The Waiting Game

Bloated, exhausted, emotional, and anxious from the Estrace, I wait for day one of my next cycle. I can't help but have that slight hope though that maybe this month will be different and my period will never arrive. You would think that by now, I would have erased this unlikely hope from my monthly repertoire, but I've never quite managed to extinguish it. In all likelihood though, that unwelcome monthly visitor will arrive and this time, instead of just lying around with a heating pad and ibuprofen and naproxen, I'll be injecting myself daily with hormones and preparing for my first IVF attempt. It's terrifying and exciting all at the same time.

My husband feels bad watching how the Estrace alone has impacted me. He feels helpless that he can't take the suffering away from me and that he can't share some of the burden of this process. I think that the partner's suffering in the IVF process is often overlooked and not acknowledged. While I dread the thought of what it might feel like to go through these various alien steps in this procedure, at least I have control because I'm the main attraction in all but one of them. Being a bystander through a process if often worse than being the person at the centre, especially when you love the person you're watching experience everything.

It is difficult for the two of us not to feel alone through this process. As I mentioned before, we don't know anyone personally who has ever gone through this process. Our friends who long ago stopped asking about our odyssey to conceive have largely drifted away, busy with their own lives, and almost none of them know we're even going through IVF. Our families, though supportive of us seeking help for our fertility issues, have had various reactions to the turmoil we have been undergoing through this process ranging from supportive to dismissive to silent. I suppose no one can ever really understand what this process is like unless they have undergone it themselves.

At least we can take comfort knowing that celebrities have publicly gone through this difficult process (since we don't know of any none celebrity who has undergone IVF) and have succeeded in conceiving children, reportedly Chrissy Teigen, Nicole Kidman, Christine Brinkley, Mariah Carey, Emma Thompson, and Celine Dion, among others. So we're not alone, it just feels like it. Lately, some celebrities have started to speak out more about the difficult journey of IVF, such as Maria Menounos and Chrissy Teigen. Perhaps celebrities participating in the dialogue more and raising the profile of processes like IVF will help to extinguish the stigma around fertility issues.

Stay tuned for what happens next (today is day 27 of my cycle, so things are about to get interesting). . . .

Estrace- Day 18 until Day 1 of Next Cycle (Synthetic Estrogen)

I bought the prescribed Estrace from the fertility clinic (one can also buy it at a drugstore). It is a form of estrogen (estradiol) and is taken from Day 18 of the patient's cycle and then stopped when their period starts (day 1 or the start of their next cycle). It is supposed to prepare the endometrium in the uterus to be of an adequate or optimum thickness for the blastocyst to be successfully implanted.

My nurse told me that I could expect to perhaps feel emotional, tired, and swollen. Various articles on the internet (yes, the internet can be a terrifying place when reading about medical conditions and drugs) list potential side effects for oral estrogen as nausea, headaches, irritability and mild depression, and tender breasts, among other side effects. This are also more serious side effects that can occur such as chronic insomnia, strokes, and ovarian cancer. However with IVF, estrogen is part of the complicated cocktail for creating a successful pregnancy.

I decided to take the tablets in the evening with one of my other medications, but I was told I could take them at any point during the day (but to take them at around the same time each day).

The day after my first dose I felt slightly more swollen. I noticed it in my hands (my rings were tighter on my left hand and I couldn't get one of my usual rings onto my right hand). I felt about normal until the afternoon when I started to feel really tired, but it was a sleepy long weekend, so who know.

The day after my second dose I think my fingers were even more swollen (I couldn't get my wedding ring or engagement ring off around midday) and I slept for eleven hours last night, but I also feel like I might be fighting a cold, so I'm not sure if this is the Estrace or not. I ate less today than I do normally, but again, I don't know if that was because I was fighting a cold or not.

The day after my third dose my fingers are slightly less swollen and I only slept 8 hours which is normal for me. I didn't feel quite as tired, but I was still lethargic. I started to become tender in the breasts as if I was going through a second puberty.

The day after my fourth dose, my fingers were as swollen as two days before. I felt tired and emotional.

The day after my fifth dose my fingers were swollen and I couldn't wear my loosest pair of slip on canvas shoes because my feet were quite swollen first thing in the morning. I had constipation and then diarrhea the rest of the day. I felt tired, emotional, and highly anxious. In the evening I had terrible stomach pains and gas. I seem to have had more headaches than usual through this week. Food is tasting unappealing this week and somewhat strange or different to me when it isn't to my husband. I was convinced that the turkey bacon I had was off, but it was just me as it tasted totally normal to my husband.

The day after my sixth dose, I was again swollen in the fingers. My abdominal area was quite swollen. I had intermittent stomach pains and nausea all day. I also had constipation and gas all day. I felt hungry yet sick all day (not an appealing combination). I had very low energy, but was filled with frenetic anxiety. All in all, I felt like I was going through a second puberty mixed with a menstrual period between the breast tenderness and abdominal pains.

One week after taking my first dose, I slept for eleven hours. The three doses of Metamucil yesterday seemed to have helped some of my gastrointestinal issues, but by the time the afternoon rolled around I was feeling bloated, nauseous, and constipated again. I sort of feel like an exhumed corpse with a tender bosom and swollen features, perhaps as if I was dredged out of a river.

But despite the side effects, I am envisioning growing a nice plush endometrium for the blastocyst to nestle into and grow into a healthy fetus.

Opening the bottle I found cotton and the tiny tablets that only occupied about one fifth of the bottle. Why do manufacturers always use such large bottles for such small tablets?

The tablets are tiny and a lovely teal colour (though not lovely enough to erase their side effects)

Doctor Visits, Specialist Visits, and Lab Tests Oh My!

Both my husband and I have been exhausted. Our cat, as usual, sleeps all the time. We have the feeling that maybe our hive is suffering from colony collapse. But let's hope it's nothing that serious. We're probably just overwhelmed with this whole IVF process, all the appointments, the uncertainty of our situation and future, and sacked out from work.

The lead up to any pregnancy often includes visits to the doctor and lab tests. People might check if they are healthy and in good condition to get pregnant or ask what vitamins they might need to take to ensure a healthy pregnancy and baby, for instance folic acid. When you have particular medical conditions though, the number of appointments is multiplied with visits to specialists on top of your GP. And lots and lots of lab tests.

Last week I went to the lab to get blood work done again, this time for the endocrinologist regarding my thyroid.

Yesterday, I visited my endocrinologist to review my thyroid levels, since mine are still in flux and thyroid levels are vitally important in pregnancy. Sub optimal thyroid levels can lead to:
1. Inability to conceive or lower chances of conceiving;
2. Higher risk of miscarriage in first trimester; and
3. Lower IQ in the baby (still in normal range, but at the lower end).
My endocrinologist reviewed the numbers from my blood tests, along with weighing me, and asking the same series of questions that he always asks. He concluded that my thyroid levels are currently perfect for pregnancy. I will do another set of blood tests for him and see him again in 3 months. If I get pregnant I will need to phone his office immediately and get an appointment right away (they make room even if there is no room because thyroid levels and pregnancy are so critical). Thereafter, I would see him every 4 to 6 weeks (usually every 4 weeks, unless the thyroid levels look really, really good).

In the same office, a while later, I saw my GP to ask for a new referral to a perinatal psychiatrist since my own psychiatrist refuses to treat me while I undergo IVF due to concerns with regard to what the prescribed hormones will do to my mental state and stability. But of course nothing comes easy, so my psychiatrist, through his assistant, refused to refer me and said that my GP would have to. That makes sense! The assistant said if I had trouble getting a referral from my GP to call back and she'd see what she could do about getting my psychiatrist to give me a referral. So reassuring. . .

My endocrinologist weighed in about this method of obtaining a referral to a specialist when I was visiting him earlier that day and said that that's often how things are done in our medical system where the GP is considered the hub, but he agreed that our system is really inefficient.

My GP was happy to give me a referral and prepared it while I was in the office. He also gave me a refill on my psychotropic medication to last me until I might see the new psychiatrist. The referral was sent out immediately. I received a call from his assistant later that day, saying that the psychiatrist's office has a three month wait.

I was in no man's land without a psychiatrist. Obviously, this is not a reassuring place to be while undergoing hormone therapy to try to become pregnant (my psychiatrist had warned me that the hormones could destabilize me). While I was feeling fine, I worried that if I started to feel unwell in the future, I would have no one to treat me and might end up in the hospital. Clearly, this should be avoided.

I called the perinatal psychiatrist's office this morning and talked to her assistant. I explained that I had seen this psychiatrist before and that my current psychiatrist won't treat me since I'm now on hormones for IVF. The assistant told me that that I needed a new referral (as she did when I talked to her last week). I told her that I had received one yesterday from my GP. She found it and asked why my psychiatrist hadn't referred me (especially since he was the one who wanted her to see me). She was perplexed as to why he had refused. I, of course, had no answer.

She reviewed the psychiatrist's calendar, as well as the other psychiatrist who also works in that office (it's in the Victoria General Hospital) and said that the earliest appointment available was July 26th (two months away). I asked what would happen if I became pregnant before then, because normally blood tests have to be done to check that the levels of the psychotropic medications are therapeutic (so the mother doesn't destabilize) and certainly not at a toxic level that would harm the mother or baby. She said she supposed I'd just have to be treated by my original psychiatrist. I again explained he was refusing to treat me. Silence. She clearly understood the ridiculous and unfortunate situation I was in but was perplexed about how to help me. I would have been too. She said I should call the office of the perinatal psychiatrist if I was pregnant and she would get the psychiatrist to give advice to my current psychiatrist, or my GP if the psychiatrist refuses to treat me even with this advice, on how to treat me while pregnant, until I can get in to see the perinatal psychiatrist. She also put me on the cancellation list in the hopes of getting me into the office sooner.

All in all, this has been an extremely frustrating experience. I can't imagine what would happen to someone who was less proactive and less able to be their own advocate. Our medical system certainly leaves something to be desired.

Doctor's office bathrooms always have awesome lighting!

Look at that fluorescent glow.

The waiting room in this doctor's office has a mix of florescent and natural light. 

The light in the exam room . . .

Sonohysterogram and IVF Orientation

The sonohysterogram test sounded horrifying. They perform an ultrasound, wash the uterus with iodine to prevent infection, fill the uterus with saline using a catheter so they can observe better if there are any problems with the uterus, and lastly they take a bit of the lining of the uterus and this is biopsied to check for problems (endometrial biopsy- not done in all sonohysterograms, but was to be done in mine). Research has shown that this test can allow blastocysts to implant better and thus it is often done before the first round of IVF to improve the chances of success.

Given the discomfort of the HSG test with the contrast dye in the fallopian tubes (major cramping and then bleeding, like having a short bonus period) and the fact that they said that this test would take 10 minutes (the HSG took about 2-3), I was terrified. It sounded so painful and the write up they gave me wasn't very reassuring (I know they have to prepare you for the worst).

I visited the Victoria Fertility Centre office five days after our last visit. My sister drove me there and then took her baby for a walk so the whole office wouldn't have to hear her howls of dismay at being trapped in a clinical environment for an hour and a half. My husband has been working in a different province during the week for the last couple of months, so I didn't have him there and I rather wished that I could have, because I felt nervous and alone.

I paid the deposit for the IVF process ($1,500) and then was taken to an examination room. I had to wait a while for Dr. Hudson and I amused myself by taking selfies on the exam table. The nurse set up. Dr. Hudson turned the screen, so that I could take some photos for the blog. He's very kind. He showed me the uterus first (they do an ultrasound first), then both of my ovaries, with one of them having a follicle that was just about to rupture (so ovulation was imminent). He said that my bladder was so full (shouldn't have had that extra cup of tea) that it had pushed the uterus up and that he would have to "pull it down" (I said "that sounds horrifying." The nurse laughed, but he just soldiered on). I had cramping with the "pulling down" of the uterus, then the iodine, saline, and excision all happened in about two minutes, as I deep breathed and stared up at the ceiling tiles. Then suddenly we were done.

I think the whole procedure took about five minutes start to finish and for pain level, it was uncomfortable and crampy, but not near as bad as the HSG test, for me at least. The bleeding after was minimal, much less than the HSG test,  for me anyways.

I went to sit in the waiting room and then my lovely orientation nurse came to give me my IVF orientation session. She gave me a cup of tea (how civilized, good luck finding that at any other doctor's office). She had asked what day I was in my cycle (day 14) and she produced a calendar with when I would start the first hormone (Estrace), when I would start injectable hormones (she'll teach me how to inject myself with these drugs once I return for my blood tests and ultrasound at the start of my next period on day 2 or 3 of my cycle), and the day by day process leading up the egg retrieval, fertilization of the eggs, and then implantation.

She answered all of my questions about how much the hormones would make me swell and other side effects, what the survival rate is of the frozen embryos (97%), how much a frozen embryo transfer costs if the first IVF cycle doesn't succeed and there are any frozen embryos to work with ($1,300), the level of pain associated with egg retrieval and what they do to make you more comfortable, and what does the implantation procedure feel like.

I found that about half an hour with her alleviated a lot of my anxiety about this alien procedure, especially because not only did she have an excellent bedside matter, but she was also very knowledgeable, and her sense of humour didn't hurt either.

Examination Room

Examination Room Selfie

Ultrasound of my uterus- I have no idea if it looks abnormal or not.

Another shot from the ultrasound of my uterus (also before saline- I was too uncomfortable at the end to grab a shot with the saline)

One of my ovaries can be seen as the black hole in the middle of the white image.

This is the other ovary with a follicle about to rupture (ovulation- I was on day 14 of my cycle)

Third Consultation, Instructions to Carry Forward with IVF, and Anti-Mullerian Test

In the spring of 2016, we called to book another appointment with Dr. Hudson. He was full up until May 2016. I asked to be put on a cancellation list. But no cancellation happened and we ended up seeing him on Friday the 13th of May.

We told Dr. Hudson that if he thought we were good candidates for in vitro fertilization (IVF) then we'd like to proceed as soon as possible since that had the highest chances of succeeding (flip of a coin odds) and we weren't getting any younger.

The price quoted for IVF was $10,000 ($6,000 if you have drug coverage through insurance). There was also a premiere package offered where the first cycle is $6,500 if you have drug coverage, the second cycle is $4,500, and the third is $4,500. This is what they have moved towards in Europe to make IVF more affordable and try to take the pressure off the couple to get pregnant the first time. Obviously stress isn't good for getting pregnant or staying pregnant (the older the mother, the higher the chances of miscarriage).

Dr. Hudson said that he thought we'd probably make good candidates, but he'd do more blood tests on me (including the Anti-Mullerian hormone test to check my egg reserves). He gave me a requisition and then I was given another pelvic ultrasound in his office. I was given an appointment to come back for a sonohysterogram and orientation for the IVF process with one of the nurses at the clinic.

I went directly to the lab to have my blood tests done. This was the start of our IVF journey.

Another blood test!

The start of our IVF journey

Second Consultation

At our appointment in December 2015, Dr. Hudson said that we had "unexplained infertility."So, technically we should be able to get pregnant, but for some reason or another that was unclear, we had not been able to get pregnant.

 Then Dr. Hudson laid out a variety of options for how we might increase our chances of conceiving. He said our current odds given my age (almost 36 by that point), my husband's sub-optimum sperm quality, and how long we had been trying to conceive were about 2-3% each month (with a 25% chance of miscarriage given my age). The treatments offered boosted our chances to about 3-4% per month to 50% with IVF (all still with the same chances of miscarriage, 25%).

As I listened to how low our chances were and how much the various treatments cost,  I felt a combination of rage and despair. I fought back tears. Dr. Hudson said that we should think about all of the options and perhaps give it some time, but that he wouldn't leave it more than six months given my age. He said that he wouldn't be surprised if we got pregnant in the meantime without his help given the fact that we could in his opinion (again the use of "unexplained infertility.")

After I left his office I was so upset, I couldn't stop crying. I could not believe the cruelty of fate. Why was this happening to us when we had always wanted children? By that point I had been on prenatal vitamins and extra folic acid for almost six years.

Through the next several months, I tried to process my grief and decide what to do. I was devastated and terrified about the future. I continued working with my counsellor through my sadness, rage, and grief.

My husband and I tried to maintain our open communication as well as we could, but since we had both so much wanted children for so long that period of time was very, very difficult for us. Through this whole process, we couldn't help but feel completely alone. We didn't know anyone who had ever had trouble getting pregnant (or if we did, they didn't tell us). We definitely didn't know anyone who had ever gone to a fertility doctor and undergone a treatment with one either. Our friends had stopped asking about how our journey to have children was going and our families walked on eggshells around us. We grappled with the fairness of our situation as we observed people in the world who didn't even want children having accidental pregnancies and then some of them neglecting these children. But life isn't fair.

We both started to see a naturopath who offered suggestions of even more vitamins we could try to improve our fertility, herbal remedies, and gave us acupuncture to boost our fertility. We both underwent about two months of acupuncture on at least a weekly basis. We did not get pregnant.
I bought a box of ovulation testers. I was sceptical that they would work given that I always drink so much water and dilute urine can throw those tests off apparently. I had a box of 10 and despite signs that I was ovulating, the kit never showed that I was. Ultrasounds have shown that I do ovulate, so I think the tests just didn't work. All I can say, is that waiting till a certain time every morning when you've drank way too much water the night before is agonizing and I was glad to be done with the box.

Then, on the suggestion of the naturopath, in complete desperation, I started taking my basal temperature every morning. This too was annoying, but I was willing to do anything to up my chances of conceiving. The months passed, showing a consistent pattern of monthly temperatures, but we still didn't get pregnant.

First Consultation with a Fertility Specialist

We were referred to Dr. Hudson at the Victoria Fertility Centre. We had to wait about six months to get into see him. Our initial consultation  was in July 2015. He reviewed our blood tests and the semen analyses. He ordered blood tests, gave me a pelvic ultrasound in the office, ordered a further semen analysis for my husband, and I was sent for a hysterosalpingogram (HSG).

In the intervening time between our first and second visit to Dr. Hudson, we both had our blood tests done. My husband had another semen analysis done. I had the HSG test done. This test is where they pump contrast dye into your uterus to see if your fallopian tubes are blocked (under X-ray). The test takes about two minutes but caused intense cramping for me (that's normal) so it was like getting a second period in a month (it causes bleeding too).

The HSG results were normal. The blood tests were normal. The semen analysis was basically the same.

We both researched further vitamin supplements for fertility. We took even more vitamins. We did not conceive.

The Journey to a Fertility Specialist

Six years ago I turned 30 and suddenly a distant future goal of wanting to have children, became much more pressing. Overnight I went from observing babies with disinterest to longing. I can remember sitting on trains in Japan and staring at mothers with babies and bursting into tears like a complete weirdo.

I started seeing a naturopath and my doctor six years ago because my health (mental and physical) was taking a complete dive. I wondered if my busy and stressful career as a trial lawyer was just getting to me or if something else was at play.

I started taking prenatal vitamins and extra folic acid in preparation for pregnancy, but unfortunately a diagnosis with hypothyroidism and difficulties regulating my thyroid even with the help of an endocrinologist led to a delay in being able to try for a pregnancy (thyroid levels must be in a healthy range to avoid potential problems in pregnancy like miscarriage and brain damage in the developing fetus). My doctor also said that other medications that I was on would have to be removed or replaced in order for me to have a safe and healthy pregnancy.

The years slid by. My endocrinologist said that my thyroid levels were safe to become pregnant. I was referred to a perinatal psychiatrist who looked at my list of medications and my condition and agreed that I could now try to get pregnant. That was November 2013.

My husband and I were so relieved. We had always planned to have children (we even discussed it the first night we met each other) and now we were sure that this would happen in good time. It didn't.

First I went through blood tests. Then he went through blood test. Then I had a pelvic ultrasound. Everything seemed normal. He had a semen analysis done...and another...and another. The results continued to be sub-optimal. He saw a urologist. The urologist thought that sperm quality could be improved with a varicocelectomy. He had this day surgery done in May of 2015. Subsequent semen analyses were about the same. The urologist didn't see why we couldn't get pregnant in spite of this.

But we didn't get pregnant.

Introduction

Knowledge is power. Not knowing about something makes you fear it more. It is our hope with this blog that we make the process of in vitro fertilization (IVF) less scary. We feel alone because we don't know anyone else going through this process, but that can't be true because up to 16 percent  of North American couples struggle with infertility at the present time. Plus every time we go to Dr. Hudson's office there are many other people there, so they might be going through the exact same roller coaster of fears, hopes, and unknowns right now. Our wish is that with this blog others will feel less alone than we do right now.