Four and a half months after our disastrous 'no eggs' cycle, we steeled ourselves to try again and booked in for our third IVF cycle at SIMS. I had been introduced to a woman who was cycling at SIMS at the same time as me in January 2007 and we had become quite friendly over the course of our simultaneous cycles. She had been on her third cycle when I was doing my second and ended up with just 2 embryos on that third cycle; yet by the time I was commencing my third round, she was 4 months pregnant, which I found inspiring (I soaked up and stored away all the good news stories that came my way, like a secret stash of hope to draw upon when I hit the bottom of a well of despair). I was now ready to do a third cycle. I had found an excellent acupuncturist; a woman who only did fertility related acupuncture. I had a lot of faith in her and always felt soothed after my visits. I felt intuitively that she was a true healer, which was a relief after encountering a few charlatans along the way. Not a 'healer' in the crank or miracle sense, but that she was a genuine 'wise woman'. She prescribed Chinese herbs, which I brewed up in a large saucepan every three days. The concoction was dark brown in colour and had a pungent smell and taste, but I was prepared to ingest anything, do anything which might help. DH and I had also been to about 5 sessions of infertility counselling by the time our third cycle started, which was incredibly therapeutic and constructive.
One month before I was due to start injections, DH gave into my constant begging and bought me a puppy for my 32nd birthday (see post on main page about our dog http://lastoneofmykind.blogspot.com/2011/02/my-canine-baby.html). Every morning onwards felt like Christmas as a small child, as upon waking I would run downstairs to the kitchen to see this gorgeous little thing in his bed looking up at me with bright brown eyes. He was like medicine and acted as a lovely form of distraction for us both. I also felt far more relaxed during this cycle as I had started my new job and was not working long hours anymore (I still felt anxious sneaking out of the office for ultrasounds and acupuncture however, being a new employee...). My younger sister also gave our spirits a lift around this time by offering to donate eggs to us if things did not work out on this cycle. She had made an appointment with an IVF clinic in Australia where she lived, to find out about how we would go about donating. I had never asked her to donate and was very touched and relieved that she offered one day out of the blue over the telephone. Having the same genetic connection to my mother meant everything to me; sisters are a 100% DNA match. But the prospect was complicated, as we did not know whether she might also have premature ovarian failure, as from my research it seemed to affect sisteres (as it turned out, she did have POF too). A cousin of my mine, who had completed her family, had also sent a message through her mother offering to donate eggs to me (cousins share 50% DNA); it was very touching, overwhelming even. How could I ever repay such a debt?
I attended SIMS Clinic on day 6 of injections for an ultrasound, after taking 450g of Menopur each day. Menopur was messy to inject as it was powderlike pure follicle stimulating hormone (derived, apparently, from menopausal womens' urine) and had to be mixed with vials of water with a large needle and then drawn up into a smaller needle for injecting. DH became very adept at preparing these injections and I was grateful for his assistance. It felt like a joint enterprise preparing the meds together and we joked that if we ever developed a hard drug habit that we would make excellent junkies, due to our proficiency in 'shooting up' (flick flicking the syringe with thumb and forefinger to make sure no air bubbles were present).
But on Day 6, Dr W was not happy with my response to 'stims', as they are called, could not see significant follicle growth and recommended that we cancel the cycle and start over again in a month or so with a higher dose of stims from day 1. He did say we could choose to try another 2 days of injections, increased from 450g to 600g and see how things stood in another 48 hours. DH and I chose to press on for another 48 hours but felt very despondent. We stopped in a little cafe in Ranelagh on our way to my being dropped back at work and talked it over (the counselling was doing wonders!). We had known that my condition and general prognosis was poor, but after weeks and weeks of acupuncture, positive thinking, Chinese herbs, strict nutrition and numerous vitamins, it was still crushing to think that nothing was making much of a difference. At least we had our puppy to play with all weekend, whilst we waited to see if my body would co-operate. A nurse at SIMS told me to talk to my ovaries over the weekend, which is what I did; urging them on to grow, grow, grow. I could feel twinges and tingles every now and then and hoped it was a good sign.
But on Day 6, Dr W was not happy with my response to 'stims', as they are called, could not see significant follicle growth and recommended that we cancel the cycle and start over again in a month or so with a higher dose of stims from day 1. He did say we could choose to try another 2 days of injections, increased from 450g to 600g and see how things stood in another 48 hours. DH and I chose to press on for another 48 hours but felt very despondent. We stopped in a little cafe in Ranelagh on our way to my being dropped back at work and talked it over (the counselling was doing wonders!). We had known that my condition and general prognosis was poor, but after weeks and weeks of acupuncture, positive thinking, Chinese herbs, strict nutrition and numerous vitamins, it was still crushing to think that nothing was making much of a difference. At least we had our puppy to play with all weekend, whilst we waited to see if my body would co-operate. A nurse at SIMS told me to talk to my ovaries over the weekend, which is what I did; urging them on to grow, grow, grow. I could feel twinges and tingles every now and then and hoped it was a good sign.
On the day we returned to SIMS, 4 follicles were apparent and we were given the choice to proceed with egg collection, with the warning that we may get no eggs again, and the best we could hope for was a maximum of 4 eggs. Dr W could not say what the outcome would be, but once we chose to proceed with egg collection under anaesthetic, the bulk of the clinic's IVF fee would be non-refundable (i.e. thousands of euro), as surgical egg collection is where the bulk of the cost lies. We decided to go for it. Egg collection went well enough and they recovered 2 eggs on Friday 22nd June 2007. I was told the result immediately upon waking from the surgery and was happy enough - 2 was better than none! Dr W however wanted me to go to hospital for the night I had a blood clot during the surgery, but I did not want to go to hospital, so he sent me home to bed. Luckily it was the weekend and I had 2 full days to recuperate from the collection before embryo transfer. On Saturday morning I got a call from the clinic to say that 1 of the 2 eggs had fertilised. DH and I had been anxiously expecting the call since we awoke. A work colleague of DH's was at our house when the phone finally rang. I had to signal to him by hand (1!) the clinic's news whilst he chatted away to his oblivious colleague. He nodded at me and smiled. We had both guessed correctly the night before that we would get one embryo. Afterwards we hugged each other and repeated our mantra "all you need is one!"
On Day 5 I attended the clinic for the embryo transfer. We had a Day 5 top-grade 'blastocyst' embryo, which according to the clinic gave us a 50% chance of achieving pregnancy. We were both very excited and hopeful. But Dr W, who managed the clinic, could not do the embryo transfer. His absence made me feel nervous and the transfer did not go well. It was quite painful; so much so that the lower half of my body spontaneously jerked awkwardly on the bed just at the stage when the embryo was being inserted by catheter (subsequent events caused me to re-live this moment over and over). We returned home and as I had taken annual leave, I planned on bed rest for 3 full days. Some clinics say that bed rest is not necessary at all, but everything I was reading recommended it. I wanted to give our sole precious embryo the very best chance to embed itself into my womb. The two week wait then began. As each day got closer to test day, I was convinced it had not worked and that I was not pregnant. I did not feel any of the signs or symptoms that I had experienced when I had been pregnant in previous years. Ever the voice of reason, DH reasoned that it was probably too early to be experiencing symptoms, even if I were pregnant.
I was supposed to test on a Monday but, as per usual, patience not being one of my strong points, I did a home urine test on Sunday morning - very early in the morning whilst DH was still fast asleep. I could not sleep the previous night and just wanted to put myself out of my misery, so to speak. I wanted to do it alone too, so I could have a private moment and compose myself before breaking the bad news to DH. I was fairly despondent as I placed the stick on the windowsill of the bathroom. Whilst I waited for the result, I comforted myself with the thought that I would be able to have a lovely glass of red wine that evening, quit my daily injections of progesterone and heparin (both of which caused a lot of bruising) and get to go home to Australia soon for a visit afterall (we were not going to fly anywhere if I were pregnant). When I turned to look at the stick I gasped; my heart leapt - TWO LINES! A positive test!! I prayed and thanked God (I had been praying for a miracle throughout the entire cycle). Floods of relief washed over me. Everything was going to be alright afterall. I now understood why I had been made to go through what I had. It was a test. My faith, hope and tenacity had been tested and I had passed the test - finally! I ran upstairs and shook DH awake and gushed out the news. He said, 'Are you sure?' I showed him the 2 lines. We immediately rang his parents to tell them. DH's mother sounded very happy and emotional. She said she loved us both and we told her back how much we loved her and DH's father and thanked them for their support.
Wow! I texted my close girlfriends through the course of the day, who all knew about the cycle, and received back amazing heartfelt congratulations about 'third time lucky' and how people had prayed for us and how we deserved a miracle (I grimace looking back at myself. I really thought I had been through the ringer - I hadn't a clue what lay ahead - what an eejit I was). We kissed our dog all day and said he was our lucky charm. I got so worked up with this thought that I started thinking if the baby was a boy that I would make Hamish his middle name (the name of our dog!). Did I worry about miscarriage at this time? Yes - of course, but for this pregnancy I was taking all the miscarriage treatments I had not previously been given; steroids, blood thinner (heparin injections) and baby aspirin and was still going to acupuncture. So my mind was more at ease. Surely nothing more could go wrong - we had a perfect blastocycst embryo and now a positive pregnancy. I attended the clinic the day after my home test to do a proper blood test and they confirmed the pregnancy and gave me instructions. The IVF nurses were all so nice and heartfelt in their congratulations. DH however felt self-conscious being told congratulations at the clinic where there were desperate couples sitting in the waiting room close by. The clinic said they would ultrasound me in a couple of weeks time, when I was 7 weeks pregnant, before I was referred to an obstetrician.
36 hours after attending the IVF Clinic for the blood test, I started spotting blood late in the evening. I felt pure dismay. Was I now miscarrying? I called the clinic first thing the next morning. They told me to come straight in for another blood test. I waited all day for the results, which confirmed that I was still pregnant. The clinic recommended that I do bed rest and take it easy and go back into them in 48 hours for a further blood test. The blood test measured the pregnancy hormone hcg and if it kept going up over the course of time it meant that the pregnancy was progressing and the spotting was not a miscarriage. I was told that some women can bleed throughout their whole pregnancies and deliver healthy babies. I was so worried. I prayed and prayed to God to make it alright and He came through! A second blood test showed that my hcg levels increased from 202 to 530 in 48 hours, which was in keeping with what they should do; they should double every couple of days. I did not feel pregnant however, which was puzzling. I was not ravenously hungry, nor did I have a heightened sense of smell as before....
Another 4 days passed and the spotting continued. A further hcg blood test revealed the doubling of pregnancy hormone yet again. But on the day of that further blood test I began to feel dull cramps. One minute I felt full of hope after receiving the blood test results from my GP and the next I was cut down again. I went home and stayed in bed for a few days. A further blood test showed hgc of 2300, which I was told was a 'good result'. I was now around 6 weeks pregnant. The light spotting, of dark 'old' blood continued as did the blood tests. What was going on? We were heading toward the time at which an ultrasound would be able to detect a heartbeat, but from one moment to the next DH and I had no idea where things stood.
Time dragged. Finally, a day before our scheduled week 7 scan at SIMS, I woke on a Sunday morning to find that there was blood in my urine, which coloured it bright pink. I mentioned it to a friend (who was a GP) later that day but she said that it could be from the spotting. I felt very tired and drained and as the day wore on, I started to experience dull pain in my ribs which intensified to the point where it hurt to breathe in and out. I thought for a short while that it was trapped wind (so dumb! I know). It was kind of like the sensation of really bad indigestion, which I had experienced once or twice before in my life. I fell asleep in the afternoon. I was in so much pain that I just stole away to our bedroom. I did not have the energy to talk to DH. He came to check on me around 9 pm and I told him it now felt like my back and ribs were broken and that I thought maybe these symptoms, combined with my spotting, meant we had an ectopic pregnancy (where the embryo implants in and grows in a fallopian tube, outside of the womb, where it should be). DH wanted to go to the emergency department of a hospital, but I dreaded the thought of being in so much pain and sitting on a plastic chair under fluorescent lights in the waiting room of a shoddy Irish hospital for hours and hour, being ignored as the night wore on. Besides, we had a pre-booked ultrasound with the IVF Clinic at 9 am the following morning, which would settle things once and for all. So I took a handful of nurofen and managed to sleep through the night.
Dr W was very attentive upon being alerted of my rib and back pain the following morning. He moved the ultrasound wand this way and that and after some time, informed us that he was very sorry, but he could not find any evidence of a pregnancy in my womb. He did however think he could detect a pulse outside of my womb and poked the wand at an awkward angle. He was not sure if this was my pulse or the embryo's, so he put his fingers on my wrist to measure my pulse against the pulse he saw on his ultrasound monitor. I will never forget this. He confirmed this was our baby's pulse, as it was beating in different time to my own pulse. It was still alive! Its heart was beating but it seemed to be embedded in my fallopian tube, which was at risk of rupturing, if it had not already. I asked whether they could do surgery and move the baby back where it was supposed to be in my womb. Dr W shook his head, placed his hand on my knee and said he was 'so, so very sorry'. He really meant it and I felt a little bit sorry for him. I said "thank you - that's ok. It's not your fault" or "don't worry, it's ok", or something to that effect and smiled my best. Automatic politeness kicked in, I guess as a coping mechanism. I did not cry, nor did DH. We had been here before. No point in crying. But it was hard to get our heads around. On previous occasions, our babies hearts had stopped beating but here was our miracle sole embryo fighting on inside me and nothing could be done. I was going to have to be rushed into hospital for emergency surgery and they could not save this little thing that battled soooo hard from the moment that sperm met egg. DH and I had been willing it on when it was in the incubator and then inside me. I truly believed that it had received all our emotional and spiritual energy and responded in kind, when it grew and implanted inside me.
Dr W wanted me to go into hospital in an ambulance but I wanted DH to drive me. I guess I did not want a fuss. It would have been better to go in the ambulance however because I was made to wait in patient reception at the hospital for about half an hour once we arrived. It was only after I reminded an admissions nurse that I had been sent in with a suspected ruptured fallopian tube and internal bleeding and that I might lose consciousness in her waiting room and/or die that I was swiftly moved upstairs in a wheelchair and treated as an emergency admission (ha ha!). Then a million questions were asked. When did I last eat and what meds was I on? The hospital did not like the fact that I was taking blood thinner - heparin - as this made surgery more risky. I was made to wait for an hour until I got into surgery, but funnily was not in any great pain. I kept being asked was I in pain. I said 'no, but I was in agony yesterday'. A trainee obstetrician told me she did not think I had an ectopic as I would be in severe pain if I did. 'But I was.... yesterday'. My theory is the blood thinner helped to save my life. Internal bleeding can cause shock and kill a person, but the heparin thinned my blood enough to allow it to escape a little through my passing urine. I was in theatre for quite some time according to DH and no one updated him as to what was taking so long. It was a dreadful time for him. At one stage he thought that maybe I had died (as the IVF Clinic had stressed the danger of ectopic pregnancy to him) and that no one had yet mustered the nerve to tell him.
Dr M (whom had performed my D&C for our second missed miscarriage 2 years earlier) did the emergency surgery. She now saw me afterwards in recovery and said she and her intern were both surprised to discover that - yes - my fallopian tube was ruptured - imagine! And I wasn't in any pain! (I was the day before - I again repeated). Dr M said that there was just under 2 litres of internal bleeding that she had suctioned out of me. I was sent into a recovery ward. I felt very sore and my wound was bleeding through the dressing. DH had bought some food from outside the hospital for me and around nightfall he left to go home to our dog. His mother had come in to see me earlier and probably thought I was coping well. I felt no emotion. I chatted to her normally. I sent texts to all my friends to tell them the news (seeing as I had stupidly told them all I was pregnant in the first place). Some of them telephoned me and were audibly emotional, as they assured me that David and I would be parents one day, whether it was our own baby or through adoption (the A word! I did not like to hear it, and still don't, as for me, it meant the end of hope at that time). Friends wanted to visit and asked whether I needed anything. I said I was fine and planned to go home tomorrow. I felt nothing. I called DH before I fell asleep in my hospital bed to check on him. His brother had gone over to hang out with him for the evening, which comforted me, knowing he was not at home alone.
Dr W wanted me to go into hospital in an ambulance but I wanted DH to drive me. I guess I did not want a fuss. It would have been better to go in the ambulance however because I was made to wait in patient reception at the hospital for about half an hour once we arrived. It was only after I reminded an admissions nurse that I had been sent in with a suspected ruptured fallopian tube and internal bleeding and that I might lose consciousness in her waiting room and/or die that I was swiftly moved upstairs in a wheelchair and treated as an emergency admission (ha ha!). Then a million questions were asked. When did I last eat and what meds was I on? The hospital did not like the fact that I was taking blood thinner - heparin - as this made surgery more risky. I was made to wait for an hour until I got into surgery, but funnily was not in any great pain. I kept being asked was I in pain. I said 'no, but I was in agony yesterday'. A trainee obstetrician told me she did not think I had an ectopic as I would be in severe pain if I did. 'But I was.... yesterday'. My theory is the blood thinner helped to save my life. Internal bleeding can cause shock and kill a person, but the heparin thinned my blood enough to allow it to escape a little through my passing urine. I was in theatre for quite some time according to DH and no one updated him as to what was taking so long. It was a dreadful time for him. At one stage he thought that maybe I had died (as the IVF Clinic had stressed the danger of ectopic pregnancy to him) and that no one had yet mustered the nerve to tell him.
Dr M (whom had performed my D&C for our second missed miscarriage 2 years earlier) did the emergency surgery. She now saw me afterwards in recovery and said she and her intern were both surprised to discover that - yes - my fallopian tube was ruptured - imagine! And I wasn't in any pain! (I was the day before - I again repeated). Dr M said that there was just under 2 litres of internal bleeding that she had suctioned out of me. I was sent into a recovery ward. I felt very sore and my wound was bleeding through the dressing. DH had bought some food from outside the hospital for me and around nightfall he left to go home to our dog. His mother had come in to see me earlier and probably thought I was coping well. I felt no emotion. I chatted to her normally. I sent texts to all my friends to tell them the news (seeing as I had stupidly told them all I was pregnant in the first place). Some of them telephoned me and were audibly emotional, as they assured me that David and I would be parents one day, whether it was our own baby or through adoption (the A word! I did not like to hear it, and still don't, as for me, it meant the end of hope at that time). Friends wanted to visit and asked whether I needed anything. I said I was fine and planned to go home tomorrow. I felt nothing. I called DH before I fell asleep in my hospital bed to check on him. His brother had gone over to hang out with him for the evening, which comforted me, knowing he was not at home alone.
I returned to work in Ireland after my holidays and healed fairly quickly. But as the weeks wore on and my physical recovery was completed, my state of mind deteriorated. SIMS Clinic telephoned to check in on us. They wanted to let us know about their new egg donor programme which they had set up with a Ukrainian fertility clinic. It was an option, but it was double the cost of their standard IVF cycle (at 10,000 euro) and did not feel right to me. We continued discussions with my younger sister about her donating to me. Timing was bad however, as she had just become engaged to be married and was thinking about starting her own family and we did not know what problems she might encounter. These couple of months following the rupture of my fallopian tube on 29 July 2007 were undoubtedly some of the blackest of my life, trumped only by the illness and death of my mother from cancer. I questioned what the point of life was, of anything.......To hope, fight and pray so hard and be given a miracle, only for it to be snatched away. Really....WHAT WAS THE POINT? Even worse was the prospect that my fertility had further been impaired. I knew that my ovaries were sub-standard but now my slim chances of a natural pregnancy ever occurring again were halved. Each alternative month, opposite fallopian tubes carry an egg into the uterus. Where a tube is missing, there can be no pregnancy in a month where an egg is released from that side of the ovaries that has no tube attached. I brooded over this often and imagined that I felt twinges of pain from my phantom missing fallopian tube, just as an amputee does after losing a leg or part of an arm.
DH and I went back to counselling to cope with the grief. Through the process of talking it all out, it became clear that I/we were still not ready to give up on the idea of having a child that was part of me. Our counsellor pointed out that it was particularly difficult for women to move on to egg donation or adoption where they had lost their own genetic baby after being pregnant at some point in time. One of the nurses from the clinic also said that it was very hard for couples who got pregnant on IVF once to give up. I guess because you have had a little taste of what could be....if it had happened once, surely it could happen again? We just needed to be brave and fight on. After one counselling session we came to the conclusion that we wanted another chance. DH said he was prepared to try again so long as I thought I could handle it; he pointed out that it was me who had to do the injections and the surgery. But it is emotionally gruelling for a man too and I think he both supported me and also was not ready to give up on having a child that was both a part of him and a part of me.
Our fourth cycle was very difficult. The doses of stims were higher than ever and I was depressed and physically exhausted. At the same time, my closest Irish girlfriend had just become pregnant with twins on her very first cycle of IVF. My IVF SIMS friend had a beautiful baby, another friend with elevated FSH, who though she would need fertility treatment, gave birth after a natural conception and another friend announced her pregnancy. She was in the exact same week of her pregnancy as I would have been if things had worked out with this third pregnancy. I felt like I had spent hours talking over my friends' concerns about their fertility and been there to share their sadness over motherhood seemingly elluding them, but now they had all gotten lucky. But I would never be the lucky one. Still, I managed to put on my brave face and met these friends for coffee and lunches, but it was exhausting. On the weekends, I stayed in and mostly slept the day away. I started avoiding family functions or events where new born babies, small children or pregnant women would be present. Our infertility counsellor told us this was a good thing to do if we did not feel up to it. She gave us both permission to feel that we could put ourselves first and engage in a bit of self-protection.
Again on our fourth cycle, Dr W recommended we cancel after we attended for our first ultrasound after starting injections, due to my poor response and the lack of activity in my ovaries. We took a day to decide what to do. It came down to money. If money was not factor, we were prepared to press on; after all, the clinic wanted to cancel our cycle last time and we ended up with a blastocyst top grade embryo and a positive pregnancy (notwithstanding that it was in my tube). DH's wonderful parents, very generously, told us not to be worrying about money and I think that steeled our resolve. Egg collection took place a few days later. The clinic retrieved 1 egg. The day after the surgery, whilst walking into my office, my mobile rang. The embryologist was very sorry. Our sole egg had not fertilised. No embryo transfer. No hope.
A few days later I was at a social function arranged via work with two women clients (one of whom I knew personally) and some female lawyer colleagues. One of the clients was heavily pregnant and all of the women at the table had children. The topic of conversation naturally turned to issues like maternity leave, obstetricians, nannies vs creche and then finally, whether two of the women at the table fancied having more babies. One talked about the 'deliciousness' and smell of newborns and confided that she did not think she was finished completing her family just yet. Three of the four women at the table knew that I had lost my third pregnancy a few months earlier, but they all appeared oblivious to how upsetting the conversation was for me (although one apologised later and said she felt bad). I excused myself and went to the bathroom just to escape.
Around the same time as this episode, DH and I attended an information night for prospective adoptive parents run by an agency accredited by the Adoption Board to run training and home studies for couples who wanted to be approved for foreign adoption. We had placed our name on a waiting list and were eager to learn more about adoption but the session we attended - which went on for over 3 hours - was dispiriting. We were told of the years of waiting that were involved; up to 4-5 years from beginning to end in Ireland and how bureaucratic and fraught with obstacles (and legal difficulties) the process was. But most upsetting of all was the adamant statement of the Adoption Board's rule that under no circumstances should couples engage in the adoption process until they were finished with fertility treatment; the authorities in Ireland took a dim view of couples engaging in IVF and adoption home studies at the same time, notwithstanding that the adoption process took years and the earlier you started, the earlier you got a child. I thought this seemed outrageously unfair and the way in which this policy was communicated to the obviously vulnerable and desperate audience was even more upsetting. A woman sitting in the chair in front of me started crying but no one comforted her (including myself). The social workers running the session confidently declared that couples could not bear the emotional strain of undertaking adoption approval and IVF simultaneously. DH and I left the session incensed; who were these smug people to tell us how strong we were and what we could and could not handle? We had just lost our third baby and wondered how qualified any social worker was to tell us what we could or couldn't handle - thanks very much. We both felt very disillusioned about adoption.
I was tired. So tired. I had run out of stamina and wanted to curl up in a ball permanently and never leave the safety of our bedroom. Each day was getting harder and I seemed to be getting more and more fragile. That evening I told DH I did not think I could go on the way things were; with putting on my happy face and going into work everyday. I felt like I was falling apart. I was very worried about my ability to cope with work in the coming months. But we had large mortgage repayments to make and the words "credit crunch" had started being bandied about in mainstream media. We talked it over and he told me to do what I had to do. I handed in my notice the following day and planned on taking a career break for a year. 2007 had been a truly horrible year - my annus horribilus. Whether the future held a baby or no baby, I was running on empty and something had to give.
