Appointment with Dr Candour today to review the cycle. He confirmed that:
They were happy-ish with the stim. Eight eggs is what they are aiming for. Six eggs is pretty good.
Oestrogen levels were good and rose nice and steadily
Lining was good (10.5mm which I thought was a bit on the low side, but there you go)
We had beautiful eggs - six/six fertilised is not usual
The embryos we put back were perfect, they couldn't have been better - particularly the fact that one of them was compacting
Because everything looked so good, he said that, at transfer, they were very "gung ho" about our chances of success. He was therefore very surprised that I started bleeding at 8dp3dt. Given that I started bleeding so early he thinks my beta of five on 10dp3dt was a false positive result rather than a chemical pregnancy. Apparently the false positive level goes up to 8, so it's hard to tell either way unless the number is higher than that.
Responding to all of this, the protocol for next time would be:
Long day 21 again. Although this is slow, it got us some high quality eggs so they don't want to mess with it. His experience of antagon protocols is that they produce fewer and less good quality eggs. I tested the antagon/letrozole protocol with him that Pru is on and he had never heard of anyone in the UK doing it other than for breast cancer survivors. So now he wants to meet Pru's doctor.
They will start me on 200iU of Puregon next time, instead of starting at 150
Much against clinical evidence, which says that there is no difference in pregnancy rates between PIO and suppositories, he wants to respond to my early bleeding and use PIO next time. Oh joy.
He is not in favour of assisted hatching or 5 day blastocyst transfer as neither show any improvement on 3 day transfer rates. Assisted hatching does show a small positive improvement in pregnancy rate for women over 39, which I will be, but he says it's not enough to risk it yet. Blastocyst transfer improves success rates per transfer, but not per cycle started. They have not found it worthwhile to do the "survival of the fittest embryo" on a regular basis for that reason. If I had six good embryos on day 3 next time, they'd be prepared to have the discussion, but he wouldn't recommend it as a starting protocol.
However (you could tell there was a 'but' coming, couldn't you), he first needs to scan me to see how bad these endometriomas are on a non-stimulated cycle after my ovaries have calmed down. Which means a scan in the first half of January, after two unstimulated cycles. Then he'll decide if we should do a lap or if we can go straight to IVF. Broadly we have four options re the endometriomas:
Do nothing. They'll stay there, and will gradually get bigger. Hence not a very good option long term.
Aspirate them. They fill up again pretty quickly
Drain them and laser clean the walls. They are likely to reform, but more slowly and in 10% of cases they are gone for good. This is what he did last May for the one I had then
Drain them and ablate the cells surrounding them. This removes them for good 90% of the time. It also destroys a significant chunk of the ovary that surrounds them. Hence not a good option when, in his words, "we are trying to preserve fertility."
He will therefore consider either option 1 or option 3 depending on how they look in a couple of months time.
Again we had a very good discussion. Although he kept us waiting for 30 mins, he did then gave us an hour which was double our appointment time. He did stop at one point and ask me if all the research I had done was helping me or making me more stressed (after I asked him a question about the effect of androgenising hormones on endometrial quality and egg quality in the context of an antagon cycle), which I thought was a good question. H thinks that at the margins the research makes me more stressed, but I do feel I need to know stuff, and I have stopped myself on obsessing on some things which only make me feel worse like the success rates for women with endometriosis. I told Dr Candour that and he said: "well, as long as you've got it under control, you should do what helps you the most."
I asked him about the effect of endometriosis on implantation. He says that the evidence is equivocal. Because they still don't understand the basic biology of implantation it's hard to say what this problem is, but his sense is that it there is a link, given the lower success rates for IVF for women with endometriosis even when they have the same quality eggs and embryos as a couple coming in with, say, male factor. I forgot to ask him about beta-integrins and whether it's worth testing for a problem there, possibly linked to implantation.
Other questions I forgot to ask him were:
Was I not a bit oversuppressed after 17 days on Buserelin before stims began? In fact I did ask it, but we got distracted half way through his answer
What does he think about immunological issues as contributors to endometriosis? And what does he think about the work on diet and endometriosis in that context?
So where does this leave us? I have today filled in the form to get my records released to send to the Big Guns Clinic (hereafter BGC). We'll do another cycle at my current clinic, then see where we are. However, I'm desparately sad that all this waiting means we are a year away, at best, from a baby. On the current schedule, assuming I don't need a lap, we'd start at the end of January, retrieval would be mid-March. If I do need a lap, all bets are off.
This just seems so far away. I am less and less likely to have a baby before I turn 40. But I just want a baby. I want to be a mother. I'm sad and mad that it's so hard for us. I want to do this for me, I want to do this for H. I want to bring someone into the world, to love them and help them become a real person. I want to find out what they are like and what they want to do with themselves. I want to watch them grow and learn. I want to bake them cake and have them cover the cake with too much icing and ugly sprinkles. I want to treasure glittery paintings. I want to put sticking-plaster on skinned knees and hold them on my lap when they cry. I want to tell them they're beautiful. I want to watch them sing twinkle twinkle. I want to help them with their homework. I want to watch them play football with H or head off on their bicycles to the park together. I want to worry about them when they're out too late at a party. I want to listen for them sneaking up the stairs, thinking we don't know how late it is. I want to take them to the leaning tower of Pisa and explain to them why it's not straight. I want them to explain how a train works to me, and point out all their favourite dinosaurs at the Natural History Museum. I want to take them on the Earthquake at the National Geological Museum and tell them how their Grandpa used to take me there every Sunday. I want to wach them climb the climbing frame in the park and worry about them falling off. I want to help them buy their first flat and chose something lovely from home for them to decorate it with.
It's not so much to ask, is it? But it all seems so far out of my grasp.
I had dinner last night with my three best friends from university. We try to see each other once every two or three months. Sometimes the conversation is deep, sometimes it's a question of catching up on events in each of our lives. One is a hotshot doctor in a prestigious hospital with a difficult relationship, one is an academic writer with a three and a half year old son and a standoffish partner who is addicted to running (and who doesn't like me much, I think, but I've never dared ask), one has a three year old daughter, runs her own business, and has a problematic partner who doesn't feel able to live up to his commitments. And then there's me. There is also a missing member of our group, who lives in New York. The four of us who met last night all lived on the same corridor in our first year at University. There were only six rooms on this corridor so we did pretty well on our hit rate of friendship. And let's just reflect that it's 19 years since we started university.
We're all quite different, but we love each other a great deal, and we understand each other pretty well. It was the doctor who said, a few months ago, "but you've always been a worrier, T." when I was talking about the endometriosis. And of course, my worrying has turned out to not be too far off the mark. So a worrier with good reason?
Last night we laughed, we cried, they listened to me talk about my dead embryos, and tried to stop me feeling that my body killed my (prospective) babies. We talked about what comes next, and discussed the mutual friend who is about to give birth to her second IVF baby.
But last night the conversation also went deeper than usual. We started off on religion as the academic asked for advice on how to talk to her 3.5 year old about death, which he'd just started to understand. She was wishing she believed in heaven, so she could tell him that story. But she doesn't, and she won't, but she wondered what we'd do.
None of us feel up to telling real or prospective children the heaven story, but this led into a discussion of how we each feel about death, and to what extent we have been shaped by our experience or are able to change how we behave (in relation to the two problematic men).
It turns out that the business-owner's attitude has been dramatically shaped by her father dying when she was 16. Her attitude now is that bad things are bound to happen to you, so you might as well just get on with things and live your life with that understanding. She doesn't need to control things because she knows that they can't be controlled. She isn't scared of dying except, now, for the impact on her daughter. The academic has a desparate need to make everyone ok, based on the experience of her half-sister and half-brother suddenly coming to live with her family after their mother was killled in a car crash when the academic was three and the brother and sister were 7 and 8. Her father, who was also their father, hadn't seen his other two children for two years before this due to a misjudgement about what would be better for them given an acrimonious divorce. Her parents tried very hard to be fair, which meant she suddenly got less attention and shows of affection from them, and it seems she's been making it up ever since by making sure she always stands on her own two feet and doesn't ask for anything from anyone.
The doctor obviously knows about death, and isn't scared of it. She's another one who is always trying to make people better (ha!) and is the caretaker in her family. She's also terrifyingly private to protect the limited amount of personal space that her family allowed her. And me? I've been radiating "I'm okay, I'm okay" since I was 6 months old, according to my mother, to make up for her terror that I would have mental defects like my aunt. I dealt with a lot of that baggage in therapy, but I don't think it ever goes away completely. It's only because H offered the perfect comfort to me in the early part of our courtship (What I feel for you is not dependent on what you feel for me) that I managed to sustain a relationship with him rather than push him away as one more person in my life that I had to take care of.
We talked about the academic's partner's experience with his parents, who died within a month of each other when we were in our mid twenties, and how the academic had struggled with this close experience of death. And our friend in New York whose college boyfriend died of cancer a couple of years after we graduated. The academic was there to support her, but struggled to know what to do.
It turns out that the two problematic men both had incredibly difficult childhoods. One was left by his parents with his aunt and grandparents when he was 5 months old, and didn't meet them again til he was 6. The other lived in the UK until he was 5, was then moved back to his family's home country where his mother died. His father then quickly remarried and the family returned to the UK. In neither family was there any discussion of what these little boys were feeling. It's no wonder they both struggle with committing to their own families. I think one difference with them may be that they don't talk about this or even acknowledge, in one case, that it has affected them that much. At least the four of us are fairly clear about why we are the way we are. That has to be the first step to being able to do something about it, surely.
I'm not doing the conversation justice and I'm sure that it's not that interesting to anyone but us. But I wanted to write about it because these women are so important to me, and I love that we can talk like this together, with so little worry about whether we'll hurt someone's feelings, and go to such a deep level in our understanding of each other's situations based on this long history that we have. I feel glad that I'm female and can talk about my past and my present like this, and feel very sad for the men we spoke about because they seem so locked into unhappy behaviour.
Which brings me to H. I think he's really quite sad, but just not talking about it. He's been in a terrible mood all day after a man cut him off in a car park this morning. That's not like him. And I've been sad because I can't make him feel better and I can't help feeling like a bad wife. He does so much looking after me and about the only thing I seem to be able to do for him is bake. And since we both struggle with our weight that's not the best way for me to nurture him!
I want to be able to do more for him, but when he's sad he wants to be on his own and watch sport, or read. I can't do much to bring him out of a mood, and that makes me sad. But perhaps I shouldn't worry so much and should just leave him to it? What works with your husbands and partners?
The results are in and...it's negative. Which is good, right? So why do I feel so sad again? I honestly wasn't that bad yesterday, much as my post seems to have come over that way. But today getting the "I'm sorry it's negative" call made me cry.
I keep having these moments where I think, "I get it now." But then I have another one 24 hour later. "Oh yes, NOW I get it." I'm wondering how long this process of getting it is going to take. It reminds me of being in therapy where I'd talk about a particular issue for weeks and weeks, and finally come to the realisation of what it was all about. Then we'd move onto the next issue. And we'd discuss that for weeks and weeks, and I'd finally come to the realisation of what that was all about. And it would be the same thing, again. A couple of rounds of this and I started to feel really stupid. How could I not have made those connections myself? Why did this all take so long?
I came to the conclusion that made me feel slightly better. I saw this as one long process of peeling the layers off an onion. An onion where the spade had made a scar in it as it was being dug up. So when you examined the surface of the onion, from close quarters, you'd see the skin, and then you'd come across the scar. When you peeled off the skin, the next layer down would be different so you'd take time to explore that, and then you'd come across the scar only this time it would look different again. And so on. Each time the angle is different, the realisation is different, but it's still the same onion.
And of course, peeling onions makes me cry, so that's appropriate.
So I'm here, wondering how many more layers this particular onion has to go before, finally, I get it. Before I finally, at a deep emotional level, come to terms with the fact that I was pregnant. Not completely, just a little. But I was, and now I'm not. And there was no baby in between.
It's been quite a long time between posts, for my recent posting rate, at least. Two reasons. One is that I have had a huge amount to do at work. The second is that it's hard to find something to write about. I had a couple of thought-pieces I'd been thinking about to keep me occupied during the 2ww (the ethics of infertility, for example), but it's been hard to motivate myself to write them since my 2ww was so rudely interrupted. I will do eventually, but my focus just hasn't been there.
I have no new news on the cycle. The second blood test is tomorrow and I am hoping very hard that the beta will be zero. I think it will be. I have no particular reason to know that that is the case, but I'm chosing to see that as the most likely option.
It's been odd adjusting to the news that, at some point in the last two weeks, I was pregnant. That's a wierd thought. I've never seen a double line on the peestick, except for the time I peed on a stick after my hcg shot just to see what it looked like. I had never been pregnant. And now I have, just a little bit. You know, I never really appreciated the title of Julie's blog until now. I hadn't really thought about it, I'd focused on her story and her writing, and hadn't considered what the title meant. But now I get it, at least a little bit.
I haven't been unremittingly sad. I was a basket case on Tuesday, not in good shape on Wednesday, but suddenly on Thursday, after I'd recovered from the blood test experience, I was ok. I couldn't quite figure it out but while I was speaking to a couple of friends to tell them the news that evening, I didn't burst into tears and I was able to joke about it, a bit. Friday similarly. Then Saturday I got very sad again. It's all quite odd but I suppose it's just like any normal mourning process, it goes up and down.
Yesterday was a bit of a test as I spent most of the day in a review meeting. A lot of the junior women in our office are pregnant so there was much discussion about part time work and when they were all going and coming back. There was such cameraderie in the room as my colleagues remembered when their first child was born...I was ok for a while and then it started to really hurt. A club that it feels like I will never be able to join.
H has been sad, but he doesn't show it much. He cried, just a little tiny bit, on Tuesday with me. Then on Thursday when he was the one who listened to that phone message, I could see that he had been hoping that they would tell us that I was pregnant, and that he heard the message as if that was still a possibility, hope was still there. I had to disabuse him of any hope after I'd listened to it five times and realised that it almost certainly said the level was 'five' not 'fine'. He, of course, had heard the latter. Because Hope was in his ear. He got very sad again then. He'd been holding a little secret hope between Tuesday and Thursday, whereas I knew it was over when I started to bleed, or even before. I love that he keeps hoping, it keeps me sane. After being sad for a few days he's now back to being a little bit hopeful for the future. I do love him.
So to keep this post from being entirely one long whine, here are a few people you should go and see. S just found out her IVF (within a day of mine) didn't work. April's IUI didn't work. Megan, on the other hand, has some good news. So whether you're in a congratulatory mood, or a sympathetic one, you have a destination either way.
I thought I'd seen the end of this category. But no, got to resurrect it because it's not over until the fat lady gives me a beta hcg level of less than 5. And yes, the level was five. I said to Dr ICU that he should speak more slowly when he leaves messages on people's answerphones. He said he'd take that into consideration which was nice of him. He also asked me how many IUIs I'd had, which showed a little carelessness since (i) it indicated no one had bothered to get my file out this morning, and (ii) it's proof positive that the doctors don't remember us as he's the doctor who did the pre-transfer consult with us and told us about our lovely embryos. Oh well.
So, as Susan predicted (unfortunately from personal experience), the story is that if the level goes up, it is almost certainly an ectopic. If it goes down, it shows that the poor embryo tried to implant but was too defective to get anywhere, as Summer suggested. So for heavens sake please let it go down. Having an ectopic really would be the final kick in the teeth to this stressful and somewhat pointless cycle.
Obligatory bloodtest this morning. It felt so pointless and reduced me to a quivering wreck again on the way home. We've never been to the hospital before where there's no possibility of good news. I persuaded them not to call either of us on our mobiles but to just leave a message on the home machine, which we can't check remotely. I didn't want either of us to have to hear more bad news in the middle of a work day where we were just getting back on a sort-of even keel.
Around six my mobile rang. I saw it was H and ignored it as I was in a meeting. It rang again. Then my desk phone rang. Then the mobile rang again. I excused myself and answered it. We all know what I thought it might be. Instead it was :H saying he was locked out. I promised to be home by 8 and he went to a cafe to work.
I spoke to one of my best friends on the way home to tell her our sad news. I was still on the phone as I walked into the house. H met me on the steps and carried my bag in. I kept talking while he listened to the message. He kept making faces at me to get off the phone but I didn't want to cut my friend off. Eventually we said goodbye and H handed me the phone. I listened to the message. It was Dr ICU. Which meant it was hard to understand.
So the message? Well the nub of it is that my blood test is either “five” or “fine”. It is definitely “weakly positive” (indicating that “five” is the more likely), and I have to come in again in a week to see if it has gone down to negative level, which is “more than likely” or “maybe likely”, or whether it has “continued to rise.”
No hopping about, please. I will put money on it being 5. I am clearly not pregnant. Honestly I have bled too much for it to be anything but a negative result. But I wonder where that 5 came from. Does this mean that a poor embryo was trying to hang on while its environment disintegrated around it? Could it mean that if I'd had mega doses of progesterone it might still be there?
I will call them tomorrow and attempt interpretation. It would have been better if it had been negative. “Or positive,” H said. I asked if he had been hoping for that. He had. I had not. Sure, I'd experimented with the idea but I just can't imagine how an embryo could be hanging on through this deluge.
So no, I'm not pregnant. But it looks as if, for about five minutes, I was.
Diana Wynne Jones's book, Fire and Hemlock, relies for its denouement on two stone pillars which rotate. On each pillar are the letters, N, O, W, H, E, R, E. Between them then they can spell No where, Here now, Where now, Now here. That's what this feels like. Rotating spheres of meaning, coming and going, and in the end signifying not that much. It's hard to make sense of this.
I knew on Monday that it was over. Those pangs I wrote about were clearly period pain. Of course knowing and believing are two different things. Certainly my subconscious knew it. I dreamt all night that I wasn't pregnant. It was one of those dreams where you are completely convinced that it's real. It was horrible. When I woke up at 04:15 it took me a minute to orient myself again. Then I tried to feel relieved that it was just a dream. That I might still be pregnant. Then I felt the pangs again and knew that I wasn't. I slept on and off until about 07:15 when I gave up and went to the loo. And found blood. I wish I could remember the precise words of the ending to The Peacock Spring. Una gets her period and it's the end of her final clinging onto her relationship with Ravi. But my copy is in a box somewhere and I don't want to murder Rumer Godden's words. So let me try. It felt like the end. It felt like a final full stop on a story. A sharp cut to the thread of hope I'd been finding it increasingly hard to sustain for the last 18 hours. "The curse has come upon me." (My mother and her generation called their period "The curse". Do you think they got it from Tennyson or is that something from time immemorial? Do Americans of a certain age ever call it that?).
And while we're on the topic of hope, let me be clear that there is no hope for this cycle. Nothing could survive the total destruction of its habitat like this. I refuse to call a period Aunt Flow, but boy is this flowing. It's dark and red and heavy and hot and angry. Of course I guess I could have an ectopic. But since I have no symptoms, even though I've been told by the clinic to continue the suppositories, I very much doubt that I'm going to be subjected to that particular trauma. Which I suppose is one lucky break I've had. But it is full on. I'm having the worst pain I've had for years, which is leaving me nauseous as well as crampy. Which at least has the bonus that I wasn't tempted to drown my sorrows in food yesterday. I did eat some of the HUGE box of chocolates that H went out of his way to buy from the best chocolate shop in London (I don't think he realised how many chocolates they can pack into a box, or how much it would cost!), but my heart wasn't really in it. Nor did I fancy breaking my wheat-fast and so while H had pizza for dinner, I had a salad. I think I'm too sad even to want to over-eat. That's a rare occurrence for me.
I'm crying at the drop of a hat. It's not easy as, unlike Susan, I can't hide under my desk to do it. Luckily yesterday I was able to turn all my meetings into phone calls. So I did everything from home in my pyjamas. It got the work done. Today I have to be chirpy and present in person again. I reckon I can do it in 30 minute increments. I'll have to find some reason to duck out when I need to.
I still have to go for a blood test, but I got the nurse to let me go in tomorrow instead of Friday. I just want this to be over with. I have an appointment with Dr Candour on the 29th. We have to wait that long because, get this, "It takes two weeks for the clinic doctors to look through the file and return it to Dr Candour." Two weeks. No worries. How about I walk over there and just help them with that little task, huh? Or don't you think they'd apppreciate that? While I'm there tomorrow I have to sign some kind of consent form for them to release our records so I can get a copy for big guns clinic. My intent is still to do another cycle where we are and then see what happens. In the meantime I want to get going with BGC as they have quite the waiting list. Not surprising given their figures.
I'm not ready to start hoping again. I know that this cycle was not the end, but it is so hard to let go of the thought of our perfect eight celled embryos and the perfect boy/girl twins they were supposed to turn into. I had already imagined their summer birthday parties and chosen a few potential names. I know. I'm a sap and an idiot. When I noticed myself doing it I stopped myself, but it's hard to keep control of your brain all the time. I keep telling myself that doing another cycle is a good idea because it gives us the potential of a few more frozen 38-year-old embryos for future reference. Actually, they'll be 39-year-old since my birthday is in January and there's no way they'll let us cycle again before then. I never thought I'd be 39 and not even pregnant. Life wasn't supposed to be this way.
I haven't tested. I don't think I'm going to. I'm too scared of it being negative and being inconsolable more than once this cycle. H confessed to me today that he's really stressed about Friday, too. I'm sorry that this has got to him, as well. He's usually my rock, and he still is, but I hate to lean on him so much when he's clearly having his own tough time.
I am really scared. I want it to work so badly, and I'm close to being sure that it hasn't. I know it's all non-sensical but I had period-like cramps today, and other than the sore(ish, not very much) boobs which I know are down to the progesterone, I have no symptoms. I know it's probably too early, but still. Every time I felt a cramp today my brain completely disconnected from the meeting I was in and I wanted to shoot whoever was talking: "Don't you know that my body might be rejecting our baby as we speak? How dare you babble on about HR?" Only I didn't say any of that. I just smiled and nodded and tried to keep going.
I think the final indignity would be to start bleeding before Friday. I'd rather it held off until after I know the cycle is a bust. Please keep your fingers crossed (because we all know that that does a lot of good!) that I am allowed that little concession.
The good news is that I now know I can do IVF. It's not so bad. I will do another cycle as soon as they'll let me. One more cycle at my current clinic then we pull out the big guns and go to the UK's most successful clinic - where they treat you like cattle but get you pregnant, about 38% of the time. For four times the cost, but you know, it will be worth it if that's what it takes.
In the meantime my cycle buddy Lindy has some hopeful pee-stick results that I'm sure a bit of congratulations would make all the more satisfying.
I've run out of creative ideas for titles. Feel free to suggest your own.
Thanks for all the advice on the last one. First, re the baths. Persephone and Lynette are not to worry, the bath I took was on Sunday, before the transfer. Although none of the doctors told me not to take baths, I'd seen that particular advice before and so have resisted since the transfer on Monday, despite being sorely tempted due to the only alternative being a lukewarm shower. Let me tell you, that word lukewarm is highly misleading. When you're in it, it feels pretty damn cold. It's been like that, or getting worse, for a month and our bloody useless plumber has procrastinated, until a tearful fit on my part on Friday morning encouraged H to get another plumber in today. It will still take a week or so to get it fixed, since the problem is that a part is broken and the shower we have is so obscure there's no way to get a replacement part, so we have to get a replacement shower, but at least we are on our way. But no more baths, I promise. I'll just go and have a shower at the gym tomorrow, I think.
As for the constipation, if I'd posted yesterday I would have written something virtuous about how much water I drink and how my diet is entirely composed of leafy green vegetables, brown rice, and fruit, and it's had no effect. But after a couple of days of upping the water intake to nearly three litres (that's 101.442 fluid oz to you wierdo Americans) a day, and consciously eating even more spinach, kale, cabbage, peppers and brown rice than I thought was possible, this morning the bowel movements were exemplary. Of course, this probably just means that I'm not pregnant, but I'm hanging on to optimism while there's still time.
Speaking of whether or not I'm pregnant. I'm pondering the stick peeing question. I'm sorely tempted. Partly because I have a very busy day at work on Friday so I haven't figured out how I'll cope with getting the test result. But I know that getting a negative result any day is going to kill me, so I'm not sure why I think Friday will be any worse. Perhaps because before then I can tell myself that it's too early? By the way, those of you with short luteal phases normally, were they longer on IVF or on progesterone? Or should I be starting to worry about whether I'll start bleeding from Monday onwards?
Oh this is so much fun! I can't understand why more people don't do this!
2dp3dt. Wow. I feel all grown-up writing that. My first post-IVF signifier.
But seriously, folks, let's talk about the progesterone. How do you get through the 2ww, let alone a pregnancy, on this stuff? The constipation is AWFUL. And constipation when you're inserting rectal suppositories every evening is NO JOKE. I need to pick up some prune juice tomorrow. Are those fibrogel type drinks ok to take when you're, ahem, trying to be pregnant?
The progesterone, as all of you who have gone before me know, is also a fun provider of other symptoms. Like sore breasts and a crampy uterus. I had to give Hope a serious talking-to last night as she kept saying: "4dpo isn't too far off a normal implantation day. Maybe it's implantation!" Then I kicked her down the stairs and locked her in the cupboard. I can still hear her banging on the door, but I'm trying to balance tuning into her moanings with a good dose of scepticism. I had a moment of too-convincing scepticism earlier, though, when I remembered how I didn't get promoted the Christmas before we got married. I was absolutely devastated, thinking about how I would never be able to plan a wedding and get promoted in the same period. After I got over the devastation I just focused on having a good six months and enjoying the wedding preparations, and on the runway after we landed back from honeymoon I got the text that told me I'd been promoted. I decided that the IVF might be like that, just because the Powers that Be don't want to hand out fulfillment and happiness that readily. They like us to suffer first.
Oh shit. I've just realised I wrote the "just relax" story of my promotion. I take it all back!
Of course that analogy also implies that I'm now thinking I'd get pregnant the next time we did IVF. Which of course is nonsense, but honey, this is my brain on progesterone - you can't ask too much of it.
I've also retreated to the guest bedroom as the stonkingly vivid dreams wake me up, and H just being in bed with me then disables my ability to go back to sleep easily. H is a bit unhappy about this and accused me of secreting George Clooney upstairs. Sadly, no. Somehow I don't think George would see me as much of a catch.
Oh and did I mention that I decided to have a nice relaxing bath and was having a lovely time until H came running upstairs to tell me that water was pouring through the ceiling? Nice. Not sure where the leak is but hopefully the insurance will pay up.
Sorry this is so random. I think that's just where I am right now.
All six fertilised. One arrested at two cell stage.Transfer of two perfect 8 cells went v smoothly, done by Dr Condescending who was positively chirpy. One was starting to compact. Freezing one good 7 cell, one good 6 cell, and one less good 5 cell. It could scarcely be better news. Off to acupuncture and then nap as did not sleep at all well.
I decided yesterday to write the whole story of retrieval, since it seems that all too often we are too zonked to do so and I thought it might be helpful to someone. Yesterday's attempt was of course witty, hilarious and quite above my usual standard of writing. Today's may be less inspired, but I'm determined. Got the 'draft' feature turned on on Typepad, H is watching Man U beat Chelsea which is keeping him happy and occupied, so there's nothing to stop me. Here goes.
06:55 H and I arrive at clinic. H goes off to buy a paper. I wait outside with a lovely woman who is on her fourth IVF in hopes of conceiving number two, and an Asian woman who already has two older children and is struggling to conceive with her new husband. They talk about the longing for a child that no one else can understand, even if it is number two or number three. It is cold. We all shiver a bit and wonder why the bloody hell if they ask you to show up for 7am they can't open the doors at 0650 or so.
07:00 Clinic doors open. Nice receptionist tells me to go sit on the sofas til I'm called.
07:02 H shows up with the paper, all anxious in case he's missed anything.
07:05 Nice nurse (Nurse Cheery, I think would be appropriate) shows up and starts calling out names. We are the only ones there. That probably should have told us something. Nurse Cheery shrugs and says she'll get started with us, then.
07:08 Nurse Cheery ushers us through to the egg retrieval area. It's in a portacabin off the side of the clinic. There are six beds spaced around two walls of an L-shaped room. The theatre entrance is to the left hand side of one of the other walls, next to the door to the women's loo. I try not to worry about that. Nurse Cheery seats us in bed area number three. There are curtains that can be drawn round, but they aren't fully closed - just about 2/3rds of the way down the bed so that we won't be able to see the faces of those in the beds next to us, but we will be able to see their legs. I'm in bed #3, which makes me patient #3 for today. Unlike beds #1 and 2, which are tucked down the narrow bit of the L, bed #3 faces into the main part of the room, directly opposite the theatre door, so I can see everything, including straight into the curtain areas for beds #5 and #6. Lucky me. No seriously. I'm very nosey so I don't mind this at all.
07:10 Nurse Cheery takes all the usual info - name, DOB etc. She shows me my bracelet and asks if it's accurate. I say yes and she clamps it on. Does blood pressure and heart beat. Asks if I have caps, crowns, allergies, etc etc. Tells us we'll go in at about 09:30 or so given we're #3. I begin to wonder what the hell we're doing here so early but decide to be a good patient and don't complain.
07:15 Nurse Cheery goes away and comes back with two more sets of patients. Patient #2 is v glamorous and I immediately hate her. She's wearing a lovely embroidered skirt, her hair is all blond and lovely and clearly blow dried. Her legs (which I can see in my sideways view) are tanned and her feet are tiny. I'm wearing black yoga pants, white t-shirt, and a big grey sweater that zips up the front that H bought me on our trip to Stockholm a couple of years ago. My feet are not tiny. Feel like a bad patient. Patient #1 looks pretty normal, as does patient #5, who arrives about 15 minutes later and then goes away again in disgust at how long they're going to have to wait. I figure out that patients 1, 2, and 4 are on their first cycle, like us. Patient #5 is clearly a veteran. I never get a good look at patient #6.
07:15-07:45 Nothing happens. H goes to get a coffee and something to eat. I read the paper. Nurse Cheery does all the entry stuff for the other 5 patients, which takes her about 10 minutes. Then everyone sits around.
07:45 Dr ICU arrives and sits reading everyone's notes at the table that is between my bed and the theatre. He looks quite smart today. Nothing happens to us. Nurses chat and other doctors come and go. A very shy looking woman who seems to be about 14 shows up. I assume she's a trainee nurse as the nurses are all being v nice to her and showing her where stuff is.
08:00 Dr ICU starts doing the rounds of the patients, starting with patient #1. I can hear the words: Risk, consent etc being bandied around. I start to get tetchy as by now I have finished the paper, and am v hungry, bored and thirsty. H is working. I complain to H that I don't want Dr ICU to do our transfer even though he's reformed. I want the star-retriever Dr Condescending. H tells me indulgently not to panic. I panic. H tries to look as if he's not laughing at me.
08:05. Dr ICU is on patient #2. H is working. And eating, and drinking coffee blast him.
08:10 Dr ICU arrives. He tells us that although he is doing everyone else's retrieval today, Dr Condescending will be doing our retrieval, he's just here to do the consents. H tries a bit harder not to look like he's laughing at me. Dr ICU goes through the rigmarole. What's my name and DOB. Do I have any allergies or crowns etc. The procedure may result in perforating my bowel or other internal injury causing them to have to open me up. He points. I sign.
08:15 I try to read the crappy chick-lit novel I brought with me. Only it's really not very good, and hence it's not very distracting. Dr Condescending appears in a tight grey sweater dress that clings to what looks like a four-month pregnant belly, and knee high black boots that make a lot of noise as she strides from one end of the portacabin to the other. And back again.
08:15-08:45 Nothing happens except some milling around and some more striding by Dr Condescending.
08:45 Dr ICU appears again in theatre gear. Dr Condescending does some more striding.
08:48 Anaesthetist comes to see me. Asks what my name is, if I have any allergies or crowns, etc. She is nice, so I forgive her for being the 75th person to ask me that today.
08:50 Nurse Cheery hands patient #1's partner a sperm collection kit and sends him off. Patient #1 has the curtains drawn so she can change into her theatre gear.
08:55 Nurse Cheery comes over and gestures towards the shy young 14-year-old I saw earlier, who is now in scrubs. "A medical student would like to observe your procedure," she says, "is that ok?" I nod yes, and feel strangely flattered that I am the only patient who is asked. The fact that this means that my ovaries are almost certainly more fucked than anyone else's in here today does not occur to me until later.
09:00 Nurse Cheery hands patient #2's partner his sperm collection kit and sends him off. I wonder if there are two wanking rooms, and if so, which one is better.
09:04 Nurse Cheery hands patient #1 a grey cardboard tray. All I can see in it is a rubber glove. Patient #1 goes off to the loo, clutching her gown closed behind her.
09:10 Patient #2's partner returns clutching his paper bag. I feel bad for patient #1's partner.
09:15 Patient #1's partner returns. I feel relieved.
09:17 Patient #1 is walked off to theatre. Dr Condescending does some more striding. I am bored. And hungry.
09:18 H is sent off to do his bit. Plastic cup with a lid, he has to write his name and DOB on both lid and cup. And fill in a form that goes in the paper bag with the cup.
09:19 Patient #2 does the curtains closed, change into gown, disappear off with grey cardboard tray thing.
09:26 H returns. Feel v proud of him for being such a performer. He tells me there was a porn film playing with the sound down but he didn't turn it up, partially for fear that the sound of panting would reverberate through the clinic.
09:35 Patient #1 returns on her gurney. She looks out of it. I get a bit tense. H holds my hand.
09:37 Patient #2 walks through to theatre. She is so skinny that she doesn't have to hold her gown closed. Hate her a little bit.
09:38 I get to do the curtains closed, get changed thing. Nurse Cheery says she'll be back in a minute with my suppository. Aah, light blossoms.
09:40 Dr Condescending does some more striding. My stomach is rumbling.
09:45 Nurse Cheery has not returned with suppository. I am anxious. And hungry. H volunteers to go and get her, but I feel bad about making him ask for my suppository so I say no.
09:50 I am worried still. H goes and reminds Nurse. She immediately shows up with suppository equipment tray. Apparently it's a long acting pain killer to help after the procedure. I go and play in the women's loo. It's not difficult but I am glad of rubber glove. Wondering if they'll give me some to take home for the progesterone suppositories.
10:00 Patient #2 is wheeled out of theatre. She is sitting up and laughing and joking. Long blonde hair is spread over her pillow. Hate her a bit more.
10:05 Theatre nurse comes to get me. She asks me my name, date of birth, checks my bracelet, asks if I have any allergies or crowns, etc. I decide hitting her would be a bad move. She walks me into theatre. H kisses me goodbye.
10:06 The theatre looks just as scruffy as the outside room. There are at least six people milling around including Dr Condescending who has at least changed into scrubs. She says hi. One nurse undoes my gown while another helps me climb on the table. I scoot down and someone helps me put my legs into the holders. A blond woman leans over me and introduces herself as one of the embryologists. She checks my wrist bracelet and asks me to say my name and DOB. I want to kiss her for not asking if I have any allergies. Decide not to.
10:07 Anaesthetist starts looking for a vein. I point her to the good one. She puts the IV in, then adds drug number 1. I feel tingly. She then starts to add drug number 2. She says it will make me feel like I'm drunk. I comment that I'm a cheap drunk, and will the anaesthetic have the same effect. She laughs and says maybe.
10:35 I wake up when they ask me to move from the theatre table to the gurney. I am amazed to have slept through it all. They wheel me out to a visibly relieved H, who says that since I'd taken over 30 mins he was convinced I was bleeding out on the table. Nice to know I'm not the only one who freaks out like that.
10:37 Dr Condescending appears and tells us we got six. I feel a bit sad, and ask about the others. She explains that they were either too small or too hard to get to in the case of two of the ones behind the endometrioma. She is nice. I decide her bedside manner is much improved by her scrubs, and perhaps by doing something she is really good at?
10:38 Dr Condescending leaves. I cry at the thought of my hopes for eight. H holds my hand.
10:40 I try to nap but the bloody blood pressure cuff keeps going off just as I drop off.
10:50 Nurse Cheery says she'll bring me some water in a minute. H points to the bottle of water he'd already bought for me. She smiles at him. I drink water.
10:55 Patient #1 leaves with her partner. I hear her talking about four eggs. I feel guilty for worrying about six. I drink some more water.
11:00 Nurse Cheery offers tea and biscuits. I say no to biscuits (no wheat, don't you know) and yes to a hot chocolate (hang the no sugar). I sip hot chocolate. It's not very nice.
11:02 Patient #4 returns from the theatre. She seems to be sleeping. I read the gossip magazines H has bought me and think about posting to you guys on my blackberry. Only my handbag is on the floor and I can't face picking it up and asking H seems too hard, too. H is so bored that he is also reading a gossip magazine. I promise not to tell anyone (except the internets)
11:15 Patient #7 arrives with her partner, they are ushered towards bed#1. They both look frighteningly young, and scared. I want to give them a hug and tell them it will all be ok, but I realise that it might not be, and it's none of my business.
11:20 Patient #2 has her exit discussion. I hear her ask, "If we are lucky enough to have three on Monday, will they let us put three back given my age?" I don't hear the answer but feel a new kinship for her humility and her worry about Monday. Also am glad that I figured out that they wouldn't do their usual two day transfer if it fell on a Sunday, and so last night called my assistant and cleared my diary for Monday. Wish I could have cleared it for Tuesday, too, but that just was not to be.
11:25 Nurse Cheery offers me a sandwich. I ponder the no wheat thing and then refuse. She says I have to eat something. H points to the nuts and raisins he bought me earlier. She says I can eat those. I eat them. They are delicious. I drink more water.
11:27 Patient #5 is wheeled out of theatre. She is crying. I hear the nurse saying: "But 15 follicles doesn't mean 15 eggs." I can't hear how many she did get but it's either six or eight. Get cross with her for crying, then realise that I'd be the same way if I thought I was going to get 15 and I only got 6. Feel sympathetic instead.
11:30 Patient #2 leaves with her partner. She still looks v glamorous, but feel a new sisterhood with her given what I overheard. Don't hate her any more.
11:35 Dr Candour shows up. He looks very dapper. He comes over with my notes and says he's happy with six. I say eight would have been better. He says yes, they were hoping for eight but six is the best they could do given my anatomy. That he was on the phone to Dr Condescending during the surgery and agreed with her choices. That six good ones are better than 20 poor quality ones, and all we can do now is hope. We find out from him that the embryologists will only call if something goes wrong. I think this is a policy designed for maximum tension in us, but decide not to bring that up as am already the patient from hell. Dr Candour smiles and pats my hand, and leaves. He looks dapper from behind, too.
11:45 Nurse Cheery says we just need one more measurement, then I can get dressed.
11:50 I've passed and can get dressed. Do so. Am in considerable pain. Nurse Cheery notices and comes back with some painkillers and suggests I get back on the bed until I feel a bit better. H goes to put money in the meter.
12:00 H returns. He tells me that patient #4 got no eggs. He's just met her husband in the car park. I heard in their intake discussion that they've been trying for six years. I feel terrible for them. Start to cry again. Distract myself by reading about the new Spanish princess.
12:15 Am feeling better. Nurse Calm comes to do the discharge discussion. She draws our curtains and does the whole discussion by pointing to the piece of paper she's carrying, so as to protect the feelings of patient #4. H and I comply. I realise later that this means that H has understood nothing of the discussion, but that doesn't matter as he and I both retain the observation that we need to bring £400 on Monday or else they won't freeze anything. Nurse Calm reiterates the 'no news is good news' mantra, and affirms that we need to come in on Monday at about 10, and I need to have a 'comfortably full bladder'. I try to figure out what that means. Antibiotics are to start tonight, Progesterone pessaries on Saturday night.
12:20 We leave. I feel ok about the six. Am a bit surprised at myself. I post from my blackberry to you guys.
12:30 Home. I sit on sofa. H makes smoked salmon and scrambled eggs on (wheat free) bread. It is delicious. He goes upstairs to work and takes my mobile with him so as I don't have to panic when it rings. I watch America's Next Top Model. It's one I've seen before but I don't care. I sleep.
There you go. It's now Sunday night, and no one has called. Which means that barring anything bad happening overnight, which I'm sure can happen, we have some embryos to transfer tomorrow. I am very excited. I know it's ridiculous, but this is the closest we've ever been to being pregnant. It feels good to have got this far. I still feel a bit uncomfortable, enough so that I'm glad they didn't do the transfer today, much as that would have given me two potential bed-rest days.
I am worried about not doing bed rest. I know the studies say it makes no difference, but it's a bit like some of the dietary stuff. I don't know if it will have any effect, but I want to do everything in my power to make this work. But I have stuff in my diary for Tuesday that I cannot move. So tomorrow I will go into town to do acupuncture, go back to the clinic for transfer, go back into town to do acupuncture again, then go home in a taxi and rest for the rest of the day. Then on Tuesday I will get up and start to live my life again. I'll post another blackberry post tomorrow just to confirm how things went.
S, despite your kind wishes I'm afraid I'm going to have to kill you. I wrote a very long post about yesterday, and was just ready to post when I went to your site and got your address to put into a link. I clicked 'back' and internet explorer crashed. It's the sixth or seventh time it's done that, and I've now realised that it's always when I'm coming back from your blog. So I'm sure it's not your fault, but it's very very frustrating! Next time I'll save as draft before I do anything so daft...
I've tried to write it again, but I don't have the will right now. I'll try again tomorrow. For now just know that we haven't heard from the embryologists, which is good. At our clinic they only call if there is a problem. So at the moment we have no news, which is good news. I'm feeling a lot better than yesterday but still quite uncomfortable. I'm chanting my new mantra, which is: Two to put back. We just want two to put back.
Thanks for all your good wishes. They mean a lot to me. Transfer is Monday.
They got six. Dr condescending and Dr candour both came to see us. Others were too hard to get at or too small. Six seems ok, although candour said they were aiming for 8. Am quite uncomfortable so will sleep now and write more later.
If you can get the song reference in the title, I will be your eternal fan. But then, I'm a huge fan of most of you already, so perhaps this is the wrong incentive...
Ladies, I give you the facts. They're quite good:
On the left: 16, 14, 14, 11
On the right: 22, 19, 18, 17, 15, 14
Lining: 10.6mm
E2 3659 (997 American)
Clearly my right ovary is going for the mid-term performance turnaround, while my left is still skulking in the "could do better" corner. Not to knock it, or anything. I'll take those four follicles, thank you very much indeed. The growth seems very random - a couple have grown just 1mm, while others have shot up by 6mm, and two on the right seem to have come from nowhere. I assume that at least some of this wierdness is due to the follicles being hard to measure accurately. It's fairly miraculous to think that we could retrieve as many as nine or even ten eggs. That is of course assuming they can get all of them, that the little ones keep growing, and that all the follicles actually contain eggs. But still, that's a lot better than three! I bow to all of your superior wisdom on this point, particularly Wessel who took the trouble to write all that detail in the comments.
The doctor took 20 minutes to do the scan, and was very good at telling us what was going on once he'd had an initial look. He showed us all the follicles and described what they'd have to do to get round the endometrioma. I now have three follicles, all on top of each other, all directly behind the endometrioma. That's the right ovary pretending to play nice, but secretly trying to mess us around and still get an A. They'll basically have to go in with the needle straight on top of the camera probe, and try to get one at a time without losing them or puncturing the endometrioma. Sounds like fun. He kept telling me how complicated it was and what a difficult scan it was. Luckily once I saw all the follicles I was in a considerably better mood and was able to crack jokes about what a tough patient I am. This doctor, by the way, was Dr ICU. I think Dr Candour spread my memo around the place as Dr ICU was a different man today than at my last interaction with him.
So we trigger tonight at 22:30, for retrieval on Friday morning. I'm sort of excited now. Of course, they may not get all those eggs, and the eggs may be crap, etc etc., but I think I'm allowed a little excitement after the general shittiness of the news so far this cycle. The good news is that they will (probably) put the most experienced egg retriever doctor on the case on Friday. The bad news is that this is Dr Condescending. I'm sure that her medical skills outweigh her interpersonal ones, or they wouldn't be suggesting this. After all, it's in their best interests for this to work.
And I almost forgot the really good news. From a conversation with a colleague at work where she figured out I was doing IVF, I was pointed to our company's administration office in the US to check on the global health care policies. Apparently since I am now quite senior I'm covered by an additional insurance policy that I didn't know about, and it covers fertility treatment. All our costs are covered - drugs and everything! I still have to submit everything and given all of your experienes with US insurance companies I'm sure it won't be entirely straightforward to get the money, but it will be a great help to get it. Our insurance also covers up to $10,000 of adoption costs. The only thing they don't cover is surrogacy. Since that's not an option we've considered (yet), that doesn't make me too sad. Confused about why that would be excluded, but not sad. I'm thanking my lucky stars and feeling very blessed to work for such a generous organisation.
Picture me breathing a big sigh of relief, and repeating the mantras from your comments on the last post. Grow, follicles, Grow! I'm still working on Ovagirl's image of them "like coloured balloons, blowing up into beautiful rounded globes of goodness." There's no mistaking that she is a writer and I am not, is there? Thank you for all your thoughts. I'm in a much better place today, and even feeling slightly foolish for my trauma at other points in this cycle. No doubt I will be foolish again before this cycle ends.
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