Infertility: Ultrasound and Next Steps?

I haven't even started IVF yet and I'm already acting crazy... It's very scary and there's a lot of factors to consider and it can be quite overwhelming. My moods have been all over the place lately and I'm pretty sure 90% of it is due to the amount of anxiety and general fear I have around this process. It's all so unknown and I absolutely cannot deal with unknowns. Anyway, before I go any further I wanted to send out massive congratulations to one of my blogger friends who I have known for quite a few years now, Lyndsay (and her partner V, and the adorable woofer Robbie of course) on their successful IVF cycle!!! Check out her blog, she's awesome.

Image via pixabay
Anyway. Let's go back to 22nd August. It was my 29th birthday and I had an appointment for an internal ultrasound and also had to have some blood work done. I've never been one to make a huge deal out of my birthday so it wasn't like a massive problem or anything but still... having an ultrasound wand assaulting your cervix on your birthday isn't ideal! ha. The tech was so lovely and it really wasn't as bad as a smear. No evil speculum, you get to wear a gown to protect what little modesty you have left at this point, and honestly it's just a bit uncomfortable. The worst part by far was having to hold 1.5ltrs of liquid for over an hour!!!! Initially, the plan was to do the topical ultrasound then go for the internal but because I was cycle day 28 and we were really looking for abnormalities, there wasn't much point to the topical so I was allowed to pee - and promptly sprinted to the bathroom, felt a million times better - then we got down to the awkward bit. 

So what happens in an internal ultrasound? It's just you and the tech. She had the referral and is the master of making you feel at ease. You get your gown, remove what's necessary and assume the position. This part made me laugh. There was nothing for me to put my legs on so all I had was a chair, classy. The most important thing is to relax - yes, I'm aware this is near impossible but just trust me here, think happy thoughts and do some deep breaths. OH! The tech will place a condom on the ultrasound wand, be very generous with the lube and then well... in it goes... ha. 

I'll be completely honest here, I was so fascinated by the images on the screen it nearly almost completely removed any anxiety and discomfort I was feeling. It was amazing to see what was going on inside my body! Of course, part of me was terrified of seeing a massive physical problem but being the medical nerd I am, even that would have been quite cool to see. Yes, she's right up on your cervix to see your ovaries which is pretty uncomfortable, but it's more of a pressure than actual pain, and as long as you don't tense up it's manageable. The whole process took maybe 10 minutes, 15 at most as I kept asking questions and basically had a grand tour of my uterus.... hahahaha. 

Results? There is nothing wrong! Structurally sound and I am indeed ovulating. I had some brilliant follicles and no signs of PCOS at all. The only slight issue was that my lining was quite thin for CD28, but again this is just evidence of my bizarre body so.... meh. So on the one hand it's brilliant news and such a huge relief, but it also puts into mind an awful lot of questions as to why I am failing to conceive. 

The following week I got a letter. I am being referred to an Obstetrician that specialises in pre-conception medical management prior to being sent onwards for IVF. Once again I am left with more questions than answers but I am looking forward to meeting with another specialist and learning more. Of course, I will update when this happens. 

As an aside: I was advised that I need to start tapering off of venlafaxine due to its contraindication in pregnancy. I have not begun this yet as my moods are quite erratic and I don't want to add fuel to the fire. Full disclosure: I am cycle day 39 and an absolute mess. It is well documented that hormones are a catalyst for a range of psychiatric conditions, so even in the absence of the down-regulation and subsequent stimulation aka stimming that IVF provides, I am already struggling. It makes me wonder if I am actually capable of enduring such a massive dose of hormones without slipping into a major depression/psychosis. It's a very scary possibility, which is perhaps why I am being referred to a specialist obstetrician. I don't know. 

Brutal honesty: I am absolutely terrified by the very grim reality that I am at a high risk of perinatal depression and/or psychosis and it does make me wonder if IVF is the right decision. I have considered looking for a surrogate...

Infertility: and so it begins

I finally have an update on our infertility journey! 

We met with a specialist GP last week in Littlehampton to discuss the masses of test results and our options going forward. Going into the appointment I was fully anticipating to be given a prescription for clomiphene or letrozole and told to come back in 6 months, and perhaps be referred for some further investigations to rule out any physical problems. The doctor was wonderful, she was so kind and really tried to involve my partner in the conversation - even though it was very awkward, TMI which he doesn't do well with - and it was of course me asking questions and trying to gain as much information as I possibly could as to why on earth we were sat there at the age of 29! No-one ever expects to have problems conceiving, especially in your late 20s... it's a very strange and frustrating situation to be in and all of the doctors and nurses I have met are so sympathetic to this fact. 

So. Following the discussion that there was no evidence in my blood work to explain the problem; I am indeed ovulating as I should be albeit in a bit of a weird pattern but not enough to warrant clomiphene. At this point my thoughts went to IUI to help things along. Nope. We are going straight to IVF. Yes. At 9am on a Friday morning the IVF bomb was dropped and I honestly didn't know how to react. I'm still processing it to be honest. She also recommended an internal ultrasound and that referral should be coming through quite soon, on top of that I also have to repeat my HIV/Hepatitis serology bloods as these tests are only valid for 3 months. Go figure. My partner also has to be tested too which I'm actually pleased about in a mean sort of way! 

The only 'problem' with our current situation is my being on venlafaxine, which is contraindicated in pregnancy. This isn't something to be taken lightly and it is quite likely the IVF clinic we choose will not accept us until I am off it. Of course, as I've talked about before, coming off venlafaxine is hellish and I'm not at all looking forward to it. I need to discuss it with my GP and possibly a psychiatrist, as I have been very stable and we need to put something in place that is safer to use in the case of possible pregnancy. The trouble with this is I only respond to heavy duty antidepressants, which of course are incredibly risky to an unborn baby so... I don't know at this point what will happen with that but it's certainly given me a push to at least try to get off this demon drug and see how it goes. 

So that's where we're at right now! If everything goes according to plan we could be looking at starting around the end of the year which is really exciting/terrifying/every emotion ever... 

IVF.... really?!?!?!  


Adventures in Psychiatry: When to stop medication?

This is something I have been pondering a lot recently. Despite my decade of experience within this realm, making the decision that I am well enough to come off my anti-depressant has never been clear-cut. Yes, I have had months of stability since cutting my dose of venlafaxine in half - from 150mg to 75mg - so that in itself is a good indication that my brain is doing ok, however coming off venlafaxine takes months and it is akin to alcohol withdrawal in terms of the reaction it evokes. 

The sole reason I haven't approached my GP, who would have no problem in my decision to lower my dose again, is because I have been through the withdrawal from venlafaxine once before and it was hell. Simply put, I'm avoiding putting myself through it again because I have other stuff going on in my life and I can't be out of commission for a month while I'm stuck in bed throwing up, shaking and crying. 

I do want to come off venlafaxine, so much, but timing is a crucial factor. Life needs to be stable and good, I need to be physically strong enough to cope with it and mentally ready for the chaotic emotions that come with the hell of withdrawal. Granted, last time I stopped it cold turkey which was incredibly dumb on my part and definitely attributed to just how much I suffered, so maybe this time will be different but I'm just not sure I'm ready to take that risk just yet. 

There are a few things that have prompted this: I guess the primary one is that with our infertility referral in motion I am very aware that my being on antidepressant medication doesn't bode well for me in terms of what I will be offered compared to if I was medication free. While there is no evidence to suggest that venlafaxine is harmful during pregnancy, that is only because it is incredibly unethical to test which is fair enough. I am also painfully aware that even though mental illness is very common and those that need medication to function are no different to diabetics needing insulin, within certain medical specialties there is still a stigma around this side of medicine and it is entirely possible I will be treated differently and even told not to come back until I am off the venlafaxine. It wouldn't be the first time I've come across comments such as "if you're on antidepressants you're not well enough to be a mother..." and such...

Secondly, I'm pretty fed up with having to take it. It may just be where my thinking is at right now than anything else, but it's a reminder of just how unwell I got 18 months ago and I get stuck in the memories of that absolutely terrifying time in my life and I don't like it at all. I could do with going to therapy to process it more but I'd rather not part with £50 a week on something I just want to forget. I'm aware that's contradictory and makes little logical sense, but this is mental health we're talking about and more often that not there are some cognitive pathways that are in knots and produce this kind of stuff... 

Finally, it would be amazing to go back to university medication free but there is a part of me that does wonder if I should stick with the venlafaxine as a precaution, just to make sure that the chances of depression showing its face again are reduced during what will be one of the hardest academic challenges of my life! I don't know. 

Perhaps I can try to reduce in August and see how it goes. June is full of travel and July has a holiday with my friends - there's something I never thought I'd say! - and I'm hoping that I will be taking my driving test that month too so I certainly want my brain to be on my side. 

It's a tricky one. If I could offer any advice to anyone reading this considering the same thing, please just make sure you're well enough and prepared to go back to your old dose if it doesn't work out too well. 

I have been keeping a secret

Wow, it's been an awfully long time. I feel like I say that every time I write now... The past few months have been positive: I am able to read and write again and I am pushing forward with my recovery as much as I can. Learning to accept and work within my limitations has been the most challenging aspect thus far. On top of that, I am feeling an utterly irrational social anxiety towards blogging and twitter, having been away for so long it's quite a challenge to get back into the realm of the internet world. I have sat for many hours trying to remember why I started this blog in the first place and trying to find that passion and drive to continue. It has not been easy. The internet is saturated with people, and while I think it's amazing that everyone has a space to share their views and be who they are, I can't help but shake the feeling that in a realm of such a vast expanse of information, how is my input going to help anything? But, what I came to realise is that it is each of us, with our own voices coming together that makes the most noise. I was never here for the views, or for the recognition, or anything really... I needed to 'talk' and give my best attempt at supporting the campaign against stigma. 

In terms of my mental health, I am doing much better. I fought as hard as I could against depression and suicidal thoughts between January and March, using every single skill I had learned in hospital and with venlafaxine, propranolol, buspirone and cyclizine to aid the long journey I had infront of me. Every single day I would wake up and want to rip myself apart for taking intermission while all of my friends were entering their final semester. But I also knew that I was in no position to study. I couldn't read. I couldn't write. I was sleeping a ridiculous amount and unable to do the simplest tasks without being utterly exhausted. I made the right decision but I was still furious at my body and my brain. As much as I understood the science, which used to help, it didn't this time. 

Mindfulness. Acceptance. Rest. 

It took what felt like forever. I needed new targets. I decided to bite the bullet and try to get my full driving licence. I started learning when I was 17 and stopped when I was around 21, after several rounds of getting ready for my test. I am now with the AA Driving School and things are going incredibly well. My anxiety around driving is nothing like it used to be and I have all the existing knowledge in the recesses of my brain so all we're really doing is working on my confidence. It's a very liberating experience. We're not rushing me into my test, but I am aiming to have my full driving licence by September. I have my theory test booked for Wednesday and I'm more than a little worried I'm going to fail it, which would be oh so embarrassing. We shall see. 

In other news: this has been something I have kept hidden for 2 and a half years now and it has taken a LOT of thinking to finally come out and say it... I will do a more detailed series on this as time goes on but for now I would like to share that I am going through infertility investigations in preparation for a referral to a fertility specialist, potentially an IVF clinic. I am 28 years old, 29 in August, so time is still on my side but after such a long time with no success it was time to see what the problem was and figure out a solution; be that medication such as clomiphene or attempting IUI or IVF. The current research says that you are at your most 'capable' of conception prior to hitting 35 years old, for a woman that is, so we're not racing against my biological clock by any means but neither of us want to be 'old' parents, and seeing our friends become pregnant and raise their families is quite the kick in the stomach after years of negative pregnancy tests.

For the past 6 weeks I have been having blood tests to monitor my hormone levels and had to bite the bullet and have internal exams done too: for a referral to a fertility specialist on the NHS you need to have your hormones measured at cycle day 3 (Follicle Stimulating Hormone, Luteinising Hormone, Testosterone and Oestradiol) and 21 (Progesterone), then 28, 35, 42 and so on until the next cycle starts. You also need to be tested for Hepatitis B and C, HIV and Rubella and also have an up-to-date smear test and have swabs taken for chlamydia and gonorrhea. You also have to be a healthy BMI, never been pregnant or have any children from another relationship. Your partner will have to have a semen analysis done too. Once all that is completed your GP can send off the referral!

Throughout my entire life  my blood results have very rarely revealed a problem and I was almost certain they would come back normal, so imagine my shock when I was told that we actually found something that could give us a clue as to what was going on! My progesterone levels were very low which indicates that the problem may be with ovulation. We're not sure yet but at least we have something to work with, which is more than we have ever had before!

So, there's that. We're now waiting for the referral to go through and see what happens next. I feel very lucky to be working with the same GP who cared for me during some of the darkest times in my life. It's pretty awkward to sit in front of a male doctor and discuss your sex life, periods and all that jazz so removing at least some of that barrier is a real blessing. I wasn't at all surprised that we are having these problems, my body has proven time and time again it needs help with all sorts of things, but it's still very challenging to deal with and I just hope that all this work will be worth it in the end. 

The University Diaries : The Hardest Decision

It's been a while, hasn't it. I don't really know where to start but to cut a long story short, my degree took over my life and that's why I haven't been writing. I have such admiration for people who can keep up with their degree and still find the energy/brain-power/motivation to write in their blog too. I just couldn't do it.

So. I made it into my final year, somehow. My grades were shit and I was dragging myself through purely because I didn't want to fail. Not so much in an academic sense, but by letting my depression/anxiety and chronic fatigue affect me. I know that's absurd because it's not something you can really control at all; if it's going to flare up, it's going to happen and that's why we have drug treatments. At a low level, yes you can keep plodding on and using your mindfulness/CBT/whatever therapy and that's what I have been doing for about 9 months. 

I don't think I will ever be able to explain just how much of a challenge it is to go to university when you have mental health and/or physical health problems. You're already been challenged so much to function on a basic level that the extreme stress a degree puts on you is like putting a propane tank next to an open flame. At some point, shit could get really bad really fast and that's exactly what has happened. 

Now, I love my university and I am so thankful to them for their understanding and patience and bending over backwards to help me when exam time rolls around. I don't do well with them. I can revise and revise and revise and practice and revise some more, but put me in an exam room and my brain will projectile vomit everything I have ever read all at once in an incoherent mess and there is nothing left to use to answer what is being asked. So, we tried take-away papers and essays which worked beautifully.

The exam period that has just gone by was different. I had 2 modules from third year plus a module I failed in second year to do. This was following lectures and an inhuman amount of work on my dissertation. I was mentally spent. I think people forget that health conditions of any variety have an impact on your cognition. My request for alternative modes of assessment was accepted, and following a series on confusing emails my arrangements were sent: TEN THOUSAND WORDS IN FOUR WEEKS, plus 1,500 for a piece of coursework. 

I did it. I don't know how, but I did it. However, on 21st January I ended up being 6 minutes late to submit around 7000 words of the 11,500 total, thanks to Southern Rail and their oh so reliable service. On that specific day, I was not in the financial position to give a taxi driver £50+ to speed his way to campus, and even then at that time of day there is nothing to say that I wouldn't have gotten caught in traffic from people picking their kids up from school. I was stuck and frantically calling and emailing everyone in the university I could think of. If I wasn't there by 4pm, tough shit. 

So. Following a lot of ranting and exhausted tears, I had a decision to make. The initial thought was that resitting the missed deadlines and graduation in the winter with a 2:2 was the only real option, which devastated me even more than the fact that all that work was flat out rejected, and I still had more to do. I was beyond exhausted and couldn't think, so I went to bed and slept. And slept. And slept. When I woke up, my first thought was: "I can't do this anymore", which I have experienced before but the context and end result was quite different! For months I had been feeling my depression getting worse and was in so much pain and exhaustion I was already reduced to writing my essays in bed because I couldn't sit up anymore. This isn't what I wanted my degree to be about: working myself into a non-functional mess. Nothing is worth compromising your health, especially when you have worked for years and years to get you to this point. 

I had to withdraw. I went back and forth for days, trying to convince myself that I could do this final semester and I'd make a 2:2 work for me. Haha, nope. I would much rather graduate with a smile on my face and the ability to function than keel over at the finish line and spend the next year or so of my life trying to put myself back together again. 

Maybe this is a blessing in disguise, I don't know. My request for temporary leave went to my school yesterday. I'm still going back and forth beating myself up over this, but my instinct has never steered me wrong and this just felt like it was the right choice. Time will tell I guess. Hopefully they will let me come back in September so I can have another run at a 2:1 and actually be able to do it! 

For now, all I want is sleep. 
Samantha Nicholls. Powered by Blogger.


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