Tag Archives: 2ww

31 January 2014

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.
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A two post kind of day.

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.

29 January 2014

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.    

28 January 2014

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.

27 January 2014

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.

One more step.

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.