Her: Heartbreak

Knowing that I couldn’t eat or drink anthing for 6 hours before my egg retrieval, I got up at 6am to sneak in some breakfast before I went back to bed again.

I had also been told to take a pain relief suppository (Voltarol) an hour before leaving home.

When we arrived at the hospital, we were shown to my Recovery room pretty much right away.  Well I say a room, but really it was an open plan cubicle surrounded by a curtain.   Inside, there was a gown, some foam slippers and a hair net for me to change into. 

A man in one of the cubicles directly opposite mine was telling one of the nurses that his partner was in agony – not really what I wanted to overhear shortly before my turn!  Another nurse was telling a lady that they were still counting her eggs.  As I waited with my husband, I felt both nervous and excited.  

We met with the doctor shortly before I was due to go into the egg collection room.  He put it simply to us – best case scenario was that we would get 3 eggs, worst case was 0 eggs.  What happens during egg collection is that a fine needle is used to empty the follicles in each ovary.  The fluid from each follicle is then examined under the microscope to check for any eggs.

Shortly before my husband was called to produce his semen sample, I followed the doctor blurrily into the egg collection room (as I couldn’t wear my contact lenses and I had to leave my glasses in the recovery room).  Inside, I met a number of other people involved in the procedure – a nurse, an anaesthetist and their assistant.

I was asked to confirm my name and date of birth before lying down.  Something that felt like a needle was inserted into a vein on the back of my right hand.  The anaesthetist explained the medication that would be given to me – a painkiller, sedative and anti-sickness medication.  At the same time, an oxygen mask was put over my mouth and I was attached to the equipment that would monitor my heart rate and blood pressure.  Everything seemed to happen so quickly and efficiently.

I remember chatting to the anaesthetist about where I lived and him telling me that he used to live near there.  The doctor was asking about whether something was ready.  Then the sedative must have taken efect as I was overcome by the weirdest light-headed feeling, the ceiling panels I was staring up at started to move like a conveyor belt.

When I opened my eyes again, I was back in the recovery room with the nurse who had greeted us when we first arrived.   My husband hadn’t returned yet and I asked what time it was – it was about 20/25 minutes after I had entered the egg collection room.  He soon arrived though and asked me how I was feeling.  I actually felt fine – like I had been woken up abruptly from a dream and was relieved and surprised that I felt no pain other than from the catheter that was still attached to my right hand.  I only realised later when I got up to get changed that I had bled slightly from the procedure.  This had come from the site where the needle had passed through the vaginal wall during egg collection.

I was attached to a machine which continued to monitor my heart rate and blood pressure while I rested for a hour or so. 

We had just finished some tea and biscuits when the doctor came in to explain that the procedure had been straight forward to perform.  However, when it came to it, I only had one follicle and when this was checked out, there was no egg to be found.  Needless to day, this was an outcome far worse than I had anticipated.  I knew 0 eggs was a possibility, but it never occurred to me that I would lose 2 follicles!

The doctor put it down to the fact that the other 2 follicles had probably run out of steam.  Fair enough as on average,  egg collection happens after 13-15 days of stimulation.  I had been doing maximum dose Gonal-F injections for over a week longer.  Although the cycle failed, I have no regrets that we continued for as long as we did as this was the only way that we would know for sure that we had tried our very best. 

It will take a bit of time for us to recover from such a massive disappointment.  Since leaving the hospital, I have been  overcome by feelings of sadness that hit me out of the blue.  At first, even my husband’s hugs which are always a reliable source of comfort were not enough to pull me out of these moments of deep melancholy.  Instead, they served to remind me of our disappointing experience.  It was my husband’s birthday a couple of days ago and I am so sorry that I wasn’t able to make his birthday wish come true.  If nothing else, this process has brought us closer.  He made time to accompany me at every one of my 7 scans.  I have never been more grateful for his love and support.

So here ends our first and maybe our only IVF cycle.  We have a follow up appointment with the consultant gynaecologist on the 10 March to assess our treatment.  It will do me good to return to a bit of normality for a month or two (Yay, no more injections or scans!)  Some kind of holiday would also be good.

I am doubtful that it would be worthwhile having another go at IVF but let’s see what the consultant says.  I would like to understand better why our cycle failed and whether there are any other options available to us before embarking on the egg donation route. 

I need reassurance that my body is able to produce eggs.  If it is, this cycle hasn’t given us any information on what the the quality of my eggs is like.  Also, say they were able to collect an egg or two, would my husband’s sperm have fertilised them to produce an embryo?

Her: Lucky Scan 7

Wow!  7 scans and 23 Gonal-F injections later, we finally have the go-ahead for egg collection.

Today, we bumped into the consultant gynaecologist who did our initial consultation last May while we were in the waiting room.  She stopped to ask us how things were going (slowly but surely) and wished us luck.  That was nice.

Before we left the clinic today, we were told that there would be a meeting this afternoon to agree what I need to do next to prepare for egg collection.  The nurse called at 5.15pm which was late enough to make me think that she had forgotten about me.

I took my last dose of the Nafarelin nasal spray earlier this evening and will relace my usual Gonal-F injection with the hCG (Ovitrelle) injection at 11pm tonight (38 hours before my planned egg collection).  This final injection causes the final stages of egg ripening to take place.

Up to today, I really thought we would end up being the one in ten statistic that they quote in the brochure for having our cycle cancelled.  I have approached this whole process as a series of hurdles to negotiate – what a high one the first one has been but we’ve made it!  The nurse today made a comment about how we now stand as good a chance as any other couple of a successful IVF cycle.  I, on the other hand am still erring on the side of caution.  We only have 3 follicles to play with and we don’t yet know whether they will all contain eggs or what the quality of my eggs are like.

Her: Not quite judgement day ….

Well, I’ve had another 2 scans since my last post here.  Not sure why, but the doctor rather than a nurse did my scan on Monday (8 Feb).  This showed a developing follicle in the right ovary which had previously shown no activity whatsoever.  So a follicle count of 3 which seemed to be enough for the doctor to suggest that I come in for another scan today.

With all the scans I have been having, I have developed what seems to be an irritation/skin allergy between my legs which I thought most likely to be caused by the latex which covers the ultrasound probe.  In fact, I was in quite a bit of discomfort by Monday afternoon!  I really didn’t want to risk having that experience again so mentioned it to the nurse before today’s scan so that she could use a non-latex probe covering .  I think that’s done the trick!

The scan today showed that I now only had one follicle in my left ovary and this along with the one in my right ovary were continuing to grow.  It is a mystery what happened to the third follicle but in any case, the remaining 2 follicles had grown enough for the nurse to say that it was worthwhile for me to come in on 12 Feb for what would definitely be the final scan.  With every scan I have been having, my womb lining has been getting thicker which is a positive sign that my ovaries have been active. 

I only had 300 IU of Gonal-F left so had to order yet more today.   After my scan, we were sent back to the waiting area and wait for another nurse to call us.  We assumed that this was so that she could arrange for the drugs to be ordered and book us in for the last scan.

Well, we were called in by the nurse who was accompanied by one of the doctors.  This nurse told us that they had decided that we should cancel our cycle as the doctors felt that my ovaries simply hadn’t responded enough despite me being on the highest dose of Gonal-F.   After leaving the ultrasound room with more hope than I had when I entered it, only to have that hope dashed so abruptly soon afterwards, I started to weep. 

The nurse said that if we insisted, we could continue another 2 days but the doctors really didn’t think it was worth it.  I was too sad to do anything other than to nod at what the nurse was saying.  My husband spoke and asked that we continue.  The nurse left the room to speak to the consultant before coming back and confirming that we could do so just to see what the scan on 12 Feb showed.

As we wait for judgement day, I reflect on all those stories of patients who have fought against the odds despite doctors telling them to prepare for the worst.  Will my story be one of those or will it end in tears?

Her: Come on ovaries!

The scan showed that I only had 2 follicles which had grown since Tuesday but they’re still not big enough.

They’ve suggested that I continue injecting 450 IU of Gonal-F each day and come in for yet another scan on 8 Feb.  It is clear that I am showing a very poor response to stimulation but we agreed that we would carry on.  Although I’m expecting the cycle to fail, we agreed to go all the way as this is the only way that we know for sure that we have tried our best. 

We had to order more Gonal-F.  Each Gonal-F pens contains 900 IU in total so only enough for 2 days worth of injections.

When I found out that my ovaries had only produced 2 follicles yesterday, I really thought that our cycle would be cancelled.  I’m relieved that it’s not over just yet. 

Never before have I so wanted the cliche “quality is better than quantity” to apply.

Her: Under Responding

Gutted that the scan results were disappointing! 

The scan seemed to take ages but it seems that so far, my ovaries are struggling to produce even the minimum three follicles I need to progress to egg collection. 

So I am now doing the maximum dose of 450 IU each day with the Gonal-F pen and will go in for another scan on 5 Feb to see if this has increased the number and size of the follicles within my ovaries.

I can’t bear to think of the worst case scenario of us having to cancel our cycle but let’s see what happens on Friday.

Him: Not good news…

We went back for the 1st scan since starting the FSH injections (Gonal-F).  We had been taking a dose of 300 for 6 days… well, I say “we”, but I mean the missus.

This time there were two nurses.  We’re not sure what their different roles were, but the 1st nurse had troubles doing the scan so handed over to the 2nd nurse.  Perhaps one was junior and the other more senior, or one was an embryologist whilst the other was more experienced at scanning (?)

Anyway, the scan seemed to be fairly similar to the scan before starting the FSH injections, i.e. the right ovary was still not visible, seemingly very inactive.  The left ovary had a cyst still, and had a few small follicles.

At this stage, I think they were expecting the follicles to be larger.

They suggested that we increase the dose of Gonal-F to 450, and then go back for another scan on Friday (3 days later).  This means we’ll have to have a courier deliver more Gonal-F pens.

On Friday, hopefully we’ll see a better scan, i.e. larger follicles, otherwise they will have to cancel the cycle.  I’m not sure what will happen after that, but I guess we can discuss it at that point, if we have to.

I felt sad throughout the day.  It seems to confirm that there is a ovarian reserve problem – which we weren’t really sure about due to the conflicting results we’ve had back before.

I thought that since there doesn’t seem to be a good enough response to the drugs that perhaps it means there is no point in trying IVF in the future.

In a way, this could be a good thing.  It would be worse if it seemed there was a half-chance, and we went all the way through the cycle and it failed.  And worse still if we tried IVF several times and they all failed.  Both for the emotional, and financial cost.

The other things I’m wondering now, is if other clinics would have any more luck.  Or also there seems to be a “short protocol” which can work for some women who don’t respond to the “long protocol” that we tried.

Also, there is anecdotal stories about acupuncture helping, but the missus seems quite against trying that, so far.