That’s a Negative, Ghost Rider…

January 15, 2010 at 12:35 am (Uncategorized)

The good news is that I’ve been feeling really happy, calm and sane right throughout this first round of IVF. The bad news is that it didn’t help. Or perhaps it did help, but we still don’t have the result we were hoping for. Things started looking dicey just after I wrote yesterday’s post, when an innocent trip to the bathroom changed everything. I knew instantly the signs were very bad. Now, I never saw myself as the weeping-on-the-toilet-bowl kind of girl, but you find out all sorts of surprising things as time goes on. I let myself cry. Then I called Llew, and when I opened my mouth to leave a message, discovered I couldn’t speak without dissolving into choking tears, the sort that constrict your breathing and make you feel like you’re going to be sick. Next I called the nurses at IVF Australia. Unfortunately or fortunately, depending on how one looks at it, this too went straight through to voicemail, and I left a long, strangled message for whichever hapless nurse had the misfortune to receive it. I think I probably ruined more than my own day yesterday, diligently dispensing this piece of bad news about town like DeLillo’s slow-moving airborne toxic event.

I called Llew again; this time he answered, and I had the awful task of beginning to snuff out his hopes too. I couldn’t and can’t stop apologising. Being sorry and being at fault are two different things, but it’s true I can’t help feeling somehow to blame. This is natural, so I’m told, and I can confirm that among the range of feelings lurks the unpleasant sting of guilt. I feel responsible even though I know – and I do know – this is not my fault. And yet the sense of failure and of owning that failure is acute.

But it’s early days, and I’m not going to try to reign in irrational feelings. I’m giving myself permission to move through them all, everything my heart throws at me, at whatever pace I see fit. I have no desire to pretend things are any better or worse than they are: this is where I find myself. And at present I am waiting for the phone to ring, waiting for IVF Australia to call and confirm from this morning’s blood test what I already know. I know because my body has given me incontrovertible evidence, and plenty of it. For this first round of IVF, there is no hope left.

Trying to stop what had already started, yesterday I retreated to the bedroom, crawling under a blanket armed with my billowing self-pity, a cup of tea, a pen, my IVF diary and Wolf Hall. Cookies were introduced into the mix a short time later. I calmed down, pulled myself together, and waited it out. Llew came home and, sad and anxious himself, spent the night taking excellent care of me. We went into the clinic together this morning, and we’ll go back together, and we will try again. Together.

Better luck next time, or the time after that, or the time after that, or the time after that. Onwards. Round two, here we come!

POSTSCRIPT: I’ve also just been notified that my DoctorDi submission wasn’t accepted into an anthology of Australian blog writing. 2010 may be a handsome new year, but some weeks still stink.

And… I’ve had the call. I think my email to the Darklings just now sums up my thoughts:

You know, I thought a positive result would be surreal; instead, this is, knowing it’s no good, that this round is over and aside from a big financial hole we have nothing to show for it. I think the strangeness reveals to me how much I had hoped it would work, because I keep having to catch up to these new facts, and I find them, for a long sombre second, bewildering.

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30 Comments

  1. litlove said,

    I’m so sorry, Di. This one wasn’t meant to be. But maybe the next one, or the one after that will. I know you’ll hang on in there, and you have good support from Llew.

    • doctordi said,

      Thanks, LL. Better luck next time – it seems we are gamblers after all.

  2. Pete said,

    Sorry, Di. That sucks. And I’ve heard that if often takes several tries. My sister tried once and said no more. But glad to see you’re going back. In the meantime, retreating to the comfort of blankets definitely in order. Cookies, Wolf Hall, whatever it takes.

    • doctordi said,

      Damn straight it sucks, Pete, and thanks. Yeah, one of my friends is an IVF veteran and she says the first disappointment is the worst, and I can imagine that being true for me too. I’ll go into the next round with what’s probably a more realistic expectation. I can understand why your sister said thanks, but no thanks, after one round – it takes a lot out of people.

  3. Lilian Nattel said,

    I’m so sorry Di. I am thinking of you and reading and sympathizing.

    • doctordi said,

      Thank you, Lilian. It’s okay – no point crying over dropped eggs, right? Best to see if there’s any good ones left in the carton!

  4. Fugitive Pieces said,

    Oh CRAP. Oh, love.
    It’s dark, gusty, and the snow is thawing here. I keep drifting off to sleep, and being woken by avalanches off the roof, and then remembering your sad news. Each time I hope it was just the remnant of a dream, but no. Hugging the pillow tight, and sighing for you. And hoping too.

    • doctordi said,

      Fugitive, thank you love, that is so sweet… I really like the idea of dream fragments drifting off the roof like snowflakes… it’s a lovely image and very comforting. A poetic way to let go of an ungranted wish.

  5. davidrochester said,

    I think you’re very wise to give yourself permission to just feel it, as awful as it is, and feel your way through it. And that sense of having to “catch up” to the facts, as you so eloquently put it, is such a hard thing.

    Thinking of you and Llew, with love.

    • doctordi said,

      Thank you, Mr Rochester. If this were a game decided on one’s support network, I feel certain I’d be delivering babies in writhing litters.

      I think I’m on the other side of the disappointment: the message has gotten through, and been accepted as true.

  6. Samantha Roberts said,

    Hello Di, I’m Jenny’s daughter-in-law Samantha. I’m so sorry for your loss. I completely and utterly understand how you are feeling. We’re in the midst of cycle # 10 after enduring IVF for 13 months, during which time we have had a biochemical and a clinical pregnancy which ended in miscarriage. We finally got back to embryo transfer today (the first since the miscarriage 7 months ago). We were so relieved to be finally experiencing a transfer again until the doctor told us the quality of the embryo. I’ve now sunk into a very low mood, convinced it can’t possibly work. I just want the 2 week wait to be over as I’m sure I can predict the outcome. Such is the emotional life one experiences doing IVF. Upon seeing my disappointment, the doctor said persistence is the key. Yes, but I wanted to add and resilience and preferably a gambling addiction with large sums of money at one’s disposal (especially since the greatly reduced Medicare rebates kicked in on 1 Jan). Doing IVF is the equivalent to gambling: you hand over large sums of money without any guarantee of anything in return. This mild stim antagonist cycle cost us $3,500 out of pocket (up from $1,500 per natural cycle last year). At least in NSW you don’t also have to undergo national police record and child protection order custody checks in order to prove your fit to be a parent. It’s just a shame that the fertile population isn’t also asked to undergo such ridiculous procedures in order to become parents, then I could take seriously the Victorian government’s desire to protect the best interests of its future citizens. Instead, could it be something to do with the fact that single women and lesbians are now “allowed” to access IVF in Victoria? Pandering to the right wingers in both the ALP and the Liberal party more like it. For all the banging on about population growth you’d think both the state and federal governments didn’t actually want us to have children. Enough of my ranting; I could go on and on and on. Best of luck to you and Liew for round 2. In the meantime, be kind to yourself.

    • doctordi said,

      Oh, Samantha. Welcome to DoctorDi – I only wish a different, happier cause had brought you to my virtual door. I mourned your miscarriage last year very keenly – you definitely have a devoted cheer squad in the Darklings; even if you’re unaware of it, those good hopes are always there wending their way to you. I had no idea you’d faced down this challenge so many times – you rival my IVF veteran friend for stamina and dedication. Yes, it’s all very well for them to say persistence is the key – tell me, are you ever overcome by a wild desire to punch them in the mouth when they say this to you? I know I would be. After ten rounds, you *have* persisted, and it’s unhelpful to have people, however well-meaning, bleating platitudes at you the whole time. I think I’d scream “PERSISTENCE? PERSISTENCE?? WHAT THE FUCK DO YOU CALL THIS?!!” and they’d have to lead me away from all the other women in the waiting room.

      Yes, the bottomless money pit is very sobering too. Each round represents thousands of dollars down the drain if it continues not to work. Again, it’s all very well to tell women they just have to keep going, but it’s another matter paying for it, especially now our wise, benevolent Government has made it even harder. I am shocked and disgusted by the police and custody checks you have to endure on top of everything else. That is a disgrace, Samantha, and I hope you’ve written to your state parliament to tell them so. These are all things that more fertile people – regardless of THEIR oftentimes totally suspect fitness to raise children – simply don’t have to deal with. Perhaps that explains some of the acute insensitivity that persists in certain quarters – some people genuinely have no idea.

      I have everything crossed for you, Samantha. I hope so much your blastocyst surprises you and turns out to be the supreme stayer. All luck.

      • Samantha Roberts said,

        Hello Di, thank you so much for your reply and all good thoughts. I had no idea all the darklings were “egging” (pardon the pun) me on! It’s actually very consoling to know this.

        My IVF clinic does 2 not 5 day transfers and I’m not confident the one on board would have got to the latter stage. Still, conception is mostly a mystery, so who knows?

        I should qualify my 10 rounds of IVF. I have begun 10 cycles but 60% were cancelled as follows: premature ovulation x 2; fertilization failure x 2; premature lutenization x 1; and the best one of all: empty follicle syndrome x 1. Which leaves me with 4 completed cycles which in IVF speak means all the way to an embryo transfer; 2 of which were semi successful (biochemical pregnancy and clinical pregnancy) and the current one unknown at this stage.

        I have mostly been doing Natural IVF which relies on the one dominant follicle so a lot is always riding on this one. Still, I’ve done a lot of academic research on IVF and it remains my preferred strategy. Unfortunately with the new Medicare rebate structure, natural cycles have gone from being the cheapest to the most expensive cycles. We were paying $1,500 out of pocket per cycle but now that has increased 150% to $3700 per cycle and as a result, is beyond our means. I’ve written a lengthy letter to the federal Health Minister about the inquity of it along with other issues to do with the new funding model for IVF/ART services. I await her response.

        I have become yet again a female warrior and activist but this time the issue is IVF/ART, in particular the new discriminatory Victorian legislation (not to mention the federal government’s reduction in the Medicare rebates). I have my case against the Victorian government currently with a Human Rights legal resource centre and have a meeting with them this week to discuss the next strategy.

        It would be great if IVF clinics offered a refund of sorts (partial perhaps?) if they didn’t get you to at least the embryo transfer stage. Apparently some clinics somewhere in the world are doing exactly this but only for women under 35.

        Have you read Invitrofertility Goddess by Jodi Panayotov? If not, do, it’s hilarious! Many thoughts you think you’re the only one to have (such as a wicked response to the person who says persistence is the key) are clearly shared by other fertility challenged goddesses. Check out her website http://invitrofertilitygoddess.com/

        Best,

        Samantha

  7. woo said,

    Oh Di, I’m so sorry to hear that this first round didn’t work. But I think you and Llew are doing exactly the right things: being there for each other, being honest about how you feel and giving yourselves time and permission to feel lousy about it, before picking yourselves up, dusting yourselves down, and starting all over again. It CAN work, hang in there. We’re behind you 🙂

    With love
    Tx

  8. doctordi said,

    Thanks, Woo – yeah, it’s a major bummer. But we’re far from alone, and although I know everyone who does IVF desperately wishes they all had something else in common, some of the stories we’re starting to hear of multiple attempts are very hopeful and inspiring. Of course, the truth is it *doesn’t* always work, for some people it never works no matter what they do, but we’re a LONG way from that kind of thinking and that kind of playing field. We’re not done by a long shot. You know me – nothing if not tenacious!

  9. doctordi said,

    Samantha, yes, the Darkling wing-span adjusts as required! And I can only imagine that, irrespective of the outcome, even commencing ten rounds must be hugely draining, and no less so for cancellations at some point in the cycle. If anything, I sort of think that would make it worse. So I maintain you’ve been through so much, really a full-scale ordeal of myriad shades, and right now I’m only able to appreciate the smallest fraction of what that’s been like. There is great solidarity and comfort knowing the disappointment is shared; there are so many women like us, all going through this very same thing. But I also know we’d all drop out of this club like a shot. We’re all reluctant members of our particular gang, but perhaps that’s precisely what makes the empathy we feel so potent.

    Please let me know how you go with these bureaucratic battles, Warrior Woman – I’m very keen to hear. And for this round, may the mystery resolve in your favour this time.

    • Samantha Roberts said,

      Hello Di,

      Thank you again for your encouraging response.

      I had a meeting with the Human Rights lawyers and we’ve decided to plow ahead by seeking further legal advice about challenging the validity of the national police and child custody order checks contained within the Victorian Assisted Reproductive Treatment Act on the grounds of its incompatibility with the Victorian Charter of Human Rights and Responsibilities Act. If the legal advice is positive, then we will challenge it in the Supreme Court of Victoria. If a statement of incompatibility is found, the government will need to respond. However, they don’t have to change anything (such is the weakness of our Charter of Human Rights. Bring on a national Bill of Rights now!). But it is an election year so the heat will be on. Watch this space ….

      Best wishes,

      Samantha

  10. doctordi said,

    Samantha, yes, I would have thought (just as a layperson) that indeed it *would* violate a pre-existing piece of Human Rights legislation. And everyone always seems frightfully nervy about the Privacy Act – is there potentially something in there too?? It’s unfortunate that we do probably need it to be an election year for something like this to gain traction, but at least you’ve put the wheels in motion, and good on you. I wonder if this is something to bring to the attention of the National Federation of Australian Women (NFAW)? They definitely lobby government on matters affecting Australian women.

    By the way and unrelated to your political efforts, have you been checked out for endometriosis? I only ask because I have a friend who did nine rounds of IVF before the specialist said, okay, let’s do a laparoscopy, and there it was. I had one after a year of failing to conceive naturally – having had three early miscarriages the year before – and they found I had endometriosis too. So I just thought I’d ask in case.

    • Samantha Roberts said,

      Hello Di,

      Unfortunately the Privacy Act is no good; neither is the Equal Opportunity Act. I’ve exhausted all the possible legislation I could. And unfortunately our Human Rights Charter is weak as it does not prevent the government from passing legislation that is incompatible with the Charter. Why bother to have such a Charter then? Well, it’s a first step and over time it will be strengthened.

      No endo is not my problem; I’ve had two laparoscopies to determine that. My problem is my fallopian tubes: left one is blocked and right one is a torsion, the latter of which only occurs in 1 in 1.5 million women! (i.e. very very rare). The cause is unknown but I speculate it happened in my late teens/early twenties when I had two consecutive sexual partners who had had previous sexual partners (one including prostitutes); and as I was on the contraceptive pill, I was at an increased risk of contracting an STI and pelvic inflammatory disease, which in my case would have been asymptomatic. Ahhh, risk taking and youth.

      In response to your ‘In brief’ blog entry, I wanted to say that the success of IVF is overwhelmingly dependent on the woman’s age (under 35 is best) and the quality of her eggs. Hence you will find wildly different results regarding number of eggs collected and quality depending on the woman’s age. However, the average fertilization rate is 60% (unless you’re doing ICSI which is higher due to forcing a single sperm into an egg). Thus 40% of the eggs collected are duds. Then of those 60%, some won’t fertilize properly. Then when you freeze what’s left (assuming there is any), 30% don’t survive the thawing process. It’s a law of diminishing returns.

      This fact is a lot to do with why I chose to do natural, despite the higher risk of cancellation of such cycles which in my case has been 60% of cycles; however the 40% that were completed were very successful, notwithstanding a miscarriage which has nothing to do with having conceived on a natural cycle. Moreover, by doing so I’m supporting Darwin’s theory of natural selection (and I am particularly fond of dear old departed Darwin). Particularly as an older woman (39.5), the chances of me producing more than one good egg in the cohort that compete with each other for dominance every month, is remote. So why take all those drugs to remove all the ones that are competing but are highly unlikely to succeed?

      For a great visual example of what I’m trying to convey, take a look at these green and red dot drawings http://www.advancedfertility.com/eggquantityquality.htm

      I also have a great example for you. A month before I commenced natural IVF, a friend underwent her first stimulated cycle at the age of 27.11 (let’s say 28). She took the lowest possible dose of FSH (72.5 IU per day), but still suffered the dreaded Ovarian Hyper stimulation Syndrome, and produced 18 eggs, 15 of which fertilized via ICSI (so therefore the fertilization rate was higher). She exhausted all 15 embryos (7 single embryo transfers; the rest did not survive thawing) until she got to the final one which has resulted in an ongoing 20 week pregnancy. As a comparison, I got pregnant quicker than she did by doing natural (5 months quicker to be precise) but mine ended in a miscarriage which was more than likely due to chromosomal problems of the embyro and thus my age and the quality of my egg. As she is much much younger (reproductively speaking) than me (by 11 years) her chances of miscarrying were much lower. Still, I couldn’t help but think I’m so glad I’m doing natural cycles. (In her case a stim cycle was necessary due to the need to do ICSI, however, she could have done a mild stim cycle with ICSI).

      Australian IVF clinics are very large by world standards (every year each caters to thousands of women). As a result, they are totally focused on the conventional stimulated cycle because this cycle is the most convenient for them (via the down regulation phase (the pill) they can control your menstrual cycle and therefore, can schedule you in to their timetable). It’s understandable (my IVF specialist alone does 500 ovum pick up’s per year! He told me that this is equivalent to the total output of an average sized European clinic and yet, he’s just one of twenty doctors at my clinic). Just imagine how unworkable it would be if every woman did natural cycles (which are very hard to control as they do not submit to a doctor’s timetable) but still, conventional stim cycles are not necessarily what’s best for every individual woman. Even if women knew all the options that are available (which are not routinely advertised), many would still choose the default position but not all.

      Europe on the other hand generally has smaller clinics and therefore has been moving away from mass production via conventional stim cycles to natural and mild stim cycles. Even the original pioneer of IVF Dr R G Edwards is supporting this trend. As I have come to learn about IVF in Australia, it’s a factory production line and we’re all forced on to the conventional stim conveyor belt unless you’re informed and brave enough to ask for something else. Fortunately for me upon a second opinion, I found such a doctor but my original attempt to get what I wanted was simply met with stone-walling. I was so disappointed that I nearly decided not to proceed with IVF at all because of the first doctor’s attitude. But I did more research and was recommended another doctor whom has been a god send. The first time I met him and told him that I didn’t want to take the drugs and wanted to do natural cycles he said “yes of course you can, after all it’s your body”. I promptly burst into tears with relief that finally, a doctor was prepared to accommodate my wishes. He also said what was there to gain by denying me something that they offer (but do not advertise)? I would simply walk away without ever trying for a baby and that would be a loss to everyone. Needless to say, it certainly pays to shop around and do your research.

      Now that natural cycles are cost prohibitive (thank you Minister Roxon), we are doing mild (antagonist) stimulated cycles where you get less eggs, but the quality is higher (based on research) as you only remove the very strongest of the cohort that are competing with each other. Thus there is much less wastage (not to mention less drug taking). I would however rather have stuck with naturals.

      It’s interesting to note that when I did naturals, the eggs that fertilised into viable embryos and were subsequently transferred, were grade 1 and 2 embryos. I got pregnant with both the grade 1s. Now that we’ve switched to do a mild stim cycle, we’ve produced a grade 3 embryo which substantially reduces my chance of becoming pregnant. I can’t help but think it’s all to do with overriding natural selection and taking a mild course of FSH. Still, I’ve got another week to go before I find out the final result. And if negative, we’ll need to do another mild stim cycle. However, I’ll be very interested to see what grade the next embryo(s) will be. I hope my anecdotal observation based on 2 mild stim cycles vs 8 naturals will be proven wrong over time.

      If you’re interested to learn more about natural and mild stimulated cycles, the best place to start is the International Society for Mild Approaches in Assisted Reproduction. See http://www.ismaar.org/

      Did the doctor think that the endo was the cause of your recurrent miscarriages?

      Apologies for the long post.

      Best wishes,

      Samantha

  11. doctordi said,

    No need to apologise, Samantha. On the contrary, I’m very happy for DoctorDi to be a small vehicle for getting more IVF information out there, and thanks for all that you have provided here.

    Yes, of course you’re right, and the question of egg quality is becoming very pressing in my own case. I smoked for ten years, so I’m worried I’ve damaged my reserve. It can be as plentiful as they like, but if the quality is no good, nothing will change that. After the three early misses and now a failed blastocyst, I have to wonder. My doctor said there appears to be a direct correlation between egg reserve and egg quality, but from 13 harvested, I had just two deemed of sufficient quality to transfer and freeze. So… I think that steep drop off from a decent harvest result is certainly contributing to this dull anxiety in the back of my mind that I unwittingly poisoned all my eggs back when I was a smoker. They know smoking irreversibly damages a woman’s eggs, so I discovered to my horror at the information evening, having never heard it before, so I’m not sure it’s such a big leap to imagine it’s possible to damage them all. Of course I’d have to be desperately unlucky for that to be the case, but I’m also 37 now, and it’s a whole different ball game for a bunch of reasons.

    No, they don’t think the miscarriages are related to the endometriosis. Separate issues; as far as I can ascertain, endometriosis may prevent pregnancy but won’t produce miscarriages.

    Fingers remain firmly crossed for your test.

    • Samantha Roberts said,

      Hello Di,

      Yes the smoking connection. I don’t think I realised there was one until I too commenced IVF. Then you hear all those anecdotal stories such as my friend who was underweight and a chronic smoker and who had two “accidental” pregnancies and healthy babies in her early to mid 40s without the assistance of ART and I don’t believe there were any miscarriages. Some women have all the luck!

      Then there’s the stat that if your father smoked, you are four times more likely to develop a childhood cancer. Lucky for me I escaped that one.

      Don’t be too hard on yourself re the smoking. I know it’s difficult not to blame oneself but with the benefit of hindsight we may have both done things differently. However, there’s no going back.

      Unfortunately it’s the inescapable fact that our biology’s are rather primitive however, the way Western women live their lives is anything but! Did you know that half of all girls in Niger have their first baby by the time they’re 14? Still, I wouldn’t swap my life for one of theirs for all the tea in China. Having lived in East Timor which has the highest birth rate in the world (8 per woman) I continue to feel very blessed that by accident of birth I came to be in Australia. There are very few countries where being born a girl you could consider fortuitous. Regardless of my need for ART/IVF and the outcome, I have a rich and wonderful life with many more options to explore than the sole one of motherhood. I’ve already given much thought to plan B if this doesn’t work. Until then, I’m giving this my best shot.

      On Monday I went and claimed my $4,498.90 Medicare rebate for cycle #10. It was the largest one I have ever received but was very deceptive. Last year my rebates were $1,841.65 a month (for a natural cycle) and yet my out of pocket costs have gone from $1,513.20 for cycle #9 (natural) to $3,716.95 for cycle #10 (mild stim). That entire rebate will go on my credit card which will partly pay off the initial upfront cost of $6,585. The private hospital bed fee and anesthetist fee went on a debit Visa card.

      I received an initial response from the Minister of Health regarding my letter. She has passed it on to someone in her department for follow up and response. At least it wasn’t a “thank you but” letter. So we will see.

      I have either PMT or pregnancy related symptoms. It’s very hard to tell the difference. I really wish our bodies could give us a signal that it was one or the other. Whatever it turns out to be, come Monday I will either begin cycle #11 or begin waiting out the critical 12 week period, neither of which fills me with much glee. I’ve already imagined the telephone conversation with the nurse and my response to whatever the result will be.

      What happened to the embryo on ice?

      Did they do any further investigations as to the reasons for your recurrent miscarriages? (Normally after three they will investigate).

      Regards,

      Samantha

  12. doctordi said,

    Hi Samantha
    The spare embryo remains on ice. We have our next appointment with Dr P on February 8 – he’s currently on a holiday we probably helped fund! – and we’ll discuss the next step then. I understand it may not survive thawing, and in some respects I would personally prefer going for another full harvest, especially given my remaining eggs are quietly ageing every month that goes by.

    Aside from a raft of blood tests and the laparoscopy, no, they didn’t investigate further. They all (my GP, my neighbourhood obs/gyn and now Dr P at IVF Australia) seemed to think we were just unlucky; I wonder if there’s a tipping point when they start to think more than bad luck is at work.

    That’s good news about the Minister of Health. I’d be keen to know the eventual response.

    And yes, while I really hope it happens for you this time and for me eventually, I totally agree. I am so lucky, I lead a great and fulfilled life, and I am grateful for it every single day. Nothing changes that, and it keeps this particular trial well in perspective. I’m glad you’re the same, and not wholly consumed by it.

  13. Samantha Roberts said,

    Hi Di,

    Is the embryo on ice a blastocyst?

    Our doctor is also away overseas with his family and I have no doubt that we helped fund his trip. Still, the destination sounded very interesting and educational so I’m quite happy, in a small way, to have contributed. Moreover, someone should get some enjoyment out of this whole sad, sorry business.

    As I expected, our grade 3, 2 cell embryo was not up to it. I still have to go in for the pregnancy blood test on Monday morning to satisfy the clinic that I’m really not pregnant in order to commence cycle #11.

    I’ve just paid off the credit card so can whack on another $6.5k. It really does feel like I’ve got a gambling addiction. However, this addiction is starting to bore me. I’m feeling quite over it. I wonder how much a trip to Antarctica would cost? Now that would be enjoyable.

    All the best with the frostie and cycle #2 should it be necessary.

    Regards,

    Samantha

  14. doctordi said,

    Hi Samantha
    Sorry for the delay in responding – this last comment slipped through the cracks.

    Yes, the embryo on ice is a blastocyst.

    Quite right regarding the holidays – everyone needs them.

    I’m really bummed to hear your embryo this round didn’t make it. I’m sorry, Samantha. And I know you were managing your expectations (most impressively!), but that probably doesn’t make it any less disappointing. And what now for round 11? Starting from scratch? UGH.

    Yep, we’ll be on the $6.5k monkey wagon with you. I bet it’s getting boring – I would definitely recommend that trip to Antarctica. You’ve earned it.

    You really have. Take a trip. I’ve always wanted to go to Antarctica myself – have a blast if not a blastocyst!

    • Samantha Roberts said,

      Hello Di,

      I’ve followed your meeting with Dr P and your decision to go round two before thawing the frostie. Good luck!

      I’m in the midst of cycle #11 and the OPU is scheduled for this Thursday morning. This is our second mild stim (antagonist) cycle and I have two follicles on the left and possibly one on the right. It may not seem a lot but when you’re use to doing natural cycles and relying on the one dominant follicle, any additional follicles are still a novelty. As my doctor was away last week I saw one of his colleagues for the first scan and she said, “so you’re into quality not quantity then?” Yes, I proudly replied.

      I’ve investigated the cost of travelling to Antarctica. Prices range from $5k to $50k depending on where you leave from and how long you spend there. The cheapest option is to leave from Argentina. Apparently leaving from Hobart is costly as it takes 7 days to reach Antarctica by ship. That’s a bummer as Hobart is a lot closer than Argentina! Anyway, we cannot possibly do IVF and take a trip to Antarctica so for now, the trip will have to wait.

      How about your possible trip to France? Have you been before? I’ve visited a number of times as I lived in London for two years back in the early 1990s. It’s not high on my list of places to return to as I have become a lover of all places wild and with as few human inhabitants as possible. Hence my desire to visit Antarctica.

      Regards,

      Samantha

  15. doctordi said,

    Hi Samantha
    Yeah, Dr P said his own suspicion was that focusing on the strongest follicle was probably the most logical approach, and that it would mean being able to abandon some of the drug courses altogether, but he seemed to say (and there was a lot to take in, so I could be wrong) he didn’t believe there was enough clinical evidence at the moment to prove it. But I left with the impression that this was his preferred model for the future.

    GOOD LUCK TOMORROW!

    Yes, I’ve heard Antarctica trips are pretty steep…my sister-in-law is so lucky – she’s a photographer and got to go down with the summer crew not once, but twice!! I would love to go. LOVE to. I’ve always thought it would be really on another scale of experience altogether.

    We’re the same on the financial front – France is slipping away as we speak. Yes, I’ve been before, and we did the years in London too, so we have much in common! I went to an international college in Canada twenty years ago for my final high school years, and a bunch of my Euro-based friends are organising a mini-reunion in France in July, hence the destination AND the pressing issues of time and money. Usually Llew and I set our sights on somewhere neither of us have been before. But it is looking increasingly unlikely there’s any way we can pull it off. Sigh.

    Let me know how you go tomorrow – I know it’s crazy, but I am looking forward to starting round two. I think it’s because it makes me feel like I am DOING something.

    • Samantha Roberts said,

      Hi Di,

      The law of diminishing returns has hit us very quickly this time around. Yesterday we had four eggs collected (our highest ever total) and I thought great, at least one will fertilize. Daniel thought I was being too pessimistic and said no, at least two.

      Upon returning home from the gym this morning there was a voicemail message on my mobile phone left by my IVF doctor. I immediately knew the news was bad and guessed that all four eggs had not fertilized. I returned his call and he was with a patient so he called me again whilst I was in the shower. I got out, sat naked and wet on the floor and answered my mobile phone with “Hi [Dr’s first name], it’s bad news isn’t it?” Yes, it’s bad news he replied. “None of them fertilized right?”. Right he said. F***! F***! F***! F***!

      He was terribly sorry and said that he didn’t want to make the call to tell me the news. When he checked our gametes this morning, all four eggs were mature and looked really good as did the sperm but the sperm were failing to penetrate the zona pellucida. He said that fertilization can be very perplexing.

      At least this wasn’t the first time fertilization failure has happened to us (in fact, it is the third time). And I have become so used to the disappointment of failed cycles, that each time it happens, I’m not surprised. I’m far more surprised if I actually get to embryo transfer (which has only happened on four occasions over eleven cycles and when it does happen, our success rate is good: one biochem and one clinical pregnancy).

      I said to my Dr that I was beginning to feel that since moving from natural to mild stim cycles that everything was going wrong. He concurred and said that yes it feels as though the wheels have fallen off the wagon since you moved from natural to stim cycles. Perhaps we need to reconsider and go back to naturals? If only we could bloody well afford them (thank you Minister)!

      My Dr asked if he could send our failed gametes off to the research arm of the clinic for further investigation. Of course I said as we’ve definitely got a fertilization problem. Only 33% of my eggs are fertilizing (four out of a total of twelve collected over eleven cycles) whereas it should be double that number (60 to 70%). D’s sperm will undergo a number of Sperm–Oocyte interaction tests.

      Some good news at least is that fertilization failure is often caused by defective sperm that may appear fine. In conventional IVF, complete failure of fertilization is mainly due to defective sperm-zona pellucida interaction (binding and penetration) which is usually associated with poor quality of ejaculate (low sperm numbers, poor motility or morphology or in combinations). These common sperm defects can be detected by routine semen analysis. However, research has found that about 25-35% of infertile men with normal semen analysis results have defective sperm-oocyte interactions and they require treatment by ICSI rather than IVF.

      I am hoping that D is one of the 25-35% of men with normal semen analysis that in fact has a defective sperm-oocyte interaction. That way we can try IVF-ICSI. If not, it means it’s my eggs and there’s nothing that can be done about them!

      Ho hum. There I was thinking it was just my fallopian tubes that were to blame. Now there’s the possibility that both of us has a problem. Better that possibility than it all be down to me. D said this morning that he wasn’t with me because of my fertility. I replied, you mean my infertility!

      The results of the testing won’t be known for two weeks at which point we will be due to commence cycle #12. Hopefully we may have more information to help guide us as to what sort of cycle (if any) number 12 should be. We’re also about to hit the $20k out of pocket expense mark which we really could have used to visit Antarctica with!

      On a different subject, I too lived in Canada (Vancouver) for two years in the early/mid 1990s. (I spent four years living between London and Vancouver.) So there’s another aspect of our lives we have in common. Where did you live in Canada?

      Also, I really liked your “have a blast if not a blastocyst” from your previous post. It made me laugh.

      All the best for cycle number 2.

      Regards,

      Samantha

  16. doctordi said,

    Hi Samantha, and SHIT SHIT SHIT FUCK SHIT!!!!! Damn it. God, it’s soooo frustrating. But take heart: Woo, one of my blog friends (if you scroll up she’s left a comment on this post and you can click into her blog from her hyperlinked name), has just reported a friend’s successful birthing of IVF twins, a boy and a girl, at the age of 46 and after multiple failed attempts. This cheers me up more, I must admit, than some of the other success stories I’ve heard, and I hope it cheers you too. GREAT that they can do some analysis of the gametes, and also great that the doc’s instinct is the same as your own as far as the type of cycle goes, although I don’t understand why it’s a more expensive option.

    I didn’t know this about the apparently normal sperm potentially having a problematic profile. What is the test they do? Llew’s had his tested but I think it’s just the general motility etc test – oh, no, hang on, maybe we did do something else… I’ll have to ask him/look through the paperwork again. But if there’s a specific test name you could pass on, I’ll double-check that we’ve had it too. Then again, they told Llew he had super sperm, so I’m figuring he’s in the clear!!!

    I was on Vancouver Island! I was a scholarship student – as were we all – at Lester B. Pearson College of the Pacific – have you ever heard of it? http://www.pearsoncollege.ca, in case you’re interested. A phenomenal place and a life-changing experience.

  17. Samantha Roberts said,

    Hi Di,

    They’re simply called Sperm–Oocyte interaction tests which test for the following: sperm-zona pellucida (ZP) binding, ZP-induced acrosome reaction (AR), and sperm-ZP penetration. These subtle sperm defects are the major causes of failure of fertilization when all or most oocytes from a couple do not fertilize in standard IVF.

    The good news is that the scientist who invented the tests, is now the head of andrology at my clinic. So our gametes do not have far to travel!

    I’m very happy for your friend’s friend who had fraternal IVF twins at the age of 46. That truly is a miracle. However, it is so incredibly rare at that age to have a successful pregnancy that it doesn’t necessarily give me hope. I too know of IVF pregnancies at the age of 46 (identical twin boys) and 45 (a boy) but these are truly exceptional. When I discussed these with my IVF doctor, the first question he asked me was “with their own eggs?” and that was a question I actually did not know the answer to. More often than not at that age, they are donor eggs. Further, the woman who gave birth to a boy endured a number of miscarriages in the process as half of all pregnancies at that age end in miscarriage. Success stories like these can and do give unrealistic expectations of the chance of taking home a baby in one’s mid 40’s (which in reality for any given cycle is less than 5%).

    Have you heard the latest research coming out of Israel? That a woman has lost 90% of her eggs by the time she is 30. It’s a mind blowing statistic.

    I hope I haven’t deflated your mood. I’m a very pragmatic person and feel secure with the facts and take great comfort in the stats. I entered the IVF journey completely aware of the reality and have never been one to say “when I have a baby” but always “if I have a baby”. I try to maintain hope although this has been shaken (yet) again with the latest cycle cancellation. However, the results of these tests will determine whether we continue or not and I feel that will be a resolution of sorts. And I don’t mean to take away the joy of the 46 year old mother of twins. Her babies are truly little miracles. If IVF has taught me one thing is that we are all truly miracles.

    I’m also reading Cormac McCarthy’s The Road and that is influencing my mood somewhat. I’ve decided that if I don’t have children then at least I will be spared the guilt had I had them.

    I’ll check out the college’s website. Have you been watching the winter Olympics? Yesterday I watched the men’s moguls whilst pounding the treadmill at the gym. The scenery was lush and brought back very fond memories of my two years in Vancouver. The city has once again been ranked the world’s most liveable city and Melbourne was ranked number three as determined by the Economist Intelligence Unit. I feel very blessed to have lived in both.

    Regards,

    Samantha

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