Haisla's Adventures in Endoland

So, I decided to take a couple of days to reflect and gather my thoughts after our consult with the doctor before sharing them on the internets.

I'm aware that most of my recent posts have been of the more depressing kind, and although I have received such kind and compassionate responses, I am a little sick of always using this blog as the site where I discharge my darkest musings.

So I thought I'd take some stock and try to express here some of my more reasoned and balanced reflections for once.. (we'll see how I'll fare with that!)

Firstly, let me say that as a result of our consult, an IVF doesn't appear to be in the cards for us any time soon just yet.

For some reason I had misheard the doctor the last time we saw him and was under the impression that in our area NHS dishes out 3 IUIs and one fresh one frozen cycle of IVF to infertile couples.

Well, turns out that I was wrong and we are in fact entitled to 4 rounds of IUI (M. had thought this was the case, but had been wary to contradict my certainty). It also turns out that NHS is rather reluctant to skip any of the lower intensity procedures, so we are stuck with two more IUIs for now. With a month's wait in-between. Plus any extra-curricular postponements and delays that seem to be the NHS's forte.

The good news is that for the next two rounds we'll be using injectables rather than the blessed Clomid that nearly gave me double vision. The doctor seemed rather concerned about that. Apparently it has something to do with the hormones in Clomid triggering the pituitary gland, which can then have an affect on one's sight(?). The injectables on the other hand directly affect the ovaries, bypassing the pituitary glad completely. So that's one positive that came out from this consult.

So, note to self, if Clomid gives you eye-symptoms, ask for injectables instead!

When I asked about my age and whether IVF would not be better option for someone over 35; the doc's answer (I really need to come up with a name for him - let's call him Dr Caterpillar, in reference to good old Alice's Adventures) was that NHS will do IVF treatments up to the age of 40. I was so shocked at this answer that didn't know what to say in response! So, they would be quite happy to make me wait till I was forty before offering me IVF. No urgency, no recognition of my 'advanced maternal age', no appreciation of my rapidly diminishing ovarian reserve or decline in egg quality. Sometimes the NHS just makes me sick!

Then came a discussion of my weight again. I'd been quite pleased as I'd managed to maintain my weight steadily at the just over 20 BMI mark all year and had been quite self-congratulatory about it. Well turns out that that's not quite good enough and Dr Caterpillar considers me a poor responder based on our second round of Clomid (only one follicle). A poor responder?! But I ovulate every single month on my own!!! How am I a poor responder? (I didn't actually say this out loud - there is something about receiving these treatments free of charge that makes me bite my tongue, in case they decide to take it all away.. despite that fact that I have paid my tax an national insurance for the past 15 years in this country and am well entitled to the treatments I am receiving..)

Anyway, he recommended that I try to gain more weight. Apparently fat not only helps us to keep warm, but also regulates hormones, and so the more fat (within reason i.e. below BMI 30) the better the response to medicated cycles, it would appear.

Ironically since that appointment I have been suffering from the runs for three days now (apologies for TMI!), so have managed to lose even more of the precious weight  that I'd so carefully maintained.

I'm torn. On one hand I want to do everything in my power to make these cycles successful, on the other hand I am so sick of trying to eat more than is natural to me for the purpose of gaining weight. I had to do it last year for the lap and it left me feeling miserable and physically ill. I'll do what I can to make sure that I eat hearty meals and have snacks in-between, but I am not going to drive myself nuts over this.

So, the next steps forward look something like this:

Try naturally this coming cycle since we are flying to Finland for a two week holiday and I will be ovulating whilst there. (Nurse Nelly was thrilled when she heard that we are going on holiday and gave us a little encouraging smile that no doubt meant to say 'hopefully I won't be seeing you again'. I was almost expecting her to add the cheerful 'just relax' adage, but she knew better than throw herself to the wolves like that).

In August when we're back my period should start fairly shortly after that. I am to call Nurse Nelly again, pick up injectables and start jabbing myself at CD2.

If this round is unsuccessful, then we'll have a month's break (as stipulated by NHS to 'try naturally') in September and return back for IUI#4 in October.

With this timeline I am not expecting us to reach IVF until December, perhaps even Jan - Feb 2015, depending on the spanners that no doubt will be thrown in the works by whatever administrative errors, ultrasound closures, doctor's holidays etc that the NHS may care to conjure up. I am just trying to be realistic with my expectations here, having had my hopes dashed so many times.

So here are the positives:
1. We're doing injectables rather than Clomid
2. According to Nurse Nelly injectables are better for the uterine lining, which is excellent news, since with Clomid mine seemed to remain on the thinly side
3. We get 4 rounds of IUIs - I should surely view this as a positive; more is better than less, no?
4. We are still due two rounds of IVF - fresh and frozen - should all else fail
5. We aren't offered 6 rounds of IUI as is the case in some boroughs - can you imagine that!!! With all the 'rest cycles' that amounts to bloody 12 months all in all. And for some that is not a choice. It is a set of hoops randomly selected by NHS for people to jump through before they get to do IVF.

The negatives:
1. I'll have to wait at least 5 more months until we get to do IVF (i.e. we will remain on the "kiddie coaster" even longer than expected - thanks to JCH4DCU at Four Years Later for that lovely metaphor! : )
2. I will be a few months shy of 36 when that happens
3. My eggs are withering - why doesn't the NHS care!!!??

The questions I didn't have the tenacity to ask:
1. We've had two rounds of IUI - why didn't they work? 1 egg + 1 sperm + 1 reasonable uterus is all that is required and as far as we know we had all the components in place. WTF?!
2. I am getting older, and somewhere deep in my psyche IUIs seem like a big waste of time. I ovulate every month, M's sperm's okay, we have timed intercourse - what is the difference? What is the point?
3. What if I'm a poor responder to IVF meds and we don't get enough eggs to freeze? Do we forfeit our right to the FET?

Bottom line is that I feel peculiar after this consultation. I feel like the NHS is eking out these treatments in the vain hope that one of the cheaper ones will 'catch'. I don't think they really are able to see us as real people due to their restricted funding and guidelines. There is no real choice, we are on a conveyer belt and the choice is to accept what is on offer or walk away. And at the moment walking away would mean walking directly to a private clinic and parting with thousands upon thousands of pounds of money, which we can ill afford.

So the question is: do I stick with the free, no-choice treatments (with the risk that I may be wasting my time with sub-par clinicians, practices and facilities) or take our savings and choose to do probably max. one cycle of IVF at a top notch clinic and thereby exhaust all our options in one clear swoop (because the NHS would not take us back from going private). Since we are not rich, I am leaning towards option one. Am I being foolish?