Wednesday, 9 December 2015

IVF Pre-Planning (Pre-Pregnant)

We went to the fertility clinic for our first appointment about IVF yesterday.

The general gist is that things could go tits up at any point.  Right from the first scans to count follicle number. In my area you can get one round of IVF on the NHS, and certain hurdles preclude you from IVF altogether, so this is all very nerve racking.

We have a proper planning appointment at the end of January, after this we can go for it whenever we like.

The process will start on the first day of my period.  At this point I will be booked in for an antral follicle count (AFC) either on day 2, 3 or 4 of my cycle.  This is an internal scan to count how many follicles are present at this point.  There must be a minimum of 6 to continue. I will also have a blood test to check my level of follicle stimulating hormone (FSH). This determines ovarian reserve. FSH is responsible for (as it says on the tin!) stimulating follicle growth, and normal levels are below 9. Although higher levels don't mean an end to IVF, it can determine whether a 'long-protocol' or 'short-protocol' of treatment is used.  If the FSH level is above 20 our clinic will not carry on with the treatment.  In basic terms, the level of FSH you have at this point in your cycle indicates how hard your body is having to work to produce a follicle; and as FSH levels increase as women get older, higher levels indicate a reduced ovarian reserve. My last FSH was below 9, so I imagine I'm ok.

I will be booked in for an injection lesson, will be delivered my medication and will start injecting Suprecur on day 21 of my cycle (assuming I will on the 'standard' long IVF protocol) every single morning, at the same time.  Suprecur down regulates the ovaries. The clinic has full control over your cycle after that!

When I come on my next period I will have another scan and bloods to check that my ovaries have in fact stopped doing what nature intended.  At this point I will be advised to start a 2nd injection, usually Menopur, every evening.  This stimulates superovulation, and my ovaries hopefully make lots of follicles with lots of healthy eggs inside them.  Whilst I am using Menopur, I will be scanned and have blood taken on Monday, Wednesday and Friday mornings, until my blood levels show that I am responding well to the medication and the scans show lots of mature follicles (but not too many!).

Once they are happy with the numbers, I will be instructed to do a trigger shot (yes, another injection) of hCG (human Chorionic Gonadotrophin) 35 - 37 hours before egg collection.  On the day of egg retrieval, we will both go into the clinic, I will be sedated so a fine needle can be passed through MY vaginal wall into MY ovaries to collect as many eggs as possible.  (I put 'the' in place of the MY before so I could distance myself from it!) They will go for every follicle they can put a needle in.

Bean will be there to look after me before and after the procedure, and he will also need to produce a sample.  This sperm sample will be washed to get all the best swimmers.  Then the eggs retrieved and the washed sperm will be put together in a petri dish. Hopefully more than one will be fertilised.  They will be left to mature, probably to day 5 blastocysts, depending on their quality, and a single embryo will be transferred back into my uterus. Any other good quality embryos will become frosties, and stored for later use, if required.

I will be given a 2 week sick note by the clinic to rest up, and by the end of these 2 weeks I will have had tests to check if I'm pregnant. If it is positive, it will be repeated again later to check that it's not just a chemical pregnancy.  The risk of miscarriage is the same as any one else, IVF or not.

With superovulation comes the risk of ovarian hyperstimulation syndrome (OHSS).  At best this will make you bloated and nauseated, at worst this will kill you.  Obviously they are monitoring for this, and if you have the beginnings of this, that is the end of the cycle. There would be no further NHS-funded, assisted conception treatment available to us should this happen.

I'm going to try and end on a more positive note!

Yes, it is complicated, it is going to disrupt our lives (personally and professionally).  Yes, I'll be hormonal (and probably sweaty) and there are risks.  Yes, this whole process could get stopped before it's even started.  Yes, we could go through all this and not get a baby at the end of it.  But, being pregnant can disrupt your life, make you hormonal, and put you at risk.  Being pregnant sometimes stops before it's really started.  And sadly, women all over the world go through pregnancy and don't get to take their baby home at the end of it.

I am pre-pregnant! I will consider the month and a half, nearly 2 months, of injections, scans, blood tests and general discomfort, as part of my pregnancy. Rather than 9 months, I'll have 11. I'll take that if it might result in our little sprocket coming home with us in the end.