I was still wary of telling people in the early days, but when my friend Romana, who I’d met through mothers’ group, rang to tell me she was pregnant and due on 26 April, I just had to blurt out my news. We were ecstatic to be taking this journey together. She and I babbled on about booking into the same hospital so we could keep each other company in the birthing suite. Our kids would be babies together; they’d grow up together. It was so much fun planning the next nine months and the many ways we could share this wonderful experience.
All was progressing well and a few weeks later, when Mario suggested we go to a footy match together, I was happy to go along for some couple time while Grandma minded Madeline. About halfway through the match, I began to feel a bit strange and I went to the toilet.
The queues were long, as always. When I finally got into the cubicle, I discovered there was blood on my underwear. It wasn’t a lot, but it was definitely a bleed. I messaged Roshan straightaway and he advised me to stay relaxed and come and see him first thing Monday morning.
I went home with such a bad feeling.
The next day there was thick blood and gluey smears of cervical mucus on the toilet paper, and I was gripped by a deep sense of foreboding. On Monday, Roshan did the scan and announced straightaway that there was no visible heartbeat.
‘I’m sorry, Jacqui. You’re going to have a miscarriage.’
I can’t say I was surprised, but his words still filled me with enormous sorrow.
He told me that I could wait for my body to naturally expel the foetus or I could book in for a dilation and curettage. I was keen on the D&C. I’d recovered quickly from the first one, following the second failed antagonist cycle, and personally I wanted the whole sorry episode to end sooner rather than later. I would also feel better starting the next cycle afresh, with the added confidence that everything had come out so there was no risk of infection.
However, Roshan was cautious. There was no heartbeat but blood tests were telling us that the pregnancy hormone was still rising so he was unsure exactly what was going on. He wanted to wait a few days to see what happened and he sent me home with some medication to speed up the miscarriage. Sure enough, a couple of days later I passed what looked like a pregnancy sac in the toilet. As difficult as it was, I was relieved that it was over.
A scan revealed that the pregnancy was entirely gone and now we just had to wait for another period. There were no more embryos in the freezer so the next round would be an antagonist cycle.
Many women suffer enormously after a miscarriage. The losses that I had already experienced during IVF prepared me for this one in a way. I certainly felt weepy, but I had my little girl to keep me busy and another cycle to prepare for so I probably moved on quicker than most.
I have two vivid memories from that time.
The first was when I’d just miscarried and a few days later I opened a letter from City Fertility Centre that contained a cheery ‘Congratulations on your pregnancy!’ Of course, there was no way they could have known about the miscarriage when they sent it but, oh, it made my heart ache.
The second was when I finally had to tell Romana that we could no longer be baby-bump buddies. I waited a few more weeks before I broke the bad news to her because I didn’t want to upset her at this early critical stage. She was shocked and sad for me, of course, but we stayed in touch throughout her pregnancy and she went on to have a gorgeous healthy boy on 24 April 2014.
My ordeal didn’t end there though. After I passed the sac I continued to bleed for the next six weeks – it was like my body was making up for all those years without periods! Finally, in early October I had to go in for a D&C to find out what was going on.
During the procedure Roshan discovered a uterine polyp, which he removed then and there. A polyp is a blobby growth that forms from overgrown cells in the lining of the uterus. They can be as small as a pinhead or grow to a large mass that crowds the uterus and might even extend down into the cervix. Mine was only about one centimetre long and thankfully, like the majority of cases, it was not pre-cancerous.
Unfortunately, the D&C meant that I had to wait for my uterus to recover before we could commence the next cycle. I was nearly forty-one years old and acutely conscious of time ticking away and the fact that we didn’t have any embryos. Would I still be able to produce viable eggs?
The antagonist cycle commenced in mid-November and I was praying for a decent harvest and strong, healthy embryos. We’d booked to go to Canada for a pre-Christmas holiday. I’d spent a lot of time training in Whistler during my career, and I was longing to show off Madeline to my Canadian friends. I still had a small condo there and a whole lot of very happy memories, including Mario proposing to me on the balcony!
Roshan had warned me that if I did get pregnant, international travel was not ideal, but as usual, I wanted to do it all. This first proper family holiday was important; I didn’t want to jeopardise it on the slim chance that we might strike it lucky. And there was always the option that if we did get some good embryos, we could put them on ice and do the implant at a later date. It had been two years since I had last started an antagonist cycle. It was a lot like groundhog day: back to City Fertility to pick up the cooler bag and the brown paper bag full of the necessary drugs. At this point I was beginning to feel like an expert in IVF; I knew the routine, I knew the calendar and I also knew that anything could happen.
Roshan was optimistic and all the procedures went well. The regular internal scans showed some healthy follicle growth; I was hoping for a good harvest despite my ticking biological clock. After egg pick-up, Roshan came to my bedside in the recovery room and indicated that we had eight eggs and they were all still intact at collection time. Later I was told that one of them wasn’t viable and the remaining seven were successfully inseminated using ICSI. Then it all went downhill fast.
Twenty-four hours after pick-up, the embryologist rang with the news that only two had fertilised. My heart sank. What had happened? What went wrong? Roshan recommended we do the transfer on Day 3 so that the remaining two would have their best chance of survival in the uterus, but by the morning of the transfer, one of them had stopped progressing at three cells. The other one was underperforming at seven cells – it should have been at least eight cells by this stage – but we decided to go ahead.
Roshan maintains that even if an embryo isn’t looking great, it can still result in a healthy pregnancy. If all that’s left to choose from is a low-grade (BB or BC) embryo, the transfer can still go ahead because there is a small but very real chance it will succeed. He said, ‘It’s not shaping up to be a good cycle, Jacqui, but stranger things have happened.’ I appreciated his honesty, as always.
Looking back, I can see that I didn’t really give this cycle a chance. For some reason I just couldn’t invest in it. Previously, I had nurtured a strong mental image of the tiny struggling embryos. ‘Come on, little buddy, you can do it,’ I would silently urge them. Now that I had Madeline, I was far less fixated on what was going on inside.
The transfer happened on 27 November and we were due to fly out on 12 December to Canada. Roshan thought about the timing and decided to bring the pregnancy test forward a couple of days. He said, ‘Why don’t I just get the pregnancy test out of the way now?’
So I did and it was negative. It was another disheartening blow, but I was busy holidaying with my little family so I didn’t dwell on it too much. The only destructive thought that I found impossible to shake was that the latest cycle might have been a dud because I was too old. Was that it for me?
Mario and I talked a lot during that holiday, laying our cards on the table. We figured it had taken three difficult cycles to get Madeline, and I’d had one miscarriage and one failed cycle after her. Perhaps if our third attempt didn’t work we should call it a day. I was getting older and I thought that my clock was just about to stop ticking. We couldn’t be happier with our little girl – why continue to put ourselves through the anguish?
I’ve heard it said that the first child is for the parents and the second child is to keep the first child company. I’m so close to my sisters and I couldn’t imagine my life without them. The thought of depriving Madeline of a sibling really troubled me. When she asked me years later why she didn’t have any brothers or sisters, I wanted to be able to say that we did everything in our power to give her one. Regardless of the outcome, she would know that we tried.
At the same time I didn’t want to be continuously injecting my poor stomach, wrestling with my unlucky uterus and forking out thousands of dollars if we only came out with substandard eggs. I was content with my daughter. I’d been blessed with something that I thought I might never have and she deserved all the love and attention that I could give her. Diverting my mental, physical and emotional energy into IVF wasn’t good for her and it wasn’t good for me.
I discussed my dilemma with Roshan. While his number one concern was my physical health (for example, he’d say, ‘I recommend you don’t take this holiday in case you are pregnant’), he understood that I was prioritising my mental health (for example, I’d say, ‘My family and I desperately need this holiday for our wellbeing’). He recognised that, above all, it was vital that we work together.
This is one of the many occasions when I was reminded how fortunate I was to have a doctor who could see the bigger picture. I could rest assured that I would emerge from this process feeling satisfied that my team and I had done everything possible. If I didn’t succeed in getting pregnant again, it would be easier for me to accept that it just wasn’t to be.
The right specialist for you
If your IVF specialist doesn’t make you feel like they’re on the same side as you, keep searching until you find one who does. I could never have won world titles or set records without a coach who believed in me. And with IVF, all my success came when I had a team who believed in and supported the plan, the goals and, of course, me.
14
Double or Nothing
In Australia, IVF regulations require both parents to sign off on the number of embryos that are going to be transferred back to the mother, for every cycle. It’s a simple precaution to ensure that everyone is still in agreement before going ahead.
When the form arrived for Mario and me to sign, it sat on the kitchen counter for a few days. I’d assumed we’d transfer one embryo because, according to the statistics, the likelihood of a third miscarriage was very low and I had a better chance of carrying a single baby to full term than two babies.
The day before the procedure, I reminded Mario once again that we needed to put down one embryo and sign off.
Out of the blue, he announced, ‘I think we should go for two.’
‘What the …?’
‘Double or nothing – we’re not getting any younger!’
And that’s the most sense that I could get out of him.
We needed to make an eleventh-hour phone call to Roshan; asking him for his opinion and if need be, medical permission.
EARLY IN JANUARY, ROSHAN TOLD me that he was going to tinker with the medication this cycle. After the last attempt, we needed to find a way to increase the yield and the quality of the eggs I produced. He explained that bodies respond differently to different absorption methods and he wanted to try another way of administering the follicle-stimulation hormone. Previously, I’d been using a ready-mixed preparation that looks a lot like an EpiPen (an autoinjector that contains a measured dose of emergency medication). This time we were going to try a method where you combine a powder with a liquid and then inject the resulting mix.
With no sign of a period, once again I took progesterone to start the cycle. On 11 January I began self-injecting, using the new preparation method. I went in for a scan every two days and it looked like some decent follicles were forming.
Roshan thought my body was responding better to the new medication, but I didn’t want to get my hopes up. I remembered how the last antagonist cycle had produced seven usable eggs but we ended up with only two substandard cell clusters. I also knew you can have eight promising follicles but on collection day those follicles can be empty sacs with no eggs inside. It’s easy to understand why I was wary of setting myself up for another disappointment.
This was my sixth egg pick-up, with a sixth transfer to come in a few days. I remained calm and focused; I knew the drill so well. On 24 January the egg pick-up was performed. Nine eggs were collected and inseminated, which was a brilliant result for a woman who’d just turned forty-two.
I told Roshan he was an absolute genius. The new medication had clearly done the trick, the polyp had been discovered and removed, and my uterus was spritzed up and ready for action! Overall, I felt confident and hopeful, although my internal dialogue swung wildly between optimism and pessimism and continued to be a toxic presence. It seemed there was nothing I could do to stop it even though I was busy with work and taking care of Madeline.
A day later, seven eggs had fertilised successfully and were continuing to grow. All the drama tends to happen between Day 1 and Day 3 when there’s rapid drop-off, so I was expecting some disappointment by Day 3; however, for the first time there were still five in play, including a hatching blastocyst and two AA quality embryos. It was textbook perfect.
On Day 5, based on many medical reasons, Roshan and his team at City Fertility Centre allowed the decision to transfer two embryos. Roshan was fully on board but brought up one looming issue. The end of January happens to be one of the busiest times for professional speakers. The holiday season is over and team-building events are planned for employees to kick off the new working year. Things were firing up on the work front and it was good to be busy. Roshan made a point of saying that I should take it easy after the antagonist cycle due to the fact that I might be carrying two babies.
I knew it wasn’t ideal to be as busy as I was, but women all over the world get pregnant and work from dawn to dusk or carry heavy loads for miles. I figured that getting up on stage and talking to a roomful of people wasn’t particularly taxing.
Roshan’s primary concern was my physical wellbeing – that’s his job – and my primary concern was my mental state. That’s my job. To me, the prospect of sitting at home worrying about what was going on inside was far worse than getting a bit tired from being out on the road. After all, I’d been travelling regularly since I was eighteen. And those first few cycles, when I spent endless hours online, were so nightmarish and counterproductive, I never wanted to feel that dependent again.
This is how I saw it: the outcome of every IVF cycle is unknown, but continuing to work is enjoyable, career-building and generates income. That’s three known outcomes.
Roshan was focused on the 48-hour window when the blastocysts are either going to implant or not. He mentioned the fact that aeroplane pressure has been identified as a factor in ectopic pregnancies – evidenced by an increased rate for flight attendants – but I had confirmed bookings from up to a year earlier and I was determined to keep those dates. Roshan suggested I freeze the five embryos that we had and do an implant next month when I was less busy. I thought hard about it but I wasn’t getting any younger and with five to work with I decided to go for broke.
On 28 January, without fuss, two of the embryos were transferred and the 2WW commenced. Twenty-four hours later I flew to Sydney to host the La Trobe Financial 2014 Sochi Winter Olympic Cocktail Party. It was great – a warm summer evening spent on a rooftop in Sydney’s Darling Harbour with some of Australia’s greatest Olympians treating La Trobe Financials’ clients to an evening with the best of the best. Spending time working was so healthy for me; I wasn’t thinking about the 2WW or the what-ifs. I flew back to Melbourne the next morning and did another interstate presentation a few days later. I felt some cramping, though I was not aware of any little ‘bites’ that would suggest embryos bedding down into the uterus lining. The whole two weeks went by without any sign of bleeding.
Most women would do what their
specialist advises. On this occasion I chose to fly and I don’t regret it. I think of it as one of those pivotal moments during the IVF process where you have to make a decision that you can live with, whatever the outcome. Do we implant one egg or two? Do we transfer on Day 3 or Day 5? Do we use the more expensive ICSI process or hope the egg and sperm will naturally fertilise? Do I continue with Chinese acupuncture or not? There are so many important decisions to make that could determine the success or failure of a whole cycle.
I knew that the decisions I made could have massive consequences for my career, but I couldn’t allow myself to dwell on that. It was like that fateful jump in Salt Lake City: it meant I never won Olympic gold, but I also never would have met Mario without it, so I wouldn’t have it any other way. You just have to be okay with it and move on.
I was back in Sydney again and it was the day of the pregnancy test. I dropped in early to a pathology centre that was close to the airport. The results came in while I was still in the air, and when I landed in Melbourne there was a message from City Fertility. I rang them as soon as I hit the terminal. The results were positive. I was pregnant, due early October, just after Madeline’s second birthday.
I was so proud of myself. I’d proven that I didn’t have to put my life on hold while undergoing IVF, that I could meet my commitments and still get pregnant. Roshan was pleased for me. I’d taken a chance and it ended well.
Although blood tests indicated that the pregnancy hormone wasn’t increasing as rapidly as we would have liked, everything else was progressing as it should, with one notable absence: no morning sickness. I’d suffered with it when I was pregnant with Madeline, but I’d not had any sickness during the pregnancy from the fourth transfer, which had ended in a miscarriage. I tried to keep my fears at bay with small excuses. If I was feeling a bit off my breakfast, I’d say, ‘Uh oh, this must be the morning sickness!’ or if I experienced slight dizziness, it would be, ‘Aha! Nausea.’ I focused my attention on looking forward to the scan at seven weeks, when we would find out if there was one or two babies.
Frozen Hope Page 13
