IVF:The other road to motherhood

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Part 13: The four eventful week

It's been four eventful week. I had mentioned in my last blog that the nurse took some blood samples to test my estrogen, lutropin (Luteinizing hormone ) and FSH levels and thankfully they all came out to be normal. They even conducted a test to identify the egg reserves and it's fine too. 

I started out with Puregon shots on the night of January 8th with prayers and lots of good wishes in mind.

The first week was quite an exciting one and at the end of first week I was called in again for an ultra sound to monitor the growth of follicles. The effect of the Puregon wasn't visible on follicles but the econometriaum line was developed finely.The biggest follicle stood at 5mm. Again I was asked to continue with the same 50 units per day shots of Puregon. After the end of second week, I once again had an ultra sound. Now this time the follicle grew just by 2 mm which is below the expectation. So after two weeks of 50 units of Puregon, the dosage was raised to 58 units. This dosage increase had a slight impact and on the beginning of third week, the biggest follicle stood at 10mm, the second was at 8,9 mm and the third was 7mm. Once again I was asked to continue with the prescribed dosage and called again in five days. This time there was slight improvement. The biggest follicle was 11,9mm and the rest each had a growth of 1.5mm respectively. Dr.Vicky was bit worried and concern as despite the increase in dosage, the follicle is not growing at an expected rate. So she gave me two options: A further increase in dosage, which might result in three big follicles. But under the Danish law, a doctor cannot perform IUI on three follicles. So they'll have to puncture a third follicle using a local anesthesia. Considering my age, she felt it's unnecessary for my body to undergo those depressing procedures. Another option was to wait patiently and continue with the same dosage. After a good mind boggling session, we decided on the second option. She also said that towards the end the follicle experiences a sudden growth overnight. So it's better that we wait and watch.

I was called yesterday for one more round of ultra sound. And yes the miracle did happen. Within three days, the follicle was at 14.9 mm. And the nurse said that my body is now capable of taking a trigger shot. She asked me take one more shot of Puregon last night, which is expected to further increase the growth of the biggest follicle to 17mm. She also gave me an Ovulation Stimulating Hormone injection called Ovitrelle 250 micro grams which I'll be taking tonight at 23:15. They called me for IUI procedure on Thursday morning 11:15 exactly 36 hours after the trigger shot. 

Meanwhile, in the whee hours of the morning I started experiencing period like cramp. I got scared and lost my sleep. I just called up the clinic and the nurse asked me to take a ovulation test and it came out negative. But still wondering what this cramp is all about. I seriously don't want to loose my follicles after I had put in lots of efforts to nourish it! At this juncture more than been excited I'm scared. I'm scared of loosing my follicles and I'm scared of unsuccessful IUI. I'm born pessimist!!

Asmi

Date: 04 February 2014

Day: Tuesday

Time: 14:19 GMT+1

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Now that's my ultra cool Puregon kit complete with a bin to dispose off the used needles. 

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Part 12: Arrival of the T-Day

The aunt flow paid a surprise visit on early morning of January 7th. I was happy for various reasons. First it came just two weeks late, second, I can finally start with my infertility treatment and third, I can finally dream and hope about becoming pregnant soon. 

The very day I called up my clinic and informed the nurse about the very recent development in my anatomical front. She gave me an appointment for next day i.e. second day of my menstruation. 

On January 8th, I went to the clinic all anxious as they were going to perform ultra sound on me. It might sound gross but that’s the reality a woman with infertility has to face. The nurse made me feel calm and relax. Later, she smoothly performed the ultra sound explaining me about the internal reproductive system. This time I got to see 5 follicles in each of my ovaries in various shapes…slanting more towards round and oval. However, she didn’t tell me if it is normal to have 5 follicles in each of the ovaries at this phase of the period. But she concluded saying that everything thing looks normal and endometrium lining is bit thick as it’s still second day of my menstruation. 

After calculating certain things, she signaled me to follow her to the office. Once there, she asked me how often I get my periods and she wanted to know the precise days between each period. For that I told her my periods are quite irregular and that is the precise reason why I’m there at the fertility clinic. Apparently, Dr.Vicky didn’t brief her much about my case. But that’s fine…as my case was registered on their online database. The nurse went through it in detail. Then she came up with Puregon 300 injection kit.

Puregon is one of the most effective follicle stimulating hormones (FSH). It’s the result of 12 years of hard work, brain drain and someone’s determination and dream. In a way I feel so special using this hormonal therapy. I truly hope this magical potion helps me to become pregnant in the first attempt of IUI. Sounds too ambitious right? But that’s how desperate I’m and so are the most of the women around the world who are suffering from infertility. 

Now back to the point, the nurse gave a brief intro about the contents of Puregon and it’s impact on my body. It reacts different on different people like any other medicine. So next 15 minutes I spent learning how to use this pen injection. It’s quite simple and there are several videos available on the net. So let me not take the space here explaining how to use it. But I’ll share the picture here. It looks ultra cool :-) 

The interesting thing about this beta injection is that it should be taken at home by oneself in the night around the same time every night. It comes in 300IU/0.36 ml, 600 IU/0.72 ml  and 900 IU/1.08 ml solution for injection. I have been prescribed with the first one and asked to take the shots every night for seven nights. I started taking Puregon shots from January 8th night. Today is going to be the third night and I’m all excited. So far I haven’t experienced any side effects… may be because I’m still menstruating and the menstruation symptoms might overshadow the symptoms of Puregon. So I’ll have to wait until my blood flow ceases. 

On the 8th day, the nurse will conduct another round of ultra sound to see the growth of the follicle/s. I’m all finger crossed XX Apparently, such shots also results in growth of multiple follicles which are sometimes not suitable for IUI as it might lead to multiple pregnancies. 

Meanwhile, the nurse also took some blood samples to test my estrogen, lutropin (Luteinizing hormone ) and FSH levels. So thousands of things depend on my internal balance. And still I’m advised to relax and be happy. I try to ignore negative things but I’m fickle minded and highly sensitive human being!  But I have to do this for the sake of my potential unborn child!

Asmi

Date: 10 January 2014

Day: Friday

Time: 17:35 GMT + 1 

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Part 11: Some Progress

After waiting for one and half months, I went to a local lab and tested my TSH on 19th December 2013. The result came out positive with a count of 0.72miu/l, which is in the lower end of the normal range - a perfect count to kick start my fertility treatment.

I was suppose to menstruate on December 25 2013 as per the normal 30 days cycle but as usual I didn't and as of today, I'm little over one week late for my periods

Meanwhile, I wrote an email to Dr.Vicky pertaining to my normal THS level and she asked me to visit the clinic on 27th December morning. She took an ultra sound of my uterus and Fallopian tube which were normal. The ultra sound showed that I had ovulated (on the left side) and the sac was empty. The econometric lining was thick. She said that it's too early to detect pregnancy if it all it had happened and asked me to wait for one week and than take a home pregnancy test. If it's negative then I wait for few days until my periods return or else I start taking provera.

Provera will result in menstruation and it should be taken only when the endometrium lining is thick otherwise the doctors administer contraceptive pills if the lining is thin. Now the problem doesn't stop here. Once I start menstruating, on the second day they'll take an utlra sound of my uterus. If the internal anatomy looks fine they'll inject follicle stimulating hormone or else this will further delay the treatment.

So if I menstruate in the coming weeks, I still have few more tests to pass before I start on my actual infertility treatment.  Dr.Vicky and I decided to wait for few more days and see if my menstruation return naturally and set our selves a goal of two weeks out of which one week is already over yesterday. So I gotta one more week and then if it doesn't come, I'll have to start taking provera. Of course after taking one more round of home pregnancy test. 

As of now, my breasts have become tender and nipples have become sore. Which I always believed are classic sign of my periods but these symptoms sometimes fools me. Two months back I had the exact symptoms for a month and my periods came after 65 days. So I really don't no anymore what to look out for! 

Fingers crossed and waiting for that magic to happen :) And also hope that 2014 gives me that bundle of joy that I have been yearning for a long time now!  

Asmi

Date: 3 January 2014

Day: Friday

Time: 11:05 GMT + 1 

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Part 10: Counting the days

Come December 16 and I have a trip to a lab to test my TSH level. I truly wish the level is normal and meets the parameter to start my fertility treatment. Otherwise even a single digit here and there, things will go down to the drain again. And I'll have to wait once again helplessly for another one and half months before I debut my fertility treatment. I'm eagerly waiting to start my fertility treatment and truly hope things turns out to be normal this time. I know I'm sounding super eager to become pregnant but then this is something I wanted to become for a long time now. It's been almost two year of fruitless TTC. 

Waiting period is something I dread as lots of negative thoughts fly around my mind and I become a restless soul! But do I have a choice given the situation? No! So I have to wait for few more weeks...helplessly of course! 

Asmi

Date: 10 December 2013

Day: Tuesday

Time: 09:27 GMT+1

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Part 9: The fluent flow

Well it's been a long time since I updated my blog so thought of putting my thoughts and events together before it erases from my mind.

As a teenager, I never had issues with my menstruation and it used to be quite prompt but things changed as I progressed into my mid.20s. And in those days, I hardly paid any heed. Involved in my education and career. Things started changing after marriage. I started noticing the changes in the pattern. Initially, I was quite reluctant to become pregnant and I started diligently noting down the dates and used to get freaked out even if it delayed by a week. Soon, I discovered that I have a problem with irregular menstruation.

After six months of tracking my menstruation, I reported to my GP and after one year of assessment by my GP, gynecologist and a endocrinologist I was put on a contraceptive pills. I was happy that it came on time with a normal flow and the best thing was I could actually predict the day like any other normal woman. But soon enough I had a realisation that the doctors only treated my symptom and not the underlying cause. The cause is what is preventing me from becoming naturally pregnant. 

Unlike other women, I don't have an organic disease but hormonal imbalance. My doctor feels that it's quite natural for some people to have a irregular menstruation throughout their productive years. This is something I never hear before. The frustrating part is none of the doctors so far ever tried to diagnose what kind of hormonal imbalance I have. Is it the problem with my estrogen or progesterone or androgen levels etc.? I have fucking no clue. This irregular menstruation has not only affected my fertility but to certain extent damaged my mental health too.  

All I'm waiting for is to become successfully pregnant and once it's done my next step will be to find out a good physician who will listen to me and treat my hormonal imbalance or whatever the deficiency is. Human body is like a domino's effect...even a single lapse in the internal body can great impact on other organs. 

Now coming to the point, 65 days after my last menstruation came the saving grace again with a wonderful flow on November 26. For some reason, menstruation is a rejuvenating experience for me. I feel serene on the second day once the cramps subsides and yes I enjoy the whole experience of the blood gushing down from my system!!! And it takes away my anxiety and paranoia. It's like I'm born all over again. And now god knows when I'm going to have my next menstruation as lot my fertility treatment depends on it. Just crossing my finger and waiting for the B-day! X

Asmi

Date: 10 December 2013

Day: Tuesday

Time: 09:13 GMT+1

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Part 8: High TSH

I mistook the appointment date as November 14. My appointment was yesterday thanks to my mail to Dr.Vicky where I had mentioned about my appointment with my endocrinologist. Otherwise I would have missed out on my appointment with the specialist. 

On November 7, I was asked by my endocrinologist to give some blood sample to test my TSH level. The TSH count was down at 4miu/l from 11 miu/l two weeks back. But the count is still at higher end of the normal range. Both Dr.Vicky and the endocrinologist made it quite clear to me that my fertility treatment will kick start only after the TSH count comes down below 2.5miu/l. I gotta a long way to go now...

After a discussion with the endocrinologist, I realised that the sudden change in my TSH level is due to the fluctuations in the time at which I used to take Euthyrox every day. The endocrinologist said that a slight change in the timing has deep impact on the function of thyroid hormones. He increased my dosage from seven pills a week to nine pills a week and asked to me go for one more round of tests after December 16. Dr.Vicky also made it clear that she cannot start my fertility test until after December 16 after checking my TSH level post-new dosage. 

My menstruation is delayed by 53 days as of today and Dr.Vicky asked me to take a pregnancy test although I know for 100% that I'm not pregnant. I asked Dr.Vicky if it is possible for her to regulate my menstrual cycle for which she replied that there is nothing she can do at this point as everything depends on my post December 16 TSH count. And this means I have to spend another 35 days of my life in uncertainty, a bit of frustration, miserable and stress!!! 

I wish I can control my desperation and lead a calm life. I know this stress will not solve my problem and on the contrary it'll affect my internal health. But then I'm paranoid person!

Asmi

Date: 13 November 2013

Day: Wednesday

Time: 14:56 GMT+1

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Part 7: Passing the time

Being overly health conscious, I wrote to my endocrinologist citing my fear over the sudden rise in my TSH level. So I asked him whether I should increase my dosage of Eurthrox. He too found the sudden rise quite a peculiar thing but asked to me undergo one more round blood test towards the end of this week. 

But I was so freaked out with the test results that my mind was switched off completely. After calming down in the evening I let my mind to wander freely. And in the process I realised that the day I went to give my blood sample, I did not take Euthytox as I thought I'll have it after the blood test. And this may be one of the reasons why the blood result showed high TSH level. But I was such a jerk that I wrote to my endocrinologist in a paranoia state. Nevertheless, will tell my endocrinologist next week when I meet him in person. I  also decided to try not to freak out again if the blood shows such a random discrepancies. 

I seriously I don't know how I'm going to spend my time patiently until 14th of November!!! 

Asmi

Date: 4 November 2013

Day: Monday

Time: 12:53 GMT+1

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Part 6: New complications

A few hours back Dr.Vicky rang me up to update me about my metabolism levels. She told me that my TSH level has suddenly shot up to 11 miu/l and wanted me to fix an appointment with my endocrinologist as soon as possible. (Normal TSH in adult should be between 0,2-5,0 miu/l ). 

Well  I have been diagnosed with sub clinical hypothyroidism some 2.5 years back. Since then I have been diligently taking Euthyrox 50 micro-grams every day before my breakfast/brunch.

After hearing from Dr.Vicky, I was quite shocked and surprised at the same time. Surprised because just two weeks back when Dr.Vicky performed various pre-fertility treatment tests, my TSH level turned ou to be quite normal. In fact I remember being quite arrogant about it as I have been religiously taking the prescribed levothyroxine dosage :) 

I have called up  my endocrinologist's clinic and  got an appointment with  in about two weeks.Now this means a considerable delay in with the start of intra unterine insemination procedure! 

On another note, I have been feeling excessively tired, breathlessness, constipation, irritable bowl moment, jittery, shaky, depressed and painful limbs. But not once it crossed my mind that this could due to the rise in my TSH levels. All this while I have been thinking that these changes could be due to the pre-natal vitamins I have started taking recently. 

All I need now is some peace of mind!!

Asmi

Date: 1 November 2013

Day: Friday

Time: 14:25 GMT+1

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Part 5: Off the track

I just realised this morning that I'm 10 days past my periods with no signs of it coming soon. I have always been in rhythm with my body so the slightest change in the beats simply freaks me out. But now I have been so much used to this concept of 'Irregular periods' that I have accepted it. It no longer bothers me now especially since I decided to take an alternative road to become pregnant.  

There was a time even a slightest delay in the menstruation used to turn me off and dominate my entire consciousness. But time makes you accept everything. 

Now coming back to the point, I shot an email to Dr.Vicky telling the same as all the major questions regarding the treatment came down to my menstruation. Dr.Vicky told me that if my menstruation delays further she will administer me with half a pack of contraceptive pills to bring the normal menstrual flow. After which they can start the treatment. So today I reminded her of the same suggestion. Interestingly she was quite quick in her reply this morning. 

Let me quote her here:

Have you done a pregnancy test?

If you are not pregnant, we will see you for an ultrasound scan, when we have got the result of the blood sample for the metabolism. If you have got a large endometrium by ultrasound, we will give you a hormone called Provera. If you have got a narrow endometrium, we will start p-pills.

I haven't taken the pregnancy test yet as I ovulated just four days back. I would like to wait for few more days before I resort to take pregnancy test, which I know for sure is going to be negative. After all I'm in sync with my body! 

So waiting is what I have to do and that too with a lot of patience - something an impatient person like me hates to do. Well hate is a too strong word. Let me say 'dislike'. And I don't understand when people say have positive thoughts and don't stress too much. How can you be not worried to death especially when there is something gravely wrong with your biological function? I tried being indifferent to the whole thing but it's next to impossible. I also acknowledge that cribbing about the problem will not solve it either. I say let my take it's own journey. Let it heal by itself  Time does miraculous things. So let me take my own course...

Asmi

Date: 31 October 2013

Day: Thursday

Time: 11:43 GMT+1

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Part 4: So it's artificial insemination

Last Monday, Dr.Vicky confirmed that I'll be given the treatment of artificial insemination after my husband's sperm count came out normal.

However, before proceeding further with the treatment she wanted to do a few more round of blood tests on me. This includes a test for metabolism among others.So this morning went to the lab and gave my blood sample for metabolism testing.

Apparently, metabolism plays a crucial role in egg supply as well as help in sustaining pregnancy. I was told by my nurse that the metabolism level in my particular case should be in the lower end of the normal range. The normal range is between 0.5 to 5, while in my case it should be between 0.5 and 2.5. So that they can right away inject the ovulation stimulating hormones. If my metabolism turns out be "normal" i.e above 2.5, then they will refer me to an endocrinologist who will bring down to a lower end with medications. And this will further delay the start of intra-uterine insemination. 

Simply hoping that the results turn out to be in my favour. 

Another development is that my blood results for  rubella, chlamydia, thyroid, prolactin etc. turned out to be normal. Now that saying my foggy mind can see a ray of hope. 

Asmi

Date: 30 October 2013

Day: Wednesday

Time: 11:25 GMT+1

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WHAT MAKES YOU FEEL BETTER WHEN YOU ARE IN A BAD MOOD?

Music

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Part 3: The first trip

Earlier this week, a rainy afternoon, we made our debut visit to the fertility clinic and got to meet our doctor - a tall, fair, blond with light eyes. Generally, I have a good record of having cordial relationships with my doctors and I wasn't disappointed when I met her. I'll call her Dr.Vicky. Dr.Vicky must be in her late 30s or early 40s with a pleasing personality. 

As our dialogues progressed, I observed that she is also quite approachable, which I personally feel is a very important aspect in a doctor-patient relationship. After all I have surrendered my very precious body and part of my mind to her. So it's very important that a doctor reciprocates my trust and faith with same zest. 

After question sessions with my husband, Dr.Vicky finally came to my case. The best thing about her was that she directly came up with a solution instead of unnecessary pondering over my case, which my GP is otherwise famous for :)

Dr.Vicky, without wasting any time, said that either I'll be given artificial insemination or IVF (In vitro fertilisation)  after a detailed assessment of my husband's sperm count. 

She presented me with the following scenarios:I'll be given Artificial Insemination if my husband's sperm count turns out to be really good. (A separate blog is coming up on this topic).

 If the sperm's motility turns out to be bit low, then I'll be directly given IVF treatment. 

OR

If the artificial insemination fails to make me pregnant even after four attempts, then I'll be given IVF treatment. 

Simultaneously, I'll be given ovulation stimulating hormone shots on the second day of my menstrual cycle.

And to put it in a lay man's words, the artificial insemination seems to be a time consuming one while in IVF, the embryo is directly implanted in the womb!!!  

As of now, all I have to do is cross my fingers and wait for the right time!!

Asmi

Date: 24 October 2013

Day:Thursday

Time: 15:27 GMT+1

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Part 2: Certain Realisations

April 2012:

I discontinued my course of p-pills with the intention of starting a family later in the year. It's no secrete that the system takes six months to a year to wash out the artificial hormones created by the p-pills and replace it with a natural one. As expected my menstruation came 45 days late after stopping the pill, which is considered quite normal.  

Fast forward to August:

My husband and I decided to start a family instead of waiting for few more months as it sounded meaningless to be that punctual. So I decided to visit my GP for a basic health check up and more importantly for her advise. After going through my previous medical record, my GP conducted few blood tests which included tests for German Measles, hormone levels etc.and a swap test. The result turned out to be normal and she gave me a nod to go ahead with my TTC with the cliche advice of having intercourse every other night and to take folic acid tablets. 

Confused September:

I missed my menstruation and was quite confused. I was sure that I wasn't pregnant as we had only few intercourses and my body didn't show any sign of pregnancy, not even the most common symptom of sore breast. I rushed to my GP, who conducted a chain of blood tests and urine tests. And there came the negative pregnancy test. So what caused my menstruation to go off track? My doctor thought it might be due to high liver count and suggested for Ultra Sound of liver. Being in a welfare country, such facilities comes with it's own package. I was relieved to see a friendly radiologists who went an extra mile and scanned my kidneys as well as the inner reproductive system apart from liver. 

Meanwhile, I was quite confident that my missed period has nothing to do with the high liver count. The liver count keeps fluctuating in a human body all the time and a trip to fitness club will simply boost it. And I suspected this is what happened in my case as I went to the lab after my work out session. But my GP simply dismissed my voice and I went along the ride.

In the end, the results turned out to be normal as something I expected!!

Disappointing October:

In the second week of October I experienced some spotting. I was euphoric thinking that either I'm pregnant or I'm going to start my period. I wanted a clear picture. It was time where it didn't matter any long whether I become pregnant or not. All I wanted was my system to function normally. But to my dismay, none of the above happened. The continuous spotting turned out to be anovulatory cycle. 

Plain November

With November, I was loosing my patience and becoming restless about the whole thing. We even stopped TTC as my mind was taken over by paranoia. Plus my GP's inability to diagnose the exact cause was also bothering me a big time. The whole thing was so frustrating!!! In short my life was in awry!!! But life doesn't stop. It has to go on... All I wanted was a sound mind and a healthy body. Then came the third week of November where my actual period started 45 days after anovulatory bleeding and three months after my actual menstruation.

For a change my menstrual cycle came on time in the following three months. I was happy to see that it was getting on track.... 

 Hopeful March 2013:

With the onset of spring, we resumed our TTC. I missed my periods and was quite positive that I was pregnant as I had some pregnancy like symptoms. My breast became very painful and it was quite sensitive to touch, my aerola became dark, then the green veins started showing up in the breast, and on and off feeling of nausea. In short I was positive that I was pregnant. To confirm my wildest thoughts, I decided to take pregnancy a week after I missed my period. The first test came negative but I was still hopeful as I read various articles on the net that sometimes the HCG doesn't show up so soon. Next day I took another test and again negative. In all I took some five tests. All of them were negative. My body was playing all kinds of tricks. 

End of the guesswork in April:

I rushed to my the GP with all the symptoms. She conducted one more pregnancy test and it turned out negative. My hopes were crashed with the start of menstruation. Apparently, all this while I was suffering from pseudocyesis (fake pregnancy syndrome). Human mind is mystic. Never thought it can play such realistic tricks. ^-^

The next four months continued with the same pattern of irregular periods, which means I was unable to track my ovulation phase and in turn the TTC was a failure. 

Fast Forward to August:

This time I was determined that I'm no more going to waste my time visiting the GP and repeat the same history. It took me over year to realise that my GP has laid back attitude so I better fix it now or change the doctor. But they say known devil is better than unknown friend. I decided to stick with her but ensured that this time she actually empathise with me. I became proactive and some research on the net groomed me a bit. I also suggested my GP that I might be suffering from hormonal imbalance. So she better give me a referral to a good gynecologist. After feeling pity at my pathetic state, she came up with the suggestion of a fertility specialist. I liked the idea considering the success rate the fertility clinics have achieved around the world. 

Simple September:

I was under the impression that a quick trip to the fertility clinic will solve my problem. I was so naive.... The lady in the clinic told me that they cannot take my case until and unless they my husband's GP sends them referral. In other words, they wanted my husband's basic fertility results.

So a month was lost with a several trips to his GP and lab. But at least his primary results turns out to be normal. Something I'm happy about :-)

Asmi

Date: 23 October 2013

Day:Wednesday

Time: 18:24 GMT+1

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Part 1: The introductory post

There comes a day in a woman's life when she wants to be a part of the so called traditional-conventional society no matter how free spirited woman she is. Mind you! she doesn't think twice before putting that carefree life behind and embrace an elevated status of motherhood.

I wanted to become a mother even before I decided on my carrier.

Now 12 years later, here I'm working towards realising the very dream that I had seen as a teenager.  

So it recently occurred to me that blogging is the best way to preserve my thoughts and share my experiences with women who have chosen a similar path like mine. Since virtual world has taken over the reality, this is a perfect way to record my journey to a possible motherhood - one of the reasons of my very existence :-)

Asmi

Date: 23-10-2013

Time:15:59 GMT+1

Day: Wednesday