Harvest festival

After two weeks of twice daily injections the day had come to harvest my eggs. We’d both awoken really early that day and I wished I hadn’t had the glass of wine the previous evening (although it was very much needed after the news of impending chemo) as my mouth felt really dry. Just what you want when you’re not allowed to drink any fluids! We arrived at the hospital early – 06:30. Pats ate some brekkie in the car and we waited in the reception area. As we sat and waited, teams of people started to trickle through the door, all in pairs. We only waited for about 10 minutes before a lady called my name and showed us to my room.

Well this was a completely different experience – a bed to lay on, a TV and an en-suite bathroom! A lovely lady called Kate introduced herself and asked some medical questions. She had funny sense of humour and had us both laughing! Then another lady came with a menu with a list of lunch options for us to choose from – Pats too!

They’d said I’d be going to theatre at approx 09:20. As the hours passed I felt more and more bloated and really quite uncomfortable. Perhaps it was because I hadn’t had any water that was making it worse (I’d had to drink at least two litres of water a day for the last two weeks). I was relieved when they came to get me and, after kissing Pats goodbye, I waddled down to the theatre with two nurses. The nurse said they would call Pats shortly to perform his half of the procedure!

As I laid on the bed ready to go into theatre I said that I felt really quite swollen. The anaesthetist fitted the cannula to my arm and as the nurse chatted away to me to distract me I gradually felt myself floating off.

I came round to the sound of nurses talking around me and I felt pain in my abdomen. ‘Do you want something for the pain?’ they asked. ‘Yes please’, I said in a daze. She gave me some pethodene which relieved it slightly. A little bit later she asked me again how the pain was and I asked for more, this time it relieved the pain much better.

They wheeled me back up to the room where I was reunited with Pats and they told us that they’d collected 29 eggs. Wow! How amazing we thought. A bumper crop and super harvest festival it seemed! They were surprised that there were an extra six eggs that they hadn’t seen on the scan earlier on in the week. The embryologist asked us what we’d like to do in terms of IVF and ICSI.

In vitro fertilization (IVF) is where the eggs and sperm are mixed in a petri dish and left overnight to fertilise naturally (60-70% eggs fertilise this way). Intra-cytoplasmic sperm injection (ICSI) is where the embryologist selects the sperm to use and, using a very tiny needle, gently injects it into the centre of the mature egg. They wait until the following day to see whether the egg fertilises (typically 70-80% of eggs fertilise via this method).

All along they had said that they would use the ICSI method, however the embryologist said that as there were so many eggs we could do half and half. We asked her what her opinion was and she suggested doing this as IVF is a more natural fertilisation method.

They then bought us a delicious lunch and after a short while I had recovered enough, so got dressed and we made our way home. They said they would call us in the morning to let us know how many of the eggs had fertilised.

The embryologist called us early the following morning and told us that eight of the eggs had fertilised. Eight? Crikey. A friend had already warned me that the numbers would drop off but I really hadn’t anticipated it being that much, especially as there were so many eggs to start with. She asked if we wanted to take all the embryos onto to blastocyst stage.

A blastocyst is an embryo that has been developed for five or six days after insemination, as opposed to conventional IVF where they watch the eggs develop over the next two to three days. With a blastocyst, the embryo has advanced to the five or six-day stage meaning the embryo has divided many more times into more cells over this period. This time-lapse video shows an embryo from the time of fertilisation developing through to the blastocyst stage.

Blastocysts potentially have an increased chance of implantation when they are transferred . The majority of fertilised eggs will develop into a three-day old embryo, but only approximately 40% of these embryos will develop into a blastocyst. They are therefore considered to be a better quality embryo with a higher chance of pregnancy, and as ours were going to be stored in the freezer, they would have a better chance of surviving the freezing and thawing process.

It was a tough call to take as we could have potentially frozen all the embryos we had, but known that they might not be the best quality. Or we could take them all on and risk losing a high percentage of them. At the outset we thought the best option was the blastocyst stage so we agreed for them to take all the remaining ones on.

By Sunday we were down to five embryos – three that were doing well, doing what they should have. The rest were dividing but not as well as they’d like. We’d have to wait and be patient for the remaining ones.

The more I thought about this during the day the more upset I got. Would we end up with enough quality embryos for us to get pregnant? That and the enormity of everything else going on just got on top of me. It wasn’t supposed to be like this, I’d hoped that by now we would have got pregnant naturally…how different it all looked now. I felt absolutely terrible too, I was so bloated, (I’d put on at least 4-5 pounds since having the eggs collected) and it felt uncomfortable to do anything other than sit or lay down. They certainly didn’t pre-warn me that I’d feel like this!

As the days passed and the numbers kept decreasing, I also I also started to wonder if I’d be able to fit in another cycle to harvest more eggs before the chemo starts. I spoke to the nurse at the Nuffield and she said I’d have to go back for a scan to check that my ovaries have gone back to normal levels and that if I was alright they could potentially take me through another short cycle.

Pats was really concerned about pumping me with more oestrogen and said there was no point in having more embryos in the freezer if it was going to put me at risk. I knew he was right but I felt so annoyed that we hadn’t chosen to have all the eggs fertilised via the ICSI method. Fancy asking us, or especially me, when I’ve just literally come out of theatre and am probably not having the clearest of heads to make such a big decision. But of course it was too late, so tormenting myself with the what if’s was just more torture.

By the Wednesday the embryologist called to say that three of our little embryos had reached blastocyst stage – go Moonmins! One of them was slightly lower quality than the other two, but had still made it to blasto stage. She didn’t think the remaining two would make it but they would keep them on until Thursday/Friday as she could be proved wrong.

Whilst we were both pleased that three of our little Moonmins were safely banked in the freezer, I couldn’t help feeling gutted that there weren’t more. This will seem really ungrateful to others as I know some are not lucky enough to have the opportunity to have IVF or to even get three so I must put it into perspective. I’d finally taken the decision that having another round of IVF treatment, especially when there were still cancerous cells left in me after the lumpectomy, wasn’t the right thing to do. This is what we have and we have to pray that will be enough.

I was also gutted that those little Moonmins were going into the freezer. All those other ladies at the clinic would have been having their embryos implanted back into them and they would be onto the next step of their journey. We now had to wait.

The Nuffield Victoria Wing

At our first consultation appointment we met with a nurse who went through some questions regarding my breast surgery and planned cancer treatment.  She explained that the fertility treatment would commence at the start of my period and that I would be put on a “short protocol” to get me through as quickly as possible.

I had an AMH blood test taken – a hormone test that gives an indication of how many eggs I have left in my ovaries.  The result wouldn’t give a number of how many eggs are actually left, it would be a measure of how strong the hormone is (if the level was not very high it could indicate approaching the menopause). The result of this test would help them get the correct dosing for the medication used for the IVF.

She asked if we were self funding the treatment which we said we were because I wasn’t due to be having chemotherapy and because we were over the age of 34. She said how much of a post code lottery IVF funding is and that had we lived in Surrey we would have been able to have treatment up to the age of 39 and would have been funded for two cycles.  Damn it – we just moved from Surrey!!

We both completed a medical questionnaire each and a whole host of other paperwork and then she scheduled in our next appointment which she said would be approx. 2 hours long. This session would cover how to do injections, how they monitor the cycle with ultrasound scans, how they collect the eggs and then create embryos for us as well as storage of the embryos and the hormone supplements to be taken.

The nurse also explained the two types of fertility treatment . IVF (In vitro fertilisation) where the egg and sperm are put together in a dish and they find each other and fertilise naturally. ICSI (Intra-cytoplasmic sperm injection) where they manually inject a single sperm into an egg which increases fertilisation rates. She said they would rather prepare us for the fact that we may need the latter as it would cost an extra £1,300 rather than shock us on the day. Jesus, this is all so expensive!

She said that the average number of eggs collected is between 8-10, although not all of those would be high enough quality to freeze – they would only freeze the good quality ones as they’re the ones that will survive the freezing and thawing process. As this would be our only shot at having the treatment they would likely freeze as many as possible.  The storage of the embryos would be done in a batch and would cost approximately £400.

We were then introduced to the Doctor for our initial consultation.  He immediately brought up the topic of funding, and said he couldn’t understand why our case hadn’t been look into in terms of funding on the NHS. We explained what the consultant at QA had said to us about my planned radiotherapy treatment and the upper age limit making us not eligible. He said they would apply for funding for us and see what they would say, it was worth the chance and he said in my situation they may be slightly more flexible.

He agreed that the right decision had been made in terms of having the surgery first, and that in the window between having the op and starting treatment they would take me through a cycle. He said that the recommendation after you have been on Tamoxifen for two or three years is that it’s possible to place the embryos back. Current teaching is that Tamoxifen is taken for five years, however he said that conventionally it’s two to three years (this would depend on the staging and type of cancer from the analysis).

The doctor reassured us that they will do their very best to obtain the best quality embryos to maintain my fertility and whilst it may not be my priority in terms of getting through the cancer, once I am through with my treatment that my ability to carry a baby would in no way be compromised.

He said his goal would be to get around 10 eggs, to then have seven to eight embryos, with four to five blastocysts. We would have an approx 30% chance per transfer of each of those embryos.

He offered us their counselling services and also suggested we take Omega 3, Vitamins B, C and D and a supplement called Proxeed. We were already both rattling with about 12 different vitamin supplements we’d been taking so think we were safely covered there!

We walked away feeling positive about the potential results of the treatment and definitely felt like we were in very safe, caring hands.

Back at home later on that day I received an unexpected delivery of flowers from a colleague at work. They were beautiful and I was touched by her kindness and thoughtfulness.