To My Tiny Blob of Cells

I’m writing this with a photograph of you in my hand. A photograph taken when you were six days new. Just a collection of cells too small to see with the naked eye, but containing so much potential. So much hope.

Your Dad and I had been through a lot to get you to that point, and I was afraid that once you were back inside my tummy it wouldn’t be enough. That I couldn’t take good enough care of you. I was afraid you would fade and slip away, taking a piece of my heart with you.

But yesterday, ten days after that photograph was taken, I took the most nerve wracking test of my entire life – worse than my driving test or University finals. A plastic stick that would either fulfill or shatter our dreams. It was the test that would tell us if you were still there.

 

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And just like that, you made your presence known by a second pink line.

Already you will have grown and changed since we saw you in the laboratory where you started you life. And now I feel full of new hope that you will go on doing so. And I will do my very best to keep you safe, whatever it takes.

When you’re older, and we tell you the story of how you came to be, I hope that there will be no doubt about just how loved and wanted you are.

You are our longed for second child. And I can’t wait to meet you.

All my love always,

Your Mummy xxx

Diabetes and IVF

One of the reasons I gave for sharing our IVF journey was to do a small bit towards addressing the paucity of information about handling type 1 diabetes alongside fertility treatment. Of course, I then got wrapped up in the actual trying to get pregnant stuff, and so far have mentioned very little about the diabetes side of things.

Before I started IVF, however, I was somewhat frustrated by the lack of information about doing it alongside diabetes. There are a handful of threads of a variety of fertility forums, and a similar number on a range of diabetes forums, but just a few personal experiences recounted on blogs and very little credible scientific or medical literature.

That is not to say there is nothing of use, just not all that much and it would be remiss of me not to share a couple of helpful resources. One of the first sites I turned to is a blog written by Cheryl Alkon which is sadly no longer updated. Cheryl underwent fertility treatment back in 2006 and blogged her way through it, sharing a number of useful insights. She then went on to write the successful book “Balancing Pregnancy with Pre-existing Diabetes” (which I reviewed here). The book itself also contains chapters on fertility treatment. (Some of the information contained in the book may not be strictly relevant for readers outside the US, but it is an excellent starting point.) And another useful resource and personal account of the IVF process can be found on The Kaitake Blog, written by a New Zealand woman, who is happily currently about half way through her pregnancy.

I wondered, though, whether the fact that I couldn’t find more was because the combination of IVF and diabetes is not that common. But looking back now, having actually done it myself, I think it may be more likely that it isn’t talked about much simply because there isn’t that much to say that isn’t standard diabetes advice about frequent testing and adjustments.

And my own quietness on the subject is almost certainly a reflection of there not being that much to mention. I can honestly say that diabetes has not had a major impact on IVF, and whilst IVF has obviously affected my blood sugars to a degree, it has not been horrifyingly unmanageable. After all, if you live with diabetes, you have to be used to a bit of unpredictability!

If you ask people who, by their own admission, know very little about the process of IVF to share what they do know, many of them seem to mention the “induced menopause”. In proper IVF-speak this is known as “down regulation” – the process of shutting off the bodies own hormonal cycle, before starting to stimulate the ovaries to produce lots of eggs. However, this isn’t an inevitable part of the treatment, and not everyone undergoing IVF goes through the down regulation process, otherwise known as the “Long Protocol” (LP).

I was on the alternative option – the “Short Protocol” (SP) in which stimulation of the ovaries begins on around day 2 or 3 of the cycle, alongside drugs to prevent ovulation. As the name suggests, this a quicker treatment cycle, injecting for around 8-14 days in total,compared to 3+ weeks.

This has distinct advantages for people with diabetes. Firstly it is a less dramatic suppression and replacement of your own hormones, so my guess is that it has slightly less dramatic effects on blood sugar levels. And secondly, the shorter duration means fewer days overall of taking drugs with the potential to affect control.

As it worked out for me, I spent a month taking the contraceptive pill before commencing the active part of the treatment. This is common as it allows clinics to time your cycle, as well as reducing the risk of cysts (ha – that obviously didn’t work for me!) or the uterine lining not being thin enough. I’ve taken the pill before, albeit a long time ago, so I had some idea what to expect. Typically taking external oestrogens raises my requirements for insulin by around 25%. So I raised my basal rates around the clock and kept a close eye on the CGM. Which worked out well.

I then had a break of about six days between stopping the pill and starting to inject Burserelin, the medication which prevents ovulation. In my previous hormone-using days, I had a different profile set up in my pump for the hormone free week. However the week off medication was a stressful one, with discovering a cyst of my ovary and having it drained. I realised afterwards that I had maintained the increased basal rate with only a modest increase in hypoglycaemia during that time. And when I started Burserelin, everything fell back into place.

The leaflet included with Burserelin specifically mentions that it may cause raised blood sugars in people with diabetes. And based on my experience, I’d say that effect is equivalent to the effect of oestrogen. Your diabetes may, of course vary, as it is a completely different hormone. My best advice is to test, test, test.

The stimulation drugs – I was on Menopur – by contrast, had very little noticeable effect on things. I had a number of stubborn and sticky highs, but an equal number of troublesome lows. Overall, I’d say my blood sugars seemed a bit more volatile – swinging more from high to low – than has been normal for me of late. But stress and anxiety during fertility treatment have a lot to answer for too, and obviously it becomes impossible to tell for sure what is affecting what.

The bottom line, however, is that IVF with diabetes is totally do-able. Compared to the changes you will experience in pregnancy (which is the intended outcome, after all) it really is a walk in the park. As with everything diabetes, frequent testing helps. A CGM helps even more. And a pump provides the flexibility to react day-to-day and hour-to-hour much more than multiple daily injections.

I’ll definitely do it again if we have to. And diabetes would be a very long way down any list of reasons not to.

For Now, I Have Hope

If I’d allowed myself to think about the two week wait before we started IVF – which I didn’t, for that meant assuming that we’d get enough eggs and sperm, and that they would fertilise and make it to a stage suitable to be transferred, which all made me tear-up just to think about – then I think I may have assumed that I’d be chomping at the bit to pee on a stick and find out if it had worked.

Funnily enough, though, I’m not.

It’s not that I don’t want to be pregnant just as much as I ever have done. Or even simply that I’m afraid of a negative result – although, of course, I am. It’s a more complex truth. At this moment in time I’m possibly as close to being pregnant as I’ll ever get again. So right now, I’m full of hope and optimism for a future as a family of four, with a new baby joining our family before this year is over.

Hope is something that is often in short supply for the completely infertile. By which I mean those couples amongst us where the male partner has azoospermia, or the female partner has completely blocked or absent tubes, or any other cause where the chances of getting pregnant without external help have dwindled to nothing. I don’t envy anyone with a diagnosis of “unexplained infertility” (hell, of course I don’t – I wouldn’t wish infertility of any kind on any person). It must be deeply frustrating to not know why things aren’t working. But at least there is still a tiny glimmer of hope each passing month that his will be the lucky one, the one where something was a tiny bit different. On the infertility forums I’m been dipping in to lately, stories abound of women getting their longed for positive the month before their IVF cycle was due to start. For us, if this doesn’t work, there is no hope of a miracle natural conception to soften the blow. 

As soon as I see the test result, my hopeful state of mind will be gone. A dream shattered to smithereens by a single pink line. Or a sense of hope replaced immediately by fear when a second line appears.

Ah, yes, fear – that familiar pregnancy companion. Fear that it won’t be ongoing. Fear that something – anything – will go wrong. That my blood sugars won’t be good enough. Or some other unforeseen issue will arise. If this works, I know it only the beginning of another journey itself.

For now, I simply have hope. It’s actually quite a nice place to be.

Waiting to Fall Pregnant

The last seven days have felt much longer than a week. I can’t believe that it was only last Sunday that I was awaiting egg collection, full of fears and anticipation. I knew it would be a tough week, that there were a lot of hurdles to overcome and potential pitfalls hiding in each new day. I knew there would be waiting that I needed to try to handle patiently. I just didn’t realise it would be quite such a roller coaster, with so much not knowing until the very last minute.

Of our dozen eggs, nine were suitable for ICSI. Of these six fertilised, but one did so abnormally, which left us with five embryos.

So that was Tuesday morning. So far, so good.

Then I got the news that taking Thursday off work was going to be a bit of a no-go, because we had a surprise inspection to contend with. And that kicked off my first proper melt down.

During IVF embryos are transferred back to the womb on either day 2, day 3 or day 5. By day 5 they have typically developed in to what is known as a blastocyst. The advantage of waiting until this stage to transfer them back is that it “weeds out” any embryos that simply aren’t going to make it that far and makes it easier for the embryologists to select the very best embryo. The flip side of that, of course, is the query of whether embryos that arrest in the lab on day 4 might have made it in the womb. In general clinics advise a 3 day transfer if you either have a very obvious front runner from your embryos, or if you don’t have a lot of embryos to choose from. If you have a greater number, the drop off between days 3 and 5 is less likely to leave you with nothing to transfer, so the question of whether they would have made it becomes less relevant.

My embryologist was frank with me. With only five, we were more than likely heading for a three day transfer. She was willing to bet on it happening. On Thursday.

My original work plan had been to call in sick on the morning of transfer. But suddenly that was not an option. Ideally I needed to be there. But if I couldn’t be there then I needed to commit to that on Tuesday to allow arrangements to be made. But committing to anything with IVF is really, really hard.

Several tearful phone calls to the clinic later, we had a plan. They agreed to schedule the embryo transfer at a different time to normal, so that I could work half the day, encompassing the inspection. So I cancelled the afternoon at work, calmed myself back down and set about preparing my paperwork for the inspection.
 
I woke up on Thursday morning mentally ready for my three day transfer. And physically I got myself prepped… lucky knickers, bikini line checked, that kind of thing.

The phone call from the embryologist came as a bit of a surprise. Four of our embryos were “top grade” with nothing to choose between them. The fifth was also good, although it had behaved a little oddly so they were keeping an eye on it. Bottom line: they advised going to blastocyst. On Saturday.

Should have been a relief right? Well yes, obviously I was ecstatic that our little embies were doing so well. And it meant no dashing from work to the clinic in fifteen minutes flat. The only problem was that I was also supposed to be working on Saturday. Wouldn’t you know it? I work one in six. One in SIX and it had to be my Saturday. Obviously I always knew it was a possibility that it could fall on that day, but the call in sick plan had extended to the Saturday. But now, I’d cancelled out a whole afternoon on Thursday, including moving people from that day to… you guessed it… Saturday.

Thursday morning was my major pinch point. I was dealing with the normal stresses of work, plus an inspection, plus trying to liaise with the clinic about what I wanted to do.

And to be honest, what I wanted to do was just get an embryo back inside me. I’d been geared up for it, as well as organised for it and the change of plans somehow hit me hard. Suddenly I was facing the fear of none of my embryos making it to day 5 and being left with nothing to transfer. And I couldn’t for the life of me see how I was going to get through it and still keep my job. It’s easy now to say I was being a little irrational (it is highly unlikely I’d have lost my job!) but between the hormones and the emotions and everything riding on this, I was probably entitled to a bit of a crash.

So Thursday saw several more tearful phone calls to the clinic trying to work out what to do. They were dead set against transferring an embryo “just because”. Initially we discussed an early transfer on Saturday morning which would enable me to head straight to work afterwards, but somehow I couldn’t see myself being able to cope with it. So finally they agreed to do an afternoon transfer, which is not usual for a Saturday. I’m very grateful for all their help and flexibility in sorting it out (although a tiny bit of me also thinks this is what we are paying SO MUCH money for!).

Saturday morning dawned. I got myself geared up again for transfer, but this time with a small amount of trepidation that we’d be getting the bad news that there was nothing left to transfer. 

The phone rang as I was putting on mascara (for work, you ideally need to be make up free for transfer) and I jumped about a foot in the air, smearing mascara across my forehead. Good look.

The news wasn’t bad. All the embryos were still hanging in there. But… none of them were blastocysts yet. So no transfer today. We needed to give them another day.

If only I’d known at the beginning that we would end up with a transfer on Sunday, I’d probably have been a lot less stressed. But this is how it plays out during IVF: you never really know quite what is going to happen. You can plan, but you’d better be prepared to change those plans and then change them again.

I answered the phone to the familiar voice of the embryologist this morning. She asked how I was. “Nervous” I replied.

“It’s OK, I’ve got good news” she said immediately. I felt my neck and shoulders relax as I let out the breath I was holding. “You’ve got one top quality blastocyst, so we’re definitely on for transfer.”

Finally. Finally. Six days after egg collection, my embryo was going back where it belonged and I’d be the closest thing to pregnant I’ve been in a long time.

Where I am concerned, however, there is always a “but”. The less good news was that none of the remaining four had made it to blastocyst. Six days to get to blast is slow, but normal. Longer than that is starting to get unusual. Although I’ve come across some studies that say 7 day blasts can still lead to a good outcome, the stats are no where near as good as for 5 and 6 days blasts. And our clinic policy is not to take them beyond 6 days. Which also means they couldn’t be frozen.

One top quality blastocyst is fantastic. No frosties is a bit of a downer.

But then the embryologist threw out a curve ball. Ordinarily in a woman of my age they would only transfer a single blastocyst, to minimise the chances and risks of a multiple pregnancy. But because the other embryos weren’t actually blastocysts and didn’t have a great prognosis, we had the option to have a second one transferred. And we had about an hour between the phone call and the transfer to make the decision. 

I feel that I need to make it clear that I am not one of these women who dreams of twins. I think parents of multiples are amazing and of course, if we had twins, we would cope and it would be wonderful. But it’s never been something that I’ve wanted to actively seek from our IVF cycle. I wasn’t expecting to have the option of a second embryo, as all along it has been made clear that at my age an elective single embryo transfer is advised. But suddenly we were faced with the option to transfer an extra embryo or let it perish. Knowing that we’ll have no frozen embryos as plan B if I don’t end up pregnant makes us want to do absolutely everything we can to maximise the chances of success. The chances of twins remains small, but it does give us a small increase in the chances of pregnancy too. And the bottom line is that I don’t want to look back from behind a negative pregnancy test and wonder “what if…?”

So we elected to transfer the two.

The transfer itself was straightforward. The procedure was equivalent to a smear test, and certainly less uncomfortable than having a coil inserted. Ian sat to my right and we held hands as a consultant whom I met for the first time this morning squirted our six-day-old embryos in to my uterus.

So that is that. The end of the cycle as far as actual treatment goes. There is nothing left to do but wait, some more, to do a pregnancy test in a couple of weeks. 

I’m not quite pregnant yet, but I very soon could be. Go little embryos, go!

{Living Arrows} 6/52 – A Boy and His Stick

My new goal is to try and publish a Living Arrows photo at the start of the week when the linky opens, instead of always being the very last one, scraping in at the final minutes. But better late than never. And better a poorly composed phone snap than nothing at all!

This photo is significant for a really silly reason. See those things on Thomas’s feet? Yes, they’re wellies. Seems pretty ordinary, right? But this is the first time that Thomas has ever worn wellies without having a major meltdown. We’ve never understood exactly what he had against them, but no amount of stories with children splashing in puddles, or being told that he couldn’t splash in puddles until he wore his wellies seemed to help.In the end the answer was Thomas. The Tank Engine one. A pair of wellies with a picture of Thomas and he couldn’t wait to wear them and “splash in puddles Mummy”.

He found this stick whilst chasing the pigeons through the mud and wouldn’t put it down. He dragged it all the way home, stopping every few steps to hit is against a wall, or drag it along some railings. Best free outdoor fun we’ve had amongst all the appalling weather!

And after all, every boy needs a stick.

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Boiled, scrambled or fried… A DOZEN Eggs!

So today was the big day. Or rather, the first big day of the big week where it all happens. Today was “egg collection” day.

As I described last night, I had a lot of fears going in to this. But it turns out that my number one worry this morning was that they wouldn’t be able to get a cannula in to my rubbish veins and I’d have to do the procedure drug free. It turns out that fear wasn’t totally unfounded. Well, I knew it wouldn’t be from previous experience. But the problem with egg collections is that they are a bit time critical. Wait too long, and the eggs will be ovulated out naturally. Plus, without wanting to make it sound like a production line, I knew there would be someone else waiting for their egg collection after me, and that couldn’t be delayed either. So there isn’t a lot of time to keep trying to find that elusive vein.

In the end they got a little butterfly needle in a tiny vein so I did get some pain relief, but I wasn’t properly sedated.

I don’t want to panic anyone reading this who is about to go through IVF themselves, because the situation of not getting enough drugs is very rare. But I also can’t lie. The egg retrieval itself was extremely painful. At one point Ian, waiting in a room across the corridor could hear me shouting out in pain. The trouble is, it’s the kind of pain that instantly makes you want to move to get through it. But move is the one thing you can’t do with your legs in stirrups, and a scanner and a giant needle shoved in your nether regions! So shouting was my only other release.

To complicate matters further, my right ovary had decided to go in to hiding behind part of my bowel. After a number of attempts to reach it the consultant was on the verge of giving up. I really didn’t want to waste these eggs, as this would decrease our chances of success, most specifically of having enough to freeze some. So they gave it one last go with the nurse who was assisting putting pretty much her entire body weight on my abdomen. It was agony, but it did the trick, pushing the ovary down.

The procedure was scheduled to take about fifteen minutes, but with all the difficulties I was gone more than three times that, while poor Ian had to sit and watch a ticking clock – whilst hearing me shout!

The advantage of not being at all out of it was that I could hear them counting out the eggs as they found them. There is an embryologist sitting in the corner of the room (honestly, I’ve reached the point of not caring how many people get a view of me with my legs akimbo, and if you’re about to do IVF, you will too!) with a big microscope. As they sucked the fluid out of the follicles on the ovaries, it was passed over to her to check for an egg, as not all follicles will contain one. Hearing the numbers going up kept me going through the discomfort.

And in total we got a full dozen! Which is a great result. 

It’s like a year’s worth of natural ovulations in one go! And it definitely gives us a good chance of several fertilising, which increases the chances of some going all the way to blastocyst stage (the point at which they “hatch” just before attaching to the uterine lining) before transfer, and increases the odds of having some to freeze. And some in the freezer is obviously our “plan B” if this cycle doesn’t result in pregnancy.

The other good news of the day was fresh sperm! We had opted to have Ian provide a fresh sample today even though we knew the odds of it containing any sperm were tiny. But we figured it couldn’t hurt and I just wondered in the back of my mind whether all the poking and prodding they did during the surgical sperm retrieval might have shifted any blockage. Having them look at a sample today was a “free” way of finding that out (by which I mean rather than paying for another full semen analysis further down the line). And they found some. Not many, to be fair. They have still had to unfreeze half our frozen stash and prepared us for the fact that another SSR  may still be required if we need to do another full cycle. But it’s still good news!

So now we wait. This afternoon they will have performed the ICSI process where they inject the sperm in to the eggs. And tomorrow we will get a call to tell us how many of the eggs have fertilised. I’m feeling surprisingly calm, as I know that it is all out of my hands at this stage.

I’m not the sort of person who goes in for signs or superstitions, but this afternoon, right around the time they would have been injecting my eggs, a huge, bright rainbow appeared. It made me smile, and I couldn’t help but take a bit of positivity from it.

Sorry about the crappy phone photo. I was lying on the sofa and snapped it. We later got some better ones, but I'm too tired to upload them right now!
Sorry about the crappy phone photo. I was lying on the sofa and snapped it. We later got some better ones, but I’m too tired to upload them right now!