A week after our negative result we were back at the clinic to talk with our consultant about the next steps.
That week contained a lot of tears and sadness, but also a lot of gratefulness for what I already have. We spent a wonderful weekend away from everything in a last-minute trip to Corfe castle, and the weather was great, Toby was brilliant, and John was just amazingly wonderful as always. We had such a great family time together, and I felt I regained some perspective, and with it, joy.
So I was not particularly looking forward to this consultation. Hauling myself back into all the decisions and consequences and hopes and fears.
Luckily our consultant is a great guy. We talked about what had happened at egg collection last time. He now thinks the most likely explanation was that I ovulated some of the eggs away naturally. Despite the lack of fluid around the ovaries and uterus (signs of ovulation), and my progesterone levels only just beginning to rise (therefore not being as high as they’d expect after ovulation), this is still the most likely scenario. My only-slightly-raised progesterone levels could be explained by the fact they were taken only days after any potential ovulation might have occurred. The progesterone peak is expected a week after ovulation. Therefore the fact they were slightly elevated points to the possible beginning of that progesterone spike, simply sampled too early.
This shouldn’t have happened. The Buserelin injections were to mute my own hormones, including Luteinizing Hormone (LH), the one responsible for triggering ovulation. But PCOS sufferers have a naturally higher level of LH. Perhaps the Buserelin was not effective enough? This seems to have been the unlikely case.
In light of this, and our history of a previous successful pregnancy some time after ovarian diathermy (burning holes in the ovaries to “encourage” them to behave), these were the options presented to us:
1) Have another laparoscopy and ovarian diathermy, followed by a course of high-dose clomid (200mg), to see if that helps me to ovulate, followed by trying to conceive “naturally”.
2) Have another bash at the same kind of IVF we just did, but with a special injection of Buserelin (or Buserelin-like drug, I wasn’t too sure), that lasts for 4 weeks, rather than the daily injections we had last time.
3) Try a slightly different approach to the IVF, using an LH antagonist instead of Buserelin, which is an agonist. The difference is that Buserelin acts on cell receptors to stimulate them until they are biologically exhausted, and therefore stop producing LH. But the antagonist competes with my natural hormones and takes their place in binding to the receptors, thereby switching the receptors off from producing LH. Or as this paper puts it:
“Unlike the indirect pituitary suppression induced by GnRH-a [the agonist, Buserelin in my case], GnRH-ant [antagonist] administration causes immediate and dose-related inhibition of gonadotropins release by competitive occupancy of the GnRH receptors in the pituitary”
Practically, this approach would mean I start the FSH injections *before* the antagonist drugs which mute my own hormones. This is the opposite way round to what we did last time. The hope is that this approach might more effectively stop my own LH from interfering and prevent my ovulating those precious eggs away.
We then considered each of these options on their own merits and challenges.
Option 1 is quite intrusive. It would involve an operation and put me out of action for two weeks. It wouldn’t guarantee any results, and even if it does work, and I do ovulate on 200mg Clomid, we then have to actually conceive. This could happen the first month, or it could take 6mo-1yr before chance brings the egg and sperm together. This is by far the least controlled option, and after a year and a half of trying already, not one we’re keen to follow.
Option 2 seems to bear little advantage over what we’ve already done. It seems it is mostly to minimise user error – to reduce the chances of you forgetting to take the injections daily. Which we didn’t forget to do.
So Option 3 seems our best chance at the moment.
So then I asked the question I didn’t want to ask. The one I’d been dreading the answer to…
Should I lose weight before trying anything else?
Our consultant said the less I weighed, the more sensitive my ovaries would be to the drugs. He wisely warned that losing weight wouldn’t guarantee an immediate result, but that it would lower risk factors at each stage, from follicle stimulation right through pregnancy. I’d have a lower chance of getting OHSS (the hyperstimulation of my ovaries as a result of the IVF drugs, which can be very serious), and it reduces the chances of miscarriage and other pregnancy complications such as gestational diabetes.
I asked him what he thought we should do?
“Lose the weight”, he said. “Then come back and do antagonist IVF. It’s more controllable and hopefully will generate several embryos that can be frozen and used in successive cycles.”
He warned that I’m still at high risk of OHSS, so even if I can lose the weight and have a successful egg harvesting followed by successful embryo-making, we might still have to freeze all the embryos and wait a month or so for my hormones to calm down and for me to get well again.
Taken all together, the bottom line is we are in this for the long haul. Our time line is now significantly longer than we’d anticipated, with the added time required to lose weight, and still has many hurdles and potential complications to overcome.
However, our consultant said that we have “a very good chance of extending our family”. He reassured us that he’d always tell us the truth, and he wasn’t just saying that to be nice. Because I’ve been pregnant before and because of our diagnosis with no additional complications, his medical opinion was that this is possible.
It’s just going to take a while.
Time feels like our biggest pressure. None of us are getting any younger, grandparents included! There are so many reasons why we’d like this child sooner rather than later, including our ages, having a little brother or sister closer in age for Toby, my work-life decisions, and what can best be summarised as socio-community factors.
The latter is something I feel rather than John. 5 of my friends have announced pregnancies in the last few months, and there is a part of me that feels left behind, worried our relationships could change as our stories drift apart. This seems rather silly to my rational brain. I know these friendships are solid and the people so loving and wonderful. I think the fear for me harks back to the schoolyard actually. To my days of being bullied, my fear of being excluded and left out of social situations decades ago that is somehow still casting echos forward to 2017. But these fears are unfounded. I’m writing them here to bring them out into the light.
I can see the benefits of a bigger age gap between siblings. All the things of Toby’s early life we get to enjoy, unhindered by a screaming newborn and sleepless nights. The stages he’ll have gone through by the time baby arrives – potty training, toddler bed – all easier without a baby around. The greater understanding he’ll have of what’s happening when I finally am pregnant, how he’ll be better able to get excited and look forward to the new arrival. The time afforded to us by the wait – time to do things as a family we couldn’t do with a little one in tow. And then considering how things will be when the baby is born and Toby is at preschool, perhaps even getting closer to big school – the time I’ll have just for the baby because Toby is now old enough to be in childcare for a portion of the week. These are all very real benefits of having the baby a bit later. So although upset about the lack of immediacy of pregnancy, I think I am coming to terms with our new outlook.
For now we are on a mission to lose weight. I’m aiming to get from 13st 9lbs down to 12st. And when I’ve done that, we’ll call the clinic to start again. This will probably be the last blog post for a while. If you see us regularly, please hold us to account. If you see me about to eat something carb-loaded, knock it out of my hand and rugby tackle me to the floor.
Or just remind me that I’d like a baby more than a cake.