ICSI (Intracytoplasmic Sperm Injection) was incorporated into our IVF treatment cycle to enhance fertilisation due to low end sperm count.
IVF has long been used to treat infertility and involves eggs and many sperm placed together in a petri dish, left to ‘naturally’ do their thing. ICSI is a more recent development and involves injecting one single sperm directly into the mature egg under microscopic vision. The embryologist prepares the sperm by washing and sorting them so that only the healthiest, most optimal sperm is used. Pregnancy rates achieved by this method are very similar (if not better if severe male infertility is a factor) to that of IVF.
Just when I thought it couldn’t get much worse than daily injections, I’m introduced to Synarel (a nasal spray) and Progesterone Pessaries, tampon looking ‘tablets’ which are not injected or ingested orally! Cue the self-doubt here – it’s difficult to know whether or not you’re doing any of this correctly. Thank you Dr Google!
Progynova Here’s where it began. I started taking Progynova on CD5. Progynova is a tablet that’s ingested orally and contains estrogen to thicken the lining of the uterus (endometrium) before FET can take place. I started by taking 1 x 2mg tablet twice a day.
Side effects include but are not limited to: mood changes/depression, spotting, premenstrual like symptoms, nausea, stomach pain, headaches, feeling tired, acne, weight gain.
I was feeling quite bloated and nauseous for a few days and my CD14 scan revealed I still had some fluid. My lining was only 5mm and needed to reach 8mm before moving to the next step so my FS increased Progynova to 2 x 2mg tablets twice a day. I had a blood test to check progesterone levels and also commenced taking Synarel.
Synarel is used to suppress the growth of follicles and is absorbed in the bloodstream. I had one spray twice a day, 12 hours apart (one nostril in the morning and the other at night).
Side effects include: headaches, hot flushes, nasal irritation, muscle pain/weakness, acne, mood changes/depression, increase in hair growth.
I hated Synarel. Half the time I didn’t know if I sniffed it in deep enough, if the angle of the bottle was ok, if it was too far up my nose, if anything was even being absorbed. It left a disgusting taste at the back of my throat that lingered for a while and made me want to gag. Hold in your sneezes and don’t blow your nose because you don’t want to be taking another dose!
Progesterone Pessaries My next scan was CD18. My lining was looking good but I had a follicle/cyst (damn PCOS) and needed to have another blood test to check that progesterone levels were ok. In the afternoon I received a call from the nurse giving me the all clear to commence Pessaries the following morning – 400mg twice a day, 12 hours apart, while continuing to take Progynova. Progesterone Pessaries are used in the luteal phase (LP) to support the endometrium and ensure that the lining of the uterus is optimal for implanting an embryo. If FET results in a pregnancy, you’ll be lucky enough to continue administering these Pessaries twice a day (sometimes up to four times a day!!!!) for the first 12 weeks of pregnancy. I can only laugh….
Pessaries are stored in the fridge and need to be used immediately as they have a cocoa butter base and start melting pretty quickly. Side effects include: nausea, acne, fluid retention, weight gain, breast tenderness, abdominal pain and discomfort and pretty much every other pregnancy symptom you can think of!!
I have a really sensitive tummy (yes, I’m a decaf drinker for this reason) so usually feel the bloating/fluid retention/gastric upset side effects. It was no different with the Pessaries. I could definitely feel it in my tummy – bubbling, cramping and nauseous.
No more morning gym sessions for me. Instead I lie flat and can’t move for at least 30 minutes after the pessary is inserted. Give me needles any day! How the hell can four doses of these things be taken in one day!?
If you’re the 1 in 6 Australian couples who are confronted with infertility, there’s a good chance you will experience the physical and emotional stress it brings whether you’re months or years into treatment.
There are highs and lows; hope and despair, implications on your mind, body, relationship and finances. There’s sacrifice and heartache and for a considerable amount of time it’s overwhelming.
As I wait to commence a medicated frozen embryo transfer (FET), a number of coping mechanisms have come to mind that I’d like to share. IVF is not only a numbers game; it’s a huge psychological journey. Here are my tips for getting through it:
Connect with others – whether it be talking to a close friend or trusted family member, joining a support group, starting a blog or personal journal, talking to someone or writing is an excellent way to ensure you don’t bottle up your emotions. There are some great online support groups where there’s no such thing as a silly question. No one will understand what you’re going through more than these amazing women.
Spend time with your significant other – go on regular date nights. See a movie, go out for dinner, go for a long drive to wherever the road takes you, be spontaneous and get out and have some fun. Do what you can to take your mind off IVF. Your mind will thank you!
Spend money on something other than treatment – pamper yourself. No one deserves it more than you do!! Go on a holiday or cheap weekend getaway. A change of environment does wonders. We love going away on holidays. It’s like a ‘reset’ button and we always come back feeling refreshed and ready to tackle whatever is thrown our way next. Instead of always buying presents for anniversaries, birthdays and Christmas, we much prefer to get away and have some extra spending money up our sleeve.
Exercise – get outdoors, enjoy the fresh air and go for a walk. Do the kind of exercise you enjoy doing. For me it’s running and boxing. Nothing beats smashing out your anger and frustration or clearing your mind and the many thoughts constantly going on. Exercise has long been known to boost happy chemicals and release endorphins, making it a fantastic stress relief. Of course there will be days when you just don’t feel like exercising (and that’s totally fine) and days when you will actually be advised against it.
Take a break – I know this may seem counterproductive but it’s nice to take a break from the daily race against the clock. We took a break over Christmas. It great not to constantly be on the run planning my day around what time I need to be home for injections.
Control your mind – most of my stress comes from my own mind. If you’re anything like me, your mind rarely takes a break from general day to day things let alone through the process of IVF. How will I respond to meds this month? How many eggs will I produce? Will they fertilise? Will this be it? The journey is not only physically but emotionally draining. Channel your inner thoughts and try to be positive. Have hope and faith. I know for a lot of people this can be easier said than done.
Be kind to yourself – take some time out for yourself. Get a massage, catch up with friends, read a book, cook, write. Do whatever you need to do to get through each day as it comes and ensure you take the time to REST.
Be prepared to gain some kg’s – especially if you suffer from PCOS. It’s hard enough to maintain a healthy weight with PCOS and with all the hormones being pumped into your body it’s just another nasty side effect we need to deal with.
Be grateful – Know that there’s someone else who is always worse off than you are. Be grateful that you’re alive and have access to incredible doctors, healthcare and the latest technologies.
Before the procedure We were instructed to arrive at the hospital at 8.40am to complete some paperwork, finalise surgery fees ($500 for the procedure) and prepare for the egg collection. Daniel sat with me for about 10 minutes before he had to go to the IVF clinic down the road to do his part. It’s strange to think that we were in separate hospitals for this whole process!
I was called in by one of the nurses and sat with her in a waiting room. She took me through a few things and I signed a consent form, put hospital tags and hair net on and changed into a gown and robe. I was visited by the anaesthetist, another nurse and then my FS. It was great to see my FS there. He put my mind at ease but also reminded me that I was at risk of Ovarian Syperstimulation Syndrome (OHSS) due to the large number of follicles I had at my last scan. Due to this risk, I knew that it was highly likely we would not be able to proceed with a fresh egg transfer five days later.
OHSS occurs when there has been an over response of the ovaries to the stimulation medications. Women who have PCOS, are aged under 30 years and have 20+ follicles retrieved at egg collection are at higher risk of overstimulating. Symptoms include abdominal pain and distention, severe bloating, nausea, fluid retention, weight gain, vomiting, shortness of breath, reduced urine output and pain not relieved by Panadeine or Panadol.
The nurse then walked me into the theatre and I got onto the bed. My FS was cracking some jokes while we waited for the anaesthetist to arrive which relaxed me but I couldn’t help but notice how many people were in the room. At least I knew I was in good hands. The last thing I remember was my FS holding my hand, telling me everything would be ok and saying “sweet dreams” while the anaesthetist inserted the drip in my arm to put me to sleep.
During the procedure, an ultrasound probe is inserted through the vagina and a needle is passed through the ovary into the follicles. Fluid from each follicle is drained to retrieve the eggs.
Waking up in recovery
20 minutes later I was in recovery with a heat pack on my tummy. They gave me pain relief almost immediately. I felt sharp pain low in my abdomen but it soon spread all over. I was desperate to know how many eggs had been collected and the first thing I did was ask the nurse. She handed me a note from my FS which confirmed he had collected 25 eggs and that they would be frozen for a transfer at a later date. They continued to give me pain medication. The more eggs retrieved, the more invasive and painful the procedure is. You should also expect a longer recovery time.
After a little while I was moved to a recliner chair and given something to eat. I felt quite uncomfortable and it was difficult to move. As time passed I was asked to empty my bladder and get changed when I could. The walk to the bathroom was painful. I’ve always thought I had a pretty good pain threshold, but this pain and bloating was a whole different feeling. Little did I know over the next few days, the pain would get much worse and I would gain 7kg of fluid.
Trip to emergency
The nurses discussed my risk of OHSS with me and said they would be monitoring me closely over the next week with daily calls and weight monitoring. They also told me that if the pain got worse and I developed symptoms of OHSS, to go straight to emergency at the Royal Women’s Hospital as it was the Easter long weekend and the clinic was closed. The following night I ended up at the RWH where they gave me pain medication, took bloods samples, measured how much water I drank and my urine output weighed me and measured my abdominal girth. I spent the night in hospital and Daniel was sent home. I was given a prescription for stronger painkillers and was on bed rest until symptoms started to improve. I was also told the pain and bloating would get worse before it got better and that my weight could continue to increase with fluid.
The following week at home
I lay on my back for the next week, barely able to move. I couldn’t sleep on my side, couldn’t sit up on a chair, couldn’t laugh, cough or sneeze and was in agony when I did. I’m not joking when I say I looked six months pregnant. Each night I cried myself to sleep in pain. I’m not one to take painkillers – I need to have a pretty bad headache to take Panadol. Every four hours on the dot, I was taking the next two pills I could. Each morning I weighed myself and my weight was steadily increasing. 1kg, 1.5kg, 1.3kg, 1.2kg, 1kg…..in total I gained 7kg of fluid. I vomited in the first couple of days and my whole stomach was so tender. At one stage, I had a fluid shift which was pretty scary. The 7kg of fluid in my stomach started moving to my sides and back. Wherever the fluid was, was rock hard to touch. It made it difficult to breathe at times and I would get puffed out just from talking.
Daniel was my saviour during these days. I couldn’t walk up the stairs to our bed, so we slept downstairs in our spare bedroom for the week. I would dread going to bed at night. There would be no TV to distract me, no one to talk to, nothing to keep me busy and all I could think about was the pain I was in. I barely slept for the first few nights and was exhausted during the day. Daniel would heat my heat pack every couple of hours, and cater to my every need. Lucky for him it was a long weekend as he ended up pretty sleep deprived too!
I can assure you that if you face OHSS, it does get better with time, even if you think it will never pass and your ovaries feel like they’re going to explode. I promise you that there is light at the end of the tunnel! Rest and take all the time that you need to recover.
The day after your collection, you will receive a call telling you how many eggs fertilised. Out of the 25 collected, 19 were mature and 16 were fertilised. They keep a close eye on them in the lab for the next few days. At day five, we had six embryos to freeze.
I was really relaxed when we commenced our first IVF cycle, probably because I had been through months of injections and we were really eager to get started.
There are four potential outcomes when it comes to your scan
1. Poor response – need to increase medication
2. Over response – monitoring for overstimulation
3. Not ready for trigger
4. Ready for trigger
Injections started on day 3 of my cycle with the aim of having 10-15 follicles for egg collection. They were different hormones and at a higher dose to ovulation induction. I was on 75iu Luveris and 100iu Bemfola every night beginning Thursday 30th March. On Tuesday 4th April I had my first scan for this cycle showing slow growing follicles that were small in size. My Bemfola dose was increased to 137.5iu, while continuing with Luveris and adding in Orgalutran from then until trigger to prevent ovulation. Orgalutran stops eggs from being released too early and is taken at the exact same time every morning. The syringe is pre-loaded and needs a real push to pierce through the skin. It was a much more controlled injection that had a real sting to it.
My next scan was on Friday 7th April and although there were an increased number of follicles growing, they remained small and insignificant. Bemfola was increase to 162.5iu and I continued taking Luveris and Orgalutran as normal. I was scanned again on Monday 10th April and the scan revealed I had 20 follicles putting me at risk of overstimulating. My medication dosage was reduced (Bemfola 100iu, stopped taking Luveris) for the final two days of injections. I had already planned to have this week off work as I had lots of time in lieu which turned out to be great timing.
I knew on Monday I would find out what day egg collection would be. It was scheduled for the Thursday. By this stage my bloating was quite excessive and I could barely fit in water and food during this week. It was recommended I have small frequent snacks instead of meals in the lead up to egg collection. I could no longer wear jeans and I couldn’t go to the gym. I was just too bloated, tired and uncomfortable.
Monday and Tuesday I continued my medications at the lower dose with the addition of the trigger injection Pregnyl 5000 on the Tuesday night. Pregnyl controls the release of eggs from the ovary, causing ovulation. It comes in two glass ampoules of powder and liquid that need to be drawn up in a syringe and mixed together. I received a call from the hospital with instructions on the Tuesday night about my Thursday procedure and timing for the Pregnyl trigger. I was told to administer the trigger at exactly 8.40pm, 36 hours before my egg collection. I was to fast from midnight to 6am with only sips of water allowed. No water was to be consumed from 6am until after the egg collection. The side effects I had from the triggers I had during the course of my treatment were bloating and night sweats. There were a number of nights I’d wake up soaking wet from head to toe – to the point I would have to change my clothes a couple of times during the night. Of course, I complained at the time, but these side effects were nothing compared to what I faced after egg collection.
The first step for us was timed intercourse with follicle stimulating hormone (FSH) injections. The aim of the injections is to develop follicle/s, stimulating the ovaries to ovulate and allow fertilisation to occur naturally by timed intercourse. I was under the impression that if I can produce an egg there shouldn’t be any reason why it can’t be fertilised naturally. Well, it sure wasn’t as easy as that and we faced six failed cycles.
The aim of this cycle was to produce one or two dominant follicles. We started at a very low dose of Puregon because with PCOS there’s a higher chance of overstimulating (producing too many follicles) which could result in multiple pregnancy and in two of my cycles ‘octomum’ where we had to cancel the cycle. Due to the low dose medication, most of the stimming continued for over 20 days (one cycle was over 40 days so you can imagine my disbelief when my period arrived after being absent for years). It was all very slow and steady with 20+ days of having internal ultrasounds every three days and frequent blood tests to check hormone levels. Regular ultrasounds are necessary to check the number of follicles and their development. Each appointment cost $100 – $130 in addition to the cost of medication. We were lucky enough that our FS only charged us for the first five appointments per cycle. To this day we have spent thousands and thousands of dollars on tests, scans, appointments, medication, IVF – we have a folder of receipts but we have no idea of what we have spent up until now. We just know that one day it will all be worth it.
We were to have sex every second day during the stimming then at a specific window of time once a trigger injection is given for ovulation. There’s nothing more romantic about being told when to and when not to have sex!
Injections are administered in the stomach through an epipen looking device. I’ve never really been fussed about needles but did get nervous about injecting myself for the first time. Daniel is definitely not a needle person and I knew there was no way he would be able to inject me. We watched YouTube videos about loading the pen and injecting the needle. They made it look so quick and easy. To be honest I couldn’t feel a thing when injecting Puregon. It was definitely the easiest and pain free needle with little side effects. After the first failed cycle my FS prescribed Ovidrel as an extra support to stimulate follicle growth. I was taking Puregon every night plus the Ovidrel injection every second night. My fridge was beginning to look like a drug lab.
I administered injections at 6pm each night. I knew that at this time I would usually be home from work, and if it was on a weekend I could do it at home before we went out. On one occasion we went to see a show in the city and had dinner at a nice restaurant beforehand. I had taken my meds to work with me and left them in the fridge along with an ice pack in the freezer. We had a 5.30pm dinner booked so we could make the show and I knew I’d need to do the injections in the bathroom. As it got close to 6pm I got up with my freezer bag and went into the bathroom. I went in the toilet and locked the door. There was only one unisex toilet and I was freaked out at the thought of people waiting outside. I was nervous and shaky. I quickly did the Puregon injection but ina panic dropped the needle tip for the Ovidrel injection in the bin. I desperately tried to ruffle through the bin (ewww) but had no luck. I quickly left the bathroom to tell Daniel what had happened. He tried to reassure me in his calmest tone that it would be ok and we could just inject the second needle when we got home. I was distracted for the rest of the evening until we walked through the door at home.
One concern I had when commencing fertility treatment was how I would juggle it all with work. I decided to tell my boss early on during my fertility treatment. I honestly think I would have had a breakdown if I went through the whole process without the support of my employer. I think it would have added to the stress if I chose to keep my treatment private.
As we did ovulation induction with injections prior to IVF for approximately six months, I was having scans every three days and frequent blood tests and although my work is only a 10 minute drive from the clinic, it took time to get there, find parking, have my appointment and pick up any meds. I would end up being out of the office for one or two hours at a time. I’m very lucky that I have a flexible workplace with wonderful colleagues and very supportive and understanding management. If ever there are last minute appointment changes or I’ve had to miss an important meeting at work, it’s never an issue. IVF treatment is time consuming and at times very demanding and my absence was never questioned. I think your choice to disclose your treatment will ultimately come down to your relationship with your employer and how comfortable you feel discussing it with them.
There is no right or wrong about working during fertility treatment and IVF. For me, I worked full time during ovulation induction with injections and dropped a day when I commenced IVF. Do what works for you. I know some people who have worked full time and some who have worked part time. Do what you’re comfortable with and what suits you best.
After you have met with your FS and all of the relevant testing is conducted, you and your partner will require police checks, child protection orders and will need to participate in a mandatory counselling session where you are given the chance to ask any questions, raise concerns, discuss and sign consent forms. You will also meet with your nurse who will go through with you a detailed example of your treatment plan and visual slides of what happens during the egg retrieval and transfer. Daniel was not impressed to learn of the invasive details! The session went for about 90 minutes and was information overload. We both walked out a little speechless. Know that you don’t need to remember everything that was said during this appointment. Your nurse and FS are always available for questions or concerns and are with you every step of the way. When you get to your IVF cycle, you’re given a thorough plan of what to do each day and at what time. Here is an example of the cycle plan we were presented with at our initial appointment with our nurse.
The clinic will also get you in touch with someone from the accounts department who will discuss payment options with you. We were given an initial quote of $10,000 – $12,600 per cycle, yes PER CYCLE, excluding the cost of meds and egg retrieval. What a joke!! We had the option of paying the full amount up front at the beginning of the cycle, 50% at the start and 50% at the end or the full amount to be paid after egg collection. We opted for the last option. You aren’t given any notice as to the exact day payment will be taken so don’t be alarmed when your bank account is down $10,000+.
It was no surprise that once we were married, people didn’t hesitate to ask:
“Are you pregnant yet?”
“When are you starting a family?”
“What are you waiting for? Clock’s ticking!”
“Why aren’t you drinking?”
I took it in my stride for a while, told people not to worry and that we’d let them know when I was pregnant. I’m generally a positive and open person but this is one thing that really annoys me and everyone else who is going through struggles with fertility. You never know the situation people are in – they could be grieving a miscarriage, they may be suffering in silence, in the process of fertility treatment or have faced numerous failed IVF cycles. You may not realise the effect this can have on someone but I can assure you they probably want to punch you in the face and tell you to f$*% off. If this can detract one person from asking this question then this post has achieved its purpose!
When you’re trying to conceive, everyone around you seems to be pregnant or having babies. It starts to get to you when you hear of all the teen pregnancies and people getting pregnant without trying, or hearing of parents who neglect their children or hearing people constantly complaining about their pregnancy and kids. It’s obvious they haven’t faced the challenges of infertility. I urge you to think before you speak. Your seemingly innocent questions and comments may be received with a fake smile that’s hiding a deep pain, frustration and stress beneath. The bottom line is whether you’re a family member, friend or just a nosy person in general, it’s really none of your business and if someone wants to let you in they will do so at their own time.