Frozen Hope

by Jacqui Cooper

  I was definitely moody on the Clomid, and I heard of many women who went slightly crazy and blamed the hormones. To tell you the truth, I don’t think it’s so much the hormones as the tremendous pressure that the process puts on you, knowing that this is your last chance, with IVF around the corner. That’s the craziness. And the craziness of the sex schedule, and the craziness that you’ve only got six months for this to work before you’ll have to start coughing up a small fortune …

  After the chemical pregnancy, I didn’t ovulate for the entire time that I was on Clomid. Ravi adjusted the medication to different days and played around with the levels in a bid to get me started, but nothing happened.

  We’d been officially trying to get pregnant for a year now and clearly there was a problem that would not be easily solved. In March 2011, Ravi announced that there was nothing more that he could do for me. He recommended I make an appointment with his good friend and business colleague, Dr Roshan Shamon.

  It was time for IVF, but before we made that commitment I made a commitment to getting my body ready for a pregnancy. My girlfriend Rebecca is a yoga teacher, and she suggested I spend time on a yoga mat ‘being kind to myself’. She suggested a lot of restorative yoga for my battered and bruised body. I also needed to open up my hips and increase my ‘ojas’ – the idea was to nourish my vitality. On her advice, I booked a trip to a tiny seaside village in southern Sri Lanka for six weeks. Every day was spent healing, strengthening, restoring, calming, and opening and lengthening my body. It was like a training camp for my soul (and my uterus).

  TTC (Trying To Conceive) acronyms

  2WW 2 week wait (the often challenging time between ovulation or embryo transfer and your pregnancy test)

  AC assisted conception

  AF Aunt Flow (period or menstruation)

  AMH anti-mullerian hormone

  AO anovulatory (this means no ovulation is occurring)

  ART assisted reproductive technology

  ASA anti-sperm antibody (proteins in blood, vaginal fluids or semen that damage or kill sperm)

  BBT basal body temperature (the lowest body temperature reached during rest or sleep)

  BCP birth control pills

  BD baby dance (having sex with the prime aim of conceiving a baby)

  Beta HCG pregnancy test (a blood test to assess the level of beta HCG in the blood, which is an accurate way of assessing for pregnancy)

  BFN big fat negative (a negative pregnancy test outcome)

  BFP big fat positive (a positive pregnancy test outcome)

  BMS baby-making sex

  BW blood work

  C# cycle number

  CD cycle day (the day you’re up to in your menstrual cycle)

  Clomid a medication used to kick-start ovulation

  CM cervical mucus (also known as cervical fluid; fluid produced by your cervix as you approach ovulation due to increased oestrogen)

  CP cervical position

  CS caesarean section

  CVS chorionic villus sampling (a test during pregnancy that checks the foetus for some genetic abnormalities, such as Down syndrome)

  D&C dilation and curettage

  DD Dear Daughter

  DE donor egg

  DH Dear Husband

  DP Dear Partner

  DPO days post-ovulation

  DPR days post-retrieval

  DPT days post-transfer

  DS Dear Son

  DS donor sperm

  ED egg donor

  EDD expected date of delivery

  Endo endometriosis or endometrium (the lining of the uterus)

  EPO evening primrose oil

  EPT early pregnancy test

  EPU egg pick-up (procedure to collect eggs from the ovaries, also called OPU)

  ET embryo transfer

  EWCM egg white cervical mucus (fertile cervical mucus)

  FA freeze all

  FET frozen embryo transfer

  FF Fertility Friend (a fertility tracker website and app)

  FMU first morning urine

  FP follicular phase (the part of the monthly cycle before ovulation)

  FRER first response early result (early pregnancy test)

  FS frozen sperm

  FS fertility specialist

  FSH follicle-stimulating hormone (helps control the menstrual cycle and production of eggs by the ovaries)

  HCG human chorionic gonadotropin (hormone detected by pregnancy tests)

  HPT home pregnancy test

  HSG hysterosalpingogram (a fertility test in which fluid is run through the fallopian tubes to check for blockages)

  IC internet cheapie (a pregnancy test)

  IC incompetent cervix

  IC intercourse

  ICSI intracytoplasmic sperm injection (a type of ART)

  IMSI intracytoplasminc morphologically selected sperm injection (a type of ART)

  IUI intrauterine insemination (a type of ART)

  IVF in-vitro fertilisation (a type of ART)

  LH luteinizing hormone (a hormone that triggers ovulation)

  LP luteal phase (also known as the 2WW)

  LSP low sperm count

  MF male factor (the reason someone is having difficulties TTC)

  M/C miscarriage

  NT nuchal translucency scan (an ultrasound done between 11 and 14 weeks of pregnancy to test for chromosomal abnormality such as Down syndrome)

  OHSS ovarian hyperstimulation syndrome (a possible complication from some forms of fertility medication)

  OI ovulation induction (fertility treatment that induces ovulation to occur)

  OPK ovulation prediction kit

  OPU oocyte pick-up (procedure to collect eggs from the ovaries, also called EPU)

  OT ovulation tracking (fertility treatment that tracks through blood tests and ultrasounds the stages of the menstrual cycle and the best time to TTC)

  PCO polycystic ovaries

  PCOS polycystic ovarian syndrome (a condition where follicles in a woman’s ovaries stall during development and form cysts instead of releasing an egg)

  PICSI physiological intracytoplasmic sperm (a technique used in ICSI to help select the healthiest sperm)

  POAS pee on a stick

  RE reproductive endocrinologist (fertility specialist)

  RO right ovary

  SA sperm/semen analysis

  SD sperm donor

  SIUI stimulated IUI (like IUI but given medications – FSH – to increase the response of the ovaries in order to produce a follicle)

  SMU second morning urine

  SURR surrogate

  TD treatment day (what day in the IVF treatment you are)

  TB testicular biopsy

  TESE testicular sperm extraction

  TTC trying to conceive

  Trigger HCG shot given to induce ovulation

  TSH thyroid stimulating hormone

  WFP wait for period

  WIC where in cycle (unsure what day in the menstrual cycle)

  7

  Paperwork and Practicalities

  Roshan was particularly diplomatic during our first consultation. Careful not to leap to any assumptions, he introduced the idea that we might want to start with a range of tests. That way, we might be able to work out exactly what the problems are and try to fix them before taking the next step.

  Then he paused and said slowly, ‘Or you could …’ and I jumped in, blurting out at exactly the same moment as him, ‘go straight to IVF!’

  Snap.

  ALTHOUGH I FELT LIKE I’D been doing everything I could to get pregnant without assistance, there was always a small part of me that had been preparing for the likelihood of IVF. Ravi knew exactly what he was doing when he handed me over to Roshan. As a fertility specialist, Roshan had become an expert at handling difficult cases of infertility and the challenges presented by older patients such as myself. He’s a gentle and diplomatic man with a talent for listening, but he doesn’t sugar-coat the facts.

  When we met for the first
time, Roshan was prepared for a long discussion about my options. Usually, a patient will want to take tests and explore alternatives before embarking on the daunting and expensive process of IVF.

  From the moment I declared that my next step was IVF, Roshan knew that he didn’t have to tiptoe around me. I clearly had a strong idea about what I wanted. He listened carefully and he let me know that he liked how motivated I was. He assured me that this kind of focus was going to be an advantage in my quest to have a child.

  I realise now that I was quite bossy in that first consultation. I was feeling nervous and desperate and I wanted to show Roshan that I had done my research and that I was ready for the next big step. By the end of that first hour, Roshan had made an appointment for me with a fertility nurse so we could start moving on the paperwork. And this is when Mario and I needed to grapple with the practicalities.

  1. What do we have to do to qualify?

  We’d already experienced a loss of privacy during my six-month stint taking Clomid. It’s not a whole lot of fun having to report on every detail of what is or isn’t coming out of your body, and exactly when you’d last had sex, but we’d done our best to make light of it, and we accepted it as part of the deal.

  The application process in Victoria to undertake IVF took intrusiveness to a whole new level. Although the checks we had to pass might not sound like much, I was surprised by how invasive it all felt.

  The legislation surrounding IVF treatments differs from state to state and country to country, so I’ll try not to be too specific here. In our case, we had to apply for a criminal record check to confirm that neither of us had been found guilty of a sexual or violent offence. Having a criminal record can hold up the qualification process or halt it altogether. If one or both parents happen to originate from another country, it may take a long time for the right pieces of paper to come through international records. It can be incredibly stressful to have the months tick by when you’re trying to beat your biological clock.

  We also had to undergo a Child Protection Order check to determine whether there had ever been an order made against either one of us to remove a child from our custody or guardianship.

  On paper, these checks sound reasonable, but Mario and I couldn’t help feeling resentful that everyone else could go ahead and have a child regardless of their criminal past and we had to prove that we were okay to become parents because we needed IVF. Then again, we did understand why we had to gain the official ‘all clear’. Medicare spends a considerable amount subsidising IVF, and we were grateful that the government would help us realise our dream. Although we would pay thousands of dollars upfront, we would get about half the money through the generous Australian health system – because we were officially deemed ‘medically infertile’ – so we couldn’t grumble too much about the need for scrutiny.

  Here’s where I must mention an important rule about IVF and adoption. Several months earlier, when it looked like we might have trouble getting pregnant, Mario and I had begun to explore the possibility of adopting a child. We had registered our interest in attending an adoption information session and we were working our way through the application form. The adoption process is notoriously difficult and drawn-out in this country, and we wanted to be in the system already if having our own biological children didn’t work out. Make no mistake, we had talked it through and we were ready and willing to make our family with non-biological children. But we also knew there are no guarantees that an adoption would eventuate, and we wanted to hedge our bets.

  However, I discovered that once you apply for IVF you have to take yourself off the adoption list. You can’t do both at the same time. The logic behind this is that you could be on the verge of receiving an adoptive child and then become pregnant via IVF and cancel the adoption. Frankly, if that had happened to me I would happily parent both kids, but I guess it doesn’t always happen that way.

  The fact that adoption is no longer an option while trying IVF adds to the pressure and the feeling that this is your sole chance to have a child.

  Unless you are using a donor sperm and/or egg, you also have to undergo couples counselling before you qualify for the Medicare rebate. Medicare (Federal legislation) will fund all in-cycle counselling during the 30-day cycle anywhere in Australia. However, it is mandatory in Victoria for any patient undergoing an IVF cycle to have a counselling session. For any donor cycles (i.e. using donor eggs, sperm or embryos) the patient must have two counselling sessions. Requirements can differ for each state and depending on whether donor gametes are involved.

  I’ve always been a supporter of therapy and I had seen various counsellors throughout my sporting career. After all, I did so much to maintain my physical health as an athlete, why on earth wouldn’t I do the same to take care of my mental health? Talking to a professional and objective person has provided useful insights throughout my adult life, and it has proved to be a great source of comfort when I’ve had a particularly confronting issue to deal with.

  IVF is recognised as one of the most stressful experiences that a couple can go through. There are some very sobering statistics on the high rate of relationship breakdowns, especially if IVF is not successful. The likelihood of multiple births can also take its toll, and couples need to be prepared for that.

  It took us around three months to get all the checks and paperwork done. I was impatient to get started. At thirty-eight years old, I was keenly aware that every month was taking me closer to the dreaded forty years old, when the stats say fertility plummets even further.

  Our counselling session was the last thing on our to-do list. At that early stage, it was quite straightforward: opening the lines of communication and making sure that both of us were on the same page about wanting a child. We also had to talk about the invasive procedures that I would undergo, the financial burden we needed to prepare for, and the emotional ups and downs ahead of us. I found the counsellor to be quite pessimistic and matter-of-fact, but I guess it was her job to make sure we were aware of the downsides before we finally committed, and she certainly did that.

  2. How much will it cost?

  At first glance, IVF is ultra-expensive. The cost would worry most. At the start of each IVF cycle, there is an upfront payment (which varies from cycle to cycle,) but some huge relief comes immediately when the Medicare rebate is applied. Mario and I had an upfront cost of roughly $10,000 for our first cycle, but after the Medicare rebate and private health fund payments, our out of pocket was only $3500.

  This is still a lot of money in any language, and most couples rarely stop at one cycle. There are plenty of sad stories out there of people undergoing cycle after cycle to get pregnant and bankrupting themselves in the process. I certainly wasn’t expecting to take it that far, but who knows how desperate we might become?

  Finances will be discussed with the clinic before you finally commit. Every clinic has different protocols when it comes to payment but generally, prior to the retrieval of eggs, the fertility centre will take credit card details with the patient’s authorisation to put a hold on funds.

  Like the cost of almost everything else in this world, the cost of an IVF cycle will steadily continue to increase. As more sophisticated methods and medications come into play, there will no doubt be more ‘hidden extras’ to factor in, too.

  3. How much does it hurt?

  Notice that I say, ‘How much does it hurt?’ and not ‘Does it hurt?’ Yes, you have to be ready for a level of discomfort and even pain during some IVF procedures. I had grown used to being poked and prodded by doctors when I was an athlete, so the medical side of things didn’t intimidate me, but I know plenty of women who found the physical side of IVF quite difficult, suffering considerably through cramping, bloating and tenderness.

  The main thing that most women worry about is the injections. During my career, on a few occasions I had to self-inject blood-thinning medications to avoid a DVT (deep vein thrombosis) after an acute injury, so self-injecting was
n’t new to me; however, having to do it a couple of times a day for several days was really unpleasant. Some of the injections hurt more than others and I came to dread them, particularly if I was feeling anxious and emotional.

  Injections and self-injecting

  At the moment, injections are still an unavoidable part of the IVF process. Some women are so profoundly terrified of needles that they are unable to go through IVF and, sadly, miss out on the possibility of conceiving a child. Unfortunately, injecting is the only effective way to take certain medications at this point in time, but advances in medicine mean this might not be the case for too much longer.

  When I was an athlete, I had to self-inject when I was recovering from an injury. I was travelling back to Australia from Switzerland after knee surgery and I needed to inject blood-clotting medications while I was on the flight. I remember bracing myself against the wall of the tiny bathroom, preparing the syringe over the sink and injecting myself in the thigh. It was uncomfortable and unpleasant and I felt a bit like a junkie, but I made it home in one piece without a DVT!

  At City Fertility Centre, they have a special kit to demonstrate how to self-inject and I had a quick refresher course when I got all my medications. Using an empty syringe, a needle and a piece of plastic designed to look and feel like skin, the nurse showed me, step by step, how to prepare the syringe, locate the area to inject and do the deed. Then I was on my own.

  How you self-inject is quite a personal matter. I compare it to pulling off a really big, bad bandaid! Some women get another person to do the injecting – they don’t want to know when the prick is coming. I like to know exactly what’s going on, so I always did it myself. I needed to prepare myself for the sting and any discomfort that followed.