So our previous post got us to the point of making the decision to start with IVF (In Vitro Fertilisation). IVF vs IUI is a whole other ballgame. It’s basically the process of fertilisation by extracting a woman’s eggs and manually combining them with sperm in a laboratory dish. If the fertilisation is successful the embryo(s) are then transferred to the woman’s uterus.
When we decided to start with IVF, it seemed the natural progression from IUI and home insemination, but when I look back at it now, it is actually a massive step. When you are in the thick of it however, it just becomes normal for want of a better word. It’s just a part of your everyday life. From tracking your ovulation to injecting each night, it just falls into daily routine.
At the time when we started IVF, the success rates were 50% for my age group which compared to the 12% IUI success rates, these were amazing. So we embarked on this journey of injections, bruising, suppositories, pessaries, internal scans and sharps boxes. We had to wait for a full clear cycle and then take the pill to regulate my cycle.
Unlike IUI, the responsibility of knowing when is best to do everything, is taken out of your hands. Dependent on each individual cycle, and the particular medication, the doses vary and the next steps all depend on how the body reacts at each stage. I feel it also important to point out here, before we get too deep, that eveyone’s journey will be different. And also clinics are different, this is just our story, with some facts thrown in!
You start with a baseline scan which is an internal scan completed whilst on your period just to check the lining is as it should be and not too thick. You are then given a schedule to follow which details all of the medication you are going to need and the dosages. Each of the different medications do different things, but they are all to get your body ready for hopefully a successful implantation.
Now the injections sound scary and many people would say to us, I don’t know how you inject yourself, but you do what you got to do to get to where you want to get to. And they are not actually that bad at all. It does take a bit of getting used to but once you find your groove it’s pretty easy.
One medication which I never really loved was the Cyclogest pessary/suppository. These are progesterone in the form of a bullet shaped delight. And they do an amazing job of thickening the womb lining in preparation for implantation. The problem is you have to make a decision, front or back. Now this is a bit TMI – but we are all friends here right? Use the front and you would have that oozing out all day (I was prescribed 3 a day). In the back and although it was more quickly absorbed and there was no leakage (I know what a visualisational (that’s a made up word I think) treat I am giving you right now!) it really made me need to go for a poo, like a lot. I also had to continue to take these for 12 weeks after the transfer. In the grand scheme of things it was nothing and there was no pain with it, but just a bit of an annoying aspect.
Back to the injections. For our first IVF cycle we were prescribed Gonal F for the follicle (little pouches that may or may not contain an egg) stimulation. It is a pen type injection which has multiple doses in it and you click it around until you get to the correct dosage and then inject. You pinch some skin on your stomach, inline or below your belly button but not above, push the needle, which is about 1.5cm, into the pinched skin and depress the button on top of the pen. I would let go of the skin and leave the needle in for about 10 seconds, then pull out the needle. Not sure what if that is the actual process or not – but it worked for us! The needle would then come off and go in the sharps box and the pen back in the fridge. At first finding a spot is easy but once you are bruised it can become difficult to find an untouched area.
We also had Orgalutran injections. These were ready measured injections and were by far my favourite one. Mostly because they injected really easily and as it went in, I could also feel it under the skin, which I kinda liked – maybe that is weird though?! Orgalutran blocks the natural luteinsing hormone. This hormone communicates to the body to release the egg from the ovary or begin ovulation. By suppressing this action it allows the Gonal F to continue to develop the follicles fully. Once everything looks to be at its best, with follicles not too big or too small, a third injection, Ovitrelle, is taken.
This is known as the trigger shot, and releases the eggs ready for collection. Ovitrelle contains the active substance called choriogonadotropin alfa which is a copy of the natural hormone hCG (human Chorionic Gonadotropin). This helps maintain pregnancy and triggers ovulation It is taken at a very specific time based on when you are booked in for egg collection. We did ours at 11pm, then went in for collection around 34 hours later.
Throughout the injection process, we were scanned every couple of days to check how my lining and follicles were doing. Depending on the results, the medication was adjusted accordingly. There is a fine line between stimulating them to get to the best size and being over stimulated. This could cause the bigger ones to get too big and the smaller ones may never get to the size needed. Follicles had to reach a certain size before the procedure will be arranged. If none make it to required size, the cycle could have been abandoned. Fortunately for us, we did not have to abandon a cycle at any point.
The regular scanning was very necessary, but there were many. My boss was super supportive and whenever I needed to go, I could. I tried to get the appointments at the most convenient time for work as well as us, but they did involve a commute into London each time. This meant the early or late appointments were not always the quickest option, when it felt as though the whole of London was using the underground!
Once you have a good number of follicles at the correct size you are scheduled in for your egg collection. This procedure is fairly short and involves you being sedated under general anaesthetic. So where as some of the other appointments could be just me attending on my own (although on cycle one that didn’t really happen), this one can’t be. So you get gowned up, you walk to the room, get given your plastic shoe covers. Then everyone comes and speaks to you about what sperm you ordered, asking you if this is your signature on the donor order from, tell you about the anaesthetic etc. Then you are put under. The actual procedure takes about five minutes and in that time all of the eggs are removed and I assume put in a test tube or petri dish (???).
Once this is done you wait for your phone call a couple of days later to find out whether any of the eggs have fertilised. It’s a long wait for that phone call. And in fact the whole conception process, from waiting for your period, to ovulation, to this and the two week wait, is just one long waiting game.
There is a chance all, some or potentially none of the eggs will fertilise. We were lucky and at the end of this cycle (including egg sharing, which I’ll post about at a later date) we had 5 embryos, and over the next day this went down to two good embryos. We chose to let our eggs to go day 5 blastocyst. Blastocyst refers to a human embryo that’s five or six days old, it is the stage at which an embryo must reach before it can implant in the uterus. Waiting to the blastocyst stage (as opposed to transferring on day 3) allows the cells to develop further and provides better co-ordination between the embryo and the uterus as the embryo is placed back in the right place (uterus) at the right time (blastocyst stage). Many clinicians believe that transferring better developed embryos makes a pregnancy more likely.
Once all is good in the hood, or the lab in this case, on day 5, we went back in for the embryo transfer of one of our embryos. The other was frozen. This is again a fairly short procedure. However I found this one really hard. You need to have a full bladder for the consultant to be able to get the catheter in the right position to place the embryo back in. A full bladder, coupled with a speculum – you know the success I have with them – and a posterior cervix, are not a match made in heaven let me tell you. The urge and need to wee, especially when they are pushing down on your stomach with the probe constantly is not a nice feeling. Once done, they take the catheter out and check that the little embryo has left the tube and you’re done. Well, done to run to the toilet to relieve your bladder!
Then you wait again. 12 days until you pee on another stick.
We had two cycles of IVF. The first was successful, however we heartbreakingly lost our baby through a silent miscarriage. I won’t go into details now, this deserves its own post. We then had a frozen embryo transfer (FET). This is where the embryo is thawed and transferred. You take some medication, but far less than you do to get your body ready for collection and then the same procedure as above. There is a chance that an embryo will not survive the thawing process, however this is looked at during the fertilisation stage. Decisions are made at that point as to whether the embryo is strong enough and of a good enough quality to withstand the freeze/thaw process. Even if it is deemed strong enough, this is still not guarantee.
The FET was unsuccessful, and once my cycles were back to normal we went in for round 2 which is the same process as above with the exception of using Menopur instead of Gonal F for our hormone injection. Menopur is the more natural choice. It contains human menopausal gonadotrophin. This is a combination of two naturally occurring female hormones – follicle stimulating hormone (FSH) and luteinising (LH). These are extracted from the urine of post-menopausal women, hence it being more natural. We actually ended up with less eggs using this hormone injection. From the 5 retrieved we had two embryos get to the blastocycst stage. We could not have a fresh transfer however as I was suffering from ovarian hyperstimulation syndrome (OHSS).
OHSS can affect women who have been taking injectable hormone medication. It is where the level of hormone in your body is too high and leads to your ovaries becoming swollen and painful. This can be mild, severe or critical. It was basically like I had been pumped up around my stomach, not nice at all. The clinic will not ordinarily transfer if you are suffering from OHSS.
So we had to wait for an FET. And that is the transfer where we fell pregnant with our little rainbow babe, Ottilie Asta.
And we still have one embryo in the freezer.
One thing that really impacted my thoughts, was having a frozen transfer on our last attempt. I was really hung up on needing a fresh transfer. In my mind, we had fallen pregnant with our first transfer (a fresh transfer) and not with our second transfer (frozen). When I was told we had OHSS, I was convinced that the next attempt would not be successful based on the fact it wasn’t fresh. However, looking into some research (Zoe not me!) there is some thinking around this being better for implantation. Due to your body not being pumped full of hormones etc. from the injections, it may be a more natural environment for a teeny-tiny embryo to flourish.
I can’t say which is better. I have been pregnant twice, once from fresh and once from frozen. It will happen when it happens. As we have experienced, pregnancy is one thing in life that you cannot guarantee or predict unfortunately.
The whole IVF thing is a pretty big deal and a whole lot of time, emotions and money go into embarking on that journey. Fertility treatment is full on. The countless scans, pills, injections you have to have, really do take their toll on you. However it does get easier as you go along. At first, every injection was an event in the evening, every scan was booked when we could both attend. But as you get further into the treatment and cycles, this becomes more ‘normal’. Those things just become part of your life. You just do the injections without a second thought. You may have to go to a scan on your own because of a work commitment etc. Personally, although it was a massive part of our lives for so long, I think, like many others, we just took it in our stride. Yes I worried every single second of the day, but I would be doing that anyway, and at least this way it was about something important.
It is so easy to get lost in the process of everything. I found it quite comforting trying not to focus on the now. Instead thinking ahead to our baby being in my arms or in the *pram waking around a shopping centre whilst I stopped at various coffee shops to feed – who know how true that would be. Well except about the pram bit as she hates this – insert *carrier.
There are some amazing people who work there, but the bedside manner at times was questionable. Even after going there for 4 years pretty much, the receptionists still acted like we had wandered in to ask for directions – come on lady!! It was also rarely on time which when you have left work for an appointment, you just needed it to be an in and out kind of affair. We did however meet some lovely people. The sonographers were great (most of them. One of them we did name the baker as she would use that internal scan wand like she was mixing a heavy cake mixture!). We saw a lot of people but there were some who stick in your mind. One sonographer, Becky, who is also an awesome midwife was so good we carried on our private scans with her and still have a bit of an insta convo every now and then – she also has a great blog – go give it a read if you get five mins midwifenextdoor
But at the end of the day, everything aside, those people we saw at the clinic, as well as those behind the scenes do absolutely amazing work. If it wasn’t for them we would not be mums to this little beaut.