June ICLW and gargoyles

Today my husband and I took an impromptu trip to Oxford, just to escape our worries for a few hours. We took lots of photos as we strolled around the city. I didn't stop thinking about what might be going on inside me but it was a lovely few hours. I did realise, whilst wandering along a cobbled street, that I have done nothing for ICLW this month. This isn't good and I will attempt to rectify my error with gargoyles.



Two and a half weeks ago a doctor placed two perfect embryos into my well prepared uterus. The whole experience was spellbinding and I held out for a staggering six days before I buckled and took a pregnancy test.

Two perfect pink lines popped up. Shocked, I don't know why getting pregnant via IVF is shocking but it is, my husband and I celebrated.



Things started to go a bit wobbly when I couldn't stop myself from peeing on the dreaded sticks. 

The blasted things refused to go darker or to stop fading in and out. 

I wished, hoped and prayed. It didn't help; the darn tests refused to comply. I succumbed to the fear and begged my GP for a blood test.

The result, from a blood sample taken at 13dp5dt, was 81mIU/mL. The doctor said this was low and ordered a second test.

I duly submitted my arm to the phlebotomist fifteen days after our exquisite embryos had entered my uterus.

There was 130mIU/mL of hCG in my blood at 18dp5dt 15dp5dt. This is low, low, low. My GP warned of an ectopic pregnancy and instructed me to call my clinic. My clinic confirmed fears of an ectopic pregnancy, told me what to watch out for and said the hCG was low and slow.

My husband went on an internet rampage and found a chart that we hoped would comfort us.

If you look closely you can see our first blood test just scraped into the minimum acceptable level. However, our second blood test result has fallen off the bottom of the bloomin' scale. The doubling time for my hCG hormone level is 75 hours. Not great. Ideally the hormone should double every 48 hours but anything faster than 72 hours is considered okay.

Recently my husband and I have been doing a lot of this:

It could still all be fine and dandy but it isn't looking likely. So we are still doing this:

Second beta at 15dp5dt - Bugger

Just a quick update. There are no pictures today or silliness about chocolate lollipops.

My beta has gone from 81 on 13dp5dt (18dpo) to 130 on 15dp5dt (20dpo). Those measurements were  over 52 hours apart. My clinic isn’t too hopeful; the lovely people who help me there have gone from being chirpy to gloomy. The clinic and my GP suspect that I might be in possession of an ectopic pregnancy. Quite handily, they have given me a list of warning signs which, if any of them happen, should send me galloping on over to my local hospital. I will have another beta on Monday and, if I make it, a scan next Friday. There is a small chance that this pregnancy will work out but you'd really need a high powered microscope to see it now. I am clinging on to that small shred of hope. I want to keep my diamond, dammit.

Pregnant? Yes, just a little bit.

It was supposed to reassure me and make it all crystal clear. A blood test would tell me if this was going to be okay. However, the universe looked at my plans, took a deep breath and laughed in my face. A huge great belly busting shriek of a laugh.


My blood test results are back. I am pregnant. No doubt about it. This is good, right? It's what I wanted, right? Achieving pregnancy is the first step on the winding, probably uphill, road to reach this:




 My beta-hCG result is 81 mIU/mL at 13dp5dt (or 18 days past ovulation).


That is not a sparkly, glittery or exhilarating number. That, my friends, is a number that is an excruciatingly low, frighteningly poor number. It is the type of number that could mean this pregnancy is going nowhere fast. My GP was kind but not thoughtful; beginning the conversation by asking if I was bleeding wasn't going to make me feel at ease or anticipate good news. In fact, it was blanket hiding time again.




How did I react to this agonising news? I scoffed my way through a bag of chocolate lollipops, a chocolate bar and a coffee, and not the decaff stuff either. I know, I know, I am wild and reckless. However, that was only stage one of post-beta meltdown.


Stage two involved trawling the internet, until my bum went numb, searching for success stories. As the pages loaded in front of me, the steaming pile of crap got higher and higher. I waded through the mountain of misery, reading about loss after loss, miscarriage after miscarriage, and then, I saw it, just poking out of the top of the mountain of soggy, stinking dung: a diamond. My eyes focused on the gleaming words. It happened, it was real. Someone out there had the same dismal number as me and won. For a while, all I could see was the sparkling gem of hope. Now, I can still see the shit but I am holding tightly onto my nugget of faith.


Stage three comprised of flicking through  the maternity wardrobe of Catherine, Duchess of Cambridge. Not literally, obviously, but courtesy of Go Fug Yourself. I don't know why I choose to punch myself in the gut quite so hard. I felt better when I remembered that she had married into the royal family and all the beautiful bump flattering clothes in the world can't make up for that.


So what have I learnt today:

• I'm pregnant but probably possibly won't stay that way
• Sometimes people beat the odds
• Eating chocolate on sticks is highly enjoyable
• Kate Middleton is a beautiful pregnant lady
• I'm not feeling creative and am resorting to recycling pictures

I had another blood test today and, hopefully, I will get the results tomorrow.


I thought I would leave you all with a very special treat:



Source

Am I? I think I am.

This week has been, as I suspected it would be, utterly crazy. Pregnancy tests suck! I hate them, I hate them, I hate them. Ahhh....that's better.  

I didn't wait until Friday to test; I didn't make it until Thursday or even Wednesday. By the time Monday turned up I was already clinging on to the last shreds of my very fragile mind. I didn't want to break but how could I resist? I needed to know. The agony of being so close to pregnancy was driving me insane, really it was climbing the walls time; it was also torturing my husband. We went back and forth. Shall we? No let's not. It won't hurt. No we can't. Eventually, on Tuesday, we flipped a coin. Heads I test, tails I don't. The coin spun in the air, landed on my hand and I peeked. Tails! Arrggghhh. Not tails, surely!?! That was it. Our will was broken.


I unwrapped that first magic stick and let the urine flow. Had I drunk too much? Not enough? Was it too early? Should I wait to use my morning wee? Too late, the stick was soaked. Placing the test face down on our dining room table, we waited. Three agonising minutes passed. We couldn't look, we held each other and then we saw this:

It wasn't the darkest line in the world but, look, there's definitely a second line.


We went to bed happy. Oh so very happy. My mind was filled with bliss, until the next morning when I decided, as you do, that one test wasn't enough to keep me going and I got slapped round the face with this little beast:

 

 

Yes, you're right, the second line has vanished. What on earth did that mean? Was I pregnant or not?

 

 

Life was not fun that day. The birds weren't singing and the sun didn't shine. I couldn't wait to get home and pee, and pee I most certainly did; this is what we saw:

 

 

 

 

 

Yipee! Oh, do pardon the pee pun. The second line returned. We could be happy again. We chatted joyfully about how it would finally be our turn for a little one. Until, of course, I lost my shit and went for another test and then, because I am a lunatic, another. I don't know how anyone stops at one. Good Lord, I admire you solo testers. To me pregnancy tests have the same allure as heroine does to the most drug addled junkie. In case you haven't guessed, and I imagine it's the same for any addict, the fix did not make me smile; we got these suckers:

 

 

 

 

The lighting is a little different but the story is the same. The final test was lighter than the previous one. What the crappity crap does that mean? Can you get pregnant, a smidgen more pregnant and then less pregnant again? Since that fateful evening there have been two more tests and they don't seem to be progressing in the way any IVF survivor would be proud of. 

 



 

 

 

I'm not an expert, not in anyone's book, but several hours of scouring the Internet makes me believe that something isn't quite right here. Tests shouldn't fade in and out, and by 11pd5dt, or sixteen days past ovulation if you prefer, the test line should be jumping right out of that oval window; it shouldn't pale into insignificance in comparison to the control line.

 

 

I am trying to remain hopeful, optimistic and bright. I mean, I've got two lines on a test so why am I even complaining? How ridiculous that I am not shouting "yay! yay! yay!" but instead I am whimpering over relative densities.

 

 

Maybe it's all okay. Maybe my embryos are just slow starters. Who knows? I heard on the pregnancy grapevine that sometimes test lines can be stubborn and refuse to pop out as quickly as you'd wish.

 

 

Tomorrow is my official test day and I will, once again, be peeing on one of those little devils but this time I can actually tell my clinic I have done so. I will also have to admit that I have been testing for some time now and that I am going berserk. I have no idea what they will say or do about my woes. Under normal circumstances - I think we have established these aren't normal circumstances - the lovely receptionist would book me an appointment for my seven week scan but, holy cow, I can't wait three more agonising weeks.

 

 

When I wake tomorrow, assuming I sleep at all tonight, I will also call my GP and beg her to do sequential blood pregnancy tests (betas) to see if the pregnancy hormone is doubling normally. My GP's practice is terrifyingly tight-fisted. The doctors there are so mean they point blank refuse to write a prescription for more than four weeks' worth of medication at a time, even if you need the meds permanently. If they cast me aside when I fall on my knees and cry for help, which is certainly possible, I am going to resort to begging the lovely doctors who took care of my first pregnancy to save me from despair. They made the foolish mistake of writing us a kind letter to let us know that nothing would be too much trouble if I ever got pregnant again.

 

 

One more thing, just before I sign off and while I have your attention: I am developing a constant pain on my right side just under my bikini line. Anyone know if that's not something to go a little bit mental about?

 

 

If you do have any answers, advice or any knowledge at all, please share. There's a handy comment box below to write out all your thoughts.

 





Good days and bad days

Almost two years ago, on the first of July 2011, I got married. It was the best day of my life. There were months of preparation; plenty of visits to boot sales, antiques fairs and charity shops, hunting down forty individual vases to fill with mixed bunches for the table decorations. Many hours had been spent painstakingly designing, cutting, pasting, and attaching ribbons to piles of  handmade invitations. Rose petals were pressed, cakes baked and iced, food sampled and alcohol purchased.  When I woke on that most special of mornings, I could feel my stomach was knotted with excitement and anticipation. My beautiful bridesmaids and I giggled, like the school friends we used to be, over a champagne breakfast; we slipped in to our pretty dresses in my cramped apartment overflowing with flowers, lace and happiness. Make-up applied, hair styled and simple posies carefully placed, we bundled ourselves, and boxes of confetti cones, into my friend's trusted car and sped along the scenic country roads; the sun was shining, the was weather warm and a landscape of green welcomed us. The world was bright and vibrant; we felt alive. When we arrived at the venue, we were greeted by our registrar; she sensed the nerves, comforting me with kind words and explanations of the formalities. The day was passing in a blur; I willed the world to turn slower; I tried hard to absorb every detail, to remember every smile, every laugh and every single moment of joy. My new husband looked anxious but exquisitely handsome and happy, oh so happy. Petals fell onto the dusty floor of the ancient barn; we drank, we ate, we danced.

Two days later my husband and I strolled through the brilliantly bright streets of Bangkok. Stepping into a marble lobby, chandeliers sparkled overhead, we moved forward to the reception desk of our luxurious hotel. The receptionist was courteous, helpful and understood what a magical time our honeymoon was. As we were led to our suite, we passed the faces of relaxed holidaymakers, serious businessmen and the maids scuttled down the corridors around us. Once we crossed the threshold, the bellboy showed us the features of the peaceful apartment; we were presented with a delicately iced cake to celebrate the special time. Finding ourselves alone, my husband and I fell onto the soft sofa; our hands touched, our fingers became entwined and joy radiated through our bodies, from our smiles right down to our toes. Unpacking my case, I pulled out seemingly endless reams of light colourful summery fabric. Each dress chosen to flatter and reveal the new figure I worked so hard to achieve. After fourteen days of adventure, endless delight, one elephant safari and with two sun-kissed faces, it was over.

When we arrived home, we were greeted by flowers and cards; our loved one's generous words tumbled from messages full warmth and happiness. We felt loved and connected; our joy was complete and our hearts were full. We lingered as we opened each present, read each card and committed the well-wishes into our memories. Surrounded by a sea of tissue, we came across a present that we weren't sure what to do with. It wasn't a vase we could place lovingly on a sideboard or a picture that we could hang with care. The confusing wedding gift was the opportunity to name a star. My husband and I talked about what to call the star; we came up with nothing, we shrugged and I put the box under the coffee table until the day that inspiration would find us.


Six months ago, on the twelfth of December 2012, our babies died. It was the worst day of my life. There had been months of preparation; countless trips to fertility clinics, specialist doctors and maternity wards, to achieve and sustain the pregnancy our hearts ached for. Many hours had been spent injecting, pill popping, testing, and undergoing scan after scan to ensure the eggs would mature, graduate to embryos and the resulting babies would survive. Maternity clothes were bought, nurseries dreamt about, friends told and my belly grew bigger.  When I woke on the morning of our thirteenth pregnancy scan, I could feel that my stomach was knotted with fear and dread. My husband and I talked with hushed tones as we dragged on our heavy clothes in our bedroom filled with exhaustion, fear and sadness. Teeth brushed, hair scraped back and our maternity file carefully placed in my bag, we shuffled to my beloved car and drove along the grey wintry roads. Snow lay on the ground, the weather was icy and a landscape of gloom surrounded us. The world was dark and still; we felt stunned. We arrived at the hospital and were greeted by our midwife, she sensed the fear; comforting us with kind words and explanations of the formalities. The day was passing in a blur. I willed the world to turn slower and I fought hard to blink back the tears, to cling to every shred of hope, to remember every blurry image and hold onto every single moment of joy. My husband looked tired, desperately worried and sad, oh so sad.  As the ultrasound got underway, the words shattered the air around us as they fell from the doctor's mouth, the babies were gone; we shook, we cried, we crumbled.


Two days later my husband and I walked through the depressingly dull streets of Reading. Stepping into a yellowing lobby, the fluorescent strips flickered overhead, we moved forward to the reception desk of the labour and delivery ward. The midwife was kind, helpful and understood what a tragic time the loss of our babies was. As we were shown to our suite, we passed the faces of expectant couples and anticipating grandparents; the midwives rushed through the corridors around us. Once we crossed the threshold into our delivery room, the midwife showed us the features of the deathly quiet apartment; my cervix was prepared for the impending birth and pills were given to start the contractions. Finding ourselves alone, my husband and I fell onto the uncomfortable sofa and our hands touched, our fingers became entwined and agony radiated from our souls. Unpacking my case, I pulled out a limited stock of heavy, dark clothes. Each item chosen to hide and cover the pregnancy I worked so hard to achieve. After nine hours of labour, endless torture, an emergency surgery and a blood transfusion, it was over. The next day, we stood like statues with fragmented hearts as we looked at our daughters, both of us too scared and broken to stretch out a hand and touch their cool skin. 


When we arrived home, we were greeted by flowers and cards; our loved one's comforting words tumbled from messages full sympathy and sadness. We felt loved but alone; our worst fears had been realised and our hearts were empty. We sat in stifling silence as we opened each envelope, read each card and committed the grief to our memories.


Some months later, as I cleaned round our coffee table, I felt my foot touch something cold. I knelt down, reached under the table and pulled out a box that I didn't recognise. I prised opened the metal lid and a thin sheet of instructions floated onto the carpet. I smiled when I realised it was a forgotten wedding gift; the leaflet told me it was our opportunity to name a star. My husband and I didn't need to discuss what to call the star: inspiration had found us.  

Could I be pregnant?

Every 28 days, always around this time in my monthly cycle, my hope gene starts working overtime. Yes I do have a very regular cycle, thank you for noticing. In case you are unaware, I can tell you that the hope gene encodes the hope protein which, in turn, triggers the hope activatory pathway. Even though many doctors have told me I almost certainly won't get pregnant, the hope gene has not been switched off and it certainly hasn't resulted in, what I'd really love, hope protein down regulation. Which, in an ideal world, would bypass the hope activatory pathway altogether.


Nine days ago an egg, or ovum if you want to be all fancy about it, left one of my ovaries, travelled down a fallopian tube (I'm betting it was my right one) and, whilst on its journey, may or may not have met up with one or more of my husband's sperm. What we can be pretty sure about is that, if they did meet, the big egg and the little sperm almost certainly didn't hit it off. I don't know who's got the issue and, if I could, I would get them together in a room or, as my embryologist does, a petri dish and force them to be friends or, better still, lovers.   


And now, one week and two days after the magical release, I can't stop thinking "could I be pregnant?", even though deep down inside I know I'm not. This treadmill of hope and despair has continued now, with a brief interlude for an ill-fated pregnancy, for two years and seven months. It doesn't seem to matter how many times I sit on my toilet seat and watch transfixed, with tears in my eyes, as the blood red spots fall onto the soft white paper. But every single flaming time I pick myself up and I get over it. I promise myself that when it happens again, which it inevitably does, I will be stronger, better, harder, tougher. Blow it, I say to myself, next month I am going to be the Jane Eyre of infertility - there may be a crazy lady in the annex but it ain't going to phase me - until, of course, it does.


Last month I promised myself that, when I finally yield to the call of the little white siren hiding in the bathroom cabinet, I wouldn't dream of two perfect pink lines popping up instead of the usual lone crusader. I don't want to fantasise about a pregnancy that never happens, even if it is for just five minutes. But here I am dreaming on my sofa once again and, even as I am typing these words, my internal voice is whispering "this time you really might be". And of course it's right, I might be - except I know I'm not. So I could be pregnant. I could, I really could.

The first step

Little Pill, as you sit on the table in front of me, I look at you and wonder. I examine your size, your shape, your texture. I marvel at your neatness; how compact you seem lying here before me. I take you in my hand and let you sit there for a while. I want to know more about who you are: what might you do to me? So I search; I am rewarded with new knowledge about your structure, your function and I laugh at your unpronounceable name.


Little Pill, if I swallow, will I become Alice? Will I fall down the rabbit hole? Will you come with me through Wonderland? And, Little Pill, is there a chance I could awaken to a brilliant new reality? Can you make my dreams come true? Or, Little Pill, will I be trapped here, still in this never-ending infertile nightmare?


So Little Pill, as you can see, I am nervous and fearful. We have been here before, you and I. Can I take this leap of faith? If the worst comes to pass, will my heart be strong enough to bear the pain? My soul longs for what's on offer: for the promise of a different life. But I have seen the underworld; I have taken a walk through Hades. I look at you once more, Little Pill. You sit still, motionless, ready. 

Can coffee mess with your IVF cycle?

Do you know what helps bees to remember which plants they would like to visit again? Yes, that's right, the answer is caffeine. According to scientists, who are definitely some of my favourite people, bees like to return to flowers which produce caffeine containing nectar. If you think that's an interesting fact, you can read all about it here, I suspect you are going to enjoy this blog post. Although caffeine is a relatively simple molecule (see it's structure below), it does have some pretty impressive properties and there is considerable debate about the impact of caffeine on pregnancy. The World Health Organisation recommends that pregnant women not exceed a daily caffeine intake of 200-300 mg. However, in constrast, a recent Cochrane Review concluded that there was insufficient evidence to determine whether restricting caffeine consumption improves pregnancy outcomes (see here). But I am sure you're not so interested in bees or pregnant ladies; what you really want to know is: will caffeine make your IVF cycle less likely to succeed? Well, you're in good company because so do I.

Let's go together now and take the third step on our research journey or, as I have affectionately called it, Operation Big Belly. As you may remember, we looked at the evidence that diet can impact an IVF cycle here, whether a drink or two will reduce your chances of having an IVF baby here, and, as usual, just a reminder that the ground rules can be found here.


So then, caffeine and IVF. Well, once again, I have spent a considerable amount of time searching on-line databases to provide you with the all the latest information. And, as usual, I have found very little data on the impact of lifestyle on IVF success. This time I was looking specifically for caffeine data and, frustratingly, I haven't found a larger data set than I dug up for the effect of diet or alcohol on IVF cycles. In fact, I have managed to only scrape together two studies. Still, two studies are better that none and it does give us something to get our teeth into.


The earliest study, led by Hillary Klonoff-Cohen, was conducted between 1993 and 1998 in Southern California. During the clinical trial, 221 couples, undergoing IVF or gamete intra-fallopian transfer (GIFT), were recruited to determine if there was a link between caffeine consumption and IVF outcome. The authors reported that, for women consuming caffeine from coffee, tea, soft drinks, cocoa drinks, or chocolate, the risk of miscarriage, not becoming pregnant and not achieving a live birth was significantly increased.  There was, however, much better news for the boys: male caffeine consumption did not negatively affect sperm, embryo transfer rates, the chance of getting pregnant or pregnancy outcomes. But, and this is quite a big but, men's caffeine intake did correlate well with an increase in the number of multiples. So if you don't want to have twins......


You might not like the findings from that first study, and who could blame you, neither do I. But, let's remember, it is a very small study and only a lone study. Perhaps more recent data will give us better news.


The second study we are going to take a look at was conducted in the slightly more exotic location of Saudi Arabia. This time 619 women took part and all of them went through their first IVF cycle between 2002 and 2003. Unlike the majority of the studies we have examined, this study has something special; the lifestyle results are not only based on questionnaires completed by the patients but, in addition, the actual concentration of caffeine was measured in blood and, more excitingly, in follicular fluid. The study authors concluded that they could find no association between coffee and tea consumption, or the level of caffeine in serum, and pregnancy rates (yay, some good news at last). However, they did find a negative correlation, albeit a weak one, between tea drinking and the number of good embryos - the more tea you drink the fewer the good embryos. And there was also a link between high caffeine consumption and miscarriage. Sadly, the study didn't continue to assess the women for the next nine months, so we can't tell if caffeine would have impacted the live birth rate in those women.


So, let's sum up, we have one study that shows caffeine does negatively effect IVF cycles and one that indicates it probably doesn't. Oh, if only we had more data. Hang on, what's this? Ah, I am about to break Operation Big Belly's ground rules; I have found one more relevant study that was reported at a scientific meeting but has not been formally published. However, the meeting abstract and the subsequent press release are available on-line.


The study was a large one - this time we're in Denmark - and was presented last year to the European Society of Human Reproduction and Embryology (ESHRE). The researchers followed nearly 4000 women before and after their IVF cycles to find out if drinking coffee would result in lower pregnancy or live birth rates. Once all the data were collected, the investigators found that having up to four cups of coffee per day didn't really make any difference to the IVF outcome (yay, again), but having five or more coffees reduced the pregnancy rate by a whopping 50 percent and the live birth rate by, an equally staggering, 40 percent. Oh.


It seems that, at the moment with a very limited data set, heavy coffee consumption can reduce your chances of taking home a baby after IVF. Although, of course, it is possible that future larger studies, which I hope that some smart research group is working on right now, will show that caffeine doesn't really cause less women to become pregnant or babies to be born.


So, that's caffeine dealt with. What's coming up next? Well, in case you haven't figured it out already, the first phase of Operation Big Belly is dealing with consumption: we have looked at food, alcohol and caffeine.  As I am not planning to tackle illegal drugs, the only thing left to look at is cigarette smoking. Ahhh, the evil weed. Until next time....

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.

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.

 

 

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.

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.