It's what's affectionately known as a WTF Appointment in the world of infertility and fertility treatments. The idea is you meet with your doctor and discuss what the fuck went wrong, especially as in cases such as ours when we had perfect conditions and a brilliant embryo.
I was half expecting it to be a waste of time. I was anxious that we were going to go in there with our list of questions and feel like we were just being awkward or stupid. After all, I've done a bit of research myself and in my experience when you go to the doctor to tell them what you think is wrong, their immediate response is to ask to see your medical degree.
Well, it could not have gone better!
The routine for the clinic is one I'm rather familiar with as this is my fourth time at it (if you count the time before we officially started, five if you count the time when we went after having been taken off the waiting list). You sit in the waiting room with the other nervous and anxious couples.
I like to play the 'how many times have they done this' game, which is where you surreptitiously glance at the people around you and try to figure out what stage of their treatment they're at. The resigned looking couple in the corner, they've just had their first failed round which they were sure would be The One; the nervous guy and excited woman with the heavily creased letter, they're new to all this, she's read and reread the letter with the date of their appointment on it dozens of times, even though she's had it memorised since the day it came; the woman who arrived ten minutes before her husband, both in business suits and clearly taking time off from their work day, they've got a folder with lots of paperwork in the familiar purple and cream of the ACS unit's protocol sheets; they're old hands and are probably getting ready for another frozen embryo transfer if this appointment goes well.
I've been all of them. Now we're a new couple in the scene; the cross between the newbies and the old hands, with a hint of the dejected about them. I'll be watching out for more of us at future appointments. Except I don't feel so dejected now.
We have a plan.
At the clinic there's several doctors on and I think it's hit or miss which one you get. Last time we saw Dr R. (who was brilliant). This time it was Dr L. We've known Dr L. since our Nuffield days (three long years ago) and she recognised us straight away. She was lovely and chatty and really familiar with our case and history, which was good because I didn't feel like I had to explain too much. There's nothing worse than going for an appointment and having to explain everything when you know it's all there in your notes if the person you were seeing had taken a look.
Last time I felt like Dr R. had read my mind, this time it was like Dr L had pinched my diary!
Here's the questions I wanted to ask and what Dr L. said:
Thus far, I've started bleeding/spotting the day before testing, the day after and eight days before, why might this be? Could Progesterone be an issue?
Dr L. caught me off guard when we sat down in the room by bringing up the miscarriage, rather than the recent failed cycle. In a way that makes sense that's the closest we've got so it also gives us the biggest clues to what's gone wrong.
She was aware that I'd started spotting and then had a bleed. When I told her that once the bleeding started all my pregnancy symptoms stopped and I knew it was over I could almost see the lightbulb over her head.
Then she said 'I think Progesterone is an issue'.
And I smiled.
Because that's what I thought too.
That was my reasoning when I asked to switch from the Cyclogest pessaries to the Crinone Gel on the last round.
And it's fairly easy to tackle. I just need to take more Progesterone.
The bad news is, it looks like I'll be back on the pessaries (the good news is, I have an excuse to lie down for an hour every day; the bad news is, I have to lie down for an hour every day). The other bad news is that additional Progesterone comes in the form of an injection. It's intramuscular and it's a MASSIVE needle (trust me, I've googled it so you don't have to). But how awesome will it be if that's the magic solution we're looking for. Totally worth every one of those injections!
Dr R. mentioned the clotting factor and some drugs we could try in future cycles - Asprin and Clexane, could we try this next?
Mr Click brought this one up (I was getting there, I was just a little giddy about the whole Progesterone reveal). Dr L. told us that they're actually moving away from Asprin but that we could one hundred percent try the Clexane.
I said that Dr R. had told us that they can do a blood test to see if blood clots might be an issue and that the problem with the test is that it's not always definitive, so sometimes they'll just give it without doing the test. Dr L. agreed and didn't seem to think it would be necessary to do the test. She also agreed with my outlook that this is our last NHS cycle so we're just going to throw everything at it and hope that something sticks.
Since yesterday I've done a little more googling (why wouldn't I?) and I think the Clexane may well be an injection as well. Fun times ahead!
Our fresh cycle was half-IVF/half-ICSI, none of the IVF'd eggs fertilised, could we do ICSI on all eggs in the next cycle?
I mentioned this just as we were starting to wrap up the appointment, like I'd been saving it until the very last minute in case I didn't like the response. The hospital's policy is that if the sperm sample looks good and you've got more than a particular number of eggs (I want to say either eight or ten) then they do half IVF and half ICSI; less than that number and they ICSI all of them. We were looking good and we had 19 eggs, so we did half and half.
And none of the IVF'd ones took. Not one.
I think all of our ICSI'd ones fertilised normally, so we got seven embryos when we could've had twice that number. And as our stocks of frozen embryos dwindled I thought wistfully of how many we might have ended up with, even though it's not an exact science and I might not have gotten any more usable embryos, it's just what you do when you're having fertility treatment.
When I mentioned it to Dr L. (very quickly, like ripping off a plaster), she immediately paged back through my notes to the records from the embryologist and said 'definitely IVF all', which made me panic until she caught and corrected herself to 'definitely ICSI all'.
It's just another thing I can relax about and just focus on making those eggs, not worrying about how many we'll lose when we sacrifice them to the IVF gods.
Should we look at making any changes to our protocol when we start again?
Dr L. was our doctor when we had to cancel the private cycle due to hyperstimulation. I can still hear her voice as I sat on the windowsill at home when she phoned to check I understood why we needed to stop treatment, and she was right because two days later I was in hospital.
She's totally aware of my tendency towards overstimulating (I'm easily overstimulated through and through it seems, even my ovaries like to get in on the action); even our full fresh cycle was only two eggs away from being classed as hyperstimulation. She said that given my history they would stick with the same protocol, which I'm cool with, it worked well enough for us last time so hopefully we'll get similar results again, except, y'know, with a baby at the end of it.
Can we wait until February to start the next fresh cycle?
No one is more aware than me of how time is ticking on. When you're going through all the tests to find out whether you need fertility treatment all the doctors tell you that time is of the essence. Then you start and you're waiting for your place on the list, waiting for you slot in the next cycle, waiting for your next scan, and everything seems to go so slowly.
And yet the last thing you want during a time sensitive fresh cycle is the stress of whether you'll be able to get off of the small Scottish island you call home because the weather is bad and the boats aren't running. Case in point, on our way home from our appointment yesterday only one boat was running and the sea was pretty rough. This morning they were cancelled.
Dr L. is completely understanding of the situation. I suspect because we kind of made a song and dance about it right from the beginning. So the plan is that I make a request to get slotted in during February, perhaps calling up in January to make sure they have room for me. You then have the waiting to be allocated, waiting for your period, etc. etc. etc. so we should hopefully be ready to start just in time for the better weather in March or the beginning of April.
Are we okay to continue taking the Vitamin D?
Mr Click brought this one up and was met with a resounding yes. Dr L's exact words were 'We should all probably be taking Vitamin D.'
We'll also continue the Pregnacare vitamins, I'll continue avoiding dairy (where possible, I'm not militant about it), avoiding caffeine and all the other stuff we've been doing so well.
I've felt a little bit lost and confused about the who IVF/ICSI thing since the last one failed so spectacularly. There's the old saying 'the definition of insanity is doing the same thing over and over again, but expecting different results' and I was concerned that I would feel that way when we started Fresh Cycle 2.5 (the .5 is the cancelled cycle).
But I don't feel it'll be like that now.
I'm feeling optimistic that we might have identified the other problem (aside from my wonky tubes) and knowing what you're facing is half the battle. The two failed cycles were awful and there's still a hole in my heart from the miscarriage, but each of those things has taught us something new, and each little clue we're given helps us to figure out what we need to do differently to make it work.
And I'm determined that this time it will work.
Even if it does take 3cm long needles!
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