The meeting- part two

Before we were called to our appointment, I took the time to have a look at the people we were sharing the waiting room with. It was strangely calming to see people just like us, sitting in their little sections, reading magazines, drinking coffee, smirking at tests. I felt like we were part of a club – the Assisted Pregnancy Club. Not quite the same as the Mile High club – neither are groups I would like to join, but the former we have found ourselves involuntarily fully paid up members of. The latter you could not pay me enough to become a member of.

Sometimes (a lot of the time) I feel like I stick out like a sore thumb. In the company of my friends in Hong Kong I am one of the few mums with only one child. When their second children were small babies it didn’t seem to matter, but now that they are growing up, having their own play dates with the siblings of the children that are my sons age, I feel more and more like I am the odd one out – being left behind.  People are announcing pregnancies at a rate of knots; so far I have shared due dates with 3 people, 2 of whom have gone on to have their babies, one of whom is still pregnant. I have watched their their bumps grow, heard the stories of their births and wondered what it was I did in a past life to not only lose our babies, but have to watch other people follow the path we were at one time on? Luckily they are all people I love dearly so after the initial upset, it’s easy to forget our loss and focus on their joy and enjoy their little bundles, but Mother Nature doesn’t know that and I think she could have been a little more lenient.

As our son grows up, more and more milestones remind me that this is not how we planned it. For example, he has just started pre-school. He goes 5 mornings a week for 3 hours. He loves it. I hate it. I had always thought that by this time in our life, he would be at school and I would be at home looking after a new baby. Never did I think that I would be coming home to an empty house. Silence and emptiness do nothing to help the mood, which I suppose is another reason I am blogging. It gives me something to do.

Anyway, back to the meeting room and I felt at ease and ready for our appointment. When Dr UK IVF came to call us in I was immediately a fan. He was a normal, nice, family man who frankly could have been a banker, accountant, brain surgeon, or any other profession that did not require looking at my private parts and talking about periods and cycles. It can be exceptionally uncomfortable and embarrassing discussing such personal aspects of your life with a stranger, but Dr UK IVF immediately made us feel relaxed and I only semi cringed when I remembered the fully comprehensive questionnaire we’d filled in and I knew he’d read. Words like period (which sends my Dad scurrying into his study faster than Jenson Button to the chequered flag) and sperm were just words, and it was easy to be frank with him. The AMH levels were discussed immediately – and again we were reassured that the test is not entirely reliable, I had had it 2 days after my ERCP which could have impacted it, and anyway it didn’t matter as I had a good number of follicles.

Then we got down to the nitty gritty. Dr UK IVF talked us through the process of IVF and of Array CHG - Chromosomal screening. I tried very hard to take it all in but there was so much to listen too and I have to be honest, I wanted to fast forward that bit and just have it done. Again, slap dash as Mum would say, impatient. He used lots of long words and had a flow chart, which for a stay at home Mum was about the most intellectually stimulating topic of conversation I’d had in a long time and I was struggling to keep up. I understood the timeline of injecting hormones into myself to control the ovaries and then a week later start injecting a stimulating drug to make the ovaries ovulate, more blood tests at this point and daily or alternate day scans to see what’s up (brilliant – my friend the probe makes his entrance again). A different type of hormone is injected a week after the ovulating injections, and then 36 hours later I have my eggs harvested. It sounded fairly invasive and intense but when it comes to all things medical I am no shrinking violet and am more than equipped to deal with any of this. I’ve spent more or less my whole life under the watchful eye of some doctor or another mainly due to degenerate discs in my back, hospitals don’t scare me, in fact I find it probably a bit too easy to sign myself over to the men and women in white coats. I couldn’t keep track of the number of injections but I knew it was a lot and I may be doing them myself, but as a Nearly Doctor that’s no biggie and I’d already been injecting myself with steroids for the last pregnancy so I could tick that off the list. The bit of the process however that started another wobble was the egg harvest. Rewind to AMH levels and 6 miscarriages, all chromosomal abnormalities, and here’s our next roadblock. Will they get any eggs? Will they find one that they can use? Will they all have gone bad? What if we do all the injections, complete the process and find we’ve got nothing to work with? Even as I type this I start to panic. When you involve scientists, there is no hiding from the truth. Dr UK IVF was saying that there was a problem and we needed to find out what it was before we could possibly have success. A list of 20 blood tests was put on a sheet of paper in front of us, testing literally everything. My chromosomes, my husbands, my liver function, protein level’s, HIV, thyroid, a blood clotting disease that I had already had tested the previous summer and come back with a ‘mutation’ which is the most hideous word. Some that I cant pronounce and have no recollection of what they were, but one tested my immune system which is a dreadfully scary test to have – have I got cancer? Is there some deadly disease coursing through my body that I do not know about? I felt like I was being bombarded with too many issues to deal with, the major one being the IVF, the secondary one being my general health. To date, not all of the tests have come back, luckily the ones that have are ok, we have 3 more weeks to wait for the full compliment to be in and we will know what we are dealing with, totaling 9 weeks of the unknown. I wake up in the night in a total panic from a dream where I am being told I have some horrible disease, or that its not possible to go ahead with the IVF, or on a really bad night, both.  The waiting is intense. I was so worried our hedonist lifestyle in Hong Kong (over here we are all very lucky to have live in domestic help – babysitters are not a problem which means going out is very very easy. Add that to an extremely social ex-pat life and you have a recipe for dialysis) and the impact it would have on our chances, I swore I would not drink between then and the treatment, which I have stuck to if you ignore Christmas that got rather in the way a week after we returned. I found and still find myself making deals with God – I’m not even particularly religious but I prayed and pray, asking that if He would help us get through this I would do charitable work, go totally organic, be kind to even the most irritating people and generally turn myself into a modern day Mother Teresa. I think God probably has the foresight to see that with all the good will in the world, that’s pushing it a bit but I hope he sees that I am trying to adopt a more tolerant and caring approach to life.

I had 20 vials of blood taken that day, my husband had 5. The upside said the nurse, was that I could have a Kitkat afterwards to bring my sugar levels back up. I don’t like chocolate, so my upside was somewhat of a let down.

We left our appointment with a potential time of April for IVF, when hopefully all the ‘retained product’ of the last miscarriage had gone. We had tones of literature to read about Array CGH (more about the technicalities later as I feel this is a ludicrously long blog and very confusing!). I was allowed to exercise again, and I resolved to get my back and pelvis (somewhat shot from my last pregnancy) in tiptop condition, lose the stone or so I had put on throughout the pregnancies, and we would treat our bodies like temples. In the car on the way to Heathrow we were quiet and reflective. More than ever we had been made aware that IVF is not a given, it is a delicate and fragile process that has no guarantee’s. It is not always the answer, as I had naively thought, and for the next 4 months we would be in no mans land. For a control freak such as me, getting to April was going to be another test. Because even thought we’d had 6 miscarriages, Mother Nature thought we could do with another test. She and I are on no speaks by the way, although I try as part of my bargaining with the Big Man to believe she does mean well. 

The meeting - part one.

I should explain that I grew up in a small village (well town now, but when I grew up we didn’t have quite so many new houses and Range Rovers) just outside Nottingham. I also went to University in Nottingham. I do like the area but I do feel as though it has a tendency to draw me back when I would perhaps like to be somewhere else. Take University for example. I studied Broadcast Journalism. A fairly new course, it was available in Nottingham or Bournemouth. I liked the idea of the seaside and my sister was in Southhampton so I thought it could be fun to go to Bournemouth, but all those nice advisers that guide you through the UCAS forms as they were then, said resolutely, ‘Nottingham is the best course, it’s industry recognised and you will be extremely lucky if you get in.’ Makes it quite hard then to say you’ve chosen a stick of rock and deck chair over journalistic brilliance, so I chose Nottingham. All my friends packed their cases and went off to a life of student digs in glamorous places such as Oxford, Manchester, Leeds, Hull  - ok I realise that is stretching the glamorous bit – but none the less their adventures started in new cities, mine was 15 miles away from Mum and Dad and frankly, dull. Anyway, my advisors were irritatingly right, it was the best course and I did do quite well out of it.

Fast forward quite a few years and here I am back in Nottingham to start another milestone in my life, IVF. Dr HK IVF had said a couple of weeks earlier, in tones I had heard many years before, ‘There are two centres you can do this, New York have a gold star lab and are fully proficient in the process and have very high success rates. Or there is a place in England you could go to. Have you heard of Nottingham?’ Have I heard of a place called Nottingham? Just call me Robin Hood. Not to be put off, I immediately and vocally voted New York; I could see myself and our son walking around Central Park, amusing the locals with our very British accents and being signed up as the next Piers Morgan (ok that’s ridiculous) while my husband made a name for himself as a banking Guru on Wall Street.  Interrupting my day dream was Dr HK IVF who went on to say, ‘The Doctor in Nottingham is the pioneer in this treatment, the world leader. He trained the guys in New York, so they are good, but he has the best lab and why would you go to someone who had been trained by the best when you can have the best?’ or words to that effect. Exit New York stage left, hello Nottingham. But every cloud and all that, Mum and Dad, or Granny and Poppa as they would be in this role, were nearby and we could stay with them and they could help with the little fellow. Having not ever been able to rely on Grandparents as we live in Hong Kong, my first experience of being able to share the load was this trip, and I really do have to interrupt the flow at this point and say thank goodness we did chose Nottingham. When the going got tough and I needed a moment, Mum and Dad stepped in and took control, our son thought he was a King and had the best holiday ever, and I allowed myself to be looked after by my parents. We hadn’t even got as far as discussing the actual treatment but I knew that if we did go ahead, there would be no way I could do it in New York, I needed my Mum and Dad as my husband would be in HK for most of the slog having to work. He was happy knowing that while he couldn’t be there to hold my hand, Mum and Dad could. It also made me realise that our baby hopes were our whole family’s baby hopes, I can see now how hard it is for my parents and my mother in law to see our struggle. Being a mum, seeing your child or children go through difficult times is just unbearable, at any age.

So, here we were, not in New York, in Nottingham meeting our doctor for the first time. First things first and I had to have a vaginal scan. Not something I would ever put my hand up for, in fact when I had our son, I was more terrified of having an internal than I was of giving birth. I am a prude and I do not in any way like lying on a bed, legs akimbo while some stranger puts a phallic shaped object in a place I like to keep private. I also have a brilliant ability to be wearing odd or holey socks on such occasions; which adds to my deepening embarrassment. On this occasion it was two nurses who were doing the deed, one a trainee (brillant). They were incredibly kind, ‘have you had this done before?’ Oh yes, just about a billion times,  mainly to tell me my baby is no more,  to confirm my infertility is a first. You can see my mood was darkening and I was beginning to panic. We all fell into an uncomfortable silence and the probing began. The nurses wanted to see the state of my uterus, fallopian tubes, and ovaries and count the follicles on each ovary, which would give a good indication of how many eggs we might get. Or not, seeing as I had decided it was all a waste of time. It took forever to get there, first of all we got to a junction, turn left to left ovary, right to right ovary, but there was an obstruction. Retained product from my last ERCP. That’s nice. A visible reminder of the reason we are here – my babies don’t survive. My eyes prickled a bit so I started making jokes, which bless them they laughed at when I am sure they were really thinking, ‘we’ve got a right nutter here.’ We finally got to the left ovary and the nurse began counting. This is where the IVF handbook would have come in handy as I had no idea what she was counting or why. Luckily she explained that she was counting follicles, and God love her said ‘oh that’s nice, you have 11 on this side.’ I didn’t say a word. She then did a quick detour around the retained product and started on the right side. ‘Wonderful, you have 12 on this side. You have very nice ovaries, they are a bit small but all good.’ Pardon? You said wonderful? What does that mean? Well, they explained, that’s a good number of follicles which should lead to a good crop of eggs. Que?? (In total Manuel from Fawlty Towers  style – seriously – I do turn into a total idiot in times of stress) But I have a lower than low AMH – this cannot be right? I told them my ‘score’ and they too looked puzzled, it was indeed odd to have that score, my history and these ‘nice’ ovaries. Not to worry, they said, forget the AMH score, this is good so far.

Honestly I could have cried, but I still had the undignified process of getting off the bed in just my socks and a woolly jumper, if I had started crying they may have felt compelled to hug me and that would have been highly awkward. A week of thinking I was infertile and our IVF dreams were dashed, and one cheeky probe into the hub, and all is well? I resolved to ask Dr UK IVF as soon as we were in his consulting rooms, but for now it was a mad dash back to the waiting room to tell my husband the good news. And to find out how he’d been doing…

Our IVF centre in Nottingham is rather nice. We are paying privately to have this done, and its sweet the effort they have gone to to make us feel at ease. They have lovely coffee, every magazine you could hope for (including Good Housekeeping which is my absolute favourite), nice newspapers for the men and a whopping great plasma screen TV which sadly let the side down as it was showing Jeremy Kyle. Still, it was as comfortable environment as you could hope for, given the other 4 couples and I knew we were here to have our bits poked and for the men, to produce a sample. Schoolgirl smirk. Honestly, neither my husband nor I know why we smile at this part of the process in a very childish manner but not at my internal scans, but we do. I trotted back from my scan to convey the good news about my nice ovaries, but there was no sign of my husband. He must be doing his sample. While I waited, the room filled up with men who I had not seen when we first arrived, they must have been whisked away to 'perform.' I was gratified to see that they all came back with a small grin and their wives struggled to keep a straight face too. I realise we were all probably behaving in a very adolescent manner, but sometimes its the little things that keep you going. I settled down to Good Housekeeping and then my husband came back, smirking a little. This is not his blog so I won't reveal the details of his part of the appointment, but all was well. He was delighted at the ovary news, we giggled nervously at the first chink of light in the process, and waited for our name to be called.

Holidays and hormones

I am sure there is handbook out there that prepares you for the challenges of IVF before you embark on it. We haven’t read it if it does exist, so we are learning the hard way that the road to IVF is not only full of potholes, there are quite a few dead ends and it is unbearably long.

First of all on our journey, I had a blood test taken in Hong Kong a couple of days after my ERCP for the last miscarriage, to determine my AMH levels. It’s a nifty little test that can tell a woman what her ovarian reserve is, simply put – how many eggs you have got left. As I had got pregnant every time we tried and had 6 pregnancies in the last 18 months, I was fairly sure mine would be ok and therefore didn’t give it a moment’s thought.  I was more concerned with the sub zero temperatures the UK was experiencing at the time. As we have lived in Hong Kong for 5 years we are officially pathetic when it comes to the cold and my wardrobe is not sufficiently equipped to deal with such temperatures. 

The trip had been organized in a rush – which I am sure my mother will say is the story of my life. Impatient. Can’t possibly wait. Thing is, when you already have a child and you are trying for another the age gap between brother and brother/sister becomes an obsession. There are those that will say having a bigger age gap is brilliant as the older child will cope far better with the baby, but for the couple trying, every month that passes is a month separating the children and their potential friendship further. Love any sibling as I hope my son will, I have no doubt that if I am still trying when he is 7, a newborn who will become a toddler who will become an irritant is not what he would like – and you can’t really blame him. He wants a playmate now, and in an ideal world, we want that for him too. Our doctor in Hong Kong had played a blinder and contacted the Doctor in England who was the world leader in this field – they’d gone to Uni together - and he had agreed to see us. He had one appointment before Christmas and even though that meant uprooting my son and I last minute and flying to the UK alone, my husband joining later as he had that rather large commitment called work – we accepted the appointment. We already had a holiday booked to Dubai for a couple of weeks before, and so we went on that full of hope and optimism. The downside was the fact that hormones and an exercise ban for the past 18 months have taken their toll on my body and I have gone from relatively acceptable in a bikini to definitely not.  However, fat and all I had a week to soak up the sun, be with my family and enjoy life without thinking about babies. Which I did, if you ignore the tears around the pool as I realized my son was pretty much the only child staying at the hotel who didn’t have a brother or sister to play with. There were a few misty eyed moments as the lovely proud pregnant lady rubbed her tum in her bikini – although it’s debatable if I was sad for my lack of bump or my definite collection of bumps plural that made up my wobbly thighs and tummy. But I could have a glass of wine, which was nice (should be for the amount they charge for alcohol in Dubai – criminal) and I was grateful that I was able to spend quality time with our fast growing up little man.

Restored and recharged I flew to England.

First thing that happened; an e-mail with my AMH results had come in overnight, and I woke up on the first morning to read that lo and behold, this fertile creature that I envisaged myself to be, was in fact verging on infertile. My score was 3.62, which is interpreted as low fertility. So low that some IVF clinics won’t even let you through the door.  Fast as you like, I was googling madly to interpret the results and see what the prognosis was. Bad. Awful. Not even a tiny bit ok, just dreadful. My poor Mum, who was struggling to come to terms with the whole IVF process already “just explain it to me one more time darling” got the brunt of my horror with incoherent ramblings through a torrent of tears, which I swiftly followed by a panicky e-mail to a friend of a friend - who happens to be an embryologist (you never know when your friends careers will come in handy, but at some point they all tend to. Even my friend who is a taxidermist) - asking for her view. My husband was 8 hours ahead in Hong Kong – so he got a hysterical call from his wife. Well his answer phone did – he was at a meeting, which just left me alone with my thoughts, which with an imagination like mine is a dangerous place to be. I felt physically sick. I was in England to have IVF that can screen for Chromosomal problems, which would in turn result in a successful pregnancy and we could complete our family. Yet here I was in my thermal PJ’s, jet lagged and cold, husband other side of the world, facing the stark reality that my baby making days were over. I cannot describe the feelings I had. As dramatic as it sounds, I honestly felt like part of my world had ended - and this fear of IVF not working has never gone away. For the first time it was abundantly clear that this was not a guarantee, far from it - we could end up spending a tonne of money, investing a year of our lives, and putting my body through a rigorous medial trial, all for nothing. I felt such a stab of disappointment - and I still get that same breath taking panic. It tends to wake me up in the night in a dripping sweat, and more regularly than I should admit. Stupid thoughts that shouldn’t even be in your subconscious surface at these times of panic. Should we look into adoption? Is this fate saying enough’s enough, just be content with the son you already have? Would my husband leave me for a woman who can have children? For the record he said no, unless she was a movie star in which case he said it would only be fair to consider his options. I felt numb. On that occasion, my saving grace was my son, who roused from his bed, gave me a sleepy smile and when I asked him if Mummy could have a cuddle, he obliged - wrapping his chubby little toddler arms around me. I went from despair to gratitude fairly smartish - we do have a son and we are so incredibly lucky. Yet when the lovely warm fuzzy moment had passed, reality started to sink back in again. As wonderful as he is, we DO want to have another child, this was not supposed to happen. I'm not brilliant at being down in the dumps or negative - I get rather bored with the whole glumness - probably because I have a very short attention span and it bores me, so after a little while of woe is me I did what is now predicable. Google.

It appeared with further investigation (well past page 5 of the search results) that all might not be lost – an e-mail from my embryologist friend confirmed this. The AMH test it appears has flaws, and while my score was undoubtedly low, it was not necessarily the end of the world. Women with lower scores had responded very well to the hormone stimulation drugs and produced just enough eggs to proceed. I’d been pregnant 6 times in 18 months for goodness sakes – surely that was proof enough?

We had a week to wait before our appointment and it was frankly an uphill struggle. I dealt with it by taking advantage of the exchange rate being in my favour and emptying all of my favourite UK shops of their wares. I didn't really want to talk about it - and when the nasty niggle of AMH levels, infertility and general despair crept back into my mind, usually after my son had gone to bed; I helped them disappear with a dose of red wine and British TV. Doctors should actually start prescribing that as a cure – it really does work. For a little while anyway, just long enough to gather one’s sanity back and at least create a calm exterior.

We had 5 days until my husband landed and 7 days until the appointment. I can honestly say it was one of the toughest weeks of my life. I did a lot of soul searching, a lot of secret crying and more praying than I think I have ever done in my life. When my other half, and I mean that literally not figuratively -I really don’t work without him - arrived, he did as he always does, calmed me down, talked rationally, and shared the burden away from me. We had a wonderful weekend, and by Monday, D-Day, we set off for our meeting.