Thalia's fertility journey: hopefully more comedy than tragedy

It's going to be a loooong winter

Appointment with Dr Candour today to review the cycle. He confirmed that:

• They were happy-ish with the stim. Eight eggs is what they are aiming for. Six eggs is pretty good.
• Oestrogen levels were good and rose nice and steadily
• Lining was good (10.5mm which I thought was a bit on the low side, but there you go)
• We had beautiful eggs - six/six fertilised is not usual
• The embryos we put back were perfect, they couldn't have been better - particularly the fact that one of them was compacting

Because everything looked so good, he said that, at transfer, they were very "gung ho" about our chances of success. He was therefore very surprised that I started bleeding at 8dp3dt. Given that I started bleeding so early he thinks my beta of five on 10dp3dt was a false positive result rather than a chemical pregnancy. Apparently the false positive level goes up to 8, so it's hard to tell either way unless the number is higher than that.

Responding to all of this, the protocol for next time would be:

• Long day 21 again. Although this is slow, it got us some high quality eggs so they don't want to mess with it. His experience of antagon protocols is that they produce fewer and less good quality eggs. I tested the antagon/letrozole protocol with him that Pru is on and he had never heard of anyone in the UK doing it other than for breast cancer survivors. So now he wants to meet Pru's doctor.
• They will start me on 200iU of Puregon next time, instead of starting at 150
• Much against clinical evidence, which says that there is no difference in pregnancy rates between PIO and suppositories, he wants to respond to my early bleeding and use PIO next time. Oh joy.
• He is not in favour of assisted hatching or 5 day blastocyst transfer as neither show any improvement on 3 day transfer rates. Assisted hatching does show a small positive improvement in pregnancy rate for women over 39, which I will be, but he says it's not enough to risk it yet. Blastocyst transfer improves success rates per transfer, but not per cycle started. They have not found it worthwhile to do the "survival of the fittest embryo" on a regular basis for that reason. If I had six good embryos on day 3 next time, they'd be prepared to have the discussion, but he wouldn't recommend it as a starting protocol.

However (you could tell there was a 'but' coming, couldn't you), he first needs to scan me to see how bad these endometriomas are on a non-stimulated cycle after my ovaries have calmed down. Which means a scan in the first half of January, after two unstimulated cycles. Then he'll decide if we should do a lap or if we can go straight to IVF. Broadly we have four options re the endometriomas:

1. Do nothing. They'll stay there, and will gradually get bigger. Hence not a very good option long term.
2. Aspirate them. They fill up again pretty quickly
3. Drain them and laser clean the walls. They are likely to reform, but more slowly and in 10% of cases they are gone for good. This is what he did last May for the one I had then
4. Drain them and ablate the cells surrounding them. This removes them for good 90% of the time. It also destroys a significant chunk of the ovary that surrounds them. Hence not a good option when, in his words, "we are trying to preserve fertility."

He will therefore consider either option 1 or option 3 depending on how they look in a couple of months time.

Again we had a very good discussion. Although he kept us waiting for 30 mins, he did then gave us an hour which was double our appointment time. He did stop at one point and ask me if all the research I had done was helping me or making me more stressed (after I asked him a question about the effect of androgenising hormones on endometrial quality and egg quality in the context of an antagon cycle), which I thought was a good question. H thinks that at the margins the research makes me more stressed, but I do feel I need to know stuff, and I have stopped myself on obsessing on some things which only make me feel worse like the success rates for women with endometriosis. I told Dr Candour that and he said: "well, as long as you've got it under control, you should do what helps you the most."

I asked him about the effect of endometriosis on implantation. He says that the evidence is equivocal. Because they still don't understand the basic biology of implantation it's hard to say what this problem is, but his sense is that it there is a link, given the lower success rates for IVF for women with endometriosis even when they have the same quality eggs and embryos as a couple coming in with, say, male factor. I forgot to ask him about beta-integrins and whether it's worth testing for a problem there, possibly linked to implantation.

Other questions I forgot to ask him were:

• Was I not a bit oversuppressed after 17 days on Buserelin before stims began? In fact I did ask it, but we got distracted half way through his answer
• What does he think about immunological issues as contributors to endometriosis? And what does he think about the work on diet and endometriosis in that context?

So where does this leave us? I have today filled in the form to get my records released to send to the Big Guns Clinic (hereafter BGC). We'll do another cycle at my current clinic, then see where we are. However, I'm desparately sad that all this waiting means we are a year away, at best, from a baby. On the current schedule, assuming I don't need a lap, we'd start at the end of January, retrieval would be mid-March. If I do need a lap, all bets are off.

This just seems so far away. I am less and less likely to have a baby before I turn 40. But I just want a baby. I want to be a mother. I'm sad and mad that it's so hard for us. I want to do this for me, I want to do this for H. I want to bring someone into the world, to love them and help them become a real person. I want to find out what they are like and what they want to do with themselves. I want to watch them grow and learn. I want to bake them cake and have them cover the cake with too much icing and ugly sprinkles. I want to treasure glittery paintings. I want to put sticking-plaster on skinned knees and hold them on my lap when they cry. I want to tell them they're beautiful. I want to watch them sing twinkle twinkle. I want to help them with their homework.  I want to watch them play football with H or head off on their bicycles to the park together. I want to worry about them when they're out too late at a party. I want to listen for them sneaking up the stairs, thinking we don't know how late it is. I want to take them to the leaning tower of Pisa and explain to them why it's not straight. I want them to explain how a train works to me, and point out all their favourite dinosaurs at the Natural History Museum. I want to take them on the Earthquake at the National Geological Museum and tell them how their Grandpa used to take me there every Sunday. I want to wach them climb the climbing frame in the park and worry about them falling off. I want to help them buy their first flat and chose something lovely from home for them to decorate it with.

It's not so much to ask, is it? But it all seems so far out of my grasp.

The fat lady sings

The results are in and...it's negative. Which is good, right? So why do I feel so sad again? I honestly wasn't that bad yesterday, much as my post seems to have come over that way. But today getting the "I'm sorry it's negative" call made me cry.

I keep having these moments where I think, "I get it now." But then I have another one 24 hour later. "Oh yes, NOW I get it." I'm wondering how long this process of getting it is going to take. It reminds me of being in therapy where I'd talk about a particular issue for weeks and weeks, and finally come to the realisation of what it was all about. Then we'd move onto the next issue. And we'd discuss that for weeks and weeks, and I'd finally come to the realisation of what that was all about. And it would be the same thing, again. A couple of rounds of this and I started to feel really stupid. How could I not have made those connections myself? Why did this all take so long?

I came to the conclusion that made me feel slightly better. I saw this as one long process of peeling the layers off an onion. An onion where the spade had made a scar in it as it was being dug up. So when you examined the surface of the onion, from close quarters, you'd see the skin, and then you'd come across the scar. When you peeled off the skin, the next layer down would be different so you'd take time to explore that, and then you'd come across the scar only this time it would look different again. And so on. Each time the angle is different, the realisation is different, but it's still the same onion.

And of course, peeling onions makes me cry, so that's appropriate.

So I'm here, wondering how many more layers this particular onion has to go before, finally, I get it. Before I finally, at a deep emotional level, come to terms with the fact that I was pregnant. Not completely, just a little. But I was, and now I'm not. And there was no baby in between.

We're living in Limboland

It's been quite a long time between posts, for my recent posting rate, at least. Two reasons. One is that I have had a huge amount to do at work. The second is that it's hard to find something to write about. I had a couple of thought-pieces I'd been thinking about to keep me occupied during the 2ww (the ethics of infertility, for example), but it's been hard to motivate myself to write them since my 2ww was so rudely interrupted. I will do eventually, but my focus just hasn't been there.

I have no new news on the cycle. The second blood test is tomorrow and I am hoping very hard that the beta will be zero. I think it will be. I have no particular reason to know that that is the case, but I'm chosing to see that as the most likely option.

It's been odd adjusting to the news that, at some point in the last two weeks, I was pregnant. That's a wierd thought. I've never seen a double line on the peestick, except for the time I peed on a stick after my hcg shot just to see what it looked like. I had never been pregnant. And now I have, just a little bit. You know, I never really appreciated the title of Julie's blog until now. I hadn't really thought about it, I'd focused on her story and her writing, and hadn't considered what the title meant. But now I get it, at least a little bit.

I haven't been unremittingly sad. I was a basket case on Tuesday, not in good shape on Wednesday, but suddenly on Thursday, after I'd recovered from the blood test experience, I was ok. I couldn't quite figure it out but while I was speaking to a couple of friends to tell them the news that evening, I didn't burst into tears and I was able to joke about it, a bit. Friday similarly. Then Saturday I got very sad again. It's all quite odd but I suppose it's just like any normal mourning process, it goes up and down.

Yesterday was a bit of a test as I spent most of the day in a review meeting. A lot of the junior women in our office are pregnant so there was much discussion about part time work and when they were all going and coming back. There was such cameraderie in the room as my colleagues remembered when their first child was born...I was ok for a while and then it started to really hurt. A club that it feels like I will never be able to join.

H has been sad, but he doesn't show it much. He cried, just a little tiny bit, on Tuesday with me. Then on Thursday when he was the one who listened to that phone message, I could see that he had been hoping that they would tell us that I was pregnant, and that he heard the message as if that was still a possibility, hope was still there. I had to disabuse him of any hope after I'd listened to it five times and realised that it almost certainly said the level was 'five' not 'fine'. He, of course, had heard the latter. Because Hope was in his ear. He got very sad again then. He'd been holding a little secret hope between Tuesday and Thursday, whereas I knew it was over when I started to bleed, or even before. I love that he keeps hoping, it keeps me sane. After being sad for a few days he's now back to being a little bit hopeful for the future. I do love him.

So to keep this post from being entirely one long whine, here are a few people you should go and see. S just found out her IVF (within a day of mine) didn't work. April's IUI didn't work. Megan, on the other hand, has some good news. So whether you're in a congratulatory mood, or a sympathetic one, you have a destination either way.

The joy never ends

I thought I'd seen the end of this category. But no, got to resurrect it because it's not over until the fat lady gives me a beta hcg level of less than 5. And yes, the level was five. I said to Dr ICU that he should speak more slowly when he leaves messages on people's answerphones. He said he'd take that into consideration which was nice of him. He also asked me how many IUIs I'd had, which showed a little carelessness since (i) it indicated no one had bothered to get my file out this morning, and (ii) it's proof positive that the doctors don't remember us as he's the doctor who did the pre-transfer consult with us and told us about our lovely embryos. Oh well.

So, as Susan predicted (unfortunately from personal experience), the story is that if the level goes up, it is almost certainly an ectopic. If it goes down, it shows that the poor embryo tried to implant but was too defective to get anywhere, as Summer suggested. So for heavens sake please let it go down. Having an ectopic really would be the final kick in the teeth to this stressful and somewhat pointless cycle.

Mindfuck

Obligatory bloodtest this morning. It felt so pointless and reduced me to a quivering wreck again on the way home. We've never been to the hospital before where there's no possibility of good news. I persuaded them not to call either of us on our mobiles but to just leave a message on the home machine, which we can't check remotely. I didn't want either of us to have to hear more bad news in the middle of a work day where we were just getting back on a sort-of even keel.

Around six my mobile rang. I saw it was H and ignored it as I was in a meeting. It rang again. Then my desk phone rang. Then the mobile rang again. I excused myself and answered it. We all know what I thought it might be. Instead it was :H saying he was locked out. I promised to be home by 8 and he went to a cafe to work.

I spoke to one of my best friends on the way home to tell her our sad news. I was still on the phone as I walked into the house. H met me on the steps and carried my bag in. I kept talking while he listened to the message. He kept making faces at me to get off the phone but I didn't want to cut my friend off. Eventually we said goodbye and H handed me the phone. I listened to the message. It was Dr ICU. Which meant it was hard to understand.

So the message? Well the nub of it is that my blood test is either “five” or “fine”. It is definitely “weakly positive” (indicating that “five” is the more likely), and I have to come in again in a week to see if it has gone down to negative level, which is “more than likely” or “maybe likely”, or whether it has “continued to rise.”

No hopping about, please. I will put money on it being 5. I am clearly not pregnant. Honestly I have bled too much for it to be anything but a negative result. But I wonder where that 5 came from. Does this mean that a poor embryo was trying to hang on while its environment disintegrated around it? Could it mean that if I'd had mega doses of progesterone it might still be there?

I will call them tomorrow and attempt interpretation. It would have been better if it had been negative. “Or positive,” H said. I asked if he had been hoping for that. He had. I had not. Sure, I'd experimented with the idea but I just can't imagine how an embryo could be hanging on through this deluge.

So no, I'm not pregnant. But it looks as if, for about five minutes, I was.

No where

Diana Wynne Jones's book, Fire and Hemlock, relies for its denouement on two stone pillars which rotate. On each pillar are the letters, N, O, W, H, E, R, E. Between them then they can spell No where, Here now, Where now, Now here. That's what this feels like. Rotating spheres of meaning, coming and going, and in the end signifying not that much. It's hard to make sense of this.

I knew on Monday that it was over. Those pangs I wrote about were clearly period pain. Of course knowing and believing are two different things. Certainly my subconscious knew it. I dreamt all night that I wasn't pregnant. It was one of those dreams where you are completely convinced that it's real. It was horrible. When I woke up at 04:15 it took me a minute to orient myself again. Then I tried to feel relieved that it was just a dream. That I might still be pregnant. Then I felt the pangs again and knew that I wasn't. I slept on and off until about 07:15 when I gave up and went to the loo. And found blood. I wish I could remember the precise words of the ending to The Peacock Spring. Una gets her period and it's the end of her final clinging onto her relationship with Ravi. But my copy is in a box somewhere and I don't want to murder Rumer Godden's words. So let me try. It felt like the end. It felt like a final full stop on a story. A sharp cut to the thread of hope I'd been finding it increasingly hard to sustain for the last 18 hours. "The curse has come upon me." (My mother and her generation called their period "The curse". Do you think they got it from Tennyson or is that something from time immemorial? Do Americans of a certain age ever call it that?).

And while we're on the topic of hope, let me be clear that there is no hope for this cycle. Nothing could survive the total destruction of its habitat like this. I refuse to call a period Aunt Flow, but boy is this flowing. It's dark and red and heavy and hot and angry. Of course I guess I could have an ectopic. But since I have no symptoms, even though I've been told by the clinic to continue the suppositories, I very much doubt that I'm going to be subjected to that particular trauma. Which I suppose is one lucky break I've had. But it is full on. I'm having the worst pain I've had for years, which is leaving me nauseous as well as crampy. Which at least has the bonus that I wasn't tempted to drown my sorrows in food yesterday. I did eat some of the HUGE box of chocolates that H went out of his way to buy from the best chocolate shop in London (I don't think he realised how many chocolates they can pack into a box, or how much it would cost!), but my heart wasn't really in it. Nor did I fancy breaking my wheat-fast and so while H had pizza for dinner, I had a salad. I think I'm too sad even to want to over-eat. That's a rare occurrence for me.

I'm crying at the drop of a hat. It's not easy as, unlike Susan, I can't hide under my desk to do it. Luckily yesterday I was able to turn all my meetings into phone calls. So I did everything from home in my pyjamas. It got the work done. Today I have to be chirpy and present in person again. I reckon I can do it in 30 minute increments. I'll have to find some reason to duck out when I need to.

I still have to go for a blood test, but I got the nurse to let me go in tomorrow instead of Friday. I just want this to be over with. I have an appointment with Dr Candour on the 29th. We have to wait that long because, get this, "It takes two weeks for the clinic doctors to look through the file and return it to Dr Candour." Two weeks. No worries. How about I walk over there and just help them with that little task, huh? Or don't you think they'd apppreciate that? While I'm there tomorrow I have to sign some kind of consent form for them to release our records so I can get a copy for big guns clinic. My intent is still to do another cycle where we are and then see what happens. In the meantime I want to get going with BGC as they have quite the waiting list. Not surprising given their figures.

I'm not ready to start hoping again. I know that this cycle was not the end, but it is so hard to let go of the thought of our perfect eight celled embryos and the perfect boy/girl twins they were supposed to turn into. I had already imagined their summer birthday parties and chosen a few potential names. I know. I'm a sap and an idiot. When I noticed myself doing it I stopped myself, but it's hard to keep control of your brain all the time. I keep telling myself that doing another cycle is a good idea because it gives us the potential of a few more frozen 38-year-old embryos for future reference. Actually, they'll be 39-year-old since my birthday is in January and there's no way they'll let us cycle again before then. I never thought I'd be 39 and not even pregnant. Life wasn't supposed to be this way.

8dp3dt = CD1

I knew it. I dreamt about it all night. I'm bleeding.

7dp3dt: So this is what "petrified" looks like

I haven't tested. I don't think I'm going to. I'm too scared of it being negative and being inconsolable more than once this cycle. H confessed to me today that he's really stressed about Friday, too. I'm sorry that this has got to him, as well. He's usually my rock, and he still is, but I hate to lean on him so much when he's clearly having his own tough time.

I am really scared. I want it to work so badly, and I'm close to being sure that it hasn't. I know it's all non-sensical but I had period-like cramps today, and other than the sore(ish, not very much) boobs which I know are down to the progesterone, I have no symptoms. I know it's probably too early, but still. Every time I felt a cramp today my brain completely disconnected from the meeting I was in and I wanted to shoot whoever was talking: "Don't you know that my body might be rejecting our baby as we speak? How dare you babble on about HR?" Only I didn't say any of that. I just smiled and nodded and tried to keep going.

I think the final indignity would be to start bleeding before Friday. I'd rather it held off until after I know the cycle is a bust. Please keep your fingers crossed (because we all know that that does a lot of good!) that I am allowed that little concession.

The good news is that I now know I can do IVF. It's not so bad. I will do another cycle as soon as they'll let me. One more cycle at my current clinic then we pull out the big guns and go to the UK's most successful clinic - where they treat you like cattle but get you pregnant, about 38% of the time. For four times the cost, but you know, it will be worth it if that's what it takes.

In the meantime my cycle buddy Lindy has some hopeful pee-stick results that I'm sure a bit of congratulations would make all the more satisfying.

5dp3dt: No bathing here

I've run out of creative ideas for titles. Feel free to suggest your own.

Thanks for all the advice on the last one. First, re the baths. Persephone and Lynette are not to worry, the bath I took was on Sunday, before the transfer. Although none of the doctors told me not to take baths, I'd seen that particular advice before and so have resisted since the transfer on Monday, despite being sorely tempted due to the only alternative being a lukewarm shower. Let me tell you, that word lukewarm is highly misleading. When you're in it, it feels pretty damn cold. It's been like that, or getting worse, for a month and our bloody useless plumber has procrastinated, until a tearful fit on my part on Friday morning encouraged H to get another plumber in today. It will still take a week or so to get it fixed, since the problem is that a part is broken and the shower we have is so obscure there's no way to get a replacement part, so we have to get a replacement shower, but at least we are on our way. But no more baths, I promise. I'll just go and have a shower at the gym tomorrow, I think.

As for the constipation, if I'd posted yesterday I would have written something virtuous about how much water I drink and how my diet is entirely composed of leafy green vegetables, brown rice, and fruit, and it's had no effect. But after a couple of days of upping the water intake to nearly three litres (that's 101.442 fluid oz to you wierdo Americans) a day, and consciously eating even more spinach, kale, cabbage, peppers and brown rice than I thought was possible, this morning the bowel movements were exemplary. Of course, this probably just means that I'm not pregnant, but I'm hanging on to optimism while there's still time.

Speaking of whether or not I'm pregnant. I'm pondering the stick peeing question. I'm sorely tempted. Partly because I have a very busy day at work on Friday so I haven't figured out how I'll cope with getting the test result. But I know that getting a negative result any day is going to kill me, so I'm not sure why I think Friday will be any worse. Perhaps because before then I can tell myself that it's too early? By the way, those of you with short luteal phases normally, were they longer on IVF or on progesterone? Or should I be starting to worry about whether I'll start bleeding from Monday onwards?

Oh this is so much fun! I can't understand why more people don't do this!

2dp3dt: Progesterone: Why?

2dp3dt. Wow. I feel all grown-up writing that. My first post-IVF signifier.

But seriously, folks, let's talk about the progesterone. How do you get through the 2ww, let alone a pregnancy, on this stuff? The constipation is AWFUL. And constipation when you're inserting rectal suppositories every evening is NO JOKE. I need to pick up some prune juice tomorrow. Are those fibrogel type drinks ok to take when you're, ahem, trying to be pregnant?

The progesterone, as all of you who have gone before me know, is also a fun provider of other symptoms. Like sore breasts and a crampy uterus. I had to give Hope a serious talking-to last night as she kept saying: "4dpo isn't too far off a normal implantation day. Maybe it's implantation!" Then I kicked her down the stairs and locked her in the cupboard. I can still hear her banging on the door, but I'm trying to balance tuning into her moanings with a good dose of scepticism. I had a moment of too-convincing scepticism earlier, though, when I remembered how I didn't get promoted the Christmas before we got married. I was absolutely devastated, thinking about how I would never be able to plan a wedding and get promoted in the same period. After I got over the devastation I just focused on having a good six months and enjoying the wedding preparations, and on the runway after we landed back from honeymoon I got the text that told me I'd been promoted. I decided that the IVF might be like that, just because the Powers that Be don't want to hand out fulfillment and happiness that readily. They like us to suffer first.

Oh shit. I've just realised I wrote the "just relax" story of my promotion. I take it all back!

Of course that analogy also implies that I'm now thinking I'd get pregnant the next time we did IVF. Which of course is nonsense, but honey, this is my brain on progesterone - you can't ask too much of it.

I've also retreated to the guest bedroom as the stonkingly vivid dreams wake me up, and H just being in bed with me then disables my ability to go back to sleep easily. H is a bit unhappy about this and accused me of secreting George Clooney upstairs. Sadly, no. Somehow I don't think George would see me as much of a catch.

Oh and did I mention that I decided to have a nice relaxing bath and was having a lovely time until H came running upstairs to tell me that water was pouring through the ceiling? Nice. Not sure where the leak is but hopefully the insurance will pay up.

Sorry this is so random. I think that's just where I am right now.