Trying for a baby can be stressful for some people. Especially if they already have any underlying medical issues or it is taking longer than they expected to become pregnant. Information surrounding trying to conceive can sometimes be confusing or misleading. So here, Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife offers some myth-busting facts to clarify any grey areas and give a bit more information.
BY KELLY (GUEST WRITER)
As an ‘older’ couple we didn’t want to hang around waiting for the ‘right time’ to try for a baby. So we decided early on in our relationship to come off contraception and let ‘nature’ run its course. And we waited…
Nothing happened- so we decided to be a little more planned; using a Fertility app and peeing on ovulation sticks (oh and obviously having sex) – but still nothing. A year had passed.
So we visited the GP and had some basic fertility checks; blood tests and a semen analysis. We were referred for fertility treatment April 2015 after tests revealed malefactor infertility; analysis showed a near normal count but low ‘normal forms’- meaning that although natural conception was possible, it was unlikely.
Following some more tests; more bloods and tests ruling out STDs and other infectious diseases, specialist fertility blood tests and ovarian scans- we were picked to go ahead with a funded IVF cycle.
We were referred to a local fertility clinic to commence the process. I was told my AMH levels were high (indicating a good reserve of eggs)- but that this possibly indicates PCOS. Further sperm analysis revealed a range of figures- which confused us an didn’t seem related to any health or lifestyle changes. Due to sperm quality we were told we needed to have ICSI- this is when the sperm and egg are not simply put in a dish to do their thing- but that the selected speed is actually injected into the egg.
Our cycle started in October 2018- a few days after a lovely holiday and my birthday. I felt stressed- I wasn’t feeling optimistic or positive, I felt badly prepared and was having increased responsibility at work increasing my stress load further. I hadn’t done that much research and was just trying to ‘go with the flow’. Every appointment was met with nervousness and anxiety from me- my partner tried to help relax me- but there was a lot of tears.
IVF treatment can involve a range of drugs/treatments- from self administered injections, to tablets, nasal sprays and vaginal pessaries or rectal suppositories. The box of drug supplies for a cycle is overwhelming- a huge amount of unfamiliar drugs with a scary amount of needles and syringes! I was fine with the needles and drugs; I’m a nurse, so this part of the process didn’t bother me at all.
It was the mental side of it; after wanting to be a mum for so many years I was so nervous it wouldn’t work. Anxious at every stage and felt it was hard to relax and get rest.
So the injections were ongoing (to grow the follicles and mature the eggs) at each appointment they were counting 30-40 follicles! This was a high number; and they said I was at risk of OHSS ( ovarian hyper stimulation syndrome)- and wanted to monitor me closely- they reduced my dose injected stimulation drugs to help reduce the risk. (Normal amount of follicles is expected to be approximately 10-20). I can not describe the feeling of huge fluid filled ovaries; it was certainly weird and uncomfortable!
The nurse told me ovaries are around the size of walnuts- but after 7 days of stims mine were now the size of large oranges. When I walked quickly I could feel them ‘bouncing’ inside me; and I was told no running or activity due to a risk of torsion.
So I had a scan and blood tests in a Friday; and was due to return on the Monday, on the Monday my scan revealed a shock- massive follicles! The nurse was shocked and said she was unsure how they’d grown so much on a reduced dose- I was surprised, I’d had no dose adjustment. It turns out they left a voicemail that I never received- to half my stim dose!!! I was told to stop stims and await blood results; a call came later that my hormone levels were dangerously high- they were 21,000 and should be less than 17,000. I gad to return to the clinic- I was given a drug called cabergoline to counteract the effect and hopefully stop the likelihood of hyper stimulation syndrome. I took the drug- but was scared; and I had to return to work.
I quickly felt very unwell; I collapsed vomiting at work in the corridor, Nick had to come fetch me. I had such severe vertigo and sickness that I could only lie flat or crawl; I’d never felt so ill. The clinic said it was a severe allergic reaction to the drug; and that I needed to try and drink 3-4litres of water a day.
After 2 days of being poorly; with severe sickness and inability to drink- I had egg collection. We retrieved 20 eggs from 31 follicles. To retrieve the eggs they insert a dildo like implement into your vagina- poke a needle through your vaginal wall and into each ovary; sucking out the contents of each plump follicle. In my clinic I was sedated, so don’t recall a thing; afterwards just a little period type pain and spotting of blood.
After the great news of 20 eggs- 17 were mature and yet only 7 fertilised. This was gutting!!!! We had hoped to get at least 50%. Then came the wait; we had to wait for a call, hoping that day by day our cells would divide normally. The aim is to get them to a 5 day embryo; called a blastocyst.
On day 3 we had a call- we only had 3 embryos left in the running- and they were not brilliant quality; we were advised to come in for transfer. The risk was if was waiting until day 5 there would be no embryo to transfer. We were gutted.
I remember crying en route to the hospital. Nick played my ‘relaxing IVF app’ but it didn’t help- I was in pieces. So two embryos were transferred; a ‘good’ 8 cell embryo and a fragmented 10 cell (you can tell from the pic that the top embryo looks more equal and the cells are similar sizes).
I remember Nick asking the Dr what we could do to improve our chances; should I rest etc.- she replied ‘either you get pregnant or you don’t’.
Then came the dreaded two week wait- the most awful time; questioning every potential symptom- do I have sore boobs, any pain, is my period coming. 11 days later we got our answer.
We returned to the clinic to have our thoughts confirmed- it hadn’t worked! A urine and blood test confirmed this cycle had not worked. We went home to cry.
Not only had this cycle not worked- but it was our only funded cycle- our only chance of getting pregnant on the NHS. What millions of couples take for granted- having a family- we were going to have to find thousands of £££ for.
Yes- infertility sucks! It affects you mentally, physically and financially. It challenges your relationship, can make you seriously ill and makes you feel like a total failure! Why can’t I do the main thing we were put on this Earth to do. I just wanted a baby- a family!
Have you been through IVF? Did you struggle to conceive?
YOU CAN FIND KELLY ON;
INSTAGRAM: IVF NINJA
BY NICKY ELLIOT (GUEST POST)
I have written this as a kind of guide to what happens during an IVF cycle, as I find there isn’t much out there on the detail of what to expect & I really would have benefited from knowing exactly what was going to happen.
Trying to have a baby is easy for some, not so easy for others. If you fall into the latter category it can quickly become an all-consuming pursuit. In an age where women are successful and independent it’s hard to face that some situations are beyond our control, and yet that’s fertility; we hand it back to Mother Nature and after likely decades of expressly trying not to get pregnant, we expect it to happen instantly. And when it doesn’t? It can be confusing, isolating and downright painful.
I started trying to get pregnant as soon as I got married in 2014. Three years later I welcomed my daughter into the world, and there had been what felt like a chasm of time between those two dates – of trying, and trying again, ovulation tracking, sex schedules, paying attention to body temperature and cervical mucus. Exhausting, and for me ultimately futile.
Considering IVF was not a decision I took lightly, and nor is it a miracle cure for infertility issues. It doesn’t always work, but after investigations we knew we had ‘unexplained infertility’ i.e. there was no specific issue for myself or my husband – it just wasn’t happening. I’m still not sure if that made it easier or harder to process. We knew that we had a decent chance of IVF working based on my age and our ‘vital statistics’ with regards to fertility, and we could have kept trying on our own, but the clichéd biological clock was ticking, and we decided to start IVF in early 2016.
IVF: three little letters that can feel heavy. There is a preconception of hormones and injections and it feels like a massive undertaking. For anyone considering it or about to go through it my only advice is to take it one day at a time. There are hormone injections, and the amount and strength of those depend on your specific needs, so it’s different for everyone. For me the idea of it all was far worse than the reality, and taking it day by day got me through it – twice!
The IVF Cycle process is broken down into roughly five phases (and these may vary depending on your protocol so don’t panic if yours is slightly different to the below). Down regulation is the first phase, where you start injecting to counter-intuitively ‘quieten’ your ovaries before the next phase, which is called stimulation. It’s what it sounds like – stimulating your ovaries to produce as many eggs as possible in one cycle. If you normally produce one or two eggs per cycle then you’re aiming to produce one or two dozen here, so this is where the discomfort can come in.
You know that pre-period bloat? Multiply it. You do feel bloated, windy and uncomfortable but it’s for a very limited time. You might also feel insanely emotional – the hormonal storm that is occurring thanks to a massive influx of hormones is not to be underestimated BUT it is manageable, as long as you go easy on yourself, limit your expectations of what you can do during that time, and make sure your partner is understanding, supportive and completely on board with the process. As with everything to do with bringing babies into the world the hard work is down to you. My husband was an awesome support in this time, and that helped me get through it all knowing I could have as many meltdowns as I wanted, without judgment. During these phases you’ll be scanned regularly via an internal ultrasound to check on the progress of your follicles (which contain the eggs). When the time is right the doctor will tell you do a trigger injection which triggers ovulation at the exact right moment to prepare for the next phase – egg collection.
Once the follicles containing your eggs are the optimum size and you’ve done your trigger injection you’ll be sedated about 36 hours later, and the doctor will remove the eggs from the follicles. This step terrified me but it was like having a nice sleep – I went through this process twice and didn’t feel a thing either time!
When you wake up you’ll be told how many eggs were retrieved – some eggs may be immature and some follicles empty, but the ones that are good to go are put together with your partner or donor’s sperm and left to do their thing! There are fertilisation reports in the subsequent days where you’ll hear how many eggs were fertilised, and some of those will likely drop off and stop developing, while others will go from strength to strength. If possible your doctors will aim to put what’s known as a blastocyst back inside you on day 5 after your egg collection – a blastocyst is a fertilised egg on its way to becoming an embryo. This may happen at the time or the blastocyst can be frozen and transferred after a break if necessary which was the case for me.
Embryo transfer is the next phase – a tiny tube is passed through your cervix into your womb where the doctor will use ultrasound to find the perfect spot in your uterus to put the blastocyst. You might be able to give your little guy a wave on a screen before it goes in (it’s about one sixth the size of a dot drawn with a ballpoint pen at this point, so you see it under a microscope!). And then you’re good to go and the final phase – the two week wait – commences.
This can almost be the hardest part even though the hormones and prodding and poking are over. Now you’re on high alert for every twinge and every feeling. Are you pregnant or is it period pains? Has it worked or not? There is absolutely no way of knowing and it can be stressful wondering and waiting to take that pregnancy test. For me the best way to manage my anxiety in this period was to take it relatively easy, but keep up my usual routine, and to give it back to Mother Nature – I lit a candle for my blastocyst every day and just looked at its picture. I told that bunch of cells that we loved it and were ready to welcome it into our family.
I’m one of the lucky ones and in early 2017 we did just that when our daughter was born. In 2019 we started the process from scratch as our remaining embryos from our first cycle didn’t take, but a second fresh cycle got a great batch of embryos, and we now have two amazing children to keep us on our toes!
For anyone who is considering IVF there are many things you can do to prepare yourself physically, and the ‘right’ things to do on that front are different for everyone, but to prepare yourself mentally I would just say – be prepared to go easy on yourself, to trust the process, and to have hope. If it doesn’t work and you hoped it would you won’t be any less devastated, so don’t beat yourself up for having it. Alexander Pope said “hope springs eternal in the human breast.” My advice is: if it’s there, hold onto it.
Did you know all about IVF cycle, and what goes into them? Have you been through IVF cycles yourself?
YOU CAN FIND NICKY ON:
WEBSITE: WILDER ONES