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...

First Buserelin injection - what was I worried about!

So that's me just done my first Buserelin injection. Although the nurse had been great about showing me what to do and saying "you can't really go wrong." I still was worried about inserting that little needle into my skin for the first time... If you've not done it before, it is true what they say - you don't need to worry.

So I will talk you through the process I went through....

• 8am Got up. Looked out all the kit, plus cotton wool balls and an ice pack.
• 8am to about 8.15am. Double, triple and quadruple checked I had everything and had read the handy crib sheet provided to me by NHS Lothian.
• 8.15am to 8.30am. Started questioning if I could remember everything the nurse told me to do at the last appointment, then decided to have a look on YouTube to find a video of someone who could provide insight for the point of view of being the patient. Found this great video from @chelenic 

Then I just got on with it:

• Used icepack to numb tummy (in hindsight, don't think this was really required)
• Took the Buserelin, removed the cap, swabbed top with antiseptic wipe
• Also swabbed area for injection on tummy with antiseptic wipe
• Opened packs with cute little syringe and, not so cute larger needle (with yellow cap). 
• Also half-opened slightly less scary looking small needle (with green cap)
• Slotted large needle on top of syringe (without touching needle, so keeping it half in the pack)
• Turned Buserelin bottle upside down.
• Placed large needle in and slowly pulled down approx 1ml/1.5ml of Buserelin (top tip from nurse to take in more than full dose initially).
• With the needle still in the upturned bottle - Spotted one wee air bubble, so tapped...tapped again...and again...and again...and again...mildly panicked that I couldn't get air bubble out...then stopped being a woose and tapped a little harder a few more times and it eventually moved.
• Then (still with upturned bottle) put excess liquid back into Buserelin vile (only needed 0.5ml).
• Removed needle from bottle, which was still upturned (it has a rubber seal, which is very tight so you don't need to worry about liquid coming out).
• Removed yellow needle and replaced with small green capped needle (again being careful not to touch the needle)
• Rubbed tummy again with antiseptic wipe (am I sounding a little OCD?)
• Pinched skin...paused...pinched skin again...paused...questioned "am I doing it right?" said back to myself "Just get on with it!" (going ever so slightly mad).
• Placed needle to skin and gently pushed...It was in before I knew it or could really feel it.
• Started to slowly inject Buserelin...nipped only very slightly (less than a slight pinch of the skin), however the nipping eased if I slowed a little
• Gently removed the needle and that was it!
• Lastly followed @chelenic's fab tip of pressing down on the injection site afterwards to stop any last irritations.

And now my journey has moved onto the next stage...Will aim to keep more of a log here as and if things develop (I gather I could be experiencing a mini menopause over the next couple of weeks). 

Due to have the Buserelin injections up to 26 July, when I will go in for them to check if I'm ready to start the process of kick starting follicle production.

Here's to being another step closer! (though obviously toasting with a soft drink, not least because it is morning, but of course to also maximise my chances of the ICSI treatment working!)

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!]

The Power of Positive Thinking Presents: A Happy Mother's Day

So it's Mother's Day in the UK - it is important to remember that this day has meaning not just for those who have children, but also those with angel babies and those who are struggling to achieve motherhood. As well as a celebration, this can also be a difficult reminder for some.

It would be so easy to let this be a reminder of the fact that I still don't have kids, but I'm not letting infertility beat me. Instead I'm seeing this as a day of hope and of course celebrating all those fabulous mum's I'm aware of in my life. It is a day of hope, because this day represents all those women who have been on a similar journey to me and in the end have experienced the joys of motherhood. It is the sign that every day we are one step closer to being a mum. Thinking in this way has made this a very special day for me.

I feel so happy and contented to be me. "I have a great mum and I will be a great mum" - not everyone can say the same. The infertility journey has brought me so many opportunities and taught me so many things that I would never have learned had we been luckier in trying to conceive.

We continue to look to the future and have our screening appointment for IVF in a couple of weeks. Excited and nervous about what the future holds - will we ever conceive our own child? I do hope so,  but if this doesn't work I am now confident that I will look to adopt. There are so many wonderful children born into the world who don't have the family lives they deserve and who need people like us to be there for them. 

These thoughts were reinforced in me when I recently went to see a life coach. She tasked me with thinking what I would do if I won the lottery. Now I'm sure many of you out there in the blogosphere have thought about this. And I began with using some of those things I've joked about in the past, but then she got me to really think genuinely what I would do...I would begin with some relaxing breaks with DH and then separately with my mum, sister and cousin. Once truly relaxed I would look at investing in having a child. Ideally I'd like three children: two that we produce ourselves and one adoptive (all equally my children). I'd move to somewhere like Loch Lomond, with beautiful scenery, but not too far from a city. I'd build my own house (which would include a living area which has a window for a wall that looks out onto a Loch or river) and of course a fantastic play room. I would open a local community centre, which had a library, live folk music, tea and cake (a bar on occasions), a room for yoga, a play room for mothers and toddlers and a separate room where support groups (eg infertility support groups) could meet. The cafe would have a large glass window, which would look out into an area of natural beauty. The window would be tinted and sound proofed, so that we could watch the stunning Scottish wildlife as we drink our tea. Those working there would be highly motivated and love their job - getting a perfect balance of work and life. I'd organise events that would bring families and communities together and generally create a hub of happiness or at least relief.

This may all sound like a Disney fairy tale, but these dreams keep me thinking positively through the ups and the downs. And while I may never fulfill all of this without that winning lottery ticket, I am happy with the direction I'm going and look forward to seeing what the journey ahead holds for me. 

So huge hugs and Happy Mother's Day to all: 

• those that already mothers: relish the time you have with your children
• those who have lost: we will never forget your little angels and the happy memories they have left you
• those who are yet to be: never forget every day you're one day closer to being a mum...

The comfort of strangers - journey to the top of the IVF waiting list

Since my last progress report, my awful auntie flo arrived, but just as hope was fading once again, the next day a letter arrived from the Edinburgh Royal Infirmary saying we were just about at the top of the IVF list! Treatment is due to begin in July/August! I know there are no guarantees, but it definitely feels I'm yet another step closer to being a mum.

We had been told that there was a two year waiting list, so you can imagine our very pleasant surprise! And of course I was straight on Twitter announcing the news, as I knew my Tweeps would understand better then anyone else just what this means. I've experienced some great encouragement and generosity from my IFTweeps (particularly from the lovely @Mrs__K_ ). I will never forget the support that I have received from relative strangers that I've met through social networking...though these strangers understand me better than many lifelong friends - one major bonus to have come from our infertility journey! Thank you to all of you.

Talking of strangers, I'm also incredibly excited about meeting Dr Thong (yes, really!) at the hospital. They will be our Gynecologist for this next stage of our journey. July/August can't come soon enough, but who knows we may yet be lucky before then...

So in the meantime, I'm still using Duo Fertility. It is very easy to use and takes away any of the stress of needing to remember to take my temperature at the same time every day. The little monitor that records your temperature sits under my arm all day every day recording temperatures. I receive regular supporting emails and a very quick response when I emailed with a query to check I was recording things correctly. It all seems to be working. My temperature was a bit slow to rise at ovulation, but then I was full of the cold and breathing through my nose, which I gather can impact on temperatures. It dropped again when AF arrived. I'm now just about to enter my first fresh new cycle using Duo Fertility...and the monitor is already showing when my next fertile period is due. Very clever! (nb - it looks like it's increased again today, but forgot to reattach monitor after exercise last night).

I only had one scare, when I thought I'd lost the little monitor you're meant to stick under your armpit. I hardly feel it when it was on, so didn't notice when it moved. I retraced my steps through parks, public transport and the hotel we were staying in...couldn't find it anywhere! I was feeling really rather stupid, frustrated and, if truth be told, a little annoyed that something so expensive would be so easy to lose. I was thinking about what to do next and hoping they would provide a replacement, when I suddenly noticed it had somehow found it's way round to my breast.  Wishing it had a wee pin and piece of string to attach to my bra, just to be sure it stays. But, I am keeping an eye on it now and being extra firm when I stick it on, so hopefully this wouldn't happen again. I did laugh at my stupidity.

So things are still progressing...Here's to a fresh new cycle and the hope of a bfp (for me and my other IF Tweeps) in 2012!

Lessons from an inspirational mother and her angel baby

Today my thoughts are with a lovely lady and wonderful mum, who lost her beautiful, brave little girl yesterday to the heart muscle disease, Cardiomyopathy.

This is a friend I once worked with. We didn't socialise outwith work. I don't know why, as I always greatly admired her and enjoyed our conversations together...just one of those things, juggling work and life. However, I hold the cares and concerns of any friend... I celebrated with her as she experienced the joy of a bfp, was concerned for her as she faced as she discovered the baby had a chromosomal abnormality, celebrated again at the wonderful of the arrival of her beautiful little girl and was there with her wishing for that miracle when her daughter was diagnosed with this awful condition, of which it appeared there was no cure. My friend gave up work to dedicate time to looking after her little Rose. Their roller coster continued. She was given some hope by Great Ormond Street Hospital, but sadly the miracle wasn't to be. Yesterday she posted to say that her little angel had lost her fight for life and passed away peacefully. I cried buckets when I heard...I can't imagine what she must be going through and wish there was more I could do for her and her family.

Throughout her journey, this inspirational mother maintained an amazing level of composure and dignity, dedicating time to ensure that her baby had so many wonderful, happy times hear on earth. Whenever I met her little girl, her smile lit up the room. She was such a brave wee thing.

Hard to think of my own selfish needs at this point. I just hope I can be half the mum that my friend is and that, if required, I have even an ounce of the bravery that both of them demonstrated through this tragic journey.

My thoughts are very much with them. Rest in peace little Rose. xxx

If you would like to help families like my friend's who are suffering from the affects of this awful disease, please donate to the Cardiomyopathy Association.