Briss
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Natural IVF. IMSI, FSH 30, low sperm count and morphology
My dear husband (DH) and I have been together for about 11 years, started trying to conceive (TTC) when I was 34: not too early and not too late (or so I thought). Seemed like a good age to have a family: our careers were established and we have enjoyed our life together and were ready to have a child. I did not think it will be hard. However, it took us 5 years, 7 IVFs, 1 chemical pregnancy and 1 miscarriage. I have to say I was not coping with this very well. I just carried on even though I was completely emotionally drained and physically broken. It's been 5 long years, I was nearing 39, but my ovaries were aging much faster than I was. We tried everything under the sun and every single thing we tried failed to get us any closer to pregnancy. It even seemed like it was actually getting worse. Racing against time was an exceptionally frustrating and heart-breaking experience. I had to say goodbye to my high flying career as TTC became my full-time job. I lost most of my friends as no one in the real world could remotely relate to what we were going through so they ended up (unintentionally) hurting me. I really could not afford any more pain on top of what I was getting from TTC. despite all that we carried on.
I guess my point is that even with low sperm count and practically zero morphology and FSH of 30!!! and when everything is against you and you are constantly told to give it up, you can still get pregnant with natural IVF. But of course you need to have your cycle and ovulation.
Apologies in advance that my post is not well-written, partly as a narrative and partly as a diary. I was writing and re-writing parts over a period of time so it may not flow that well. Also sorry that it turned out to be such a long post but I hope it will be helpful for someone struggling as I was. I have to warn you that my story starts as fairly optimistic and happy and gradually turns sour and negative.
Step 1: We are making a baby! DH and I have been together for over 8 years, married for around 2 years. We are close to 34 and in a good place career wise so looks like the right time to start a family. We stopped using protection! For some reason I assumed a random BD session will get us there… I could not be more wrong. Apparently it only works when you do not want to get pregnant.
Step 2: Light hearted TTC. I feel totally fertile but to improve our chances I leant about OPK, folic acid and vitamin D and for the first year it was completely stress free, we BD when we felt like it but I did try to ensure that we do it at least once during the fertile period every other month. Did not work but we are still very hopeful, after all we are only 34 and totally healthy.
Step 3: Medical check up (GP): me - fine, DH - low sperm count. No idea what this means but I am sure whatever it is we can deal with it. Referred to an NHS fertility specialist (FS), went through every know test including lap&dye/hysteroscopy; HSG; cycle monitoring; lots of blood tests (bloods) etc etc. me – fine but "old" (+ a small complex cyst on the right ovary); DH – low sperm count. FS said we should do IVF asap. Refused to believe this was our only option. Slightly depressed but decided to persevere naturally. I am only 35…
Step 4: TTC as a full time job. Did lots of research and started taking it seriously: started using a fertility monitor (CBFM) and recording my basal temperature every morning (temping), we must not miss ovulation but with DH and me both working long hours having sex in weird places became the norm (btw baby changing facilities in Canary Wharf are pretty good for this purpose in case you were wondering); consumed tonnes of vitamins; adopted serious lifestyle changes (bye bye my beloved coffee, hello wheatgrass) etc etc. Having read the entire world library of TTC related books and medical studies I am becoming a serious specialist in TTC and fertility and can easily write a PhD on this subject (but who's got the time!). Another year passed and things are getting worse. DH SA is worse; me – turned 36 and FSH is rising. FS urged us to do IVF. I refused again. We have not exhausted our natural options yet.
Step 5: Traditional Chinese medicine (TCM). I became disillusioned with Western medicine that only provides one answer to most fertility problems: IVF. Turned to wise Chinese men (and women). Tonnes of carefully selected books studied; thousands of needles inserted; litres of nasty Chinese herbs consumed + cupping, moxa, reflexology; I changed 3 practitioners and spent a small fortune on TCM. one more year passed: DH: still low count + low morphology; Me: turned 37 and FSH is at all time high at 19!. FS said it is now too late to do IVF, my ovaries will not respond to stimulation. it is possible for us to get pregnant naturally but there is no guarantee and it may take many more years. Since we have exhausted all natural methods we decided it's time to go artificial route. better late than never…
Step 6: private IVF 1. Decided to start with natural IVF, all seemed OK, the dominant follicle is growing nicely; lining is fantastic; blood flow is perfect; DH's morphology is low so ICSI is the only option; the egg fertilised; grade 1 embryo with no fragmentation transferred and for the first time in years I could see two nice lines! result! not so fast. OTD: the second line disappeared; beta is very low – this was just a chemical pregnancy. was hit very hard but determined to see only positives – at least some kind of attempt at implantation. we are getting closer.
Step 7: private IVF 2. the clinic suggested to step up and do ovarian stimulation (stims). Looking back that was a huge mistake. My ovaries did not respond to low stims – only 2 follicles are growing out of 10; the dose increased – the third follicle developed. EC is a nightmare: Only one mature egg. I had a temp rise in the morning and suspected I ovulated and turned out I was right. one of the two follicles on the left disappeared – the best egg is lost to early ovulation. Somehow, the doc managed to get one more egg from my right ovary without touching the cyst so we had 2 eggs collected but the lab later confirmed that only one egg was mature for ICSI. The only mature egg was not of good enough quality and did not fertilise. devastating. But just to make sure I am completely crushed by the whole experience - got my AF out of the blue 3 days early. giving me a super short 23 day cycle and only 11 day LP. this has never ever happened before even when i had the lap my cycle was not screwed like that. there is just something not right with the meds and my body, they do not mix well. Need time to get my body to recover from this medical hell…
Step 8: urologist. DH could not take it any more seeing me taking on all these meds and finally agreed to go to the best urologist in town and do whatever he is told to try to improve his SA (with hard-core medication this time rather than naturally or with Chinese herbs). Our FS refused to refer him to a urologist as she believed IVF was our only option and nothing can be done to improve SA. We have to go privately. Various tests and examinations done; low testosterone levels revealed. DH was put on tamaxofen. DH also quit beer! and agreed to take a billion of vitamins every day. testosterone level went up so did his sex drive - thank you very much!! count still low; 8 months on tamaxofen - count is getting lower. urologist says it is unlikely to improve. Morphology is still 0-1%. recommended IMSI + stim IVF (to get more eggs and a choice of embryos) seems the only way forward.
Step 9: NHS/IMSI 3. Begged my FS to refer us for IVF on the NHS. Finally she agreed with the caveat that we will be refused funding anyway due to my high FSH. waited 6 months for the initial appointment; did all the tests and bloods; finally got the funding approved (just between us I stuffed myself with vitamin D to increase AMH levels and played on estrogen/FSH rationship to get the right day for FSH testing - managed to get just below 12 so under the threashold) - 4 months after that started short protocol; stimulation with maximum dose, only 3 follicles are growing; LH went up early so suggested abandoning the cycle in case of early ovulation; Decision is made to carry on. On the morning of EC scan revealed that the largest follicle shape is uneven - sign of ongoing ovulation, still decided to proceed with EC - a miracle we caught that egg and 3 more! absolutely delighted! but not for long. Within hours after EC I developed severe abdominal pain, was hospitalised and diagnosed with haematoperitoneum - intra-abdominal bleeding caused by a blood vessel that was accidently punctured during EC (they never ever tell you something like this can happen!); Lost up to a litre of blood. blood trapped in my abdomen is causing terrible pain even morphine does not help. while in hospital in agonising pain I got a call from the lab informing me that none of the eggs fertilised - total devastation. it took me 6 weeks to recover and about 8 weeks before I felt strong enough to actualy cry about what happened. I am now 38.
Step 10: abroad we go or back to natural IVF: decided that stim IVF does not really work for me - I do not produce many follicles and egg quality gets compromised by stim meds and/or poorly managed maturation process so natural IVF it is. After some more reaseach I realised that it's going to take many months of natural IVFs before we will get anywhere so no way we can pay 3-6K for each try in the UK - exploring Europe in particular Czech Republic, Germany, Spain, Greece.
Natural IVF in Brno: clinic is very approachable, everything is done via email; direct contact with the doctor (unlike the UK where you get seen by a different doc every time you come, here you are monitored by the same doctor); they suggested to try mild stims but I am determined that natural IVf is the way forward for us; after a few emails where I explained the reasons and how cetrotide fails to stop me ovulating in medicated cycles and how this affects the egg maturation process, the doc agrees that we should try natural IVF. a scan on day 9 revealed 2 large follicles (without any stimulation!) ready for picking, trigger shot administered the same evening; DH and I flew to Brno for EC the next day after trigger. Checked in at the clinic at 8 am, am scared terribly cos of my previous unfortunbate experience with internal bleeding from EC but I said my mental goodbyes to everyone so I am ready, where is that doctor! started panicking as I feel like we are losing that egg; was taken to the theatre only around 10 am (in tears - too late!); there were 2 follicles still seen on the scan so there is hope; EC done with no sedation or painkillers (no antibiotics either for that matter) - painful but super quick. bad news - no eggs collected. where have the eggs gone? I had strong estrogen levels before the trigger which indicated that I should have had eggs or at least an egg, apparently not getting that egg out is the side effect of natural IVF, sometimes it's a bit too late and the egg gets away (could be just before the procedure), empty follciles is also posibility as well as human error. I am 38.5, I did not even cry, I think I am beyond tears at this moment. we are going to try again next month.
Natural IVF in Brno - take two: our doctor seems very optimistic we can try again the very next cycle. The process is the same I do all my scans/bloods in London and fly over to Brno with DH the day before EC. We got the egg!! so happy. The clinic does not do IMSi but they offered PICSI. unfortunately DH's sperm sample is not good enough so we had to go with just ICSI. nervously waiting for fertilisation report - all is well we can come for ET on day two. It was a very happy Christmas, hoping for good news but unfortunately it's a BFN.
Natural IVF in Munich: We loved Brno but decided it's time we move on mainly because we really needed IMSI to improve our chances. Germany proved far more challenging than CR as everything is in German so filling in consent forms took ages - thank you google translate! The first cycle did not work as I somehow managed to ovulate by day 8 - that never happened before - blaming Czech progesterone for that. Trying again next month. One follicle seems to be growing but bad luck - I got a terrible cold and was very ill so was not sure if we could go ahead but we went to Munich anyway (still not sure how I managed to board that plane feeling so crap). Luckily my temperature was down on the morning of EC and they went ahead. We got one egg. Very unexpectedly i had two follicles on the scan before the procedure, no idea where the second one appeared from but they were both the same size. that second follicle on the right had an egg but the main one on the left did not. very strange. Maybe my body switched follicles in the last minute because of my illness? the procedure was very brutal, no sedation and it took 5-6 punctures before they got to my left follicle (apparently it's higher than then the right one), i was close to passing out from pain. I am not sure I can find it in me to do that again. I will ask for sedation next time. I also started bleeding after the procedure. and all that on top of my general chest infection. basically in the end the egg fertilised. It's really strange how I never get any fertilisation on stim cycles but my eggs tend to fertilise when it's a natural cycle. We went for IMSI this time as the sperm sample was not great. I had the transfer on day 2. I was still bleeding but they said it's vaginal from EC wound so not an issue. I saw my beautiful embryo on the screen before the transfer
I am PUPO!!! but so unwell i am still coughing and my chest hurts a lot but I am so pleased!
Step 11: BFP: happy ending at last? no, not really, more drama and heartache in store for us. It started really well, two perfect lines, HCG is fantastic from the start and doubling well as it should. 21 day post ovulation/EC (DPO) scan is promising - we got a little dot in the uterus. our pregnancy is on the way. 35 DPO scan: no heart beat (HB). what? why? after everything I've been through to get here?? is it possible that it's too early? the NHS says "maybe" come back in two weeks. Munich told us to repeat my HCG and they have not increased as well as expected and 3 days later they started to go down - this is the end, was told to stop progesterone. A few days later I started bleeding and the embryo was gone the next day. I was the saddest when I was told it's likely going to be a missed miscarriage which happened a week earlier cos by that time I already lost my pregnancy symptoms so I was suspecting something was not right. When the actual bleeding started I was relieved cos my body finally recognised the situation and started doing something about it. Too much information warning (TMI): when i was told that i actually need to "give birth" to miscarriage (mc) i thought it was figurative. apparently not. I had proper uterine contractions for about 6 hours before I passed the embryo (most of it was on the plane cos we were abroad at the time and by that time i had about a few moments between the contractions and they were so intense my legs were shaking). I never had a mc before so was not sure what to expect and how to manage it. my body did everything for me I was just observing and despite the sadness of it all i could not help but admire my body. it's absolutely marvellous in how it knows what to do without any instruction or help from me.
I supposed I should admit that at least in that I was lucky, my body managed my MC really well without any medical intervention. Now, what do we do next? We were lucky to get pregnant on our first natural IMSI. we have sperm issue (on top of my FSH) so all our ICSIs failed but even IMSI cannot guarantee they can pick a sperm that's chromosomally sound hence the MC (I think but it may as well be poor egg quality that cycle due to age). we cant do the genetic testing of our embryo cos we only get one per cycle. I really do not know what to do to minimise the chance of MC. The clinic told me the best thing is to do D&C and karyotyping of the embryo but I really did not want any intervention. I think my body can manage everything better if less medication or medical intervention is used. also it can only tell us if the embryo was chromosomally abnormal which is the most likely reason for a mc. if this is the case, there is not really much you can do, is there? I have been thinking about immunes but somehow I think our MC was most likely due to an accidental chromosomal error. Immune tests are so expensive, we could use this money on our next IVF. also, from what I read if a mc is due to immunes it usually happens a bit later (week 8 or so) and you could also see a HB on a scan which then stops. In our case the embryo slowed its growth around week 5-6, there was never a HB and the actual mc happened at week 8.
Step 12: more tests: after a MC you feel you need a closure. why did it happen and what can I do to make sure the next pregnancy goes to term (if you are lucky to get a BFP again, that is)? read tonnes of books on miscarriage and immunes. decided to investigate: hundreds of new tests done. visited an endocrinologist and reproductive immunologist. discovered that my thyroid is absolutely fine and not to blame. Blood clotting tests seem OK. immunes seems overall OK but Dr G would run some further tests which I did not think were necessary (and all quite costly), discovered I have genetic issue in absorbing synthetic forms of folic acid and B12 so these were replaced with natural forms (goodbye folic acid) - nutritionist consulted. Overall conclusion: MC is most likely due to bad egg/sperm due to age/sperm issues.
a slight diversion here to talk about infections and in particular the mysterious "hidden C". I do not have the final answer on that but I feel this is important to mention. generally it's a very good idea for both partners to take a course antibiotics from CD 1 for a couple of weeks to clear any possible infection. there can be many and it's impractical to try and test for them all, easier just to take antibiotics (AB). Important that both partners do it at the same time to avoid re-infecting each other. Surprisingly, it can also improve sperm situation which can be caused by undetected infection. I should have thought of that before actually. While DH and I did take AB in the last 5 years we never did it simultaneously. In my quest to find the reason for MC I sent a sample of my menstrual blood to Greece (what a weird thing to do but it gets to a point where this seems like the most natural next step). A clinic In Greece studies samples for any possible infection and suggests a course of antibiotics. I was tested for any possible STD many times over by traditional methods in the UK but getting all negative did not seem to answer my questions and this clinic was promising to do a more thorough analysis. To my shock it came back positive for chlamydia or what they call "hidden C". WTF??
In fact I received two test results from two different Greek labs and one said negative while the other said positive. the Greek clinic is adamant the positive one is correct and we should immediately start a 25 day AB. unfortunately by the time I got the result I already had ET and with embryo inside trying to implant I have no wish to take AB unnecessarily. I am in agony researching the hidden C - there seems to be two opinions: (i) mainly medical community - hidden C is a total nonsense - you do not have chlamydia; (ii) mainly ladies who tested positive, then had AB + Hysto and got pregnant or not - swear this is the reason for infertility. I was in correspondence with the Greek doc and the lab itself for a few weeks trying to understand the test result but i did not get any closer. My main issue is that the positive result lists about 15 names of various strains of Chlamydia - so what exactly I had been "diagnosed" with? The Greek clinic is adamant what I have is Chlamydya trachomatis because the blood came from uterus. but the lab could not conclusively confirm that, they just say it is Chlamydiaceae DNA (which includes the following strains: Chlamydia trachomatis, Chlamydia muridarum, Chlamydia suis, Chlamydophila pneumoniae, Chlamydophila psittacii, Chlamydophila pecorum, Chlamydophila abortus, Chlamydophila felis and Chlamydophila cavia). It could be any of those but among them the only relevant one is Chlamydya trachomatis, the rest do not seem to have any effect on fertility and actually most people would test positive particularly if you had chest infections as a child (also caused by a chlamydia strain - Chlamydophila pneumonia but not by sexually transmitted Chlamydya trachomatis) or Chlamydia can also show up if you suffer from asthma. I feel the Greek clinic does not understand this test and the lab is just being vague on purpose. I am quite sure if you take a vaginal swab and check it for the entire Chlamydia family it will come back as positive for a lot of women but somehow our labs do not do it, they only check specifically for Chlamydya trachomatis and not any other chlamydia strain. also the life code test that I did on the same blood sample specifies that you are being tested for Chlamydya trachomatis and it came back as negative and I think that's the key why the other Greek lab has such high % of positives. The Greek clinic should know better than telling us this test is "more sensitive"?? it's not, it's just broader than necessary which is unhelpful. Unless i can see a piece of paper that says i tested positive for any particular chlamydia strain I can't see any use in this test if I am honest. but I worry nevertheless. I should never have done this test
also their explanation that chlamydia can hide in parts of uterus and that's why it's sometimes very hard to treat even after several rounds of AB - is this really accurate?. Chlamydia trachomatis is one of the most treatable things you can get, responds really well to AB. But Chlamydophila pneumonia on the other hand is almost impossible to get rid of (but not because it hides but because it exists in different forms). the question is whether we really need to try to clear it? as far as i understand it does not have any affect on TTC. again, everyone keeps telling me that you need to take AB not to clear this infection but to suppress it. I really do not see how this can work. it only develops resistance to AB over time which is not the result you want. I had to spend a lot of time researching the issue and talking to Greek doctors, the lab itself and other professionals before I became comfortable that taking AB after ET would be a far more risky strategy. Even then a part of you would still doubt your decision so my advice based on tonnes of research - do not do this test! it's just not helpful in a way that it does not tell you which strain of chlamydia family you have tested positive for which is the most important thing you need to know.
Step 13: back to natural IVF or the story of my last 38 year old egg. Decided to try again the very next cycle after MC but the clinic missed my egg. Trying again next month. Consulted two more clinics: in Greece and in Prague as well as my previous clinic in Munich. loving Munich more than other options as they are the ones that got me pregnant but was informed they cant do EC on a weekend. what? it's a natural cycle i can't tell my body when to ovulate!
Tuesday: The first scan showed a functional cyst and my dominant follicle is not as big as it's supposed to be. it's CD 7 and it's only around 10.5 mm, Looks like I am going to ovulate on Sunday. have been stretching between the 3 clinics (so stressful) and still no idea who is going to take me on. Spoke to Athens and they are concerned about this cyst and the fact that they have not seen me (we only communicated by email) so they are not sure they can offer the best care but not rejecting me completely so there is still hope. Munich can only take me if I ovulate on Monday but it does not look very likely. they are also not happy with my today's scan. have scheduled another scan on thursday so we will hopefully know then if this cycle has any hope. but tbh, despite it not looking very optimal I am still sure I'm going to ovulate and have an egg this month so I really want to give it a chance. spent hours trying to work out the logistics of going to Athens. Tomorrow will have to do the same for Prague in case we end up there on weekend.
Thursday: another disappointing scan, does not look like I have a proper follicle, small ones are still there but the only large one on the left may or may not be a cyst. it started having an irregular shape so possibly it's releasing my egg or just some liquid if it's a cyst. how confusing. will have another scan tomorrow but it just does not look like I will be going anywhere this week… how disappointing to be wasting a second cycle after my MC.
Working with three clinics is a nightmare as everyone makes different conclusions: are they looking at the same scan/bloods? Prague says we should do another scan tomorrow, Munich says ready to trigger either today or tomorrow and Athens says trigger tonight for EC Saturday. My gut feeling is that I have at least one more day before the trigger. I could be wrong. I am also not clear if this is a good follicle or a cyst. For some reason no one cares about the smaller follicle on the right. Everyone's focus is on the follicle/cyst on the left. Serum's view is that it has an egg but they do not know me. I usually get higher estrogen levels on the day of trigger then what I have today. another practical matter is that it's almost impossible to get a flight to Athens for tomorrow evening. I am so stressed. Do I give up on Athens for this cycle and see what Prague suggests tomorrow? It's much easier to travel to Prague than Athens. it could also be too late if my CBFM shows a peak tomorrow. Athens sounds so confident about triggering now. Should I just go with it?
I really struggled to make a decision. We discussed it at lengths with DH whether or not to trigger. In the end I did not take the trigger thinking ovulation on Sunday is more likely and I'd trigger the next day and go to Prague. fingers crossed.
Friday: I was afraid I get my LH surge this morning but CBFM was still on high which was encouraging - it seems like it was a right decision not to trigger yesterday. However, after this morning's scan it does not look like I am going anywhere this cycle. This cycle just did not look normal from the start. My large follicle (or cyst) was over 20 mm by day 7 and then it went down to 18 mm on day 9 and today it was already down to15 mm?? If it's a follicle with an egg it's supposed to grow not to shrink! That's really puzzling. possibly I ovulated super early or am ovulating now (have very common ovulation pains at the moment) or it might just be a cyst. I am struggling to understand this cycle. but what I did not want to do is to spent a lot of money to go abroad just to have an EC/puncture without feeling any confidence in there being an egg. my estrogen levels are good but cysts also produce estrogen so how do I know if there is an egg particularly when the follicle is shrinking rather than growing. it's disappointing but I am OK with that because I can see my ovaries are just not playing nice this month.
Repeated my LH and progestrone today: LH is still relatively low and progesterone does not suggest that ovulation has started. Yet Prague said my follicle on the left does not look right and the one on the right is too small and did not grow much - suggested to abandon this cycle. Sad.
Saturday: it's getting more and more confusing. After talking to Prague I started letting go of this cycle. I was expecting a peak on my CBFM but instead it stayed on HIGH, again it could either be that my egg is still growing and i will get my LH surge later or that this is a bad cycle and I won't get LH surge at all (it happened in the past a couple of times). I was still mentally letting go but then Munich came back and asked me to do my LH test today and if it's OK we may still make a decision to trigger tonight for EC Monday. having mixed feeling of hope and false hope.
I did not trigger in the end. my LH was 14.5 and Munich decided it's too high and I will ovulate on sunday night which is too late for monday morning EC. if I am honest LH 14.5 is not high at all and in the past I triggered with LH being over 40! and we still got the egg. I did not want to argue this time cos I am just not confident in what's going on. My progesterone was still low so no ovulation has happened yet. I am hoping to get a peak tomorrow to restore the normality of this cycle. if my CBFM stays on HIGH it's probably going to be anovulatory cycle. I am gradually trying to focus on my next cycle. I am going to be away on holiday but luckily a local fertility clinic agreed to do scans/bloods for me (so much cheaper than London!) so I can hopefully start my next cycle there and fly to Munich if necessary I can only hope I will be ovulating on a weekday next cycle so Munich can take me on. I found it rather stressful to be dealing with several clinics because they all had a completely different opinion on what's going on with my cycle and when to trigger. still not sure which clinic was close to the correct timing. time will tell.
Sunday: no peak for me this morning so it does look like I may not be ovulating this month. dealing with 3 clinics was stressful but it was still better than the feeling of sadness and depression that I am getting today. this cycle was my last chance to get pregnant at 38... bring on 39! I do feel rather scared that this cycle is not a one off but an indication of my FSH results (which was 30!! last month) but I must keep on hoping next cycle will be normal. Decided to go out shopping to pick myself up. I went to all the "young" shops like top shop and bought stuff that would remind me that I am still young. I really needed that considering my FSH levels.
Monday: I got a PEAK!! OMG, what's happening? I actually already knew that on Sunday night cos my sex drive was outrageously high and I could not sleep all night. This means the egg is still there because most cycles I ovulate the next day after peak. Wrote to Munich begging to take me for emergency EC the next morning but they did not want to without trigger shot cos they could not time EC. Feeling desperate. Rushed for a scan in the afternoon and sure enough there was a 17 mm follicle on the right side and my left side cyst resolved. Why no one cared to observe my right follicle? I did ask many times to check up on this follicle because somehow I was sure from the first scan that the dominant follicle for this cycle is growing on the right. Feeling let down but the clinics but I must try and try. It took quite a few emails to persuade Munich to give us a chance. They did not want to take a risk as I may ovulate during the night. I kept on writing begging emails while swallowing indometacin as I was reading their responses cos it does help keep the follicle intact for EC. In the end they said "fine", risky but there is a small chance. I booked last minute BA flights on Monday night (cost a fortune). made up some medical emergency at work. Chaotically packed a bag for DH and myself and rushed to the airport. I must be mad but that's TTC for you.
Tuesday: we are at the clinic by 7.30 am. Emergency scan - the follicle is still there but it's still 17 mm, has not grown since yesterday. The doc thinks the egg may not be mature and really hard to say anything as we do not know when LH surge started without the trigger shot. He tried to convince me to abandon this cycle and try to do some stims next month. He could see quite a few small follicles which could give us a better chance next month. I am getting annoyed but trying to be patient and explain why stims do not work for me and why I think this is the perfect time to pick up my egg. In the end the doc gives up and I am rushed to the theatre. No sedation (ouch!) but the egg came out after the first puncture. It was so much easier than the last time when i had to have 6-7 punctures on both sides. I know we have very little hope but at this point I only live on little hope anyway so at least it's a chance. The agonising wait for fertilisation report begins. DH is off to London. I am staying in Munich and learning the German word for "fertilised". Rather unhelpfully they send the report in German so previously I was close to fainting by the time I managed to work out whether we have an embryo for transfer so trying to be prepared.
Wednesday: [Befruchtete!] It fertilised!!! Going for well deserved schnitzel and apple strudel.
Thursday: Very uneventful embryo transfer. unfortunately the embryo was only 2 cells but the doc was still very encouraging and said it was still morning and they fully expect the embryo to turn 4 cells in the afternoon. I know that chances are slim but it's still a chance so I am in a better place today than I was last week. what i take from this dramatic experience is that we can't let go really and have to keep a close eye on our cycles as clinics do get it wrong. I am grateful Munich trusted my gut feeling. If I ever write my memoirs I'd call this chapter something like "how my ovaries outsmart three fertility clinics" I guess they did not want to go through EC so they fooled everyone by growing a cyst so the clinics got distracted and did not notice that on the other side my ovaries were slowly growing the egg. I love my ovaries! regardless of FSH...
Step 14: Keep calm and carry on. We went on holiday after ET and tested on 11 DPO - BFN. Was disappointed but then with natural cycle it does take a few attempts so I was ready to try again. My clinic wanted to see blood test results before allowing me to stop progesterone but it was taking a few days to get the result and I was worried that progesterone could screw my next cycle (happened before) if I do not stop it earlier so I started reducing my dose despite the clinic's instructions. on 13 DPO I was about to give up progesterone completely but a part of me had doubts so just to be absolutely sure I rushed to the nearest pharmacy first thing in the morning (still holding my first morning urine (FMU)…
to get a clear blue test and to my surprise the second line appeared well before I finished peeing. I immediately went back on progesterone. Cursing myself for not being prepared and not taking first response (FRER) test stick with me on holidays. I did not expect not being able to buy FRER there and this is the best early test I know. I tested with local brand on 11 DPO and this test just was not sensitive enough to pick up my beta. Why did I trust it? I guess I am just used to being disappointed. I got my beta results in the evening which were 16 – low but still considered positive. I repeated my bloods on 14 DPO and the result was over 80. Was I happy? I was relieved - we are still in the game - not sure "happy" can describe it. But that was about time when I ordered some sterile containers to collect miscarriage tissue for karyotyping in case of MC ... very sad but after what I've been through one feels strongly that you are not allowed to feel happy because experience tells you that as soon as you do who knows what can happen. So stay focused and be prepared for every eventuality hence the sterile containers.
Next steps were a scan and a blood test on 21 DPO to make sure the embryo is implanted inside the uterus and check for beta levels doubling properly which they were. After that I had a scan on 31 DPO to check for a HB. I really cannot describe my state of mind when I entered the scan room but probably close to a person entering a court room awaiting his verdict. I am grateful the doc observed my state immediately and did not delay. I looked at the screen immediately as she inserted the probe and could just see the picture was not static, there was something flicking. "Here is the HB!" I could not stop the tears. I did feel truly happy... for about an hour but then doubt and fear returned. after so many years TTC and a very recent MC I was not able to relax at all. I had many more scans and bloods almost on a weekly basis because I was constantly so very scared and stressed. It's a shame really I saw other ladies waiting for scans all exited and happy while I was just seating there literally shaking with fear expecting all sorts of things. The safest approach for me was to just stay focused on going through the milestones - all part of an IVF cycle albeit a very long one.
I have now seen the HB 3 times, my HCG is doubling well, progesterone and estrogen levels are where they should be. Next step - Panorama! Considering my age and previous MC one does need to look at the chromosomal state of things and tests like harmony or panorama are probably the best way to do that early on. I picked panorama because it's available from week 9 and I really could not delay this because I was on edge all the time. I could not consider myself properly pregnant until I knew the baby had a chance. The test is only for the major chromosomal errors so it does not test for everything but it's still a great comfort and an indication of a healthy pregnancy. I would not go into detail about the state I was in while waiting for these results and the kind of negative thoughts that run in my head and all the planning I did for ANY outcome – all not helpful. When I got my "low risk" result I literally had to shut the door to my office and cried and laughed uncontrollably for about 30 min. This is the first time (even though i was 11 weeks) that I finally admitted to myself that I AM pregnant. and it's a Girl!!
p.s since writing this story i am happy to report that i gave birth to a baby girl even though my birth experience was very traumatic and the first few months proved to be extremely challenging I think more and more about TTC again. I do not know if it's even possible at this stage but I just know I must try.
My dear husband (DH) and I have been together for about 11 years, started trying to conceive (TTC) when I was 34: not too early and not too late (or so I thought). Seemed like a good age to have a family: our careers were established and we have enjoyed our life together and were ready to have a child. I did not think it will be hard. However, it took us 5 years, 7 IVFs, 1 chemical pregnancy and 1 miscarriage. I have to say I was not coping with this very well. I just carried on even though I was completely emotionally drained and physically broken. It's been 5 long years, I was nearing 39, but my ovaries were aging much faster than I was. We tried everything under the sun and every single thing we tried failed to get us any closer to pregnancy. It even seemed like it was actually getting worse. Racing against time was an exceptionally frustrating and heart-breaking experience. I had to say goodbye to my high flying career as TTC became my full-time job. I lost most of my friends as no one in the real world could remotely relate to what we were going through so they ended up (unintentionally) hurting me. I really could not afford any more pain on top of what I was getting from TTC. despite all that we carried on.
I guess my point is that even with low sperm count and practically zero morphology and FSH of 30!!! and when everything is against you and you are constantly told to give it up, you can still get pregnant with natural IVF. But of course you need to have your cycle and ovulation.
Apologies in advance that my post is not well-written, partly as a narrative and partly as a diary. I was writing and re-writing parts over a period of time so it may not flow that well. Also sorry that it turned out to be such a long post but I hope it will be helpful for someone struggling as I was. I have to warn you that my story starts as fairly optimistic and happy and gradually turns sour and negative.
Step 1: We are making a baby! DH and I have been together for over 8 years, married for around 2 years. We are close to 34 and in a good place career wise so looks like the right time to start a family. We stopped using protection! For some reason I assumed a random BD session will get us there… I could not be more wrong. Apparently it only works when you do not want to get pregnant.
Step 2: Light hearted TTC. I feel totally fertile but to improve our chances I leant about OPK, folic acid and vitamin D and for the first year it was completely stress free, we BD when we felt like it but I did try to ensure that we do it at least once during the fertile period every other month. Did not work but we are still very hopeful, after all we are only 34 and totally healthy.
Step 3: Medical check up (GP): me - fine, DH - low sperm count. No idea what this means but I am sure whatever it is we can deal with it. Referred to an NHS fertility specialist (FS), went through every know test including lap&dye/hysteroscopy; HSG; cycle monitoring; lots of blood tests (bloods) etc etc. me – fine but "old" (+ a small complex cyst on the right ovary); DH – low sperm count. FS said we should do IVF asap. Refused to believe this was our only option. Slightly depressed but decided to persevere naturally. I am only 35…
Step 4: TTC as a full time job. Did lots of research and started taking it seriously: started using a fertility monitor (CBFM) and recording my basal temperature every morning (temping), we must not miss ovulation but with DH and me both working long hours having sex in weird places became the norm (btw baby changing facilities in Canary Wharf are pretty good for this purpose in case you were wondering); consumed tonnes of vitamins; adopted serious lifestyle changes (bye bye my beloved coffee, hello wheatgrass) etc etc. Having read the entire world library of TTC related books and medical studies I am becoming a serious specialist in TTC and fertility and can easily write a PhD on this subject (but who's got the time!). Another year passed and things are getting worse. DH SA is worse; me – turned 36 and FSH is rising. FS urged us to do IVF. I refused again. We have not exhausted our natural options yet.
Step 5: Traditional Chinese medicine (TCM). I became disillusioned with Western medicine that only provides one answer to most fertility problems: IVF. Turned to wise Chinese men (and women). Tonnes of carefully selected books studied; thousands of needles inserted; litres of nasty Chinese herbs consumed + cupping, moxa, reflexology; I changed 3 practitioners and spent a small fortune on TCM. one more year passed: DH: still low count + low morphology; Me: turned 37 and FSH is at all time high at 19!. FS said it is now too late to do IVF, my ovaries will not respond to stimulation. it is possible for us to get pregnant naturally but there is no guarantee and it may take many more years. Since we have exhausted all natural methods we decided it's time to go artificial route. better late than never…
Step 6: private IVF 1. Decided to start with natural IVF, all seemed OK, the dominant follicle is growing nicely; lining is fantastic; blood flow is perfect; DH's morphology is low so ICSI is the only option; the egg fertilised; grade 1 embryo with no fragmentation transferred and for the first time in years I could see two nice lines! result! not so fast. OTD: the second line disappeared; beta is very low – this was just a chemical pregnancy. was hit very hard but determined to see only positives – at least some kind of attempt at implantation. we are getting closer.
Step 7: private IVF 2. the clinic suggested to step up and do ovarian stimulation (stims). Looking back that was a huge mistake. My ovaries did not respond to low stims – only 2 follicles are growing out of 10; the dose increased – the third follicle developed. EC is a nightmare: Only one mature egg. I had a temp rise in the morning and suspected I ovulated and turned out I was right. one of the two follicles on the left disappeared – the best egg is lost to early ovulation. Somehow, the doc managed to get one more egg from my right ovary without touching the cyst so we had 2 eggs collected but the lab later confirmed that only one egg was mature for ICSI. The only mature egg was not of good enough quality and did not fertilise. devastating. But just to make sure I am completely crushed by the whole experience - got my AF out of the blue 3 days early. giving me a super short 23 day cycle and only 11 day LP. this has never ever happened before even when i had the lap my cycle was not screwed like that. there is just something not right with the meds and my body, they do not mix well. Need time to get my body to recover from this medical hell…
Step 8: urologist. DH could not take it any more seeing me taking on all these meds and finally agreed to go to the best urologist in town and do whatever he is told to try to improve his SA (with hard-core medication this time rather than naturally or with Chinese herbs). Our FS refused to refer him to a urologist as she believed IVF was our only option and nothing can be done to improve SA. We have to go privately. Various tests and examinations done; low testosterone levels revealed. DH was put on tamaxofen. DH also quit beer! and agreed to take a billion of vitamins every day. testosterone level went up so did his sex drive - thank you very much!! count still low; 8 months on tamaxofen - count is getting lower. urologist says it is unlikely to improve. Morphology is still 0-1%. recommended IMSI + stim IVF (to get more eggs and a choice of embryos) seems the only way forward.
Step 9: NHS/IMSI 3. Begged my FS to refer us for IVF on the NHS. Finally she agreed with the caveat that we will be refused funding anyway due to my high FSH. waited 6 months for the initial appointment; did all the tests and bloods; finally got the funding approved (just between us I stuffed myself with vitamin D to increase AMH levels and played on estrogen/FSH rationship to get the right day for FSH testing - managed to get just below 12 so under the threashold) - 4 months after that started short protocol; stimulation with maximum dose, only 3 follicles are growing; LH went up early so suggested abandoning the cycle in case of early ovulation; Decision is made to carry on. On the morning of EC scan revealed that the largest follicle shape is uneven - sign of ongoing ovulation, still decided to proceed with EC - a miracle we caught that egg and 3 more! absolutely delighted! but not for long. Within hours after EC I developed severe abdominal pain, was hospitalised and diagnosed with haematoperitoneum - intra-abdominal bleeding caused by a blood vessel that was accidently punctured during EC (they never ever tell you something like this can happen!); Lost up to a litre of blood. blood trapped in my abdomen is causing terrible pain even morphine does not help. while in hospital in agonising pain I got a call from the lab informing me that none of the eggs fertilised - total devastation. it took me 6 weeks to recover and about 8 weeks before I felt strong enough to actualy cry about what happened. I am now 38.
Step 10: abroad we go or back to natural IVF: decided that stim IVF does not really work for me - I do not produce many follicles and egg quality gets compromised by stim meds and/or poorly managed maturation process so natural IVF it is. After some more reaseach I realised that it's going to take many months of natural IVFs before we will get anywhere so no way we can pay 3-6K for each try in the UK - exploring Europe in particular Czech Republic, Germany, Spain, Greece.
Natural IVF in Brno: clinic is very approachable, everything is done via email; direct contact with the doctor (unlike the UK where you get seen by a different doc every time you come, here you are monitored by the same doctor); they suggested to try mild stims but I am determined that natural IVf is the way forward for us; after a few emails where I explained the reasons and how cetrotide fails to stop me ovulating in medicated cycles and how this affects the egg maturation process, the doc agrees that we should try natural IVF. a scan on day 9 revealed 2 large follicles (without any stimulation!) ready for picking, trigger shot administered the same evening; DH and I flew to Brno for EC the next day after trigger. Checked in at the clinic at 8 am, am scared terribly cos of my previous unfortunbate experience with internal bleeding from EC but I said my mental goodbyes to everyone so I am ready, where is that doctor! started panicking as I feel like we are losing that egg; was taken to the theatre only around 10 am (in tears - too late!); there were 2 follicles still seen on the scan so there is hope; EC done with no sedation or painkillers (no antibiotics either for that matter) - painful but super quick. bad news - no eggs collected. where have the eggs gone? I had strong estrogen levels before the trigger which indicated that I should have had eggs or at least an egg, apparently not getting that egg out is the side effect of natural IVF, sometimes it's a bit too late and the egg gets away (could be just before the procedure), empty follciles is also posibility as well as human error. I am 38.5, I did not even cry, I think I am beyond tears at this moment. we are going to try again next month.
Natural IVF in Brno - take two: our doctor seems very optimistic we can try again the very next cycle. The process is the same I do all my scans/bloods in London and fly over to Brno with DH the day before EC. We got the egg!! so happy. The clinic does not do IMSi but they offered PICSI. unfortunately DH's sperm sample is not good enough so we had to go with just ICSI. nervously waiting for fertilisation report - all is well we can come for ET on day two. It was a very happy Christmas, hoping for good news but unfortunately it's a BFN.
Natural IVF in Munich: We loved Brno but decided it's time we move on mainly because we really needed IMSI to improve our chances. Germany proved far more challenging than CR as everything is in German so filling in consent forms took ages - thank you google translate! The first cycle did not work as I somehow managed to ovulate by day 8 - that never happened before - blaming Czech progesterone for that. Trying again next month. One follicle seems to be growing but bad luck - I got a terrible cold and was very ill so was not sure if we could go ahead but we went to Munich anyway (still not sure how I managed to board that plane feeling so crap). Luckily my temperature was down on the morning of EC and they went ahead. We got one egg. Very unexpectedly i had two follicles on the scan before the procedure, no idea where the second one appeared from but they were both the same size. that second follicle on the right had an egg but the main one on the left did not. very strange. Maybe my body switched follicles in the last minute because of my illness? the procedure was very brutal, no sedation and it took 5-6 punctures before they got to my left follicle (apparently it's higher than then the right one), i was close to passing out from pain. I am not sure I can find it in me to do that again. I will ask for sedation next time. I also started bleeding after the procedure. and all that on top of my general chest infection. basically in the end the egg fertilised. It's really strange how I never get any fertilisation on stim cycles but my eggs tend to fertilise when it's a natural cycle. We went for IMSI this time as the sperm sample was not great. I had the transfer on day 2. I was still bleeding but they said it's vaginal from EC wound so not an issue. I saw my beautiful embryo on the screen before the transfer
I am PUPO!!! but so unwell i am still coughing and my chest hurts a lot but I am so pleased!Step 11: BFP: happy ending at last? no, not really, more drama and heartache in store for us. It started really well, two perfect lines, HCG is fantastic from the start and doubling well as it should. 21 day post ovulation/EC (DPO) scan is promising - we got a little dot in the uterus. our pregnancy is on the way. 35 DPO scan: no heart beat (HB). what? why? after everything I've been through to get here?? is it possible that it's too early? the NHS says "maybe" come back in two weeks. Munich told us to repeat my HCG and they have not increased as well as expected and 3 days later they started to go down - this is the end, was told to stop progesterone. A few days later I started bleeding and the embryo was gone the next day. I was the saddest when I was told it's likely going to be a missed miscarriage which happened a week earlier cos by that time I already lost my pregnancy symptoms so I was suspecting something was not right. When the actual bleeding started I was relieved cos my body finally recognised the situation and started doing something about it. Too much information warning (TMI): when i was told that i actually need to "give birth" to miscarriage (mc) i thought it was figurative. apparently not. I had proper uterine contractions for about 6 hours before I passed the embryo (most of it was on the plane cos we were abroad at the time and by that time i had about a few moments between the contractions and they were so intense my legs were shaking). I never had a mc before so was not sure what to expect and how to manage it. my body did everything for me I was just observing and despite the sadness of it all i could not help but admire my body. it's absolutely marvellous in how it knows what to do without any instruction or help from me.
I supposed I should admit that at least in that I was lucky, my body managed my MC really well without any medical intervention. Now, what do we do next? We were lucky to get pregnant on our first natural IMSI. we have sperm issue (on top of my FSH) so all our ICSIs failed but even IMSI cannot guarantee they can pick a sperm that's chromosomally sound hence the MC (I think but it may as well be poor egg quality that cycle due to age). we cant do the genetic testing of our embryo cos we only get one per cycle. I really do not know what to do to minimise the chance of MC. The clinic told me the best thing is to do D&C and karyotyping of the embryo but I really did not want any intervention. I think my body can manage everything better if less medication or medical intervention is used. also it can only tell us if the embryo was chromosomally abnormal which is the most likely reason for a mc. if this is the case, there is not really much you can do, is there? I have been thinking about immunes but somehow I think our MC was most likely due to an accidental chromosomal error. Immune tests are so expensive, we could use this money on our next IVF. also, from what I read if a mc is due to immunes it usually happens a bit later (week 8 or so) and you could also see a HB on a scan which then stops. In our case the embryo slowed its growth around week 5-6, there was never a HB and the actual mc happened at week 8.
Step 12: more tests: after a MC you feel you need a closure. why did it happen and what can I do to make sure the next pregnancy goes to term (if you are lucky to get a BFP again, that is)? read tonnes of books on miscarriage and immunes. decided to investigate: hundreds of new tests done. visited an endocrinologist and reproductive immunologist. discovered that my thyroid is absolutely fine and not to blame. Blood clotting tests seem OK. immunes seems overall OK but Dr G would run some further tests which I did not think were necessary (and all quite costly), discovered I have genetic issue in absorbing synthetic forms of folic acid and B12 so these were replaced with natural forms (goodbye folic acid) - nutritionist consulted. Overall conclusion: MC is most likely due to bad egg/sperm due to age/sperm issues.
a slight diversion here to talk about infections and in particular the mysterious "hidden C". I do not have the final answer on that but I feel this is important to mention. generally it's a very good idea for both partners to take a course antibiotics from CD 1 for a couple of weeks to clear any possible infection. there can be many and it's impractical to try and test for them all, easier just to take antibiotics (AB). Important that both partners do it at the same time to avoid re-infecting each other. Surprisingly, it can also improve sperm situation which can be caused by undetected infection. I should have thought of that before actually. While DH and I did take AB in the last 5 years we never did it simultaneously. In my quest to find the reason for MC I sent a sample of my menstrual blood to Greece (what a weird thing to do but it gets to a point where this seems like the most natural next step). A clinic In Greece studies samples for any possible infection and suggests a course of antibiotics. I was tested for any possible STD many times over by traditional methods in the UK but getting all negative did not seem to answer my questions and this clinic was promising to do a more thorough analysis. To my shock it came back positive for chlamydia or what they call "hidden C". WTF??
In fact I received two test results from two different Greek labs and one said negative while the other said positive. the Greek clinic is adamant the positive one is correct and we should immediately start a 25 day AB. unfortunately by the time I got the result I already had ET and with embryo inside trying to implant I have no wish to take AB unnecessarily. I am in agony researching the hidden C - there seems to be two opinions: (i) mainly medical community - hidden C is a total nonsense - you do not have chlamydia; (ii) mainly ladies who tested positive, then had AB + Hysto and got pregnant or not - swear this is the reason for infertility. I was in correspondence with the Greek doc and the lab itself for a few weeks trying to understand the test result but i did not get any closer. My main issue is that the positive result lists about 15 names of various strains of Chlamydia - so what exactly I had been "diagnosed" with? The Greek clinic is adamant what I have is Chlamydya trachomatis because the blood came from uterus. but the lab could not conclusively confirm that, they just say it is Chlamydiaceae DNA (which includes the following strains: Chlamydia trachomatis, Chlamydia muridarum, Chlamydia suis, Chlamydophila pneumoniae, Chlamydophila psittacii, Chlamydophila pecorum, Chlamydophila abortus, Chlamydophila felis and Chlamydophila cavia). It could be any of those but among them the only relevant one is Chlamydya trachomatis, the rest do not seem to have any effect on fertility and actually most people would test positive particularly if you had chest infections as a child (also caused by a chlamydia strain - Chlamydophila pneumonia but not by sexually transmitted Chlamydya trachomatis) or Chlamydia can also show up if you suffer from asthma. I feel the Greek clinic does not understand this test and the lab is just being vague on purpose. I am quite sure if you take a vaginal swab and check it for the entire Chlamydia family it will come back as positive for a lot of women but somehow our labs do not do it, they only check specifically for Chlamydya trachomatis and not any other chlamydia strain. also the life code test that I did on the same blood sample specifies that you are being tested for Chlamydya trachomatis and it came back as negative and I think that's the key why the other Greek lab has such high % of positives. The Greek clinic should know better than telling us this test is "more sensitive"?? it's not, it's just broader than necessary which is unhelpful. Unless i can see a piece of paper that says i tested positive for any particular chlamydia strain I can't see any use in this test if I am honest. but I worry nevertheless. I should never have done this test
also their explanation that chlamydia can hide in parts of uterus and that's why it's sometimes very hard to treat even after several rounds of AB - is this really accurate?. Chlamydia trachomatis is one of the most treatable things you can get, responds really well to AB. But Chlamydophila pneumonia on the other hand is almost impossible to get rid of (but not because it hides but because it exists in different forms). the question is whether we really need to try to clear it? as far as i understand it does not have any affect on TTC. again, everyone keeps telling me that you need to take AB not to clear this infection but to suppress it. I really do not see how this can work. it only develops resistance to AB over time which is not the result you want. I had to spend a lot of time researching the issue and talking to Greek doctors, the lab itself and other professionals before I became comfortable that taking AB after ET would be a far more risky strategy. Even then a part of you would still doubt your decision so my advice based on tonnes of research - do not do this test! it's just not helpful in a way that it does not tell you which strain of chlamydia family you have tested positive for which is the most important thing you need to know.Step 13: back to natural IVF or the story of my last 38 year old egg. Decided to try again the very next cycle after MC but the clinic missed my egg. Trying again next month. Consulted two more clinics: in Greece and in Prague as well as my previous clinic in Munich. loving Munich more than other options as they are the ones that got me pregnant but was informed they cant do EC on a weekend. what? it's a natural cycle i can't tell my body when to ovulate!
Tuesday: The first scan showed a functional cyst and my dominant follicle is not as big as it's supposed to be. it's CD 7 and it's only around 10.5 mm, Looks like I am going to ovulate on Sunday. have been stretching between the 3 clinics (so stressful) and still no idea who is going to take me on. Spoke to Athens and they are concerned about this cyst and the fact that they have not seen me (we only communicated by email) so they are not sure they can offer the best care but not rejecting me completely so there is still hope. Munich can only take me if I ovulate on Monday but it does not look very likely. they are also not happy with my today's scan. have scheduled another scan on thursday so we will hopefully know then if this cycle has any hope. but tbh, despite it not looking very optimal I am still sure I'm going to ovulate and have an egg this month so I really want to give it a chance. spent hours trying to work out the logistics of going to Athens. Tomorrow will have to do the same for Prague in case we end up there on weekend.
Thursday: another disappointing scan, does not look like I have a proper follicle, small ones are still there but the only large one on the left may or may not be a cyst. it started having an irregular shape so possibly it's releasing my egg or just some liquid if it's a cyst. how confusing. will have another scan tomorrow but it just does not look like I will be going anywhere this week… how disappointing to be wasting a second cycle after my MC.
Working with three clinics is a nightmare as everyone makes different conclusions: are they looking at the same scan/bloods? Prague says we should do another scan tomorrow, Munich says ready to trigger either today or tomorrow and Athens says trigger tonight for EC Saturday. My gut feeling is that I have at least one more day before the trigger. I could be wrong. I am also not clear if this is a good follicle or a cyst. For some reason no one cares about the smaller follicle on the right. Everyone's focus is on the follicle/cyst on the left. Serum's view is that it has an egg but they do not know me. I usually get higher estrogen levels on the day of trigger then what I have today. another practical matter is that it's almost impossible to get a flight to Athens for tomorrow evening. I am so stressed. Do I give up on Athens for this cycle and see what Prague suggests tomorrow? It's much easier to travel to Prague than Athens. it could also be too late if my CBFM shows a peak tomorrow. Athens sounds so confident about triggering now. Should I just go with it?
I really struggled to make a decision. We discussed it at lengths with DH whether or not to trigger. In the end I did not take the trigger thinking ovulation on Sunday is more likely and I'd trigger the next day and go to Prague. fingers crossed.
Friday: I was afraid I get my LH surge this morning but CBFM was still on high which was encouraging - it seems like it was a right decision not to trigger yesterday. However, after this morning's scan it does not look like I am going anywhere this cycle. This cycle just did not look normal from the start. My large follicle (or cyst) was over 20 mm by day 7 and then it went down to 18 mm on day 9 and today it was already down to15 mm?? If it's a follicle with an egg it's supposed to grow not to shrink! That's really puzzling. possibly I ovulated super early or am ovulating now (have very common ovulation pains at the moment) or it might just be a cyst. I am struggling to understand this cycle. but what I did not want to do is to spent a lot of money to go abroad just to have an EC/puncture without feeling any confidence in there being an egg. my estrogen levels are good but cysts also produce estrogen so how do I know if there is an egg particularly when the follicle is shrinking rather than growing. it's disappointing but I am OK with that because I can see my ovaries are just not playing nice this month.
Repeated my LH and progestrone today: LH is still relatively low and progesterone does not suggest that ovulation has started. Yet Prague said my follicle on the left does not look right and the one on the right is too small and did not grow much - suggested to abandon this cycle. Sad.
Saturday: it's getting more and more confusing. After talking to Prague I started letting go of this cycle. I was expecting a peak on my CBFM but instead it stayed on HIGH, again it could either be that my egg is still growing and i will get my LH surge later or that this is a bad cycle and I won't get LH surge at all (it happened in the past a couple of times). I was still mentally letting go but then Munich came back and asked me to do my LH test today and if it's OK we may still make a decision to trigger tonight for EC Monday. having mixed feeling of hope and false hope.
I did not trigger in the end. my LH was 14.5 and Munich decided it's too high and I will ovulate on sunday night which is too late for monday morning EC. if I am honest LH 14.5 is not high at all and in the past I triggered with LH being over 40! and we still got the egg. I did not want to argue this time cos I am just not confident in what's going on. My progesterone was still low so no ovulation has happened yet. I am hoping to get a peak tomorrow to restore the normality of this cycle. if my CBFM stays on HIGH it's probably going to be anovulatory cycle. I am gradually trying to focus on my next cycle. I am going to be away on holiday but luckily a local fertility clinic agreed to do scans/bloods for me (so much cheaper than London!) so I can hopefully start my next cycle there and fly to Munich if necessary I can only hope I will be ovulating on a weekday next cycle so Munich can take me on. I found it rather stressful to be dealing with several clinics because they all had a completely different opinion on what's going on with my cycle and when to trigger. still not sure which clinic was close to the correct timing. time will tell.
Sunday: no peak for me this morning so it does look like I may not be ovulating this month. dealing with 3 clinics was stressful but it was still better than the feeling of sadness and depression that I am getting today. this cycle was my last chance to get pregnant at 38... bring on 39! I do feel rather scared that this cycle is not a one off but an indication of my FSH results (which was 30!! last month) but I must keep on hoping next cycle will be normal. Decided to go out shopping to pick myself up. I went to all the "young" shops like top shop and bought stuff that would remind me that I am still young. I really needed that considering my FSH levels.
Monday: I got a PEAK!! OMG, what's happening? I actually already knew that on Sunday night cos my sex drive was outrageously high and I could not sleep all night. This means the egg is still there because most cycles I ovulate the next day after peak. Wrote to Munich begging to take me for emergency EC the next morning but they did not want to without trigger shot cos they could not time EC. Feeling desperate. Rushed for a scan in the afternoon and sure enough there was a 17 mm follicle on the right side and my left side cyst resolved. Why no one cared to observe my right follicle? I did ask many times to check up on this follicle because somehow I was sure from the first scan that the dominant follicle for this cycle is growing on the right. Feeling let down but the clinics but I must try and try. It took quite a few emails to persuade Munich to give us a chance. They did not want to take a risk as I may ovulate during the night. I kept on writing begging emails while swallowing indometacin as I was reading their responses cos it does help keep the follicle intact for EC. In the end they said "fine", risky but there is a small chance. I booked last minute BA flights on Monday night (cost a fortune). made up some medical emergency at work. Chaotically packed a bag for DH and myself and rushed to the airport. I must be mad but that's TTC for you.
Tuesday: we are at the clinic by 7.30 am. Emergency scan - the follicle is still there but it's still 17 mm, has not grown since yesterday. The doc thinks the egg may not be mature and really hard to say anything as we do not know when LH surge started without the trigger shot. He tried to convince me to abandon this cycle and try to do some stims next month. He could see quite a few small follicles which could give us a better chance next month. I am getting annoyed but trying to be patient and explain why stims do not work for me and why I think this is the perfect time to pick up my egg. In the end the doc gives up and I am rushed to the theatre. No sedation (ouch!) but the egg came out after the first puncture. It was so much easier than the last time when i had to have 6-7 punctures on both sides. I know we have very little hope but at this point I only live on little hope anyway so at least it's a chance. The agonising wait for fertilisation report begins. DH is off to London. I am staying in Munich and learning the German word for "fertilised". Rather unhelpfully they send the report in German so previously I was close to fainting by the time I managed to work out whether we have an embryo for transfer so trying to be prepared.
Wednesday: [Befruchtete!] It fertilised!!! Going for well deserved schnitzel and apple strudel.
Thursday: Very uneventful embryo transfer. unfortunately the embryo was only 2 cells but the doc was still very encouraging and said it was still morning and they fully expect the embryo to turn 4 cells in the afternoon. I know that chances are slim but it's still a chance so I am in a better place today than I was last week. what i take from this dramatic experience is that we can't let go really and have to keep a close eye on our cycles as clinics do get it wrong. I am grateful Munich trusted my gut feeling. If I ever write my memoirs I'd call this chapter something like "how my ovaries outsmart three fertility clinics" I guess they did not want to go through EC so they fooled everyone by growing a cyst so the clinics got distracted and did not notice that on the other side my ovaries were slowly growing the egg. I love my ovaries! regardless of FSH...
Step 14: Keep calm and carry on. We went on holiday after ET and tested on 11 DPO - BFN. Was disappointed but then with natural cycle it does take a few attempts so I was ready to try again. My clinic wanted to see blood test results before allowing me to stop progesterone but it was taking a few days to get the result and I was worried that progesterone could screw my next cycle (happened before) if I do not stop it earlier so I started reducing my dose despite the clinic's instructions. on 13 DPO I was about to give up progesterone completely but a part of me had doubts so just to be absolutely sure I rushed to the nearest pharmacy first thing in the morning (still holding my first morning urine (FMU)…
to get a clear blue test and to my surprise the second line appeared well before I finished peeing. I immediately went back on progesterone. Cursing myself for not being prepared and not taking first response (FRER) test stick with me on holidays. I did not expect not being able to buy FRER there and this is the best early test I know. I tested with local brand on 11 DPO and this test just was not sensitive enough to pick up my beta. Why did I trust it? I guess I am just used to being disappointed. I got my beta results in the evening which were 16 – low but still considered positive. I repeated my bloods on 14 DPO and the result was over 80. Was I happy? I was relieved - we are still in the game - not sure "happy" can describe it. But that was about time when I ordered some sterile containers to collect miscarriage tissue for karyotyping in case of MC ... very sad but after what I've been through one feels strongly that you are not allowed to feel happy because experience tells you that as soon as you do who knows what can happen. So stay focused and be prepared for every eventuality hence the sterile containers.Next steps were a scan and a blood test on 21 DPO to make sure the embryo is implanted inside the uterus and check for beta levels doubling properly which they were. After that I had a scan on 31 DPO to check for a HB. I really cannot describe my state of mind when I entered the scan room but probably close to a person entering a court room awaiting his verdict. I am grateful the doc observed my state immediately and did not delay. I looked at the screen immediately as she inserted the probe and could just see the picture was not static, there was something flicking. "Here is the HB!" I could not stop the tears. I did feel truly happy... for about an hour but then doubt and fear returned. after so many years TTC and a very recent MC I was not able to relax at all. I had many more scans and bloods almost on a weekly basis because I was constantly so very scared and stressed. It's a shame really I saw other ladies waiting for scans all exited and happy while I was just seating there literally shaking with fear expecting all sorts of things. The safest approach for me was to just stay focused on going through the milestones - all part of an IVF cycle albeit a very long one.
I have now seen the HB 3 times, my HCG is doubling well, progesterone and estrogen levels are where they should be. Next step - Panorama! Considering my age and previous MC one does need to look at the chromosomal state of things and tests like harmony or panorama are probably the best way to do that early on. I picked panorama because it's available from week 9 and I really could not delay this because I was on edge all the time. I could not consider myself properly pregnant until I knew the baby had a chance. The test is only for the major chromosomal errors so it does not test for everything but it's still a great comfort and an indication of a healthy pregnancy. I would not go into detail about the state I was in while waiting for these results and the kind of negative thoughts that run in my head and all the planning I did for ANY outcome – all not helpful. When I got my "low risk" result I literally had to shut the door to my office and cried and laughed uncontrollably for about 30 min. This is the first time (even though i was 11 weeks) that I finally admitted to myself that I AM pregnant. and it's a Girl!!
p.s since writing this story i am happy to report that i gave birth to a baby girl even though my birth experience was very traumatic and the first few months proved to be extremely challenging I think more and more about TTC again. I do not know if it's even possible at this stage but I just know I must try.
what a detail research you have done. I give you a virtual Nobel Price. This story is a nice draft to write your book.
