Either way, I would recommend you have someone present to give you support while you’re self-injecting, whether it be your partner, a family member, friend or even a neighbour. A little bit of encouragement goes a long way, and it can be a nice bonding experience, allowing the support person to feel involved in the process of helping you make a baby.
Mario was away in Brisbane when I did my first and second course of injections so I asked my sister Sarah to be my injecting coach. She was living only about five kilometres away but we did most of it by Skype. Sarah would call me up and help me to get started: ‘Okay, come on. LET’S DO THIS!’
I’d set up the medications and get the needles ready, and then she would count me in to the actual injecting part. It took only a couple of minutes each time, but she told me later she really loved those sessions because it made her feel included. We even took a couple of screenshots to remind us!
There were two kinds of medications that I needed to inject. In the first week I just injected the medication that helps grow the follicles. The needle was very thin and stung only a little. I was relieved, thinking it was going to be a piece of cake to get through this injecting part. Then, in the second week, I also injected the second medication, which prevents ovulation. This is injected separately but at the same time as the follicle-stimulation injection, and it did hurt. That’s when I really needed Sarah’s encouragement to go through with it. I was careful to find a different spot every time; I used the entire mid-section of my stomach and emerged with a bunch of impressive bruises.
Injecting was not fun, but I kept my focus on the fact that countless needle-shy women before me had managed to get through it and, if all went well, I would be amply rewarded for the pain.
My last piece of advice:Don’t forget to breathe!
4. What will Mario have to do?
There aren’t too many upsides to IVF; however, to be brutally honest, after the bi-state craziness of Clomid it was a relief to be able to take both Mario and distance out of the equation. On a practical level, the male parent’s only official role is to provide the sperm sample when it’s time to fertilise the eggs. Of course, Mario gave a whole lot more than that in terms of support and encouragement, but it was me, the mother, who was physically going to do all the hard yards.
Mario was very conscious that all the invasive procedures would be happening to me; I would be the one on the front line. As long as I was willing and able to take all that on, he would be with me 100 per cent. I was in the driver’s seat.
Having said all of that, I believe very strongly that the emotional impact of the IVF process on the partners must not be overlooked. The sense of who they are as a partner and as a man can be severely shaken when they are sidelined to the role of sperm donor, while the mother and doctors are intensely engaged at every step.
Happily, there are IVF support groups and discussion forums for men. More and more IVF clinics have male-focused counselling sessions, and their websites have info pages and advice specifically for men starting the IVF process with their partners.
Some women want their partners to be with them throughout the procedures and benefit greatly from their loving presence even though they can’t actually do much. Mario was still working in Queensland and I was fine with that. I was glad that he was occupied with his job, and I could pour all my energies into the IVF procedures. Needless to say, the phone bills were enormous.
While Mario and I were coming to grips with all the facets of beginning IVF, and while the paperwork was working its way through the system, Roshan began running preliminary fertility tests. Mario had to take a semen analysis test, in which he was required to provide a sample that was tested within the hour. His sperm were examined to determine how many million there were per mL, their ability to move forward (their motility), and their size and shape (their morphology), among other things. Results showed everything was fine in that department.
For me, the anti-mullerian hormone (AMH) test was the first cab off the rank. Medicare doesn’t cover the test, but the cost was less than $100 at the time and all I had to do was provide a simple blood sample.
Every woman is born with her entire lifetime-supply of eggs, and as each year goes by those eggs decrease in quality and quantity. AMH is a hormone that is secreted by the developing cells in the eggs sacs, or follicles. By testing the level of AMH in my blood – the level doesn’t fluctuate so you can take the test any time of the month – Roshan could get a good indication of my ovarian reserve.
He explained that the test would come back with a number between 14 and 25. The lower number indicates that your reserves are very low and you’re heading into menopause. I was thirty-eight years old, so the expectation was that my number would be around 16 or 17. It turned out to be 24.5. According to the AMH, I had the fertility of a thirteen year old!
Roshan said this was a major clue indicating that my body didn’t produce enough follicle-stimulating hormone (FSH) needed to grow an egg to maturity or luteinizing hormone (for ovulation). I was like a clucky chicken sitting on a big store of eggs that couldn’t be released because I didn’t have the right trigger. None of my eggs were robust enough to be released. The inability to ovulate can be due to a number of factors, from low skin-fold measurements to high stress, such as when the body is in a constant state of fight or flight, as in wartime, or when (surprise, surprise!) the body is in a constant state of preparation for high-level athletic performance.
That was a big ‘aha moment’. The AMH test told us I had plenty of eggs and we just had to work out how to get them to grow big enough and strong enough to drop. Exciting news! I loved being able to visualise what was going on inside me – it made everything more real and achievable.
The next test was the clincher. Roshan did an internal scan that confirmed something that Ravi had suspected for a long time: I suffered from polycystic ovarian syndrome (PCOS). All those years that I never had a period had indicated that PCOS may be an issue, but I had never been tested officially. Sure enough, the scan revealed my ovaries were like the surface of the Moon! There were clumps of yucky-looking cysts crowded all over them, which can be a classic symptom of PCOS (although not all women with PCOS will have lunar-landscape ovaries).
My particular case was unusual because I didn’t exhibit any of the typical symptoms of PCOS that occur due to the hormone imbalance. Being overweight is one, and I was as thin as I’d ever been. Another sign is excess hair on the face, chest or arms, and I’ve always been distinctly hairless in those areas. Research shows that there’s a genetic factor at play with PCOS too, but I wasn’t aware of anyone with it on either side of my family tree.
You could put it down to the rigorous athlete’s life throwing all my hormones out of balance, but I think I just wasn’t producing any hormones at all!
There’s no surgical option for treating PCOS; it’s about managing the symptoms and adjusting your lifestyle. At least now we knew why my egg reserves were still so high. Month after month they sat inside the walls of my blistered ovaries, not one of them ever reaching the stage of maturity.
On the upside, Roshan told me that women with PCOS often make good candidates for IVF. He said because I had a good store of immature eggs, the IVF drugs would provide the right hormones to finally allow those eggs to grow to maturity and successfully unite with a sperm.
By June, all the checks had been done and we finally got the green light. I was raring to go and eager to see what the future would bring. Now that we had identified the PCOS and I knew that Clomid couldn’t have helped us anyway, I wanted to begin working with the experts to help us achieve our dream.
At the same time, I had to carry the heavy knowledge that this was my last chance to conceive a child. If IVF didn’t work, we were out of options and I would have to accept that I would never be a biological parent. The desire to have my own baby was stronger than it had ever been. I could almost taste it. Just as I had done for twenty years during my sporting career, I now needed to make sure that I
was doing everything possible for a successful outcome. We had a plan and a great fertility team, I was exercising lightly, and I was still spending four sessions a week on a yoga mat being kind to myself.
Knowing the pressure was on, knowing this was our last real option to conceive our own biological child, I wanted to add one more thing to my toolbox – traditional Chinese medicine (TCM) and acupuncture. Someone suggested I go to see a Chinese acupuncturist who was dedicated to getting women pregnant. He is quite well known for the little miracles he has helped create. I made an appointment with him; it was a six-week wait but it was worth it. When I walked into his small suburban home that had been converted into a successful business place, the walls were covered in thank-you notes and photos of newborns. I felt hopeful. The TCM doctor told me that I would need to see him regularly for acupuncture to create blood flow to my uterus and that my diet needed to change dramatically if I was to give myself any chance of conceiving a baby. He said that my uterus was cold and that it needed warming; when I heard that for the first time I didn’t understand what he meant. ‘What do you mean, “cold”?’ He said that the uterus is like an oven and nothing bakes in a cold oven. If you eat ‘cold’ foods and drink cold liquid, your oven stays cold. I was told to remove salads, yoghurt and cheese from my diet, along with most of the fruits and vegetables I would normally eat. What I needed was some warming up! He suggested that I indulge in prawns, lamb, chicken, coffee, butter, raspberries and apricots, to name but a few things. The other major change was making sure I drank only room-temperature water. I didn’t care about a changing diet. I knew this was my last chance and I was willing to do whatever it took – just like I did when I was an athlete.
8
TV School
I was glued to the Giuliana and Bill reality TV show, fascinated to see what would come next for them and therefore me. I remember watching the part where Giuliana had her first appointment at the IVF clinic and she came out carrying bags and bags of drugs. I thought, ‘They must be doing this for television – it can’t be real!’ I truly believed they were bunging it on for the sake of the cameras.
Two weeks later, I had my first appointment at City Fertility Centre and, sure enough, I staggered out of there loaded down with carry bags and a cooler full of medications.
WHEN YOU’RE TRYING TO GET pregnant and struggling with fertility you can feel very isolated. Everywhere you turn, it seems there are adorable babies and proud, beaming parents. Chances are that your friends and relatives are getting on with their own families, so a lot of social interaction centres around children. My sister Sarah already had two beautiful kids, and I shared her joy at their antics and achievements.
At the same time, it felt like I was on another planet. There were days when I was swamped with envy after hearing about yet another girlfriend falling effortlessly pregnant. I had to work hard to keep my emotions under wraps. I didn’t want people to feel they had to tiptoe around me and my desperate longing. It is a sad state to be in, and it is hard work trying to maintain ‘normal’ responses to other couples’ happy news.
Looking back on that time, I realise that connecting with other women in my position – to someone who could relate to how constantly torn I felt because they were going through the same thing – would have been helpful and healthy. There were groups run by counsellors, but not any close by, and I must admit I wasn’t that keen. These days, however, there are patient-led groups springing up all over the place. Usually they are attached to a clinic but there are independent ones, too, and they are definitely worth exploring. I like the idea of everyone in the room being more or less in the same boat.
In 2011 I was eager to find other women whom I could relate to and most of my searching happened online. Then I stumbled across a television show that became my guiding light in those early months of IVF.
Giuliana and Bill was a US cable network reality show that featured a celebrity couple, the Rancics. Entertainment anchor Giuliana and her entrepreneur husband, Bill, had a very public courtship and marriage, and their struggle to have a child became the central focus of the 2011 season. From my point of view, the amazing thing about the show was that Giuliana was going through IVF exactly two weeks ahead of me. This meant that I could watch the process unfold for Giuliana and then a couple of weeks later I would go through the same thing! It was like TV school.
Of course, I was totally addicted and I couldn’t wait for those weekly episodes to find out what was going to happen to me next. There were marked differences in our situations, but it was extraordinary how similar our experiences were in other ways. I gained invaluable information and tremendous comfort from that show.
Believe me when I say that nothing, and I mean nothing, can prepare you for what’s ahead.
The most common method, or ‘protocol’, for women starting IVF is an antagonist cycle. Basically, the woman has to grow some eggs for the specialist to extract and fertilise, resulting (hopefully) in some strong, viable embryos. Antagonist cycle Day 1 starts when you get your period. As we all know, I don’t get periods so I had to take progesterone tablets to bring it on. When my period began, I rang City Fertility Centre and they instructed me to come in that day or the next day to collect the IVF drugs. I was excited! I couldn’t wait to get started.
I have a very clear memory of that first morning in the waiting room at City Fertility. There were at least six other people waiting – couples and women on their own – and I couldn’t help wondering what they were there for. To see a nurse? A patient information session? Embryo transfer? Collecting drugs like me? We were all sitting around reading parenting magazines and looking at brochures, stealing glances at one another, all curious but too shy to engage!
Then I was called in to one of the meeting rooms, and I sat down at a small round table with the nurse. There was a mini-bar stocked with juice and fresh sandwiches for all those people who had to leave work for their appointment and didn’t have time for lunch. It was a nice informal set-up and very welcoming.
The nurse brought out the specific drug prescription that Roshan had organised for me. There were brown paper bags filled with medications and a mini-cooler bag filled with all the drugs that needed to be refrigerated. She also had an instructional tray with fake injections and artificial skin so I could try injecting here, before I had to do it on myself.
The nurse carefully explained what I was going to have to do. As she unpacked everything the round table quickly filled up. It was a lot to take in and afterwards I thought I should have filmed it on my phone so I could refer to it later. My injection regime consisted of three different medications. I would start with one a day, then two separate injections twice a day, then a combination of three a day. I definitely didn’t want to mess up! When I got home, I’d have to clear a whole shelf of the fridge and a kitchen cupboard to store my ‘baby drugs’.
The last thing she gave me was the all-important planner. It’s just a simple generic calendar page divided into thirty-one days; together with your IVF team you plot out how the cycle will play out. The planner was to become my bible. I stuck each new page to the fridge and referred to it constantly. Everything was noted down: what time of day to inject and the amount of medication for every shot, the projected trigger day, the projected egg pick-up day, the likely transfer day, and the subsequent two-week wait until you take the pregnancy test.
Starting the injections also meant increasing my visits to my traditional Chinese medicine doctor for some ‘fertility acupuncture’. My first injection was on 20 June. You inject at the same time of day, every day, to coordinate with the trigger injection and determine the egg collection thirty-six hours later. The hormone needs to move through the body at a sustained level so exact timing is vital. Wherever I was and whatever I was doing, at 8 p.m. I needed to stop everything and inject myself!
On Day 2, I was at an evening Gold Class movie with some friends. We had organised the date some weeks before and I decided the injecting wasn’t goin
g to interfere with our plan. I had a syringe that was small enough to tuck away in my handbag and a small yellow haz-chem disposal unit for when I was done. I used the light on my phone to see what I was doing, and it all went off without a hitch.
Injection cycles vary between nine and fourteen days. (I had twelve days of injections – Day 13 was the trigger injection.) Halfway through I began seeing Roshan every second day for an internal scan. Normally a woman produces a single follicle in one ovary every month, but the injections were to stimulate multiple follicle growth and Roshan had to check both ovaries for follicle production. That first cycle I had seventeen follicles instead of the usual one. In my mind that made me seventeen times more hormonal. I coped relatively well but it’s no wonder some women go a bit loopy at this point! An important reason for scanning is to monitor for hyperstimulation. This is when there are too many rapidly growing follicles in the abdominal cavity, causing a range of symptoms from bloating and nausea to shortness of breath, decreased heart rate and other risky conditions. If a woman goes into hyperstimulation, the IVF cycle will be cancelled. It’s simply too dangerous to continue.
Once my follicles had reached two centimetres in diameter, it was time to book in for my procedure – the egg pick-up. Any bigger and they’d be ‘overcooked’; any smaller and they’d be ‘undercooked’. Bear in mind that through all of this I was carrying seventeen two-centimetre follicles around, feeling bloated and tender. My spirits were high, though. I was confident that we were going to hit the jackpot first time around. With a healthy store of eggs, a good crop of follicles and my expert fertility doctor to help send them on their way, I thought success was all but guaranteed.
The next step was the trigger injection, and this is when things got dramatic. Timing is everything and if you miss the sliver of a window, the whole cycle is a bust.
Here’s how it goes: the trigger injection contains a hormone that releases the eggs from the follicles, and exactly thirty-six hours later you need to be prepped for a surgical procedure during which your fertility specialist will insert a special needle and extract the eggs from their follicles
Frozen Hope Page 8