Thalia's fertility journey

Well, aren't we feeling smug as a nation. And a little bit scared

The Olympics have been tremendous fun. I'm not quite sure what we do now as a nation. Ever since Nicole Cooke cycled across the finish line two weeks ago to win Britain's first gold of the Olympics, but particularly since 'Super Saturday' where we won four golds in a day and had our best medal performance in a single day for 100 years, we've been basking in sporting success in a way I can't remember happening since we beat the Aussies in the Rugby World Cup in 2002. Every day, more good news. Being third in the medal table from Super Saturday until about 24 hours before the end when the Russians' stronger performance in track and field just pipped us to the post. For a country of our size, not bad. Although not as good as Jamaica, New Zealand or the Bahamas, who beat us convincingly in the medals/head of population table.

I understand the Americans have been using a different medal table than the rest of the world, one which compares countries on total medals won. We do ok on that one, although we don't beat the Aussies, which is at least part of the point. But it amuses me that the Americans need a table which shows you beating the Chinese, when the Chinese beat the USA so convincingly in the table the rest of the world uses, which starts with how many gold medals have been won, and only in the event of a tie includes silvers and bronzes. Steve Ovett, in one of his commentating chats with Gabby Logan, complained about both tables and suggested one which gave three points for gold, two for silver and one for bronze. Perhaps unsurprisingly, the positions on that one don't change much from the standard world one, so we end up feeling pretty good however you measure it - interested to hear how those from the USA feel about being second in both the 'standard' table and one which ascribes relative values to the different medal classes.

I'm also wondering about the iconic images of this games. Obviously each country will have its own medal heroes, but there are some medal winning events which transcend country patriotism, or at least I hope so. I think the US television deal with Beijing may have affected which images stay in my mind from this Olympics. Because the big piece of the deal involved putting the swimming and gymnastics on in the morning Beijing time, so that US audiences could watch before going to bed, these events were on in the small hours of the morning in Europe. So we only watched them in highlights in the breakfast programmes, or occasionally in full length races in the case of Rebecca Adlington's swims, and perhaps a couple of Michael Phelps's . Or if you were dedicated you could use the BBC's red button service to watch anything in full length if you had the time. But the major broadcasts necessarily showed excerpts.

Since we were on holiday for a week of the games, we therefore missed seeing almost all of the gymnastics apart from the two British medal contenders, and a few highlights of the rest of the competition, and just heard about Michael Phelps from the highlights and the 'Phelpsometer' in the BBC's transmission room. I'm imagining that in the US Phelps will be all over the images from these games, but for us I bet Usain Bolt's runs will stand out more, along with our own medallists, particularly the cyclists, who would have been something like 10th on the medal table all by themselves, and the men's coxless four, coming through to beat the Aussies at the last minute. Not to mention the outstanding opening ceremony.

Particularly heartwarming was the unspoilt nature of some of our athletes. Watching Rebecca Adlington, for example, on the BBC's evening show the day she won her second medal, I realised she really had no idea what she'd done or the level of interest in her story. Gabby Logan asked her if she'd spoken to her parents and she said she'd spoken to her dad but her mobile prepaid card had run out before she could speak to her mum, although she hoped to get a new one the next day. Gabby Logan said gently "you could call her from the BBC's phone, Rebecca," and the swimmer looked chuffed and rather over-awed. It was adorable. Not to mention the Independent's interview with her when she got all excited about maybe being allowed to go on 'Top Gear' and talk to Jeremy Clarkson, and her excitement about owning a pair of Louboutins. You have to warm to a girl like that.

It was great. I, the ultimate un-sporty intellectual, always walking out of the room while my family watched the football, or H watched the Rugby, was completely sucked in. I'm looking forward to sharing the excitement with Pob in 2012 - and I just hope London can make a good showing after the immaculate performance that Beijing put on. Well done, team GB, thanks for a great 16 days.

Sweet people

Thank you everyone. I'm doing ok. Our holiday hotel is not quite what we expected (rather more of a resort than a secluded upmarket beach place, but very nice with it), but we are having a lovely time in the wind and the sun. Pob has charmed everyone in the hotel with many shouts of "Dad DAD dad DAD DAD!" As well as lots of crawling after dangerous or forbidden items, and even more smiling and waving. She's developed a very cute habit of shrugging her shoulders up to her ears and grinning and giggling simultaneously. She does it when she sees her teddy, when she thinks something is funny (not much rhyme or reason to what she thinks is funny), or when we are laughing at her. It's a virtuous cycle.

I am doing ok. I was pretty sad on Monday, sadder than I thought I would be. The thing that really made me cry, however, was having to wait 35 minutes at the clinic for my bloody blood test. Which takes about 90 seconds once someone calls you. It's not as if there were lots of people waiting, just 5 or so in line in front of me when I arrived. And plenty of nurses, just none of them taking blood, for about 25 minutes. Somehow the utter injustice, as well as the stress of trying to get into work early so I could leave early and do Pob's packing before she went to bed, just got to me and I ended up in tears when the nurse who finally called me in then asked me if I had permission to have my blood test on day 13. What was I going to say at that point, no?

Anyway, I knew it would be negative, even while I sort of hoped otherwise. But really, Aurelia aside, my internal instinct, my sensing based on vague symptoms, and the pee sticks, have always been true before, so there's no particular reason to doubt them now. And they were spot on.

What's next? Of course, sod's law, I'm travelling over the days I will probably ovulate this month, so we're unlikely to have another miracle. We'll see Dr Candour on the 28th for a review. The question is whether it's worth doing another fresh cycle given how crappy my eggs turned out to be this time, even while there were a lot of them. H thinks we should give fresh one more try. I dunno, I've lost faith in my eggs somewhat. I've ordered some DHEA, will give that a try and at the very least, we will do a frozen cycle in October - September is just too busy with work for it to be realistic. We're down but we're not out.

Will write more when I get back from holiday. Thank you again for your lovely messages.

Yup, beta=0

For the first time ever, beta of zero. On my first cycle, where I bled at 8dp3dt, it was 8 on 11dp3dt. On my third cycle, it was 2 on 12dp2dt. Today it's zero. I guess there's a first for everything.

Huh. Am not old lady IVF superstar at all. Am just ordinary old lady. Bollocks.

Just a trick of the light

Completely white this morning, not a shadow of a line. A brief chemical perhaps, or just a rubbish test. Less drama this way, I guess its better to be clear.

The answer is unclear

It's been both a lovely weekend and a tough weekend. I was pretty sad yesterday morning, although hanging out with Pob is enough to lift my mood almost entirely, so I was nowhere near where I would have been 2 years ago. We had visitors nearly all weekend, and multiple people in each slot, as this is the last 'free' weekend we have unti the end of September due to holiday, weddings, hen parties, and the birthday parties of all the babies from my antenatal class. We had friends from university and their children. We had my father. We had my mother (not at the same time). We had one of Pob's honorary Gdparents and her daughter. Pob did amazingly well with all these visitors, particularly with the three big girls (5, 5, and 3) who were here today, who all wanted her to do various things with them. She good naturedly let them marshall her around, enticing her into her paddling pool by holding out her teddy in front of her, etc. She was a bit of a star.

The toughness was mostly about the not-pregnancy. Because I was sad on Saturday, and the the friend who stayed on Saturday night tried hard to cheer me up by talking about how great it is to have an only child (she has a five year old and is unlikely to have any more for various reasons, not really by choice but by circumstance). I just am not ready for that conversation. I know if Pob is an only child she will be fine, better than fine, but at the moment I want her to have a sibling for all the reasons I've discussed before.

The odd thing about the weekend is that I kept feeling an ache in my pelvis, with occasional sharp pains around where I imagine my ovaries are. I decided it was just my incipient period, althogh surprised as the gestone usually keeps it well at bay. On my way to bed just now, I decided to pee on another stick, just for the hell of it. It was white.

Then I brushed my teeth, washed my face. Took about 5 minutes, say.

And then, as you do, I looked at the stick again, and saw maybe a shadow of a very faint line. So faint that I'm sure H couldn't see it, unused as he is to peering at these things. So faint that I'm not convinced it's there. So faint that I had to hold up a positive from when I was pregnant with Pob (yes I have the sticks stacked in a drawer in our bathroom, so what?), to make sure the line i thought I was seeing was where a positive line would be should there be one. Sadly the blank one from yesterday has long since been thrown in the dustbin, and I'm not desperate enough to go searching for it to do a comparison.

So here's the story. It may be, possibly (because it could also be an evap line), that I am a little bit pregnant. A little bit. These FRERs measure something between 6.3 and 25mIU/ml of beta-hcg, depending on which site you read. If I'm pregnant to the tune of 6.3mIU on 9dp3dt, well, let's face it, chances are this will drag on for a few days and then crash and burn. In fact, it's eerily similar to the FET, where i had a positive on a peestick on about the same day, only I didn't even realise it until after the beta came back at 70mIU. And then it stayed at 70mIU. And then I'd had my first chemical pregnancy.

And it still may not be a real line.

Mindfuck.

Beta in the morning. Flights on Tuesday morning to Ireland. Who knows?

I'd like to think of a clever title

This morning H's bloody alarm went off at 6am. That was not helpful. I lay there for 10 minutes, trying to get back to sleep, while he drifted off again. At 610 Pob started her morning chat. If we leave her she often goes back down until about 7, so I lay there listening to her for a while, then gave up, grabbed the monitor, and came downstairs. I went to the loo, then started cleaning. I poured the water for Pob's bottle. I washed up the two bottles from yesterday afternoon and night. I washed up the pans and dishes left in the sink. I washed up her water cups. I emptied the dishwasher. I put the coffee on.

In between each task, in the space around the full stops so to write, I examined the peestick I'd laid out on its instructions. Not that I need the instructions you know, just so as to keep it off the kitchen counter. The last time I had a peestick on the kitchen counter it was already saying 'pregnant', but that was 19 months ago. This one stayed snowy white. It's still snowy white. As I suspected, not pregnant.

It's 8dp3dt so it's possible it's too early. But not convincingly. I've been pregnant three times. The first time I got a positive at 10dp2dt, a clear strong no-doubt-about-it positive, which means it would almost certainly have been positive the day before. My beta on 12dp2dt was 251 and doubled beautifully. At six weeks the embryo had no heartbeat, and at 8 weeks I had an ERPC.

The second time I was pregnant my test at 10dp2dfet was equivocally positive. I didn't notice the positive at the time, only when I re-examined it after my positive but low beta at 12dp2dfet of 70. That pregnancy never went anywhere.

The third time I tested on the evening of approximately 13dpo, and it was clearly, strongly, positive. A beta at 15dpo came back in the 250s. That was Pob.

So you see, a negative at this stage is either a clear negative, much more likely with my crappy embryos, or a weak positive which won't go anywhere. Sadly Kath and I don't get to do it again together. It hasn't worked.

Yet another study showing IUI doesn't help

After the last time I posted about this, a lot of you commented about how IUI had been the right treatment for you, and how at least it was affordable in the US, unlike IVF for many people. Also, a couple of you had diagnoses where IUI was the appropriate treatment - medium-level sperm issues, a lack of cervical mucous, etc. I am fairly sure that this study excludes those factors so read on.

A study published today shows that for those with UNEXPLAINED infertility, treatment with either IUI or clomid had no discernable effect. The doctor on the BBC news this morning pointed out that if you aren't ovulating, then clomid is an appropriate treatment. If you are, it has no effect on your chances of becoming pregnant. Here are the details:

In the six-month study, participants had all suffered unexplained fertility problems for more than two years.

Overall, 101 women ended up having a successful pregnancy.

Of those who tried to conceive naturally, 17% became pregnant and gave birth to a live baby.

For clomid, the birth rate was 14%, and insemination 23% - not significantly different from the chances of success with no intervention.

However, the women undergoing active treatment were more reassured.

The last sentence tells you why doctors keep on prescribing clomid and IUI when they are not specifically indicated. It's very hard to tell a patient to go away and do nothing, or that they are better off with IVF when, in most places in the UK, the local health authority will have a 2-3 year waiting list for IVF and lots of restrictions about who can be enrolled on the list. Or in the US because the patient may not be able or willing to take on the huge cost of IVF before they've "tried everything," or at all.

I'd like to look at the statistics for countries like Israel, where IVF is readily available and paid for by the state. Do more couples go straight to IVF, bypassing these intermediate and less effective treatments?

The thing to be careful about is asserting - IUI is the right treatment because it worked for me. This study shows that you are just as likely to have become pregnant by being sent away to keep going for six months as you are to have conceived with IUI, even if you've already been trying with no success for two years before that. It's just a probability game, and you happened to have hit the one month with IUI when you most likely would have achieved pregnancy without it. However, this is only true if you have unexplained infertility, not if you have a specific condition where IUI can help.

It makes sense if you say - I couldn't bear doing nothing any more, and IUI was the affordable option. That's a personal choice, not about the statistics. It's of course fine to say, we couldn't afford IVF so we went for IUI, but it actually is probably not a good use of your money - you could have saved the money you spent on IUI and spent it on something unrelated to fertility treatment.

Clomid is a bit of a different story - most people hate taking it and it can actively inhibit fertility by drying up cervical mucous. If you are ovulating, it really really should not be given to you. It's just a nonsense treatment.

So the point here is that the numbers by no means tell the whole story. They don't tell the story of how bloody miserable it is to try every month to no avail. At least by taking clomid or doing an IUI you feel like you are taking action to deal with this horrible problem. They also don't tell the story of the money flows in infertility - the intense rationing of IVF in the UK, the extraordinary cost for those in the US whose insurance doesn't cover IVF. Numbers are powerful but not omnipotent. Everyone has to make the decision that's right for them. I just wish the doctors and the insurance companies and the NHS would review their standard procedures and at least start having these conversations with people.

Is the pain valuable?

About 12 years ago, my friend Girl Detective and I went to see a Chinese film at the Ritz Cinema in Philadelphia. I can't remember what it was now, perhaps 'Raise the red lantern'? We came out profoundly depressed, and agreed with each other on the way home that we didn't need to be that depressed by Art. We could go through the rest of our lives as good, caring, responsible citizens while avoiding other similar works of Art that were likely to upset us. I've mostly stuck by this decision.

Except with the news. H is very keen on watching the news, and so we often have it on in the evening while I'm catching up with work on the sofa. Mostly I'm fine with it on, but occasionally a story gets me angry or upset. Angry about the situation in Zimbabwe, for example, or desperately upset about the incipient famine in East Africa. I wear my emotions very close to the surface, I always have, and I find it hard to switch off when something touches me.

But worse than what I see on Channel 4 every evening, are the three stories I've read recently on the internet. I'm not going to link to them now because I don't want to inflict the pain on all of you, and I know the temptation to click is hard to resist. All three are stories of terrible things happening to children. In the first two examples, because their parents, otherwise entirely caring and loving, didn't realise the child was in their care rather than the other parent's. In the third case an extraordinary neglect case. The first two happened in Italy, the last in the USA.

The point here is not what happened to those children, although it's appalling and horrible, but what I choose to do to myself. I know that I am going to carry the awful knowledge, the awful pain of those stories around with me for weeks, if not months. The images of what it must have been like for those children rise to the surface, unbidden, at regular but unpredictable intervals. I'm left wondering two things about myself. First, why did I click through when I knew it would upset me? Second, do I have to know about these things? Would it be ok if I just closed my eyes and let those stories pass by me?

It's a tough one for me. I want to know about the holocaust, for example. I think it's important that everyone knows it happened, some of why it happened, what we might do to prevent it happening again. Everyone in the world should know. I think the world should be aware of what's happening in Zimbabwe, be aware of the extraordinary events that are commonplace there - a man's wife being murdered because he dared stand for election, for example. Not to mention the other places in the world where awful things are happening right now.

So where do I draw the line? Is it enough to know that child abuse happens, awful accidents happen to children when their parents aren't paying attention? To know in the theoretical sense and not have to know the details? Or is it important to know the details of the stories, to let them haunt me because in doing so I...what? Decrease the chances of it happening again? What impact can I have on similar stories? I'm not a social worker, or a child care worker, or a charity worker who might fund the right programme.

I don't know. It's messy. I have to know these things exist, I have to have empathy for those children, but do I have to carry those stories with me - to honour the children concerned, at least in memory? Does that help?

                                             ***

6dp3dt - none of the cramps and pullings I've had before when I've been pregnant, except for one sharp one yesterday. Resisted peeing on a stick this morning because I only had two expired ones, one digital and one cross-type, the latter being notoriously hard to read, and the former being unsatisfactory in the peering and twisting activities. Torn between hoping and being pretty sure that one doesn't get that lucky twice in one's life.

The ridiculousness of planning

H and I are not very good at holidays. When we take them, they're usually great, but we are in the extremely lucky position of having plenty of choice, and this perplexes us. We discuss all the possibilities, feel overwhelmed, then decide to think about it, and meanwhile I'm getting booked up at work and tickets are getting more expensive. When we were in the middle of primary infertility, this confusion was compounded by not knowing when the next cycle would be, when the blood test would be, whether or not I'd be pregnant. We didn't take many holidays while we were trying to get pregnant with Pob, and one of them in particular was crap.

Things should be easier now, but we don't seem to have become any more decisive. Of course now we have a bunch of restrictions on what we (mostly I) think is a good holiday choice. Italy - superb choice. Fairly reliably good weather, people love babies, delicious food, fascinating things to see. What's not to like. H? Not so keen. We went there, you see, so now he wants to be off to one of the 1000 places to see before he dies. Like Victoria Falls (malaria), the Masai Mara (malaria), the Pyramids (bloody hot), Bali (20 hours on a plane with a baby, are you kidding me? Not to mention the 11 hour time difference), New Zealand (see above). Or he wants to go out into the wilderness and do some serious fishing and hiking and mountain climbing. While Pob and I stay at the hotel I think - not that he doesn't want to spend time with us, it's just that his hunting/shooting/fishing fantasy doesn't really have passengers - or shouty babies - in it.

I suggested a range of options. Mountain walking in Austria. Friends in Vermont or Cape Cod. Northern England, Italy (see above), Portugal, Madeira, a bigger holiday later in the year. None of them seemed to bite. Eventually we were down to a week when we could be away given work commitments I'd stupidly agreed to (covering for colleagues who are better than we are at carving out holiday). So we decided to pull our fingers out and book something. We settled on a week at a nice hotel near Cork, with good facilities, overlooking a beautiful beach, etc.

The only challenge? It would involve flying off on 12 August, the day of my scheduled beta. Now you know I will POAS before that, so I'll know what the story is, but I need to have that blood test for my own sanity and for the clinic to prescribe me any follow-up meds I might be lucky enough to need. So I suggested to Dr Not My Favourite on Friday that I could come in the day before. He initially told me this wasn't possible, but eventually said it was ok to have the test that day he supposed (let's face it, whether I'm pregnant or not, a beta on day 13 is going to be perfectly clear). However, he told me he would not advise flying in early pregnancy (should we be so lucky).

This seemed odd given the fact I've flown plenty in pregnancy before, and Dr Candour has never seemed concerned, although he did gently dissuade me from going to California when I was 5 weeks pregnant with Pob. But Ireland and California are not really comparable journeys. So I followed my usual strategy and emailed Dr Candour, who just replied to say he thought a day 13 blood test was fine, and Ireland was fine, although if we got a low positive we might have to change plans so that I stayed near a hospital in case it was an ectopic.

So that's ok then.

What I hadn't really considered is my addiction to betas. Although my clinic, like most in the UK, doesn't usually do repeat betas, Dr Candour has always pandered to me and allowed me to come in whenever I want for a follow-up. If we go away for a week, that's not going to be so feasible.

But this is all ridiculous, because the chances are that I won't be pregnant so all of this will be moot, and I"ll feel really silly about this post. And that's the ridiculousness of planning. We have to plan for these eventualities, no matter how silly they turn out to be. But this time we won't let that need to plan defeat us. We're booking the hotel and the flights tomorrow. We'll see if there's a problem when that problem shows up.

Optimistic? Sort of

I have three embryos on board. Yes, that's three. Which is pretty much impossible in the UK if you are under 40, which I'm not, and hard even if you're over 40, which I am. But we were confronted with the scenario this morning of three good embryos, two six cell and one five cell, and two average embryos, both 6 cell, and two embryos which gave up the ghost at 2 cells, although one was still hanging in there. This made me ask the question about whether it was worth transferring all three good embryos to give us the best chance at a (singleton) pregnancy.

H was against transferring three. I came to the idea after hearing about how this crop of embryos had done overnight. It is the poorest crop of embryos we've ever had. Trransfer previously has been of 'excellent' embryos - 8 cells at day 3 or 4 cells at day 2, and I've been pregnant twice, both times unsuccessfully, with those better embryos. So I felt we had the best chance of getting pregnant with three. Pregnant with a singleton, at best. So I asked about three, the embryologist checked with Dr Candour, who ok-ed it. And I figure if he ok-ed it, he's pretty sure our chances of triplets or even twins are close to zero.

All this took a long time and I was glad I'd paced myself with the water drinking. Last time I was about ready to explode before transfer. This time bladder was full, but bearable. The same doc did the transfer as did our last transfer. I think they got him up specially to do me as I had a long wait on the table, so I think I should be flattered. But I'd rather have someone else. He's very kind, but has hurt me more than any other doctor at transfer. So it was uncomfortable, even a bit painful, but ok - better than the last time, anyway.

I had to get myself home in a taxi as H rushed off after transfer to take Pob to Gymboree. I went to M&S and bought yummy strawberries and cherries*, came home and sat on the sofa all afternoon watching episodes of ER and reading blogs. It wasn't a bad afternoon, as they go. And when Pob got home she was delighted to see me and told me all about her day. At least that's what I think she was saying.

Thank you so much for all the good wishes. I read many of them while in various positions in the clinic today, it meant a lot to me to have all of your support again.

* I know many of you are put on bedrest by your clincs after transfer, but honestly I've looked at the evidence and it's nonsense. The only sensible study I could find found that women who took a normal level of activity after transfer had higher clinical pregnancy rates than those who went on bedrest. So though I did take it easy and did feel a bit crampy on and off, I feel fine about having had a wander this afternoon.