Fertility
My fertility journey is a long one involving various consultants, clinics, hospitals, not to mention the medication!
I have had 4 rounds of IVF in total so far and I want to share my fertility story and what I've learnt.
My fertility story
My lengthy fertility journey started in 2012 after my husband and I had been married for 2 years. We wanted to start a family, and so I stopped taking the pill and assumed it would be easy. My periods returned with a vengeance and I just thought it was a side effect from stopping the pill.
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I started to get ill every month with severe period pain and a menstrual migraine. This actually went on for 2 years before I convinced my GP to refer me to see a specialist gynaecologist! After a trans-vaginal ultrasound scan he suggested I might have fibroids and potentially endometriosis. Both would affect my fertility. I had my first laparoscopy confirming that I had both conditions. At the same time, one of my friends had started trying to conceive, and was successful in getting pregnant straight away. I was really happy for her, but started to feel a bit sorry for myself and my husband because it was getting harder and harder to keep trying to conceive.
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After my first laparsocopy, my consultant tried me on a drug called Chlomid (Clomifene). This is a tablet that basically helps you to ovulate. It didn't work for me, instead I had severe migraines and again my period became horrendous and unmanageable.
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By 2018, I'd had 4 laparoscopies and 1 myomectomy to remove endometriosis, adhesions (scar tissue) and polyps. I was stuck in a cycle of having surgery to correct issues, only for it to make things worse through the formation of scar tissue.
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We had our first round of IVF (ICSI) in 2018. We had everything crossed that it would work, each scan seemed to be favourable. 10 eggs were collected, 7 fertilised and 2 were transferred to my uterus. The remaining 5 embryos didn't develop. Unfortunately, it hadn't worked and we were heartbroken. I went back to work and tried to pretend I was ok. I had no idea how to react when a friend told me that she had just had a second successful round of IVF through going private. She also mentioned that another friend was also pregnant with her 3rd baby naturally (they didn't think they'd be able to conceive a 3rd so decided to start trying and were successful straight away).
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For the second round of IVF, we went to a different clinic. I'd taken time off work to focus on the IVF cycle this time. I'd also had acupuncture and was on a new/stronger fertility supplement. This time, 5 eggs were collected and 4 fertilised (good news). Again, 2 were transferred to my uterus as the remainder didn't develop. I had a horrible feeling that this cycle had also failed when I started to get my usual menstrual migraine during the two week wait. Yep, my period started and the pregnancy test was negative.
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In 2020, after more surgeries we did a third round of IVF using an egg donor. This time, 4 eggs were collected and 2 were fertilised. This round was also unsuccessful.
By 2021, it was our fourth round of IVF (again using an egg donor). This time 9 eggs were collected! We were both cautiously optimistic as surely we would have a greater chance? However, only 7 made it to insemination and then 4 ended up fertilised. We had 1 blastocyst transferred to my uterus and pinned all our hopes on it. This was the first time we'd actually had a blastocyst transferred. It didn't work. The pregnancy test was negative. Our consultant said she could not do anything else to help us. We were heartbroken again but I’m glad she was honest with us.
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We are now with a 3rd fertility clinic. At the time of writing this, we are currently waiting to start our 5th and final round via an egg donor. I'm also waiting to have my 11th surgery to remove my remaining fallopian tube (this needs to be done before we do the IVF round). This fallopian tube is leaking fluid into my uterus (hydrosalpinx), and this can be toxic to an embryo. After several scans, I also was told that my uterine lining may be too thin to even sustain a pregnancy. Unsurprisingly, this is due to all the surgeries and scar tissue. At this point, it had been a while since my husband had his semen tested and so he queried this with our clinic. They carried out a test and it (predictably) revealed a higher DNA fragmentation than last time. It's another blow but our consultant suggested continuing with fertility supplements, adding in Vitamin E, and the possibility of us doing a round of PIMSI (a specialised method of sperm selection to identify the 'ideal' sperm for fertilising the egg) instead of ICSI.
The clinic did a mock cycle for us last year with the aim of trying to thicken my uterine lining. This involved A LOT of hormones (injections, patches, pessaries), so much so that I had severe nausea for several days. I felt stronger for getting through it though (as well as managing to inject myself on a moving train). The mock cycle was successful (the lining thickened substantially) and so my consultant will be prescribing the exact same doses for our 5th and final cycle.
A little update:
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IVF Stages
The NHS website provides some useful info on each IVF stage here. https://www.nhs.uk/conditions/ivf/what-happens/
The stages of your IVF cycle can vary depending on your individual needs but these were the stages of my first round:
Down regulation
This involves ‘shutting down’ or stopping your natural menstrual cycle to be able to start afresh and control the next stage.
Baseline scan
This scan will normally be done between days 1 - 3 of your period. This is the start of your cycle after down regulation.
Ovarian stimulation
This involves stimulating your ovaries in order to produce as many eggs as possible.
The medical professional doing your scans will monitor how many follicles are being produced and the thickness of your uterine lining.
You may have several scans during this stage to check how the medication is working and whether it needs to be tweaked.
Egg collection
At this stage, you will have a light sedation before your consultant collects as many eggs as possible from your uterus.
My experience was feeling like I had fallen asleep and was then woken up feeling relaxed but with some light cramping.
Fertilisation
The eggs collected will be mixed with sperm. Your clinic should then keep you updated on how many eggs have fertilised, their progress and when you will be asked to attend for embryo transfer.
Blastocyst - Blastowhat?
A blastocyst is a group of cells that forms about five to six days after a sperm fertilises an egg. If implantation is successful,the blastocyst will eventually become an embryo and then a foetus.
Grading embryos
Embryo grading seems to differ between clinics. Grading allows the embryologist to select the best embryo(s) to be transferred. The example below is from IVI Fertility:
“In embryo grading, the number, from 1 to 6, identifies how far the blastocyst has expanded and hatched out of its shell. The letters indicate the quality of the inner and outer cell mass. To put it into perspective an embryo with an A grade is excellent quality, B is good quality, C is fair quality, and D is poor quality.”
Embryo transfer
You will need to have a *full bladder for embryo transfer. This will give the embryologist a clearer view of your uterus on the screen in order to guide your embryo to the correct place.
*Full bladder means comfortably full. For me this meant drinking just under 500ml water. Don’t go chugging down as many pints of water as you can because this will make you very uncomfortable, and you may be asked to partially empty your bladder!
Two week wait
The dreaded two week wait (where time slows down to a snail’s pace) is where your embryo should hopefully develop and implant. Your clinic should advise you on what date to do a pregnancy test.
During this time I would recommend not googling your symptoms as it will just drive you crazy!
Try and do something to take your mind off things, as hard as it will be. During the first cycle I took a few days off work, and my husband and I did a couple of day trips e.g. to the beach. Another cycle, I just worked through or was too ill from having a cold.
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Please remember to look at your employer's Maternity Policy as support for your fertility treatment may be covered under this.
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