Pun intended.

This is the summer where it all happened … baby-making was in full swing. I wish I could say that this was the summer where we were acting out like rampant rabbits, trying out all sorts of ‘positions’ and just having fun. Wedded bliss, eh? Nope. This was the summer where love-making gave way to sharps bins. The summer of IVF(s).

So actually, pun UNintended.

And even more actually, ’twas the summer of 2018. (Choosing a title as ‘Summer of 2018’ just doesn’t quite have the same ring to it as ‘Summer of ’69’. What it lacks in pizzazz, it makes up in content. And I’m exercising my rights to freedom of speech since, well, it’s my story.)

What people do not realise is that preparations for IVF begin months prior to actual treatment. It’s not a decision that you wake up to one day and begin the next. It is never that simple.

Let’s rewind to set the scene.

We had been trying naturally for a baby for 2 years before we embarked on tests and, ultimately, IVF. Our first IVF was in the summer of 2014. (The failure of it took me a whole year to get over; both emotionally and physically. Hence, it was a very big decision for us to agree on another round.)

During the 4-year period in between the IVFs, we explored every other avenue possible (e.g., acupuncture, nutrition, hypnotherapy, spirit babies, etc.) – I listed the crux of it in my post, Extremes of TTC. Although we achieved optimal results that demonstrated we should be able to conceive naturally, we never did. Not ever in all these years.

So now it was time to re-think our baby-making plan.

The year is 2017; the month: December. The decision to go for another round of IVF was set in stone. Preparations begin by getting inital tests done via my gynaecologist.

January 2018 – more tests

It’s now my husband’s turn and all necessary tests are done via his andrologist.

February 2018 – the hunt

Scouting for a clinic that we will be most comfortable with, which aligns to our priorities and principles, and will (hopefully) help us achieve our dream. We did not want to go back to the previous one – bad experience of which we’re better informed now. We attended several open evenings at various clinics. (Something I highly recommend you do because you can gauge it pretty well and also, it’s free. Otherwise, you’re paying a fee for every initial consultation.) By this stage, we had plenty of experience under our belt to suss out the right one (if any) for us, and by sheer luck, we came across one such clinic that resonated with us – IVI London.

March 2018 – tending to affairs

This is really about sorting life out, getting tedious things out of the way, putting work on the backbench and essentially clearing our diaries to make way for the IVF. We also undertook a stringent set of tests at the clinic (IVI London) in order to determine our treatment protocol. Some of these results take weeks to arrive; therefore, it’s always a waiting game.

April 2018 – it all begins

We’ve been to see our nutritionist again. We all know that natural conception is very different to assisted conception. It’s no surprise that nutrition-wise, this law also applies. Different supplements; different do’s and don’ts; different everything.

April 15^th

I’m on a different protocol (drugs-wise) this time around on the IVF compared with the one in 2014. My AMH level (known as Anti-Müllerian hormone; key for all fertility issues) is remarkably low and that means I have a lot fewer eggs left than 4 years ago, and there could be a quality issue too. (You will start to notice IVF jargon surfacing from this stage on, including names of drugs. When I first started to formulate this blog post in my head, I wasn’t sure how detailed I would get in to it. I still am not sure at this stage; I only trust that the story will be revealed the way it’s meant to and the way it wants to.) I begin Norethisterone 5mg tablets, taking them twice daily for 15 days. These are hormone tablets designed to give the ovaries a ‘break’ and, once I stop taking them, I should have a withdrawal bleed 2–3 days later. This week, I also received delivery of my injections.

May 2018 – stims

May 4^th

Day 2 of my cycle. (A cycle refers to the monthly cycle of a woman. Day 1 is the first day of the bleed, or period.) I have my baseline scan at IVI and all appears to be okay. Thus, I begin the daily injections, which are administered in the sub-cutaneous fat around the belly – remember I had mentioned that having some belly fat is advantageous? I’m on a protocol of Bemfola 300IU, Menopur 75IU, as well as Cetrotide 0.25mg. That’s three injections daily. The Bemfola and Menopur must be taken every night between 9 and 10 p.m. The Cetrotide is introduced on Day 5 of the stims (that’s short for stimulations) and needs to be taken between 6 and 8 a.m. I opt for 9.30 p.m. and 7.30 a.m.; timings for the evening and morning injections, respectively. The injections must be administered at precisely the same time each day; they are hormones after all.

The role of the Bemfola and Menopur is to encourage the follicles in the ovaries to grow. Usually in natural conception, only one follicle grows and becomes the dominant follicle each month (i.e., the follicle that grows to the optimal size and the one that releases the egg; all others die). In IVF or assisted conception, the aim is to grow as many follicles as possible to the optimal size. The function of the Cetrotide is to help prevent spontaneous ovulation. (When follicles reach a certain size, the body’s reaction is to naturally ovulate – or release the egg. In IVF, you most certainly do not want this to happen as you then cannot harvest the eggs.) I’m on a much higher dose in this protocol, with a total of 375IU of hormones injected. Last time I was only on 150IU.

The next few days pass by with the daily routine of injections, followed by visits to the clinic for scans and blood tests every other day to monitor the progress of the follicles. I administer the injections myself; I don’t trust my husband to do them (!) and at least this way I have some control of this whole process. They are so painful, and I soon run out of injection sites.

I have days when I’m bloated, moody and have headaches. With each passing day, it takes me that little bit longer to psyche myself before each injection, and frustrations mount when trying to calibrate the solutions for the injections. Then, I have days when I’m happy, full of energy and feeling positive. I take long walks in the woods, manage some light yoga and spend hours in the sun, reading. To help me get through it all, I have recurrent bookings of head massages and acupuncture sessions, and I alternate between the two.

All other life is on hold; I fill my days with things that make me happy; I only meet up with people who I want to see; I prep meals in advance; evenings are taken over by the injections, with a whole array of needles, syringes, antiseptic wipes, vials and, of course, the sharps bin, all reigning over the dining table. I feel like an apothecary, mixing powders and solutions with drawing needles and inserting needles. The perks of IVF.

May 13^th

Day 10 of stims. I took my last Bemfola and Menopur the previous night. Today is the last day for the Cetrotide. Then the ‘triggers’ are administered in the evening. These are two sets of injections that must be taken at a pre-determined time, exactly 36 hours prior to the egg collection (EC).

May 15^th

EC day. All this happens in the theatre, under sedation. The theatre is full with five clinicians; the doctor, the anaesthetist, the assistant anaesthetist, the embryologist and the nurse. And me of course. (Somehow, noting these details are important to me.) Hospital gown and hairnet in place, I prop my legs up on the stirrups to be securely fastened. It’s all very exciting. The oxygen mask goes over my nose and mouth, the anaesthetist administers his drugs through the canula on my wrist, I feel a cold sensation and a dizziness overcomes me. Within 5 seconds I’m knocked out.

It’s all over in an hour. I’m awake, back in my room; the doctor comes to inform me that they drained five follicles and collected five eggs. (Not all follicles contain eggs. This is true for all women. I was lucky that these five did.) After some tea and biscuits, and once they are happy with my vitals, I am released to go home. All medication is stopped for now so that my body can recover back to its natural state. No pills; no injections; nothing. Only my supplements as recommended by the nutritionist. Now, it’s just a waiting game.

We will get a call on Days 1, 3 and 5 from the embryology team informing us on the progress of our embryo(s). At IVI, they use the time-lapse guided method to monitor the embryos. This is when a camera continuously records the development of the embryos, so that the embryologist is not required to take them out of the incubator to examine; thus, avoiding any disruptions. Time-lapse at IVI is not an ‘extra’; it’s already part of the treatment plan. At other clinics, it’s an optional add on.

May 16^th

Day 1 of embryos. The embryologist called in the morning to inform us that we have two embryos that are doing well. Out of the five eggs they collected, one wasn’t mature. The other two disintegrated as soon as they injected the sperm. (It is worth noting at this point in the story that our protocol involved ICSI – it’s a step up from IVF, whereby the sperm is directly injected in to the egg. It is all technical and the best sperm is chosen under a high-powered microscope. In simple IVF, the sperm and egg are put in a petri dish and allowed to fertilise on their own. For all our treatments, we did ICSI. You can look up the full meaning of ICSI yourselves; or e-mail me and I can explain more.)

By now, I am getting quite anxious that I may need to go through another round of stims at this rate.

May 18^th

Day 3 of embryos. The embryologist phoned and reassured us that both embryos were doing well. They were developing correctly for this stage. Phew! Now to get through the next 2 days so that they could reach the blastocyct stage, after which they will undergo PGS testing and be frozen until the PGS test results are back.

May 20^th

Day 5 of embryos; normally marked as the blastocyst stage. The embryologist called; the news was not that great. One embryo was lagging and still in the cellular stage. The other had not quite yet reached blastocyst and they want to give it another day. We were so deflated. We were heartbroken and so sure that this embryo will also not make it because, well let’s face it, luck has never been on our side when it comes to babies. So we did what all sane people do; we went shopping. Nothing quite like retail therapy to keep your mind off things!

May 21^st

We had been waiting for the call from the embryologist. No longer nervous, we had succumbed to the impending outcome. Lo and behold, our little Trooper had been ‘busy all day yesterday and was ready!’ We were elated! I cannot remember the last time we felt such extreme happiness. It felt as if the baby was here already, in our arms. So. Much. Joy. Trooper was indeed a trooper! The other embryo did not make it.

They now take some cells from the embryo to send for PGS testing. They then freeze the embryo until the transfer. PGS testing is to check for any chromosome abnormalities. The result takes about 2 weeks to come back. If it comes back abnormal, IVI discourage transferring the embryo back in the womb as it would most certainly lead to a miscarriage. Along with the time-lapse method and blastocyst development, PGS testing is another one of the principles IVI believe in and stick to. So is frozen embryo transfer (FET). More on that later.

During this week, we had a long chat with our doctor at IVI and came to a decision; we will pursue another round of IVF. There are many reasons for this. First, we know that the PGS test takes 2 weeks to come back. Statistically, there is a 50% chance that the embryo is normal. I would still have to prep my body with drugs for the transfer; hence, another couples of weeks before the actual transfer takes place. If I do fall pregnant with this embryo and it results in a full-term pregnancy, the earliest I could do another round of treatment in the hope of baby #2 would be at least 18 months later. By then, who knows what the situation of my eggs will be like. Also, if this embryo is abnormal, we have no other left. So, in the grand scale of things, we would delay the whole treatment plan by 2–3 months and get another IVF cycle in, compared with a possible lifetime decision if we did not go ahead with it. It was the sensible thing to do.

June 2018 – IVF #3

June 4^th

We had our nurse consultation to plan for the next IVF cycle. The clinic had some great news for us; the PGS test results of Trooper came back NORMAL! This means that the embryo has no chromosome abnormalities and should have the best chance of implantation.

June 8^th

I’m at Day 14 of my cycle. I begin the down-regulation phase by taking Norethisterone 5mg tablets, twice-daily for 10 days. I cannot wait for the stims phase and have consoled myself that the only reason I am doing another round is purely to secure the possibility of a second child. I have no doubt that Trooper will be our first. (Never in my wildest dreams did I think I would be ‘one of those’ people who have multiple rounds of IVF. I never knew I was strong enough, and I never thought I would succumb and surrender.)

June 22^nd

Day 1 of my cycle and Day 1 of stims. I have my baseline scan and everything appears to be in order. All set to begin stims. I’m on the exact same treatment protocol as last time and I begin the Bemfola and Menopur injections that evening. I’ll start the Cetrotide on Day 5 of stims.

June 24^th

It’s a Sunday and we’re celebrating my husband’s 35^th birthday with a BBQ at home. (After 2 months of only concentrating on IVF, you inevitably get back to other life’s routines and commitments.) We had some friends and family over and it was fantastic. But by the evening, I was flat out. Exhausted from all the cooking and entertaining, the injections took longer than usual, and really hurt. I could no longer continue this way and needed to get back in the ‘zone’. I could feel the angst building up. It was all too much and we had to reign ourselves back.

June 25^th

Happy birthday to my husband! We spent the most wonderful day together. Just what we both needed.

July – EC and a little break

July 3^rd

It’s EC day! Same story as last time; but this time they drained eight follicles, which contained eight eggs. So far so good.

July 4^th

Day 1 of embryos. The embryologist called to announce that out of the eight eggs, only six were mature, which they injected with sperm (again, using ICSI). However, four of these disintegrated, and we only have two embryos in the running again. F*CK. (Excuse my French. Lately, I have a tendency to swear.)

‘Nerves of steel’. ‘Nerves of steel’. I repeat, ‘Nerves of steel’.

July 6^th

Day 3 of embryos. Both embryos are still doing okay.

July 9^th

Day 6 of embryos. Yesterday, the embryologist informed us that both embryos were still at the cellular stage; so not looking good. They were going to give them one more day to see if they perk up and get to blastocyst stage. Today, they have not developed any further. So that’s the end of this round #3.

It’s alright. We still have one embryo.

Since everything is dependent on my cycle, the preparation for embryo transfer (ET) will still not be for another few weeks. What we love about IVI is that it is very focused on research. Their studies show that it is optimum to have the body recover after the stimulation phase. They prefer FETs over live transfers. This is partly because they prefer the body to get back in to its natural rhythm following from all the drugs taken during the stimulation phase. You can imagine that with such high doses, the oestrogen levels in the body have sky-rocketed. In a ‘normal’ conception, the oestrogen level in the body is around 1000. In IVF, the level could be around 5000 (in my case anyway). The other reason is that they advocate PGS testing, and results for this test take 2 weeks. So, it’s advisable to let the body recuperate while waiting for the results.

We take advantage of this recuperation phase and host another BBQ to make the most of the summer. We get back in the social scene and enjoy other people’s company for a few weeks. We also take a few days off to enjoy some sun, sand and sea.

Now we are all set for the big transfer phase.

July 30^th

Preps for the transfer have begun. It’s the first of 10 days of another round of Norethisterone tablets.

August – ET

August 15^th

Having discussed all our options whilst planning for the transfer, I agreed to have a hysteroscopy to increase our chances of implantation. Back in the theatre, sedated again. It’s my third sedation in the last few months. I’m an advent fan of it! Honestly, I get such a great feeling and for those few minutes, your mind is at ease. Not thinking or worrying. Think of it as an addiction. Again, the perks of IVF!

(Food for thought: could IVF be disguised as an addiction after all?)

We have also discovered that I have a slight clotting issue. This means that in addition to taking baby aspirin tablets, I will require further injections – in the form of Clexane – for several weeks. Clexane is notoriously known to be painful and cause severe bruising. Fun times ahead!

Hysteroscopy all done; I begin the dose of Progynova tablets. They need to be taken three-times a day, for possibly 10 weeks if successful implantation occurs. I will soon also start the twice-daily progesterone suppositories. Again, these will need to be continued for approximately 3 months if implantation is successful.

August 30^th

ET day! The embryo had to first survive the thawing process, and it did. (One more hurdle overcome.) Back in theatre, but this time fully awake and alert, with a full bladder ready to burst any minute. (It’s not by choice – a full bladder makes for a clearer ultrasound.) It’s all very emotional. My husband accompanies me in theatre and holds my hand through the procedure. The nurse is pushing against my bladder whilst the ultrasound probe gives a visual of my uterus. The doctor is ready to begin. The embryologist is on alert, ready to hand over the long tube containing the embryo. It’s actually uncomfortable and painful; bit like a smear test. We get to see our little Trooper on the monitor as it’s been placed back inside my womb. All done, and the doctor reassures me that I can go relieve myself. The act of peeing will NOT in fact drop my baby out! The evening routine of Clexane begins.

September 2018 – the 2-week wait

This is the bit where you just have to rest and relax. Nothing strenuous; no heavy lifting; just taking things slow and easy. Another alteration in supplements and diet. It was great because my mum had flown in from Kenya to be with us and look after us. She had arrived just a few days before the ET, and I cannot express just how grateful we were to have her here with us, looking after us.

We had opted to have a blood test done to give us the outcome of the ET. We could just as easily have used those home pregnancy tests, but you know how I loathe peeing on those sticks! Usually, the test is done 11 days after the ET. However, to play to superstition, I opted to push it to 12 days. The reason being, in the first IVF we ever did (back in 2014), I started my bleed the day I had my blood test after the transfer. Hence, I figured, ‘If only I could get through the actual day of the test. If all is well and the day goes by smoothly, then surely it’s a positive?’ What’s one more day of waiting?

The test was booked in for the 11^th of September. The weekend before the Tuesday, I was in a foul mood. I had cramps. I also had a feeling that the treatment did not work. Yet, I consoled myself that cramps could mean anything; even implantation. (Side story – another friend of mine was going through IVF around the same time as me. Even though she started her treatment after my first one in April, she had finished hers way before I began my second round. Different protocol; different clinic; different plan. Anyway, like me, a few days before her pregnancy test, she had cramps and some bleeding. I had reassured her that they could be implantation cramps. I was right. She tested early, and it was a positive!)

September 10^th

Went well without any hiccups.

September 11^th

D-Day! The morning of the test. Still no bleed (my period) so feeling really optimistic. My doctor comes to see us whilst the nurse takes my blood test. She’s feeling very optimistic and envelops me in a hug. (So much love from everyone at the clinic. So important emotionally.)

The results will be in that afternoon.

5.00 p.m. – my doctor calls and gives us the shattering news … ‘It’s a negative’.

As my husband pointed out, we just had our own 9/11.

So, this is how our summer went … all 9 months of it. The time it takes for normal individuals to make and have a baby. All I have left to show for it is an empty sharps bin, leftover medication, a bag full of syringes and needles and a face full of zits. Lots of them that still lurk and re-surface, continuously reminding me of the summer that passed.

How did your summer go?

(I could only recollect in such detail above because I kept a journal for each IVF cycle. I’ve lost count the number of times I wrote down, ‘This will be the last set of injections’; ‘The last IVF’; then, ‘The FINAL IVF’. Just to psyche myself up. Just to carry on. I now know what makes me tick … ‘I got nerves of steel, baby. NERVES OF STEEL!’)