Cycle One: Starting with Synarel

The first part of my IVF routine is a nasal spray called Synarel, which I need to take twice a day. This starts before your actual cycle starts (day 21 of my previous cycle) and works to stop normal ovulation. (Ovulation needs to be stopped so we don't lose the eggs I'll be producing.)

The actual taking of it is pretty simple - remove cap and safety piece, stick it up your nose, squirt and sniff. I have to keep to a strict time table - every 12 hours (7am and 7pm in my case), and people have warned about forgetting to take the cap off - and when it's as expensive as it is, you don't want to lose any spray.

The taste is a) terrible and b) long lasting. This morning was actually better than yesterday to start with, because I had the sniff just after I had some coffee, but it's really kicking in now. Some people recommend peppermint to mask the taste, so I'm trying to decide if that means Minties or I'll just invest in Mint Slice biscuits. Also, as bad as it tastes, it's not as bad as the reflux tablets I had to have as a child (taken on their own they tasted like dentists cotton. Except I couldn't take them as tablets and mum had to smoosh them into a watery paste with water and I had to drink/lick it all out. I still want to vomit just thinking about it).

Side effect wise, some people don't seem to have any. Some people seem to get them by day 4. I seemed to start yesterday. Because the drug stops ovulation, they say the side effects are similar to menopause. Not sure if my side effects are like menopause, but I'm tired and achy, have tightness in my lower abdomen and I'm really irritable. (Apparently another side effect is shrinking breasts. I'm hoping this is a long term effect for those who take it for other issues. I have precious little breast to lose!) It's possible that some of these effects are pre-menstrual, but I'm definitely more irritable (I felt like I had something crawling under my skin this morning) and also having more trouble sleeping. So it seems like I got hit with the side-effect hammer!

I forced myself to get out for a walk yesterday, which seemed to work, plus I'm going to increase my water and see if that helps. Hopefully the side effects level soon, and they should definitely do so when I start the injections.

Learning all their is to know about IVF (and wishing I knew more)

Yesterday, M. and I had our compulsory session with the fertility nurse. The objective of the session was to make sure we were comfortable with the elements of the procedure, go through different aspects and supports and through the money stuff as well.

The nurse is really supportive and her information was comprehensive, though there were times when I wished her office was set up a little better so that M. could be better included. I realise I'm the one doing the spray/injections/day surgery, but he's the one supporting me and the one who'll but up with my frantic questions if I forget something. She's given me a tonne of information to go through as well.

What I'm doing is known as the Down-regulation cycle, or the Long Down Regulation cycle. Basically it means I start treatment a week before my cycle actually starts (in fact, I started treatment today). Treatment consists of a nasal spray for up to 24 days, injections starting around day 5 or 6 of my cycle and going for around 10-12 days, then an injection to trigger the eggs into fertility. Then there's the 'egg pickup' which involves a general anesthetic, then an internal ultrasound with a needle attached (pretty cool when you think about it). Then the scientists do their magic (funnily enough, they do this in a suburb where I lived for 6 years). Finally there's the embryo transfer, followed by the horrid two week wait. During that time I also take progesterone to keep conditions all nice.

What else did she tell us? Well she reminded us that there are counselors available, and that they can help me if I'm having trouble dealing with any part. She walked me through the delightful side effects of many of the drugs. She had no problem with me continuing my ballet class, though I'm not sure she understood how strenuous some of the jumps can be. She recommended 3 litres of fluids when I'm on the injections which is going to be delightful back at work. She also gave us the great news that with my health and age, I'm in the 'golden' zone for IVF, and my chance of getting pregnant could be as high as 50% (which is huge).

So with that down, we were all ready to begin the treatments . . .

Picture from Flickr

Making the choice of reproductive treatment

Well, we've made our choice. At this stage we will be beginning IVF in my next cycle, with preliminary treatment starting next Tuesday.

In the end, it wasn't a real hard choice to make. IUI sounds a lot less invasive (we just put washed sperm into you), but it does involve taking hormones every month, with some pretty harsh side effects. There's an increased chance of multiples (not at the moment, thank you) but a relatively low chance of actually falling pregnant. The insertion of the sperm doesn't sound like a picnic either - and with a lower chance, we'd probably have to go through it a few times at least.

IVF isn't great the first time. There's a nasal spray, injections and then the egg retrieval under general anesthetic. It will mean some significant time off work. But, the chances of falling pregnant (and carrying the baby through to birth) are significantly higher, and we're only going to choose to have one embryo implanted (common practice in Australia these days) so less chance of multiple birth :) . If it isn't successful the first cycle, we'll have had the embryos frozen, and latter cycles would be a lot simpler for both of us.

Considering all things, including our collective mental state, our comfortable financial position and how long we've been trying, IVF seemed the obvious choice. It won't be pleasant, I'm sure, but thankfully we're in a country where this is possible, and the science is good, and we have the means to be able to make this choice first. Most importantly, it's a decision we've made together, and one we're comfortable with.

Oh, you silly thyroid!

On Monday, the doctor decided to test my thyroid again since Stupid Doctor had said it was all ok.

Good thing we did, since the levels indicating an underactive thyroid were ridiculously high. The Fertility Doctor rang back yesterday and is sending out a new script. Until then, I'm on two tablets one day, one the next.

This is a change in the last month, though, and doesn't change the fact that we've had 19 cycles of trying prior to that. So we're still going ahead with treatment.

But it's nice to know there was a reason I was feeling bad!

Facing a new set of facts (Or the sucky post of suckitude)

This is going to be a very difficult blog post to write.

Before yesterday's meeting, we had a fair amount of hope that we knew what was wrong and it was quite easily fixable. Seems it was a case of counting the chickens before we'd seen the eggs.

My thyroid count wasn't as high as we thought it might be. The tablets are working as they have been, and my levels are only just above the preferred level. Because the Stupid Doctor had said all was well, the Fertility Doctor wanted to do another blood test to see if the result would be the same. However, he's pretty certain that the thyroid problem is not what's preventing us getting pregnant.

The only other issue was slightly lowered morphology in M.'s sperm test. This could be due to slightly too much caffeine or alcohol about three months before the test, and is so slight, that again, with all the time we've been trying, it can't be counted as what is preventing us getting pregnant.

So, our official diagnosis is unexplained fertility.

I believe that there are a couple of further tests available - increasingly invasive and/or embarrassing tests. I believe they probably won't tell us what we don't already know - my reproductive system is essentially healthy, M. is essentially healthy - but they will take a financial, and more importantly at the moment, an emotional toll that I don't think we can really deal with at the moment.

Which leads us to, what next. Essentially we're looking at IUI or IVF.

And that's a whole new world to get my head around. The doctor was great yesterday, gave us all the information and answered all my many, many questions, but I must admit there was an overwhelming feeling of having lost something yesterday. A feeling that persisted through the afternoon and resulted in quite a lot of tears last night.

We've talked about it, a little. We've read up on it a little. We think we've made our decision. But we're not going to make anything final until tomorrow. Then we'll get the ball rolling on a whole new approach to getting pregnant.

Photo from flickr

Surviving the HSG

Yesterday was the dreaded date for the hysterosalpingogram (HSG). I really wanted to avoid this test if at all possible, but unfortunately events conspired and there I was yesterday.

We timed our arrival pretty well, leaving enough time to park and find where we were going (the diagnostic rooms are part of the nearby private hospital) and to fill in a few forms. Unfortunately, things were running late, and we were left in the quiet waiting room for around three quarters of an hour, which was enough time to really get my anxiety up. (Not to mention my disgust at the magazines which seemed to be filled with pregnancy and baby stories)

When we were finally called, they organised me to get changed. Thankfully, it was not a full change - just the lower half of my clothing (you do feel better with some of your own clothes on) were exchanged for a hospital type gown. Then down the hall to the room. They wouldn't let M. in the room, but he was able to wait outside (I would have preferred him in there, honestly).

The nurse explained the procedure to me, and then the doctor repeated the instructions. They were nice, but they insisted on carrying on their own conversation from earlier, which did nothing to distract me from my anxiety. Then I needed to get myself into position for the test, which involved a fair amount of contortionism, particularly when I had to hold my feet in a teeny little shelf. In the end, my muscles and ability to stretch did not work for me, and they had to hold my feet in place for me.

Medically, the procedure involves putting a speculum in, inserting a catheter through the opening of the cervix, inflating a small balloon to keep it in place, then injecting a liquid dye through and taking x-rays. From my perspective, it involved trying desperately to relax while the speculum was put in, increasing cramping and discomfort through that and the catheter, sharp lower cramping while the balloon was inflated and ongoing cramping through the whole procedure.

Afterwards, I had to lay there for a bit. The radiographer (I think) tried to make conversation, mostly around my birthday (just after Christmas), but she went on to say how her daughter shared my birthday, that she never wanted a Christmas baby, went back on the pill to avoid it, but got pregnant just after going off it. Just the right conversation for a woman obviously there for infertility, right? (No, I didn't tell her off. It's hard to tell people off when you're only wearing half your clothes)

I was mildly uncomfortable afterwards (M. did a lovely job rubbing my back which relieved it heaps), had mild nausea going home, and took myself straight to bed as the anxiety/stress caught up with me. About three hours after the procedure I had horrible stabbing cramps which were slightly relieved by panadol. This morning I woke up with almost no discomfort.

The good news was that there were no blockages, and the whole area looked fine. I just wish there was another way to find that out, and hope I never have to go through that again.


Photo from flickr

All systems going ahead . . .

Two of the bibs I crocheted for my best friend

This has truly been a week of ups and downs when it comes to everything fertility related (and in my mind at the moment, everything is fertility related).

Monday and Tuesday were relatively quiet, though not without their quirks. Wednesday morning brought my period with it, along with the first lot of work colleagues approaching me to make sure I was ok (no, not really).

Thursday was filled with more inquiries into my well-being (just tired, I tell them. Not sleeping well). Then I met up with my best friends for coffee. One of my friends is pregnant, and I had crocheted gifts for her, which once again made me realise how healthy the crocheting is for me. Seeing her joy at the unexpected gifts, knowing they're going to be loved and used, filled me with joy, something which I really needed at that point in time.

Then, within half an hour of giving her the gifts, there was the phone call from M. and a whole heap of new emotions, from anger and frustration, through to hope.

Since then, I've gone back and done some reading on hypothyroidism and how it affects health in general and fertility specifically. The general symptoms are well documented - tired, aching, weight gain and digestive issues are the most well known, but it can also show in slowing speech (which may explain the trouble I've had reading aloud this year?), hoarse voice (big problem this year, but may be because I've had to yell more), drooping eyelids, intolerable to cold (though it was cold in my state this winter!), coarse and dry skin (even the fertility doctor picked this one), dry hair and tingly hands. The problem is, of course, is that these things are relatively innocuous and can be explained by other things. However, if they are symptoms, I'm going to feel great when we adjust the medication dosage - and feeling great has to help fertility.

The information on hypothyroidism and fertility is less conclusive. I've seen information which suggests it makes ovulation less likely, while other information talks about problems with the luteal phase, making it difficult for a fertilized egg to implant - basically a chemical pregnancy. Either way, I'm going to wait until I see the specialist and ask him what his take on it is. I'm also going to ask what my levels were - good for fertility is 1.0, but acceptable range in Australia (for non-fertility) is up to 3.0, I believe. If it's close to that, I'm going to be adding that to the complaint I make about Stupid Doctor.

What comes next? Well I get a short week at work this week, because Friday I need to have a HSG (hysterosalpingogram) which is an x-ray of my uterus and fallopian tubes. The doctors describe this test as 'uncomfortable' which is a term they also used the last time I was recovering from surgery (bloody painful would have been a better description). Then the Monday after that we're back at the fertility specialist for our 'where to' update and a shiny prescription for some 'make me healthy again' tablets.

The baby blanket I crocheted

Well . . . That is 'Interesting' News

Today my husband M. contacted the fertility doctor's rooms in regards to the tests he had done on the weekend. In his discussion, he was able to find out quite a lot of information to be further discussed in our next appointment.

Most of the news was positive. M. is all 'normal', which is really wonderful news. Most of my tests came back great, including the one which measured the 'age' of my reproductive system - basically finding out if it's in the state it should be for a 29 year old. Just one test threw up a question . . .

The bloody thyroid test.

Remember Stupid Doctor? The one who told us to just go back and try a bit more? Well one of the things he did do was put me in for basic blood tests, including my thyroid. I've had Hashimoto's Thyroiditis for a couple of years now, which is controlled with a simple tablet every day. I'm not great at remembering to get my blood tested, but the last few times, both doctors who have tested it have expressed concern about the levels, and said if it continues they'll revisit the dosage. Stupid Doctor said no such thing, instead completely clearing me with the nurse (despite all the doctors being at the same practice and my file containing the notes of other doctors).

But the blood tests taken at the fertility clinic only a couple of weeks later are showing my levels to be right out. And one of the main symptoms of this . . .infertility.

The stupid bloody doctor has basically missed the easiest thing to diagnose about me. Thank goodness I went to another doctor. Thank goodness he referred me to a good doctor. But we've basically wasted at least two cycles and a huge amount of stress and energy for such a treatable thing.

The good news is, though, that this is a treatable thing. And the treatment makes me feel better, which is just a bonus. It'll probably combat the fatigue, headaches, digestive problems and about ten other things which are classic symptoms of my levels being out. And which I probably would have put together if the stupid doctor hadn't cleared me.

Stupid bloody doctor!

Unfortunately . . .

It seems that this month has also been a big fat unsuccessful.

The hardest part about an unsuccessful month at this stage? Dragging myself through the next day when I just want to curl up in bed and cry. Or the fact that I'll be probably having an 'uncomfortable' (usually doctor speak for bloody painful) procedure next week as the next step in finding out what's wrong. Or trying not to inhale whole family sized blocks of chocolate . . . :-)

On to the 21st cycle . . .

How to survive the two week wait

Every two week wait (and this one is my 20th!) is slightly different from the others. There are different 'symptoms' (all of which turn out to be pre-menstrual in my case), different obsessions, different distractions.

This month I'm distracting myself with crochet. One of my best friends is expecting her first child in February, so I've made her a big round blanket, as well as a range of bright, colourful cotton bibs. I like crochet because it keeps the mind busy, I feel like I'm actually producing something and it's easier on the eyes than endlessly playing Angry Birds.

As for symptoms, I keep going back and forward on them. I had a vivid dream last night (featuring Dr Karl from Neighbours . . . ) which obviously means I'm pregnant. Or it obviously means my period is coming. My husband's glass of wine hasn't made me turn up my nose this month, which means my period is coming. Or I'm pregnant. My breasts hurt. Which means I'm pregnant. Or my period is coming!

The very real problem is, that after all this time I really don't trust my body anymore. There have been months where I've been absolutely certain that this is the month. And then my period comes, and all those hopes I've worked up feel especially heavy. Before we started trying to conceive, I was definitely more comfortable with all the signals my body sent. Now I just feel confused!

The good news is, it'll all be over soon. One way or another, I should know something before the end of the week. Then the next step of planning can begin.

Photo from flickr

When Facebook Strikes: My Ranting Reactions to the 'Breast Cancer' meme

I'm a pretty regular Facebooker. I use it to keep in contact with family, share photos, make jokes with workmates current and past, and post links to news articles I'm pretty sure only two people other than me care about.

I understand the pitfalls, most of them related to people I went to high school with, and usually I just ignore and move on. Unfortunately, the latest one was a little like a hefty kick to the stomach, leaving me feeling depressed and then angry.

It's one of those ridiculous 'Breast Cancer Awareness' memes, that in actual fact have nothing to do with Breast Cancer or awareness. Like the colour of your bra or posting your shoe size in inches to make people cast aspersions on your partner's penis. This delightful little number gives you the sentence '_______ weeks and craving ________', and gets you to fill in the blanks with a little reference chart based on your birthday.

I saw this for the first time yesterday morning as the status of someone rather close to me. I had no idea that it was a meme, so was absolutely shattered when I saw it. Shattered that she was obviously pregnant, shattered that she had chosen Facebook to tell me and everyone else, shattered that I still had another week of the two week wait and in every single way I was over it. I cried before I went to work. I opened up to a colleague and almost cried some more. I spent the day in a deep funk.

I came home and found another message from her assuring everyone that she wasn't pregnant, it was just something else. It wasn't until later, when I saw another one, that I twigged to what it was about. Then the anger set in.

Not at the friend who posted it first. English is her recent second language, and there's a very real possibility she didn't understand the full meaning of what she posted. But at the sadistic bastard who came up with the self serving meme in the first place.

Pregnancy, just like breast cancer, is not a joke. Not something to 'keep men out of' (as the email that sets up the meme implores you to do), not something to play around with. Pregnancy is a deeply personal thing for so many women, who might be infertile, worrying about how they're going to afford to raise the child they're carrying, recovering from a miscarriage, unsure if they'll ever be in a position to carry a child safely, grieving for a stillborn child. Not to mention, the treatment for breast cancer can leave women infertile, making the whole thing even more nasty.

By turning the process into a joke, the meme basically says that it's okay to hurt people (and judging by the blog posts I read this morning, there is no way I am the only one who feels this way), okay to remind them of what they cannot have.

But what about real pregnancies? That was a comment that I saw on one forum this morning. A woman who was 'super fertile' (she complained that she had a hard time not getting pregnant because they couldn't afford protection all the time and loved each other too much not to have sex. I did not leap through the screen to kill her, but I'd be happy to send her some condoms) whinged that she was tired of having to be 'super careful' of whatever she said so she didn't upset people. The difference between real pregnancies and this, in my mind at least, is that real (wanted) pregnancies are wrapped in the most wonderful joy. You're so pleased for the friend or acquaintance who is having a baby that any kind of sting is immediately softened. A joke 'pregnancy' has no kind of joy attached, no balm to take the sting away.

There is so much we can do to raise awareness for cancer and other diseases. There are hundreds of support and research groups out there doing everything they can to find causes, support treatment and discover cures. If we want to raise awareness we can link to them, encourage people to have check ups, encourage people to get behind charities we're passionate about. We don't need to exclude and hurt to make a point.

Edited to add:
Here's a couple of links to people who have also blogged about this, sometimes much more eloquently than I can:
Regarding the Facebook "Breast Cancer Awareness Games" by C. G. Ward Photography
It Does Not Raise Any Awareness, I Swear by Tales From This Side of the Mamahood
Pretending You're Pregnant Isn't Cute  from Yolk

Photo from Flickr