Tuesday, 8 February 2011

WTF

WTF appointment . . . apparently this is what the follow-up appointment after a failed cycle is commonly referred to by my tweeps. I wasn't sure at first if the WTF stood for the same phrase I usually use it for, but I'm assured it does, guess I can see why!
A week last Monday we had our WTF appointment at Bourn Hall to discuss our first failed IVF/ICSI cycle. At the time, I thought it was a great idea to have this booked for our first day back after our holiday [silly silly girl] and in hindsight now I realise it was a bit of a stupid idea.  It was all just too much to come back to straight away and with jet-lag too I was pretty much a crying mess all day. It was very upsetting to be back at the clinic and I hadn't given this a seconds thought before, but it seems obvious now that I would feel emotional to be back there. Anyway, we saw the consultant for about an hour and it was good to talk it all through but all the information was a bit overwhelming.

I made some notes from our appointment . . .
I produced 15 eggs, 13 of these were mature, 8 of these fertilised with ICSI. I was a little disappointed with our fertilisation rate but the consultant said it was just above average, I’m not so sure, sounds average to me. At Day 3 there were possibly 2 embryo’s of good quality [sad there were only 2], after Day 3 there was ‘disappointing progress’, by Day 5 most had deteriorated significantly :-( The embryo transferred in the end on Day 5 was in fact not the one that looked the best at the time of Day 3, instead of a blastocyst, our embryo was a few hours behind, at the morula stage. The consultant said he has seen morulas develop into viable pregnancies so it still could have worked. In the future it may be better for us to stick to Day 2 / 3 transfers instead, but he would repeat the cycle again and if there were enough embryo’s fertilised he would still take them to blastocyst again as each cycle is different and no pattern can be seen yet until we have another go.  This was the part I found most overwhelming, I wasn’t filled with optimism and it feels like we would be setting ourselves up to fail again. It’s such an emotional, physical and mental strain to go through an IVF cycle that I would be absolutely heartbroken if the same happened again by Day 5 and worse still that there would be nothing left to transfer. We discussed this at depth with the consultant and he reassured me each cycle is different and we should try to go to Day 5 again but we can stick with earlier transfers if we prefer, but what do I know, I am no expert. 

My AMH level is low for my age apparently (5.6), as an NHS patient at Bourn they use this value (rather than a baseline scan) to predict the number of follicles I will produce and to calculate my Gonal F stimulation dose (225 IU), apparently I am in the 10% of people they see where AMH is not an accurate predictor of my ovarian reserve (he thinks possibly it was a low trough level for me but it's probably unlikely). They expected me to produce in the region of 5 – 7 follicles and so they think I was close to OHSS (I also had a couple of uncomfortable stomach bloating episodes). For the next cycle he would like to drop my dose down one notch (187.5 IU) in case my other ovary responds and take a more cautious approach (the cycle would have to be cancelled if I suffer OHSS), upping the dose at one of the monitoring scans if needed.

My FSH, LH and estradiol levels and uterine lining were all fine. There were no issues with the embryo transfer.
He said not to be concerned that only one ovary really responded this time, this could happen again or it may not.

I mentioned that I struggled in my third week with the down reg nasal spray (Suprecur), I felt very depressed. For the next cycle he will try to schedule this so I am only on the nasal sprays for three weeks rather than four.
I found the very initial part of egg collection painful (largest speculum in the world maybe? largest needle for local anaesthetic?) but the rest of the procedure was fine, I even watched the egg collection take place on the little screen. He is reluctant to increase the dose of the muscle relaxant drug I took beforehand, my only other option is general anaesthetic which I would rather not do. He suggested I use the gas and air that is available next time [I avoided this the first time as I had a last minute panic that it would make me feel sick and I might ruin the egg collection procedure, no idea why, loopy, yes, must have been the drugs!] and take 12 consecutive breaths of this before the start of the procedure and then I will be fine (hmm!).

The sperm sample on the day of ICSI seemed better on paper than OH’s last sample as the count had doubled, the consultant said that the motility and morphology were similar though. There is not much more that can be done to improve OH’s sperm other than continue taking his Wellman supplements and maybe cut out alcohol as this is a known factor. Other tips were to not be exposed to heat in that area (already got that one covered) and also to not inhale metallic/exhaust fumes (good job OH isn’t a car mechanic?!).

There has to be 6 month gap between fresh cycles (only 3 I think between fresh and FET) according to the new guidelines, and this time line is from egg collection to egg collection. So for me this is 6 months from November 2010 which brings my next NHS funded cycle to May 2011 which is slightly sooner than I thought, the schedule would be something like this depending on my cycle dates - 

Bourn Hall – NHS Funded
Down Reg Mid – April for approx. 3 weeks
Stimulation injections - Early May
Egg collection - Approx. 17 May
Embryo transfer - Approx 20 – 22 May
Test date - Second week of June

After our appointment I felt a bit all over the place for a couple of days, lost in my thoughts, wondering why it has to be this hard and did I do anything to deserve this?
I’m not sure I’m ever going to feel any more ready than I do now for a second cycle, I’m just wondering how to get myself psyched up for it, how do you get yourself ready to go through it again?

Last Friday we met with the Herts & Essex Fertility Centre for our first consultation for a private cycle, all in all we were there for a good couple of hours. Their website claims that they have the highest success rates in the East of England, North and North East London, I’m not sure if I entirely believe this but their rates do look fairly good, they are only about 10 minutes drive from where I live and there is no waiting list.
We met first with a nurse to take some routine measurements and then OH popped off to provide a sperm sample :-) It would be analysed there are then so the results could be reviewed with the consultant. We met with the Medical Director, Mr Michael Ah-Moye, who was a little eccentric but very knowledgeable as you’d expect and talked a lot about recent scientific research.  He looked over our medical notes and the details of our failed cycle, he agreed with much of what we had heard at Bourn except he did not feel I was close to OHSS. In fact he said there were only a few follicles that were at the desired length, the others were a bit shorter. In his opinion he would maintain my Gonal F dose at 225 IU and monitor closely, I would also have a baseline scan to check the number of antral follicles and make a final decision on the dose at that point. I feel comforted that there would be this baseline check before starting the stimulation injections.

For down reg they prefer the use of buserelin injections rather than a nasal spray, he explained the rationale for this and after becoming a dab hand at the injections from my first cycle I’m happy to do this, I think a one a day injection will help me get on with my day and try to be more ‘normal’ [if there is such a thing], the best part being is that I would only need to do this for 2 weeks. For egg collection they use the deep sedation method [I already like the sound of that!], so I will just feel a bit sleepy and I won’t remember anything and the recovery time afterwards is still quick.

The results of the sperm test came in during our consultation, OH’s count has doubled again so this is brilliant news, it’s actually around the 30 million mark now (low count is considered below 20 million). The motility and morphology results still require us to have ICSI but they are very slowly getting better too so heading in the right direction.
With a self funded cycle with this clinic I could start in February if I wanted [omg!!!], OH and I mulled this over and decided perhaps that was a bit too soon and to get our mind in the right frame let’s aim for a March start, this is how the schedule looks -

Herts & Essex – Self Funded
Down Reg Mid – Mid March
Stimulation injections - Early April
Egg collection - Mid April
Embryo transfer - Mid April
Test date - End April

Should we by unlucky again and this not cycle not work I can move my NHS funded cycles to Herts & Essex and have this lined up for afterwards. The 6 month rule only applies to NHS funded cycles and so as long as I’ve had 2 to 3 menstrual cycles after my private funded cycle I could go ahead with the next NHS funded cycle when I’m ready. Feels good to have a back up plan.

When we left Bourn Hall on Monday, OH was thinking that maybe we should wait for the next NHS cycle and go with their cautious approach, but after meeting Herts & Essex we both felt at ease, it is much closer to home, we don’t have to wait until May, so decision made I think, I just need to book our medication teach session with the new clinic closer to the time [and pay the money of course] and we’re good to go.

I thought I would feel immense relief that we can move ahead with the new cycle, or at a least a little bit excited, but I’m not there yet, I feel a bit scared and apprehensive, scared of failing again. If any of you ladies out there know how to psych yourself up for round 2 please let me know!

[longest post ever, if you made it to this point please give yourself a pat on the back :-)]

8 comments:

  1. Hi Moony, it's such a big decision to make about where to have treatment and what the best course of action should be so well done you & DH!

    Your EC does sound awful, I had much more sedation and it didn't feel much pain at all. Hope it will be better at Herts & Essex.

    Glad to hear DH's sperm has improved so dramatically, that's fantastic! My poor OH only has 2 million!

    I think it's only natural to feel apprehensive second time round but remember that your goal is to have a little baby and when you achieve that it will be totally worth it!

    Lots of hugs & will look forward to supporting you on this cycle xxx

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  2. I'm not sure how to psych yourself up Moon, but I do know that this all sounds great. You have options and back-up plans in place. Start getting excited babe!! You could be pregnant in a couple of months and all these decisions will be behind you xx

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  3. It's great to have options!

    My IVF history is a bit different from yours, so I didn't have the apprehension with my second IVF cycle (second pregnancy, yes, and as it turned out, rightfully so, after the first one ended in a miscarriage). I saw it more as 'hopping back on the horse'. That I was on a path that's going to end with a baby, and so I had to get back on it and keep going.

    Glad the sperm results are looking up -- always encouraging. :)

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  4. Hi Moon. I have removed pineapple from my post as I received an email from my RE friend who says that fresh pineapple can actually cause uterine contractions. Not worth risking something so dubious so give it a miss!

    My fence sitting with melatonin is due to my background concerns from a sleep medicine view point. It probably isn't harmful, but I really believe that if your circadian rhythm is working normally that you have the melatonin you need being secreted at the right times. I'll do some more research on it and let you know if I change my mind, but maybe ask your RE what they think?

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  5. Hey Arohanui, so spooky I must have just left my comment on your blog at the same time you left this one (great minds). Thanks so much for looking into the pineapple further, what you mention is what I have read too (I'm a scientist!). I also read the conflicting info about bromelain but there is no firm evidence and so I think you're right and I won't take the risk on my next cycle.
    Thanks for the info on melatonin too, you're such a star! My circadian rhythm is fine but I might ask about this and Vitamin D when I next go to the clinic, will let you know if I find anything out.

    Moon x

    Thanks so much to everyone for your supportive comments on here and on twitter, I really appreciate it xx

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  6. It's wonderful how thorough they were in your WTF appointment! It sounds like they've really gone over all the details. Your ER does sound awful, they just put us out for our ER so I woke up when it was all over and I don't remember any discomfort at all.
    I always feel better when I can jump right back into a new plan. But I know sometimes it takes a while to process the last loss before going forward!

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  7. Yea, I get a pat on the back. As I was reading this I noticed that your language changed. at the first office you seemed unsure and apprehensive, but when you talked about the second place you sounded optimistic and ready. I am hoping this new place has the answers for you. *fingers crossed*

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