Rising from the ashes

Thankyou for your supportive comments, emails, phone calls and messages. This last week has been challenging for both Murray and I. I'm not quite up to writing too much right now, especially since I have come down with a killer flu today, but we are coping.
For the moment we aren't pursuing any more fertility treatment. That's not to say we wont in the future, but the pain of all of this is going to take some time to fully deal with.

And zero equals none

None of the embryos made it. We are heartbroken. I don't even know where to begin.
Another door has closed.

Insanity

They say the definition of insanity is doing the same thing over and over again and expecting a different outcome. I guess I'm insane.

All of our eight embryos have arrested, with no cell division at all. The embryologist said that there is a slim chance that one embryo may still divide and just be extremely slow, but to prepare ourselves for the fact that none have made it.

I can't express the anguish or the shock.

Day 24 - Fertilisation Results

After a couple of hours playing phone tag with our clinic, we have our fertilisation results. Of the ten eggs collected, two were immature and unable to be injected (ICSI). However of the remaining eight eggs that were injected, all eight have fertilised! We are thrilled with this result, and are now holding on for each days update.

I am really hoping that we will be able to do a transfer (day 3 or 5, either will be fine), and then have at least two to freeze so that we can avoid doing any further stim cycles.

Day 23 - Egg Collection

Egg Collection is over and done with and we have ended up with 10 eggs! It's the lowest number of eggs I've had retrieved to date, but as a result, my OHSS risk is quite low which is great. Also great is how good I am feeling after the procedure! Concept use a twilight anaesthetic which I am completely in love with after today's experience - no nausea, no breathing tubes, up and walking in an hour and a half after surgery.

So for now I am resting up, I haven't slept much these last couple of days, so using this time to catch up my sleep debt. I have to call the clinic between 2 and 3 tomorrow to find out our fertilisation results. We did ask the embryologist this morning if we could use ICSI rather than straight IVF, just to throw everything we have at this round of treatment, and they have agreed to our request.

Praying so hard that we make it to embryo transfer.

Day 21 - the results

We are going ahead with egg collection on Friday!!!

I am so relieved that we are able to go ahead with treatment, I let out the biggest sigh of relief once I got the phone call with the good news. It was actually the nurse who I had the altercation with this morning which made the conversation a little interesting. She made a comment at the end that I 'got what I wanted' which I thought was a little snarky at the time. But I'm not dwelling on that, I am just so pleased to finally get to this point.

It has been two years since my last egg collection! And this time it is at a different clinic with different protocols. From what I've heard, Concept use a twilight anaesthetic instead of a general which is a little scary! But apparently a lot easier to recover from which can only be a good thing.

So my trigger injection will be at 7.30pm tonight (at the concert!) and then we get to the clinic first thing Friday morning for egg pick up at 7.30am. All going well, next Wednesday we will have a little embryo on board!!!!!

Day 21

Plenty of follicles, one at 20mm, a whole bunch between 14-16mm, and even more at 10-14mm. I'm fairly sure they wont trigger me tonight and may even wait until Friday to trigger.
I am utterly spent. I have cried more in this cycle than I have for the whole year before this month. I am on edge all the time, and the slightest thing can send me into a tail-spin. It doesn't feel like my usual depression-mix though which makes me think it is purely situational - the hormones and treatment cycle are just pushing my buttons hard this time round.
That may explain why I ended up in a (how to put it politely) 'disagreement' with one of the fertility nurses this morning. I came in with good intentions, just needing to let them know that I was nearly out of drugs and would need some extra from tomorrow. Somehow it turned into a debate as to how far to push a PCOS patient during IVF, with the nurse disputing that my Dr is conservative, and basically saying that I had no idea what I was talking about, that she did know, and bla bla bla. I know I'm a little sensitive at the moment, but she was getting agitated and I wasn't happy, so I walked out of that room very upset and having a good cry in the car before I headed to work. Now I just hope that she isn't the one who rings and gives my results this afternoon.

Day 20

It's mixed news according to the nurse who called with my results this afternoon. My hormone levels have risen which is a good sign, but they are confused about why my follicles and estrogen aren't matching up. They think that it could be a sign that the eggs aren't the best quality. He nurse said the doctor is considering whether to cancel the cycle. She also said that an alternative may be to go ahead with egg collection and freeze all the embryos.

My comments back to her were that firstly, if we do an egg collection, unless I am hyperstimulating, I want to have an embryo transfer. There is nothing lost in trying it, and if it doesn't work, we are no worse off than if we had chosen to not have a transfer. The other thing I said was that I needed more information to make an informed assessment of the situation. Does 'the eggs may be poor quality' indicate that no these eggs wont work at all, or is it simply sub-optimal. If it is the latter, and it is only a reduction in quality (eg from a 45% success rate, to a 35% or even 25% success rate), then I want to keep going. There is a school of thought that embryos that come from a OHSS cycle are poor quality, yet we managed to get pregnant twice from those eggs, so surely it's not the be-all and end-all? But I also realise that if when they mean poor quality they are actually saying the eggs are unusable, well that's a different story. The nurse mentioned that fertilisation can be poor with these eggs, but surely that is what ICSI is used for, where there is a prediction of poor fertilisation?

My estrogen level today is back at 3400 and I have another scan tomorrow morning. If things go well, I may have to take my trigger injection, smack bang in the middle of a concert we are going to tomorrow night. My favourite artist of all time is coming to town and there is no way I am going to miss the show, but it will certainly be experience trying to get a needle through security!

Day 19

I am so nervous. I've done this 13 times before, I should be used to it by now. But I am so scared that we wont get to egg collection. I'm petrified the doctor will say we have to many follicles and risk of hyperstimulation is too high. I worry that my call from the nurses each afternoon will say my hormone levels are too high, or too low, or too something. I have never felt the rollercoaster as much as I have this round.

I don't have a Plan B. I have always had something else to move onto - first it was IVM, then IVF, then frozen transfers, donor sperm and adoption. But we are all out of options. Right now this is the only option, and it is a one time deal according to our Dr. I can't afford to have this fail. I'm not sure my heart can deal with another failure. I keep having these fleeting moments of hope, which I have to squash down so I don't set myself up for a fall. And then I play with my bestie's littlies next door, and my heart beats squeals at me to keep going.

My scan this morning showed around a dozen follicles on each side, the biggest at 16mm with a bunch of 10-14mm follicles trailing. I will update when I know what my estrogen levels are and what is happening next. My guess is another blood test tomorrow, possibly triggering Wednesday night and egg collection on Friday. Trying to keep my head screwed on, and not panic too much. Gosh it is hard.

Edited to add that my blood test results are back and my estrogen levels have dropped to 2200. The clinic can't explain it, and I don't understand it. They said that it may indicate a quality issue, but considering I haven't had that issue before, they are still proceeding. Off for another blood test in the morning.

Day 18

And my hormones have dropped a little bit today, back down to 3300. Had a mini freak-out on the phone, but the nurse assures me that it is perfectly normal for the levels to fluctuate a bit. I'm off to the clinic again tomorrow morning to check what is happening with my follicles. Am hoping there aren't too many people at the clinic in the morning as I have a 9am meeting which our General Manager chairs - not a good look to be late for that one!

This has been a decidedly lazy weekend; lots of lazing on the lounge with the furbabies, heater on, and the football on television. It helps that the weather outside has been on the wet side, giving me an excuse to be this lazy! Hope you are all having a fabulous weekend, wherever you are and whatever the temperature!

Day 17

We are still in it. Estrogen is at 4700 so it hasn't risen too much, yet just enough. My lead follicle was at 14mm (although Murray and I think it is 13mm and the Dr wrote it down as 14 just to make me feel better - true story!). I sighed such a deep sigh of relief when I got the phone call with my results. The nurse said that I need to come in for a blood test, but that my trigger injection should only be a couple of days away.

I can't believe that we are actually going to get to egg collection. At this point of our treatment woes, I can't even visualise being pregnant, but the hope this brings me is immense. I have so many people sending me messages on facebook, twitter, sms and email, moreso than I ever have for other cycles. We need this. Lord, please let this be it.

Day 16

Estrogen is at 4400 and I have to go in for a scan and another hormone check in the morning. Please let this be it...

Day 15

My estrogen has risen to 3300, so fingers crossed my body has finally worked out what to do. I have another blood test in the morning, and then probably a scan on Saturday morning. Every time the clinic rings with my results, I expect something bad to happen and for the cycle to be cancelled. But we are still here. Every part of my body is willing this to happen.

Day 13

My estrogen has gone up to 1200 so we are still in the game for now. My ultrasound shows a bunch of follicles around the 6-9mm mark, still very small for this stage of my cycle, but we are going to push on and see if we can get them to grow to maturity.

My head is all over the place. For the first time in all of our 14 treatment cycles, I cried while having my ultrasound done. I couldn't help it, I was so upset that there was no lead follicle, and that they were still so small. The nurse ended up spending 10 minutes with me afterwards, helping me to calm down.

Most likely this cycle will be cancelled. Logically I know that. But I am so grateful that we are still pushing through to see if we can salvage something from this situation. Just to get to egg collection would be a miracle in itself.

Fingers crossed.

Day 12

My estrogen has popped back up to 580. No idea what is going on with my body so back for another ultrasound tomorrow morning. At least it is something.

The Call Back

Eventually I got a phone call last night at 6pm, but unfortunately I was in the shower and missed it. Instead of leaving instructions like they usually do, I was asked to call back today to get my results. Right. So I called at 8 like they requested and was told that someone would call me when they were free. By 11am I still hadn't heard, and had no idea whether to continue with my drugs or not. I called back and told the receptionist that I wasn't hopping off the phone until I spoke to a nurse. Finally I spoke to a nurse who seemed surprised that I hadn't been called back earlier.

The results weren't great. My estrogen has dropped back to 350 and they don't know what is going on. They have said for me to keep going with my drugs and have another blood test tomorrow morning. It might just be drawing out the inevitable, but considering I have all the drugs here anyway, and my body is unpredictable, I may as well keep taking them and monitoring my levels to see if by some miracle, my body comes right.

I was meant to go to my father-in-laws birthday last night, but I ended up sending Murray by himself instead. It has been a really rough couple of days, and my coping mechanisms are not working. I didn't want to be around other people, least of all a newborn baby. Instead I spent the night cuddled up with my fur-babies in front of the tv, watching the full first season of 'The Big Bang Theory'. It was great therapy to laugh at mindless jokes, and forget about everything going on. I need that.

Unimportant

Apparently I am that unimportant, that the clinic couldn't even be bothered calling me back with my results and instructions this afternoon. I went in for my blood test and scan this morning. The scan showed lots of antral follicles but no other follicle development, so I know that things aren't good with this cycle, but I left clear instructions with the nurse about what I wanted to happen (use up remaining drugs and continue to monitor to see if we can convert to IUI).  I also had a good cry to the nurse as I was upset about the scan and the whole nine yards. SO they knew this was important.

But apparently it is too freaking difficult to call all of your patients back. You know, because it's not like we are paying them huge amounts of money or anything.

It might just be a small stuff up, but after the week I have had, it's the straw that has this camel at breaking point.

donors, embryos and ivf

I called the clinic today to check where we are on the Donor Embryo waiting list. I shouldn't have got my hopes up. We are number 50 in the queue at the clinic. With only a handful of embryos donated each year, it is pretty much a write-off.

Another roadblock.

I'm seriously considering advertising in one of the Perth womens magazines, appealing to women who have had their children through IVF, if they have finished their families, to consider donating their remaining embryos to us. We don't care about ethnicity or physical features. We just want a child to love and care for.

This IVF cycle hasn't busted... yet. At least that is something to hold onto. My estrogen was at 510 this morning, so I am off to the clinic in the morning for a scan. I just need something to go right for us.

Email from Adoption Services

I got into work this morning to find an email from the coordinator at Adoption Services. Turns out they never even sent off my original medical report. And apparently the BMI limit is mentioned at one of the workshops I went to. I can categorically say 100% true that it was not mentioned, ever.

The email is below

Hi Rebecca

I thought I would send you an email, as I know that you feel very upset today with the news that our medical doctor has not recommended you as fit to adopt, as your BMI does not satisfy the criteria of 35 or less. I thought by sending an email you can read with your husband, so that you both have a clear understanding of the issues, and then call me when you are ready if you have further questions. I will still send you the official letter notifying of the medical outcome within the next week.

I have searched your records and spoken to relevant staff to try to clarify why you were not sent a letter last year when you submitted your medical in May 2010, as I did not work here at that time so have no prior knowledge of your application. My inquiries have revealed that it appears your medical was not sent to our doctor. I have been told that this was at a time when the officer who processed left, and there was a gap in replacement for a few weeks. That seems to be why you were not sent a letter. I apologise on behalf of our unit, as appears was an oversight at that time.

However, you should know that because your BMI was over 35 at that time as well, as recorded on the medical report you sent in from your own doctor, that the same outcome would have occurred as now when your medical has been resubmitted - as your BMI is still over 35. I know that this does not make it right that your medical was not sent, however the outcome would have been the same, that of notification that your BMI is over 35 and not approved as fit to adopt. Also your husband's medical issues were also occurring and have only just been resolved, with his approval as fit to adopt, so you would have had to submit a new medical as you have as are re-done every year during the application process.

Staff have also informed me that at the Information seminars applicants are told about the BMI requirements, and are asked to speak to staff for further information if they think that this may be an issue that will impact their assessment. I cannot speculate on why you have not understood this medical requirement to adopt.

Please do not hesitate to contact me to discuss further, and again I am sorry if you have not considered the BMI requirements before now.

Kind regards

Hang on, you guys stuffed up. You admit you never sent through the medical report, which I paid money for, followed the correct process, and you did nothing with. You didn't advise me then, at the proper time, that there was an issue. So this whole year, we have believed that my medical was accepted as 'fit to adopt'. If we were told then, it would still have been frustrating, but I could have done something about it! Instead, due to their stuff-up, we have wasted a whole year of our time and money on this, not to mention the stress of Murray's application issues.

But what do you say to me? That I have not considered the BMI requirements before now!!!

Are you kidding!!! This is the first time it has been mentioned!!! How can I have 'considered' the requirement if I didn't know it existed until yesterday!

Furious.

BMI for adoption in WA

I've been doing some research on BMI limits in WA, to try and find out where the hell this weight limit has come from and what our options are.

The most recent review of Adoption in Western Australia had a section on BMI

4.3.2 Use of Body Mass Index (BMI)

A persons BMI may be relevant in assessing whether the person is physically able to care for and support a child until the child reaches 18 years of age. Currently, a persons BMI is considered as part of the medical examination report provided by an applicant to the Honorary Medical Panel. The panel may seek a specialists opinion where there are concerns. Following this, the panel will provide a report on the persons overall health to the AAC as to the persons medical fitness.

Committee’s analysis of the issues and findings

The committee acknowledges concern from some that using the BMI discriminated against those who are obese. However, the committee considers BMI is a relevant factor to be taken into consideration as part of a persons assessment and is satisfied that the AAC does not have arbitrary rules in relation to the use of BMI. Each individual case needs to be considered on its merits. As was recently acknowledged in Parliament, no applications are rejected solely on the grounds of weight. Rather applicants are not approved on the basis of failing to meet the criteria set out in s.40.(which states that the applicant has the physical and mental ability to care for and support a child until the child turns 18). The AAC appears to be properly informed by the medical panel on issues relating to BMI as part of a holistic assessment of a persons physical capacity to parent a child until 18.

Link to Legislative Review Report 

I don't know what that means for us, the report is four years old now, but surely factors other than BMI are more important? For crying out loud, I have run three triathlons in the last two years. I help out with three littlies next door. I am freaking capable of running around after my own child. I don't imagine I am going to die before I turn 43 (when the child would turn 18). And who's to say that somebody with a BMI under the 35 limit wont get hit by a bus tomorrow, or be diagnosed with cancer, or have a heart attack? So angry and upset, I just cant think straight right now.

Kick in the guts

I spoke to Adoption Services an hour ago. At this stage the medical panel wont recommend me for adoption because my BMI is over the 35 limit.

The kicker is that the legislation has no mention of a weight limit, nor does any paperwork in the process so far, nor has anyone mentioned this in our workshops or numerous phone calls and face-to-face meetings.

The other thing mentioned was that they would want my doctor to also provide more information on my depression. I questioned the adoption coordinator as to why my initial medical report was accepted with no questions at all, when my weight and depression were all a part of the initial medical report done in April last year. She couldn’t answer me. She also couldn't tell me why I hadn't been told about the weight limit and couldn’t point out where it was written in any of the documentation.

This was my big hope, the thing that has kept me going. My heart is in a million pieces right now, and I am not coping at all with this new hurdle. How many things can be thrown at me? I can't get my head around the losing weight, the time and effort and energy expended that I will need to put in, I cant even imagine me at the weight they want me to be at. There is such a mental block with my weight, something I can't lift.

We have the option to continue with the adoption process, but we were advised that the full adoption panel rarely, if ever, approve applicants who are not recommended by the medical panel, and she suggested that we put it 'on hold' for now. Right. I feel like I've spent the last five years 'on hold'.

I can barely breathe.

IVF Update

Day 6 today - had a blood test this morning, estrogen levels are baseline still at <150, which I expected. Dr has given the okay to up my Gonal-F dose to 75iu, and have another blood test on Friday to see if that makes any difference. We'll see...