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!

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!

Our five snowflakes that weren't

Over the course of the last year and a half we've had three IVF cycles and I've had a total of five embryos transferred into me. Five little snowflakes which had the potential to grow into babies but sadly didn't. I can't help wondering what kind of people they might have one day become. How many of them were boys, how many girls? Would they have had my eyes? My husband's smile? Or even our bad eye sight (haha)? Even though they were only growing and alive for such a small amount of time, I loved them wholeheartedly.

Last week we had the follow up appointment at our clinic ( also nicknamed the "WTF meeting!"). It turns out the two embryos that were transferred during our last failed IVF were rated 1 (which is the best possible mark here!) and 2 (which is also very good). Since hearing that, I have felt mixed feelings. Sad to think of our perfect embryos that weren't to be and wondering what went wrong, why even one of the two didn't take. The doctor put it down to bad luck. Everything looked great he said. It should have worked...

I've felt happy though that my partner and I are still able to create such good quality embryos despite the fact that I'm classed a poor responder to IVF hormones and don't have that many eggs grow each time. The doctor said that our egg and sperm quality are great which means we *should* be able to have a biological child. However, there are no guarantees with IVF, I've learnt that lesson time and time again. Sometimes you can have everything go right, transfer a perfect embryo and for whatever reason it just doesn't implant.

The good news is that the doctor says he's not worried about me running out of time and my fertility decreasing if I want to take several months break. That's a relief and I feel justified now in our decision to book our flights to Oz. I asked if it would be ok to wait until this summer and he said absolutely. I actually hate the thought of going through it all again; the Intralipid infusions, the injections, the feeling crappy, the egg retrieval procedure, the emotional upheaval. So I will need several months just to be able to gather my strength before I can try again anyway.

On Wednesday I went to my gyno. I told him about our plan to try the other clinic. He doesn't think they are any better than our local one, in fact he says their results are generally slightly worse. That was disappointing to hear! But he understands our wish for a second opinion after three failed IVFs at one place. He kindly offered that if we decide to go ahead with treatment at the other clinic, he could do some of the ultrasounds for me here and send them the results so that I wouldn't need to travel 60 kilometers there and back each time. That was a nice offer! I'll ask at the new clinic whether that would be feasible. He said he'll try to support me whatever way he can. For instance if I want to get the intralipids done again. He's a good doctor, I like him a lot.

He's not too impressed with natural IVF though when I asked him his thoughts on that because it still includes the egg retrieval procedure but has only low chances of success with one egg. He said it only makes sense for older women or poor responders. I explained that I AM a poor responder since he might not have realised. I only had 2 eggs during IVF#1, 1 during IVF#2 and four during IVF#3. He agreed it might make sense in my case then. Our fertility doctor isn't a big fan of natural IVF either. They don't even offer it here. But he encouraged us to go for a consultation at the other clinic to decide if it could be right for us. He said many women do a low dose / mini IVF with the drug Clomid which is much cheaper than the other meds once they run out of IVF rounds covered by their insurance. I couldn't help feeling a little sorry for them (and us). It's no fun reaching this stage!

That said, overall the appointments went well. It's great to have the support from my gyno in terms of getting intralipids or ultrasounds done so I wouldn't need to travel to the other clinic every time if we decide to get treatment with them (I'll just need to find out how much extra that might cost). And I'm happy to hear that we are still able to create great embryos together and that having a few months off shouldn't affect things negatively (that was one of my worries particularly after turning 35 last month). I've decided I do want to go for a fourth IVF, whether it will be normal / natural or mini, probably sometime this Summer because I feel (hopefully not naively) like there is still a little hope that it might work for us.. And my husband has also agreed to us trying one more time. At that stage we will both feel like we have given it our best shot and can then move on with our lives one way or the other!

After our appointment at the clinic I went shopping and bought myself some new Summery clothes for our trip to Perth in a few months time. A bit of retail therapy can be good sometimes! I am so over this freezing cold never ending winter here. It even reached minus 10 degrees this week. I hope the weather is a bit nicer wherever you are!

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!

We have a plan

We finally had our phone consultation with the immune specialist doctor which we had waited six weeks for to discuss our blood test results. The GerMann downloaded a recording app on his smartphone beforehand so we could record the conversation in case there is anything we might miss. I was also worried that I wouldn't understand all the medical terms in German.

The doctor was nice and explained things well. The good news is that I don't have any indicators for an autoimmune disease, just the high NK cells by themselves. I will have four different new meds to take as part of my treatment. The first is Thyroxine for my thyroid. I was surprised at this as my throiyd values were all within range. My TSH value was 2.30 (the range given is 0,34 - 2.50). However the doctor said that she would like to reduce that value and that 1 would be more optimal for pregnancy. I should be able to get a prescription for it with my general doctor and then she suggests getting the values tested again in four weeks.

The next thing is the intralipid infusion which I had been expecting due to the elevated NK cells. She suggests getting the first one between day 5-10 of the cycle before IVF, then between day 22-28 and finally after the egg retrieval before the transfer. If I get a positive pregnancy test then I would have to keep up the intralipid infusion roughly every two weeks. Possibly until the second trimester but I think I would be given another blood test to check on the NK cell levels.

Another drug she recommend is called Predisolone which is a steroid. I would start taking that after the transfer but in a very low dose which would then be gradually reduced once I get pregnant. The side effects from that are weight gain and insomnia. And the final extra medicine is called Granocyte. This is because I am lacking a few "KIR" genes which can lead to a higher risk of miscarriage and problems with the placenta development apparently and this I would take in injection form starting after the transfer. According to the website: Various studies (Würfel 2010, Scarpellini and Sbracia 2009) have shown that the pregnancy rate increases significantly and that the success rate of pregnancies in patients suffering from recurrent miscarriage shows a similar increase with treatments incorporating granocyte starting from the implantation phase.

I asked about whether it would be ok to fly to Ireland for a week around Christmas and she told me that she used to advise people not to fly at all but she has had loads of patients travel abroad for treatment and it hasn't affected their results so she thinks there is no problem with us going to Ireland, a short flight, for a week after the transfer. So that was good to hear! We will have to miss my cousin's wedding in early January which is disappointing but we will be with my family for Christmas itself and that should also help the two week wait pass quickly! We would fly back to Germany in time for the blood test result and then if I get a positive test I'd continue with the meds and treatment.

The doctor also mentioned that our fertility clinic doctor, Dr. Direct, had written to her saying that he wouldn't administer the intralipids at his clinic. This confused us as he had told us at our consultation a few weeks ago that I would be able to get it done there and that he would support the treatment. So now I'm wondering whether he had written her the letter before our chat with him and changed his mind or whether he decided after talking to us that he doesn't want to administer the intralipid at his practice for some reason!

Apparently the intralipid medicine itself is difficult to procure in Germany. You either need to find an international pharmacy that will order it for you or you contact a pharmacy abroad such as in Austria yourself. The immune doctor also mentioned that medicine is cheaper in France and we'll save money if we buy some of the meds there. We need to wait until she sends us out the prescriptions and treatment plan before we can buy the meds though. She said she would send it in about two weeks. In order to go ahead with IVF in December, I would need to get the first intralipid infusion around mid November so I just hope I'll be able to get the meds in time and find a doctor willing to administer it.

So there you have it! I feel positive having a plan and happy that I should be able to get started soon. I hope things will work out timing wise, that we'll be able to get the meds required and that I can start the intralipid infusion in a few weeks. I am a little anxious about potential side effects and how I will respond to everything. However, I'm a member of a German facebook group and a lot of the women who followed the treatment plan suggested by this immune doctor had success which is promising. Let's get this show on the road!

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.

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?

The green room #MicroblogMonday

There's a room in our new house that we painted green. I thought that would be a nice neutral colour for our future kid's bedroom. Right now we have some book shelves in there and might use it as a guest room in the meantime. Is it just wishful thinking and possibly a little delusional even that we both still feel so hopeful that we will be able to have a baby despite the low IVF odds?

Since we've bought our house, questions from people asking if and when we are going to have kids have been more frequent. And some of the comments can actually be a little hurtful to someone who is trying to have a baby and struggling. We generally just say yes that we would like children since that's the truth but just wanting them isn't enough unfortunately!

We recently had some relations over to show them the house and they commented that it's too big a place for just us but ideal for a family of four. That stung. I know they meant it in a nice way as they assume having kids is just something you choose to do when you are ready.

The actual choice we face is how many rounds of IVF to go through before giving up. And how will we save enough to afford our mortgage AND a fourth round if this one doesn't work out. However, I have decided that it's ok to still be hopeful. Our "maybe baby" journey isn't over yet. We are not out of options so we will keep going, hoping the green room won't remain empty for too much longer.

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!

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.

The journey continues

I was tempted to name this blog post something along the lines of "yet another invasive medical procedure on the long journey to have a baby", but I decided that probably sounded too negative!

A few months ago at our appointment to dissect what went wrong during the first round of IVF (I've heard some women refer to this as the WTF appointment!) my doctor, who I'm nicknaming Dr. Direct (since he tends to state it like it is, and has little time for empathy) started off by saying everything went well during the last attempt and he feels good about round two. Next time I'll try different medication, an antagonoist protocol, which should hopefully help more eggs to develop.

I mentioned that the other doctor, who I'm nicknaming Dr. Gentle (because she is the opposite, has lots of empathy and is more caring), had noticed that my womb lining was on the thin side and whether that could be an issue. Dr. Direct looked over his files on us and he said that yes it was thin; only 6mm whereas they like to see between 8 and 10mm. He then suggested I should consider getting a hysteroscopy which is when a camera is inserted into your uterus to see if everything looks ok. He gave me a referral to another doctor for a consultation.

Whenever we leave appointments with Dr. Direct we always end up feeling overwhelmed with information and choices. Neither hubby nor I liked the idea of me having to get another procedure done under general anesthetic but after doing some research I started to think it would be worth doing, just in case there IS some sort of issue and especially once I realized we could combine it with an endometrial scratch.

That's a relatively new pre IVF extra that has shown very promising results in trials. Basically a tiny scratch on your womb causes the lining to be regenerated with new lining that is extra receptive to embryos the following month. In some studies it even doubled the chances of a successful pregnancy from 29% to 49%. I'm loving those improved odds!

We had to postpone when we could start our next IVF for various timing reasons unfortunately but we should be good to go in a few weeks time. The chances of a 2016 baby are no more but I'm hopeful now for 2017. At least our future child will know they were very much wanted as there is no way anyone would put themselves through the gruelling IVF process if they didn't absolutely have to!

Update: I had the hysteroscopy and scratch and it all went well.

IVF Diary - the first ultrasound

When I had my first ultrasound since starting the hormone treatment I found out that I have six follicles growing (three on each side) but they only measure 1.3cm and they need to be over 2 so I need to do an extra three days of injections. The doctor didn't seem to have any issue with me only having six but I'm disappointed. Six follicles doesn't seem like a lot especially when I was hoping for 8-12 eggs. Also during the information evening at the clinic we were told that they would only freeze extra embryos if they have at least 5 good quality ones which means it's already looking a little unlikely that I might have any extras to freeze for the future.

My worry is that if we only end up with a few embryos and then I don't get pregnant this month, since let's face it there's a 70% chance it won't work, and if we don't have any frozen embryos to use then I would have to do a second full round of ivf again. And right now I'm just finding it all hard going, and I'm only one week into it the process! I would definitely take a several months long break afterwards before being able to face the idea of a second round.

Oh well... Six eggs is better than none I suppose, I should probably look on the bright side and try to stop worrying so much! Easier said than done of course. I've another appointment at the clinic tomorrow for my next ultrasound so I'll find out then if any more follicles have grown in the meantime. 

IVF Diary - the first few days

Tomorrow I go back to the fertility clinic for an appointment. I'm dying to find out how everything is looking, for instance how many follicles are growing. If you have too many then you are in danger to getting hyper ovarian syndrome which sounds really awful. But too few eggs gives you a lower chance of IVF working and less potential embryos leftover to freeze which is also not great! Obviously I really hope this works for me so that I don't have to do several rounds of IVF however if this attempt were to fail and I had some extra frozen embryos then at least I could do a second round without having to go through all the injections and egg retrieval procedure again which would be a lot easier to handle.

I have six days of injections behind me now. This morning the pergoveris burned a bit going in again and was very unpleasant. I've been warming the bottles up with my hands a little first as maybe the fact they were in fridge and therefore cold, is the reason it was burning. I tried that the past two days and it seemed to be helping as the mixture didn't hurt going in. All in all I would say the injections have been getting easier. That said, it's still the least fun part of my day and my stomach feels like a pin cushion!

Yesterday I had some stomach cramps and felt bloated and uncomfortable, probably since my ovaries are starting to grow to produce lots of follicles. I was out in town with some friends but wasn't able to stay out too long. Once I got home I put a hot water bottle on my stomach and changed into comfortable tracksuit bottoms and then I felt better. Apart from the cramps which come and go I've been feeling mostly fine though, no nausea or any other bad side effects so far.

Will let you know how tomorrow goes. Let's hope everything is looking good!

IVF diary - As ready as I'll ever be

Yesterday I went to the doctor, he gave me an ultrasound to check everything looked ok, then told me to start with the injections tomorrow morning. They should be done at the same time each day.

The plan is that after a week I'll go back for another ultrasound and then he'll be able to tell me when the egg retrial procedure will be. I really just want to know already. Some friends were texting me about meeting up next week but I don't know yet if that will be a good time or not. I imagine that the evening before the egg retrieval process I won't be up for meeting anyone and for a few days afterwards I'll be recovering.

After seeing the doctor I then was given a tutorial by the doctor's assistant on how to prepare and administer the injections. It's quite tricky! I'll have to give myself two injections, on alternative sides of my stomach and switch sides each day. One is called Decapeptyl and that is to prevent me from ovulating, and the other is called Pergoveris and is to make my ovaries produce loads of eggs. 

The Decapeptyl is quite simple, it comes already made and you just have to inject it, but the pergoveris is trickier. It comes with two vials of liquid and two vials of powder. You get the large syringe and suck up the liquid then push it down into the powder then do the same for the other vials and then suck all the mixture up into the one syringe. And once that's done you change to a smaller needle.

The medicine has to all be kept cool so the pharmacy gave me a cool bag to bring the medicine home and now I have to keep it all in the fridge. Tomorrow is day one!

Where the bleep is my stork?!

Every so often facebook shows you memories from that particular day in the past. Recently it showed me a picture of the GerMann and me on our honeymoon. It made me feel sad to think that two years later we are gearing up to start IVF treatment and I don't know if it will even work and whether we will ever be able have kids...Though I'm really trying to stay positive and am hoping that this time next year we might have our miracle baby.

I've been wondering about whether to talk about this topic or not but in the end I decided that having a blog is a way to share thoughts and make sense of things and it might be helpful to have an outlet while I'm going through all this. So I'm going to create a series of rather personal posts about what's been going on the past few months to fill you in.

Girl meets boy. They date, fall in love, get married and then start a family. Right? Unfortunately I'm learning the hard way, it's not so easy for everyone. One in eight couples these days experience infertility, which is defined as not getting pregnant after one year of trying. That's a lot of couples dealing with something that people don't really talk openly about so you can end up feeling quite lonely when going through it and it can feel hard to find people who relate. You also experience such a rollercoaster of emotions; hope, guilt, depression, anger, sadness - it's a lot of ups and downs.

When we started trying for a baby I was worried at the back of my mind we might have difficulty as my doctor here had warned me as due to my having had surgery when I was younger I probably have scarring around my fallopian tubes. But still I was hopeful. The first six months I wasn't overly worried or thinking about it that much as I'd read it could take some time (up to a year is still normal) but I did start to try other things at that stage such as improving my diet, trying acupuncture, using ovulation sticks, the list goes on. During a HSG test where they put dye through your tubes to see if it can flow freely I found out that one side was blocked but the other side looked fine. And I'd read a lot of women also fall pregnant shortly after that test- maybe the dye helps clear our any old cobwebs, haha!

Unfortunately though, after several more months of nothing happening once we reached the one year mark it was time to make an appointment with the doctor...to be continued..