Moving Forwards Slowly?

Yesterday morning I woke up excited and a little terrified. It was the 10th of September, our long-awaited IVF appointment. I imagined seeing one of the warm and caring doctors that we know well, asking our two A4 pages of questions, and feeling encouraged and supported. I imagined coming up with a concrete plan and knowing what the road ahead might hold.

Today I woke up flat and dejected. The consultation was disappointing. It wasn’t that we got any bad news as such, just that it wasn’t the appointment we had thought it would be.

Things didn’t get off to a good start when another couple arrived in the fertility clinic with their two small children in tow. Although there were plenty of seats in the waiting room, they sat right next to us (perhaps they were attracted by the fellow lesbians?) and right by the door where everyone else would have to walk past them. They hadn’t brought any toys or books to keep the kids occupied, so they were running riot all over the waiting room. It was impossible to shut them out. To make matters worse, the parents periodically made comments along the lines of “you’re a nightmare, you are” or “getting some peace without you two”. Rationally, I know that parenting is difficult no matter how long it’s taken you to get there, and that all mums (and dads) forget to bring toys sometimes, or get frustrated and make disparaging remarks, but I felt the whole thing was very insensitive in a room full of infertile couples. I couldn’t know what their situation was, but I imagined they must have conceived those kids very easily if they were coming back for a third, and the unfairness of it all brought me to the verge of tears. Here was I, waiting to see a doctor who would tell me I was infertile, and they were rubbing it in my face.

Then we were called through by one of the more junior doctors, the one who isn’t particularly warm or empathetic, and my heart sank. He opened our appointment by saying that because I’ve only had two superovulated IUI cycles, I need one more before proceeding to IVF. I explained that I had asked about this when we opted for a fourth natural cycle, and we were told that although the usual protocol is three natural cycles plus three superovulated, we would be eligible for IVF after six IUIs of any sort. The doctor then decided that since we’d been told that by someone more senior, we could go ahead.

Then he scared us by saying that we might need to go back on the sperm donor waiting list before we could have IVF. My first thought was, “That sounds very unlikely, I’m sure he’s wrong,” then, “Oh my God, if I have to wait for another two years I’ll die,” then, “Don’t be silly, if the worst comes to the worst we’ll import the stuff from Denmark again.” I love how I can go from logical to melodramatic to practical all inside the space of two seconds. Luckily, he went out to check and confirmed that our donor is approved for IVF with ICSI*, so there won’t be any issues there.

I didn’t feel comfortable asking all of my questions – the clinic was about to close, and it felt as though at most two or three were expected. (I had around forty.) We were told the next step was to make an appointment at the IVF consent clinic, where the treatment would be discussed in detail, so I tried to focus on the most important ones. I asked why he felt IUI hadn’t worked for me, and he said there probably wasn’t anything medically wrong, that the most likely explanation is simply that we haven’t been trying for long enough. So reading between the lines, although our local NHS criteria make reference to testing my fertility through six IUIs, it seems the cutoff point has been set for reasons that are mostly practical rather than medical. Fine by me. 🙂

I also asked about my cervix causing problems at embryo transfer, and he said they will do a mock transfer first, and that having a full bladder should help. Basically, my cervix is a nightmare to navigate because my uterus is tilted far forwards, and having a full bladder will help push it into a straighter position. That might explain why our first three IUIs were easier: I always go to the loo when I arrive at the clinic, but on those first three occasions they were running late, so there was more in there! I’m a little frustrated that a full bladder was never suggested sooner – I’d thought I was making IUI easier for myself (who wants to need a wee while someone shoves a catheter through their cervix?) – and I don’t understand why I was previously told my uterus was tilted backwards, so kudos to junior doctor for correctly diagnosing the problem with ultrasound and coming up with a solution.

He gave us an IVF leaflet, which answered some of our questions, and I was especially pleased to see they offer 5-day transfers (it’s easier to spot the highest quality embryos if you wait until they’re five days old, although there is also an increased risk of them dying in the lab). I had a scan which showed a normal antral follicle count of eight, and some screening bloods, then we went to reception to book our next appointment. The nurse had said there isn’t usually a long wait for the consent clinic, so we stood there optimistically with our calendars on the September page.

The next available appointment isn’t until 23 October, six weeks today.

I know six weeks might not sound that long to some people, and I’m sure I’ll get through it somehow. I’m just so sick of being in limbo. I want our IVF, all our IVFs, to be over so I can know whether I’m going to have children or not and move on with my life. I’ve spent the past year in a kind of no man’s land where I can’t plan any trips away without worrying about them clashing with treatment, and where our house is cluttered with baby stuff that we might or might not need, and I think that’s the hardest part. The thought of over a month where nothing is happening, for no good reason other than available appointments, is hard to come to terms with. Worse, I forgot to ask any questions about funding. The doctor didn’t seem like the best person to know – and in fact, that’s part of the problem: I’m scared we’ll get to that appointment in late October and find out he was right all along and we can’t have NHS-funded IVF because we didn’t have the right sort of IUI. But even assuming the previous advice was correct, I don’t know how many cycles the NHS will pay for, so I don’t know whether we should be sticking to an extremely tight budget to save up for future treatments. I would be gutted if IVF didn’t work first time (which is about 60% likely) and then we had to give up our dream due to a lack of funds, but ICSI is very expensive.

I guess I know what I need to do: ring the fertility clinic (or look for the answer on the internet) and find out. I also have the contact details for the clinic’s counsellor, and I’m going to make an appointment with her too. I’ve been feeling close to breaking point for a long time, but hopefully with the right support and reassurance, I can get through the next six weeks. One day at a time…

* ICSI is where each egg is directly injected with one sperm, as opposed to being left in a Petri dish to fertilise naturally. This technique is often used to overcome male infertility problems, but in my case, it’s probably been recommended because the sperm has been frozen.

IVF Questions

I promised On Fecund Thought that I would share our list of questions with her, so here they are! It’s proving to be quite a long list already and our appointment isn’t until 10 September.

  • How many fresh and/or frozen cycles will be funded by the NHS? How much do you charge for private IVF and FET?
  • Why do you think IUI hasn’t worked for me? What percentage of apparently fertile women using donor sperm will end up needing IVF?
  • Should we be concerned about the miscarriages, or are they just ‘one of those things’? Does the fact that I have been pregnant still increase my chances?
  • Is there an increased risk of miscarriage with IVF? I’m aware that IVF pregnancies are more likely to miscarry than natural ones, but I believe this is thought to be because infertile women are more likely to have miscarriages rather than because of the IVF itself – is that correct? Is there any chance that selecting the healthiest embryos will actually reduce my risk of an early miscarriage?
  • What do you think our chances of success are, and what can we do to maximise these? What is the likelihood of no viable pregnancy after several IVF cycles?
  • I’m concerned about my cervix making embryo transfer difficult and reducing our chances. How do you plan to address this? Do you do a mock transfer? Should I be concerned about my tilted uterus for any other reason?
  • What’s my AMH and antral follicle count? (I remember being told my AMH was fine, but I’m starting to worry about my age…)
  • Do I need any further investigations? If not, how soon can we start?
  • Is it safe for me to take a prenatal vitamin, magnesium and omega 3s? Are there any supplements you would or wouldn’t recommend?
  • Do you use the long protocol or the short protocol? I’m concerned about down-regulation – since I have a history of depression, would the short protocol be better?
  • How often would I need to come in for scans?
  • Do you use sedation or GA for egg collection, and can OH be in theatre with me?
  • Do you intend to use standard IVF or ICSI, or does it depend on the quality of the sperm once defrosted?
  • At what stage of development do you transfer the embryos, and do we get a choice in how many are transferred?
  • Is it OK for me to use the progesterone pessaries PR?
  • If a cycle is unsuccessful, how long are we likely to have to wait for a review appointment, and how long before we can try again?
  • If a cycle is cancelled, does it still ‘count’ as an NHS cycle? If a privately funded cycle is cancelled, what are the charges?
  • What are the contact details for your counselling service?
  • How much would it cost to store any remaining embryos for a sibling? Would it be feasible to use these embryos in OH?
  • Is it possible to donate any spare embryos to another couple?

I feel rather sorry for whichever doctor will be on the receiving end of these!

One Door Closes…

Do I need to write this post, or can you infer what has happened?

Open the dark door to the light.

Image courtesy of winnond / FreeDigitalPhotos.net

Our sixth and final cycle of IUI went smoothly (no injection issues, ultrasound-guided insemination, no tenaculum) but it wasn’t a success. I’m not pregnant… again. Instead, I have the somewhat dubious honour of being crowned officially infertile.

I have very mixed feelings about this. On the one hand, I’m pleased to be moving on to IVF. Depending on which statistics you look at, it at least doubles our chances of becoming parents, and OH and I both have hope that it could actually work. She lost faith in IUI a long time ago, and I’d have been ready to stop after attempt #5, if it weren’t for the fact that one more failed cycle would qualify us for free IVF on the NHS. Even the ‘infertile’ label has come as something of a relief to me, as although you could argue our local NHS has set the barrier too low (are six IUIs really equivalent to a straight couple trying for a year?) it seems to give meaning to the devastating year of miscarriages and BFNs and a cancelled cycle that we’ve just been through.

On the other hand, not being able to have a child semi-naturally feels like a big loss. I’m grieving no longer being that girl who got pregnant first time (well, I still did, but…) I’m grieving a year of unsuccessful procedures and heartache. I’m grieving the loss of an easy and straightforward relationship with God: I cry every time I go to church now, sometimes able to hide it, sometimes not. I cried on Sunday because the hymn we were singing happened to contain the words ‘conceived’ and ‘period’… yes, really. And most of all, I grieve for my babies. Every time I see my youngest niece – who looks like me – she reminds me of what my own son or daughter would have been like. Of what should have happened.

I’m coping mostly by throwing myself into Plan B. I have books on IVF, a big long list of questions for our next appointment on 10 September, and I’ve started a healthier diet, cutting back on processed foods and simple carbs. Sometimes this gives me focus and drive but at other times I just need time and space to fall apart. I think in a way it’s harder for my OH, as there’s little she can do to prepare for IVF and she just feels powerless. I know some of you are lesbian couples who’ve experienced pregnancy loss or infertility – do you have any suggestions or know of any resources for the non-bio potential parent?