Three

-courtesy of google images-

It's been 3 years this week since we began our TTC journey. Wow, I can't believe it's actually been this long . . . we've never seen those magic two lines, not once :-( makes you wonder can it ever happen for us. I'm sad to write that as I know it's a sign that I'm losing hope, it's inevitable I guess, but I'm still clinging on, just about. 
As it's been so long I thought I should update the About Moon page and Our Journey page links in the top left corner of the blog, so check these out if you want the latest on our treatment plan.

After my magical weekend away I came back to earth with a bump. Ahead of our third ICSI cycle my consultant recommend that we have the chromosome karyotyping test for peace of mind and that I should be able to get this on the NHS through my GP, failing that we can pay for it and have it at the fertility clinic, easy? well you'd think so.
I called my GP last week, she seemed a bit put out, she had never been asked something like this before, it's not protocol apparently, I'm to go direct to my NHS consultant (I've named him Mr Moody) who she referred me to initially. I was a little upset by this but I guess it made sense. I called my NHS consultants secretary (Moody Sidekick) . . . she was just plain rude to me, a nasty nasty lady. She said she didn't have my fertility clinic's follow-up letter in front of her so she didn't know what I was talking about (go get my file?) and so she couldn't help me. Errr what? She didn't know what test I'm talking about and they couldn't possibly do anything like that for me! In the end she made me fax her a copy of the letter which she would show the on call consultant. She rang me back the next day (the first day of my escapism weekend), she continued with her disgusting attitude and told me that as I hadn't seen the consultant in the last 2 years, as they had referred me on to a fertility clinic, that I no longer was 'their' patient (cue outraged hysteria), apparently I am 'discharged' from them and if I want to see/speak to the consultant I have to start again by seeing my GP and getting a new referral.

WHAT???

After a crying hissy fit, a quick chat with Mr Moon (btw OH's new name, I kinda like it) I was back on track and decided to park it all until after the weekend. I called my fertility clinic at the beginning of this week to arrange to have the blood tests privately, easy? again, you'd think so. Apparently as my next cycle is NHS funded (my last cycle was self funded) they are unable to carry out the test for me and the consultant shouldn't have told me that they could, this is only allowed for private cycles (cue more tears).
One brick wall after another, how frustrating! I tried to persuade them that the test is independent of next cycle and it was recommended by a consultant at their clinic. Luckily, by the end of the day Mr Moon had fixed it, he had recently seen an andrologist in London and we can have the tests through her instead this weekend. Why is nothing simple?

Since then, I've been having a tough week, feeling like a yo yo, up one minute and down the next. I'm struggling with carrying on with normal life whilst I have this great big black cloud following me around. The culmination of reaching 3 years of TTC and the brother/SIL-gate is just too much, I'm completely cracking under the pressure now *tears*
I don't want to burden anyone with my troubles too much, they're too consuming and it's not fair on them, I have some lovely friends who try to support me but I'm just letting them scratch the surface and trying to put on a brave face when they ask after me.

After a tearful evening, I made the first step earlier this week and have contacted my employee assistance programme, through work I am eligible for a few sessions of counselling. I've had a initial clinical assessment over the phone last night and needless to say he approved my request and so I'm awaiting to be assigned a counsellor. Hopefully this is a step in the right direction.

Thankfully my acupuncture sessions with Dr Angel change from fortnightly to weekly again next week and I've decided to try yoga again in a new class starting in two weeks. Bring back the zen.

Escapism

"Escapism is mental diversion by means of entertainment or recreation, as an "escape" from the perceived unpleasant or banal aspects of daily life."

That's what Moon did this weekend, I escaped and it felt good. 

With a partner in crime I helped plan the most fabulous hen weekend for my gorgeous cousin, for those who know me, I LOVE planning (sad but true), I think I may have missed my calling in life to produce colourful, multi-tabbed spreadsheets all day long.
We had fun from beginning to end and it took me back to my care-free days before all 'this' started. So, instead of my usual TTC related blog posts (no panic, they'll be back real soon) I thought I'd share my weekend with you and a few photo's for a bit of light relief.
I found the most amazing loft apartment to rent for the weekend in Islington . . . absolutely perfect for the glorious sunny weekend we had, and the ultimate party pad (pat on the back for Moon). Floor to ceiling windows, mezzanine, balcony over a private canal and even it's own piano?!!

On the Friday we met the bride-to-be for lunch and led her to her first surprise . . . to The Blow Bar, a blow dry salon in Islington's vintage haven - Camden Passage. We'd booked their private room to have our hair styled and make up by a professional artist whilst supping champagne and strawberries, bliss! (this is the life). A fab idea to pep you up for a night on the town. That evening we headed to Momo's Restaurant, an intimate Moroccan restaurant (food here was yum yum in my tum) and then onto Zenna Bar, a cute little indian cocktail bar - cocktails with a spicy kick! I'd recommend visiting these places if you're in London for a night out.
On the Saturday we took a morning speed boat on the Thames from near London Eye pier, muchos fun!! It lasts about an hour, you get to see a few sights at a leisurely pace and then off you go speeding through the river, blew the cobwebs away and got us all over our hangovers quick smart :-)  After lunch on Southbank we headed back to our apartment for civilised tea and cakes (check out the cupcake toppings, ha haa).

The evening activities started with cocktail making at our apartment, a cute little man comes in with all his gear, shows us his tips and tricks and splits us into two teams to compete with yummy cocktails. No idea how much alcohol I consumed in my 'taste testing' :-)

The rest of evening was spent in Islington for dinner and then onto a cool bar with sharing cocktails! I danced like I was young and carefree again.

Escapism, I recommend it.

You Can't Choose Your Family

Along our TTC journey I’ve shared little tit-bits about the up’s and down’s with the sister-in-law (SIL) situation, it hasn’t been pretty (that’s an understatement) and I tried not to write too much about it on my blog as the ‘situation’ clashed with the failure of our first ICSI cycle and throughout our second ICSI cycle so there was more than enough to deal with. Instead I’ve mentioned it on twitter and here on my blog but probably not enough detail to put you in the picture, one of my tweeps, @saleschick, suggested I blog about it, and I think the time is right.

I could write for hours, but I’ll try (!) to summarise, if you have any advice, I’m all ears.

My brother is my only sibling, we are (were) very close, he’s 5 years older but I guess I acted more like the older sister. We don’t live near each other but talked on the phone 2 or 3 times a week depending on what was going on.
I didn’t share much detail of our TTC journey with him over the years, just key milestones . . . when I had suspected endometriosis, being referred to our consultant and then I shared a bit more info as we approached our first ICSI cycle.  He met my SIL maybe 3 years ago now, they have an incredibly volatile relationship, always breaking up and then getting back together. In the first year or so my brother would ask me for advice ALL THE TIME, he wouldn’t go into much detail but I would give the female perspective and help him work out a way to move forward with her. As time went on, they became more serious, got engaged, it was all moving quite fast. We got to know my SIL more and more, a little difficult at times as they were forever falling out / breaking up and we would just have to pretend that everything was fine. OH and I would try to stay out of any awkward situations and as difficult as it was I would shy away from conversations my SIL would try to draw me in to moan about my brother. My SIL resented that my brother spoke to me quite so openly, so in the last year or so we talked less in general, and definitely less about ‘them’, this was much easier all round.

Anyway, after numerous break-ups they decide they want to get married, and quickly too as they found a venue with availability in 11 weeks (interesting logic there), my parents and I expressed our concerns at the rush as they hadn’t proven they could even live together for any duration of time, he assured us it was fine so we supported them. I had always hoped I could be a bridesmaid for my brother, but seems that my SIL had other ideas, call me paranoid, but instead she proceeded to exclude me and definitely give me the sense that she didn’t like me much. I was hurt, there is no denying that, but I did what any sister would do and I continued to support my brother and helped with the arrangements he was responsible for.

Whilst they are on honeymoon and we were in the midst of our first ICSI cycle, my dad suddenly fell very poorly and was admitted to hospital.  OH and I spent a lot of time up North with my mum, ferrying her to and from the hospital, my brother and SIL also made frequent visits. On one of their visits, there was a tense atmosphere, she ignores us all, packs her bags and walks out of the house. Naturally we’re concerned and for the first time in a long time we ask my brother how are things with them and what’s going on?? He says that we wouldn’t believe it and he’ll send me a copy of a letter she has written to him later that night. The letter is shocking, it basically says that she wants marriage counselling after being married a month, otherwise maybe they should get divorced!? The rest of the letter seems like lots of tiny things that are blown out of proportion that don’t seem that important (we all didn’t know at the time that she was indeed pregnant at this stage). We decide to stay out of it, my dad was our priority and so we encouraged my brother to look into counselling. 

Lets fast forward to the outcome of my first ICSI cycle in Nov 2011, the day we realise that it’s failed I let my brother know as he happened to call, in the very same call, he decides to tell me that my SIL is 5 weeks pregnant and phrases such as ‘we didn’t realise it could happen this quick’ are muttered . . . so after being married for 3 months they are already pregnant, fabulous, I’m congratulatory of course but it was a little hard to hear on that day especially. We took the first ICSI failure hard, it was heart-breaking, I felt I couldn’t look to my brother/parents for support as they had happy news to focus on.  We decide life goes on so put on our brave faces and tried to enjoy a pre-planned family night on the town about 2 weeks later just before Christmas. We see my brother / SIL and congratulate them, I manage to keep my distance from my SIL until near the end of the night, eventually she plucks up the courage to speak to me. I speak honestly as she asked ‘how am I’, I tell her it’s hard, especially with my the problems with work earlier in the year and also my dad’s recent health problems and now the BFN it just feels like one thing after another. She says a couple of comforting remarks along the lines of talking to my mum more for support . . . then somehow she manages to transcend into a conversation about my brother and how difficult things still are (how do I get trapped in these situations!). I don’t say much as I’m in shock really, I let her talk at me for quite some time, eventually I excuse myself for the bathroom at which point I’m a crying mess as she suddenly made the conversation all about her AGAIN, I didn’t want to listen about their problems right now as I had enough on my plate.  OH rescues me and not before long the night is finally over.

A couple of weeks later we see them again at my parents for Christmas day, we notice that they are both being a bit weird with us but put it down to the fact that it’s an awkward situation for all, we just had our BFN and they are pregnant.  Move forward to a phone call in early February, I’ve had a 3 week break away on holiday and I’m feeling stronger so I mention to my brother that I’ve realised I need more support from my family as the ICSI cycles are really tough. Surprisingly he is quite abrupt back and we get into a heated conversation where he basically says - what did you expect when I told my SIL that hearing about their pregnancy was like a ‘slap in the face’. Obviously I’m outraged and in tears, this was a phrase I’ve never used before and suddenly I’m being accused of this and also lots of other mixed up things that have either been blown out of proportion or untrue. Over the next few couple of weeks there are a series of emails exchanged where I try to explain that is not my recollection of the evening, I maintain my dignity in it all, I don’t lower myself to her level and I don’t go into any detail as I can see it’s not going to get me anywhere. I also find out that she has read all of my private emails, chat messages and texts with my brother!? Randomly she texts me one day with disgusting and vile comments about how she will be making my parents grandparents first and that they have made a 'baby out of love' and that I have 'wrecked the family', basically rubbing our infertility situation right in our faces, completely unforgivable. Again, I do not lower myself to her level and I don’t reply.

I eventually persuade my brother to meet with me, it was awkward at first but then it was good to have a chat and see him. I clearly explain that I have done nothing but support them and suddenly I am being accused of numerous lies. He’s in a tricky situation, it’s clear to me what she is doing, but not so much to him. She is of course having the worst pregnancy which is not making any of this easier. I leave it with him to discuss it with her to decide a way forward. Instead of moving forward we take ten steps back, over the next few weeks sends more abusive texts to me and also calls my mum on several occasions dragging her into it all and being very rude to her about her issues with me, wtf?! Again, I don’t reply to any of her mad texts.

At this point, we’re at a complete loss of what to do and we are approaching egg collection for our second ICSI cycle, OH speaks with my brother and asks that he give me some space for the next two weeks minimum until I get in touch. Our second ICSI cycle also failed, again another heart-breaking and difficult time for us both. A few weeks later I make contact with my brother (by text during the day, apparently I’m not allowed to call him in the evening in case ‘she’ is there), we agree a date/time to talk properly which was last week. The call was hard, I still ask after her and the baby (am I a mug?) . . . I’m only really interested in my niece/nephew, they have decided that the only way forward is for my SIL and I to talk about the conversation in December . . . I have to remind him that this is so much more than that ‘conversation’ now, she has since dragged up so many many other things, yet I have not retaliated and said what I think of her and her behaviour over the years. I know what she wants to do, she just wants an opportunity to have her say to my face, this won’t get me anywhere because if I say one little thing about what I think about her actions she will surely just come back and say you can’t speak to your brother (which is her ultimate plan anyway). Judging by her recent behaviour I will just have to sit there whilst she shouts and tells her ludicrous lies to my face, I’m not strong enough to deal with that right now, especially when I don’t get my brother back, I explain this to him and he hadn’t really thought about it from my point of view. We have a family wedding approaching where I will be a bridesmaid to my cousin who has been more of a sibling to me of late (and which I am so grateful for) . . . my brother and SIL would like to come to the wedding even though my SIL will only be 2 weeks from her due date and it's a about a 7 hour round trip (ludicrous right? she just wants to put her belly in my face I’m sure and ruin the day for everyone). I’ve asked my brother to think about how this is going to work with the situation with me and also my parents with my SIL, it just seems like madness.

I just want a relationship with him for now (realising that it can never be how it was, but I would like to be able to speak to him occasionally) and maybe time will heal the rest, but he explains that can’t work as she won’t allow separate relationships. The call just ends with tears and he said he’ll have a think about things.

So that brings me to now. I’m grieving for my brother as I've lost him for now.

Pill Poppin'

OH and I are slowly on the mend, we tried to do some fun things this weekend and ended up in London for a nice walk along the South Bank, we had chance to have a good talk too and get a few things out in the open to help each other through it.

Yesterday we even visited our friends who recently had a teeny tiny baby girl, and oh my is she tiny and I loved holding her. She was super cute, I was a little nervous beforehand but it was really lovely (gotta keep my eye on the prize), OH thought it was the happiest I had seemed for days which is pretty ironic!

So I made it in to work today (progress), ugh, can't concentrate much, but I made it here so that's step one complete, so I'll aim to do something productive tomorrow :-)

 

This weekend, OH has started popping the pills, there are hundreds of them. this is the plan for the next 3 months but we're left wondering what the side effects could be :-/  It all seems a bit drastic (and desperate maybe?), but OH has researched it and there are many people doing something similar with positive effects. I'm not sure what our other options are before heading in to our next treatment cycle as we are at a loss of how to improve our chances so I guess it's worth a try.

Some tweeps have asked about what vitamin regime we have planned as many of you are doing something similar or plan to, here's the list, let me know if there is something missing, or alarming!

MORNING

Vitamin C 500mg

Vitamin B complex                

L-arginine 500mg

L-Carnitine 500mg

Vitamin E 200mg

Pyncnogenol (pine bark) 100mg

Omega Fish Oil 1000mg

EVENING

Wellman Conception 1 pill

Zinc 2 pills (30mg)

Selenium 200mg

Omega Fish Oil 1000mg

Co-Enzyme Q10 30mg

Maca 1000mg

Vitamin C 500mg

Vitamin E 400mg

Folic Acid 400mg

Pyncnogenol (pine bark) 100mg

Tablespoon of Tomato Puree (lycopene)*

*hmm this one doesn't sound too pleasant, think we change this to a tablet form.

Fingers crossed it does the trick.

WTF 2

Shucks, this is so hard, I cannot begin to describe how we’re feeling right now, other than heartbroken. Yesterday we had our WTF appointment for our second failed ICSI cycle, amazingly this clinic gave us an appointment only two days after I called them, our first clinic had us waiting a torturous two months.  

I’ve tried to summarise our appointment with the consultant in the hope that it may help some of you in a similar situation and also you may have suggestions for us that we haven’t thought of yet, believe me we are at a loss right now and so all suggestions are welcome! In TTC for coming up to 3 years soon, we have never had one positive pregnancy test, with have 2 failed ICSI cycles under our belt, no frosties ever, and we have never made blastocysts before. Herein lies our problem, if we cannot make blasts then it ain’t gonna work, full stop. So why don’t we make blasts and are we wasting our time . . . are you sitting comfortably?

I thought I would be seeing the same consultant as at our first appointment, instead we saw the new guy, I was a bit sceptical at first but in the end I was pleased we saw him, he has only been at our clinic for 3 weeks, prior to this he was the medical director at The Bridge Centre in London. He sussed me out within seconds after asking me if I studied Biology at school, I held my head up high and said I studied it as my degree, ha!

On the whole our second ICSI cycle did seem to go well and just like last time after Day 3 our embryo’s pretty much deteriorate.   Here is how Cycle 1 and 2 compared:

CYCLE 1
15 eggs collected, 13 mature, 8 embryo’s. Day 5 single embryo transfer (morula not a blast), no frosties.
CYCLE 2
13 eggs collected, 10 mature, 6 embryo’s. Day 3 double embryo transfer (1 excellent, 1 good), no frosties.
 
He said the cycles in terms of eggs/embryos were comparable and he is happy with the numbers, the quality of the embryo’s this time around were better than last time, but the same deterioration happened post day 3. The sperm sample on the day was the best OH has had since we started on this journey so we think the multivitamins he has been taking and lifestyle changes may have had an effect. In essence we are told that the sperm sample can fluctuate a lot and so there is just no knowing how it will be on the day, but it is going in the right direction. Now that I have had two cycles he will admit there is a pattern forming  but it’s not possible to say whether it is the egg or the sperm (or both) causing the problem, it’s likely to be the sperm but impossible to say for certain.
We discussed Day 3 vs Day 5 transfers, his preference is to get the embryo’s back as soon as possible if there are clear front runners, if it’s not possible to choose the best ones then he would opt for a Day 5 transfer. It is possible that the embryos could form blasts within me but not within a petri dish, he has seen the poorest quality embryos work before so you just never know (I know I know, it only takes one).  However for us, if we’re not producing blasts then it’s possible there is a genetic issue.

We discussed various tests that we could do to help diagnose or influence how to do our next cycle . . . he thought there was no point in seeing a urologist at this stage, it’s unlikely they will be able to tell us anything given the improvement in OH’s sample over our ICSI cycles. We discussed chromosomal karyotyping, this is a pre-requisite for some clinics before starting IVF/ICSI, it’s unlikely this will show anything for us both as it only detects major chromosomal defects but it may be worth doing for peace of mind. With regards to other tests, DNA fragmentation and Sperm Aneuploidy, he didn’t think these were worthwhile as these figures can also fluctuate, if we were to go ahead with these we have to be aware of the limitations of the results in that they look at a snapshot of the sperm at that time, on the day of ICSI the sample could be better or it could be worse, it will not help us in choosing better sperm. This was a little hard to hear, before we saw him we were adamant that we should do this type of testing before progressing, but we can see his point, it won’t help our upcoming cycle or change our situation (as we’re not going to give up just yet) and so should we bother? He said that the results of a DNA fragmentation test will only help determine whether to do ICSI or conventional IVF, as we’re already doing ICSI it won’t tell us anything new, he asked us to think about what we will do with the results, will it stop us from doing another cycle? I guess the answer is no.
 
We also discussed PGD (pre-implantation genetic diagnosis) and CGH (comparative genomic hybridisation), these are expensive options we could do in the future, unfortunately for us though it only helps in choosing the best embryos (or eggs) so this may not be useful if we can’t also select the best sperm in the first place to make the embryo. For this the latest technique is IMSI (intracytoplasmic morphologically selected sperm injection) as opposed to ICSI (intracytoplasmic sperm injection). It’s just like ICSI but uses a higher degree of magnification to choose the sperm, it’s thought that the fertilisation and success rates could be higher for people in our situation as they are hopefully choosing sperm that is less fragmented right before injecting into the egg.  I had looked up IMSI briefly before our appointment, I could only find one clinic near us (in London) that does this, it seems to cost a few hundred pounds more which is not much more in the grand scheme of paying for a treatment cycle. IMSI is not available at our current clinic, but the consultant offered that if we decided to pursue this in the future, he would be happy to link us up with a satellite clinic abroad (possibly France) for the egg collection/transfer part of the cycle. This seems like our only option moving forward in the future. Other tests we could do are full chromosome karyomapping and SNIP technology, I’m not sure what this would tell us but it’s something else to add to our list of research for the future. We discussed immune testing briefly too but given that we can’t seem to get to the implantation stage yet (we need to make a decent embryo first) he thinks we should hold off on this for the moment.

Our first ICSI cycle was NHS funded, we are lucky enough to be in the right postcode area to have funded cycles but have a restriction of 6 months between cycles, this is why we opted to privately fund our second ICSI cycle to bridge the gap. This means our next cycle will be NHS funded which is great but means we can’t do any extra fancy stuff, so we’ll take the NHS cycle and give it another try and ramp up OH’s vitamins based on some of our own research we have done, if this doesn’t work we can then perhaps pay for an IMSI cycle afterwards.
In terms of other lifestyle factors, the amount of alcohol we have (not much) he thinks is absolutely fine, he said just be sensible, no binge drinking and advised that during treatment I don’t drink. Eat a sensible diet, have my vitamins, continue with acupuncture if I find it relaxing and the OH should try to keep his stress levels down.

So we agreed a plan:

• Chromosomal karyotyping – he will write to my GP to see if they will fund this test for us both, it’s just for peace of mind (I’m persistent).
• Change my stimulation medication from Gonal F (recombinant FSH) to one from natural sources, such as Menopur or similar, just to see if it makes any difference.
• Agreed to transfer two embryos even though it’s an NHS cycle (did I mention how persistent I am)
• Keep up the good diet / lifestyle / mind & body relaxation.

Are we filled with hope, no not really, but we have to try again and in the mean time we’ll research IMSI and simply hope for the best. We might proceed with the other sperm DNA fragmentation tests anyway, he understands that we feel helpless and just want to gather as much information as possible. In the meantime the hundreds of vitamins keep arriving through the post box!

We felt relieved after the appointment to draw a line under it and to look ahead, but it didn’t last long. By late evening, I went in to a serious meltdown when I got home, we both did, so much so that we both could not go to work today and face people. I put on a brave face about 90% of the time, it’s impossible to sustain and stay positive and pretend everything is normal, we’re so far from normal that I’ve forgotten what normal is. I don’t want to burden anyone so I find myself distancing myself more and more, who’s interested in someone going through their third cycle or however many more we might need?!

Today is a new day and we do feel a little better, but our life is the same still and we have no choice but to keep putting that brave face on and keep going. 

Apologies for my longest post ever (zzzz).

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 :-)]

Yum Yum in My Tum

I've been suffering from jet-lag this past week so have fallen behind a little on my blogging, plus if I admit it I think I've been hiding too as it's difficult to come back from a lovely holiday and face reality. 

After my last post we spent a few more days in Kuala Lumpur with OH's family, luckily we had no further car drama's but we did continue to stuff our faces will all things spicy :-)

Now, this photo may not look that appetising, but trust me, it is delicious! This is a 'steamboat' restaurant. Each table has a portable cooking pot with it's own gas supply (novel), the pot is split into two sections, one side has tom yam soup, the other side clear soup and you basically steam fish, tofu, noodles and vegetables at your table, the hot soup is completely addictive, yum yum in my tum.

We then headed back to Thailand to have a few days of much needed relaxing time on our own and chose an amazing resort called Indigo Pearl, where every fitting and fixture was in their tin-mining theme, pretty cool. It's their peak dry season there at the moment but we did experience some freakish weather, our first evening there was mad thunderstorms and lightening for about 2 hours, we lost all power and got ready for the evening by torch light (thank you iPhone!), made it interesting though.  We did have grand ideas of taking a boat trip to the Phi Phi islands, but it didn't take long after we arrived to decide we were firmly staying put, the resort was really nice and we didn't want to leave.  

I was hoping that these few days I could really relax and get away from everything and forget my worries . . . felt like it was impossible though to completely forget, infertility is such a big part of our lives now so not sure who I was trying to kid by thinking I could forget it all.  We did have a relaxing time though, our days mainly consisted of laying by the pool, laying by the beach, drinking cocktails, napping, reading and more laying by the pool and laying by the beach. There was a spa on the resort so we treated ourselves to a couples massage and facial, OH skipped the facial and had a steam bath instead though :-) Ironically, the spa package I chose was called a pregnancy package (if only!), this was the only one that had a massage and facial combined so I went for it anyway and very quickly explained ha haa, keep smiling, I'm not pregnant but can I have it anyway, ha haa, keep smiling. What I didn't bargain for was to come away with 12 insect bites, yes 12!! Now, anyone that knows me knows that Moon and insects are NOT FRIENDS, EVER. I tend to have some over-reaction to insect bites and the result is not very pretty, enormous lumps and bumps. Doesn't matter how strong the repellent is and whether I have dosed myself up on antihistamines it happens every time, in fact, it's quite boring now :-) After one trip to the chemist and two very sleepless nights I was better just in time to come home. Just to make sure that I truly had a break from it all, Aunt Flo also made her appearance on my last day, fan-bloody-tastic. Anyhoo, we really did have a lovely time though, and it was really nice to be away and only have to worry about where to sunbathe today and which restaurant to eat in, we had an amazing room, I beat OH at pool (once!) and it was hot hot hot. I read a book called One Day by David Nicholls, a good holiday read that I'd recommend, and I'm about half way through Eat, Pray, Love by Elizabeth Gilbert which also seems quite good so far.

Whilst I was away, Shona over at aPGDblog was kind enough to give me a blog award, yay for me. Thanks Shona, I really appreciate it, if you haven't seen Shona's blog, please go over and read her story.

Here are the rules for the acceptance of the award:

• Thank and link back to the person who awarded you the award.
• Share 7 things about yourself.
• Award 15 other bloggers.
• Contact these bloggers and tell them about the award.

Here are the 7 things about me that you may not already know . . .

1. My little kitty cat is called Macy, she was a rescue cat and I love her to bits.

2. I have an unknown allergy and carry an EpiPen (adrenaline). A couple of years ago in Malaysia I suffered an anaphylactic reaction to something I ate (very scary!!) but I have been unable to identify the cause.

3. I have a love hate relationship with snowboarding.

4. I have OCD tendencies and like things to be straight :-)

5. I hate cinnamon.

6. I have this weird fascination with the Gherkin building in London.

7. I miss who I used to be before infertility.

Here are the peeps I'd like to give the award to (in no particular order) . . .

My Cheap Violin 

Yolk

My TTC Story

Hoping For Rainbows

Tales of my Follies

My Lazy Ovaries

Love, Life and Infertility

Built-in Birth Control  

Liberal Granola Girl

Baby Wishes

Buford Betty 

The 2 Week Wait

Braving IVF

One Good Egg 

A PGD Blog (rules are for breaking so I'm linking back to you) 

On another note, I've had an eventful week in terms of our TTC journey, on our first day back to work we also had our follow up appointment to discuss our failed cycle (in hindsight, perhaps not a great idea for my first day back, not sure what I was thinking!) and on Friday we had our first appointment with a potential new clinic . . . will blog about this soon.

Out of Office

Blogging from Kuala Lumpur, Malaysia, ain't technology great :-)


So . . . here I am, at my in-laws apartment in the hot, humid weather . . . chilling out, eating, drinking, and eating some more [impossible to resist the yummy spicy food here, and with the jet lag I'm muchos hungry - my excuse!]


My flight over to Bangkok to meet OH was quite nice and I managed to get a few hours sleep and watched a couple of films too, Social Network [fab film] and The Switch [hmm not too bad, mildly amusing tale about an unmarried 40-year old (Jennifer Aniston) who uses a sperm donor to get pregnant, obviously it worked on her first attempt, cos it's really that easy!]. 
I spent one night in Bangkok with OH and had dinner with some of his work colleagues and then we escaped to Vertigo for some midnight drinks at the Moon bar there, an amazing rooftop bar at the Banyan Tree Hotel overlooking the city [ha ha, the "Moon" bar - so kind of them to name it after me, it would have been rude not to visit].


We haven't done much since arriving, just chilling out and enjoying being 'out of office' :-)
Here are a few things that have made me chuckle in the last few days:

• It's very much still Christmas in Bangkok! In our hotel there were three Christmas trees in the lobby and two nodding reindeers :-) I'm guessing they didn't realise it's bad luck if you don't take the decorations down by the twelfth night, or maybe they did and they plan to keep them up for the entire year!
• We popped in to the Levi's shop at one of the malls here, I'm browsing for some new skinny jeans, the size they had on the rack was 23" waist with 32" leg, err who has a body like that?! When I asked for my size she chuckled, ha ha, everyone is so so tiny here!
• We made a school boy error and lost the car in the shopping mall car park . . . cue 15 minutes aimlessly wandering around trying to retrace our steps! We've made this mistake many times before on our trips here to malls as the car parks are very confusing!  I even took a photo of our exact location, but it was no help when you're in the complete wrong car park and lost, LOL!

We've managed to already have our top four favourite dishes too . . . all with a spicy connection, I was so busy stuffing my face I forgot to take photo's but here are some from Dr Google, mmm yum yum in my tum!

• Roti canai - Freshly baked layered flat bread with spicy curry and dhal sauces on the side for dipping, costs next to nothing but tastes amazing. 

• Laksa - my favourite dish, a spicy noodle soup  usually with chicken and prawns, completely addictive. I've had this dish twice already!

• Banana Leaf - rice, curry and vegetable side dishes all served on a fresh cut banana leaf.

• Kway Teow - spicy fried flat-noodle dish with vegetables, chicken and prawn with a yummy charred taste.

We did a spot more shopping today at another mall, KLCC, had yet another Starbucks (OH has discovered Peppermint Mocha Frappuccino a.k.a heaven) and chilled out watching the world go by . . . OH took a great shot whilst we were at KLCC, right next to the Petronas Twin Towers . . . if only we could stay here longer and holidays could last forever . . .

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 

 

Cherry on Top

More choccies from a dear friend (thank you!) . . . gotta stop feeding me these naughty things soon though otherwise I'm gonna be the size of a house before Xmas arrives :-)

I haven't blogged for a little while as I felt like I needed to hide for a while . . . not that hiding solves anything and until now writing has helped me cope these past few weeks, but I guess it's a form of self preservation. I still feel incredibly sad that our treatment cycle didn't work and this is making it difficult to return back to normal, I do keep asking myself though, what is normal? 
My main concerns are that all the drugs, procedures and all the waiting is emotionally and physically draining . . . why were our embryo's not strong enough . . . will it ever work . . . did the other stress I was under affect anything? If I rationalise it, I know it's a numbers game too and I believe in fate and so it wasn't meant to be our turn this time.  Also seeing so many other infertility tweeps get BFPs lately does give me hope that it can happen.
I've surprised myself actually, I usually 'cope' with everything but I guess the accumulation of the events has not helped, not really sure where I go from here, I'm not sure counselling will help as I know I just need to focus on moving on and taking sick leave from work is not going to help me either. So . . . instead we've booked a holiday and boy do I need some pampering time.  So I'll be gone for just over two weeks in January and then it will be February before I know it, perfect, I literally cannot wait to get away and chill out!

I went back and read some of my older posts (makes interesting reading, ha!) and with everything going on I forgot to mention a blog award I received back in November from one of my favourite tweeps, Low Fat Lady, so sorry it's taken so long to post but thank you!  I was so chuffed to get this as this is my first ever blog and was wondering if anyone would enjoy my drivel.

The rules: link back to the person who gave you the award, pass it on to five (or a bunch of) other blogs, and leave them a comment telling them of the award.

So here goes . . . I give this award to (drum roll please) -

My Cheap Violin 

Yolk

One Good Egg

My TTC Story

Low Fat Lady (rules are for breaking so I'm linking back to you as I love your blog!)

The other day @saleschick reminded me of my mantra from one of my first posts, I'd forgotten all about it!

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

I need to be stronger and I know that's a state of mind so that's what I'm gonna do, be strong, I know it's ok to cry from time to time, but most of the time I hope to be strong and I know it will get easier.

Actually, I'm currently in a dire 4 hour teleconference (who schedules 4 hour calls?!?!), and I am showing great strength in persevering :-)