Saturday, 19 December 2009

The tale of the egg collection

Thanks for all the good wishes ahead of Tuesday's egg collection - every one was much appreciated and brought me support. Here's the story of how the day went.

I was nil by mouth from midnight the night before, and had assumed I'd be too anxious to sleep, but in fact I was exhausted by 9pm and retired early to a surprisingly decent night's shuteye. I woke at 6, lay for an hour contemplating what was ahead, then rose.

I'd bought special organic unscented shower gel and deodorant for the day of the egg collection and embryo transfer as we'd been advised both by the clinic and by friends who've been through IVF that strong perfumes should be avoided.

I showered, stared for a while at my hideous, gnarly unpainted toenails and then got dressed in the exact same outfit, down to the socks, that I wore for my HSG so very long ago. My logic was that a) the garments in question rank among the most comfy, cosy clothes I possess and b) I survived that so, in the same way that I always tie the exact same red ribbon on my suitcase handle when I fly because so far every plane has landed safely, I'd survive this.

My mum arrived to collect me absurdly early - I inherited this trait from her - and we arrived at the clinic well in advance of my 9am slot. I had started to sense a flutter of panicky nerves during the car journey, but sitting in the waiting room I could feel my body determinedly relaxing in the way it does immediately before trauma. My most pressing concern was the amount of pain I was by now in from the bloating caused by so many follicles. My stomach was hugely distended and uncomfortable, and I felt like I needed the toilet all the time. I could not wait to get those eggs out of me and into petri dishes.

Hubby and I were both summoned into a consulting room by a nurse I hadn't met before. I didn't really warm to her: she tried to make jokes, and I suffer from sense of humour bypass on aeroplanes and in distressing clinical situations. When her cheerful remark that the drug they'd give me was so nice she'd "like to get some for the weekend" was met with a blank stare, she shut up and gave us the facts: they were running a little behind, so we'd need to wait in reception some more before going through to prep me for theatre.

This we duly did. I wasn't irritated that they were behind schedule - these things happen in hospitals - but I do remember glancing at the clock when it reached 9.45 with something like despair, as I'd assumed I'd be nearly done by then. Fool that I am.

It was gone 10 when we were eventually escorted to the ward and introduced to the ward sister, who I immediately liked for her warm but no-nonsense manner. There are four beds in the ward - amazingly, the clinic perform five egg collections each weekday - and I was the fifth and last patient of the morning. That meant I didn't get a bed to prep in, because there were two beds in use by recovering women, one awaiting the imminent return of the current operatee, and one with the girl before me in it. We were therefore shown to hardback chairs immediately adjacent to the curtain around my predecessor's bed.

It was fine at first but my abdominal discomfort started to increase - I guess the timing of the hCG injection means your eggs start to mature right before the collection - and sitting on an unyielding chair was no fun. Hubby was doing what he does in airports (I'm terrified of flying): reading a book and studiously ignoring me. The girl in the bed next to me started to complain about her own abdominal pain, which irritated me because at least she was lying down.

The sister then returned and went through the paperwork. She gave hubby a pot with his name on it, and me a credit card thing with mine. We then had to go over to the computer and scan both - they each had a barcode - to "lock us in" to the system and make sure everything that either squirted out of him or was gouged out of me was assigned to us.

After that the sister explained that the doctor - head honcho consultant, I was pleased to learn - would come and put a portacath in my arm ready for the administration of the drugs once I got to theatre. She asked if I had a problem with needles and was rewarded with a hollow laugh.

Hubby was then dispatched to produce his sample. I sat chewing my nails, fully expecting his sheepish head to emerge from the wank room and announce he couldn't get hard. I had a variety of waspish responses ready should that eventuality occur. My favourite was "You need to get a grip - literally".

He was back surprisingly quickly and sufficiently flushed and furtive to suggest that his endeavours had been successful. I asked as much and he announced that they had.

"Where the fuck's the sperm, then?" said I. He explained that there's a little window in the room - sort of like a dumb waiter - where the man puts the pot and then presses a buzzer when he's done, presumably to spare him the mortal embarrassment of walking out into the ward clutching his juice. How very thoughtful of the clinic. Shame stirrups don't come in embarrassment-free models.

Hubby returned to his book looking decidedly pleased with himself. The sister returned, congratulated him - yes, really; blokes need so much bloody encouragement - and then told me to get changed into a theatre gown, over which I was allowed to put the dressing gown and slippers I'd brought along.

I ducked into a tiny changing room furnished with lockers and a load of theatre clogs, presumably for girls who forget their slippers. Luckily I'd brought with me what I lovingly refer to as my "fluffy feet" - a pair of whimperingly soft and furry bedsocks which I wear nightly on my return from work until they get up and walk to the washing machine themselves.

The theatre gown was similar to the one I'd worn for the HSG: press studs in the back of the neck, then loose ties at the shoulders and waist, and otherwise open to the four winds. I was very glad of my dressing gown as I trudged back to our seats.

At this point, the girl in the next bed really started to get on my tits. The doctor was with her when I returned, putting in her portacath. I have sympathy for people who are afraid of needles, I really do, but for fuck's sake. I have no idea how she coped with the daily injections. Anyway, she was squealing and weeping and just generally overreacting in a highly vexing fashion. Hubby saw the expression on my face and his lips curved with amusement. After it was in, she immediately - immediately, mark you - started giggling and claiming to be hysterical, until the doctor pointed out wearily that she hadn't actually administered any drugs yet. At that moment my - and I like to think, the doctor's - mind was made up: drama queen. And she didn't even appreciate that she had a bed.

A few minutes later a new nurse came to collect her. I couldn't see through the curtain but I soon heard the nurse say, "No, sorry, you can't wear that - we need to be able to talk to you. Didn't you bring a CD?" and I knew that she must have not read the admission notes, which expressly forbid iPods, properly. "Nooooo," wailed Norma Desmond. "I need my music!" I mean, I ask you. The nurse sighed and said, "What were you planning to listen to? We have a few spare CDs if you'd like to choose one." The response, uttered whiningly: "Some chuuuuuurch muuuuuusiiiiic.".

After she departed I knew I had probably about half an hour still to wait. I was hoping they'd transfer me into Norma's bed, but they didn't. By this point my stomach was really hurting - it was like having horrendous wind - and the only way I could get comfy was to slouch back in the seat and prop my feet on the low magazine table in front of us. This was fine until a man arrived, presumably to produce a sample, and elected to sit in the chair DIRECTLY opposite my naked vagina. I was less than thrilled.

By this time it was nearing 11am - a lot longer than I'd thought the whole process of checking in would take. I started to worry that I'd ovulate the eggs and ruin everything, but hubby assured me that they wouldn't allow this to happen. Finally, Norma was wheeled back into her cubicle, blessedly quiet now, and the doctor came to say good morning and insert my portacath.

It went into the vein in the crook of my elbow fine, no worse than a blood test really despite what I've heard, and was taped securely in place. The doctor flushed some saline through it to make sure the liquid was going into me and then said it'd be just a few minutes more.

Shortly after that, a new nurse appeared and introduced herself as the theatre nurse. She took my CD - Sarah McLachlan, about the most soothing artist I own, with the particular album chosen for the presence of a song with the line "it'll all be worth it, worth it in the end" - and, after a quick peck on the lips from hubby (for me, not the nurse) led me down the corridor to the theatre.

At first glance it looked like a torture room from one of Eli Roth's less palatable films. There was a low sideboard spread with heinous implements, including pliers (what the FUCK could they possibly need those for? screeched my brain) and an ominous bed upholstered in black leather on a sort of raised dais in the middle. I had to walk to the end of the room, with another nurse beckoning me like a floor manager in a TV studio, and was instructed to insert my barcoded credit card into a reader. A voice then spoke to me from the wall. If I was a religious woman, I might have thought it was God, except it said "Hi, I'm Emma, the embryologist, can you confirm your name and date of birth please?" which doesn't seem like the sort of thing God would say.

Having duly confirmed my vital statistics, the nurse took my dressing gown and slippers and I was asked to clamber on to the bed and lie down. I was wearing my glasses, having sensibly left my contacts at home in case the drugs made me fall asleep, and the nurse said I could keep them on if I wanted to. This relieved me as things are always scarier when you can't see properly. I had to confirm I didn't have any allergies and wasn't wearing any nail polish (which, surely, they could have seen for themselves.

Once I was in position, though not yet in the stirrups, my blood pressure was taken. Next, a clip was placed on my left forefinger and an oxygen mask over my face. The doctor was bustling around with who-knows-what at the business end, and the theatre nurse told me she was going to administer the pain killer now, and then once it had taken effect, the sedative.

I didn't feel anything for about a minute but then suddenly it was like this warm, woozy sensation flooded me, starting in my legs and soon taking me over completely. The best way I can describe it is like being very, very drunk, but without the queasiness and room spin that often entails. I'd be lying if I said it wasn't quite pleasant. But one thing about it was that I knew I was no longer in control of my faculties; that I probably couldn't leap off this bed and run away if I wanted to, and that was a bit freaky.

Happy it had taken effect, the nurse started pumping in the sedative. And then it seemed things started immediately, although time sort of took on a fluid quality so perhaps there was a delay. The doctor said she was going to examine me, and I felt an icy cold speculum being cranked open inside me. It twinged a bit more than a speculum usually does, which made the words "Oh, fuck" scoot across my mind. Then that was removed and the scanner put in its place, which wasn't so bad.

"We'll do the right side first," the doctor said, and then there was a terrible pain. It was brief - it lasted maybe 15 seconds - but it was bad. It would have been the needle penetrating my vaginal wall and going into my right ovary. I must have gasped, because they all told me it was OK and how well I was doing.

I don't really remember much about the eggs on the right side coming out, just a feeling of intense pressure, slight crampiness and the sense that a lot of implements were rummaging around very deep inside me. Then I heard the dreaded words, "And now the left side" and braced myself for that stabbing pain again.

I remember nothing after feeling that. They said I might not remember any of the procedure - I like how I remember the pain of my wall being perforated but not something boring like being put on a trolley - and I certainly don't recall it ending, the scaffolding being dismantled and me being put back on the ward.

I woke up after what I assumed was only about ten minutes. I was in bed, in a curtained cubicle, in the recovery position, no longer wearing my glasses. I stared for a while at the curtain until I could focus and noticed that it was printed with images of bridges and famous buildings from the city where I live. I then became conscious of awful cramping pains in my lower tummy, and flipped on my back to ease them. A nurse checked on me just as I was doing this and told me I needed to lie on my side in case I was sick. She helped me roll over and then told me to sleep. I lasted about a minute on my side and then flipped back again. I'm nothing if not disobedient.

I dozed for a while but it was noisy on the ward - I had the sense there were throngs of people milling about - and I wanted my mum. I must have been woozier than I thought and whimpering as much because after what seemed like only a few minutes, the nurse was back asking if I wanted anything. "My mum," I said, so she went to get her. The sound of my mum's voice asking, "Is she OK?" as she was led down the corridor was music to my ears.

It turned out I had slept for nearly an hour and a quarter. Mum got a bit freaked when the first thing I said was that the bridge was on my curtain, until she looked and saw that it was true. She was with hubby, and they each took one of my hands, my mum chafing the one she held between her own as if I'd just come in from the cold. She put my glasses on me and the nurse propped up my bed so I was sitting. The cramps were still bad but subsiding and I started to feel better quickly.

I was given toast with strawberry jam, orange juice and coffee. I hadn't imagined I'd be hungry in a million years, but having not eaten since dinner the previous night I found I was ravenous. My mum read out a checklist of the things I needed to demonstrate before being discharged: namely, sitting up, eating, drinking, walking, and urinating. Anxious to be home, I did all of them.

The embryologist came to see me and told me they had got ten eggs, which she said was really good. I was told to phone at 10.30 the following morning to check fertilisation, and with that was sent on my relieved, if not merry, way.

The only issue on the way home were speedbumps, which jarred my tummy something rotten. But once back in my house I spent the afternoon snoozing in bed and on the sofa, and by evening felt as right as rain, if still a little bloated and sore.

I'm still tired and feel like I've written my fill today, but I'll be back tomorrow to tell you about embryo transfer - all ten eggs fertilised, and we ended up with three good embryos, one of which is now (hopefully) nestled inside me. All in all, it's been a dramatic week.

Monday, 14 December 2009

IVF, weeks 4-6

My egg collection is tomorrow morning at 9am.

How do I feel? There's a scene in the film Armageddon where one of the astronauts about to take off answers that same question. His verdict is: "98% excited, 2% scared. Or maybe it's more like 98% scared, 2% excited - it's hard to tell but that's what makes it so intense." That sums up my mindset this rainy, chilly evening.

I managed fine with the injections in the end. I got to be quite the dab hand with the old liquid siphoning by the finish. Inevitably on my last day I performed the maneouvre perfectly. Had my last morning injection been a gymnastic routine, I finished on the equivalent of a perfect en pointe dismount.

I managed to escape with only a little bit of thigh bruising and several sliced fingers, and the side effects haven't been as bad as I feared. I've suffered with migraines in the past so I was pretty well resigned to having one of those once the hormone cocktail kicked in, but I've avoided them so far. There was a thudding headache every day between day two and six, but a headache is very different to a migraine and I was able to cope.

The nerves I felt going for my first scan were about as jittery as anything I've experienced throughout this process. Because of my high FSH level I'd convinced myself there was a chance I might not respond at all. My big dread was the monitor revealing two stubbornly small and flaccid ovaries which had refused to produce so much as a pimple.

There was no need to worry. To be fair, the secret voice in my brain which is currently insisting that this whole thing might just work had told me I had nothing to worry about because I'd felt my ovaries kick in round about day five. It was the same feeling I had on Clomid - a sort of low ache, almost like you have wind, worse on the right side.

The head doctor at the clinic did my scan with her trademark - and actually increasingly appealing - no-nonsense style. The hell with KY jelly and easing it between my lips - the Renault was rammed, bammed and thank you mammed into me with very little in the way of opening pleasantries. Which suited me fine as I was burning to know what my pesky ovaries had been up to all that time. Despite the twinges I'd felt, it still seems weird that a little jab in your thigh flab every morning can make eggs grow there.

Immediately the doctor murmured "Oh, this is good," and I craned my neck to look at the screen. Even I could see them - oval, shadowy follicles clustered on my right ovary. She counted five, then twirled the Renault and located seven on the other side. Withdrawing the scanner with similar gusto to that with which she had introduced it, she proclaimed this to be excellent progress and sent me on my merry way with a view to presenting myself for a final scan on Saturday gone.

The jabs got a bit sorer after that, presumably because there wasn't much expanse of thigh flab left that hadn't already been skewered and injecting into a bruise isn't much fun. But I persisted and as I did the windy ovary pain got a bit worse each day, and my stomach started to bloat.

Saturday's scan went like a dream. I now have 14 follicles, seven on each side, all of which the doctor deemed to be the perfect size. I administered my hCG injection last night - it stung like a motherfucker, being cold out of the fridge, and the injection site on my beleaguered thigh flab is puffy and inflamed, but it is done and I now have no more needles to deal with. Hurrah and huzzah. I felt like cracking open the champers but since I've sworn off alcohol for the duration of this - might as well treat my body like a temple being the logic - I had to make do with water with lemon.

I've felt emotional but not as much as I feared. I imagined I'd be breaking down in tears at adverts, or howling in anguish on the train platform when I'd just missed one (both of which are exhibitions of myself I've been driven to previously by fertility woes).

But since the first scan revealed all was well, I've actually felt happier and more positive than I have for a while. It has to be said that this is down to some fairly wonderful caregiving by my legendary best friends, mind you. Friday night saw me not fretting and angsting over the next day's scan, but instead munching pizza, sipping peppermint tea and giggling in my PJs on their sofa. To be distracted, taken care of and amused during this nightmare has been wonderful.

So now. A short description of my physical state.

My stomach is distended like a malnourished orphan and I fancy that I can feel every one of those 14 follicles jostling for position on my ovaries.

I have unpainted toenails, as instructed by my egg collection admission form, which also forbids me from wearing makeup (unthinkable; surely a slick of mascara won't harm my eggs), deodorant (but cunningly, I have bought an odourless organic one - a girl doesn't want to be smelly), perfume or body lotion.

(It is worth pointing out that I have not had unpainted toenails for longer than it takes to remove one coat and apply another for at least 15 years. I always thought I had quite pretty feet but it turns out it was the varnish making them so. They are butt ugly naked. My nails are a sort of pallid yellow colour - as a result, one imagines, of nearly two decades of continuous varnish-wearing - and they look bigger, ganglier and sort of masculine. I hate them. My mother - from whom I inherited my obsession with toenail varnishing - was appalled.)

I now need to pack my bag - I'm instructed to bring a dressing gown, slippers (with which I can hide my unattractive feet, thank fuck), a toilet bag and a favourite CD with me. Then it's early to bed in the hope of some sleep. I'm not allowed to eat or drink after midnight, because of the sedative they'll give me. I'm to be there for 9am.

I'm told I may not remember the procedure - I bloody hope I don't - but I'll do my best, tomorrow or as soon as I feel well enough, to describe what I do recall here.

I very badly wish all this was over. But while I'm anxious, I know this is just another hurdle I need to get over in my quest to get what I want more than anything in the world.

Wish me luck.

Thursday, 3 December 2009

IVF, weeks 1-3

So. I started Synarel nasal spray on Sunday November 8, after a training appointment during which we were taken through the whole process in blow-by-blow detail. I've taken it every day, twice a day, since then.

I thought I'd have blogged more during the first weeks of IVF but it's surprised me how tired I've been and how little I've had to say.

I think one reason I haven't written anything is that there's not an awful lot you can say about taking a nasal spray. The bad things are, in no particular order:

1) remembering to take it at 9am and 9pm every day. This is inconvenient because I leave for work at 8 so most days I need to take it in the office toilet. There are days when I've been busy, distracted or just forgotten and then been stricken with panic at 11ish and forced to hare along the corridor to do my sniffling.

Taking the evening dose isn't much better. So far I have inhaled it during a ghost hunt at a castle in a rainstorm, sitting in the cinema during a film, at a salsa class, and round the side of a theatre ahead of meeting a moderately famous comedian.

2) sometimes when you snort in the wrong way, it goes into your sinuses and stings like when you were a kid at swimming class and inhaled chlorinated water. It also tastes bitter and unpleasant when it trickles down your throat, a bit like chewing aspirin without water.

3) the side effects haven't been too bad for me, limited chiefly to the odd hot flush in bed at night, several medium-strength headaches and one fainting episode (but that was when I was poorly anyway with a virus, and I'd just stepped out of a hot bath). One odd thing is that I seem to have low-level heartburn all the time in that when I eat or drink I feel a slight burning sensation in my throat and chest. But, like I said, no side effect so bad that I can't cope with it.

The good things are - well, there aren't any, unless you count the fact that I've responded to it. I had a scan on Tuesday which revealed two very subdued, deflated ovaries - and so they bloody should be, for what they're putting me through - and an empty womb with minimal lining. Everything as it should be after nearly three weeks on the spray. I now need to keep taking it up until the egg collection at which point I can replace this daily activity with the delightful alternative of ramming a pessary up myself.

So I was given the go-ahead to start the injections. I had a training appointment with my favourite nurse after my scan. To say it went badly would be to do injustice to the word 'bad'. I am completely ham-fisted and clumsy at the best of times. Dealing with tiny, fiddly-as-fuck vials and needles while under a reasonable amount of strain and immediately following a vaginal probe did not improve my dexterity.

For my first trick, I shattered the tiny glass vial which contained the dilutant solution. WHY do these need to be so small? I get that there's not a huge volume of liquid and we are living in an age when minimal packaging is considered environmentally sound, but for fuck's sake, I'm not a member of the Sylvanian Family.

And another thing. Why do they have to be glass? It's not like they can be recycled - they get thrown in a sharps box and incinerated as clinical waste, so make them plastic and easier to handle! I cut my hand in four places trying to snap one open in front of my initially amused and then anxious nurse. I left the clinic with four elastoplasts on one hand and another on my arm where I'd had my blood test. I looked like I'd made an extremely bungled suicide attempt.

I'm on four amps of Menopur because of my higher than average FSH levels, so having eventually opened a dilutant vial and sucked its contents into a syringe, I had to be shown how to pierce and dissolve four separate (glass) vials of powder. Each time, you have to squirt the contents of the syringe into the vial, dissolve the powder, and suck everything back up again. Fiddly doesn't begin to cover it.

After that you detach the big fuckoff needle and reattach a smaller injecting needle before easing the plunger up to 1ml, getting rid of the air and then doing the jab. For this you need six hands because you have to pinch your skin, insert the needle, depress the plunger and withdraw it all at virtually the same time. All I can say is thank fuck it's women who do the injections during IVF, as we all know men can't multitask.

At the clinic, I injected myself with a bit of saline solution to prove I could do it, then my first real jab was yesterday morning. I had set everything out the night before, like a cook before a big dinner party, and barely slept because I was so nervous about being able to manage without the nurse. But it went surprisingly smoothly - which, as I discovered this morning, was beginner's luck. It reminded me of the first time I parallel-parked my car after my driving test: it went in first time and I sat stupefied by how this could possibly have occurred. The next time, it took 40 minutes and involved tears, howls and a prang on the bumper.

Perhaps this morning's disaster was because I hadn't slept a wink, having spent the entire night convinced a demon was hiding in the wardrobe after watching Paranormal Activity at the flicks. I knew things weren't going to go well when I immediately sliced my forefinger opening the glass vial. I bleed a lot even from small cuts so was seeping all over the assembled sterile apparatus, but feared I'd be even more bumbling wearing a plaster so I left it.

The next problem was that I couldn't get the frigging syringe to suck up the fluid from the first vial of powder. I kept pulling it up too far and running out of syringe and then leaving a load of liquid in the bottom. If you're not superhumanly quick it seeps out the end of the needle anyway, and for a while I was making absolutely no progress. Time was ticking towards when I needed to leave for work, despite me allowing 20 extra minutes for the injection, and I began to get flustered.

Chanting "fuck, fuck, fuck" in a low but urgent voice, I eventually got all four vials of powder sucked up through a manoeuvre that combined the speed of a panther with the cunning of a fox (essentially, just tilting the vial, ramming the needle in the corner of it and twirling it quickly to attract all the liquid).

However, I had created loads of air with my epic syringe endeavours so the resulting mess looked a bit like a bubble bath by the time I was ready. I started remembering all the films where a murderer injects air into a person and causes a clot that kills them. So I had to tap the syringe for ages to get the bubbles to clear.

After all that, it seemed cruel that I still had to get through the painful bit. I was on my right leg today, which means as a righty that the angle and needle trajectory is more complex, so it hurt more than it did yesterday and I've developed a bruise for my trouble.

All this snorting spray and stabbing needles would be a lot easier if only I were a crack and heroin user. But what am I saying - if I were, I wouldn't need IVF since drug addicts get pregnant at the drop of a hat.

I needed comforting after all that and since hubby had fucked off to work long before I even began my endeavours, I decided waffles, maple syrup and blueberries were the way to go. They were good. But then my car wouldn't start. It has been making a low but insistent beeping noise for a bit now and I've been studiously and foolishly ignoring it. Having consulted the manual and talked to my stepdad, I knew all that was needed was some water in the radiator, but rather than sorting this out at the weekend when I had bags of time, I'd left it till a few minutes before my weekly 50-mile drive to the office I work out of on Thursdays.

I'd never topped up my radiator before but figured if I could inject myself with hormones then surely this couldn't be beyond me. So rather than driving to a garage where I'd be mocked for female incompetence and probably charged for the privilege, I decided, unwisely, to tackle it myself.

Well, I couldn't get the cap off, could I? I tried everything - pulling, twisting, tearing, even prising with my key - but it was all to no avail since my car was manufactured by safety-conscious, obsessive-compulsive Volkswagen. (I believe I howled "Come on, you German bastard" at one point.) Eventually, defeated, hormonal and weeping hysterically, I phoned my mum and yodelled for help which was provided - bless him - within ten minutes by my stepfather.

It remains to be seen what tomorrow will bring. I guess there's a knack to it and that you get better every day. I also think a good night's sleep will help. But the trauma has stayed with me today and I've felt extremely weepy. I suppose it's only natural, given I'm suddenly flooding my system with hormones after suppressing it for nearly a month, that I should feel odd.

I think, though, that being reasonably au fait, if a tad incompetent, with the concept of sticking a needle into my thigh after two days is testament to the fact that you can do anything if you put your mind to it, and want it enough. I think I'll leave it on that reasonably positive note.