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Q&A regarding infertility: The body

23.07.2018
Skabt af Cathrine Widunok Wichmand

I am extremely, extremely happy that you guys asked me tons of questions on my post about fertility treatments. That you put your trust in me and want to hear more about my experiences. Thank you!

I’m going to approach it like this; everything body related will be answered in this post. So the physical treatment, the amounts of oocyte collections, why the treatment etc. Then I have also written a post about the more mental aspect of the fertility treatment. And another post with questions regarding us and the surrounding society. Does that make sense? I hope it does!

rockpaperdresses, Cathrine Widunok Wichmand, Stine Goya red suit, Mads Nørgaard 101, Julie Bjarnhoff, Tullinsgade
When did you decide to contact a doctor about not getting pregnant? And how was it to approach that conversation?

 It actually happened the other way around – as in we hadn’t even started thinking that it couldn’t be done just like that, we were frustrated yes, but no where near thinking about treatments/check-ups. I went off the pill in March 2016 and then we were a little careful/a little lala until July 2016. But approaching November 2016, I was experiencing pains in the area around my ovaries and went to see my doctor, who straightaway asked if we were trying to have kids. The answer was yes and she sent us to a gynaecologist to get a check-up, to see if everything was okay. Everything was great, loads of eggs etc. At the same time as I went to the gynaecologist, the doctor thought about sending the both of us for a bigger round of check-ups; blood tests, sperm tests, etc. ”Two healthy young people and me who hadn’t taken any kind of birth control in nine months and have a super healthy cycle – we might as well get it checked out”. So that started without us even asking for it. And I received all my test results in December 2016; “Super fertile young woman with loads of eggs”, thank you. And then Adam’s results came in January 2017 (read more here) and on the results it said that icsi was recommended. Then we started googling! What the hell does ICSI mean?!

 

Why did you choose a private hospital instead of for example Rigshospitalet? I recall that you once wrote something about waiting times, was that the only reason why?

When we received the message about fertility treatment, that’s also when the stories about the long waiting lists prevailed the media. That you had to wait up to 14 months just to get a consulting appointment as well as the risk of being rejected within only 3 cycles (which is about 3 months for me). That seemed completely everlasting when we at that point had already been trying for a year, more or less. That was the reason we choose to seek out private practices – as well as signing up to the public procedure at the same time. And guess what? We have still not gotten through the public system, even though we have been to the obligatory and quite terrifying lecture, in my opinion, about the treatment. To sit there with another 100 people in a big room, well-knowing that we are all there with a little heartache and probably a small portion of shame, and then to sit and listen to someone talk about bad sperm, the treatment step by step, getting good advice and to put your hand up to get something explained further in depth. To sit there with your super intimate situation, which you perhaps haven’t shared with anyone yet – ugh, I thought that was too much. This lecture was the last step before starting the treatment and we left there with the message “start-up before the summer” and with the nurses advice that if we got pregnant in the meantime we could always decline. We are still waiting.

If I can just add something, I think it is such a shame that there are not more funds for fertility treatment. 1) It is an area without treatment guaranty, even though time definitely is a factor. 2) Infertility is a rising issue – but we need citizens also if the welfare has to continue. 3) I could fear for the future, that having kids will be reserved for people of a certain financial status. Through public services you only get 3 tries (4 in few scenarios) and then you have to move over to the private and there are no help at all if you’re trying to get number 2 or number 3. So if one wants siblings it’s straight to the private procedures from the beginning. Even though you didn’t get help for the first one through the public (whether you went to a private institution or was able to without help). That is not right in my opinion and could potentially result in a sad development.

You can read my blog post about the private healthcare system here 

Is there absolutely no chance that you can conceive the natural way?

Yes, there is. However, as my fertility doctor explained very well at the very first meeting: “Imagine your egg is a football kicked out over Zealand (island in Denmark) – and that there are only 10 players to find that ball. They may find that ball, but it can take a really long time. However, if you have 100 players to look for it – yes, it will be a little more efficient.” I really think that explains the challenge well. The question is, how long are you willing to try? What is reasonable? What are the prospects? And that is what’s hard – you don’t really know, would it take another year? Or maybe three? Would it maybe never happen? It can be very psychologically exhausting to try for that long – I have girlfriends who have been very impatient after trying for six-months (and on average it takes eight months to get pregnant).

Everyone’s fertility is varying – who knows; maybe it will happen naturally next time? Otherwise we know the drill.

What made you decide on IVF? Did you try IUI? Do you have any other problems than a lost ovary?

You don’t just try around and then just choose freely on the selection of treatments. Based on the results of the study, one is recommended either IUI (insemination which is a very mild treatment with less hormone and without oocyte collections), IVF (which includes oocyte collections, where you add approximately 150,000 sperm per egg and rely on that one of the sperm cells fertilizes the egg) or ICSI (which includes oocyte collections but taking one sperm and injecting one egg at a time – one can help fertilization as much as possible). If the sperm quality is really bad, you will not go through IUI and IVF first but directly to ICSI.

I did not lose my ovary during my GUL (pregnancy outside the uterus), I only lost my fallopian tube. The ovaries are so brilliant that they can pull eggs apart, for example, if their fallopian is missing, so the message from Herlev was that my fertility is almost unchanged. Should we go through ICSI again with kid number two and three, they will still take eggs directly from the ovary and I will not use my fallopian tube at all. But no, I have no problems regarding fertility, but it’s still me as a woman who goes through the treatment. That’s the game.

You can read more about treatment types the public care system offers here.

 

I have thought about how many times you had to go through the treatment before you succeeded? And did you get some eggs frozen or was there a new oocyte collection every time? How many eggs did you get taken out the 2nd and 3rd time?

I have had eggs taken out twice; one time there were eighteen eggs that were taken out and another fourteen eggs. Statistically, fertilization will be achieved at approx. 50% of the eggs, and of the remaining 50% will not divide and further develop. Out of the 18 eggs, three blastocysts came on the freezer and due to the risk of over stimulation (the egg follicles are filled with fluid after oocyte collection and the fluid may penetrate the abdominal cavity and it is both risky and painful), we had one egg inserted after the cycle after which became my GUL) and then the subsequent two in each cycle. The second time there were 14 eggs and they became two blastocysts – the last became our son, the fifth embryo transfer. So no eggs frozen for a sibling.

You can read my remarks about oocyte collection for the first time right here

These are quite average numbers relative to the “egg out / blastocyst” rate. The “happiness” is not necessarily the many mature eggs and it is believed that the optimal number of eggs is approx. 10-14 eggs. But so – it’s so individual. In principle, you only have to use one good egg – but sometimes there must be a few rounds before it succeeds.

You can read my post before another oocyte collection here

Read an older article about how many eggs it takes from IVF forums.

rockpaperdresses, Cathrine Widunok Wichmand, hverdagsglimt
What medicine / supplements did you take? How affected were you by these hormones? How did you experience it? Were you through the entire emotional register during that period? Or was it not “as bad” as people say? How long do you have to have these hormones before attempting? Can you take care of your job without problems or do you feel bad in any way?

I have had Gonal-F to mature my eggs, Orgalutran to inhibit ovulation until the right time, Ovitrelle to start ovulation and a little Suprefact to boost after embryo transfer (which is also used during down regulation, which I have not tried). Then I have received estradiol to thicken the endometrium – but we quit that quickly as it had no impact on me. The only effect it had on me was that it did not get thicker – which resulted in having to skip a cycle once. In addition, I’ve got Crinone after one embryo transfer to hold the egg (which I really did not like – a kind of cream in a pipette that is brought up in the vagina but does not come out by itself – it has to be “picked” with your fingers, ew). After the other four transfers, I got Lutinus, though in higher doses because it is as “effective” as Crinon. That was more me.

There is both short and long hormone treatments before oocyte collection and I have been in short treatment both times. I respond very strongly to hormones and get a low dose in order to not mature too many eggs. Before the first oocyte collection, I got really bad pains in the week before. Imagine; normally we mature one egg per. cycle that becomes your period if not fertilized. Suddenly, they force your body to mature many eggs at one time, and it is therefore heavy in the small ovary – it just hurts to move in the week before the oocyte collection.

The second time it was addressed and I got less hormones. Second time I was not as bothered. During both collections I went to work, but I could not bike and work out the week before the first oocyte collection. I did not experience being very moody, but I thought it was a bit hard to get injected – especially with the “big” needle, Orgalutran. Adam had to inject me (in addition, it gives the feeling of a bee sting around it – perhaps have a ice cube ready to soothe the skin, it works!). The rest of the syringes I managed myself.

It is completely normal to be sore a couple of days after oocyte collection – but most people can go to work the following day. On the day of oocyte collection, I would recommend that you take the day off completely – both before and after. It’s a treatment that’s not very comfortable, and you’re getting morphine during. Also, just emotionally, you may just need to recover for the rest of the day.

Read more about medication in regards to the treatment at Trianglen.

 

Have you taken supplements and which?

In relation to dietary supplements, I have received some Chinese herbs before other oocyte collection, on the recommendation of my reflexologist. I would rather no talk too much about that, since there is no proven effect, and recommendations were given specifically to me for my specific situation. I just needed to do something else than shoot medicine into my stomach.

And then I have taken my regular supplements for a long time; Omni-B-Active and Omnimin Pure – Both from Biosym. It is primarily multivitamins and a good amount of folic acid. I have taken my fish oil from Puori for a long time now – also before treatment.

 

What are your experiences with alternative treatments like acupuncture and reflexology? Not that it necessarily led to pregnancy, but more if you noticed a difference on your body and mental well-being?

Before the first embryo transfer, I was pretty relaxed. I received acupuncture when the fertility clinic recommended it. But that was really it – and well yes I almost did not touch alcohol and was in no way drunk in the time leading up to. I continued my training in moderate amounts, etc.

As the embryo transfers flew by and there was no luck (besides the first egg that turned into a GUL), I became more and more stringent and was onto myself constantly. Almost no exercise, no alcohol, lots of acupuncture, weekly, which cost me a fortune, fertility-promoting yoga, etc. It was autumn / winter 2017 and it was clearly my darkest time. I was very, very unhappy and was very far from being myself. I lost a lot of weight in October / November and was advised to stop the treatment at the clinic and take a little break from it all.

We started attending a psychologist to process everything that had happened. And then I stopped doing anything that had something to do with “fertility”. Stopped with fertility yoga, stopped with the acupuncture, where I just felt like a needle pillow. I decided to only do things for me – without any intentions whatsoever. It was so nice and so right for me. I needed that everything in my life did not point to infertility. I started training again; yoga primarily, I would drink some bubbles and white wine when it came to mind, and then I started doing reflexology, which has been a very nice experience and far from the acupuncture, where we would just lay on each mattress with a curtain in between. Here there was a human who only had time for me, with her warm hands and presence. It made a huge difference. I started looking for a yoga stay just for me and actually wrote to someone in India (which I did not go to for good reasons).

It ended up being a two months pause, due to our New York trip and poor timing with the embryo transfer. In January I got the last f
ifth eggs inserted – and that was it.

You can read about my first experience at the acupuncture here

What is your general attitude towards all the different things you can do during treatment (alternative treatments, diets, etc.) and all the things you can / cannot do? You mentioned at one point in a post that you had taken great pleasure in taking it easy and living more freely in relation to all the rules and restrictions there may be.

I have no attitude towards all the things you can do because it is so different why we end up being treated – and what can be done for it to succeed. In 10% of cases, you do not know what the reason is and the remaining 90% the distribution is approximately: 1/3 of the cases, it is the woman that is the reason for treatment, 1/3 is the man, and then there is 1/3 where it is a common challenge. For some women, it makes sense for them to change diet if, for example, the challenge arises from PCOS. In my case, it can be said that diet changes were irrelevant, as I wasn’t the reason. But healthy food is always good.

You can read my post here about what I did along the way; acupuncture, massage, yoga

I believe that a happy body is a safe environment for a small egg to get stuck in. If you are completely deprived, exhausted, cut off from all the joy of life, I do not think the little egg will think “HERE is nice, here I want to live!” It is completely my own home-made, holistic thought. I was in a good place here in January – but if that’s the reason, or if it was just coincidence / our trip / the right egg – it’s impossible to say. I even noticed that the first egg got stuck (though in a wrong place – but that’s just an accident) and the last egg got stuck – clearly in periods where I’ve been in a good place.

A couple of the other eggs have also got stuck but have become BIOs (biochemical pregnancies that do not develop but disappear by themselves).

Read more about infertility in general here, with the public sector

 

In recent years, we have followed the “fight” on your part in terms of hormones, syringes, etc. (which is understandable when it is yours and not Adams blog). Can you open up how the treatment looks like for the man? Has Adam also been through hormone treatment, etc. or is it only the woman who is exposed to it?

I have actually made a number of questions to Adam, whom I would like to ask him, as there are not many men who opens up about this. But he does not feel like it now, and I respect that. Just because I’m opening up, that does not mean he’s going to (although we both looked each other in the eye before I published it all). Perhaps one day.

However, according to the traditional medicine, one does not actually do anything to strengthen the man in connection with IVF / ICSI. Yes, you do not smoke, drink alcohol, and moderate exercise and healthy diet is recommended, but it’s just the woman who has to do all the medication and syringes – even if it’s the man who initiated the treatment.

If you ask about alternative medicine, you will get quite different answers. Someone believes an acupuncture or zone therapy before the important sperm test (to be used to fertilize the eggs) works. Other alternative therapists will also propose a variety of supplements, including zinc, folic acid and Q10. Adam has received a lot of supplements since January, but I would rather not recommend anything, as it is so individual what the challenge is and very little is evidence-based. Talk to your own doctor and alternative therapist if you have one.

Rockpaperdresses, Cathrine Widunok Wichmand,

 

 

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