IVF Diary Vol II: 15th Jan 16

Medication(s) administered and dosage(s). Gonal-F 300 iu & Menopur 150 iu.  Chris really is great at this injection thing.  I prepared the Gonal-F whilst Chris prepared the menopur.  We both read the instructions to remind us how to mix everything up, but like riding a bike, it was easy this time around.  Chris was a little bit nervous, but he needn’t have been, he did a great job.  I even looked down at the needle as he was injecting it – I am still not good at watching the needle break the skin though :-s.  The menopur did burn a bit as it went in, but it wasn’t quite as bad as I remember it to be.

ivf2_day1Stims

Medical procedures undertaken. Nil.

What are my symptoms? Period started right on cue yesterday morning!  Hot flashes and a bit of dizziness a couple of hours after my 2 first injections of this cycle.

How do I feel today?  A little bit annoyed that my plans to have a more relaxing stim period and 2WW are falling to pieces. Some short turn around-high impact work may fall on my plate next week.  I would have to forgo some of my steadfast principles for quality work and accept that in this case a 40% solution can only be delivered in the time lines given.  I have stuck to my guns though to some extent – where I was going to be taking the whole week off work, I am now only taking Monday and Friday off.  Tuesday and Thursday I will be working from home, Wednesday I’ll be in the office.  As we talked about this potential work, I started to feel sick to my stomach.  I started thinking back to last time around when I was trying to get my project finished and how stressed I was feeling about balancing the IVF process and work.  I let down my quality levels then – no one noticed (of course I noticed), in fact I got lots of praise for that piece of work.  Last week when a senior boss praised this work in front of the whole division I sat there quietly proud, but felt a bit sad that I had accomplished that with little help during a shitty time of IVF, followed by the whole ectopic pregnancy thing and ultimately miscarriage.  My boss has been great by not dumping everything on me right now, he quite easily could have done, but he didn’t so I appreciate that, but I can’t quite help  thinking about how IVF is holding me back from doing my absolute best.  I don’t think my colleagues around me think like that (fortunately they are all smart, intelligent people who know me), it is just myself I am fighting with these thoughts.

All that being said, I’ll talk about something positive.  We decided to go out for dinner at our local restaurant to celebrate surviving and nailing those first two injections.  Chris deserved his beer!  As we were finishing our meal the power went out in some of the building.  There was a storm that evening so it must have knocked the power out.  I said don’t worry, we are on a different power grid to our neighbours over the road (the block our restaurant was on) and last time their power went out, ours stayed on.  As we walked back, we realised that our grid was out and our neighbours’ over the road was on! Typical.  Fortunately we are well prepared for such events (for hurricanes and other storms etc), and carried on with the power of candles 🙂  It was a little bit romantic…I snuggled up in bed preparing for the power to be out all night and the temperature to dip.

power_out

Power outage = Candle lit bedroom!! Fortunately we have quite a few candelabras left over from our wedding table decorations still 😉

But then came the hot flashes!  I needn’t have worried about keeping warm, it seemed the drugs were doing a great job of that for me!!

Any results?  Estradiol <20 (as it should be, the same as IVF 1).  Progesterone <.2 (as it should be, the same as IVF 1). FSH 3.21 miU/ml (IVF 1 was 9.29, in 2014 it was 6.8) LH 0.771 miU/ml (IVF 1 was 3.48, in 2014 it was 4.9).  My LH level came up as red in my results…this means it was out of the ‘normal’ range, it is very low.  But not by much.  So I looked into it.  Although lower FSH is good, low LH is not good…apparently calculating the FSH-LH ratio and knowing the LH levels are good predictors of IVF outcome.  Let’s just say that I read several scientific reports, plugged in my numbers and the stats aren’t good.  But, the good news is that I don’t care! Why?  Because women with this kind of level and ratio still got pregnant.  And I am going to be one of those women in 4 weeks time 🙂 In your face science!!! **

What’s next? The same injections Sat, Sun, then monitoring appointment on Monday morning.

Weight. Work stress = nom nom nom bads.  But I did do the mixed martial arts P90x3 routine and pushed myself hard, so I don’t feel so bad.

Waist.  NSTR

Boobs. NSTR

Hours of Sunshine 🙂 Still NONE.  Let’s see if the sun comes out this weekend!

Fun Activity to keep Dani from going insane. IT’S FRIIIIIIIIDAYYYYYYY!!  I need say no more.  Surprise date night.

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

** Reserve right to have science egg in my face later

‘Tis the season…Pt 2

‘Tis the season to be jolly.  True.  But my feelings can’t help but be a bit up-and-down like a see-saw.  So I decided to split my post into two.  Depending on how you are feeling this season, you may only want to read one or the other.  Maybe you feel a little bit like me, so read both!

Pt 1: ‘Tis the season to be jolly

Pt 2: ‘Tis the season to be not so jolly


‘Tis the season to be not so jolly

I already blogged about the difficulties of the holiday season for those of us struggling with infertility (my post is here), so I won’t cover old ground.  But this isn’t always the season to be jolly.  And as much as I have equally had lot’s of jolly things going on, I have recognised that life isn’t always quite so jolly at this time of year.

1. Gift Shopping.  I hate shopping at the best of times, and shopping with the Christmas crowds – my worst nightmare – I’ve written about this before.  Shopping for baby gifts – EUGHHHH.  I am an emotional roller coaster with this one!  I love buying cute baby stuff, but when I see cute baby Christmas stuff – especially adorable onesies with “My 1st Christmas” I’m a wreck.  I don’t think I need to say anymore about this one.

2. Distance.  I am a few thousand miles from some of my greatest friends and of course my family.  So when my mum told me she had received my Christmas Parcel and cried, I cried.  Damn it.   It’s not easy being far from loved ones at this time of year.  We have had lovely offers from friends inviting us over to theirs for Christmas Day, but in fact this is something we just can’t do this year.  We are going to start our own family traditions – I wrote about that already – we are excited to do this, but it’s not easy to do.  Some people may say that we are lucky we don’t have to deal with ‘forced family reunions’ with nosey inquisitive family members; but even if we were back in the UK we are lucky that we have the most supportive family that this wouldn’t happen for us.

3.  Trying to Conceive.  Officially we are allowed to try to conceive again, but I have mixed emotions about it.  I wrote a separate post about it so I won’t repeat it, but this has been playing my mind this week.

4. Facebook.  A friend posted on facebook what seemed to be a pregnancy announcement, until you get to the bottom of the long carefully written post and realise they are just talking about santa clause.  It was poor taste for someone like me struggling to get pregnant…but even more so because I felt sad that this couple may just find them selves to be one of the “1 in 8 facing infertility” one day.  I wanted to tell them it was in poor taste, but then realised that I would just come across as a scrooge bag as so many people had already commented how funny it was.

5. Money worries.  As my credit card bares the scars of many swipes this holiday season and our bill from the infertility clinic shows up with a surprise payment from September, I have the constant feeling of every penny counts.  Actually, we are very fortunate to be in a comfortable financial position, but I want to keep our options open for the future and don’t want to close a door because I didn’t keep control of our outgoings.  But Christmas is a time for giving, so in general I don’t feel guilty for the gifts I purchase or the charities we give to – it’s just the gifts that Chris and I give each other and the seemingly endless nights of eating out that make me feel guilty!!!

6. Coping with loss.  This applies to anyone who has lost a loved one, not just those who have had to deal with losing a child, as well as anyone who has experienced loss of something of their physical self.  Ultimately the Christmas holidays plays heavy on the heart of someone who has lost their hopes and dreams.  As I sip my cup of tea in my new mug “When it rains look for rainbows” this reminds me to remember the positive things and love that I have been lucky to have experienced and made me a richer person, and “When it’s dark look for stars”, this reminds me to look up and remember our dreams are still out there and we are being watched over.  It’s still difficult, and gets harder getting closer to the big day itself.

be nice

Everyone you meet is fighting a battle you nothing about.  Be kind. Always.


We have far more jollynesss to keep us going for the festive season  but it’s these kinds of things that remind me it isn’t easy for everyone, and even more so for many more people who don’t have the jolly things I described in my earlier post.

On the subject of coping with the festive season.  Resolve has an excellent fact sheet about coping with the holidays (here) – it provides a collection of great articles I recommend for reading over a cup of tea.  You may need some tissues to go with that too.

Period after HSG and miscarriage

If you are not into reading about periods and period blood you should stop reading this now and come back tomorrow when I will be talking about less gross things in life 🙂

This is my first period since my recent Hysterosalpingogram – HSG – test.  This is also (probably) my second period since my miscarriage.  And it’s a weird one!!  It is on schedule – for which I am truly grateful for (isn’t it funny how we celebrate the little wins on this journey!!).  But this period is weird so far.  The pains are different, I cannot explain what is different about them, they don’t hurt so much, but the pain ‘rumbles’ inside me rather than the typical’radiating’ and ‘sharp’ pains I get from my normal period.  The blood is a heavy watery-pinky-mucusy mix.  Normally I get dark brown or red, thick and clotty blood.

So I got onto my friend google (like you do in a situation when weird stuff happens to your body).  I extensively searched for possible causes and whether this is normal or something I should call the nurse about.  My biggest concern is that my uterus lining won’t be up to scratch in preparation for our next round of IVF.

The best and corroborated explanation for this unexpected weirdness is that it may be an indicator of anemia or low iron stores and/or unbalanced diet/suffer from poor digestion.  Both of these things are plausible in my case, but can be easily resolved with some supplements.

I was worried it could be associated with the HSG procedure or the miscarriage, but it seems to not be the case.  So nothing to  worry about or to call the nurse about specifically, but I will mention it when I speak to her next.

Crisis averted, thank you google!  Now….pass me the liver and spinach 🙂

November: My blog therapy month #NaBloPoMo15

I challenged myself to write a post every day in November as part of National Blog Posting Month 2015.  Well, I certainly wrote more posts than I thought I would, but I didn’t quite manage to post every day.  I managed  22 posts out of a possible 30 :-s  If you posted every day, kudos to you my friend!!! It isn’t easy.  The thanksgiving holiday and travelling to Europe for work has limited my success in posting every day/  The days I didn’t blog were the days I yearned to write; just had little physical time to sit down and write it.  I got withdrawal symptoms when I didn’t write.  And I still have a long list of things I want to write about.  Fortunately, I never experienced writers block, I always had something to talk about.  Which is surprising, because I am not much of a big talker in real life!

I have written about some things that perhaps have given you more insight to my ways of thinking – an insight to the inner Dani!   If you are still here reading – Thank you for sticking with me!!!!

I have written about infertility related issues, and explored some broader topics about becoming a parent.  I have written about things that have bothered me and simply writing about them has helped me get over them.

I have also killed some time; time until our next cycle of IVF cycle.  I now have a new countdown – Christmas!!!! And I even have an amazing 3D Christmas Tree advent calendar that my granny gave me which will help.  I bought Chris a Birthday present – a daily lesson of couple’s massage for a month.  Basically he gets to be the stooge whilst I learn how to massage properly. It’s the gift that keeps on giving!!!! Not only does Chris get a mini massage on a daily basis (assuming I don’t hurt him whilst learning the massage techniques!), it brings us closer together through the power of relaxation – AND this daily lesson will be another count down to Christmas!  Then, after Christmas it is only 3 days until my Birthday, which will also most likely be the start of my IVF Diary Vol. 2.  Whoop whoop!

Time has flown this month, NaBloPoMo15 has signified a lot more to me than just exploring my ability to write and blog.  I have discovered that writing is therapeutic, something very much needed.  It has helped in my recovery to positivity.  I am feeling ready to start afresh.  January 2016 is going to be a rollercoaster ride.  But I have a feeling that we are going to have a great start to the year.
NaBloPoMo November 2015

What-ifs? And Bias in Diagnosing Ectopic Pregnancy

Yesterday Chris and I were talking about the ‘What-ifs’ of the future.  We tend to find ourselves having these kind of conversations regularly.  It’s difficult to plan anything when dealing with infertility.  Not only because of things we can’t do ‘when we are pregnant…’ but, also what to do with our savings.  We want to buy a house together, but it’s difficult to have these conversations with little knowledge of where our infertility journey is going to take us.  For example, if we bought a house now, we might not be able to keep our options open to afford egg donation, surrogacy or adoption.  So we hold off on making these big decisions for now.

We talked about what we would do if I am pregnant again and we face a similar scenario that we faced after our first round of IVF – slow rising hCG, nothing seen on the ultrasound (Pregnancy of Unknown Location), suspected ectopic pregnancy.  Chris said that at least we would know what to expect!  This is very true.  But, I think I might do things differently.  There is a small part of me that feels guilty for giving in and taking the methotrexate treatment.  Part of me wonders – what if?  What if I hadn’t taken the treatment.  Would I have just prolonged the inevitable?  Or would I be into my second trimester by now? I actually feel sick writing those words!

We made the decision to take the methotrexate treatment after 5 doctors from our clinic had suggested we should do that.  Our doctor had spent 20 minutes meticulously looking for an ectopic pregnancy on the ultrasound, said she couldn’t see anything that looked like an ectopic, and concluded that I must have miscarried already (I had started bleeding two days before) and then effectively released me from monitoring.  The next day she phoned to say she changed her mind.  What made her change her mind?  Did something not fall into place?  Did another doctor tell her she was leaving herself exposed to liability for misdiagnosis?  Did the other 4 doctors tell her she had made the wrong call?  How did she make her decision?  Did she review the evidence afterwards in a more objective manner?

It got me thinking – FIVE doctors told me I should take the methotrexate to terminate the {ectopic} pregnancy.  That should be enough to qualify for my ‘second opinion’.  But I never really thought about it until now, that organisational bias may have come into effect here.  All these 5 doctors work together every day.  They all make decisions on their own every day, but sometimes they ask each other’s opinion when making a decision or a diagnosis.  Not only do doctors face their own personal biases but they face bias that becomes systemic in their clinical practices.

I am not a stranger to these biases – I teach methods and techniques to the military to help them overcome all kinds of biases when they make decisions.

There are many opportunities for a doctor to become biased in their own decision making or diagnosis, here are some of them:

Confirmation bias:  The tendency to over emphasise data that supports an existing hypothesis rather than data that refutes that hypothesis.

Overconfidence Bias: Over-reliance on the opinions of the expert that can before (the attending or consult etc)

Availability Heuristic: this patient has whatever your last patient who looked like this has or whatever is commonly discussed

Premature closure/anchoring: the tendency to decide that the patient’s current problem is related to the first thing we diagnose rather than more than one issue.

Commission Bias: the tendency to need to do something rather than stand there.

Hassle Bias: the tendency to take course of action that is easiest or exposes the physician to the least amount of grief

Regret Bias: the tendency to take course of action due to guilt from a missed diagnosis

Commission Bias: the tendency toward action rather than inaction.  An error arises when there is an appropriate committal to a particular course of action.  It is more likely to occur in someone who is over-confidence, and reflects an urge to ‘do something’.  It satisfies the obligation of beneficience in that harm can only be prevented by actively intervening.  Commission bias may be augmented by team pressures or by the patient.

One or more of these biases may have played a part in my doctor’s decision making process for my diagnosis*.

In addition to the individual and organizational biases doctors face, there are also the established guidelines that doctors follow.  Every clinic will develop its own guidelines for diagnosis and treatment of ectopic pregnancy, generally based off national best practice and research – my clinic is within a medical school so I like to think they are up to date on their practices.  Guidelines will vary from clinic to clinic because they have the freedom to do so.  However, in the UK, the NHS is very transparent about many of these national guidelines by publishing them on the internet, and so I know that if I was in the UK I probably would have been treated very differently to how I was treated by my clinic.  In the UK I would have been sent home and told to keep taking home pregnancy tests until the date for next ultrasound scan or until I received a negative pregnancy test or if my situation changed to go to the hospital if I had developed any signs or symptoms of ectopic pregnancy.

I can’t help but wonder “what if”….I know the chances were slim that my pregnancy was going to be successful – the statistics told me that.  But I have read about a very small number of cases of women having slow rising hCG level after IVF, with nothing seen on the ultrasound up to 9 weeks and delivering to full term healthy babies.  There is a facebook group called “Misdiagnosed Ectopic Pregnancy Given Methotrexate”, and I have learned that research in this area is lacking, particularly for women going through IVF and women with retroverted/tipped uteruses.

I don’t regret my decision to listen to the advice of 5 doctors to take the methotrexate.  But it does make me think about how difficult a doctor’s job is to make that decision, the biases they face on a daily basis when making those diagnosis decisions, and the overall lack of research in this area.  I hope I never have to face this scenario ever again.

If you have found my blog because you are facing this situation, please feel free to contact me: dani@thegreatpuddingclubhunt.com because I wouldn’t wish this upon my worst enemy and will try to offer you a hand through it.

 

*If you would like to know more about bias in clinical decision making there is an excellent website that provides more information: http://www.improvediagnosis.org/?ClinicalReasoning

The cost of a suspected ectopic pregnancy

You can’t put a price or a value on having both your fallopian tubes intact.  In fact I imagine that anyone who has lost one or two of their fallopian tubes wouldn’t be able to put a price on how much they are willing to pay to have them whole and functioning again.  Without a doubt.  And so when the doctor told me that there is a risk that I had an ectopic pregnancy and a fallopian tube could rupture at any point, you simply don’t think about the $$$ money.;

After I found out that my pregnancy was non-viable, the whole process of determining whether or not I had an ectopic pregnancy was absolutely soul destroying and mentally exhausting.  I tried to research what the likelihood was of having an ectopic pregnancy was with IVF.  I tracked my hCG levels to try and determine what my odds were.  I even joined several online groups to talk to other women who had experienced what I was going through.  (I have probably mentioned this before, I dislike online forums because you get exposed to some real stupid, dumb, insensitive and simply irritating people.  And you just can’t get rid of them.)  All of this led me to some tiny hope that I was going to be one of those women who was going to beat the odds and carry a pregnancy despite the slow doubling hCG levels.

The doctors cared a lot about my wellbeing and were concerned of an ectopic.  I mostly followed their recommendations:  We both dropped everything to come in to the clinic for blood tests, consults and ultrasounds.  What they didn’t tell us was how much it is all going to cost.  Like I said, when there is a risk of losing a body part or even worse, your life, the money doesn’t matter.  And now I can finally say how much it all cost.

I am not complaining about the cost because we are lucky, we have amazing insurance and we can afford to pay the bills.  What I would like to know is what about those people whose insurance wouldn’t cover the costs?  It’s just another slap in the face if you have saved up or taken on debt to pay for IVF.  Of course, most insurance companies cover the cost for maternity healthcare, but the treatment of an ectopic or any other type of pregnancy loss doesn’t come for free.  Remember I told you about the woman who couldn’t afford to have an ‘abortion’ to end her life threatening pregnancy at her hospital because of a CRAPPY law? (You can read about it here).

When you save up and take on debt for IVF, no one tells you to save a little bit extra in case things go slightly wrong.  I have discovered, however, that most hospitals and healthcare providers will negotiate the costs if you can’t afford this type of care.  There are also some charities out there that can help.  I also believe that friends and family will be there too to help out.  We have helped out some friends in the past when they got caught out with unexpected medical bills.  It’s not only a difficult emotionally, it can quite quickly become difficult financially.

So how much did it cost?  Luckily for us, not much.  The total cost was $3,107 of which our insurance covered most of it, and so cost us $140.   I have updated my ‘Cost Lowdown’ page with the breakdown of where the biggest costs lie here. But this has made me think about putting aside more savings specifically for unexpected healthcare costs.

My appreciation for the UK National Health Service has simply sky rocketed.

Abortion and the grey space

We hear this word used in everyday life – abortion. We can all formulate an idea of what abortion is….someone choosing to end the life of their baby. But this isn’t a wholly accurate or fair description and is certainly not what medical professionals use the word ‘abortion’ for.

According to Wikipedia, the term ‘abortion’ can be defined as:

“The ending of a pregnancy by removing a fetus or embryo from the womb before it can survive on its own.”

The unintentional expulsion of an embryo or fetus before the 24th week of gestation is called a ‘spontaneous abortion’. This is the clinical term that is used by medical practitioners in their notes to describe what most lay people would understand to be ‘miscarriage’.

The intentional expulsion of an embryo or fetus is called an induced abortion. Reasons for intentionally inducing abortion are either therapeutic or elective:

  • Therapeutic abortion is performed to save the life of the pregnant woman; prevent harm to the woman’s physical or mental health; where indications are that the child will have a significantly increased chance of premature morbidity or mortality or otherwise disabled.
  • Elective abortion is voluntary when it is performed at the request of the woman for non-medical reasons.

And then there are the methods of abortion, including medical abortion and surgical abortion:  Medical abortion (sometimes also called chemical abortion) is induced by drugs or pharmaceuticals.  Where as surgical abortion includes procedures such as vacuum aspiration, Dilation and Curettage (D&C), Dilation & Evacuation (D&E) and hysterotomy.

The use of methotrexate to terminate my pregnancy of unknown location or ‘ectopic’ pregnancy is described as a medical abortion and can also be described as therapeutic abortion. Clinically, I did not miscarry.  Although I am sure I had started the process of miscarrying before I took the methotrexate, and would consider it to be a spontaneous abortion – or – miscarriage – or – early pregnancy loss. However you want to ice it, in my medical notes it will be described using the word abortion.

For those who are not aware that this is actually a clinical term it can come as quite a shock to see those words on their medical records.  For example, here is a link to a news article: “Mom to be shocked when miscarriage called ‘abortion’ in medical records” that shows how easy it is mis-perceive the term abortion.

But definitions of abortion vary across and within countries as well as among different institutions. Language used to refer to abortion often also reflects societal and political opinions and not only scientific knowledge. Popular use of the word abortion implies a deliberate pregnancy termination, whereas a miscarriage is used to refer to spontaneous fetal loss when the fetus is not viable (i.e. not yet unable to survive independently outside the womb).

Paul Freeling and Linda Gask* explain the problem well:

“As children many of us learnt the old rhyme “Sticks and stones may break my bones but words can never hurt me”. As we grew older we discovered that the adage was untrue. For most of us whose profession involved interacting with other people it became obvious that clumsy or inapposite use of language could cause pain. An attempt to avoid such pain has provoked…to suggest that distress in women who have miscarried would be reduced if changes were made in the language used by professional carers…the word “abortion” should be avoided because the lay public interprets it as applying to a termination of pregnancy.”

And then there is the grey space in between all of this. This is where in the US definitions and clinical descriptions are all important for insurance companies.

I recently read about a lady who fell right in between this grey space….

At a 13 week scan several doctors told her that her baby had a heartbeat, but the organs were not inside its body, the hands and feet are curled, one limb was missing, the neck was not right. Overall, the baby was unlikely to survive and should be removed as soon as possible before it could cause serious health issues. By definition, in Ohio, this situation was considered by the insurance company as an optional abortion because there was still a heartbeat, therefore, they would not cover the cost of the $10000 operation at the hospital. Planned Parenthood would be able to perform the surgery at a cost of $800.

Eventually, after the doctors re-worded the case, the insurance company agreed to cover the costs. But it came at a cost. You should read the whole article to fully appreciate what this poor woman went through: http://www.huffingtonpost.com/tamara-mann/heartbeat-involuntary-miscarriage-and-voluntary-abortion-in-ohio_b_2050888.html

This blog post is not about pro-life or pro-choice. It is merely a brief peek into the complexities of the use and definition of the term ‘abortion’.

For me personally, the insurance company did not initially cover the cost of my methotrexate treatment because it was being used as an abortion drug. Eventually we managed to claim the cost back directly via our European insurance provider.

I don’t have a solution to propose, I just know that abortion – whether it is spontaneous, elective, optional, surgical, medical – is a confusing grey mess of an area in the US.

* Freeling, P. & Gask, L., Changing terminology is no substitute for good consultations skills BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7165.1028 (Published 17 October 1998)

NaBloPoMo November 2015

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??!!!?!

My Mountains Monday Memoirs: Healing Holidays Days 1 to 9

This is actually a very recent memory!  But there there were lots of mountains in this holiday and we pretty much remained at altitude as we spent the majority of it on the Colarado Plateau. So here we go….!

This holiday was never meant to be a healing holiday.  We had been planning this road trip for almost a year, we even delayed it from May to October because of the infertility treatment.  But we decided to bite the bullet and book it for whatever stage we were at.  We were cautious and kept things less adventurous and a little more comfortable just in case I was anywhere up to 5 months pregnant.  We didn’t imagine that we would be leaving for this holiday with a cloud of sadness over our heads.  But yet despite the sadness, this holiday came at a great time.  It has been a chance to reset and refocus.  I know not everyone can afford to take the time off work or even have the money to travel afar, but I highly recommend getting away somewhere, switching the phones off and avoiding the rest of the world to help heal the mind.

This road trip was always planned to be epic.  And it sure was!  Here is a brief run down of our adventure:

Day 1: Excitement sets in (NV).  Finished work early (Friday)!  Fly to Las Vegas, arrived late and stayed at nearby airport hotel.  Teased by the sights and sounds of Vegas!!!  There are even slot machines in the airport baggage terminal.  Do people really get that addicted?

Day 2: Trippy & Valley of Fire State Park (AZ).  Picked up our rental campervan – AKA Trippy!  Can you guess why we called her Trippy??!

This was our 'cosy' home for the last two weeks - AKA Trippy.

This was our ‘cosy’ home for our holiday AKA Trippy.

We were upgraded from the small campervan we originally booked – woohoo! When I say upgrade – I mean we got an extra two feet of storage space!  Which we were grateful for.  Trippy had a table and chairs in the back that converted into a queen size bed and took up the whole width of the van.  Cosy.  In the boot (trunk), Trippy had a sink, mini refrigerator and gas burner.  All that was left to do was sign our lives away on a dotted line and Trippy was ours for 13 days.  We were off to our first stop – the Valley of Fire.  It truly was like the valley had been set on fire, the rock was a beautiful orange/red in the midst of a green flat plateau.

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Over looking the valley of fire

Day 3:  Zion National Park (UT).  Change of time zone.  Travelling five states in 2 weeks that are in different time zones soon became confusing!

We hiked up Angel’s Landing – a challenging climb if you were to have vertigo.

We hiked and scrambled to the top of Angel's landing

We hiked and scrambled to the top of Angel’s landing

Some people turned around as their fear got the better of them.  Chris and I on the other hand love this kind of hike/scramble.  It is easy to tell why this park was called Zion.

If you have vertigo this is not a great hike for you!

If you have vertigo this is not a great hike for you!

The view from the top of Angel's landing

The view from the top of Angel’s landing

Day 4: Bryce Canyon (UT).  The weather turned and the rain came in.  Our first disappointment came when we got the phone call from the horse riding tour company that they had to cancel the pony trek.  We were gutted because this is something on our bucket list!  It is also not a good idea to be in the lower rim of the canyon due to the high risk of flash floods, so we didn’t hike too far down into the canyon either.

Bryce canyon and the Hoo Doos

Bryce canyon and the Hoo Doos

According to the native Americans the ‘hoodoos’ formed when a tribe who did bad things were turned into stone by Coyote.  We don’t know the exact story because the story can only be told during winter time (according to tradition – the park upholds this out of respect for the tradition) – we will just have to go back some day in the winter to find out!  Despite the disappointments it was one of the most unique and spectacular places I have ever been to.

Day 5: Grand Canyon North Rim (AZ).  The rain followed us, and the clouds too.  Our first sneak peak of the Grand Canyon was somewhat disappointing.

A view of Angel's point on the North Rim - it was pretty cloudy. There was a whole canyon hiding behind this!

A view of Angel’s point on the North Rim – it was pretty cloudy. There was a whole canyon hiding behind this!

We were teased by little breaks in the clouds, but we could not get an impression of its greatness.  We waited for three hours at one of the view points for the clouds to break.  All of a sudden there was sunshine and we ran to the view point!  It wasn’t completely clear, but we could see a bit further down in to the canyon.

Chris got a great shot with the canyon in the clouds

Chris got a great shot with the canyon in the clouds

So we gave up and checked into the campsite.  This was when I got the phone call from my clinic telling me I should be having weekly blood tests.  I felt a bit emotional after this call because it was the first time in days that I had really thought about what the future 9 months wasn’t going to be.

As there was a bar at the Canyon lodge we decided to hike the 1.5 miles from the campsite to the bar just as the sun was setting.  As we reached the lodge, we were blessed with the most incredible sunset as the clouds dissipated!  It was truly magical – great things come to those who wait came into mind!

Finally! This is what the Grand Canyon looks like!

Finally! This is what the Grand Canyon looks like!

After our first alcoholic beverage of the holiday – and my first drink in months we hiked in the dark back to Trippy.  Chris took some wonderful starlight photos from across the canyon.   Just as we made it back it started to tip it down with rain.  What an incredible day – full of highs and lows in emotions.

Day 6.  Horse Shoe Bend & the Antelope Slot Canyons (AZ).  Wow.  The drive from the Grand Canyon to Page, Arizona, was spectacular!  Along the way we stopped at the Colorado River Horse Shoe Bend.  It was busy with tourists, but we were able to sit down for about 30 minutes whilst we waited for the shadows to move out for Chris’s photoshoot he wanted to get.  We sat and people watched.  So many people literally took a picture and headed back to their car.  It made me sad that this amazing feat of nature was not really taken in for all it’s incredible glory.  But hey.  We can’t all be nature lovers right?!

Horse Shoe Bend in all its glorious colours

Horse Shoe Bend in all its glorious colours

Following the incredible drive we arrived at Page where we had booked a Native American tour guide into the Antelope Canyons.  The canyon itself was impressive.  We were hearded through quickly like sheep.  Our tour guide was informative, but the crowds made me sick.  Apparently there are many other slot canyons like this in the Native American reservations but this was only one of two open to the public…and it is incredibly popular, apparently over the last year or so business has been booming because of the internet.  It’s great that so many people want to appreciate it, but I worry about the conservation of it.

Chris took some beautiful shots of the formations

Chris took some beautiful shots of the formations

it's a guitar....

it’s a guitar….

Day 7.  Four Corners and Monument Valley (AZ, UT, CO & NM).  We spent most of the day on the road, but managed to stop at the four corners monument…

One limb in each of the four states - CO, UT, NM & AZ

One limb in each of the four states – CO, UT, NM & AZ

…put all four limbs in each state all at the same time!   We also visited Monument Valley which is where a lot of wild west movies have been filmed.  It was truly an outstanding park.

Monument valley - everything image you had of a wild western was shaped by this landscape

Monument valley – everything image you had of a wild western was shaped by this landscape

Sadly there was not enough time to do a hike to one of the ‘monument rocks’ and we couldn’t drive.

Day 8.  Mesa Verde National Park (CO).  A.M.A.Z.I.N.G.  We managed to shake off the crowds, Mesa Verde was a lot quieter, there were no coach tours bugging me (I am completely selfish when it comes to enjoying nature – I want to enjoy it in peace and quiet without Japanese and Korean tourists shouting and selfy-ing everywhere I looked).  A lot of Mesa Verde had closed for the season, but we did get a tour round one of the more ‘adventurously located’ settlements of the cliff dwellers.  What struck me as really odd was that what we were looking at were rock dwellings that seemed to be from thousands of years ago.  But in reality, they were only 800 years old…it was amazing to compare the dwellings in Europe at that time and how different life was for the Puebloans (what I mean is how undeveloped they seemed compared to Europe).

Cliff Dwellings at Mesa Verde

Cliff Dwellings at Mesa Verde

Our tour around one cliff dwelling was a little 'adventurous' I was super impressed to see an 87 yr old lady climb this ladder successfully! Go Girl!

Our tour around one cliff dwelling was a little ‘adventurous’ I was super impressed to see an 87 yr old lady climb this ladder successfully! Go Girl!

We hung around the park to have dinner in our campervan and watched the sunset over the mountains.  Chris took some more amazing starlight pics.

Trippy under the star light at Mesa Verde

Trippy under the star light at Mesa Verde

Day 9.  Santa Fe (NM).  We weren’t really sure what there was to do in Santa Fe, we had a walking tour planned and knew we wanted to try some New Mexico cuisine.  We were surprised at the incredible art galleries here.  We also saw America’s ‘oldest church and building’ (considering we had just come from mesa Verde I am not sure they could claim the oldest building title).  I chose a mexican restaurant and was excited to be eating Mexican food that was actually spicy!  Where we live in Virginia the Mexican food has little spice to it and is covered in cheese – more Tex-Mex than Mexican.  So it was a real treat, and poor Chris ate it despite his ‘sweating’ from the spice.

America's oldest Bell in the Oldest Church - with whole bunch of Milagros (representing miracles) pinned into the wood

America’s oldest Bell in the Oldest Church – with whole bunch of Milagros (representing miracles) pinned into the wood

How lucky are we? Just 9 days in and it was already epic!   Days 10-16 to come next  week!

Mountain Lesson #8: Enjoy the journey.  Sure the infertility journey can be a long one, but sometimes you need to take a little diversionary break to feel the power of mother nature and help lift your mood to higher states of happiness.  Take a breath, take a rest, soak up the sun – let the beauty of the mountains reset you.

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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.