Guest Blog Written By Chic Mamma: Coreen Van Es Ruck
I can vividly recall the first time I had to inject myself with the “trigger shot” Ovidrel as part of my fertility treatment. It was bloody frightening; the needle looked huge. I asked my husband to pour me a BIG glass of red wine as I sterilized the area around my navel to prepare for the shot. It’s rather comedic looking back on it. I had the injection aimed and ready as I took a deep breath, then another, and then I told him I couldn’t do it. He suggested that I go to the bathroom to try. More of the same… Breathing, aiming and then chickening out. Then I told him to do it, it would be easier if I didn’t see it coming. He meticulously washed his hands while I sterilized for the 20th time. As he was ready to inject me while I pinched the skin I suddenly yelled “you’re going to stab my finger. Give me that!” He quietly poured me a second glass of wine. I finally took a deep breath and jabbed myself and then laughed about all of my apprehension and fanfare. It was nothing, a small pinch and a slight burning sensation. That was all. I didn’t realize that this was to be the first in hundreds of needles, (many much more painful), that I would be giving myself during my treatment for infertility over the next few years.
I met my husband in August of 2005, almost eight years ago as I write this. I was 34 and he was 33. Neither of us had children, but we were fairly eager to start a family. I’m happy to say that I have a beautiful one year old son, but we did not conceive easily or within the timeframe that we expected. Not by a longshot. We were married after dating and living together for about 22 months. Having had a teenage pregnancy that did not result in a child and many scares along the way, I had no worries about becoming pregnant. We used protection religiously. I just assumed that when we decided to start a family, I would become pregnant and that would be it. I look back now and laugh at all of the money we wasted on prophylactics! Getting pregnant was not in the cards for us right away.
After six months of trying in earnest, we invested in an ovulation prediction kit. I tracked my periods, I tracked my temperature and I peed on sticks; all to no avail. Getting pregnant was hard and about to get harder. I started reading about my declining fertility and increased risk of miscarriage and birth defects after the age of 35 and began to panic about my prospects of a family slipping away with each period. After 10 months, my doctor said “maybe it’s time to look into a referral to a fertility clinic”. I agreed. With the referral made, I sat back and waited for a phone call. And I waited, and waited some more. During my wait time, I developed a severely inflamed gallbladder in July that required treatment and removal. My doctor told me “don’t you dare get pregnant until it has been removed. You don’t want to have emergency surgery while you’re pregnant”. So I waited some more. Thanks to wait times for surgery being what they are I did not have my surgery until December of that year.
I began treatment in February of 2008. The first month was just monitoring my cycle, running a multitude of tests to check my general health, freedom from STIs, hormone levels, egg reserves and uterine and tubal patency. The monitoring required several blood tests, transvaginal ultrasounds and meetings with the nurse. With all systems go and a fairly good egg reserve for my age we began the treatment phase. This was essentially more (intrusive) monitoring and blood work watching for my luteinizing hormone to spike indicating that I would ovulate. We started with the least invasive of the protocols. A single injection of Ovidrel, a gonadotropin, used in my case to quickly ripen any follicles and ensure that an egg was released in synchrony while my hormone levels were optimal. The doctor explained that sometimes infertility is just a case of bad timing and the body failing to orchestrate all of the necessary hormonal processes at once. I really hoped that mine would be.
We (meaning I, as up to this point my husband was only required to give a semen sample for analysis) underwent more invasive tests. The hysteroscopy – where the doctor looks at the lining of your uterus with a camera and takes a small biopsy and the hysterosalpingogram where the doctor shoots dye through your fallopian tubes while taking a series of X-rays to check for blockages. The doctor explained that sometimes mucous can build up in the tubes creating issues, but that it can easily be fixed with laparoscopic surgery. The news was both good and bad, I had a blocked tube and would need to have it fixed, but this may cure my infertility. My surgery was scheduled for June and we continued treatment using Ovidrel and the doctor added oral progesterone to ensure that my uterine lining was “sticky” enough should an egg become fertilized.
Two days before my surgery, we got the news we had been waiting for, a positive pregnancy test. We both heaved a sigh of relief. I was elated at how easy it was! I cancelled my surgery and we relaxed a little bit. We told everyone that we were pregnant. I was on cloud nine and we were thankful that we had been successful fairly early on. Unfortunately, I miscarried late in August while at our family’s cottage. I had a lot of support, as my whole family was there, but it also was a very emotional and public event for the same reason. It impacted us all. We began the work of “untelling” everyone and listened to all of the mindless platitudes of “it wasn’t meant to be” and “nature knows when something is not right”. Wounded, but not defeated we went back to the drawing board. What stung the most was the feeling that another three months had slipped away and I had just turned 37. My biological clock was ticking so loudly, it was almost deafening. By the time I had completed miscarrying and my period returned it was October. I underwent the laparoscopic surgery and was again hopeful when the doctor told me that some women have a slightly increased period of fertility in the three months following due to their squeaky clean fallopian tubes. We hoped to cash in on this phenomenon.
We started a new, but still fairly uninvasive protocol by adding an oral medication Femara to the mix. Traditionally used for breast cancer patients and highly teratogenic, I was concerned about the possibility of birth defects should I become pregnant. The doctor assured me that this would not happen but the benefit was that it would stimulate extra eggs and follicles to increase our chances. After another 3-4 months of this protocol with no results, we met with the doctor who advised that it was time to become more aggressive. At this point I had been in treatment for a year and I still didn’t have a baby. I recall asking one of the ultrasound technicians as she painfully poked and prodded, again looking for my tricky ovary that liked to hide deep in my abdomen somewhere, “do you ever see women just give up”? She told me that sometimes women who already have children do throw in the towel, but women without children “never seem to give up”. I already knew that that would be me; I would keep trying until I was successful no matter what. I desperately wanted to have a baby and begin a family with my husband Kevin. I watched as others effortlessly became pregnant, went on maternity leave and enjoyed their babies, hoping that soon, I would join their ranks and become a mother.
We began daily injections. Insanely expensive injections that were thankfully mostly covered through my work`s insurance plan. I was now taking orally femara and progesterone and injecting a new follicle stimulating hormone called puregon, a gonadotropin, used to ensure that eggs ripen and reach maturity. I became surly, often snapping at my husband, crying hysterically for no reason and wanting to kill my relatives for even mentioning fertility treatment. Miraculously, my husband remained supportive, calm and loving when I was at my absolute worst.
After three months, it was suggested that we switch tactics and begin intra-uterine insemination. My husband would have to become more involved, supplying two samples on successive days at the time I was ovulating. We were hopeful with this new protocol as they used the best of his sperm and deposited them very close to the fallopian tubes. The cost was $500 a cycle. We again became pregnant and subsequently miscarried that summer. More time was spent completing the miscarriage and getting back to a regular cycle. We added a new daily injection, menopur, a menotropin also used to stimulate follicles. All of these injections were used to stimulate and ripen several follicles, which may or may not contain an egg for release. I was usually able to produce about four or five. We stayed with this protocol until late January of the following year, 2011.
I had always looked at my treatment as a necessary medical intervention as I could not allow myself to become emotional. I refused to let it get the best of me or I knew that I would lose heart and become a basket case, possibly wanting to give up because of the dejection month after month; but I knew that nothing could outweigh the heartache of never having a child, never being able to give my husband a baby and the family we so desperately wanted. There were times that I felt hopeless. I felt like a dud whom my poor husband had unwittingly married and was now stuck with, but he never lost faith. Not once.
Did I mention that undergoing treatment was also the beginning of an emotional roller coaster ride that I wouldn’t wish on my worst enemy? We began each cycle very hopeful that this would be “the one” only to have our hopes dashed on the day of our pregnancy test each month. Add to this very early morning appointments for monitoring my cycle on days three, six, nine and then almost every day following until I ovulated on day 16 or 17, a cocktail of hormones both oral and injected taken at very specific times each day (so I could not sleep in, nor could I go to bed early as I had to maintain a rigid schedule). We were rarely able to make any plans for the first 14 -17 days of the treatment phase as it was impossible to know when I would need to be at the clinic for monitoring and as an added frustration, my husband was often out of town for work so at times we didn`t even know where he would be when it was time for me to be inseminated. Miraculously, his work schedule interfered on very few occasions. I had to take the train to Montreal once for a couple of nights in order to have ‘fun’, otherwise an entire two weeks of injections would have been wasted. It finally began to wear on me. I met with the doctor in February 2011 and he enthusiastically stated that my blood work and ultrasound showed that I was having one of my best months ever and we should switch the cycle over to IVF. I blurted out “I need a break!” A shock to both of us. He encouraged me to take some time off and come back when I was ready.
I took six months off. I didn`t want to think about treatment and I refused to talk about it with anyone. We went to Cuba, we spent weeks at our cottage, we drank, we partied with friends, I slept in, we made plans with everyone that we hadn`t seen in ages and we got back to a spontaneous sex life. It was glorious. I felt like a weight had been lifted and I was my old self again. We finally returned to the clinic in September ready to begin an IVF protocol. I was now 40 years old. It was essentially the same regimen, but with much higher doses of injected medications. On November 6, 2011, I had my eggs harvested. It was a minor surgical procedure where the doctor inserts a long hollow needle through the vaginal wall and then aspirates the eggs out of the mature follicles. It was painful, even with a shot of whatever painkilling medication they gave me. We were lucky enough to obtain 8 eggs. At the time of my embryo transfer four days later, we had only four viable embryos as two had failed to progress to cell division, one failed to eject the extra set of chromosomes and one began cell division but arrested. The doctor suggested that all four embryos be transferred into my uterus. We agreed.
Then we waited for 12 very long days for my pregnancy test. They were the longest 12 days of my life. I was lucky enough that my doctor signed me off of work for the next seven days, allowing me time to just rest and “let my body perform a miracle”. I recall lying on my couch feeling a pinching pain in my uterus for several hours and then tears of relief spilling down my cheeks; somehow knowing that this was the pain of implantation. I returned to work and attended for my blood test on November 22. I recall thinking it was a good omen as it was my husband`s birthday. I just knew that it had to be good news. It was. I got the call in the late afternoon congratulating me on my pregnancy. We had done it. If all went smoothly, I would have a baby in July of 2012.
My pregnancy was not a smooth 9 months, however, nothing had been easy thus far. I bled, I was diagnosed with a sub chorionic hemorrhage that made the first 25 weeks hell, I had gestational diabetes, it was a twin pregnancy and one of the heartbeats had stopped, but my little baby held on. I did my best to stay relaxed and I tried to enjoy being pregnant, but I won`t lie, I felt like I held my breath for a good portion of the first and second trimester. But as the months passed and I felt my sweet baby moving and rolling in my belly I began to let myself believe that I would be a mother, that he was going to be fine and I was finally going to start a family.
He arrived without incident on July 18, 2012 via C-section. It was without a doubt the happiest day of my life. The moment I heard his cries in the delivery room I sobbed tears of joy, I cried tears of relief to shed the crushing anxiety of all the previous months and the years of doubt and I cried tears of pride because I had finally given my husband and I the baby and the family we so desperately hoped for. The most perfect, healthy baby I had ever laid eyes on. Jackson Michael Thompson Ruck, 8 pounds and 5 ounces of pure perfection and he was all ours.
He turned a year old yesterday and my husband Kevin and I couldn’t be happier. We will also be returning to fertility treatment to try for a second child. I know it`s going to be harder with a baby, with early morning appointments and my husband being out of town at times; but I also know now just how precious the payoff is. I`ll be 42 in a week, so I don`t have the luxury of time to start with the lesser invasive protocols – we are going to have to start with IUI and then straight to IVF if we want to move quickly, but I`m full of hope that we can do it again.
If I had to give another woman advice about the process, I might tell her to try a more aggressive therapy as soon as possible, especially if she is over 35, as I felt that we wasted a lot of time on the less invasive protocols. I would tell her to relax and breathe, to meditate and have regular massage. I would suggest acupuncture as I have heard that it works well. I myself had only gone for only one appointment as it was at a time that I just did not have the energy to squeeze in another therapeutic intervention, although I will most certainly do it this time around. I`d tell her to do anything that works to keep her mind calm during the process and her body ready for a baby. We ate organic and cut as many toxins from our home and personal products as possible. But mostly I would tell her to stay calm, to believe, and to not give up hope. Miracles happen every day and why shouldn’t one happen to you? It`s what I’ll be doing when I return to treatment in a few weeks to maintain my sanity and centeredness while trying for baby number two. Wish me luck.