Embryo Transfer

Wednesday 6th December 2017

King's Fertility
King's College Hospital, London

I am officially PUPO! This is the closest I've ever come to being pregnant (as far as I know) and I'm not going to lie, it makes me feel a little warm inside. Initially, I was concerned about the two-day transfer as I'd not heard of this before, everyone talks about 3dt or a 5dt but never a 2dt. Why did they want to put it back so early? The reason, we found out during the transfer, was because we only had one egg and the best place for it to continue to fertilise and grow is back in the uterus. If you have more eggs to play with, they will try and nurture them in the lab until day five as they say you have more chance of pregnancy success with a blastocyst. The embryologists can also learn more about the quality of the embryo if it makes it to this stage. I guess they didn't want to risk losing my egg in a petri dish so decided to put it back where nature intended.

For me, the transfer itself was the least stressful stage of this process. I think I was so happy to have made it this far, I was glowing and couldn't wait for our embryo to be back where it belonged - I was even belting out Queen songs on the way in the car! Mr B on the other hand, did not find this part enjoyable at all. After a stressful wait to get into the tiniest hospital car park, I could feel the tension in our cubicle as we were delayed another hour on the ward at King's College Hospital. The nurses seemed a little disorganised and in a muddle about who was supposed to be going into theatre next which only added to his angst. Jon was also quite emotional which I think surprised him (and me!), he was really suffering in the run up to our transfer. I was just keen to get on with things as I had a full bladder that was getting extremely uncomfortable.

Eventually, after much confusion, we were called into the theatre room. I was surprisingly nonchalant as I clumsily climbed onto the bed and put my legs into the stirrups. It felt like I was in this graceless position with my nethers on show to the whole room for an awfully long time while the consultant went through the procedure, but she did make everything as relaxed as possible for both of us and I felt an incredible calmness. There was a screen on the wall where we could see live images of our embryo in the petri dish in the lab next door, she told us that it looked good (four equally divided cells) for a two-day embryo with little fragmentation. Both of us were completely overwhelmed at this point as reality sunk in that we had made this microscopic seed (with the help of a little bit of science) and it could potentially grow into our very own human. We watched the little dot being sucked up into what looked like a long pipette type receptacle and and a few seconds later, the embryologist emerged from the lab carefully holding the catheter containing our embryo.

I was expecting to find the procedure as uncomfortable as the trial embryo transfer I had experienced a few weeks ago, but I hardly felt a thing as they passed the tube through my cervix and placed the seed into its new home. I knew it was silly but I still asked the consultant if there was any danger of it falling out, to which she said, think of it as a sesame seed stuck in a peanut butter sandwich! After we watched the embryologist check the catheter under the microscope to check it hadn't gotten stuck, we were given the all clear to go.

As soon as we were back in our cubicle, Jon was overcome with emotion and it was a really poignant and touching moment. I was just grinning like a Cheshire cat who desperately needed to pee!

On the way home we stopped at Maccy D's, it's an old wives tale that the salt on McDonald's fries help implantation and some women swear by it. I have no idea how this superstition is supposed to work but do I care? No, it was guilt-free excuse to visit the golden arches if nothing else!

Scan Two

Friday 1st December 2017
Kingston ACU
Kingston Hospital, London

Today has been one of the toughest days I've had to get through since we said goodbye to my darling Dad exactly two years ago.

Alongside the sadness that comes with every anniversary, I was feeling calm but not too expectant as we once again got in the car to go to the hospital for another follicle monitoring scan. The initial bloating I had experienced 5-6 days ago had now pretty much subsided and I had expressed my concerns to Jon about the lack of discomfort a couple of days previously. Surely I should feel like my ovaries were ready to explode after seven days of stimulation injections? Luckily for Jon, I've had no manic outbursts, although part of me wished I had felt in the mood to throw a few pans around - at least I'd have some indication that the hormones were working.

I've always had a realistic outlook on life and today was no different, we can't change the situation and it's completely out of our hands. The inner control freak in me tried to remember this as I was laying on the bed with an ultrasound probe up my noo noo. I could feel my hopes slowly depleting the longer I laid there, the nurse was certainly having a good look around, I was starting to wonder if she could find anything at all. Eventually she said she was going to get the doctor to get a second opinion, as was always the case with a low follicle count. There, she had said it.

It seemed like an eternity before they both returned, but hardly any time for the doctor to confirm there was only one possible plan going forward. There was one lonely follicle which was considered 'ready' in my right ovary, the rest (maybe two or three) were non-runners, too small and extremely unlikely to grow to maturity, even if I kept up with the stim injections. I was devastated.

In the time it took me to re-robe reality had sunk in and I was fighting back tears. I was trying to keep it together so I could remember everything the nurse was telling me, Jon held my hand as he could see I was getting increasingly distressed and by the time we had sat down, I was inconsolable. The nurse was asking me questions but eventually offered to just talk so I could compose myself. We were told the plan was to bring egg collection forward to Monday, if we leave it any longer the one ripe follicle could become over-mature and we could lose it.

Back the waiting room I became more aware of all the couples who were a similar age to us, I was wondering if they'd had more promising news than we'd just been dealt. Regardless of their situations, everyone was there for the same reason, clutching their bags of medication and looking decidedly anxious. Thankfully, after a short wait we were called back in to see the doctor to go through the protocol for the weekend. The plan is to carry on today as we have been; three Suprecur nasal sprays and two Menopur injections. Tomorrow night, the stim injections will be replaced by a trigger injection (hCG) which has to be administered exactly 36 hours before egg collection. This induces the final maturation of the egg inside the follicle, if indeed there is one. I'm even starting to have doubts about that.

As we were leaving the hospital, we passed a lady pushing twins in a buggy, it was almost too much to bear. By the time we got to the car I was sobbing and I don't think anyone could've said anything to make me feel any better at that point. We drove to a car park in Richmond Park so we could have a chat (and another good cry). I wanted to go home and curl up in a ball on the sofa but I came to the conclusion that going into work and keeping busy would be the best option. I'm glad I made the call to be around people and not restrict myself to my own thoughts today, I'm definitely feeling a smidge more positive tonight.

So this is the hand we've been dealt. I'm completely heartbroken there will be no frozen embryos to have another shot if this one fails. This is it.

Aside from myself and Jon, the other person I'm really feeling for today is my Mum. Not only is she mourning her husband, I've just had to tell her our dreadful news. It has crossed my mind that we might not ever be able to make her a Nanna. For that, I feel awful.

Progress

After visiting my GP two years ago, I was referred for a pelvic ultrasound at St. Helier Hospital. I'd stopped taking the contraceptive pill 18 months previous with no success so we were keen to find out if there were any complications. The results of the ultrasound were fairly inconclusive, but I appeared to be ovulating which was encouraging.

Because nothing significant showed up on the ultrasound, I didn't return to my doctor for another 12 months. We'd moved house shortly after the last hospital appointment and it took time to settle into the new neighbourhood and change doctors, I guess we again just assumed we would conceive naturally during this time. What happened next changed all our lives forever - my father suddenly and unexpectedly passed away on 1st December 2015 from a massive heart attack. My world was completely turned upside down, I adored my daddy. For a few months, whilst I was going through the various horrific stages of grief, I couldn't even bear to think about children. It was too painful to comprehend that my Papa would now never meet his grandchild or that our son or daughter would grow up never knowing my lovely dad. On the other side of the coin, mum's deep sadness turned into longing for a little person to fill a small part of the colossal hole dad had left in our lives.

After a few very sad and challenging months, I booked an appointment at the new practice and went through my history with my new GP. She was really supportive and referred me to the gynaecology unit at Queen Mary's Hospital in Roehampton. I had my first appointment at the clinic in June of last year.

Two months later I had been booked in for a transvaginal pelvic scan and hysterosalpingogram - thankfully abbreviated to HSG. The first is an ultrasound which involves the insertion of a probe, enabling detailed images of the uterus and the ovaries to be obtained. The second is an x-ray using dye to determine if the fallopian tubes are open and to see if the uterus is a normal size and shape. I can only compare this to a lengthy smear test, it didn't hurt but it was assuredly uncomfortable. After these procedures I was given a mixed bag of good and bad news. The dye had travelled freely through my tubes which meant there were no blockages but my uterus appeared to be an abnormal shape. I had no idea what this meant and I wasn't given anymore information at the time.

During the follow-up appointment in October 2016 - my first meeting with Consultant Obstetrician & Gynaecologist, Mr Emmanuel Kalu - we talked about the results of the scan, the irregular shape of my uterus and the possibility that I could be suffering with endometriosis. And that was my first introduction to the condition. En-doh-mee-tree-oh-sis.

After studying the ultrasound and HSG results he tried to illustrate the possible semblance of my womb with a series of drawings. Doctor's scribbles are as bad as their handwriting so I've redrawn them for the purpose of my blog - I do like a good doodle. He suggested that he would be very surprised if the outcome wasn't option B or C.

Bog standard uterus

Arcurate uterus -  looks like a normal uterus, except it has a dip or a slight indentation at the top.

Septate uterus - the inside of the uterus is divided by a muscular or fibrous wall called the septum.

Mr Kalu advised I would need a further procedure called a laparoscopy to determine if I was suffering from endometriosis. It would also reveal which of the three illustrations resembled the shape of my uterus, which would be critical if we wanted to have children. He explained about the small incisions he would make in my belly button (wince) and abdomen and the possible surgery he would carry out if endometriosis was found. I felt confident and happy being under his wing. We discussed private health care as this is something I could claim through my insurance at work, he agreed this would be the most favourable option.

Of course I went home and googled endometriosis straight away. I read pages and pages about the condition. I was astounded to discover that 1 in 10 women suffer with it in varying degrees. If it's so common, why has it not been mentioned before by my GPs, considering my previous history?

My first laparoscopy was booked in for 10th December, six weeks after my appointment with Mr Kalu. Unfortunately I had to postpone the operation due to suffering with a chest infection the previous week, I was devastated. I had to wait eight weeks for another date - Saturday 4th February 2017.