Follow-up

Tuesday 9th January 2018
Kingston ACU
Kingston Hospital, London

It's been nearly three weeks since our BFN. I've been feeling a bit more positive about things over the last few days, I guess that's because the acute agony we suffered post IVF is becoming a lousy memory that we can now slowly move on from. I won't say it's been easy - I've had some really low days over Christmas and New Year - but it's definitely becoming less painful. Until today.

The day didn't start too well when we arrived at Kingston Hospital and the car park was rammed as usual. After driving round for 15 minutes and getting increasingly more stressed with the other frustrated drivers, I decided to head in to our appointment on my own. I hadn't been in the waiting room more than five minutes before I was called in, typically the one day I was hoping they were running late. Sitting there feeling extremely vulnerable, the consultant went through all my blood tests and scans over the past few months and told me the results were extremely disappointing for someone of my age (no shit!). She told me I was still young in terms of IVF years but my AMH levels were as low she'd expect to find in someone in their late 40's, someone 10 years older. She asked if there was a history of early menopause in my family, to which I replied there was; Mum was 45 when she went through 'le change'. Although it's been discussed between my mother and I, especially recently, I hadn't really considered that I might have already entered perimenopause. I had hoped unrealistically that it wasn't heritable.

My AMH and FSH levels have been fluctuating over the last few months so she advised that it might not be worth us spending thousands of pounds on another round of IVF, I could get another month like the last where there was pretty much zero response from my ovaries. By this point, I was close to tears so I was relieved when Jon interrupted the delicate conversation about my failing female bits and asked to join us on speaker phone (still no luck with the car park).

Because they had already given me the maximum allowed dose of stims (Menopur 450IU), the consultant said there's not a whole lot they could change if we were to try again with another round. They don't advise to inject that amount of hormones for longer than a few days; it's not good for anyone, let alone someone of my diminutive stature and especially someone with a history of endometriosis. She suggested leaving my body to recover for a few weeks and get my bloods tested again when we felt ready to take the next step, if indeed there is to be one. She mentioned that if we were to try again, using donor eggs might give us more of a chance. We have already talked about this as a possibility but my head isn't quite there yet, I'm not done with grieving my own fertility and I'm not sure I'm ready to give up on my crappy eggs. We have a lot to talk about but unfortunately, unless we have a miracle (and I realise they do happen!) it's looking highly unlikely I'll ever be a biological mother.

After stopping for the obligatory post-appointment sob in Petersham Car Park, I dropped Jon off in Richmond and made my way into work. I felt numb and mentally exhausted and wanted to be anywhere in the world than sitting at my desk putting on a brave face. I pushed through the day and when I got home I had a big cuddle from Jon followed by a very large Gin and Tonic.

Down-Regulation Scan

The witch arrived a few days ago. On one hand this is fantastic news because it means I can go ahead with the next stage of my treatment, the flip side, I've been suffering with the usual stomach cramps and trauma that comes with this time in my cycle. Pair this with a tortuous liquid diet and a throbbing hole in my mouth where my gum used to be and you have a perfect recipe for self-pity and utter misery.

Once I'd manage to pull myself out of my pit of gloom, I booked my down-regulation scan for this morning. This was another internal ultrasound scan (hello Wanda!) which is carried out to ensure that my lining is thin and my ovaries are quiescent after the down-regulation phase (in my case, sniffing). My scan today confirmed both so we're finally ready to start the stimulation stage.

I don't have a phobia of needles, I can quite happily look down at my arm during a blood test, but something about self-administering fills me with complete fear. I had asked Jon during a conversation a few weeks ago if he could do the injections for me. Unsurprisingly, he wasn't particularly keen but unfortunately it is a necessity so one of us has to be brave. As I'm the one getting punctured, it seems only fair that he plays the nurses role. "It'll be nice for you to be involved at this stage" I keep telling him!

As I mentioned in a previous post, my stimulation protocol is 450IU of Menopur, the highest approved dose in the UK. Menopur comes in vials of 75IU so I need six of these mixed with two bottles of solvent, this means two injections with 225IU in each. After the scan a very steely nurse (that's being kind, she had no compassion whatsoever) showed us how to mix the injections and she administered the first two, one in each thigh. It actually stung more than I was expecting so I think we're going to try in my tummy tomorrow night, there's definitely more flab to grab there!

I read the patient information leaflet a few days ago and aside from the usual instructions on what to do if you take too much/miss a dose/get DVT, I came across this section:

1. What Menopur is and what it is used for
What Menopur is
Menopur contains a medicine called menotrophin. This is a mixture of hormones obtained from the urine of women who have passed the menopause.

WTF?!

Today was another one of those days crammed full of appointments. After my first injection lesson, I scooted across SW London for another dental check-up in another hospital with yet another dentist. She admitted the lady who had performed the surgery nine days ago had made a bit of a cock-up (not her exact words) and my gums were a mess. Fantastic.

I also went to my first acupuncture session which I thoroughly enjoyed and found very relaxing. Victoria spent a long time going through my health and fertility history before deciding on which areas to concentrate on. I don't know if it's going to improve my chances of IVF success, it did however, make me feel less stressed and more calm, which has got to be a good thing.

IVF Lingo

Since our initial consultation, it's no surprise I've fallen head first down the IVF rabbit hole. I've immersed myself in facebook groups and been reading up a lot on the matter in hand. Most of it has baffled me as it seems like a completely different language! I've also been in touch with a couple of other ladies, Sarah & Vicky, who are cycling around the same time as me and they've been great at keeping my head above water and offering advise.

I've made up a list of the most commonly used terms and abbreviations which might help you understand what I'm talking about over the next few months. It's a lesson for me too.


2WW  Two Week Wait (after ET and before OTD)
6dp3dt  16 days past 3 day transfer
AF  Aunt Flo (period or menstrual cycle)
AFC  Antral Follicle Count
AH  Assisted Hatching
AMH  Anti-Müllerian Hormone (indicator of egg reserve)
BBT  Basal Body Temperature
BCP  Birth Control Pill
BD  Baby Dance (sexy time)
BFP/BFN  Big Fat Positive/Negative (result after POAS)
CD  Cycle Day
CM  Cervical Mucus (my personal favourite)
EC/ER  Egg Collection/Retrieval
ED  Egg Donor
ET  Embryo Transfer
FET  Frozen Embryo Transfer
FMU  First Morning Urine (most concentrated wee)
FRER  First Response Early Result (pregnancy test)
FSH  Follicle-Stimulating Hormone
HPT  Home Pregnancy Test
ICSI  Intracytoplasmic Sperm Injection
IF  Infertility
IUI  Intrauterine Insemination
IVF  In Vitro Fertilisation
LH  Luteinising Hormone (triggers ovulation)
LP(D)  Luteal Phase (Defect)
MF  Male Factor (male IF)
(M)MC  (Missed) Miscarriage
OHSS  Ovarian Hyperstimulation Syndrome
OPK  Ovulation Predictor Kit (another POAS)
OTD  Official Test Day
PCOS  Polycystic Ovary Syndrome
PG  Pregnant (if only)
POAS  Pee On A Stick
POF  Premature Ovarian Failure
PUPO  Pregnant Until Proven Otherwise (during the 2ww)
Stims  Stimulation Injections
TSH  Thyroid Stimulating Hormone
TTC  Trying To Conceive
US  Ultrasound (new best friend)

So there you are, a little insight into the TTC online community!

First IVF Consultation

Tuesday 26th September 2017
Kingston ACU
Kingston Hospital, London

I was excited but a little nervous while we were waiting for our first IVF consultation at the same hospital I'd been treated at a number of times this year already. The clinic was running late and we had a long wait before we were called into the appointment, which didn't help the with the feeling of imbalance. I couldn't help but look at the other couples in the waiting room, I suddenly wanted to know all their stories. As you can imagine, the demographic was fairly predictable - couples in their late 30's to early 40's.

During the consultation with the Senior Fertility Specialist, Miss Despina Mavridou, we had a baseline scan, which is an internal ultrasound to determine my antral follicle count (AFC). The scan showed a very small number of follicles, two on each ovary to be precise, and my left ovary was tucked high up behind my uterus with little mobility. She discussed that it could potentially be difficult to access at egg collection. I started to feel like we were already fighting a losing battle and we hadn't even started the treatment yet - endometriosis has a lot to answer for! Due to the low AFC and previous blood test results detecting low AMH and elevated FSH levels (a good indication of a woman's ovarian reserve), they decided to put me on the very maximum dose of stimulation drugs. We then went through a number of things in detail, including the reasons treatment might fail, operative risks, side effects and the predicted percentage of success (20%), which I thought was quite high, all things considered.

I'd already started to feel very overwhelmed with information to process but this was nothing compared to how I felt after the second part of our appointment. After a further short wait we were ushered into another room to see lovely nurse Laura MacGreggor to go through a phone book worth of HFEA consent forms that we had to sign and date. This was in fact a contract between the two of us and the clinic outlining all kinds of morbid but necessary scenarios such as:

Do you consent to embryos created before your death being transferred to your partner after your death, and to being registered as the legal parent of any child born from your partner’s treatment after your death (ie, posthumous birth registration)?

We then went through our IVF protocol, highlighting key dates over the next three months. I was frantically trying to scribble everything down as I was so concerned I might mess things up if I had forgotten a vital piece of information (my short-term memory is non-existent). Key things I managed to scrawl on the back of the appointment letter were:

• Order the IVF medication from Boots
• Have blood tests (HIV, Hepatitis B & C)
• Jon to provide (yet another) sperm sample
• Ring clinic to book a trial embryo transfer (due to previous womb history)
• Start taking a birth control pill (they know I'm trying to get preggers right?)
• Start sniffing another drug to turn off my ovaries (see above)
• Phone in to book 1st scan (down regulation)
• Start injecting stimulation drugs
• Egg collection under sedation (preferably knocked out)

Laura then explained that the real embryo transfer would be at a different site at King's College Hospital in Denmark Hill. This means that within minutes of my egg collection, Jon will be handed a medical transportation box (fridge) containing my lovely eggs and he'll have to hotfoot it over to King's on the train where he'll then do his his part of the bargain. The following day, we'll hopefully get a call telling us the magic has happened and we have some beautiful little embryos in a petri dish.

Holy moly.


Guy's Hospital, London

As if my mind wasn't frazzled enough after our consultation, I decided to go to my first ever Endometriosis UK support meeting that evening at Guy's Hospital. I'd joined the London facebook group a few months previous and I'd already gained a lot of information but I wanted to meet ladies in the same position I now found myself in. Jon came with me for moral support as I was feeling very anxious about the session. I'm naturally very shy, especially in situations where I'd be meeting someone for the first time, so this was completely out of my comfort zone. Not one new person, but a whole room of new ladies all with one shared condition.

It turns out I had more than one thing in common with a couple of the ladies there that evening and towards the end of the discussion, a question about infertility and IVF was presented. At the end of the evening I got talking to Tijen and Kelda, both of whom were about to start the IVF process, we swapped email addresses to keep in contact over the next few months. I was aware I was talking really intensely as I blurted out my story to them, I'd had so much information to process that day, I was feeling extremely vulnerable and overwhelmed. On the way home, I had a chance to contemplate everything and I felt happy I had two people I could now talk to.