Thalia's fertility journey

Hmm, perhaps am just normal old lady

Looking ok but not great today, three 3-cells, three 2-cells, all labelled 'good'. The other one has disintegrated overnight. I asked the embryologist shouldn't they be 4-cells by now, he, rather non-committally, replied "all embryos have their own timing."

Hmm. Not bad but not stellar. Let's hope we have some decent-looking ones tomorrow.

Am old lady IVF superstar

Seven out of ten fertilised normally. Not bad, eh? Have also come to work for the first time on a day after retrieval, and so far am feeling ok. Will try to go home early. Transfer on Friday unless they all look crap tomorrow.

Not too shabby

10 eggs. We'll see what's left in terms of embryos, but not too bad a start. Transfer scheduled for Friday unless something goes wrong and they want to do a day 2 transfer instead (which is standard at my clinic). I asked for a day 3 transfer due to work stuff, but we'll see.

Going to sleep now.

The baby is fine, mummy will need some time to recover

As caused you much hilarity on my last post, all was fine. Pob had a hard time going down at bedtime, and got quite upset when we weren't there when they got back from the park at lunchtime today, but other than that she was happy and chirpy, did lots of walking (supported by Granny, I hasten to add), lots of standing up and cruising, lots of chatting and plenty of crawling.

The party was lovely. My friend really had thought of everything, and turns out all her friends are nice - from 4 or 5 major parts of her life, we by no means knew each other, but everyone got on and had a good time. "There are no assholes here," exclaimed one colleague after the first hour. We had afternoon tea on the lawn, drinks in a different part of the grounds, dinner outside with a huge barbeque, dancing and dessert inside the lovely dining room. I wimped out around midnight due to a rather frustrating stomach upset (must have eaten something that disagreed with me - odd because usually I have the iron constitution). H partied on with cigars and whiskey until 130 or so. So no nookie, which would have been nice, but a fun evening nonetheless.

We had a good time. I missed her. A lot. Last night I quite enjoyed being without Pob for the early evening. I was free to have a long soak in an 'infinity bath' (ever seen one of these? very funky. It had underwater glowing lights as well), then shave my legs, then have a shower. Then sit around with my hair wet and cool off a bit while watching my current favourite programme. Then dry my hair. Then sit around a bit more. Then get dressed, and choose my jewelry and my shoes. It all took nearly two hours and was most enjoyable. It was also good to sleep through the night and into the morning - although we both woke at 6, we managed to sleep until 8 before finally getting up (time for my injection, anyway).

But the rest of the time, I would have been happier if she had been with us. Yesterday afternoon, having tea on the lawn, in front of this beautiful hotel, in the very uncharacteristically glorious sunshine, I wished she was there, crawling around on the grass and telling us what she thought about it. This morning at breakfast another baby was shouting 'nananana' (meaning, give me more scrambled egg, daddy), and I imagined her shouting 'upupupup' at my mother, demanding more toast. It wasn't a horrible feeling, it was just a sensation that I would be happier if she was with me.

We arrived back at my mother's just before Pob woke up from her nap, and it felt wonderful to go in and get her when she started to stir. She was pleased to see me. She showed it not with big grins, but by hanging on for dear life for the first 15 minutes after she woke up. She was also pretty screamy for the rest of the afternoon, not sure if it's connected or not. She's happily asleep now despite it being 26 degrees in her room, so I imagine by the end of tomorrow she will have forgotten we ever left her.

So everyone concerned had a good time. My mum had a lovely time, although she did take the opportunity this afternoon to drop in a few more comments about how she thinks we overfeed Pob (more on this in another post. I am a bit worried about it - Pob has shot up to the 95th centile for weight (75th for height), and I don't quite know what to do. Anyway, more in another post). But it was good. And I'm glad we're back.

Tonight we sleep the sleep of the just

A veritable bevy of follicles. 21, 19, 19, 17, 15, 13 plus some little ones on the right, 17, 16, 16, 16, 13, 12 on the left. We are to trigger at 2330 tomorrow night and go in for collection on Tuesday.

Yet another new-to-me doctor (nice, blonde, good sense of humour) told me we should be there at 7 on Tuesday morning, but given I've previously triggered at 2230 and still waited hours for retrieval, I negotiated an 8am arrival so that we can be at home with Pob until the nanny arrives.

We put Pob down for her afternoon nap at Granny's house, and are now heading out of the big smoke towards druid country. I am quite nervous about leaving Pob but I know she'll be fine. She'll miss us, but she'll be fine. We'll miss her, but we'll be fine.

What's that story about tortoises and hares again?

I had over an hour at the clinic this morning. First the scan, which showed

• Left: 14, 14, 13, 13, 4<10
• Right: 19, 18, 16, 13, 13, 4<10
• Lining: 10.

So not bad. Heading in the right direction, roughly a mm a day. Which is a bit slow but at least they are doing something.

***

Contrast in doctors' personal styles was observed. The nice doc from last weekend saw me in passing, and said 'Hello Mrs [realname], how are you?' Five minutes later, the doc I saw on Wednesday was the one who called my name for the scan. He called me then went and fiddled with paperwork for a while. Then called me again, while looking straight at me. Then when I pointed out I was standing and waiting he ushered me into the scan room and introduced himself. Which is ok, I guess, better than not doing so if he's not sure he's met me before. But let's just call him Dr Memory for the sake of it, yes?

The whole memory thing was borne out when he ushered me out of the clinic straight after the scan, without remembering to ask I needed more meds. Which I do. Luckily I remembered before I got to the bus stop, so I came back, had to wait around to get someone to give me a prescription, then wait around to get it filled. Luckily in that process I thought to ask if I could do a blood test that Dr Candour has ordered to try and get underneath my blood panel results at the clinic rather than going into town to a specialist lab. They agreed to do it and that saved me a trip, although it did cost me yet another nasty bruise on my arm. Which doesn't look good in short sleeves.

***

Dr Memory left it til 1635 to call me with my instructions for the weekend, which was leaving it a bit late given they close at 1700. The call came 5 minutes after I left a polite but slightly stroppy message, so I do wonder if my paperwork had fallen on the floor somewhere. Anyway, they want me to come in for a scan on Sunday morning. This is not good, as H and I are going away this weekend, without Pob for the first time. A friend is having a rather swanky 40th birthday party at a hotel in the deepest darkest countryside, and we thought we'd have a little jaunt and leave Pob with my mum. Which will be somewhat less fun if we have to get up at 6am on Sunday morning to drive back into town for a scan. I asked if I could come tomorrow, Saturday, instead, just in case that way we can avoid the Sunday scan, and Dr Memory acquiesced. So let's hope they're all clearly growing tomorrow morning - let's say 21, 20, 18 and a bunch of 17s, and then we'll be able to trigger Sunday night and get on with this.

Although to be honest, retrieval on Tuesday and transfer on Thursday will totally bugger up my work week. But that was always going to happen, yes?

Clinics

Why, my dear friend Kay asked, have we gone back to clinic 1, the clinic of Drs Candour and Gorgeous, Shoes and Casual. Only Dr Shoes is on maternity leave, and Dr Casual seems to have flown the nest. Haven't seen Dr Gorgeous either, come to think of it.

Anyway, why clinic 1 instead of top notch best results clinic? Well, because I just didn't like top notch best results clinic (TNBR). They make you wait for hours. They charge you lots and lots of money and then don't give you test results. For example, I still haven't had my immune panel results from them. They kept saying they'd get a doctor to call me and they never did, and every time I called the right person wasn't there. Yet they knew I was pregnant at the time and presumably they should have been practicing decent enough medicine to want me to have the best information to sustain the pregnancy? They called me to tell me 'the doctor really needs to discuss your immune panel results' before they knew I was pregnant, so the sceptic in me thinks the tests show I should have been dosed up with IVIg, which I don't believe in, but when they found out I was pregnant and doing fine, they didn't want to share the results as it makes the test look bad. But I don't know since they won't give me the bloody data.

I have a certain amused connection to them in that it was the doctor who did the day 13 scan on our practice cycle there saying, "there's the follicle ready to go, but don't try and get pregnant this month, you're going to go through lots of tests instead," that encouraged me to go home and jump H's bones, and the rest, as they say, is history, well, Pob actually. So perhaps I owe them that little filip to our conception efforts. But given that we went there because we'd failed at the clinic we liked, and then we showed we could do conception and pregnancy just fine, I don't see any reason to put myself through the stress of a cycle there when we can do it much more easily with a clinic we like and which seems, well, fine. Just fine.

I know, writing this out I sound like an idiot. Why wouldn't we go to the best possible clinic? Perhaps it's related to the fact I don't really believe in IVF for us, but am doing this because it's officially the best way for us to get pregnant. Why do a more painful IVF cycle if I don't think it's going to work? Let's do it with the least pain and get it over with? Perhaps. I would have had a hard time working the last week with the demands that TNBR clinic makes on patients - scans and bloods every morning, lots of waiting around etc etc. I don't need the stress.

Let's see what happens. Hopefully we won't have to go through that painful changing clinics process again. If we fail to get pregnant this time I imagine we should at least consider another move.

Hmm, old lady go slow

Well, the appointment on Monday went well. E2 at 1068 (291 American), follicles at 14, 12, 12, 10, and 5<10 on the right, and 10 and 4<10 on the left - growth of 2-3mm on average since the previous day. This put me about 3 days ahead of where I was on the cycle we did in August/Sept 06 - the last fresh cycle we did. They told me to start the antagonist and come back today, day 8 of stimms, for another scan.

Today's still looks ok, but everything has slowed down somewhat

• Right: 16, 15, 14, 10, 5<10
• Left: 12, 12, 11, 11, 3<10
• Lining: 9.9mm

So it's ok, but not as encouraging. These results would make me just 1 day(ish) ahead of where we were on cycle #3. The doc (another new one) said he thought we might only get three eggs - the three large ones on the right. If we keep on stimming at this new rate, I think we might get more - it's a similar number, and similar size follicles to IVF#3, where we eventually got 14 eggs, although retrieval was on day 16 and we didn't get pregnant, so it's not exactly the cycle I want to emulate in every detail. In any case, I have to return on Friday and we'll see what's happening then. At the earliest, retrieval will be Monday. I kind of hope it is Monday as that will make next week a lot easier with work, but we'll cope with whatever we get.

Oh, and I'm on 300mIU of Puregon, I forgot to mention that previously I think. I'm thinking about self-medicating and upping the dose, maybe to 375 - given this slow-down - what do you all think?

Well, that last post went down like a cup of cold sick, didn't it?

I've read a lot about BlogHer, both this year and the preceding years. I've never wanted to go, not since the first time I heard about it and the focus seemed to be on increasing traffic and making money from your blog. My blog is so far away from being a money-making venture, that the concept of discussing how to make it more commercial seemed utterly alienating. I do this to get my thoughts out there in a constructive way, I do it to be part of a community, I do it to keep in touch with people I love, even though I've never met most of them.

What also put me off was when Julie and Julia went, I think in 2006, and Julie reported back that this was not a happy place for the infertile. Fine, I thought, I'm sure yet again that this is not the place for me. And then there's the whole America-as-the-only-country-on-the-internet blinder which is guaranteed to drive me bananas, so that was the final nail in the coffin.

My impression has been both confirmed and confounded by the reports I've read this year. The American focus? Yes. The unfriendly place for the infertile? Yes, yes and yes again. The perhaps minor but still irritating lack of concern for some substantial minorities attending? Yes (Mel, you may think it's ok not to provide something you could eat in the building, but I don't).

The commercial thing? I'm less sure about. It is not my focus, and just won't be. I have an extremely well-paid job that I'm lucky enough to enjoy. Like most of us, I'd love to write a book someday, but I show no signs of getting on with it. My blog, however much I try to push it, market it, get it linked to by all and sundry, could never be an important source of revenue for me. However, I love the idea that here are a bunch of women, all together, with some shared goals and aspirations, figuring out ways to subvert standard business models and make money in a way that suits them. That I like, that speaks to the feminist in me. So while that focus may not be for me, I can see how it is a good thing.

The thing that has stayed with me, although I'm not sure what, if anything, to do about it, is Cecily's report back from the 'make something of your blog' section about deciding what you're about and sticking to it. Isn't that the critical problem all of us who went through infertility and loss but are now parenting? We were about one thing, now we're about another, although we might dip back into the first from time to time, and we certainly don't feel at home - and aren't connected to - the community on the second topic.

So what do my readers come here for? Yes, for a few people it's about continuing to follow the story. But for some people the story has changed so they aren't interested or can't bear to read the story any more. And right now I'm in the middle of being ultra-unfocused, since in one week I've written about Pob, about an IVF cycle, and about breastfeeding. No wonder no one left a comment yesterday (except Jenn!). it just wasn't what pretty much anyone came here wanting to read, and so no one had anything to add.

What do I do about it? The blog is really for me, although of course I'm also writing an extended letter to all the readers I know about and understand. I want to keep writing about what I want to keep writing about, but I also do want to continue to have a community of people who tell me what they think about what I've written. Should I write separate blogs for separate topics? I don't love that idea because it separates out the story. Should I edit out some topics partially or completely? Perhaps, although that affects the integrity of the story.

There are some obvious things to do to help bolster that sense of community. Keep leaving comments, that helps. Write more regularly, that helps a lot. Get more original content in rather than life updates. That helps but it's hard with limited time.

Or decide that the blog really is for me, and I should let go of needing the validation of the feedback and conversation with readers, and just write what the hell I like.

Hmm.

Don't be so quick to hit 'save' next time

Apologies for those of you who've been eying this page and wondering just how lazy one blogger can get - posting a link with no post. Answer is, obviously, I hit 'save' rather than 'save draft' and forgot about it. Since I saw it show up in my bloglines this morning, perhaps I should just get on and blog about it and save the other pending posts (I'm getting really behind - now got a list that includes: Pob at 10 months, Secondary infertility, progress on this cycle, the trip to the zoo, the naming ceremony. Argh) for another day.

So yes, this article. Apparently breastfeeding promotes the release of a 'trust' hormone - oxytocin - in the mother's brain. Unsurprisingly, perhaps, they don't know what's going on in the baby's brain simultaneously. I would imagine perhaps something similar - although perhaps baby brains have a lot else going on so this may be just one change of many they are experiencing during that period of extraordinary growth and change in the first year, and hence lost in the shuffle.

It's not really a ground-breaking study, nor is it telling us something we didn't really know. But it got me thinking. I wonder what it misses out. Does the same thing happen when someone takes their baby in their arms and lovingly offers them a bottle? Does thinking about your baby while you sit attached to a breast pump have some of the same effect? I know the aim of much of this research - or much of the promotion of this kind of research - is to promote breastfeeding, but what is there out there for those of us who struggled to succeed at breastfeeding, and for whom, therefore, these kind of articles are like a poke in the eye with a large sharp stick? Is there any evidence (I bet there isn't) that women who didn't breastfeed their babies - or didn't breastfeed for long - have weaker attachment to their children? I know the evidence for the health benefits, but I'm less clear that there is evidence to show stronger attachment - after all, how exactly would you measure it without being confounded by a lot of additional factors that are hard to identify and pull out of the data?

Having said that, I am delighted I persevered in my totally insane way with breastfeeding, despite everyone (except some of you, dear ladies in the computer) telling me to give it up as a bad job. The last two months of breastfeeding, where Pob seemed to really know what to do, and where I was less stressed, and where she started to need less from the bottle (perhaps because she started solids around six months), were lovely. Some of the times earlier were lovely too, but they also involved me being chained to the house most of the time, and constantly measuring what I was producing and what she was getting, which was less fun. Not to mention the part where I cried all the time. But despite that, for us it was worth it. Those moments were lovely.

Might I have had those lovely moments with bottle feeding? Yes, I might. And we'll never know what the difference would have been. For us, it was right to persevere. I would do it again if I had the time over again. For others, it might not be right to persevere in the same way, and that's ok. I don't think it means that 'trust' between mother and baby is necessarily less, just perhaps that the way trust is formed might be a bit different. But isn't each relationship between a mother and baby quite unique? Let's bear that in mind when reporting about breastfeeding issues and talking about breastfeeding in general (cue another post about the breastfeeding websites that come up when you're having trouble, and how much like shit they can make you feel if things aren't going well).

Not bad for an old lady

A lovely day for a day five scan. It's sunny and breezy after days of on-again off-again rain and grey skies which yesterday put rather a dampener on Pob's playdate with some other 10 month old babies in the park. I left Pob having breakfast with H and zipped off to the clinic, which is less than 10 minutes away in the early Sunday morning non-traffic.

I only had to wait five minutes or so before a doctor I'd never met before came up to introduce herself and usher me into one of the scan rooms. She was about the most efficient scanner I've come across, and so nice that I had to forgive her for being one of those docs who can't let you look at the screen at the same time. And the good news was that I've got six likely looking follicles on the right, and four slightly smaller on the left. They're all still quite small - around 10mm or so - but worth counting nonetheless. Since the largest one is still only 12mm, I have to go back tomorrow for more scans and bloods to see if I'm ready to start the antagonist.

What a difference lack of suppression makes. Every other time I've had a day 5 scan, they've got all worried and upped my meds. This time things seem to be progressing nicely. Of course half those follicles (or more) could stop growing, or some of them could be egg-less, and of course at least half the eggs are going to be crappy, but this is a decent batch to start off with.

It's Pob's 10 month birthday, and when she wakes up from her nap we are off to the zoo to celebrate and to make the most of the weather. She seems to really love animals so we're hoping she'll enjoy it. And we'll of course get to enjoy her.

For Joss worshippers

There's a new Joss musical in town. Rather funny and the music isn't bad - although not as perfect an event as 'Once more with feeling,' I imagine we should count ourselves lucky to have it.

Never heard of the video software it's using. Do you think they sponsored the whole thing?

Ah well, here we go again

It is ironic, or just sucky, that my period started while I was changing Pob's nappy this morning? Probably just a bit sucky - or rather, not as sucky since here I was, being reminded of the extraordinary blessing that is Pob, at the same time as being reminded that giving Pob a sibling isn't going to be as easy as I had hoped. Thoughts on secondary infertility will be forthcoming when I've got the time to think them through.

I really really really don't want to do this IVF cycle. I'm not convinced that at 41 there's much chance of it being successful - which is silly as I am as hopeful as all get-out every month that we try on our own. My brain is obviously unconvinced by the stats.  Because the stats for previous IVF tries aren't bad - I got pregnant on one out of our three fresh cycles, albeit only for 8 weeks, and on the one and only frozen cycle, albeit for about 5 minutes. This will be the first IVF cycle where I haven't been over-suppressed first, so I'm hoping I might get to stim for less than 15 days - my previous average. I think at my age we should be delighted if we get four or so eggs. But no doubt I'll feel like an under-achiever if it's anything less than 6 - our previous lowest number. And I'm trying not to obsess now about the possibility that we won't get any at all - which has to be a real possibility again given the presumed decrepitness of my ovaries at this point.

The clinic has been called, the drugs are ready to go tomorrow morning, we're back on that particular train. I need to find time to go in and update my hepatitis and HIV status, and should probably book a smear, too, since I haven't had one for three years (three years is the usual timing in the UK). Oh joy!

Thank you Mr Steptoe and Dr Edwards

In 11 days time, Louise Brown will be 30. She has her own son, Cameron, who was conceived spontaneously just over two years ago. She comes across as a nice, thoughtful, sensible and articulate woman, very aware of the role she's played but in no way starry because of it.

We owe a lot to her parents, to Mr Steptoe and Dr Edwards, and I'm sure a lot of unsung nurses, embryologists, researchers and other doctors without whom the good gentlemen would not have been able to treat Mrs Brown, who had blocked fallopian tubes. It's hard with scientific progress to disentangle the multiple threads that come together into the tapestry which is an individual breakthrough, but these articles give you a sense of the long line of clinical and scientific progress without which IVF would not have been possible. I did not previously know that the first IVF pregnancy ended in an ectopic, for example, although I was aware that Mrs Brown's pregnancy resulted from harvesting a single egg, caught just after ovulation, since the drugs to produce controlled ovarian hyperstimulation and to control ovulation were not yet well developed (hyperstim was already in use, just not put together into the edwards/steptoe protocol).

If we think back to all those many pieces of work, the century (at least) of work on human fertility which led to Louise's birth, we can marvel all the more at what's been developed since. The drugs to help us to produce multiple eggs in one go. Agonists, antagonists and recombinant chorionic gonadotropin (hcg) to control when ovulation happens. ICSI. The understanding that many women need progesterone support after artificial induction of ovulation to support a pregnancy. The use of trans-vaginal needle aspiration rather than laparoscopy to retrieve eggs. Laser surgery for endometriosis. Hysteroscopies to remove fibroids. The ability to freeze embryos. The use of estrogen therapy to support frozen cycles. Progesterone suppositories to replace nasty intra-muscular injections. Automatic dispensing pens for FSH rather than having to mix powders. The understanding of the role of blood clotting in recurrent miscarriage. And so on.

It is extraordinarily difficult to deal with the fact that - and oh so much more so to experience - after all that progress there are still some of us for whom the technology doesn't work, and some of us whose infertility has no apparent cause. In the next 30 years I believe many of those situations will be treatable. Probably not all, but more than today. Roll on progress.

Until more of the causes of our infertility are treatable - and until women's fertility is no longer over at 42 or so - thank you for all that progress has already given us. Thank you to Mr Steptoe and Dr Edwards. Thank you to Mr and Mrs Brown. To Louise and to her sister Natalie - the first IVF-conceived woman to bear a child. Thank you to all those couples who participated in early work on IVF, who agreed to be guinea pigs. Thank you to those who agree to be experimented on today - trying new drug protocols, participating in randomised trials. Many of our children would not be here without you. Thank you.

Must write something, anything!

I am really busy. Work is busy. We are having a baby blessing for Pob on Saturday so organising that and the party afterwards which includes 17 children and three babies is keeping me busy. Plus the weather forecast is awful so we've had to run around trying to find a marquee as there isn't room for everyone in the house. I've been to the US and back this week - for a worthwhile meeting but still, it takes time out of the week.

I'm busy hoping against hope I will get pregnant this month and we won't have to do IVF, but pragmatically ordered the drugs I need, which were delivered today. Neither H nor I have told anyone we're doing a cycle, except me telling the internets of course. It somehow seems less of a big deal this time. I'm sure I won't feel that way if it fails, but it feels that way right now. Oh how I am not looking forward to those PIO shots. Not to mention my current travel schedule and how that works with retrieval etc.

Pob is wonderful but after about 2 weeks of sleeping well, she's waking up again around 3, having done a huge poo, and then isn't going back to sleep again after we change her, just lying awake and alternating whining, chatting and crying for several hours. It's not very restful - for us and for her. Hope this is just another tooth coming through and we get some sleep in at some point.

Must go and do stuff.

Bits and pieces of hope

Some interesting articles relating to infertility recently. Here's a digest:

1. Potential for a new kind of pain relief - aromatase inhibitors (those currently used in treating breast cancer) have been shown to be very effective for relief from endometriosis-related pain.

2. PGS does not improve pregnancy rates, or reduce miscarriage rates. The British Fertility Society strongly recommends it is not offered to women unless as part of a defined clinical trial. I think we kinda knew this one - I've certainly seen comments to this effect, but important if your doctor is currently suggesting it.

3. Australian scientists are engaged in a long range study to look at what genes are expressed in blastocysts, and how these vary between blastocysts which turn into live take-home babies, and blastocysts which fail to implant or to turn into embryos which survive through the pregnancy. Very interesting story, which has already identified (no shit Sherlock) that genes involved in cell adhesion, cell communication, and response to stimuli, are all involved. They've also found that up to 20 cells can be removed from the cell lining layer of a blastocyst with no adverse effects. They are aiming to promote single embryo transfer - but arguing that for this to be widely accepted, couples need to have greater faith that SET is likely to work. What I don't quite get is how to transfer this to the clinic setting, as you would presumably have to do the gene amplification within a day so that you could put the blasts back before they start trying to implant. Or perhaps they plan to work backwards so that you could take a cell from a day 3 embryo and test it against their findings.

4. In the realm of "Thalia feels very smug," a finding that many doctors are moving away from ever recommending IUI, and going straight to IVF, which in the long run is often cheaper and less traumatic for couples as it's more likely to work. I've always thought IUI is a waste of time, given how little it improves your chances over trying alone, even with the addition of clomid and/or injectibles. It's also more likely to lead to higher order multiples in the hands of over-eager docs in the US, so a good thing if it's on the decline. Old-fashioned technology.

5. Data that says that IVM may not be the way to go in many instances. Eggs matured in the petri dish have a different pattern of development than those matured in vivo. Which also means that labs should be working to develop culture media that better replicate the ovarian environment.

6. Feed your male partner folic acid. It reduces the level of DNA abnormalities in sperm.