Cycle 3: Day 0

My period has arrived this morning so tomorrow will be my first shot of my third and last cycle.  I don't know if it's due to the acupuncture or the natural fluctuations of life, but my period seems heavier and a brighter red.  I swear I've never had much interest in the qualities of my period.  Getting all involved in your fertility does strange things to you!

I had a doctor's appointment on Friday for my pre-cycle scan.  Everything looks okay.  There were 7 good follicles on my ovary.  My cyst looks to be about the same size.  I asked if the seven we were looking at were what we had to work with for this cycle.  The doctors said that some of them will go away, but some smaller ones will emerge and it's a good start.  I think it's similar to the past two cycles, so that's okay.

So tomorrow I'm on 300 Gonal-F and on day 4 I add the Cetrotide.  I'm also going to schedule my next scan for day 4 so that's Thursday.  As we are changing the drug dose this cycle, it may need to be more closely monitored.  The doctor said he might reduce it ond ay 4 or might keep it the same, so we'll see what happens.

I also paid for this cycle which really hurt the bank balance but it is what it is.  When I was paying, I again flagged the issue of the 'follow-up appointment' charge, as I've now been charged twice for it.  This time, she went to speak to the clinic director who said that it is definitely not included.  So I told her that I thought this was really unreasonable.  She said the only time they do a 'free' appointment is in the case of a failed IVF cycle.  But I argued that in that case, firstly, the couple comes in one more time after the retrieval so gets to speak to the doctor, and isn't all drugged up and also secondly, as I knew I was going to do at least two cycles, it was fairly obvious that there was a mandatory 'in between appointment' and it was shit to be charged for it.  She said she would raise it at the next internal meeting, in the meantime however, I'm out the extra money.  I mean fine, in the grand scheme of things it's a small proportion of the money, but I'd rather they bump the overall fee by 100 pounds and then include it then dump it on you like that.  It's annoying.  And what you don't want to be, in an emotional and hormonally charged process, is annoyed by things that seem really stupid.

I also learned that my clinic has been bought by/has joined a larger network of IVF clinics in the UK.  I'm not sure it makes any sort of difference as it seems more of a higher level management issue and each clinic seems to be independently run.  But I suppose it can't be a bad thing in the long run, particularly if in a couple years time I'm not in London but somewhere else in the UK, it might be easier to use a local related clinic then go back down to London but that's a long way away to be thinking about.  I suppose although it's interesting, it really doesn't seem to impact me at all.

The other thing I'm looking forward to now that this cycle is starting is getting my fridge space back!  This is more for my non-UK/European visitors but having had my drug delivery a couple of weeks ago, it's put a serious limit on my fridge space!  I have a flatmate, and she gets the bottom half of the fridge, so as you can see from the picture, space has been a little tight!

Anyway, that's all the news from here.  I'll keep things updated as this cycle goes.

Meeting with the Doctor

Today I had both my follow up meeting from my last cycle and preparation meeting for my next cycle with my doctor.  Again, I got charged for this visit and I plan to call them later this week to hammer out what the deal is with getting charged for this appointment.  Last time they said they charged me because I had a scan, but I didn't have a scan this visit.  I should have argued when I was there but I wasn't in the right mindframe to do it.  I've been incredibly stressed all day and I just couldn't deal with it.  Probably a mistake.  Whatever.

Anyway.

Here are the things we talked about in no discernible order.

Probably one of the most important is we discussed my results from the last cycle (4 eggs) compared to the first cycle (6 eggs).  Of course this disappoints me somewhat, but then if I had 2 ovaries I would have 20 eggs total instead of 10 (lets say) and I'd be perfectly happy with that.  So I don't feel like I can be that upset about it.  I stressed this was my last possible cycle due to financial considerations.  So the doctor said that as it was my last cycle he felt we could try to push the ovary a bit more and he's going to increase my Gonal-F and see how it goes.  In both of my cycles there had been additional smaller follicles that didn't catch up or grow as fast and I guess he's hoping to catch them by upping the drugs.  As with most of this process, I have to trust that he is basing this decision on his experience and expertise and I trust him.  I'm conscious of having read other women who didn't respond well to higher drug doses, but I trust that my clinic scans me every other day, and will monitor me closely and he wouldn't suggest this if he didn't think it was a good plan.  It's hard to feel like I'm gambling with my last cycle, but on the other hand, I've read about a lot of women on the higher dose of Gonal-F, so it's not like it's that odd or extreme.  I'm sure it will be okay.  I'll obviously keep track here of how everything goes.

In keeping with that, I got my prescription for all the drugs so I need to get in touch with Healthcare at Home to send it in and arrange the delivery.  I'm going to remember to insist that they include the sharps bin this time!

We arranged my norethisterone prior to the cycle.  As my cycle is about 30-31 days, I'm going to do 9 days of the norethisterone.  For the first cycle I did 8, the second I did 7.  So this is another change although one I'm more on board with.  The nurse had suggested I do 9 for my second cycle but the drugs didn't arrive in time so I could only do the 7.

We talked about birth control pills.  Specifically about whether or not I could go back on them after the third cycle and if there were any implications for future fertility. He said there is no indication that birth control pills affect ability to conceive and that I should be fine going back on and he had no reservations.  So that was good news.  I miss my birth control pills!

We talked about my period.  Okay, skip over this if you don't want specifics.  Basically I've noticed that as I've gotten older, my period is much darker, and lighter, and a bit shorter.  Of course as I go through all of this I just panic that this somehow means my womb is an infertile place and I can't conceive.  He said the color of your period means absolutely nothing.  He also said that the frequency of your period and heaviness have more to do with your ovarian reserve than your ability to get pregnant. He pointed out that there are women close to 50 who get pregnant- they have no eggs left, but their womb can still healthily function.  Obviously I am not planning on being 50 and pregnant, but this was comforting news.

We also talked about the counseling service that is available.  I sort of wish I'd picked up on this sooner.  They have to counselors who have an office space and I just need to call and arrange an appointment and they will often schedule alongside your scan if the timing works out.  Although I might start this sooner seeing as how once my scans start there isn't much time left for any counseling.  At any rate, it will probably take time to arrange it anyway.  So I'm going to do that and will also have updates here.

So really, that was all great, other than being charged 120 quid for the visit.  This irritates me to no end, but my comfort and trust in the clinic outweighs my annoyance.

The only other thing of interest is that they are doing some building works to the clinic and so I'm lucky I didn't try to schedule for this month as I don't think they would have done it.  They're moving around some of the lab and clinical spaces on the ground floor although the doctors offices and scan rooms on the first floor aren't affected.  The building works are supposed to finish right when my next cycle starts, so that allows an extra week and a bit for them to run over before it's a problem. I am just going to assume it's not going to be a problem.

Anyway, that's the update.  One month countdown to the third and final cycle begins!

Cycle 2: Day 12

Had another scan today.  Still at about 6 follicles or so.  Two of them are larger and could be collected but the doctor is hoping the other four will grow and catch up.  I had a good talk with this doctor today.  I said that I was feeling a bit discouraged about the lower follicle count compared to the first cycle.  She told me that I really had no reason to be discouraged.  That it was a reasonable outcome for someone of my age and with one ovary.  And that I was responding well to the medication.  She said that when they usually see women it's because they are having fertility problems, and I don't even know if I have any problems at all.  She reiterated that it's really a lot about the egg quality.  She told me she's seen women who get over ten eggs and none are good quality and another woman who came and only got one egg and then she got pregnant.  Apparently they've also used frozen eggs successfully.  Although they were donor eggs (and so most likely younger than my eggs) there were two frozen and they got a single pregnancy.  So all of that was good.  She also mentioned that I might want to take advantage of the free counseling that the clinic offers.  I mean, I'm not entirely sure what a counselor can tell me.  I sort of know what the deal is, it's just stressful.  On the other hand, I feel a lot better having talked to the doctor and so maybe it would help to talk to the counselor and considering it's free, why the heck not?

I also asked the doctor about the protocol they use compared to the ones I hear about from the other egg freezers I know in the States.  It seems like the UK protocol is much simpler- less drugs and almost no blood work other than the initial blood work.  The doctor told me that they've looked at all the results so far from these procedures and they feel they simply aren't necessary.  Obviously each doctor will have a different opinion but I do feel good that they at least keep up with these things.  My clinic is one of the best in the UK with high results to prove it.  They have to know something right about what they're doing.

In the meantime I continue on the same schedule- 225 Gonal-F and .25 Cetrotide.  My next scan is Wednesday and collection will probably be Friday or maybe Saturday but I'll know for sure after the next scan.  Seems like I'm on the same time schedule as the first cycle.  Oh, and I did say something about how I felt like it was along time and she assured me that this is not a long time.  She said some people take 3-4 weeks, and that's a long cycle!

Cycle 2: Day 9

So back from my scan and of course I am depressed.  There just aren't as many follicles as last time.  The doctor (not my normal doctor) measured 6 although I think I saw at least one or two more.  One is way out ahead so it probably won't last the duration.  At this time last cycle I think I had at least 12-14 follicles showing and I only got 6 eggs.  I'm steeling myself to get a low collection number.

Of course this is upsetting.  Firstly, it's upsetting because it's all conjecture.  Each follicle COULD yield an egg and I could do just as well as last cycle, I just don't BELIEVE that is what is going to happen.  So that sort of sucks.  If I go on a 50% yield, I'm looking at a collection of 3.  Of course any is better than nothing.

This is what I keep telling myself.  I mean, what am I getting so upset about?  This is where my fertility is at right now.  If I was trying to get pregnant, this is what it would be.  If I wait around for when I hope to have children, it's going to be worse.  The only thing I can be doing right now is this, and this is what my body produces.  Any frozen egg is better than no frozen eggs.  But it is so hard to not want to place blame or look for some sort of 'answer' to why it's not as good as I want it to be.

I recently answered some questions for an interview on egg freezing in an Australian magazine and the interviewer asked me if I wish I'd done this sooner.  Yes.  Absolutely, 100% yes.  It's hard not to feel like I've let my best years go.  Obviously when I was younger I had hope that things would just work out but that's not what's happened.  So now, at almost 39 I just feel annoyed that I didn't know about this sooner, didn't do it sooner, let all those better eggs go sooner....

Not that any of that is productive.  The only productive thing that I can do right now is exactly what I'm doing.  I need to just try to stay focused on that and not let myself get worked up about things that are completely out of my control.

But it's hard.

Anyway.  I'm sticking to the same dose for injections.  Next scan is Monday with again not my usual doctor but not the one I just saw either, instead the one I saw at the start of my cycle (which I think covers all the doctors because I think there is only the three).  I'll update here again after the scan.

Cyle 2: Day 6

So I just got back from my first scan after starting the stimulation.  As per last cycle, my follicles are slow starters.  The doctor measured 7.  He also measured my cyst, which does not appear to be growing.  I was a bit disappointed by 7 and thought that was less than the last cycle.  He checked and said at the first scan in the first cycle, he had noted 8.  So yeah, one less so far.  He didn't seem worried though and said that I just seem to have slow starters and it's too early to be able to tell anything yet.  He's keeping me on the same drug protocol as last time.  So I guess that means I'm definitely in for a long stimulation cycle.  And I'm preparing myself for a low number collection.

I think what's hard about the medication is how quickly I can get upset.  I honestly don't notice any other side effects of the stimulation drugs.  But when something happens that could possibly be upsetting, I feel like it's devastating.  That could also be because this process is stressful in general.  Obviously what anyone who is doing this wants is the most mature eggs as possible.  It's frustrating to know you can't really do anything about it.  What the scan shows is what your body has.

I keep reminding myself that if I had two ovaries, these would be really good results for someone who is almost 39.  In fact, if I was getting twice the number, I would be pleased.  So it's not really my body at fault.  I'm simply asking or wanting too much from it.  I'm being unrealistic.  I've come across women with two ovaries who have gotten the same number of eggs from their cycles.  I shouldn't be upset.

I guess it's not that I'm upset.  I'm just disappointed.  But then I remind myself, that the very best thing I can be doing right now to address this, is exactly what I'm doing right now.  And that makes me feel a little bit better.

Drug Delivery

About a week after I'd sent off my prescription to Healthcare at Home (HaH) I got a call to arrange payment and delivery.  They were really helpful and friendly on the phone.  There was a bit of a mess because it was going on my mom's credit card and she's in the States and they needed her to verify the payment but actually in the end it was all rather simple and easy and so the drugs were paid for at the price I was quoted (still can't believe it) and delivery was arranged for today.

They made a point of telling me that some of the drugs require chilling and so would need to be put in the fridge straight away and instructions would be provided.  This proved to be true.  It was marked on the box...

...as well as on the inventory.

So all of that has gone straight into the fridge, super easy.  The rest is all the Cetrotide which apparently does not need to be refrigerated.  That's a lot of Cetrotide!

The only disappointing thing about this was that the drugs and the inventory were all that was in the box.  I had asked if the sharps bin came with the drugs and I was told in my original contact by email as well as over the phone that everything I needed would be included, but I'm sad to report it was not.  On the other hand, I don't think it's that complicated to get a sharps bin (I'm fairly certain I can pick one up from a pharmacy or from my GP).  It's just a small hassle that I wasn't expecting.  In the grand scheme of things, it's fine.  And I think it's probably an oversight or error since multiple people told me that it would be there.

I'm really not complaining all things considered.

So it's weird to have all the drugs again.  It's still a month away and I've got a three week trip to the States that's going to happen in between now and then.  Part of me is sort of looking forward to getting it started though, and part of me is looking forward to just getting it done.

Reducing Drug Costs

I could have also called this post, "I won't do that again!" or "I wish I knew then what I know now!"

I have just received an estimate for drugs from Healthcare at Home for the drugs and I am blown away by the price difference.  Now, just to be clear, my prescription is not quite for enough drugs so I don't 'over order' but let's compare.  This was the previous drug breakdown from my first egg collection cycle:

Drug	Cost
Gonal F 900 pen x3 (£360 each)	£1080
Gonal F 450 pen	£180
Cetrotide x12 (£32 each)	£384
Ovitrelle single dose	£16
Total Cost	£1660

This is what I was just (April 2013) quoted from Healthcare at Home:

Drug	Cost
Gonal F 900 pen x3 (£142.56 each)	£427.68
Cetrotide x10 (£10.80 each)	£108
Ovitrelle single dose	£6.48
Delivery Fee	£30
Credit Card Fee	£11.44
Total Cost	£583.60

Based on my previous cycle, this is two doses short of Gonal F and two doses short of Cetrotide- if my protocol lasts as long as my first.  But lets be clear.  This means my drugs would be almost 1/3 the cost of the drugs from the clinic!!  That is a HUGE difference.  Even if I have to order a couple extra doses, it will still be significantly cheaper, even with the delivery fee and credit card fee.  I mean, I will be getting a Gonal F 900 pen for LESS than the cost of the clinic 450 pen!!

So this means if my previous projected cost for cycle 2 with no changes was £4471, my current projected cost for cycle 2 with the drugs listed above is £3384.  Even if I have to purchase a Gonal F 450 pen and two more Cetrotide from my clinic (although why would I?) the projected cost will be £3628 for a total projected savings of £843.  And if I do need extra drugs and buy them from Healthcare at Home then I will save a bit more (around £40 more based on the above costs) even with delivery and credit card fees, so still worth it!

Part of me is annoyed I didn't know to check this out for my first cycle.  I'm also a tiny bit annoyed that my clinic never mentioned it, although obviously they make profit on selling the drugs, so I don't entirely fault them.  To be honest although I think it would be a nice thing to do, it's really not their job to mention it- I didn't specifically ask if there was any way to reduce my costs either.  However, I definitely know where I'll be getting my drugs from for cycle two.  I need to get on with ordering them now as I'm out of the country for most of May and when I get back for the start of June it will be time for round two.  But I'll keep updated here with my drug purchasing experience.  So far Healthcare at Home has a huge endorsement from me (if you can't tell by my repeating their name and posting the link :) )

Follow-Up Consultation

Today I had my fist meeting with the doctor since my collection.  I am sad to report that I was charged for this visit.  I feel that this is not ideal and that a single follow-up consultation should be standard with an egg collection procedure.  But, you can't be pleased with everything.  So the new update on costs is:

Previous total cost	£6876
Follow-up consultation	£120
Total cost to date	£6996

But it is what it is.  Either I choose a different clinic, or I accept that this is how it is.  Can't be pleased with everything.  And overall I am really generally pleased.  So I am going to stick with them.

So I saw my doctor today and we discussed how everything went and he did a scan to check on my ovary since I said that I could still feel it and I knew it had not gone back to normal size.  I was of course concerned it was the cyst but I am happy to report that my cyst is still the same size as it was before and has not grown at all.  On the other hand, my ovary is currently about twice it's normal size.  The doctor said this was 'normal' and that it can take up to two period cycles for it to return to normal size.  When stimulated it can be 7 or 8 times normal size.  So my ovary has definitely 'gone down' but it's not all the way down yet.  In keeping with this he suggested I stay away from impact exercise and twisting until I don't feel it anymore.  I'm glad that I wasn't making it up that I still 'felt' the ovary and also glad I was taking it easy and not rushing back to the gym.

We discussed how the retrieval went.  In the end there were 10 follicles and 6 had eggs and all 6 were mature.  They can't tell you anything about the quality of those eggs.  I asked if there was anything I could be doing now to help improve number or quality as there are many things talked about online.  He said the only thing he suggested was that I consider some slow weight loss between now and my next procedure.  That's fair.  But he cautioned me it needs to be slow and steady, not a crash diet as that can negatively impact egg production or quality.  So I need to be a bit more serious about seeing if I can lose 10-15 pounds in the next two months.

He said he felt the protocol was good and he didn't particularly want to change it.  He said that as I only have the one ovary he didn't want to be too aggressive or risky because we want to protect the ovary as well.  That seemed reasonable to me.

He gave me a prescription for my drugs and said they are happy for me to source them elsewhere if I can get them for cheaper, so that was good and I need to follow up with that over the next couple of weeks.  He also said that my retrieval procedure was a bit tricky.  That surprised me. I asked why and he said that my ovary moved around a lot during the retrieval.  Apparently the dermoid cyst can make it wobbly or a bit less stable, or even float inside the gut, so apparently it wasn't exactly straightforward to retrieve my eggs.

So there you have it.  I'll post more about drug pricing as I look into that.  In the meantime I have 2 months to see if I can drop some weight.  That's not going to be easy though if you consider I'm back in the States for 3 weeks in May.  But I'll do the best I can.

Days 14, 15

Last night was my last Gonal-F injection!!  It was 187.5 as opposed to the 225 I've been taking for the rest of my cycle.  And of course the Cetrotide.  The past two days all of the injections have been pretty easy which has been nice.  Today I have my last injections before egg collection.  At 7pm I take the Cetrotide and then at 8pm I take the Ovitrelle that is waiting for me in the fridge.  Monday- no shots!  Then Tuesday morning I need to pop in a Voltarol suppository before heading to the clinic super early.  The Voltarol is for pain relief and seems standard practice for some UK clinics according to forums on the internet.

I've arranged for my friend to be there by 10 and I imagine I should be able to leave by 11 at the latest.  So the end is almost here.  I can see it.  I'm both nervous and excited.  And I'm not going to lie, I'm also excited to get my life back for a couple of months where I'm not injecting myself every night and giving up alcohol and caffeine.

My right side where my ovary is feels a bit tight but honestly it's felt worse at different parts of this journey.  I've been very careful to avoid twisting and I can't help worry about things like OHSS and what happens after egg collection, but by the time my period comes it should all be flushing away and reverting to normal.

It's easy to get wrapped up in this experience but I still find it challenging that the support and advice for egg freezing is just dwarfed by IVF.  The issues are entirely different.  I do find it useful to read IVF forums for understanding issues regarding the egg collection process, but all this DH this and BFN/P that- it's not relevant to my journey and in some ways highlights the wrong thing about this process as it only painfully reminds me that my life is not where I had hoped it would be at this point.

It's also interesting the responses I've had from different friends about what I'm doing.  I have been reasonably open about telling friends of mine what I'm doing and the results have ranged from "That's amazing and you would make a great mother." to "Why would you do that?" to "Why don't you just get pregnant now?".  The responses have not necessarily coordinated with the friends I thought they would have, either.

I'm not rushing in to any decisions.  I just feel that this gives me an option I would otherwise be passing up.  And I believe that it is a good idea and the right thing for me to be doing at this time.  In addition, having lost an ovary already, it makes sense to try to preserve eggs from my remaining ovary which, as discussed already has a small cyst on it, because as I well know- anything can happen and then your choices can be taken away from you.

On the other hand, it puts into stark relief things about my life that have disappointed me.  It forces me to consider things that I have not necessarily been considering.  And I feel it is additionally challenging to be undertaking all of this alone without anyone to truly share 'the burden' of the harder thoughts with.  Or just the stupid moments of having injections and sharps boxes.

It's part of the reason I made this blog, and have tried to find others.  Or maybe I'm just someone who likes sharing.  Anyway.  Enough Sunday morning rambling!  I will continue to keep this blog updated with the results of this cycle, any thoughts in between, and when I do the second cycle (which I am entirely assuming I will do as there is no reason at this point to think I won't) I'll return to it, though possibly not the day by day description that this first cycle has been.  But as my doctor says, that's still a ways away.  First things first!

Last day of shots today!! Woohoo!!

Day 13 - Scan

The end is in sight!

Had my scan this morning.  The doctor said that Tuesday would really be better for collection as the goal is to have as many good eggs as possible and I do have some follicles lagging behind.  I'm sure that I could question him for his reasoning and thinking, but as my IVF experienced friend said, "What is he going to tell you really except that this is what he thinks they should do based on all the other patients they've seen and the results they've had with different protocols?".  It's true really.  Whatever they say to me isn't going to be the magic pill that "promises" the prize.  Either you trust your doctor, and the clinic, or you don't.  So lesson of the day- be very happy with your clinic and doctor because that's really all you've got.

At any rate, he counted 13 follicles and there may have been a couple others.  They are getting big!  He suggested that I should be looking at 5-10 eggs.  Of course there is a massive difference between 5 and 10.  And there is absolutely nothing I can do about it except wait and see.  Obviously I hope for 10 and I will be disappointed with 5 but it will be what it will be and lets just hope that it's not any less than that which is of course, also entirely possible.

So I have my final drugs now, and I need to be back at the clinic at 8:30am on Tuesday morning for my procedure at 9am and I might be able to go home by 10 and hopefully by 11.

Tonight, I'm on the same drugs as usual- Gonal-F at 225 and Cetrotide.  Then tomorrow I do them again but the Gonal-F reduces (I have it written down- I think it's one eight something or other).  Sunday at 7pm I take the Cetrotide and then at 8pm I do the Ovitrelle which came pre-packaged and is currently in my fridge waiting for me.  Monday- no shots!  Hooray!  Before I head to the clinic on Tuesday morning, I take a suppository.  I think it's a painkiller.  I'm not sure, I'll need to double check, and I will post more about all that later.

This has of course prompted me to consider does the procedure actually hurt? It may sound stupid but it hadn't actually particularly occurred to me.  Then of course I made the mistake of looking at the internet which is full of both sides- people in pain and people feeling nothing.  Well, there just isn't any way to know what it's going to be like until it happens.  I'd say my tolerance for pain can be pretty high, but I do tend to flinch.  Hopefully I get enough sedation to just knock my ass out.

I've arranged for my friend to come meet me at the clinic and go home with me.  It's all heading to the finish line now!

I did say to the doctor today that my ovary feels uncomfortable, my digestive system seems to be a mess, and I've been feeling particularly grumpy.  He said it's all normal.  At least I can be objective at the moment.  The hormones haven't gotten that bad yet!!

Day 12

Okay, I've taken to writing in the morning, not after my injections in the evening.

Last night's injections sucked.  They all seemed to be painful and pokey.  I say "they all" because although the Gonal-F is super easy and not a problem, I had to do the Cetrotide 3x before I got it right!!  First I tried a spot that was just too pokey so I couldn't manage.  Not sure I properly broke the skin but I think I must have been just on top of a nerve or something.  So needle out.  Pick another spot, still pokey but just want to get it done with, get it in and AGAIN I realize I've forgotten to get rid of the air bubble.  Needle out.  Third spot still a bit pokey.  At this point I wonder if I've blunted the needle with too many tries, but I get it in and done with and then just generally felt uncomfortable and poked from the shots.  And even though the Gonal-F is fine, I still picked a somewhat pokey spot.  So a big blah to the injections last night.

In the meantime, this amused me for no particular reason.  And as my cleaner comes today, it will all be gone shortly.  I wonder what she's going to think of my rather full bedroom garbage....

Looking forward to my scan in the morning.  I am hoping with all my might that they think Monday is perfect for collection.  Although I did ask the doctor I saw on Wednesday if I have the collection Monday morning did she think I could be traveling Monday night and she pretty much looked at me like I was crazy.  And said I should definitely not be riding a bicycle for a couple of days.  I think I'm someone who always thinks I can do things before realizing I can't.  So in my head these were completely sensible questions.  And to be honest, I'm going to see how I feel and if I think I can travel the evening of the collection, and if I think I can ride my bike, I'm going to do it.  I just can't keep putting off my normal life for so long.  Although I could skip the bike- it would mean a lot more walking and possibly taking taxis which is not ideal, but also not impossible.  Anyway, we'll see how I feel.

I've decided that I'm getting grumpy.  And this could be a side effect from the drugs.  It could also be a side effect from undertaking a somewhat stressful procedure.  But I feel particularly grumpy and irritable which is how I tend to feel when I have periods.  So yeah, maybe this is a mild side effect.

Day 11 - Scan

So I had a scan this morning with a different doctor.  All going well.  I saw her count ten follicles and I saw a few more she didn't count.  She said it was good that they were mostly growing uniformly- that there weren't one or two 'ahead of the pack' in terms of growth which is good.  I guess they try to generally measure only the biggest ones.  She said they were also growing at a regular and steady and desirable rate.  So that was also all good.  The sad news is she said my collection could be Monday or even Tuesday.  It just keeps getting pushed further away!!  Ugh!  I hate the waiting!!!

Also this means I need to try to rearrange my "support" person as the person I had lined up is only free Thursday and Friday.  I think I've arranged someone though, so that's good.

I'm staying on the same dose of Gonal-F (225) plus the Cetrotide.

I asked if I was at any risk of OSHH.  The doctor told me that she didn't think so- especially as I had only one ovary.  If I had two ovaries, then maybe.  I thought this was interesting as I haven't seen anything about OHSS risks being reduced by having one ovary, but hey, I'll take it.

I learned the leftover injection pen and vials can go directly into the trash.  I'm not sure I 100% believe this, but the nurse said that they just put it all in regular trash so I can put it in my trash at home.  So I guess I will, even though it feels vaguely wrong.

Also, I learned that the clinic does see patients on the weekend for procedures- but they don't do scans and regular consultations on the weekend.  That seemed reasonable.

I definitely feel a tightness or pressure on my right side where my ovary is.  It's mildly annoying but not painful.  I can't say I've really had any other side effects that I've noticed.  I have some mild bruising across my belly from all the shots, but it's not that bad, and not painful.

Just back to shots and waiting...

Day 9 - Scan

Back from the doctor, had a good chat with him about the whole cyst thing.  He showed me how a (my) dermoid cyst looks a lot like the bowel.  Because my dermoid cyst is very small, it can be difficult to spot.  It is able to seen now because the ovary is enlarged.  It "moves" with the ovary.  But, when the ovary is smaller it can be hard to see from the surrounding gut.  He reiterated that it's very small and nothing to be concerned about.  So I feel much better about all of that.

On to more exciting news!  Follicles!  Now I see from reading other blogs that people get measurements on their follicles and I don't know what mine are.  So I can't say if I have good size ones or not.  I know they are growing though, because the doctor says so!  However, they are growing slowly.  So instead of collection being Thursday or Friday this week, I may be looking at Monday.  Which frankly, sort of sucks.  But I'm going in for another scan on Wednesday and then again on Friday.  So this is going to be a very busy week for my vagina. :)

I was careful to count the follicles he was measuring- so he measured 8 but he didn't measure a bunch that were on the other side.  So I counted ten or eleven follicles.  Obviously some are bigger than others.  Anyway, from everything I can gather, this seems like a good foundation.  So I'm excited.  I just now wish the little eggs would mature faster!

Obviously I'll find out more on Wednesday.  Unfortunately I don't see my regular doctor but I'll see another doctor in the clinic.  Although I'm not concerned about that.  I'm scheduled to see my regular doctor again on Friday.  I have this sneaking suspicion that perhaps they aren't open over the weekend?  I hope that's not the case as it would upset me to think that my collection is predicated on what is best for the doctor's schedule and not what's best for my body when I'm paying a lot of money for this.  But that's me making a gross assumption.  I'll not worry about that until Wednesday, when I'll try to glean more.

Oh, also, this longer stimulation time is a little bit annoying on the budget.  At this rate I'm going to be paying an extra 50-60% for the expensive drugs because I'm going more days than I thought.  In the grand scheme of things, it's okay, but it's a little bit annoying and I wasn't necessarily prepared for that length of extension.  I'm figuring it will be an extra £600 (~$900) per cycle.  Across two cycles, it's something to think about.  But hey-ho, in for a penny in for a pound!

Oh yeah, last thing- when I asked about the break between cycles the doctor said that after collection my period would hopefully come around the 11th of March.  Then April, then May, and THEN I could consider the next cycle.  So assuming everything goes as planned, my second cycle will be June.  Which gives me a good amount of time to relax and have fun in between.  Of course the doctor says to me "One step at a time!".  But I am a busy person and I need to schedule!!

Tonight, the further adventures of the human pin-cushion.  I'm still staying on Gonal-F at 225 with the Cetrotide.

Day 5

I have two tiny circular bruises on me from the shots.  The biggest and darkest is actually from my very first shot.  They seem more likely to bruise if they well up with blood when the needle is removed.  To be fair, I don't have that many dots on me having now given myself a total of 8 injections.  Maybe half have been followed by a blood dot?  Oh yeah, in other news I was talking to a friend who did many IVF cycles and she said that she had been told to stay within a two inch radius of the belly button and not to go out to the sides.  Which could have explained why the shot I did further to the side hurt more.  So sticking closer to the belly button it is!

I did the Gonal-F first again tonight.  I was holding it in for the ten seconds and then I moved my thumb and saw it was stuck on 25 again!  So I moved my hand and pushed the plunger more firmly and the last 'click' went and the rest of the drug went in.  Now I know what happened yesterday.  Which makes me feel better about doing the second injection of 25- it was the right thing to do.  Today though, I got it all in, albeit after a bit of a pause.

Anyway, on to the Cetrotide.  Today with pictures!  So first, out of the box we have a sealed container, and an info booklet.  Peeling off the top of the sealed container we have two alcohol wipes, two needles, a pre-filled syringe, and a vial of the Cetrotide in powder form.  Let me preface this gallery by saying that if you are going to take Cetrotide, make sure you read and follow the instructions that come with it fully- this is an abbreviated version and is no substitute for correct medical advice.

 

Right.  The first thing you do is get the little vial of the powder, remove the blue cap, and wipe it down with one of the alcohol wipes.  You can see when the blue cap is removed it exposes a rubber stopper end where you will insert the needle.

 

Next, you attach the big (yellow ended) needle to the syringe.  On a hard surface, you insert the needle into the rubber stopper and then depress the plunger to add all the liquid in the pre-filled syringe into the vial.

Now they say that it dissolves instantly.  But then it says if it doesn't all dissolve you can swirl it gently.  They say not to shake it as that adds air bubbles.  As you can see from the photo on the left, it really doesn't dissolve cleanly.  It takes quite a bit of swirling and scraping at the bits stuck to the bottom with the needle.  And some tapping on the side of the vial.  It's really a matter of being patient.  It does get there eventually, even if I did get a few air bubbles in it (as shown in image on the right) but some gentle tapping sorts those out.

The part that I didn't show is how you are supposed to turn the vial upside down, draw down the needle so it's just in, and then suck up all the liquid.  This is not so easy.  You don't want to withdraw the needle, and you want to get all the liquid, and not fill up the syringe with air.  Again, I think it's more about patience.  Taking your time, and if you get too much air, pushing that back so you have space to try to get the rest of the liquid.  I managed to get pretty much all of it eventually, as well as a bunch of air.  So then I swapped out the big nasty needle for the injection needle (as shown below) and slowly pressed the plunger until the tiniest bit of liquid was visible on the tip.  Ready to inject, and so I did.

Next scan is early tomorrow morning.  I need to get myself to bed to get up early to get across town to the clinic.  I'll be getting more drugs tomorrow as I only have enough Gonal-F left for one more injection at 225 and 2 more Cetrotide boxes.  I will definitely be asking about when possible collection day is going to be.  Lets hope everything has been continuing in the right direction.  I continue to oscillate between being hopeful and being terrified there won't be anything out of this.  Useless, I know.  And I try not to do it, but I don't see how it can possibly be completely avoided.

Day 4 - Scan Day

Today's entry is in two parts.  First, the scan. 

Today I had my first scan after 3 days of injections.  I could see the screen as he looked at my ovary and measured the little follicles that were there.  I counted about 7 or so.  Two were clearly bigger, which I assume is a good thing.  I will never get used to the UK doctor approach which is basically not very talkative.  I prefer the continual information dump and running commentary approach.  I suppose it's in part what I'm used to, but you know, I like to be included in my medical health discussion.  Not that I have any complaints at all about the clinic- or the doctor for that matter.  As when I ask him stuff, he is happy to answer and discuss with me.  It's just that I need to ask, it doesn't happen automatically, and I find it a little bit weird.

So as I say, I saw him measuring all the little follicles.  I sort of lost count, I swear he measured some of the same ones twice.  But he was also very quick.  It was definitely more than 5 although some were small.  So he said I should stay on the same dose of the Gonal-F (225) and tonight I also add the Cetrotide.  My next scan is Friday morning.  He didn't see any cysts (which is good).  He said it all looked like what he'd like to see so far (without being particularly descriptive about what it is he likes to see).  He said that the trick is that they wouldn't want to overstimulate the ovary- you don't want 20 follicles on one ovary.  But that a good response would hopefully see me get 10.  If I actually got 10 eggs (and if those could all be frozen) that would be superb, because two cycles would give me the magic number of 20.  I'm not sure I'll actually get 10 freezable eggs, but the closer I can get to that number the better.

It's kind of crazy to think I'm just back there in less than 2 days, but the more scans, the more information, the more care and looking at I'm getting, then the better as far as I can tell.  So like I said, I'm very pleased with the clinic so far really.  Oh, they said that my unused needles should all go in the sharps bin and that any unused medicine or medicine containers I can bring in and they can dispose of.  So that was good to know.  Although today they took the unused needles in the Gonal-F box, even though they say on their handout that they don't take unused needles not in a sharps bin.  I don't think it was a big deal really.

I'm writing this in a cafe just now.  I'll return to it later tonight when I discuss my shots.  The regular Gonal-F and the new part of the regimen, mixing my own Cetrotide.

Okay, I wrote that part before and I'm picking up this post where I left off.  My intention had been to take pictures and post about the mixing but I got home late so I just wanted to get the shots done to stay close to my schedule.  I took the Gonal-F about 45 minutes after my 24 hour time and the Cetrotide about 15 minutes after that.  All within reason to be fair, but I was just conscious about getting it done.

And what an annoyance last night was!  First, I did the Gonal-F.  I figured I had it down, I understood what I was doing, and it's easy.  So I prep, I measure, I inject, I wait ten seconds, take the pen out.... and it says 25 left in the black window.  Crap!  If it has a number left it means you didn't take the full injection.  But I did depress the plunger all the way (or so I thought).  So I was first annoyed, then worried, then I just decided to give myself the 25 with a new needle.  So I did that and it definitely went to 0.  But it was an extra little bit of bother when I was already just trying to get it done!  Ugh!  Also, two pin pricks.  Double ugh!

Or, make that three pin pricks.  Because I had to mix up the Cetrotide.  This was more complicated than I thought it was going to be.  I will take a picture of the box set up hopefully for day 5 and post more about the mixing.  Needless to say, there were a number of steps, it didn't all dissolve straight away so I kept trying to mix it without shaking it (as that adds air bubbles).  Getting it back into the syringe was also not 'obvious' and I got a bit of air in there and I'm not convinced I got 100% of the drug back in the needle (although I did get most of it) and then I had to do yet another injection although that went fine when I finally got to that point, I was just glad to get it done!

Now my next scan is first thing Friday morning.  I look forward to getting more information on how this is all going.  It would be good to have an idea of what day collection might be for- as I need to figure out who I know that can come with me.  If it's Thursday or Friday I have someone but if it's Wednesday, I might be on my own.  I think that's the only shitty thing about this whole exercise- is really being on your own.  It's part of the reason I don't find as much help from the IVF blogs- they're all with partners, they have different objectives, it's really a different sort of procedure and expectation.  Egg freezing is similar, but it's different.  I wish more women were sharing their stories!!

First Drugs

So now I'm just waiting for my period...

In the meantime I thought I'd put up what I got from the doctor.  They had it all ready for me in a blue plastic bag.  This is probably about half of the drugs (or a bit less) than I will actually need.  I appreciate that they are only giving me what I need.  I've read some blogs where people were encouraged to buy all the drugs up front and of course they may adjust the dose so then you have left-over very very expensive drugs.  You're looking at over £600 of drugs and equipment here ($900).

To give you some idea of size, that paper on top is A3 (11x17).  I felt like a serious junkie on my way home from the clinic!  I will post more pictures as I go through the process.  I don't know.  It helps me feel calm and collected to document the process.  The first thing I'll be taking is the Gonal-F on the second day of my period.

For the love of... I'm not computer illiterate!  I don't know why it insists on rotating this photo.  I give up.  So anyway, these are two injection pens.  I'll give more details when I open my first box.  Probably the 450 box.  I'm starting on a 225 dose, so the first pen will have 2 doses.  The second 900 pen has 4 doses.  But they may lower the dose after my next scan which should be on day 4 of injections.  On day 4 I also start the Cetrotide which is the one that came with the instruction sheet because I have to mix it.  That is always the same dose, so each box is a single dose with everything you need to mix it up.  Again, more on that as it happens.

But the thing that really made me feel the most like a druggie?  The sharps bin.  Here you can see the place for my needles... and the top of my instruction schedule.  The nurse was very careful to tell me that as it's shown there it's 'closed' but if I push it the whole way, it will lock.  So don't do that.  Of course I need to travel around with this thing and I'm thinking, if it doesn't close, can't things fall out of it???  I'll just have to pack it carefully.

Now on with the waiting for my period... honestly.  It's worse than being a 12 year old girl!

First Pill

Popped my first pill this morning.  Two a day until my scan and meeting on the 5th.  I'm excited and nervous.  I can tell that this whole egg freezing thing is going to be fairly emotional.  I can't predict what's going to happen obviously, but I would have to be some sort of grand master to keep my mind from occasionally wondering if it will go well (ie, a good number of eggs collected) or if it will go badly (ie, a poor number or even no eggs collected).  When these thoughts come upon me I just need to take some deep breaths and remember that whatever it is going to be is what it will be and the best thing I can do is stay calm and positive.

All Systems Go

Alright.  Lots of back and forth from the clinic.  Back from my trip to Australia.  All systems are go for egg freezing round one.  This starts with taking Norethisterone on the 29th of January 2x a day until my first scan on February 5.  On this day I have my nurse appointment and get to learn all about giving myself injections and will also collect the rest of my drugs, as well as be tested for a slew of STDs.  Collection is tentatively scheduled for around February 22 depending on when periods start and how scans are going.  This works fairly well with my schedule though it looks like I need to move one appointment.  I'm both nervous and excited for it all to be underway.  In some ways it doesn't seem real.

So current issues are:

• Get to the 5th of Feb and ensure that all planned scans, etc do not conflict with my rather hectic back and forth schedule.
• Move that one appointment that is likely to conflict with collection day.
• Try to find someone to meet me at the clinic on collection day as they don't want you to go home alone.

Although I asked and they said if I really can't find anyone, I just need to arrange a taxi to take me home and not take public transportation which seems fine.  It's just that I'd be asking someone to take off work and that seems unlikely.  I have one friend I can maybe ask, but I'll try for that as it gets closer and I have a better idea of the actual collection day.

In other news my mother started freaking out that the treatment was going to create another dermoid cyst and that I'd lose my last remaining ovary in the process.  She lost both ovaries to dermoid cysts and I lost one.  So there is a fair worry there, but I reminded her that I asked the doctor specifically about this issue and he said it was very unlikely.  On top of which, given all the scanning I'll be having, if any cyst starts to develop, I imagine that they will be able to notice it and stop the process.  Also, early cysts can be dealt with, without losing the ovary.  It's a risk, but a minimal risk.  And my only option is otherwise not to proceed.  The doctor did not think it was a high risk.  I think I need to go with his experience on the matter.

So that's where I'm at.  Now I'm getting nervous that it's all going to fail and there won't be any eggs or not enough eggs.  It's really kind of amazing the mental ups and downs you go through.  I mean, I understand it, and it all seems a bit text book.  But being typical doesn't change that I'm still going through it!  Deep breaths.  Calm thoughts.  After all, if I meet someone in a couple of years, and we wanted kids and tried IVF then, it would be worse then.  This is the best I can do, doing this right now.  We'll see what happens.