Full IVF cycle part 2

When starting IVF I thought it would be a simple case of complete step 1, step 2 and step 3 and ta da here are your embryos.

What I've learned is that like all of our bodies are different on the outside, they are also different on the inside. When it comes to faking your body into a hyper fertile state, there are so many variables and each fertility specialist has a different approach and drug regime to try and get you to reach an appropriate level of hyper fertility.

In addition to following the prescribed drug regime, there is a stack of monitoring. Monitoring involves blood tests and ultra sounds to ensure hormones are increasing appropriately and that the all important follicles are developing.

My daily injection is going fine, as it turns out I'm a professional. The monitoring is showing that each ovary is developing 5 or 6 follicles of about equal size. This is really good news. The follicles need to be developed to certain size for the eggs that come out of them to be mature. My doctor said that my body is doing exactly as it is supposed to do and wishes all his patients were as well behaved.

Some women have the case where early monitoring shows they don't have enough follicles, so their injection medication level is increased - however this can lead to follicles that develop late, and therefore are not mature by the time eggs are harvested.

I keep doing what I'm doing. I'm injecting at just after 7am and getting blood tests and scans as instructed. Finally my doctor tells me my follicles are all the right size and it time to do the 'trigger' shot.

The trigger shot is the hormone that tells your body OVULATE. Apparently after this shot it takes about 37 hours to ovulate. Therefore, about 36 hours after you do this final injection it is important that you are having the eggs harvested from the follicle.

The doctor tells me I'm booked for a 2pm egg pick up on Wednesday, this means that at 1am on Tuesday morning I need to wake up and give myself an injection. Clearly this timing thing is a little confusing. The doctor tells me, that is like Monday night you need set the alarm - it is really important that I get the timing right.

Given my policy on anything that will increase my chances of IVF success is on the to do list, I was awake at 12.45 am on Tuesday prepping the injection (that this time isn't in one of the easy to administer epipens). Once I administer the injection I'm straight back to sleep.

The next two days are great. No drugs at all. After 4+ weeks of nasal sprays and 2+ weeks of daily injections a two day drug break is a luxury. The break also means the business end of the IVF cycle is around the corner.

The year of medical interventions IVF part 1

I've been completely cheating on the blog. It is funny what comes out of the wood work with friends, family and strangers when you start writing some of your inner most thoughts and publishing them for anyone to read. In April I was hit by a few comments that led me to decide to take a break from the blog.

A lot has happened since I last blogged and I thought it was worth getting back to publishing.

May and June were all about IVF. I hoped July would be about first trimester musings, but as it turned out July was all about my gallbladder.

It will take me a few posts to catch up on everything. In case you have been wondering my first IVF cycle was unsuccessful in the sense that I still do not have a bun in the oven. On the other hand, the cycle was very successful in creating multiple viable embryos (essential for future attempts at achieving pregnancy) and for improving my mental health, where for the first time in a long time, achieving pregnancy seems imminent and therefore an overarching panic about not being pregnant has diminished.

In late May I left the fertility specialist's office with my very own cooler bag, filled with legal drugs in their own epipens for easy administration. I remember as I stood at the lift thinking 'I can't believe it has come to this'. It was overwhelming to think that now my conception chances were all about injections and nasal sprays, and not intercourse.

It just felt so unnatural. All those ingrained ideas and fears float around my mind. Perhaps as some suggest I am only a holiday and a bottle of wine away from getting up the duff (which for the record, I would like to state did not work on all attempts tried). Even worse I get all martyrish and think perhaps if you can't have children naturally maybe I'm not supposed to. And worse again I start thinking perhaps I'll finally get to have a baby, suffer from relentless post-natal depression, hate the baby and wish I had remained childless.

I sneak the drugs back into the office and hide them in the fridge on another floor of our office in an attempt to avoid any questions and try to conceal that I am doing IVF from my colleagues (ironic given that I write and publish a blog for anyone to read). Back at my desk for the afternoon I am distracted by continually reminding myself to not forget drugs in upstairs fridge. Must remember drugs, must remember drugs, that design looks good, must remember drugs upstairs.

Thankfully I remember the drugs when I'm leaving and get them home safely and into my own fridge. By this stage, I've already been taking a nasal spray for about a 2-weeks and I've had 1 blood test, just to make sure all my hormones are where they should be if the nasal spray is working. Tick - all go for commencing injections.

A few weeks ago Matt and I sat through a 90 minute session with an IVF clinic nurse in which we were shown how to administer all the different drugs. My doctor also has made me use one of the epipens in his rooms. He makes me dial up the dosage and over the bin I push down on the end of the epipen, hold for 10 seconds to witness how the release of drugs is a little delayed. When I get home I put my drugs in the fridge and find they've come with another DVD with instructions. I tell myself 'must watch instructional DVD to ensure correct procedure is followed, therefore increasing eggs produced and all chance of IVF success'.

In fact everything I'm doing at this point was about increasing chances of IVF success. Must not drink wine to increase chance of IVF success. Must exercise and eat well to loose weight to increase chance of IVF success (fertility specialist had again mentioned that any amount of weight loss would help, even 2 - 3 kg - which I decided was achievable and as would increase chance of IVF success was on the to do list!). Must get 8 hours sleep to help stay relaxed and stress free to help chance of IVF success. Must take multi vitamin, pre-conception vitamin, iron tablet and fish oil to increase chance of IVF success.

The next morning I have my set time for injecting. I have to pick a time that I can consistently meet everyday, including weekends, workdays, potential flights. I pick just after 7am as the most achievable consistent time for 10 - 16 days of injections. By this time I realise I don't have enough time to watch the instructional DVD (should have done so night before) and blowing caution to the wind proceed with first injection. I was extremely pleased with the ease of injection and zero pain and decide no longer need to watch DVD as clearly I'm a professional already.

Post surgery blues and brightness

It's been two and a half weeks since the surgery to remove my left fallopian tube, with ectopic pregnancy. I'm lucky they could perform the surgery laparoscopically, which means I don't have any big wounds. My doctor explained to me before I went in for surgery that because I have a little extra padding (yes, that's what he said) that it may not be possible for him to perform the surgery safely laparoscopically. If he couldn't it would have meant much more invasive surgery, a longer hospital stay and more painful recovery. So when I came out of surgery, I was pleased to find out laparoscopic surgery was possible.

I only had an overnight stay in hospital. By the time I got out of surgery and came to, it was late at night. Matt was waiting for me in the hospital room. The doctor had called him to let him know all had gone well through the surgery. I was zonked out, so Matt went home.

The whole process was very stressful him. My sister had visited in the hospital before the surgery and had organised for Matt to have dinner with her and wait at her place, which is only 1km from the hospital. Matt told me he was okay while he was with my sister and Aunty, but when he went on his own to pick up dinner, negative thoughts started to creep in. Surgery is inherently dangerous and Matt was worried something might happen to me.

Even with just three small wounds I did have a lot of pain for the week after the surgery. I had terrible bruising around my belly button (where the biggest cut is made) and on my arm from the anesthetist but by week two things were settling down. I still get a little twinge from time to time and I still have stitches. My anesthetist may have been rough with the needles, but he was also very generous with the post surgery drugs! He sent me home with the good gear which lead to a few zippy afternoons jumped up on prescription drugs.

As I entered the second week of my recovery I started to take less less pain killers and as I came out of the drug haze feelings of sadness overwhelmed me. I remember how devastated I was when we lost our first pregnancy and the sadness I am feeling this time around is very different. It is sadness about everything, I'm sad to still not have a child. I am sad about how hard it has all been. I am sad that I can't keep up with my work anymore and that for the first time in my life I've had to ask for some leniency as I step up my fertility treatments. I was just so sad.

Coming into week three the sadness is under control and I'm starting to get excited about the next step in our fertility treatments. I am hoping that having recently managed a natural pregnancy - that perhaps our chances will be better with a little medical assistance.

Close to tears

On Monday we returned from a 10 day break on beach. I definitely feel more relaxed and rested than when I left, but all this relaxing and recuperating has the disadvantage of giving me more time to think.

My first few days of holdiays I was still wondering "Am I pregnant?"...  I don't mind this time. Thinking and hoping.

Having had one pregnancy, I have experienced the early symptoms of pregnancy, so when I started to get sensitive nipples and sore boobs I try to not to hope too much. Having had these symptoms often since the first pregnancy, and not being pregnant, the best thing about getting them is I know the wait is coming to an end. Once these symptoms are happening I'll know I'm either pregnant or not in the next couple of days.

This month, once again the wish was soon brought to an end with the onset of my period.

I didn't dwell on it, but immediately kicked into the plan set for the next cycle. The fertility specialist had already told me to double my dose of clomid / serophene if I wasn't pregnant. I'd packed in readiness for the result and had my drugs on hand. Because I was away I didn't get the same blood tests done to confirm my period had started.  Once I thought my period had started in earnest I started taking the clomid / serophene.

I'm supposed to take it at the same time every day. I stuffed up one day and simply forgot...got carried away with beaches and swimming, but still managed to take it within a couple of hours of the set time. I'm not worried about that as all the blood tests have shown I'm ovulating every month, so a think a few hours late on one day of clomid / serophene won't be a problem.

The five days of medication taking pass and I've done all I can do. Then the waiting begins. Waiting for the fertile window. Last month this was the peaceful time, this month not so peaceful. I start in on myself mentally, I remember every glass of wine, every late day in the office, every coffee, every unnecessary calorie, every gym class missed. Having the plan and everything in place simply delayed the anxiety. I'm on the edge of tears all the time. Almost anything could set me off.

Yesterday I went to work - one day in the middle of my holidays - to ensure everything would be in place for a big meeting I have on my first day back. I was immersed in busy-ness. Rushing to meet a deadline, try to purge some of the hundreds of emails in my inbox and get the presentations completed for next Monday. The busy-ness distracts me from all the worry.

I think the worry really doesn't help anything, but finding the off switch, other than work, is hard.

With Christmas holidays around the corner, I'm beginning to dread the free time and all that time to think.

Oh well, coming soon is my next fertile window and I'll have the week of hope and contentment.

Injection perfection

On Thursday I visited the fertility specialist to get my first pregnyl injection. As I understand it this injection puts a little bit of HCG in my system, therefore preventing the premature breakdown of my uterus lining that I experienced last month. 

The doctor had me prepared with the prescription, so I had my drugs ready to go and knew what to bring with me. Instead of being worried about the impending injection, all I was thinking about was the holiday notice. I wondered if it would be fixed, or if I would be subjected to erroneous notice for the duration of my wait. 

Needless to say, I was smugly pleased to see the notice had been fixed in the week between my visits. So much so I snapped a record on my iPhone while the receptionist was out of the waiting room....

Having learned from my last visit, I skipped the pile of magazines. While I enjoyed what felt like a win on the revised holiday notice I didn't want to spend too much time looking at the baby notice board either. Instead I immersed myself in my day ahead, reviewing my diary and reading my emails.

My wait was much shorter and I felt great when the doctor called my name. 

So the purpose of the visit was not just to get my injection, but to learn how to do them to myself, so I could be self reliant for future injections. For this particular series I only needed the three injections, one on Thursday, then Sunday (today) and then the coming Wednesday. But as it turns out there was a lot more to it than just the injecting bit.

I needed to be shown the technique for breaking open the glass vials in which the two separate elements to the drug have been provided. My hands were shaking as I was trying to crack them open. Once cracked open, the doctor shows me how to put a syringe together and then draw the liquid out of the first vial. The doctor then squirts the liquid back in the vial and hands it back over to me to do the same. Drawing the fluid up is pretty easy. I then squirt the liquid into the other vial that contains a powder. The powder quickly dissolves and the doctor instructs me to give it a stir with the needle. I then have to draw up the combined liquid into the syringe. This is when it starts to get tricky. I have to be careful not to suck up too much air. Once it is all drawn up I have to hold the needle point up and flick the syringe to tap out any air bubbles. Its just like on tv - only I'm going to inject it in myself and I'm genuinely worried about air bubbles! The doctor tells me the amount of air left in the syringe won't hurt me. So, now I have to swap from the horse needle I've been using for all the drawing up etc to the finer injecting into myself needle. 

This is all pretty simple, but brings me closer to the sticking point, where I have to jab myself. The doctor tells me to pinch some of the F A T (yes he spelled it out) on my tummy and then I need to push the needle in half way. Away I go.... While I'm jabbing the doctor tells me this is the worst of the needles he teaches his patients, because it stings the most. Meanwhile I'm thinking - I'm brilliant at this, it doesn't hurt at all. The doctor gets me to push the needle in a bit further and then I have to slowly push in the syringe. It really isn't hurting. I'm really pleased about that. Once it is all squirted in I slowly pull out the needle. The doctor tells me I've done really well and starts to pack me my very own drug kit for home. Extra syringes, needles, a little plastic cap to help crack the viles open and my very own sharps disposal kit.

As he is packing it all up I check out his tie, this time it is storks delivering babies. This guy clearly likes the novelty tie. He is really warm and likable and the novelty tie really suits him.

My drug kit

Today I had to repeat the injection process at home. I laid everything out and was impressed at my drug kit. I did pretty well repeating the process, only making the one mistake, where I prematurely changed the needle, preventing me from being able to draw up the completed potion. I then had to lever open my sharps disposal container to retrieve the big needle to draw the combined potion up. I flick the syringe to knock out the air bubbles and swapped needles to the finer injecting one. I get ready for the injection - just like in the doctor's surgery, only I swap sides as the doctor had told me to try not to do them all in the one place. I pinch some F A T and got ready for the jab and it stings like a bastard!!!!!

Giving myself my second injection

I don't what I did differently at the doctor's office, but this needle is unpleasant. I persist and push the syringe down. When I draw out the needle I'm left with a little hole that bleeds a little bit. I check and yes I have definitely changed to the small needle. I've got no idea why but this time the injection giving was really unpleasant.

At least there is only one more to go.

When the 'love doctor' calls

After remarkably fewer blood tests monitoring my hormone levels than last month (only three) yesterday the 'love doctor' called. 

In our very first appointment we all giggled and thought it was funny when the fertility specialist advised the 'love doctor' would give us a nod and a wink when the blood test revealed the LH spike that means that the next day I will ovulate. In fact last month literally we were told "all go for tonight". It really is strange to have someone (and now anyone who reads this) being across what (and more specially when) we are getting funky.

I love knowing that I am ovulating and when I'm ovulating, but it does mean spontaneity and romance have disappeared from our sex life. But what surprises more is that even with the lack of spontaneity and romance the quality has improved remarkably.

I guess the spontaneity had left some time earlier. Something kicked in after trying to conceive for months/years, where resentment, or anger, or disappointment seemed to underpin much of our baby-making efforts. And then there were the questions about the activities undertaken by one or the other partner, that seemed counter to the baby-making efforts. So for me, Matt would ask questions like why should we even bother when this weekend we are going to be going to [INSERT ANY PARTY] and you're going to drink a bottle of wine, thus undoing the efforts. And for me, I'd wonder, perhaps I've had too much caffeine this week, or sugar, or haven't done enough exercise, or I've worked too long, or drank a glass of wine at lunch....and so on and so on and so on....

Having access to information from the fertility specialist certainly helps because at least now we know our timing is on the money - hence removing a whole bunch of thinking about getting that right. Also given that both Matt and I have quit smoking ages ago and drink very little most weeks the fertility specialist has advised the occasional bender isn't going to be a big fertility issue, reducing the worry about the times we let our hair down.

Less stress about the peripheral issues seems to have made things a lot better for us in the bedroom.

Right now I'm still feeling positive, having just gone through the fertile window and knowing that this could be the month that it all come together again. For those that haven't figured out how this works just yet, in a week or so I'm going to be on the rapid down hill slope in the hideous waiting period - but you'll hear more about that when I get there.

Today I picked up my prescription for the injections I have to start giving myself later this week. I have a short appointment with the fertility specialist to learn how to do this on Thursday morning.

It is hard to put a lot this down, so thanks again to all the great emails, comments and messages of support.

So what's been going on till now?

I rang the Doctor's office late on Tuesday night, unfortunately a little too late to get the results of my blood test. The answering machine gave me an after hours number to ring, and that message gave me another 'urgent' pager number. I decided the results of this blood test can wait until the morning.

On the dot of 8am today I rang and was told that the blood tests show my period hasn't started properly yet. I don't what this means for the whole fertility deal yet, it just seems weird and has me wondering what's been going on for last however many months. 

When did my period starting stop being my period starting?

Since my first pregnancy miscarried and having a suction DNC (curette) in August 2009, my cycle has not been what it used to be. My cycle could vary from 26 to 40 days in length. When you are trying to get pregnant there is nothing you would like more than a nice regular cycle. The irregularity is bad, but it is the long cycles that mess with your head, make you do a million pregnancy tests, get your hopes up to the highest heights and then send you crashing back down.

I reported all this irregularity to my GP, who referred me back to my original obstetrician, who said I needed to be patient. After another month or two of patience I went back to my GP who I have been seeing for about 10 years. In tears again my GP said all this patience was ridiculous, given the emotional distress it was causing, so she prescribed Clomid to try and aid in a speedy pregnancy.

So I've had the clomid for a few months and the irregular cycle has settled down, but now I find out that everything is haywire anyhow.

So how does this result make me feel? Better than I have in months. I feel better because someone is looking into it. The doctor wants me to repeat the same blood test tomorrow. And I hope that the results tomorrow shed more light on what the hell is going on. I certainly hope even though I've got no idea what is going on, that the doctor will.

How do I know it's my period?

My obstetrician was particular about my waiting 12-months. She tells me the high percentage figure of healthy couples that will conceive naturally in this time period. Given the fact that my husband and I had conceived once naturally in 2009 she assured us that patience was necessary. 

Having lasted about 10 of the full official 12-month waiting period, last month I managed to get a referal to see a fertility specialist.

Our appointment was a great 15-minutes in front of a professional who like the obstetrician said given the results of a few test we'd already undertaken so far there wasn't too much to worry about. My weight could be a problem, so perhaps I should try and loose some and step up the exercise program (which he acknowledges this sometimes more difficult than it sounds). 

He sent us away with a lot of blood tests. These tests to be done by me over the course of the month would allow the doc to follow the rise of fall of certain hormones. We left with the certainty that this month the 'love' doctor would give us the nod ensuring our baby making efforts were concentrated around my most fertile window. It wasn't much, but it was enough to bring back hope. At last we were doing something, we had some support, we had scientifically accurate information about my oestrogen, LH and progesterone levels and a phone number to ring. 

With science on my side, I have also stepped up on my part. I've renewed a gym membership and have been getting a lot more regular exercise. I've also been seeking some alternative therapies to help me with some of the emotional difficulties I've experienced around my failed pregnancy and my general well being.

Today I decided that I would ring the fertility specialist to report that my period had started 7 days after I ovulated. Having done swathes of internet research I knew this was bad news. A short luteal phase doesn't allow the body enough time to get pregnant - or something like that. The doctor wasn't there when I rang, but with the receptionist informed of my concerns, I was advised I would either receive a call back later in the day or that I should call again in the morning.

I was pretty bloody happy when the doctor rang me back in the early evening. I found myself talking quickly and openly about spotting and light bleeding and how it all started just 7 days after the date of confirmed ovulation. I was however surprised by the doctor's response, "how do you know it's your period?"

I've been having periods for let's say 23 years. Yes, this bleeding is light, but it has been going for 4 days and doesn't look like easing up. Last month was just like this, long period, but slow getting started with lots of light days. I have done a few cheap internet pregnancy test, but they all come up negative so I don't think it is implantation bleeding. But when it comes down to it, I guess I don't know, I just assume it is.

The doc sends me to the pile of pre-prepared blood test forms that I left his office armed with from our 15-minute meeting and tells me to get a 'quantitative hcg' test. This test will confirm if I'm pregnant or not and all the other results of oestrogen, LH and progesterone levels will confirm if my period has started, or not.

I'm so glad I weaseled my referral a month or two early and that finally I am getting some help. Tomorrow morning I'll be there when the Sullivan Nicolaides doors open at 7am for another jab. And in the afternoon I'll ring that number to find out whether it is my period or not.