Haisla's Adventures in Endoland

Since it's nearly midnight and I need to wake up tomorrow at 6am ready for retrieval, I'll try to keep this brief.

The retrieval is booked for 10.30am, but we've been asked to arrive at the hospital around 9.30am, so we'll set off driving at 7.30am since we live quite far from Central London.

Surprisingly I don't feel nervous much, just sort of anxious to get this show on the road.

I just find it amazing that inside of me are eggs that might make up our children and that tomorrow the clever doctors will take them out, mix them up with M's sperm and presumably make little human beginnings; the beginnings of our potential offspring. And those little embryos (I'm assuming there will be embryos) will contain all the human potential required to build up a unique individual.. all the traits and genetic material that will make the person who they are is stored in those few cells.  Isn't that just the craziest thing you've ever heard? It kind of just blows my mind.

We were given the prediction that we'll get around 15 eggs (providing that all the follicles contain eggs). Oh, please God, let it be so. And let them be of the most amazing quality; let them mix beautifully with M's sperm and grow into strong, resilient embryos out of which our healthy, happy babies will grow. Please, God.. I don't often ask you for 'things', but this one thing I ask. Please.

..that is the question.


Now, I like sex.

I'm sure I've said it here before.

But for quite a while during our infertility journey things were not this way. This was especially before I got my endo diagnosis, when I often found sex (and intercourse in particular) to be painful and not in the kinky, turn-on kind of way. I find now that I know what is wrong with me, I can better manage the condition, and believe it or not, somehow the pain also feels more bearable, when I know I'm not doing permanent damage to my innards, but that there's just something in there that oughtn't be there, that is always going to emit a level of pain.

As is the case with most IF journeys, there obviously also came the time when sex became strongly associated with rigid timetables, high expectations (talk about performance anxiety) and perpetually dashed hopes. Add to that heady mix a level of depression and despondency and you have a potent marital bedroom buster in your hands.

So we've worked really hard to reclaim our sex-life back from the claws of infertility and it's really only been this year that I've finally got my mojo back.

I have to say that ART has played a huge part in this. Knowing that we don't have to try so hard every month has lessened the sense of panic and pressure and we've actually had time to recover our sexual appetites again.

From reading other blogs, I'm aware that a lot of ladies give up sex during their IVF cycles, often at their doctor's orders and I, too, have contemplated this myself. However, the thought of giving up this (fairly) newly rediscovered source of joy, (now that we are finally embarking on our first IVF cycle) is a little disconcerting.

So, I've been doing a bit of research.

It turns out that there are quite a few studies conducted to decipher whether it's safe to engage in bedroom sports during IVF. I know that different clinics have different policies. Our clinic has been fairly laissez fair; I think we were told that we can have sex up until a few days before the retrieval (in fact, more sex = improved sperm quality) and haven't been given any guidance on what to do or not to do after.

This study from the Oxford Journal (2000), appears to suggest that the male partner's sperm introduced into the uterus during an IVF cycle may have a positive impact on implantation rates. If I've understood the study correctly they reckon that the male partner's sperm may 'familiarise' the mother's body to the 'paternal bits' (yep, that's the technical term I have decided to use) of the embryo so it is better able to accept the embryo and not reject it as an invading, foreign object. The effects appeared to be more pronounced for some reason in the fresh IVF cycles than the frozen ones.

The only risk that I could see them identifying were uterine contractions that may result from intercourse as these may have the unintended and unfortunate consequence of disrupting embryo implantation.

I still think, that in the light of this study (even if it is a little old now), it may be advisable if not advantageous to engage in a bit of rough and tumble at least before the transfer (providing one is not completely incapacitated following the retrieval). There seems to be no harm in having some of M's 'material' inside of me, welcoming the embryo(s) in, especially since some theories purport that endometriosis may do funky things to one's  immune response and set it on a bit of an overdrive.

However, since I have history of having occasional bad period-style cramping post-orgasm (especially in the post-ovulatory phase for some reason), I think I'll definitely try to abstain after transfer (plus who would want to mess around when using those messy pessaries anyway.. they act as a bit of a mood-killer from what I can recall).

At least these were my thoughts on the matter, before I stumbled upon this case study. According to it, a woman undergoing IVF treatment ended up with a quadruplet pregnancy (after a transfer of two embryos) as a result of having sex during her IVF cycle.

To cut the long story short, there was a happy ending in that she had the babies at 34 weeks and they all survived and lived on in health and happiness (apart from having more siblings than was intended). However, there were some questions asked about how she could have ended up with quadruplets from having had only two embryos transferred. Apparently this is a highly unlikely scenario. When they looked into the case more closely and studied the babies genetically, they found that the four babies could not have originated from the two embryos transferred. It transpired that the couple had had sex both before the HcG injection and before retrieval and that at least two of the babies were the result of natural conception that concurred with the embryo transfer and implantation. Crazy stuff, eh!!?? The writers of this case study suspect that more of the twin  and triplet pregnancies that occur in relation to IVF treatment may actually be as a result of unprotected intercourse that takes place at the time of the treatment. As this issue hasn't really been studied to try to establish whether the babies all originate from the transferred embryos, the assumption has always been that for some unknown reason IVF results in greater number of twin and triplet pregnancies than natural cycles. It's interesting stuff, and perhaps more studies should be (or may have been since this is quite an old case study?) conducted.

This study did give me pause for thought. I certainly don't want to end up with triplets let alone quadruplets. Could my 'throwing caution to the wind' attitude heighten our risk of having multiples!?

With further thought, the lady in this case study was suffering from secondary infertility and had been able to conceive naturally and without any problems six years previous, which may place her in a completely different category from me. At least she had proof that her body was able to produce a natural pregnancy.  Considering that we have now been trying  for 3.5 years with absolutely zero results (not even the chemical kind), the fear of a natural pregnancy occurring simultaneously with our IVF cycle sounds a bit fantastical. I think at this stage in the game I should really be more concerned about whether we'll be able to get pregnant at all..

So, I think "to have sex" it will be for us, but in a well-considered, moderate and scientifically approved manner, in order to maximise our chances of a successful pregnancy..

However, first we kind of have to get to the transfer stage, I suppose.

I shall write a bit more on that later.


 

So it's been interesting..

The nature of my job dictates that I have had to disclose to (some of) my regular clients (whom I am caseworking at the moment) that I will be going through a medical procedure in the very near future and will be taking some time off for that. Trying to dodge questions would have been even more difficult than being semi-transparent, but it turns out that with IVF even semi-transparency can get ever so complicated.

Somehow (probably due to my response to past IUI cycles - what folly!) I was under the impression that by day 9 (of stimulation) scan I would pretty much be guaranteed to be bloated to the hilt and almost ready for retrieval and therefore told clients (and colleagues alike) that I would possibly, probably have to take the rest of this week and some of next week off.

Well nothing could be further from the truth. On Tuesday at our day 9 scan, we found out that my eggs are nowhere near ready for collection. I think there were a few 'larger' follies at 8mm but majority were still tiny-weenie. If this was some kind of a race, we would've hardly left the start line. But hey, since this is Endoland, it figures. My eggies are probably racing backwards or something.

I am trying not to panic about the implications (although couldn't help googling 'slow response' to Gonal-F), as the nurse told us that at this point almost anything is considered normal.. My eggs are not only racing backwards, they are probably also lazy.

So we've been instructed to carry on with the Buserelin and Gonal-F shots, have another scan on Friday and then see where we're at. The nurse was almost certain that nothing of interest will be happening until late next week. So I'll now have to go back to work tomorrow and reschedule everything again with my clients. Grrreeaattt. And we're talking about highly vulnerable and often quite inflexible individuals who have a hard time understanding that I may have life outside of work.. This is going to go down like a lead balloon.

Well at least I now know the reason why I haven't been bloated like a whale yet and have only experienced minimal discomfort so far - I have hardly anything going on in my ovaries!! I can still fit in my normal work trousers etc. So my worries about the choir thing and the interview today were completely unfounded, which is great in someways, but means that I'll have to experience more awkwardness at work, trying to shuffle my regular clients, scoot off to more scans in the middle of work day and explain away the uncertainty about not knowing when I'll actually be taking time off for this 'procedure'.

I am planning to take at least two days off for retrieval (retrieval day and the one after) and then at least one or two days off for transfer. I really, really wanted it all to be done and dusted by late next week and early the following week, but it looks like we are pushed way back now. Unless my ovaries decide to have a crazy growth spurt and get to the finish line in record time.

I think basically what I hate is how out of control I feel with this IVF cycle. I cannot organise my timetable, as I don't know what's happening and when. So much is unknowable and I cannot make my eggs grow faster, just by trying harder. Normally I can achieve things and make thing work out if I just work hard enough. This whole experience is almost like the total opposite. I just need to let go and allow my body to do the thing it needs to do, preferably with minimal interference from me. I am so, so outside of my comfort zone.

I am, however, glad I took a few days off this week (these were meant to be the 'bloat days'). I got to hang out with M after our scan on Tuesday and sit by the river in the sun. It was gorgeous and I feel far more relaxed for it.

And today I had my second interview. It went well. I looked presentable and non-pregnant. I was able to answer all the questions and come across as competent and effective (which I am, I promise). They tried to ring me twice this evening after the interview, but as they'd said they'd contact us tomorrow with the news, I wasn't paying attention to my phone. So I'll need to ring back tomorrow morning.

I have decided to be forthright about our IVF and my possible need for time off if I get offered the job (and if this cycle is a bust). It might be a bit of a career-suicide step, but I'm just so sick of hiding this and fretting about it, that I'd rather bring it up now than later. If they then decide that they don't want an infertile / possibly soon pregnant lady working for them, then too bad for them. I can still carry on in my current job and be £12,000 / year better off (albeit continually stressed out). M. and I even wrote a little spiel for me to quote should I get offered the job tomorrow and it's more about negotiating time off with short notice (poss. during probation period) than me asking their permission to engage in IVF treatments. Obviously they may come up with some excuse to withdraw the offer, but if that's the case I don't think it'll be the kind of organisation I'd want to work for anyway. Obviously if they don't offer me the job, this is all moot, but I'd rather be prepared and have the peace of mind that I am entering this situation with honesty and integrity.

So that's that. Everything (possibly) is happening at once. Things would be far simpler if I didn't get that job.. Although on the other hand, I really would like it. I'm trying to see this as a win-win again, whichever way the cookie crumbles. And crumble it will. Tomorrow.

So we're in the midst of our very first IVF cycle. It is finally really happening.

This is going to be quite a boring post about jabs and dates and so on, just for posterity's sake really or for anyone interested in finding out what a real life IVF cycle looks like courtesy of NHS.

I've been on the blessed Buserelin injections for more than three weeks now (since CD 21 i.e. 27/03/15) and have experienced all the 'fun' side effects of the stuff, such as hot flashes, mood swings (ranging from anxiety to red-hot-rage to bouts of depression and back), lack of concentration, disturbed sleep and difficulties in remembering things.

My period was much lighter than usual, but has just gone on for ever and ever. I bled heavily for two days and have had light bleeding for the past 11. That has been incredibly annoying. I hate wearing pantyliners, but what can you do. I asked the nurse whether this is something to be concerned about but she didn't seem worried. Apparently it can be a side effect of Buserelin.

I will mention it again at our next scan on Tuesday if it hasn't eased off my then, as surely I'm supposed to start growing some plump womb-lining and bleeding is sort of counterproductive to that end.

Anyway, I digress. We had our first scan on Monday 13/04/15 to check that my ovaries and womb were all subdued and cyst-free, which was the case. We therefore got the go-ahead to start the Gonal-F injections too (300 IU / daily) and to reduce Buserelin from 0.5ml to 0.2ml / daily.

So I have Buserelin shots in the morning and Gonal-F in the evening. Always something to look forward to. ; )

Despite the Gonal-F needle being tiny, I still am not able to bring myself to self-inject. I guess I should pat myself on the back for actually managing these shots at all and not fret about overcoming my needle phobia. I never really thought it ran that deep, but it turns out to be a proper, real thing.

So we now have a little injection routine every morning and evening, where I sit on the bed, with M beside me, I grab the headboard with both hands, close my eyes, take three (or more) slow, deep breaths and then give M the go-ahead to do the shot. I swear I cannot manage the shots without this little regime. We've tried belly shots (doesn't that sound fun, like something you'd do in a bar!?), but I just go into hysterics, so we've dropped that act. All I can say is that if you hate needles and have to go through IVF, just find something that works for you. NHS recommends breathing relaxation exercises or the applied tension method. I find that the smaller doses of the meds (0.2 ml vs 0.5ml) has also made the injections easier, because what I've discovered I hate even more than a needle piercing my skin is the sensation of something seeping into my body. Yuck, and it's even worse if the stuff stings which is the case with Buserelin. And somehow ass shots are easier than thigh shots (IMO) although with Buserelin and Gonal F, butt is not an option.

However, before you freak out about all these injections, please know that I have a very low tolerance level for such things, which is why I go on and on about them. This is my way of purging it all and getting it all out of my system. I'm sure most other women going through IVF find the needles far less traumatic.

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Our next scan is on Tues 21/04/15 and we should then find out whether we're ready to pull the trigger on them eggs. So the earliest possible date for retrieval is Thurs 24/04/15 and the latest Mon 27/04/15. I've taken Tues and Weds off next week mainly because I don't fancy doing a long 11.5h shift when I am likely to be as bloated as a whale if our last IUI cycle is anything to go by..

Which handily takes me to my next subject of moan - the bloat. Am I the only one who ends up looking approx. 5 months pregnant on these meds? I am meant to be performing with our Community Choir on Sunday (this is a work thing) and my worry is that I'll get funny looks and inopportune questions from people as I'll be huge and on display on stage. Great. I tried to buy some bloat covering clothing today after work, but since I'm not normally seen in floaty dresses, I fear that my attempt to cover up might end up back-firing on me. My greatest fear is that people will just ask outright whether or not I'm pregnant. What am I to say to that? "Umm.. no, I'm just really full of eggs, thanks for asking.." M. told me to tell people that the bloat is constipation related should they be silly enough to ask. Apparently that should shut them up. Thank you, M, for your words of wisdom..

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In other news, I've also managed to secure myself a second stage interview for a boring but low-stress job. The bad news is that the interview will be taking place on Wednesday next week, which is also the day after our second scan and at a time when I am going to be just about fit to burst with eggs. I am basically going to be attending an interview looking like I am pregnant, whilst I'm actually not. I've eyed through my whole wardrobe and tried to decide whether attending an interview in yoga pants might be appropriate under any circumstances .. sadly I haven't yet found a shirt and yoga pants combo that wouldn't make me look like I'd snuck out of a mental hospital, but I'm just not sure that I'll be able to fit into any of my smarter trousers. Hmmmh..

I just don't understand how I always manage to get myself into these situations where I am job hunting or attending interviews in the middle of cycles (I think last time it was during or just before/after our second IUI..?) I am starting to see a pattern here. Do I somehow subconsciously crave additional and unnecessary stress? What is wrong with me!!??

The kick in the teeth is that if I do get offered this job I'll have to make a decision about whether to take up the offer before I actually know whether or not the cycle has been successful. However, with my 3 month notice period and lack of driving licence (which was stated as a desirable, not a must have for this job) I don't think I'll be their top candidate. So I'm sort of thinking, if I do get an offer it'll be borderline miraculous and at that point I'll have to seriously consider whether it might be a sign from the universe that it's time to move on.

Anyway, I'm not going to worry about that just yet. My priority right now is this IVF cycle. Everything else is secondary, the job interview included.

So far things are going good, though. I feel like I'm as ready as I'll ever be. Let's get this show on the road!!xx

The meds arrived yesterday.

And I am feeling decidedly unenthused.

It's weird. This is the thing that I've been waiting for the past, ummm, I don't know, year or so, and now that it's here I feel strangely calm and reluctant to hop back on the roller coaster of crazy.

I managed to whip myself into such a frenzy last year, desperate for things to happen, for this journey to move on, and in the past months I've kind of found a strange new sense of serenity (or maybe gotten used to the 'new normal' of being in an eternal limbo) and I am sort of a bit bereft that it's coming to an end soon as I know that whichever way this IVF cycle will go, there will be heightened emotions involved. I think I may have overdone it with heightened emotions last year and now I'm all emotioned-out.

Or maybe I am keeping myself safely numb in preparation for whatever is to come.

So the meds are here (partly strewn across the dinner table, partly piled away in the fridge), we had the nurse's appointment on Wednesday to confirm the programme and I will start jabbing myself with Suprecur on Friday. No nasal spray for me it turns out, but thankfully the needle is tiny, to the point where I may be able to overcome my needle phobia and do the jabbing myself. Counselling appointment is booked for 2nd April and first scan for 13th.

I think this might really be happening..

So we had our first IVF appointment today and since I confess to feeling somewhat overwhelmed by everything I've decided to put my thoughts on paper (I mean screen)..

First things first, the clinic is wonderful, the staff friendly, and I am so very happy with our choice. It's a world away from the bumblings of our previous (IUI) clinic.

However, something obviously had to go wrong (it's us we're talking after all) and it turned out that we not only had we not received our invite letter, we were also missing tons of consent forms that they should have sent to us in advance (we only received the invite letter via email yesterday after pestering the clinic with phone calls and emails). In their defence, they are an extremely popular clinic and therefore extremely busy. These things happen, and thankfully this problem was easily rectifiable.

The downside was that today during our appointment we were literally bombarded by different staff asking us to fill out, read and sign sheets and sheets of papers. For all I know I may have just donated all of my vital organs to science.

So that was one of the drawbacks; having to decide the fate of your future embryos in a busy corridor of an Assisted Conception Unit under some considerable time pressure. I think we decided to give them up for research (should there be any left once we're done with family building) which with hindsight feels perhaps a little callous. Apparently we have the right to change our minds yet. Maybe once the embryos turn from a mere fantasy into reality I may feel somewhat different and wish to hold on to them for more than 55 years (that was one of the options given on the numerous forms - perhaps with the advance of science I'll decide to try to get pregnant again when I'm 90).

Anyway, I digress.

The next item on my list of today's experiences may appear as far TMI for some, so please proceed with caution. I am only writing this for the benefit of those new to the IF world. These are the lengths to which we are willing to go to have a baby:

Today I had for the first time in my life the dubious pleasure of being ultrasound scanned on day 2 of my period, also known as 'the blood fest'. I genuinely thought that the mention of menstrual blood would deter them in their eagerness to scan me, but alas(!) it was not so. I have therefore now faced the ultimate dildocam shame and humiliation of having a man scan my uterus whilst it is merrily shedding itself away and onto his clean exam bed. Unnerving.  Oh, and it was my first encounter with real stirrups. I didn't quite know how to hoist myself onto them, but figured it out in the end. It felt like I'd finally graduated into the big girls' infertility clinic.

In positive news though, both my uterus and ovaries looked all fine and dandy.

Meeting with the doc was positive, too. She was lovely and interested and actually took the time to ask questions and listen. She noted down my endo diagnosis and our four failed IUI cycles and those seemed to give some extra credence to our case (i.e. nope we're not just making this up and nope 'just relaxing' at this stage won't make one bit of a difference - oh, the sweet vindication). She seemed a little concerned about M's sperm analysis, too, based on the notes from the previous clinic and as she wishes to take no chances with our chances (because she cares!) she is recommending ICSI. The last thing she would want, she explained, would be to find out that my eggs and M's sperm aren't getting jiggy with it on their own (I have heavily paraphrased here) hence the little extra helping hand from science.

Also, and this was a huge shock to me, there is a possibility of us transferring two embryos and not just one. I thought this was a complete no-no with the NHS unless one is over 40 and even then they would do it under duress. This clinic seems to have far laxer stance, and yet they boast fairly low levels of twin pregnancies. I think the fact that I am at the cusp of being 36 (gulp) makes two embryo transfer a possibility depending on how our embryos turn out overall.

I also asked about the risk of breast / ovarian cancer as a result of taking all the blessed hormones requires. She said research has shown that the hormones used are safe and should not heighten the risk of cancers generally. However, in those individuals who are genetically 'destined' to get cancer later on in life, the hormones may speed up the process. Am I destined to have cancer? I don't know. My mum had both breast cancer and ovarian cancer, but as far as I know she didn't carry the genetic marker. But I guess if I am genetically pre-disposed to getting cancer then a whole host of things may have an accelerative effect on the dormant cancer genes and at the end of the day, I can't live in a bottle. So for now I am deciding not to worry about that yet.

One last thing before I go to bed.

They are running a thyroid anti-body research at the clinic and asked whether I would like to potentially take part. As anyone who reads this blog regularly will know, I freaking love research, so I immediately said yes. If I am chosen for this research (this will only be the case if I turn out to have thyroid anti-bodies in my system) I'll write more about it later on.

For now all I can do again is wait until my next period, which should be in approx. 25 days' time. Then they will start me on a long protocol which will involve using nasal spray for some weeks from before day 21 of the cycle (spray rather than needles - yay!!!) and then later on a pen for stimming rather than those ghastly vials and needles (double yay!!). Anyway, by my calculations it'll be late March until anything really interesting will start happening, so I've got a bit more time to get my s**t together (meaning mainly my health back after this string of illnesses). But hey, at least we're on the road to somewhere!!

I realise that this blog has become a bit of a 'this is what happened whilst I was gone' journal..

In the past months I've just needed to step back from TTC and the lovely IF community whilst our waiting limbo has continued.

You may remember that in early December we were due to see our Fertility Doc at our local clinic to discuss next steps.

The good news is: IVF is our next step

The bad(ish) news: We cannot have IVF at the same clinic as the IUIs (they do not provide the service)

So in the past two months we have needed to have our application for IVF funding approved (check), choose a fertility clinic out of a choice of four (check - it was a tough choice, but we went for convenience of travel, shortest waiting list and reasonable stats re: outcomes), have our STI tests re-done (check - second time in two years - as if we'd had time to be have extra-marital affairs what with all this TTC nonsense), and get our referral successfully sent to the chosen clinic (check).

So far all the above has happened and actually taken place at quite an astonishing speed. For all my moaning and groaning about the inefficiencies and sluggishness of the NHS, I must say that I'm impressed.

We now have an appointment for our chosen clinic on Tues 09/02/2015 to discuss our IVF treatment. Considering that we had our last appointment at the previous clinic on 09/12/2014, I would call this a modern miracle.

Of course there have been some minor hitches to the ride: we didn't receive an invite letter for the appointment, just a text message reminding us of the appointment we weren't even aware of. Thank goodness for their automated text message service. I wouldn't have been best pleased if we'd missed the appointment because of their admin error. But all in all and compared to previous experiences this has been plain sailing.

So, what have I been doing in the meantime whilst waiting for all of this to happen? Well, I've mainly been sick (I had a vomiting bug just before Christmas, caught a cold during Christmas holidays, have had a couple of minor colds throughout January and now a real killer cold that started last weekend and floored me yesterday); we have also had (despite my diseases) copious amounts of amazing (non-TTC) sex (we made a pact that now that the big guns are almost out, we'll no longer torture ourselves with timed intercourse, but have a tumble when the feeling takes us) and on top of that I have waded my way though a pile of trashy romantic novels. So in one word I have distanced myself as far as possible from TTC. Which has meant that I have also read fewer blogs and done so less often and generally been a bad blogger and commenter. For this I apologise, but sincerely, I only did it to preserve my sanity.

So much sadness and joy is contained within the blogosphere (happily many of my favourite bloggers have gotten their long awaited BFPs, but so many also struggle with losses and failed cycles), that sometimes the breadth and depth of emotion just becomes overwhelming. So I step back and drown myself in fiction, because in trashy novels you always know you get your happy ending.

But hey, here I am dipping my toes back into the blogosphere again to see how it feels, and so far, it ain't too bad.