Ignorance is Bliss

Has anyone ever said something to you along the lines of: “If you knew how much responsibility was involved in parenting you wouldn’t ache so much for a baby?” or worse, “Here, take my children then see if you still want a baby so much.”

People who say this to you most likely care for your well-being.  It’s kind of like your bestie asking you just before you walk down the aisle – “are you absolutely sure you want to do this??”.

Dani and Chris-165.jpg

My Bridesmaids asking me: “Now are you sure you want marry this man?!?”

But what these people do not realise is that their message also comes across that we are ignorant.

If anything, I am more certain of my future responsibilities because I have had much more time to think about them.  I am lucky in the sense that I have the time to prepare.  Some women may only have 9 months to prepare for their future responsibilities.

I understand that I will never fully appreciate the responsibilities involved in parenting until I become a parent myself.  But please, let me dream about it for now.

Balancing Work and Infertility Treatment

I have been mostly open with my colleagues about the infertility treatment that we are facing.  I told a small number about the three IUIs, but in preparation for IVF I decided I needed to tell a few more of my colleagues in my team.  In fact, my team gave me a gift card for a nice restaurant as a I was about to take four days of sick leave for the Egg retrieval and embryo transfer for our first round of IVF.  But it’s not something that everyone is comfortable  initiating a conversation about it all with me.  They don’t know where the line is, so I try to  be open about it as much as possible and help them to feel comfortable asking me whatever questions they may have.

This ‘open’ approach has mostly worked in my favour; but that doesn’t mean it has been easy.  It is coming up to almost a year of treatment and my boss has known about my appointments and treatment for the majority of that time.  He has been accommodating, caring and supportive to my needs.  But ultimately, it doesn’t matter how supportive your peers and bosses are, there is the issue of the work that still needs to be done.

I feel unreliable, I feel flaky, I feel selfish and I hate not being flexible. I feel like the weak link in the team.  I hate that it is almost impossible to plan long term projects and work travel – a key part of my job.  I feel helpless, sometimes I feel useless.  I try to compensate by being overly proactive in areas that don’t require long term planning; I try to over achieve on short term goals and tasks.  But ultimately this impacts my career.  I feel like I have taken a career break. 

Juggling work with infertility treatment requires meticulous planning – and yet what are you told when it comes to IVF treatment?  Always expect the unexpected.  So planning for the unexpected becomes an overly stressful burden to your sanity.

For me, the first time we went through IVF it was a quiet time of year for us – August.  Many of my colleagues were on their summer holidays, so all was good.  This time around we are expecting to start stimulation in the New Year.  Things start to get a whole lot busier at work at this time of year.  I have already had to say no to travelling to Europe in January because it is likely my egg retrieval will be in that week.  Not attending this meeting in Europe may impact my involvement in the project overall.  Or simply just add another layer of stress even if I do pick it up afterwards from playing catch-up.

Then, there is the added problem of being physically at work; suffering from pain and tiredness as a result of the hormones and your body coping with the side effects of the drugs.  I tried to hide the pain.  I must have gone to the toilets about 25 times a day to hide.  Sometimes I just spent 5 minutes sitting there taking a timeout.  And it wasn’t just the physical pain, the emotional strain plays a part in all this too.  Simply put, the infertility treatment has also affected my mental focus on doing a good job.  For example, I was not satisfied with my output around the time of the IVF (I had a deliverable due just before the start of the IVF cycle – this was a terrible terrible idea!), although I know I am very self-critical and set high bars for myself – no one has actually complained about my work thus far.  I just hope that is because what I delivered was satisfactory, and not because people were afraid to upset me!!!

I just hate this.

And I am lucky that I do not have to lie to my colleagues.  I cannot imagine having that added pressure of guilt and keeping up with lies in addition to the stress of the treatment itself.  Some people need to keep their treatment a secret either for job protection or it is within their nature to keep family life private.

So what have I learned?  Second time around, I will schedule in a combination of annual leave and sick leave into my diary for the start of stimulation.  Fortunately it’s a new year of leave, so I will be able to do this this time around.  Who knows what would happen if we have to do IVF all over again after this round.  But this time, I’m going to try to focus on the treatment rather than juggling it with work.

Maybe I’ll take up some knitting or do some oil painting to keep me occupied.  I’m going to need to find something to keep my mind busy!!!

:-s

As for the long term impact on my career, well, I will just have to not worry too much about it just now.  Maybe if we get to summer next year and still no pregnancy, how I feel about my career is going to really influence my decisions about what we do next.

A voice of the child free family

Yesterday I talked in quite some depth about our goal to become parents and how we are struggling with infertility with someone who lives child free by choice.  He is a very direct and to the point person (He is German after all and told me that there is no word in German for ‘Polite’ – he’s a funny guy). So, I tried not to be offended by his probing about why we want children.  He wasn’t trying to convince me that we shouldn’t have children like him and his wife, but he was pointing everything out about the benefits of being child free.

And now as I write this, although he was probing, blunt and direct about his thoughts and questions, I wonder if actually he was ultimately being kind and thoughtful to me.  He was trying to tell me why being child free is a good thing, he was telling me it’s OK if we don’t succeed at this.  Life without a son or daughter of our own is not going to be the end of the world.  He explained to me how their decisions have ebbed and flowed over time.  Although at first I was pretty uncomfortable talking about why Chris and I are ‘chasing’ fertility treatment, it was refreshing to listen to a different point of view.

He hasn’t changed my mind, but I thought it came at an interesting time, particularly after some of my recent blog posts have mentioned living child free (The childless analyst, The Uncertain Future of the World, Sorry, but being a mother is not the most important job in the world).

I survived!

Of course I survived…no one dies from an HSG right?!?!

As I sat on my own in the procedure room waiting for the doctor I noticed just how dated everything in this room looked.  I also noticed two capsules stuck with cellotape onto the wall behind the head of the bed and the other on the needle disposal box.  I was intrigued because they said ‘amonia’ on them.  I wondered why these capsules were stuck there.  As more time passed I finally figured out what it was for – smelling salts for passed out patients! There was a piece of paper stuck on the wall that gave steps of what to do in an emergency – the kind of emergency when  patient passes out and you have no clue what is wrong with them.  The first step said: Keep calm! I found this quite amusing that a doctor/nurse needed to be reminded to keep calm first of all.  One of the other steps described how to use the ammonia capsule to see if the patient ids responsive. There was another sheet of paper stuck on the wall next to these emergency instructions, giving instructions for what to do if a patient was having an allergic reaction.  I suppose some poor people in the past have found out that they truly are allergic to shell fish or iodine as a result of this HSG procedure! So I guess you can die from an HSG afterall.

After waiting for 20 minutes ready to go, the doctor came in and introduced herself – as if I had never met her before.  She didn’t recognise me at all.  Even with my British accent she didn’t recognise me and proceeded to ask me questions as if I was a new patient.  Considering the number of times she has seen my vagina and cervix (I can count 8 monitoring appointments and 2 inseminations) I was a bit upset by this fact.

So we got down to the business….and the procedure hurt so much that I had tears in my eyes.  It was all over after only 5 minutes, but they were a painful 5 minutes.  I peeked at the video of the x-ray as she was cleaning me up.  I could see my upside down uterus and the dye free flowing through my tubes.  And then something weird happened – my uterus flipped upright at the end of the procedure!  I felt her do something weird, did she manipulate my uterus? Or was it just the xray moving to a different position?  Logically the latter doesn’t make much sense…but then again neither does the manipulation! I’ll know exactly what happened when I go for my baseline ultrasound in the new year.

Good news is that I passed the test!! IVF round 2 is on in the new year!!

After the procedure I went back to the waiting room to pick up Chris because he wasn’t allowed in with me.  And there sitting in the waiting room was someone I knew.  It was funny because Chris was sat with his back to them and he didn’t realise he knew them.  It was a bit of a bizarre moment because I guess we didn’t really know what to say to each other.  I don’t know why they were there specifically, but I feel a little sad that infertility affects so many of us around us we just don’t know about. Today was just another reminder of that fact.  Infertility – you truly are a sneaky bag of crap.

The dreaded HSG

I am not going to pretend to be brave here.  I am actually a little bit nervous about tomorrow’s HSG procedure.

The Hysterosalpingogram – AKA the HSG – is an x-ray procedure to check whether the fallopian tubes are open or blocked, and if the uterus is normal.  Iodine dye is inserted into the uterus to allow a contrast to be seen on the x-ray.  It allows the doctor to see on the free flow of the fallopian tubes and any abnormal lining of the uterus.  The procedure is relatively quick -about 5 minutes.  But for me it really was painful.  I took 800mg of Ibuprofen an hour before the procedure as instructed – it still hurt.

For my first test I was naive and had no clue it might be painful, so I wasn’t nervous.  But now, knowing what I know now!  I AM anxious!  The crappy thing is that Chris isn’t allowed in with me, there is nothing more I would like than for him to hold my hand whilst the dye is injected and I feel that burning cramping sensation run through my body.

When I called the clinic to make my appointment the receptionist who now recognises my voice (OK so I bet they don’t have that many Brits as patients) asked me why I hadn’t had an HSG already.  I pointed out I had one in January but I had to have another one after the possible ectopic pregnancy thing and how much I was dreading it.  She was very sweet and apologised, her tone also changed to be more somber for the rest of the call.  Bless, it was nice that she sounded to care. It must be a hard job working in a fertility clinic – it must be a bit bi-polar with so many highs and lows everyday.

Perhaps I will do some meditation to help me relax a little before hand :-s

On the positive side about this – once we have the results of this test we can go ahead and hopefully firm up plans for IVF round 2.

My HSG X-ray with my retroverted uterus (it's hard to see because it's hiding behind the catheter)

My HSG X-ray with my retroverted uterus (it’s hard to see because it’s hiding behind the catheter)

IVF round 2 – December/January 2016

We met for our follow-up appointment with our doctor yesterday.  There were no surprises.  Which is a good thing!  So the plan of attack is a fresh round of IVF…get a couple more embryos frozen:

  1. Schedule a Hysterosalpingogram (HSG – if you would like a refresher what this procedure entails, check out my post from last time here) – I will do this as soon as I start my period (who knows when that will be!!!).  It is very unlikely that my fallopian tubes will be blocked, but she wants to be sure.  Fair enough.  However, I am NOT looking forward to this test.  Last time I was completely naive to the potential pain ahead for this particular procedure, now that I know exactly how much it can hurt I’m a wee bit nervous!
  2. Plan to start Birth Control Pills to regulate my cycle in December with an egg retrieval date for early January 16.  There is a period of 3 weeks that the embryology lab is closed over the Christmas period.  Seriously – how unlucky am I?? Last time my cycle was delayed because the embryology lab was being refurbished.  Oh well – I guess everyone needs a holiday.

There is a potential chance we could start Birth Control Pills in November, and do a retrieval before Christmas, but I think it will be close to my 3 month period of ‘no baby making’ because of the methotrexate shot I had affecting fetus development.  I have been researching this, and I would be willing to go ahead a week or two earlier because doctors are overly cautious with this 3 month time stamp.  As long as I keep taking my folic acid I should have no problems.  However, this is something to be discussed once we have a better idea of a) when my period is likely to be and b) assuming my HSG test is all clear!!!

There will be no change to my protocol, perhaps a slight increase in some of the medication dosages to mature more of my eggs.  As a reminder from our first round we had 9 eggs retrieved, 6 of these eggs were mature, 4 of these eggs were successfully fertilised by ICSI, 2 good 8 cell embryos were transferred on day 3, and 1 of the 2 embryos made it to Day 5 blastocyst and was frozen.  Our doctor mentioned that she would consider waiting to Day 5 for the transfer this time around, especially as our frozen one is Day 5 – she wants them to be the same.  We like this plan!

This gives me some time to concentrate on work for a little while, get my body healthy and start growing some strong eggs!  What is amazing is what the horrrorscopes says for me next week…

horoscopes

I was already planning on going back on my sugar free, healthy diet next week! Freaky! Sooooo….which old friend should I Skype on Sunday next week and wants to reveal a long-held secret to me??!!!?!

A discovery – How far are we willing to go?

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

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 🙂

Trying not to cry at work is HARD

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!

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

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!!!