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Hoops to jump, tests to pass

8 Jul 2018

Okay folks.  Here is where what you're going to read is going to start erring on the TMI side.  This is your heads up.  If you're not okay with me talking about cervixes and ovaries and all the bits of this story that see me wearing a surgical gown and no underpants, this is your last chance to turn back!


The night before my first appointment with my specialist, I hardly slept.  Partly because of excitement, and partly because I just couldn't get my brain to shut up.  My head was a merry-go-round of thoughts.  When my alarm went off in the morning, I was exhausted.


The staff at the clinic I had chosen had matched me up with a female doctor who practices out of her own private offices in East Melbourne.  At our first meeting, Dr P took a detailed medical history (I also gave her details of the heart condition I had as a kid, but which doesn't affect me anymore).  She asked me if I'd ever thought about freezing my eggs in the hope that I might meet a man in a couple of years.  I told her that whilst I had considered it, I don't think the option is for me.  Part of this is because the process and storage fees are as expensive as IVF can be, and there's no guarantee that the eggs are going to be viable when you do decide to use them.  Also, I really am not counting on meeting someone in time that I like enough to have a kid with - it can take years to get to know someone well enough to determine whether you want to have a family with them.


She advised that I should start taking between 500-800mcg of folate daily.  I showed her the vitamin supplements I've been taking (which I'd carried with me to the appointment - classic over-preparer).  Currently, I'm taking a 3-a-day prenatal vitamin I order from the US which includes folate (it's one of the few I've been able to find that doesn't contain fish oil - I'm vegetarian); a vegetarian DHA supplementflaxseed oil;  and CoQ10.


She pored over my bottles of pills and gave a nod of approval, but advised me that in the event that I do undergo an egg retrieval procedure down the track, I should stop taking the DHA and flaxseed oil, as they can cause unwanted bleeding.


Generally, however, all of these supplements have been shown to improve the quality of eggs (which is particularly important in women my age and older), as well as improving the success rate of implantation of embryos.  Whilst women are born with all the eggs they will ever need, those eggs remain "immature" until 3-4 months prior to ovulation.  It is those 3-4 months that are crucial to the healthy maturation of an egg.  The right supplements can be the difference between a healthy egg which is chromosomally and genetically normal, and an egg which is chromosomally abnormal and has almost no chance of resulting in a healthy pregnancy.  And the older a woman gets, the higher the number of chromosomally abnormal eggs her body will release.  As a chromosomally abnormal egg has little chance of implanting, and an even worse chance of reaching full term, I figure it's important to do absolutely everything I can to maximise the quality of the eggs my body is releasing by taking these supplements in the months leading up to conception.


I must stress though to anyone who is trying to conceive, whether naturally or using assisted fertility methods, to please, please, please consult your doctor/specialist about any supplements you are considering taking in advance.  For example, I'm also considering taking a melatonin supplement, but I want to run this by my specialist first, as it has been shown that melatonin supplements can interfere with natural ovulation if IVF cycle stimulation medication isn't being prescribed.  It is therefore not recommended for women who are trying to conceive naturally, and as I don't know whether my treatment plan will involve stimulation medication yet, I want to make sure I'm not doing anything that is going to jeopardise my chances.


All of this information has been gleaned from an amazing book, It Starts With The Egg, by Rebecca Fett (a patent attorney in New York who also holds a degree in molecular biology and biochemistry).  The book was recommended to me by a friend who, at 42, is now pregnant with twins conceived via IVF.  As well as detailing supplements which have been shown to improve fertility, it also sets out what to avoid - for example, plastics and other materials containing BPA (including canned foods, and shopping receipts!  They're literally covered in it!).  The book also warns against phthalates, another product additive which is also found in just about anything that has "fragrance" listed as an ingredient (so basically, all perfumes, lotions and beauty products).  Both BPA and phthalates have been shown to negatively impact fertility, however neither are properly regulated and can be found in a scary number of products and household items that we use daily.  To err on the side of caution, I am trying to minimise these in my daily life as much as I can.


But back to my appointment with the doc.  I explained to her that because I'd read that the success rates for IVF were quite a lot higher than those for IUI, I'd really prefer to go with IVF straight off the bat.  Even though IVF is more expensive per cycle, the amount of money a person can spend on less effective treatments such as IUI can quickly add up if you have to go through several rounds, and it often proves more cost effective to have just done IVF in the first place.  However, Dr P told me that unfortunately because I'm single (and I therefore have "social infertility"), I will be forced to go through two or three rounds of IUI before I will be eligible for any subsidised IVF treatment.  She explained that after two or three rounds of unsuccessful IUI, she would be able to make a case to the government that I have a real medical need for IVF.  Only then will I be eligible for the government assisted subsidies to help pay for my treatment.  Whilst this was a little disappointing, I understood that the decision was not my doctor's to make and she was simply ticking all the boxes she legally had to tick in order to be able to help me.


The next step would be to order a round of blood tests, and to have a transvaginal ultrasound.  The blood tests would include checking my anti-mullerian hormone levels ("AMH"), which costs $80 and isn't bulk-billable.  This hormone is secreted by the follicles in which a woman's eggs mature, and can therefore be an indication of a woman's egg reserve.  I had this test done when I was 30 as well (a couple of months before B and I split up, as fate would have it), and had brought in my results from that earlier test for comparison.  A high AMH level can indicate good fertility, whilst a low AMH level can indicate poor fertility.  When I was 30, my AMH level was 24.4 pmol/L (smack in the normal range of 14-30 pmol/L).  It will be interesting to see how it has changed over the last four years when my blood results come back.


Dr P also ordered a genetic screening along with my blood test, which will set me back $400.  This test screens my genetic makeup for conditions such as Cystic Fibrosis, Fragile X Syndrome and Spinal Muscular Atrophy, and my likelihood of passing these genes on to my child.


Dr P also explained that as part of the transvaginal ultrasound, it would be advisable for me to undergo a tubal patency test ($617.05 after the Medicare rebate).  This test looks at whether there are any blockages in my fallopian tubes, and at the general health of my uterus.  Dr P explained that alternatively I could undergo a laparoscopy under a general anaesthetic in a hospital at no cost (as this procedure would be 100% covered by Medicare), however I would need to take a week off work and would have several incisions made in my abdomen.  I chose to pay the money to have the tubal patency test instead, as I can't really take a week off work and didn't fancy having holes cut in my belly.  Dr P explained that on the day my next period started, I would have to call the clinic and book the test for around day 6-12 of my cycle, as this is the only time in the cycle it can be performed.


Next, I was sent downstairs to Dr P's patient liaison officer.  She arranged my blood tests with the nurse and processed me as a new patient on Dr P's system, and explained to me what I was going to need to do next:  apply for a police criminal record check ($46.90), a child protection order check, and book in as many as six sessions with counsellors and nurses.  Without these, I would not be approved for treatment or for access to the clinic's sperm donor registry.  She also explained that I was going to need to book in for a follow up appointment with Dr P to go through my results a couple of days after my tubal patency test.


By the time the day of my tubal patency test had arrived, I had done a bit of reading about it online and sort of regretted it.  I read that the procedure starts off a little like a pap smear:  a speculum is inserted into the vagina, to allow the doctor to feed a catheter through the cervix into the uterus.  A small balloon around the catheter is inflated to keep it in place.  The speculum is removed and the ultrasound device is inserted to allow the doctor to view your insides on screen.  After this, a saline infusion is passed through the catheter into the uterus and, hopefully, through the fallopian tubes.  The infusion shows up on screen bright-white, so it enables the doctor to detect whether there are any blockages in the tubes.  Needless to say, I wasn't looking forward to it, but I was doing my best to relax and not stress it too much.


The first part of the test, which was simply a preliminary transvaginal ultrasound, was fine.  Actually, it was pretty fascinating.  I managed to forget that someone was manoeuvring a big contraption up my clacker as the doctor showed me parts of my body that I had never seen before on the screen in the treatment room.  She said my uterus looked good.  She explained that the black circles on screen were my ovaries;  that the one of the left was bigger because I was likely going to ovulate out of that ovary this month;  that the little black dots around the ovaries were my active follicles which were busy maturing my eggs (5 on the right ovary, 6 on the left - 11 in total).  She said that it looked like a follicle on my right may have had a little bleed at some point, either that or I had a small endometrioma, but it was only tiny so she wasn't concerned about it.


Next came the tubal patency test.  I'm afraid to say, here's where it got bad.  Turns out I'm amongst about 1% of women who experience something called vasovagal collapse / cervical shock if my cervix is tampered with.  As soon as the doctor began inserting the catheter, my heart rate and blood pressure bottomed;  I lost feeling in my hands and feet;  broke out in a cold sweat, and began to lose consciousness.  The catheter hadn't made it all the way through the cervix, so it was removed.  The doctor gave me a minute to catch my breath.  Through the ringing in my ears, I heard the doctor say that they'd try it one more time and if it didn't work or if I passed out completely, they'd have to abandon the test.  The doctor reassured me that it wasn't my fault;  it was simply my body's response to the procedure and there was nothing I could do to stop it.  They tipped my chair back to try to encourage blood flow to my head.  The nurse squeezed my hand and we began again.


The second attempt was successful in that the catheter went in correctly this time, but I continued to struggle to stay conscious.  I was drenched in sweat, my ears rang, and I still couldn't feel my hands.  And it was painful.  I was panting as if I was having a contraction.  I found myself completely involuntarily pledging a full jar of agave nectar to the goddess Yemaya if she would take the wheel and get me through it.  Part-way through, the doctor asked me if I was feeling any better.  I told her I was okay, to which she responded that I was a terrible liar.  Thankfully, a few minutes later it was over and the instruments were all removed.  The good news was that my tubes were as clear as Roman aqueducts.  She made sure to make a note of my vasovagal complications on her report.


The nurse set about popping a damp towel on my forehead and feeding me jellybeans to bring up my blood sugar level.  A few minutes later I was well enough to be moved to a recovery room with a cup of tea.  Half an hour later, I was well enough for mum to drive me home.  I experienced cramping similar to period pain and some weird spotting-like discharge for the next 24 or so hours, but thankfully I knew that this was an expected consequence of the procedure.  I realised later that it was probably a good thing that I had read about the procedure beforehand.  If I had had these complications without having any understanding of what was being done to me, it probably would have been a lot more frightening.


And honestly, it was a pretty traumatic experience.  Whilst I joked about it with my sister and with the girls at work, I was actually in a little bit of shock about it all.  A couple of days later as I was getting ready to meet some friends, a wave of emotion hit me mid-shower and I began to sob.  I realised that all IUI and IVF procedures are performed using similar catheter insertions.  Was I going to experience this reaction every single time?


I know that when I see Dr P again in a couple of days to go through the results, I am going to have to ask whether anything can be done to either prevent this reaction, or knock me out so that I don't have to experience it.  Will something like valium help?  Is having a general anaesthetic an option?  I know too that even if I was put under an anaesthetic, I would need to have my heart rate, blood pressure and breathing monitored closely to prevent me from possibly going into cardiac arrest.  With my history of heart problems as a child, to say that I am worried is putting it mildly.


Sadly, I'm a lot more afraid now of what lies ahead than I was a week ago.  I was already trepidatious about going through this alone, but now, knowing how my body reacts to these procedures, I'm even more scared.  Even though all my bits appear to be working well, the thought of having to go through the stress and upset of passing out every time I have a procedure is enough to almost bring me to tears every time I think about it.


Hopefully, the doctor will have some good news for me.


Meanwhile, I've got to be the only person who's ever asked for a printout of their uterus...without being pregnant:




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