Thursday, 28 July 2011

We have a date!

Things have been pretty busy around here recently, and the only sign of anything out of the normal has been the increasingly regular alarms going off on my phone, reminding me to take one drug or another.

My new business is starting to look as though it may break even in its first year, and I've taken the fairly momentous decision to give up the 'crutch' of freelance work in my old field to concentrate solely on the new business. I'm doing my last bit of freelance work right now, and hoping to finish it before next Tuesday evening, because...

On Tuesday evening we're driving up to the town where the new clinic is, ready for transfer (assuming all goes well with the defrosting) on Wednesday.

I had a scan on Monday, my tenth day of taking oestradiol, and my lining was 12.4 mm, with no sign of any anomalies. I asked specifically about the polyp, and the nurse who did the scan looked very carefully and said if there was a polyp it would be filled with fluid, and there was no sign of anything fluid-filled in there. The consultant had said that it could be shed with the lining if I had another bleed, and I had a bit of bleeding last week, so I'm assuming that's what happened, and that I am now polyp-free.

So after six weeks of preparing my body for this, two years of fertility treatments and over three years of trying for a baby, how does it feel to be this close to transfer?

I don't think I can really identify my feelings towards it at the moment. In one way, I'm planning for success, thinking about how I would juggle pregnancy and childcare with my new career, repeating to myself the names that we've chosen, and imagining where the cradle will go in our bedroom for a newborn.

In another way, I can't imagine ever being successful. I'm very cautious about the next stage in our treatment, and very conscious that it is only the next stage - that it could fail now, and even if it doesn't, there are months and months of possibilities of failure ahead of us. I spend a lot of time thinking about how our life would be if we never had children, what the positives of that would be, and reminding myself how difficult it would be to continue to build up my business with a baby - preparing myself for failure, in other words.

Am I excited about Wednesday? My family certainly are. DH is. I'm.... keeping my mind busy. The people I do this freelance work for are usually very good at estimating how long it'll take, and I've got four to five days' worth waiting to be done. I'm starting it today, and I'd like to finish it before we leave on Tuesday evening. That means working at least one day of the weekend, and it's tedious, mind-consuming work. At the moment, I'm thinking about getting that done.

I've also cleared my diary so that, assuming I get this work finished, I can spend a couple of days at the end of next week with my feet up, catching up on some long overdue reading.

So activity-wise, the 'before' is sorted, and the 'after' is sorted. We've got a hotel booked for Tuesday and Wednesday nights, and DH has booked the time off work.

And that's it. I've told a few people that it's happening, because they asked how things were going. They've got very excited, and I've tried to damp down their excitement by pointing out that the embryos might not even survive defrosting. I worry a little bit that I've got a dreadful cough at the moment, and if it gets even worse, I wonder if we'll even be able to go ahead.

Mostly, though, I'm relaxed. I'm not obsessed with this process, as I was for previous IVF treatments. When the nurse came to give me my intralipids, she commented that my blood pressure was low - when I was working in London, it was high, so surely that's a sign that I'm more relaxed these days.

I can't even say I'm waiting, because I'm too busy getting everything else done to have the luxury of waiting. All preparations that can be made have been made already, and now I'm just getting on with everything that needs to be done and the perpetual juggling that my life seems to entail at the moment.

Is it the calm before the storm? Will I become more preoccupied with it again as the time gets closer? Will my state of zen-like calm crack and bring with it the emotional messiness of previous cycles?

Who knows - but I'm sure I'll be appreciative of any prayers and sticky thoughts that you can send my way next Wednesday.

Thursday, 14 July 2011

One step forward...?

Thank you so much for your comments on my last post. I've been such a bad blogger recently that I'm amazed anyone is still reading, and Sonja's comment in particular really reassured me.

I had another chat with the lovely consultant on Tuesday, and he finally gave me an opinion and said that given the size and position of the polyp, he was 60-70% in favour of continuing with the cycle. He said he personally didn't think the polyp was very significant, but that he had to give us information on all the latest research and let us make our own decision.

We agreed that I would start taking oestradiol valerate that evening, and they would pay close attention to looking out for the polyp when I had a lining scan 10 days later.

The next step was to organise my intralipids infusion, which they want me to have done within a week of starting the oestradiol. That was when it all got a bit frustrating again.

I suppose I was spoilt at XXXX clinic, where they do everything themselves - drug provision, hysteroscopy, IVIg, and anything else they consider necessary during your treatment. The decision about whether to have a hysteroscopy was made harder by the fact that the new clinic doesn't do them, XXXX clinic couldn't do it for me, and I would have had to shop around for somewhere, get a referral, and then probably join a waiting list.

The new clinic also doesn't do its own intralipid infusions. In one way, that's nice - because they use a company that can set up drips in patients' homes, all I needed to do was arrange for a nurse to come to my house and then I could have my intralipids in the comfort of my own home, while getting on with some work (which, by the way, is really picking up now and has been very busy over the last month).

But the way they did it this week was for the clinic to ring the homecare company and set up an appointment - without asking me when I was available. I then had a call from the clinic saying that it was going to be done on Friday morning.

Well, as it happens, I have a stand at an event tomorrow which I hope will lead to some more work for me. The stand was offered to me free of charge as a thank you for some other stuff I've done for the organisation concerned. Not only can I not afford to miss out on the opportunity to advertise my business, which is still in its first year in a highly competitive market, but I also can't let these people down at the last minute.

I told the nurse at the clinic that there was no way I could do Friday morning, and she told me to call the homecare company direct. The woman I spoke to said there was no other time they could do for me within the one week period, and I was then shuffled into a game of telephone tag with these two women. It culminated in me being told not to start taking the oestradiol on Tuesday after all. The new instruction was to start it this Saturday, and someone from the homecare company would ring me to arrange a date for the intralipids.

I got the call yesterday (rather inconveniently, while I was out on a job). My intralipids infusion is now booked for... Monday. Which by my reckoning is within a week of this Tuesday - so why didn't they offer it to me initially when I said I couldn't do Friday?

I then have a scan the following Monday at the satellite clinic, and depending on what it shows, they may want me to go up to the main clinic again so they can rescan for themselves and see what the polyp is doing.

I was a bit irritated by the further delay in starting the oestradiol - I'll have been on buserilin for six weeks now, and the night sweats and hot flushes are beginning to get more than a little bit boring.

But then there was a new development last night. If I wasn't on buserilin, AF would be due round about now - and sure enough, last night I started bleeding. This is odd, because the scan on Monday showed that my lining was pretty thin. But the consultant did suggest that if I came off the buserilin and had a bleed, the polyp might come away on its own.

So is all this waiting around going to result in the polyp disappearing of its own accord? And is it normal to have a second bleed when you're on buserilin? All intriguing questions, and I'll be on the phone to the clinic again later today.

I just hope the start of the oestradiol isn't going to be pushed back beyond this Saturday...

Tuesday, 12 July 2011

Still up in the air

Well, I stayed on the buserilin while waiting for a repeat scan, so am still fully downregulated (and having regular hot flushes and night sweats - all the fun of the fair!).

Yesterday we finally made it to the clinic for the scan - it took so long because they wouldn't let me use the satellite clinic and we had to have a couple of clear days so we could go up to our main clinic.

The polyp is still there - it's at the top of the lower third of the uterus, and is about 3-4 mm, so pretty small.

One issue we have is that this clinic doesn't do hysteroscopies, so if I wanted to have it removed I'd have to arrange to have it done somewhere else. I rang XXXX clinic, and they said they couldn't do it for me, but also said that if it was small and not 'impacting on the uterus' (whatever that means), they wouldn't bother anyway.

The consultant we saw yesterday - who was absolutely lovely - was fairly equivocal about whether he thought we should abandon this cycle and get the polyp removed. He said some studies indicated that it might be a good idea, but we should make the decision ourselves and I should stay on the buserilin until we decide.

I've consulted Dr Google. There are lots of people on the forums talking about having to abandon cycles in order to have polyps removed. I also found this useful book which has information on various studies that have been done. Unfortunately, none of them is really conclusive, but it seems that the greatest evidence for polyps affecting the outcome of IVF treatment is with polyps over 1.5-2 cm (way bigger than mine). It seems that polyps don't affect implantation rates, but may have an effect on the likelihood of miscarriage - but again, this is not certain and may only involve polyps over 1 cm.

The other imponderable is that there is some evidence that oestrogen causes polyps to grow - I haven't started taking oestrogen yet in this cycle, but if when I do it makes the polyp grow larger as well as making my endometrium thicken, then this would be a bad thing.

If the clinic did hysteroscopies and polypectomies, I think it would be a no brainer - I'd just go ahead and let them do it. My problem is in deciding whether this is a big enough deal to make me not only abandon this cycle after over 5 weeks of downregulation and have a further delay of what could be a few months, but also have to find another clinic that will do the polypectomy and have yet another set of doctors poking at my bits.

Yesterday we were all ready to go ahead. Right now this minute, I think I've talked myself into thinking that if this cycle ultimately isn't successful, I would have fewer regrets if I had had the polypectomy than if I hadn't - whereas if it is successful, I won't mind the extra time and expense anyway.

This is hard - I wish the consultant had been a little less wishy-washy in his advice and had just definitely told me what he thought I should do...