Frozen Hope

by Jacqui Cooper

  Then he said, ‘The eggs might be post mature, but how about we do the pick-up on Thursday?’ I asked how that would be possible, since he only does egg pick-ups on Monday, Wednesday and Friday. Quick-thinking Roshan made arrangements for a Thursday egg pick-up at another Melbourne hospital that City Fertility Centre uses. Extra planning and logistics were needed for this procedure; the hospital was on the other side of the city. A big drive for Roshan, a big drive for the attending embryologist (with a portable incubator) and a big drive for us.

  Once we had the booking at a surgery, I counted back thirty-six hours to the exact moment when I would need to take the trigger injection. My heart sank. It was 8 o’clock on Tuesday night – smack bang in the middle of my Bathurst presentation. There was no wriggle room at all. Roshan said I was on my own with that particular dilemma, but he was sure I would find a way.

  The event was a sports awards night at Charles Sturt University. Most of the audience would be made up of students, and I only had to fill an hour, between 7.30 and 8.30. I was praying there would be a bit of flexibility and goodwill.

  When I give a presentation, I generally have a theme to focus on – something like ‘driving success’, ‘outperform’ or ‘resilience in the face of adversity’. All uplifting stuff. I have a range of standard talks that I’ll tailor for each occasion. My presentation is normally sixty minutes long; I take the audience on a journey of my career highs and lows. My presentation style is ‘conversational’, with big energy. I tell a few jokes – I do make fun of my misfortunes – and people don’t know whether to laugh or cry, but they leave feeling like anything is possible. It takes some time to plan what I’m going to say, but when I get up there in front of my audience I don’t read from notes or have any sort of script. I prefer to think of it as more of a one-sided conversation.

  The students turned out to be a great crowd, easily pleased. When I reached the moment where I had to nip off to do the trigger injection, the easy-going vibe was perfect. Asking them to take a break and grab another drink was a smooth and easy transition. I didn’t miss a beat.

  I flew back to Melbourne first thing in the morning. Both Mario and I were there on Wednesday so that we were ready for the early pick-up on Thursday morning. It was strange going to another hospital for the procedure, but it all went off without a hitch. Roshan had tinkered with the medication since the last cycle, because even though he’d harvested ten eggs, we’d only ended up with two, which was not a great result.

  This time I woke to find he’d harvested fifteen eggs. When they were inseminated (by the same ICSI process), we lost only one! Our prospects were far better with fourteen eggs to work with. And so began the wretched 24-hour wait to see how many fertilised. My heart pounded every time the phone rang. I was willing the caller ID to come up ‘City Fertility’.

  A day later, the phone call came. The embryologist told me we still had ten and I was very happy with that, though I was bracing myself for the inevitable drop-off. I was thrilled when at Day 3 the ten embryos were still holding their own, and it looked like a transfer on Day 5 was likely.

  Although we didn’t know what the final tally would be, it was time to again discuss how many embryos to transfer and the possibility of multiples. Roshan reminded us of the Australian national guideline for multiple-embryos transfers, and City Fertility Centre’s strict case-by-case policy on transferring more than one per cycle.

  Just like the first cycle, there was a lot of time to-ing and fro-ing, weighing up everything, and then of course leaving the final decision to Roshan. We finally came to the same decision as cycle 1, and it was agreed and supported by Roshan to transfer two embryos.

  This cycle was a much better result for us; we had news that we could use two and still have two left to freeze. I was excited knowing that we had ‘backup’ if needed.

  Roshan spoke to me of his concern about the difficulty we had inserting the catheter into my cervix last time. There was nothing I could do to make it easier; he just had to find the right way to do it. With so much at stake, he wanted to do a practice run. We arranged an appointment for the next day in his clinic rooms. Roshan was using his own monitor because he was used to it and the whole thing was like a dress rehearsal for the real thing. It did not go well. He tried every possible pelvic angle and it took just as long as it had before to finally get the cervix to budge.

  For the real transfer the next day, Roshan decided to call in assistance. A friend and colleague, who was also a City Fertility Centre specialist, came in to help. He held the ultrasound and exerted gentle pressure while Roshan worked with the catheter. At one stage Roshan asked him to swap places to see if he’d have better luck. I was starting to cramp up, which was not a conducive environment for embryo implantation. Between the two doctors, the catheter finally went in and two of the four high-quality blastocyst embryos were bedded down. We could see the two little white dots on the monitor. It was mission accomplished. What was normally a ten-minute procedure had taken nearly an hour.

  I lay there quietly for five minutes, staring at the palm trees and willing my body to welcome the embryos, and then I had to vacate the chair for the next patient. I’d already gone way overtime.

  I went straight from the clinic to my Chinese doctor for some acupuncture. He felt it was very important that plenty of blood was moving freely to the uterus straight after the transfer, and he shifted appointments around to ensure I was fitted in.

  This 2WW went a lot better, because I knew what to expect. The weather was lovely and the conference season was in full swing so I was busier during the days. Always in the background though, my brain was obsessing. What was happening with the embryos? Every night I was back on the forums following those damn discussion threads.

  I was applying the Crinone and counting down to the pregnancy test. If I wasn’t pregnant, I would probably bleed before the fourteen days were up. My days were full of visits to the bathroom – checking the colour of the Crinone and examining the toilet paper for any sign of blood. I was hypersensitive to the workings of my body.

  As an athlete, I knew an awful lot about how my knees worked; now as an IVF patient, I was becoming an expert on my uterus. I’m glad I did so much research, and I’m certainly going to encourage my children to learn about their bodies from a very young age. My mum told me next to nothing, which was pretty typical for the times. Until I started the IVF process, I knew nothing about the female cycle and what it all means, especially when it came to fertility. The fact that I never had periods didn’t trouble me until I was trying to get pregnant.

  On Day 12 after transfer, the Crinone took on a slightly pink tint but there was no blood. I made it to Day 14 without a period. All the online discussions indicated that I was pregnant and my hopes were soaring. The fact that I was taking a cocktail of drugs to make my body behave like it was pregnant didn’t figure in my reckoning. I was so excited to be taking that pregnancy test that I stood at the pathology centre’s front door, waiting for them to open.

  I did the pregnancy test and they marked it urgent so that I would get the result by lunchtime. The hours dragged by. It was excruciating staring at the phone, willing it to ring. Finally, it did. The City Fertility Centre receptionist asked me questions to verify my identity, and then she told me that the test was negative.

  I couldn’t believe it. Calmly, she instructed me to stop taking the Crinone and said that my period should arrive in a few days. I could get in touch when I felt ready to proceed again. And that was it: game over.

  I’d been planning to break the good news to Mario in Brisbane. When I finally reached him on the phone, I was sitting in my car, blubbering away about how stupid my uterus was and how it didn’t know what to do, with the same old declaration that parenting two cats wasn’t enough for me. Poor Mario couldn’t say much, sitting in a room full of work colleagues.

  The following week I booked a ski holiday for us in Japan in January. I needed to get away, forget about things, clear my
head and treat us both, before we started on our third try. My persistent and positive mindset kicked in yet again. I was now even more determined to try again and succeed. I would not let this beat me.

  Third time lucky? I could only hope.

  11

  Bettering the Odds

  When I woke up in recovery, Roshan was right there beside me holding my hand. I’m usually pretty groggy after surgery and I don’t remember much, but I’ll never forget his words: ‘Jacqui, it’s really good that we did the procedure. Now we know why you weren’t getting pregnant.’

  AFTER THE SECOND FAILED CYCLE, I had a massive bee in my bonnet.

  I’d just had a great antagonist cycle that yielded four AA embryos. Up until transfer, it could have been viewed as a perfect cycle, in IVF terms. But as soon as those precious embryos were entrusted to my uterus, it was game over. There was something wrong that we weren’t aware of, something that the scan wasn’t telling us. I was sure of it.

  For some time I’d been hearing about surgery that some women were having before they started IVF, called a laparoscopy. It’s an invasive, exploratory procedure where small incisions are made in the abdomen and then surgical tools, such as a thin tube with a light and camera attached, are guided inside. Problems such as cysts, fibroids, endometriosis, adhesions, ectopic pregnancy and infections can be detected and even dealt with on the spot.

  Sounds useful, doesn’t it? But many doctors don’t recommend it. There are long queues for laparoscopies in the public health system or you can skip the queue and pay thousands of dollars upfront to go private. Recovery can be painful, and often there’s nothing to find and the whole procedure turns out to be a waste of time.

  Roshan was reluctant from the start. Like any surgery, a laparoscopy carries risk and he didn’t want to add to my growing list of procedures. Besides, he believed that we already knew the main reasons for my infertility – my weird hormones, PCOS and my age.

  Roshan and I had a number of discussions as I became increasingly convinced that I should have a laparoscopy. I was also keen on having a dilation and curettage (D&C). This is a procedure where the patient is placed under anaesthetic, and the doctor opens up the cervix with a tapered surgical dilator. Using a small spoon-shaped instrument, the doctor scrapes the tissue lining of the uterus to clean out any debris or identify any abnormalities. Sometimes light suction is used to remove stubborn tissue. (I liked the image of a vacuum cleaner and having a sort of ‘spring clean’.) Afterwards you might experience mild cramping and you need to take it easy for a couple of days.

  I simply couldn’t shake the conviction that my uterus needed a major investigation and a proper clean-out. It sounds like I was a little knife-happy, but I’d had plenty of surgeries and they didn’t faze me in the least. My priority was to get some definitive answers before we went any further.

  Roshan argued that I’d only been through two IVF cycles and we didn’t have enough evidence yet to start exploratory surgeries. I came back with the fact that many women had laparoscopic surgery at the very start of their IVF journey, before they knew anything about their particular issues. It was my understanding that my uterus was emerging as the problem area. Why not deal with it now?

  Roshan said we had learned a lot from the two failed cycles and were getting closer to success. I kept pushing him. I wasn’t getting any younger and there were two fantastic embryos in the freezer. I didn’t want to waste a single one on a dud uterus. In the end, I more or less insisted that we had to get this right and do it now. Roshan gracefully conceded; I was the patient and ultimately it was my choice.

  On 17 November 2011, I went into hospital and had a laparoscopy and D&C. Roshan was the first to say the surgery had been the right call, uncovering four more major issues affecting my ability to get pregnant.

  First, he found the environment inside my uterus was extraordinarily toxic, so it was no surprise that embryos weren’t surviving there. He took out a large cyst that had been weeping pus that was so acidic that an embryo had no hope of implanting. Second, he removed a large amount of tough scar tissue that coated the walls. Basically, the surface of my uterus was tough and hard and it was impossible for the embryos to bed down in it. This scar tissue may have been due to a malfunctioning IUD or trauma when I broke my pelvis. Third, one of my fallopian tubes was completely mangled and it was removed then and there. Last but not least, the whole uterus was twisted and bent, making access difficult.

  As I headed into Roshan’s room for a check-up a couple of weeks later, we bumped into Ravi. He had heard about the new discoveries. He said, ‘You’re certainly not making this easy for us, Jacqui. Most women have one or two issues affecting their fertility; we’re up to about seven now with you!’

  Jokingly, Roshan agreed. ‘If we thought getting you pregnant was tough before …’

  But I was full of hope again. The problems had been identified and dealt with as best we could. My uterus was clean and clear for the first time, ready to receive one or both of the top-grade blastocysts. Hallelujah!

  This time it would be a frozen transfer (FET cycle). I did not need to repeat the antagonist cycle because we had the two embryos on ice. I was fine with using frozen as opposed to fresh embryos even though the success rate is slightly lower. (Success rates for frozen embryos are getting better all the time with advances in technology, but the biggest problem is still surviving the thaw.) I was glad to give my uterus a rest from the antagonist procedures; it had been pushed and prodded and thoroughly cleaned out, and it needed a break. Using frozen embryos also costs considerably less because you’re only paying for blood tests, specialist’s fees, and the thaw and transfer procedures.

  Ahead of us, we had Christmas to celebrate and our Japan trip coming up in January so we decided to start the third round when we returned. In early December, I was busy with housework, scrubbing away and polishing the floors, when my knee collapsed. Since retirement I’d had a couple of operations to ‘clean up’ old injuries and knee problems weren’t unexpected, but this time I needed emergency surgery straightaway and that meant our Japan trip was off. I’d been looking forward to a holiday with Mario. I hadn’t been skiing since I retired and Japan is such a beautiful, inspiring country. I was beside myself with frustration and disappointment and was emotionally exhausted!

  Then I started thinking that perhaps we could take advantage of a bad situation. Roshan agreed we could start doing blood tests to see what my hormones were up to. A mid-December cycle was not out of the question.

  12

  Changing Luck

  Roshan fed the syringe into the catheter, which was placed at the exact spot where we hoped the embryo would bed down. As the contents were slowly squeezed out, the phone in Roshan’s pocket chimed once, alerting him that a message had arrived in his inbox.

  Roshan smiled and said, ‘My mother always told me that the sound of a bell ringing at a particular moment is good luck. It’s a sign that the timing is right and that fortune is with us.’

  I’m not particularly religious or even superstitious, but I like to think that it was more than just science helping us out that day.

  ROSHAN WAS CLEAR FROM THE get-go that City Fertility Centre was going to be closed over the Christmas break. Everyone needs a holiday, and that includes specialists and patients too. I totally agree.

  We were looking towards the next cycle and needed a starting point. I began taking blood tests to see if anything was going on with me in the fertility department. Just after Christmas, Roshan rang to say that my follicle-stimulating hormone was rising and the scan showed the lining of my uterus was thickening. It looked like I was going to ovulate naturally around New Year’s Eve.

  My body was finally doing what it was supposed to do. Perhaps the laparoscopic clean-up had done the trick and jolted my dormant volcano into action, but once again, my timing was terrible. To mimic the natural cycle, the five-day-old embryos would need to be transferred on 7 January when my uterus and hormones were
in sync.

  ‘The clinic is closed,’ said Roshan. ‘You’ll have to miss the cycle. But this is a wonderful indicator that your body is coming good and you’ll have success in the future.’

  I’m embarrassed to say that all reason and politeness deserted me.

  ‘What do you mean CLOSED?’ I shrieked.

  A scene from National Lampoon’s Vacation popped into my mind. This 1983 road movie starring Chevy Chase is about a family crossing America in a campervan to visit their favourite theme park, Walley World. The father in the story, Clark Griswald, is determined to enjoy this once-in-a-lifetime holiday, but everything goes wrong from day one. In the end, after a million setbacks, they make it to Walley World only to discover that it’s closed for repairs. I was feeling a whole lot like Clark. I’d finally arrived and the clinic was closed.

  ‘Come on, Roshan, you must have some pull here. There’s got to be a way around this. We’ve come so far. What if this is the best shot I ever get?’

  Shamelessly, I kept on needling him until eventually he said, ‘Leave it with me and I’ll see what I can do.’ That’s all I needed to hear, that he was going to try for me. It was the best that I could hope for and I was grateful.

  An hour later he rang back. ‘Jacqui, we’re going to open the clinic for you. We’ve located an embryologist who’ll be there the night before to thaw out the embryo, and I’ll be there in the morning to do the transfer. Happy New Year!’