Archive | March 2013

Transfer day!

Well………it’s done.

I’m at home watching movies and snuggled up on the couch with Arnold our toy poodle. He seems unimpressed by the fact he is no longer allowed to lick my face by way of greeting. Doug insisted that once the embryo transfer took place Arnold and his licky tongue had to keep their distance from me. I had an immunity to his doggy germs, but a little bubby certainly wouldn’t.

But I’m sure you want to hear all about my transfer, right?

First of all, let me start by introducing my Nemo. What a good looking embryo!

Nemo

This photo was taken by the embryologist prior to freeze about a month ago. The “baby” is the dark mass in the middle of the larger bubble. The placenta is around the outside of that bubble. The smaller bubble is the shell, which Nemo was almost completely hatched out of right before freeze took place.

By the time we arrived at the clinic this morning and the transfer took place, Nemo had re-expanded nicely, was looking strong and remained AA graded. He/she had also hatched completely and this is great news. Hatched embryos have a heaps better chance of successfully implanting, and often implant straight away or within the first 24 hours after transfer.

I have blocked Fallopian tubes, and embryos that move around looking for a nice place to set up camp can often end up traveling towards blocked tubes and then get stuck. We do not want an ectopic pregnancy. That would be awful.

After I was given the photo of Nemo and taken through to the room where I would have the transfer, I had a chat to the nurse who told me “Don’t be afraid to pee and poop! The embryo won’t fall out!” Oddly enough, I think that’s the best advice I have received so far because I think that’s honestly something I would have stressed about, given I was worried about eggs falling out when I went to the toilet prior to my egg pick-up in February.

The nurse also told me that even though the official beta test date, where I’ll have blood drawn to tell if I’m pregnant, isn’t for two weeks I can take a home pregnancy test (HPT) after 10 days and it will almost certainly be accurate. This isn’t the case for women doing fresh transfers because the trigger shot used during egg collection has pregnancy hormone in it and will give a fall positive on a HPT.

They then showed me another image of a now-hatched Nemo (which unfortunately I couldn’t keep) and the embryologist came into the room with my little one in a syringe attached to a catheter. After the doctor inserted the catheter and released the contents of syringe, the embryologist went back to the lab to check that Nemo wasn’t still hiding out in the fluid left in the dish sitting in the incubator but luckily it was all good.

And that was it! All over! All the nurses hugged me and wished me good luck. I was in such high spirits as I left and headed to get my acupuncture. I spent the 45 minutes of acupuncture with my hand on my abdomen, just silently willing my embryo to implant. I wanted so badly for Nemo to stay with me today and for the rest of my life.

I sent a copy of Nemo’s photo to Doug and his parents. His mum Kate responded “Welcome Nemo! Hope you decide to stick around!” and as usual, his dad cried tears of joy. That man……………

I’ve done research (I’m studying a masters degree, research is kind of my thing) and I know that because my Nemo was a hatched 6 day blastocyst at transfer I should be able to tell if I’m pregnant 5 days after transfer.

I just know I’m not going to handle this well. I just know I’m  going to test every day.

But I’m going to limit myself to just ONCE per day. I’m not going to be one of those crazy ladies carrying 300 cheap internet pee sticks around in her handbag so she can test every time she gets the urge to pee.

Tomorrow is my last day at my current job and then it’s a four day long weekend for Easter. It’ll be easier to keep my mind off whether or not I’m pregnant over those four days, then it’ll be a long wait until beta day I think.

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FET eve

It’s just like Christmas eve, only better!

Tomorrow I’m getting my embryo transferred. My one little 6 day old blastocyst. My Nemo.

This afternoon we jumped the last hurdle prior to the transfer – the embryo thaw. Even though my little one was AA graded, there is always a small chance an embryo won’t survive the thaw. I kept my eye on my phone all day while I was at work, hoping that it wouldn’t ring. I didn’t want the clinic to call and tell me Nemo hadn’t made it. He/she was our only chance! But that phone stayed happily silent.

I’d hoped to keep the transfer a secret from everyone except my mother, who had kindly offered to replace Doug and hold my hand while I got the transfer. Doug unfortunately has a really important business event on during the day and won’t be able to make it. Doug also unfortunately told his family of the transfer so I got a whole bunch of good luck text messages from his mum and stepdad, dad and stepmum and sister Jess.

There are some tips on support forums for women going through embryo transfers (both fresh and frozen) and I’ve decided to follow some and not others.

Today I went to the naturopath on my lunch hour and got some acupuncture. I don’t necessarily believe in acupuncture, but scientific studies have suggested it might have a slightly positive effect on achieving a pregnancy.  Whilst more studies need to be conducted, I’m happy to try it out. It certainly won’t hurt the cause.

It is also suggested couples have sex either the night before or morning of an embryo transfer. The presence of the semen may help to prepare the environment for the embryo. This is one tip Doug and I have decided we definitely will not be following. As I said in my last post, I can’t even stand to put my own fingers near my cervix right now so I certainly won’t  be forcing Doug to go through that ordeal. Crinone gel is messy. Messy, messy, messy. Other women obviously have much weaker gag reflexes than I do. Or possibly their cervix doesn’t hold the crinone gel like mine does. Regardless, no sex for us!

Finally, there is huge debate about whether you should rest after an embryo transfer or move around straight afterwards. I’ve noticed particularly in the USA women are put onto strict bed rest for up to a week following a transfer. Sometimes it’s so strict they even use a bed pan instead of even getting up to go to the toilet.

I am firmly against bed rest after transfer and I’ll tell you why:

Several important studies have now been conducted in Australia and also overseas that show absolutely no correlation between bed rest and pregnancy success rates. You can find more information at this link: http://humrep.oxfordjournals.org/content/14/3/590.full or google it and you’ll find a heap of other websites with links to peer reviewed journal articles.

Not only does best rest have no positive influence on achieving pregnancy, scientists have now found that not resting after transfer may actually be the key to increasing success. Why?

  1. By getting up and moving around straight away, a woman is getting the blood flowing faster in her body. Keep the blood moving, keep the blood headed towards the uterus, keep the embryo safe and healthy, assist implantation. It makes logical sense, right?
  2. There are those who think if a woman stands up too soon after transfer, the embryo will simply “fall out” but this isn’t further from the truth. A uterus is like a piece of bread slathered in sticky strawberry jam and then folded in half. Once an embryo is there, it’s there.
  3. A woman’s uterus doesn’t work like most people think it does. It is “right way up” when a woman is standing, not lying down. So bed rest is actually counter intuitive. By staying upright, your uterus also stays upright so the embryo actually has less chance of slipping out of the uterus (if there ever was any at all).
  4. Lying in bed for extended periods of time is bad for a woman’s mental state. Anyone who is stuck in one place and restricting their movement for days at a time will end up feeling depressed. But lying there stressing about whether you’re pregnant is even worse! Getting up, moving around, and taking your mind off things will ensure better mental health and will ultimately be better for the embryo.

I cannot stress enough that women who spend a week lying in their beds stinky from not showering and grotty from using bed pans are wasting their time. Please do some research into this. There are so many scientific studies that prove moving around is much better for you.

*Ok I’m hopping off my soap box now*

I’ll be going to the clinic tomorrow at 8.30am, transfer is at 9am and should only take 5 or 10 minutes and then I’m off to have some more acupuncture at 9.30am. I’ll spend the rest of the day relaxing at home – relaxing is different to lying in bed! And then head back to work on Thursday.

Nearly transfer day

Well as you can see I haven’t updated in a while. But I’ve been super busy.

I ended up having nearly two weeks off work recovering from OHSS and have started back at university for the final semester of my masters degree.

I’d also applied for a promotion in a different faculty at the university ages ago – before my last round of IVF, and simply forgotten about it. Out of the blue a week ago I got a call to come in for an interview. I felt very conflicted about it. The job meant more money, was located on a campus closer to home and was ideally suited to me. It was a lot more similar to my old dream job than what I’m currently doing. Except obviously timing isn’t ideal. My workplace has been so supportive of my treatment, my boss and team have been great, and I wasn’t sure if I could add the stress of a new job to my already stressful life.

Nonetheless, I went along to the interview. Doug convinced me to still attend as interviews are always good experience. I wore an extremely loose fitting dress to cover my swollen belly but I was still in so much pain from OHSS I could barely walk up the staircase to the interview room.

Needless to say there were several moments during the interview when I was in so much pain I simply lost my train of thought and had to say “um…can you please repeat the question.” I also had to undertake a work test, and I really struggled with the Microsoft Access section of the test because my brain is still so foggy.

I rang Doug as I left and laughed at how stupid I must have looked. “That’s one job I certainly won’t get a call back for!”

But as it turns out I did get a call back. I was asked to come in for a second interview, which really surprised me. At the second interview a week later I was much more myself and my brain was less foggy. I felt I performed much better and as I left the building I realised I felt very nervous. It somehow had begun to matter to me if I got the job or not.

Meanwhile, preparations for my FET were continuing. After my period ended I started on progynova. Progynova is used mainly as part of hormone replacement therapy for menopausal women because it replaces the hormone oestradiol that the body no longer makes. But for FET cycles it’s used to build up the lining of the uterus to the point where it’s an inviting place for a little embryo to set up camp. I went back to see my doctor several times and he checked the lining of my uterus to make sure it was building up to the point where it could sustain a pregnancy.

I also started on crinone suppositories. Crinone is super fun! If you’re a masochist.

Crinone is a progesterone gel. It’s favoured by most fertility specialists in Australia because it has the best results of any gel available. They prefer to use gel suppositories to progesterone injections because the injections are painful, can cause bad bruising of your butt and also build up lumps of oil at the injection sites, which often make it painful or uncomfortable to sit down. Depending on individual circumstances women are prescribed one or two crinone suppositories per day. They’re usually inserted in the cervix, but as a secondary option they can also be inserted in the backside (to put it nicely :|) if there is a reaction in the cervix.

A lot of women would be used to using a pessary or some sort of gel to treat thrush, which is also inserted in the cervix and then sort of slides out over the next few hours. Crinone isn’t like that. Crinone stays put. As you insert more and more, you get a massive disgusting heavy build up to the point where it’s hard to even insert the gel anymore because nothing else fits up there. Sometimes huge gooey lumps of crinone will fall out. It can be white, it can be grey, it can be pink, it can be peach. It is always disgusting. It horrified me, but my doctor encouraged me to not irritate my cervix by scraping it out with my fingers. So I had to just let it sit up there, itching me. It got to the point where putting my finger near the opening of my cervix to insert more gel made me gag. I would describe the inside of my cervix as feeling like a cold cauliflower covered in lumpy mayonnaise. You’re welcome!

The first time some of the crinone fell out of my cervix I was in the shower. It was a smelly grey lump about as big as a 50c coin. Doug was in the bathroom cleaning his teeth. I screamed and he came rushing over to me.

“LOOK AT THIS!” I cried. “MY INSIDE IS FALLING OUT. WHAT IS THIS???”

“OH MY GOD DARLING WHAT IS THAT?” Doug replied, matching my level of shrieking. “DO WE NEED TO TAKE YOU TO THE HOSPITAL?”

As nothing else fell out, I decided to wait until the next morning to visit the clinic. There, a  fertility nurse at the clinic calmed me down and explained it was normal and expected. Yeah, thanks for the heads up there guys! Super appreciated!

The best news of all is that you get to take crinone for a very long time. It’s not a short term deal like the IVF injections. If you get pregnant after your treatment, you have to take crinone for the entire first trimester. I shudder at the thought!

While all this FET and crazy grey goop stuff was going on, I got the phone call to say I’d been given the promotion! I was thrilled but also very nervous. How awful to start a new job possibly pregnant. I felt like I was letting my current team down by leaving them after they’d been so supportive, I also felt like I was letting down my new team by maybe abandoning them in 8 months time.

But I’ve also realised I can’t let the world stop spinning just because I’m going through IVF. I need to take opportunities when they arise, and live for myself, not just for my future children. So I start my new job next week.

But before then, I get my embryo transfer in two days. I’ll get to meet my little Nemo. So happy!

Seriously though……why does everything have to happen at once???

Nemo

Sorry for not updating. It has been an extremely traumatic week for me.

As we feared, I ended up suffering from what the doctor called “moderate to severe” OHSS. I am still on leave and recovering at home. It will probably be at least another week until I can go back to work. I am only just now able to walk again, though I still struggle getting up and down the staircase at home.

OHSS is scary. Really scary. It means constantly feeling like you are gasping for air because of the fluid pushing against your lungs, it is indescribable pain that inhibits the simplest of movement, it is the inability to sleep lying down for fear you will silently suffocate and never wake up, and it is incredible bloating. I have put on 8kg of fluid in a week and it honestly looks like I am about 6 months pregnant. None of my clothing fits me.

Stupidly, the doctor told me I was fine to go back to work last week. I went back on the Wednesday armed with a heating pad and strong painkillers. I made it to lunch time before I was throwing up from pain and unable to walk. I phoned the nurses at the clinic who panicked and told me to get myself to the emergency room at the hospital as soon as possible because I needed to be admitted. I phoned Doug, who works across town, and he jumped in the car immediately and drove to pick me up.

While I was waiting for him to arrive I tried to phone my doctor to inform him I was coming to the hospital, but he was in surgery. I was transferred through to the on-call doctor in the maternity ward and delivery suite. When I told her my symptoms, her response was a very stern “come now darling, come now!”

By the time Doug arrived to collect me I could hardly move to get to the car. I could see the worried look on my colleagues faces as I left, and I knew they didn’t expect me back anytime soon. We raced up to the hospital, where we were intercepted by my doctor. He had finished surgery and had a break before his next surgery would begin.

He performed an internal ultrasound (yay! good to see those are still part of the process even after the eggs are picked up!) and it was shocking to actually see the amount of fluid sitting inside my body. It was like my organs were drowning in a sea of black liquid.

“Yes hmmmmm,” he said, staring at the monitor. “No wonder you are sick!”

“She needs to be admitted.” Doug said. “She’s so ill.”

“No no no,” the doctor shook his head. “We will treat Sadie as an out patient.”

“What!” Doug said angrily. “You have to be joking!”

“Trust me!” the doctor argued. “This is the best way to get her well. She needs to be in her own bed recovering. She will come up to the hospital once a day and I will scan her and make sure she is ok.”

The biggest mistake we made was once again trusting the doctor’s judgement. What I really badly needed was to have been admitted to hospital where I could have received the care I needed. What I really badly did not need was the agony of an 80 minute round trip to the hospital every day, where every bump in the road felt like I was being stabbed. And then of course there was the added problem that Doug had to go to work and I clearly couldn’t drive. My poor mother had to drive me every day and wait on me and take care of me.

My doctor also changed my IVF cycle to what they call a “freeze all”. As the name suggests, any viable embryos are frozen and no embryos are transferred until the patient is well. That was a hard blow to my already fragile emotional state. I lay in bed, unable to move, in constant pain and crying about the fact I wasn’t even going to be able to have my transfer. I knew it was absolutely the right decision to make, given the circumstances, but that didn’t make it any easier to accept.

“Don’t worry!” the doctor assured me. “You have 11 embryos and because you’re young I’m confident your embryos will be good quality, and most if not all will end up being frozen. You will have many chances to get pregnant!”

The doctor estimated there was a 60% chance we would end up completing our family (which we would ideally like to include three children) just from this one frozen batch of embryos. Doug was extremely pleased with those odds, to say the least.

I received a phone call during the week to inform me on day 3 post egg collection that we had 7 embryos remaining. The others had been too slow to develop and “dropped off”. By day 5 (the day they are normally frozen), 4 embies remained but only one had made it to blastocyst stage and it wasn’t a good quality blast. The embryologist wanted to wait 24 more hours to see if any of the others came good. All embryos need to be frozen or transferred by day 6 (they can freeze them on day 7 at the absolute latest but only do that when absolutely necessary as the quality is lessened).

As day 6 fell on a Saturday the embryologist promised someone would still call me to tell me the results, but as the clinic was technically shut (embryologists work 7 days a week but the rest of the clinic doesn’t) I wouldn’t be able to call them. It was a one-way communication system.

After another sleepless night (thanks to both OHSS and a severe amount of worry) I spent the entire day on Saturday with the phone in my hand. I kid you not I checked that phone every 2 minutes.

Have they called yet? No. Have they called yet? No. Called yet? No. Called yet? No. Called yet? No. Called yet? No.

I’m sure if I’d been able to walk very far I would have paced the length of the house until I wore through my slippers. I nearly drove Doug completely insane.

At 4.30pm Doug finally dragged me out of bed to help me have a shower, stressing that if they were going to call they would have already done so. When I came back to bed at 4.55pm guess what? I had a missed call from the embryologist! I phoned back straight away, but of course I only got the “sorry this clinic is closed” voice mail as they told me I would. I was distraught that I would have to wait another night not knowing if any of my embryos had survived. I was an emotional wreck.

Yesterday morning (Sunday) I woke up and tried phoning again, even though I knew I wasn’t going to get through. I couldn’t even believe I was having to endure an entire weekend of this mental turmoil, on top of the physical nightmare that is OHSS.

Finally in the afternoon a call came through.

“Hi Sadie,” started the cheery embryologist, clearly unaware of the nightmare I’d been living for the past two days. “We just thought you’d like to know we were able to freeze one of your embryos yesterday.”

The first thought that popped into my head was oh thank you thank you thank you they got one. My second thought was holy shit I had 34 eggs picked up and only one made it through to freeze. What the hell happened?

The embryologist explained that my embryos had all suffered from late onset fragmentation. Here’s a link to a site that explains fragmentation pretty nicely: http://www.inviafertility.com/blog/uncategorized/david-hazlett/embryo-fragmentation-what-does-it-mean-3

Essentially, a small amount of fragmentation is to be expected, but any embryo with more than 50% fragmentation is too weak to survive a freeze and subsequent thaw. In order to determine whether an embryo is right to be frozen or transferred, they’re given grades. These grades differ from country to country. My clinic grades embryos based on the following criteria:

  • lastocyst development stage – expansion and hatching status
  • inner cell mass quality (whether the cells are tightly or loosely packed)
  • trophectoderm quality (whether the cells form a cohensive layer)

I had four embryos make it through to blastocyst stage. They were graded AA hatched (woohoo a perfect hatched embryo!), CC, CC and CD. Anything less than BB is considered unviable for freezing, though in some cases doctors will still transfer them to a patient if they’re fresh. My CC and CD embies had come to the end of the road. Life was cruel.

When I asked the embryologist exactly why all of my embryos had fragmented so badly, she said it was because I had too many collected. The words were so powerful they virtually echoed through my ears.

Too. Many. Collected.

“Really that many eggs should never have been picked up.” she said. “You’re never really going to get good quality embryos when the eggs haven’t been given enough space to develop in your ovaries.”

It was the doctor’s fault.

He was the one who had told me it was ok to go ahead with the stimming, even though we thought we might need to cancel the cycle. He was the one who had the power to stop the egg pick-up if he thought I had too many eggs. Not only was I suffering from OHSS because of his poor decision, all but one of my embryos were now dead. And to make matters worse he was forcing me to come up to the hospital every day for treatment because he simply refused to admit me! I remembered the way the clinic nurse had reacted weeks before when I’d confessed I was concerned about his level of care. We had trusted him and he had led us astray. Clearly we are not the first patients who have felt this way about him.

I went back to see him this morning for my check-up, purely because at this stage there’s no other fertility specialist who can treat me and I want to know when I can go back to work.

“How did you feel after your egg pick-up Sadie?” he asked, reviewing my file.

“Um what do you mean?” I asked, screwing up my face in confusion.

“Well were you sore after pick-up? Did you get cramps?”

“Um I have OHSS…..” I frowned. “That’s why I am here? You are treating me as an outpatient for OHSS.”

“Ohhhh yes that’s right so I am!” he laughed, like it was some kind of joke.

He had forgotten.

And then he gave me a prescription for a medication I am allergic to. An allergy which is clearly printed in red pen on the front of my medical file.

I want to cry! I don’t know what we are going to do! But I am also trying to stay positive.

We have this one perfect little embryo who has managed to survive against the odds. AA graded! When all their brothers and sisters perished, this embryo fought hard and made it all the way. It was almost like natural selection. This embryo was meant to be our child. We have nicknamed it Nemo, because it is our “one egg” haha.

It looks like at the moment we will need to go through our current doctor to undergo a frozen cycle with our little Nemo, and then hopefully we will become pregnant (touch wood). We can then look to find a new doctor when we go back for our second.

For now I just have to rest and recover. Then, once I get my period (probably in about a week) we will be able to start the cycle for the frozen embryo transfer (FET).

I guess I am in shock at how crazy this whole process has been. Surely doctors have the ability to make it more seamless, or at least less stressful for patients? Or maybe this is just how fertility treatment is for everyone.

I will update again when my FET cycle begins.