Tag Archives: In vitro fertilisation

12 hours to go…

… says my pregnancy countdown as I’m writing this. My due date is tomorrow and we have decided to go with medical advice and accept induction at 40 weeks. Two days ago I went in for a second membrane sweep, but although it had been 12 days since the last attempt, there was no progress at all. It was impossible to do a sweep on me. My cervix is still tightly closed and the baby is not engaging at all. The doctor said they would have expected to see at least some development at this point, but since there is none it’s very unlikely to make any difference to postpone induction a few days or even their usual policy of 10 days past the due date for low risk (and non-IVF) pregnancies.

Basically there are strong indicators that I will need induction no matter what. So if there is only a very slim chance of any benefits to waiting, why take the risk and the worry. Especially since they do not actually investigate how well the placenta is working at this point. With this we feel at peace with the decision and in acceptance of intervention once again. Whatever it takes, whatever happens – it will all be worth it!!

In thinking about this over the last two weeks, I have come to realise that I’m not attached to any particular idea of a natural and idealised birth experience. I only care about the end result of holding a healthy baby in my arms, while of course hoping that the process to get to that point will go as smoothly as possible and involve as little distress as possible for both me and baby. But I would never even consider giving birth anywhere else than in a hospital and I trust the professionals there to deliver my baby safely by whatever means necessary. ‘Mother nature’ is also cruel and cannot necessarily be trusted. The millions of women and babies who have died and still die in childbirth in places and times with no access to medical help, is testament to that.

Personally all those years of infertility has taught me not to celebrate or have blind faith in ‘the natural way’ or be attached to any idea of ‘mother nature’ as a superior force. Of course I wish I could have gotten pregnant easily and naturally by making love to my husband rather than by way of doctors and IVF procedures in a hospital, but the reality turned out to be what it was. I no longer mourn that fact. It is what it is and my gratitude to modern medical science, and the intervention that got me pregnant, is limitless. The miracle of life is as amazing under these circumstances as in any other. Maybe even more so.

Tonight at 9pm I will be admitted to hospital to begin the induction process and I will stay there until the baby is out one way or another. It will be prostaglandin gel to start off with and probably a second dose later if nothing happens. Later again they might break the waters and eventually if labour is still not progressing they might put me on a syntocinon drip. They told me there is a risk that induction will fail and in that case a c-section will be considered. Thus prepared, we hope for the best while accepting to take each step as it comes and deal with whatever happens. In the end of the day no labour and birth is guaranteed to go smoothly. Anything can happen to any of us in that situation. Natural low risk labour can end up involving serious complications and drug-induced high risk labour can work out just fine. As with life in general you just never know what you’re gonna get!

IVF and early induction at 40 weeks?

Yesterday I went to the hospital for the first membrane sweep. It failed. The consultant couldn’t reach my cervix, which is still long, closed and posterior. The baby also has not fully engaged. So all in all, the conclusion is that labour looks likely to be far off. The conditions are unfavourable as the consultant put it. At 38 weeks this is not really that surprising, but it does bring the prospect of medical induction to the forefront since the general practice at the hospital is to induce IVF pregnancies early at 40 weeks, i.e. on my due date the 17th August. They will attempt a sweep again on the 14th which is just 3 days before my due date, but with the way things are looking I have my doubts whether there is any chance that it will help trigger labour naturally. Consequently I’m also starting to doubt the planned medical induction at 40 weeks. This I wonder might pose greater risks than allowing the baby to go overdue. Especially if the next sweep attempt reveal that conditions are still unfavourable.

So I have been google searching like crazy to try to find evidence for why IVF pregnancies should be induced early at no later than 40 weeks. It seems to be common practice in a lot of hospitals in the UK going by forum posts and the like. Although there are also many examples of this not being the case. The advice women, who have gone through IVF, are being given is clearly very inconsistent. And the evidence for the risk of going over the due date is sketchy at best, as far as I can find out. The reasons given are usually similar to what we have also been told – namely that the risk of still birth is higher due to the placenta not functioning as well beyond 40 weeks in IVF pregnancies.

Based on the lack of evidence there seems to be good reason to question the plan of induction at 40 weeks if the cervix is still not showing signs of being ready. We have decided to wait and see whether we should postpone the induction date. Maybe things will start happening in the mean time. Move on downwards baby boy 🙂

Full term in the midst of the olympic buzz

Last night we celebrated hitting the 37 week mark while watching the opening ceremony of the olympics. For us the countdown to the olympics has had a very special meaning because it’s taken us almost as long to get to this point as it has taken London to make the olympics possible. Now it’s all happening right around the corner from us here in East London while we are waiting in anticipation to meet our little baby boy. Everything is buzzing with a typical London combo of excitement and chaos. The chaos part is the worrying bit, because the hospital where I’m giving birth is right in the epicentre of it all. In fact it’s the officially designated hospital for the olympics. Not that the maternity unit as such will be affected by that, but the journey to the hospital will…

On Thursday 2. August we will get a taste of how difficult it is going to be to get there. I’m having a ‘membrane sweep’, which is the first step in the process of induction they have planned. We have been told that they want to ensure that I do not go over 40 weeks because it’s an IVF pregnancy. Apparently there is a higher risk of stillbirth when overdue because the placenta does not work as well anymore. Whether this has more to do with higher maternal age than IVF as such is difficult to say since the two factors often coincide. In any case, we do not see any reason to take the risk so we will go along with the plan.

A membrane sweep is viewed as the natural approach done prior to medical induction. It involves manually stretching the cervix and sweeping inside to try to encourage the release of prostaglandins, which are hormones that help trigger labour. It sounds rather unpleasant, but if it means a chance of avoiding medical induction it is worth the try. How effective it is is questionable. Presumably there should be about 50% chance that you go into labour within 48 hours. But it depends on how ready the cervix is at the time. If it doesn’t work they will do another one a week later. If nothing has happened by my due date (17. August) it will be time for medical induction. By then the olympics will be over, so it will be easier to get to the hospital. But I’m so hoping to avoid medical induction and I’m also just ready for him  to come out now. So fingers crossed for an olympic baby!! 🙂

Booking appointment and kicks

Today I’m 23 weeks and as of yesterday finally all booked in for maternity care in London. The booking-in appointment at the hospital antenatal clinic where I self-referred was at 8:30 in the morning and we ended up being late… Traffic was horrendous meaning that a 15 minute journey ended up taking almost an hour. Welcome to London! 🙂

Anyway once we got there we were seen by a midwife who booked me in by spending ages asking loads of questions about our social and medical history. They took all the blood tests and did a quick scan since I’m still not in possession of my records or test/screening results and scan reports  from Amsterdam. I have tried calling and also sent a letter recorded delivery. Still no response. It makes me wonder if my file is still missing… But maybe at this point it does not really matter much anymore.

The midwife booking me in did not seem to know anything about the issue with the marginal insertion of the cord which the obstetrician in Amsterdam told us represented a risk at birth. But because it’s an IVF pregnancy it seems to be standard practice here to provide obstetrician-led care at the hospital antenatal clinic all the way through, i.e. both antenatal care and birth. So as far as we understood this means I will mainly be seeing obstetricians rather than midwifes. The first appointment with an obstetrician is in two weeks. Hopefully we will then be able to get the issue with the cord investigated further (see update below). Although the ultra sound technician who did the quick scan yesterday told us that it’s not something they normally check for in the UK. I am also curious why an IVF pregnancy is viewed as a risk factor generally (see update below). We have not heard this before and since it’s not a twin pregnancy I wonder what it’s all about. Has anyone else been told there are more risks associated with IVF pregnancies then normal pregnancies?

Regardless, I’m happy to be offered consultant-led care at the hospital in any case. It’s not that I’m particularly worried. I just prefer medical professionals with as much knowledge as possible.

All that aside, everything seems to be going great with my pregnancy! My bump is growing and the scan yesterday revealed that our baby boy is indeed growing as he should. I’m feeling his kicks and movements daily and it’s absolutely amazing. My husband has been able to feel them from the outside as well for the last 2 weeks or so. The kicks are getting stronger by the day and I love it every time he gives me that little sign of life. It’s a strange, fascinating and wondrous sensation. That combined with my growing bump makes it so much more real.

*Update: Two weeks after the booking-in appointment we got to see a consultant, but it did not yield any more information about the umbilical cord issue. Apparently here in the UK they do not regard marginal insertion as a problem and we were thus more or less told not to worry about it. They do however view IVF pregnancies in general as more risky – particularly with regards to being overdue which they said involves a higher risk of stillbirths. They are therefore planning to induce me at 38 weeks.

Read more about about marginal insertion of umbilical cord here: http://www.jultrasoundmed.org/content/21/6/627.full.pdf+html

20 weeks, anomaly scan and relocation stress

On Friday the 30th of March I hit the half-way point in my pregnancy! An amazing milestone-day which we spent relocating from Amsterdam in the Netherlands to London in the UK. This meant getting up before the crack of dawn, load a rented moving van with all our stuff and drive all day (except for the two hours on the ferry crossing the channel).

The last few weeks have been extremely stressful dealing with everything an international move involves on top of being quite busy with some freelance work I’ve got on at the moment. So I have been pretty absent from the blog-world.

The stress has mounted further due to uncertainties  around our new life in London, both with regards to jobs and housing. The latter meant that we could not bring our much loved cats which we have had for 6 years since we rescued them from wild as kittens. We could not find anyone we knew to take them and we also could not bring ourselves to just leave them in a cat shelter for adoption. So a week before the move we travelled all the way to my parent’s farm on a small island in Denmark with the cats. It was a 12 hour journey by air, train and ferry to get there, but the cats handled it well all things considered. They are now trying to adjust to a new life as outdoor farm cats and we miss them terribly! Not a night goes by where I don’t dream about them in some way or another.

By now I’m both physically and mentally exhausted from it all. Although my husband has been extremely vigilant in making sure I did not lift anything heavy in the process, a move like this really cannot be recommended while pregnant. But such is life. There was no way around it for us. The move to London had already been postponed since September due to the urgency with getting started on IVF.

A few days before the move we went to the hospital for the 20 week anomaly scan. The good news is that everything is absolutely perfect with the baby!! And it looks like we are probably having a boy. The ultrasound technician was not a 100% sure, but more or less so. We had not had any energy or space in our heads to be even just a little bit nervous before the scan. We just went in looking forward to see the baby again since it had been 6 weeks since the last scan. It was beautiful and amazing to see how much development and growth had been going on in that time. Although my growing bump indicated as much. In fact a few days before the scan at 19 weeks I was offered a seat in the tram for the first time. It took me by complete surprise but made me smile and feel the happiness of being pregnant.

Right after the scan we saw the obstetrician to interpret the results and only then did we become aware that not everything was completely perfect. Apparently the umbilical cord is attached to the side of the placenta rather than in the centre as normal. Thinking back I do remember the ultrasound technician having trouble finding where the umbilical cord was attached at first, but she did not indicate that it isn’t normal. It is apparently called ‘marginal insertion of the umbilical cord’ as far as I have been able to find out consulting Dr. Google and occur in about 7% of pregnancies. What the implications could be is quite unclear to us at the moment. The obstetrician did not go into any detail other than mentioning that it could cause problems at birth because of risk of rupture if the cord is pulled since it’s more vulnerable than normal. In addition my google research has thrown up the potential risk of restricted growth later in pregnancy.

In the consultation however, we did not press for more information which we should have done of course. I could have kicked myself afterwards. But it was a doctor we had not seen before, he was rushing because the scan had taken longer than expected making us late for the consultation with him and generally he did not seem to care. On top of that he did not have our file… apparently it’s location was unknown. This was particularly irritating since we had been promised a copy of the file to take with us to the UK, incl. a letter in English detailing the results of the tests and screenings carried out so far. Needless to say we were quite distracted by this misplacement of our file and having to leave our last appointment there without any documentation of the pregnancy so far. All in all it was a bit much to deal with in the middle of the moving chaos.

The doctor promised that the papers would be sent to us in the UK, but of course that has still not happened. Yesterday I managed to get myself registered with a GP (family doctor) here in London and learned that they will not acknowledge the pregnancy until all tests have been done all over with them. First step is taking a urine sample to the chemist to get it tested to prove that I am pregnant…  I couldn’t stop laughing. I’m 20 weeks and 5 days along, I’m clearly showing and I’ve had 4 ultrasounds scans by now and countless blood tests. But hey none of that matters – they won’t take my word for it. I need to prove it with a positive urine test administered by the local chemist… To top it all off I could not get an appointment anytime soon to get the ball rolling. Not a nice situation if something should happen. I’ve got no midwife or obstetrician to call in case of any concerns or emergencies. And I really want to get this thing with the umbilical cord investigated further and know more about the potential implications and risks.

Today we went to our chosen hospital and managed to self-refer for their antenatal clinic. We filled in a form which will then go to the referral department which means a two week wait for a first appointment. But at least it’s in process and skips the waiting time to get an appointment with the GP and then the time it would take with whatever tests he want’s to do before even referring me.

So here we are. Stressed out by all the implications of relocating  while pregnant and living temporarily with my husband’s family in the midst of the chaos of the unpacked boxes that are not in storage.

But we will get there. Things will work themselves out as they always do somehow or another. Our situation at the moment is far from ideal, but in the end of the day it doesn’t matter in the grander scheme of things. I have made it half way through my pregnancy and our baby is looking healthy and well! What more could we wish for!!

Looking back on a long journey

There is something special about February. It’s the month of love. It’s the month we first met on a dance floor in London 9 years ago in 2003. It’s the month we decided we wanted to start a family 3 years later in 2006. It was so special and romantic for us to make that decision then. Little did we know what kind of journey lay ahead and that wanting to have children is something completely different from actually being able to make it happen. Now, 6 years later, it’s February again and I have entered the realm of the 2nd trimester of my first pregnancy.

February now feels more magical than ever before. But it also makes me think back on all those years of living with unexplained infertility and going through fertility treatment. These 6 years have changed me and us forever. I can’t imagine myself and our life any other way. We have learned that life is unpredictable and beyond our control. We have learned that nothing can or should be taken for granted. We have learned that it is possible to be happy even when life is turning out so differently from what we had imagined. We have learned that resisting what is only creates more suffering. At the same time, we have also learned that there are subtle, but very important, differences between denial and acceptance. We have learned that there is a time to let go and rest, but that there is also a time to start fighting again. We have learned that living outside the social norm is difficult, especially when you have had no choice in the matter, but also liberating. It teaches you to find your own way and to make conscious choices about who you are and how you want to live within the limits of whatever life is handing you. It has make us stronger and closer as a couple.

To put it differently, we have learned that being involuntarily ‘stuck’ in a liminal life state like infertility for years is painful on many levels, but also transformational. Looking back on my posts prior to IVF and pregnancy, I did know this when we were still in the trenches (see for instance this post), but only tentatively. It is much easier to reflect on it now when I’m no longer in the same state. As I do so, I realize to my surprise that I don’t actually wish that these years had been any different or that we had been spared the long journey to get to this point. I also realize that the only reason I can feel and say this is because the liminal state of infertility has effectively ended for us. For now at least. Over the course of the first three month of pregnancy I have transitioned into a new state – that of pregnancy. We have not become parents yet, but for the first time ever we are actually on our way there. We can see the light at the end of tunnel. This last stage of the journey is significantly different from any of the stages that have come before because the creation of a new life is no longer theoretical and impossible. It is happening. A new life is coming into being slowly and steadily with every day that passes.

We resisted IVF for a long time, but in the end it was IVF that made the miracle possible. Yesterday we went for the NT scan* and got to see our little miracle dancing again. He/she was making it very difficult to get the measurements done because of all the moving around. As the technician was waiting patiently for the right position we had lots of time to enjoy the show and revel in the representation of our miracle on the screen. I’m still in awe. I still can’t quite grasp that it’s really happening, because it has seemed like a complete impossibility for so long. But I’m getting there slowly. More so now when the morning sickness has lessened because I’m functioning more normally again. We have not looked at baby stuff or anything like that yet, but a few days ago I started looking at websites of hospitals in London to try to get an idea of where to give birth since we are moving there. As I was watching a little video that took you on a tour of a birth center, tears started streaming down my face. It was hitting me. It’s happening, it’s real. I’m pregnant. We are going to have a baby.

*Update 16/2-2012: We received a letter two days after the scan with the assessment of the risk for Down’s Syndrome etc. based on the combination of blood results, NT measurement (1.1) and my age (37). The risk was assessed to be 1 in 11000, which is reassuringly low for my age. 

Seeing a tiny little heart beating

It was amazing. Indescribable. By now I have experienced a lot of ultra sounds, but this one was out of this world. In the best possible way! There on the screen we saw the blinks indicating that a tiny heart is beating away at 156 bpm. It is really happening. Our baby is growing and developing inside me. It’s a miracle, nothing less. The miracle of life.

I’m 8 weeks pregnant today, so we still have a while to go before we reach those 12 weeks. But seeing a heart beat gives us so much more confidence to keep believing and trusting that everything will be fine.

It also means that we are slowly starting to transition out of this liminal state we have been stuck in – as I have written about in previous posts (Tagged with Infertility & Embracing the liminal space). It has felt like life was on pause for a long time. Now it’s moving forward again. With every day, every week that passes we are entering a new stage in life. That of expecting parents. I can’t even express how thankful I am!