IVF treatment

About a week after having the lumpectomy I started the IVF treatment. My hubby had a meeting in the city on the day of the appointment and as I wasn’t yet able to drive, he dropped me off at the clinic and would come and pick me up later.

I met with the nurse who showed me all the kit, the needles and how to mix the drugs together and told me how and when to do the injections. I’d tried my hardest to concentrate on every little detail she was saying so I didn’t get anything wrong. I went on my way with my kit bag containing all the equipment I’d need – needles, plastic tops to open the glass water vials, a sharps box to dispose of the needles and I went down to the pharmacy area to pick up the prescription for the medication. The nurse had prescribed me enough drugs to last for seven days. I would need to go back for a scan the following week and collect the next lot of medication.

As I sat downstairs in the main reception area waiting for Pats, I somehow managed to get myself in a bit of a state and started worrying that I wouldn’t remember what the nurse had told me when we got home. Since my diagnosis I don’t seem to be able to take in or remember information as well as I have previously – slightly frustrating!

Pats arrived at the hospital and saw I was in a bit of a pickle so we went back up to the fertility clinic and the nurse kindly went through the whole procedure again. I felt so silly, but better to be safe in the knowledge of what we were doing – it wasn’t like I was just going to be popping a couple of paracetamols twice a day!

The Menopur injection needed to be taken at the same time each evening, with a 30-minute grace period either side of when you first injected it. There are two vials of drugs that need to have water injected into them, mixed together, and then finally sucked back up into the needle ready for injecting.

We started at 7.30pm that evening and Pats asked me if I wanted him to inject the needle or if I preferred to do it myself. Having already inserted an empty needle into my tummy on a previous visit to the clinic, I felt confident I could do this again. It was the strangest feeling the first time I did this. Not in that it really hurt, more that after our months and months of trying to conceive naturally, here we were mixing up drugs together and injecting me with a needle to be able to create our child. This certainly wasn’t going to be the romantic conception we had hoped for, but bingo the first one was complete.

We did the same the following night and then I had to inject a second drug (Cetrotide) first thing the following morning (there was only 10 minutes grace for this one). I decided 7.30am would be a reasonable hour to do this one and as there was no fiddly mixing between two vials I did this one by myself. Within a matter of days we had both got used to this routine, and whilst I won’t say it was “normal”, it certainly didn’t seem quite so strange.

I continued with the injections, and I must say that having heard other people’s experiences, I expected to be much more hormonal than I was. I’d warned Pats about potential outbursts that might come out. To be honest at that time of the month I’m not usually throwing abuse and saucepans anyway so the prospect of doing so was a little disturbing!

We returned to the clinic the following Monday and the scan showed I was responding well to the treatment and that 17 follicles in total were growing. The nurse said that to put it into perspective, the average number of follicles that ladies have is 8-10. Wow great news! The biggest was 19mm in size and the smallest 9mm. The nurse explained that those that were 14mm or above in size were large enough to contain a mature egg (5 were already at that stage).

Because I have “multi-follicular” ovaries (ovaries which contain many enlarged follicles at the same time) they decided at this point to lower the dose of my medication so that they would continue to grow, but avoid overstimulation, or ovarian hyperstimulation syndrome (OHSS).

We returned to the clinic again on the Wednesday and again the scan showed I was continuing to do well with 23 follicles in total growing nicely. They confirmed that I would go in for the operation on the Friday morning for the egg collection.  I was also prescribed Pregnyl (an injection to be stored in the fridge) and said I would receive a call from the nurse later on that day with a specific time at which I needed to do the injection. The Pregnyl injection basically stimulates the follicles to mature, mimicking the action of luteinising hormone (LH), causing the release of the eggs from the ovary.

As I had responded so well in terms of a large number of follicles, they also prescribed me Cabergoline to reduce my risk of OHSS.

A glimmer of hope

The very next day we were back at the hospital again, this time to meet with the fertility specialist that Claire had arranged. I felt really nervous going back to the hospital that day. What were they going to say to us? Would they burst the bubble on the dream of our little family? Pats and I sat in the waiting room together clutching each other’s hand.

We were greeted by a chap who was a Consultant Gynaecologist. He started off asking us lots of questions about our history, health and my cancer diagnosis and treatment plan. After this he went on to explain that there was a possibility of trying to preserve some embryos before I undergo treatment.

He said if I wasn’t undergoing chemotherapy then my ovaries wouldn’t be affected in a major way by the anti-oestrogen tablets but it would obviously delay matters if I wanted to get pregnant.  ‘And at the age of 39, time is much more of the essence than if you were 32/33 because whilst you’re on the anti-oestrogens you can’t get pregnant – so there will be a delay of a number of years. If you were to get the all clear in 2-3 years’ time you’ll be 41/42 and your chances of getting pregnant then are less than they are now.’ He went on to say that most ladies they see  are having chemotherapy which destroys some of the eggs meaning their chances of getting pregnant are much less than those having the treatment that was planned for me.

‘So it is possible that you’re able to conceive after the treatment, but there will be an effective delay.’ His words brought a sense of relief and I was now starting to feel much better and more confident that there was still a chance for us further down the line – albeit when we are a bit older!

He said if we wanted to go ahead and preserve and store the embryos that would mean the chances of getting pregnant would be from the age of a 39-year old as opposed to someone aged 41-42.  I would need to undergo an IVF cycle which he said was complicated and expensive, because in my circumstances it was unlikely that funding would be available. He said the costs were substantial and would be approximately £4,000 for an attempt at IVF and storing embryos. He stressed that if we wanted to go down that road it would need to be done as soon as possible and that they would try to fit it in between surgery and the medical treatment and that I would need to liaise with my oncologist as it will mean the tamoxifen treatment will be delayed by a number of weeks.

He said the first decision we would need to make is whether we wanted to go down that road and also whether we were prepared to pay for it. I asked him if the funding wasn’t available because of our age or where we lived and he said that IVF funding on the NHS is very limited and is available for some couples, but that we’d need to tick a number of boxes and that unfortunately one of the boxes is that I should not be older than 34. I had heard there was an age limit from friends who had tried for NHS funding but thought that 34 seemed a really low age to cap it and that the tick box criteria seemed a little unfair given our circumstances. He explained that they try to obtain individual funding for special cases but that those are for women having chemotherapy because they have less of a chance of conceiving afterwards.

If we wanted to go down that road, he said they would need to make quite a few arrangements to fit it all in. The treatment wouldn’t be available in Portsmouth, with the nearest clinic being at the unit in the Princess Anne hospital in Southampton. We would both need blood tests for screening, I would need an ultrasound scan plus there would be a lot of paperwork to be completed.  I asked whether that was an NHS unit in Southampton and he said it was but that they also see people who are paying for treatment themselves. He said it wasn’t essential that we go there, if we were paying for the treatment we could go anywhere we wanted.

They would start the treatment on the first day of the period I have following the surgery. I asked if there was any risk of taking the fertility medication. He said that the drugs used will stimulate the ovaries to produce a good amount of eggs meaning they’ll be working on overtime and therefore the oestrogen levels in my blood will be pretty high. With breast cancer there is always a concern that the high oestrogen levels may have a detrimental effect on the cancer itself. He said it wasn’t proven, but it certainly was there and to try and counteract this they would give me an additional drug that they don’t normally use to try to keep oestrogen to a lower level. He said the risk is more theoretical than real but the theoretical risk is certainly there

Pats asked how long we had to decide, what with not being eligible for funding, we’d need to organise how we pay for it if we were to go down this route. He said we’d need to decide before the surgery, and preferably sooner, because we would need the blood tests done and to have results and paperwork in place.

I asked if whether being pregnant in the future would have an effect on whether the cancer would come back. He said I would need to speak to my oncologist about that but in general the risk would be small. ‘They wouldn’t advise you to get pregnant unless they’re happy anyway – they’re not going to tell you to get pregnant 6 months after surgery – it’s going to be a number of years.’ Pats commented that I’d need to take the anti hormone tablets for five years, to which he said that it may not necessarily be as long as that ‘Medicine is not black and white, it depends on individual circumstances and they may be willing to reduce that time period.’  Well that was another positive, perhaps I wouldn’t be as old or have to wait as long as we initially thought.

He went on to say that as part of the treatment I’d need to go onto drugs that would take control of my ovaries allowing them to create more than one egg. During the treatment I would undergo regular scans – 2-3 times a week. The treatment would take 2-3 weeks and involve a small operation to take the eggs out of the ovaries and that on the day Pats’s ‘services would be required’. They would inseminate the eggs with his sample in the lab on the same day. The next day they would know how many have fertilised and they would let them grow into embryos for approx five days and then freeze them. Only embryos of good quality would be frozen – average quality embryos wouldn’t survive the freezing and thawing process. The embryos could then be stored for up to ten years.

Pats asked about what happens when the time comes to put the embryo back in. He said that this would be a much simpler process, where they would give me some drugs – but nowhere near the same amount – and it would then just be a matter of preparing the lining of the womb and then putting them back. He said the chances of it working putting one embryo back with a good quality egg is on average one in three (about 35%). In my case it would be less because of my age, and for a 39-year old it would be around 25% per embryo put back. But he said we may have more than one egg to put back and that each one put back will have the same chance each time (assuming the embryos survive freezing). The charge each time to put an embryo back would be approx £1,000.

He then gave us some more detailed information to take away and think about. He reiterated that there would be financial implications for us and that we’d be expected to pay the cost when we start the treatment itself. He said he only works at the hospital on Tuesday’s and Thursday’s so would try and fit us in the following week and recommended we went in on that Friday to get the blood tests underway.

As we both left the hospital I could tell Pats was still thinking about whether we should do it or not – and at £5,000 it’s certainly not a cheap option. But to me it was our only option and this was the only window in which we could ever do it as there would be no other options further down the line given how old I’d be.

Someone had offered us a chance and to me it was one we should grab with both hands.  The 25% success rate is not amazing but hey, it’s 25 times better than 0.