IVF Long Protocol - The good, the bad, and possibly ugly

My Purple IVF kit is complete.  I picked up the last of all of it yesterday and it has blown my mind somewhat.  The Huge big fat needles for one of the injections are also freaking me out a bit.  In order to restore my sanity and sense of control, I researched what each one of the things I will be taking is, does and may do to me.

So here it all is, more for me than for you                

The Pill (BCP) Femodene - start on day 1 of the cycle the month before IVF treatment

Dosage – 1 tablet a day

What it does - Femodene  is a low-dose monophasic oral contraceptive with estrogenic (stops ovulation ie the body doesn’t release the egg) and progestogenic (changes cervical mucous conditions to inhibit the implantation of a fertilised ovum)peripheral effects.

Why do I need it? – To regulate my ovulation and make my period predictable before we start this IVF cycle.  I was on Clomid which was making me ovulate more than 1 egg at a time.  This will get everything back to normal before we start with the heavy injectable stimulants.

Side Effects -  breast tenderness, pain, secretion; headache; migraine; changes in libido; depressive moods; contact lens intolerance; nausea; vomiting; changes in vaginal secretion; various skin disorders including pigmentation; fluid retention; change in body weight; hypersensitivity reaction.

Ok, that one isn’t so bad…. What happens next?

Lucrin – Start on Day 21 of the cycle the month before IVF treatment and continue until Aspiration Day

Dosage – 20 Units per day, Injected Subcutaneously in the belly area at 6pm

What it does - Lucrin  causes the pituitary gland to release high amounts of FSH (Follicle Stimulating Hormone) and LH (luteinizing hormone) for several days until its stores are depleted. Since continued use of Lupron prevents the pituitary gland from producing new supplies of FSH and LH, the amount of these hormones being released per day becomes very low after 7 to 10 days. The goal that we achieve with Lupron is to ensure that blood levels of LH are low during the last few days of follicle growth, since we know that high levels of LH can lead to poor egg quality and stimulate progesterone production by the ovaries. A premature rise in progesterone may cause inappropriate maturation of the uterine lining and lead to a lesser chance of embryo implantation.

Why do I need it? My egg quality is in doubt, so the Lucrin helps, alongside diet and reflexology, to get the best eggs possible out on Aspiration Day.

Side effects - hot flashes, vaginal dryness, etc.; however, these often go away after stimulation begins since estrogen levels start going up with gonadotropin treatment.

Fostimon –Only on day 2 and 3 of IVF Cycle

Dosage – 2 powers to one water ampule

What it does - Fostimon injections contain the active ingredient urofollitropin, which is a form of follicle stimulating hormone (FSH).  FSH directly affects the ovaries in women, where it increases the number of growing follicles and stimulates their development. Within the follicles are the developing eggs. FSH also increases the production of oestrogen, and under the influence of this hormone, the largest follicles continues to develop.

Why do I need it? Because this is an IVF cycle we want to get as many eggs out, of good quality, at one time as we can, so that if the cycle doesn’t work, there is a chance of having some embryos to freeze.  In tht way you don’t have to go through the stimulating process again.

Side Effects - Over-stimulation of the ovaries (ovarian hyperstimulation), causing the production of many eggs (see warning section above); Headache; Constipation; Bloating of the abdomen; Pain at the site of injection; Disturbances of the gut, such nausea, abdominal pain, indigestion; Lethargy; Dizziness; Changes in mood; Difficulty in breathing (dyspnoea); Increased activity of the thyroid gland (hyperthyroidism); Nosebleeds (epistaxis); Flushing of the skin due to widening of the small blood vessels (erythema); Itching (pruritis); Breast pain and enlargement; Hot flushes; Fatigue; Urinary tract infection (cystitis).

Hmmm – that’s a lot of side effects.

At the same time as that I also start taking a tablet calledMeticorten

Meticorten – Start on day 2 of IVF cycle and continue until 3 months pregnant

Dosage – 2 Tablets in the morning.

What it does - prevents the release of substances in the body that cause inflammation.

Why should I use it - In patients in which one suspects implantation problems based on an immune tolerance or auto immune basis, Meticortin is extremely valuable to promote implantation an maintain early pregnancy

Side effects – sleep problems (insomnia), mood changes;acne, dry skin, thinning skin, bruising or discoloration; slow wound healing; increased sweating; headache, dizziness, spinning sensation; nausea, stomach pain, bloating; or changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

Menonys - the Menace -  Start on Day 4 of the IVF cycle and continue till day 8. Doc will advise if to continue after day 9 scan.

Dosage – 3 Powders to 1 water ampoule, injected with a HUGE needle into the upper half of the buttock

What does it do - has the equal activity of FSH & LH. its helps in the maturation as well as rupturing of Graafian follicle (in which the egg is developing), hence it helps for Ovulation.  This stuff gets the eggs to maturity – seeing as there are so many maturing at one time, they need a little bit of help getting there.

Why do I need it?  So the Lucrin is suppressing ALL the hormones but I need the LH and the FSH to actually mature the eggs.  So this stuff puts back the FSH and LH in equal quantities to help the eggs along.

Side Effects - Injection site pain; Lower abdomen tenderness; Fluid retention; Headache; Emotional irritability; Breast discomfort; Fatigue; Multiple births; Severe pain or swelling in lower abdomen or extremities; Shortness of breath; Vomiting or diarrhoea

Day 9 Scan

At this point we see how may follicles are developing on each ovary and wether or not we continue with the injections, and how much to change the dosage.  This is a critical time in the process – if there aren’t enough eggs then the whole cycle can get cancelled.  

Day 11 Scan

We check the eggs again to determine how much they have developed on since the last scan, and decide when the Aspriation Day (the day they remove the eggs) should be based on the size of the majority of the follicles.

The Trigger – Ovidrel

This is an injection used in fertility treatment cycles to help follicles mature and trigger the release of mature eggs from a woman's ovaries following treatment with stimulants prior in the cycle.  Aspiration day will be 24 – 36 hours after The Trigger injection.

So that’s the next 21 Days or so mapped out.  We start with the Lucrin injections this weekend.

.

That hill you climb at the start...

I feel like I am on that hill you climb before the first downhill on a rollercoaster, where you build all the momentum to get you through all the twists and turns and loop de loops ahead.  Have you ever anticipated something?  I honestly have the same feeling I did before I got engaged to my handsome hub!  This feeling of expectation, but not knowing when that expectation will be fulfilled

I was waiting for 5 days.  Waiting for my cycle to start. Waiting for the safety bar to drop over my head and the ride to start.  I was 5 days late.  I am rarely late! This would usually get me very excited (If I am 5 hours late I run off to the pharmacy to buy a pregnancy test) except we have had a scan already at the new Fertility Specialist and the news wasn’t exactly encouraging...

We went to Bio Art.  Where Medfem was calm and serene and predictable environment, Bio Art was not. There were so many people there, that there were not enough waiting room chairs to sit on, and there were couples and nurses and people just everywhere.  Initially the chaos really confused me and got me worked up but one of the nurses explained that one of the 2 doctors was not in and so the other was doing all the routine scans, procedures as well as the booked appointments.

For those of you not in fertility treatment, let me take a moment to explain how this works.  If you are in treatment there are certain days of your cycle that you need to go and have a scan on, 9, 11, 13 or the insemination procedure on day 14 or 15... So you don’t book appointments for these days, you just go in first thing (7am) and the doctors do all the scans first, and any procedures that have to be done, like inseminations or embryo transplants before they start with their booked appointments.
So when one out of two doctors is out, you can imagine what chaos ensues! Anyway, moving on....

What a lovely, and experienced, new doctor Dr C is! He picked up on more and it now looks like there may be more "wrong with me" than previously thought.  He gave lots of attention to hubby's results, which he (hub) liked, as the other Dr has often just glossed over them. Of interest to the Doc was the low morphology and a high CMA 3 count, where the other Doc has always been more interested in the motility issue.  CMA 3 is the measure of immature DNA in the nucleus of the sperm cell.  Although it’s high, it’s not hopelessly out of range, and Dr C seemed to think that hubby could get me pregnant naturally.

BUT...

Dr C scanned and said that it looks like there were implantations this month :-(and seeing as I was a day late they gave me a Home Pregnancy Test - was negative.
He also thinks that I am still having strong immune responses to implantation of the embryos brought on by the endometriosis, and losing them before they really even have a chance, although we are not sure we actually want that embryo’s to implant, because we think they may be blighted – possibly a combination of my poor quality eggs plus hubby's poor immature DNA in his sperm is giving us dodgy embryos, which are implanting but probably wouldn’t make it past 6 or 8 weeks anyway if it weren’t for the immune response - he reckons I would have recurrent miscarriages if we treated just the immune response and continued to try naturally.

On the up side, he said that a pregnancy would sort me out - it stops the endometriosis and all its nonsense in its tracks, so if you have had endometrial complications is highly likely that once you get pregnant and break the cycle you don’t struggle with endometriosis again.
It will be interesting to actually see what the egg quality is like once he gets them out, and see if his suspicions are correct.

So the Plan of action is as follows, as soon as my cycle shows up I start the Birth Control Pill, then on Day 21 I will start the Long Protocol IVF cycle. We will definitely have to ICSI. (Inject the sperm into the egg). We are also chucking in intravenous Intralipids just to distract my immune system while my embryos implant. Dr recons we will be lucky to have a successful fertilisation of 60% of the eggs, but recons that there may not be too much to put back, best case 2 or 3, given the DNA issues. If we have 2 we will definitely put 2 back.

We were then chased down the corridor by one of the nurses for blood tests and a small chat about the rest of the procedure. The nurse also did a Beta quant (pregnancy test) and promised to call me on Friday if there was anything worth reporting.... no phone call
.
I am on a strict dietary regimen to try and improve the egg quality:
No alcohol, No Sugar, No refined Carbs, NO carbs or fruit after 5 pm, No white flours, No Saturated fats (NO fun!). Let’s be honest the hill is not the fun part of the rollercoaster!
Lots of fresh fruit, Veg, Monosaturated fats, 3l water a day, lean protein, fish, legumes, nuts and low fat dairy.
The dietician is a little worried that I may become underweight for what we are trying to achieve - I have already lost 7kgs since September, so we will monitor that and make sure I don’t become too underweight for what we are trying to achieve

So I guess my prayer needs are for good quality eggies, and that we will have some great embryos to put back and that they will (both?) stick!

I paid the deposit on the treatment, I wondered to myself if this was what it feels like to buy an engagement ring?  That nervous sense of expectation, the guy hope the outcome is favourable but there is a chance it may not be, and with that in mind he spends thousands of rands on a diamond ring? 

We have a meeting with the nurse next week to pick up all the meds and get a small tutorial on how each one is injected. So I will write another update after that milestone.

We are all buckled in - I am so excited - let the rollercoaster ride begin!

 

Hello Autumn!

Let it be known - I am not a winter person! In fact there is something so utterly depressing to me about the imminent change in season that the only thing that gets me through winter is knowing that I have a wonderful summer wardrobe to look forward to as I take out the winter clothes from the suit case at the top of my cupboard and hang all the winter clothes and pack all the summer clothes.

Usually I wait as long as possible, denying the presence if the morning chill and pretending that there is still a piece of summer left. This year I am so over denial! Today really IS the first day of autumn! The weather man said so - it is time!

It is also time for us to admit to ourselves that we are going to need more help to get this conception thing right. The comment made by the embryologist while preparing our sample was that these sperm, although much improved, are "IVF sperm". I suppose that was one of the reasons for me not being too surprised when the AI didn’t work. It’s definitely the reason I don’t want to bother with AI again - It felt like wasted time energy, emotion and money at the end of it all.

I have also come to accept that we cannot continue on at Medfem... Thety have moved us in the right direction, found and eliminated the Endometriosis, sorted out the low progesterone levels, and provided quite a stable nurtuting environment in which to undergo all the tests and start wading our way into the infertility waters. As much as I like the place and respect the skill and expertise of the doctors and embryologists there, and I do think that it is a first class facility, and I would stay if we could, but we have just had to face the facts - it’s too expensive for us!

We move to a clinic, BioArt that will do the same treatment for almost half the price, and amongst the online fertility community is widely respected and is achieving really good results.  Lots of positives. I see the new fertility specialist this week. I truly cannot wait - I am more excited about this that I am about my birthday which is round the corner too.

On the miracle side of things, we have had some miraculous financial donations come through specifically for treatment, and some extra bonus money from work which makes an IVF cycle immediately possible.  I am always amazed at how God honours our faithfulness!  At the end on Jan, we were challenged to give a offering, larger than something we would usually consider, to missionary friends of ours living in an eastern Country.  We were challenged and hesitant, but we did it anyway.  God restored that offering to us in abundance - we have not been left out of pocket at all! 

This is not the only example of how he has provided for this IVF cycle.  I strongly believe we need to go through with this.  That this whole weird, sad, frustrating journey is purposeful and I foresee several "ahhaaa" moments in the years to come as I realise how God is using it. (I DO NOT see them yet - this is a faith statement.

So maybe, come spring in September, I won’t be unpacking the summer wardrobe. I won’t be able to because all my size 12 outfits don’t fit, I am in maternity wear!  I really do have a lot to look forward to this winter - bring it on! 

Right - I am off to do the wardrobe swop
 

You are More than Infertility!

On the day I called
You answered me
And the hope in my soul increased
I lift my hands
And turn my eyes
To the God who heals my heart
And gives me peace

You are more than
My words could ever say
You are Lord over all
Over all of my days
I will see this season through
I will fix my eyes on You
Only You

Extract of "You are More" Hillsong Publishing

Hope Erupts

We have had positive news on the Analysis, all the numbers are up, and everything, except motility, is within Normal ranges, but there is a ten fold improvement here, so thats great.  We have loads more options open to us now.  Now all we have to do is try! ;-)

My body has responded well to the meds, we test Progesterone levels next week this time to see if they are above 30.

All things considered this is the good start to the new year that I needed. I dont regret taking a "holiday" from the TTC normals in December, and am so pleased with the boost of good news.
Yay!

Expensive blood

(This post was written at the beginning of December, but not posted until January)

Another few months go by, and "the usual" old story, nick named "Aunt Flo" by the infertile community, she is the sign of another wasted cycle and more time slipping through the hour glass.

Last time I blogged hubby was enduring the aforementioned procedure, which I must mention, due to his completely awake state, he said was the worst experience of his life so far.  He has had some pretty hairy hospital experiences as a child, so as an adult I think this must have been traumatic for him.  I took the whole experience quite lightly, like a dentist appointment, maybe root canal, but to him this was just not the case.  It wasnt particularily painful, I think it was pretty frightening though.  However he was up and about the next day - we even went to the Coldplay concert.

They (those who have been there) say that it takes 3 months to start seeing the effects of the Op on the swimmers.  So we are waiting till Janulary before we do another analysis, but they (the same "they") have also seen positive pregnancy tests after 5 weeks.  So now the dilemma, if we have cured the problem and we start to get happy lil well formed swimmers within the next 3 months we have not cured the little hormone problem on my end. 

I started taking the Fertomed (Clomid generic) in November, just incase one of the lil guys makes it, I think I gotta make sure I have enough progesterone to hold on.  Oh my word! I have pain in my ovaries like never before while I was ovulating - in both ovaries, and the pain lingered for days. The pain just kept me constantly aware of being on fertility treatment and counting where I was in the cycle.

Then Aunt Flo was 4 days late.  Oh the Hope that blossomed in my little heart.  They (the ladies on the Fertilicare forum) shared thier Clomid experiences with me, all remained on time. Enter the Digital Clear Blue test... "not pregnant".  After a weekend of nausea and vomitting, and on the advice of the dietician, (grasping at straws a little maybe),  I went for a blood test at Lancet, confirming the Clear Blue test result.

December... We are on a break.  A break from diet, a break from no caffiene, a break from counting days and sex because we HAVE to, a break from the unhappy world of ttc.  I am so done with this for the year.  We'll pick it up in January again, when we finally go and have the analysis that should tell us if we can just expect this to naturally happen, or maybe we have more to work with than last time but still need IVF, or there is no imporvement and ICSI is the way forwad.

In the meantime, the pregnanacy announcements from people close to us abound.  One, who is pregnant with her second, and we found out she was pregnant with her first just as we started trying.  A reminder of the passage of time this process has been.  Its bitter sweet, trying to be genuinely happy for them, while dealing with the dissappointment that being left behind brings.

Variocele Embolization

Today is Varicocele embolisation day.

After our devastating news in August we decided not to take the "this just happens" as gospel truth from the Dr, who, after all is a Gynae.  We got an appointment with the Urologist who diagnosed Varicocele.

70 % of Mafe factor infertility is caused by a varicocele and in 50 % of thise cases it is treatable with either an iperation or this embolisation procedure.

Varicocele - What is it

A varicocele is a widening of the veins along the cord that holds up a man's testicles.

A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.)
Varicoceles usually develop slowly. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum. Varicoceles are often the cause of infertility in men.
The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right.

Varicocele Embolisation

An alternative to surgery is varicocele embolization. This method is also done on an outpatient basis. However, it uses a much smaller cut than surgery, so you heal faster. A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area.
Using x-rays as a guide, the health care provider moves the tube into the varicocele. A tiny coil passes through the tube into the varicocele. The coil blocks blood flow to the bad vein, and sends it to normal veins.