Tag: hormones

First transfer

First transfer

by Stephanie Rodgers ♥ 0 Leave a Comment

(Content note: this one involves my vagina, like, a lot. Also blood. And that whole infertility/anxiety thing.)

Of our four fertilised eggs, two were deemed high-quality enough to proceed to the next stage, embryo transfer. The old days of putting multiple embryos back into your uterus to increase the chances of pregnancy are gone, apparently, so we were able to keep one, and freeze one as a backup. That provided a lot of reassurance, and even a tiny sliver of hope that we could think about having a second baby one day, without having to go through all this rigmarole again.

But first: the pessaries.

Between egg collection and embryo transfer the clinic gave me progesterone pessaries. “Luteal support” they call it. It’s great for maintaining a soft cushy lining in your uterus, and also for getting SUPER FAMILIAR with your own vagina.

I was on two pessaries, three times a day. You insert them much like a tampon, except it’s a small plasticky ball bearing (indeed, two small ball bearings) going right up to the edge or your cervix – and sometimes the little sods WILL try to follow your finger back out and sit uncomfortably like an over-full tampon right at the opening.

They warn you, “You’ll get some waxy discharge.” The pessaries are mostly made of vegetable oil, and that’s the part that doesn’t get sucked up your cervix. So it makes sense something’s going to come back out. Except you’re thinking “vegetable oil” and not “it will look like someone’s literally ground the end of a candle into your knickers”. It’s white. It’s solid. Bits WILL fall out of your labia or off your loo paper and float on the surface of the toilet like cut-price fake snow.

It is a deeply weird process.

My top tip? Set your timer ten minutes early. Use that time to cue up a podcast, get into your pyjamas (obviously for the last-thing-at-night round, but maybe also for the other two as well?) and go to the toilet, after turning the bathroom tap on to warm.

I was doing this as winter was threatening, and there is nothing that’s going to make this routine worse than washing your hands in icy cold water before they go up your snatch.

The transfer

Every other stage of the process has a heavy sense of ceremony, even though what’s happening is invisible. The daily injections. The close monitoring of your ovaries. The drugged-out ritual of egg collection.

Embryo transfer was simultaneously the most important thing we ever did, and the most trivial. No sedation, no long waiting period; you walk into the room under your own steam and lie down on the same bed, but fully aware of everything; you try to make out the shape of your own uterus on the ultrasound; and then there’s a long needle, a twinge, and a tiny white speck seems to float up into your body.

And that’s it. Get up, off you go. The paperwork is reassuring: literally, “don’t worry, your embryo won’t fall out”. They are very good at knowing what you’re afraid of. But I was already an overthinker before we started all this and after weeks of hyper-focusing on every little detail, worrying that anything could be The One Thing That Makes Or Breaks This – am I timing the injections properly? When do I need to stop eating? Are the pessaries in far enough? Have I lain down for long enough? Don’t forget you can’t lie down all the time, some exercise is good! But what kind of exercise? – having that microscopic dot so full of potential and hope sitting back inside your body really does feel like the one thing you cannot fuck up.

I’d seen it. It was really there, even if I couldn’t feel it. And everything rested on whether or not it would find a home in the lining of my uterus. I was the closest I had ever been to being pregnant, but things were still completely out of my control.

There was nothing to do but wait for the blood test that would seal my fate. (You could probably take an over-the-counter test but God, why do that to yourself?)

The wait.

Nine days later, I was 90% sure my period had started. But I didn’t want to think about that, so I ignored it, telling myself again and again that what mattered was the blood test, the phone call, the certainty of a clinician’s voice on the line, not my own total inability to determine if the smear on my pad was actually red (bad) instead of reddish brown (possibly good).

Some brownish spotting is normal, you are told. Or at least they phrase it, “some women do have brown spotting before a positive pregnancy test” but they don’t give you the exact numbers because like every other stage of this process it’s really just magic. It happens or it doesn’t. No one knows why.

Of course, for me and many other people who menstruate, brownish spotting is ALSO perfectly normal immediately before my period properly starts. So the past 24 hours was really fun: checking the paper every time I wipe, is that brown? Brownish? Is there a bit more pink than last time? Inserting pessaries becomes a whole new world of miniature gore when you get to pull out your finger and assess what’s trapped under your fingernail. Definitely brown. Reddish but brown. Definitely.

Don’t worry, part of me definitely wonders if this is Too Much Information. But I really do wish I’d known about some of this in advance. I wish I’d spoken to my friends who have also gone through IVF about these small mucky details – but that’s a whole other difficult topic. The point is, what the clinic are going to tell you is the cool, clinical (sorry) details. However compassionate they are, there are just details you don’t hear about and have no way of anticipating.

The literature they give you is full of reassurance. It’s normal to overthink things. It’s normal to worry, or cry, or take a day off work. Normal normal normal.

But when it’s your first time, nothing is normal. And every abdominal twinge, every damp feeling in your knickers, is either a sure sign you’re pregnant and it’s wonderful OR a definite sign you’re not and you’ve failed again, and you swing between the two on an endless painful oscillation that only ends with time.

The phone call came. And it was not good news.

Photo by Lina Trochez on Unsplash

The eggs, the lube, the triggering

The eggs, the lube, the triggering

by Stephanie Rodgers ♥ 0 Leave a Comment

Just as the self-injection routine started to get good and routine, and I wasn’t having a total emotional break on a daily basis, came the sharp reminder that this was only one stage in a massive project, and things had to be kept on track. At this point, that meant an ultrasound, and not the television-friendly wand-on-the-tum kind. The question was: were my ovaries responding properly to the hormones, and growing a whole bunch of eggs?

They were.

I got to see the swollen follicles myself, gaping black voids on the surface, a definitely upsetting experience for anyone with trypophobia (the fear of lots of little holes). They were measured and found to be sufficient in quantity and size by the doctor – who was not my usual consultant; and a bit of warning might have been nice, given he was a man.

A note on lube

Now, I have nothing against cis men – like Cher, I love dessert – but there’s a distinct difference when it’s a guy controlling the plastic wand going up your groin. On the social conditioning side of things it just feels very very awkward to be giving guidance like “a bit lower; no, that’s too hard; yep, that’s it” to someone I have zero, possibly even negative, sexual interest in.

On the physical side of things, there’s lube.

I’m just going to put it like this. If you are a medical professional who does not now have, and never has had, a vagina, and your work involves putting things in other people’s vaginas, you need to lube that wand like it’s going up your own butt.

IVF is a process that involved a lot of vaginal ultrasounds so I can definitively say, from the other side of it, I would rather have to wipe some excess gel out of my labia afterwards than feel like screaming “what’s wrong with a kiss, boy?” in my best John Cleese at a thoroughly professional clinician.

Anyway.

Things looked pretty good, so I was sent home with more drugs, ready for the next stage.

And there was not much to do but sit at home and be consumed with ~feelings~. It’s a paradox: after so incredibly long, thinking about nothing but wanting this and trying for this and counting days and degrees and becoming an expert on one’s own cervical mucus, we’d overcome one of the big hurdles … and I wanted things to slow down.

From deciding to go private to the first consultation was only a few weeks (longer than usual due to COVID); from consultation to first injection was only a week after that, thanks to a well-timed menstrual cycle.

Then it’s one more week, and you’re on the doorstep of egg collection and insemination (and handing over another couple of thousand dollars) and a whole new cycle of waiting and hoping and not being able to do anything to affect the outcome, until you get told if you’ve been lucky, if there’s an embryo, if they can try to plant something back into you that might become the baby you’ve ached for and you have no idea what you’ll do if you can’t make a home for it inside yourself.

It feels impossible that everything can move so quickly after it’s taken so long to get here. It feels unthinkable to process it all in just a few weeks – when you couldn’t even start to process the idea of being infertile for a decade.

Triggering

There’s an obvious internet-discourse joke to be made here. I will refrain.

Once the ovaries were signed off and the blood tests were checked, we were on a rigid timeline. The New Injection, Ovidrel, had to go in at 9pm sharp. It’s a “trigger” injection that tells your eggs to get ready to rumble after they’ve been hanging out on your ovaries, refusing to go anywhere. That was the easy bit after a week of practice with Gonal-F: same pen shape, same needle tip.

Then put 36 hours on the clock for egg collection. It’s a weird time span to think about. Doing something 24 hours beforehand? Easy, that’s how time works. Doing something this evening to prepare for the morning after tomorrow morning is confusing as hell. I don’t know how many times I checked the instructions and the calendar and the time – yes, Stephanie, today is TUESDAY so the after tomorrow is THURSDAY and you are taking the drugs at the right time, that’s why the text message from the clinic says TONIGHT, just like that, in all caps.

They’re used to these kinds of meltdowns.

On Wednesday, do not eat after midnight (and make a Gremlins joke). On Thursday morning, clear liquids only and three paracetamol.

Off to the lab. Local anaesthetic. Sedation. Prepping for a needle to go all the way into my ovaries and burst those little black bubbles – so huge on the monitor but only 2cm across in reality. Which may or may not be huge in the context of an ovary. I don’t even know how big an ovary is. Call myself a feminist!

And hopefully, the bubbles contain eggs, which the clinic pulls out of me and introduces to J’s elite swim team; and Mum picks me up and takes me home and I sink into an indulgent haze of tea and biscuits and awful television.

That was the plan, and clearly everything went according to it, but I simply don’t remember. It’s like having your wisdom teeth out: I have such a vivid memory of the dentist telling my mother, “I’ll give you the instructions because she won’t remember”, and I scoffed, and after that … nothing.

I took a very bleary selfie in the prep area. I stared at the bizarre curtain patterns. I walked myself into the procedure room, very proud of not being the slightest bit dizzy, and then … not a freaking clue. I don’t even know if I got tea and biscuits.

End result: four eggs, which didn’t feel great. From that, four fertilised eggs, which felt miraculous.

And then we waited, to see how many would survive the first five days, and be viable to be implanted back into me.

It always comes back to waiting.

Photo by Natalie Rhea on Unsplash

The needles

The needles

by Stephanie Rodgers ♥ 0 Leave a Comment

(Content note: infertility, IVF, injections)

I definitely didn’t plan it this way, but here we are carrying on with the anniversaries: because it was a year ago today that I found myself wandering down Victoria Street carrying five thousands dollars’ worth of the less fun kind of drugs.

The first big piece of the IVF puzzle is the eggs. You need to stimulate the ovaries to produce as many as possible, then collect them so they can be fertilised in the lab. And that means playing with hormones – which is exactly what you need on top of all the emotional and psychological pressure of nearly a decade of trying and failing to have a baby.

Put it this way: I needed to start taking the first set of jabs on day 1 of my menstrual cycle. And as everyone with a period tracking app knows, day 1 is counted from when you get full or “normal” flow – for your typical cycle – before noon.

So when my period started at 12:30 on a Saturday, I naturally had a minor breakdown about how to count days, and also time. Did that count? Was it day one??? How heavy was a normal period for me anyway????

J gave me a very firm look and said “It’s full flow before noon. That means day one is tomorrow.”

On the plus side, I impressed the Fertility Associates nurse with my quick command of popping a needle onto the drug pen and jabbing it into a weird beige eight-by-five centimetre piece of demonstration “belly” skin. It felt like a weird magical ritual, and also too easy, but also the most difficult thing in the world. At least I knew that my feelings were very normal, based on how many times the nurse reassured me that I definitely wasn’t going to screw it all up.

I didn’t. My hands didn’t even shake. But that didn’t stop at least some part of my brain from freaking out anyway; I spent the rest of the evening walking around with incredibly tensed posture, like my belly was made of porcelain and any movement might shatter it. Porcelain with a very very sharp little mosquito bite in it.

My medication plan involved taking the injection (Gonal-F) for a week, and on day 6 adding another one (which hurt like hell) to make my ovaries hold on tight to all those precious eggs they were (hopefully) prepping.

When it came to it, I once again forgot what counted as day 1 of my cycle, and/or how to count to 6, and ended up calling the clinic just to double-triple check the very clear instructions I had already been given verbally and in writing.

They are very, very accustomed to those kinds of phone calls and were very, very kind about it. It didn’t stop me feeling bloody silly. How on earth was I qualified to have a baby if I couldn’t manage something this simple?

You’d think that by day seven it becomes old hat, nothing to worry about, you’ve nailed this process. You’ve got your little prep ritual ready, with a comfortable place to sit and a cup of peppermint tea at the ready to stave off the nausea.

But with IVF there’s always the next step in the process to worry about. And the next step was an ultrasound scan to see if my ovaries were cooperating. Something I could not see or control or have any sense about until it happened.

No pressure.

Photo by Diana Polekhina on Unsplash