Tag Archives: ivf

26 February 2014

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!)
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19 February 2014

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.

5 February 2014

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.

4 February 2014

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.).

3 February 2014

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.

2 February 2014

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

positives!

A final footnote.

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.