles to grow and mature.  This is where the drugs Gonal-F and Menopur come in.

Gonal-F is a follitropin alpha medication (also known as a gonadotropin).  It is a synthetic version of the naturally-occurring FSH.  Where as, Menopur (also a gonadotropin), a combination of both FSH and LH, however unlike Gonal-F, Menopur is natural; it is extracted and purified from the urine of post-menopausal women -ummmm nice.  It is believed that a small quantity of LH during ovarian stimulation produces a better result in some patients.  It is for this reason that my doctor prescribes a combination of the natural and synthetic combination of gonadotropins, menopur and gonal-f.

As the gonal-F and menopur start to work, we need to make sure ovulation doesn’t occur prematurely, therefore they use the injectible Cetrotide.  The active substance in cetrotide is cetrorelix, this blocks the natural hormone LHRH (Lutenising hormone releasing hormone).  LHRH controls the production and release of LH which causes ovulation.  The cetrotide stops the production of LH, preventing premature ovulation.  This allows the doctors to carefully control when ovulation will occur.

The trigger injection.  The controlled hormonal stimulation I have described so far usually lasts for about 8-12 days, and dosages vary depending on how the woman responds to the drugs.  This happens all before another drug is injected – Ovidrel.  Ovidrel is the trigger injection containing a synthetic form of the hormone human chorionic gonadotropin – hCG.  There are several brand names for the hCG trigger shot including Ovidrel, Profasi, Pregnyl, and Novarel.  hCG is known as the pregnancy hormone, but it also happens to be molecularly similar to LH. In a natural cycle, LH triggers ovulation. As part of fertility treatment, an injection of hCG is used to trigger the maturation of eggs.  Ovulation usually occurs 36 hours after this trigger injection is given.  In the case of IVF, egg retrieval is carefully timed to collect the eggs just before ovulation, but long enough that the eggs have matured in the body ready to be extracted for fertilisation.

In part 3 I will focus on explaining the second phase of the menstrual cycle which includes the lovely hormones estrogen and progesterone….yippeeee!!!

Life lessons and bloody blood. For blood’s sake.

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I stopped my birth control pills as instructed by the nurse on Monday (cycle day 13).  Today, 3 days later I get my period….now come on Aunt Flow…..you just stopped bleeding only 6 days ago!!! And of course the bleeding is accompanied by the usual pains 😦

Oh well, only conciliation is that tomorrow we start our first IVF cycle.  Am I nervous? Yep! Excited? A teeny bit, because we are moving forward, hopefully!

Whatever happens over the next four weeks, good or bad, we will learn something new:

  • Chris will learn how to stab me with various needles.
  • We will learn how to mix up our own drugs.
  • I will learn how good or bad my veins are for drawing blood.
  • I will learn that my vagina is no longer my own, not even during my period.  Sorry Chris.
  • We will learn about how my eggs and Chris’s sperm work, or do not work together.
  • We will learn about hope, love and strength in our marriage.
  • We will learn whether we will become parents.

Plus loads more…I like learning new things so my glass is half full right now, despite how scary that list looks 🙂

It can be all a little bit confusing

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Infertility treatment IS pretty darn confusing.  And I’ve spent 100s of hours researching it.  It’s confusing because there is no one single way to treat infertility.  If they had figured out a magic pill to get you pregnant we would all be taking it.  Unfortunately, there isn’t that one pill.  There are many causes of infertility and so treatment is specific to the couple being treated.  The journey each one of us take to the great pudding club will be unique.  And it can be confusing with all that medical jargon, drugs (brands and generic versions), procedures, timings…and to make things worse, it will probably be different each time we have another try to make a little one.

We have been asked many questions by friends and family about our infertility, and I am so glad they do ask – firstly, it shows that they care, and secondly, it helps spread awareness of infertility (did you know that 1 in 10 couples are infertile?).  So to this end, I have put together a page on my site that introduces some of the important terms we talk about a lot, all in one place.

(My new page: What does it all mean?)

I have also updated the ‘about me’ page to include a timeline of what we have tried so far.  We will be using these pages as a place to direct family and friends for a bit of background as we start our first IVF cycle and tell a few more people what we are going through.

My dear friends, I just wanted you to know how grateful I am that you are here with us and support us along the way.  Thank you for understanding and thank you for providing us with words of strength and comfort X

IVF Diary Vol I: 04 – 09 July 2015

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IVF_Diary_Vol1I’m starting my IVF Diary today.  I’m going to be tracking a few things about my first IVF experience over the next 6-7 weeks .  I’ll be blogging too, but I want to capture the experience like this….in a kind of organised manner, to help give me some sense of control over something, because I fear that I will have to let that go!

Medication(s) administered and dosage(s). Ovulation Control Pill (OCP) Reclipsen 0.15MG-30MCG x 1

Medical procedures undertaken. Nil

How do I feel today?  I was feeling grumpy, then a bit teary eyed today.  No one asked me if anything was wrong, but I reckon some people probably thought I got out of the wrong side of bed today!  Which perhaps I did because it’s the first night I slept all the way through without needing to pee or wake up from night sweats….and then the alarm woke me up and I really didn’t want to get up.

What are my symptoms? It’s period time, so I am bleeding pretty heavily today with some gross and huge clots (sorry if that’s too much info, but this is what this diary will be – blunt and honest! It’s not going to be all fairies and sunshine).  I also have normal period pains and feeling of emptiness in my tummy like I want to do a huge fart or burp (It’s the kind of feeling I get when I am really hungry)

How does Chris feel today? Chris is very busy at work at the moment, but when I asked him he how he was feeling, he said he hasn’t thought about IVF today! 🙂

Any results? NA (but the nurse finally told me today that my blood test results for HiV, Hep B, C and Rubella all came back just fine even though I called her last week to check up on them and the results came back 2 weeks ago!)

What’s next? Hoping that my body can handle these Birth Control Pills!

150709_IVF_Stats

09 July 2015

Weight. NSTR

Waist.  NSTR

Boobs. NSTR

Hours of Sunshine 🙂 Not enough….0.25hrs (I walked to the shop)

*Notes.  I take First Response Reproductive Health multi vitamin gummies (pre-natal) and CoQ10 200mg gummies daily.  NSTR = Nothing Significant To Report.

Double Trouble: options for elective single embryo transfer

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Double trouble can only mean one thing – twins!  A couple of weeks ago our friend recently gave birth to two handsome little boys – fraternal twins.  I visited them after they were just a few days old, and as I held one of the boys I tried to imagine how it was possible to fit two of these little babies in anyone’s tummy!  I know they are curled up pretty tight in there, but seriously – it must be magic!  I am so amazed at how my friend carried these two boys to full term and not break her back!  I am also super impressed that she avoided a c-section, despite one of her boys being breach – what a super mum (mom).  And I am under no false impressions that it was easy!  So all this got me thinking about our first IVF cycle and the number of Embryos we will transfer…and our chances of twins.

Now…Chris and I have already discussed and agreed that we are OK with multiples…we had to make that decision when we had our IUIs, in fact for one of my IUIs I had three follicles, so there was always a chance for triplets! Yikes Treble Trouble.  But being OK with multiples is not the same as actively desiring multiples.  For IUI, it was kind of out of our hands how any eggs would fertilise and implant, it was still very natural.  But for IVF, we kind of have a choice.  Our clinic typically transfers 2 embryos for women <35 and first round of IVF, but of course, we can choose to just transfer 1.

I read somewhere that 29% of IVF patients said that twins were a desirable outcome.  Why?  Well it’s kind of like BOGOF (buy one get one free).  IVF treatment doesn’t come cheap, both financially and emotionally, so I can understand this logic.  But for me this is all about probability and gambling….not with money, but with needles and drugs.  Sure it costs $$$$s but fortunately we have it covered by insurance. It’s the emotional and physical cost that I am particularly nervous about.  I have no clue what it will be like, so I feel like for our first IVF round we can’t make a firm decision just yet how many embryos we will transfer. I want to wait and see what all these hormones are like first and what our doctor’s prognosis will be when the time comes.twins

However, that doesn’t stop me looking into it now.  Whilst I was surfing the web for more info on this subject I discovered an article that my RE had commented on regarding the a study that had shown single embryo beat double embryo transfer.  Her point of view on the study was very vanilla and cautious! Random. I also found that the CDC provide a good little list of things to consider for elective Single Embryo Transfer.

So for now this topic lays to rest until we get a bit closer to transfer day.  But until then, I’ll keep educating myself on what it might be like to be a mother of twins as well as help out our friend however we can with their teeny bundles of joy 🙂  So it’s not just double trouble – it’s also double the adorable 🙂

Starting my IVF diary

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I have been thinking about writing an “IVF Diary”.  Something a bit more formal and structured than my blog.  I will of course post my IVF diary on my blog and keep posting other things, but I wanted to create a bit of structure to my diary to help me.  Plus, I am all about the data (did I tell you I’m an analyst??!), I can’t help but think of it as s kind of data collection plan. Soooo this is what I think my template will be, but I would really like some input from anyone who has been through this before.  I’ve crawled some blogs to try and figure out what would be useful to monitor:

Day X, date, cycle #, cycle type

Medication(s) administered and dosage(s).

Medical procedures undertaken.

How do I feel today?  (i.e. my emotions)

What are my symptoms? (i.e. my physical reactions)

How does Chris feel today?  (i.e. his emotions, if he is willing to share them that is)

Any results? (i.e. blood tests, ultrasounds)

What’s next? (any thing significant in the next 24-48 hrs)

Weight. (has it changed?)

Waist size.  (has it changed?)

Boob size

Temp?? (should I do this or is it pointless because meds screw temps up?)

I want to start this week so I can capture a baseline of some of these stats before I start Birth Control Pills next week, like weight etc.

Do you think I have missed anything???

Pregnancy chances increase among women who soak up sun before IVF treatment

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Pregnancy chances increase among women who soak up sun one month before IVF treatment

I was researching my next blog post and accidentally came across this recent headline.  Basically, some Belgian researchers discovered that an increased exposure to sunshine one month before conception can increase chances of getting pregnant by IVF by more than a third.  WOAH.  An increase in chances of a positive outcome by a third?  Chris…quick book us a holiday to the Caribbean and let’s hit that beach! Stat!

Well, we do know that melatonin is important in cell development, as well as the importance of Vitamin D, so it does make some sense.  So I tried to hunt down the source of this claim.  It took me aaaages because the researcher they referenced was not the prime author.  Anyway.  It seems the researchers from Ghent University have not yet published their findings in a paper, but I did find their poster from the conference, so you can take a look at the results for yourself.  Now there are definitely some significant findings there, but as we all know, correlation doesn’t equal causation….but I’m happy to give the sun a go!  It’s pretty low risk, doesn’t require giving up anything and who doesn’t love a bit of sun?! Now, I wonder whether the factor of suncream makes a difference…hmmm….

So ladies – we all know about honey moons and baby moons…now we need to make pre-conception moons a thing #preconceptionmoon (I’m sure it will catch on).