PIO on the go

I had a plan!!!! My plan was to give myself the Progesterone in Oil (PIO) injection at Philadelphia airport lounge in between my two flights.  I would get some ice from the bar, put it in the ziplock bag I had packed and ice my backside to numb it.  I would then use the nice clean, usually quiet, restrooms to prepare and administer my injection – there are even sharps containers to dispose of my used needles.  It seemed perfect.

But nothing ever goes to plan in the land of infertility!!! Oh no!!!

My flight to Philadelphia got delayed once we boarded – we sat out on the pan for an hour, then they decided that the aircraft jet engine was actually broken (just as well we didn’t take off then??!) so we headed back to the terminal and de-planed.  Practically all the passengers on the flight were transfer passengers and because I was soooo desperate to pee I ended up at the back and so waited forever in the huge queue to figure out if it was possible for me to get my connecting flight to Amsterdam.  By the time I got to the agent, my flight in Philly to Amsterdam was boarding…so no, I wasn’t going to Amsterdam.  I explained to the agent that I didn’t mind flying the next day – but that flight was oversold already. Grrrrrr.  He was going to send me to Amsterdam via London – and I would need to stay in Heathrow airport for about 15 hours before getting to Amsterdam a day later.

Ummmm no.

So I asked about the possibility of getting to Brussels – my true destination.

After the attacks in Brussels I booked my flights via Amsterdam because there were still no direct flights with my preferred airline – American – from the US to Brussels.  But the agent said…hmmmmm I wouldn’t have thought about sending you to Brussels instead of Amsterdam, but if that is what you want then I can get you there via London tonight.  So I accepted the challenge of the additional transfer in London and decided what the heck, I’ll go to Brussels airport (I guessed it wouldn’t be that bad).  From that point onwards I was just unlucky with every flight and barely made the connections. My plan to do the PIO injection in a nice clean restroom went out the window, I was going to have to do it on the transatlantic flight.

I ended up doing the injection in the teeny weeny aircraft toilet.  Fortunately I got some ice so I was able to numb my backside whilst I prepared the injection.  It was pretty challenging to do all of this in the teeny toilet with no flat countertop space…., plus I just get the general heeby geebies about aircraft toilets (people are just so gross in them and never clean up after themselves -sorry grumpy frequent traveler whining!!!). Then there was the turbulence! Everything went slipping everywhere…the progesterone bottle…the needles…the alcohol swabs! Aghhhh!!!! Finally once I got the injection drawn up and ready to go, I got all flustered thinking about people waiting outside and wondering why the hell I was taking so long!  So it took me a couple of minutes to mentally – wooooohhhhsaaaaaaahhhhhh – breathe – relax.

I waited for the turbulence to calm down and I managed to finally give myself the injection and pierce the skin without any issues.  But of course it takes a few minutes for the oil to be injected because it is so thick…and whilst that was going on the turbulence came back!  I was hopping around the toilet trying to balance on one leg and not tense up my butt and leg muscles whilst the needle was still in it.  Very challenging indeed.

I then remembered it was the day to put on new vivelle dot patches (estrogen) on my tummy, as I was doing this I dropped everything on the floor.  Gross.

But despite all this, I barely had any blood after this injection (impressive considering all the joltyness), and I was super proud of myself for not completely freaking the f*** out.

Having said that….I don’t want to have to do that ever again!! I do not recommend to anyone doing this injection on the go.  I did the Lupron one in the plane toilet before and that was easy compared to the Progesterone.  If I’d been more organized I would have asked my doctor for some progesterone suppositories for the days I am travelling.

Anything to keep this little one growing inside me 🙂

PS.

If you are interested to know – my unexpected trip to Brussels airport wasn’t too bad, but it did trigger some thoughts.  I thought about that day as I went to pick up my luggage.  I thought about how that day there were many customs border staff stopping practically everyone to check their bags as they left the airport.  I recall that how at that time I laughed because I was one of the lucky ones who did not get my bag rummaged through.  But today as I went through customs there was only one man.  I thought about how if I had been stopped by customs that day, I probably wouldn’t have been upstairs in departures when the bombs went off.  It was then weird to walk out of the baggage area to see the boarded up area from where the damage had been caused from the explosions upstairs.  I recalled the images of this area in the media and matched it to what I saw today.  A shiver went down my spine as I tried to find my way out of the airport to the train station.  No starbucks for me today.  The route to the train station today brought us out through the parking garage I had found myself in immediately after the explosions, not knowing where the hell I was or where to go.  Today I found myself thinking back about my whole experience.  It was very solemn…but I was OK.

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IVF Vol 2 begins!

Yesterday my period arrived, just one day later than anticipated, but that’s all good.  I called my nurse and started with the Birth Control Pills (Reclipsen).

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Birth Control Pills (BCPs) – YEY!!!!

I will be on Birth Control Pills for 14 days (1 day longer than last time), then 3 days later we go into the Clinic for my Cycle Day 3 baseline ultrasound and blood tests – this time we won’t need to have all the lessons on injections – but we will need to sign some paperwork and sort out the finances.  Then the next day I get my instructions for injections…and we are off on IVF/ICSI cycle 2!  Here is a calendar of our cycle…

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Planned Dates for IVF Cycle 2.

It is all happening a week later than I expected, which puts me in a conundrum about work travels.  This would mean travelling for work almost the day after I take my first beta blood test.  If it is positive, then I will be flying transatlantic to the UK just 4 weeks pregnant, and have to figure out how I’m going to do these progesterone injections.  Or if it is negative and I am not pregnant, then I will be away from Chris at a sad time. Either way, it kind of sucks.  If I don’t go on this work trip then I will be a real let down to my team.  I’m hoping Chris might be able to come with me on this trip, but it is really hard for him to get the time off work.

Anyway, I am genuinely excited to be starting this cycle, but I had a little cry yesterday.  I think it was all the period hormones running around.  I cried because of the whole situation of fitting everything in life around this IVF cycle.  I’m trying to make it easier for myself by taking some leave off work, but it is a busy month for my team, there is lots of work to be done, I have already had to pull out of one work event (in Switzerland :-|) and so I feel guilty.  Despite feeling like this….I still have hope for 2016 🙂

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2016 is the year I will be stronger, braver, kinder and unstoppable.  This year I will be fierce!!!

For those of you who are new to the whole IVF process or want a reminder of how IVF works you can find a summary on my “What does it all mean?” page here.  Currently I am in Step 1 of the process!

 

Effects of flying and jet lag on fertility pt 2.

In my previous post I described some research that indicates fertility may be effected by the disruption to the body clock as a result of travelling across time zones (or any other job that requires shift work).  There is one hormone that may be taken as a supplement to help overcome and regulate the problems our bodies face as we fly in to different time zones – melatonin.

Melatonin is not new to me.  Some of my US colleagues have told me about the use of Melatonin to help them overcome their jet lag quickly when they are in Europe.

Last year I landed in Germany with a terrible headache that had lasted more than two days, pain killers just didn’t touch it, and I couldn’t sleep – which was probably perpetuating my headache.  So my US colleague suggested I took some melatonin to help me sleep and kick start my body into a natural rhythm.  He warned me that melatonin can have side effects, such as vivid dreams.  I already dream a lot normally, and I had problems in Afghanistan with Anti-Malerial drugs causing vivid dreams and hallucinations; so I was very cautious of taking melatonin.  But I was willing to give it a try as by my third night in Germany I was consistently unable to fall asleep until about 5AM, then working all day with this awful headache.  So I took two of the little melatonin pills, and they helped me to fall asleep before midnight.  Bliss.  I did have some vivid dreams, actually they were more like nightmares, but at least I got some shut eye!  My headache didn’t disappear though, so I decided not to take any more melatonin. I was more afraid of my dreams than my headache.

I didn’t know much about melatonin at that time; I didn’t really look into it.  But since suffering from infertility I have been educated more into melatonin and its purpose.  I came across it in the book “It starts with the Egg” by Rebecca Fett, but I didn’t pay it much attention.

So what is melatonin?  It is a hormone that helps regulate many other hormones in the body and helps to maintain our body clocks (or circadian rhythms).  During light hours of the day, our natural melatonin production drops and when it is dark, the body produces more melatonin.  If we are not exposed to enough light during the day or too bright artificial light in the evening this can disrupt the body’s natural melatonin cycle.

What does melatonin have to do with fertility?  Melatonin is produced by the pineal gland in the brain, but it is also produced by the follicles within an ovary, the mass of cells that surround the follicles, and in the immature follicle itself.  It is here where melatonin acts as an antioxidant which supports cellular health and protection of the immature egg from oxidative stress, especially at the time of ovulation.  Melatonin has beneficial effects not just on eggs but also on embryos.  Mouse embryos grown in a lab with melatonin showed an increased rate of forming bastocyst-stage embryos [1].  As a result of this success, clinical trials were undertaken.   A study of 115 women showed that melatonin may increase egg quality by reducing the level of one oxidising agent called 8-0HdG in the ovum, which is a natural product of DNA oxidation [2].  Women who were given melatonin had a fertilisation rate much higher than their previous cycle and nearly 20% of the melatonin treated women became pregnant.  Whereas only 10% of the non-melatonin group became pregnant.

Melatonin also helps to control body temperature, the timing and release of female reproductive hormones and possibly egg quality.

Finally, melatonin is known to act as an antioxidant during early pregnancy.  In addition, melatonin in the mother’s blood passes through the placenta to aid the creation of the fetal suprachiasmatic nucleus (SCN) where the central circadian regulatory system is located.

Melatonin levels decline with age, and as a result the ovaries lose their natural protector against oxidative stress; hence could be an additional contributor to age-related infertility.

If you are going to consider taking melatonin as a supplement when trying to conceive you need to be careful and should ask your doctor, because the melatonin supplement may disrupt the natural hormone balance and interfere with ovulation.  If you are going through a controlled hormone cycle with IVF this is less of a concern.  In addition, melatonin can cause side effects, such as daytime droziness, dizziness, and irritability and may worsen depression.  Melatonin can also interact with other drugs, so this is why it is important to check with your doctor before taking it.

If you are going to take melatonin as a supplement whilst travelling it is also important to know what time to take it.  You should take the supplement after dark the day you travel and after dark for a few days after arriving at your destination.  In addition, taking melatonin in the evening a few days before you fly if flying eastward.  Again, there is caution to be made here because the long term effects of taking the supplement are unknown.  Therefore this is not overly helpful for airline attendants or shift workers, and only for those who travel infrequently.

For me, personally, I am undecided as to whether or not I will take melatonin as a supplement for either my next IVF cycle or when I am on my next international trip.  But I will certainly be asking my doctor next time we speak.

Have you taken melatonin as a supplement? What are your experiences with it?

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[1] The effect of melatonin on in vitro fertilization and embryo development in mice.  Available here: http://hera.ugr.es/doi/15015646.pdf

[2].  The role of melatonin as an antioxidant in the follicle.  Available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296634/

Effects of flying and jet lag on fertility pt 1.

I am just returning from yet another trip to Europe, Belgium this time!  This has been my 9th transatlantic trip this year.  Last year I made 10 trips, and the year before that 11.  With an average of a trip every 6-8 weeks I spend a lot of time either sat in a plane or at an airport or, trying not to fall asleep in meetings whilst I try to get over the jet lag!!

Travelling like this is stressful.  I always have a connection to make in the US because I do not live near an international airport, and sometimes I have another connection in Europe as I travel to cities that do not connect directly with the USA so I can often end up with 2 transfers…it can be very stressful making these connections when flights get delayed or security lines hold me up.  For example on this particular trip to Belgium, due to a series of unfortunate and unrelated disruptions it took me 9 hours longer to reach my destination (on top of the planned 14 hours of travel).

I am simply sick and tired of it.  Yes, I get to go visit some cool cities, I am grateful for that opportunity, but it is physically disruptive to my life.  As this is my last trip of the year and I already have 7 trips planned in the first 5 months of next year :-s I am beginning to wonder whether it is such a good idea to do all this travelling.  I am not sure how many of these I will be able to commit to with my next round of IVF coming up.

This got me thinking about how little I know about the effects of flying on my fertility.  Is it even an issue?  Should I be concerned?  So I did a bit of research and here is what I have found so far:

There is currently no overwhelmingly strong evidence that flying has a direct cause of reduced fertility.  However, there are a few studies that indicate that there may be some correlation.

One study I found to be compelling used mice to investigate whether shifting the body clock has an effect on their fertility [1].  The results of this study showed that there may be serious implications for a woman’s reproductive health if her work involves shift work or time zone changes.

To understand the outcome of this study, you need to understand the body clock.  Our body clocks are called circadian rhythms, these are physical, mental and beahvioural changes that follow a roughly 24 hour cycle, responding primarily to light and darkness in the environment.  Your circadian rhythm is produced by your body, but it is also influenced by the environment.  Light is the main thing that influences circadian rhythms – it turns on or off genes that control your internal clock.  Your circadian rhythm can change your sleep-wake cycles hormone release, body temperature and other important bodily functions [2].  (I know travelling certainly screws up my body temperature because I discovered this last year when we were trying to conceive the good old way and I was actually bothering to monitor my temps.)

The researchers of this study found evidence suggesting the severity of circadian disruption may be linked to the severity of pregnancy disruption: mice subjected to advances of the light-dark circle had greater circadian clock disruption and lower reproductive success.  This group’s pregnancy success rate was only 22% compared with the control group of 90%.

WOAH. That’s quite a difference!

So what does this mean?  This means that if this affects mice, there is a good chance it affects humans too – but to what extent remains unknown, more research is needed before conclusions can be made confidently. ….but I couldn’t find anything taking this research further forward.

Now, there have also been a large survey study of flight attendants to examine fertility….there are two interesting conclusions, first that flight crew were found to be more likely to suffer from irregular periods, and also more likely to suffer a miscarriage.  But I find the study designs less compelling, so I’m not even going to write about this in much detail (but you can judge for yourself here).

So is there something that can be done to prevent suffering from the effects of flying and jet lag?  No one knows for sure, but we do know that Melatonin is an important hormone that regulates other hormones…this can be taken as a supplement, but it can also have negative effects on fertility too when taken as a supplement.  And this is what I will talk about in some more detail in Part 2 later this weekend!

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Am I less fertile because I travel trans-Atlantic a lot?

[1]  Summa KC, Vitaterna MH, Turek FW (2012) Environmental Perturbation of the Circadian Clock Disrupts Pregnancy in the Mouse. PLoS ONE 7(5)

[2] Circadian rhythms fact sheet on the National Institute for General Medical Sciences website

Is the pain in my mind?

I have had a very specific pain around my right ovary for the past four days. The pain worsened in the evenings, I slept it off after getting to sleep with the aid of the pain killers and my sheer exhaustion.  It felt like something was pushing inside, wanting to pass.  The acetaminophen & codeine-3 was barely hitting this very specific pain.

Late last night I considering going to the Emergency Room.  I knew that my doctor had said I shouldn’t travel to Europe if I was having pain.  Well I was in pain, the drugs weren’t stopping it, but I wasn’t doubled over with the pain, I was getting waves of pain, increasing intensity and then becoming dull but it was in this one particular spot.  I couldn’t ‘touch’ the pain, when I pushed down it didn’t hurt more or less.  Was I being stubborn or just simply stupid for ignoring this?  I read stories of women whose fallopian tubes had ruptured weeks after taking the methotrexate.  Surely this was a very rare event, it can’t be happening to me?  I cried a lot in my indecisiveness.  Chris even cried with me because he didn’t know how to help me – it was my decision to make whether or not to go to A&E – he felt helpless.  I didn’t want to go to hospital to spend a fortune for me to be sent home again – or worse – they wouldn’t be able see anything again on the ultrasound and end up opening me up. Chris asked me a very good question – was the pain in my mind?  Was I making it out to be worse than it was because I didn’t want to travel to Europe?  It was a harrowing question to think about.  It was definitely a possibility.  The mind can play cruel tricks.  But I eventually decided that in the morning if I still had that specific pain we would call my clinic or go to ER.  That was my line.

I woke up this morning PAIN FREE!!!! It was an amazing relief.  I was exhausted and felt like I had been out on the town all night, waking up with a hangover.  Oh how I wish that were the case!  But I felt free.  That was for about 3 hours….then the heavy bleeding and passing of clots continued along with all that type of associated pain.  But this pain I could deal with compared to the specific pain I was having the past four days.  Such a relief.

So here I am waiting for my flight to Europe.  After connecting flight #1 I have discovered that flying whilst still miscarrying is not the greatest idea I’ve ever had.  I could feel I was about to pass something, then of course there was turbulence and the seat belt sign came on.  The flight attendant barked at a little old lady to sit back down!  So I sat there in my seat hoping I would not leak everywhere (sorry – I know this is probably way too much information!!!).  20 minutes later I couldn’t sit still anymore, so I got up despite the turbulence and dashed to the toilet.  I sat on the toilet thinking how ridiculous this whole situation was and sobbed.  I am so glad I didn’t wear mascara today, in fact, mascara has not been part of my make-up regime for several weeks now.  I thought about all the things I would shout at the flight attendant if she gave me grief about getting up from my seat! Fortunately she was too busy to bark at me.

I just have a 9hr flight to London, followed by 2hr flight to Stockholm to survive this mess!  Wish me luck!!!