We were in many ways very lucky with our infertility journey. All in all in took 2,5 years from when we started trying to finally seeing a positive pregnancy test. We managed to get four stimulation cycles at three different clinics during this time, which is quite a lot within that period. We got many surprises during our journey but they were all necessary in order to finally become pregnant.
HOW IT ALL STARTED
It all began in early 2016 when I was finally ready to go through child birth in order to become a mum (I was suffering from severe tokophobia, fear of childbirth, but that’s for another post). One of those good things that happened is that I went to the doctor almost straight away just to check that everything looks ok in there. In Sweden, for example, one cannot go and check “if everything is ok” had you not tried to become pregnant and have reason to think that something might be wrong. Usually couples can seek help after trying for themselves for at least one year (6 months if the woman is over 35 yo), but I thought, how will anyone ever know what we’ve been doing or not doing in bed for the last 12 months? So I used that little white lie and said we had been trying for some time and that nothing had happened. I was sent for all the classic hormone analysis, U/S, etc and they could not find anything wrong with me. Great! I thought and went straight for the goal. But since that white lie, the doctor wanted us to do extensive analysis to find the cause of the “problem”. I was sent for a Hysterosalpingogram (HSG), where a contrast liquid is flushed into the uterus followed by an X-ray that detects how the liquid is moving around in there. I avoided this procedure for a couple of months as I assumed that probably nothing was wrong with me (by that time I had only tried to get pregnant for three cycles), but the doctor was pushing for doing this procedure so I thought what de heck, let’s go for it.
- Don’t wait with doing all the tests, better early than sorry!
- Nobody will ever know for how long you have been trying, use the white lie
- Follow the doctor’s advice on the tests until you are completely sure that everything is ok
I was so relieved after having done the HSG procedure as I had heard it could hurt and be quite uncomfortable, so I was happy it didn’t hurt at all. The doctor told us to sit down for the results and had quite a serious look on her face. We were told that both my fallopian tubes are blocked and that’s why we were not getting pregnant. It was quite a shock. One second I was sitting there happy that the procedure didn’t hurt and in the next I was told I will not be able to become pregnant on my own. I spent the following two days in bed, watching Sex & The City and constantly crying. I felt as my womanhood had been taken away from me, the most natural thing that was supposed to happen in life was suddenly a challenge. After those two days I had literally cried my eyes out and was so tired of feeling sorry for myself so that I had to go for a solution instead.
- Take days off to grief and let it all out
- Make sure to research a lot, it gives you hope and confidence
- Read the book “It starts with an egg” by Rebecca Fett and start with all the supplements and restrictions as soon as you can
STRAIGHT TO IVF
The second “good thing” with our journey is that my diagnosis took us straight to IVF. Usually, when the problem lies in the hormones or in the sperm, patients are offered a hormone treatment or at least three IUI’s (where sperm is “washed” and then inseminated into the woman’s uterus). But since my problem was pure mechanical (where the egg and the sperm simply can’t meet because of the blockages) the only way forward is IVF. We buried ourselves in research and started our first treatment in Moscow in August 2016.
- Again – research! The infertility field is so unstudied, new information and facts come out every day. Make sure to advocate for yourself if you have heard or read something different from what the doctors are telling you
- Don’t wait! Time is precious when it comes to fertility, even if you are and feel “young” that might not be the case with your ovarian reserve or egg quality. Sadly as it sounds, 6 months can have a huge impact on the outcome
LOTS OF EGGS
We were quite excited for the first round as we were told we are great candidates for IVF, we were also told that couples like us would likely become pregnant on the first trial. At first it was a bit scary and weird to stab yourself with a needle three times per day and keep track of all the meds, but after a couple of days I got used to it. I personally didn’t experience any discomfort from the medicines. I didn’t bloat, didn’t gain weight, didn’t experience mood swings (aside from the regular ones, haha) and didn’t get any bruises from the shots. Everything developed perfectly, I had 20 follicles on retrieval day and they got 20 eggs out of them. I got a slight version of Ovarian Hyperstimulation Syndrome (when the abdomen is filled with liquid and in severe cases has to be pumped out of the body) and was recommended to not do a fresh transfer (of embryo) in that same cycle. Out of the 20 eggs only 8 was fertilized and 5 of those made it to day 5. Our third “good thing” was that we decided to do PGD testing (genetic testing of the embryo before it is transferred back to the uterus) on the embryos, even though we were not recommended to do so. The 5 embryos that made it to day 5 were biopsied and the material was sent off for genetic testing. The embryos were frozen in the wait for the test results and my recovery from OHSS.
- After an egg retrieval, really listen to the instructions on what to eat and drink and not! After the retrieval I felt great and was sooo hungry. We went out for Asian food with lots of rice and noodles and I think I even had a beer – NOT recommended! I suffered quite hard after that meal
- Eggs and embryos die off, its normal. Expect approximately 25% of your eggs to result in viable embryos on day 5
- Embryos die off because of genetic errors, the errors arise from either the egg or the sperm where the genetic material is stored. That means, an embryo that arrests on say the second day, means either the egg’s or the sperm’s genetic material was insufficient from the beginning. This is not “babies dying” in a lab (as I have had people telling me), they would never become viable anywhere. We can’t see this process when it’s happening in the uterus, but it is indeed happening in there when you are trying to become pregnant naturally. That’s why there is only a 20% chance to become pregnant each cycle before the woman is 30 years old.
ONE SINGLE NORMAL EMBRYO
After a couple of weeks we got the call with the genetic test results. Out of the 5 embryos only one came back as normal. We were quite devastated. Out of 20 eggs and all that promises of us being great candidates we only managed to get one viable embryo to transfer. This was in the middle of December so we decided to take a break for a couple of cycles to be able to go on Christmas holidays without any shots, appointments and stress (the IVF process is quite tricky to fit in a busy schedule).
In February 2016 we finally transferred that only normal embryo. It was a girl and again we were told that this is probably it, we should become pregnant in this cycle. We didn’t really reflect on why only one of 20 eggs became a normal embryo at this time, as we were so focused on the transfer. I remember being quite stressed over work around the time of the transfer and also that I had to go to Kazan for a business trip for four days, where it was -20 degrees Celsius and freeeezing cold. Also, I had to go to some random clinic in Kazan every other day to get a bloodwork in order to check my progesterone and estradiol levels. The whole thing was quite stressful as I really wanted to increase my chances for success, yet I couldn’t tell anyone about what was going on and why I didn’t drink/went to the SPA/wanted to go to bed early/rented my own room at the hotel at my own expense/didn’t want to go for walks in -20 degrees. The doctor I had back then prescribed me up to 9 estradiol pills per day, which is A LOT I realize now having done a successful transfer. One side effect of 9 estradiol pills is that your vision starts to become very blurry, so it was quite hard to follow the slides on the conference, haha.
Back in Moscow and 15 days post transfer I went for my first Beta, which came back as negative. Luckily, I had taken that day off just to make sure I didn’t have to be at work if getting bad news. That day I bought myself a Kiini Bikini and had two glasses of wine during my solo lunch.
Even though this was a tough time, I was happy we did the genetic testing. Hadn’t we done the testing, I would have to do all of this for five cycles instead of one.
- Do genetic testing!!! If it’s legal in your country and is you can afford it, that is. The ugly reality in countries like Sweden and Germany, where PGD is prohibited by law, is that women like me are said to believe that all of their frozen day 5 embryos have a chance of becoming pregnancy. Then they spend several years transferring those embryos that wouldn’t become a pregnancy anyway. Spending two years in your thirties on transfers instead of egg retrievals can have severe consequences on the ovarian reserve as well as the egg quality. I just heard a Swedish podcast where a woman had done one retrieval two years ago, then had 11 embryos frozen and still had four more embryos to transfer. That’s horrible! By the time she will finish transfer all of her embryos, three years have passed! If PGD testing is illegal in your country I would highly recommend doing IVF abroad.
- Don’t go on stressful business trips after transfer Jtake time off if you’re an anxious person like me
START ALL OVER AGAIN
After the failed transfer we realized that we were back on square one with the whole process. Plus, the knowledge that something is wrong, but no explanation of what it might be. The only thing that was looking somewhat different was the result of my husband’s sperm, showing lower morphology than normal. But when doing ICSI (when the best sperm is chosen and directly injected into the egg), which we did, that result shouldn’t matter that much. Our doctor suspected that the morphology problem might be an indicator of a greater problem that we had not yet tested for. Before jumping into any conclusions we were recommended to do another round of IVF where more attention would be payed to the sperm selection process.
We started the stimulation protocol right away which was basically the same as last time, as I showed good response to the stimulation drugs and we managed to get 20 eggs out of it. This time the shots were even more manageable and I didn’t experience any side effects from them this time either. On egg retrieval day they managed to retrieve 12 eggs, although there were about 18 follicles. This happens sometimes when some of the eggs are immature and will not “let go” of their follicle. But 12 is a good number too so we were content with that result. Full of expectations we went home and DIDN’T eat Asian food with beer, which turned out to be much better for my health after the retrieval. I also joined an IVF support group on Facebook and started to listen to podcasts in order to gain more knowledge, now that we were not those “perfect candidates”.
- I would really recommend joining infertility support groups as soon as you find out something might be wrong with your infertility. First of all, it will make you feel less alien going through this process that your friends and family might know little about. Secondly, you get lots of great and new information that you wouldn’t get from your doctor or from just googling around. These are the support groups and podcasts that joined and would recommend them to anyone.
- Beat Infertility podcast
EMOTIONAL ROLLERCOASTER, DESPAIR AND UNCERTAINTY
During the following days we got updates on the progression of the embryo development. They managed to fertilize 8 eggs and by day 3 there were 7 embryos, great so far we though. By day 5, when usually embryos are biopsied and frozen, the clinic couldn’t tell us what grades they were, only that there were 5 embryos left and that they needed one more day to develop. This is usually not a good sign, but when we asked what was wrong we never got any sufficient answers. On day 6 we were informed that there were 3 embryos left and that they had to keep them one more day in order to perform a biopsy. To keep embryos to day 7 is like unheard of. In the support group on Facebook (with 17K members) nobody had heard someone keeping embryos unfrozen for that long. We finally managed to get the grades of the 3 embryos that were left and they were no good. None of them was even suitable for biopsy, meaning definitely not suitable for transfer and to become a viable pregnancy. We couldn’t believe it. We though the outcome of the first IVF trial was bad, but in the light of the second one it seemed quite good, at least we had one embryo to transfer. Without any explanation to why this had happened, we decided to leave that clinic and try to find an answer by ourselves.
- Do take a vacation and treat yourself during this process. In hindsight, I believe lots of the problems we’ve had were caused by my mental state. The IVF-process in itself is quite stressful, but I also had an emotionally stressful job where anxiety was a normal part of my day. It might sound whu-whu, but looking at my mental instability back then compared to the IVF round when I fell pregnant, is like night and day. I believe getting your mental state in order is key to success in IVF and infertility
VARICOSE SURGERY AND NEW CLINIC
The only lead we had was the decreased seamen quality so we decided to see an urologist that specializes in male fertility. We did an extensive seamen analysis called DNA fragmentation test, showing that the genetic errors in the sperm was within normal range. The only thing that they found was light varicose that might (and we found out later it actually didn’t) cause lower seamen quality. Desperate as we were (and some clinics wanting to earn more money on excessive treatment) we agreed upon a surgery to remove the varicose. The surgery went great and while recovering from it we started to search for our next clinic to start our third round of IVF. But we also took take some time off to heal and regain some emotional stability in this uncertain time.
- Unless the varicose is very extensive it might affect sperm quality. Although, it is not clinically proven that even then a surgery might help. Do your research and rely on the scientific proofs before letting the clinic push for drastic actions. We were lucky everything went well with my husband’s surgery, but had we known the scientific proof behind this, we would have never done it. There are always risks associated with surgery, especially in such fragile areas.
- If the DNA fragmentation test is within normal range and there is a fair amount of sperm, you can achieve a healthy pregnancy with ICSI. You only need one healthy sperm for this to work and an ejaculation contains millions of sperms, even if the amount is diagnosed as “low”
STARTING ROUND #3
The choice of the third clinic was simply based on closeness to my work. It was a brand-new clinic that seemed nice and fresh and had good ratings (although those ratings are not always something to fully rely on). The many scans and appointments associated with IVF makes your schedule quite hard to plan and follow, so having the clinic next to your office was a perfect solution. We shared all of our previous IVF-history and jumped right into the process. This was in July 2017 and now that we had the surgery done and supplements taken for better seamen quality, our hopes were back up. The new doctor changed my stimulation protocol, hoping that it would give better results. I was on a short protocol for the first two rounds and that’s what they put me on for the third as well, as low weight and age are said to be a risk for the long protocol. Long protocol and good ovarian reserve are associated with higher risk for OHSS (Ovarian Hyper Stimulation Syndrome) and the doctors don’t want to risk their licenses in putting their patients at this risk.
I started with the shots again and this time around it felt as natural as brushing my teeth. 18 follicles were detected in good seize before the egg retrieval and we hoped that all good things come in three, so this time should be our lucky one.
- If/when changing clinics, make sure to keep record of all your tests and medications, even if it is a lot to keep track of. The more information you have to give to the new doctor, the better
- If possible, search for doctors and their success rates in IVF, that is live births per year. You can be at a great clinic but get an average doctor and vice versa
We were really hopeful on retrieval day, 18 follicles is a good amount and the clinic felt promising. I remember waking up from the anesthesia after the retrieval, having some small talk with the girl next to me who also just woke up from her anesthesia. She had just removed an ovarian cyst before starting her first IVF cycle and I shared my best advice being the experienced IVF patient as I was. In the middle of our conversation a nurse came in to check on us and told me that they had managed to retrieve four eggs from me. I was in shock. How could 18 follicles end up in only four eggs? What happened to the other 14 eggs?! Apparently, seven of the follicles had ovulated on their own before the actual retrieval and the other seven eggs were immature and could not be sucked out from their follicles. The doctor said she had never seen this before and she couldn’t explain why this had happened. My reaction to the stimulation drugs was for some reason much more different from the first two times.With the statistics from our two previous stimulation protocols four eggs was not a good number. The doctor kept saying that these four eggs still had a good chance to become four great embryos, but knowing our statistics I didn’t have much hope. On day three two of the embryos had arrested and on day five no embryos were viable. Nothing to freeze or to put back in. Again. I thought that things couldn’t get worse than during the second stimulation, when they had to keep embryos until day 7 and finally nothing to freeze. But this round turned out to be even worse, with all embryos arrested on day 5. After having talked to the embryologist we got new and surprising news – according to them the semen quality was good, but the issue lied in the egg quality. Something that nobody had told us before.
- The diagnosis Unexplained Infertility is often associated with poor egg quality. That’s the only thing that we cannot test when doing infertility examination. To test it would mean we have to take out one egg and destroy it to see what quality it has. We prefer using the eggs for fertilization when the chance is given
- Usually, good ovarian reserve equals good egg quality, but not always. Just as in my case, the woman can have lots of eggs and the hormones in good proportions, but the eggs that she has can be of insufficient quality. There are no known reasons for why this might happen, but science suspects stress levels and genetic conditions to be two determining factors
- The only way to suspect bad egg quality when all other tests are good, is by recurrent failed IVF attempts where the embryos do not survive to the freezer
NEXT TRY - SPAIN
I started to read everything about improving egg quality, and found out there’s a lot of things we can actually do. As I said before – the book “It Starts With an Egg” is a really good source for this information. We were tired of not getting enough explanations by the doctors here in Russia and decided to look for a clinic abroad. We also started to consider solutions with egg donors as we didn’t know if I would manage to get any good eggs of my own. We were open to all countries and clinics, as long as they had a good track record and were in the forefront in the scientific field as this area is not fully understood. We ended up choosing Institutio Bernabeu in Alicante, Spain. That clinic checked all the points on our list and also had a generous egg donor program in case we needed one. We were also very lucky to get the founder of the clinic, Mr Rafael Bernabeu, as our doctor. He was one of the first doctors in Europe to successfully perform an IVF cycle.
- When looking for clinics abroad, make sure to choose a country that has liberal laws in the area of fertility treatment. PGD and egg donor are two main things that should be allowed
- There are lists and reviews online about the different clinics, also read about the doctor and his/her track record as they can vary even within clinics
REMOTE FERTILITY TREATMENT
First we though that we had to stay in Spain for several weeks in order to do the IVF cycle. But everything could be managed by Skype and with scans of local Ultra Sounds. Initially we had our first meeting over Skype, sharing all previous data and trials. We finally decided to go for the long protocol, as that is known to address egg quality issues, now that we knew that we had one. I was also prescribed testosterone gel that I had to apply to my thigh every night one month prior to the stimulation protocol. This is known to increase egg quality as well.
After starting with the stimulation drugs I went to a local Ultra Sound diagnosis center in Moscow and monitored the development of the follicles every third day. When the development was sufficient I booked a flight to Alicante and spent the last four days of the stimulation protocol there, with daily checkups at the clinic. The atmosphere at the clinic and Alicante was beautiful. Since I had to go there for four days I took time off from work and I think that was quite good thing to do as well. I’ve always seen myself as a hard worker that can take anything coming my way. But looking back I’m pretty sure I was not listening to my body and inner self and just let the stress take over. Egg quality and ovulation are highly dependent on stress levels, so while some people know their limits in terms of stress and know when to wind down, some (like me) might push themselves harder, not realizing how harmful it can be.
- Stress is a major factor in infertility and it often becomes a catch-22 – you’re stressed, you go through infertility treatments which is quite stressful in itself, things doesn’t turn out the way you hoped which leads to even more stress, your egg quality or ovulation is affected by the stress etc… Having said this, make sure to do what you can in order to stay in a healthy mental state. Use meditation, cut down on work and let the closest colleagues know what you’re going through
- Self-Care is trending now and I wish I had immersed myself more in this trend while going through infertility treatments. Many couples go through a couple of treatments, get emotionally stressed and “take some time off” in order to get their minds in balance. But the time when you want to have your mind in takt is not just between the treatments, but also while on a treatment. Create a weekly self-care schedule with your favorite self-care activities, that can help you stay balanced during the actual treatment
I got 16 eggs this time but only 8 of them were mature, which frightened us a bit. But that’s double the results compared to the last retrieval. All 8 eggs got fertilized and on day five we had five visually good embryos to send for PGD testing and then freezing. We were so happy that we finally got something to test and freeze! We still didn’t want to celebrate too soon as we still had to wait for the test results, and last time we did PGD testing only one of five embryos turned out to be genetically normal.
FINALLY SOME GOOD NEWS!
Two weeks later the clinic called to inform us on the results – three out of five embryos turned out to be genetically normal. We were so happy and relieved! That was a result we only could dream about. During the third stimulation trial I found out that I had Endometritis, an autoimmune disease which presents itself as constant inflammation in the uterus. It is not dangerous and is not something you would notice unless you do a biopsy of the uterus, but it does prevent embryos to stick after transfer (or during natural conception). It is simply solved by antibiotics that needs to be taken one week prior to transfer. The transfer was scheduled for the beginning of February 2018 and we couldn’t wait.
For the transfer we only needed to stay two nights in Alicante. The transfer itself takes only about 10 minutes and one is allowed to fly back within 48 hours (that’s the time it takes before the embryo sticks to the uterine wall). I made sure to do three sessions of acupuncture (which they offered at the clinic), two session before transfer and one after. It is important to keep your feet warm after transfer and in general being warm. As I’m always freezing I made sure to go all in and had my Uggs and fur coat in 19 degrees Celsius in Alicante, haha. On the 5-hour flight back home I made sure to be up walking and put my feet up in the air a couple of times to keep the blood circulation going.
Then the long 10 days wait started, that’s when you can go and get your blood checked for pregnancy. For me it turned out to be quite symbolic - on March 8, also known as the International Woman’s day (which is a huge thing in Russia, but not for feministic reasons). I remember being very nervous as I was waiting for the results from the bloodwork, the anxiety of possible getting another negative result was physically unbearable. I finally got the mail with the results and couldn’t open it. My husband, who was on the phone with me all the time as he had to be away on a business trip, opened the e-mail and read the BETA number 131, which meant I was pregnant. I just couldn’t believe it. Had I finally fallen pregnant? I couldn’t believe it for another month, thinking something must go wrong. But after seeing the little heart beat on the Ultra Sound in week 8 I was finally convinced that I was actually pregnant for real.
SO WHAT DID I DO DIFFERENT FOR THE FOURTH TIME?
It’s hard to say exactly and each case are different. But I have my beliefs and guesses that I definitely think are worth trying if you’ve been suffering from recurrent embryo losses.
On improving egg quality according to “It Starts With an Egg” by Rebecca Fett
- Quit using beauty products and creams that contain phthalates and parabens, as these interfere with the hormone harmony required for good maturation
- Quit using plastic food containers containing BPA, for the same reason as above
- Take the following supplements:
- DHEA (6 months prior to stimulation) or Testosterone Gel (one month prior to stimulation)
- Omega 3 fatty acids
- Folic acid (lots of it)
- Melatonin 3 mg during the stimulation cycle
- Vitamin D
- No alcohol and cigarettes two months prior to stimulation cycle
- Less sugar, if possible switch to slowly digested carbohydrates
- Natural foods, not processed and pre packed
- Avoid trans fats
- Lots of green veggies
- New position at work with a boss that knew exactly what I was going through. I didn’t feel comfortable sharing this information with the boss I used to have during the first three cycles, so this added more stress in sneaking out for checkups, come up for excuses for egg retrievals etc. If it is possible, I would always recommend informing your boss and closest colleagues on what you are going through
- I took days off work around the main IVF related events, one week for the egg retrieval and one week for the transfer. I think this gave my mind space and calm to let my body do what it needed to do
- I practiced some form of yoga every day. Sometimes it was just sitting in Child’s Pose for 15 minutes, while sometimes I immersed into full blown Power Yoga flows
- Connected to the yoga I always made sure to meditate. I even got “fertility enhancing” crystals which I put on my belly during the meditations. I’m not saying that crystals works, but for me it was a way to feel calm and have faith in my body
I deeply hope this post helped you in some way. Please share it with people you know going through infertility. This journey is not a fun one, but together we are stronger and I am glad to answer any questions that you may have. Feel free to reach out in any way you prefer:
Through mail: [email protected]
Through Instagram DM: @Olgaringquist
Through Facebook: Olga Ringquist