Infertility in the news

Since infertility has been a big subject in my life the past few years, whenever I see things in the news about it, it peaks my interest. Recently a study has come out about men's declining sperm count. "Sperm counts in the West plunge by 60pc in 40 years as 'modern life' damages men's health." The decline shows no sign of stopping either. That is crazy when you think about it!

The article also said that poor sperm can be an indicator of other health problems; Aside from the obvious implications for reproduction, the researchers said the declines were consistent with reported trends in testicular cancer, the number of children born with one or both testicles missing, the onset of male puberty and total testosterone levels. This is not something that should be ignored. There were several possible reasons given in the article; chemicals... BPA... processed meats... but I got the impression they don't really know for sure. If there are chemicals in the food that we are being exposed to that are causing problems like this (plus who knows what other issues could be attributed to it such as cancer), something needs to be done.

The same study was also covered in the Daily mail, which is a tabloid paper. They commented about how women are typically "blamed" for infertility when often it is the man at fault. I really wonder when the blame game of women "being career women" and "waiting too late" is going to stop. Anyway, the article mentioned that maybe men and women will have to start freezing their sperm and eggs when they are young for future use! This is not an ideal solution for numerous reason. It's an interesting idea though. I'm currently reading "The handmaiden's Tale" for my book club and articles like this make the book seem not all that far fetched!

The comments under both articles (there and on the facebook pages) were despicable though. Firstly there were lots of people blaming "feminists" and "feminism". That made my blood boil. Come on! Some people seriously think that women having equal rights and being allowed to work and vote for instance is causing men to feel so threatened that their bodies produce less sperm?! Give me a break! The other most prevalent comment was about "overpopulation" and that this sperm issue is hence "a good thing". That also upset me. I can see how over population can be a problem is certain countries especially with poor access to family planning and contraceptive measures but in the western world we have the opposite problem. Germany has an aging population for instance. Many couples these days only have one kid on average, or none at all! And people not being about to have the choice to have children is in no way a "good thing". I wouldn't wish infertility on my worst enemy! It is heartbreaking to go through.

By the way I wanted to add that by using a picture of the manly Jon Snow from Game of Thrones I'm not in any way suggesting that there might be any issue with his swimmers... But if there were, it wouldn't make me think any less of him!

Juggling act and living in limbo

Ask any couple going through infertility treatments and they will be able to tell you all about the many ways that it interferes with their lives. Whether it's dealing with the hormones and side effects, managing all the appointments, experiencing the emotional rollercoaster, giving up alcohol/caffeine/whatever, having to miss out on things to save money or not being able to plan much in advance, it becomes really difficult to juggle your life! I've a good friend who regrets how much her and her husband's lives were put on hold during all the time they were going through treatment. They barely went on any holidays together, certainly not flying anywhere so she didn't see her family who live abroad for years. I have always made an effort to try to still live my life as much as I can while going through all this. We postponed our second IVF cycle for instance so we could enjoy Christmas last year without the stress of it all and then later we postponed again so I could go on a family holiday and then for a wedding in Ireland at Easter. It was really nice at the time to take the break from it all and feel like myself again. Not to mention enjoying wine since I'd cut alcohol completely in the months leading up to and during IVF.

It hasn't been easy juggling it all though and I find it can be stressful trying to find a balance. Having to fit appointments around my job means sometimes having to get up crazy early followed by long waits at the doctor and then still having an eight plus hour day in the office. It meant not being able to take off as much time as I might have liked after my first IVF egg collection due to the stress of a work deadline which ended up being the same week! We have had holidays we would have liked to go on but didn't since we knew we would be going through treatment and needed to save money instead. We've had to cancel social events with friends on several occasions too. For instance a dinner and wine tasting that you had to buy tickets in advance for when I thought I might be pregnant by then. There was also a German festival event that was taking place during the IVF two week wait when according to my doctor I should avoid crowds to not risk picking up an infection so we stayed at home instead.

Other bloggers have commented that going through infertility feels like living in limbo land and I can relate to that! I don't belong with single friends who are out partying at the weekends because when you are trying to get pregnant you are supposed to quit alcohol and live super healthy. But I don't fit in with friends who are mothers either and when they all chat about their kids nonstop and plan play dates, I feel left out. Friends who are childfree by choice can be fun to hang out with, though it's still rare to find couples who don't want kids, and they generally can't relate to the lengths you are prepared to put yourself through to try to build a family. Other friends going through infertility are great as they totally get it. If they get pregnant though, of course you are delighted for them but it can leave you feeling left behind once again.

It's so difficult trying to plan anything. I mentioned that we have lots of things coming up over the next year such as weddings of family members and good friends. I would love to attend as much as possible but I'm nervous to book any flights until we know when we can begin treatment for the natural killer cells, how long it will take, and when we will be able to start IVF again. I'd love to go to Ireland over Christmas time but if I do manage to get an IVF transfer done by then, would it be crazy to fly in potentially early pregnancy? One friend said recently that me getting pregnant is the most important thing and I shouldn't think about any flights or trips. Another friend also told me if I were to fly and then had a miscarriage I would regret it! So are my priorities all wrong? Am I crazy to be trying to find some way to go ahead with IVF in November/December and still fly to Dublin at Christmas? If I were to get pregnant and I thought that it would be at risk then of course I would give up a holiday in Ireland. But I'm just wondering whether it would be possible to have both? Another option might be postponing treatment several more months but then I worry about doing that since the older I get the less likely IVF is to work!

So should I continue trying to find a way to still live, travel, enjoy my life around treatments, or is it now time to focus 100% on making having a baby our number one goal? At this stage we're only a few months off from having been trying for three whole years. It's a long time! I suppose all we can do is wait for the phone call with the doctor and then we'll be better able to decide whether we would be able to do the treatment and still fit in a trip to Ireland at Christmas. According to what I've read online the intralipid infusion therapy against natural killer cells would start the month before you do IVF and involves an IV infusion for about two hours. It should be done every two weeks up until the 12th or 24th pregnancy week. I'm already wondering how I would be able to juggle the extra doctor's appointments with my job. Finding a balance between fertility treatment and my life isn't going to be so easy the next few weeks and months but I'm leaning towards doing the treatment for high NK cells in case it's the answer, giving IVF round three our best shot as much we we can and everything else will just have to take second place.

Some thoughts as I approach my third round of IVF

The last few days have already felt like a rollercoaster of emotions and I haven't even started the IVF process yet!

Anxiety and apprehension

I found it hard to sleep the night before last with so many thoughts racing through my mind. How am I going to cope with it all this time around? How will I juggle IVF with my life and job? I have also been feeling stressed about the intralipid infusions which I am meant to get every two weeks at the immune doctor's practice. It's quite far away and awkward to get to so I would have to take at least a half day off work for each appointment.

December is going to be a busy month, busier than I had realised. This year we have loads of people to get Christmas and birthday gifts for and to be honest I always find present buying stressful! Trying to figure out what to get someone that they don't already have and that they would like and then trying to locate it or hoping it will arrive in time if you order it online. Once I start the IVF process I'll be more tired than usual and especially lately with the weather so cold and dark I'm not going to be feeling very much like wandering around the busy shops. I'm hoping to buy a lot of stuff online. It still doesn't solve the problem of figuring out what to get people though!

Not to mention all my worries about how IVF will go this time. Will my body respond better to a different protocol? Will I get more eggs at the retrieval or end up with empty follicles again? How many embryos will we end up with? Is it possible we might have some extras to freeze? Will I get pregnant and please God get to keep the baby this time? Or babies, since in theory we could end up with twins!

Hope

Well of course there is always hope, it's what keeps me going through infertility treatments. The dream of having our child or children one day. The idea that we could have a baby by next Christmas. Wouldn't that be wonderful! We already have a room in our house that would be perfect.

Realism, bringing myself down to earth

I try to remind myself that IVF generally has higher chances of not working than it does of being successful. For whatever reason it could very well not happen this time and we need to be aware of that and ideally not get our hopes up too much. That is really hard for me though, as the only way I can get through the IVF process.- injections, side effects, etc is the hope that it might lead us to our baby. So I don't know whether I will be able to keep calm going through it.

The GerMann and I have already spoken about what we would do if it doesn't work. Take some time off from it all, plan a holiday and then if we feel up to it go to another clinic for a second opinion. If they think they can help us and say that a fourth round has a good chance of working we would consider it, but only if I feel like I can physically and emotionally go through it all again. It is quite possible that we might both decide that we have had enough with IVF at that stage. And if that happens I've reminded myself it would not be the end of the world. Our lives would not be how we imagined but we could still find a way to be happy..

Optimism and positivity

I've actually been feeling really positive yesterday and today. I had an appointment with my local gynecologist. He hadn't received my emails for some reason but when I told him about the immune treatment that has been recommended for me, he knew all about intralipid infusions and has even supported other patients with them. So the good news is that I'll be able to get the them done at his practice. He'll charge me for it (50€ each time) of course but it means I won't need to miss as much work. So that was a relief. I'll go there tomorrow for my second intralipid infusion.

And then the other thing is that I decided to tell work that I would be going through infertility treatments and explain that I will need to go to a lot of doctor's appointments over the next while. I had been feeling quite nervous about telling them, especially as I am quite a private person about stuff like that but it could not have gone better! Both the HR and my direct manager were really supportive. It won't be a problem at all if I have to come to the office late after attending the various appointments and the HR manager even told me not to worry about work, that I just need to focus on this which is more important! My manager told me he had already suspected but didn't want to ask. He's had lots of friends who've had infertility issues. It felt like a weight has been lifted off my shoulders to get that sort of support since I had been feeling anxious about how to juggle IVF plus the added immune treatments with my job.

So lots of mixed emotions overall but at the moment I am feeling fairly optimistic and ready to face IVF round three.

What next?

Well I still can't really believe that we have three failed IVFs behind us now. How did I end up here? I just really thought that it would be third time lucky for us and I had already planned it all out in my head - how far along in the pregnancy I would be by which month and even when I would be due. It all seems a bit stupid now of course. If it had worked I would have had my first scan last Thursday. Wouldn't that have been something? The odd thing is that our first IVF was actually the most successful in that I was properly pregnant and for the longest, even though it only lasted five weeks. These past several months between the immune testing and treatments not to mention the IVF itself was just so all consuming. Now that it's over I've been feeling at a loss. Sort of aimless and unsure of myself. The support from all of you has helped me a lot. It really means a lot to me, so thank you so much!

While I was googling IVF failure, I came across this article which I found very helpful. There are few resources available for when infertility treatments don't work so it can be a hard and lonely time. It's been difficult as you can imagine but I think I am handling it well all things considering. I was grateful that I had a few days off before I had to go back to the office. I'm still feeling quite fragile. It seems like every time I log onto facebook there's a new pregnancy or baby announcement! How I wish that were us. Yesterday hubby told me that friends of ours had their twins on Christmas day. I am embarrassed to admit this but I burst into tears when I heard. They also went through infertility and had a long journey. Actually when I did my second round of IVF, they did their first and for them it was successful. I am delighted for them, just disappointed for us.

I would have been due this month if the second round had worked. I probably wouldn't have been able to travel to Ireland in that case if I was so far along, and I would have missed out on a lovely Christmas with my family though. I liked the suggestion in that article to take up a new hobby or write a list of things you'd like to do. So I've decided to jot down lots of simple things like restaurants we've been meaning to try out, places I'd like to visit and so on. I've also thought about possible hobbies like doing a dance class, writing a book or taking up painting so maybe I will try something new. It would be good to focus on something else for awhile.

We've gotten an appointment at the other clinic I mentioned for early March. It's actually nearly an hour and a half away but I have heard great stories from people who have gone there. I'm really happy we have this appointment and keen to hear what they tell us. We'll have a long list of questions for them! I've read about some women having success with certain supplements such as DHEA and royal jelly but I'd prefer to get a doctor's advice before taking them. They offer natural IVF at the other clinic and I'm planning to discuss whether that might be something we should try. I'm also wondering whether it would be a good idea to get the scratch done (again) to increase our chances and whether it would make sense to check my tubes to see if one is still unblocked. In the meantime we have to fill out a three page questionnaire and send them all our medical records etc. I'll have to go back to my gyno to get a referral.

Hubby and I watched a few Netflix documentaries recently that revolved around food and health that made an impact on us. The documentaries were basically about how there is way too much processed and fast food these days. And also that people should cut back on animal products and dairy. So we decided to make an effort to eat healthier this month. We have been trying out some new recipes and cooking together more which has been fun! Just trying to incorporate lots more vegetables in our diet, more home made stuff, less sugar. I've also decided to try cutting out gluten. I've been having some digestion issues on and off for awhile now and I've noticed on days I avoid gluten it tends to be better so I'm going to give it a go. I also came across some research indicating that a gluten intolerance could lead to overactive natural killer cells in some women so I've been wondering if that might be what's happening to me. If I can improve my digestion, be healthier and improve the NK cells over the next few months that would be great!

I'm also hoping to get my thyroid values back under control. The day after our transfer I got my blood tested and found out my TSH value had gone up not down (it went from 2.30 to 2.46)! This is despite taking meds to reduce it the previous six weeks. I freaked out, worrying that it would affect the embryos implanting (and maybe it did...) I went to my doctor and she prescribed me stronger thyroid meds as the ideal value for pregnancy is around 1 and definitely under 2. Not sure why mine went up not down though I've read that IVF hormones can affect it. A higher TSH value means underactive thyroid. So my plan is to keep taking the meds and hopefully get my thyroid under control over the next few months.

Several people have asked us recently about adoption. It saddens me a bit as it sounds like they don't think we'll be able to have kids ourselves whereas we haven't moved on from that hope yet. Years ago when we started having problems hubby and I had a chat about what things we would consider and he said he doesn't want to go down the adoption route. I remember feeling sad at the time thinking that if IVF doesn't work then we would end up totally childless but when I thought about it more a few days later I realised that I also don't feel particularly drawn to adoption myself. It's a great thing for loads of people, don't get me wrong, I just don't feel like it's right for us. I can't imagine having the energy to start down that long road either if our other treatment attempts fail. Also for me the biological connection is very important. My Mum died when I was younger and I love the idea of a part of her living on.

People have told me about friends who adopted and then got pregnant naturally implying it might work in our case but that's not a good reason to pursue adoption! We also don't feel comfortable with the idea of donor eggs or sperm. Both are illegal in Germany actually (However it is actually legal to "adopt" already created embryos from another couple here). Update: only donor eggs are illegal here. Basically if it doesn't work with our own DNA we would stop. Hubby didn't even want to try IVF initially but luckily came around to the idea. And at the beginning we had agreed on 3 (or max 4) rounds. I have been starting to wonder about what I would consider depending on what we are told at our next doctor's appointment. Going through infertility means you end up having to think about all sorts of things. One friend even suggested we go to India to find a surrogate! I can't imagine ever doing that and thankfully I haven't been told that I can't carry my own child so we don't need to consider options like that. Our doctor has never said there are any issues with our own eggs or sperm either. Both are good quality. I think the main problem is that I don't respond well to the IVF hormones and we don't end up with many embryos. Maybe our thoughts on donor eggs or adoption might change in the future but for now we are still hopeful that we might be able to have a biological child. I hope that doesn't come across the wrong way. Each couple has to decide what is right for them.

Our plan is to see what they say at the other clinic and then decide our next steps. I am open to doing a fourth round at some point. Hubby isn't so keen on the idea, like I mentioned before, he's already ready to stop and try to move on. However he's open to finding out what the new doctors have to say. He just hates seeing how hard IVF is on me. I have heard of women who take five or six rounds to be successful but I don't know how much more I can take. I tell myself it will be worth it in the end when we have our baby but I do worry about the long term effects. The emotional rollercoaster isn't good for my mental health either. Each failure just feels worse than the last! The hardest thing at the moment is deciding where to draw the line. If IVF is never going to work for me then I would obviously rather stop now than keep putting myself through it (and spending more money)! Our health insurance will pay towards a fourth round and it's great to have that option.

So that's where we are at now. I hope my post didn't sound too sad. It has been an incredibly disappointing time. I'm doing ok though. Feeling a little better each day and I am hopeful that maybe something will still work this year. I would love to be pregnant by the summer. Oh man, we would love that baby (or babies) so much! I would be the happiest woman in the world if it worked out. But I also want the doctors to tell it to us straight. If our chances are slim, I will try to accept that. In which case I will also start moving on. Hubby and I have also discussed what that might mean for us. We could consider getting a pet. Or we could plan some amazing holidays. Hubby has never been to Thailand. We would both love to go to the States together. It would also be such a relief to be done with all the doctor's appointments and injections. I hope by this summer we will have our answer either way. Please God we'll be able to have a healthy baby one day.

We are hoping to fly to Australia for my brother's wedding in April. It would be something to look forward to! Initially I had been thinking about staying here so that any potential treatments wouldn't have to be postponed but then I realised that I would regret missing out on seeing my brother get married and a month or two delay shouldn't make a big difference. My life has revolved around infertility treatments so much the past while and I'd like to focus on other things and try to enjoy life again!

The Handmaid's Tale #BookClub

Everyone seems to be talking about "The Handmaid's tale" recently. It was written in 1985 by Canadian author Margaret Atwood but has gained more fame recently after a tv series has come out based on the book. I was intrigued by the premise and happy when it was voted as our next novel in my book club.

I knew that there would be some infertility elements so I was prepared for that. The book is set in a dystopian society in the future. The majority of women are barren and infertile. It seems like a lot of the men are sterile but it is a male dominated sexist society so the male side isn't acknowledged openly. The women who ARE fertile are known as handmaidens and they are first trained and then sent to live with a couple in order to try to conceive a child with the husband which will then be raised by the man and wife. A few months after the birth, the handmaiden will be sent elsewhere and the cycle continues. It is a several tier society. Wives have more power than the handmaidens but not as much as the husbands. There are women called Marthas who are barren that work as housekeepers. There is a strong police presence and spies known as "Eyes". People who say or do the wrong thing get taken away and tortured or worse.

The book centers around the story of one handmaid, "Offred". That is the name that has been assigned to her. All part of losing individual identity. Initially she is a little like a zombie, just going along with the life she has now. Well, it's not like she has much choice in the matter! She often wonders about her ex boyfriend and child who were taken away from her. Without giving too much away, she gradually becomes aware of a secret resistance movement.The husband of the house she's living in also starts wanting to bend the rules with her. As does the wife. Both of which lead to her taking more and more risks.

In terms of the infertility element I found myself often feeling sorry for the wives who weren't able to have their desperately longed for child. It was awful how the handmaids were reduced to baby making machines, which just made me think of how ridiculous it is to base a woman's value on whether or not she can conceive. Women are so much more than that! The book was really good. Not like anything I'd read before. Once I got into it, I definitely wanted to find out what would happen next. I thought the ending a bit abrupt though, a lot is left open. The book has some disturbing scenes and the scary thing is that the world described doesn't seem all that far fetched at times. Let's hope it never becomes a reality!

Stronger together - grateful for the online community

Recently a few people both in real life and online have commented that I'm brave to write so openly about our struggles with infertility. It wasn't something I always felt comfortable sharing. In the beginning when I just started going through it I felt a lot of shame. Over time after coming across a whole world of others online opening up about their stories, I started to change my attitude about it all. We shouldn't feel ashamed or embarrassed that we are struggling to have children, and if someone else is judgemental towards us then that is their issue, not ours. So many people (1 in 8 couples) are dealing with infertility these days and it helps when people can be open about it so that we all don't feel so alone.
One of the main things that has helped me to cope has been the amazing resource of blogs written by others going through it. The whole community is so supportive of each other which is really great. I also get very involved with everyone's lives and feel upset when they are struggling but am delighted for them when things are going well. I admire their strength and honesty. It's such a personal topic and I do feel quite vulnerable at times sharing some of our fertility struggles online but hopefully it might help other people and reduce the silence around the subject.

Anyway what I'm trying to say is thank you to everyone who has read my blog, whether you have commented or not but just sent some virtual support. You all rock!

Natural killer cells - friend or foe?

The first time I heard the term "natural killer cells" in relation to miscarriages and failed IVF cycles, I thought it sounded awful. As if certain women have these toxic cells in their bodies destroying any potential babies! However, I have since learned that everyone has natural killer cells and they are generally a good thing. They help your body fight off infections and diseases (including cancer) and indicate a strong immune system. The theory, which is quite new in the infertility industry, is that some women (I read somewhere it's around 10-15%) have elevated levels which could then interfere with pregnancies. Initially when an embryo arrives into the womb, it will appear as a something foreign since it will have different DNA, and her body will need to decide that this is something good and should be protected and not fought off. It is a complex process so I guess it's easy to imagine that something might go wrong along the way.

While researching NK cells (which has left me more confused than ever to be honest!) I came across a blog saying that if you have elevated levels then you should figure out why, and not just take medicine to reduce them. That makes sense but I don't think it's so easy. I went to a gastrologist recently to discuss some occasionaly digestive issues I've been having and am now getting tested for celiac, just to rule out any other food intolerances. I hope I don't have any more as living with lactose intolerance is already difficult enough! I'm not sure what else I could be tested for. The gastrologist I went to was actually really uncaring and abrupt. He agreed to do some testing but when I tried to show him the blood tests results, he basically just told me to discuss them with my gyno. I had mentioned my miscarriage following IVF to him to explain why we had done the further blood testing and he looked like he couldn't care less. He certainly didn't show any sympathy. Clearly he doesn't believe that stomach issues may have any connection with infertility. I felt quite upset actually after the encounter. On my way home I was sad thinking about those three IVF potential babies that were transferred into me during the first and second round and what could have been...

These days a lot of people have food allergies and intolerances. It's probably due to the western diet, too many processed foods, plus we eat too much dairy in general. A cow's milk is designed for calves not humans. I still eat dairy with lactase enzyme tablets. Completely cutting it out is just too difficult since I love yoghurts and cheese but I have been trying to reduce the amount. I tried osteopathy two years ago when I was attempting natural fertility options (such as acupuncture) and the lady told me that she has had several women who couldn't get pregnant who she advised to quit dairy for three months and they then fell pregnant shortly after! She had the theory that a lot of people probably have undiagnosed food intolerances that they don't know about but could be causing stomach inflammation. It could be the case that your body then says, oh something is wrong, and the natural killer cells get elevated. One of the women on an IVF forum I frequent was able to substantially reduce her elevated NK cells naturally when she followed the so-called AIP diet (Autoimmune Protocol) which is an even stricter version of the paleo diet. It is great to hear there may be some other ways to treat the NK cells, and I also read something about omega3 helping (I'm taking supplements now), but I don't think I would be able to follow such a restrictive diet for that long!

During my research I came across a website saying how great natural killer cells are, that they fight off cancer and some tips on how to elevate them which seemed ironic since I am trying to do the opposite! In general I rarely get the flu and don't come down with many colds so maybe I do have a strong immune system. The treatment for elevated NK cells can leave you more prone to infections so it's important to be aware of that. I came across IVIG & Intralipid Therapy in IVF: Interpreting Natural Killer Cell Activity for Diagnosis and Treatment which mentions the importance of testing for NK cells in relation to fertility and wishes more reproductive doctors would take it seriously.

However then I also found Fertility Fraud: Natural Killer (NK) Cell Testing which says there are too many false positives and no need for the unnecessary treatments. Another negative article: Natural killer (NK) cells – fertility fraud? which suggests the idea of the human uterus attacking an embroyo it is designed to nurture is "preposterous". And from another post on the same site:
Anxious IVF patients are soft targets for hard marketers. In consulting rooms and online, they’re told their bodies may be sabotaging their pregnancies because their embryos are perceived as infections. This ‘NK’ scare may be completely unfounded. Natural killer cells: you have to hand it to the person who coined that phrase. It’s a mortifying description for vulnerable IVF patients willing to try anything to improve their chances. The truth is, intralipids might help. Might. Not will

The next article I read, Reproductive Immunology – What is the truth about Natural Killer cells? sums it up such;
Studies looking into these cells have produced conflicting results, but the majority of leading scientists in this area dispute that Natural Killer cells are a problem in fertility treatment and pregnancy. Given the potential side effects accompanying Natural Killer cell treatments, there does not seem to be enough justification for undergoing this testing and treatment.

Reading all those of course makes me wonder if the tests and treatments could just be a complete waste of money, unjustified and potentially put my health or that of my future unborn baby at risk. Going through IVF, I am already prepared to take certain risks with my own health but I definitely would not want to negatively affect any children! Then again I also read lots of sites which were on the other side of the controversy, for instance: Miscarriages can be Prevented, and this study which concludes:
The results of present study demonstrated that the level of NK cells as a risk factor is associated with pregnancy loss in women with IVF failure.

There was also this interesting article: Natural Killer Cells & Fertility:Cutting Through the Controversy which summarizes;
Studies are beginning to surface that demonstrate IntraLipid therapy does in fact improve the odds of pregnancy for those with recurrent implantation failure. In fact, well-reputed journals (Human Reproduction (2016) 31 (1): 217–218; “The absence of evidence is not the evidence of absence” and (2015) 30 (7): 1526-1531 “Enough! Stop the arguments and get on with the science of natural killer cell testing”) are publishing articles outlining both the pro’s and con’s of testing natural killer cells. Unfortunately, many people opposed to the testing only cite the publication that argues against it. That being said, not everyone requires testing for natural killer cell activation – it should be reserved for certain patients that have already demonstrated an implantation issue. And treatment of these individuals, should their test be positive, has been successful in thousands of anecdotal cases.

I asked around a bit. Two doctor friends think that having high natural killer cells does not cause fertility issues and the numbers can just be raised due to other factors such as stress and to be wary of any "treatment". I heard from someone else who has a doctor friend in Hannover that specializes in fertility that she has had eight patients helped by the NK treatment, even a few of them who got pregnant naturally after failed IVF! I've also read loads of stories on forums from women who had several miscarriages and then got the treatment which worked for them. It doesn't work for everyone though, I know that. Hearing the positive stories makes me hopeful and I think it could be worth trying in our case. That said, I do feel somewhat uncomfortable about it and will definitely be asking my doctor a lot about the risks and side effects.

Would you pursue the natural killer cell treatment if you were me?

February highs and lows

If I had to choose my least favourite month of the year I'd pick February without a doubt. It's normally around this time that I just get fed up with winter! Not much happens in February either and it tends to be cold, grey and dark. The good thing is that it's a short month. When March comes around there's St. Patrick's day to look forward to and the start of Spring. However, this February two of my good friends from Dublin came over and we all had the best time! Now that we have the house there is plenty of room for visitors especially since our green room is still empty. We enjoyed showing the girls around where we live, cooking for them and we also took a trip to Baden Baden for the day and went to the thermal pools there. On Saturday night we went to a mexican restaurant for good food, cocktails and then we went out dancing afterwards. More fun than I've had in awhile!

In fact I had a really good few weeks despite everything. The GerMann even commented recently that "there are advantages to not having children". Usually I would hate him saying something like that but this time I agreed. If having children isn't in the cards for us, I could see how we could still have a very nice life. I can't say I don't enjoy being able to be spontaneous, go out in the evenings when we want and plan a big holidays like our trip to Australia in April. Hubby and I have also been getting on very well lately. We're both grateful to have found each other as corny as that sounds! He makes me laugh and we just click really well. He wrote me a nice message in my Valentine's card this year along the lines of whatever happens he loves me so much and will always be there for me.... I'd also written something similar in my card to him, that I know I'll have a lovely future with him by my side no matter what. It's a different message to our previous year's cards where we wrote along the lines of, "I can't wait to start a family with you" back when we still had more faith that IVF would work.

The past while, I'd also been so focused on my goal of having a baby that I think I had forgotten that it wouldn't be all rainbows and unicorns! I've been reminded from conversations I had with my friends who have kids lately how hard and stressful it can be. I think in my head I'd built the idea of having our child to this amazing magical thing. Hearing stories from my friends about babies screaming all night long, sick kids, toddler tantrums and so on, reminded me that my life at the moment is nice, in it's own way. I'm not saying I still wouldn't want to have children, just that I took the rose tinted spectacles off and could see how IF it isn't in the cards for us, we'd still be happy (down the line, as obviously if it doesn't work out, I'll still be very disappointed at first.) Maybe you could say I've been starting to come to terms with things.

Mali from nokiddinginnz wrote about how hope can change over time for those struggling with infertility, and I guess you could say that's been happening to me. I'm still hoping that it might one day happen for us but I'm also becoming more realistic and facing the alternative. My path to mommyhood and differentshoresblog wrote about enjoying life without children, "because I don't have children" and how that can bring up complicated feelings. We don't want people to think we didn't/don't really want children hard enough because we are able to enjoy the time without them or that or that our lives are somehow "perfect" either because it hasn't been easy ending up on this path but at the same time it's nice to enjoy ourselves when we can. Life is really so short after all- It's good to try to make the most of things and be as happy as you can with the life you have. So yeah I'm going to enjoy that glass or two of wine and sleep in on the weekends then have a lazy breakfast making pancakes with hubby, and try to plan trips and holidays and be spontaneous when I can.

However, despite the really good few weeks where I felt happy and more like myself again (I feel like going through infertility has definitely made me more world weary in general. Less carefree and positive than I'd like to be...), I started feeling really down last weekend. I guess there had been a few "triggers". There's a girl from my old neighbourhood back home, a year younger than me who recently had her second baby, and she keeps sharing the adorable pics on facebook, practically giving a week by week account. We visited friends of ours who did their first IVF round the same time as our second round and now have lovely twin girls. And there's a work colleague who's walking around with her lovely pregnant bump at the moment. Happy for them all, sad for us.

There can also be a disconnect between me and my friends here. All my close friends have kids now and there are times when I just feel left out. And since I don't have children I'd like to make the most of the "advantages" and go out for dinner, drinks and dancing for instance. However the girls can only meet day time during certain windows around baby nap times, and then only at kid friendly cafes. Plus children often get sick so they need to cancel or postpone a lot. I do enjoy spending time with my friends' kids, I'd just like to have more adult only events too. Look the thing is, I totally get it, of course if you have kids your schedule is different and you may have to cancel or postpone, I'm just saying it can be hard for the childfree friend now and then.

Recently we arranged to meet up for lunch and I ended up having to wait half an hour on my own as the others were late. Once everyone eventually arrived we had a really nice afternoon. One of the girls commented to me later though that she was glad it was me who had to wait the half hour and not her or one of the others as they wouldn't have been able to wait that long with the kids. I know she didn't mean anything bad by it but my immediate thought was "Right, because as a person without children my time is therefore less valuable". If any of my friends with kids read this, I want to stress that I love you all, I'm just trying to give an example how it can be hard when you're at different life stages to your friends.

When I was feeling down those few days I did have a nice Skype with my sister which helped (she said I could be experiencing "friend withdrawal" after the fun visit!) and hubby noticed something was off and suggested I tell him everything that was bothering me (it wasn't only related to our problems building a family though that was probably the main thing upsetting me at that moment..). I ended up having a good cry. Getting it all out and having his support helped and I felt a whole lot better afterwards, and lighter even!

I actually have a lot more friends back in Dublin without kids so in some ways if I were still living there, not having kids wouldn't bother me as much. I've booked a trip back to Dublin by myself for a few days the end of this month. I had some extra leave I'd carried over from last year which I have to use up by end of March so I figured why not go back for a long weekend. I can try to meet up with some of the friends I didn't get a chance to meet up with over Christmas and just spend time with family. We're going to go out for afternoon tea as well at some point which is one of my favourite things to do. I've even considering having a section on my blog where i review all the best places to go for afternoon tea in Dublin, haha! Full of photos of cakes and scones of course.

I was chatting to one of my best friends here who had a baby after her third round of IVF and she totally gets some of the things I've been feeling lately. It's the not knowing the outcome which is really hard! If I already knew that we won't be able to have our own biological children, then I would be able to start coming to terms with that and accepting it. However since I don't know yet, I'm still living in this limbo land with the hope that it might work, therefore I keep imaging a different future for us. I was also telling her about x,y,z I read about recently wondering whether this or that might be the problem why it hasn't work for us. (For instance, should I get my blocked tube clipped/removed/dye put through it again, or should I get a sample from my uterus in case there's an inflammation and I need antibiotics...etc etc) and she said she remembers being the same way.

It's frustrating not knowing IF it will happen and the exact reason of why it hasn't happened so far (no doctor can really tell you why, there are just so many unknowns in the land of fertility! It's a wonder people manage to have children at all considering the amount of things that need to go right in order for it to happen!). The IVF cycle that worked for that friend was the one she did with the new clinic we are getting a consultation at in March. We just sent off all our paperwork including a very detailed eight page questionnaire last week. Our plan is still to wait and see what they advise us and then we'll be able to come up with an action plan.

In the meantime though, I can say I've mainly been making the most of our childfree life, and that can only be a good thing!

First intralipid infusion down

On Tuesday I got my first intralipid infusion done. This was for my elevated natural killer cells. When the doctor inserted the needle into my arm it was sore for a few seconds but otherwise the whole thing was painless. The speed at which the solution was dripping was set extra slow since it was my first time getting it done and it lasted 2.5 hours altogether.

The GerMann came with me since the doctor said I should be accompanied the first time. Just in case something went wrong I guess. I was glad he was there to keep me company as it was quite boring! I had also brought some snacks with me as other women who had gotten the intralipid infusion mentioned feeling hungry. Later that day once we got home I felt exhausted. That could have been a side effect but it could also have just been from the stress of the past week!

Oh man, where do I start? So the first intralipid was due between days 5-10 of my cycle before I start IVF again. When we had the phone call with the immune doc several weeks ago we had explained the timing of things, that we wanted to do IVF in December. She assured us that we would receive the treatment plan and prescriptions in two and a half weeks. I worked out that should still give me a week to get the intralipid meds in time for the first session.

Firstly I didn't realize that getting the intralipid solution itself would be difficult. I asked at two pharmacies here. One took my number and called me back saying it's called Clinoleic in Germany. When I looked up the consistency of that, it's made from different ingredients so I decided it would be better to stick with the exact medicine I had been prescribed. The other pharmacy just said a flat out no they don't have it. The immune doctor had mentioned it's possible to order the intralipid from Austria. I looked up some pharmacies and contacted two in Austria, one in France. One didn't have it, the other said you can only pick it up from there, but the third said they have it and once I send them the prescription they can send it out and it should only take 1-3 days to arrive in Germany. Great.

However three weeks passed and I still hadn't received the prescriptions and treatment plan from the immune doctor. The GerMann phoned and was told that despite our files being marked as urgent, they still hadn't been processed! I asked him to phone back and ask whether they could at least scan the intralipid prescription and send it by email so that I could order the meds in time. They did that though it took another two days for some reason. Once I got it I immediately send the prescription to the pharmacy and ordered the meds. That was last Wednesday and I knew my first infusion should be the following Monday ideally. I did think that if it ended up being a day or two late, it probably wouldn't make a big difference but I wanted to follow the doctor's recommendations ideally as closely as possible. (It didn't end up arriving until Monday but luckily just in time for my appointment on the Tuesday.)

In the meantime I'd been having trouble finding a doctor who would administer the infusion! Initially Dr. Direct at our fertility clinic had said I could get it done there but then during the phone call with the immune doc she mentioned he had written to her saying the opposite! I wasn't sure whether he had sent the letter before or after our appointment with him so we decided to try to find another doctor just in case. The immune doc had suggested we try a regular GP and I'd seen on a facebook group I'm in for German women dealing with infertility that most of them just got the intralipid infusions done with their local GP, no big deal.

That would have been too easy though! We went to my local doctor (I bought hubby along to help explain it all in German). I knew this particular doctor was pretty anti alternative in general but I figured it was worth a try since the location would have been so handy. Disaster. We started by explaining the blood test results and the recommendation for thyroid meds. She said she had read mixed articles about the ideal thyroid values for pregnancy and isn't convinced that my levels are too high but she reluctantly agreed to give me that prescription and I can come back in six weeks for another blood test there to check my values again. Then we bought up the intralipid treatment and she was totally against it! She called the whole thing "hocus pocus" basically and said she understands our need to "clutch at straws" but we should be wary of people trying to take our money for some new treatment without enough clinical trials. She didn't come across as being very understanding or sympathetic and afterwards I felt pretty pathetic.

We decided to try my other GP in a different part of town next. Yes, I have two since sometimes I can't get an appointment at the one in town and then the local one is handier. Anyway the other doctor was a lot more understanding. She seemed to comprehend how the natural killer cells could be too high and prevent an embryo from implanting. She said she would phone the immune doctor to talk to her about it and then call me to let me know in a few days. It seemed quite promising that she would agree and I felt sure that the immune doctor would explain the whole thing to her and persuade her. Anyway several days came and went but still nothing. The GerMann mentioned that it's very hard to get through to the immune doc so maybe she I should give it more time. After a few more days, I phoned the doctor myself. The receptionist told me that the doctor had said that I can't get it done there and that I should rather ask my gynecologist. It was Thursday at this stage and I was meant to get the first intralipid done by the following Monday, so I was definitely starting to feel stressed! The GerMann and I couldn't get through to our fertility clinic by phone so we wrote an email to Dr. Direct explaining we weren't able to find another doctor and could we get the intralipid done there asap.

He replied saying as per the letter he had written to the immune doctor, he wouldn't administer it in his surgery. Just a short email, no reason. At this stage I was definitely starting to worry! Neither hubby nor I were impressed with our fertility clinic doctor for not helping us out. The other clinic where we had considered going for a second opinion but didn't in the end support immune treatments there. But anyway we wrote a super polite email back saying we had tried other doctors but couldn't find any and thought we could do it there if we were stuck, and could I at least get the first intralipid infusion to give us more time to find someone in time for the next one two weeks later. Then his receptionist phoned and explained that they just don't have the capacity at the moment and that's why they can't help. They wouldn't have anyone to check on me while I was getting the intralipid and they are sorry. So then I emailed my gynecologist who was on holidays explaining the situation but I knew we wouldn't get a reply in time.

Next hubby phoned the immune doc to ask if she knew of any doctors in our area who might do it but she said that she's had other patients from where we live who also couldn't find any doctors willing to administer the intralipid at their practice. So we ended up having to make an appointment to get it done at the immune doctor's practice. We made the appointment for Tuesday, to make sure I'd have the intralipid meds by then (just as well since they didn't arrive till Monday mid morning!). Considering I needed someone to accompany me and how far the immune doctor's place is (two hours with public transport or an hour by car), both the GerMann and I had to take a day off work. I do have a few days left till the end of the year which I'd been saving in case I needed them for IVF so it wasn't too hard getting the time off but it was still awkward and not ideal since I'll need to get the intralipid done every two weeks.

Anyway, so we rented a car via car sharing and the GerMann drove and everything went fine in the end (apart from some arguments in the car. I was using my phone GPS to navigate and there was some miscommunication over when he was meant to take some turns! We ended up missing our motorway exit and taking a slight detour). We made the next appointment there at the same place for my second intralipid which is due in two weeks just in case we still can't find another doctor by then. This time they had an available appointment for the afternoon so I could probably manage by only taking a half day not full day off work.

The immune doctor also gave us a letter to give to the next doctor we ask which says that I had no bad reactions from the medicine and explaining what needs to be done. I scanned it and emailed my gyno again. He still hasn't replied and it's been a week. I'm wondering whether my emails might have ended up in his spam folder! I guess I'd better try to phone tomorrow to find out which also means probably trying to explain the whole thing in German to his receptionist on the phone. I wish getting the immune treatment wasn't all so difficult! Overall I am happy the first intralipid infusion went well though and I guess I'll manage somehow even if it means taking half days off work every two weeks.

There were some baby albums in the waiting room at the clinic full of photos and letters from previous patients who had been helped by the immune doctor. It was really nice reading some of the stories! One wrote that words can't express how grateful they are for the help and that they now have their wonderful child. Another letter in particular stood out.

Roughly translated it says;

Dear other couple who are reading this in the waiting room, don't give up. You are so close to your goal, keep going. It is worth it!

Normally I hate the "never give up" advice you often see on infertility groups, usually said by someone who has their baby because the fact is infertility treatments don't work for everyone. Also there is nothing wrong if a couple reaches the point where they decide to stop and accept a childfree life. That is a brave move. However reading that letter and the others made me wonder whether maybe we are close to being parents, that this might just work for us... And I ended up getting quite teary and emotional in the waiting room! Will we be sending a baby card to the immune doctor thanking her for her help in a year's time? Only time will tell...

What next

After a failed IVF it is typical to have a follow up meeting with your doctor, often nicknamed the "WTF meeting" in the infertility circuit. It's a chance for you and your partner to ask loads of questions, discuss what went right or wrong and what could be done differently next time. I mentioned that we have been considering getting a consultation at another clinic which is unfortunately a lot further away. We phoned them and the earliest appointment we can get there is end of August! I would also need to take time off work just to go to it which is quite awkward. In the meantime we had our follow up appointment at our local clinic and actually it went a lot better than we had been expecting. Better that is in the sense that the doctor took loads of time to discuss things with us at length and answer all our questions, not necessarily in terms of our future chances which are still hard to say.

We have a few things working against us. My one confirmed blocked fallopian tube and the other one which seems to not be working hence the need for IVF in the first place. And now it turns out I'm classed as a "poor responder" to IVF hormones. My body doesn't make as many follicles as it should. And even when they do grow, some of them are empty so that doesn't help! The doctor has a theory now that maybe some months I'm not producing an egg naturally and he thinks this is part of the reason for our not getting pregnant naturally. For all I've researched into "empty follicle syndrome" (which is what it's called when you have less eggs retrieved at the egg collection procedure than the number of available follicles) I have never come across this theory.

If it were correct I've been trying to work out what that would mean for our chances trying naturally. The first IVF round I had six follicles but only two eggs. The last round three follicles and one egg. So that would mean a one in three rate of eggs approx. So in a given year, twelve months, I would only have about four eggs, that is only four months with an actual chance. Given that one fallopian tube is definitely blocked that would half it to roughly two. So only two months out of a year when there's a chance of conceiving. Add that to missing the "fertile" window one month if our timing is off and that would leave only one month per year. So that could explain why I haven't gotten pregnant naturally before now IF his theory is true! Hubby was wondering afterwards whether we should have tried naturally for longer before pursuing fertility treatment when he heard that. But if both tubes aren't working at all then it would never happen naturally no matter how long we wait.

Anyway. The doctor says we could try the antagonist protocol next time which might work better for me. Hopefully. But he also said I don't have to rush as the few eggs I do produce are great quality and he's not worried about my age. He suggested we take about six months off. He also said it could be a good idea to do some further tests before going "blindly" into the next round. He suggested we get our chromosomes checked and to test me to see if I might have a blood clotting factor (although last round he prescribed me baby aspirin after transfer just in case).

There is also a lab where you can send your blood to for more thorough tests and they check for natural killer cells. This is a very controversial area. The idea is that some women have overly effective immune system response cells which attack the embryo thinking it's a foreign body. There are meds you can take to suppress this response. Our doctor said that some doctors don't believe in it at all and think it's just a waste of money whereas others thinks it's really great. There was a conference in Biel in Germany apparently where there was a presentation and any of the doctors who went there were convinced. He said he's also had some patients who were helped. But it's up to us whether we want to go down that avenue or not.

I figure it's worth getting the tests done their anyway. They also test your vitamin levels and any gene issues. The problem is it takes about three to four months for the testing and we also need to try to see if our health health insurance will contribute towards it first so that will take some time sorting that out. With health insurance help it might just cost a few hundred euro here but without help it would be closer to 3000€ in which case we wouldn't be able to afford it right now!

If we're going to be busy with our new house over the next few months anyway, why not get these tests done and give round three our very best shot. Especially since the third round is the last round our insurance will pay towards and what with the new house and bills, we probably wouldn't be able to afford any more rounds after this. Yes the third round will most likely be our last whether it works or not since that is what we had agreed beforehand and at some point we don't want to just keep throwing money at something if it looks like it's not going to work. If it did turn out that the next round were to fail hubby and I differ somewhat on how we would proceed. He thinks at that stage we should accept kids aren't for us and try to move on, whereas I would probably consider looking into other options like mini/natural IVF with less hormones and less costs before being ready to accept it. We've had some difficult conversations about it all. I try to think positively in general but after two failed IVF cycles I am starting to really worry more about why it isn't working and what the future holds.

Apart from all that life has been great lately. It's very exciting that we've found new house and we'll probably be moving in just a few months; job wise things are also going great, I recently even got a small promotion! Now that I'm not currently going through fertility treatment I've had more energy for my social life and it's been fun meeting up with people more often and drinking wine again! I have also become friends with a new Irish girl living here which has been great since over the past half year several close friends have moved away. And I'm very happily married; it'll be our three year anniversary this August. So a lot of things are going really well and I'm very happy with my life...I just hope there will be a baby in our future.

How I've been preparing for my 4th IVF

It's a strange feeling knowing I could be beginning our fourth IVF in just a few weeks, Or I might not be starting for a several months. Would you believe we're still waiting for the results of my uterine biopsy? We emailed our doctor while we were in Australia and she said that it takes about six weeks. So initially we had been told one week by the doctor who performed it, then three to four by the receptionist and now six. The not knowing is frustrating but since there is nothing we can do I'm trying not to think about it too much! Anyway, these are the way I have been preparing for our 4th IVF;

• Step one - uterine biopsy to rule out any infection such as endometriosis

The uterine biopsy and scratch was suggested by Dr. Peppy at our new clinic as it's the one test I haven't had done yet. It was uncomfortable but luckily not painful and only took a few minutes. The long part was getting to and from the clinic, as it's in a different city to where we live. If it turns out that I have an infection such as endometriosis then I'll need to take antibiotics for a month and probably test again so it would definitely affect how soon we can start our next IVF cycle.






• Step two - go on holidays

We went to Australia in April for my brother's wedding and had an amazing time. It was so nice to spend time with family, have a holiday with hubby and just relax and not think about infertility treatments! It was really good for us to take some time off from everything. Traveling is one of my favourite things to do. I'll try to do a separate post on that and share even more photos. I'm really glad we decided to go on the trip in the end. Initially we had been considering staying here to save money and not have to postpone IVF too long, but a family wedding is such a special event and I'm glad to have been a part of it.

Usually I try to quit alcohol in the months leading up to IVF but I haven't been doing that this time. I haven't been drinking much though, just the odd glass or two of wine at the weekends, but then in Australia I ended up consuming a fair bit, as you do on holidays! For instance, we went on a Swan Valley wine tour one of the days and my sister and I got very tipsy. I hadn't laughed so hard in a long time! I've decided to not let myself feel bad about it as I needed the break after everything. Once I start with the IVF injections I'll cut out alcohol completely.






• Step three - supplements to prepare ourselves

We are both planning to take his and her preconception supplements once we start our IVF cycle. I've also got hubby on Coq10 which has been shown to improve DNA fragmentation. He hasn't been shown to have any issues with his swimmers, but no harm doing whatever we can to improve things. Hubby and I have both been taking vitamin D as our blood tests showed we were low.
My doctor agreed that I can try DHEA before this cycle which can help women who respond poorly to the IVF hormones. Of course, I'm also on folic acid. For egg quality I'm taking 600mg of coq10 each day and I'm planning to start 3mg of melatonin once I begin the IVF injections stage until the egg retrieval as I've read good things about it. I had taken thyroid meds for several months after my blood tests showed my levels were slightly off but my most recent blood test showed my thyroid is ok now. Let's hope it stays that way!






• Step four - general health and diet

Since January, I decided to go gluten free and eat low dairy and less sugar. Apparently that could help reduce elevated natural killer cells. Hubby and I have also been trying to avoid processed foods as much as possible and generally eat lots of vegetables and legumes. We've both cut down on the amount of animal products in our diet. It has been fun trying out new recipes together and we've both been feeling great. I decided to try going gluten free after reading this study which concluded;

Patients of childbearing age having fertility problems may have subclinical NCGS and they should be informed that the treatment of NCGS by a gluten free diet might improve their fertility. Based on the case we are presenting, the possible prevention or treatment of reproductive effects may be achieved through a strict gluten free diet.

NCGS stands for 'non-coeliac gluten sensitivity' by the way. In some people your body apparently mistakenly thinks it is something bad and there can be an autoimmune response. I figure I could try it for a few months, what have I got to lose? Since going gluten free my general digestion has also improved which is a plus. It can be quite challenging following a gluten free low dairy diet living in Germany though, particularly when eating out! Here's a picture of a delicious breakfast I ate in Perth. Vegan buckwheat pancakes with fruit and cashew cream.






• Step five - general self care

I haven't started this yet but I'm planning to try to make more time to do nice relaxing things for myself. I'd like to book a massage for instance, read more as I love reading, take long baths, listen to music and so on. And make sure we also do nice things like go on dates. It's very easy to get into the habit of staying in and binge watching tv shows and as much fun as that is, it's good to get some variety and go out for walks, dinner, cinema etc.

Won't it be nice once all this is over and I can eat, drink and do what I feel like without worrying about affecting my egg quality! Also it will be great once I'm done taking so many tablets each day. But it's ok, I'm happy now as I know that I am doing it all for an important reason. I've also noticed that the Australia trip has done me a world of good! I feel like I got to be myself again. My brother's wedding was so much fun! I was hanging out with a lot of his friends who are about three years younger than me. The handy thing was that none of them were at the kid stage yet (it's quite typical to not get married in Ireland until your 30s) so hubby and I weren't constantly being reminded of our lack of children like we might be when we meet up with friends our age. It was interesting to get to know my brother's friends and his life on the other side of the world. I had fun dancing like crazy on the dancefloor! Myself and some of the other girls from Dublin even attempted to do some Irish dancing, haha!

I would even go so far to say that I feel stronger emotionally after the Australia trip too. For instance on the flight there I refrained from watching "Bad Moms" or "Storks" on the plane as I was still feeling too fragile and worried that they would upset me too much with too many triggers. However on the flight back I watched them both! Bad Moms had some moments about how great it is being a mom and so on but otherwise it was mainly silly and funny and perfect for wasting a few hours on a long flight! During Storks I did cry a bit at the end but everyone did!

Hopefully I'll hear from Dr.Peppy soon so we can finally start planning when our 4th round will start. In the meantime we have another wedding to go to this month, so there will probably be more drinking and hitting the dancefloor!

Michelle Obama's revelation #MicroblogMonday

A few weeks ago my husband told me that the Obama daughters, Malia and Sasha, were conceived through IVF and that Michelle had previously had a miscarriage beforehand. She has written all about it in her new book apparently. I was surprised by the news. At the same time I was also glad, not about Michelle's miscarriage which is very sad of course but about her opening up and bringing infertility and IVF into the open.

I suspect a lot of celebrities end up having to get help but most don't talk about it. Chrissy Teigen was open about her and John Ledgend's children being IVF babies but she is in the minority. Beyonce and Jayz are suspected to have gotten help but they never confirmed or spoke about it.

Of course if a celebrity is going to be open about it, it is more likely to be after they have come out the other side and have a healthy baby. It is even more rare for them to say they tried but were not successful in conceiving and have had to move forward in their lives going in another direction. My book club are thinking about reading Michell's memoir and I'm sure it will be an interesting read!

Eating for three

Yesterday I had the transfer. The GerMann was able to come with me this time which was nice and hopefully brings us some extra luck! On the way to the clinic I was feeling anxious. If two of my eggs didn't even fertilize maybe it was a bad batch altogether? Or maybe one of the embryos might have arrested and stopped growing. Once we got to the clinic the nurse at the reception remembered who I was and immediately told me that our two embryos were doing great. That was a relief and great to hear!

I listed to the Zita West relaxation meditation tape beforehand to get into the right frame of mind. The transfer itself went absolutely fine. The doctor said the two embryos are schön (beautiful) and four cell. I've since googled it and at 48 hours after egg retrieval you want the embryos to be 2-4 cells so 4 is great!

It was a lovely day. Hubby was very sweet to me and it was nice to feel hopeful. I mainly took it easy. The nurse had advised not to sit too much, so I lay down watching tv (Call the Midwife & New girl), baked some muffins and did a few things around the house. She had also advised me to eat lots of protein so I made some scrambled eggs and avocado for lunch.

A side effect from steroids can be weight gain and apparently increased appetite is the reason. I've already noticed I've been feeling extra hungry! I had a second breakfast after I came home from the transfer. I figure I'm not going to stress about gaining a few kilos. It doesn't matter in the scheme of things at all. When hubby and I were discussing what we'd have for dinner yesterday he remarked that I'm "eating for two..no wait, for three now"! It was a cute moment.

I had my third intralipid infusion today and that went fine. It took almost two hours and was mainly just boring! The GerMann says I get bored easily though. I guess that can be true as I do find it hard to sit still for a long time. At the end of the Intralipid infusion it occurred to me that I'll only be getting the next one done if I'm pregnant in two weeks time. I so wish I could see the future! Tomorrow I'm going to my GP before work to get blood taken to check my thyroid levels have gone down. A TSH level below 2 is better for pregnancy according to the immune doctor.

I've been worrying and feeling anxious a lot lately. And then I worry that all this anxiety could be bad for the embryos so I try to stop myself! Before we started this third round of IVF I had been thinking that if it doesn't work there is always a plan B of going to another clinic for a second opinion and maybe trying the natural protocol. However lately I've just been thinking that I can't bear the thought of going through this all again. And would there even be any point? I'm not exactly an ideal candidate for IVF being a poor responder to the hormones. I would definitely need to take several months off from doctor's appointments and treatments if this fails before I could even contemplate next steps but then the thing with infertility is that time generally isn't on your side. The GerMann is ready to stop with treatments whenever I am. He didn't even want to do IVF in the first place. My desire for a baby has always been stronger.

I'm happy that the next two weeks I'll have quite a few distractions between working, visiting my husband's family and then Christmas in Dublin. The doctor gave me a note for the airport to say that I require certain medications so that I should hopefully not have any issues bringing them in my carry on luggage. I've worked out I'll only have to give myself two injections while I'm staying with my family which shouldn't be too tricky. Other than that I'll just need to remember the progesterone three times a day, the steroid tablets plus baby aspirin in the mornings and and a prenatal.

My moods are quite all over the place at the moment, which you might have noticed. Swinging from positivity to despair in a moment. I'm definitely feeling extra sensitive today. The best way for me to not stress as much I've found seems to be by not letting myself think about all the what ifs and just focus on the moment. Trying to do things that make me happy also helps. I created an upbeat 80s music playlist which I've been singing along to, plus drinking large amounts of (decaf)Barry's tea. Tonight we'll watch an Irish movie (Sing street). Other than that we'll just keep praying and crossing our fingers that it might be third time lucky.

Wishing everyone who reads this a lovely Christmas season and all the best for 2017!

week 29 - birth preperation course #pregnancyDiary

This week we had the birth course morning where the partners were also invited. It took place on a Sunday and there was heavy snow that day! This time the course instructor didn't try to sell us anything which was good. At the start the men had to introduce themselves and say a bit about what they are hoping to achieve from the course. It was clear most didn't have any idea what to expect. A few said things like Ich lasse mich überraschen. Which is like, "I'm ready to be surprised".

Anyway this time the main focus was the birth which was useful. For first time mothers the instructor suggests you labour around 2-3 hours at home before going to the hospital. For second timers it's better to only wait around 1 hour. This rule doesn't apply if you have any bleeding or your water breaks. And if there is any green in the water then it is a sign the baby is in distress and you should get an ambulance and get to hospital asap. There can be a little spotting a few days before the birth starts apparently which is a sign that you shouldn't venture too far away from home at that stage such as not taking any big trips as the labour could be imminent. She was pretty against epidurals especially ones that you have for a long time as it can cause the baby to sleep and things might stall and then you could end up needing a c-section. The rate of c-sections at the hospitals here are around 20-25% percent. She said that usually c-sections are only suggested if there is risk to the baby or the mother's lives and then they are very important. Though apparently some women in Germany choose elective ones.

The course was particularly useful for the men I found though. It was good for them to hear about how to support their wives during labour. For instance not to keep asking questions but to just be helpful! And instead of saying for instance "you're not doing the breathing right", he should start doing the breathing himself and she will copy. We all practiced the breathing exercises and were given a printout of various positions for the different birth stages. I liked how there was a lot of focus on the women and how the men should be involved and active during the labour. They aren't just taxi drivers bringing their partners to the hospital she pointed out! Hearing about some things that can potentially go wrong during the birth (baby doesn't turn etc) was a bit scary but in general I am still feeling overall positive about the birth. The teacher explained a little about hypnobirth theories and how you have to breath and accept the contractions and not fight against them.

I am a member of two facebook groups for other February Mums to be. One is for Irish women (mainly living in Ireland) and the other is for women who did IVF and infertility treatments beforehand. I've definitely noticed the ladies in the latter group are especially appreciative of their pregnancies. There was a post the other day about how we just can't believe sometimes that this is happening and how grateful and lucky we feel. The other evening I was just relaxing watching tv and suddenly it hit me again that I am, please God, going to get my own baby to keep! I won't have to give her back! It was just a lovely feeling.

This week was also the third birth preparation class - an evening with just the women. I found it really informative and useful. The course covered a lot about bonding with the baby after birth and breastfeeding. The people in the class are also mixing more now too I've noticed. I suggested we set up a whatsapp group so we could meet up some time and the idea was well received. It would be a good way for me to keep up my German language skills while I'm on my parental leave.

In Germany the period after birth is known as Wochenbett (lying in/confinement). For the first six to eight weeks the mothers are encouraged to stay in bed and just focus on breastfeeding, resting and bonding with the baby while everyone else brings food and looks after them. That sounds nice! I normally get bored of lying in bed for ages though so provided I'm feeling ok I think I would try to get out for walks now and then if I can. I'll play it by ear though. Staying at home and having that time to bond with the baby also sounds lovely.

To be honest I still worry and get anxious sometimes. I read a really sad story recently about an Irish woman who had a stillborn baby at 35 weeks. And on facebook a group called "stillborn angels" popped up on the suggested groups for me! I had to keep reminding myself it was just because of some stupid programming algorithm and not a bad sign or omen. I've even looked up where Germany stands in terms of stillbirth compared to other countries. It's about 2.4 births per 1000 which is a fairly low number (though ideally there would be none at all of course). However it happened to one of my best friends in Ireland so I definitely am aware that is is more common than you might think. It's just devastating for anyone to go through. I am trying to calm myself by reminding myself that the majority of babies do arrive safely. It will be a relief though once our baby is here and everything is ok. My friends have told me that being a parent means a lot of extra worry that never really ends!

Still though, apart from occasionally being anxious about things like that, in general I am feeling good and positive. I hope everyone reading this has a lovely Christmas period and "ein guten Rutsch", a good slide into the New Year, as the Germans would say!