Frozen Hope

by Jacqui Cooper

  Instead, I just reclined there, contemplating the big mural on the wall in front of me. It was a beach scene – waving green palms, brilliant white sand and glittering blue ocean – placed there, no doubt, to encourage patients to relax. I couldn’t help thinking that if these embryos turned into twins, it would be a long time before Mario and I could entertain the idea of taking a romantic tropical holiday together!

  It was the weekend and all was quiet in the clinic when I got up to leave. Roshan had disappeared and the embryologist was back to embryo watching. The nurse chaperoned me from the embryo-transfer room out to the front of the clinic, where I collected my little bag of drugs and the slip of paper to take to the pathologist for a pregnancy test. Even the street outside was deserted. I really understood then the striking imbalance between patient and professional. What was a massive deal to me was just another inconsequential, daily procedure to the clinic staff. Just another day in IVF land.

  I sat in the car gently patting my belly and whispering, ‘Here you are. Safe inside at last!’

  On the way home I stopped by my Chinese doctor’s clinic for some acupuncture. This was an ideal time to promote blood flow to the uterus, now that it was officially hosting two possible human beings.

  As instructed by Roshan, every day I used a gel called Crinone, which the clinic supplied. You administer it vaginally via a disposable applicator, just like a tampon applicator. It is simple to insert, and there is no discomfort at all for most women. Crinone is a specially formulated gel that delivers progesterone to the uterus. This natural female hormone prepares the uterus wall to receive and nourish an embryo. Women with a hormone imbalance (like me) don’t produce enough progesterone. When the progesterone level drops, the uterus is not able to support a pregnancy. Bleeding commences and any chance of pregnancy in that cycle is over.

  During IVF, you start taking Crinone when the embryo is transferred. If you are one of the lucky ones and the embryo implants, you continue taking Crinone for up to three months, until the placenta is producing enough progesterone on its own to support the pregnancy.

  It sounds like a wonder drug, doesn’t it? Well, it definitely is for women with fertility issues, but it has its drawbacks.

  First, there’s the cost. The IVF program provides you with enough Crinone to take you up to the pregnancy test, but beyond that you pay for it yourself. It won’t break the bank (it cost me about $13 a day), but it can add up when you take it for a prolonged period of time. Every woman’s case is different. Some women take it for one month; I took it for three months.

  Second, Crinone is a strong hormone and it affects everyone differently. I’ve heard of women who experienced large mood swings and quite severe depression. Some say that it made them feel like they were going crazy. Put Crinone together with the agonising wait to find out if you’re pregnant, and it can be a very volatile time.

  Third, it can be rather gross. Whichever way you ingest it, Crinone is designed to attach itself to the wall of the uterus so that the hormones that it contains are absorbed by the tissue; however, what’s left behind doesn’t conveniently dissolve, but instead tends to work its way out of the vaginal canal in pale, gluggy clumps. If you look through online IVF forums, you’ll find descriptions of women with underwear full of ‘cottage cheese’ and general yucky, clumpy discharge as a result of using Crinone. It was quite a shock the first time I saw it. Gluey, clumpy Crinone isn’t pretty, but don’t worry, it is pretty normal. Prepare yourself and make sure you’ve got a good stock of panty liners to mop up. For women starting IVF now, there are other options available that are less expensive and not as messy. That is good news!

  Under non-IVF circumstances, a woman will ovulate and if she doesn’t get pregnant she will bleed around fourteen days later. With IVF, the egg pick-up date works like the ovulation date. You start using Crinone to artificially maintain the pregnancy hormones over the next fourteen days and then you take the pregnancy test. The Crinone is preventing a period from happening in the hope that a pregnancy has occurred. If you take the pregnancy test and it comes back negative, you stop taking the Crinone and eventually a period starts.

  The two-week wait (or 2WW) is one of the most notoriously difficult parts of the whole IVF experience. On the physical level, it’s relatively straightforward: you take your Crinone and try not to do anything very strenuous while you wait to see if the embryo ‘sticks’.

  On the emotional level, it’s a whole different ballgame. I was looking for the tiniest sign that indicated what my embryos were doing and whether I was pregnant or not. I was feeling crampy, which was supposed to be a sign of early pregnancy, but I knew that cramps could also be a result of all the activity my uterus had recently been subjected to. Crinone was also said to cause cramping. I was over-diagnosing everything, and it was sending me round the bend.

  Mario was away and there was hardly any work to keep me occupied. I had way too much time on my hands and I was addicted to trawling the internet. As much as it was time-consuming, soul-destroying and emotionally draining, I still got on Google and typed in ‘IVF success stories’. Obviously, I was so desperate for anything that would suggest I could be pregnant. I would read different threads for hours and hours; some nights I would look at the bedside clock and be shocked that it was 4 a.m. Women’s personal stories sucked me in the most and, oh boy, did I feel like screaming when I’d find someone in a similar situation to me and the thread would suddenly stop. I’d speculate wildly. She must be pregnant and be so busy that she didn’t have time to write anymore. Or maybe the cycle had failed and she had just stopped IVF completely.

  It’s so easy to overthink and analyse everything; small signs of hope can be very uplifting and reassuring during IVF but what I learned is that those stories and online threads couldn’t change what was going on inside me. Those threads are best left unread.

  One post said that I would be able to feel the embryo burrowing into the wall of the uterus. Can you imagine what that did to my ultra-sensitive state of mind? Every vague twinge and tiny cramp became a possible pregnancy.

  Another post said that the implant would have happened by Day 3, which meant that I could potentially test for the pregnancy hormone four to five days before the official two-week wait ended. There was no mention of the fact that the trigger injection you take to ovulate contains the pregnancy hormone HGC. There’s a good chance it could still be lurking in the system and give a false positive for pregnancy. I didn’t give in and take the test early, but I was seriously tempted.

  Every day, as I waited, I found it harder and harder to know what to do with myself. As an athlete, exercise had been a large part of my day and a productive way to pass the time, but I produce a lot of testosterone when I exercise and Roshan said we definitely didn’t want that. Instead, he encouraged me to go for a long, gentle walk every day. No weights, no machines, no raising a sweat. He even said to avoid yoga during these two weeks, fearing some of the poses wouldn’t be ideal for an embryo trying to bed down. It was good advice.

  Throughout my IVF journey, I kept up my daily walking routine. I would thoroughly recommend it as a way of maintaining fitness. With a walk, you also get fresh air and a bit of perspective when the endorphins flow.

  So far, I had been getting the clumpy white stuff in my undies but no sign of a period. Two days before I was due to take the pregnancy test, the clumps of Crinone began to take on a slightly pink tint. I immediately googled what this might mean and discovered that there were loads of other women seeing the same thing. Everyone was speculating wildly, but the general consensus was that it could be some old blood from the transfer procedure.

  ‘I’ll buy it,’ I decided.

  By evening the clumps were dark pink.

  The next day, it was a light period. Google told me there are some women who continue to bleed right up to the fourteenth week of pregnancy. It just depended how the blood looked, Google said. I nervously examined the colour of the Crinone on toilet paper.
Was that real blood, or just a deep tint?

  In the end, I needed to be put out of my misery. I went in a day early and took the pregnancy test. It was negative, which was hardly a shock. I’d braced myself for what was coming, but I was still devastated.

  When the call came with the results, I was home alone with our two cats. My period had begun in earnest and I was utterly miserable. I rang Mario, sobbing, ‘I don’t want to just be a parent to two cats. They’re not enough – I need more!’

  Mario gently reminded me that we had prepared for the possibility that the first cycle wouldn’t work. ‘It’s disappointing, but now it’s done.’ He encouraged me to focus on the future and ring Roshan to ask what we should do next.

  Roshan was sympathetic. He said I should take a few months off to let my body recover because the first antagonist cycle really knocks you about. ‘Go away and forget about it and we can start the next cycle fresh and strong.’

  I thought back to the woman crying in the recovery room two weeks before. She’d woken up after surgery to find that she had no viable eggs for fertilising while I had ten. I’d felt so lucky! But those ten eggs had gone down to two embryos, and neither had resulted in a pregnancy.

  The hard truth is the woman in the next bed may have exited the race early, but I still didn’t win. I didn’t even get a place. My athletic brain was telling me that I had to get back up, brush the snow off and take another jump. You can’t win every competition, but by trying again you give yourself another shot at winning.

  10

  The Perfect Cycle

  Standing up on stage in front of a roomful of uni students, my brain was going a million miles an hour. I knew I had only a tiny window to give myself the trigger injection, but I hadn’t worked out how I was going to do it in the middle of a presentation.

  Under normal circumstances, I never check the time when I’m presenting to an audience because it looks a bit rude, like you’re impatient to finish. So I started telling a story and managed to weave in, with actions, the line ‘And I looked at my watch and realised, oh no, I’m late for training!’

  With a theatrical glance at my wristwatch, I saw it was three minutes to eight. Time to make my exit. Everyone was relaxed and in a good mood so I paused just before the punchline of the story, broke into a beaming smile and said, ‘You know what? I think this would be a great moment for everyone to go and refill their glasses.’ The good-natured crowd happily obliged. I grabbed my purse, zipped into the bathroom, injected myself with the trigger and was back on stage in less than a minute.

  ‘How’s everyone going? Are you ready to hear the end of my story?’

  IF YOU CRASHED OUT AT one Olympics, there’s no way you could go back and compete at another Olympics one month later. It would simply not be possible to be physically, mentally or emotionally at your best. I had no problem accepting that I needed to take a break from IVF. I needed to give my body a chance to heal, and I needed to get my head right after such an intensely draining experience.

  The clinic offered me counselling. Although I chose not to take them up on it at the time, it was good to know I could talk through my feelings with a trained professional if I needed it. Instead, I stopped everything – no googling, no traditional Chinese doctor, nothing IVF-related – for two weeks. Then I gradually picked myself up and began preparing for the next round, with warm foods, acupuncture and gentle exercise.

  I did a lot of thinking after that first cycle. I needed to remember that I was more than just a wannabe mum, I was also a woman with my own life goals that I would continue to work towards regardless of my IVF outcome. This was at the forefront of my mind as I approached the second round. I was determined not to let the process disrupt my day-to-day activities any more than it had to.

  That month certainly highlighted how challenging it can be when you decide not to put your life on hold. It also resulted in a level of doctor–patient respect and understanding for which I am eternally grateful.

  I discussed with Roshan my desire to carry on as normal and he clearly understood how important it was for me. He’s a very busy man, but he managed to go that extra mile to ensure that I could complete the cycle and still fulfil a work commitment that had been set up months before.

  Roshan’s support gave me a huge emotional boost and a comforting sense that we were in this together. I knew that whatever happened, I would emerge from the process with my career on track and no regrets about letting people down.

  This time, Mario and I decided not to broadcast the fact that we were embarking on another cycle. We were very open the first time and kept everyone updated on developments, but as a result people were quite nosy without meaning to be. They were interested in the process and wanted to help in some way, but it was exhausting answering questions and, when it didn’t work, having to break the bad news to so many people compounded our disappointment. Now that we realised the journey was going to be longer and more difficult than we’d anticipated, I decided to only tell my immediate family.

  Logic had kicked in and I was more realistic about our chances of success this time. I knew that even if I did everything right, there was still no guarantee of a positive pregnancy test at the end. I also had the benefit of experience: I knew that some injections hurt more than others and I knew how uncomfortable it might feel after the transfer. This time I was prepared for those occasions and I would deal with them better.

  It was October 2011 and I’d been retired from sport for nearly two years. My new career was bubbling along nicely and I was heading into the busiest part of the speakers’ season. When I had started taking bookings earlier in the year I’d had no idea where I’d be with IVF in October, but I had decided not to cancel anything and do my best to make it work somehow.

  There were a couple of reasons for this. First, I dreaded the prospect of those endless hours and days waiting for the next thing to happen. It was no good for my mental health to be stuck on the couch, hanging out for the results of scans and pregnancy tests, driving myself crazy as I trawled the online forums. I needed to be occupied and productive, and entertaining crowds of people certainly fit the bill.

  Second, there’s a kind of momentum that builds up with this line of work and a great deal depends on word-of-mouth. After a successful presentation, agencies, clients, participants and event managers recommend you to other companies and new bookings are made. If you decline a booking or cancel it further down the track, word gets around that you’re not reliable.

  I don’t like letting people down or backing out of commitments. I could see that Roshan is a ‘doer’ too, so I figured that together we could work to fit my engagements around IVF. Roshan knew that I was going to continue working, though I didn’t spell out the extent of my speaking schedule. He just reminded me that there would be certain days in the cycle when I would have to be in Melbourne. I didn’t realise how challenging that would prove to be.

  Spring was well underway when we started the next round. The days were warm and I had been doing lots of walking and visiting my Chinese doctor regularly. Because we’d used up all the embryos in the first cycle, we had to make some more so this was going to be another antagonist cycle.

  Mario and I had begun calling my uterus the ‘Dormant Volcano’ because it sat there and did nothing.

  Not surprisingly, my dormant volcano was inactive. I hadn’t had a period since the first failed cycle, so we had to bring the jumper leads out again (progesterone) and get to a Day 1.

  It was nerve-racking not knowing when the period would start, because that day would determine how the next three weeks would unfold in terms of a schedule. But even then, there would continue to be unknowns.

  When my period began, I madly started calculating the possible clashes with my speaking schedule. Sometime in the next forty-eight hours I would have to go in to the clinic to pick up my cooler bag, the brown paper bags full of drugs and the all-important calendar plan. On Day 4, I would have to start the daily injections and
then have regular appointments with Roshan to see how the follicles were developing.

  At this point I would have only a general idea of when the egg pick-up might happen. Mario and I would both have to be in Melbourne for pick-up, so he’d be flying in from Brisbane. Exact timing depended on how fast the follicles grew, whether hyperstimulation became an issue, whether the medication dosage was right or not, and so on.

  Looking at the calendar, I could see there might be some hurdles to overcome, but everything was going to depend on how my body behaved. We’d learned from the last cycle that we needed to increase the medication that stimulated follicle growth and that would probably make a difference; however, it was still too early to call.

  My sister Sarah was my injection buddy again and with the help of Skype it all went smoothly. In the evenings, I went back to trawling the internet, following those stories that ended abruptly, leaving me hanging. Last time I’d been searching for IVF stories that focused on getting pregnant at the first attempt. This time, not surprisingly, I was mad for second-attempt success stories.

  Again, I found myself chasing the story threads into the early hours, hoping a snippet of someone else’s experience or their advice would reveal the secret of certain pregnancy for me. I was losing sleep and it was having an impact on my health, especially as my days were busy with work.

  Roshan gave me a likely date for the egg pick-up: either Wednesday 5 or Friday 7 October. He books theatre space for this specific procedure on Mondays, Wednesdays and Fridays, so that narrowed it down at least. Mario was standing by to fly down, but with back-to-back meetings in Queensland that week it was going to be a juggling act for him.

  The follicles were coming on well and Roshan named Wednesday 5 as pick-up day. I was so relieved – there was nothing scheduled on that day. Then I looked at my diary and saw that the night before I was booked to present in Bathurst, 800 kilometres away! A quick check of flights revealed that it was impossible for me to complete the presentation and be back in Melbourne for the pick-up at 7.30 the next morning. Roshan suggested I get the eggs taken out in Sydney and Mario could join me there, but I didn’t like that idea at all. Too much stress! Even then, Roshan never suggested that I cancel my presentation; he was completely on board with the ‘don’t put your life on hold’ mindset.