Thalia's fertility journey

(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.

Talk amongst yourselves

It was a good week in Austria. Too bloody hot, but very rewarding in terms of my interaction with the participants. They were a great bunch and really open to learning, so I felt my investment was worthwhile. Now I'm back, and on another Sunday evening am in a car travelling to my next working destination. I guess that's one of the reasons they pay me the big bucks. At least this time it's in the UK. I don't know what to write about so I'm just going to write and see what happens.

On Monday I would have entered the second trimester. That's all I'm going to say about that.

A little rant. Why do people stop posting when they get pregnant? I know about survivor's guilt, and I know about morning sickness, and I'm sure some people get busy at work, but it just seems really, well, ungrateful to me. A kind of, "thanks for your support, but I'm fine on my own now so you all just keep going without me. Buh-bye, have a nice life!" It cheats me of the happy ending and all the little happy bits of news in between. And really makes me cross. So please, don't stop writing because you think we don't want to know or because you feel guilty. We DO want to know, even if we don't read or comment as often. It's important that those happy endings exist. And we need to feel wanted and needed even if our pain is hard for you to take. And of course, blogging's all about us, right? </rant>

I had an orgasm in my sleep last night. Never happened before. I've got turned on in a dream but never gone all the way. It's a sign of just how dysfunctional our sex life is that I told H about it today and he thought it was my way of giving him a hard time for not wanting to have sex most of the time. Or at all. What I was trying to do was to encourage him to go for a little morning fool-around. Obviously my seduction techniques suck. No sexual satisfaction ensued since he got a bit sad and defensive, and then it got too hot (I bloody HATE this weather. Have I mentioned that? It's going to be 35 degrees on Wednesday and I say that it's just not BRITISH and it should STOP) so he had an excuse. What on earth am I going to do to revive our sex life? I love him so incredibly much, and he has such trouble with this, and I don't really think I can cure it. He's got to find the right counsellor or we've got to find the right couples therapist or something. He says yes yes, but he doesn't actually do anything about it. And in the end, I can't make him go.

I'm getting car sick, so will stop.

Pointless, yet poignant, post just to get that last one off the top of the page because I can't bear it any more

I'll apologise to Dar now for having mangled her title, but oh boy was I lacking in inspiration this morning. It's been a week. A busy week but one in which one of my clients told me I'd transformed him. Which was nice. But also a week in which I spent the whole of Saturday night writing a memo, and then went to bed. Which pissed me off. A week in which we struggled through our Saturday morning appointments (which were a session with the trainer at 0745 and a hair, nails etc appointment at 9am for me, but well, when else am I going to fit it in?) in order to get to my parents-in-law's house on time for what we thought was an intimate family lunch consisting of our PsIL, H's brother and SIL and their two children, and H's cousin who is over from Oz and his wife and two children.

Only when we got there it turned out to be those people PLUS all of H's father's brothers (4) AND all their wives (4) and children (about 20) and grandchildren (umpty million). Yup, no one in that family has any trouble procreating. Except us of course. And the number of people who said: "Wow, we haven't seen you since the wedding and how have you BEEN?!" with a questioning look on their faces would need to be counted on the fingers of very much more than my two hands. The food consisted of the EU's entire backstock of new potatoes (my MIL miscalculated somewhat. Seriously, we all ate a lot and then when we'd finished we discovered the world's largest stock pot on the stove, still full of potatoes. It was like that fairy story of the magic cauldron), plus a huge variety of barbecued (incinerated) meat. On the one hand my FIL was very keen to cook the meat properly, hence the high carbon content. On the other hand when distracted he just started loading the cooked meat back onto the platters where the raw meat had been marinating. Hence kind of invalidating the whole "don't give your guests food poisoning" element of incinerating the meat in the first place. And then after about an hour my SIL and I realised that our MIL was really quite drunk. It was the picking lamb chops off the plate and tearing them into pieces her fingers, then wiping her fingers on the tablecloth while telling us a long involved story about the sports club they belong to that gave it away. It was actually quite funny in a hysterical sort of way.

Sorry. I do love my PsIL very much, but yesterday was all a bit much for me.

In a minute we are off to my mother's 70th birthday party. Yes, this is the birthday that keeps on giving. Sadly the weather has gone from nicely sunny yesterday to grey and showery today. Which is what British weather does, I guess. Mum seems to be holding it together quite well for someone who has 100 people coming to eat lunch in her garden in a few hours. The only thing she has nagged me about in the last 24 hours is finding her some Essie nail polish in Pomegranate, because apparently hers has chipped. But I'm insisting that there's none to be found despite not really having tried. Because I'm a terrible person like that.

After the party I fly off to Austria where I'll be leading a training course all week. It's going to be pretty busy so I might be a bit quiet. Have fun without me.

Dr Candour loses some brownie points

I just got the following email from the esteemed doctor.

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Re miscarriage, 30% chance of pregnancy, then a 15% chance of miscarriage. (I could have sworn he said sthg different in the meeting, but there you go).

Your karyotype results are back. Normal 46XY

Regards

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Yup, not the most tactful way to break the news.

I didn't realise how devastated I would be to know that it was a boy, not to mention a normal boy. I was very convinced it was a genetic problem which would be just bad luck and might or might not happen again. But if I miscarried a normal boy, then presumably I might do that again. What do we do now? I know the answer is nothing, we just try again, but somehow it is even more terrifying. And very very sad. It is so much more real to know that we had a boy, not just an embryo. A boy who would have become our son, if something hadn't stood in his way. Something that we don't understand and therefore can do nothing about.

Just when I thought things were on the mend.

A plan

It wasn't my most satisfying appointment with Dr Candour, but we came out of there with a plan. The contributors to it being less satisfactory is that I really wanted a conversation about what happened and our chances, but he was having one of his over-scheduled mornings, and the results from our cytogenetics weren't back yet so we were missing one vital piece of information. He ended up spending about 10 minutes on the phone trying to get hold of the cytogenetics information, but the lab weren't cooperating. So we don't know yet if there was a genetic problem - or even if we had enough genetic material to find anything out. We briefly discussed the Prague meeting and he said it was very good, although he was a bit stunned about how much publicity it got.

We discussed the fall-out from the ERPC and my trip to the ER. He asked me if I was ready - emotionally - to try again. I said I wanted to try again as soon as possible. He wanted me to think about it whether I was prepared to be thrown into the hormonal maelstrom again. I said I was terrified about getting older and how long everything takes, and I wanted to get started. He was fine with that, he said that physically it was ok, it was just a lot of additional stress to pile onto a difficult emotionally stressful situation. We briefly discussed doing a frozen cycle. He pointed out that fresh cycles are more likely to work, although they bring with them all the extra invasive procedures and hormonal interventions. I said that we wanted to do exactly what we did last time, and he was fine with that. He told us that they've used the same or similar protocol on several women since I had it, and are becoming more comfortable with it.

So the story is, wait for my period. On the day of my period or 1-2 days after, have a scan to make sure I don't have any new endometriomas. If everything is ok, on the same day have the Zoladex shot. Four weeks-one month later, start Puregon. We'll start at 300 mIU this time. Then we'll see what happens. He gave us about a 30% chance of getting pregnant - increased odds because we got pregnant last time - and a 15-20% chance (per cycle, not per pregnancy) of having another miscarriage. That seems to mean that once we are pregnant there's a 50/50 chance we will miscarry (30% chance of a pregnancy per cycl, 15% chance of a miscarriage per cycle - am I messing up here?). After we see the heartbeat there is an ongoing 10% chance that we will still miscarry.

I asked him how many times he'd let us do this. He said five in total - three more. There is a cumulative improvement in the chances of getting pregnant through the first three cycles. And a slight improvement through the next two. After that it flatlines: "it's a bloody miracle," he said, "when people get pregnant on the 7th or 8th cycle." Because we got pregnant on the second cycle, that ups our chances of getting pregnant again, so if this one fails he'd be happy to try 3 more, assuming that we get a good follicular response on each preceding one. After that we talk about donor eggs. He assured me that we don't need to go there yet, which I'm relieved about since I'm very much not ready to go there yet. He assured me that there was nothing to worry about in that on our first cycle we had six of six eggs fertilise, while on the second only five of nine did. He was so distracted by me mentioning the six of six that he ended up writing ICSI on our prespcription form for the cycle as he was busy talking while he was writing and said while he wasn't concentrating his brain was telling him that that kind of fertilisation could not have been straight IVF!

This somewhat scuppers our holiday plans as we were planning on taking off two weeks mid/end August, but that might be just when we're stimming, depending on when my period comes. My hcg on Satuday 17th, the day we went to A&E, was just 141 which means that it should have been zero sometime the weekend before last. Which means that my period should come about two weeks or so from now. That would take us to mid August for the start of stimms. Maybe. Who knows what my body is doing. I should probably pee on a stick, as Kath suggested, and see what's going on. Not sure if it should be an OPK or a pregnancy test, I'll see what I've got in the cupboard at home. I went to do one this morning but was distracted by H being in a very grumpy mood due to the difficulty of sleeping when it's so hot. Tonight we'll talk about when else we can take a holiday. The alternative is to take the holiday while I'm on the Zoladex. That will mean that we need a slightly less strenuous holiday than we were planning since I get migraines on Zoladex if I get dehydrated or too tired. But since we don't know when I'll need to get the Zoladex shot, it might be a bit tricky to plan the holiday. Perhaps we'll have to be spontaneous for a change - and pay spontaneous prices!

I'm left feeling quite emotional, and quite sad. I'm so scared of going through another cycle and finding out it's negative. I can cope with the cycle itself. Injections are no big deal and I know now how to manage the minimal side effects that I get. It's the negative result I'm scared of. If we don't get pregnant again, the next time we'd be able to cycle is just before my 40th birthday. I never thought that's where we'd be, still not pregnant at 40. Oh how I envy those of you who started this journey at 30, or 26, or 34 (without POF) or anywhere other than 38/39/40 when you can feel that death knell of your aging eggs hanging over you. I'm more scared of us not getting pregnant than I am of getting pregnant and miscarrying again. Perhaps because getting pregnant is the first hurdle, perhaps becasuse it's the hurdle we've always fallen at before. As Dr Candour said, it's very hard in this endeavour to find the right balance between hope, which keeps us all going, and realistic expectations. Anyone would think he read infertility blogs.

Getting started again

It's been a long time without a personal post - nearly 2 weeks. Partly because that ESHRE post took me AGES to do, so it took up quite a bit of the available blogging time. Partly because I've been busy at work. Partly because I've been uninspired. It's not very exciting to plan a post which you know will at least partly consist of talking about sadness and difficulty. I feel as if I've had my share of posts where the only comment anyone can leave is "I'm sorry." I'd like to get back to more engaging thoughts, posts, writing in general. I guess the ESHRE post was a good start, I'm so pleased you appreciated it. There were many more pieces of research I could have written about, but I had to draw the line somewhere. Most of what I read isn't going to mean anything for most of us, but it's always good to know what's going on. I'm glad my doctor was there.

So how am I, many of you have asked. I'm ok. I'm a lot better than I was. My meltdowns have gone down to one or two a week, rather than several a day. I'm cooking again, which is therapeutic. Last Sunday we had friends over with their three children for brunch. I made three different kinds of muffins, and they were all absolutely delicious. And then I also made scrambled eggs and smoked salmon, and finally orange and ricotta pancakes - a Nigel Slater recipe from his latest book that I've been dying to try. I worship Nigel Slater. Such an unapologetically greedy cook. It was too much food, but it was fun. And it meant we safely had leftovers when my father, brother and nephew arrived mid-afternoon to watch the football.

This weekend I cooked again, for no good reason other than I seem to be addicted to baking. I made two more sets of muffins (the orangette recipe is for a loaf cake but I made it into muffins). Sadly the pear and goat cheese ones didn't really work. I expect a muffin recipe to make 12 unless it says otherwise. So I gaily half filled 11 muffin cases, then realised that I was supposed to still have half the batter left. I didn't. I stole some out of a couple of the cases that looked 2/3rds rather than half full, and persevered with the goat's cheese and the rest of the batter. As a consequence they don't really have enough support for the filling. And the taste is only ok. The first ever muffin I've ever made that I probably won't make again. Luckily the banana/chocolate/ginger/pecan ones were delicious, so H had enough good stuff to take round to his friend's yesterday to watch the football with. I joined them to watch the second half, and extra time, and penalties, and to comfort my poor sad man when they inevitably crashed out. England, oh England, you're always just a bit disappointing as a team.

You may be surprised that I was round at a friend's house with H, watching the football. Let me explain. H went to see one of the counsellors at the clinic this week. He found it was very helpful, and quite practical. She pointed out that when we're in the middle of all this shit, we tend to not have the energy to nurture ourselves in other ways - things that we enjoy doing fall by the wayside. It's definitely true in our case. H is very social, I am less so, but we've barely seen anyone socially other than our families in the last six months. H sees one friend once a week to play squash, but that's about it. H made his list of 'sustainability' activities (his homework from the counsellor), which included seeing friends more often. So that's why I agreed yesterday to go round to the squash friend's house to watch the football and stay for a barbecue. It was actually really nice, very relaxed. The husband is one of H's friends from school, and his wife is a very down-to-earth Northerner. They have one daughter who is now five. The wife had such bad post-natal depression that she never wanted to be pregnant again. We just had a fun, relaxed time, and talked about nothing much. I never want to go to these things in anticipation, but it's never that bad once I'm there!

It's bloody hot here again. And today my brother is moving out of his home. He and my SIL (they're not married but they've been together for 8 years and have a child together so I've considered her my SIL for a while now. They did get engaged, but then they got pregnant and the wedding seemed to decrease in importance). We don't really know why they're separating. My brother just told us that it's been a bad year and they're going to spend time apart while they try and work things through. When we've seen them together they've been fine with each other - no sniping - but we do often only see my brother and nephew - at the last minute my SIL will have a hangover or a yoga class she needs to go to and drops out of whatever arrangements we've made. I know my brother has been keen to have another baby, and my SIL has not, and I wonder if that's part of the cause of the split, or just a symptom of other issues.

They were doing quite well, keeping it amicable then apparently on Friday, my SIL's birthday, it all deteriorated into a big screaming match, unfortunately in front of my nephew, who is 3 and a half. Today my brother came round with a friend and a van to take away the bed, futon/sofa, bookcase, bedside table, lamps and other sundries we're loaning him while he and my SIL decide whether this is for good or just for now. H has been a bit of a hero, carting our furniture down four flights of stairs and driving round to my brother's new (rented) flat to help him cart it up two flights of stairs again. They all left here looking distinctly dishevelled and sweaty. I supplied what I could in terms of frozen fruit lollies, water, and beer, but they didn't seem to want any girls involved in moving stuff, so I've stayed a bit out of the way.

On Tuesday we see Dr Candour. I'm hoping very hard we can get going as soon as possible. I stopped bleeding about 10 days ago, but am showing no signs of ovulating so I'm wondering how long this cycle will go on before I bleed again. I haven't peed on a stick, but I assume that I'm no longer hcg-positive. We haven't re-convened marital relations yet, so there's no chance of one of those miracle pregnancies (haha, as if), and the lack of nooky is becoming a bit of an issue. We both kind of want to, but are a bit nervous about H's problem resurfacing, and I think it holds such tension for both of us that we talk about it and then avoid it. Perhaps the right answer is to plan to just go to bed next weekend after we've had a nice meal and a bottle of wine and just see what happens. No pressure. But that's not very realistic. For H there's always pressure.

I have reconvened going to my trainer, although sadly I've only got 6 weeks left before she moves back to Australia. Anyone know a good personal trainer in London who does fun stuff (preferably kick boxing) and lots of stretching and flexibility work? I felt really good after I saw her yesterday. My back has been really bad since I stopped being pregnant, making me think that perhaps the pregnancy hormones were masking the problem in some way. She really got my back going - stretching and various twisting and stretching exercises, and it was great to feel physically tired again. I've been sleeping ok through the night, but then waking at about 5am and not really falling asleep again - just dozing for 10 minutes or so at a time. It means that I get up already tired, which isn't a good start to the day.

I have more to say, but want to craft a few posts rather than just continuing to burble. Thank you all so much for all the support. As a community, we rock.