Monday, 29 April 2013

A diary of a surrogate

I have posted an article which was published in the British press this weekend. The piece is a diary of a woman who carries twins for her brother and his wife; it is incredibly moving and equally fascinating.


Secret diary of a surrogate mother

Saturday, 27 April 2013

WTF!?! & a new plan

It was Tuesday and, unlike most Tuesdays, it was a very important day. My husband and I worked together to make sure that, with a little luck, there would be no hiccups. Hell, having spent some time finding a model with great reviews, we even bought a brand new telephone. We felt that a decent phone was high on our priority list. After all, we did want to be certain that, when it filled our living room, the sound of the doctor's voice would be crystal clear. We desperately hoped not to miss a single detail, no matter how small, as it could be the all important clue that we were searching for. My husband had the day off and stayed at home and I, as I usually did, woke up, got washed, dressed, ate my cereal and went out to the office. Work was the same as work always was, except, on this particular Tuesday, I took care to ensure everything would be finished on time. I was hopeful, and nervous too, but mainly hopeful.

In the afternoon, as I left the office, the sun was shining. It wasn't hazy, but instead, it had a brilliant radiance which illuminated the white clouds hanging against the sheer blue sky. I crossed the car park and my nerves started to jangle. Even though I am not superstitious, my heart still believes that bright sunny days bring good news, whilst bad things happen on cold dismal days. Oh dear, look at that, I've lost my thread again and got distracted by being all wordy. So, back to it, where was I? Ah, yes, it was Tuesday and the sun was shining. I had left work with time to spare but, as I drove past the same hospital I pass every day, the traffic slowed to a crawl and, with only five minutes until appointment time, I fielded a frantic "where are you?" call from my husband. After what felt like an age, the cars moved, I hurtled towards home and flung myself through the front door with 30 seconds to spare. Phew, I made it. 

Then, as I plonked myself down on the sofa, I grappled with the new technology, dialled the number and waited for Mr T, our fertility specialist, to speak. And so began our first ever Why-The-Fail appointment.

Soon enough, the familiar Greek tones of Mr T came down the line and the conversation, after a few pleasantries, went like this: 

Mr T: Your recent failed frozen embryo transfer was a very nice cycle.

Me: Oh, very nice?

Mr T: Yes. The embryos were of perfect quality and your uterine lining was fine.

Me: Oh, perfect quality?

Mr T: Yes. The transfer went well and there really weren't any concerns.

Me: Oh, anything else?

Mr T: No. You were just unlucky. It happens sometimes.

Me: Oh.

A million and one thoughts were whirring round and round in my head. I wanted to shout "If it was so perfect, then why didn't it work?" or "Can you please make sure my next perfect cycle doesn't fail?". I didn't shout, or say, or even whisper anything. He didn't have the answers I wanted and can't give me the guarantees I long for.

After giving us a few moments to digest the avalanche of information he had just thrown upon us, Mr T went over the plan for our next fresh IVF cycle. The entire call lasted, from hello all the way to goodbye, almost precisely, eight minutes.

So, once again, we've been hit with the unlucky stick - I do wish it would give us a rest for a while - but, very happily, we do have a new plan. Well, actually, it isn't a new plan at all. It is the very same plan as we had for our first IVF cycle. You know, the one that led to wonderful identical twin girls that didn't quite make it.


Wednesday, 24 April 2013

Operation Big Belly: Booze and IVF

When I come home from a long, hard day, I like nothing more than to slip the shoes off my weary feet, sink deep into my soft green sofa, having taken a brief detour past the fridge, and take long, slow sips of chilled, clear, golden Chardonnay. Oh, dear Lord, just the mere thought of it makes me feel happy, relaxed and a little bit goose bumpy.

Perhaps you aren't a fan of a white wine; although I am struggling to imagine why not. Maybe you prefer a beautifully chilled, ice cold beer on a hazy summer afternoon or, just possibly, you would rather have a wonderfully spicy, warming mulled wine on a frosty winter's eve. Whatever your tipple, or even if you don't partake at all, wouldn't it be lovely to know that having a drink or two won't affect the outcome of your IVF cycle? Well, I really think it would, wouldn't it?

So, here we go again, Operation Big Belly takes the second step on our research journey, and I am really looking forward to this one; Big Belly does booze.

Just a quick reminder that the ground rules, along with Big Belly does food, can be found here.

If you read my blog post about the impact of diet on IVF success and were dismayed by the lack of funds pouring into that particular research area, you are are going to be even more disappointed now. After a pretty extensive search I managed to dig up two - really, honestly, only two - research articles that examine the effect of alcohol consumption on IVF cycle success rates. However, there is some good news: one of the studies was large and included 2,545 couples who underwent a total of 4,729 cycles; that's a pretty healthy data set.

One interesting fact to think about before we get going is that, according to a survey conducted in 2012, 73% of women drink alcohol prior to commencing an IVF cycle and almost 49% drank during their cycle. So, it seems there are a lot of us out there who like drinking and would like to keep on doing so and, given how stressful IVF can be, that is hardly surprising.

Of the two studies I found that did examine the impact of alcohol on IVF cycle success rates, the older, and smaller, study looked at the effect of both male and female alcohol intake on cycle outcomes. The authors reported that women who had just one drink a day, even before the start of the cycle, had lower numbers of eggs collected, an increased risk of not achieving pregnancy and a higher chance of miscarriage. Oh dear, not brilliant news. And, it doesn't get better for the men-folk either. It seems that having just one drink a day significantly reduced the chances of a pregnancy resulting in a live birth. But, let's not get too down-beat; it was just a small study, the results may not be reliable and we still have our big-study trump card left to play.

Between 1994 and 2003, more than 2,500 couples in the Boston area were enrolled in a study and went through 4,729 IVF cycles. The research aim was to establish whether drinking alcohol at the start of an IVF cycle made any difference to the outcome. Unfortunately for anyone who, like me, loves a glass of vino, the researches found that women regularly drinking white wine were 16% less likely to achieve a live birth than women who had less than 4 drinks per week.  In addition, drinking more than 4 alcoholic beverages a week was associated with lower numbers of eggs retrieved and a increased risk of embryo implantation failure.

As for the men: drinking wine did seem to negatively impact sperm morphology and concentration but alcohol intake didn't reduce the chance of a live birth. So, there was some good news. But, hang on, what about when both men and women are drinkers? 

Well, let's see, ah yes, for couples in which both partners drank the chances of a live birth were 21% lower compared with couples who drank fewer than four drinks per week. Oh. That's not what I was hoping to hear.

Hmmm.....even though only two studies yields a very limited amount of data, I guess it is fair to say that having a couple of drinks a week might do me no harm but, if I want to play it safe, it is probably best to cut out the hard stuff completely. At least until a baby (I'm just going for one here) is safely home in my arms.

Right, enough of the wine, where's the coffee pot? Oh, hang on, what about caffiene and IVF? Well, you'll just have to wait until Big Belly's next mission to find out.

Sunday, 21 April 2013


This week I am trying something new. As a matter of fact, it seems that April 2013 is going to be a month chock-a-block full of new experiences for me. I wrote my very first blog post, had my first frozen embryo transfer (it failed), will have my first WTF appointment on Tuesday and now, for the first time ever, I am participating in IComLeavWe. haven't heard of IComLeavWe, hey? Well, it works like this - I think: it is one week a month where bloggers can go round the web, read other people's blogs and, if they like what they see, leave a comment.

In the spirit of embracing my infertility, instead of letting it slowly eat me up from the inside, I am also trying to embrace blogging and join, as a fully participating member, the blogging community. So, if you are just stopping in from ICLW, welcome to my blog. Please make yourself comfortable, look around and enjoy. And, just so you know where on earth you are, I have written a little about my journey below:

On Tuesday, my husband and I will have an appointment with our fertility specialist to discuss why, even though my lining was perfect and we had two exceptional embryos, the frozen tranfer failed. They call it a why-the-fail appointment but my heart tells me that those three letters should really stand for something else. We are hopeful - we are always hopeful, that is, until reality slaps us round the face once again - and we are looking forward to being told that we can get on the IVF merry-go-round for one more go. I never thought that I would want to hear the words "yes, let's do another IVF cycle" quite so much as I do today. And, it has never before occured to me that I would dread hearing, "no, not yet, we just want to do a few more tests first". Please, oh, please doctor, no more tests.

So, in a very brief nutshell, that's where I'm at. I hope a few of you stop by and leave a comment and tell me where you're at too.

Oh, by the way, if you are not on the ICLW train and have just stumbled past, feel free to say "hi" as well.

Right, I'm off to find some blogs to comment on......

Big Belly goes shopping

Question: What happens when you write a blog post about what to eat to improve your chances of a having a successful IVF cycle?

Answer: You look in your cupboards and realise you have nothing suitable to eat.

Solution: Recipe hunting, list writing and shopping.

Operation Big Belly went to the supermarket and bought......

Thursday, 18 April 2013

Operation Big Belly: Food glorious food

Before you read this blog post, I would like you to try an exercise for me; don't worry, it won't hurt. Take a few moments out of your hectic schedule, close your eyes and think of food.

Did you just carry on reading? I do hope not.

What pictures came into your mind’s eye? If you are like me, you just visualised a glorious spread of triple-layered chocolate cakes, sugary sweets, calorific candies and all things scrummy. If, on the other hand, you are more similar to my virtuous husband, you pictured grilled chicken, salads and rice. No, I don't get it either - why think salad when you can think chocolate? The point is, there are many different ways to fill your tummy but, when it comes to artificially making babies, does it really matter?  

First off, before we get started on our mission, I would like to introduce the ground rules. Well, all serious operations require rules, don’t they?

Operation Big Belly's ground rules:

  • Only scientific data from peer reviewed journals  will be included
  • All studies discussed will be available on PubMed
  • No-one shall take my opinion as anything other than the ramblings of a fool – I am not a medical professional
  • When the rules are broken, all good rules need breaking, it shall be noted

Okay then, if you are ready and sitting comfortably then let's get started.

The first important thing to note is the surprising scarcity of scientific data on the topic of IVF and diet. Type "IVF" and "diet" into PubMed and you will be rewarded with only 47 abstracts and, when you examine the results closely, most of the results are not really relevant. In fact, after quite a serious search, I found a only three studies which examine the role of diet in IVF success. Not very impressive, is it?   

During my investigations, I found that all three studies were conducted at the Department of Obstetrics and Gynaecology at the Erasmus University of Rotterdam. Now, I have always liked the Dutch but I was beginning to like them even more and I was keen to know all about this group of researchers. So, I dug a little deeper and discovered that most, but not all, of the work was done as part of a PhD thesis by a wonderfully intelligent student named Marijana Vujkovic. She really is a clever girl; I have read her thesis, although not every single word, so that, if you don't want to, you don't have to. Let's take a look at what I found out:

The most recent study, published in 2012, found that following the Netherlands Nutrition Centre(NNC)dietary recommendations could increase the chance of ongoing pregnancy, after IVF or ICSI, by as much as 65%. Amazing, right? Just so you know what to be eating, the NNC's recommended dietary food wheel is below: 

And, in 2010, our friend Marijana Vujkovic published a paper, in the Journal of Fertility and Sterility, which described a study indicating that following a Mediterranean diet, i.e. one with a high intake of vegetable oils, vegetables, fish and legumes, increased the probability of pregnancy, in couples undergoing IVF or ICSI, by a pretty respectable 40%. Wow, that's good too, isn't it?

What more can these Dutch scientists tell us?

Well, in their third, and final, study the Dutch researchers revealed a link between women with diets high in omega-3 and potentially improved IVF outcomes. Women with diets rich in omega-3, which is primarily found in fish and fish oils, had higher day 2 estradiol levels, which corresponded with embryos that had improved morphology, than women with with lower levels of omega-3.

I think we have learnt quite a bit from our Dutch friends but I am not quite finished; I am about to break two of Operation Big Belly's ground rules. The study I am about to discuss hasn't been formally published in a peer reviewed journal and can't be found on PubMed, but the results were presented at the European Society for Human Reproduction and Embryology's meeting and widely reported in the British press (see below), so I am going to include it too.

An analysis by a team at Harvard School of Public Health, they must be very clever people, identified that women who consumed high levels of saturated fats, such as animal fats, produced a lower numbers of mature eggs during IVF cycles. Whereas, diets that were high in unsaturated fats, such as olive oil and avocados, were associated with an increased number of, and when I say increased number I mean more than three times as many, live births.

Well, wait a minute, isn't that almost the same result as the researchers from Rotterdam found when they looked at Mediterranean diets? Do you know, I think it is.

Without further ado,I would like to take this opportunity to unveil Big Belly's IVF diet tips:

Words of caution: The results discussed here come from very small studies, we are talking about hundreds of women not thousands. So, it is entirely possible that, in the future, larger studies may prove these studies to be entirely false. However, at the moment, there are no other data so we're just going to have to take their word for it. Also, there is no evidence in any of these studies that changing your diet before an cycle IVF helps. It is possible that you may need to be on these beneficial diets for a long time, maybe even a lifetime, for you to get a better IVF outcome.

I should also mention, there are several other studies that have investigated links between diet and infertility, rather than IVF. However, that was not my topic here and, for that reason, I have not included them. Also, there are many, many animal studies that, whilst very interesting, can't really tell me if eating donuts will stop my IVF from working, so I chose not to discuss them either. But, do feel free to investigate these other studies yourselves.

One final thing before I sign off; what is all this stuff about pineapple? I mean, I get the theory - pineapple contains bromelain which aids implantation - but where, oh, where did the theory come from? It is a very widespread notion; a quick search on a popular trying-to-get-pregnant website yields 1088 hits! Nearly all posts by people who swear by it. I have searched high and low and I can't find the source of this "fact" anywhere. I did find a paper published in 1969 which examined the impact of bromelain on the uterine lining, but it didn't indicate that it would help with implantation. I can really find no scientific evidence that pineapple helps people get pregnant at all - I wish I could, I really wanted this one to be true. If you can find any papers on the subject, please send them my way.


Monday, 15 April 2013

Operation Big Belly

There are many ways to get pregnant; IUI, IVF, ICSI, IMSI or, as some people still do, use a good old fashioned turkey baster. Even though are so many high tech options available, according to a study published by The Guttmacher Institute in 2010, it has been estimated that 41 percent of pregnancies in 2008 were unintended. Yes, you read that right, 41-flaming-percent! Which means that, assuming not much has changed in the last five years, of all the pregnant ladies walking around the world, nearly half of them didn’t even mean to get knocked up. These women didn’t take supplements, eat more veg, cut out the booze, or the cancer-sticks and they certainly didn’t have a whole team of people working behind the scenes to get a sluggish sperm to penetrate an evasive egg. Unfortunately, I am not those one of those lucky ladies, maybe you aren’t either, and I need all the help and advice I can get.

Let me welcome you to Operation Big Belly. Over the next few weeks, whilst waiting for my IVF stims to start, I will be researching, reading and sharing all the information I can get my desperate little hands on to super-charge the following transformation:

From this:
To this:

Let the journey begin and, if you are starting your own journey, supporting someone who is, or are just plain curious, why don't you come along for the ride? Hold on tight now, here we go!

Note: this blog post was edited on 21 Apr 2013 to include links.

Saturday, 13 April 2013

Am I really, though?

There’s been something on my mind. It was lurking in the darkest corners of my unconsciousness and crept up on me when I wasn’t paying attention; always a dangerous thing that, taking your eye off the ball. It never occurred to me that it would burn or that once the words had tumbled onto the screen they would sting. You might be wondering what could have got me quite so rattled. Well, ponder no more, I can tell you that my nerves have been jangled by my last, and first, blog post. Not all of the post, that would be quite exhausting, just a very teeny-tiny portion. Most of the words fell out of my consciousness as soon as they tumbled onto the screen but three little words remained imprinted on my mind: I am infertile. Just to be clear, in case you’re still confused, it really only one of those words that seems to be bothering me. To be completely precise, which is always the best way I feel, just three small syllables: In-fer-tile.

Prior to my last post, I don’t think I have ever said, typed or even thought that I might really be infertile. I know, I know, after 2 years, six months and no babies I might have got the message but, really, I hadn’t. After the opening gambit of my first blog entry spelt it out so crisply, I couldn’t get the thought out of my head – am I infertile? Maybe I am, maybe I’m not - I just wasn’t one hundred per cent sure. Perhaps I am just a little bit sub-fertile, or possibly, just a touch below par in the fertility stakes. I desperately needed to find some clarity. Well, dear reader, we already know that I am not an A grade student in the baby making class but am I in a completely new category?

As with most unanswerable questions in my life, I went to the only water-tight, fool-proof resource I know, the infertile lady’s friend, the World Wide Web and here’s what I found;

The National Institute of Clinical Excellence (NICE) in the UK have published guidelines which define infertility as “failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology”.

Oh dear, this wasn’t looking good. I have definitely passed that entrance exam to the infertility club, at least that is, to be included in the United Kingdom’s gang. Hmmm…..not good enough for me…… I needed to expand my search and go further afield. Well, just to be thorough, I went global and turned to the World Health Organisation (WHO) for some concrete answers. Surely the clever bods over in Geneva would solve this tricky conundrum for me. Let’s take a look at what they’ve got to say on the subject; the WHO defines infertility as “the failure to conceive following twelve months of unprotected intercourse”. Blimey, it’s not better, it’s worse; I’ve aced that test several times over!

So, I’m satisfied I have my answer; I am a proper, no doubt about it, infertile lady. Turns out, it’s not so bad. In fact, I’m feeling liberated; released from my confusion and desperation of the endless baby-making attempts and justified in my quest for a medical solution. And, as those handy bods at the WHO tell me, I’m not alone; worldwide infertility affects between 50 and 80 million people. Phew, that’s an awful lot of us.

Note: this blog post was updated on 21 Apr 2013 to include links.

Friday, 12 April 2013

Lessons learned

My name is Ana and I am infertile woman – there I’ve said it! I am infertile. For whatever reason, and we haven’t quite got a handle on what the problem is yet, no matter how hard I try I don’t make babies. Never did I think I would be sitting where I am today. When I was just a young  girl in her twenties, my dreams  of the future where full of beautiful daughters, wonderful sons and long summer days running together through a scent filled garden – oops, sorry, just made myself a bit queasy there – I was full of such naivety and arrogance. I can’t even say that my nightmares were filled with the fear of infertility or barrenness, they weren’t. To put it quite simply, the possibility that I wouldn’t get to choose when, where and how many children I would be blessed with didn’t exist. However, quite painfully, my current reality is not the idyllic scenes played out in the dreams of my youth but, in their place, are long, heart-breaking trips to infertility clinics to poked, prodded and pricked.

So, why start writing now? After all, I am not at the beginning of my infertility journey. Far from it, I am now two and a half years in. I’m deep in, very deeply in; you might even say that, if you felt like it, I’ve got stuck in the trenches.  Although, the first six months I spent on the road to conception don’t really count as I was bouncing along, still blissfully unaware of the trouble that lay ahead, very contentedly. I was completely happy about my fertility status, although I was getting a bit weary of all the extra sex, and I would spend my waking-hours day-dreaming about my future babes, who were clearly going to be turning up very shortly. Hang on a minute; I’m digressing – slipping back into the memory of the happier me.  Well, it’s so easy to do, isn’t it? To get back to the question I asked myself (honestly, this is going to be hopeless if I can’t answer even my own questions), I am writing now because I am staring down the barrel of a failed frozen embryo transfer, completed with my last two embryos, and I, quite frankly, need to talk.

Eight days ago I carted myself, along with my lovely husband, onto a train bound for London with as much enthusiasm and excitement as I think it is possible for any single person to bear. We nervously chatted and smiled together like two young lovers, complete with packed lunches, skipping school. We were off to get our embryos back! The two little blighters had been spending quite a while messing around in liquid nitrogen together. Don’t be too harsh on them, it wasn’t their fault; in between their creation and our reunion their siblings got to have the first go at developing into new-borns. So very sadly, their siblings failed on their mission, they won no prizes, and they didn’t manage to make it all the way to their first breath.  The little babies’ hearts stopped beating 16 weeks and 5 days after their particular miracle of creation began. So, you see, the two little embryos we went to collect had been waiting in the wings for their chance to grow and we couldn’t have been happier to oblige. We were warned not to get too carried away, that there was a chance it would fail, that we should cushion our hearts against the almighty blow that could be dealt. But, perhaps unfortunately, but I am not sure anyone else would have done it differently, we didn’t listen to a single word. We believed, maybe foolishly but definitely whole heartedly, that in nine months we would be saying hello to our little balls of cells, clearly there would be many, many more cells than started out, in person. Now here I am, eight days since the transfer of our embryos into my unyielding uterus, and it doesn’t look like those chicks are going to be coming home to roost. We are down five of the best pregnancy tests money can buy, no point scrimping at the end, and not a single positive among them. The negative tests, along with increasingly uncomfortable period cramps, are screaming at me, loud and clear, that this ship has sailed. And, although she might not actually be singing just yet, that fat lady has finished her warm up, is facing the bright lights and heading on out to the stage.

So, to deal with the title of this post, – don’t you just hate it when you can’t figure out how the title relates to the post? – what lessons have been learnt? Well, I’ve discovered, albeit a little late in the game, that fertility shouldn’t be taken for granted. And, that no matter how hard you wish, or visualise, or pray, or even beg, sometimes the universe, or God if you prefer, just isn’t listening. And, finally, I suppose I’ve learnt, very begrudgingly, that even if you get knocked down again and again you just got to get up and get on…….dreams, apparently, don’t come easy or, now I think about it, cheap. So, onwards and upwards and here’s to looking forward to another fresh cycle.