Our first appointment was booked in the November of 2015 but it didn’t make me feel any better. I was in a lousy place mentally. I’d lost myself. I didn’t like Lucy. Everything around me was grey and I didn’t enjoy anything we did because the sadness inside me was too intense. Of course, I tried hard, where I could, to cover this up and smile to the outside world. I would cry and tell Craig that I wanted to give up. This wasn’t true but fear consumed my body and mind, leaving me feeling paralysed. Exhaustion hit yet I needed to find some energy as the next test was the tests.
I’ve always been a bit of a wuss when it comes to hospitals mainly because, up until then, I had been fortunate enough not to have had many dealings with them. I’m not sure if I’d call it a phobia but I thought of them as places where people receive bad news. This was ignorant of me as we are so lucky in this country to have our NHS and lots of happy moments happen in hospitals too – one being the birth of our daughter. It’s no secret to those who know me, that I can be rather melodramatic at times and also have a teeny amount of hypochondria in my genes – I have my paternal Grandmother to thank for that, so I’ve been told! So, the first drive to our local NHS hospital (a 40 minute drive, that became all too familiar) was an agonising one. I was so apprehensive about what they would discover. Part of me just didn’t want to know.
I must add at this point that, actually, the very first test performed for anyone battling with fertility is a test of the male’s sperm. This is because the test is a) less invasive – I’ll let you read between the lines as to how the sample is collected – and b) sperm count and quality is a common reason why couples don’t conceive and therefore it can be addressed first. Craig was healthy with billions of super strong and high quality little swimmers so that was a relief and one thing we didn’t need to worry about. We were exceptionally lucky in this respect and we knew it. Then it struck me… this meant that it was all me. My fault. My body was the one hindering us. As Craig was fine physically, he had the tough job of trying to keep me positive.
We sat in the tiny, drab-looking waiting room and I’m sure anyone who saw us could tell we were ‘newbies’. For starters, we arrived over an hour early for our appointment (I always like to leave ‘extra time’ when attending an appointment for anything but this was a bit extreme)! I had showered, shaved my legs and made sure I was wearing my best knickers – it didn’t take me long to realise that nurses and doctors do not have time to notice, or care, whether you have been using the latest ‘Venus’ razor or if you have, in fact, spent a fortune at a fancy salon having the latest high-tech leg wax (or bikini wax for that matter)! Sitting nervously, we didn’t really know where to look. There are obviously other couples waiting too but, as many people want to keep their fertility journey private, no one really looks at each other. You pretend to pour over a magazine or you become engrossed in a depressing looking poster, peeling at the edges, on the wall – one, you don’t fathom at the time, that you could be woefully staring at for many more months to come. The reality is, you are all sneaking a quick glance at each other trying to guess what everyone’s problems are and if, hope of all hopes, they might be just like you.
I would be having an ultrasound scan for my initial test. It would be a vaginal scan which was quite daunting. These would soon become all too familiar as I must have had well over a hundred by the time we eventually got pregnant via IVF, and even had more after that. During your IVF cycle, you have this type of scan every other day before you have even had your egg collection. This was quite a commitment when we were doing our second round of IVF in London, as I had a 30 minute car ride to the station, followed by over an hour on the train and then a 20 minute walk to the clinic. This was all to attend a scan lasting no more than 15 minutes and then I’d travel back again – absolutely worth it though. At this point, however, Craig and I hadn’t any understanding of how this all worked, and we were fairly newly married. I decided that, as his wife, I ought to maintain an air of mystery; I didn’t want the romance in our relationship shattered by an intrusive examination with my legs in stirrups so I told him that he could wait outside for me. After all, I wouldn’t take my husband with me for a smear test. Asking him not to come in with me was a gargantuan mistake. Every appointment and procedure after that (except my egg retrieval operations where he wasn’t allowed in theatre), he came in with me and held my hand, encouraging me to be brave, never dropping his gaze from me with his deep brown eyes. He did always remain at the ‘head end’ wherever possible though! There is nothing he hasn’t seen (it probably prepared him for birth which, we have since learnt, is not neat and tidy like they portray in the movies) and, strangely, it’s brought us closer together. Watching me endure so many painful procedures has actually made him love me more – his words, not mine.
I had to learn to be tough…quickly.
I followed the nurse into a small room, one of many that would soon begin to feel like home, and was asked to strip waist down, cover myself with the effortlessly plain, pale-blue, coarse paper towel, and lie back on the bed. I felt very vulnerable and exposed. As time went on, I became more and more accustomed to this – you have to be – and I realised that all the doctors and nurses have seen it all before. I now joke that, every time I walk into a doctor’s room, I automatically drop my trousers out of habit. Thankfully, for my poor GP, I do just about remember that this is not necessary when visiting him about an ear infection!
If I am to uphold my original statement, at the start of all this, to be honest, frank and ‘warts and all’, I’m afraid that, from now on, I am going to have to go into a bit of detail. For anyone who I’m acquainted with and would prefer not to know, I suggest now would be a good time to stop reading!
None of it embarrasses me. During my days of scouring the internet, I rarely found anything that said it exactly as it was and I desperately needed to. In order for my blogs to help anyone enduring a similar path, I’m going to have to bear all (no pun intended)! It is the reality of infertility treatment.
A vaginal scan involves a probe which looks identical to something one might find at the back of an Ann Summers shop! The nurse puts a condom (I did not expect to see one of these in the process of trying to get pregnant) over it and puts a big, cold dollop of lubricant on the tip. It is then inserted into the vagina and an ultrasound image of your uterus appears on the screen. It looks exactly like the scan pictures you see people share when they are pregnant except, obviously, in this case, no baby was seen. The nurse can then move the probe around to view anything she wants to see – ovaries, endometrial lining and uterus. She slowly began looking around and said that my uterus looked lovely. I breathed a huge sigh of relief. She said my endometrial lining was a good thickness for that stage in the month (this is the rich blood lining that the embryo implants itself into or, if there is no embryo, it sheds itself once a month as a woman’s period). I actually began to relax a little and think, ‘it’s going to be alright.’ Then, she went a little quiet. You can tell when a nurse or doctor has seen something they are concerned about because they stop chatting to you as much. I felt the air go cold. She then turned to me and said ‘these are your ovaries. Do you see that ring around each one that looks a little bit like a pearl necklace?’ I kind of did although the image was so grainy and fuzzy (plus, naturally, I wasn’t that familiar with my ovaries and had never attempted to decipher a scan image). She said, ‘you have polycystic ovaries.’
Time stood still. My brain suddenly went into overdrive, almost as if it was doing a mammoth google search for everything I had ever read. Yes, I had heard of Polycystic Ovary Syndrome (PCOS), only because I had read that Victoria Beckham and Jools Oliver had it – but they each had lots of children so perhaps I would too. Despite this, I knew it wasn’t a good thing. I think I was actually only about 11 or 12 when I first read the word ‘polycystic ovaries’ in Victoria Beckham’s biography (the Spice Girls were at their peak) and it had always stuck in my mind. Strange how things like that happen when we read so much in our lifetime, lots of which just passes us by without another moment’s thought. Other than recognising the name, I had no idea what we were dealing with. I burst into tears (not the delicate kind…the big, fat, hysterical kind) and I suddenly felt completely alone. It was in that moment that I instantly regretted not having allowed Craig to come in with me. He was the only one I wanted.
I sobbed all the way home. Craig might actually describe it as more of a howl and quite a lot of snot!
I couldn’t breathe. Fear struck once again. The thought of never becoming a Mum, which I had dreamt of since I was a little girl, whirred through my head like a klaxon.
Nothing else was said to me at the hospital as I had to wait for a follow-up appointment with the consultant. I had been given a small leaflet which explained the basics of PCOS.
I got home and read the leaflet over and over. Dr Google also reared his ugly head again too. ‘Polycystic ovaries contain a large number of harmless follicles that are usually up to 8mm in size. The follicles are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means that ovulation doesn’t take place. Your ovaries become enlarged and contain many fluid-filled sacs (follicles) which surround the eggs (it’s important to note that, despite the name, if you have PCOS you don’t actually have cysts).’ There were symptoms of PCOS that I read which I didn’t have so I was getting confused. I wasn’t overweight. I didn’t have irregular periods. I didn’t have excessive hair growth. I didn’t have hair loss from the head (I suddenly started panicking whenever a single strand fell out however). I didn’t have acne. Obviously, there was one symptom that must have been occurring though which was that I wasn’t necessarily ovulating each month. I had never missed a period in my life. I naively thought, if your period comes, then you must be ovulating. Why would I have known any different though? It’s not something that I ever learnt at school or that was ever talked about around the kitchen table.
Before my meeting with the consultant, I had lots of blood tests as well as a procedure called a HyCoSy (Hystero-salpingo Contrast Sonography). This is a technique used to check whether your fallopian tubes are blocked. These are vital to achieve a pregnancy as they are the tubes that carry the fertilised egg to the uterus for implantation. I had to go to theatre for this test but would be awake and Craig was allowed to come and hold my hand. It hurt…intensely. The test involves passing a fine catheter into the uterus and injecting a dye which the doctors watch on a screen to see if the dye flows through the tubes. The painful part was the catheter being inserted; this is because it goes through your cervix and your body isn’t keen on this. Our bodies are clever. It recognises the catheter as a foreign body and therefore tries to reject it, resulting in agonising cramps. Once it was in place though, it was more manageable and the fact that the dye shot through my tubes in seconds (meaning they were perfectly clear) made it all the more bearable. It was over quite quickly and I was relieved.
The blood tests revealed that I had low progesterone levels. This is the hormone that rises significantly when you first become pregnant and helps to maintain the pregnancy during the first 12 weeks of gestation. When progesterone levels drop, this is when your period begins. It rises and falls throughout a woman’s monthly cycle. Some women can experience spotting between periods which can be due to dips in their progesterone levels – I had experienced some of this occasionally and therefore it made sense – but in order to carry a pregnancy, in the early weeks, I would require some artificial help. I learnt all this from Sally (my acupuncturist) – this particular hospital never explained anything to me which didn’t help. I’m much calmer if I understand the facts – like most people.
Finally, my ovarian egg reserve was tested. This is called an AMH (Anti-Mullerian Hormone) test. Mine came back as having slightly more eggs remaining than average for my age. This wasn’t anything to get excited about because it’s about egg quality and not quantity. Even in someone who gets pregnant very easily, not every egg released each month is going to make a baby. It’s only the high quality ones that will and, even then, there are so many other factors that come in to play – they don’t call babies a miracle for nothing! Regardless of this, I was relieved that there were actually eggs in there! The reason I had more for my age was because of my PCOS. As this was stopping me from regularly ovulating (sometimes I would, sometimes I wouldn’t), there were more left than usual.
The initial tests were done; it was time to meet with the consultant.
During our fertility journey, experiencing treatment in two different hospitals highlighted to me just how important it is to be in the right place and to feel cared for as individuals. During this first meeting with the consultant, it felt like we were just another couple, referred to as a hospital number, who were rushed to read a whole heap of fertility jargon from a leaflet and told to make a decision about what we wanted to do, with little explanation or reassurance. Suddenly, we had to be grown-ups and make big decisions, right then. We had three options:
- Ovulation Stimulation: least invasive – I would be given a drug called Clomid which would help stimulate ovulation. We could continue trying to get pregnant as normal. I would be prescribed progesterone pessaries called Cyclogest. Anyone who’s used these, knows just how messy they are. You insert them like a tampon, morning and night, and all of the pessary falls back out in chunks about 30 minutes later. It was definitely time to ditch my best underwear and buy a cheap pack from Primark! I was also prescribed a drug called Metformin; this is often given to people with diabetes and has been proven to help sufferers of PCOS.
- IUI (Intrauterine insemination): somewhat invasive – this would involve some injections (I’ll discuss injections, and my superstar husband administering hundreds of them, at a later date) to force my body to grow more than one follicle, each with an egg in. Hopefully, one egg released is a healthy, high quality one, therefore giving you a better chance of success. They would then place the sperm inside my uterus to facilitate fertilisation. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and, subsequently, increase the chance of fertilisation.
- IVF: very invasive – in short, this involves stimulating your ovaries to produce many, many follicles with eggs in. An egg collection operation is then performed to harvest an egg from each follicle. The eggs are then put with your partner’s sperm, in a laboratory, in the hope that some will fertilise. Then, by the end of it, you hope and pray, that one good quality embryo will have survived. Three to five days later, if you have one left, it’s put back and you wait to see if the embryo has implanted, resulting in a pregnancy. On average, IVF fails 70% of the time. Each clinic, has their own set of live birth statistics. I’m going to stop there as IVF will be a focus of a separate blog. It’s a very interesting yet complicated mine field!
Some may have heard of the term ‘postcode lottery’. This is true. As it stands at the moment, different counties offer different NHS funded fertility treatment. For example, some people actually move house to a county that offers three NHS IVF rounds. In our county, you are offered ovulation stimulation, only one round of IUI and only one round of IVF; you can do them in any order. Craig and I decided that we would try ovulation stimulation first as this was the least invasive and we were told it could work for us. I wasn’t in the right head space to be trying anything more yet. I didn’t want to believe that we would need further help and I was still desperately holding on to the fact that we could do it on our own. It seemed like the right decision and one that, in my frenzied mind, I longed would solve our problems.
It didn’t solve our problems.
After a few months of taking clomid (which, for a tablet so miniscule, literally turned me into a version of myself I didn’t recognise), I fell pregnant.
Then, I miscarried.
Our fertility test continued…