Fertility (Part 1)

I decided to write a fertility “giggles” blog, because at some point in this “what doesn’t kill you makes you stronger” absolute nightmare journey of conception that we are on, if I don’t find some laughs – I’ll be crying. 24/7. Literally. I thought this was going to be quite an amusing blog, but as I seemed to have spent a vast bulk of it explaining AS MUCH AS I KNOW, because 1) I don’t think I have and 2) a lot of people just don’t understand the world of conception or fertility – even if they have conceived – I decided (with a little help, thanks Nicki!) that it needs to be split into two blogs. So Part 1 here is explaining the ins and outs. Part 2, for the laughs, can be found here; The giggles

FYI.. Probably best for my in laws and parents, and probably general family and anyone that doesn’t want to know or finds my oversharing too much info, to just to not read part 2.. 👍🏾 (or, if you feel like that, any of them?!)

So here is the knowledge I’ve gained so far. I’m certainly no expert, but I’ve now hung around enough doctors, consultants, nurses; ALL the fertility specialists, and I’ve had enough cameras, probes, speculum’s, catheters, ETC. inserted into my vagina to have figured a little bit of this challenging world out. 💉

Beginning to understand fertility starts when you fire up the baby-making tools, so for us, almost 3 years ago. 

And we are still only beginning to understand. 

 For lots of lucky people out there, you seem to “just conceive” on first attempt. This in itself is a miracle – let alone how beyond belief it feels for those of us that struggle like hell to conceive. I don’t think anything I have been through and anything I will go through in the future will be as all-round physically, mentally, emotionally challenging and draining as the world of trying to conceive. London Marathon was literally a casual stroll in comparison.

 So, for you lucky couples that conceive naturally – it hasn’t actually happened “any time within the last 4/5 weeks” {since your last period, ladies} but, in fact, within a 48 hour time frame after you’ve ovulated; usually around day 14 of your cycle. Sperm can survive 7 days in your womb/fallopian tubes, but if not fertilised, your egg will die 48 hours after ovulation. So, for a “live example” you could have had sex on Sunday, ovulate on Wednesday and conceive Thursday without having sex again. It is literally, a miracle. I think I’m right in saying, that by the time you’ve noticed you’ve missed a period, you’re officially around 2-3 weeks pregnant on average (period timings dependant), but because it’s been 4-5 weeks since your last bleed, you’re considered 4-5 weeks pregnant once you get that BFP (Big Fat Positive). Pregnancy is counted from the first day of your last period. The chances of any given couple with no fertility issues conceiving in any given month are just 14%.

 Ovulation in itself is one of those things your body just does on its own without you realising. Each cycle your body develops a follicle (sac) or follicles, on your ovaries, which each contain an egg. Ovulation is when the follicle matures enough and releases the egg… hopefully you know the next bit.. little eggy travels down your Fallopian tubes towards your womb, where, if you want to conceive then you’ll hopefully have some little sperm hanging around waiting to fertilise that egg, or eggs… more than one egg means more than one [non identical] baby/babies… non identical twins/triplets/quads etc, outside of fertility treatment, are passed through families genetically on the maternal side. If there’s a history of non-identical twins in your family, you could have them: it’s genetic that you are producing more than one follicle, and thus egg, at a time. That is my understanding anyway! The chance of non-identical twins in those undergoing fertility treatment increases because you are stimulating your ovaries (more on this later!) to produce follicle(s); however this can change for every woman on every cycle: what happens one month won’t necessarily happen in another month – as we have previously seen for me, where I hyper-stimulated in our first try at IUI and had to cancel the treatment.

Identical twins can happen to anyone: the egg splits to create twins, or triplets, or quads, etc. which are identical. I am fascinated and always have been by identical twins.. I would really love identical twins! 😍 Although I am well aware it wouldn’t be easy… but like an old colleague of mine who had identical twins in her first pregnancy said, she “didn’t know any different” – two babies at once were the norm for her.

 So – quite a lot of information you may already know, or not, before we’ve even started the fun and games of fertility treatment!!

 As we know, I’m the “problem”. Shock horror, right. Never mind Jay-Z’s “99 problems” – I’m just one big problem 🤣! 

So, after the little summary above, you should understand that the next words mean, no matter what we do each month, without the aid of fertility treatment, there is absolutely no chance we can conceive, because…

I don’t ovulate. 

 This is known as “anovulation”. I have been tested and tested time in time out. Sometimes blood tests, sometimes we can just tell from having had scans on the right days and finding no “mature” follicle. I’ve been tested Day 21/22/23. I’ve been tested Day 28 to see if I just ovulate late, and I’ve been tested Day 7 and Day 14 to see if I just ovulate early. Nada. I just don’t. So no matter how frequently James and I “baby-make” – there is literally no way we can actually make a baby. Poor little spermies are swimming all that way to meet.. nothing: certain death.. ☠️

I’d say it is fairly commonly known that your GP will tell you not to worry and to keep having regular, relaxed intercourse for at least a year of “trying” for a baby, before you will be referred on the NHS for treatment. I don’t dispute this. On average it takes a couple a year to conceive naturally. It just appears, when you’re trying for a baby that everyone else conceives overnight, without even trying. And ladies – you need to be prepared if you are on the pill, it can take up to a year for your body to resume normality. Fortunately for me, I came off it at the age of 25 (18 months before we started trying) due to being TOTALLY AND UTTERLY BATSHIT 🦇💩 CRAZY HORMONAL – and let me tell you, it took 9 months then for my periods to return to normal. My utterly useless (soz if this offends anyone, but my current ones are fab!) GP at the time actually thought I was 9 months pregnant at one point (and 8 and a half stone; as if!)

In hindsight; I don’t ovulate, so I never even needed to be on the pill in the first place…great one.

 For me – and I think any female who doesn’t ovulate – the first steps of fertility treatment (after ALL the scans, bloods, checks and tubes, camera’s and general prodding up your vagina) is Ovulation Induction (OI) in the form of taking (Clomifene) Clomid. Clomid is a tablet which you take once a day, for 5 days, from day 3 of your cycle (FYI, day 1 is the first day of your period), although I have read about some ladies taking this on slightly different days and becoming more successful than me; everyone is different, and if I could go back, I would try that as well. You are measured (although I can’t fully remember how!) for the first 3 months of taking Clomid to see if you are responding to the medication and ovulating. Within that first 3 months, I appeared to ovulate once; so not the greatest success rates! Regardless, I continued taking the Clomid whilst waiting for the next step. To me; taking something was at least potentially increasing my chances, rather than zero chances at all without it. On my fifth cycle, I realised that all the side effects I was feeling matched exactly that of the side effects from the Clomid. I can’t remember them all now (there was quite a few!) but the main one was consistent headaches, which is one of the big worry ones. They weren’t horrendous headaches, they were just there. It is recommended if you notice one of those “worry” side effects, you stop treatment… but like I said, one more month of headaches vs definitely not conceiving, meant I continued with the meds..

 So, 6 months down and we still aren’t pregnant – now we move onto Ovulation Induction in the form of injecting {me, with} Gonal-f daily, once again from day 3, until your follicle(s) are big enough (mature). [I am not good with needles. I have been known to faint. This was scary for me.] In Taunton, you are scanned transvaginally to check follicle growth three times a week. FYI – these scans are painless. Frankly I can’t see any difference between a camera-vaginal-probe going up there or a penis/tampon going up there -and we are pretty sure I have a low pain threshold! I am unsure of what the chances of conception using Clomid/Gonal-f for OI are, but I imagine it is not much increased – if at all – from that of an average couple conceiving naturally, as OI is simply encouraging the woman to ovulate like she should be anyway..

A mature, big enough follicle is between 18-20mm, and with this treatment, you aren’t really allowed more than 2 follicles.. As mentioned earlier, 2 follicles means 2 eggs which can mean 2 babies.. but if any of those eggs also split, you could end up with a lot of babies in one cycle. I love the idea of identical twins, but multiple pregnancies are riskier for both Mum and babies. The more babies, the higher the risk.

I always responded fairly quickly to Gonal-f, so generally I only ever had 2 or 3 scans to my ovaries before another injection (Ovitrelle) to trigger ovulation. You have to be quite on top of when your follicle might be ready to trigger ovulation, as really you want to be having regular sex in the week leading up to it to ensure there are lots of sperm ready and raring to go! I’ve learnt to draw on my merchandising skills to forecast (merch friends will find this hilarious; we are such geeks 🤓) when we might be triggering ovulation, because once you have ovulated, you got 48 hours to fertilise that egg. It can take 24 hours for sperm to travel to meet said egg. Sperm can survive for up to 7 days in the womb. So basically, like I say; you want to be having ALL of the sex [umm, with your partner, yeah 🤣] 7 days before you ovulate and the 1-2 after… any time outside of that is actually just for fun/pleasure… but believe me after a year of precisely timing EXACTLY when you NEED to have sex [and for us, a year prior to that just trying to conceive naturally with the standard stated “regular intercourse” when I don’t even release an egg.. 🙄] fun/pleasure basically no longer exists. I’ve read before and I totally agree that actually starting a treatment like IUI/IVF takes the pressure off couples HAVING to have intercourse – sex now is like bonus sperm in the womb, but the pressure is off, slightly, because the lovely people at BCRM “turkey baste” 🦃 me…

So, as we know, I sadly didn’t conceive with the aid of OI. Not for want of trying, and I was certainly sad to leave the fab team behind at Taunton; as we had to move to another clinic (Bristol or Exeter are our nearest) to move into IUI/IVF. So obviously, this moves me nicely into IUI. Intra-Utrine-Insemination is treated similarly to Ovulation Induction with Gonal-f, you again inject Gonal-f daily from day 3 until follicles get to ideal size; you are scanned roughly every other day, but depending on your rate of reaction/growth, when once again you then trigger ovulation (still Ovitrelle), your partner produces a sperm sample in a pot, which is “washed” and removed of the “useless” sperm, and roughly 2 hours later is inserted directly into your womb, via your vagina using a catheter. You get the added bonus of a second injection each morning when 1/2/3 follicles (no more than 3) reach 14mm, this second injection, Cetrotide, stops you ovulating off your own accord: unlikely for me but some women do ovulate on their own, (anovulation: not ovulating, isn’t the only reason fertility treatment is needed, but is our only reason!) and obviously, when you are being inseminated, you want the egg to be there at the right time or it’s all pointless! Again, I found this not too painful – just uncomfortable. When my husband asked me what it felt like, my words were “it feels like my vagina is wide open”. Essentially, it was. The procedure is almost exactly like what you see in the movies when the woman is lying on the bed with her legs in stirrups; the only difference is the bed/chair thing is now more modern – and actually pretty comfy! I reckon if I wasn’t distracting myself with a 3 way conversation between James, the nurse and I, I could have probably fallen asleep!! After insemination, you are left for 10-20 mins to let gravity do its thing, before you are sent on your way, with instructions to insert pessaries twice a day for 15 days, and then the day after they end, to do a pregnancy test… There are no real suggestions or recommendations for what else you can do or not do to encourage a pregnancy. Many women try to take it easy and relax. Those that have been fairly hard-core on the exercise take a break (myself included). I’ve tried to keep myself busy; surrounded by friends and keeping my mind occupied with little time to overthink. I am also EXHAUSTED, so sleeping a lot!

I’m just going to pop in here to explain/use me as the real life example of how any woman can react differently on every cycle using Gonal-f.

Whilst at Taunton, I had to inject 75(whatever the measurement is) daily. For 6 months, the maximum follicles I ever had was a risky 2.5 (the .5 wasn’t quite big enough but likely could have been by the time ovulation occurred after the trigger). Some months I had only 1 follicle, some 2, some 1.5, etc. Every month was different. Some months everything would happen on my left ovary, other months the right, and sometimes one on each. There is no rhyme or reason, but believe me, everyone was surprised when, on my first IUI cycle with BCRM (Bristol Centre of Reproductive Medicine) I “hyper-stimulated” on the exact same dose as I’d been for the last 6 months, and ended up with 5 follicles and having to cancel treatment. You are not allowed to continue with 5 follicles due to the increased risks of multiple pregnancies. It’s fair enough and we understood, no matter how disappointing. Hyper-stimulation is exactly as it sounds from what I’ve said so far; your ovaries have been overstimulated and produced too many follicles. In some cases, it can get much more out of hand than my 5, and can then be dangerous and painful for the female; I felt nothing.

I am not going to go into too much information around IVF (In-Vitro Fertilisation) because 1) hopefully we won’t get to that point, and 2) I think generally people “hear” more and “know” more about IVF. Quite simply, I believe the female continues to inject Gonal-f to produce follicles, but, with IVF you want to produce as many as possible (so yes, essentially hyper-stimulating). These follicles/eggs are then “collected” (unsure how, other than under anaesthetic, which having never been under anaesthetic, I am somewhat scared of!) there are then tests done to see which eggs are healthy – unhealthy ones essentially get chucked – the healthy ones are fertilised, then we see how many actually “fertilise”/become an embryo, and then an embryo (or 2) is popped back into your womb; all the embryo then has to do is implant itself in your womb, and stay there and grow for 9 months, et voila! I believe the success rates of IVF increased to 42%. IUI sits between 18-21%.

Both Clomid and Gonal-f (for use with OI) are only licensed for 6 cycles each, so essentially, you get 6 months, 6 chances, max, to be taking that medication and get it to work. Now – I am glad to have moved on, but I do find this odd that it is only licensed for 6 months, when its suggested it can take up to a year for a couple to conceive naturally… surely if the Clomid/Gonal-f is doing it’s job and making you ovulate, you should be trying for a year?! I am not sure why they are only licensed for 6 months; but I’m not going to argue, because frankly, 2 years of trying to conceive including 1 year using Ovulation Induction and still not being pregnant, feels to me like more than enough time that I can’t get back gone forever.

All this happy sharing has lead me onto a new “dilemma”. I wouldn’t say I was particularly worried about it, though I am unsure what to do, and what I want to do. Within the next 2 weeks we will know if we are pregnant; however, if we are successful, we will be in very early days – the kind of early days when those not undergoing fertility treatment wouldn’t even know they are pregnant. I could still loose the “baby”; and some women [conceiving naturally] probably do without even realising they are pregnant, just assuming it is their period. But if we are – that tiny bit of hope that we might be – I am sure I will want to share it, to tell the world that finally it has happened. I am also fully expecting some of my closest friends to be messaging me asking either way.. and it’s a little nerve wracking I guess, because it’s such early days anything could happen – I could be “pregnant” for a day and the next miscarry… and then the “world” will know. But then, why shouldn’t they? Miscarrying is no-ones fault; whilst it is much easier for me to say now, having (maybe, probably) not had it ever happen; I believe that miscarriages tend to be nature’s way of letting you know this has happened for a reason, suggesting something is not right with the baby – why should any woman/couple have to then battle through that silently? I’ll need support like I’ll have never needed support before. James too. Why shouldn’t we be entitled to that when we really need it rather than fighting it alone? We’ve shared so much and had incredible support from friends and family, that why wouldn’t we share this and, if need be, have that support again? Obviously, the ideal situation would be to be pregnant, and healthy and happy forever more.. but “what ifs?” Always lurk.

So, as ever, we all have everything crossed that between having James’ reject sperm rinsed out of the way of the decent sperm, alongside the pessaries is what we’ve needed all along, and in less than 2 weeks we will know if we are happily pregnant…🤞🏾

P.S. SORRY THIS TURNED OUT TO BE THE SUPER MEGA LONG ONE! 🤦🏽‍♀️

SO true – nabbed from google images ☺️
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