Tag: IVF

Patience is a virtue

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No matter if you have been trying to conceive for 3 months or 3 years, there is something about the two week wait (2WW) that makes us question every single little pain, change in body, or change in any bodily function.  Is it a sign?  Is the pain normal?  Is my body supposed to do this?  I am currently in my 2WW and I have been thinking about early pregnancy symptom watching.  I have also been thinking about how different my 2WWs have been between a medicated 2WW, a ‘natural’ 2WW and just an ordinary last two weeks of a cycle (i.e. without trying to conceive).

Last cycle we took a break from trying to conceive – I gave my body some respite.  I noticed a lack of pain, but I did have a couple of twinges that were likely to be PMS or IBS.  I felt like I was also pretty good at not actively looking for any changes in my bodily functions.  Except for the associated period pain, overall, last cycle I was painless.

This cycle we have been trying to conceive naturally, without any medical intervention whilst we wait for IVF….because there is still a chance we can do this on our own!  I have not done any ‘temping’ or ‘peeing on a stick’, so I am not really sure exactly when I ovulated, but I know, give or take a day, that I am 9 Days Past Ovulation.  Having been through 17 2WW, I’m starting to wonder whether every single niggle and pain I have ever experienced is just my imagination?  It is probably more about the fact that I am looking for a sign.  I’m impatient.  I want a sign.  So my brain is telling me to look for a sign.  This 2WW I have experienced short sharp pains, but not as painful as I have had them in the past.  These don’t feel like IBS type pains (By the way, the doctor suspects I may have endometriosis, but I have not ever had it confirmed, so the pain just may be that).  I have been tired, yawning a lot (I just yawned as I wrote the word yawn – weird) but I can’t tell what is jet lag or otherwise.  I have been very emotional, random bouts of tears.  Also a few nights ago I had the strangest dream.  I dreamt that I gave birth to a baby, the placenta followed, and then the baby ate the placenta.  It was a pretty gruesome and a graphically detailed dream.  So far, my 2WW has been eventful in comparison to my last cycle, but not as eventful as when I was taking the medication.

So, do I just ignore all these niggles, pains and possible early symptoms of pregnancy?  Well, I probably should – after all, the only real way to tell if I am pregnant is with a blood test.  But I know at some point I’m going to google it.  And google usually confirms most of my suspicions.  (I know – google usually can confirm ALL suspicions, like “Am I an Alien from space?” google tells us “probably”)  Yes, all of the above I experienced in this 2WW could be early symptoms of pregnancy.  So I tell myself today:

“Dani, just be patient.  You’ve waited this long, a couple more days won’t hurt.”

I’m not very patient when it comes to queues (lines) or being in crowded places trying to get somewhere, I’m afraid patience is my weak spot.  I’m going to have work hard at it, I’m going to have to learn to deal with it.  Maybe, this is one of the positives to come out of infertility – learning how to be more patient.

So, do you want children too?

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So, do you want children too?

Multiple choice answers, you only get one chance to get the right answer:

A) Reply smoothly, “Yes, some day soon – kids are cool”.

B) Reply, indignantly “No, never ” (By the way, did you know that you just spent 10 minutes complaining about kids taking up all your free time – you have put me off them for life).

C) Reply, matter-of-factly “Yes, actually we going to be making one in a petri dish next month, maybe even two.  Hopefully that will do the trick.”

D) Pretend to see someone calling you from the other side of the room and run away, trying not to cry until you make it to the toilets.

This weekend I went to a beautiful wedding back in the UK, my friend from school was tying the knot!!  I lamented in my last post about drinking alcohol at the party and dreading answering the question why I wasn’t drinking.  In the end, I decided to have a couple of drinks, but only a glass of champagne and glass of wine – I also tried a bit of gin and tonic (ohhhhhh how I miss you gin and the bitter-sweet taste of tonic water with a slice of tongue tingling lime).  I will say, that having not being used to these beverages I was a little tipsy – in a good way – it went straight to my head!  But a merry affair was had 🙂  It was just the most lovely wedding and I am so happy for my friend that she has found love with a rather lovely gentleman who will treat her well.

The wedding was at a beautiful venue in a harbour on the South coast (a tad windy!)

The wedding was at a beautiful venue in a harbour on the South coast (a tad windy!)

Right, back to the subject of this post.  Without thinking much about having to answer the question “Why are you not drinking”…I forgot about the classic question that came a bit out left of field “So…how about you, do you want children?”.  And to make matters worse, the question came from a ‘high school ex boyfriend’ who I haven’t since in as many years.  He had just spent several minutes talking about his kids (who, by the way, were two adorable little cuties who are super bright) and he then just came out with the question.

So which multiple choice answer do you think I gave???  Well, for some reason I decided to go with C: “Yes, actually we going to be making one in a petri dish next month, maybe even two.  Hopefully that will do the trick.”  I don’t know why it was my instinct to say it, but then the conversation just got awkward after that.  Damn it.  I hate awkwardness.  I won’t be using that answer EVER again 🙂  I’ll stick with A: “Yes, some day soon – kids are cool”.

The ethics of ICSI – Intra Cytoplasmic Sperm Injection

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ICSI for unexplained infertility

I felt pretty well versed and comfortable in the ethical debate behind IVF, well, so I thought until we came across ICSI.  Intra-Cytoplasmic Sperm Injection (ICSI) was recommended by our doctor because we have been diagnosed with unexplained infertility.  She explained that this procedure is worth trying because in our case of unexplained infertility there could be a chance that there may be something in the fluid surrounding my eggs preventing fertilisation.  ICSI overcomes this potential problem by injecting a sperm directly into the egg, avoiding the fluid.  It is important to note that with unexplained infertility there could be many other reasons unknown to us why we have not been able to get pregnant yet; we just can’t pinpoint the exact cause at this moment.  By performing ICSI (for a few thousand dollars more) it slightly increases our chances of success.  I have been looking into the evidence behind unexplained infertility and ICSI and the jury is out on whether it is worth while or not.  Despite the mixed reports on the internet, I trust our doctor, and as our fertility clinic is attached to a medical school I like to think that they are up to date on these things.

I hadn’t thought much about ICSI previously because Chris’s sperm is pretty good, I didn’t think it was on the table.  So I hadn’t read much about the procedure.  As I began to read up on the procedure, I started to think more about the ethics and morality of it.  Selecting the ‘best looking sperm’…is it any different to selecting the ‘best looking egg or embryo’ as would be the case for normal IVF?  And so I decided to look into it a bit more to understand what ICSI really is, and the considerations for and against this artificial reproductive technology procedure.

This post is just me putting ideas out there and exploring the issues, I do not necessarily agree with everything written here.  I may have been unintentionally selective or biased in some of my arguments, there are probably many more arguments for and against ICSI, so please feel free to comment and add at the bottom of my post.

What is ICSI?

ICSI – Intra Cytoplasmic Sperm Injection is an in-vitro fertilisation procedure that has been in use since 1992.  Fertilisation is achived by the direct injection of a single sperm into the cytoplasm of the egg.  The sperm can be extracted from fresh or frozen ejaculate, as well as being extracted directly from the testes (yikes, sorry guys, doesn’t sound fun at all).  The egg is prepared to facilitate penetration of the sperm.  The preparation of the egg includes enzymatic treatment and micro dissection of the cells which surround the egg.  Injecting the sperm bypasses the normal interaction it would have with the egg upon first encounter.  The deliberate selection of sperm for the procedure involves an assessment of selection criteria including: size, form and mobility of the sperm.  Despite the selection criteria, there is no guarantee that the sperm is actually ‘normal’ and therefore, there is no guarantee that fertilisation will occur.  It is even possible to select X or Y sperm to select gender, but only few fertility clinics offer gender selection for when it is necessary to avoid a known genetic disorder being passed.  I have also read about some fertility clinics offering gender selection if the family has one child already, and they want to ‘complete the family’ by selecting the opposite gender of its sibling.  This totally blows my mind.  After the sperm is injected into the egg, the egg is placed in an incubator and checked the next day for fertilisation.  If fertilisation is successful, the embryo is left for 2 or 3 days and then a decision is made whether to transfer the embryos back into the woman’s uterus for the next stage implantation.

Statistically speaking, there is evidence that ICSI slightly increases the pregnancy rate (but not statistically significant) compared to normal IVF.  The spontaneous abortion rate with ICSI is slightly lower, but this maybe as a result of the younger age of the mothers and the absence of female-related infertility.  The frequency of multiples is about the same (probably because the policies for number of embryos transferred remains the same).  The statistics for randomised trials of normal IVF v ICSI show that there is no significant difference.  Some researchers suggest that ICSI should only be reserved for the use of severe male factor infertility.  However, the use of ICSI is on the rise and becoming the new normal as infertility clinics like to reduce the risk of failure for the patient.  I can understand why that little extra % chance all adds up.

Ethical and moral considerations of ICSI – the arguments pro and against.

All ethical debates relating to IVF still apply to ICSI.  But ICSI may be considered effectively as a further layer of ethical debate  because we are potentially further ‘messing with nature’ by selecting one single sperm.  Often Pre-Implantation Genetic Diagnosis (PGD) will be part of ICSI, where there is a screening of cells of pre-implantation embryos for the detection of chromosonal disorders before an embryo transfer.  We are not doing PGD.  This can also add a further level for debate.

I will start with what I have found regarding the pros of ICSI, and other Artificial Reproductive technologies, followed by the against arguments…

Pro ICSI: The right to procreate.  To want a child is probably the most legitimate need in the world.  The right to found a family is one of the most important human rights as declared in the Universal Declaration of Human Rights (948, Article 16.1)  ICSI enables and supports this right.

Pro ICSI : Genetically related offsping. Before ICSI was possible, couples with male infertility would likely have resorted to donor sperm, or due to religious or personal beliefs would have rejected the use of a donor and remain childless.  With ICSI, it is possible for couples to have a child that is genetically related to them that previously was not possible.

Pro ICSI: Reducing the risks to the couple. If natural IVF was chosen over ICSI the woman may be unnecessarily putting herself at increased risk, physically and mentally for both partners.  For instance, if natural IVF were to fail first time round, ICSI may have prevented failure.  There are no guarantees, but as a couple puts themselves through multiple rounds of IVF, the physical and mental stresses increase, including the financial burden.

Against ICSI: The risks to the child itself.  There is much debate about the use of ICSI in male infertility and associated genetic abnormalities.  Chris does not have male infertility, so the risk of genetic abnormality is supposedly lower.  But the case for natural selection is negated with ICSI, there is no competition as would be with natural fertilisation, the chosen sperm may be a factor in genetic malformation.  There is also a risk of choosing a sperm that is immature and may interfere with the process of genetic imprinting and could result in growth retardation and functional disorders.  However, there has been little evidence to support these concerns.  Having said there is little evidence, ICSI has been around only since 1992, so children born from ICSI have not reached far into their adulthood and so studies are limited on the long term health related issues of ICSI born children.  Not to say the least, that the long term generation effects of ICSI on the population overall are not well understood and are only theorised.  For example, will infertility be passed? In itself, will ICSI simply contribute to further medicalising in the future?

Against ICSI: Multiple Embryos.  With IVF, to give a couple the best chance for a pregnancy multiple embryos are produced, grown, and then implanted into the uterus.  Some embryos may be discarded if they aren’t of good enough quality to present a healthy chance of pregnancy.  ICSI increases the likelihood for the generation of surplus embryos.  For some people, each embryo represents a life and so the disposal of embyros is considered in the same light as abortion.

I found one eloquent and well articulated argument that explains why some people are against multiple embryos “Where doubt exists on the level of fact, the integrity of conscience requires that the presumption be in favour of the life.  There is a classic example, if a hunter hears a rustling noise in the bushes, and is unsure whether it is a deer or another human being, he must assume it is a human being until such time as he can establish that it is not.  Similarly we may accept the argument that there is scientific uncertainty as to the precise moment when an individual human life begins.  That uncertainty, however, does not remove the obligation of care and respect for what certainly has the potential to become, and may already be, a distinct human individual.”

Against ICSI: Human Error. I have read about people worried about sperm/eggs getting mixed up in the laboratories.  We learned that sperm is dyed a certain colour for each patient so there is no confusion – this was why Chris’s sperm was purple!!  But to err is human after all and so are we potentially increasing the risk for a morally complex problem?

Chris's purple sperm

Chris’s purple sperm

Partial ICSI – overcoming some of the issues at hand?  Partial ICSI is where some of the eggs are left to fertilise ‘naturally’ in the petri dish as with normal IVF, and the rest of the eggs are injected with individually selected sperm as ‘back up insurance’, just in case normal fertilisation does not occur naturally.

There are many different valid and understandable viewpoints about assisted reproductive technologies like IVF and ICSI.  I am the type of person who respects others’ viewpoints and tries to understand as much as possible all sides of an argument.  I am an analyst by profession so I like to think I am good at that.  We have decided to do IVF and ICSI knowing these issues.  I just hope that others can equally respect our decision for IVF and ICSI.  But I now feel suitably versed to think about some of the important ethical and moral issues surrounding these artificial reproductive technologies.

Other notes and interesting references

On a side note, I found an interesting statement as I was researching that I wanted to share with you, it is about IVF and women’s rights in general.  Mary Anne Warren, (a philosophy professor who wrote a lot about abortion and criteria for personhood) wrote:

“If women’s right to reproductive autonomy means anything, it must mean that we are entitled to take some risks with our physical and psychological health, in the attempt to either have or not have children.  Neither abortion nor many forms of contraception are entirely safe, but women sometimes reasonably judge that the alternatives are even less desirable.  Having a wanted child can be as important a goal as avoiding an unwanted birth.”

Other references which discuss some of the more interesting medical facts than I am not willing to describe in my blog as I am not a medical professional or just interesting…

Potential Health Risks Associated to ICSI: Insights from Animal Models and Strategies for a safe procedure, Front Public Health. 2014. 2: 241.  Accessible here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235077/

Ethics of Intracytoplasmic Sperm Injection: proceed with care, Wert, G.M., Human reproduction, 1998 vol 13 (1)  Accessible here: http://humrep.oxfordjournals.org/content/13/suppl_1/219.full.pdf

Dealing with uncertainties: ethics of prenatal diagnosis and preimplantation genetic diagnosis to prevent mitochondrial disorders, Human reproduction update,  2008, vol 14 (1), Accessible here: http://humupd.oxfordjournals.org/content/14/1/83.short

Ethical issues in Assisted Reproductive Technologies, a presentation by Effy Vayena: http://www.gfmer.ch/PGC_RH_2005/pdf/Ethics_IVF.pdf

Ethical issues arising from the use of Assisted Reproductive Technologies, Dickens, B.M., Accessible here: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.195.8966&rep=rep1&type=pdf

You might be upside down, but you’re gorgeous to me dear Uterus

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I have been told by several doctors that I have a beautiful cervix, and today I discovered that my uterus is just as “gorgeous”.  Well these were the exact words of my Reproductive Endocrinologist (RE)!!!

Today was my hydrosonogram (also known as a Saline Infusion Sonogram).  This procedure was the final test I required prior to our IVF treatment.  The hydrosonogram is a procedure where the doctor inserts a catheter into the uterus and injects saline into the uterine cavity whilst performing a transvaginal ultrasound.  The water shows up as dark black on the ultrasound against the white endometrial lining.  This allows the doctor to look for smooth edges of the uterine cavity.  If the ultrasound shows an edge that is not smooth then these rough and lumpy edges maybe polyps, fibroids or scar tissue which could be a possible problem for embryo implantation.

The procedure in itself was an interesting experience.  Greedily, I had three doctors in the room as well as the nurse! The three doctors were: my RE, the doctor whose name I can’t pronounce and performed two of my IUIs, and one of the male student doctors Chris conversed with at our last IUI.  I wasn’t quite sure if my RE was overseeing the procedure, or she had called in the other doctor because she was more familiar with my cervix and therefore inserting the catheter.  Either way, there were a lot of people clambering around my vagina in this one tiny examination room.  It was rather amusing.

First the doctor with the unpronounceable name inserted the speculum, and then peered up from between my legs and showed me the ‘flexible’ catheter and said, “remember this?  Was it this one we used before?”. Ummmm….. “I think so??!!!” I replied.  How am I supposed to know these things???! When she inserted the catheter I could hardly feel it at all.  The speculum was removed with the catheter still in, and then she inserted the vaginal ultrasound ‘wand’.  We could see the catheter on the screen, there was a lot of excitement amongst the doctors.  The nurse was tying to hold something in whilst the two female doctors discussed tactics of why it wasn’t distending with the saline, perhaps the catheter was up against something, my uterus wall…or perhaps it was bent somehow.  Either way, when they removed the magic wand, the catheter came out.  They apologised and said they would try again.  So back in the speculum went (this was only the painful part, no different to a pap smear), the catheter went back in, speculum was removed, magic wand went back in.  And there was a gaggle of excitement as this time it had clearly succeeded; the saline filled the uterine cavity and I could quickly see there was a nice oval shape, with no rough edges on the screen.  My RE told me my uterus was “gorgeous!”.  She took a few shots on the screen, and showed me in 3D my uterus.  With this image it actually looked more like a normal shaped uterus that you see in biology books rather than what I saw on the screen during my HSG x-ray.  You can see from the image from my HSG below that it was upside down.  Today’s ultrasound, it was the right way round and looked almost perfect.  Text book.

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)

I don’t have a copy of images from my ultrasound from today, but I have found a link that shows the difference between a normal and abnormal result from a hydrosonogram.

After all the excitement and the nurse had cleared everything up, suddenly my RE exclaimed! “Wait!  I need to see her ovaries so I can calculate her dosages!” So back in the stirrups I went and the nurse re-prepared everything for another peek inside using the magic wand.  We had a very quick look at my ovaries to count the number of follicles.  As today is Cycle Day 7 I had about 5 or 6 follicles in the right ovary and then a dominant one in my left.  She seemed pleased with this. I mentioned that I knew it was going to ovulate from the left his month because I could feel it.  I can always feel pain in my ovary on the left side when I’m ovulating from this side.  I’m not sure why.  The doctor who’s name I cannot pronounce seemed very interested in this fact. I left wondering why.

All in all, I left with a sense of relief.  But my feelings were mixed.  I was relieved that we can still proceed with IVF and there was nothing seriously wrong that would require surgery, but I had the feeling of frustration. In the back of my mind, we still don’t have an explanation for why we have not been successful in conceiving so far.  Unexplained infertility can really niggle away at your mind.

On a side note, today I have experienced two more pregnancy ‘announcements’.  One whilst I was at the fertility clinic, a lady found out she was being released from the fertility clinic to her OB/GYN.  She kept asking the nurse if she was sure, then she cried a lot (tears of happiness of course) which made pretty much everyone else around cry too.  Including myself.  And secondly another of my colleagues who recently married is pregnant.  Soooo all I’m thinking is – who is the third?  They usually come in threes, right??!

Suggestions for keeping your sanity on the Emotional Roller Coaster of Infertility Treatment

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In our pack of homework there was a little article from our fertility clinic’s resident psychologist.  I am sure she wouldn’t mind me copying it to my blog to share with everyone else if it helps anyone else.  Thank you Dr Barbara Kersey for your wise words….

1.  Lower your expectations of yourself at this time.  Infertility treatment is stressful.  Learn to say “no” to other commitments that are not absolutely necessary.  Chris and I both agreed we need to do this more.

2. Don’t listen to “horror stories” from other patients or friends.  Keep your own counsel in the waiting room.  Exchange only helpful, positive suggestions with others.  I haven’t heard too many horror stories on the blogs.  I don’t go to forums too much because this is where I have come across horror stories.  I’ll be honest, I tend to find bloggers a bit more educated in their opinions compared to those who may be posting on forums.  That doesn’t mean all people on forums are not educated, I just find that sometimes forums can be a little laisez faire behind posts.  So far we have not spoken to anyone in the waiting room, and we probably won’t; it’s quite a daunting place, but you never know if someone there has just had a miscarriage or just found out they are pregnant.  I’m not inclined to start any conversations here.

3.  Make it your business to be as calm as possible when you are here for treatment.  This won’t guarantee that you will get pregnant, but it can only help.  Whenever I have an appointment I have had my blood pressure taken – there is definitely a correlation behind the type of appointment and my increased blood pressure!  But I have noticed that it was lower for my third IUI.  Hopefully that is because I am relaxing a bit more.

4.  To  help develop your sense of calm, try yoga, meditation, full body massage, journaling, walking etc.  ANYTHING that helps keep your balance.  I love yoga, blogging, walking – I think one can always add in a massage or two here or there!

5.  Recogonise that the staff is here to help you.  Anxiety and anger are natural feelings, but won’t help you (or anyone else) to let staff bet the recipient of these feelings.  We spoke with a nurse once about this issue.  I said that they must have a very difficult job when dealing with such sensitive patients.  The nurse said she finds it hard and there are very difficult days, but equally a number of rewarding days.  She never knows how a patient will react so tends to keep very reserved.  My hats go off to the doctors and nurses working in this industry for the challenges they face everyday.

6.  Get outside support.  Try Resolve, the national support group for couples who deal with infertility.  For information go to www.resolve.org.  Once softball league is finished next week, we might go to one of our local meetings.  We both agree it might be a good idea to meet some others and get some support.

7.  Recognise that infertility is a COUPLES’ issue.  Keep the lines of communication open with your partner.  Infertility is a huge stress on marriage.  Get outside help if needed.  Well Chris wrote a blog post about this the other day…so I won’t say much more other than he is a great rock to me, I hope I am to him too.  I hope we can keep doing this all the way until we have a little F. (Obviously keeping the whole marriage thing up afterwards too 😉 )

Happy Friday Y’all!!! (Check me out with my American speak!!!)

First meeting with our IVF Nurse Coordinator

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On Tuesday Chris and I met with our IVF Nurse Coordinator at the fertility clinic.  She had asked us to set aside about 1.5hrs for the session, so we both took the afternoon off work…and I’m glad we did!  I left the meeting with that type of headache feeling you get after you have just sat a 2 hour exam.  I felt completely awash with new information.  Fortunately, we were given a nice homework pack to take home and read so we could absorb it in slow time.

We discussed the IVF process, basic biology and advanced cell biology.  Schedule and timings of events. Medication and blood tests for both of us.  We also talked about insurance issues, consent forms, checklists and calendars.  Our nurse has been doing her job for 15 years, she knows everything there is to know.  I was seriously impressed.

Unfortunately the embryology lab is closed for a few weeks in June/July.  We thought this would be OK, but when we actually sat down with my period dates we worked out that we were going to have to wait another month.  The nurse is not allowed to start anyone on a cycle that starts from the 29th May to 20th June.  As my period started yesterday my next period is due around the 16th June.  We were hoping I would two 28 day cycles to push me to the 20th June, but it now looks like that won’t happen.  I was very frustrated.  This means we will be expecting a retrieval date around either 3rd or 10th August, right in the middle of my mum visiting us in the US. Which I am sure she won’t mind, but it means we can’t plan any fun sight seeing trips until we get closer to the date.  At least we will have time to get medications sorted and August is a nice quiet time at work so that will be good but Grrrrr, July would have been so much better for us.  Oh well.

It looks like our insurance will cover Intracytoplasmic Sperm Injection (ICSI).  Great news!  We now need to sort out purchasing our long list of medication (by all means, I have a very short list compared to some other ladies) and choosing a pharmacy that our insurance accepts (we discovered we can choose what ever pharmacy we want and what ever brand of medication we want too).

My list of medication will be:

Birth Control Pills – yup, it’s ironic!  I’ve never taken these before so I had a lesson on how to take them!  This will help controlling my cycle so we can start the IVF stimulation at a certain time.

Gonal-F or Follistim – this is a Follicle Stimulation Hormone drug, adminstered by a subcutaneous injection. Oh great! Needles!  This helps stimulate the ovaries to grow lots of follicles, more than I did for the IUI where I had 2-3 follicles, the goal is 20 or so! Yikes.

Menopur – A Follicle Stimulation Hormone together with a Luteinising hormone (were you paying attention in GCSE biology??!).  Another subcutaneous injection.

Ovidrel – The trigger shot.  Been there, done that.  Although this time I will be taking this injection at a very precise time just before my egg retrieval surgery.

Ganirelix or Cetrotide – this will prevent me from ovulating on my own so the eggs are ready at the right moment for retrieval.  Another subcutaneous injection.  Wow.  Four different needles already.

Progesterone in oil – I’ve heard about this one before and the needle terrifies me! It is an intramuscular injection.  Just google progesterone in oil and look at the images page.  This is instead of the progesterone suppositories I had with the IUI.  Chris will have to give me this injection every night – in the buttock muscle!  Have you seen the size of that needle????!?!?!

Vivelle patches (transdermal etrogen) – An estrogen hormone patch.  YEY something that isn’t an injection!!!

Doxycycline – antibiotic for my egg retrieval (so I don’t get an infection after inserting the big needle they are getting to use to retrieve my eggs through my vaginal wall)  Chris also gets to take doxycyline because we are doing ICSI, this drug affects the sperm and makes them less ‘sticky’ so it’s easier for them to select just one sperm to inject into my egg for fertilisation.  That was something I did not know!  Rather cool.

It was an intense session, but I was very excited that we are actually starting this and moving a step closer to becoming pregnant.  We came home in a bit of a daze afterwards.  The emotions running around were definitely mixed.  Interesting times ahead.

Facts are stubborn things

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Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence.

John Adams, ‘Argument in Defense of the Soldiers in the Boston Massacre Trials,’ December 1770

Facts are stubborn things, and in a court of law the statement attributed to Mr. Adams makes great sense. ‘…Whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.” What this quote fails to address are the situations in which emotion outweigh fact, override fact and outright overwhelm fact,

We are meeting with our IVF counselor this week to discuss the timetable for our next treatment. We will sit and discuss the day by day steps to be taken, hear factual descriptions of the laboratory procedures and be given % chances of success. All the facts will be laid out before us, helping us understand how our chances of conceiving will be good. And yet, we will probably leave the meeting with some degree of trepidation, some niggling concern, and perhaps some fear….what if it doesn’t work this time? The cause of these feeling is emotion, overriding the logic and the facts.

The facts of IVF are only part of the story, in fact (pun intended) they are only a small part of the IVF journey, Emotions are the main event, and this is where the trouble starts. Emotions are irrational, they can sneak up on us and they make this entire process much harder. Couples going through infertility treatment have to deal with a lot of new facts whilst at the same time dealing with a lot of new emotions, many of which will be strong emotions. Whilst the IVF clinics are sensitive to this it is not their role to handle the emotions for the couples, that is something the couples must do for themselves.

Couples are a team, and strong couples will work together through the hard times, supporting each other, with each person playing a part. Usually hard times impact one partner more than another, such as a the death of a relative. This is not to say couples don’t share pain but there are very few occasions that truly impact both people equally; the loss of a child perhaps being the most obvious. IVF is a little different, the hard times are experienced by both people at the same time but the nature of the hardship is likely to be different for each person. With IVF it is rare for the issue to be linked to both partners, so perhaps one partner may have feelings of guilt that they are ‘at fault’. Conversely, the other partner may feel guilty because they don’t have any issues and therefore are causing pressure for the person with the issue. This type of second guessing is all to easy, and comes from us making assumptions and trying to apply logic (often flawed logic) to try an understand emotional situations.

Couples that do not communicate often and openly are liable to fall victim to this second guessing and assumption making. Couples that try to conform to stereo types are also at risk. If a man feels that he should be supporting his partner and should be the ‘pillar, the rock, the strong supportive one’, then he is not being honest to himself about his emotions and he is not being honest with her about how he feels. This type of approach can be done with the best of intentions but cause the worst of responses. The man may appear to be unaffected by the issues and thus the woman may wonder if she is over reacting and end up hiding her feelings. This is the complete opposite of what the man may have intended.

So what am I getting at here.? Openness, honesty and regular communication can help prevent misunderstandings when dealing with strong emotions. We (Dani and I) have found that talking a little and often has helped us, talking in the shower together, whilst preparing dinner or when driving to the shops. There is no schedule for us to talk about the emotions we feel, there is no time that is off limits and this helps us…at least I think it helps us….perhaps Dani is not being open with me and I am making assumptions….see how easy it is to get caught in this line of thought?

By being open about how we feel means we don’t get washed away in a torrent of emotion when faced with tough facts. Knowing that we are not hiding anything from each other makes the journey a little easier, a little safer, and a little less scary.

Caught in a friend gap

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Moving to a new country thousands of miles from friends and family has been a mixed bag of emotions.  Three years ago when I applied for my job in the US, Chris and I thought very hard about whether leaving the UK was the right thing to do.  We had only been married for about two months, and in the three years we were together preceding our marriage, I had spent one of those years in Afghanistan and another half a year traveling with work.  So as you can imagine, it might have seemed a little crazy to be moving half way across the world so soon after we tied the knot.  But it was our dream to live abroad, at the least before having children.  So we went for it, and on 1st January 2013 we packed our two suitcases and got on a plane to Virginia, USA.

We have missed weddings, birthdays, births, parties, funerals along with just missing friends and family in general.  But we have made new friends, and experienced weddings, parties, birthdays and births here in the US too.  At the ripe age of 32 years old, we are not the socialites that we used to be.  We pretty much like being in bed by 10pm, some nights you will find us in bed at 9.  We even joined a sports and social club where we have met some very lovely people, and made some very lovely friends.  But I can’t help but feel in friend limbo.  We haven’t been here long enough to have established the types of strong friendships that we have in the UK, whom we have known since childhood or university.  I think part of this is our age.  We are old enough that we don’t bond with people who like to go out drinking or partying, but people who are our age tend to have children, and it’s difficult to bond over something you don’t have yourself.  Dreaming of having children isn’t quite the same.

In the US the average age of a parent is 25.1, in the UK it is 30.  And that statistic sums up our predicament.  Maybe I am mistaken behind this reasoning, but I feel like we do not bond quite as well with people our own age here in the US because they typically have children.  We have a couple of friends who have children, but I can’t help but feel like our bonds haven’t fully sealed.  Just as we started to make friends with some younger people, but they have moved on, just like we did….to other parts of the country, or even other countries.  And I really honestly have reached a point where I feel like not bothering to make new friends.  Working with the military, I am now getting a bit tired of making friends just for them to move on after 2-3 years.

With infertility looming over our heads, I sometimes feel lost without good friends by our sides.  Fortunately, I have some amazing friends back in the UK who have been so incredibly supportive through everything so far.  I am so lucky.  But I have hardly told anyone here in the US about our infertility treatment.  And so this is why I am considering going to our local RESOLVE meeting; I hope to actually meet other couples similar to us.  Friends in the UK are great, but it’s not so great when you just want a hug or just fancy doing something random and spontaneous to help get you out of hole.

Without knowing if my contract will be renewed at the end of the year, we are on a weird cliffhanger.  This may be our last summer here.  We may only have 6 months left to see and do everything.  But we may be here longer.  We keep telling ourselves that we should live in the present and not hold back.  But even still, I can’t help feel like we are caught in a friend gap right now.  Why does it feel like as we get older, having a kid is the ‘get out of jail free’ card?  It just doesn’t seem right.

Where to go for more information about IVF?

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When we decided to go ahead with IVF at our last appointment, the doctor gave us a rundown about the whole process, but I did not learn anything new that I had read about already.  Of course, I had done some research on top google hits about the process in general. I have also been following a few blogs about ladies going through IVF themselves.  But I will be honest…I have not really stepped up to my usual level of research.  Probably because I thought I had plenty of time before we start this.  Also I’ve been keeping myself busy the last couple of weeks, both at work and at play.  Next week we have our first appointment with our nurse, so I want to make sure I ask all the right question from the outset.  And so, the time has come!  I feel like I have a big gaping hole in my knowledge and I need to fill it…stat!!

When I first started following blogs I was put off following IVF blogs that were overly acronym-ised and had lots of numbers on it.  Without any reference, it felt like gobbley-de-gook to me.  In fact it was (and still is) terrifying.  I am sure it will all make sense soon, but for now I am following a select few who make it easy to read for newbies (thank you for that by the way!).  But where do I start my research?

Areas I would like to better understand:

  • Medication for IVF
  • Embryology
  • Ethics
  • ICSI
  • Complimentary Therapies
  • The statistics low down! Because I just can’t help myself being an analyst by trade, I’ve got to know!

Do you have any good suggestions for books or websites that you have found helpful with your IVF journey?

Our options widen…but not on the kids’ parties front

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I had a great email today from our legal department.  They told us that the US government forsees no legal impediment based on our visa status for adopting in the US, either domestically or internationally. They are also aware of two other families from my organisation who have previously adopted successfully, however one family had a few complications over the legal issues.  However, it sounds like if you have money to burn, the legal issues will disappear.  I don’t mean in a corrupt way, but rather the more you pay the more you get in terms of service.

We asked our legal team to help us look into our visa status so we would know if it was actually possible for us as ‘legal aliens’ to adopt if we decide to stay in the US.  It took about three weeks for everything to be double checked, but it was worth the wait and now we know….we can adopt!

I also had a phone call from our IVF nurse co-ordinator today.  We have an appointment next week with her to go through the whole process in more depth than the doctor did – apparently it will take about 1.5hrs!!  She sounded very friendly and helpful (I guess you have to be do that job!)  She also informed me something the doctor forgot to tell us last week.

The Embryology lab is going through a refurbishment in late June/early July!

Fortunately it sounds like it won’t affect us as we would expect an egg retrieval in mid July.  I hope they don’t over run their re-furb or delay it because that would suck going through all that just to have our cycle cancelled because of some lazy painters!!! But I’m sure they wouldn’t let something like that happen.

I’m currently on Cycle Day 19 and I’m feeling great.  I have had the odd pain, but nothing like the sharp pains from the last two IUI cycles.  Fingers crossed they don’t come back that it was just a side effect of the progesterone and nothing else nasty causing them.  Our break from trying to conceive has been quite fun; next weekend we are planning a trip to our local beer festival and Bush Gardens to try out their new roller coaster ‘Tempesto’!

Physically the break is doing me good.  Mentally, I’ve still had a few odd moments.  This last weekend we didn’t go to our friend’s daughter’s 3rd birthday party at the petting zoo.  Now, I love animals. Love love love them, and who doesn’t love to pet animals!  But I freaked out at the last minute about going someplace where everyone else will have a kid with them and we would be the odd ones out.  I mean, why would anyone go to a petting zoo without a kid in tow?  If it had been a party at their house or somewhere more neutral in that sense I wouldn’t have had a problem. It was just the idea of feeling like we didn’t belong, with the potential for random strangers asking ‘oh which one is your kid’? Or, like the time a random granny noticed us at a Christmas tree lighting ceremony, told us ‘It’s OK that you don’t have a kid’. Yeah, I’ve been there before….and right now it is not for me.  I felt bad that I couldn’t pull myself together to go, I hope they can understand.  I’m sure they do.  I just wish I didn’t feel like this.

So to end this post on a positive note…here is a picture of a cheeky goat that we know.

Who wouldn't want to pet this cheeky goat? Oh that would be me, big chicken pants.

Who wouldn’t want to pet this cheeky goat? Oh that would be me, the big chicken pants.