Needles and natural killer cells
I thought I would do a bit of a run-down on what is involved with a fresh IVF cycle, because unless you have done it, why would you know? It's easy for some, difficult for others, both emotionally and physically.
I would probably fall somewhere in the middle. I'm a pretty pragmatic kind of girl. I get on with the job. Only once have I cried over failed IVF. My problems are more of the physical type. Some people recover quickly and have little pain, but me -I'm a bit of a handful and have had a few post-op complications resulting in hospital admission and a lot of very nice pain relief. But I'm one of the lucky ones. I stimulate really well and one of the side effects is a fair bit of discomfort, because I have an abdomen full of ripe follicles. Some women are lucky if they get one. There are so many variables, but it's a whole other blog post. This is to tell you what I have been up to for the last couple of weeks.
So the regime begins on day two of the menstrual cycle. I'm doing what they call an 'antagonist' cycle, which has just become a lot cheaper thanks to the government adding the antagonist medication - ganirelix - to the PBS. Previously they had been about $90 a shot. That's the medication that stops ovulation. Day two begins like any other. I take my 5mg of folic acid, which helps prevent neural tube defects in the hypothetical developing foetus. I take ten times the regular dose, because I have a gene mutation than can cause deficiency of Methylenetetrahydrofolate reductase - I prefer the acronym MTHFR - which is thought to be a cause of recurrent miscarriage. I take the folate then three capsules of CoEnzyme CQ10, a cap of omega 3 fish oil, a general conception multi-vitamin, all washed down with a Berocca - not because I'm hungover, but it gets the vitamin B in and I really find it gives me a good boost.
Then in the evening, it's a shot of Follicle Stimulating Hormone (FSH) to the stomach. The regime continues for three days then I add a tablet of ethinyl estradiol to the mix in an attempt to coax my rather pathetic endometrium - that's the bit the embryo buries itself into and mine is borderline thin - to grow more than 8mm. The next day is the first of many blood tests to check my hormone levels. Not much is happening, so my FSH dose is doubled and the regime continues for another two days. Another blood test and yay, estrogen levels are high enough to commence injection number two - the antagonist that prevents ovulation. The whole idea is to get the ovaries to produce lots of follicles - which are meant to contain the eggs - at the same time preventing the body's natural urge to trigger ovulation.
Regime continues for another two days, then another blood test - something thing I don't do too well; the poor nurses have a shocker of a time finding my veins and more often than not I end up having it taken from a painful spot on the top of my right hand - and then it's time for an ultrasound.
(Now if you know me in real life, you might want to tune out now - yes Mum, that goes for you - because I am going to talk about vaginas.)
You do get used to them, really, but they are such an invasive procedure. It's not the happy "ooh that's cold" tummy-style ultrasound that pregnant women get. This is something that is known across the IVF world as dildo-cam, DC for short. Because it's like a dildo, with a camera on top. Five times in the last two weeks I have lain on a skinny, uncomfortable bed in a freezing office in Bondi, and had my holiest of holies invaded by a long, cold, unforgiving sceptre. They call it a transducer - I call it cruel. But it's great we have the technology, right? DC gets dressed for action with a condom rolled over and held with a rubber band at the base, and a squirt of that ice-cold blue gel before, ahem, entering.
Unless the nurse is too vigorous - and none of my fave girls are - the procedure isn't painful, more uncomfortable, because it goes in a really. long. way. My last ultrasound on Wednesday showed I had around 30 follicles between 10 and 20mm. 20mm is the sweet spot and so that night, while at a charity party filled with self-congratulatory media types, I injected Ovidrel which triggers the follicles to release the egg. But don't get too excited for me, dear reader, because 30 follicles doesn't promise 30 eggs. I'm hoping for ten good ones, from which I would like two embryos at the end - one to transfer, one to freeze.
Today I go in for the egg retrieval. My stomach is distended like I'm five months gone, and I waddle. Oh the cruelty! Any passing observer would think I was having a particularly uncomfortable pregnancy. The regime has reduced to pills-only over the past two days, but from this evening, I get to crank up the fun again, this time with a lovely little (you all get sarcasm, right?) gift from science called the progesterone pessary. It says a lot that I would rather inject myself every day than endure the PP. Imagine ladies, if you will, a small conical candle, 2cm high by 1cm across. Twice a day, you stick the candle up your fanoir and let it melt slowly, stickily out. Chafe? Why yes, I do!
Luckily I get to fulfil that dream of injecting every day, because from this evening, I also need to shoot up Clexane - a blood thinner than I need because of my high percentage of Natural Killer cells - no explanation needed, really - which is an auto-immune issue that can affect embryo implantation. Or something like that. I'm only newly diagnosed so I need to read up on it all.
So if things go to plan, in five days I will be back in the clinic to have my embryo - which has been prepped using a technique called "assisted hatching" to help thin out the wall of the embryo and help it attach to the endometrium - transferred, and in ten days I'll either be pregnant, or not. Or I could be a bit pregnant. That happens too.
Oh and PS is it weird that I'm looking forward to the general anaesthetic? I love that two seconds of druggie goodness before you go under. Of course the recovery is a shocker, but those two seconds are pure bliss.
Leave a message on Prue's blog.