12 months off

After much soul searching and discussion with my partner, we have decided to take a year (at least) off our conception attempts. We are both studying and working this year, and the physical and financial strain is too much right now. It’s time to take a break, spend some time focusing on other things and regain our health. It’s also important to me to gain control of my weight again, I managed to put on 20kg over 3 IVF cycles last year.

Results day

Today is the day I find out the results from my current cycle.
I tried to cheat with a HPT yesterday, but I failed at cheating.
I knew that there was a strong chance of a false positive due to my last Pregnyl dose (750 units) on Thursday, it normally takes 6-12 days for 1500 units to wear off, so 3 days for 750 units may have been optimistic. I decided to do it anyway as I’d rather know if it was definitely negative before today’s results are phoned through.
5 minutes after doing the test, the indicator panel was blank. No lines. I checked it every minute until 15 minutes, and it remained blank. After 30 minutes there was still no sign of change. It wasn’t until almost 2 hours later when I checked it again that there were two faint lines. The test instructions say to ignore results that don’t appear in the right time frame, so I’ve thrown it in the bin and now I’m waiting semi-patiently for my phone call this afternoon with the results of my blood test.
It doesn’t help that it’s a humid and overcast day today, my head feels weighted down and I’m finding it hard to concentrate on anything.
I would really like this one to work.

3 weeks without an update!

My calendar told me today that it’s Day 21 of this cycle. I can’t believe I’ve gone 3 weeks without an update. Most unusual.
My clinic are trialling a new drug regime proposed by the manufacturers of the hormones (gonal-f) where they set a dose based on height/weight and maintain that dose throughout the cycle, rather than increasing aggressively to get a response. So I was put on 187.5 units of gonal-f for a few weeks, only ended up with 2 follicles and had an egg collection last Friday. One of the eggs fertilised so that was transfered on Monday (Day 3). Things have been pretty smooth, no hyperstimulation or anything weird, uncomfortable or unusual. My next event is a blood test on Friday, then my final blood test on Monday week. Until then I have pessaries 3x a day, 5mg steroids 2x day, an aspirin 1x day and 750 units of Pregnyl injected every 3 days.

Day 6

Six days into my current IVF cycle and I’m feeling good.
The injections seem insignificant, the hardest part has been getting myself out of bed at 7:15am each day over the recent long weekend. I can’t get back to sleep again afterwards, I guess it’s preparation for the disruption to my sleeping habits when we have a child. So far I’m just doing Gonal F injections (187.5 units), but I’ll be starting on Orgalutran tomorrow or Thursday.

My weight was fine for my appointment on Friday last week, I managed to lose 3kg so was below the target weight they had set me.

I’m feeling really good about this cycle. I think the third time you do something it becomes fairly routine, I am comfortable with the steps, there isn’t any of the anxiety that comes with not knowing what happens next.

I’ll have to book a day off work towards the end of next week to have my egg collection. It feels strange to be this prepared, to know what’s going to happen before I’ve even had an ultrasound.

Day 1 – A New Hope

It’s Day 1 of my new cycle, and I’m preparing for another round of IVF.
We met with our new ob/gyn on Monday, as my old one has retired. The new doctor seems great, he is very thorough and to-the-point (a huge contrast from the lengthy, off-topic rambles of my old doctor), and he is clear about what needs to be done. We went through my whole regime for this cycle together, and I’m happy with what I’m going to be doing. Third time around, at least we’ve learnt some lessons from the first two cycles about what my body responds to.

Tomorrow I need to go in to be weighed (I needed to drop 2kg from Monday’s weight before I can start), have a blood test and pay for my cycle (about $9000). On Monday I’ll be starting on a mild dose of steroid (5mg) to prevent my body from potentially rejecting the embryo. I’ll also be using Gonal-F and Orgalutran again, and a trigger injection before the collection. I’ll be using pessaries again following transfer, and this time we’re going with 2 x 3 day embryos or 1 x 5 day.

Fingers crossed that my weight is right tomorrow morning!

Negative

After a long wait for results, I have just found out for certain that my current IVF cycle has been unsuccessful. I suspected this, and I did a home pregnancy test during the week which came up negative.
So I’m off all the support hormones and waiting for my period to start in the next 5 days so that I can begin another attempt in October.

I can’t say that I’m not disappointed, although I have had a week to come to terms with this so the news today hasn’t been a shock.

5 day blastocyst transfer

I had my blast transfer yesterday. I can barely remember the details from my previous transfer, so I’ll write it out in more detail this time.

10:45am – arrived at day surgery with a full bladder (as requested) for my 11:15am transfer.
11:15am – still waiting, hadn’t been called. Uncomfortable bladder! My partner asked how much longer we’d need to wait, we were told they were running about 1/2 hour behind.
11:35am – Allowed through to pre-theatre consultation room, to go through procedure with nurse, and to meet the doctor who would be doing the transfer. The doctor this time around is the Medical Director of the clinic, I hadn’t met him before so he came in to introduce himeself and go through the details. He also asked if he could include another doctor who has just started working at the clinic in to observe the transfer. Next up I had to get changed into a hospital gown, cap and blanket, had my ID bracelet put on and met with the embryologist to discuss my embryos. At day 5 there was one that was clearly ahead of the pack, it was rated a 3A something blastocyst, so that was the one they were transferring. A few others may or may not continue properly through blastocyst stage, I need to call the clinic today to find out if any can be frozen. The embryologist was great, she explained in detail how the blastocyst is formed which was really exciting. It’s amazing to think that the embryo being transferred has already started splitting into foetus and placenta cells.
11:45am – with a very full bladder I went into theatre. As soon as they saw my bladder on the ultrasound I was asked to empty 3/4 of it, as my retroverted uterus was partly hidden behind it. How hard is it to only empty 3/4 of your bladder when you are busting? I did the best that I could, and we were able to proceed happily. It’s weird to see my uterus from an external ultrasound after seeing my ovaries and uterus through all the internal ultrasounds early in the cycle.
I got to see the flash on the ultrasound monitor as the embryo went in, that was incredible. After that I was moved into recovery for 20 minutes, feeling a bit woozy (after being angled head down on the table so the doctor could be “face to face with my cervix”).

Right now, I have a free-floating embryo inside me, hopefully it should be starting to affix itself to my uterine lining over the next few days. I’m hoping that this bit works! We’re doing everything we can to not stress my uterus – how can a uterus be stressed? Apparently sex is not good at this stage, and anything else that throws me around a lot, like rollercoasters and water slides. No theme parks for me for a while!

I am amazed at how many people can be involved in my IVF cycle. I’ll try to count all the groups. There are the receptionists and accounting guy, phlebotomists who do regular blood tests, 2 ultrasound technicians plus their reception/support staff, a group of nurses who monitor patients, hand out the drugs and phone with results, a nurse manager, the embryologists (I spoke to 3 this cycle), the anaethetist, the day theatre nurses, the recovery room nurses and the doctors (1 for the egg collection and 2 for the transfer). I’m sure there’s more behind the scenes, like whoever works in the blood lab that I don’t see, the donor coordinator who manages our donor sperm and the psychologist who rings to offer counselling when a cycle has been unsuccessful. No wonder it’s an expensive process!

Halfway through another IVF cycle

Today is 19 days into our second IVF attempt.

So far this cycle, I have had huge doses of Gonal F to stimulate my follicles to develop, Orgalutran to halt my ovulation, Pregnyl to balance one of my hormones, and more Pregnyl plus Lucrin as my trigger prior to the egg collection.

I have been at high risk of Ovarian Hyper Stimulation Syndrome (OHSS), as I had around 30 follicles develop, a marked increase from my last attempt where they were being very cautious.  From my egg collection on Friday I ended up with 13 eggs which were all fertilised by the lab.  By the second day, 5 of these were “great”, 3 were “too early to decide” and the remaining 5 eggs didn’t fertilise properly.  Two days later I still have 5 embryos which are rated 3-3.5 out of 4, so they are going to keep growing them to 5 day blastocysts, which means I’ll be going in for my embryo transfer on Wednesday.

Between Friday and my ET I am on an interesting combination of drugs to reduce/prevent the OHSS becoming severe, and I have been cautioned to drink 3 litres of water a day.  I am becoming sick of the sight of my 1 litre water bottle on my desk – today I’ve only got through about 500ml so I’ll need to get onto that soon.  I’m also using progesterone pessaries again, three times daily, which will continue until either a negative pregnancy test in 2.5 weeks, or week 12 of a successful pregnancy.  Fingers crossed for the latter.

An IVF cycle

The following notes were taken from my diary through our IVF cycle in May-June 2009.  I was keeping track of the drugs I was taking, the clinic visits, symptoms and anything else of note.  Now that I’ve started another IVF cycle, it’s interesting (for me) to compare my thoughts at the same stage.  I’m much less involved in this cycle, to the point that I forgot to have my injection last night, A reminded me when we were in bed (4 1/2 hours late!).

Day 1 – First day of period. Excited that we can start!

Day 2 – Blood test, ugh. Wallet test, ouch! ($6900 for IVF, ICSI, donor sperm and orgalutran – a drug which holds off ovulation). Was given a new vial of puregon to be injected daily (100iu).

Day 3 – Puregon injection (100iu).

Day 4 – Medicare rebate of $4200, meaning we’re out of pocket $2700 for this cycle. I really hope it works! Puregon injection (100iu).

Day 5 – Puregon injection (100iu).

Day 6 – Blood test and ultrasound. My ovaries have both got lots of tiny follicles (PCOS), but nothing big yet. I have never seen the clinic this busy before, it must be because it’s a Saturday morning and they’re closed on Sunday. We had to wait over an hour to get the two tests and see a nurse to pick up the orgalutran needles to take home. I was told I have to go back for blood tests and ultrasounds on Mon/Wed/Fri this week. Puregon injection (100iu).

Day 7 – Puregon injection (100iu).

Day 8 – Blood test and ultrasound. Still no major activity in my ovaries. Again I was surprised at how many people were in the clinic, there were over 20 people waiting in front of me before the doors opened at 7:30am! I didn’t get to work until 9am. The blood test hurt, it felt like the thickest needle ever puncturing my vein. I don’t have to go back again until Friday though, so that gives my arm a few days to recover. I’ve also got to increase the Puregon (150iu) from today. My eggs are being slow. Puregon injection (150iu).

Day 9 – The Federal Budget was announced tonight. As expected, they have removed IVF treatment from Medicare rebate, past $550. Urgh, that’s so insignificant compared to the costs that it’s not worth it! The new rules come into effect on 1st Jan 2010, so if we don’t get pregnant this year I don’t know how many attempts we are going to be able to afford next year. It’s not like it’s a cheap exercise at the moment, costing us about $3000 per attempt even with the $4000 rebate. Puregon injection (150iu).

Day 10 – Glad I don’t have to go in for another blood test today, although kind of wishing things were moving along a bit faster. Puregon injection (150iu).

Day 11 – Puregon injection (150iu).

Day 12 – Blood test and ultrasound again this morning. Finally, there’s movement! I have a follicle growing over 1cm in each ovary – not heaps but apparently that’s because having PCOS means that the puregon is stimulating all the follicles (about 20 in each ovary), not just 4 or 5 like “normal”. The clinic are happy with the progress though. I’m now up to 200iu puregon from tonight, and also starting the orgalutran today. The nurse told me that I should ice my stomach before and after the orgalutran as it’s more painful than the puregon. Eeek. Next tests are on Monday morning. I still don’t know when I’ll be booked in to have my eggs harvested. Puregon injection (200iu). Orgalutran injection.

Day 13 – No blood tests today, hooray! The Orgalutran injection from last night left a blue and purple bruise about the size of a 10c piece on my stomach. I’m looking a bit worse for wear around there, with puncture wounds and small bruises. Puregon injection (200iu). Orgalutran injection.

Day 14 – Last night’s Orgalutran went a bit better, it left a large puncture mark due to the thick needle, but no bruise. Had gastro all day. Puregon injection (200iu). Orgalutran injection.

Day 15 – Got to my clinic just before 7am again so I’d be first in line when they opened. A couple of other people got there within minutes of me, there was a fair crowd by the time the clinic opened at 7:30am. I was the first person to have my blood test and ultrasound, after seeing the nurse for more injections to take home I was out of there by 7:40am. Yay! They’re probably going to up my dosage of Puregon today because I’m getting closer. I have 3 follicles “of interest” right now, 1.7, 1.4 and 1.1cms. I think it would be nice to have at least 5 when they extract my eggs, that would have to give me better odds of having a viable embryo, right? I also had my “Big Bleed” blood test today. The woman who did it hurt me, and then afterwards she was having trouble stopping it from bleeding so she kept pushing down hard on the wound and moving it around to “close the vein”. I almost screamed it was so painful! She was the same nurse who left the bruise on Friday, now my inner elbow looks as gross as my stomach. I also have to move my Orgalutran injection to the morning so that I can have it before the trigger injection in the afternoon, whenever that’s scheduled. Puregon is now up to 250iu. Puregon injection (250iu). Orgalutran injection.

Day 16 – Not a lot of excitement today. I moved my Orgalutran injection to the morning at 9:30am, so I can have it earlier tomorrow. Having two lots of injections a day isn’t as bad when they’re at the same time, it feels like I’m constantly putting needles in my stomach right now. Grow little follicles, grow! Puregon injection (250iu). Orgalutran injection.

Day 17 – Another appointment at my clinic today. We got there just before 7am to be second in line! The people who have arrived a few minutes behind me for the last few days beat me today. Had to wait around for 1/2 hour for the clinic to open, then had ultrasound (3 follicles over 1cm – 2 are 2.1cm and one is 1.2cm) and blood test. When I saw the nurse she said I’d be likely to trigger tonight, but couldn’t give me my trigger as the doctor had prescribed two and needed to look at my cycle to decide which one to give me. I picked up a pack of bowel prep formula which I need to take the night before my egg collection on Friday. I also saw the embryologist, who went through the numbers with us, risk of only having 2 eggs to collect etc. Instead of doing a 5 day embryo as planned we’re now going to do 3 days as there isn’t going to be a lot of choice to select from. I’ve now had my phone call from the clinic with my schedule for the next two days – tonight I have my Puregon when I get home from work and the trigger at 8:45pm. Tomorrow I have no more needles (yay!), the bowel prep at 4pm, a light dinner and lots of water, and then fasting (no food or drinks) from midnight. I’m booked in early, I have to be at the day surgery at 7am for a 7:45am collection. It’s getting exciting now! They’ll call me on Saturday morning to let me know how the ICSI goes. *fingers crossed* that there will be something viable, although I know with only two follicles my chances are limited. It only takes one egg to make a baby though.

Day 18 - The first day without needles in weeks! I had to have the bowel prep after work, that wasn’t pleasant but I guess it did it’s job. I spent 20 minutes on the phone with the anaesthetist (Dr Collin) going through my history and medications etc. I’m glad that he is very thorough, it instills a lot of confidence in me. I liked him. After dinner I had to fast for the rest of the night/morning before the TVOA (Trans Vaginal Oocyte Aspiration).

Day 19 – My TVOA (Egg collection) was booked for 7:45am. We were at the clinic just before 7am, before the Day Surgery had opened. The anaesthetist was lovely, as were all the nurses I encountered. The needle in my hand was huge, and 3 days later has left a large puncture mark, ouch. The procedure went well, they collected 4 eggs from me. The recovery was fine, and then I went home for the rest of the day to lie on the couch with a heatpack and some panadeine. From tomorrow I have to start using pessaries three times a day, yuk.

Day 20 – I had an early morning call from the embryologist telling me that we have 2 successful embryos. The other two eggs were immature, but I was suspecting that. All is looking good so far, with only 2 embryos I’m booked in for an Day 3 ET (embryo transfer) on Monday at 12:15pm. The timing of pessaries is already annoying, having to lie down for 30 mins three times a day is a bit awkward!

Day 21 – Not much happening on Sunday, just more pessaries. At this stage we’ve become excited at the prospect that we have embryos in a lab, and tomorrow I will be “PUPO” (Pregnant until proven otherwise). That’s so exciting and a little scary! I can’t get over how hungry I am at the moment, watching Master Chef on TV after dinner and I wanted a steak, despite having eaten a regular sized meal.

Day 22 – ET day! I spoke to the embryologist before the transfer. He told me that I have two 7-cell embryos which is exactly what they’d expect at this stage. One is very good (rated 2.5/4 where 2/4 is average), the other is only rated 2/4. They implanted the best one and are letting the other one grow to a day 7 blastocyte before they decide if it’s viable to freeze or if it should be succumb. I can call the clinic on Thursday to see how that goes. Right now I’m not fussed about that, I’m more excited about my “very good” embryo. The ET procedure was ok, it was a bit strange doing it alone without my partner as she had to be at work – all the nurses and doctors kept asking where she was. The most uncomfortable part is having a full bladder while they do the external ultrasound, but it was cool to see the embryo go through the catheters into it’s new home. The staff were really good at explaining what everything was and letting me watch it all. They said that everything went perfectly, so we all have our hopes up that this will be successful. I’ve got to keep up the pessaries and have some more pregnyl injections every 3 days. I’ve got a blood test at the end of this week to check on my hormones, and then another blood test on the 9th June to see if I’m pregnant. I have to keep using the pessaries until that day, and then potentially for another few weeks if I am pregnant.

Day 23 – 3 x pessaries

Day 24 – 3 x pessaries

Day 25 – 3 x pessaries (these days are getting a bit repetitive!)

Day 26 – Started the day with my usual routine of 6:15am pessary and lying in bed for another half hour. I also had to have a pregnyl injection this morning, damn they hurt! Also needed to go to the clinic for a blood test today. Because I didn’t need an ultrasound or to see the nurses I was hoping that I’d be in and out quickly. Big mistake. I arrived as the clinic opened at 7:30am to be 15th in line for blood tests. At 8:15am I still hadn’t been seen. I think I finally got out of there at 8:30am, way too late to be at my 8:30am work appointment on time. I ended up arriving about 45 minutes late, but thankfully it didn’t end up being a problem. I’ve just had my phone call from the clinic, they say my blood results were fine (P4/E2) and I have to keep going with the pessaries until my pregnancy blood test on the 9th June (Day 37). That feels like so far away right now! 2 more pessaries to go and then one more day is crossed off the calendar. 11 days to go.

Day 27 – Another non-exciting day in my Two Week (and a bit) wait. I’m back doing my fitness classes after having a bit of a break for most of the month. I told my trainer that I’m doing IVF so hopefully she goes a little easy on me! Still doing the pessaries 3 times a day.

Day 28 – 3 x pessaries. My boobs have been getting really full and sore, they are so big and heavy that I had to pull out some of my old bras which used to be too big for me. I know it’s just the pessaries giving me all these pregnancy symptoms, but it’s hard to ignore my body.

Day 29 – 3 x pessaries and a morning Pregnyl injection (the second last one, hopefully!). This time the pregnyl injection didn’t hurt as much as normal – I don’t think I’m getting any better at dealing with the pain so it must have just been a good day.

Day 30 – 3 x pessaries. I’m getting some slight crampy feelings but it’s not like period pain. Weird.

Day 31 – 3 x pessaries. I woke up this morning and freaked out a bit because I got really hot in bed last night and now I’m a tiny bit scared I overheated and caused some sort of damage which might stop implantation. I’m trying not to worry too much, whatever will be, will be. The rest of my TWW is going to be a bit crazy, we’re leaving tomorrow afternoon to go interstate to visit my family for 4 days – I am sure I’ll end up lying on the backseat of a car for 1/2 hour on more than one occasion while I do my pessary. At least my final blood test is the morning after I get back home, so it’s not too far away now.  It’s strange to think that if I wasn’t doing IVF I should be getting my period tomorrow. From past experience the pessaries are going to screw with my cycle so even if I’m not pregnant I won’t expect my period until at least Saturday week (4 days after stopping the pessaries).  I got a letter from my embryologist today, saying that our spare embryo didn’t grow as well as they’d want so it wasn’t frozen. If we’re going to do another IVF cycle it needs to be a full one as I have no frozen embryos to use.

Day 37 – I had my final blood test for my IVF cycle today, and unfortunately it was negative.  I’m sad, as I was really hoping that this time would be successful. I’m also sad as IVF is quite expensive and going to be even more expensive next year with the Medicare cuts, so I don’t know how many cycles we are going to be able to afford.  We’ve decided to keep doing cycles for the rest of this year (every 2 months means 3 more attempts) and my partner will also do an egg collection cycle while we can get it covered under Medicare so we will hopefully have lots of frozen embryos in storage. Then we can do the FET cycles which are cheaper (and less painful) when we need to.

The journey so far…

To bring this blog up to speed, here is what has happened so far.

In 2007 my partner (let’s call her A) and I began talking about getting ready to start a family.  We came into contact with a lesbian couple who had conceived a baby after many years of trying, and decided it was time we got the ball rolling as I was no longer in my 20′s and have been diagnosed with PCOS (polycystic ovarian syndrome) for many years.  We chose a clinic from the selection of about four of five in our town, based primarily on the content of their website. 

Our first appointment in June 2007 was underwhelming.  The female doctor we saw was rude, patronising and not particularly compassionate to our circumstances.  She couldn’t understand why we would choose to have the older partner with a known fertility issue attempt to conceive and carry a baby when we had an “easier” option.  As other lesbian couples may understand, when you have two wombs in a relationship, deciding who will carry a baby doesn’t only come down to biology.  There are many other issues involved which in our case led us to make the decision that we did, which is that I will attempt this first.

We were also told that it may take a couple of years of being on the donor list before we would be offered an unknown sperm donor, so we signed up immediately, with the plan that if we weren’t ready when we had an offer we’d make a decision at that point.

Early in 2008 we received a letter from the clinic advising we could choose a donor if we were interested.  It was a bit earlier than we were planning, but we decided it would’nt hurt to start things going now with the view to delaying the “real” process until the end of the year.    We had our next appointment in June 2008, and asked for a different doctor.  We were referred to Dr B, who is more comfortable with us and our decisions.  His major recommendation was that I lose some weight to get my BMI below 30 before we began proceedings, so I had a goal to lose about 20kg as quickly (but safely) as possible.

Over the next six months I worked hard at controlling my food intake and exercising (I attended a group outdoor fitness class three times a week), and managed to get my BMI down to target by Christmas.  *achievement*

In November 2008 I was close enough that we decided to get started with our first IUI attempt.  I might write more about this later, when I find my notes from a personal diary.  This attempt was unsuccessful, as was our second IUI attempt in January 2009.

After the two IUI’s we took a break for a few months before starting up again in April with an IVF cycle.  Again, I’ll refer to my old notes and write about that in some detail another day.  In summary we collected four eggs, two of which were mature enough to fertilise.  One of these was transferred as a 3 day embryo, and the other was left to succumb at 5 days as it didn’t meet the grade.   After almost 3 weeks of 3 x daily progesterone pessaries the result was negative.

That brings us to now, about to embark on our second IVF cycle.  It’s currently day 2, which means I had a bloodtest today and begin my daily injections tomorrow.  I had to pay for the cycle today, so we’re currently $6900 out of pocket until I get a Medicare rebate of $5041.  Our rebate for this cycle is about $800 higher than last time as I’m now over the Medicare Safety Net, so we get 80% (of claimable expenses) back.