Sunday, 7 March 2010

Adventures In IVF

I've mentioned a couple of friends who are also battling with this whole infertility gubbins. One of them, the lovely T, has just had her IVF and her regular email updates have been brilliant, giving me the head's up on what to expect when it is my turn.

I thought you ladies might appreciate knowing how they do it on the continent so she agreed to write a guest post. I leave you in her very capable hands...


Hello everyone.

I am the friend Liz mentioned who joined the TTC game quite recently – we had our first “Something is not right” visit to the doctor back in October 2009. It was therefore something of a surprise to be catapulted into IVF preparations January, and, on top of that, for the first IVF cycle to be over less than two months later.
I am definitely more of a stalker than a blogger, so please forgive me if I lack the razor sharp wit and pithy insights of all you experienced bloggers out there. I hope all the same that that my experiences are insightful for those of you facing this particular hurdle.
There is no getting round it - IVF is a big deal. No more gently nudging Mother Nature along, tempting her out of her slumbers with zinc and folic acid, or trying to out-smart her with ovulation tests and calendars. With IVF we are strapping her to a hormone-fuelled rocket and launching her into space. It involves grave risks and some difficult decisions, which are matters for another day. However, as I thankfully discovered, it can also be a relatively quick, painless and trauma-free experience.
Why IVF?
People get to IVF for any number of reasons. The reason we got there – and got there so quickly – was a sperm test in early January that revealed zero motility. It was rather unfortunate to discover it on the day we were supposed to have an IUI, but that’s another story. It had of course been tested before and the numbers were low (below 5%) but apparently viable for IUI. However, in December, Boyfriend (let’s call him B) had undergone major surgery (unrelated to his man bits) and his sperm production had simply closed up shop. No problem had been identified on my side (cycles as predictable and painless as a Swiss train journey). The conclusion of the IVF specialist at the end of January was that with zero motility, and a year and a half of trying, IVF with ICSI (intracytoplasmic sperm injection - they inject it directly into the egg) was the only option. The option of waiting for B’s sperm to improve was briefly discussed and then dropped, given that they were so low pre-operation. So he filled in the paperwork, explained the process, and told us to call the clinic when my period started, which is when the treatment starts.
What’s the process?
As Liz has mentioned, IVF treatments can vary hugely between clinics and between patients. It was a surprise to me that IVF cycles can last either a couple of weeks or a couple of months, and that different drugs can be used – especially for the suppression, which can be administered in different ways (sprays and injections) and at different times in the cycle. One thing I would recommend is to find out what protocol they propose to use for you, and why.
In my case it was quite short – basically two weeks from beginning to end.
      Day 3: To the clinic for a baseline blood test and echography. The doctor issues me with a shoe-box sized box of syringes, needles, capsules of Menopur (a “FSH” - follicle stimulating hormone) and the little glass bottles fluid you have to mix it with, and explains how to do the injections. I dutifully started on 150mg of Menopur that evening.
      Days 4 – 7: Daily injections of Menopur. Gradually, my belly is beginning to tingle inside and to swell, making the injections harder.
      Day 8: Back to the clinic for blood test and echography. The good news is that she finds 7 follicles on the right, between 11 - 12mm, and 4 follicles on the left (although hiding behind the uterus to hard to see). She gives me the suppressant injections (Orgalutran, containing ganirelix, a GnRH antagonist, which comes in pre-filled syringes), which I have to add to my evening injections. B meanwhile has another sperm test, which shows motility of 25% - a huge improvement. (He had been taking Flixar - a supplement containing selenium, zinc and other goodies – which may have had something to do with it, but who really knows).
      Day 11: Back to clinic to check progress: there are now in total 15 follicles, around the 16mm mark, with one at 19mm. They are “ready” when they reach 20mm, and grow at about 2mm a day, so we are nearing boiling point.
      Day 12: Back again – follicles are now between 18mm and 20mm. It seems like we are there: doctor says to stop the Menopur, do one last injection of Orgalutran and this evening, at 23h30 precisely, do the trigger short of Pregnyl (an HCG).
      Day 13: a day of rest…
      Day 14: Collection day. A drug-induced haze, but they manage to collect 13 eggs. The results of B’s sperm sample are even better than expected – now up to 38%!
      Days 15 - 16: Two days off work to rest. Clinic calls to say that of the 13 eggs collected, 3 were not mature and 3 exploded when they did the ICSI, so only 7 were injected. Of these seven, 6 were fertilised. There is definitely cramping (slightly more than period pains) and still a bit of swelling, but much less, and nothing to lessen the pleasure of spending the day in my pyjamas on the sofa under a blanket, with a big book and a cup of tea. On the second day I am out and about, doing errands and enjoying the guilty pleasures of weekday shopping and teashops. I also started with the Utrogestan – the progesterone capsules which I am to take for the next two weeks, which are charmingly administered vaginally (but it could be worse… some people have the pleasure of rectal suppositories).
      Day 17: Embryo transfer day. Of the 6 embryos, 3 were “not good” and unusable, and 2 were “ok”, but one was “perfect”. Well, that’s all we need. So they transferred the one perfect one, and said they would see how the other 2 ok ones develop, and depending on their quality, freeze them as blastocysts.
So much for the procedure, the real question which all would-be IVF-ers will want to know (at least I did) is what it feels like. I find that knowing what to expect helps hugely in dealing with whatever comes. That said, everyone will experience it differently, both physically and emotionally, so just take this as one person’s experience.
How were the injections?
They started off fine, even though I was on my own in the beginning (B was travelling for work). I went for the “do it quickly, get it over with” technique, which I am great believer in, just like tearing off plasters, waxing legs, or pulling out wobbly teeth in small children. Then B came back and helped, and it became harder to ‘just do it’. The hand hesitated and it began to hurt. At this stage, my belly was getting swollen and sore, with a few big purple bruises appearing. The injections felt like pricking a big balloon. The swelling itself was also getting uncomfortable – waking me up in the night, I could almost feel my insides being pushed out of the way by overgrown ovaries (as the nurse explained, they go from being the size of walnuts to the size oranges, so this discomfort was all quite normal). It was a great relief to stop the Menopur injections.
How was the collection?
This was done in the day surgery under local anaesthetic; a general anaesthetic was offered, and would have been necessary had the left ovary not dropped into reach of the doctor’s instrument. The great thing was that B there all time, George Clooney-like in his blue surgeon’s outfit, his hand always within reach. Since I was under the influence of the tranquiliser, and have only dreamlike memories of what actually happened, he was able to follow everything, and have sensible conversations with the doctor, the nurse, the biologist etc. It basically took the morning, and the surgery itself took less than half an hour. We then went back to our room for a big snooze for an hour or so, until I was awoken by the need for a proper bacon and cheese burger. So off we went for a nice lunch and a wander in the sunshine. The anaesthetic started to wear off just as we got home – a bit of stabbing pain - but I avoided the worst of it by slipping into a deep sleep on the sofa all afternoon.
How was the transfer?
The transfer itself was painless and quick – by this stage you are used to people fiddling about your bits… Afterwards I was told to lie down for a few hours and then to get on with normal life. Good luck, and see you in two weeks, the nurse said cheerfully.
How much time should you take off work?
Of course this depends on the treatment and how people react. The clinic signed me off work for a week from the collection, but said that usually people find that after a few days they are feeling back to normal. I was feeling ready to go back the day after the transfer.
What next?
So it’s now a question of getting back to real life, and keeping as busy as possible to take my mind of it all for the next two weeks. We are of course looking forward to the result, but not desperately so: as long we don’t know, it is at least possible (which brings to mind something about cats and boxes - oh the joys of TWW psychology).
At the same time, we are telling ourselves that it is quite likely that it will not work. But as I said to B, the thing we should be pleased about it that we survived unscathed and responded well to the treatment. More than that, given the huge improvements in B’s sperm results, we are hopeful that, if IVF doesn’t work this time round, we can maybe go back to a more softly softly approach. Mother Nature, come back, all is forgiven.
We shall see.
So there you go, a first hand account and pretty much in real time, she only had the transfer yesterday so we are all in the dark about the outcome. Please leave T lots of luck in the comments and I'll let you know how it pans out.



15 comments:

  1. Wonderful post. Thanks for the details. I love hearing what other people are experiencing because it does vary considerably from person to person.

    ReplyDelete
  2. Did you throw in a reference to Schrödinger's cat at the end there? I think it's time you stopped being a lurker and started your own blog!

    ReplyDelete
  3. This was a great read, especially as I timidly step out into my first IVF cycle. Thanks for sharing your experience! (and Liz, thanks for sharing Gigi with us!) My fingers are crossed for your 2WW!

    ReplyDelete
  4. Thank you for sharing your experience of IVF Gigi. It definitely helps to read an account of it (and so recent too).

    Wishing you all the best in the 2WW - really hoping that it flies by. Good luck!

    ReplyDelete
  5. Love this post! I, too, am an IVF "survivor" and am proof that it does work! Here's to hoping that yout outcome is good - it's an amazing process with equally amazing results! Womb, hope all is well with you! It's been awhile! Best to you both!!

    ReplyDelete
  6. Gigi, very well written - and tons of good luck with it. Fingers crossed for you.

    ReplyDelete
  7. Well written Gigi. Good luck and tons of it! Fingers crossed for you. Come back and let us know.

    (Sorry if this appears twice. Blogspot in a tricky mood).

    ReplyDelete
  8. WOW! thanks for that Gigi and best of luck! Here's hoping!

    ReplyDelete
  9. I wanted to let you know that I'm passing on the Happy 101 Award to you. You can check out my blog (esperanzasays.wordpress.com) to see what to do! Thanks for sharing your life with us!

    ReplyDelete
  10. Thank you, thank you - Gigi, your account is helpful, comforting and I wish you the very best of luck. And I am completely delighted to have stumbled upon this excellent blog for the first time, especially as it's so nice to read a fellow Londoner. I look forward to reading more. A Bumpy Ride

    ReplyDelete
  11. Wishing you all the best, Gigi!

    ReplyDelete
  12. Great post, super informative thank you Gigi! Good luck

    ReplyDelete
  13. Good luck to Gigi!! I'm not reading this in real time and realize that she must be nearing the end of the wait. Everything crossed for her.

    ReplyDelete

I've resisted word verification for ages but I'm getting so many spam comments at the moment that I think it is time. Sorry!