Femara & Progesterone & TTC Naturally Round 1 = BFN!

The title says it all - I took the Femara CD2-6, I monitored OV with the CBFM and OPKs, we DTD on all my fertile days, and I started progesterone 7DPO, but still no positive test!

In fact this cycle has knocked me for six because I tested early  (a pregnant friend gave me some HTPs that she no longer needs) and on 12DPO I got the faintest line that gave us a glimmer of hope. I didn't feel pregnant and my usual spotting started but still surely you can't get a line if no HCG is present? So the next day I used two different tests and the line was no darker, in fact there was no line at all!!! Just cruel!

Here is the line at 12DPO (unless you are a TTCer you probably won't be able to see it and so I've marked it's whereabouts with red arrows but also it is difficult to see on a computer screen):

So I probably shouldn't write this update on CD1 when my emotions are running high thanks to AF but I figured that I should get some stuff off my chest and let people read how I really feel sometimes.

So I'm nearly 40 and still not a Mum or even pregnant - I don't want to hear "still plenty of time left". I don't feel old but fertility-wise I'm told I am old. Hubby is 5 years younger than me and has perfect swimmers, and men can father babies up to quite a ripe old age - am I making him feel old and that time is running out for him too?
Lots of people around me are pregnant or have recently had babies and although I am happy for them and I love babies I'm JEALOUS! There, I've admitted it - I can't help it!
I could could scream with frustration because there is nothing more I can do to help our situation or to speed up the process.

Most of all I feel that there is no one that fully understands what I am going through. I have a great support network and I know that I am loved but there is no one in the same boat as me. I'm not close to anyone in real life or online who is in a very similar situation who I can talk to. Someone who has tried for as long as we have, who has suffered losses, who has had operations and lots of treatments, and who is my age and so understands the added pressure and very real fact that it may never happen.

Don't get me wrong I'm very far from giving up but I could really do with a ray of hope!

Progesterone

I had a phone call from my GPs surgery last week saying the doctor would like to see me! So I went this evening and typically it wasn't the doctor who asked to see me so the conversation went like this:

Doc: Hello, what can I do for you?
Me: You asked to see me.
Doc: Oh, right did someone ring you?
Me: Yes the receptionist.
Doc: Ok, let's have a look.

The doc proceeds to scroll through my online notes while I sit there thinking I have an idea what it's about but I'll see what you come up with.

Eventually, with a bit of help from me, we found out that another GP must have been in touch with Prof Q and she confirmed that I should be prescribed progesterone while I am TTC naturally. So I got a prescription for that, which is very timely as AF is due any day! What is not timely is that I asked for this months ago and now my NHS Prescription Prepayment Certificate has run out so I'll have to payout again! But as I always tell myself - it doesn't really matter what it costs to get our Baby!

Why use Progesterone? Well some trials have shown that it can help ladies who have had recurrent early miscarriages. For example one big trial:  http://www.medscinet.net/promise/default.aspx
Also Prof Q said her partner Prof Brosens had had some success in his current trial with ladies using steroids and progesterone - so I'm giving it a go!

IVF #5 - Failed Cycle Review

Today I went to our old clinic to discuss our failed cycle. Luckily it was with the nice FS who has been looking after us. We discussed how I felt the cycle went and I told him I was upset when I had the scans because I only had 2 follicles and that the scans were painful because of the endometroma. I also told him that we were really pleased that we got 3 eggs, that all three fertilised and that we ended up with a morula. The FS said that it was very good to get 100% fertilisation and normally only 1 out of 4 or 1 out of 5 make it to blasto or morula stage and we had 1 out of 3.

The FS checked that ET had gone well with no problems like it had at the trial run that they did at EC. He also checked that the gestone had worked properly and I didn't get AF before test day - so there isn't a progesterone problem. It was at this point, when there didn't seem an obvious reason that the cycle hadn't worked that I told him about us going to Athens and having the fibroid removed. He was very interested and noted it all down in my medical notes. (I have since emailed him the video link and asked for his feedback on it).

The only negative thing about the appointment was the fact that the FS reckons we only have about 5% chance of conceiving by trying naturally because of my age, low AMH, blocked tube and endometriosis. This put a bit of a dampener on my enthusiasm to try as soon as AF arrives and I tried not to get upset, especially as I was by myself because Hubby had to work. The FS reckons that we have a 10% chance with IVF and we discussed whether we were thinking of doing another cycle. I didn't tell him about the Femara and I said that I was sticking to our plan for the next three months at least, and then we might go to Athens because it is cheaper and they try different drug regimes. He was very kind and said that if we decided to do IVF in Athens and we needed a scan doing before we go, the clinic would do it!

Finally as I left, the FS said I was to email him when I was pregnant because he reckons that we will get there one way or another because of my persistence, and I have to agree!

Answers in Athens - Hysteroscopy

Hubby went and enjoyed the huge buffet breakfast and I collected a lunch box from the hotel reception for after my op. We jumped in a taxi and arrived nice and early at the hospital. Hubby took his book because he had to stay in the waiting area for the whole time.

I was taken to a private room and told to undress and given a gown. After about half an hour they took me down to the theatre in a wheelchair and I was put in a cubical opposite a women who was asleep recovering from her op! I had a drip put in my arm which hurt and then I waited for about half an hour. In that time I met the anesthetist and the surgeon and lots of nurses. I started getting really nervous - not only because I was about to have an op but because it was in a foreign country!
I was walked through to the operating table and my legs were strapped into stirrups and my arms strapped down out stretched. Then I saw the anesthetist go to inject something for the second time into my drip and I said am I going to sleep now and she said yes. As usual I kept my eyes open for as long as I could so I know I'm not pretending to be asleep. Just before I was out for the count I felt my breathing go funny and I think I made them all jump because I started coughing - I think I remember someone saying 'just relax'.

Next thing I know I'm in the cubicle where I was watching the other lady sleep and someone else is opposite watching me! I was shaking like a leaf and my tummy felt a bit crampy but I was fine. The surgeon came to see me and he said he removed a small fibroid and he scraped the lining of the womb. I expected him to say more but apparently that was it!

Eventually I was taken back upstairs to the private room where they left me for another half an hour and then they asked if I felt ready to get up. At last I could have something to eat and drink, and I was grateful to the hotel for some orange juice and a cookie that I managed to have before getting dressed. I had started to worry about Hubby because he must have been waiting for a while and when I saw him I asked him the time and it was after 3pm - I couldn't believe it as we had arrived at the hospital at 10.30am! He had finished his book and was bored but more importantly he was worried about me! We paid our hospital bill and we were given a DVD of the op to take back to the FS.

We got a taxi back to the clinic where the FS watched the DVD and discussed it with us:

The uterus is filled with water so that the surgeon can see everything. You will see bubbles and things floating around! My uterus is a very light pink which is nice and healthy and it doesn't look like there is any infection.

The first 20 seconds is the camera travelling through the cervix and into the uterus.
At 28 seconds you briefly see the camera focus on the right opening to a fallopian tube.
At 30 seconds the camera focuses on a white lump, this is the fibroid.
At 40 seconds the camera focuses on the left opening to a fallopian tube.
At 55 seconds the surgeon starts the cutting along the wall of the uterus making implantation cuts. These cuts are at the top of the uterus called the fundus and is the best place for embryos to implant.
At 2 minutes the surgeon focuses on the fibroid and starts cutting around it. The fibroid becomes more obvious. It is hard, round and white.
At 3:50 there is a small bleed.
At 4:15 the surgeon thinks he has cut around the fibroid enough and use a grabbing instrument to try and pull it out.
At 5:15 the cutting instrument goes back in.
At 7:17 there is a slight bleed.
At 7:37 the grabbing tool goes back in and keeps trying to pull the fibroid out.
At 8:10 there is a slight bleed.
At 8:30 the cutting tool starts again.
At 9:30 the grabbing tool goes back in and keeps trying to pull the fibroid out.
At 10:34 the surgeon decides to stop trying to pull it out and start the light scraping of the womb lining which will get rid of the fluffy, floaty stuff and scrape out the fibroid - although we don't see this as there is bleeding and so it can't be filmed.

The FS believes that it has been so difficult for us to get pregnant because of the position of the fibroid, and that it could possibly have been the cause of the first two miscarriages and if the last pregnancy had continued it could have caused another loss. She believes that now that it is gone and I have implantation cuts, and with Hubby's super sperm, we have a very good chance of getting pregnant naturally.
She suggested that I take femara which is like clomid but won't affect the womb lining as much as clomid can. The femara could help me grow an egg on both ovaries so that our chances are not reduced by my blocked left tube.

Hubby and I are very happy with all this. Although we are impatient to have a baby, we believe that getting pregnant naturally is what was meant for us and so we're going to give ourselves up to 6 months to try.

Answers in Athens - Sperm Analysis & DNA Fragmentation

Hubby's Semen Analysis results:

• Number of Spermatozoa / ml 58,000,000 (according to the World Health Organisation WHO, normal is anything over 15,000,000)

• Total Sperm Number 203,000,000 (normal is anything over 40,000,000)

• Motility 60% (normal is anything over 50%)

• Morphology 20% (normal is anything over 4%)

Hubby's Sperm DNA Fragmentation results:

Fragmentation (%) of Total sperm:

• High fragmentation 7% (normal is anything less than 15%)

• Total fragmentation 10% (normal is anything less than 30%)

Fragmentation (%) of Motile sperm:

• High fragmentation 3% (normal is anything less than 15%)

• Total fragmentation 4% (normal is anything less than 30%)

The sperm sample that Hubby produced was frozen in two vials by the clinic so that if we wanted to do IVF in the future at the clinic and Hubby couldn't get the time off work, he wouldn't actually need to be there as they can use the frozen sperm.

Answers in Athens - the plan!

So our plan of action after our last cycle was to further investigate possible reasons for the failures. So after much research online and advice from some 'real life' friends, we decided to pay for a private hysteroscopy and  some other tests.

We didn't tell anyone of our plan apart from my work as I needed two days off but even then I just said I was having a private operation hence the short notice. It was in fact all down to the timing of my period - you need to have the op after your period but before ovulation so that your lining is thin and the surgeon can see the uterus clearly. Hubby had three days off work and my period had finished and so we put the plan into action.

We got up at 2:30am on Thursday 24th May and drove down to Heathrow where we had pre-booked the long-stay carpark. We got a bus straight away to Terminal 5 which was less than 10minutes away. We checked in on the computers around the terminal and waited about 20 minutes for the bag-drop desks to open at 5:00am - we were first in line!

We passed through security with no problems and went to get some breakfast. We had just finished eating and decided to go to the gate when Hubby saw a pilot he knew so we wandered over to him for a chat. We discovered that he was the pilot taking us to Athens and he got us upgraded to business class! We had a great start to our trip and it continued!

Arriving in Athens we collected our luggage and easily found our way to the Metro and into town. Hubby got his map out and managed to direct us to the clinic pretty easily! At the clinic we ended up waiting for quite a while until they apologised and said they were running behind and did we want to go get a coffee and come back in an hour. We decided to go and check-in to our hotel and get changed as it was very hot.

Our hotel and the staff were very nice and they gave us a large room on a floor near the top were the views were amazing. The airconditioning was a Godsend, the buffet breakfast had a great choice, and the roof top bar and pool were a great place to have a drink and relax!

Back at the clinic we didn't wait too long and we met the lady who was to give us fresh hope and positivity! She went through our history and suggested that my periods that were now only two days long and quite light, were not normal and that I could have scar tissue in the uterus. Also the fact that I have raised Natural Killer Cells could indicate an infection in the uterus. She said that the fact that I have been pregnant three time naturally means that the sperm is probably ok but the environment isn't right for the embryos to implant in. We agreed that it was probably best that I had a hysteroscopy and that Hubby had a semen anaylsis and sperm DNA fragmentation test just in case there is an issue with the sperm.

She performed an normal scan on me to just take a look at things and we noted four important things:

On Day 5 my womb lining should not be as thick as it was - 10mm:

There was an area of the uterus showing up as a white, thickened area on the screen which was probably some scar tissue:

My left ovary has a large 'chocolate cyst' (an endometriosis cyst filled with blood) that is impairing the ovary function but I did have two possible follicles already on the left:

My right ovary was perfect and had four follicles all about the same size on it:

This lead her to believe that I still had a chance to conceive naturally if any problems in the uterus could be sorted.

Hubby was shown to the 'play room' so that he could give a sample to be analysed. We later found out the results of this and they were excellent and Hubby was soooooo happy and proud!

The next step was to got to the hospital and get the pre-op tests done ready for tomorrow (by now it was 7pm). Hubby was not allowed to come with me and had to stay in the waiting area. I was shown to a private room and the nurse asked lots of medical questions, got me to give a urine sample and then got the stuff ready to take a blood sample. I nearly fainted at the size of the needle she used and the amount of blood she took. Instead of saying 'sharp scratch' as a warning like here in the UK, she said 'deep breath' and quickly plunged the large needle in! But there was worse to come. Next she wanted to do an ECG and with me lying on the bed she said 'sorry' and proceeded to hoist up my top and bra onto my chest and douse me with water so these sucker pad things would stick to me. She had to do it 4 times because apparently I was not staying still enough and making the monitor jump around.

Hubby and I were back to the hotel and in the roof top restaurant by 9pm ready to eat our first meal since the breakfast on the plane. I had to make sure I'd finished by 10pm ready to fast until after the op the next morning! We had a good talk about everything we had been through during the day and we felt happy with what we were doing and what we had been told.

BFN

Big. Fat. Negative.

Devastated!