Flicking back through the pages of my diary for early 2006, I see that it is littered with GP appointments. I voiced my anxiety about my failure to conceive since the previous June's missed miscarriage to my GP and she set the ball rolling with infertility 'investigations'. DH had to give a sperm sample for analysis (which turned out to be the first of many - poor DH). Around the same time, a relative of DH's spoke to me alone and asked, 'well...., have you had any luck?'. She wanted to know was I 'pregnant yet' and could not contain her excitement in proceeding to tell me that she and her husband were going to 'start trying for a baby too' and that she had thrown away her birth control on New Year's Day. I was irrationally upset by this conversation - DH did not understand when I cried afterwards to him. I can only explain it thus; I felt like she was saying to me 'you are a failure because you are not pregnant after all this time', 'there is something wrong with you', 'I am going to be pregnant real soon and you still won't be'. It was like she poked her finger into a gaping wound in my side and wiggled it around a little. It did not help that our second baby would have been due in early January. The time around a due date is particularly painful. Apparently most women who experience miscarriage experience an elevation of their grief at this time, just as people find it hard to cope with the anniversary of the death of someone they loved. These deeply primal feelings associated with my ability to fall pregnant increased, as each month during 2006 couples who had married around the same time as us began to conceive and celebrate the delivery of their first babies.
From early 2006 onwards, I was totally occupied by my seeming inability to ever fall pregnant again. This obsession was compounded by grief for our lost pregnancies, disbelief, anxiety and fear - what if something terrible had happened after the last D&C and I could never conceive again? I tried to be positive and do all the rights things and hope for the best after the second miscarriage, but things were starting to weigh me down. The despair I felt was further fed by being an immigrant to Ireland, as I had no close family and friends around me. I had started to form friendships with other women in the five years since I had arrived and I had DH, but my oldest, closest friends were on the other side of the world and my mother was dead. Some days I felt intensely homesick and did not know whether I cried for my mother, my unborn babies or Australia. DH was always there to hold me and wipe away my tears, but I suspect he felt overwhelmed by the intensity of my feelings and could not understand my despair when each month my dreaded period arrived, signalling that once again, we, or rather, I, had failed to conceive.
We moved into our brand new home in February 2006. I had asked the painter to decorate the small bedroom in baby pink and baby blue colours as I was intending it to be the nursery. DH gently asked whether I was sure I wanted to decorate it this way; perhaps I was tempting fate? I was stubborn and proceeded with the plans for the nursery. Despite the anxiety about our failure to conceive, we still had no reason to think we couldn't and I was, at various times, and when feeling positive, of a mind that it was just a matter of time. We went skiing in March and I thought that perhaps a week's holiday in the snow might be just what we needed for us both to relax and for me to fall pregnant.
Our first wedding anniversary came and went on 1 April 2006. We celebrated in the usual way by going out to a fancy restaurant but what should have been a happy milestone felt overshadowed by the fact that there was no baby on the way. On 2 May 2006, after receiving all our infertility investigation test results from the previous few months, DH and I had our first consultation with the Merrion Fertility Clinic in Dublin. All the tests and appointments for fertility treatment seemed to be made in the middle of a working day. I soon realised it was very stressful sneaking out of work at my law firm to surreptitiously attend these appointments. The day before, on the May Bank Holiday, DH's younger brother and his wife had come around to our house to let us know they were having a baby. They were very excited and did not once mention our situation (that of having, at that stage, lost two pregnancies and been unable to conceive for almost a year). If they had asked we would have told them we were probably about to commence fertility treatment. Because they did not ask, it felt to us as though our feelings did not matter to them. We were both feeling particularly despondent at this time and the yearning for a baby was constant; face to face pregnancy announcements were particularly painful. We were supposed to be excited for other people; put on our happy face. I felt that it was my fault that I could not make DH a father; that I had let him down, as here was his younger sibling on the road to fatherhood, but DH was no where close to becoming a Daddy thanks to me. DH never once suggested that I should feel this way, but I did.
The Merrion Clinic
At the Merrion Clinic we saw a female specialist, Dr F, who was very softly spoken and gentle. She told us that it was reassuring that we had conceived naturally twice. I pointed to the fact that it was over a year since I had conceived our second baby and almost a year since we had started trying again. I now seemed to be medically infertile - infertility being the inability to conceive after 12 months have passed. Dr F said that there was one test result that seemed to be 'a red herring', that of my 'FSH results'. FSH is follicle stimulating hormone and she said that mine was 'quite high' for my age (30), at 16.7. She said that she thought this could turn out to be nothing and not too read too much into it, unless I had a history of early menopause in the family - I was alarmed and said - "but my mother was 39 when she started menopause!" (she always thought it was early onset due to the stress of her divorce from my father, her husband of over 20 years). The significance of high FSH was not explained to me. I was told to get another blood test on day 3 of my cycle, book in for 'follicle tracking' (trans-vaginal ultrasounds to check I was ovulating) and come back with the FSH test when I had them. Looking back to the quality of care at the Merrion Clinic, with now over 5 years experience in infertility treatment, I can say without a doubt, that the approach they took was wholly inappropriate. Elevated FSH is a bad sign and women should be warned about its implications immediately. But what can you expect from a clinic that does not even have a nameplate on its door? DH and I commented that it was a 'secret IVF clinic' (apparently The Merrion Clinic won't put any signage up because they say patients want privacy. I think this attitude sucks big time and reinforces the Irish attitude that IVF is secret, shameful, private and something to be ashamed of, i.e. like sneaking into a STD clinic).
I got on the Internet when I got home and proceeded to read (and read) every snippet of information available about elevated FSH levels, which in turn resulted in many sleepless nights. Without having being informed by the clinic we were seeing the implications of high FSH, I determined for myself that it was bad - very bad. Going by the material available on various fertility and IVF clinic websites, my ovaries were shutting down and I had a poor prognosis for ever conceiving and carrying a baby to term. The thing that most terrified me was the band of FSH ranges and the likely outcome - at 16.7 - I was a 'poor candidate' for IVF, would likely be a 'poor responder' to the fertility drugs. Over and over again the words 'premature ovarian failure' 'early menopause', 'poor prognosis', 'poor responder', 'poor egg quality', 'higher rates of miscarriage' and 'egg donation' cropped up on my computer screen. Some nights I read on late into the night. DH came to find me on the computer to beg me to come to bed. But I was riveted by the horror of what I was reading. "Many women with premature ovarian failure may achieve motherhood via egg donation". The idea was anathema to me. It was beyond comprehension. Egg donation = never being a mother, never having my OWN child, never having my dead mother's grandchild. The thought of breaking the genetic chain with my mother in not being able to have a child that shared her DNA was very upsetting to me. The only glimmer of hope appeared to be "aggressive fertility treatment", meaning immediate IVF. But what was worst of all, some IVF clinics appeared to have FSH 'cut-off' levels. A woman with an FSH over 10 might not be accepted for treatment by some clinics.
I continued to trudge into work each day in a depressive haze, tired after sleepless nights and obsessive research on the Internet. A week after my 31st birthday, I went back to The Merrion Clinic for 'follicle tracking'. I was kinda surprised to learn that a nurse would do the ultrasounds and I would not get to see or speak to the doctor. I was mid-cycle and supposed to be ovulating around the day I went in. The nurse, (Fionnuala - I will never forget her name), who was rather cold and mean and not the type of woman you want poking an ultrasound wand around inside you, asked me was I sure of my dates? (Here we go again I thought....just like being asked "are you sure you are pregnant?" by a doctor the first time I was pregnant). Yes I was sure. Well in that case my 'lining was very thin' and she proceeded to print out the results and tell me what my lining should be and how my measured lining was very inadequate. I then told her about my high FSH and she asked whether I had a history of early menopause in my family. Yes - I said. I already told the doctor that - it should be in my chart. Oh well in that case, things are not great. I asked would I be able to be treated by The Merrion Clinic for IVF and she very coldly informed me that unless my FSH came down that they do not treat women such as myself with elevated FSH and poor lining. DH was with me and it was just as well, because after a few weeks of constant anxiety about FSH, I fell apart. I started sobbing and was ushered out to the reception desk to pay. I sobbed and sobbed and DH rubbed my back and not one of the Merrion Clinic Staff came and tried to comfort me or even ask why I was so upset. My tears smudged the ink on my chequebook as I paid them for the consult. The lady on reception did not even offer me a tissue. We walked out to the street and five years later I still have the strongest memory of wanting to step out into the front of an oncoming bus in front of Merrion Square. I felt like my life was over. But DH was by my side, tightly holding my hand and he chaperoned me straight home.
Eight days later, by 30th May, I was completely falling apart. I was clinically depressed, extremely low and was referred by my GP to Dr McC, consultant psychiatrist at The National Maternity Hospital. He took a history of my two miscarriages and prescribed me anti-depressants and queried whether I might benefit from hospitalisation. No thanks I said but I did feel like I was at breaking point. It all sounds melodramatic now but it was now 13 months since I had lost our second baby. I was at my most fragile and completely absorbed by grief. I look back now in year 2011 from a position of strength and think that the worst days are over because this time, summer of 2006, was one of the worst times. From home, I wrote an email to my boss telling him that I was resigning from my position as a solicitor immediately and hoped he would waive notice requirements on the grounds of ill health. In fairness to the firm I work at, they were very understanding and told me they would not accept my resignation and that I could immediately take a month's paid sick leave and have a chat to them after that.
From early 2006 onwards, I was totally occupied by my seeming inability to ever fall pregnant again. This obsession was compounded by grief for our lost pregnancies, disbelief, anxiety and fear - what if something terrible had happened after the last D&C and I could never conceive again? I tried to be positive and do all the rights things and hope for the best after the second miscarriage, but things were starting to weigh me down. The despair I felt was further fed by being an immigrant to Ireland, as I had no close family and friends around me. I had started to form friendships with other women in the five years since I had arrived and I had DH, but my oldest, closest friends were on the other side of the world and my mother was dead. Some days I felt intensely homesick and did not know whether I cried for my mother, my unborn babies or Australia. DH was always there to hold me and wipe away my tears, but I suspect he felt overwhelmed by the intensity of my feelings and could not understand my despair when each month my dreaded period arrived, signalling that once again, we, or rather, I, had failed to conceive.
Our first wedding anniversary came and went on 1 April 2006. We celebrated in the usual way by going out to a fancy restaurant but what should have been a happy milestone felt overshadowed by the fact that there was no baby on the way. On 2 May 2006, after receiving all our infertility investigation test results from the previous few months, DH and I had our first consultation with the Merrion Fertility Clinic in Dublin. All the tests and appointments for fertility treatment seemed to be made in the middle of a working day. I soon realised it was very stressful sneaking out of work at my law firm to surreptitiously attend these appointments. The day before, on the May Bank Holiday, DH's younger brother and his wife had come around to our house to let us know they were having a baby. They were very excited and did not once mention our situation (that of having, at that stage, lost two pregnancies and been unable to conceive for almost a year). If they had asked we would have told them we were probably about to commence fertility treatment. Because they did not ask, it felt to us as though our feelings did not matter to them. We were both feeling particularly despondent at this time and the yearning for a baby was constant; face to face pregnancy announcements were particularly painful. We were supposed to be excited for other people; put on our happy face. I felt that it was my fault that I could not make DH a father; that I had let him down, as here was his younger sibling on the road to fatherhood, but DH was no where close to becoming a Daddy thanks to me. DH never once suggested that I should feel this way, but I did.
The Merrion Clinic
At the Merrion Clinic we saw a female specialist, Dr F, who was very softly spoken and gentle. She told us that it was reassuring that we had conceived naturally twice. I pointed to the fact that it was over a year since I had conceived our second baby and almost a year since we had started trying again. I now seemed to be medically infertile - infertility being the inability to conceive after 12 months have passed. Dr F said that there was one test result that seemed to be 'a red herring', that of my 'FSH results'. FSH is follicle stimulating hormone and she said that mine was 'quite high' for my age (30), at 16.7. She said that she thought this could turn out to be nothing and not too read too much into it, unless I had a history of early menopause in the family - I was alarmed and said - "but my mother was 39 when she started menopause!" (she always thought it was early onset due to the stress of her divorce from my father, her husband of over 20 years). The significance of high FSH was not explained to me. I was told to get another blood test on day 3 of my cycle, book in for 'follicle tracking' (trans-vaginal ultrasounds to check I was ovulating) and come back with the FSH test when I had them. Looking back to the quality of care at the Merrion Clinic, with now over 5 years experience in infertility treatment, I can say without a doubt, that the approach they took was wholly inappropriate. Elevated FSH is a bad sign and women should be warned about its implications immediately. But what can you expect from a clinic that does not even have a nameplate on its door? DH and I commented that it was a 'secret IVF clinic' (apparently The Merrion Clinic won't put any signage up because they say patients want privacy. I think this attitude sucks big time and reinforces the Irish attitude that IVF is secret, shameful, private and something to be ashamed of, i.e. like sneaking into a STD clinic).
I got on the Internet when I got home and proceeded to read (and read) every snippet of information available about elevated FSH levels, which in turn resulted in many sleepless nights. Without having being informed by the clinic we were seeing the implications of high FSH, I determined for myself that it was bad - very bad. Going by the material available on various fertility and IVF clinic websites, my ovaries were shutting down and I had a poor prognosis for ever conceiving and carrying a baby to term. The thing that most terrified me was the band of FSH ranges and the likely outcome - at 16.7 - I was a 'poor candidate' for IVF, would likely be a 'poor responder' to the fertility drugs. Over and over again the words 'premature ovarian failure' 'early menopause', 'poor prognosis', 'poor responder', 'poor egg quality', 'higher rates of miscarriage' and 'egg donation' cropped up on my computer screen. Some nights I read on late into the night. DH came to find me on the computer to beg me to come to bed. But I was riveted by the horror of what I was reading. "Many women with premature ovarian failure may achieve motherhood via egg donation". The idea was anathema to me. It was beyond comprehension. Egg donation = never being a mother, never having my OWN child, never having my dead mother's grandchild. The thought of breaking the genetic chain with my mother in not being able to have a child that shared her DNA was very upsetting to me. The only glimmer of hope appeared to be "aggressive fertility treatment", meaning immediate IVF. But what was worst of all, some IVF clinics appeared to have FSH 'cut-off' levels. A woman with an FSH over 10 might not be accepted for treatment by some clinics.
I continued to trudge into work each day in a depressive haze, tired after sleepless nights and obsessive research on the Internet. A week after my 31st birthday, I went back to The Merrion Clinic for 'follicle tracking'. I was kinda surprised to learn that a nurse would do the ultrasounds and I would not get to see or speak to the doctor. I was mid-cycle and supposed to be ovulating around the day I went in. The nurse, (Fionnuala - I will never forget her name), who was rather cold and mean and not the type of woman you want poking an ultrasound wand around inside you, asked me was I sure of my dates? (Here we go again I thought....just like being asked "are you sure you are pregnant?" by a doctor the first time I was pregnant). Yes I was sure. Well in that case my 'lining was very thin' and she proceeded to print out the results and tell me what my lining should be and how my measured lining was very inadequate. I then told her about my high FSH and she asked whether I had a history of early menopause in my family. Yes - I said. I already told the doctor that - it should be in my chart. Oh well in that case, things are not great. I asked would I be able to be treated by The Merrion Clinic for IVF and she very coldly informed me that unless my FSH came down that they do not treat women such as myself with elevated FSH and poor lining. DH was with me and it was just as well, because after a few weeks of constant anxiety about FSH, I fell apart. I started sobbing and was ushered out to the reception desk to pay. I sobbed and sobbed and DH rubbed my back and not one of the Merrion Clinic Staff came and tried to comfort me or even ask why I was so upset. My tears smudged the ink on my chequebook as I paid them for the consult. The lady on reception did not even offer me a tissue. We walked out to the street and five years later I still have the strongest memory of wanting to step out into the front of an oncoming bus in front of Merrion Square. I felt like my life was over. But DH was by my side, tightly holding my hand and he chaperoned me straight home.
Eight days later, by 30th May, I was completely falling apart. I was clinically depressed, extremely low and was referred by my GP to Dr McC, consultant psychiatrist at The National Maternity Hospital. He took a history of my two miscarriages and prescribed me anti-depressants and queried whether I might benefit from hospitalisation. No thanks I said but I did feel like I was at breaking point. It all sounds melodramatic now but it was now 13 months since I had lost our second baby. I was at my most fragile and completely absorbed by grief. I look back now in year 2011 from a position of strength and think that the worst days are over because this time, summer of 2006, was one of the worst times. From home, I wrote an email to my boss telling him that I was resigning from my position as a solicitor immediately and hoped he would waive notice requirements on the grounds of ill health. In fairness to the firm I work at, they were very understanding and told me they would not accept my resignation and that I could immediately take a month's paid sick leave and have a chat to them after that.
The Lister Fertility Clinic
As part of my month's sick leave I put a plan of action in place. I started phoning around all the Irish fertility clinics to see which ones could treat us immediately. The Rotunda Clinic could not see us as private patients for about 6 months and so too the SIMS Clinic had a 5 month waiting list. Fertility treatment in Ireland 5 years ago suffered from a shortage of experienced embryologists and fertility specialists. Unlike some jurisdictions like the UK, Australia and USA, where IVF had been available since the early 1980s, Ireland really only had widely available treatment from the 1990s onwards. The Merrion Clinic were unlikely to treat me based on what I had learnt about their FSH cut-off so I starting phoning London - which was a one hour plane flight away and where my sister lived. And it was by phoning around that I discovered the Lister Clinic. They had no waiting times and no FSH cut-off limits and could see me the following Wednesday - would that suit?
DH and I hightailed it to London and had our first real appointment for our very first IVF cycle with nice Middle Eastern doctor, Dr A. He seemed to really understand the consequences of having high FSH and advised us not to muck around with IUI (inter-uterine insemination - which I think it like glorified DIY job with turkey baster) but to proceed straight to IVF. He warned that a woman with an elevated FSH such as mine did not usually 'perform' well during IVF (my FSH had however come down to 4.5 in a subsequent blood test, but it was the highest recorded level that was the baseline by which fertility is predicted). Dr A also outlined a number of blood tests that he recommended I have due to my two miscarriages - being natural killer cell tests and tests do to with the level of blood clotting. He wrote out a prescription for all the fertility drugs I would need and explained via flow charts all the dates and times that I would have to inhale on a sniffer and inject. I found it all very very confusing and was overwhelmed. I was worried about who would teach me to inject myself with needles, about how much the drugs might cost, whether I could get them all in Ireland, how I would transport the drugs and needles between airports, how I would remember when to do what when....Finally he made DH do another sperm test (poor DH!! there was never anything wrong with him but because of me he is always subject to the indignity of going into the sample room with his little plastic cup). And of course, before we left, we had to stump up about £4,000 (euro 4,500) in advance to pay for our cycle.
In preparation for this first cycle of IVF, I went to see a nutritionist and continued my yoga and acupuncture. I returned to work just before I was due to do IVF in London, but was allowed very kindly to work out of my firm's London office to facilitate my treatment. I was lucky that I had such an understanding HR Manager. Whilst some people in Ireland are anti-IVF, the majority of Irish people understand the yearning to want to start a family - family is still revered (one of the good legacies of Catholic Ireland) and I felt supported by management at this time.
Before I flew to London I had commenced nasal inhalations of a drug which was meant to 'down-regulate' or shut down my body's natural cycle. During this time I was warned that I might experience hot flashes, but I merely remember having intense night sweats and the taste of the spray was like acetate in my mouth afterwards. Around the time I arrived in London I commenced daily injections of fertility drugs. I am lucky that I found the needles fairly easy to get the hang of and could quickly self-administer the injections. I also was lucky not to experience any side effects (it was only on later cycles when I was on extremely high doses - as high as you could get that I started to get bad headaches and feel woozy). DH had to remain in Dublin working and was scheduled to fly over the day before the egg retrieval so he would be available to give his sperm sample.
I was in a state of disbelief that I had fallen pregnant naturally but was now undertaking IVF - something I had always read and heard about, but was now experiencing first hand. I kept thinking, when waiting in the clinic's receptions area, 'I can't believe I am here' . It seemed a little like what my mother described to me after her terminal cancer diagnosis. She said she could not stop thinking, 'I can't believe I've got cancer. This is what happens to other people...not me'. That was how I now felt about being 'infertile'. I was in the shock stage and was feeling sorry for myself. I stole surreptitious glances at the other women in the waiting room. I was clearly one of the younger patients at 31. The majority of the women looked well into their 40s and one or two were medically obese. I thought these women could not want a baby as badly as me if they could not lose the weight that could be the cause of their infertility in the first place. I was prepared to do ANYTHING. I felt bitter that I started trying for a baby in earnest at 29 yet here I was surrounded by women who had probably left it a good 10 years longer; it felt so unfair (I have discovered after many years that infertility is a great leveller. It was so arrogant of me to think that these women were any less worthy than me).
I was very naive in my expectations of our first cycle of IVF. Irrespective of my FSH handicap, I believed treatment was going to work; if not this time, then the next. There was a large part of me that was relieved....and I guess excited, that finally SOMETHING was being done. I was now safely in the hands of Western medicine. I had a chance. A cousin of mine had IVF twins and I had a number of colleagues at work who had children conceived of IVF, my boss being one of them. I did not know of anyone for whom IVF had failed to give them a baby, which gave me comfort. If I had to inject numerous needles and have surgical egg extraction under general anaesthetic, then fine. Bring it on, let's get it over with and bring on our baby!
Every second day I had an ultrasound for the nurse to count and measure the growing egg follicles in my ovaries. By around day 8, I was told that I needed to increase my meds, because my response (calculated by the number of follicles appearing on the ultrasound) was not good. I was upset that I had to increase my meds because my ovaries were not responding but went along to the pharmacy got more FSH for injections. There were about 5 decent sized follicles and 2 smaller ones. Generally, clinics retrieve one egg from each follicle, so I was told that I was looking at about 7 eggs. They wanted to grow the smaller 2.
DH arrived the day before the egg retrieval. I fasted the night beforehand and we got up early the next morning to attend The Lister Hospital. It was by far the nicest IVF day theatre I was ever in. Egg retrieval all seemed to happen fairly quickly. I was knocked out with my legs up in stirrups and awoke in a private hospital bed with DH by my side. There was another couple on the other side of the curtain so DH and I whispered to each other. He did not know the results of the collection, so we waited a little. Then a lovely doctor, Dr J, came in with my chart and told DH that his sperm 'was excellent' (she patted him on the back!) and that I had 'done very well'. They had retrieved 3 eggs. She gave me such a smile and was so positive that I felt pretty happy with her news. She told me she had read my file and seen I had experienced 2 miscarriages. She squeezed my hand and told me she had experienced miscarriage too and now had a healthy baby. She was lovely. Another doctor may have imparted to us that my egg yield was rather crappy but she probably figured we needed a lift. I waited another hour or so and then was allowed to go home with DH. We were told that we would be telephoned the next day with the news as to whether our eggs had fertilised. DH flew back to Dublin from London that evening. I was sent back to the place I was staying with steroids, baby aspirin and heparin (blood thinning drug).
The next day, not long after lunch, when walking along a street in South London, I got a call to say that 2 out of 3 of my eggs had fertilised and that we had two embryos that both looked pretty good, which would be ready for transfer into my uterus the following morning. I felt delighted and skipped along the street. Two good embryos!! I went to acupuncture that afternoon and silently meditated and prayed that all would go well the following day. In 9 months time I could have twins! Maybe God would give me two babies to make up for the two we had lost...
I attended The Lister by myself on day 3 for my embryo transfer. I was told to drink as much water as possible before I was called in. The transfer was very uncomfortable. Like a bad pap smear. I did not feel the slightest bit relaxed and worried immediately that my unease was causing a hostile environment for the embryos. Afterwards I was told I could have a pee, 'good luck' and that I was free to go. 'Keep taking your steroids and heparin for 2 weeks and call us when you know the result of your pregnancy test'. It was extremely hot in London that day, being mid-July and I walked all the way from The Lister to Sloane Square tube station. I was exhausted by the time I got there and regretted my decision not to get a taxi home but I was worried about a taxi going over bumps and jostling me....silly I know. But then I worried about feeling tired and what effect this would have on my embryos trying to implant inside me....
Our focus after the summer was to try and start a second cycle of IVF in Dublin as soon as possible. It was more expensive and difficult to be doing IVF in London and we were worried about money. Luckily DH had a savings account that the Irish government paid out on euro for euro in 2006 (called an SSIA) and the timing of this benefit meant we could use it to bankroll treatment. I felt then, and still do feel, so sorry for the couples that cannot afford to even attempt IVF. A cycle at the SIMS then cost around 4,500 euro. We went for a preliminary appointment in late October 2006 (at which DH AGAIN was made to have his sperm tested - needlessly, in my opinion and at still more expense). We paid our deposit and were booked in to cycle in early January, soon after returning from Australia for Christmas. I was put on the pill for a few months in the lead-up and I think this gave us both a little bit of relief from the monthly disappointment of getting my period, as in previous months we both still held out hope that I might get pregnant again naturally.
We spent 3 full weeks back in the sunshine and colour of Australia - our first trip back since our wedding there in 2005. It was in many ways a relaxing trip because we still felt that although we were going to have to do IVF again in the New Year, we had a good chance. We were being positive about 2007 and were glad to see the back of 2006, which had been such a difficult year. But this trip home was also trying, as it was the first time I had seen many relatives and friends since our wedding, some of whom questioned us about whether we had any plans for a baby or whether one might be on the way. These were usually aunties and uncles, as my close friends and family knew we had already been trying for some time. This trip also was one of many where friends and cousins had new babies that were thrust into our hands to have a hold of. One of my best friends from school had a baby the day we arrived. I managed to avoid a hospital visit by using jet lag as an excuse. A younger cousin also had a beautiful new son. I also had a few visits with another girlfriend who had been pregnant at the same time as I was pregnant with our second baby; she had lovely twins girls. DH and I assured each other that next time we visited Australia, it would be with our new baby - 2007 was going to be our year.
I commenced our second cycle of IVF at SIMS Fertility Clinic, which was then located in Rathfarnham, Dublin. It was so much more convenient being able to go to a clinic close to home and it did not seem as cold or impersonal as The Lister in London, where the waiting room churned through patients. I was not as overwhelmed with instructions relating to needles and times and dates this time, as I had worked out the A-Z of IVF on our first cycle. I also managed to have my ultrasounds scheduled for early morning so my work routine was not thrown out too much. I was very busy at work and it was stressful having to race home in the evenings, to be back in the front door by 8 pm in order to take my injections. In the end I started taking injections into work with me, as that way I could be guaranteed that if I got stuck in the office, I could at least get my needles done.
A two year qualified solicitor working in a corporate law firm is usually stressed out enough at the best of times. I definitely experienced an additional layer of stress trying to simultaneously undertake IVF whilst being involved in demanding client transactions. I was very naive in telling my immediate supervisors that I was undertaking IVF again (as I thought honesty was the best policy). I expected that they would plan work around this. I realise now that my expectations were very immature. The business world does not work in such a way and it is not personal that your personal life is not a concern. I came to realise, somewhat painfully, that lack of concern about an IVF cycle by a colleague did not amount to ill-will. It was just reality. I learnt that you are better to just keep quiet and take annual leave whilst doing IVF and no one is any the wiser; which is what I did in subsequent cycles. Honestly, IVF is so gruelling, clinics should allocate patients a seasoned IVF warrior to mentor new initiates.
Our SIMS cycle progressed along similar lines to our first cycle - my fertility drugs were increased to a high dose - around 750ml of Gonal F, but this time less follicles appeared. However immediately before egg extraction Dr W was talking about possibly recovering 5 eggs, based on 5 follicles. This was good! 5 eggs sounded better than the 3 we got previously. I attended for egg retrieval at the appointed day and hour and had my lovely general anaesthetic (I love going under - I have often joked that I must have been a junkie in a previous life...) and woke in recovery feeling hazy, with DH by my side. The first words out of my mouth were; "how many did they get?". A lovely nurse appeared by my side and I waited for her to say something. She looked pained and before my mind registered her actual words, my heart sank. "Oh sweetheart, I am so sorry, but we did not get any. There were no eggs to collect. The doctor searched all the follices but they were empty!". DH started rubbing my hand - they had broken the bad news to him whilst I was still asleep. Tears welled up in my eyes and I pushed his hand away. I was so angry. How could this be? Why were we always getting bad news? I had spent months doing yoga, acupuncture and eating well. I took all my drugs on time and did everything right and they could not get a SINGLE egg? It was very rare apparently - to fail to collect any eggs whatsoever. They could not explain it other than my potential premature ovarian failure - which now appeared 100% confirmed. Utter hopelessness and despair. Memories of my mother's terminal cancer diagnosis and news of my two 'missed miscarriages' swept through my mind. Always bad news. No matter what you try - it is never good enough. There is no hope - only bad outcomes. All of these thoughts flashed through my mind.
I wanted out of that clinic. I did not want to talk to anyone about anything and would have ripped the cannula out of my hand myself if the nurses had not immediately made a move to arrange my discharge. I heard the woman in the bed next to me, hidden from view by a hospital curtain, being told that the doctor had retrieved 18 eggs from her. My head reeled as DH walked me to the car. The nurse accompanied me on one side, DH on the other, as I was still unsteady from the anaesthetic. She stuffed Kleenex in my hand and encouraged us to speak with a counsellor, whose business card she handed to DH.
We returned to the house. Well that was it - all over. I grabbed up all the medications I had been given to take for post-embryo transfer and hurled them into the garbage bin (just as my sister had done with my mother's medications after we had returned home from hospital on the day she died). You are normally told to go home and sleep off the anaesthetic after egg collection, but I felt wired. My mind and body both powered by the furnace of my rage. DH and I barely spoke. I was angry at him in an irrational way. I did not like his quiet reaction of disappointment and pity for me. I wanted to see him breaking down weeping or raging like I was. Why was I always the one doing the feeling, the crying, the raging. His emotions were so controlled and I wanted to know he felt the same as me but he did not seem to (this is tragically such a common experience between men and women undergoing fertility treatment - read Alice Domar). I did not sleep all night. The same loop played over and over in my mind; 'no eggs, no eggs, how can this be?' I took an extra day off work and returned the day afterwards, 2 February 2007. I told my boss who had the IVF children what the result was. He sincerely commiserated and did not try to down-play how crappy it was. The pity and sympathy made me fear even more for the future - things did not look good at all. Hopelessness was reflected back at me like a mirror from people's reactions. But why oh why had I not kept this cycle a secret? Now numerous people would know of my failure and it was exhausting to have to speak to people about what had happened. I was an idiot.
Within days of that failed cycle, DH and I were both worried that SIMS would not agree to treat us again - I mean, what was the point if I could not any produce any eggs? Luckily, IVF clinics in Ireland are not obliged to report their 'success rates' by legislation and are not as focused on selecting patients according to the likelihood of their achieving a successful pregnancy. DH and I would have been all out of luck completely if this were the case. A follow-up telephone call with SIMS did however alert us to the fact that they were not keen to allow us to do a second cycle unless we could assure them that our 'emotional' state of being was being taken care of; we were encouraged to have counselling on the poor outcome of our second cycle. And so, out of sheer desperation I made an appointment with an infertility counsellor less than two weeks after the 'no eggs' cycle - this turned out to be immensely helpful. Around the same time, I handed in my notice at work at my law firm, on foot of receiving an offer to join a smaller firm (this turned out to be the wrong decision, but work was an easy scapegoat at the time). I was convinced that my long working hours were to blame for my body's refusal to co-operate with me. I wanted more work/life balance and like a blinkered horse, could only see forwards to cycle no. 3 later that year.
