Yesterday morning I was getting dressed for work when I suddenly realised my follow-up appointment with Doctor B was scheduled for 11.30am that morning. How’s that for taking my medical treatment seriously! Good job Sadie, good job.
As I’d also forgotten to let Doug know of the appointment he was unable to attend, but I really didn’t mind. I felt absolutely no pressure or anticipation whatsoever. In fact, I sort of felt like the appointment was a giant waste of both time and money. Despite my feelings of trepidation, I still dutifully ducked off on my lunch break and headed up to the hospital.
Have I mentioned there’s always a baby in the clinic’s waiting room? Always. It drives me mad. These are mothers who know exactly what it feels like to be desperate and hopeless. Their children were created through fertility treatment. They are the lucky ones who made it through to the other side. Now they’re back at the clinic to try for baby number 2 and seemingly rubbing their success in the faces of all the childless women at the clinic.
I hear you all trying to rationalize that perhaps these mothers can’t find childcare and have no choice but to bring their babies along to their appointments. But it doesn’t drown out my bitterness. If you can afford IVF you can afford to leave your damn child with a sitter! That’s my opinion and I’m sticking to it.
When my name was finally called I just felt thankful to be leaving the waiting room and escaping the cute, gurgling toddlers. And as it turns out, the appointment was actually mildly useful.
First up, we briefly discussed my last cycle and failed pregnancy. Doctor B was more than slightly surprised that my body had reacted so well to the methotrexate. My hcg levels dropped to negative in less than a week. In fact she said only one of her other patients had ever done so well with the methotrexate, and her hcg levels had dropped below 5 so quickly that they sprung back up a few weeks later. For that reason Doctor B wants to keep monitoring my hcg for the next month, just to keep an eye on it and make sure it doesn’t throw us a curve ball.
Then we discussed the options for our next move, of which there are basically two.
Firstly, we could prep my uterus lining and then go for an FET either straight away or in the new year. Doctor B isn’t concerned at all about the methotrexate shot, and said there’s no reason not to try straight away as long as my hcg stays below 5.
We currently have one embryo in the freezer, our little Jelly. But Jelly is a grade 2AB blastocyst. His expansion rate of 2 is very low and means he hasn’t actually made it to the full blastocyst stage, so there is a mild concern that Jelly won’t actually survive the thaw. That’s a huge problem for me. There are no back-up embryos waiting on ice and I don’t want to pump my body full of hormones only to find there’s no embryo to transfer.
Our second option is to give my body a month’s break from the FSH injections then jump straight back into another fresh IVF cycle and try to get us some better quality embryos to work with. In Australia there are strict regulations about the number of embryos you can transfer (maximum of 2 at any time) and also how many embryos you can have frozen while doing another fresh cycle (maximum of one at any time). Because we just have our one little Jelly the option is there for us to go back and try again before we attempt to thaw him. It only took me about 12 seconds to decide that Option 2 was my much preferred option. I didn’t even bother to consult with Doug, I just went with my gut instinct.
“Ok let’s have a look at my schedule so we can activate your plan.” the doctor said, flipping through her calendar.
I wanted to cringe when I heard the word ‘activate’. This part of the IVF process never happened at my old clinic, and it’s just basically a way to suck more money out of desperate people. Each time we want to begin a new cycle at this clinic we need to have an ‘activation interview’ which is basically the doctor going through a pre-written list and checking boxes as she goes. After the form is completed, our file is moved into the ‘activated’ folder and we are officially in an IVF cycle. The whole process takes 5 minutes and we’re charged around $1100 for the pleasure. Because ‘cycle activation’ is a made-up concept, the government doesn’t have a medicare item number for it and therefore no subsidies exist. Yay!
“Well I’m going away over the Christmas break so next time I see you will have to be the second week in January.” Doctor B said grumpily. “I hate going on vacation, it’s so disruptive to my work schedule.”
My jaw literally almost hit the floor. This woman takes more vacations than anyone I’ve ever met in my entire life. She must be off on vacation at least a third of the year. Is she trying to pretend someone forces her to go off and live the high life? Are my silly ‘activation interviews’ not paying for her jet set lifestyle? Honestly. I’d had enough and decided to give her a piece of my mind.
“The second week in January works fine for me.” I said meekly.
Yep, I sure showed her.
We then moved on to discuss the protocol we would use for the cycle, so Doctor B called one of the nurses into the room. This time it was Shirley, who is my second favourite nurse. Almost immediately the pair started talking amongst themselves about the merits of using different medications, but I kept on interjecting with my own opinions.
“Ok Sadie,” Doctor B said, turning to me. “I’m happy for you to make these decisions with us. Let’s talk about FSH. What dose do you want to be on this cycle. 125 like last time? Drop it down to 100? Or do you want to ramp it up to 150?”
I was sort of elated that for the first time ever I was getting to have some serious input into my own treatment plan. I love it when medical professionals take me seriously. I deserve to be taken seriously. I’ve been through so much, and also spent countless hours scouring peer reviewed medical journals and other research to try to decide what’s best for me and my body. Sometimes I think I know too much.
“I don’t want to move up to 150, given when I was on that dosage we yielded 34 eggs at pick up and I ended up with severe OHSS.” I said. “Even though we had a much more successful cycle last time and picked up 7 eggs I’d really like to do slightly better this time and see my numbers creep up into double figures. I know that 7 to 10 eggs is ideal for a cycle, but my fertilization rate is slightly lower than average for my age. If we could get around 12 eggs I think that would be perfect. Why don’t we do 125 plus one or two clicks?”
Realizing the room had gone silent, I looked up and saw that both Doctor B and the nurse were merrily laughing. I just wasn’t sure if they were laughing with me or at me.
“Well you’ve just thrown me for six.” the nurse said, turning slightly red.
“Sadie is one of my most well researched patients.” Doctor B said proudly. “She’s only young but she knows her stuff!”
I was pretty happy with that appraisal of my knowledge. Damn straight I know my stuff! I should be a doctor.
“Ok let’s do 125 plus a few clicks.” Doctor B agreed with me. “Would you like to do one click or two?”
The Gonal-F and Puregon epi-pens have the ability to increase the dosage in very small increments. Once you reach 125IU/mL you can then click once to increase the dose by around 8.3IU/mL, or click twice to increase by 16.6IU/mL before you hit 150IU/mL.
“Let’s start with one click.” I decided. “If it doesn’t work out, we can increase it by two clicks next time. I’d rather be less than ideal instead of hyperstimulated.”
Doctor B promptly wrote 125+1 down on my protocol form. I was pleased with my decision.
“Now, how’s your menstrual cycle going? Did we have to use provera last time to start a cycle?” she asked.
“Yes. We’ve used provera to start all of my IVF cycles.” I informed her.
“You’ve seen no improvement in your period since you’ve been on the metformin?” she asked, frowning.
“My periods are lighter now, but they’re not regular.” I explained.
“When was the last time you had a spontanous period?” Doctor B asked. “A period not brought on by provera or related to fertility treatment?”
I thought really long and hard. How long had it actually been since I had a period that wasn’t induced by medication or following on from a failed cycle?
“Two years.” I finally answered.
Bloody hell. Had it been that long? And I have to listen to one of my friends at work complain that she sometimes goes as long as 45 days without a period, which possibily affects her ability to have another child. Try going two years lady!! TWO YEARS!!
“My God!” Doctor B gasped. “So you’ve never done an IVF cycle without using provera first?”
“No, never.” I replied.
“All right let’s try that and see if this makes a difference for you.” she nodded to herself. “We won’t induce a period before we start IVF. We’ll just scan you, see what your uterus lining is doing and then just throw you straight in the deep end. Let’s see how your body likes this.”
Good. Excellent. Something new in the protocol. I like that!
So now we wait until 7 January when I will have my first blood test, then the following day I will start FSH injections and get my first scan. I also have to keep a diary over Christmas detailing any changes to my menstrual cycle. I imagine each daily entry will look something like this:
Today I had no cramping, no bleeding and no ovulating. Again.
Lots of love,
Actually to be honest I am almost convinced I will spontaneously have a period now. After two years without even so much as a hint of spotting, now that I don’t want a period I’m certain to get one. That’s just the kind of crap that happens to me.
I guess we’ll wait and see!