Old Mother Hubbard

went to the cupboard

and discovered she owned dessicated gonads.

My antenna waved Danger! as soon as I heard the tone of the nurse’s voice down the phone: even over the bustle of the RSC foyer and Harry’s grief-stricken howls (we had just discovered you need to book a timed ticket to go up the tower, and he had been Promised An Immediate Ascent) I could clearly hear that she was projecting enough Cheerful for two; I swiftly deduced that she anticipated I was about to be in deficit. 

(AMH testing is Clever-Shiny-New fertility science, and they’ve recently changed methodology to a 2nd generation assay giving values 40% higher than previously. Keep Calm and multiply by 1.4 if your previous happy AMH level suddenly looks wide of the goal posts.)

Ovarian Fertility Potential                pmol/L  (Not ng/ml, which’d be helluva lot lower.)
High Level                                            > 67.9 
Optimal Fertility                                    40.04 – 67.9       
Satisfactory Fertility                             21.98 – 40.03              
Low Fertility                                          3.08 – 21.97          
Very Low / Undetectable                    0.0 – 3.07       

I scraped a 20. Distinctly and saddeningly sub-optimal, but not quite fully disintegrated into oocytical dust in the coffins of my ovaries, either.

I… wasn’t expecting bad news. Alive to the possibility, yes, but my Autumn 2009 FSH & E2 were – I quote my Consultant – ‘beautiful’, and I felt reassured. Once I’d got my head around the difference between US & UK lab units of measurement, that is. John had been blithely complacent (the man is a congenital optimist, even appertaining to my haphazard reproductive abilities) that I had the ovaries of a nubile teenager, and has had to mentally regroup accordingly.

Ah, well. It’s been a while since I felt really slugged in the stomach. They do say a change is as good as a rest.

Of course, my previous poor response to gonadotrophins now looks completely divorced from the possibility of a still-stunned pituitary after a shitty downreg, and simply looks like common-or-garden Rapidly Emptying Ovaries instead. And the shortened cycle I was crowing over last night might credibly be the dark horseman of the Menopause galloping towards me, waving his scythe, with hot flushes spilling from his saddlebags.

Damn it.

My Consultant has altered my protocol still further on receipt of this glad news and has now prescribed me Gonal F instead of Menopur: I’m not sure why & absolutely can’t be arsed to Google it; the woman knows her business. 300iu for 10 days pro tem, and we’ll see what we get. Another day older and deeper in debt. Sources of Gonal F are, naturellement, more circumscribed than Menopur, although I have managed, after a few phone calls involving Far Too Many Fucking Zeros to get a quote that just squeaks in at under £700, so the cost differential isn’t as Implicationy as I first thought it might be.

If nothing else, this news has made me feel a little more exculpated for already having chosen IVF over IUI – and exonerated altogether for wanting medical reproductive input this time around. 

I know it only takes one egg, but we’ve got to find the bugger first.

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Curiouser and Curiouser

I’m getting good at this whole dark-art-menstrual-cycle-prediction thing. With nary a clue, apart from my heart spending 24 hours trying to explode out of my chest like a startled pheasant, I correctly diagnosed ovulation – or, at least, an event involving a strong LH surge. 13 days later, when John peered into the saucepan I was cursing loudly over and pulled a face – ‘It’s a funny-looking texture!’ – and I burst into outraged and mortified tears, I managed to surmise without a great deal of difficulty that my uteri would very shortly be closing for renovations. 

A scientist I am not, but overly analytical I certainly am, and it’s exasperating me mightily that not one, but a confusing two variables have altered this month, in the ongoing crapshoot that is the workings of my reproductive system, and I don’t know which one to credit for improvements. Firstly, I have been taking low-dose aspirin since my last period, and secondly, I started Loestrin combined contraceptive pill on the first day of this period.

Either the co-incidences are piling up, or the low-dose aspirin must step forward for a bow. Fact number 1: my cycle came in at a magnificent 5-and-a-little-bit weeks, which is my shortest natural cycle… ever, I think. Why, how, or even if, aspirin c/should shorten my tediously protracted follicular phase, I really don’t know. *intrinsically Jewish gesture denoting nonplussedness*

My right, Harry-housing uterus, only ever seems to shed road tar, not endometrial lining. The adenomyosis pain that leads me to regularly chew on the furniture is unvaryingly very left-uterus centred these days, with only an occasional bout of snarling from over on the right. Not so this time. Fact number 2: right uterus has done 90% of The Hurting this period. And, for all I know, (I was bleeding far too copiously to even think of attempting to find out) 90% of the bleeding, too. I conclude that the lovely Problem-Uterus May was correct, and that the aspirin has tickled things up in my right uterus no end.

My periods have, the last 18 months or so, become progressively more painful, and rather less heavy. Fact number 3: this period was a proper, days-of-yore, when-I-was-a-lad, don’t-make-’em-like-they-used-to, retrospective, authentic, like-Granny-used-to-make tsunami – characterised by remarkably little pain. Now, allow me to assure you that there was still pain. (So stop that there sympathy of yours in the act of convoying straight out of my blog! *waves clenched fists* Back! Come BACK! *dancing on spot* I’M STILL SPEYSHUL!) It’s just that there wasn’t bloody agony this time, which I’d virtually come to look upon as par for my course(s).

Now, either the aspirin achieved a hat trick for me with most mysterious pain-reshaping and management – or the pill has worked its Old Black Magic in jig time. Because my uteri like the pill. They behave on the pill. I wangled myself onto it at an early age, as my pubescent periods were essentially in danger of flooding the nearest river delta and sending me to an anaemic early tomb (don’t, for the love o’God, start me off on the subject of 1980s sanitary towels. I’m told I start to produce too much spittle.), and stayed on it for 15 years, give or take. It didn’t eliminate period pain, but it consistently delivered (primarily right-sided) low-mid-range pain, entirely treatable with over-the-counter analgesics, of just the type I have just re-experienced. 

Spooky.

Anyway, none of it matters a damn just at present: I started the pill a few days ago and will continue it for 3 weeks. Following a very productive session with the senior nurse last week (appointment was on my 36th birthday, which was a birrova pain, but standard array of bloods taken from both of us, standard swabs taken from me, all consents signed, prescriptions issued), I have a baseline scan booked for the 21st March. Provided neither of us is discovered to have inadvertently collected an STD or one of the Heps lately, then we’re good to go that day. Any lingering hopes I may have had of proving at baseline that my right uterus is a malevolent, clutching, retentive harbourer of substandard lining have now been kicked into touch A) by the Period Massive and B) the fact that I have remembered that the pill buggers about with your lining thicknesses anyway.

In the meantime, to keep me occupied, I have to buy my drugs. Yippee. I have a prescription for everything except the gonadotrophins, which our nurse sensibly said she would issue once they know my AMH result – which, come to think of it, I should really ring them up about tomorrow; it’s been a week. If it is nice and high, I needn’t take out an actual mortgage buying my stims; if it is low, then there will be wailing and gnashing of teeth in the outer darkness of my credit card, etc.

Either way, the New Age of Austerity is biting at Hairy Towers: money is tight, and so, sadly (and ubiquitously), are my waistlines. And one of my bi-annual episodes of reduced co-parenting approaches: John, after a couple of months of comparative agricultural down-time, is due a sharp increase in farming activity: the lambing is about to start in spades.

As it has for us before, lambing will cause a problem if this cycle is successful: ewes carry toxoplasmosis (as do cats, which is why litter trays are a no-no in pregnancy) and I have zilch antibodies. Nary a one. I have handled enough sheep to have justifiably and fairly caught it by now – but no. John has never been tested, but irrespective: his work clothes will have to stay at the farm, his hands, already raw from the washing after constant immersion in amniotic fluid will have to be scrubbed, and the dogs will have to be rather better supervised in re: consumption of afterbirths. Yuk, I know. I’m not sure how we’d either restrain Harry (who has unsurprisingly decided that his life’s desire is to bottle-feed baby lambs) or hose him down sufficiently for peace of mind, but… well.

 
“We cross our bridges when we come to them and burn them behind us, with nothing to show for our progress except a memory of the smell of smoke, and a presumption that once our eyes watered.”
Tom Stoppard, Rosencrantz & Guildenstern are Dead

On Disappointment

Yesterday’s disappointment, which rendered me mute with chagrin, has subsided to a level where I can actually bring myself to discuss it. Such a first-world set of afflictions I struggle against in my rural idyll: the be-all and end-all of my anguish is that I did not manage to gain entry to a costume sale.

RSC Costume Sale

I am lucky enough to live on the doorstep of the world-renowned Royal Shakespeare Company‘s home at Stratford Upon Avon. From time to time they have a sell-off of assorted costumes and props, and I have, somehow, missed notification of all of the previous ones. This one, I actually saw advertised, and wrote on the calendar in large letters: RSC Rehearsal Rooms: Open to the Public from 10am until 5pm.

The blurb was enticing. Around 10,000 items including Egyptian head-dresses, a variety of military uniforms, cloaks, clerical outfits – including nuns and priests, jewellery and chain-mail. The items cover a wide range of periods, including retro, vintage, Early English, Elizabethan and twentieth century. Overall, prices will probably range from 20p up to £150. Amongst the items for sales are soldiers’ tabards and chain-mail from the 1984 production of Henry V (with Kenneth Branagh) and later seen in Mel Gibson’s film Braveheart, a light blue 18th century waistcoat worn by Charles Dance in As You Like It, a wine velvet regency cutaway coat worn by Ben Kingsley, a selection of shirts worn by Ian McKellen in The Seagull and his over-robe from King Lear and numerous items worn by David Tennant (including his understudy costume from the 2008 production of Love’s Labour’s Lost).

I wasn’t after a costume: I was after a prop of some description; I have a bare chimney breast, an upcoming birthday and a husband with no gift ideas, and a liking for the odd bit of Quirk. I amused myself for weeks beforehand imagining what I might carry off, tucked gleefully under my arm.

Kenneth Branagh’s chainmail?

Harriet Walter’s head…bird…beak…thing

David Tennant’s underpants hat? Yorick?!

I was (customarily) later than I had intended when I dropped Harry (tired and fractious from the over-excitement of his first ever sleepover, at John’s mother’s. It was successful, if you define a 9pm – 6.30am solid sleep as successful – we do around here – and he is Allowed Back :-).) at my mother’s house, and carolled urgently that ‘I must go, or all the good skulls will be taken!’

I drove past the Rehearsal Rooms at 10.20am, and encountered the head of a queue that was not, alas, a dagger of the mind or a false creation, but an object of Great Wall of China-type proportions.  The national media, who also, I later discovered, had been the pre-sale trumpeting cause of my ruin, reported that the first queuer turned up at midnight, the second at 4.30am. By the time I strolled up: the queue was in the order of 1000 and there were ‘sharp elbows’ being deployed inside; by 11.30am the racks were looking decidedly depleted.

I muttered to myself, went away into town, and consoled myself a tiny fraction with a little retail therapy. I had a particularly and gratifyingly successful haul in Oxfam’s swish second-hand bookshop in Sheep Street: £11 for this corruscating little lot. The Byatt hardback is a thing of beauty, and I cackled in triumph when I saw the £2.99 price tag.

My To-Read bedside pile is beginning to bear a striking resemblance to the Old Man of Hoy of late.

Anyhoo, I… went back home, collared John, wailed, went back into town, showed John the queue (it was now noon), John laughed, I half-hearted joined the queue and despatched John to buy a much-needed and long overdue toilet seat (the tiny crack on the cheapy plastic one in our ensuite which opens up a little when a bottom is placed upon it, and closes up quickly when said bottom is removed, retaining a pinched piece of said bottom… well, it’s been like it for 3 weeks, and I was beginning to have a Pavlovian response in the order of a distinct pre-emptive tendency to sit with a pronounced list on other toilet seats and… yes. We really needed a new one, was all.), listened to three songs on my iPod, thoroughly enjoyed eyeing my fellow queuers, many of whom were sartorially flamboyant (it was a theatre costume sale, after all), eventually capitulated to mouthings of Talkative Lady behind me and removed my earphones, which was a Good Thing, because it meant I heard the pitying RSC member of staff when she walked down the queue telling us there wasn’t a hope in hell of getting in before 5pm (interesting example of Good Old British Suspicion: I was the only one who walked away), walked up the road and along the queue – which took a while – to where John had completed his vital purchase, and sat in a coffee shop and moaned at him about it for 45 minutes.

In a moving display of profound character depth, I was just beginning to master my peevish annoyance and recognise the fact that A) it was a beautiful sunny day and B) my life doesn’t really have a fat lot wrong with it, when we encountered the local Hunt on the way to collect Harry.

To answer the inevitable question, as I realise hunting has become a highly emotive topic over the years: I am, both countryside-culturally and, much more importantly, rationally, in favour of hunting; I took part – my first and only march, I suspect – in what was, at the time, Britain’s biggest-ever civil liberties protest concerning the proposed ban.

It is the bad luck of some species to be placed in the unhappy role of vermin. Foxes – who predate our fluffy baby lambs like anything, not to mention my poor hens – are controlled on our land (rather a royal ‘we’ there: it ain’t none of it mine), as are rabbits, rats, pigeons and deer. I do think that hunting is the most humane method of controlling the fox population, given that it’s usually a few minutes from start to very abrupt finish. Shooting is only fine providing you can get close enough to kill with your first shot, because, believe me, nothing makes you feel sicker than trying your best to kill an animal (whether a healthy predator or diseased livestock) cleanly and swiftly – and failing. Trapping involves prolonged stress and thirst. There are no legal gasses. I have to state: I’m not the world’s biggest fan of terrier-work when a wounded or diseased fox goes to ground, but providing the hounds are out of earshot of the fox and the job is done rapidly by someone who knows his business, I feel the stress levels of the animal are minimal – and a likely improvement on the protracted pain, thirst, sepsis, infection, starvation and hypothermia that kind Mother Nature usually doles out for ‘natural’ death. 

Have I horrified you? I’m sincerely sorry if I have. I have no quarrel with those, whether they be rural- or urban-types, who find vermin control and animal death an uncomfortable topic; I have consistently avoided visiting the abattoir that our lambs travel directly to from their field (the ones the fox doesn’t eat, that is), despite being an enthusiastic consumer of them when they come home; I tend to instinctively brake for fluffy bunnies – much to John’s professional horror, although I have shot them on occasion, too, which ought to reassure him. 

I’ve become… segued.  

To resume: we bunged Harry in the car with the promise of ‘Horsies!’ and began to quarter the countryside looking for the small and now-disappeared Hunt around the local lanes. The current state of the tattered law regarding the ban on hunting with hounds, and what does or does not constitute illegality, confuses me. We saw nary a single fox, in any case; we were, for the most part, stood watching from my car door-sills some fields away from the pack. Harry conked out and snored almost immediately, but John and I had a very pleasurable hour or so enjoying the sight of the unspeakable in non-pursuit of the uneatable under a sunny January sky. We only came home, in fact, because the rugby was on TV.

I seem to have put an absolute shedload of photos in this post. Here are another two: this

is what my dresser looks like. With the fresh insight that will have given you into my squirrelling and untidy nature, it will likely come as no surprise to you that this:

is what I found in it last week. I had not, in fact, thrown my IVF drugs away, as I said I had. I fully intended to. But no. Here they all are! £400-odd of menopur, and every last vial of it expiring either Jan or April 2008.

Galling, because we are, it seems, having a pop at this IVF business again. We are also, naturally, obliged to attend for yet another nurse information session, although we are excused with merely a ‘refresher’. My period is due in about 6 days, so the chances of getting sorted for then are almost zero, but I am going to give it the old college try in the morning.

*checks time*

Later this morning. Cheerio, peeps.

Anaemia of the Exchequer

We’ve been considering this whole IVF thing.

The clinic charges £2500, inclusive of scans, sedation & freezing, exclusive of drugs.

The HFEA charge £105 for… existing. And, yes, probably some other useful regulatory stuff that I can’t be faffed to think about just at present.

Fair enough, I thought.

And then, this evening, I looked up how much the drugs are. Dear, sweet, grinning protestant God.

Treatment scheduling: Contraceptive pill. Pennies! And GP-prescribed in any case. No worries there.

Stims: A 75ui vial of Menopur is nearly £20 a pop, and I will require at least 2 a day. I eventually upped to 3 on both IVF cycles, and stimmed for… 13 days? Longer? I can’t remember, but I know they had to keep sending me back to the pharmacy with prescriptions for MOARDRUGSLOTSMOARDRUGS. And, I threw vials and vials of Menopur away a couple of years ago when it date-expired. Why the buggery hell did I not offer it to someone else?

Disabling Pituitary: I require 0.25mg of Cetrolrelix a day, from the 5th day of stimulation until trigger day. £30 a shot. Yowsa. (Conventional downregulation, as far as I can make out, 

is £30 per cycle.)

hCG: Pregnyl is £4.00, and I reckon I can afford that, no bother, although the memory of the dose I kept in the fridge until it, like the menopur, drifted past its expiry, is irksome.

Luteal Phase Support: Cyclogest 400mg x 2/day. 84p per individual lard torpedo. £1.68p/day is a mere spit in the tarn, but I shall nevertheless be rootling through the cupboards to find the box I know still exists somewhere. It had better be in bloody date, because if I have hoarded it all this time for nothing, then I shall be cross.

So:

Pill: neglible.

Stims: let us be hopeful and say 40 vials will suffice: £756

Cetrotide: for, say, 10 days, as running out would be unfortunate: £300

hCG: £4.50

Cyclogest: £11.76/week for… what… 12 weeks? If successful? 2 weeks if not? £23.52 or £141.12

756+300+4.50+23.52=£1084. Plus the aforementioned £2605 = £3689. Call it £3,700 with postage.

And then, of course, there is the heparin (and the aspirin, natch), but the NHS will thankfully pick up the tab for that if necessary, given that I would be requiring its assistance in keeping a whole other person alive at that point.

If I require any other drugs that I have failed to account for, please hint at it very gently indeed, because I am reeling in horror, and asking myself just how scared I am of that uterus.

£3,700 worth of scared?

That’s an awful fat lot of scared.

I Did Not See This Coming

We were criminally misled. There was no ‘So! You’ve Finally Discovered Your Bits Are Broken!’ video. My disappointment was acute. All there was, was a dozen couples escorted in a subdued troop to the seminar room upstairs, and shown a 5 minute powerpoint presentation detailing, word for word, the first two pages of the IUI info booklet we’d just been given.  The other couples were so big-eyed and attentive in humbling contrast to my wandering, jaundiced stare. 

After we were herded en masse back down to reception to await our individual nurse information sessions, I surveyed our fellow IUI runners and riders. Their average age – unsurprisingly, as IUI is generally the first port of treatment call – was rather younger than I normally see in this clinic waiting room: early thirties, or a little less. We were the last couple called, so I counted them all out, and I counted them all back in (RIP Brian, btw). I observed their responses to the nurses’ call: flurries of recalcitrant, half-completed paperwork (Reams of it we were given. Reams.) and urgently instructed legs (what IS it about the British Waiting Room that we must virtually run, simply because someone is standing in a doorway with a clipboard, politely calling our name?) on their way to their clinic session; emerging once more, self-consciously clutching, or nonchalantly swinging, their injection and sharps kitbag, moving towards the exit with a noticeably more purposeful look to their stride.

I remember my first departure from that building, with my injection kit tucked satisfactorily under my arm. Early 2005, I suppose it would have been. I can’t swear to the date, even to the nearest season, but the sensation of a bright sun on my face (Metaphorically? Literally? I cannae remember!) is strong: progress, I certainly felt, was finally being made.

Good manners, coupled to a respect for the beginning of their individual journeys, along with a fair dollop of self-ridicule, all rather dictated against permitting my self-constructed image of Jaded Veteran to become fully formed, let alone become flesh: I sternly guarded against Seasoned Sophisticate as my body language of choice, although my inner Patronising Elder Stateswoman was admittedly attempting to smoke a Gitane. Through a holder. 

In this Tatooine Cantina of hope & despair, I felt a world-weary Han Solo to their fresh-faced Luke Skywalker.  I deserved a smart smack of surprise around the chops, I really did. Fortuitous, because I totally copped one.

Our nurse was a delightful lady, who, speaking of deserving, did not deserve me for a patient that morning. Her opening remark was ‘Do you have any questions?’

I suppressed my rejoinder – ‘No, but you will have, shortly!’ – and proceeded to discuss drug regimens, and quite how pointless both their Plan A and Plan B would become in the face of my stubbornly non-conformist gonads. 50mg of Clomid and 75iu of Menopur was, I assured her, although not quite in these words, about as much likely use as pissing in the river. She ferretted through my brick-thick notes industriously, noting my previous glories and (subsequent) failures. Then we got onto the past performance of the Harry Ute of Doom, although I kept it factual and didn’t linger on the topic, and then onto the whole heart palpitations thing – although that was purely because I wandered off IUI topic whilst discussing which drugs suit me (none of them) and which ones make me a sweating, screaming harpy (all of them).

‘I think I’d best go and see Dr. Kind and Beautiful Lady Consultant’ she said, finally.

‘Ok!’ I chirruped, having maintained an attitude of such cheeriness throughout the session that you could be forgiven for thinking I had a hockey stick secreted somewhere jolly about my person. ‘I sent her an email a few days ago about something not directly related to treatment, but I doubt she’s seen it yet.’

She went. She was a while. She came back. She took a deep breath.

Dr. Kind and Beautiful Lady Consultant had recommended, first of all, that I have an AMH blood test. This would be an extra £77 on top of the £650 for IUI, but I have no objection to any test she thinks worthwhile. I was a trifle puzzled why ovarian reserve had suddenly popped out of the woodwork this morning, when I saw her in clinic a bare few weeks ago, but didn’t have the opportunity to analyse the issue, as the nurse was continuing to talk.

‘Dr. Kind and Beautiful Lady Consultant’s just gone into clinic, or she’d have come down to see you for a chat. She says she’s sorry she can’t (reply to?/deal with?) your email, she’s getting hundreds a day at the moment. But she told me that she really thinks you’d be better off doing IVF, so we can replace the embryo in a specific uterus. And although you said that downregulating makes your arrhythmia a lot worse, she said we should use a different protocol using the combined pill and antagonists, so you wouldn’t have to go through a long downregulation at all. And Dr K&BLC recommends you make an appointment with Counsellor X.’

She stopped for a bit here, probably because she noticed she was confronting a pair of saggy-open jaws. I stuttered for a bit, looked at John, stuttered some more, and eventually found first verbal gear long enough to express that this WAS the counselled Me, and they should have seen the emails I was writing before therapy. And that we were going to have to go away (Again. God Al-fucking-mighty.) and chew on the whole IVF thing. And… was this advice being given to us simply on the basis of my distrust of my right uterus? Nod.

We looked at each other and I pulled my favourite ‘Well, Bugger Me Sideways!’ face. I know John doesn’t fancy IVF; Christ, he wasn’t even fancying IUI much. I asked for the needles kit anyway, on the basis that whatever we do from here on out, we’d require it, and I have an amended IUI prescription sheet with more elephantine quantities of everything on it.  We are to ring when we have decided what treat treatment we want to select off their menu.

I’m being offered a chance of using my ‘Good’ uterus – just at the point where I’d come to terms with using the ‘Bad’ one. I’m being offered a protocol I didn’t know about, aimed at low responders, and, co-incidentally, also at those whose cardiac knickers get in a twist about prolonged pituitary suppression; that’d be… me, then, really. It seems a damn good offer – providing you overlook the slight matter of the gaping wound it would deal to the Hairy exchequer, the fact that I said I’d never do IVF again, the fact that it’s a far more invasive intervention than either of us envisaged (or require?), and the fact that I could be spending thousands of (possibly gratuitous) pounds, simply because of a gut fear; a feeling that might be completely and utterly wrong. 

I shall need to do more than eschew all hokey religions and ancient weapons in favour of a good blaster at my side to work this one out.

And I wish the bloody goal posts’d stop moving.

I Have Been Googling Melanie Klein

I had a superb session with my long-standing infertility counsellor last week, walking away from our discussion feeling a growing conviction that, if I ruled the world, I would doubtless take a sauce-for-the-gander approach, and advocate Psychotherapy For All!  My stress load has lifted, quite significantly. (You may, in fact, cheer a tiny hurrah! for little victories! along with me if you like.) 

At the centre of our discussion was my fear and outright anger that I had been unrelentingly manoeuvred by mulish ovarian circumstance into agreeing to utilise the uterus that, I considered, had fired bullets that Harry failed to altogether dodge. And there was my lovely other uterus, sat so near and yet so bloody far – shackled to an ovary that barely registers one biological notch above vegetable. The Harry-Uterus-of-Gunky-Unpleasantness, of course, is connected to a sprightlier, more animate gonad.

(IVF, which alone can resolve the complicated logistics regarding reproductive geography, is not a option we are currently considering because 1. my Consultants like the Harry uterus (that was my tearing hair you just heard), 2. downregulation provoked my cardiac arrhythmia to begin with, and I am highly nervous about what another application of hormonal starvation would do to the poor organ, 3. I reponded inversely to downregulation (20mm follicle) and stimulation (zippetyzilch) on both my previous IVFs, and 4. it costs helluva lot of money that although, yes, we have, neither of us is convinced we should spend at this stage. We are, after all, planning to effectively incapacitate myself for Proper Paying Fulltime Work for several more years if this is successful.)

Anyhoo, I was gently invited to consider that my feelings of wistful frustration concerning my foiled but desperate wish to use my left-hand, non-Harry-housed, ‘better’ uterus, may be originating as an inverse result of the horrors of my precarious pregnancy and Harry’s premature birth. I have, it seems, decided that my right-hand Harry-uterus, with its endometrium of pure tar, should be labelled ‘Black, Black Death’. Might I, it was suggested, have applied a ‘White’ label to my left-hand uterus in response to this?

Why, yes. Yes, I think I absolutely bloody have.

There was more analysis of the topic, which would be excessively tedious for you, but suffice to say that I currently feel a good deal more benevolent towards my innards than I have for some years. Having thus reduced the situation to a rather simpler scenario of Practical Fear Management for Dummies, I was encouraged to email my Consultant – which I would likely not have done without urging, as I have to overcome my initial diffidence about tabling Stress as a legitimate medical concern when it’s mine. I view other people’s stress as a major holistic player, but my willingness to paddle my own emotional canoe over rough rapids can be ridiculously pronounced.

Anyway, I’ve just emailed. Here it is, and I am, as thay say, awaiting a response with interest.

Dear Dr. Very Kind and Beautiful Lady Consultant X,

 Thank you for seeing John and I at X Private Hospital before Christmas and discussing the ways forward following my laparoscopy and hysteroscopy. We are looking forward to our forthcoming IUI cycle and I’m sure we will see you in clinic; but before we embark upon treatment, I wonder if I might outline a difficulty I am now confronting that your obstetric colleagues may be able to assist me with.  

 I have been experiencing some acute anxiety, not concerning the treatment cycle or the result of it, but about the possibility that a pregnancy might go on to replicate the difficulties that I encountered with my son Harry (whom we expect will receive a formal diagnosis of ataxic cerebral palsy). My antenatal care was given by X Local Hospital and community, and from around the start of the second trimester, I repeatedly relayed to my midwife that I could hear, on an oft-daily basis, skipped heartbeats and acute decelerations on my home Doppler. I was, frustratingly, quite unable to convince her that I was using the device correctly; she naturally assumed I was unusually anxiety-prone on account of my previous infertility and miscarriages – quite rightly, of course – but I was, as it happens, hearing my son undergo frequent episodes of foetal distress. It was not until the beginning of my third trimester that Harry’s heart decelerations were eventually picked up by CTG whilst I was inpatient at X overnight following a bleed (I had regular bleeding episodes of undetermined origin), and my Consultant was alerted to the issue at some speed. 

The feeling that I was unable to enlist any support in my concerns for my child for a large sector of my 33 week pregnancy, despite being categorised from the very beginning as high-risk and receiving consultant-led antenatal care, is one that I have subsequently found very difficult to put behind me. I fully appreciate that there are no straightforward solutions to a <24 week pregnancy that is not proceeding particularly well, and that ultrasound monitoring (which I did receive quite regularly, albeit by a bemused radiographer, who was just as unsure as we were quite what markers she should be looking for) may be all that can be practically offered – but I nevertheless feel that my pregnancy (or, certainly, my stress) could have been rather more actively managed. I am very pleased to be now taking low-dose aspirin, with heparin standing ready, and I am naturally hoping very much that (should our upcoming IUI treatment be successful, and I progress as far as a second trimester) I will not re-experience the spectres of foetal distress, IUGR, premature birth and particularly the horror that is NICU, but I find myself, in light of my uterus didelphys and broadly unhappy reproductive history, unable to be optimistic on the topic; consequently, I am now considering how best to manage my fear. I am, sadly, not the type of person to find that ignorance is bliss, nor take much comfort in considering the evil sufficient to the day thereof!

As a result, I think I would find it reassuring to discuss with the high-risk obstetrics team at Big Regional Hospital X how they might conceivably anticipate approaching my care management should I happily be in a position to be referred onwards to them this Spring, and, should history unfortunately repeat itself in the middle and later stages of pregnancy, what, if anything, they might possibly manage less conservatively this time around. I realise that there are no definitive answers or categorical reassurances to be given, and expect none. However, being at ease with my position of A) poor odds and B) helplessness regarding the influence of a positive pregnancy outcome, requires a level of cognitive fatalism I unequivocally do not possess. I hope that acquiring a better understanding of what investigations and measures could possibly support a precarious pregnancy will reduce my anxiety in the face of it, and enable me to commence our IUI cycle in a little less conflict of mind than I am in at present. I am happy to have a private referral if necessary, and I sincerely hope that my worries prove to be thoroughly misplaced.

What a lengthy explanation! And I’m so sorry to trespass on your time yet further, but this last item is a quick one – I have spoken to Secretary X earlier today regarding my very great curiosity regarding the photos taken during my laparoscopy, and I think she is intending to speak to you regarding their whereabouts; if they are readily accessible in my notes, I would (I think?!) be highly delighted with them! 

We are in clinic for our nurse information session 9am this Thursday 3rd; I have also listed full contact details below.

Thank you very much indeed for your time!

Kind regards

Mrs. Hairy Farmer

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