Thalia's fertility journey

Ask again later

I'm in a bit of a funk about the appointment with Dr Candour today. I had a full-on anxiety dream about it yesterday, which included an appointment with Dr Condescending that never quite happened due to her being overworked, but did involve a long period sitting in an office with her with a bunch of other people who apparently couldn't go elsewhere; potential options on what we might do next, prepared by H on scrappy bits of paper and laid out by Dr Condescending for me to pick up and react to (I reacted very badly to the donor egg one); H disappearing to train with some soldiers over lunch, and me getting cross because he wasn't there to talk to Dr Condescending with me; A man conking out while sitting round the edges of Dr Condescending's office, and it turned out to be because she'd given him heparin when she shouldn't have done; us ending up at Dr Condescending's house where her husband walked out in a bad mood and she told me she was 2 days pregnant; me suddenly realising that it was 16:15 and we were late for our appointment with Dr Candour. I should add that in this dream Dr Condescending didn't look like she does in reality - she was fatter, for one thing. My shrink told me that if you dream of someone but they don't look like they do in reality, it's because you're conflating other people with them. I think I might have been adding myself into Dr Condescending in this dream, since the fatter bit would make sense, plus her hair was more like mine.

I wasn't even going to record it, since I know how much you aren't interested in my dreams, but once I started typing it all just spewed up onto the screen, sorry. I am not going to over-interpret it, suffice it to say I know I'm anxious and this didn't help calm me down.

I'm anxious because I'm going to ask some questions about donor eggs, and our chances of success, as well as the more mundane things about when can we cycle and should we do Zoladex again. In fact, here's the list I prepared and emailed to Dr Candour last night - anything missing?

• We want to do another IVF cycle as soon as we can. How soon is that, given that we are trying not to let the endo get out of control?
• Should we do zoladex again? One cycle probably isn't enough for the endometrium re-setting (I know he doesn't believe in that, anyway), so it's really just to keep the endo under control, and since I've now had 4 un-suppressed cycles since my last lap (2 IVF, one post miscarriage, one now), how much effect is the zoladex still having?
• Given the 4 cycles with estrogen floating around, should we do another lap, even in the absence of an indicative endometrioma? (although who knows, I may have one by now)
• Should we do a frozen or fresh cycle? How good are those embryos we've got frozen, really?
• If we get a good number of embryos again on a fresh cycle, shouldn't we be attempting blastocyst transfer? How good is the discrimination at day 2 really?
• Does the HFEA restriction re number of embryos transferred drop on my birthday exactly (13 Jan), or is there some leeway? How much?
• Are we kidding ourselves, and really we should be thinking about donor eggs now rather than later?

I'm also anxious because I'm remembering Julie's mantra from a post ages ago where she talked about what she wished she'd known, and one of the entries was: "If you've had three failed cycles, switch clinics. No matter how much you like your doctor, they aren't working for you." (I'm paraphrasing as I can't find the entry). I don't want to switch clinics. I like the atmosphere at ours, I trust Dr Candour and Dr Condescending, I like that I can email and get answers to science questions, that they know me, that it's convenient to our house, that they are non-profit making, that they designed a protocol just for me. And they did get us pregnant. Once. 

However, I have a sneaking suspicion that I am being an idiot. As I've mentioned before, there is a clinic in the UK which has double the success rates of anywhere else in the country. I know they screen on FSH, but I would pass that screen (assuming it stays where it's been for the last 2 years). Dr Candour says they also do ET at the clinic next door for patients with crappy prognoses, so that those numbers don't show up in their stats. He is a man of integrity, so I don't think he's making it up, but still their published figures haunt me. I also know that they are much harder to work with - they don't tell you what's going on, you have to go in every day for bloods etc., and they don't give appointments so you can sometimes wait for hours (hard to do with work), sometimes you have to come back in the afternoon (similarly hard with work), etc. Plus they push ICSI and IVIG on you, at more expense. But the success rates, how they call to me. A colleague at work got pregnant there, twice - with her son, and then with her twin boys, having had five failed IVFs elsewhere, so she is pushing me to go to them. I don't want to, but I think I'm being stupid. That's not a very good combination.

To clear up a couple of questions from the last post. We can't just suddenly switch to DE, there is a whole procedure to go through and donors are very hard to find in the UK, although I understand that my clinic has a good list and that the waiting time is not too bad (it can be years). So there is no question of doing half my eggs and half donor, for example. Second, Dr Candour doesn't just uniformly suggest five cycles, he suggested five on the basis that three completely negative cycles would lead him to suggest we stop, but we've had one pregnancy so that improves our chances, hence the additional two before he'd figure we were SOL. The reason that doing additional cycles delays adoption procedures is that in the UK, social services demand that you have stopped any kind of treatment before you start the adoption process, and some  even demand a six month wait time, to ensure you have mourned your biological children and let go of that (not sure six months is long enough, but there you go). So while we are still pursuing treatment, there is nothing we can do to initiate adoption. 

I can't help feeling that we're coming to the end of the runway, with no take-off in sight. Yes, I know we had a short-lived pregnancy, but many people have that and never get pregnant again. Yes, I   know my FSH is low, but I still don't stim easily. Yes, I know we produce good looking day 2/day 3 embryos, but who knows what they look like at day 7 or later? And I will be 40 in January. 40.

Let's see what happens this afternoon. I will probably be unable to post until later this weekend since we're heading off to see friends for the weekend, and not sure what their internet connection is like. I'll update when I can.

I probably shouldn't be writing this

If we had got pregnant the first time we had unprotected sex at the right time of the month, our baby would be about to have her 18 month birthday. She would be walking and crashing into things and talking to us. I would be expecting number two.

If we had got pregnant first the time we had great unprotected holiday sex at the right time of month, around the first time one of my friends told me to 'just relax', our baby would have just turned one. He would be forming words and cruising, and loving knocking over the towers that we built him.

If we had got pregnant after I had the HSG, which as every board member knows "cleans out your tubes and improves your fertility", our baby would be nine months old. He would be crawling and getting into everything and enjoying smearing food over his entire body when we tried to feed him.

If we had got pregnant after the first laparoscopy had cleaned up the endo, and the hysteroscopy had removed the fibroid, our baby would be seven months old and reaching for her blocks and keys, laughing and babbling. We would be convinced that she already had a few words, but no one else would believe us. I'd be about to go back to work and I'd be terrified.

If we had got pregnant on our abortive IUI cycle, Our baby would be nearly six months old. She would be sitting up on her own, and suffering from stranger anxiety. She'd be enjoying the treasure basket that her grandmother had created for her.

If we had got pregnant on our first IVF cycle, our baby would be about six weeks old. We would be totally exhausted, overwhelmed, and dirty. He would be starting to smile at us, and we would be bowled over in our amazement at finally getting something back from him.

If we'd got pregnant on our 'fuck IVF' holiday, I'd be about to give birth. I'd be uncomfortable and terrified and overjoyed and terrified and excited and huge and amazed.

If we had not had a miscarriage, I would be five months pregnant now. I would be clearly showing, and everyone would be congratulating us. I'd be looking forward nervously to the rabbi who married us finally noticing the pregnancy when we went to synagogue for the high holy days, and dreading him asking us why it took us so long. I'd be starting to think things might be ok. We'd know that it was a boy, and we'd be starting to think about names. My hairdresser and I would already be teasing each other about him dating her daughter when they got older.

If we had got pregnant on our third IVF cycle, I would be four weeks and two days pregnant. I would be viciously addicted to the visembryo site. I would be petrified and overjoyed at the same time. I'd be telling myself that lightning doesn't strike twice in the same place, even though I know that's a crock of shit.

12dp2dt: Yeah, well, I hate to say I told you so

So I defy even the most optimistic of you to feel good about this. Beta=2. My body clearly couldn't get round to giving a resounding negative, so it gives us a level of 2. Which means I'm supposed to go back in in a week for another test, which I find somewhat ridiculous. It's not because they think I might be a tiny bit pregnant, thank heavens, it's just so they've got a zero on the books. Even Dr Condescending said gently: I'll leave it up to you, Thalia, but we'd prefer you to come in, just so we can close off on this cycle properly.

Actually what I reckon is my body gives a low level positive on these tests anyway. On that first cycle the level on 10dp3dt, after 2 days of bleeding, was 5, and a week later the level was 2, when presumably it should have been zero. Certainly that time they didn't make me come back for another test. So I'm not convinced that the level of 2 today means anything at all. But I guess I'll be compliant and go for another test, if only for the scientific interest.

I did of course collapse into floods after I hung up on Dr Condescending. There is always that little tiny bit of hope left, but no, now the fat lady has most definitely sung. I was walking across Hyde Park when the call came, so I called H, then just kept walking. I spent some time by the round pond, having geese honk at me, remembering my grandmother as it's where she and I used to walk together. Then I walked on to a little deli, bought some good bread and cheese, and walked on home. Sadly I was not wearing walking shoes as I went to a posh conference this morning, so now my feet hurt. A lot. But it was a pretty, blustery day and I wanted to walk. Hyde Park was nice and empty so it didn't really matter that the tears kept rolling down my face.

It's really over.

11dp2dt: White as a, oh I don't know, a very white thing

Yes well, I appreciate the 'wait for the beta' comments, and yes, a part of me is doing that. But I honestly don't see how this can be looked on with optimism. The peesticks detect approx. 20 units of hcg. A beta of less than 50 on day 14 is not likely to end well (and yes, I do know that a beta of 500 on day 14 may still not end well, but at least it's a better start). If the peestick didn't pick up anything this morning (and believe me, it got held at every possible angle just in case), then there are less than 20 units of hcg around, and that means the hcg tomorrow would be less than 30, and we all know where that's going. Yes, I know about Brooklyn Girl's beta of 14 which ended up as her son, but there aren't too many other examples out there, are there, or we'd all be talking about them.

You will have every right to make me eat humble pie if there is better news tomorrow, but honestly guys, it's not very likely, is it?

I'm running through scenarios in my head. Frozen cycle? Break for a few months so that the next transfer is after my 40th birthday and they'll let us put back three (I'm wondering if it's that literal - i.e., transfer on 12 January, only 2 embryos; transfer on 13 January, 3 embryos off you go. Will they check what time of day I was born just in case they go a few hours too early?)? Go straight (as straight as possible) into another fresh cycle because after all, the stats for fresh cycles are better? Give it all up and go buy a nice holiday home in Tahiti or somewhere? Call the social worker about starting the adoption process? Give up work for six months to get myself in great shape and hope that helps?

I'm in a mess emotionally so clearly making any kind of decision isn't going to happen just yet. It hurts, oh how it hurts. I'm going to have to go through my 40th birthday without a baby, and without being pregnant. I find that prospect absolutely terrifying. 

10dp2dt: White as a sheet

Thanks sweeties for yesterday. I always go to the archives of other people's sites when this happens to me. Julie's, clearly, from my message on Thursday, and also Suz's because she had the negative peestick experience before getting a positive beta. But the thing with those is that Suz clearly had a crap bunch of peesticks, and Julie got a positive at 8dp3dt, so my continued negative today isn't really terribly encouraging. Last cycle I got a positive at 11dp2dt, and it was a bloody clear positive, so much so that it would clearly also have also been positive the day before, and almost certainly the day before that.

I did a lot of despairing yesterday. So far today (it's only been 35 minutes) I'm holding it together. I'm saving the bitter, why us, what-the-hell-is-going-on-here post for after the beta, just in case. But you see the thing is that I knew I wasn't pregnant this time. I knew I wasn't pregnant on the first cycle, too. And last time, despite my fears, I knew that those cramps and pullings meant I was pregnant. When I took that peestick on the morning of 11dp2dt, although of course I was terrified, I knew it was going to be positive. Yesterday when I took that peestick I knew it was going to be negative. Of course I hoped, of course I did, but I knew. Funnily enough, the knowing doesn't stop the despair, it isn't any protection, but it's true nonetheless.

I do understand the 'Hope's a bitch' thing better now. We can't help hoping, it's human nature. Otherwise why would we go through this over and over again. And you all know how hopeful I was about this cycle, having got pregnant last time. I honestly don't think the hoping makes the disappointment worse. It's always just going to be totally horrible, investing all your emotional, and most of your physical, energy for months, to end in nothingness. Not hoping just means you're miserable leading up to being even more miserable. But when you have to stop hoping, you feel like an idiot for ever having hoped at all. I think that's where the bitch thing comes from.

I did tell H last night, and he was devastated. I always forget how much pain he carries with all of this too. I looked at Megan's birth pictures last night, and I saw her husband sobbing with joy, and I thought, that should be what H gets to feel, too. Instead of the other kind of sobbing. He didn't sob last night, he just got teary and offered me lots of hugs. The only time I've seen him sob is after the bad scan in our pregnancy, the one at 7w1d which showed there was no hope. At least this time we didn't get that particular crumb held out to us.

Okay it does sound like the self-pitying why-us post that I wasn't going to write. I think I have to stop and go and soothe myself some other way. Luckily a few weeks ago I ordered a couple of recent Doonesbury compendia, and I'm only halfway through 2002. That man's a genius. I'm off to laugh at George Bush's sayings again (no offence).

9dp2dt: Stupidity and despair

See, I was going to write a non-IVF related post about ice-cream flavours and other diversions, following Kath's lead. But I was busy enough at work yesterday that I didn't get round to it. And today I've been feeling too terrified at the knowledge of that peestick test coming up tomorrow morning to write anything light hearted and smiley. Instead I've been watching television, reading the paper, reading your blogs, and freaking out.

I did decide that the peestick left over from the last cycle wasn't good enough to be the deciding factor in my happiness tomorrow morning, so I've just been out to buy a new stock. And of course I decided that since I had them, I might as well try them out. So I have just christened the first peestick of IVF#3. Yes, in the middle of the afternoon, and with relatively dilute urine. So tell me I shouldn't despair that it was negative? That I should ignore that vast expanse of snowy whiteness? Yes, I can hear you from here. Sadly I'm not apparently paying any attention.

I've hidden the packaging from H, who is out. I don't want him to know yet because he'll despair and I can't bear to break his heart just yet. I'll do another one tomorrow morning, and then we'll see.

7dp2dt: Basket case

You're saying all the right things but I'm a basket case. I called H earlier in the hopes of him cheering me up, but he told me he'd had a panic attack about it earlier this afternoon. He really believes in my judgement of my bodily signals, that's the problem. Perhaps I need to keep this freaking out stuff to myself rather than burdening him? He did ask what my 'friends' thought about it and when I told him you'd all told me to calm down, he said "well perhaps your friends are cleverer than we are." And of course you are.

I might or might not be having a bit of cramping. Personally I think I'm making it up, or that my body has been so cowed into submission that it's giving me little twinges, but only when I think about whether or not I'm having twinges, just to try and make me feel better. I have only had three twinges when I wasn't consciously checking to see if I had any twinges, and they were very sharp and probably gas instead.

Is ligament pain in your inner thighs a sign?

Blimey I sound like a complete newbie from the boards obsessing about symptoms. I don't deserve to live, someone shoot me please.

I feel like ranting and raving but that really makes for such boring posts. And I've written them before. That's the thing about infertility, it just goes on and on and on being horrible and stressful. Even in pregnancy none of us seem to relax. It's all hard.

I do know intellectually that we might get pregnant this cycle. I also know that we might not - and in fact the chances are more in favour of the latter. I know that if we don't get pregnant we'll keep going but oh the journey is just getting harder.

And for those who asked, yes, I will POAS. I did it at 11dp2dt last time, but this time that would be Monday which I think is a no-no. I will POAS on Sunday, to give me a whole day of no interruptions from the world to get over it. 10dp2dt is plenty late enough to get a signal if there is going to be one. In Julie's pregnancy with Charlie, she got a positive (as seen "by the light of a thousand suns") on 8dp3dt, which is the same as my Saturday morning. But given it was so light perhaps I'll wait til Sunday. Let's see if I can hold out. I'd rather not have the snowy white space and wonder if I just tested too early. And yes, I know all pregnancies are different and just because Julie got a positive that day doesn't mean I will. But it's my fucked up logic and I'll stick to it if I want to.

6dp2dt: absence

Well yes, this is kind of a: "move along, nothing to see here, people" kind of post. This time last cycle I had suggestive cramps and shiftings in my abdomen. This time, nothing. I hope that doesn't mean anything, but it's freaking me out. I do so want this. My intellectual self is assuming that feeling those cramps meant nothing last time and would mean nothing this time, but my human brain, trained to recognise patterns and draw conclusions from them, made a connection between those sensations and getting pregnant, and it's not budging.

I ask myself how things could have been better this cycle. Yes, I could have not fainted etc., but that's really got nothing to do with my chances of getting pregnant. We had the most eggs, and the most embryos we've ever had, and number of eggs retrieved is correlated with pregnancy rates. We had the best possible embryos for day 2, and the characteristics of those embryos are linked to pregnancy rates. Four cells is ideal on day 2, and ours were graded almost at the top of the range because of their symmetry and lack of fragmentation. A 1 is top, but our embryologists say they don't often score any embryo a 1, so I shouldn't worry that ours were 1.5s. After all, we got pregnant last time with one that was graded a 2. And I'm choosing not to link the fact that at some point around six weeks it stopped growing, with the grading on day 2. I don't think embryology is as exact a science as that.

So I don't think we could have started off with a much better chance than we did on Thursday last week. Of course, I could be 5 years younger, that would help. Or I could not have endometriosis...or...

Yes, that's not really very helpful, is it?

I spent time yesterday with a friend who is very much of the school of: I will take whatever direction life sends me and just react accordingly. She and I laughed about how different I am. I am raging against an apparently indifferent Fate. Fate doesn't want us to have children? Screw you, Fate. Thirty years ago we would not have had the option of intervening this way in our fertility, and we would have moved towards adoption much sooner. Thirty years ago I don't think (although I don't know, I haven't investigated) people knew so much about how hard adoption is and how many challenges it creates. But we're not living 30 years ago, just like I'm not 5 years younger and living without endometriosis. We're living now and I'm absolutely going to wring the last possible drop out of the medical advances that have happened in that time, to try and help us get our heart's desire. If this cycle doesn't work, there will be another cycle. I don't know when, as I don't know how to help my body prepare for it. Between the zoladex and the miscarriage I've only had one 'normal' period since February this year, and presumably at some point my body's going to freak out on me. If two more cycles don't work, well, then I'll have to listen to Fate perhaps.

It's all very mystical isn't it? The invisibility of what happens inside us that causes our bodies not to produce eggs in the first place, or not to welcome our embryos once they're inside us, or to miscarry our developing future children? Nothing us rationalist 21st century people can do to make sense of it or to affect it. Perhaps that's why we resort to such un-rational language - the language of Fate and Hope and Luck and Wishing. If only those last three worked just because they are felt by those around us. With all the support we give each other, we'd all be there by now.

I'm off to bury my head in the sand.

0dp2dt: Best yet, yet again

One thing I KNOW for sure - our embryos not our infertility problem. In the first two cycles we didn't have many, but we had good ones. This time eight of the nine which fertilised were looking good today. We're very impressed with ourselves. Some might say smug. We even had a five cell, but it wasn't symmetrical - one of the cells was much smaller than the others - so it wasn't top choice for replacement. Instead we put back two four cells. Both were rated 1.5 - i.e., between good and excellent, which is better than the two four cells we put back on day 2 last time. One was even an 'early cleaver' which I, with my haute knowledge of American culture, refrained from asking "Walt or the Beaver?" about. An 'early cleaver' I'll have you know is one which goes to two cells before its compatriots in the petri dish, and is forever after apparently an annointed one. So we put that one back, along with its best friend, the other 1.5 grade four cell. Which as far as I can see is just an ordinary four cell, with a little bit of fragmentation. But you know, I'm not an embryologist so who I am to express an opinion. And they've frozen everything else, five four cells, the five cell and even our little underperforming two cell (which was graded higher than one of the four cells), so we know have SEVEN embicicles to add to the six we already had (although two of those (one from each of the two previous cycles) are totally crap and not worth counting).

Turns out everyone in the clinic now knows who we are, since even the embryologist, who we've never met before, asked how we were doing post Tuesday's drama. I've got a little scar on my forehead, but nothing too impressive, so I feel a bit of a fraud. I do still feel pretty uncomfortable in my abdomen, but its definitely improving day by day so I'm hoping that by the time it starts cramping in a positive way this time next week, I'll be able to detect the difference.

Part of me feels that the clinic has just become our reality. That we go there once a month or so, or more often at 'peak times', and see people, and have stuff done to us, and that that will somehow just go on and on forever. The idea that anyone could get pregnant the 'normal' way seems to exist in some parallel universe that I can't ever remember inhabiting. Yesterday leaving the hospital was like "attack of the pregnant women." Not really surprising since my ward was in the middle of one of the UK's most important maternity hospitals, and we left during the mid-morning scan rush. By the time we got to the car park we'd passed 45 women, 39 of whom were noticeably pregnant. Being the skiving blog reader that I am I know that most of those pregnant women have their own fears and worries, but somehow I doubt they've ever been in a world where going to the clinic is more normal than having sex. Or not most of them anyway. Who knows, perhaps one or two of them were looking at us coming out of the IVF clinic, thinking: "I've been there, I know how you're feeling." I don't know and I can't know.

H asked me today as we walked back to the car today, embryos on board, if I'd give up America's Next Top Model and The X Factor if it would help us have a baby. "In a heartbeat," I replied. In fact, if you could prove to me that anything would improve our chances, I'd do it. Give up chocolate for ever? No problem. Give up reading? If I really have to. Lose 20 pounds? I'd do it. The reason I'm no longer wheat-free is that it doesn't have any effect. The reason I'm not doing acupuncture, similarly. (These might be important things for you, and I'm delighted for you to do them as I don't think they can do any harm. For me, they are not the point). But show me that something, anything, could definitively increase our chances of a full-term pregnancy and I'd be on it like a shot. Rather like us all chugging the folic acid, no? So what do you reckon, what is it that science will eventually discover is THE key to a full-term healthy pregnancy? Or will there never be a magic bullet, we will be forever destined to struggle with reproduction?

Maybe I should faint more often

H just called to get the fertilisation report. Nine out of 14. We are both thrilled. I am still feeling a little ropey, but am home and ensconced on the sofa with the latest Diana Wynne Jones (just published on Saturday, how's that for timing?). I don't feel up to typing the whole story, but suffice it to say, a night on a ward with 2 women suffering with hyperemesis gravidum did add a little ironic piquancy to my life story.

Tomorrow, the transfer. Not going to blasts (or even day 3) unless they can't tell the good ones apart tomorrow. Hear that? Good ones! Plural!

Shoes turned out not to be the point today

Well, it's been an interesting day. The good news is they got 14 eggs, which is amazing. Some might be immature, so let's not count chickens, but still, that's many more than I had been hoping for.

The less good news is that Dr Condescending had to poke around quite a bit to get them. Which means I'm pretty sore. The somewhat less good news is that after I'd emptied my bladder so that they'd let us go, I passed out in the loo, fell forward, banged my head on the soap dispenser, then bounced back and landed slumped against the wall, leaning against the bin that's next to the loo. I woke up (no more than 2-3 seconds later) to hear H and the nurse banging on the door, saying “unlock this door!” They ferried me over to the nearest bed, where I started shivering and crying with shock. My blood pressure had dropped, although it's always pretty low, particularly after an anaesthetic.

That got a lot of doctors in, and after some investigation (bloods and scan) they saw there was nothing serious (no internal bleeding) but they wanted to admit me anyway to be on the safe side. So I'm in an NHS ward which is not exactly the lap of luxury, and frankly I think I'd be better off at home where I could have a nice dinner and sleep uninterrupted, but I thought I wouldn't argue too hard. I

More stories (including shoes!) when I get home tomorrow.

Of muffins, boats and follicles

After a late night last night (dinner at a noodle bar and Volver (quite good, not Almodovar's best but Penelope Cruz is outstanding and oh my goodness I just saw that she's only 32, damn her) with my brother), I woke up later than planned this morning. I wanted to make muffins before going to the 9am scan. I woke up at 8 and bizarrely decided to bake anyway, including doubling the recipe, which then made the prep period longer by needing to chop extra ginger. This meant that I'd only just put them in the oven at 0855. Of course I'd intended to take muffins to the clinic, having had a fabulous response to taking them cookies on Tuesday, but they simply weren't close to being ready so I thought that I'd rather be on time sans muffins, than half an hour late with them.

I therefore had to go off to the scan without H, who was given instructions about how to test for muffin done-ness - he doesn't bake, he cooks, so this was quite a bit responsibility. He also felt bad about not coming with me, and, I think, just a tad nervous as the pattern in our relationship is that he drives and I sit in the passenger seat, so I'm not sure he's that keen on letting me loose on his gearbox. But actually, despite not having driven for ages, I felt fine with it, and realised that I'm a total hypocrite as I usually give H a hard time for driving too fast, when actually I'm just as bad once I'm behind the wheel, if somewhat less aggressive about other drivers.

The shoes today were a very smart pair of black stilettos, again around 4 inches high. Although they weren't red, they were so high that I felt I had to comment. (And Kristin, she was wearing some very skinny jeans which surely mean she's lost the pregnancy weight. She's pretty bloody skinny...). I complimented her on her ability to be present on a Sunday morning in high heels, and she said: "Well, it's certainly an art learning to balance on them". Which didn't really give me any insight but at least it was a form of conversation about the shoes. If she's wearing the red ones again on Tuesday for retrieval, I'll ask her about them then. Because yes, we are on for Tuesday.

• On the right: 23, 17, 17, 17, 15, 14, 12 (plus about 3 around 8)
• On the left: 24, 21, 20, 18, 17, 14, 13 (plus about 2 around 8)
• Lining: 11.7

That makes nine possible (over 17mm) and and other three maybes (the 15 and 14s). So the Ovitrelle injection is at 22:30 tonight. If we ever have to do it again, remind me oh please remind me that I stim slowly but do seem to get there in the end.

When I got back around 0930, the muffins were out. Sadly some of them were a trifle singed at the edges, but H doesn't mind burnt bits. They are good, but I'd already cut the sugar somewhat and these were still way too sweet, so if you do make them, I'd suggest using no more than 2/3rds of the sugar suggested in the recipe. The ginger is what makes them delicious, so don't skip that. Or perhaps I had a challenge in translating from cups to grams (although I used Stephanie Alexander who is usually quite reliable). Why do Americans cook in cups? It's so bloody inaccurate for baking - how do I know how hard you tamped down the sugar or flour? And why measure a cup of butter unless it's melted? You are strange people indeed. I'm convinced that baking is my child substitute. I have the whole Jewish food=love thing (oh how I need to cure myself of this before inflicting it on any potential future daughters) plus baking is just so nurturing somehow. Perhaps I could segue the feeling of nurturing into the garden? Somehow it's not quite so satisfying.

I remain quite optimistic about this cycle. I know there is no real rhyme nor reason for this, it's based on the entirely unscientific fact that we got pregnant last time (and perhaps even had some implantation the first time, who knows, with that beta of five two days after I'd started bleeding). I've found myself planning for what happens with scans etc after a positive pregnancy test, telling people I don't want to fly too much in one potentially busy week at the end of September when I'd be one week post pregnancy test, thinking of how we'll feel on our fourth anniversary of meeting, on 27 September, if I'm pregnant at that point. I keep telling myself not to count my chickens, but idle dreaming leads me back to the optimistic space. I think I'm just going to have to live with it, it's not going away, and I'm not sure being pessimistic really offers that much protection against the misery of a negative in the end. Let's see how I feel (assuming we have two to put back, which is still not a definite) in those few days before the pregnancy test where, honestly, last time I KNEW I was pregnant, much as I wasn't admitting it. Those cramps and pullings I was feeling felt so different than anything I'd felt before.

Clearly, several weeks of madness are ahead of us, either way. To edify ourselves we are about to head off to see this exhibition, and have decided to take the river boat to get there since it's such a nice autumn day. I do like weekends.

Inappropriate shoe watch, day 12

There they were again this morning. Bright red, and at least 4 inches high. Do you think she's just wearing them once every 3 or 4 days or so, and that just happens to coincide with our scan days? Or is she so addicted that she's wearing them every day? She was back in a short, colourful wrap dress today, brown with red, yellow and ochre dots. And the shoes, oh the shoes. Let's see if she's wearing them again next week*.

I've been feeling lots of twinges in the ovaries this week, to the extent that they showed up in my dreams the night before last. I dreamt that I peed on a stick and it was positive. I took it into the clinic to show Dr Casual and he agreed I was pregnant, and that the twinges I'd been feeling were in my uterus rather than my ovaries. In some part of this dream I was in a big science lab - the really old fashioned kind they had at my secondary school with old wide wooden benches with the bunsen burner connections at the front. And I realised part way through that pregnant or not, I should have been at a meeting - which was, in fact, the meeting I was supposed to be at yesterday morning. And then I woke up. I'm so sad that my subconscious is apparently not a science geek like me, and thinks that I can get pregnant in some kind of mad immaculate conception kind of way involving no sperm and no eggs.

Well, in fact those twinges seem to be relating to reality - and in my ovaries, not my uterus.

• On the left: 17, 16, 16, 14, 14, 11
• On the right: 15, 14, 13, 13, 13, 11, 11
• Lining 10.9
• E2 3185 (867 US units)

I'm clearly behind where I was on the last cycle at this point, but hopefully things look good enough that we will get at least six or seven eggs. We have to go in for a scan on Sunday, and we'll decide then if it's trigger Sunday night for Tuesday retrieval, or trigger Monday night for Tuesday retrieval. I don't mind in particular, but I'd slightly rather we went earlier rather than later as it gives me longer off work to chill out and let my body do the good stuff. But really I'll trigger whenever they think it gives us the best chance of getting most of those eggs. I'm hoping for seven, although if we can get things going enough I guess that nine might be possible? That would be good.

*Just found out that we're seeing Dr Condescending on Sunday for the scan. If she's wearing the red shoes on a Sunday I'm definitely going to ask about it!

Always more questions than answers

I have several bigger 'issue'-type posts brewing, but mostly when I'm nowhere near the computer, so sadly not making any progress on getting my thoughts clear and written down. In the meantime I thought I'd answer some questions on protocol and other science-y stuff from the comments. Because you know how I'm a geek about that.

Why won't you trigger til next Tuesday?
We don't know yet whether or not it WILL be Tuesday, it might be Monday, but either way I seem to stim so damn slowly. They didn't do retrieval til Monday (day 15 of stims) last time, and Tuesday will be day 16 of stims this time - the equivalent retrieval day to that of cycle 1. They will discount the follicle that was 16 yesterday as it is too far ahead of the others. What they want is a crop of similarly sized ones. Dr Condescending (did you notice how the three docs I see most at the clinic all got C names? Do you think I should be busy psychoanalysing myself on that one?) is estimating that they will grow between 1 and 2mm a day, so hopefully on Friday they will be around 16-18mm. I guess that might mean Monday retrieval, we'll just have to see. Last time on the Friday (day 12) there were 13 of them between between 11 and 20mm, and on the Monday we got 9 eggs, so I guess the little ones were too little still by the Monday, and I know two were empty.

Why did Dr Condescending ask if I was happy with her wanding
See, that wasn't exactly what I typed. What I typed was that she asked if I was happy for her to wand me instead of Dr Casual doing it - seeing as how he wasn't there. It was a permission thing - she was being respectful of this special continuity-of-care thing I was supposed to be getting. Yes, I didn't exactly have loads of choice, but at least she asked. And I wanted to be clear - because clearly it didn't read that way to some of you - it wasn't like she wanded me, then asked if I liked it. That would have been weird. Maybe there's some English phrasing I used that doesn't make sense in American?

Does Dr Condescending have short skirts to go with the high (red) heels?
Nope, she was wearing a tight-ish but reasonably modest calf-length dress. Which was different from when we saw her from afar last week when she was wearing a very short, tight, flowery wrap dress, again with the red high heels. Perhaps part of her maternity leave involved shoe shopping? And she's got no bloody stomach left from her pregnancy, the cow. No seriously, I do actually rather like her now. But it's funnier to be snarky.

Why does symmetrical embryo development matter?
I think the answer to this is that they don't know WHY but they do know THAT symmetricality relates to better pregnancy rates. It was one of the studies I quoted from the ESHRE meeting. In addition, I found this article. There isn't a lot of agreement here, but some factors do seem to be helpful - and not always the ones that clinics tend to score for. Just to be clear, symmetry doesn't mean going 2 cells, 4 cells, 8 cells, it means that the cells that the embryo has are spaced symmetrically within the embryo - the right relationship to each other. This is such an imperfect science that I wouldn't worry too much about it. However, given I got pregnant last time from a nice symmetrical 4-cell, I hope I'll be forgiven for feeling a bit superstitious about this.

Why is E2 not reliable on an antagonist cycle?
I'm hungry so am not going to spend the time right now to get this right, but basically in an antagonist cycle you are affecting directly the LH level (the antagonist turns it off), and that affects the oestrodiol level directly. In an agonist cycle, you've shut down the pituitary and hence LH etc indirectly by over-stimulation, so the oestrodiol level is independent. I know, that doesn't make great sense. I will read more and get back to you.

And they're off! (please oh please)

You remember how I was supposed to be getting more continuity of care? You remember how Dr Candour said that Dr Casual would be around and would make a special effort to scan me, do the retrieval etc.? Well, this morning we got in to an unusually quiet clinic at 0710, only for Dr Condescending (yes, she is back from maternity leave) to come up and let me know that Dr Casual would be away for this week and part of next week. Huh? How come he didn't mention that to us when I spoke to him on Friday? I don't want to be too negative about him, I do like my doctors to stay on their respective pedestals, so I'm thinking that perhaps it's a family emergency, although Dr Condescending's manner didn't really indicate that. She was wearing some extraordinary fuck-me red patent leather high heels. Now she always wears high heels - she says she's small and she does it to feel confident - but red patent leather? At 7am in an infertility clinic? And she doesn't half stomp in those shoes.

Anyway, she was very nice - in the way that she is nice although still remaining condescending - and asked if I was happy to get scanned by her instead. Which I was as actually she gives good scan, not to mention being a cracking egg retriever. And the alternative was Dr ICU. Nuff said. Oh the relief when she said - "I'll just show you what's going on - it's good news - before I measure the follicles." So it is good news. Two 10s and two 11s on the right, two 12s, two 10s and a 16 (where on earth did that come from??) on the left. Sounds like we will get fewer eggs than last time (we got 9, but only 5 fertilised) and I'm trying not to freak out too much about that, but just keep on hoping that we have 2 good ones to put back. I do want this cycle to give us at least the same chance of getting pregnant as we had last time.

The slightly less good news is that E2 is only 725 (203 American). Gaah. It's not accurate given the protocol, but it's an indication. It was only 247 on Sunday, so at least it's climbing, but still. Dr Condescending thinks it will be retrieval next Tuesday. Perhaps I'm just getting harder to stim as I get older? The docs aren't worried, and I'm not really worried, I'm just irritated. It would be so nice to be an IVF superstar and get 20 follicles, be able to do blastocyst transfer and have lovely frosties. But I guess that's like saying it would be nice to win the lottery and not have to do this job any more and be able to pay off the mortgage. Just.not.going.to.happen.

Two embryos please. Just two, lovely, symmetrical four cells with fragmentation below 5%. That's not too much to ask, right? That's just like asking for the bus to come along in the next few minutes rather than when you've been waiting for 20 minutes. Or that you look into the fridge and magically find that your husband went to the supermarket and remembered to buy blueberries. Not a miracle, and not a lot to ask. Just a little ask. Please?

Slow? This is funereal...

Not a particularly encouraging morning. The follicles haven't grown AT ALL. Still five less than 8mm on the left, four less than 8mm on the right. That doesn't feel good on day 7 of stims. Dr ICU didn't seem too worried, but he did tell me to put up the dose to 400. The good news is the endometrial growth - to 8.1mm from 6.1mm on Friday. If that has happened, then it means the E2 must be rising. I asked Dr ICU if he'd ever seen the E2 rising and the follicles not growing, and he said no. So we must just be patient, I guess, and assume that when we go in again on Tuesday morning things will have started moving. Tomorrow we'll get the E2 result from today and that will give us some indication. I'm certainly not going to be underestimating the length of my stim - I've booked the week commencing 4 Sept off work, assuming that I'd stim for 15 days as I did last time. If anything I'm going to go longer this time, so it was a good bet.

Problem for me in making sense of this is we've never been scanned on day 7 before. Let's compare anyway, because it's a distraction

• On cycle 1, on day 5 my E2 was 82, and I had 9 follicles under 7mm. On day 9 the E2 was 482 (132 US units) and I had 12, 14, and two under 10 on the left, and four under 10 on the right. We ended up with eight possible, but only six collected due to the endometriomas. Six out of six fertilised
• On cycle 2, on day 5 the E2 was 253 (68 US units), and I had nine follicles under 8mm. On day 9 I had eleven follicles between 10 and 13mm, and the E2 was 1253 (341 US units). (NB this was an antagonist cycle, so the E2 number is not very indicative of what's going on). We ended up with 9 eggs, 5 fertilised.

So I think I should be staying calm. If they all grow between 2 and 4mm by Tuesday, we'll be in a similar place to where we were last time, and that turned out ok. But of course I am stuggling to do that. I'm freaking just a little bit. No, quite a big bit. What I should be doing is being all Zen and calm and remembering Ovagirl's mantra from the first cycle, picturing my follicles: "like coloured balloons, blowing up into beautiful rounded globes of goodness." I'll go and work on that now.

Slowly slowly slowly

It's been quite a week on the work front, hence no posts. Although I am very proud of myself for having caught up with most of you on the 'still trying' list on various slow connections from cars and trains. I seem to have missed out on a couple of blog storms while I was away, plus several people deciding to go password protected for various reasons, and my dear internet friend Kay has quit blogging completely, which is a huge loss to our community. I have to confess, it's made me a bit frightened that at some point someone will dooce me, or I'll get spotted by the trainwreck guys (they already took one of my comments on Mare's site and trashed it, but that's not quite as invasive), or something similar. I'll have to think more about this.

Today was day 5 of our cycle, and, as is my wont, I attended the clinic for a wanding and blood tests. I find it amusing that on each cycle since the first I've had to insist on being monitored on day 5. They don't usually do it. Despite this my treatment has changed on day 5 on both previous cycles. My E2 has come back low, and they've put up my dosage somewhat - from 150 to 200 on cycle 1, and from 250 to 300 on cycle 2. Surprise surprise, today my E2 is low. Really quite low - 205 to be precise, that's 55.85 in American. I do have nine follicles appearing - for a change five on the left and four on the right (usually my left ovary is a little slacker) - all under 8mm. I produced a little spreadsheet to make sense of this. I tried to post it but it looks stupid in the column format, so you'll just have to trust me on the data.

Since today was also the day of our appointment with Dr Candour to talk about the miscarriage, Dr Casual when he called with the test results asked me to check what Dr Candour wanted to do - i.e., did he want to put up the dose or not. So we discussed it with Dr Candour. He says that above 300mIU of recombinant FSH (i.e. not the stuff purified from urine but the stuff produced in culture), there is very little improvement in response. The clinic docs had suggested putting me up to 400mIU. Dr Candour said that if I wanted to increase the dose, he'd be fine with it, but that he thinks it would have no effect so it would be mostly just to keep me happy (he said this with a smile!). When I challenged him on that, he said that he was trying to think from our side of the desk. That if he was sitting where we were, he would want his wife scanned every day, and he'd want the most responsive treatment, despite the fact that a study from Bristol has shown that it makes no difference in success rates when women are scanned just once during a cycle compared to scanning every other day (for scanning read scan plus bloods).

So he suggested a compromise. That we come in for a scan on Sunday, and see how things are going. If the follicles haven't grown (they don't get blood work at weekends) they will up the dose then. I confessed that I was tempted to self-medicate and up the dose to 350 as a compromise, anyway, and he told me straight that in his clinical experience there would be no impact of me doing so. We'll see what my instincts tell me tomorrow morning.

We had a great conversation for the rest of the consultation.

• We talked about the miscarriage and it didn't really change anything but confirmed that we should not be pessimistic. The chance of another miscarriage is less than 1%. Yes, we all know we can be on the wrong side of the statistics, but this is an ok number to go on.
• He does not think we are under-treating the MTHFR - in fact he thinks we are over-treating it, although he's not suggesting changing it.
• We talked about transferring three embryos. He said that he just could not override the HFEA's rules on this, despite the fact that in his clinical judgement it would be a good idea, and that I will be 39.75 by the time we do transfer (for those not in the know, the HFEA say that you cannot replace more than 2 embryos in a woman under 40, and that you can't put back more than three in a woman over 40).
• We talked about exercise and IVF. He said studies show it's a good idea to do some exercise, but that you must not let your core temperature become elevated, nor should you become dehydrated, so to exercise at a more moderate pace than you might usually.
• We talked about UK statistics and why one clinic always looks much better than the others. The answer is they have another clinic next door, and when cycles go badly they do the transfer at the next door clinic, and so they don't have to report those numbers. Apparently the HFEA say they can do nothing about it - it's completely legal.
• We talked about the fact he's taking the week off next week, and he had the grace to comment that he seemed to often be away when we had critical things happening. I told him that those of you who read my blog think he takes a lot of holidays. That you like him, but think he's quite lucky with his time off. He didn't really know what to make of that! He did say that we could email him at any point next week and he would get back to us.
• We talked about PGD and he said it's not indicated for us. That he can see a future (say 3-8 years out) where they will screen embryonic DNA against the total human genome on a chip to look for abnormalities, and where they will biopsy the uterus during the cycle to see if it is receptive. But that we aren't there yet, and he doesn't know whether any of us now in treatment will get to benefit from those kinds of advances. This is for all of you in your 20s now - perhaps some of this can come true for you if treatment isn't working for you right now - or maybe by the time it is available you will have moved on to other paths.

I do really appreciate having a doctor like him, who is prepared to discuss the issues with us, to take our concerns and our questions seriously. We are lucky.

So onwards to Sunday. Let's hope my body is just taking a while to get going.

Lighter, tighter, and ready to go

I am back, I am scanned, my ovaries are quiet, my lining was thin,my FSH is at 2.3 (2.3?? Must be the zoladex), and I have injected 300mIU of Puregon. Along with all that excitement I've been to the launderette (our basement laundry room is currently being rebuilt due to extreme leakage whenever it rained previously), been to the supermarket in the pouring rain, and made my husband a delicious lunch of cheese and pickle sandwiches with a beefy cup of builder's tea (just what he wanted), myself a watercress and rocket salad with cottage cheese, spring onions and tomatoes, done some work, been to the gym and am awaiting supper (a takeaway curry, H has been pining). Not bad given we only landed back at Heathrow this morning at 705am.

So there you go, that's my news, that's all you came for, right? No, really? Ok, I give in. Yes, we had a lovely holiday, thank you. It had good points and bad points, but all in all it was worth the extortionate amount of money we spent. I've been to this hotel twice before, as a single woman. To be honest, H was a bit nervous that it would all be a bit girly, as it has a reputation for being a place to go and recuperate, with a spa, a focus on healthy mind and a healthy body, and a considerable amount of spiritual therapy as well. In the end H had a great time, doing lots of Thai boxing and throwing himself into punishing workouts in the gym, as well as attending a stretch class every morning and swimming in the afternoon.

He even enjoyed the food, which is all delicious but also designed to be low-fat and low-calorie. To be honest, some of the food is more successful than others. Wheat-free pasta just isn't that nice and why a chef with all the skill of this guy, with all the wonderful Thai flavours he has to hand, even bothers to serve it up for a main course lunch choice once a week is beyond me. Buckwheat pancakes at breakfast, though, are delicious, as were his chocolate sponge cake, and the passion fruit sorbet - some western-type foods do work well in his cooking. Best of all, though, were the more eastern-based dishes, such as the Thai-inspired salads available at lunch, the pad thai, the salmon glazed with red curry, and a miraculous gingered lentil dahl, served with a lid made from naan. The dahl plus naan offered a total of 289 calories (all the food is marked for nutritional content) - I have no idea how he did that, but have asked for the recipe so if I learn anything interesting I will share.

As you know, my back has really been painful over the last year - since I basically started sitting on my butt during IVF#1. The physiologist I saw on day 1 suggested a programme of water fitness and pilates, so I did that along with my daily massage, as well as some sessions in the gym, lots of swimming, and the daily stetch class. They warned me off yoga because of the focus on forward bends, which are very hard for me and could strain the back further. I was relieved to find that I was able to exercise hard despite the Zoladex. I had thought that the fact I got migraines previously on this drug when I got dehydrated would mean that working out hard would have the same effect. It didn't. My guess is that the migraines were more related to lack of sleep than to lack of water, and sleeping was something we did well. I also read lots of books, had some good (ish) nookey, and met some very interesting people.

The consequence of all this exercise plus the healthy eating is that I am MUCH more flexible, although still in some pain (it's going to take more than 2 weeks to cure a lifetime-long back problem), and I am 3 kilos lighter, as well as 2 inches smaller on my waist. My hips, of course, have hung onto most of their fun coating of lard, but I am now only just under 1 dress size larger than when we got married and about 8 pounds heavier. Given I lost about 25 pounds during the year before we got married, and dropped 2 dress sizes, I feel a lot better about where I am now than where I was before we went away - it was so frustrating having shaped up so well and then let it all go to seed again. I had fun trying on clothes when we got back from the clinic this morning, and found I could fit into all but one pair of jeans comfortably, and two suits I haven't been able to wear for a while. There are still a few suits I bought just after the wedding that are too tight, as well as some of the clothes I wore on honeymoon, but this is a bit positive change. I wish I could keep up the losing weight and shaping up, but I feel that trying to work at that through a cycle won't be a terribly good idea. Not to mention there is of course no way I can do that much exercise while working! My aim therefore is to not gain weight or lose any flexibility during this cycle.

The physiologist gave me a pilates-based routine to do every day to continue to build strength and flexibility. The one thing I am slightly nervous of is that I remember various discussions about how strengthening your abs during stims is not really a good idea - anyone kept up a good exercise regime during a cycle and want to comment?

I have lots of ideas of things to write about, but am already getting stressed about work where all hell is breaking loose, just because I've come home. It's like they saved it all up for me, just to welcome me back. Oh how I long for that lottery win.

It will take me a while to catch up with all of you, so please forgive me while I do so.

(Partial) success breeds contempt

I have a problem. Not the usual kind of problem - bleeding, weight gain (although I've got that one in spades, it's not the issue right now), hormone levels etc. - but the opposite kind of problem. I seem to believe that we'll get pregnant again this time. It's clearly coming from the fact that we did get pregnant last time. I've never been pregnant before, to my knowledge, but somehow that combination of the laparoscopy, the Zoladex, the antagonist protocol, and those two particular embryos, worked like magic to get me pregnant. So somehow I seem to believe that because it worked last time, it will work again. I know it's not logical. I know we actually have no idea which bit of that equation is the bit that worked. It could simply be we got lucky with one of those two embryos, and nothing to do with the protocol. It could have been the folic acid megadose, or the clexane. It could have been some difference in what I was eating, who knows. As we all discover, somewhere along this journey, ART really is an art, albeit one informed by science.

So I am in this strange position of being optimistic for a change. And for the first time, I am more optimistic than H. He's always been the one who has been sure we will have a baby in the end. Now, this time, he still has that sureness about the long term, but isn't sure about this cycle. He's not completely pessimistic, but he has less confidence than I seem to have.

Of course I am not completely optimistic. I have been planning my calendar for September and am already trying to figure out how I can get out of going to Chicago for a meeting on 18 September, the day of our pregnancy test, thinking I won't want to fall apart in another country, far away from H. At the same time I'm imagining booking our 6 week scan and ensuring I can go home and cry afterwards. I haven't yet looked up what the due date would be (don't laugh, those calculators are there to be used!), although I know from basic maths that it must be sometime in late May. I've also figured out that if I force Dr Candour to be really aggressive, we might just fit in another cycle before my birthday if this one fails.

I guess the answer is that, as usual, I am all over the place, but that for a change some of that all over the place has a strong, illogical, positive bent. Nothing wrong with that, I guess. No doubt it will all change in the passage of time and hormones.

Vignettes

Work is kicking my butt this week, so this will be just a brief snippet of a few things I don't have time to blog about properly.

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I saw the lovely Kath on Sunday. How jealous are all of you? She is just as lovely as you might expect, although, Kath, I have to confess that I wasn't expecting you to be so tall and gorgeous and glamorous. Not sure why, but I just wasn't. She also, dear readers, looks as if she's about 25, damn her. We had a lovely afternoon, wandering around central London, sitting in the park on deckchairs, visiting an art exhibition, and having a proper English tea. The conversation varied from our spouses, to linguistics, to how our hair was behaving in the weather (not), and, of course, to reproductive issues, and then on to parents and siblings and stroppy journalists. It was lovely to meet a new friend in person. Thank you, Kath, for making that long train trip.

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Did anyone see that press conference last week with Mr Bush and all those babies? It was one of the most yet another cynical piece of political positioning. It made me almost apoplectic with rage. Yes, those babies are all very adorable, and I for one don't want to deny them their current existence on the planet. But GW's statement that "how could we have thrown away these children in the name of research?" made me want to scream. How many people are living with Parkinson's because stem cell therapy isn't available to them? How many researchers are trying to understand the causes of cancer and struggling because they can't do the experiments they think are necessary because the materials they need aren't available to them? How many children are dying from childhood genetic disorders that we don't yet understand, whose treatment could be advanced by investigations with donated embryos? It was one of the most breathtaking examples of only presenting one side of a problem that I have EVER SEEN. Phew.

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The nurse from the IVF clinic called me yesterday - this is our new form of IVF orientation appointment now we are old hands. Her first question was: "Is Dr Candour ok with you starting so soon after, umm, what happened in June?" I heroically refrained from saying, "No, I held a gun to his head as he filled out the form and now I come to think of it you'd better head over to his office to make sure he's managed to untie himself." "Yes," I said, instead, "he's given me the zoladex injection so we are already underway." Wasn't that nice of me? I'll get my reward in heaven, I know.

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I know there was something else I wanted to blog about, but it's gone now, so that will have to do.

Some good news, some "let's keep an eye on it" news

Everyone was running late today, but no matter. My lunch appointment just had to wait. The very thorough sonographer (the same one who did our miscarriage scans) first spent 20 minutes finding and then measuring an impressive crop of fibroids. The big sub-serosal one that we knew about, a bunch of intra-mucosal ones that I didn't know about, and then a few small sub-serosal ones that I should have known about but didn't remember. Luckily none were sub-mucosal, i.e., pointing into the cavity of the uterus. Dr Candour was not worried about the fibroids. Much. He saw all the sub-serosal ones on my last lap, and showed me the pictures to prove it. He was worried about the intra-mucosal ones as they didn't show up on the lap, so either they were there, just buried in the muscle so the camera didn't pick them up in the lap, or they have grown since. All except the big one were between 1cm and 2cm cubed. The only outcome so far is that he wants to keep an eye on them to make sure they aren't rapidly growing. At this size he says removing them would cause more damage than leaving them alone.

The good news was that my ovaries were clean, no endometriomas, and showed a healthy crop of antral follicles. Poor babies, those follicles will never get to reach their full potential as Dr Candour went ahead and delivered a dose of Zoladex that will knock them out of action. Ah well. We will start the cycle on Monday 21 August, as I suggested yesterday. One change in our care this cycle is that Dr Candour suggested that Dr Casual keeps a special eye on us. "It doesn't make a difference to outcomes," he said, "but sometimes it can make the process feel better. I'll talk to him and make sure he does your scans, your egg retrieval if possible, and certainly your transfer." We told him we would be only too delighted to work with Dr Casual. He is definitely my favourite of the doctors in the clinic, despite his sometimes somewhat brusque manner on the phone. He has always been great in person, and was very sweet about the miscarriage. I prefer (as you all know very well) a doctor who is actually prepared to have a conversation with me, and who isn't afraid of delivering bad news.

We also got a vote of confidence in our holiday plans to go to this spa I mentioned in Thailand. "Sounds like an ideal thing to do just before a cycle." Dr Candour said. So I think perhaps part of the excitement I'm feeling is excitement about having a holiday plan. I'm so looking forward to eating really healthily and doing lots of yoga, thai chi and swimming. H will throw himself up and down a few mountains, and carve up the sea in a kayak, and bash himself around on a tennis court, and I will be totally zen and meditative. Maybe. Lucky us, to be able to take this break.

We've started. One hurdle down, 7,849,353 to go.

That was fast

I'm glad I spent a lot of last week agitating with Dr Candour for a prescription for Zoladex. It turns out I'm going to need it. When I disappeared to the loo yesterday morning just before a workshop was starting, I found out that my period had started. And I was wearing white underpants, too, for the first time in months. That makes it 5 weeks and 2 days post ERPC, or just on 4 weeks since I estimate my hcg returned to zero-ish (becaue I know that it was about 150 when we went to the hospital on the Saturday after the ERPC).

While hoping the workshop would start late I rattled off some quick calls to the clinic, and had an interesting conversation with Dr Candour's (temporary) assistant:

"I need to come in after I've had a scan for Dr Candour to give me an injection. My scan is at 11:30.
"Ok, I can give you an appointment at 8am."
"Um, no that's no good as it will be before my scan"
"Well he's very booked up."
"Yes, I appreciate that. Perhaps he could call the clinic and tell them they need to scan me early? He's done that before."
"I don't think he wants to call the clinic."
"Ok then, is there any other time he could see me?"
"Yes, he can do 4pm."
"Well, that involves me spending 2 hours of my day travelling to and from work twice. Is there any other slot?"
"I guess he could see you at 11:45"
"Fantastic, I will come straight up from the clinic."
"No, not sure he can do that actually, how about 12:10?"
"Ok, I'll come straight up anyway."
"Fine."
"Thank you!"

Gotta love them. So on Friday - tomorrow - we will get started again. Assuming my ovaries look ok, which I am hoping very hard they do. They've only had one cycle on which to get messed up, so you'd think that even my ovaries could cope with that. You think? Prepare for much weeping and wailing if it turns out tomorrow they are buggered and I need another lap.

Maybe to you all a month of doing nothing after having 1 injection doesn't feel like getting started, but to me it is clearly the start of a new chapter. So that we can take a two week holiday (ish), we'll start stims on 21 August. Which means I can now predict that our retrieval will be sometime around Monday 4 September and we will find out if we are pregnant or not on my brother's birthday, 18 September. I've never been able to predict with such accuracy before but after 2 IVFs I feel that my pattern of needing to stim for 2 weeks is unlikely to change, and I feel confident that I won't just get my period early because the PIO will keep it away. I am currently resisting checking what the due date would be for retrieval on 4 September, but only just.

Speaking of due dates, Caroline, who was my cycle buddy on IVF number 1, has just given birth to twins I and W, after over 5 weeks of bed rest. If you are feeling up to it, please do go and say congratulations. I'll return to the topic of pregnant blogging in another post, thank you for all your thoughtful comments on that topic.