Thalia's fertility journey: hopefully more comedy than tragedy

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!