Chillax

I read a really good article shared by one of my tweeps over on twitter, the lovely @IVFChronicles so I thought I'd share it here (see link below). It's about the psychological effects of infertility on both females and males, and whoaa I can identify with so much of it.

The Psychological Impact of Infertility by Jo Perkins at Therapy Today

I've had a bit of a difficult week since my birthday so have been hiding a bit from my blog, ironic really, as I started it in the first place so I could write how I was truly feeling and let it all out and now I'm hiding from it, work that one out.  
I don't want to write a miserable post but just to fill you in on the highlights, my sadness this past week is mainly to do with the 'brother-SIL gate' as I'm normally pretty close to him and spoke to him frequently, I guess I just really miss him. I did speak to him on my birthday last Tuesday, on the whole I suppose it went well compared to the last phone call but it was super awkward and despite him trying to be normal it was still upsetting. We briefly spoke at the end about the awful SIL text and how upsetting this still is for me but that he is my only brother and I will always love him and not let her drive a wedge between us, felt good to finally say that to him. I've asked to meet him when he is next in London for work and offered to take time off work if he needed to get back to Bristol at a reasonable time (I realise now that might have been a bit presumptuous that he wouldn't tell my SIL, but anyhoo too late now). He finally texted earlier this week and the first time we can get together is Monday 28 March and I'll take the afternoon off work to meet him . . . so plenty of time for me to get myself all worked up about it (no point pretending I won't do this, I'm 100% sure I will).

Moving on . . .

Last Thursday was our medication teach session with our new clinic . . . here we met Nurse Chillax! Such a lovely lady, she is soooo chilled out and so I'm hoping this is going to rub off on me a little bit :-) She assured me everything is going to be fine (love her optimism) and as I'm familiar with the Gonal F she just showed me the buserelin (Suprecur) injections as I did the nasal sprays last time, seems pretty straightforward. I've paid our first little payment, signed a zillion forms and have my first baseline scan booked in already, yikes. 
To say I'm a little anxious is a bit of an understatement, I think the emotions I'm running through are fairly normal so I'm not too worried, just the usual, can I do this again, can I cope with another failed cycle and so on. These past couple of days instead of worrying about it I'm trying to focus on what I can do make myself feel better and if I increase my chances in the process, bonus!  Here's what I've been doing, it's early days though -

• I'm eating breakfast (novel for me, I tend to only partake in my most hated meal at the weekends when OH tempts me by bringing me some delights whilst I'm still in bed or doing things like Toast With a Smile).
• I'm walking to work (admittedly it only takes two minutes longer than driving as the car park is a bit of a walk, do not ask how close my new office is to home, it's embarrassing I ever drove! my defence is my hair does not do rain :-)).
• I'm eating more fruit.
• I'm drinking more water (still not enough but getting there, my bladder is small!).
• Booked my first acupuncture appointment with a lady called Angelika (I'm hoping this is a sign and that she is indeed an Angel that will look after me and make me calm).
• I'm reading before bed (to take my mind off anything stressful - work, IF, crazy SIL, whatever)
• Stop procrastinating at work (hmm a work in progress)

Not a bad list eh? If you have any other suggestions let me know. I realise 'exercise' is missing from this list, but one step at a time huh.

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 :-)]

I'm Back

. . . and raring to go, I 'think'.

Yup, I've still been in hiding since my last post . . . seems I needed more time to get over our first failed treatment cycle, especially with the festive season too, it was harder than I expected and I guess it was a bit of self preservation and I couldn't bring myself to write about the difficult days, it was too depressing.  I tried to keep up with my tweeps though on twitter and that certainly helped get through some of the tougher days (thank you ladies). But, I 'think' I'm back on track a bit more now, new year, new start, same old mantra, LOL

• Take one day at a time
• Be strong
• I can do this

I don't want to dwell on the last few weeks as it doesn't make fun reading and I'm not sure it will be therapeutic for me but I will mention a few things to put you in the picture. Since finding out the treatment didn't work I think the hardest things have been facing my family and newly pregnant SIL and also trying to adjust being back at work and being 'normal', in hindsight I should have realised these would both be impossible tasks. To top it off I came down with a nasty viral chest infection a few days before Christmas day and so I had a trip to the doctor [first time in ages for something other than infertility related, novel] and I have consumed nearly one whole little bottle of honey and 2 lemons and I think I'm only just about over it, right in time for going back to work, perfect!

Christmas with the family was HARD, that's all I'm saying on that topic, we were so glad to back to our own space a few days later . . . New Years Eve was much better, but as expected when midnight struck it was emotional for us both, the end of such a horrible horrible year, full of sadness, we were both completely drained from all the emotional turmoil and I guess it had to take it's toll at some point. Ha, New Years Day was hilarious, we were both feeling so down that we stayed in our pyjama's till like mid-afternoon, haven't done that in years, it felt good and by the evening we were thinking about the year ahead and our hope felt a little renewed.

On the infertility front, we have made progress (with a little help from my tweep, thank you @IVFLondon), I called the new clinic, Herts & Essex, and the woman on the phone was really lovely, all I needed was a copy of my medical notes and I can book my private cycle, yay. I ordered a copy of my notes from Bourn Hall and they arrived last week, it's like a different language though, not sure what most of it means but I plan to look a few things up to see if I can work it out, plus we have our follow-up appointment with them on 31 January. 

So our first consultation appointment is booked with the new clinic, I had a pick of dates actually (makes for a nice change) and chose 4 February, after our Bourn Hall follow-up appointment as we might be more informed by then and also after our holiday, did I mention I'm going on holiday [yawn] ;-)

OH left this morning for the airport already, he has to do a few days at the Bangkok office before I go out to meet him, boo, miss him already [sad but true]. But only 4 sleeps to go!

I fly out on Thursday evening to meet him and then we travel from there to Kuala Lumpur, in Malaysia the next day to see the in-laws for about 9 days and then back to Thailand to an amazing resort I found in Phuket for 5 days, bring it on!

ps - I've been tinkering with my blog lay out too, I've add some 'pages' at the top left of the page that you can click on, think I might store other bit and bobs on here and remove them from the main page, any brighter ideas you bloggers might have let me know :-)

pps - it's good to be back 

 

Toast With a Smile

Toast with a smile, that's what I asked for, so that's what I got :-)

I think I've come on quite far these last couple of days, I've made it back to office and I've been to two xmas parties (and experienced the phenomenon of 'having a good time', you should try it, I can highly recommend it). 

There have been four things key to making me strong enough to face the big bad world again

1. My OH, I would be lost without him.
2. My closest friends who I know have been thinking of me and are right there if I need them, some of whom have held my hand virtually these last couple of days, words cannot express my gratitude for their help.
3. My terrific twitterers (of course)
4. And last (but not least!) wine (obviously) :-)

I have also made some enquiries this week, for my sins I am a planner, I plan even when I'm sleeping (you think I'm lying, sadly I'm not) and so when I remembered that planning always makes me feel better, that's what I did, I took some small steps so that I'm always moving in the right direction.  I don't plan to rush in to anything but it's good to know our options for when we're ready. We fired off a couple of emails to our Primary Care Trust (PCT) and they finally replied on Friday . . . the East of England plan does require there to be a 6 month gap (from egg collection) before starting another fresh cycle with the NHS, we can mix and match private and NHS funded cycles as long as we don't go over 5 (!!) cycles in one year, and I can change from Bourn Hall (an hour away) to the clinic, Herts & Essex Fertility Centre (10 minutes away with excellent statistics), phew, some good news at last. In order to change to the new clinic we have to ask Bourn Hall to refer us to the Oxford Fertility Unit as they have a contract with Herts & Essex, so this is something that we will look into so that our NHS cycle can be lined up if we need it.

So the next steps are to plan a much needed holiday, enjoy the xmas break, have our follow-up appointment on 31 January and then go ahead with a private funded cycle . . . when I'm not sure but I will make some preliminary enquiries with Herts & Essex to see what they say about waiting lists.

I have one other picture to post today, look at these amazing biscuits from Biscuiteers!!

These really brightened my day on Saturday and are from one of the most special people in my life. If it's possible, they taste even more gorgeous than they look and they made me smile like a Cheshire cat. This whole process has reminded me how special my friends are and how important they are to me, thank you darlings.