Coping strategy #1 - Ask more questions

Well, I certainly managed to address that one! I went to see my fertility specialist today with a list of 30 questions. She responded really well and was happy to answer them. I feel so much more positive about moving forward now that we have been through everything in detail.

Lovely husband is away at the moment, so he dialed in on the phone and chipped in with a few of his own questions. Below is a summary of the conversation. Only people who are really interested in the nuts and bolts of IVF cycles will be interested.

1. Post-mortem on the first two cycles

Dr D was really pleased with my response to stimulation. She said that many women of my age don't respond very well to FSH and only produce small numbers of eggs. Whereas I produced loads - 17 on the first cycle and 15 on the second. She said not to get too caught up in the fact that we have 6 eggs fertilise abnormally in the second cycle. Rather, she said we should focus on the number that did fertilise - 7 from 17 and 5 from 15. When I look at it like that, it doesn't seem so bad.

2. Embryo quality

We have so far produced 9 blasts but all have been grade 2 (fair) and none grade 1. She said not to worry about that. There's such a small difference between grade 1 and 2 that its just not worth worrying about. She says that in more than 90% of cases at my age, the embryos are at fault because so many are chromosomally abnormal. Although that is a bit daunting, it gives us much more reason to persist with IVF. Eventually we should hopefully be able to crack a good embryo that will give us a baby.

She also said that the high E2 levels in the first cycle will not have impacted on the quality of the embryos produced. So we can be confident about proceeding with the frozen cycles.

3. What if it's me?

This is something that has been bothering me for days. What if my uterus just rejects any embryo put into it? We will never suceed if that's the case. So, we worked our way through the possible issues:

Endometriosis
Dr D said she tested for cancer antigen-125 (or something like that) and it came up low, so there's no reason to suspect that I've got endometriosis. It was about 12 and only values >25 are cause for concern. I didn't realise she had done this so it was good to hear the news. I told her I really wasn't too keen on having a laparoscopy done and she definitely agreed that it wasn't a good path to take.

Hydosalpinges
This is a fancy name for a build-up of fluids in the fallopian tubes. She said I definitely don't have this (it can apparently be seen on ultrasound).

Blocked fallopian tubes
In terms of IVF, this doesn't actually matter. IVF was originally designed to bypass blocked tubes. But it matters to us because, as lovely husband pointed out, trying 'natually' in our off IVF months will increase our chances of having a baby. If my tubes are blocked, we may as well know that is the case. So tomorrow I am having a hysterosalpingo contrast sonography tubal patency assessment.

If the tubes are blocked, we won't do anything about it but the best thing is that I might have an infertility diagnosis other than 'I'm too old'. We also will not expect to get pregnant on our 'off cycle' months.

Immune issues
I was a bit nervous about raising this one because it is so contentious. It is possible that they are interferring with implantation. Dr D specialises in recurrent miscarriage so she knew all about it. She has ordered tests for our piece of mind. I don't think she really believes they are necessary but it will help our confidence in continuing and who knows, maybe it will turn up something unexpected.

I've had blood taken to look at antiphospholipids, antinuclear antibodies, prothrombin, factor leiden and MTHFR.

Chromosomal issues
Dr D has also agreed to do a karyotype test on both me and LH. This will show if we have any chromosomal abnormalities that might mean our embryos are defective.

Endometrial lining issues
Dr D said anything greater than 6mm is fine and that's what I've had each time so no worries there. I told her my periods were a lot 'heavier and redder' when I've finished a cycle and she said that women get hung up on the heavieness and kind of bleeding and it really just doesn't matter. That was reassuring as well. Its just so easy to stress about absolutely everything.

Embryo transfer
Dr D said this was 'a piece of cake' - very straightforward. She also confirmed that I do in fact have a retroverted uterus, which has no impact on anything at all, so nothing to worry about.


3. Where do we go from here?
Well, we've got the battery of tests mentioned above, and then we go into a frozen cycle in February. It sounds really easy, which is good. Just monitoring the blood to see when I ovulate, start taking progesterone pessaries and then transfer the blasts 5 days later - easy!

As for our next stimulated cycle (if we need it!!), she said we could try ICSI. We haven't so far because we were worried about abnormalities in the baby. She said this is due to the defective sperm for which ICSI needs to be done, not the ICSI itself. ICSI will ensure that we don't get the abnormal fertilisation of more than one sperm that was a problem with the last cycle.

She also said that while my follicle counts are great and my FSH Day 3 is also very good (4), my eggs are still ageing by the month and that will impact on embryo quality. So I guess it is full steam ahead into the frozen cycle and we will see what happens next.

She actually put a figure on our changes of a baby from our 5 frozen blasts - 50%. That's as good a figure as I've ever been given, so I am hanging onto it for dear life.

I am just so much calmer now that we've been through all that detail. I can just let some of this stuff go now, which is great.