Where’s Waldo??

September 3, 201514 Comments

“Where’s Waldo? – Do you know who Waldo is?”

My doctor asked me as she used the vaginal ultrasound to search my uterus and fallopian tubes for a potential sac. Today at my ultrasound appointment my doctor carefully searched as she discussed it with the more ‘junior’ doctor. The ‘junior’ doctor also had a go with ultrasound wand. But nothing was there – not even that black teeny dot from Tuesday was there anymore.

My hCG went up to 1066 from 686 (55% increase in 44 hrs). This is not the direction my beta levels should be heading in right now.

My doctor helpfully told us today that her cut off is 7 weeks for a decision on whether to use methotrexate; in the mean time if my hCG continues to rise she will closely monitor me every 48 hours with ultrasound and beta blood tests until 7 weeks. Today I am 6 weeks 2 days pregnant, so only 5 days left for me to miscarry naturally. She is now more confident that when I return on Saturday they will see the growing empty sac now that my beta hCG is above 1000. The question remains – where will this empty sac be? We are still hoping it will be in the uterus and not the fallopian tube.

So I’m still on ectopic watch for now. I have no bleeding or spotting, the odd pain twinge here and there, today I woke up a bit more nauseous and I’m starting to pee a lot again, so my ‘pregnancy’ symptoms are now returning as my hCG levels continue to rise. But overall I feel physically well, a little bit mentally drained.

Today I took a sick day which was a good idea because I am not sure my brain could have coped with work today, instead I spent some time doing adult colouring in. Very therapeutic, but sometimes I can’t stop because I don’t like leaving things unfinished, and then it stops being therapeutic as I create a chore for myself!!!

Anyway, until Saturday…..we continue to wait.

Sad, but starting to feel mad

September 2, 201521 Comments

This afternoon I had my mobile (cell) phone with me on loud so I could hear the doctor ring with my results. I get a lot of notifications and pings every 5 minutes so I am sure my colleagues were getting annoyed with me. But anyway, I received three pings all at once, which I thought was odd, so I checked my email to find a notification from my clinic for a new appointment, with my doctor tomorrow morning (The three pings were from my email and app that tracks my appointments). Well isn’t that just nice? My eyes started to well up because I knew this had to be bad news – what a crappy way to find out? After 20 minutes of consoling myself, I finally received the call from my doctor. My hCG levels have continued to rise again to 686 (Tues) from 345 (Fri). Not good news. So my doctor starts talking more about this potentially being a tubal (ectopic) pregnancy…she didn’t really tell me anything new from yesterday, she stressed again that there is zero chance that I have a viable pregnancy (OK so I got that from yesterday when there was nothing on the ultrasound).

Tomorrow morning I will have another ultrasound to double check my uterus for a (non-viable) pregnancy and some blood tests to see if I am suitable candidate for the drug methotrexate. I have done a bit more research into this drug, and I really want the doctor to explain all tomorrow – I will be using my 3 point guide to help me feel better informed! The best guide I found is from the NHS:

“The use of methotrexate to treat pregnancy of unknown location and ectopic pregnancy” available here.

I have been having some random (but not sharp) short pains today, including pain on the left side. I have also not passed any blood today. The problem is with Irritable Bowel Syndrome for me is that stress causes pain, so I am having a hard time distinguishing between the two – I don’t feel stressed per se, but this rollercoaster surely can’t be good for my gut.

In the meantime I’m looking forward to tomorrow’s appointment as I move from feeling sad to feeling mad – mad that this feels really unfair and crappy. I’m taking bets on how many med students/doctors/fellows/nurses they can squeeze this time in the room for my ultrasound tomorrow…..I have a feeling there will be some interest 😐

Nothing….

September 1, 2015September 1, 201520 Comments

There was nothing there on the ultrasound screen, just my beautiful uterus – empty. There was the teeniest tiniest black spot that may have been the beginning of a sac, but it was so small my Doctor was not certain. She didn’t need to say anything for me to quickly realise that I was not one of the lucky 1%. My doctor checked my ovaries: my right one is still hyperstimulated from the IVF and I had some VERY big follicles/cysts (but this is normal for after IVF and of no concern, but may explain any pain I may have here), my left ovary too was swollen, but not as bad as my right one.

What does this mean? It was difficult for my doctor to say without knowing what my beta test results are. If my hCG levels are continuing to rise, it is likely that I have a tubal pregnancy (ectopic pregnancy – a pregnancy that grows outside of the uterus). If my hCG levels are falling, then it will be safe to assume that I have a chemical pregnancy* and the little black spot on the screen was indeed huckleberry.

My symptoms have been spotting dark brown blood since Friday, general abdominal pains all day Monday, my spotting surprisingly stopped today (Tuesday). I have had some pains specifically on my left side, although not overly sharp pains, and I pointed out to the doctor (doctors – there were 2 others in the room with her) where this was….yeh, about where my ovary/fallopian tubes are.

If this is a chemical pregnancy then the doctor will prescribe me some medication (a vaginal pessary, I cannot remember the name of it) to help my body along with expelling the uterine pregnancy. If this medication doesn’t work, or my hCG levels come back higher with a likelihood of a tubal pregnancy, then I will be prescribed Methotrexate (an intramuscular injection – YEY another injection, of course!!!). I want to avoid taking this drug because it will mean we are not allowed to conceive for at least another 3 months because the chemical can stay in the body and harm a developing embryo. But at the same time, we don’t want to wait and see for too long because there is a chance my tube could rupture and I would lose a fallopian tube. I have read that even after being given the shot their tube still ruptured because it was left too late.

So I was asking you to hope with me that I didn’t bleed, but now I want to bleed….please, please body, just bleed!!! I think this will be one of those times when I cry tears of happiness when I start to bleed full flow! I know it will also be sad at the same time….choo choo, all aboard the emotional train wreck!!!

I mentioned that there were two other doctors in the room, one was ‘shadowing’, the other was a fellow (no not a chappie you silly Brits!!!). The fellow interjected and answered some of our questions, he was clearly very knowledgeable, but there was a lot of bouncing around between them. Chris was getting frustrated with the information we were receiving, they were talking to us as if we were medical professionals. It took 5 minutes of Chris’s continued questioning to get the doctors to say that despite the miscarriage being bad (and sad), what we were seeing was ‘normal’ or ‘common’. What they really needed to start out with was – don’t worry, there is nothing seriously wrong with you, chemical pregnancies happen frequently with IVF (because they are transferring 2 embryos). I think I had a bit more knowledge than Chris and didn’t feel quite as frustrated because I had googled a lot on miscarriage, chemical pregnancy, blighted ovum and have read forums/blogs etc. So my lesson here is to share more of my ‘google expert medical opinion’ knowledge with Chris before these types of appointments.

We also discussed my hCG levels (49, 110 and 345) and my doctor did admit that my first hCG result of 49 was borderline low- to non viable. So why, oh why, did the other doctor (who did my IUIs) seem so happy and chirpy on the phone, proceed to tell me my progesterone and estrogen levels were excellent but fail to tell me my hCG level. All it required was this: “Congratulations Ms Dani, you are pregnant, but your levels were a little lower than average, we would like to see you again in 5 days just to make sure you levels are doubling nicely. Your estrogen & progesterone levels are excellent, so this is a good thing.” Expectation management is not a bad thing.

So – we have one big question answered, I feel a relief, albeit a sad relief – there is no viable pregnancy. The next big question we wait for an answer is – is this a chemical pregnancy or a tubal pregnancy?

*A chemical pregnancy is a clinical term for a very early miscarriage. It happens before an ultrasound could even detect a heartbeat (before the 5th week of gestation). This occurs when an egg is fertilized but it does not implant on the uterine wall. Chemical pregnancies are actually quite common, occurring in 50 – 60% of first pregnancies. There are many possible causes of chemical pregnancy – inadequate uterine lining, low hormone levels, luteal phase defect, infection, or other unknown reasons. The most common assumption is that they are due to chromosomal problems in the developing foetus. This can result from poor sperm or egg quality, genetic abnormalities from either mother or father, or abnormal cell division of the foetus.

Creeping thoughts

September 1, 20158 Comments

I have had some spotting everyday since Friday – just the teeniest amount here and there. Every time I go to the toilet I feel sick to my stomach as I wipe and check the tissue with apprehension. I hold my pee just so I delay having to see the blood. I can feel my stomach starting to bloat, with a feeling of emptiness.

My app tells me I am 5 weeks and 5 days pregnant today and huckleberry is the size of a chocolate chip. But is huckleberry in there? Perhaps huckleberry is no longer there, may be he never developed after implantation, or may be he is hanging on for us to see him once again on the ultrasound tomorrow…

Time is dragging and the fog creeps thick around us, we try to keep busy, but it’s impossible to hide our deepest thoughts. I know that tomorrow is going to be a good day, whatever happens we will have some of the answers to many of our questions.

This post may sound depressive, but I promise you I am not – just sad and anxious, and I think it is OK to be feeling like this right now, it would probably be a bit weird if I didn’t.

You just can’t make this stuff up – facebook again

August 31, 20157 Comments

They say a picture paints a thousand words…so here it is.

For those who cannot see this picture, it is a screen shot of my personal facebook post from this evening. I wrote:

“It has been a difficult week for the both of us, I am pregnant, but the doctors have now given us less than a 1% chance of my pregnancy continuing successfully. We wait to see how things go, but have readied ourselves for the worst. We are being open and honest because so many other struggle with this in silence. The IVF process has been a roller coaster of emotions for us and would like to say thank you for everyone supporting us through it all.”

Above my post is a facebook sponsored advert for stitch fix maternity clothes. Can you believe how mad I was to see this – only 5 minutes after posting it??? Especially after I have already changed my facebook settings to prevent all ads relating to parenting, family, pregnancy, babies etc. Clearly the facebook algorithm reads my post status with “I am pregnant” and over-rides my chosen settings. The fact that I am already a stitch fix customer adds insult to injury!!

I will write to facebook to tell them how upset this made – in spite of the fact that I had changed my settings to prevent this from happening. They really must do better at this.

On the positive side, we have had lots of love and kind messages in response. We thought it was time we gave an update because today when we went to our softball social league where someone congratulated us – then we had to tell them the bad news, and I think they just felt awkward over it. Facebook – the good, the bad and the ugly.

Trying not to cry at work is HARD

August 28, 2015August 28, 201526 Comments

On Tuesday, after my second beta test, I went home from work early so that I could receive the good or bad news in private. But my results had not ‘come back in time’, so not knowing when I would receive my results, I went into work on Wednesday. I was busy running around the office preparing for a one day workshop I was leading the next day when I received the phone call. You may know already that the news was ‘not good’. Receiving news like this whilst at work is difficult. My eyes were welling up when I dashed to the toilet quickly, passing one of my senior bosses and trying not to look him in the eye. I called Chris and had a good old cry – lucky there are not many women at my work to gate crash my pity parade. Chris said he would come to my work for a hug and he would be there in about 30 minutes. So I collected myself, and headed back to my desk. A colleague of mine who had promised to provide me some input to my project report for about 3 weeks decided to tell me he was not able to do it and he was going on leave the next day. Let’s just say, this was the wrong time to be telling me this. My attitude initially to him going on leave was….”and…..?????”. I had waited some time for his input and my report was already late. I said “No worries…..” in a very sarcastic and mean tone. Then my friend walked past us happy and bubbly….realised she had just interrupted something and asked if she should go, to which I nodded. Anyway, I was clearly in a grump.

After 40 minutes of being really pissy one minute, and on the verge of tears the next, Chris arrived at my work. We had a big hug and cry together in my work car park (parking lot). Chris stayed for a coffee, and we decided we would work from home for the rest of the day. I went back to my desk to finish off my preparations for the next day when my colleague (who I had been grumpy to) asked if everything was OK? So I told him about my phone call. I held back the tears as I said it, but said it was OK, I was going home for the afternoon, which he agreed I should do. I felt a little bit bad for my pissyness, but I know he understood that it wasn’t personal against him.

Thursday….I kept myself super busy at my workshop all day, I hardly stopped to think about anything else other than work. It was great!

Today, Friday, I had my third beta blood test. It didn’t start out great as my appointment was already eating into some ‘compulsory training’ time at work…and of course, the clinic had a waiting room FULL of patients. I was greeted by a nice enough nurse who I had never met before. I thought I had met them all!!!! In fact, it was very bizarre, I noticed that the receptionist was someone I had never met before, and all the other nurses I saw wondering around were all new. I wondered briefly if they had done ‘swap staff with another clinic’ day. V. weird. Anyway, the nurse who took my blood was pretty distracted by another nurse who was ‘in training’ (who at my last beta test, I blamed for my late result 🙂 ). They were gossiping, I did not appreciate a lack of attention when I was already upset with having to be there. Grrrr.

After I made into work this morning 40 minutes late, I sat in on about 1.5hrs of pointless training (I am actually already trained, and didn’t know they were going to be covering this same material). You can tell it was going to be a good day for me….not. The office was very quiet today, everyone was out on travel or on leave, which was probably a good thing, but I felt lonely. So I took myself off to a quiet empty meeting room and typed up notes from Thursday’s workshop to keep me busy…but it was slow going, my mind kept wondering to my results.

At 2pm my phone rang, I was surprised because the results weren’t due back til 3pm. It was the doctor who had done my egg retrieval and transfer calling with the bad news. He said my hCG levels were 395 (actually it turns out he was wrong, they were actually 345). My first response was wow it went up again, OK – I wasn’t expecting that! But he brought me back down to earth and said he did not believe this would be a normal pregnancy, he would expect an absolute minimum level of 800 by now, and I should stop taking my medications to prevent prolonging the pain (Emotional pain he meant), he did say that I could choose to stay on the meds if I wanted to be 110% sure, but he recommended to stop them. He also told me to arrange a follow up appointment with my doctor as soon as possible. And that was it. I actually did not cry, I was just confused. Sad, but confused. I stayed in my meeting room and focused on my task at hand, surprisingly I got a lot done in the next two hours.

It is so hard to not cry in front of work colleagues, but at the same time, being there has been a good thing when I needed to divert my mind’s wondering to sad things.

As I left work I received a phone call from my doctor, she started talking to me as if I did not know my results. However, she was far more informative about my results and what she wanted to do next. She told me that she agreed with the other doctor I should stop taking the medication, there is a very very small chance (about 1%) that this might be a viable pregnancy, but coming off the meds will not harm the developing foetus if in fact it is developing. By stopping the medication my body will be allowed to do what it probably would ordinarily have done and let me bleed. She wants to see me on Tuesday afternoon for an ultrasound and another beta test to be sure I do not have an ectopic pregnancy, although very unlikely, she wants to check. It is normal if I don’t start bleeding for another 4-5 days, but in the mean time if I get any sharp sudden pains or difficulty breathing to call her immediately. She also started talking about what we have in the freezer – we have just one blastocyst that was frozen on Day 5 stored away. They won’t do a transfer with just one frozen, so we would have to do another round of IVF. Can’t even think about that right now.

As soon as I got home I took off the estrogen patches from my stomach. It feels good to not have anything stuck there, and we don’t need to think about doing an injection either. I’m trying to think of the positives here!

I always say it’s never over ’til the fat lady sings….predicting a successful pregnancy outcome

August 26, 201518 Comments

I always say it’s never over ’til the fat lady sings. But that doesn’t mean I can’t see that fat lady getting ready to get on stage…I can also hear her warming up, running through a few scales too.

So, my suspicions were pretty much confirmed about why I didn’t get my results yesterday. My results were not good. And let me point out here that these are not my words, but the words of my nurse.

My hCG levels last Weds were 49 – just a bit lower about where they should be, but were not overly worrisome…

My results from Tues this week, however, were 126. They went up!!!! But those of you who are familiar with hCG levels and where they should be by now will know this is not a great number. hCG levels should double every 2 to 3 days. What does this mean? Well my doctor wants me to keep taking my progesterone and estrogen, just in case – there is always a small chance this pregnancy is still viable!! But I have to go in for another beta test on Friday to double check that this pregnancy is, in fact, over.

I can safely say I am no longer feeling cautiously optimistic….I am feeling pessimistic as hell and sad. If you would like to hold onto hope for us, I gratefully take your strength and thank you for helping to hold us up, but quite frankly when the nurse tells you it is not good, it’s not good. I understand she is preparing us for the worst.

BUT!!!!! I decided to do a bit of research on what all this really means, what are MY chances? You know I had to do it, as one of my colleagues told me today – GTS! (Google That S#*% !!!). OK, I’m going to get a bit technical here….hang in there if you have in interest in hCG levels (the beautiful pregnancy hormone!!)….

I found a very useful study* that looked at the predictive values of hCG levels for a viable pregnancy 13 days after a 3 day Embryo Transfer (I took my first beta test 14 days after my 3 day Embryo transfer). My result of 49, according to their model, gives me the following chances of outcome: 45% successful singleton pregnancy, 31% miscarriage, 13% bio-chemical pregnancy, 9% ectopic pregnancy, 3% successful multiples pregnancy. Well I am glad they didn’t tell me what my hCG levels were last week!

According to these researchers’ analysis, they decided that the cut-off level for predicting a viable pregnancy was an hCG level is 76 IU/I (80% sensitivity)….although this is considerably higher than some other researchers have reported (for example other studies have found the cut off at a similar sensitivity to be: 42 mIU/ml (Qasim et al., 1996); 55 IU/l (Bjercke et al., 1999); and 50 IU/l (Sugantha et al., 2000)).

Wow guys, 76 seems to be a whole lot higher than the others….so do they have credibility in their research? Well from what I can ‘statistically understand’ and in understanding their research design, it looks solid; their sample size is excellent, some of the best I have seen in articles about artificial reproductive technologies….but I am not a medical professional, so I am totally relying on my knowledge of stats and may be there is something ‘medically awry’ that I cannot see.

If I use any of these models, and consider my hCG level of 49 from last week, these researchers would have told me my chances of a viable pregnancy were always going to be low.

However, there was one interesting point that came out from this study that caught my eye:

In subjects with unexplained infertility, ICSI may result in lower than expected HCG levels (Gold et al., 2000)….The explanation for this was not clear. Although the early embryo cleavage is delayed in ICSI-derived embryos and the fragmentation of embryos is increased the implantation potential is comparable with IVF-derived embryos.

Even though my numbers have not multiplied nicely….in the back of my mind I am holding onto this slither of hope….holding on that we are the ones in that 5% extreme quantile who defy the norm, and it is because we are unexplained and our embryo was ‘ICSI-ed‘ that my hCG numbers are much lower.

Until Friday…………. :-s

*Pokkeus, P., Hiilesmaa, V. & Tiitinen, A. (2002) Serum HCG 12 days after embryo transfer in predicting pregnancy outcome. Human Reproduction 17(7):1901-1905. Available at: http://humrep.oxfordjournals.org/content/17/7/1901.full

No results today….

August 25, 2015August 25, 201512 Comments

Before work this morning I went for my second beta test.

There was a new nurse helping out my favourite nurse.

My results have not materialised today. The chief nurse called me at 1700 to tell me she has not seen them yet and she will make sure someone calls me tomorrow.

Coincidence?

I mean, how often does this happen???

My twisted mind thought of an alternative once it had gone past 4pm and the reason that I had not yet received a phone call, was that my results have come back not good and the doctor wasn’t there to give me the news with a way ahead. Why am I so paranoid about this? Well over the last few days my symptoms have pretty much disappeared. OK so I know it is early still….but…..I took a test again last night because I was just not feeling right about it all…and the line looked much fainter than the other one BUT they are different brands so I probably shouldn’t really compare. However it was pretty faint and I would have thought my line be darker by now?

Grrrrrrrrrrrrrrrrrrrrrrrrrrrr….I bet the new nurse messed it up and I am worrying all for NOTHING.

Liebster Award

August 25, 2015August 25, 201516 Comments

Many thanks to Womb for Rent for this award!!! (you can check her out here: https://healthywomb4rent.wordpress.com/)

About the Liebster Award: It is given to up and coming bloggers who have less than 200 followers. The meaning Liebster is German and means sweetest, kindest, nicest, dearest, beloved, lovely, kind, pleasant, valued, cute, endearing, and welcome. Liebster was created to discover new bloggers and welcome them to the blogosphere.

Rules:

Once you are nominated, make a post thanking and linking the person who nominated you. Include the Liebster Award sticker in the post too.

Nominate 5-10 other bloggers who you feel are worthy of this award. Let them know they have been nominated by commenting on one of their posts. You can also nominate the person who nominated you.

Ensure all these bloggers have less than 200 followers.

Answer the eleven questions asked to you by the person who nominated you, and make eleven questions of your own or your nominees or you may use the same questions. Lastly, COPY these rules in the post.

My nominations:

The secret life of Emily Maine: https://thesecretlifeofemilymaine.wordpress.com/

I love Emily’s blog because she tells it like it is. Emily has been having a tough time of it recently, and yet she is still able to inspire me with how she deal’s with some of the crap that has been thrown her way. I imagine Emily probably has over 200 hundred followers anyway, but what the hell!

Meet the Hopefuls: http://meetthehopefuls.com/

Heather and Chris BOTH write blog posts…I love that about this blog, infertility is not always just about one person. I am so hopeful for them that this cycle & soon to be transfer will be THE one.

From Zero to Zygote: https://zerotozygote.wordpress.com/

Nara is a fabulous writer, she is another very open and honest blogger. I really enjoy her posts, they are not always about infertility. Nara is navigating the world of infertility in the UK so her points of view can be a bit different too.

Disorderly Love: https://disorderlylove.wordpress.com/

Cesilee is an absolute sweetie. Life has thrown her a whole box of lemons, and her blog shows just how she has turned them right into lemonade. She is also another woman who just tells it like it is. (I am sensing a pattern here 😉 )

My womb to rent nominated some of my favourite other bloggers already….so you should go check out their blogs too: https://healthywomb4rent.wordpress.com/2015/08/18/liebster-award/

The questions I have been given:

1. Who or what inspires you the most?

Actually, it is my husband – Chris who inspires me. He is not just my husband, but my best friend. Chris is always trying new things, sometimes even in the face of adversity (even though on occasion I wish he would finish the last thing he started!!) His desire to do things differently makes me want to follow him and push myself to new levels I wouldn’t be at today without that.

2. Who is your hero?

I don’t really have a hero, I have ‘heroes of the day’, which I will mentally note as being someone who on that day has saved my ass, or inspirationally put themselves out there in the face of danger. These are typically my friends, family and sometimes my colleagues. They don’t know that I call them my hero, but I do :-p

3. What is your proudest accomplishment?

Ummmm, OK so it is work related…but it is a personal achievement too because I faced some quite stressful times I had to overcome. I was awarded the ‘Member of the Order of the British Empire’, also known as an MBE, for my services in support of military operations (my deployments to Afghanistan). I am very privileged to have even been nominated for this honour, let alone receive it!!! My medal was ‘pinned’ by Prince Charles at Buckingham Palace…as you can see from the photo with him I was grinning ear to ear like a Cheshire cat!! My parents and Chris were allowed to watch and I met some amazing people the day I was honoured. I was probably the youngest person there at the ceremony, although it is not uncommon for young people to be awarded, I felt so lucky!!!

Not really sure what I was giggling about with the Prince at this point!!

The Official ‘pose’ with my medal! It’s quite a beautiful beast that will probably only come out of its box for parades.

4. What did you want to be (as a grown up) when you were little?

A chef!!!! Which then later turned into a food scientist….but then my school wouldn’t let me study science at A-Levels (16-18 yrs) it’s a long story, but let’s just my aspirations of this ended when I was 14 😦

5. What are your hobbies?

Being outdoors! hiking, rock climbing (I miss climbing a lot since we have been TTC-ing) I really enjoy baking when I make time for it. Some day when I am older I will own my own tea shop that will sell giant home made cakes and people will come just for the cake. I love learning new things, so I tend to have something going on where I am teaching myself something new.

6. Who would you want to play you in a movie of your life?

Claire Danes – she is so lovely and talented.

7. Do you collect anything?

I have a habit of keeping souvenirs, tickets, cards and brochures of places we visit which will eventually end up in my ‘memory box’….OK so I have lots of memory boxes taking up space right now. I just can’t bear to get rid of them. I like going through them may be once a year when we do a clean out.

8. What is your favorite family recipe?

I’m sorry, I don’t have one!!!

9. If you had a warning label, what would it say?

Danger – May Hiccup Unexpectedly!

Since I returned from Iraq in 2007 I have had these random little hiccups that appear from no-where. Sometimes people think I am sneezing and will ‘bless me’. I can almost control the hiccup if I am in a meeting, but it takes a lot of effort, so if I know a group of people I will just hiccup very loudly….may be only once or twice. Even Chris still laughs at my outbursts of hiccups. I don’t know why it happens, it could be a sign of Post Traumatic Stress Disorder, but that could just be co-incidence. The other option was brain tumour, but seeing as I am still alive today, it is probably not a brain tumour!

10. What is your favorite family tradition?

I am going to answer this as ‘What is your least favourite family tradition?’. At Christmas time, my mum has a desire to play a ‘hand bells’ game where each person is given two numbered bells to ring when their number is called out. Basically this means that a tune is played by bells. It is the worst game ever. #SorryNotSorryMum

11. What is the one thing you will never do again?

Go back to Iraq (unless I am called up in my reservist capacity then I won’t have a choice, but I will find every way to avoid going back there!!)

The questions for those I nominate are:

If a genie came along and offered you one wish to become what you ever you like to be and you were given all the relevant knowledge, training and qualifications tomorrow, what career would you choose?
What is your favourite colour and why?
What is your party trick?
What is your favourite hobby?
If I gave you a plane ticket to anywhere – where would you go?
What is your favourite film?
What helps you get out of a funk?
If you could write a letter now to your past teenage self – what piece of advice would you give to yourself?
If you could only eat one type of ood for the rest of your life, what would it be?
What three things would you take to a desert island with you?

How to get the most out of your doctor

August 23, 2015August 23, 201512 Comments

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

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….