IVF/ICSI Treatment - Part Two: Follicle Stimulation and Menopur

Apologies, I haven't blogged for so long. I typed the post below ages ago then went into my own little bubble, which led to ultimately a very positive life affirming experience...

I will start to update the blog stage by stage as I remember it, so that it provides support and hope to others...Fast forward and you will find ICSI round two was a success. I'm now 19 weeks pregnant....However let's rewind to the continuation of ICSI round one and the follicle stimulation process...

So the next stage was to grow some strong follicles. Given my low AMH, we couldn't hold out for too many, but we just had to hope that those that did grow were strong enough!

After scan to see if Buserelin had worked, the nurse took me into another room to do the first stimulation injection.

I was given the Menopur pack, which had little viles of a powdery substance and lots of little ampules of water. For each injection I had to mix three powders with one water.

The nurse demonstrated how to do the injection:

• first she flicked the ampule to make sure all the water was in the base and then snapped off the top off (placing finger at blue dot). 
• She said sometimes it is difficult to take the top of the ampule without breaking it into little pieces of glass - but she said if this happens, there are plenty of ampules, so just use another.  
• She used the needle to pull up the water. She then put the needle in the first powder and told me to make sure that you see all the powder is dissolved.  
• She then pulled up the new liquid and explained that there can be a bit of a vacuum in the little jars which can make it tough to pull the liquid. 
• She did the same again with jar two, saying "try and get all the liquid up" (which later I found you don't need to worry too much about). 
• She left me to do the third, and though a bit of a challenge. Somehow I managed it. 
• Then the process of injection, was very much the same as the Buserelin...make sure no large air bubbles and squeeze liquid up so a tiny little drop appears on top of needle, then place in belly and inject...Easy?!

Warning, do not follow the next para as an example of how it should be done (that comes later): Well the next day I got up 30 minutes earlier than normal to give myself the injection. I thought that would be plenty of time...but I then found the process very stressful and started to panic as I knew a friend was coming to pick me up to take me to work. Firstly, I struggled to break off the top of the ampule. I manage to get some very small cuts (smaller than paper cuts) between my finger and thumb. I then tried to use paper towel in between and was of course shaking. Then I put needle in the first powder (still shaking)...and "wow, I didn't remember the vacuum being this tough yesterday". Struggled through powders one and two. Gulp. Took several deep breaths and tried to put needle in third jar. Vacuum kicked in before needle was fully in and the liquid went everywhere but in the jar! Arrrgghhh! Had to do it all over again - nerves shattered and clock ticking. I did it, but felt like I'd still lost some of the liquid - but had to get to work.

And then I did the thing I should have done all along, I Tweeted and a lovely Tweep came to my rescue: @earnestsmummy - she gave me Top Tip Number 1:

A simple way to reduce strength of vacuum:

• Follow process of pulling liquid from ampule into syringe
• Place liquid in water
• Pull empty needle out
• Pull air into syringe
• Put needle back in jar and insert air into jar
• With finger still pressed so no air sooked back into syringe, pull out
• I repeated this process two or three times and discovered that the vacuum was next to none, so was much easier to pull the liquid out.

After doing this for the first time, it was like a completely different process. However it still felt like I didn't sook all the liquid up.  I thought nurse had said I should really make sure I get it all, so I called the clinic. As they have been so many times before and since, they were really lovely and helpful - they reassured me that it was difficult to get all liquid and not to worry if it was only very little - phew!

So after this it became easier and easier.

After the Stims process in round one, I had 4 visible follicles, so egg collection went ahead...

IVF treatment. Part 1 - Buserelin Injections

Since I last posted, I'm almost finished with round-one of ICSI/IVF. For much of this period I have felt slightly exhausted and only now beginning to feel a little more like me again. However, it has also been an amazing process - I feel very blessed to have learned more about this awe-inspiring treatment and to have met some of the wonderful team that work at the EFREC Centre in the Edinburgh Royal Infirmary.

So where to begin. I don't want to bore you, but want to share some experiences, learnings and insights that may help others going through the same. For this post I will discuss the down-regulating Buserelin treatment:

The injections really weren't that tough to do in the end. When I began I started recording my experiences:

Day One
I charted my injection experience in the last blog. Afterwards there was a little reddening of the skin around injection site, but it settled as the day went on - the nurse told me to expect this.

I watched Andy Murray play the Wimbledon final and wept like a baby at the end - though you'd need a skin of steel not to be touched by his own emotion. He did us all very proud.

Straight away I noticed I was exhausted in the evening - not sure if this was due to the hormones or simply because I hadn't slept so well the night before worrying that I wouldn't be able to do them (I had absolutely nothing to worry about too!). I turned my light off to go to sleep at 9pm.

I experienced very vivid dreams and night sweats through the night.

Day two
Fumbled a bit with the needles this morning. Felt very clumsy. Somehow struggled to keep needle on syringe. However, manage to do the injection with even less discomfort than day one (and that wasn't much at all either). There was a little scratchiness and nipping as the Buserelin obviously moved into my system, but again using @chelenic's tip of pressing down on injection site after removing the needle relieved discomfort. There's a little reddening of the skin around injection site, but just the same as yesterday.


Day three
Put needle fully in bottle, but liquid getting lower, so initially got lots of air bubbles (should have listened again to the video above). Put liquid back in - moved needle out a bit so top tip was clearly in the liquid and had another go. Second time lucky. Hands were slightly shaky this morning, but didn't cause any more discomfort. Definitely feeling lower in physical energy than before, but mentally OK. Very tired by about 4pm.

My tolerance levels for petty office niggles were low - not necessarily bad for me as sometimes told I'm too tolerant in these situations and try to hard to please others. Now for bad ass me - well at least a version of me that just ignores and walks away.

Developing slightly redder spots on chin than normal, but imagining that this is all the hormones coming out. Slightly achy.

Trying to be careful with what I eat because I know that metabolism is a bit slower on Buserelin! But, must, must go swimming again soon...

Day four onwards
I stopped recording my experiences after day four, as they were very much the same. It got easier and easier. I only had very little bruises by the time I went in to see if I was ready to begin the stimulating drugs. It didn't make me feel very tired, but other than that I didn't get too many side-effects.  It worked within the timeline expected and I was ready for part 2...Follicle stimulation and Menopur...

The only way is ICSI

It has been a while since my last blog post. I've been very busy with work and difficult to find the time to post. However, I'm resolved to get a better work life balance as we head into the next stage of our fertility journey...

Since my last post we have been going through the final IVF checks. We've met a mix of Drs and nurses along the way. We only one bad experience, where the Dr was lacking any people skills and was incredibly patronising. She demeaned us and one of her own colleagues (also a Dr). When I told her I was taking vitamin D,  she was scathing and snapped back: "what are you taking that for?" I explained that I had started taking it following the advice of one of her colleagues and she said "hmmm well, each to their own." I should add that we just took it all on the chin, as after all we're dependent on these people to help us achieve our miracle. Later, with her nose turned up she added: "You do realise that because you're getting treatment through the NHS we can't guarantee you'll have the same Drs each time." It could have been hubby and I's interpretation and she perhaps didn't mean it, but both of us thought independently. "As long as we don't get you again."

Interestingly on that visit they wrongly labelled my blood sample for AMH, so they had to do it again. I guess none of us a perfect.

As I said this has been an exception rather than a rule - All the other Drs and nurses have been lovely. Very supportive, attentive and sympathetic. Particularly the lovely team who gave me my scan and mock transfer - I will avoid too much information, but for this internal scan and transfer Aunt Flo is still visiting, so you do feel your dignity stripped away a little more than usual. However, throughout the process the Dr and nurse continually offered reassurance and support.

So what did we learn from these last checks? Well, hubby's little swimmers sadly have low motility. So the diagnosis at that point was that we would be given the ICSI treatment (where they give the sperm a better chance by injecting individual swimmers straight into eggs).

When we finally got the results of my AMH test, we learned that I have a low egg reserve. This is when we were pretty much told that The Only Way is ICSI. With our issues combined, we have very low odds of conceiving naturally. Hubby and I were able to laugh about it all: Really will need to evoke the spirit of Rocky (who my husband loves) so that we can triumph over adversity. For those of you who know the films, I instantly pictured us in the winter training scene for Rocky IV (see below)...

Again the Dr explaining the issues to us, was really reassuring and said, but it only needs one strong embryo to succeed. This truly will be our little miracle! If we have a little boy, hubby thinks we should name it Rocky or Sly...Hmmmm!

I only wish I'd had an AMH test before buying DuoFertility, but hey ho, it's worth trying everything we can to start our family. Will need to see if I can give the monitor to someone who can truly benefit from it.

So what's next? Tomorrow I begin the Buserelin injections. Very nervous about taking the injections myself, but the nurse did give me a good demonstration. I think it will be easier once I've got the first one out the way. I've also Googled and have found some lovely fellow infertiles who give top tips on YouTube. The Buserelin will stop my hormone production in around two to three weeks - Apparently the side effects can be like a mini-menopause. After that treatment, I will receive more drugs to stimulate my follicles into producing eggs again. Once I have enough follicles, I will need to go into hospital for a wee sedated operation to remove the eggs. Finally, egg transfer should happen within a month or so of the first injection.

Each woman responds to the drugs in different ways, so it is difficult to get exact times of when I will need time off work. With this in mind, and with some encouragement from my Tweeps, I decided to tell my manager. I was very nervous about telling her, but she has been so supportive from the start. I would really recommend doing this, as it takes away an unnecessary stress - especially when Buserelin could have some visible side effects.

So here's to the next stage in my journey to become a mum. Excited, nervous and ready for the fight: Cue alternative Eye of the Tiger sing-a-long (alternative lyrics below):

Risin' up, back on the street
Did my time, took my chances
Went the distance
Now I'm back on my feet
Just a woman with a will to be a mum

So many times, it happens too fast
You trade your passion for glory
Don't lose your grip on the dreams of the past
You must fight just to keep them alive

[Chorus]

It's the eye of the tiger
It's the thrill of the fight
Risin' up to the challenge
Of our rival
And the last known survivor
Stalks her prey in the night
And she's watching us all
with the
Eye of the tiger

Face to face, out in the heat
Hangin' tough, stayin' hungry
They stack the odds
Still we take to the street
For the embie with the skill to survive

[Chorus]

Risin' up straight to the top
Had the guts, got the glory
Went the distance
Now I'm not gonna stop
Just a woman with a will to be a mum

[Chorus]

The eye of the tiger
The eye of the tiger
The eye of the tiger
The eye of the tiger 

[Original song by Survivor. Lyrics changed to give infertile women the will to be a mum!]

My relative silence explained...a reflection on our fertility journey so far

Happy New Year!

Apologies at the length of time between my last post and this one. For a long time, I found it difficult to spend the time needed to write a blog. Dwelling on the issue just upset me too much. I did continue to Tweet, but even that made me ruminate on the issues and the fact that we still hadn't conceived.

To cut a long story short, since my last post, DH went for the tests. One sample suggested his little swimmers had some slight mobility issues, but the Dr said nothing to worry about, as the second sample was OK. The Drs' tips were as expected, to focus on a healthy diet and lifestyle. Particularly to cut back on the occasional binge drinking with friends... Apparently just one session can affect sperm mobility for up to two months.

I then was referred for an ultrasound (u/s) and Hysterosalpingogram (HSG)...basically a scan of the uterus, fallopian tubes and ovaries using a dye to highlight if there's anything blocking the flow of fluids. HSG is often feared by women as it's said to be occasionally very painful, but I have to say after two aspirin and focussing my brain on relaxing as much as possible, I felt only very moderate discomfort. I found the u/s more uncomfortable - they identified I had a retroverted or tipped uterus, so I had to get a transvaginal scan (basically inserting what looked like a huge vibrator inside me, so it was more embarrassment and discomfort than anything else). The scans were all clear apart from highlighting my tipped uterus, which our Gynae Dr explained should not impact on my fertility.

After all the tests, our Gynae Dr diagnosed that we had 'unexplained infertility' and that we may still fall pregnant naturally. He placed us on the two year NHS waiting list for IVF....'Two years!!!!'...while it was good to move forward, two years still seems like a lifetime. I learned that there's still a bit of a postcode lottery for IVF in the UK and, because Edinburgh has one of the best IVF centres, the wait where we are is a little longer than elsewhere. However, we should be grateful, as it was once a three year wait before they added additional eligibility criteria (you can't get IVF on the NHS if you smoke or if you're above a particular weight). While in one sense we were moving forward, in another way it felt like the pause button had been pressed. Other than hoping that mother nature would finally notice us and grant us our wish, it seemed there was nothing more we could do. The conditions for getting NHS on IVF also prevents us going privately without fear of losing some of our NHS attempts (You get two IVF cycles with the NHS. For each NHS cycle, they give you a free frozen embie attempt, but for every private treatment you lose one NHS cycle, so essentially two attempts...I'm not feeling I can take the chance to lose!).

This is when it particularly started to take it's toll mentally. I'd been working at the place I was at for quite some time and there were a number of ladies all about the same stage in life. It seemed like it was a factory for pregnancies, but somehow I was the defective colleague. I found myself having to pick up work for other more lucky ladies and while I was delighted for them, this made my own situation seem ten times worse! Although I loved my job and the people I worked with, the repetition of work cycles seemed to reinforce this situation and was getting me down. I became less tolerant of difficult work situations and sought some support from a life coach.

After one session with my life coach I felt much better and it really helped me begin to focus on what the real issue was. I no longer wanted to be the person standing still, while others zoomed around me like the effect you get from time lapse photography. I took stock and thought: "If I wasn't still trying for a baby what would I be doing?" I had to face it could be a long time before I become a mum, and possibly it might never happen. I realised I needed to move my life on...

I began looking at ideal next career moves. Ultimately I'd like to run my own business, but felt that was one step too far at that point. I decided to take the next step up the career ladder and the first job I spotted was with a good cause I really believed in... From there everything moved so quickly and within a week I was offered the job. The buzz I felt made me realise that a change and new challenge was just what I needed!

The challenge has been great and has helped me get to a better place mentally as I'd

hoped. However it has also reinforced that my priority in life should be starting a family. For most of my adult life, I've always put my employers first - I'm a very loyal employee and beat myself up to achieve the best I can for any employer.

My lifecoach encouraged me to consider what was worth my energy and worries - "Me the manager, or me the mum." The path that fate has presented me so far, has helped me clearly decided it's "me the mum" that is most important right now...time to put my future family first.

I've discovered a system that will help me keep moving forward on that goal...DuoFertility. A review in the Daily Telegraph indicated that the monitor is "as effective as IVF." And for

people like me, they offer a "get pregnant in 12 months or your money back" deal (with basic T&Cs). I have now registered with them and backdated my charts. I have applied the sensor under my arm, which you're meant to keep attached all day every day. I was initially concerned this would be uncomfortable...but I can barely feel it. The sensor will record my temperatures throughout the day and will eventually give me an indication of when I will ovulate each month. Reviews indicate that, as it is recording temperatures so frequently, it can give you a better indication than any other ovulation test of when you're most fertile. The associated package allows me to chart all my symptoms and any other relevant information. It then relays this to DuoFertility HQ, where advisors are on hand to give me support for the next 12 months.

I will look to update this blog at least once a week to chart my DuoFertility journey, but for now I am content that I am another day closer to being a mum.

Wishing all those struggling with infertility great success in 2012!

Love my Tweeps

This is my first blog. I'm beginning to realise that you can't truly blog until you find a subject that you're truly passionate about and for me right now that's trying to conceive (TTC). My husband and I have been trying to conceive on and off for two years now, but only in the last year have I felt so ready to be a mum that it actually hurts!

So far I've consulted my GP, been tested for hormone levels, bought books, paid for fortnightly acupuncture sessions, consulted a naturopath, taken supplements and bought every magazine that I see that might have a feature on TTC and the magic solution that will work for me. Acupuncture and naturopathy have certainly brought me some relief and taken me to another stage of relaxation and the books and magazines have taught me things that no-one ever dare to teach you. I've learned I have an irregular cycle and that I don't ovulate on day 14, as some professionals may like to tell you (in fact it seems to be a different day every month!). I also learned that I only have LH for a short period of time, which means I need to use two ovulation tests a day to know exactly when I'm ovulating.

However the biggest emotional support for me comes from my Tweeps on Twitter. Discussing fertility is a faux pas at work and it is also something that's very hard to properly discuss with family and friends, especially if TTC has come easy to them. They can be supportive, sympathetic and caring and of course are the most important people in my life....But my Tweeps...Well my Tweeps know exactly what it feels like when my AF comes every month, when another friend or colleague announces they're expecting, when all you see are pregnant women everywhere, the torture of another two week wait (TWW) or simply what it's like to want so badly to be a mum! They know exactly what to say at those moments and I'd like to thank them all for that and put in writing how much they mean to me. I hope too that, when they're most in need, I can offer them a virtual shoulder to cry on and the emotional support they need to help them through what is one of the most challenging and emotional journeys in life. They're an amazing bunch of very brave and inspiring women and men, and I'm glad I have them by my side on my journey to become a mum, no matter what I have to do to get there...And Tweeps, I look forward to the days I can celebrate with each and every one of you as you all achieve you fertility/adoption goals!! Thank you! x