There was a bit of a muddle at the hospital so we didn’t get our full, all singing, all dancing, 20 week scan, complete with bells, whistles and measurements… but there is now one definitely booked in for next week. In the meantime though, they had a quick peek just to let us know that, (in a general, non-committal, capacity), everything is progressing as it should. Sometimes pictures speak louder than words and this I think is one of those times…
Hello my darling babies, I realised last night that I hadn't yet told you about a very special part of your story; our beautiful, breathless, whirlwind of a wedding day - organised in a fortnight and sealed with rings of surgical steel... wearing a £30, second hand, dress from eBay and serving our long-suffering guests nothing but a glass or two of bubbles. Having booked ourselves in for IVF we discovered that most European clinics require a marriage certificate, so plans for a decadent wedding went out of the window and in their place we had a real life fairy-tale. We didn't even have a photographer but one of your Daddy's dearest friends, Andrew Cawley, who happens to be a very successful professional photographer, took it upon himself to spontaneously capture the magic; a gift for which we are eternally grateful. It was the happiest day of my life - until we found out that we were pregnant with you and I saw your Daddy's face - and then that was the happiest day of my life... how did I get so lucky? I love you all so very, very much.
This is the poem that your Grumpa read at the ceremony. It was written by your Mummy, for your Daddy, about a year after we met. To this day the framed handwritten first draft sits on his bedside table.
Gentle, humble, generous,
Could I only be,
Thoughtful, kind and caring,
As you are to me.
To live by your example,
Admiration knows no bounds,
To follow in your footsteps,
Where contentment can be found.
You are my inspiration,
Living is worthwhile,
A scholar to your lessons,
Life is less a trial.
I would not be without you,
For the moon, the stars, the sun;
You are my soul equation,
One and one is one.
It has taken a while but my body finally seems to be getting used to our two little toxwins! I don't feel amazing but I am so, so much better than I was - the difference is night and day! After my fifth hospital admission for IV I wrote a letter to my GP asking to be referred to a different hospital and sent another letter to the lead midwife at the Southern General documenting my reasons for requesting the transfer. It wasn't a complaints' letter so much as an appeal to the senior members of the maternity team to prioritise a reassessment of their hyperemesis policies in the light of nationwide advances in the treatment being made available to sufferers. I explained that in late 2013 a leading obstetrics consultant from Ayrshire, Dr Marjorey MacLean, successfully petitioned the Scottish government for a change in hospital policy regarding hyperemesis and a legally binding commitment has now been made to institute a mandatory minimum of one hyperemesis specialist in every maternity unit in Scotland - as well as setting up a Scottish information and support network for sufferers and their carers. The legislation has not yet been processed, (this will probably take a couple of years), but it is coming. I detailed some of the facts and figures associated with the condition, including the high incidence of therapeutic terminations and the long term implications of PTSD. I pointed out that while there is only one British charity seeking to raise the profile of the condition, it was now attracting support from well-regarded public personalities who had suffered hyperemesis and were so dismayed by the lack of treatment available that they have made it part of their life's mission to effect a change. I suggested that rather than play catch up post-legislation that Glasgow's leading maternity hospital should follow Ayrshire's lead by pre-empting the new guidelines and opening an outpatient clinic where sufferers could come on a daily/weekly/as and when necessary basis for IV and that this would not only put them in line with the most forward thinking and compassionate practitioners in the country but it would simultaneously cut the cost of inpatient treatment, ease unnecessary suffering and potentially save the lives of countless unborn babies. Of course, I didn't expect a positive response or even a response at all, but I felt that I had to do something to try and help the women who will suffer in my wake and, as an un-empowered minion of the state, a letter was the only weapon in my arsenal. Imagine my surprise when, yesterday, I received a reply, that was not only apologetic in tenor but included the following commitment: 'In conjunction with one of our consultants we are now looking to set up a process whereby women can come in at day time and be replenished of fluids with a hope of a return home later that same day.' I am so proud - the toxwins have taken their first ever stand for a more fair, equitable world from the womb and they have had a small but immensely worthy degree of success! Go the toxwins! (Their sneaky Mummy has furnished Dr Marjorey MacLean from Ayrshire - the driving force in Scotland for change - with a copy of this commitment and a suggestion that her expertise regarding the condition, in conjunction with her experience of setting up outpatient facilities in her area, may be of invaluable assistance to the Southern General at this time - I have passed on the particulars of the person who made the pledge so that Dr MacLean can offer her services as a mentor... exerting clout by proxy 101). So, moving swiftly past my 6th hospital admission two days ago for a frighteningly painful bowel impaction, (brought on by prolonged dehydration), and leaving aside the matter of my 3rd urinary tract infection, what is it like to harbour the toxwins in their 19th week? They will be 5 months old, (20 weeks), on Sunday and since the majority of twins are born by week 37 and the remainder induced by week 38, (because the placenta starts to fail thereafter and this can lead to terrible complications including still birth), we are officially a minimum of half way through! Isn't that crazy?! My experience thus far hasn't been entirely typical so I was very excited, last night, to have itchy feet and painful indigestion - I was so proud of my 'normal' pregnancy complaints that Archie couldn't help but laugh and it was lovely. It was a laugh, full of affection, that said 'I remember this kooky, nut bag - she's the woman I married' - and it made me realise how dreadful it has been for him to watch me this past 4 1/2 months. Forget the fact that his workload has gone through the roof, (12hr night and day shifts, accepting every offer of overtime to pay off the IVF, cooking, doing the laundry, the dishes, shopping, walking the dog, spending every second week sitting by a hospital bed... and having to constantly reassure me that the torment will end and the babies will be OK), he has also been helpless... and helplessness, in the face of watching someone you love suffer, is about as close to that suffering as a person can get. To those of you who have been following this blog, it will come as no surprise that he has taken it all in his considerable stride - but just because something ceases to surprise doesn't make it any the less amazing. Hyperemesis has taken me to some unimaginably dark places and brought me to the brink of thoughts that, thanks to Archie, I never voiced or actioned - he believed I could survive, so I found a way to be the woman he believed I could be. It would seem that being loved by someone you respect and adore gifts you unimaginable strength - letting him down wasn't an option but, if he hadn't loved me and if I didn't thrive on that love, things could have been very different. Me and the toxwins have a lot be grateful for... (and just in case you're about to puke over the sickly sweet perfection of it all, some of this insight was garnered in the pursuit of screaming meaningless profanities at one another while I writhed in a pool of snot and vomit on the bathroom floor trying to rip my own head off... the devil is in the detail - but to the bigger picture, the spoils). As one of the luckier hyperemesis sufferers I have been able to tolerate very dry solids like toast, crackers and biscuits from about week 8 or 9 which means that I haven't been starving, just horribly dehydrated. In fact, since my pre-pregnancy diet was a super healthy feast of fruit, veg, soup and yoghurt - and for the past two months I have only been able to eat carbohydrates - I feel positively roly poly by comparison. Of course, I am now also harbouring two five month old babies, not to mention a bust that is just that, fit to bust - I don't look like a cartoon character so much as a caricature of a cartoon character. For some women bigger breasts are probably an advantage of pregnancy - me, I have all the appeal of a badly designed buoyancy aid. I have never had a singleton pregnancy, so I have no way of comparing how it feels to carry two rather than one but I'm pretty full - from hip to hip and up to my rib cage there's nothing but baby. I've read that twins play with each other in the womb, poking one another through the placentas and squabbling over whose foot is in whose ear - I like to think that they're friends already. I am desperate to see them at our 20 week scan on Thursday - I want to know that they're OK - I sometimes feel like I've let them down by providing such a lousy, dehydrated environment, riddled with infection and impaction - but I take heart from what I've read about the parasitically resilient qualities of babies in the womb. Both placentas are anterior, meaning that they are fixed to the front of my womb rather than the back, which has the effect of cushioning the babies' movement. This is neither unusual nor problematic, it just means that I'm not getting a lot by way of reassurance from being able to feel them - in fact it is debatable whether I have felt them yet at all. I will try and post again after our scan on Thursday, (when I will hopefully be able to report that the toxwins are in tip top working order). All being well I will soon go from being 'much improved' to 'better' and then I will have to rename them again - from the 'maybe babies' to the 'toxwins' - can Mummy possibly keep pace with the creative demands?
This post may not be the most coherent because I am still very poorly... and it will likely be disjointed because I only get infrequent periods where I can manage to type - so please forgive the shoddy workmanship. Part of me is reluctant to even try to account for the past two and a half months because I doubt that I have, (or ever will have), the capacity to meaningfully communicate the horror of hyperemesis gravidarum. I also have a visceral dread of provoking any kind of comment, well-meant or otherwise, which purposefully or unintentionally undermines or minimises the magnitude of this God-awful condition. I haven't spoken to, visited, been visited by, texted or emailed even my closest friends for weeks because I have been too sick to use my phone, let alone leave the house. I have never experienced anything like this in my life. When the nausea started I assumed I had 'morning sickness' - a woefully misleading moniker which the medical profession and relevant literature are striving to re-label as NVP, (Nausea and Vomiting in Pregnancy). NVP can occur any time during the day or night and is experienced to a greater or lesser degree by up to 70-80% of pregnant women. At the milder end of the spectrum some women suffer the occasional bout of temperate nausea, lasting for an hour or two, that may or may not culminate in an episode of vomiting. The further along the spectrum a woman is, the more frequent, more intense, more prolonged and more regular the bouts of nausea become, until, at the far end of the spectrum, it is defined as 'hyperemesis gravidarum' - which amounts to being relentlessly and debilitatingly nauseous 24/7, with some women vomiting up to 40 times a day. Thankfully I have never reached the heady heights of spewing 40 times a day - I can't even begin to imagine the distress and agony this must cause. By this stage it is not uncommon for a woman's oesophagus to be torn and for her stomach bile to be co-mingling with blood as it burns it's way up her ravaged throat while she clings hopelessly to the toilet bowl and wishes she could die. If, like me, you are fortunate enough to only be vomiting between 5 and 10 times a day your problem will be that, because of the relentless nausea you are unable to bring yourself to drink, since drinking makes you feel like you have been poisoned with antifreeze. If I tell you that the anti-nausea tablets, (anti-emetics), prescribed for this condition are the same ones given to people who are undergoing chemotherapy/radiotherapy for cancer treatment perhaps you can begin to understand the degree of nausea we're talking about - this is not, 'I feel sick but I can manage to potter about and get a few things done' - depending on your walk of life this is the nausea of your first bout of alcohol poisoning, your worst whitey, your most awful episode of food poisoning, your first experience of seasickness - this is 'lie on the floor in a darkened room, moaning and praying for mercy to the God that you don't believe in' nausea. This is nausea, that, unlike a hangover or food poisoning, doesn't go away after eight hours, or two days, or four days or even a week. Can you imagine feeling as sick as you did that day, every day, with no end in sight, for months? Because that's part of the problem - the cause of the condition is not fully understood but what is known is that, unlike mild to moderate NVP, which can be relied upon to go away at about 12 weeks, hyperemesis gravidarum is unlikely to go away before 16 weeks, more likely at 20 weeks but, in some horrendous cases, lasts the whole pregnancy. The fact that sufferers cannot pin point a guaranteed end to the trauma compounds the devastating nature of the condition; especially as so many well-meaning but misinformed bystanders propagate the myth that the suffering will end at 12 weeks, (which is the worst kind of false hope that you can give someone going through this kind of misery). That and telling them to eat ginger... I now have a pathological fear of ginger and will never willingly eat it again, just hearing the word is enough to make me wretch. Telling a person who has hyperemesis to eat ginger is like patching up a cesarean with a bandaid. So, what help is available? Well, this is where the tragedy is compounded by ignorance and inconsistency. The first line of defence is anti-emetics - drugs which are designed to minimise the suffering of chemotherapy patients. These drugs have not been tested on pregnant women because NO testing is ever conducted on pregnant women so there are NO studies confirming that any of them are 100% safe. Bearing in mind that, before you get pregnant, you will be advised to refrain from ingesting any and all medication that is not absolutely necessary for your survival, it is amazing how quickly, in the face of hyperemesis, the doctors I encountered started pushing anti-emetics. I have since worked out that this is because the only effective alternative is an IV drip and, since, in the UK, these can only be administered in a hospital setting, it is far more expensive to give someone an IV than it is to give them drugs. The drugs are not anecdotally renowned for being particularly effective - in the case of relentless vomiting they can minimise the number of episodes but they do little or nothing to alleviate the actual feeling of being nauseous/poisoned. So while they can help you keep down what you've put down, they can't help you feel well enough to drink in the first place. If you are unwilling to take the anti-emetics then, in Glasgow, you will be treated like a leper. In other parts of the country there are dedicated clinics set up for hyperemesis suffers where women can attend as out-patients and receive IV top ups every day/few days, until the condition passes, but this enlightened effort to 'prevent' suffering rather than only offering IV fluid as a temporary 'cure', when a person is so dehydrated that their body has started producing poisons known as ketones, (and doctors are legally obliged to admit them into hospital and treat them with IV), is only for the fortunate few, living in more humane postcodes. In America, it is normal practice for hyperemesis suffers to have IV drips set up in their own homes and to use them for the duration of the illness. So, why am I unwilling to take the anti-emetics? Well, it's certainly not because I am on a crusade, or have any desire to influence or imply that anyone, other than me, should be guided by my own judgement. People arrive at the conclusions they come to because of a complex mix of factors which are entirely relevant in the context of their own life and may have absolutely no bearing when it comes to someone else's life. I don't care what other people do in their pregnancies, I have no opinion regarding their choices, I have no desire to sit in judgement on anyone and, in turn, I feel that I should be afforded the same courtesy. I grew up in a household where my mother didn't allow for my sister or I to receive the MMR vaccination because of the risk of autism, (not a decision I would necessarily emulate, since so much more is now known and understood regarding the condition and we are all more informed regarding the risks posed to other people's children by NOT vaccinating our own - but a decision that I would have sympathised with at the time), and I have a sister who has produced 3 beautiful, healthy, bouncing baby girls on nothing but a hypno-birthing course and fresh air. So I have familial benchmarks, just like everyone else and, just like everyone else, I am swayed by their weight. I am also carrying IVF/ICSI babies who have a higher risk of congenital defect simply because of the manner in which they were conceived, in addition, they are twins which heightens the aforementioned risk further and to top it all off, I am 35 which also increases their vulnerability. Add to this the fact that, despite being told by various doctors that these drugs are perfectly safe, I know for a fact, through my research, that at least one of the drugs that British doctors are currently prescribing, (ondansetron - known in America as Zofran), was recently, (September 2013), the subject of a warning issued by the American FDA declaring it unsafe to prescribe during pregnancy since it has now been linked to a higher incidence of cleft palate and congenital heart deformities - which makes me question the currency of the information I am being given. I doubt that any individual doctor is seeking to purposefully mislead the pregnant women in their care but I also doubt that everyone in the field is up to date with their reading. I am also aware that, since no testing is done on pregnant women, all the drugs that are considered safe are only considered safe because no one has spotted any patterns between taking that particular drug and low birth weight/a particular deformity etc. They will remain 'safe' until such a pattern emerges, (which may take years since no one is actually looking for a pattern). I don't tell you these reasons because I think anyone else should embrace them, as I've said before, I am perfectly happy for other people to tread a different path and I don't think that anyone is making superior choices - what I do know is that, if there's one time in your life when you have to do what you think is right, pregnancy is that time. It's finite and irreversible and the only person who is going to persecute you if something goes wrong is yourself - so what earthly choice do have but to follow your instinct? Hyperemesis occurs in 1-2% of pregnancies; if you are having multiples your risk is increased because, (although they're not sure exactly how), they are fairly sure that it is in some way linked to increased hormones - and obviously, if you're having two or three babies the hormones in your system are doubled or tripled. Last year there were 813,200 births in the UK in total - up to 2% of those would have involved hyperemesis, (16,264). 15% of women suffering from hyperemesis terminate their pregnancies - so, last year, up to 2,500 'wanted' pregnancies were terminated. That's easy to read and dismiss but, just think about it for a moment - even if you do 75% of those poor, tormented women the disservice of blaming a lack of 'backbone', 'moral fibre', 'character', 'fortitude' or try to rationalise that they were suffering from some sort of attention seeking/hysterical psychosis, there is no way that you can possibly write them ALL off as irrational or unbalanced - which means that you're faced with the prospect of imagining just how horrendously, physically sick a rational, sensitive, loving, would-be mother would have to feel to abort her baby. On an intellectual level doctors are aware that this is a horrific condition because they prescribe the same drugs that they give to people who are being poisoned by exposure to radiation. On a therapeutic level, however, they choose to ignore it until the woman's body is literally shutting down because they know that, unlike a person with cancer, she won't die as long as she is rehydrated at the 11th hour and, in this case, prevention is more expensive than offering a short term fix as infrequently as possible. I have been in hospital 4 times so far for IV fluids - and, each time, I have been relentlessly pressured to take anti-emetics. Thankfully, Archie has been sufficiently appalled by the lack of care, which verges, at times, on bullying, that, despite being the least confrontational person in the world, he has stepped in to fight my corner at a time when I have been far too sick to stand up for myself. I am still horribly unwell every day but at 14 weeks and 4 days I am now a veteran - and although I often wake up crying because I am terrified to face another day of feeling so ill I know that I am luckier than some - as I said, it is a spectrum and there are women out there coping with much worse than me. In a crazy twist of fate, the fact that I have battled severe uni-polar depression for most of my adult life, has actually stood me in good stead - most women suffering from hyperemesis are eventually told that the condition has caused depression, which is no doubt a terrifying diagnosis for a women who has never been depressed and has heard all the horror stories about how ante-natal depression can result in post-natal depression and how post-natal depression can result in being a less than capable mum. I, however, have a distinct advantage - I know that real depression is not linked to circumstance - real depression is when, despite everything in your life being fine, you can't scrape your mood off of the floor... women with hyperemesis aren't depressed - they're miserable for a VERY good reason. If you'd been this sick for this long you'd be miserable too - in fact, you'd have to be mentally ill, of the sadomasochistic variety, to get through this with a smile on your face. That is not to say that these women don't need counselling to help them cope with the despair but there's no need to compound their misery by suggesting that it's a disproportionate reaction to the circumstances and they've somehow lost their mind into the bargain. I am not going to write about hyperemesis again in any detail because this blog is about a miracle not a tragedy and I am not going to write about my beautiful babies in the same post as I write about this filthy sickness - which means that there probably won't be any further blog entries until I am better, (please let that be sooner rather than later). As I mentioned before, I considered not writing about hyperemesis at all, such is my fear of receiving insensitive feedback - a lot of hyperemesis sufferers develop PTSD when the condition alleviates and many of them are so frightened of the sickness that they never have another baby - but I decided that I owed it to the other women who are suffering now and will continue to suffer to do my bit to raise the profile of the condition. It is an absolute travesty that hyperemesis sufferers are made to feel so helpless and hopeless that over a thousand women terminate their pregnancies every year for the want of IV fluids and a little bit of compassion... a sad and shameful indictment on 21st century Britain. If you want to find out more about hyperemesis there are two websites with information on the condition, including detailed accounts written by survivors - www.prenancysicknesssupport.org.uk www.helpher.org
Archie and I originally had a booking appointment scheduled for Monday but we found ourselves in hospital over the weekend. The combination of OHSS nausea and 'morning', (all day!), sickness eventually took it's toll and after 4 days of struggling to drink it became apparent that I would need some assistance. When we arrived at Accident and Emergency my blood pressure and blood sugar were so low that they wouldn't let me go to the toilet on my own in case I staged an unsupervised collapse. They were pretty unfamiliar with OHSS but the prominent lump that is now my right ovary was sufficiently compelling to warrant calling a specialist down from gynaecology who referred me to the relevant ward in a different hospital. Unfortunately, since I'd been plugged into a catheter and an IV, (and because it's hospital policy), I needed to be transferred by ambulance - this was unfortunate because ambulances are in particularly high demand at the weekend. So, at 2.30am, after 11 hours on a trolley, I was wheeled up to a surgical ward to try and get a few hours sleep - the ambulance didn't become available until 9.30am 12 & 1/2hrs after it had been ordered and 17 & 1/2hrs after I'd arrived. Believe it or not, I am actually a massive fan of the NHS - I don't want to see it privatised; I would like it to be more efficient but I understand that this can only derive from better funding and a genuine commitment from the government to improve rather than marginalise the service. Imagine the plethora of jobs that could be created if we were to refurbish our hospitals with all the up to date administrative/medical equipment, facilities and staff they really need. Anyway, I think all the doctors and nurses expected me to create a massive stink about being kept waiting for so long - which, of course, I didn't - people who are subject to externally imposed parameters can only manoeuvre to the best of their ability within those limitations. I only mention this because I wish that the same open-minded understanding was a two way street. When the specialist asked where we'd had IVF and I explained that it had been in Croatia she was midway through pulling a sourpuss face when I intervened with; 'We actually looked at having IVF here and at that point we were advised that because of my Anti-Mullerian Hormone, (AMH), levels and my weight I was high risk for OHSS and, since only seven eggs were stimulated, it would have been difficult to give me fewer hormones and successfully harvest any. I would prefer to be unwell and pregnant than in perfect health and relentlessly barren because health and safety regulations prevent me from making the choice to take that risk. I understand that, because I am ill, I am costing the tax payer money but a) we are that tax payer and b) we have saved the tax payer the price of an expensive procedure and the associated drugs, so any cost incurred by having to rehydrate me with saline solution and glucose is comparatively minimal and no more than our due. The chances of getting OHSS are around 5% - it has to happen to someone and, according to the British doctors we saw, it was always likely to happen to me.' She looked at me, rearranged her face somewhat and said 'Yes, it could have happened anywhere. Croatia's a lovely country. Did you get to see much of it?' Don't mess with the dehydrated pregnant woman or she'll break out the unadulterated honesty - #toosicktosufferfoolsgladly#. After 36hrs of intravenous fluid I was feeling a lot better but I wasn't discharged in time to attend our booking appointment. I was horribly disappointed because I had done nothing but worry about the well-being of the embryos and I was desperate for a little reassurance. As luck would have it though they decided not to release me without scanning my ovaries - and good fortune timed the procedure to coincide with a visit from Archie, so he was there to hold my hand while I waited for them to focus in on each little gestational sac. We held our breath while she searched for heartbeats - I had been so sick that we were terrified that one or both embryos might have suffered - but after some considerable manoeuvring two little heartbeats were confirmed. My ovaries were still engorged and the dreaded 'bed rest' was invoked for the foreseeable future but I was so happy to see our embryos and be discharged that I would have agreed to anything. We have to go back in a week for further assessment. It has taken me two days to write this post because I am having to compose it between waves of nausea akin to seasickness - I honestly don't ever remember feeling quite so unwell. I knew the nausea would return when they removed the drip but I was hoping that the rest-bite would be enough to see me through until it eased of it's own accord. That hope now fluctuates between seemingly tenuous and laughably futile depending on the time of day - but so far I am hanging on in there. (I wouldn't however recommend any well meaning 'it'll all be worth it in the end' platitudes - the sickness is sufficiently nauseating without being chivvied to choke on the bright side!)
Before our scan on Monday I was looking forward to writing an update... but I changed my mind as the day progressed. The past three days have been the most difficult passage of our journey so far. To explain why I need to start at the beginning. When we arrived at the gynaecology clinic we knew that our appointment had been, (grudgingly), allocated as a follow up to monitor the OHSS - it wasn't designated as a an opportunity for an update regarding the development of the embryo(s). This meant that there was no guarantee that we would be given information on anything other than the state of my ovaries. I was hopeful though - there was always a chance that we might get a doctor who preferred spreading the joy to spreading the 'beggars shouldn't attempt to be choosers' gospel. Imagine my disappointment when our name was called by the very same doctor that we saw the last time. I swallowed my impulse greeting - 'You promised you wouldn't be here...' - in favour of the trusty gritted teeth smile. Hard to believe that the Foreign Office turned me down for a job in the diplomatic corps - surely my winning ways far outweigh my mathematical incompetence? Anyway she floored us both by volunteering the presence of two empty but sizeable gestational sacs right at the beginning of the scan and I think she was sufficiently disarmed by my tears and Archie's heartbreakingly proud, protective, loving, (stunned), smile that she lost the advantage and forgot to eulogise until I had my clothes back on. She did her best to reclaim lost ground towards the end of the appointment, telling us that while one ovary had gone down about half cm, (7cm), the other had gone up over a cm, (9cm) and that 'this was the problem with going abroad for IVF (sigh)' - but it's hard to be confrontational when no one will take you up on it. She tried repetition, pregnant pauses and simultaneously raising her voice and her eyebrow at the end of the statement to turn it into a question - but still no response. In fact we were so convincingly blank faced that even I was beginning to wonder if we understood what she was saying. Eventually she gave up, handed us a number for the Emergency Gynaecology department and told us to go to Accident and Emergency if I got to the point where I couldn't cope with the pain. Understandably we sailed out of there on cloud nine. I had been as sick as a dog for the week leading up to the appointment with waves of severe pain and relentless nausea - but now it all made sense; both embryos were still fighting to survive, producing double the hormones and double the hcg. We were astonished, we were tipsy with trepidation, we were enraptured... little did we know that all this heady delight was to be supremely short lived. When we got home and began to digest the information we realised that, since the gynaecologist hadn't been with us the whole way through and she wasn't an obstetrics specialist, she was probably unaware that we were six weeks and 1 day into the pregnancy. I sent an email to Dr Romana and, while she didn't prophesise doom, she did confirm that at 6 weeks and 1 day she would expect to see a gestational sac, a yolk, an embryo, (or fetal pole), and, in most cases, a heartbeat. Google reaffirmed that an empty gestational sac at 6 weeks was highly unusual - sometimes it's too early to detect a heartbeat but the complete absence of a yolk and an embryo wasn't a positive sign - even if the development was delayed, it shouldn't be arrested to this extent. We were devastated. An empty gestational sac at this stage is more often than not indicative of what they call a 'blighted ovum' - which basically means that the embryo has attached to the womb lining, creating a sac and causing the body to produce pregnancy hormones but that the embryo itself has stopped developing because of chromosomal defects. Eventually it will miscarry of it's own accord - in fact, if you were to stop taking the artificial progesterone, it would probably miscarry quite quickly thereafter. That same day we received our booking appointment, offering us a scan at 12 weeks, but given the current circumstances and the GP's promise of an earlier date, (because of my previous ectopic), Archie thought it was worth phoning and asking them to bring it forward. As soon as he mentioned the ectopic they were very obliging and offered us one the following Monday, (7 weeks and 1 day), so, in the end he didn't even mention the empty gestational sacs. We were doing our best to reassure each other that the embryos were just 'faffing' - which is what we call the art that prevents Archie from leaving the house within an hour of having made the decision to go out - but we were terribly shaken and it wasn't easy. That evening, we missed a call from an unknown number and it rang again the following morning. It was the gynaecologist from the day before... she said she'd reviewed our case and she was keen for us to be seen again by the people at the assisted conception clinic and was going to pass our details on - we were to expect an imminent phone call with another appointment. She said it was to follow up on the OHSS but we both knew that there was a good chance she had gone through her notes after we'd left and realised that the dates didn't tally. The assisted conception clinic phoned shortly thereafter and offered us an appointment at midday today. This only added to our distress - to get an NHS appointment in less than three days for anything short of a dire emergency is almost unheard of. When we walked into the clinic today we sat in the waiting room, silently holding hands and wondering whether there was even any point in being there. It was only 45hrs since our last scan - wouldn't it be better just to wait a week and have a definitive answer either way? We knew from our internet research that a gestational sac couldn't develop a yolk, an embryo and a heartbeat in less than 48hrs and, until/unless we had all three we wouldn't really be any further forward, (we were past even pretending to care about the OHSS). Eventually our name was called and a rather nice lady escorted us into her office. She asked some questions about the progression of our IVF and the OHSS and then asked me to hop on the reclining chair for a scan - I am so used to taking my pants off that I almost pulled my trousers down in the middle of the room - but luckily some sixth sense came to the fore and I intuited that this was to be an ordinary ultrasound, conducted by rubbing the hand-held unit over my lower abdomen. I lay back and she scanned my ovaries - which have been unerringly impressive throughout and didn't fail to deliver this time either. I am not sure why I am responding atypically to the size of my ovaries, (currently 11cm and described by the doctor as resembling a 'pair of melons'). Perhaps it's just that I know that if I complain the only thing they can do is put me in hospital - and I don't want to go to hospital - so maybe it doesn't serve my purpose to complain. I am in pain and the constant nausea is making it harder to drink - but I know what's going on and I know that they can't do much for me in hospital apart from give me a drip so, while I can still drink, I'm not going. Anyway, she said that my ovaries are 'massive' and that I will now need to take daily blood thinning injections to counteract the effect of the water being sucked out of my bloodstream... and then... finally... she said that she was trying to find my uterus. My ovaries kept hogging the limelight but eventually she managed to squeeze between them and asked us if we could see what she could see? I didn't know what she could see but it didn't sound like the kind of question you would ask if you were going to tell someone something bad. My hopes soared; 'What can you see?' My voice cracked. 'I can see a heartbeat,' she said and she pointed to a tiny flickering light on the screen. 'Hang on a moment - we'll just look for the other one... Ah, there you go, another heartbeat. Can you see it? Congratulations. Two little heartbeats. Twin one and twin two - and they're both exactly the size we'd expect them to be 6.1mm and 6.6mm respectively. I can't think what happened the other day - there must have been something wrong with the equipment. How awful for you. But it's OK now. They're doing fine.' I started writing this post before our appointment this morning, when I didn't know what the outcome would be - I explained to Archie that the embryos had liked being written about, that they were happy the whole time I had kept the blog going, that maybe they didn't want to be a secret... that maybe if I wrote about them again I could save them. Of course it was nonsense... but our two little heartbeats are obviously partial to a wee bit of nonsense - which fills me with hope that their lives will be full of the little pleasures that make for lasting happiness. We never thought for a moment that they might both survive and, even though there's still no guarantee, we are far too delighted to pretend that not telling you would somehow protect us from devastation if things were to change. We have already talked about how I will have to go back and edit the blog so there's no heartache over who was a B/C and who was a C/C - it's got teenage angst written all over it! I will never forget the look on Archie's face when the doctor found our two little heartbeats; my best friend, my soul mate, my husband, my hero... my beautiful, happy boy and his fledgling flock - 'radiant' is a word too often reserved for mothers.
As I lie here happily sipping my disgusting decaffeinated tea, I have come to realise that the blog has reached the natural end of it's 'daily update' life span. The embryo(s) and I are now firmly engaged in the pursuit of 'sitting tight' and using all our might to merrily divide and multiply, while simultaneously endeavouring to contain the worst of the OHSS. Short of filling your heads with my own un-baby/IVF related nonsense I can't imagine keeping you enthralled with a blow by blow account of days spent lying on the couch - and the blog was never intended to be a platform for preaching personal insight on topics other than assisted conception, (besides, the more irrelevant material that I put down in black and white, the more ammunition I provide to a certain little someone if I've changed my tune in 18 years). So, every time something noteworthy happens; if the OHSS disappears or flares, when we find out how many embryos we're harbouring, if we encounter any colourful characters in the field of obstetrics etc. I will post and keep you abreast. For those of you who don't want to keep checking back and forth, if you hit 'follow' any new update will be emailed to you directly. I will miss you all but I know that I have a better chance of nurturing your attachment if I don't bore you to tears - and I want, more than anything, for the embryo(s) to continue to benefit from being cared about by such a lovely network of people. Wow - I feel more emotional than I ever imagined about letting go of your daily support - but it's not 'goodbye forever', it's just 'goodbye for now'. On our wedding invitations Archie and I had the old African proverb, 'If you want to go fast, go alone. If you want to go far, go together.' We couldn't have covered this distance without you - thank you.
I worried, after yesterday's post, that my omission to wax lyrical on the joys of being newly pregnant might leave you with the impression that I am not appropriately or proportionately ecstatic. This couldn't be further from the truth - I am elated but I am also terrified. I am scared to take our good fortune for granted - we have been incredibly lucky so far and I sense that caution is required to preserve the last of our felicitous allocation; we could still fall folly to 'chemical pregnancy', (which is where you get a positive for a week or two before the embryo dissolves); some sort of quasi ectopic experience, (I had an ectopic pregnancy that lasted approximately 6 weeks about 10 years ago); or, indeed, an ordinary miscarriage, (which we have seen cause terrible suffering to some of our friends). Since we didn't have IVF in the country there is no way for us to confirm that the hcg in my bloodstream is doubling every day as it should - because we are not entitled to standard post-IVF after-care. I don't think my odds of miscarrying are any greater than the statistical average but I do think that I have ridden the bejesus out of my luck to get this far. I also feel guilty... not hugely, horribly or pervasively guilty - just guilty enough to temper any premature rhapsodising - we kicked the ass out of someone else's chances with our positive result and I feel I owe it to them to pay a modicum of heed and homage to the bigger picture. All of that being said, I do not think I will be able to hold onto these concerns for the full first trimester, I can only imagine that with each passing day 'not-taking-it-for-granted' will become an increasingly impossible task but, bear with me for a little longer, while I give in to the futile pursuit of trying to influence the universe with the flimsy, misguided power of my mind. If it illustrates my mental state any, a close friend and my sister both mentioned that, if everything went well, this would be an October baby. I realised when they said this that I had managed to compartmentalise so effectively that I hadn't yet allowed myself to work that out. I doubt you could pull off a stunt of this calibre if you weren't mathematically challenged to the nth degree but I was pretty impressed nonetheless - check me and my self-imposed-ignorance, just imagine all the things I could fail to achieve if I really set my mind to it! As well as a visit to the gynaecologist we also saw the GP yesterday, (that's what we call a day-to-day doctor in the UK); I was nervous going in that we would be subject to more disapproval but he was harmless enough; completely uninformed about IVF and had never heard of OHSS but referred us for the traditional 12 week booking/scan at the appropriate clinic - and then said that we would probably be seen a little bit earlier because I'd previously suffered an ectopic. So no specific dates to look forward to but at least we weren't denounced for daring to jump the IVF queue, (queuing is a British institution and jumping the queue is punishable by death... stares.).
It never occurred to me that there would be any interest in the blog beyond the inevitable cliffhanger inherent to our IVF attempt - but a handful of people have expressed a desire for the blog to go on. I imagine that, in the main, these requests are a manifestation of polite kindness - but, if even one person really would like to be involved for a little bit longer, it would be my very great honour to nurture that attachment - the embryo(s) and this wannabe-Mummy know a precious gift when we see one. Besides, I'm certain it will surprise no one to discover that I haven't suddenly run out of things to say! I am not going to dwell, any longer, on our gratitude for the kindness and support we have received because I don't want to bore you with repetition - suffice it to say that, together you have cast my world in the most beautiful array of my favourite colours and banished some ghosts that had threatened to linger for a lifetime. You may have been mostly silent but, collectively, you have imparted great and powerful wisdom and, as an impoverished scholar regarding the meaning of life, I am forever indebted. Anyway, enough of that - let's get back to my vagina and it's most recent public appearance. We came back from Croatia to find a letter offering us a gynaecological appointment for today regarding an unrelated minor complaint that has long since resolved - but it occurred to me that, rather than cancel, we could use the opportunity to have my ovaries given a quick once over and get some feedback re. the old OHSS. I told Archie that when they found out that we had been to Europe for IVF they would be snotty with us but he was sceptical and I could see him silently filing this under the category of 'progesterone-induced-paranoia'. I should have been grateful to the good lady doctor for making her disapproval so eminently undeniable - it is a rare occasion that I get to prove Archie wrong - but I'd be lying if I said that gratitude was my overwhelming emotion. You would have been proud of me though - I bared my best gritted teeth smile and played dumb as she dangled her tantalising bait. Having explained the circumstances and assumed the pre-scan spread legged position she delivered her exasperated lecture on people going abroad for IVF, (sigh). I applaud her tactical restraint, she could've launched in earlier but she held back until I was at my most vulnerable which enabled her to be both literally and metaphorically below the belt. Pretty impressive you have to admit. The problem with people going abroad for IVF, (sigh), is that they're not under anyone's supervision if there are any complications when they get back, (sigh). I resisted the temptation to suggest that, if her feelings on the matter were so strong that she couldn't help but pass unsolicited judgement, she could always open up an ethically priced clinic, or indeed, commit her life and her income to the reversal of the ageing process so that the 2 year waiting list didn't pose such a problem - and I will similarly resist the temptation to 'inadvertently' email her a link to this blog. Anyway, she was unwittingly disarmed by the state of my ovaries, which were sufficient to merit the beckoning in of a student, thereby enabling her to don the eminently gratifying role of benevolent, all-knowing, superior, (with the emphasis on 'all-knowing' and 'superior'). Before we started the IVF process my ovaries were about 3.3cm wide - they are now 7.7cm wide and filled with cysts - 7.7cm doesn't sound that big but I suppose if my liver or my arm ballooned to more than twice it's normal size I might be a bit concerned. They are a centimetre bigger than they were when we left Croatia and she seemed to think that I must be lying about my level of discomfort - which I wasn't - the pain is not constant, sometimes it's so bad that I can hardly move or breath and other times it is much more manageable, (besides which, I have read about some people's ovaries swelling to 14cm so it can't be THAT bad). She also noted an increased build up of fluid in my abdominal cavity. The upshot is that I am to ignore my internal barometer and desist from all activity forthwith - just because I don't think it feels 'that bad' doesn't mean that I can get up and take the dog out. I am to stay horizontal, keep guzzling excessive amounts of water and take myself to hospital if the pain gets severe for any prolonged length of time, (I am just grateful Archie wasn't given that advice a few days ago). We are to go back in two weeks when we will 'have to be seen by a different doctor due to the timing of her rotation' - obviously we are distraught to miss the opportunity for more moral guidance but we will, somehow, find the strength to endure.
Hi, It’s Archie, I wanted to provide you with the success rates / statistics for our clinic, (I left them out of my earlier post for fear of jinxing the outcome).
Croatia, Zagreb, BetaPlus clinic:
The success rates were worked out by age and number of eggs retrieved
1 or 2 eggs,
women > 37 years old have a 10% chance of success,
women < 37 years old have a 15% chance of success,
3 – 6 eggs,
women > 37 years old have a 20% chance of success,
women < 37 years old have a 35% chance of success,
7 – 10 eggs,
women > 37 years old have a 20 – 35% chance of success,
women < 37 years old have a 35 – 50% chance of success,
> 10 eggs,
the success rates improve, women up to the age of 42 have a 40% chance of success.
3.48am - I have been awake for the past two and a half hours. My OHSS is pretty sore, which I am desperate to interpret as a good sign - but it might just be the phantom product of wishful thinking and a worried mind. 4.33am - I really need to pee - I can't pee in a container and save it for later because the hcg in urine breaks down over time - but I am loathe to wake Archie so early. Lying here with my legs crossed. ...I lasted 'til half five at which point we adjourned to the bathroom and I peed in a cup; I then passed it to Archie so that he could do the dunking. After squabbling over the length of 5 seconds, (one of life's shorter disagreements), I sat on the toilet with my head in my hands and waited for him to say something. A minute passed and still there was silence. 'It's negative isn't it? It's OK. You can tell me.' Nothing. 'Is it negative?' Pause. And then, in his best, newly acquired IVF vocabulary... 'I think we may have a squinter.' 'You mean there's a line? You can see a line? Let me see. Let me see. Oh my God, it's a line!! It's a line! Baby, it's a line!' And, with that, I burst into heart wrenching sobs - letting go of some of the most painful grief I've ever had to hold inside. While I cried the line got a little darker and two more tests came up positive. We are now lying in bed, holding hands - stupid with happiness, stunned with gratitude and, truth be told, a little scared that someone might step in and say it's all a big fat mistake. It appears that at least one of the maybe-babies is still with us. Our little miracle in which all of you played a part. I have to stop now because I am lost for words - which, coming from me, speaks untold volumes. We will never be able to thank you enough to reflect the depth of our gratitude - but it gives me the most pleasure that I have ever had, to sign off this blog with love from Archie, Temora and the little hcg secreter that you helped us to nurture xxx
Traditionally people don't actively publicise their pregnancies before the end of the first trimester because of the risk of miscarriage – sadly 1 in 5 normal conceptions don't make it to 24 weeks. The research indicates that IVF/ICSI pregnancies are no more likely than ordinary ones to miscarry, (which is a massive relief), but, given the nature of the blog and the possibility of recurring OHSS, I feel it would be remiss of me not to mention the facts... (if we are fortunate enough to get a positive result, tomorrow will not be the right time). It's hard to believe that our journey together is coming to an end; please know that, whatever the outcome, your solidarity has been an invaluable blessing. And, child, if you are reading this, then you now know that you are the product of a whole wide world's worth of love.
By last night the OHSS was back to the degree that my abdomen was sore and a bit bloated - but my tummy wasn't rigid and it would take a serious feat of self delusion to claim that it was 'worse than it had been before'. Today it is tormenting me with twinges but, once again, there's no persistent pain and/or rigid distension which is really what we're looking for. I am paralysed by the enormity of tomorrow. I knew this would be tough but I didn't appreciate just how tough; which is, apparently, what makes the 2nd try so much harder than the first - people no longer have naivety on their side. Odds of one in three may not sound terribly good but, when you embark on your IVF journey, you hear about every successful-first-time-attempt known to your circle and you start to think/hope that the figures can't be quite right. Of course, deep down, you know that this is an illusion created by the vast numbers of people having embryos transferred every day, but it's hard to keep this in perspective. First timers are also probably buffered by the fact that their initial try has often been preceded by years of failure; so their odds may not be great but, for a while, they feel comparatively astronomical. Whatever the reasons, I am loathe to admit that, despite the statistics, despite the diminishing OHSS and despite my determined efforts to practise the art of realism - I am still hopeful of a positive. I know that the signs are increasingly pessimistic and yet, if I am 100% honest, I just can't quite wrap my head around the idea that it's not going to work. I have even tried telling people that I think it will be a negative, in the hopes that by writing it down or saying it out loud, I will manage to persuade myself - but, push has come to shove and hope has beaten the odds to emerge the merciless victor - which, I guess, accounts for the paralysis... I have just made the untimely discovery that, somewhere along the way, I seem to have acquired an uncharacteristic, (and infuriatingly stubborn), streak of un-quashable optimism, (Archie, my darling, you have a lot to answer for). In an ideal world I would have managed to genuinely convince myself of a negative result by this time today so that I could approach tomorrow's test sporting a modicum of armour. As it is, I have no choice but to go into battle with my heart on my sleeve. My poor wee heart, I'm so sorry - I tried my best to protect you.
We have reached the penultimate day, which may or may not provoke a profusion of nervous posts but, in the event that I do end up subjecting you to excessive amounts of anxiety fueled drivel, I hereby apologise in advance. You don't deserve it because you have been AMAZING!! When I started the blog I thought we might get a small flurry of interest, followed by a handful of family and super-close friends checking in and out once every couple of days... but we have been blown away by the core of loyal support: 21 wonderful people signed up to receive each post by email and a further 40-60 people check in with the blog every day. On big occasions, like the egg retrieval and the embryo transfer, the visitor numbers have risen upwards of 160 and there have been random days where the daily tally soars for no apparent reason. I can see what countries people are visiting from and I have a fairly good idea who some of them are - I would like to send a little shout out to Australia, South Africa, Canada, the US and the UAE, you don't know how much it has meant to me to see your little flags reappearing day after day - I will never forget that you quietly held my hand the whole way through. We have also had some regular visitors from countries like Romania, Belgium, Thailand, Singapore, Botswana etc., (where we're fairly sure we don't know anyone); this, unexpected, kindness of strangers has been profoundly touching. Britain has, of course, topped the daily charts and we have been relentlessly humbled by the home-crowd - people say that it's 'at times like these you find out who your real friends are' and I had always thought of it as an ominous expression but - as it turns out, we have MORE real friends than we thought - which is such an indescribably heart-warming blessing that I'm at a loss to even try. I have never blogged before and I know that these are not excessive numbers but they are far, far higher than anything I ever imagined and they have been a lifeline. Each one of you has helped me to try and find a little humour and perspective in an experience which is not actually all that funny, (you don't say!), and probably quite easy to blow out of all conceivable proportion, (trust me, I am capable!). Between you, you have encouraged me to put one foot in front of the other with relative grace and I can't thank you enough - my worst fear, besides the obvious, was turning into a terrified, wild-eyed, monster which I am certain I would've done without your support - so you have saved me from myself and you have buffered Archie from a tornado of unchecked hormones. Together you have been 'Team Maybe Baby' and you have been the very, very best team in the whole wide world. I will never be able to think about you without filling up with tears - I will never forget your compassion and I will never stop being grateful. Thank you for the bottom of my heart and beyond.
For those of you who responded so kindly and with such interest to the post about eating disorders, this update is an effort to answer the question about what you could/should do if someone comes to you for support. I'm sorry, it was stupid/unhelpful to publish a list of 'don't's without suggesting any 'do's. As you know, the blog will come to an end on Sunday but you can always email me regarding this issue if there's ever anyway that I can do anything to help. If you can, you should try and guide the focus away from weight/food and get them talking about what was going on when they started cutting down their intake. What were the feelings and circumstances that led to self-denial; why did they feel judged, why did they feel inadequate, what happened to make them feel like they didn't have any control? A lot of them will immediately cite appearance related issues but, if you can, try to steer away from these and dig deeper - the social pressure to be thin undeniably, (and unforgivably!), exacerbates eating disorders ten thousand fold - but the vulnerabilities that make a person particularly sensitive to appearance related judgements don't start with appearance, they end with it. If they will talk to you, then don't offer them platitudes - they can be very clever people, thinking highly complex thoughts about the way the world works, (this is not always true but it's better to start here and adapt your approach than it is to trivialise the depth of their thinking and have them shut you out). Coming to the conclusion that you don't have much control is not illogical, it's just hard on a person if, for some reason, they have had to face it before they were ready. That 'life is NOT fair' is a more manageable concept if it dawns on a person incrementally over time – but, if someone has been unexpectedly or abruptly exposed to extreme feelings of powerlessness, especially a sensitive person who may have thought that by following certain rules they could guarantee certain outcomes, then being overwhelmed is a fairly understandable response. If you can, try and help them to explore and make peace with this new, out of control world - this world where you can influence other people's thoughts and deeds but you can't MAKE them feel or do anything, this world where, no matter what you do or how hard you try, there are certain things that all the willpower in the world will never change. From here you can start to help them explore whether there are any possible benefits to living in a world where control is an illusion. A person who is trying to be perfect by following rules is under a tremendous amount of personal pressure - if you can open up their mind to asking whether or not, since doing X doesn't always guarantee Y anyway, perfection might not be a mugs' game, approval might not be a matter of perspective and being motivated by your own wants and needs, rather than a desire to please others, is not just acceptable but probably both rational and enlightened – then you may succeed in edging them in the direction of hope; if you can help them start to see 'a world without control' as 'a world without the pressure to be perfect' then, in time, this may develop into a lifeline. You should also try to find out what they are good at that is unrelated to food and exercise - in an ideal world it shouldn't be something academic because academia has competitive connotations and the last thing they need is more comparisons - whether it's writing, painting, playing an instrument, craft projects, photography, caring for animals, making people laugh, being a good listener, being a good organiser, creating fun activities for children etc. - and find a forum where they can do this thing and receive affirmation for being good at it. They need to be praised for things that they see as 'innate' - if they only receive praise for being good at things which are competitive, like good grades, career promotions, success at sporting events etc. this will reinforce the idea that their value lies in their ability to perform rather than simply in the very fact of their being.
Today has been a day of mixed emotions. Yesterday evening came along and I realised that the OHSS hadn't given me a twinge for about 10hrs - so I decided to provoke it for a bit of reassurance. It was particularly unimpressed with hanging out the laundry the day before, so I decided that I would fold and put away the fruits of this painful labour - I bent over, I stood, I stretched, I opened and closed some pretty uncooperative draws and... nothing. I made dinner, I did the dishes, I pottered about tidying the living room and... still nothing. I stopped short of putting on an exercise DVD for Archie's sake but it was beginning to look very much like a miraculous recovery. Which is entirely possible - even before your period. If you're super 'lucky' it can just clear up overnight - you may have a little residual water retention and some lingering tenderness but it's no worse than an average bout of PMS. This morning, Archie's first day back at work, things were not improved... well, unless our definition of 'improved' involved the OHSS getting better and staying better, which it does not. I woke up feeling nauseous from the progesterone, as I have every morning - but, apart from this, I wasn't in any discomfort. I lay there for a while thinking that maybe the day would go away if I just refused to acknowledge it - but, after half an hour, I pulled myself together and got into the shower. You can't have it every which way I told myself - yesterday you were complaining that you couldn't walk the dog, so now you CAN walk the dog - so go and walk the damn dog. Which is what I did - as well as some Hoovering and a couple of other mundane bits and pieces. (Still nothing.) I also sent off an email to Dr Romana. It has been seven days since the transfer so I emailed under the pretence of giving her a timely update but, if I'm totally honest, I was really just hoping to illicit a bit of reassurance from a reliable source. I told her that the OHSS had resolved itself so I was mentally preparing myself for a negative and that the progesterone was giving me nausea and bad skin but, apart from that, all was well. Being the master of diplomacy that she is, she managed to reply in such a way as to show that she cares without giving me any false hope - she said she 'sincerely hoped I was wrong!' and told me to keep taking the medicine until after I had tested - and this is the bit where it became 'a day of mixed emotions'. She told me to email her as soon as I had done the test on Sunday. As in 'this coming Sunday'; as in 'day 9 after the transfer', not day 14. As in '5 days before I thought I would be testing'. Believe it or not, before we left, I didn't actually ask her when she thought I should test - because I was certain she would tell me to wait 14 days. I have seen some clinics operating a policy of in-house testing between days 9 & 14 but I had assumed that they were using some funky, souped-up technology that's not available in the chemist - and, that, since we are not in a position to go back to our clinic at all, we would be best advised to wait the full fortnight. However the email basically said that, if I got a negative, I could stop taking the progesterone on Sunday - which tells me that Dr Romana believes that a day 9 negative is an absolute. Thus far, I have followed her every instruction to the letter so I am not going to start making exceptions now - but I am terrified. I definitely didn't want to test when I might get a false negative - but delaying a 'positive' negative for 5 days just to postpone the inevitable is probably foolish; arguably a negative will only get harder and harder to stomach with every day of false hope that is added to the tally. So Sunday it is then. I can hardly believe that my test date has been brought forward on the same day that my OHSS has disappeared - giveth with one, taketh away with the other - ain't that the truth my friends.
Today I started thinking about what I will do if this attempt fails. I realise that I'm going to be devastated - but I was hoping that if I pre-empted the disappointment with an action plan, I could help the healing process along. The OHSS makes it a little difficult to plan 'activities' as such, because even though it's not worse, it hasn't gone away, which means I still can't do anything physical - I got so bored yesterday while Archie was out that I sneaked upstairs to hang up the laundry... heady subterfuge indeed! By the time I'd finished with a full basket I was so bloated and sore I was panting rather than breathing and had to walk funny to alleviate the pain. It went away again though as soon as I resumed my backside vigil. Anyway, if I don't get pregnant, it should pass with my next period but some people are unlucky and it lingers for longer. I mention all of this because it means 'going for a long walk with the dog'/'treating myself to an hour of horse-riding'/'going to that yoga class I keep meaning to attend' can all feature on the list but they may not be instant possibilities so I need to come up with some other stuff as well. I am a bit of an introvert by nature so doing anything wildly social doesn't appeal and I don't like shopping, which is just as well because we don't have any money, (a consideration which also rules out spa days and similar indulgences). The blog will have come to a natural end and, if I drink, I will just get maudlin... With my list limping along in pitiful condition I decided to look outside of myself for inspiration. I googled 'coping with failed IVF' in the hopes that other people would have some positive suggestions. This was a mistake - every post I came across was more depressing than the one before. People start these threads with the best of intentions - to talk about how to cope - and end up discussing every distressing reason why it was all so painful. Having read about siblings getting pregnant, (with twins), the day after a negative, best friends finding out that they are pregnant the day before, (to that one-night-stand-guy, whose name they can't remember), and letters of foreclosure that simultaneously land on the welcome mat, I drew the line at the lady who took a negative pregnancy test downstairs to find her husband making a furtive phone call to another woman. What I have learned from this exercise is that I may not be exactly sure what TO do in the event of failure but I now know categorically what NOT to do... I will not go looking for support from the recently traumatised, (and I won't be answering the phone to my sister either).
Isn't it amazing how you can be so involved in something that you completely overlook the blindingly obvious? I have been lying here for the past hour thinking that the feeling I have in my tummy is distinctly reminiscent of the feeling I get the day before my period arrives... and then it occurred to me that, if I am not pregnant, my period won't necessarily wait the designated 14 days before it comes. The progesterone might prevent it from coming but it's no guarantee. Needless to say I am horrified - I had thought that, if I wasn't pregnant, I would find out via a negative pregnancy test and that even though it would be awful, at least I would have had the chance to seriously psych myself up before taking it. I didn't think that I might just go to the bathroom anytime and discover that it's all over. The progesterone may stop your period from coming before the end of the 2ww and, if your period does arrive before the end of the 2ww, you need to confirm the negative with your doctor before you stop taking the progesterone... but it is possible that your period will just show up. For the three weeks before we travelled to Zagreb Dr Romana instructed me to take contraception - this was to try and guarantee my period arriving on a particular day. Despite this, I began to bleed a week before we left and we were terrified that our attempt would have to be cancelled. We were relieved to be advised that it was probably something known as 'break through bleeding' rather than a period and that we should come anyway. The light bleed endured for a week and stopped the day before we travelled. I never bled again thereafter. However, even though it turned out that this had in fact been my period, Dr Romana was able to proceed. Usually people take hormones from day 3 of their period and I didn't start taking them until my period was over but, since this didn't inhibit the egg stimulation and retrieval, it didn't seem of any great significance until today - when I realised that it has now been 31 days since that light bleeding began. That's 3 days longer than my average cycle. If I wasn't pregnant my period would definitely be on it's way - or trying desperately to break through the progesterone barrier. I thought about not posting this because, in a perfect world it will turn out to be the neurotic ramblings of prolonged duress, but I decided that, since the blog is supposed to be a sincere reflection of the journey, it would be dishonest to edit out all of the panic. This is the least optimistic I have felt since the beginning of our IVF journey - the OHSS hasn't flared and I am getting the kind of light cramping/heavy sensation I associate with my period. I am now scared to go to the bathroom - which is a cruel twist since I am having to drink so much liquid.
I am not usually a sedentary person; Bauer and I probably average about 7 to 10km a day - sometimes more, sometimes less - but he benefits fairly significantly from a finely tuned guilt complex, wrapped up in the remnants of a lingering eating disorder. The eating disorder hasn't been life-threatening for a very long time and I don't normally talk about it because, compared to what it once was, it is now a manageable cross; one born by more people than you might imagine. Some people know. Some people don't. It would be easy enough for a person not to realise since it doesn't always manifest itself as anorexia - I have also been severely bulimic, as well as having periods where I have an eating disorder in the same way that someone who has been an alcoholic is 'always an alcoholic' - I might be winning the battle not to starve or stuff myself but, make no mistake, beneath that serene exterior there is most definitely a battle going on. Archie often asks me why I don't write about eating disorders since I have so much 'experience' and such incredibly strong views on the subject - and I always tell him that it's because I've rarely read anything written about them that isn't just part of the problem. Most people aren't aware that eating disorders have the highest mortality rate of any mental health condition known to humankind. If you are not careful about what you say you might just kill someone - maybe not instantly - but your misguided word or phrase will lodge in their poor diseased brain and torment them to the brink of collapse. It's not that people don't mean to be careful what they say - it's just hard to be careful what you're saying when you don't really know what you're talking about. The first two massive, fundamental, epic misnomers are that a conversation, article or other discourse about eating disorders, especially anorexia, should centre around 'food' and 'weight'. This is the most tragic and corrosive misunderstanding of all - and probably the biggest reason that eating disorders have such a high mortality rate. Why? Because you simply can't solve something by making it worse. If you are trying to communicate with, connect to or understand a person with an eating disorder you absolutely should NOT make ANY reference to what they do or do not eat or how much they weigh. I cannot tell you how sad it makes me to know that when a person goes to the doctor in this, or any other western country, to ask for help with an eating disorder the first thing the doctor will do is put them on the scales. To do this is to completely misunderstand the mindset - all you have now done is given them a number which they will be compelled to drive down by the next time they see you because otherwise they are 'failing' to do well at having an eating disorder. Now, to add insult to injury, people will also be given a BMI and told what range they fall into - in fact, if they don't fall below the 'normal' range they will be told that they don't have an eating disorder - even if they know themselves that their relationship with food is severely compromised. A person who has a sub-normal BMI will realise that they are only in the 'underweight' category and not in the 'severely underweight' category which will flag up for them that they are 'failing' to be as good at being anorexic as other people. You have to understand that a person asking for help will have 5% of their brain on their side, while 95% of it will be resisting, wildly absorbing any information it can find to fuel the disease and resist this 'temptation' to 'give up', to 'fail', to be 'tricked' into thinking that it's OK to eat more. Anorexia is hugely competitive, the person is trying to 'improve' themselves and they've locked on to the idea that this can only be done by losing weight - NEVER give them more numbers, do NOT compare them to other people and don't ask them what they eat because they will be tormented to admit that they eat anything at all - and, if they do tell you what they've been eating, they will be compelled to eat less to ensure that the next time you ask the same question they have 'improved'. This competitiveness is also why putting a whole bunch of people with eating disorders in a treatment centre together is about the most epically stupid thing that psychiatry has ever come up with. Up until a certain point people with eating disorders should be kept as far away from each other as possible - by putting them together you are just compelling then to compete with each other. They won't want to but they won't be able to resist. If a person goes to a doctor and says they have an eating disorder why is it necessary to put them on the scales? If they think they have an eating related problem, then they have an eating related problem - you don't need to weigh them to prove it to yourself, it's not about you; you don't need to categorise them as having a better or a worse problem than someone else, what earthly difference does it make? You just need to HELP them. The other fundamental misunderstanding that drives me mental is the commonly heralded medical definition of anorexia as being 'a loss of appetite'. Are you crazy?!!! These people are fucking starving! They are obsessed by food. They are desperate to eat. They are hungrier than you've ever been. They haven't lost their appetites, they've lost their minds - help them find their sanity, help them escape the cult like mentality which has taken over their brain. They're not refusing food because they're not hungry - they're refusing it because they're terrified that eating it makes them a worthless failure that doesn't deserve to live. Don't try and rationalise it, (they won't eat, so they must not be hungry); it's NOT rational, it's an illness, it's not playing by logical rules. Obviously anorexia and bulimia are not the same thing - and I'll spare you my bulimia rant - suffice it to say that you shouldn't talk about 'food' or 'weight' to these people either. Weight is the barometer by which people with eating disorders are assessing their worth - but conversations about weight won't help them to solve their problems. Their issues are complex ones of inadequacy, worthlessness, imperfection, feeling judged, feeling powerless, feeling overwhelmed, feeling depressed. They are suffering from an inability to cope with the lack of control that is living - they are trying to construct a world with black and white rules so that they can survive. They are killing themselves to stay alive. If you understand that then, maybe, you can start to help them. So why do I mention all this - or even any if it? (Especially as I will delete this post long before any child of ours ever gets anywhere near it.) I mention it because my eating disorder is one of the few things that I never intend our offspring to know about their mother - and I know that the only way I can bring this about is to be entirely normal around food from the moment that they are born. I couldn't live with myself if I passed on these feelings of inadequacy. I don't care what it costs me; I don't care what I end up looking like. If we are lucky enough to have a child, especially if it's a little girl, they are going to think that their mummy loves herself; that their mummy thinks she looks good in everything that she puts on... that their mummy has never, EVER, equated weight and worth. They will get enough complete crap rammed down their throats by the media - they will need at least one half-decent female role-model and it's going to have to be me. It has been hard for me but I have been eating in healthy quantities since we started this process - and it has been made harder still by the fact that now I can't even go for a walk, (exercise and eating disorders - the very best of frenemies), but I am writing it down, saying it out loud, publishing it for the world to see so that it's out there and there's no going back. Of course, having gotten this epic weight off of my chest, I'm almost guaranteed not to get pregnant! Today has been the hardest day so far - the OHSS doesn't seem to be getting any worse which is not a positive sign. Please don't post telling me not to worry though – just for today I don't think it would help.
I haven't mentioned the OHSS for the past couple of days because it has been much the same. As long as I lie down and drink it is not by any means unbearable - although it gets worse as the day progresses and, despite all the 'doing nothing', it is pretty sore by late afternoon and at it's most painful by bedtime. It then alleviates again somewhat overnight and each day I go through the same cycle. In the morning I feel like a fraud and by the evening I realise that if I hadn't spent the whole day lying down, drinking I would be intolerably bloated and inert with pain. It's not ideal because it's very limiting but I keep reminding myself that this kind of waiting wouldn't be easy under any circumstances - if you were going out to work or running around maintaining a busy schedule you'd just be occupied and pre-occupied at the same time - which would likely mean even more emotional ups and downs because there's nothing more frustrating, irritating and draining than having to do stuff when your concentration span is severely compromised. So, I know, that in some ways, I am very lucky - I may be under-occupied but I am in a bit too much pain to be genuinely bored and I am not having to 'be normal' and face the real world full of hormones and unrequited hope. Part of the reason that women are so distracted during the two week wait is that they are obsessively monitoring their bodies for 'symptoms'. The problem is that there is no way to distinguish between the potential causes of these 'symptoms' - implantation or progesterone. In the course of a natural pregnancy your body would start releasing progesterone during ovulation and then, if implantation occurred, continue to produce it - and it is the effect of this progesterone that often alerts women to the fact of their pregnancy, since it commonly causes nausea, fatigue, worry, acne, breast tenderness, vaginal discharge etc. When enduring the 2ww you will suffer whatever side effects of progesterone you are prone to, whether you are pregnant or not - and, since you are taking more than you would normally produce, the side effects are somewhat exacerbated. So, really, the monitoring of your 'symptoms' is an exercise in futility. Once again though, almost no one lets this dispassionate logic get in the way of rife speculation. For my part the whole thing is further convoluted by the OHSS - so a list of my 'symptoms' is doubly meaningless. I wouldn't, however, want to give you the impression that I have some sort of super-human immunity to behaviour that is not entirely rational. So, just to prove it to you, here are the 'symptoms' I have catalogued thus far: waves of nausea, hot flushes, being tired out by little things like telephone conversations, (despite doing sweet FA), bad skin and one severely painful twinge in my right side that lasted less than a second but registered because it was so vicious. Of course I have been bloated all along, (and the other two minor 'symptoms' come under the 'too much information' tag). Without exception all of these 'symptoms' can be accounted for by either the progesterone or the OHSS - and, so far, the OHSS is not getting any worse. So that's me. How about Archie? Well not only has Archie spent the past few days running around cleaning, walking the dog, doing the laundry, making dinner and telling me off if I try to so much as stand - but he has also started looking at new cars. Yes, child. Your Daddy wanted you so much that he sold his prize possession just to open the door of possibility. In typical, stoic Archie fashion he hasn't so much as squeaked about the sacrifice - he just decided it had to be done and has set about doing it. So it's goodbye to the much loved BMW of the boy racer, pedal to the metal, my cars' faster, (and sexier), than yours days and hello to the days of car seats, a doggy friendly boot and fuel economy. In the event of a mid-life crisis, at least he now has the option to upgrade his vehicle rather than upgrading his wife... but joking aside, I couldn't be more grateful. If we'd been able to conceive naturally we could've kept the car - we might not have - but it would have been a possibility. If you're reading this, child, please don't think that selling the car was of any real significance, of course it wasn't - your Mummy is just taking the opportunity to sing your Daddy's praises because there is no one more deserving and he makes her so happy with the strength of his love.
I mentioned before that the two week wait is sacrosanct - a test in the first week is more or less meaningless - you might get a positive result because of the residual hcg in your system, or you might get a negative result because your body was quick to process the leftover hcg but the embryo has been slow to implant. Once the embryo has implanted it will begin producing hcg but a negative test during the second week may just mean that the hcg has not yet reached detectable levels. Do not, however, be fooled into thinking that this deters very many women from testing early. Some people will test every day after the transfer and, as far as I can establish from the forums, most 5 day blastocyst incubators buckle on day 5. This is because, after 5 days, your chance of a false positive due to residual hcg is more marginal and, if your embryo was quick to implant, the levels of hcg being produced, might just be sufficient to elicit a positive response from one of the more expensive, super-sensitive, home testing kits. These positives are referred to by the IVF community as 'squinters' - because the line is so faint that you have to squint to see it. Of course, a 5 day squinter may be a false positive, so all it really tells you is that you need to test again - you may then get a negative because the residual hcg has flushed through your system... followed days later by another positive if you are lucky - or, if you are not lucky, a persistent negative that never changes back again. In the end it boils down to each individual coping with the wait in the best way they can and there are absolutely no 'better' or 'worse' ways of doing it. I have spent three years looking at negative pregnancy tests; if you average out the hopeful months at the beginning with the hopeless ones towards the end, I have probably squinted at about 72 blank pregnancy tests since we started trying. I have tried watching them while I wait, walking away while I wait, holding each one up to the light, holding each one up to the window, tipping each one to the left, tipping it to the right, holding it far away, holding it up close, leaving it and coming back to it in 2 minutes - and sometimes even fishing it out of the bin a few hours later just to be sure... for this questionable pleasure I have cost us about £350. The waste of money has even been the cause of occasional arguments - and I have stooped sometimes to buying them in secret, like a guilty vice. I have bought them from supermarkets, chemists and poundshops, rotating between retailers to avoid seeing their pity - until eventually, there really was nowhere left to turn without advertising my desperation. I will not be testing at 5 days past the transfer because, for as long as I don't test, it's not over - I know there is a real chance that I will have to stare another negative pregnancy test in the face, pull myself together and move on again - but I will need more than a day or two more to screw myself up for this disappointment. The fragile hope I have at the moment is more than I've had in years and I won't relinquish it for a maybe. Our maybe-babies need time to become baby-babies - and if that's not to be then this maybe-mummy needs time to get her head round being a maybe-next-time-mummy once again.
We woke up today in a slightly more sober frame of mind. The embryo transfer was so touch-and-go that I suspect we were even more heady than the average bear when it went ahead. However, it has now been 48hrs since the maybe-babies came on board and perspective is beginning to sneak back into the equation. While four of our blastocysts were considered healthy enough to transfer, they were all given a 'C' grade rating in part. Googling how quality relates to success is a highly unsatisfactory experience - it appears that no one with any scientific/professional credibility is willing to document their findings. Given the lucrative nature of the industry I simply do not believe that no relevant research has been done - which leads me to hypothesise that those who are privy to the information do not deem dissemination to be in their best interests. In the case of the clinics this may be considered a stress-minimising measure - every blastocyst has a chance and, inevitably, some lower grade blastocysts will go on to survive - but there may be such a proportionally steep decline between the success rates of As and Ds that clinics don't think it benefits would-be parents to be aware. Bodies such as the Human Fertilisation and Embryology Authority may be ethically mired by 'right to life' considerations - if they publish information which promotes an IVF culture where people are unwilling to transfer anything other than AA blastocysts it's tantamount to endorsing a holocaust on lower grade embryos. Obviously this is all conjecture but it is precipitated by an unusual dearth of information in an age where almost anything that can be measured has been measured. Any information that you can glean from the forums is, once again, skewed by the fact that most people's purpose in posting is to seek reassurance, which pre-determines the nature of the responses. I must be hormonal because I find myself aggrieved by the fact that people don't ask whether 'anyone who had a C/C embryo transfer could please post the outcome either way', rather than asking 'has anyone managed to get pregnant with a C/C embryo?' We already know the answer to that question. 'Yes', otherwise they wouldn't transfer them - what we don't know is the percentage chance. Anyway I shouldn't complain because I'm not willing to participate and who am I to tell people that they shouldn't predetermine positive responses - why on earth shouldn't they if it helps them get by? For what it's worth, the only observation I can make from looking at the responses to the forum questions is that they are not as numerous as the responses to other IVF questions, (most questions generate enough responses to keep you scrolling for hours, these usually glean about four or five replies). None of this is to say that we have lost hope - we haven't. We know that, even if C grade embryos don't survive as often as A grade ones, they still do survive. Everyone wants to be supportive so, if you harvest fewer than average eggs, people will tell you that it's 'quality not quantity' and, if your eggs are C grade rather than A grade, people will say that the grading system is not conclusive. At the end of the day, Archie and I both know that quantity and quality have a part to play. They don't offer absolutes but they offer parameters and, contrary to what some people might think, parameters can be a positive thing. Knowing what your odds are, even if they're not great, creates a context for battle, which means that if you succeed, you can really appreciate the triumph and, if you don't, then you have had some time to do the subconscious emotional tempering that helps people cope with disappointment. Knowing that there's a potential crash up ahead means that you can brace yourself - it doesn't mean that you won't get hurt - but it might improve your chances of walking away in one piece.
The OHSS is pretty sore today - it hurts regardless of whether I'm lying down or standing up and walking is not really an option - but I imagine that this is a backlash from treating it with such disregard yesterday and I am hopeful that it will settle down at least periodically, as it has before. Technically I didn't bring it upon myself for at least another couple of days because, until/unless an embryo implants, what I have at the moment was caused by the last injection and I'd be experiencing it whether we'd gone ahead with an embryo transfer or not. If it flares significantly around 4-7 days after the transfer then this could mean that an embryo has implanted, at which point it becomes self-inflicted and I will be duly circumspect about any references made. At least the whole thing has an in-built element of farce to keep up my spirits - despite being in a reasonable amount of pain, I am in the ridiculous position of hoping that it gets, at least marginally, worse, even though I know that this isn't a guaranteed indication of pregnancy - because if it goes away altogether I will be terrified that neither embryo has survived. When we were in Zagreb we were unable to follow through with the acupuncture because we didn't have a car and Dr Romana didn't want me walking/taking public transport etc. before the embryo transfer. Archie was a bit disappointed because he'd been sufficiently persuaded by the information available online that it was worth having at least one acupuncture session before and after the transfer on the off chance that it might be beneficial. This being the case, he booked an appointment for 11am this morning at a Glasgow clinic. I had forgotten all about it and I wasn't convinced that it was a good idea given the OHSS, (I might involuntarily punch anyone who dared to prod my poor, distended stomach), but I agreed to go along and see what the acupuncturist had to say. As it turned out she had the most unexpected repertoire I could possibly have imagined, including 'IVF is unnatural', 'acupuncture can cause miscarriage' and 'your pregnancy is high risk' after which wonderful gems and, having stuck a few pins in me, she had the spectacular cheek to ask if I was 'calmer now?' - in the kind of tone that implied I'd come into the room, raving like a lunatic and she'd cured me with her soothing chat. Needless to say we won't be going back. I'm not saying acupuncture can't work but it had significant odds to defy in this particular setting. Here are a few pictures from the past couple of days - including one or two of me in my new embryo smuggling capacity.
I wasn't able to upload anything at Heathrow because the plane was delayed leaving Zagreb due to snow. This meant that we had to scurry through the terminal in London, otherwise we would have missed our connection. I was disappointed because I had been salivating over the prospect of a real cup of tea, even if it came in a Styrofoam cup - Lipton's is better than nothing but it's still not a patch on the real thing - and Archie was disappointed because he had been hoping that I would have an hour or so to lie on my back before we boarded the final flight, (the embryos are fine to sit but the OHSS prefers to be horizontal). It was all worth it though to know that we were taking the maybe-babies back to 178 Knightswood Road, which may not be glamorous or palatial but is, by far, the very best place for little 'Yuille have to wait and see's. Besides which, I lay down on the floor near the luggage carousel as soon as we got to Edinburgh - in Glasgow it would have been assumed that I had a hangover and someone would probably have offered me a swig of Buckfast - but Edinburgh, being the capital, is slightly more highbrow and courtesy amounts to different things in different places. Here the most polite course of action involved pretending not to notice and flashing an apologetic smile if you got caught taking a peek - which is a little less effusive but equally well meaning. After about half an hour the collection area was virtually empty and it became apparent that our bags were not going to appear. Archie made enquiries and, unsurprisingly the delay in Zagreb meant that the turn around time in London was too tight to get the luggage from one plane to the other. We filed this under 'who really cares...'. The airline had promised to deliver the bags sometime the following day and in our post-transfer glow we actually went as far as to cast it as a stroke of good fortune. Since I am not allowed to do any lifting for a little while poor old Archie had been impersonating a pack horse all day - I usually carry my own bags and I feel guilty if someone else has to do my share of the heaving - so a delivery direct to our door seemed like a pretty good deal. It turns out that in our giddy optimism we had made a glaring omission but we didn't realise that until a few hours later. Our homecoming was amazing. Our beautiful, waggy tailed boy turned so many circles of delight that he was a veritable border collie blur. The room was abound with cuddles, kisses, 'A-Woo's and excitement. At some point I will have to explain that I am harbouring his nemesis, (nemsii?), but not for a few more days. My brother, Sean, had taken amazing care of both Bauer and the house and, apart from the increasing pressure in my abdomen, I was on top of the world. A quick phone call to my mum, a text from my sister and a cuddle from my dad when he came to pick up Sean made the perfect end to an incredibly special day. And then we remembered the progesterone. It was in the green rucksack that didn't make it. I had a dose for before bed but not enough for the morning and none for the rest of the day. How epically stupid can you be? Why on earth didn't I carry a couple of spare boxes in my hand luggage - my excuse for being a complete fanny is fairly evident but I couldn't believe I'd made such a disastrous oversight. We tried to call the airline but there was no answer and, in the end our only option was to send one of those online messages where they don't even give you an email address, you just fill in a box without any idea who or when it will be received by. I was beside myself and sent off a message, dramatically entitled 'Medical Emergency', explaining that we'd just had IVF and that my embryos might not survive without the medicine. I admitted that it was my own stupid fault for not packing spares separately but I pleaded with them to contact us and help us if they could. Then we waited. A few hours later we got a call. The man who received the email had been through IVF four times unsuccessfully - and he set about moving heaven and earth to help us. He scoured schedules, chased down couriers and signed off on a delivery that he didn't have the seniority to authorise. Our luggage was delivered to our door by midnight - 'so that we wouldn't have to worry that it wouldn't come in the morning'. We have taken his name and today we are going to write a letter of commendation to his supervisor - but it's not enough - nothing could adequately express our gratitude. I knew that I wanted to come 'home' which is a big word for a person like me who has never really felt like she belonged anywhere - but last night a stranger proved to me that I finally, really do have a home. I belong here. These are my people.
I am writing this on the plane and, if at all possible, I will try to upload it when we get to Heathrow - but updating the blog from the phone is not easy, so this post may not appear until we get home. I didn't sleep too well last night because the bloating re-surfaced. Thankfully, by the time the alarm went off in the morning, it appeared to have receded - one last yo-yo just to keep us on our toes. Looking out of the window we could see that snow had started to fall for the first time since we arrived - apparently the temperature in Croatia is now set to plummet to lows of -12; it's a funny old day when flying to Scotland constitutes chasing the sun but it seems fitting that, since we arrived when the sun came out, we should leave when it goes away. When we got to the clinic I was weighed and measured - I had gained half a kg overnight but the size of my ovaries and waist remained constant. At this point Dr Romana brought over three pieces of paper, each with an image on it. The first was a picture of a little blastocyst all on its own, she explained that this little mite hadn't made it through the night and wasn't suitable for implantation. Each of the other pieces of paper had two little blastocysts on them, (four in total) - and in each image one blastocyst was described as being reasonably high quality and the other was considered marginally less robust - they were categorised as B/C and C/C respectively - and while I don't know exactly how this particular grading system works, I would guess that the first letter represents the number of cells, with B being 7 cells and C being 6 and that the second letter indicates the degree of fragmentation - a C in every case which, in the universal language of quality control, pretty much speaks for itself. Dr Romana said she was happy that there was a good possibility of conceiving from all four of them. So, at this stage, only the pivotal question remained - would she be willing to perform the procedure? And the long awaited answer? 'Yes... with reservations'. She said that if we lived in Croatia she wouldn't risk transplanting more than one - but followed this up by explaining that if we went with just one we would have to freeze the remaining three separately, as a singleton and a pair. This is because, at my age, implanting 3 is unlikely and, if they are frozen together, they would have to be thawed together - and once they are thawed they can't be re-frozen, which would mean a minimum of two return trips if we didn't want to leave any embryos behind. I asked about implanting two and she said she would do it but that I would need to give her my unequivocal word that, if she went ahead, I would spend the two week wait lying down and drinking copious amounts liquid. She says that if I get pregnant my condition will undoubtably worsen but she is reassured by my general, overall good health, (the mighty full blood count), and the fact that I seem to respond well to the lying down and drinking treatment - I'm averaging about 4 litres of water a day, plus hot drinks, soft drinks and soup. At this juncture, before Dr Romana could haver, I gave her my solemn promise to make like an inebriated sloth and the decision was finally made. We are bringing two little embryos home with us... my emotions are literally indescribable. I cried when I wrote that and I can't read it back without filling up with tears. Our incredible good fortune was brought home to me as I lay waiting for the implantation. A girl who had been in on the same day as I had for her egg retrieval was back for her embryo transfer - she told me that they'd harvested ten eggs of which seven had fertilised and she was still waiting to hear how many had survived. She was called away and when she came back her face was haunted - of the seven that fertilised, there were only two left - no snow babies at all. Her shattered look reminded me of my earlier comment about IVF mortal combat - for one person to win, someone else has to lose. When I left I kissed her hand... to thank her would have been crass but for my sanity I needed to do some small thing to acknowledge her sacrifice. There was another woman there who I didn't know from before - her story was one of four attempts in a year, each one with everything to recommend it - good eggs, good embryos and no adverse reaction to the drugs - and each one a failure. It was almost too traumatic to listen to - but if I had to hear it at all, it was at least timely - two healthy embryos is not a guarantee, it is a fabulous, fearsome, fighting chance but I still need to keep my paws on the floor. I wondered to myself - could I do that? Could I go through this again and again and again. I don't know - I hope I never have to find out. The transfer was easy-peasy - I am getting so blasé about flashing my vagina these days that I'll need to be careful I don't whip it out for an airing in a public place. Well, not quite - but the stage fright has diminished considerably. Two embryos were transferred, a B/C and a C/C - which leaves a B/C and a C/C for another attempt. Since you are not implanting 2 embryos so that you can have twins, but so that you have a greater chance of conceiving one, it makes sense to transfer a B/C and a C/C rather than two B/Cs followed by two C/Cs. At the end of the procedure Dr Romana gave me a cuddle and told me that I needed to remain horizontal for 15 minutes and then I was free to go. And, just like that, it was over. As I lay there, clasping my hands over my tummy, with tears rolling down my face the sound of 80s background music in the recovery room penetrated my thoughts... 'Ooh baby, do you know what it's worth? Ooh heaven is a place on earth. They say in heaven love comes first, We'll make heaven a place on earth.' I don't even know if this really is poignant - but I will never be able to hear it again without dissolving into tears. When they told me I could leave, Archie was on the other side of the door waiting with open arms. I actually can't write anymore just now because my sniffing is going to drive the guy in the seat next to me insane - but I will no doubt be back, I am too happy to keep my trap shut for long.
So, it is our final night in the flat in Zagreb, which - just in case we've inspired anyone to consider IVF in Croatia - can be booked by visiting www.abraxas-apartment.com. The owners have been lovely, the flat is well-presented, well-equipped and immaculate. There is a grocery shop just around the corner, it is ten minutes walk from a shopping centre with every possible modernity and the city centre is easily accessible by bus or tram. The clinic is 15 minutes in one direction, the pharmacy 15 minutes in the other and the location really has served our purpose perfectly. It has been our little haven and comes highly recommended! If you would like more information about Dr Romana and her truly wonderful clinic then please visit www.betaplus.hr. Dr Romana and her staff have been legendary - warm, efficient, kind and eminently capable. When we visited the acupuncture clinic and mentioned that we were patients of Dr Romana the acupuncturist commented that she was known throughout Zagreb as 'the best in her field, renowned not just for her professionalism but her humanity'. I couldn't have put it better myself, so I won't try. Whatever the outcome we couldn't have been treated with more regard and we are eternally grateful. Oh and, just for the record, her real title is Dr Dmitrovic - her first name is Romana - I am not sure when I started getting her name wrong but I have been consistently incorrect throughout – needless to say, she has had the very good grace to turn a blind eye and allow me this idiosyncrasy without a word of dissent. At times this fortnight has seemed to stretch on for an eternity - but tonight I can hardly believe that it is over. I will be so glad to get home but not because I have any complaints. I would, without a doubt, do it all again if I had to - and there is every probability that we will be back - maybe because tomorrow leaves us bereft, or because the 2ww delivers only disappointment, or in an effort to turn our snow babies into siblings, or maybe, child, to take you back to the place where you were conceived...
I have just received an email about my blood test results. I think it was just a basic full blood count but it has come back normal and, apparently this is a VERY good sign!!! Certainly it has cheered Dr Romana up immeasurably and she says that this makes going ahead with the implantation much more likely!! Who knew a full blood count could be so significant? I am so pleased - I know we're not out of the woods until tomorrow morning but I don't think she would have sent such a positive email if she had serious reservations. Could it possibly be that things are actually going to work out OK? I am sure it has been an epic battle between Archie's guardian angel and my malicious little army of gremlins - but it looks like Archie's angel might be taking serious casualties! For the second time today - 'Guan yersel!'.
I am going to start with the good news because, in the big scheme of things, it is by far the most important consideration. While we were at the clinic today Archie brass-necked it like a pro and asked after our embryos. The response? ALL five are still with us and doing well!! Isn't that wonderful? I know we still have 24hrs to get through but there's being cautious and there's being a complete killjoy - for all five of our little embryos to have made it this far is not unheard of but it is statistically unlikely and it is well worth a mini-celebration! We are incredibly proud of them - which is a complete nonsense because they're about as far from being self-directed, sentient beings as it is possible to be and still exist at the same time, (and if any of then hadn't survived we wouldn't have been the opposite of proud), but emotions aren't renowned for their logic and, rightly or wrongly, it's definitely pride that we feel. 'Gaun yersel' as they say in Scotland. I wouldn't normally broadcast my urinary exploits but I was delighted when I woke in the middle of night and had what, after days of low pressure dribble, felt like an ordinary and reasonably substantial pee. In fact, by the morning, the reduction in bloating was so significant that I tried to persuade Archie that a trip to the clinic was unnecessary. As it happens Archie is very good at ignoring me while simultaneously appearing to be both sympathetic and attentive - it is a gift he has refined into an art over the years. In the taxi I worried out loud about wasting the doctors time, citing the fact that the pain was now comparatively insignificant - Archie, held my hand and applied the aforementioned tried and trusted technique. Walking from the taxi, through the building, the discomfort began to return more persistently but I was still pretty optimistic - I felt so much better than the previous morning. The nurse weighed me and took my waist measurement, (I never weigh myself so I was unable to tell her whether it was more or less than normal - but it doesn't really matter - they will use it to make a comparison tomorrow morning). The reason they take these measurements is because they are an easy means of detecting excessive fluid retention. If either of them went up overnight it would not be a positive thing. I apologised to Dr Romana for the possibility that we might be wasting her time, explaining that things were vastly improved - but her response was to commend Archie for emailing and bringing me in. She said that if I hadn't spent the past 24hrs lying down then the embryo transfer would, without a doubt, have been cancelled, (Archie, being a saint, had the good grace not to look smug). It was all sounding fairly positive until she scanned my ovaries and then there was a slight but detectable change in her tenor - I got the impression that she was a little surprised by their size. She mentioned that it was unusual to get OHSS after a harvest of only 7 eggs but confirmed that at the moment I have it to a 'moderate' degree - there is also some fluid in my abdominal cavity. My first inane thought was 'thank goodness you didn't check yesterday'! She didn't say the transfer was off, she said that we would assess the situation again tomorrow and make a decision thereafter - but I would be lying if I didn't admit that she looked a little relieved when we asked some questions about frozen embryo transfer. Before sending us for a blood test, the results of which we will get this afternoon, she briefly hazarded the possibility of transferring only one embryo, (presumably because, if one takes it will produce hcg but nowhere near as much hcg as two), but it was said in a 'thinking-out-loud' capacity and we didn't push because we know that, until tomorrow, everything is speculative regardless. In the meantime I am back on the couch, drinking water like a woman possessed. I realise that the latter part of this account hasn't betrayed any great emotion, which is the antithesis of how I would normally eulogise happenings of great personal significance - but I cannot afford to start crying at the moment - every drop of liquid counts. Archie and I will have to talk about what we're going to do if the situation is the same or worse tomorrow, whether we'll risk a transfer of one or two regardless - or whether it would be wiser to wait and find the pennies to fly back. I will let you know whether the blood test offers any enlightenment.
I wasn't going to post again today, but having spent some time mining google for information regarding mild/moderate OHSS and whether it's safe/advisable to go ahead with IVF regardless, I thought I would document my findings - which basically amount to a complete lack of clarity. Whenever someone posts in a forum saying that they have symptoms of OHSS and asking whether they should go ahead anyway, they get a barrage of 'don't do it' responses from people who went ahead with it and got very sick. That being said, some of these people then go on to say that they survived the OHSS and delivered healthy babies... and some, very sadly, go on to speak of heartbreaking miscarriage - but these posts are not sufficiently scientific for me to conclusively ascertain whether the OHSS and the miscarriage were linked or whether they were just a set of tragic co-incidences. As it is I am still hopeful that I will wake up tomorrow and the situation will have resolved itself overnight... (I am closely related to a rather fetching ostrich), but for the benefit of people considering IVF tourism I feel like I should address the issues regardless of whether or not they give us more than a day or two of worry. As I mentioned before OHSS will be exacerbated by pregnancy, so if you have mild, (or even no symptoms), before implantation then the overwhelming likelihood is that they will get worse. This may amount to weeks of discomfort and inactivity or, it may result in being taken into hospital because the water being collected by your follicles eventually floods your abdominal cavity and lungs - which necessitates medical intervention to regularly drain the build up and replace the fluid/vitamins etc. that are bypassing your system. Another consideration is that, if you implant two embryos and both of them take, then the flood of hcg will be double the ordinary influx, considerably aggravating any possible case of OHSS. If the doctor advises, or you decide, not to go ahead, then you will have to wait at least a month before you can transfer any frozen embryos. So for people considering travelling to Europe for IVF, OHSS is a real consideration that you might want to preempt with some thought. I wouldn't for a minute advise that you let the possibility stand in the way of trying, since your statistical chances of developing OHSS to any kind of detrimental degree are not excessive - but you should definitely give the issue some thought so that you are not entirely blindsided by the eventuality. Up to this point, the only thing that we thought might prevent an embryo transfer was a lack of embryos - so, as a very good friend of mine used to say to me - 'learn from the mistakes of others, you won't live long enough to make them all yourself'.
For the past few days I have been trying to ignore the increasing pain in my abdomen. I mentioned earlier a condition called 'Ovarian Hyper Stimulation Syndrome', (OHSS), and how I hoped that harvesting fewer than average eggs meant that I would be a low risk candidate. It seems that this was misguided. Apparently your ovaries are full of little follicles and, once the harvesting has taken place, it is possible for all of these little follicles to fill up with water - each one can hold as much as a cupful, (I realise that's a fairly ambiguous description but it was the only comparison I could find – and, whether we're talking dainty china tea cups or man sized mugs, it's more liquid than a person wants sloshing about in their reproductive organs). This liquid causes your ovaries to expand far beyond their normal size which leads to all sorts of unpleasantness; the follicles draw the liquid out of your blood, causing the blood to thicken and making urination increasingly difficult. I knew that I was uncomfortable and that I was finding it harder to pee but, since the symptoms of OHSS vary from mild to severe, I figured I could keep myself in the mild category with some good old fashioned denial. Unfortunately, when I went into the bathroom to take a shower this morning I was unable to hide a spasm of excruciating pain from Archie, (it has been mildly painful for days but it has reached a stage where certain movements send a searing jolt through my abdomen, making me feel breathless and dizzy). This, combined with the fact that my belly is now visibly bloated, as if in the early months of pregnancy, (how's that for irony?), meant that we had no other choice than to contact the clinic. So, why does it matter? It matters because they won't go ahead with implantation if your symptoms haven't subsided. The problem is that the OHSS is, in part, triggered by the hcg that is contained in the last injection - the one that encourages maturation of the eggs. If you go ahead with implantation and an embryo takes, your body will begin producing more hcg - which means that your ovaries won't get a chance to recover and you may get very, very sick - not good for you but, more importantly, not good for your developing embryo. Archie emailed Dr Romana to ask her what we should do and she instructed that I lie down immediately and stay lying down, (apart from a visit to the clinic at 9am tomorrow so that she can re-evaluate the situation). I've to drink copious amounts of fluid, take pain killers and hope for the best. If my symptoms get worse, (vomiting, dizziness, trouble breathing), then it won't be possible to go ahead - but she'll know more tomorrow. We were supposed to go into Zagreb today for more acupuncture and maybe some sightseeing but Archie has had to go in on his own, (he wouldn't have left me but we didn't pay for Monday's acupuncture session because we thought we'd be in again today). In a way I am glad that there was a reason to compel him out of the flat - he has been cooped up with me day in and day out for a fortnight and I am now even more useless than I was before - I'm terrified to move, every horizontal second counts. He has been nothing short of heroic, stoic and compassionate from the moment we arrived but I could see a hint of desperation in his poor wee face today and even though I know it's not my fault, I feel responsible. He is such a good man and none of this is fair. On the bright side, apart from a little twinge here and there, I am fairly comfortable if I stay flat on my back - and there must be hope because Dr Romana has no earthly reason to string us along. To be honest, that's about as much good cheer as I can muster at the moment. Please forgive the lack-lustre word-smithery of this post - it hasn't been my favourite one to write.
When the clinic phoned to let us know that 5 embryos had fertilised they were quick to follow this with confirmation of the date and time of the embryo transfer appointment - which is still on Friday but has been moved half an hour from 8.30am to 9am. What they didn't do was suggest or encourage any communication between times - I assume that this is because they are trying to avoid being inundated with daily/hourly requests for embryo updates. I don't know how I feel about this. Well, I do. I want an update a minimum of every 24hrs and I had assumed, going into the egg retrieval, that this would be forthcoming. I find it hard to imagine that anyone going through this doesn't want to know what's happening as the days progress - how many embryos have made it through the night, how is the cell division coming along, is there any fragmentation? We are a long way from home with no family, friends or work to provide a distraction, we're on a tight budget and we have no car to facilitate exploration further afield - it seems almost cruel to expect us to wait without a daily 'news' deadline to look forward to. I thought about disregarding the silent but unmistakable admonishment and phoning or emailing anyway but before I acted on the impulse I asked myself 'Why do you need to know? What difference would it make?' - and disappointingly, if I am honest with myself, I have to admit that it serves no practical purpose... so long as we have embryos left to transfer on Friday we will transfer them. We already know that if we have five and they are all equally healthy, we will transfer the two best IVF embryos and freeze the rest, if there is any variation of quality across the IVF/ICSI divide then we will follow the doctors best advice and, if we have two or less, the decision has made itself. Presumably, if you had none, the clinic would phone and tell you to spare you the disappointment of an entirely pointless appointment. So, going by this logic, no news is actually good news - it means that there is still a chance and, since the quality of the embryos is evolving every day, knowing that one is doing well on Wednesday doesn't mean that it will still be the front runner by Friday. I also keep reminding myself that, despite my earlier reference to 'convenience', Dr Romana knows what she is doing and if her clinic has a policy of not updating people daily then it won't be just to spare themselves the hassle - she is a good person and she will doing what she genuinely believes to be best for all concerned. Perhaps daily updates exacerbate stress and make implantation less successful? Certainly it would be counter intuitive of her to adopt a policy which promotes stress and makes people less likely to conceive. For these reasons I am doing my very best not to push the people who are trying to help us for information that they seem reluctant to share. That being said I don't know how long my resolve will last in the face of the slowly ticking clock. I went to bed last night crying because I couldn't think how I would put one foot in front of the other for three more days - a despair which is only made worse when you consider that on the fourth day, if there are any embryos to transplant, you are merely at the beginning of what is known in IVF circles as the two week wait. The two week wait is such an institution that it even has it's own abbreviation - 2ww. There is no point in doing a pregnancy test in the first week of the 2ww because the chemical, (hcg), that the test is designed to detect is contained in the last injection that you took to promote maturation of your eggs. You will, therefore, likely have traces of hcg in your system whether you are pregnant or not, making a positive test obsolete. If your pregnancy is progressing normally the hcg being generated by the growth of your baby will not reach detectable levels until 14 days after implantation, which means that you could test in the second week, get a negative result and still be pregnant. The long and the short of it is that you can do all the tests under the sun and, regardless of the result, you won't know for sure until after a fortnight. Perhaps Dr Romana is trying to give her patients a taste of what's to come, in the hopes that they will use the opportunity to develop their resilience? Whatever the purpose, it is a hard path to tread.
The 'moxa stick' is a 'toxa stick'! We used it last night and 16hrs later the smell is an unmistakable personification of deep and meaningful conversations that will never be remembered. I wouldn't mind at all except that the flat is non-smoking and I don't want the owners to think we took liberties. If the pregnancy doesn't take and, if we have any embryos left to freeze and if we can afford it - we might be back. (If I'd tried a bit harder, maybe I could've gotten another 'if' in there... although three 'if's followed by a 'might' is not too shabby in the tenuous stakes) Anyway, the only other option is to use the toxa stick on the balcony and keep all the doors and windows shut - thereby polluting only our neighbours. I have tried to persuade Archie that this is not a good idea - that the stress of worrying about getting arrested, combined with the fear of being singed, (you're meant to hold the lit end about an inch from the skin and wave it about for five minutes), over-rides any potential benefit - but he assures me that this is just the progesterone talking. Yesterday I made the tactical error of reading out the list of progesterone side-effects, of which 'excessive worry' sits close to the top - understandably I have now eliminated what little credibility I may have had remaining. So, my friends, my future is now in Archie's hands which he assures me are 'very steady and have never burned anyone before'. At the very least it is a comfort to know that being arrested can only be good for the blog. At one point in our toxa-centric-communications I was temporarily in possession of the upper-hand. I had utilised my very best negotiation skills to barter a hot-water bottle related deal - my logic was that, since there is no contact between the toxa stick and the skin, the only real benefit must derive from the heat. So we set out on a mission to find a hot water bottle, which you wouldn't have thought would be too difficult considering that the average temperature here in winter is -1. It has actually been much more temperate than that since we arrived but surely the people ordering January's stock in November couldn't have predicted this reprieve? You'd be wrong - either Croatian purchasing departments have a direct link to the Met office or hot water bottles are for sissy's. I suspect it is the latter because when we eventually did find one, (in the very last place we looked), they were only available in girly pink miniature. But, and this is an epic BUT... you'll never guess what was nestled beside them! A bona fide - genuine - honest to God - packet of Lipton's, Yellow Label, Tea!! I don't know what the logic is behind the placement - perhaps I should be offended to find tea in the sissy aisle - but I am not. I am over the moon. I am delighted. I am ridiculously pleased. Predictably, in my excitement, I misplaced the upper-hand somewhere on the way home and I now find myself committed to both the hot-water bottle and the toxa stick, (Archie is not daft), but it is a small price to pay for a shot of the life-giving brew. So far today there has been no word from the clinic - I will let you know if and when that changes.
Five of our seven eggs have fertilised - 3 via IVF and 2 via ICSI. We are cautiously elated - an oxymoron of emotions if ever there was one. Under the circumstances this is the best we could have realistically hoped for and we are trying to be optimistic since pessimism is a less pleasant way to pass the time. That being said, there have been a few tears - we are both weary with worry and powerlessness - but we are proud of our little embryos and we are rooting for them with every fibre of our beings. For now that is all I am able to coherently say on the subject - believe me I've tried to write more but I am inarticulate with the impotence of knowing that nothing I say will make any difference. I forgot to mention that I had to start taking the Utogestran yesterday - I was given a brief reprieve and told to take the first two doses orally so as not to further irritate any tenderness after the egg collection - I can also take it orally on the day of the embryo transfer. This drug contains the hormone progesterone, which is a hormone produced naturally by the ovaries in preparation for pregnancy - encouraging the secretion of proteins to nourish the embryo. I had naively imagined that the injections were an end to the hormones but, of course, your body needs to mimic the biology of a normal pregnancy so progesterone it is then. Today we went into Zagreb for an acupuncture session. There is considerable debate about whether acupuncture improves a woman's chances of conceiving via IVF - there have been studies which indicate that acupuncture before and after implantation makes a difference, (it is thought that acupuncture may stimulate blood flow to the uterus), but these studies have been criticised by both medics and academics, who argue that the research design was flawed. I asked Dr Romana what she thought and, in the context of IVF, her response basically amounted to a dismissal - although she added that it might be good for relaxation, (which may have been a polite platitude in case I was some sort of secret alternative therapy champion). As it is, I have never had acupuncture - I am neither evangelical about alternative therapies, nor do I deride them. On the basis that acupuncture is much cheaper in Zagreb than it is in the UK and that we'll probably never have a better excuse to try it out, we decided that it might help to fill the time and, at the very least, calm the nerves. I was a bit disappointed to discover that most acupuncture is now done by laser so there are no little needles involved, (I am not mad for needles but acupuncture without needles lacks a certain authenticity). I didn't feel anything at all while the doctor was apparently zapping my pressure points and then she moved on to what is called 'scenar therapy' which involved rubbing a barcode scanner, (not really, but that's what it looked like), over my lower abdomen. The whole area is still pretty sore from yesterday and it hurt quite a bit to start with but the pain eventually ebbed away - I don't know if this was the effect of the scanner or just the fact that if you press on anything painful for long enough you stop feeling the pain quite as intensely. Lastly she broke out a 'moxa stick' which, when lit, smells like cannabis and is used to apply warmth to different areas of the body - she showed Archie how to use it and gave us one to take home. I am not sure what the advantages are supposed to be as compared to that of an ordinary hot water bottle but, so long as the aroma doesn't get us arrested, I have no objection to giving it a try.
When I came round from the anesthetic Dr Romana was there to tell me that we'd managed to harvest 7 eggs. I found myself apologising to her and then, when Archie came through, apologising to him. The average is 8-15, the optimum is 15, 20+ is not uncommon and no matter how you look at it 7 is half the optimum. I felt terrible - like I'd failed some sort of test and let everyone down in the process. Other than sorry I didn't say much else - I didn't even cry more than a tear or two - I knew Archie needed me to be OK and I felt, given my disappointing performance, that it was the least I could try and do. The procedure itself went smoothly; we were there on time, I was undressed and in the operating theatre within 15mins and I came round quickly. As I was wheeled out to sleep it off, another lady went in and then another one after her. It was busier than I expected but I'm not sure why I didn't expect it to be busy?! I was desperate to leave as soon as possible and I was really pleased when, after about an hour, they said that Archie could take me home. He'd been allowed through for 5 minutes but then asked to wait outside. When I got home I googled '7 eggs retrieved IVF' and the following results were the first four I came across - obviously this information is all gleaned from forums where people are posting things like 'only 7 eggs collected, can anyone reassure me?' - so the responses are naturally skewed to the positive but, apart from the sobering reality check of the fourth, the rest were mildly reassuring. 26yrs old: 7 eggs retrieved, 5 fertilised - 2 embryos by day 3. 37yrs old: 7 eggs retrieved, 5 fertilised - 1 embryo by day 3. 35yrs old: 5 eggs retrieved, 5 fertilised - 5 embryos by day 3. 35yrs old: 7 eggs retrieved, 7 fertilised - 0 embryos by day 3. There are two ways in which the fertilisation can take place, the one you will be familiar with is IVF - this is where the best sperm and eggs are put together and left to interact without assistance, the second is known as ICSI, where an individual sperm is taken and injected directly into each egg - the downsides to ICSI are that the act of piercing the egg to inject the sperm may damage the egg and that eggs which are fertilised by ICSI are statistically less likely to implant. Depending on your circumstances the doctor may chose to use ICSI immediately or they may chose to start with IVF and then administer ICSI if it looks like assistance is required. If any of our eggs fertilise we will be advised at the time whether it was via IVF, ICSI or a combination of the two. Some clinics implant embryos on days 2-3, while some clinics wait until days 5-6, (when the embryo is known as a blastocyst). The reason for this difference has to do with the recent emphasis on implanting only one embryo per IVF cycle. It is believed, that if you are only implanting one, then by waiting until the blastocyst stage, you have a better chance of picking the strongest contender. There is some argument that if you wait until blastocyst stage you should not implant more than one because it will increase the incidence of multiple birth. Anyone going through IVF in the UK will, at some stage, be delivered a stern lecture on the risks of multiple births; they will be told that multiple births increase the chance of neurological/congenital abnormalities and heighten the risk of complications in pregnancy which make pregnancy more dangerous for the mother and may lead to premature birth and/or time spent in intensive care. I think most women shrug off the possible increased risk to themselves but are terrified of the idea that they might expose their embryos to higher odds of cerebral palsy and other congenital defects. Each couple has to go away and consider all the statistics for themselves. We found that the increased risks were real but very much in the margins which made us wonder about the emphasis with which they were conveyed by the medical profession, (in the UK). When we did our research we found that a lot of people were skeptical that this guidance was driven entirely by altruism - obviously it's the truth but, arguably, it's the truth without the context. The truth is that multiple births are marginally more risky and considerably more expensive - there is more ongoing monitoring required and the high incidence of premature birth necessitates a stint in intensive care for both mother and babies regardless of how well all three may be doing - it's policy and it's pricey. Premature birth only becomes a real issue if the babies are born weeks before their due date - babies born a week or so premature are generally fine. So some people will tell you that the pressure to transfer single embryos is financially driven and point out that, if the legislators were serious about the increased health risks, then they would move to drive down the price of IVF, since most people only feel pressure to transplant more than one embryo because they can't afford to pay for the process more than once. Implanting two embryos does not double your chances of conceiving a single child and of the 40% of people who conceive via IVF with two embryos, only 20% of those will end up carrying twins. All of that being said, for us it is immaterial, even if we were in the UK they would now transfer two embryos because of my age - 35 is the magic number. If you are 40+ they will consider transferring 3. If you are lucky enough to have a surplus of healthy embryos by the day of implantation then you can freeze the remainder. This means, that, should your pregnancy fail to take, you could come back to the same clinic at a later stage and have them implanted without going through, or paying for, the egg stimulation, harvesting and fertilisation process again. Compared to the cost of the whole process the freezing and implantation of excess embryos is insignificant and, even with flights and an overnight stay, it would be a real possibility for a lot of couples. Of course if you don't have any spare embryos you would have no option but to go through the whole process again. With regards to blastocysts most clinics will have a grading system which may vary or be expressed slightly differently from practice to practice, however, in general terms the doctor will be able to tell you whether your embryos are: 8A, which means that the blastocyst has divided into 8 cells and there is no fragmentation, (fragmented cells are slightly broken up and, while many babies are born from fragmented embryos, the doctors prefer to work with the ones which show the least evidence of fragmentation). Blastocysts can then be graded 8A through to 8D - with A to D indicating the degree of fragmentation. 7A-D and 6A-D are also workable. Blastocysts of only 5 cells or more by day 3 are not considered to be eminently viable and are unlikely to implant. I've tried to give you all the information that you might need to interpret the up-coming posts but I appreciate that it's a lot to digest and I will try to clarify as the days go by. For now we have to wait for a phone call to find out how many of my eggs were suitably mature and whether any of them fertilised - this phone call won't come until tomorrow. Having done his bit and waited nervously by my bedside Archie is now having a well deserved beer, the first in about a month - I have attempted to preserve his dignity as regards the process with silence, suffice it to say that I am married to the best, most brave husband in the world and I couldn't be more proud or grateful. I am sore when I move but nothing that a healthy dose of ibuprofen can't take the edge off of and, other than feeling emotional and a bit overwrought, I am fighting fit.
Dalmatian dogs originally came from the Dalmatia region of Croatia. Agatha Christie spent her honeymoon in Dubrovnik, (the beach capital of Croatia). Marco Polo was most likely born on the small Croatian Island of Korcula. The White House in Washington was built from stone brought from the Croatian Island of Brac. The necktie worn by business men the world over is derived from the Croatian cravat. With a population of 23, the Croatian town of Hum holds the Guinness World Record for being the smallest town in the world. Just under a third of Croatia is covered by forest and there are 1000+ coastal Croatian Islands of which only 66 are inhabited. It is estimated that 30% of Croatia's adult population are smokers, (as compared to about 19.5% in the UK) and, in Croatia, 16yr olds can vote if they have a job, otherwise the voting age is 18. On a more serious note, up to 15,000 Croatian civilians were killed in a war between the Serbs and the Croats, known as the Croatian War of Independence, which lasted for 4 years, 7 months, 1 week and 5 days, between 1991 and 1995. This war happened in living memory of all the adults we have seen around us and it is strange to think that the nurses and Dr Romana lived through such a tragedy. When we travelled to Rwanda we found that people were quite open about the genocide, here it is a topic that the guidebooks suggest that you don't bring up - so we haven't. The capital of Croatia is Zagreb, the currency is the Kuna, (named after a small, brown, furry rodent known as a Marten in English) and it has a population of about 4.29 million - making it is smaller (56,594km sq) and less populated than Scotland, (78,387km sq, population 5.295million). The overall life expectancy is 75.7 years - pretty much mirroring the life expectancy in Scotland, which is, incidentally, considered to be one of the lowest in Western Europe. Croatia has 8 universities with literacy estimated at 98.1%; Scotland has 15 universities with a literacy rate of 99%. In 2011 the average net monthly income was 5,397 Kuna, (approx. £600) - the cost of bread is 6.07 Kuna (£0.67), 1 litre of milk is 6.09 Kuna (£0.69), 1kg of chicken is 51.15 Kuna (£5.75). Croatia boasts beautiful summers and snowy winters, (-1 to 30 degrees Celsius) - making it a great destination for both beach and skiing holidays. And that, my friends, is a study in how not to write an essay; turning lists into paragraphs by virtue of spacing. I'm afraid that my concentration span is not what it could be and I think that's the best I can manage. Tomorrow is the big day - I will let you know how many eggs we manage to collect. Apologies in advance for any incoherency - I am not entirely sure how I am going to feel after the procedure - apparently some people are knocked sideways and others are a bit sore but otherwise unscathed. If you get a chance to think some positive thoughts on our behalf that would be a very great kindness.
Oh, there was one other thing I meant to mention regarding egg harvesting. It is perfectly possible for a woman to have her eggs harvested and frozen without them being fertilised. This is something a person might do because they want to preserve the possibility of having a child past the point of their natural fertility - perhaps because they haven't met an appropriate partner yet or because of other factors like illness or career or the cost of completing a full round of IVF. What this means is that if you are in your 30s and you would like a child but it doesn't seem immediately probable you can have your eggs harvested, frozen and then fertilised at a later date. Obviously it doesn't guarantee your chances but apparently it is possible to successfully conceive and carry a child this way post-menopause. Food for thought. Again there are ethics involved - the older you are when you give birth, the less time you are likely to be alive to parent your child - but the point of this post is merely to inform, not to pass judgement because, quite frankly, I have enough trouble making my own decisions without trying to make other peoples.
For the first time today I find myself staring at the blank page in front of me with no inclination how to fill it... with less than 24hrs to go before the harvest festival, very little seems worthy of note. I am conscious that I am letting myself down; a better person would be pro-actively filling their time with a worthy, (possibly even charitable?), distraction - but, I can't for the life of me come up with a to-do list. If I were at home I might go and see my big sister and her beautiful little girls, or visit a good friend, or bake cakes and deliver them to all of Archie's friends, or we might go for a long drive and listen to our wedding playlist - none of which are particularly worthy in the holistic sense of the word but all of which are meaningful to me. I'm not mentioning this because I think I'm unlucky; if we were doing this at home there would be downsides as well - we wouldn't have had so much time together, Archie wouldn't have been home to give me my 2pm injections, there would have been no escaping everyday expectations despite the influx of hormones, I probably wouldn't have written this blog... I'm just mentioning it because, today, it is the truth and, if anyone is planning to follow suit, it might be a good idea to put some forethought into how you're going to deal with days like these. For now though I will just have to improvise - I don't have an oven or I would probably go ahead and bake cakes for all the neighbours - at once doing my small bit for international relations while simultaneously personifying my Scottish origins - they don't call us the heart attack capital of the world for nothing you know, (deep-fried chocolate cake with frosting in batter anyone?). I think what I should do is pay Croatia the compliment it so richly deserves and pull together a paragraph or two about the country we're staying in. That way, anyone reading the blog and thinking of making a visit, can be a couple of paragraphs less ignorant than we were when they arrive. See what I did there? I set myself a goal and I made you guys the goal-police. Now if I don't do it I'll feel guilty - ah, guilt, my old friend the great motivator.
I am 35 years old today; thankfully I am not one of those people who finds it hard getting older. In fact, until it became apparent that we would need IVF, I didn't think there were any draw backs to getting older at all. The older you get, the better you know yourself and the less you care what other people think; in my book that trumps any possible concern regarding vanity hands down, (admittedly though I am no raving beauty and losing something you've never really had hardly compares to losing an asset). Anyway my point is not really about appearance, it is about the naivety with which I presumed that getting older wouldn't have any implications, other than those to do with appearance. I assumed that my wrinkles would deepen and my hair would go grey but, that until I got REALLY old and my body or my mind gave up on me in some spectacular way, age would render me less pre-possessing but leave me otherwise unscathed. I find it almost unfathomable that my fertility is about to go into a steep decline. You have to be kidding me?! Really? What is this madness? It doesn't bother me so much as strike me as laughable. Even without infertility my chances of conceiving would be slowly slipping away. Biological irony at its best - bringing women the world over to the brink of selflessness and then aborting their chances. Thankfully I can't take the idea that I am in any kind of decline too seriously - I haven't stopped going up, I can't possibly be coming down... or maybe this is a biological delusion designed to offset the irony. Whatever. I'll take it. Old? Me? Never.
We went to the pharmacy yesterday to purchase the remainder of the medication. I took the last of the hormones that cause your eggs to grow last night, so no 2pm or 9pm injections for me today - hurrah! Instead I will be taking the Ovitrelle at 9.30pm, which is the one that encourages final maturation of your eggs. After this there will be no more injections until I get the anaesthetic on Sunday. The medication regime doesn't, however, end quite there - we also had to buy 8 packets of a drug called Utrogestan, which is to be taken after the embryo is implanted and continued thereafter for a number of weeks. I was very excited to open a packet and discover that they weren't injections. I was slightly less excited when Archie googled the name, (because we can't read the Croatian instructions), and discovered that they are, in fact, vaginal suppositories. Of course they are. Three a day for between 2 and 12 weeks depending on whether the pregnancy takes. People say that there is no dignity in child birth; well, just for the record, there's not much dignity in IVF either - my vagina is practically a c-list celebrity it has made so many public appearances, (don't worry, it hasn't gone to my head, I'm not going to post any pictures).. The good news is that I couldn't sleep too well last night because my ovaries feel so bloated that no position is comfortable. This is good news because, as I mentioned before, the bigger and more bountiful your eggs, (within reason), the better your chances. If I am not growing the optimum number I hope at least that I am growing what I've got to the optimum size. I'm not going to dwell on the discomfort though because some people experience far worse - I can only imagine what it feels like to grow 20+ eggs... besides which, as I was wriggling around last night, it struck me that, while your body isn't really designed to accommodate enlarged ovaries, it can't be anywhere near as uncomfortable as accommodating an enlarged embryo. When the doctors stimulate your ovaries they run the risk of causing Ovarian Hyper-Stimulation Syndrome which presents between 3 and 5 days after they have harvested your eggs. The symptoms can range from mild to severe with severe cases being hospitalised - as far as I can gather it is more unpleasant than it is life threatening but, given that I am not overloaded with eggs, I hope that I am an unlikely candidate. We also found out yesterday when our embryos, (if any are viable), will be implanted. The procedure is scheduled for 8.30am on Friday 24th, after which we are free to go home. It seems that we have been exceptionally fortunate with our timings and things have unfolded in the shortest allocation possible. Our return flights were booked for the 30th but our immediate response to getting this news was to look at earlier flights - which perhaps offers a more telling insight into the stress of the experience than a million words or phrases. Croatia has been nothing but good to us and earns, thus far, our very highest recommendation - especially the clinic, Dr Romana and her staff - but, given the opportunity, it seems we'd rather nurture our fragile chances in the privacy and comfort of our own home. The only flights available were Friday, the same day as the procedure, or Monday after the weekend - when we mentioned this to Dr Romana she advised that we travel on Friday. She said it would take our minds off of the worry. Archie was a little nervous, I think he had planned to wrap me up in cotton wool for 48hrs but Dr Romana said that studies have shown that bed-rest/remaining completely sedentary after implantation definitely doesn't improve your chances and might actually damage them. Obviously you've not to engage in strenuous exercise but, marathons aside, she believes that we'd be better served by flying home to our comfort zone than sitting about waiting for twinges. We have taken the decision that, since she is the expert, with scores of successful live births to her name and we can't claim anything half so clever between us, we are best served by following her every direction to the letter - which means that we will be flying home 2 weeks and 2 days after we arrived. You will probably have noticed that I sneaked in the bit about having a date for implantation without any fanfare - this is not because I don't care but perhaps because I care too much... I don't believe in God and I am not superstitious but I don't want to count our blastocysts before they've hatched. Go figure.
The first milestone has been set for Sunday, we've to be there at 8.30am and, all being well, there will be some 'cross Archie and Temora contamination' starting to take place by mid-afternoon. According to internet articles, quoting a study published in the journal of Human Reproduction, 15 eggs is the optimum harvest. I kind of wish I hadn't looked this up because I don't think I have 15 eggs growing, more like 10 or 12, although it is hard to tell exactly from the scan, (and I don't know if the doctor can extract them all, or whether it's more of a smash and grab). You can check out endless stats online regarding a woman's age, how many eggs were retrieved, how many eggs were mature and how many eggs fertilised but if I quote you just two you'll be able to see that they vary so widely it's impossible to infer much: 39yrs old, 8 retrieved, 3 mature, 1 fertilised 36yrs old, 17 retrieved, 14 mature, 10 fertilised Those eggs which fertilise then need to survive for 3+ days while the cells divide and multiply into blastocysts, (early embryos). During this process most people lose a few and some people lose them all - so there really is no way of telling how many viable embryos, if any, you will have by day 3. I am delighted that we have a date but I am also more frightened than I have been so far. I can't imagine what it will be like to sit and wait and hope... but I guess we're going to find out.
I heard yesterday from a lovely lady who went through this same process of hormone induced egg stimulation so that she could donate her eggs to a woman in need. It had never occurred to me that if you were going to donate your eggs you would need to be medicated and harvested, (cropped, yielded, reaped… it’s not really getting much better is it?), just like an ordinary IVF patient. Her story made me realise that there are hundreds of women out there who need eggs and there are very few people donating them. I imagine that this is a combined consequence of the fact that donating eggs is not something that an ordinary woman thinks about in the every day course of things, if she does consider it she discovers that it involves medication, hormonal disruption, discomfort and minor surgery and, then, to top it all off, there’s the ethical question about whether you’re comfortable being a parent in a purely biological capacity. I don’t know whether all children born of egg donation can chose to meet with their biological parent at 18 but this lady is prepared for that eventuality, so it is definitely a possibility. The ethical dilemma is no different from that facing a sperm donor – it’s deeply personal and different people will come to different conclusions – the actual process of donating, however, involves a bit more than an orgasm… in fact, because life is the epitome of fairness, it doesn’t involve an orgasm at all. Maybe they should throw in a freebie – ‘queues spanning the breadth of the nation as women rush to donate…’.
Which brings us on to sex. Yes, child, I am afraid it has happened – in fact, thanks to you, it has probably happened with greater regularity over the past three years than it would have otherwise. Hee, hee, hee, I’m enjoying this, but you won’t be – so why don’t you skip the rest of this paragraph, safe in the knowledge that, being the best parent’s in the world, with nothing but concern for your emotional wellbeing, we arranged to have you conceived without even touching. For the rest of our readers, I doubt very much that you expected me to go into salubrious detail and you won’t be disappointed because we’ve been told not to have sex until about a week after the embryos are re-implanted. I’m not sure what the logic is re. beforehand but afterwards it’s to prevent uterine cramping which might dislodge the embryo. Beforehand it might be a precautionary measure to prevent the stimulation of ovulation – or maybe, given the intercourse marathon involved I getting this far, the doctors are just imposing a therapeutic break. (It’s not my fault, I told you to stop reading!)
Hi there, after Temora’s post the other day where she talked about the price IVF in Croatia, I thought I’d break down our decision process and look more closely at the costs, details and some statistics. We looked at a lot of countries but as Temora has already mentioned Eastern Europe is significantly cheaper, so I’ll only mention countries in this area.
The first thing that we did was send out a load of emails to clinics in various Eastern European countries and depending on the response, or lack thereof, we narrowed the pool. Then we looked at how much return flights to these countries on our short list would be from Glasgow or Edinburgh and they were roughly:
£185 per person from Edinburgh to Bulgaria
£220 per person from Edinburgh to Croatia,
£133 per person from Edinburgh to the Czech Republic,
£350 per person from Glasgow to Estonia,
£265 per person from Glasgow to Hungary,
£250 per person from Glasgow to Romania,
£560 per person from Glasgow to Slovenia.
The next thing was to look at the actual cost of the IVF in the different countries:
Bulgaria, including drugs the price was between £2500 and £3000
Croatia, including the drugs the price was between £1900 and £2900,
The Czech Republic, including the drugs the price was from £2300,
Estonia it was from £3300,
Hungary, including drugs it was from £1900,
Romania, including drugs it was from £3000,
Slovenia, including drugs it was from £1800.
Once we had gathered this information we tried to find success rates for the different clinics. The way they broke down their statistics was different for most of them – so you need to make an informed judgement on what is the best.
Bulgaria was hard to find.
I’ve changed my mind about giving you this information just yet, Temora hasn’t looked at these and I don’t want to jinx it. I’ll add the information to the post in a couple of weeks.
The Czech Republic stated that in 2012 their success rate was 45.5%.
Estonia’s responses and website were less clear so I couldn’t find this information.
Hungary’s were broken down into age and average amount of embryo’s transferred, from 2000 – 2008;
Less than 35 years, with 1.9 embryo’s had a pregnancy rate of 41.7%,
35 – 40 years, with 2.1 embryo’s had a pregnancy rate of 39.6%,
40 – 42 years, with 2.5 embryo’s had a pregnancy rate of 23%,
42 years +, with 2.5 embryo’s had a pregnancy rate of 8%.
(75.6% were singletons, 22.3% were twins and 2.1% were triplets)
Romania has success rates of between 30 and 40%.
Slovenia was another that was hard to find but I remember reading an article that said they had the best success rates in Eastern Europe.
Initially we were actually going to go to Hungary; we had a lot of communication with a clinic and had even pencilled in a potential date to start treatment only for them to move the goalposts. Apparently in Hungary their legislation requires that before they can proceed with IVF you need to have tried an Intra Uterine Injection. We wondered why our NHS didn’t require us to do this so we looked at the statistics regarding the success of this procedure and they were awful (about 10%)! So, along with the price of IUI, double the cost of flights, plus the extra time off work Hungary removed itself from the top of our list.
Next was Croatia but it really should have been top of the list from the start, everything about it was right, Dr Romana’s emails, the costs and the slightly confusing but promising success rates. I’m glad we’re here; I feel we’ve chosen well.
Dr Romana thinks that harvesting will take place on Saturday or Sunday - with Sunday being the current front-runner. I've to go back again tomorrow for final confirmation - at which point a decision will be made about when to stop taking the second drug and start taking the third. Archie has taken over administering the injections, which is actually quite a relief - injecting yourself is overrated and my heart goes out to people who have to do it regularly. The first time he did it his hands were so sweaty with nerves that they kept slipping down the syringe, making it almost impossible to depress the plunger - he was on his knees trying to see properly and all I could say was 'please do it faster', 'please do it faster' - just as well we're in Croatia and no one can understand us or we'd probably get arrested. I don't know if it's the double whammy of combined hormones or the approaching harvest, (I'm going to have to stop using that word - it makes me feel like seasonal veg), but the enormity of what we're doing weighs heavily on me today. Every so often I feel a flurry of panic and for a split-second a voice in my head screams 'RUN!' Happily, in my current state of oestrogen inebriation I don't think this is possible - 'saunter' perhaps, 'run' unlikely. I can only assume that this fear is normal - that there comes a point in most pregnancies where the carrier gives due consideration to the possibility of flight - and that I am suffering it prematurely because of the drawn out process. Perhaps this means I won't have to panic if it actually happens - like those people who don't react to a death because it was such a long time coming. Oh dear, that was unexpectedly morbid - ladies and gentlemen I think we have hormones!
I miss my doggy... if he knew what we were doing he'd be horrified. 'A baby?! What are you thinking? You don't need a baby - I'm your baby!' As the direct beneficiary of our infertility poor Bauer is the one with the most to lose. Is it crazy that this worries me? Is it too soon to start blaming the hormones? Three weeks is a really long time to leave him behind - I know my brother is taking the very best care of him but it's still a long time.
I also miss tea. The tea here is awful - too awful to drink. Anyone who knows me will be stunned that I am only just mentioning this. I was being stoic - but all stoicism has a shelf life and, with regards to tea, a week is my limit. If I had a pram, toys would hurtle. No one should have to take hormones while being denied a basic, life-giving staple. The situation is so bad that I am drinking weak coffee; I can't believe I'm being forced to develop an addiction to coffee at this pre-pregnancy juncture. (I am now debating whether to delete that last sentence on the grounds that it presumes too much...). This is tough. On the ground-breaking daily news front, however, prepare to be impressed - Archie gave his first injection today. He really is my hero.
If you are considering Eastern Europe for IVF then cost is probably one of your more significant considerations, as it is/was for us. If money was no object I imagine some people would stay at home for the reassurance of their creature comforts and others would jet off to luxury locations across the globe - where they could fill their free time between clinic visits with trips to the beach, the casino, the shopping malls, or whatever other vice can be reasonably satisfied without too much debauchery. If you're trying to do it on a budget, however, then Eastern Europe is where it is at. The lowest cost treatment currently available in Glasgow is about £4.5K and it is offered by the private arm of the NHS - the same doctors that you would be seeing when you come to the top of the waiting list. For those of you who are not British, NHS stands for 'National Health Service' and couples who have no children between them, (from their current or any other union), are eligible for between one and two IVF attempts, (depending on where in the country they live), courtesy of the tax payer. If they conceive on their first attempt they will not be offered a second - and this, in conjunction with increasing pressure from the legislature to transfer only one embryo at a time, means that British people who are infertile and cannot afford IVF privately are essentially being offered the chance of having one child by assisted reproduction on state funds. If you come from a country where there is no state assistance at all, then this must seem utopian - certainly there are those in Britain who think that even one state funded attempt is too generous, since the condition of infertility is not life threatening. To be honest I don't have the energy to formulate an opinion - it is what it is. Beggars can't be choosers and when it comes to infertility, unless you're wealthy, you're a beggar. I am glad there is some provision - I have heard it argued that, since you pay as much in monthly national insurance as you would pay in monthly private health care, then you should get whatever you want/need... but who wants to take medicine out of the mouths of children with cancer, to create children without cancer? Like everything in life, it is complicated and there's a fine line between what people 'want' and what they 'need' - you could take the view that no one 'needs' children but then you would have to look at the fact that almost everyone has them... which suggests that this is a case of the line between 'want' and 'need' being very blurry. Certainly being unable to follow an overwhelming biological impulse is going to take some sort of psychological toll. Anyway, whatever you think about state-funded assisted conception the reality is that, between going to the doctor to say that you think that you might be infertile and coming to the top of the list you are looking at about 2 years. This, on top of the fact that you have to have been trying unsuccessfully for a minimum of a year, before the doctors will forward you for initial tests. In our case we moved house, (and therefore health boards), about six months into the process, which set things back further. The long wait, in conjunction with the statistical decline in success rates as women get older, probably plays the biggest part in why people decide to go private. Having priced the available treatment in Glasgow which ranged from the aforementioned £4.5K to 7K and noted the corresponding success rates, (basically the better their success rates the more the clinics charge), we decided to check out the cost elsewhere. To give you some context, there's a clinic in London offering a 61% success rate for 10K. Western European prices are roughly commensurate with the upper echelons of British prices - so there would be no cost saving on the treatment and you would have to pay for your flights and accommodation on top. Which leaves Eastern Europe. So, of all the clinics in Eastern Europe, (of which we found about 20 online - including clinics in Romania, Slovenia, Bulgaria, Estonia and the Czech Republic - but no doubt there are more), why did we pick this particular clinic in Croatia? Once you have decided to travel to Eastern Europe money becomes less of a determining factor than you might imagine since the treatment costs are fairly comparable across the Eastern European board. Obviously it depends on exactly what treatment you need and whether you have any test results already available but the cost of medication is estimated at between €800 and €1000 and treatment comes in at between €1500 and €2500 - (so a minimum of about £1915 and a max of about £2912). Archie and I were not only impressed by the quick, coherent and warm response we got from Dr Romana but also by the fact that she didn't try and make us pay to duplicate tests that we'd already had done. As a rough guide as long as your STD, HIV and Hep B tests are less than 4 months old and the rest of your test are less than a year old, then you shouldn't have to have them re-done. The fact that Dr Romana's English was impeccable was reassuring but what resonated most was the transparency and efficiency of her emails. We received a lot of responses which were either slightly garbled because the nature of IVF variables, (cycle dates/ovulation dates/reasons for infertility etc.), make it difficult to maintain clarity even when you're writing in your first language - or emails that I would call 'stock' responses - obviously written in the event that an English speaking potential client makes contact and sent out immediately without any tailoring or regard for the details of their actual enquiry. Dr Romana was neither garbled nor impersonal and, as much as you can make a value judgement based on reading an email, we felt she had integrity - that we might be able to trust her. You'd be surprised how much that matters. Flights to Eastern Europe are not as cheap as flights to Western Europe - unfortunately there are no £20 easyjet tickets to be had - and, if you want to save money, you need to be prepared to stay in a self-catering apartment or a hostel - but if you estimate your flight costs at about £500 and your accommodation at about £800, then you're in the right ball park. This, of course, is assuming that you do it the way we have and travel only once, staying for the full three weeks. If you have not had any tests done at all this wouldn't be an option. You would need to fly over and stay for a day or two to have all your tests done and then fly back again a month or so later - but the 2nd time you would only need to stay for about 10/12 days, so what you lost in the cost of plane tickets you'd begin to make up for in accommodation savings. So, the big question - is it all worth it? Well, that depends on you. If you can bring it in at the same price, or for less than the lowest price in the UK then you can access better success rates without paying British prices -but there is undeniable stress involved and there's still no guarantee. I travel well; I don't do much well but I do travel well, I am comfortable with the unfamiliar, (I might even be more comfortable with the unfamiliar than the familiar!) - and even I am conscious that, in some ways, this is harder than it would be if we were doing it at home. That being said, my answer to the question is 'yes' - to me, to us, this is worth it. We are simultaneously improving our chances and saving some money - we are punching above our financial weight with regards to statistics which means that we really are doing everything we can - and that in itself is a comfort. I am going to stop here because I know that it is a lot to absorb - we have so much more to share but we don't want to overwhelm you. I'm going to upload some pictures of our morning foray into Zagreb for some light relief.
** This post comes to you with a disclaimer - the reasons given below for the various timings are my best uneducated interpretation of brief cross-cultural conversations. In other words I may be talking nonsense and even if I am not, my explanation is layman to the point of dummy. That being said, this is what I think is going on and, even if it's not 100% accurate, it will give you the general gist. I have mentioned the names of the specific drugs I am taking for the benefit of anyone who wants to do further research, however I am sure there are hundreds of drugs out there that go by different names and do the same job. ** Today we had to visit the clinic so Dr Romana could check out my ovaries, (I can assure you that it's as bizarre for me to write that as it is for you to read it). Apparently I am responding well to the first drug, Gonal-f, which is designed to stimulate the growth of eggs in your ovaries - the more eggs that grow, the more the doctor can harvest. The doctor wants to be harvesting the eggs when they are about 20mm in diameter which, I gather, is slightly larger than they would grow in the normal run of things. In the course of an ordinary cycle, once your smaller crop of eggs we're about 17mm, your body would produce a hormone encouraging final maturation and release of a single egg. When you're having IVF a second medication, Cetrotide, is added to the Gonal-f to combat this natural hormone and keep the eggs where they are to grow for a couple of more days. When the doctor is satisfied that the eggs are the size she needs them to be you are given another drug, Ovitrelle, which mimics the natural hormone that you overpowered with the former medication. You then go without any more medication while the eggs mature and they are harvested approximately 30hrs, (a day and a half), after you took the Ovitrelle. The doctor has to make an educated guess with regards to the timings which is why she monitors your ovaries every few days. Today it was decided that we would begin adding the Cetrotide to the Gonal-f tomorrow. So I will take one injection at 2pm and another at 9pm. On Wednesday we'll go back and the doctor will evaluate the situation again. I finally remembered to take some photos of the clinic so I'll upload them now.
One of the hardest things about infertility is that it gives you a lot of time to think. About what you want and what you are doing. Obviously, it is preferable, if you are going to have a child, that some thought goes into it beforehand but, since 85% of people who are trying conceive do so within a year it seems that mother nature considers this a more than sufficient allocation of thinking-time. This is probably because deciding to have a child is, for most people, not something that they do without reservation and mother nature has a vested interest in your biology trumping your rationale. Very few people who want to have a child will go ahead without a) questioning their suitability for the role of parent and b) questioning whether the world as we know it is any place for a child. It is right and proper that these questions should be asked and the answers at least cursorily considered before a child is brought into the world because it is by asking these questions that people begin to build their parenting framework: I am a suitable parent because I will do this and this and this and I won’t do that; the world can be a terrible place but my belief system tells me that life is worthwhile because X, Y and Z. In the normal scheme of things couples will have a few months to think about what they’re doing and then it will be done and it will be too late to undo and the beauty of that is that none of the speculative questions matter in the face of the reality. There’s a child coming and it must be cared for – you are now morally obliged to put aside questions about whether it was a good idea and get on with figuring out how to make the best job of it possible.
If too much time elapses between acknowledging your desire for a child and actually conceiving, then you are faced with the prospect of assisted reproduction. When you take the act of conception away from the privacy of your own bedroom you make it more real; there is now absolutely no level on which you can consider the advent of your child an accident. The privacy which usually accompanies conception provides a sub-conscious buffer, an evolutionary anaesthetic, against the crushing burden of responsibility. That which happens in a bedroom can be seen or considered in some way ‘inevitable’ even if it was entirely deliberate – that which happens in a Petri-dish is the antithesis of inevitable, it’s about as in-inevitable as it gets. Which brings you back to your questions – are you a suitable parent; is the world a suitable playground?
I have had a long time to dwell on these questions. Enough time to know that the answer to the former is of course not. No one is a suitable parent. Perhaps, back in the day when the benchmark was set at ‘survival’ we were all suitable parents but now being a parent is about gifting your child happiness, confidence, contentment, purpose… ephemeral states of consciousness that you can only ever foster, never guarantee. Which brings you to the second question – is it right to bring a child into a world where they will almost certainly face unhappiness, manipulation, disappointment… deceit? Religion dictates that even if life is cruel to your child, as long your child is ‘good’, then they’ll experience some sort of utopia in heaven – but if you don’t believe this is true, if you believe that your child has one life and they will live it here on this earth – then where does that leave you? It leaves you with the realisation that choosing to be a parent is inherently selfish – you are not doing it for them. You are doing it for you. You are doing it because you want to. You are taking a gamble on their behalf – a gamble for which they will shoulder all the consequences. They did not ask to be here. They are literally only here because you wanted them. You are and always will be responsible for having made that decision. When they feel hurt, hopeless, scared, frightened – you set them up for that – and no matter how hard you try not to look at it, it’s the truth.
No wonder mother nature does her best to move things along.
So child, if you are reading this, then know that we accept responsibility – there is no point at which we will turn you away, there is no point at which we will expect you to cope on your own. If you are coping then that is wonderful, enjoy what treasures the world has to offer… if you are not, then we are here. We are always here. We made you, we want you, we love you.
This morning we took a walk into the city centre – the old part of Zagreb. Our movements are somewhat hampered by the fact that we need to be at the flat at 2pm every day to take the hormones. The time that you take your first injection determines the time that you will take each one thereafter and, since mixing three vials involves two needles and is a bit fiddly, it’s not really something you want to be doing in a cafe or on a street corner. The injections are to be taken 24hrs apart, give or take as little time as possible. The time of our first injection was entirely circumstantial – we were at the clinic and the nurses were available to show us how – but if we were going through the process again we might try to schedule the injections for earlier or later in the day. That being said, they would still have to be given during clinic hours because, while the doctor doesn’t see you every day, on the days that you are seen, it is more than possible that a change will be made to your medication or dosage. For this reason, the appointments take place about 10mins before you would usually administer the drugs, which means that any modifications can be effected immediately. All things considered there are probably advantages and disadvantages to any time of day, especially given that you won’t know how the drug makes you feel until after you’ve started taking it, by which point it will be too late to reschedule anyway. I am finding that about 2 hours after I have taken it I feel utterly drained and the lethargy doesn’t really pass until I wake up the following morning. It is also giving me a headache. Happily, both of these side-effects are beyond mundane – in fact they are the top two likely side effects listed in relation to the drug.
So, the 50 million dollar question. Have I turned into the bitch from hell? I guess the answer to this question depends on the degree to which you thought I was a bitch in the first place. It may not be so much a case of turning into a bitch, as becoming more of a bitch – or a becoming a better bitch, or being better at being bitchy? I don’t detect any noticeable improvement in my bitching technique, leading to the disappointing conclusion that, if the quality of your bitching is mediocre, it won’t be immediately improved by taking hormones – what little wit you have at your disposal appears to be your lot, hormone enhanced or otherwise. As for quantity – obviously it is hard to know how you compare with regards to other women on the bitchy front because, unless you are a supreme-queen bitch, of which I have never been accused, you only brandish your bitchy-ness in private. I think the quantity of my bitching pre and during hormone ingestion has, thus far, remained fairly constant – Archie is currently lying on the couch with his head in my lap watching the football, which is about as reassuringly far from cowering in the corner as you can get. All joking aside though, this is the side-effect I am most scared of and I am acutely aware that we are only four days in. Archie is my best friend and the idea that I might engage in some irrational campaign of base-less abuse terrifies me. In fact it terrifies me so much that I can’t write a coherent sentence about it so I guess that’s the end of this paragraph.
On the football front there is good news. Our satellite package includes a channel which shows the premier league games, it’s a kind of quasi-Sky Sports with Croatian commentary. The best bit is their pronunciation of the British names – I didn’t think it was possibly to make John Terry sound romantic – Juan Terriee! Beautiful, (as he goes in for a shin-crunching tackle). It’s hard to describe what it feels like being here – it’s not what either of us expected. We thought that since we were together in a foreign country with no work commitments it would feel like a holiday. It doesn’t. Don’t get me wrong, I’m not complaining, it doesn’t feel like ordinary life either – I’m just trying to be transparent for the benefit of anyone that is thinking of following suit. I can’t decide whether it doesn’t feel like a holiday because it’s winter and, if you live in a cold country like we do, your main preoccupation when you get on a plane is to chase the sun. It may be because we are staying in an ordinary residential apartment, surrounded by working people so there’s none of the ‘holiday’ camaraderie that you get when you’re staying in a hotel or complex with other holiday makers. It may be because we’re on such a tight budget – most of our pennies are being swallowed up buying medication and paying for the treatment – so that slightly ‘devil-may-care’, casual, holiday spending mind-set can’t kick in. Or it may be, that at the back of our minds, all the time, we know there’s a lot riding on this – that we are either going back to Scotland poor but elated, or we are just going back to Scotland poor. On a lighter note, Archie would probably tell you that it doesn’t feel like a holiday because he can’t have a beer!
Anyway, I’ll end this post where it started, which was by telling you that we took a walk into Zagreb city centre this morning; it’s about 45 minutes away on foot, across the river Sava. We weren’t able to stay long because we slightly misjudged the timing re. our 2pm deadline but it is no doubt the first of many forays. I’ll leave the descriptive bit for a day when we plan a route and take in the tourist attractions but I’ll post the handful of pictures we took just now.
So, realistically, what are our chances? Well, they're somewhere between 30 and 40% - or, to put it another way, for every three couples who undergo IVF, two walk away bereft. Age plays a significant part - the figures above apply to women up to the age of 35 - by the time you are 40 your chance of conceiving via IVF is down to 11%. I will be 35 in a few days time. I am not pessimistic about our chances - I have Archie and Archie is charmed. If I was in it on my own the doctor would turn up drunk and inject eggs up my bum - but with Archie balancing out my universe there is always hope. I don't like the idea that for every IVF baby conceived, 2 babies have dissolved - it's like being in some sort of bizarre mortal IVF combat, where you can only benefit at someone else's devastating expense. Anyway, while I am not pessimistic I am telling you this because we have been so overwhelmed by your kindness and support that I almost feel we've made you a false promise. Our odds are not that bad - but they're not that good either. We have done everything we can to improve them - I haven't had a drink since my wedding and before that I hadn't had a drink in months, I haven't smoked anything for over 6 months, (yes that was 'anything' child of mine - go wild reading between the lines), and I am as fit as the next person who is not obsessed with the gym. Archie has also been abstinent for the past month and he gave up smoking in his early twenties.... If you spend too much time reading online tips for improving IVF success you would probably be doing yoga backwards up a tree but everyone has to draw the line somewhere, (if this IVF attempt is unsuccessful my next blog will no doubt be delivered from the lesser known reverse redwood lotus position). If you didn't laugh you'd cry! If you are reading this then thank you... by being a third party you are forcing me to keep my perspective, (and I suspect this post was more for me than for you!)
Hi everyone, here’s a small update;
We have been here three nights now and are really happy with the way things are going, we arrived OK, found the clinic OK, found the apartment OK, bought the IVF medicine OK, settled in OK – everything has been OK.
I didn’t have any preconceived ideas about what Croatia would be like and we have still only seen a
Very small area local to us but what we have seen has been completely contrasting.
From the tiny airport to the brand new futuristic looking clinic, to the Eastern bloc looking apartments and buildings, (which totally remind me of the old Hermitage Academy, my secondary school), to the contemporary designed museum and the newest, biggest shopping mall in Zagreb across the road. We haven’t eaten out yet because we are watching our pennies so I have no idea what the local cuisine is like but I know that in the supermarkets they stock everything we have in the UK – but a lot of the things are a little bit different. I‘m still not sure what I think about Croatia on the whole, I am though, comfortable and content.
Literally, just as I’m writing this, the strangest thing is happening, outside there is what sounds like a man’s voice being broadcast over a tannoy, in a demanding military fashion, very like George Orwell’s 1984 – I have, however, no idea what was being said, he could have been saying anything.