Sterile AF

Now I am not only infertile, I am officially sterile, as a doctor casually remarked about three minutes after I woke up from my anaesthetic.

Those who haven’t been blessed with artificial sedation as frequently as I (three times in nine months – have I mentioned that?) may not be familiar with the deep, seductive grogginess that comes with waking up from an anaesthetic.

All the cliches are true: it’s like being dragged up from a beautiful, comfortable, underwater cave. You want to stay there forever, but you suddenly find yourself in a hospital ward and it is bright and you can’t move and you can’t think and your brain is made of candyfloss and marshmallows.

Then, about three minutes later, a young, male doctor appears and goes: “Hey Emma. How are you doing? We disconnected your second tube but your uterus looked fine. Laterz!” and skips off. And you can’t answer, because your brain isn’t connected to your mouth yet.

So you are left alone, and your mind is swimming with the thought that there is now a zero per cent chance of your ever conceiving without the aid of medicine or the deposit on a small flat. And you cry, but not one notices because your partner wasn’t allowed to sit with you as you woke up.

Obviously I wasn’t going to leave it there. The awkward conversation happened about 45 minutes later, as he tried to slope out of the ward.

“Maybe next time you are telling a woman she will never conceive naturally, wait until she is able to respond?” I said.

He had the good grace to look sheepish. “Sorry,” he replied. Then he went home.

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Here we go again

It’s laparoscopy/hysteroscopy day, yo. I had an alarm set for six o’clock so I could get up and eat  (as per general anaesthetic fasting instructions) but I’ve been up since four, Googling.

I should be an old hand at this by now: this will be my third general anaesthetic in a year. But I still feel that familiar sense of anxiety creeping over me, which I know will make me impossible to live with until the moment the surgeon comes to tell me everything is/isn’t ok.

It doesn’t help that all of these investigations were supposed to have been done last June. I’m supposed to be on to my second embryo transfer by now.

Luckily, while I am stressing about the possibility I will be told there is no hope for me today, J is entirely relaxed. “Go and make yourself some toast, then come back to bed,” he cooed as my alarm began chirping this morning. So much for those hopes of being served breakfast in bed. At least lack of sleep won’t be a problem today.

I heart the NHS

Let me start by saying this: I love the NHS. I am deeply, deeply grateful for its existence. It has saved my life not once, but twice. It has given me the potential to one day give birth (having originally completely destroyed it – but we’ll gloss over that). It is an extraordinary institution, and I feel lucky to live in a country where it exists.

But! But…

Yesterday I went to my local hospital for an appointment entirely unrelated to infertility.

I arrived 35 minutes early, as is my wont, but couldn’t let anyone know, because all the stupid electronic check-in kiosks were turned off. There were no receptionists at the reception desks. Because I know how the NHS works, I sat down to wait.

Another woman, about my age but clearly less knowledgeable about the ways of the NHS, was lingering near the kiosks, clutching a coffee and looking around anxiously. She wandered, haltingly, towards the reception desks, paused, and wandered back to the kiosks. She lingered for another minute, shifting from foot to foot, then wandered back to the reception desks.

After about five minutes of this, she spotted a man with an authoritative-looking lanyard, and strode over.

“Do you know how to check in?” she asked, gesticulating at the kiosks. “They’re all switched off.”

The man gazed in the direction of the empty reception desks and said: “You need to tell the receptionists.” She looked at him wonderingly. He shrugged. She sat down, muttering violently.

After I had checked in, three minutes before my appointment, I took a seat.

Another three-quarters of an hour passed before I was seen. Which is fine, because the NHS works at its own pace, and waiting is a small price to pay to benefit from its services.

But as I waited, I felt a familiar anxiety begin to rise in me. Have I been forgotten? Did the receptionist check me in properly? That woman over there arrived half an hour after me and has just gone in – is there a special password to be given priority?

Meanwhile, people were being called into their appointments on a PA system which was simultaneously quiet and almost completely obscured by reverb, which meant every time an announcement took place, the entire room had to fall silent and strain to hear. If a baby was crying, it was game over.

The point of this rant is that so much of the anxiety and stress of NHS appointments could be prevented by decent expectation management. A screen showing patients’ names (or NHS numbers for anonymity) and where they are in the queue would solve a huge amount of the stress patients experience.

I get the same anxiety when I’m at my IVF clinic, for the same reasons. I know enough about how the place works by now to know several different clinics are run from the same waiting room, meaning some people will go in ahead of others. But waiting is still stressful.

Managing patients’ expectations would go a long way to solving a lot of the anger and aggression experienced by patients in the NHS. It’s something to think about, anyway.

Eight to 12 weeks

It’s been a bad week: over Christmas the consultant realised that, whuuut, no one has had a proper look inside my uterus yet. After one failed embryo transfer, it seemed strange there was still an investigation to do, but she was insistent we take a peek.

“The waiting time is eight to 12 weeks,” she said breezily.

“Don’t worry!” she added after she saw my horrified face. “You’re so young! It’s only a couple of months!’

Then, during a pre-operative assessment today, I discovered the waiting time for a hysteroscopy from right now is – you guessed it – eight to 12 weeks.

“But what if I misery eat and gain my entire bodyweight again in the meantime?” I yelped as a nurse weighed me for the anaesthetist . “What if my uterus shrivels up while I’m waiting?”

“Don’t worry!” she trilled. “You’re so young! It’s only a couple of months!”

Dear lord. Can we please stop using the word ‘only’ when it comes to interminable waits? Do medical professionals not realise that when you are infertile, your life is measured out in eight to 12-week blocks? I have spent the past two and a half years wishing away entire seasons.

Last night, in a fit of whimsy, I calculated I am now close to the exact halfway point between when we started trying for a baby, aged 29, and the point at which my fertility falls off a cliff, aged 35. I have spent the majority of that time waiting patiently for eight to 12 week periods to pass.

Still, I guess once the fertility deadline does hit, medics will finally stop saying “but you’re so young!”. Everything has a bright side.

For a fun joke, today I enquired about the cost of a hysteroscopy and laparoscopy if I were to do it privately (the consultant thought she saw some cysts on my remaining fallopian tube, and thinks it needs to be closed off. Goodbye, final, weak hope of ever getting pregnant naturally).

£6,500. Jesus god. See you in eight to 12 weeks.

We have an answer

When I was 10 years old I had a tummy ache. I told my mum, a nurse, who in the grand tradition of medical parents told me to stop being such a drama queen and go to school.

Two months later, after a series of doctorly balls-ups, my appendix ruptured in spectacular style and I spent two weeks in hospital with full-blown peritonitis, vomiting through a Mos Def-style nose tube (though it should be noted I didn’t wail like a little girl when it was being put in. Well, not every time).

Fast forward two decades and it seems that ruptured appendix not only gave me a wicked cool scar (which got me off PE for like two years), but the two surgeries also caused scarring to my fallopian tubes such that they are now both blocked. This is what we discovered after my HSG last week.

Knowing this feels… kind of a relief, actually. I’m glad we know what it is. I’m glad it’s not some vague unexplained infertility, which in my head means endless rounds of unsuccessful IVF.

“Ah,” my mother-in-law nodded when I told her. “Dynorod.” Well, yes. I am going to have a laparoscopy. Which is not, as I thought, a minor procedure, but a full-blown lights, camera, general anaesthetic jobbie.

(I know this because while I was busy digesting the fact I may never have to use contraceptives again – there are some advantages to this infertility malarkey – J had Googled the entire procedure.

“Did you know they puff air into you to separate your skin from your organs?” he asked, glancing over casually).

The procedure, which requires you to take five days off work, is a kind of multi-tool procedure, which will a) make sure the blockages are not the product of the radiologist’s fevered imagination; b) attempt to clear them; c) if they can’t, seal off or remove my tubes to make sure no gross stagnant water (I’m paraphrasing) escapes from them into my uterus, which could be dangerous for any embryo that goes in there.

(I asked the doctor if that was the same as tying my tubes. She looked as though I had deeply offended her. Pretty sure it is though babes.)

After that? IVF, probably. Coupled with PGD, genetic screening of the embryos. I was so determined to do this naturally – but the longer we’ve been trying, the more upset I know I will be if we finally get pregnant, only to lose the baby because of J’s translocation.

Everyone has told me how marvellous all this is. “You can relax! You won’t have take your temperature every morning! You can have normal, non-baby-making sex!”

Yes. But if you don’t know when you’re ovulating, how do you know when to have sex?

That’s that

Well, I can officially say the Clomid didn’t work: cycle number three reached an undignified end when I burst into our bedroom yesterday morning, covered in snot and tears, brandishing a negative pregnancy test. J was less understanding than I would have hoped. He managed a croaky “I’m sorry” from under the bedclothes. To be fair it was 6am.

Wednesday was also the day we went to see the infertility specialist for the first time. It took us almost six months just to get the appointment, so I guess a part of me was hoping to come out with some kind of miracle – or at least another few rounds of Clomid. Or, you know. A newborn.

We didn’t get any of those. We also didn’t get much eye contact, or much of her looking at anything other than her screen. We told her our entire story – what felt like the 6,000th time we have gone through it with someone in the NHS – and then I started crying, and she had no idea what to do other than push a box of tissues across her desk.

(NHS tissues are tiny, by the way. Each one is designed to absorb a single tear. I used almost the whole box, then I felt bad for wasting NHS resources. Welcome to austerity Britain.)

She referred me for an HSG, a delightful little procedure whereby they inject dye into your uterus and fallopian tubes, then x-ray you to assess whether there are any blockages, and also yet another, internal, ultrasound. (I didn’t even know you could do an internal ultrasound until all this began. Imagine my surprise when they first whipped out the wand…)

When I woke up this morning I felt… bleak. Until now, there’s been a glimmer of hope that we can do this naturally, or as naturally as possible, without more involvement from doctors.

But yesterday the gynae all but told us outright IVF is likely to be the only way forward. That means more prodding, more poking – and months and months more waiting.

It’s the waiting that’s killing me. The earliest follow-up appointment, after the tests are done, is in July. For someone as impatient as I am, 18 months of trying has been a peculiar kind of torture. The suggestion it will be another seven months before we even begin to proceed with the bureaucracy surrounding IVF might just destroy me.

Some questions on Clomid

The last you heard of me (before I started moaning about my age), I was celebrating my enthusiastic new GP.

To be fair, she was great. But the pace of the NHS could be beaten comfortably in a race by most glaciers, and so I have lost patience and gone temporarily private.

I knew I wasn’t ovulating, for I have been diligently using OPKs and tracking BBT for months. Thus, I was pretty sure all I needed was a couple of rounds of Clomid and, boom, a baby would ensue. At the time, it made sense that I went private.

I’ve just started my second round and… I dunno.

The trouble is, there’s no one to ask. Mr Private Doctor is an appointment only kind of guy. I have exhausted the GP’s pretty limited knowledge of infertility (although her “aww honeyyy…” face cannot be improved upon) and it turns out literally no one in real life talks about infertility. Apart from on internet forums. Which make Donald Trump look like a beacon of accuracy.

So, here are the questions I would like to ask about Clomid, but that I have no one to ask. Answers on the back of a postcard, please.

  • When actually counts as the first day of your cycle? Because, you know, the bleeding started about six days after ovulation this time around, and progressing into more of a… gradual buildup. So I kind of guessed what my second day might be.
  • Related: does it matter if you take it on the wrong day? Am I going to die of that?
  • Related: today I felt a bit fainty. Is it because I took it on the wrong day? Am I destroying my (admittedly already not entirely functional) reproductive system?
  • Is it normal to feel like there is something sitting on your chest, all the time? Sometimes it’s about the weight of a small dog – a chihuahua, say – and sometimes it’s more of a three-year-old. Either way, breathing is not always completely easy. But that’s cool, right?
  • You know how Clomid is supposed to trick your brain into thinking it needs to release chemicals that make you ovulate? And you know how if you’re stressed you don’t ovulate? What happens if taking the Clomid coincides with your most stressful week ever? Will it still work?
  • Say, hypothetically, I got pregnant, and then I started bleeding because that’s pretty much what I do, and then I took more Clomid? What would that do? Really more as a thought exercise than anything at this stage.
  • Does my level of positivity have an impact on it working? Because right now, I cannot visualise getting pregnant. I’m trying to be super positive… but I just can’t imagine it happening.
  • Will you hold my hand please?

By the way, I have an appointment with an NHS specialist in February… but honestly, I can’t help but feel a new geological era will begin before the NHS works out what’s going on with my inner workings.