Archive | March, 2014

Locked and loaded

31 Mar

So I’m home after the TAC and the baby is locked and loaded. Very pleased!!

The operation went well, although the surgeon said it was more complex than expected due to a fibroid being right in place where the stitch  normally goes. Plus a tilted uterus and non-standard anatomy, but afterwards he said it was fine. I have 21 metal staples in my tummy now! Recovery was… honestly… pretty painful. I did take some morphine, but moved to codeine the second day and then just paracetamol.  Just home today after 3 nights in hospital.

The surgeon told me that he had a 100% success rate with patients like me!! However he did say that was statistically unreliable as there are so few examples, but he was really positive. He did give me lots of information about how much better it was to have the TAC done pre-pregnancy… not terribly helpful at this stage!

They scanned the baby before and after and said it was looking perfect, but the consultant who saw me on Sunday managed to get me into the closed EPU (Early Pregnancy Unit) and did a scan for reassurance so I got another look. I was bloated like a whale, and all swollen up from the surgery, but she persevered and found the baby and it was there with a lovely strong heartbeat. At this stage you don’t need to see the heartbeat though, you can tell it’s happy from all the bouncing around it’s doing!

I was nervous about the hospital experience as it was the first time I was going to be in a ward, but it was actually perfectly ok. A bit noisy, but they had a really strict visitor policy so only from 3-8.30 which meant the rest of the time was pretty quiet. There was a bell like in a pub at last drinks! Staff were lovely, and food was acceptable, but I barely touched it really. It was a gynae ward, so all women, but they brought in some female admissions from the emergency room late on Friday and Saturday nights. In both cases the patients were as considerate as possible, but you do hear everything and someone non-stop throwing up is slightly distracting! But I wasn’t sleeping that much really so it wasn’t too bad.

The operation has been a bit more of an ordeal than I was expecting to be honest. I have incredible RESPECT for women who do that and then go home to care for one or more kids!

I’m hoping that I’m not just pathetic, but that it will be easier next time when I can take proper pain killers and am not dealing with early-pregnancy fatigue and symptoms on top of it all. I’m pleased today to feel more pregnant rather than just post-op’y. Bit of nausea, tired and mild bloating (like I had all through the first 12 weeks) which somehow feels different to the intense nausea, fatigue and massive bloating after the operation.

And finally, to liven things up – a few pictures of baby Martin. 🙂

Baby2 Baby1 - fibroid

 

The fibroid is 3cm so looks huge on this scan, but it shouldn’t grow during the pregnancy so will quickly become less of an issue. Poor baby was having to dodge around it at the moment though.

Transabdominal cerclage

27 Mar

Just a quick post on the next operation, hopefully the last in a while.

What is the surgery:

When I had the trachelectomy the surgeon put in a vaginal cerclage. This is a stitch to give additional strength to the cervix and it is placed somewhere roughly where the cervix used to be. During last year when I had the additional operations they decided to remove it as it was causing me some trouble.

Once I was confirmed as pregnant, the doctors advised that I needed to get it put back in asap. However this new doctor is a big advocate of the more invasive, but much stronger version that is placed via the abdomen. I was a bit surprised at this but in another way pleased as the success rates seem much better. The doctors will cut down to the uterus, and then stitch in some surgical tape around the base of the uterus/top of the cervix.

This surgery is not very common, but has been done on a lot of women who have experienced cervical incompetence for a variety of reasons. It seems more popular in the US at the moment, and certainly more of them have been done than the other surgery I had. Sadly most ladies find out after multiple late term miscarriages, but I know of the risk in advance.

Cerclages

 

The surgery is done much like a C-Section, and will actually be my first open surgery. It can be done laproscopically, but not by my surgeon and the success rates are quite a bit lower (95% vs 75%). Plus this is on the NHS so my choices are more limited! However, I’m really happy to be getting this done, and I’m glad I didn’t have to try and fight for it. With this abdominal cerclage in place I should have a normal pregnancy, and with the weaker cerclage I would probably need extended periods of bedrest and still lower changes of making it to term.

Why do I need it:

Simply put my cervix isn’t strong enough to hang onto a baby long enough for it to survive. It’s been mostly removed and what is left isn’t visible enough to put the cerclage in vaginally. Once the baby starts to get bigger and put pressure on the cervix there is a good chance it would just give way, and I would suddenly find myself giving birth.

Cerclage2This type of cerclage is permanent and will remain for future pregnancies. This obviously means that my cervix can’t open naturally during labour, and so I will be having a c-section. That was always going to be the case as  I think my dodgy cervix couldn’t be trusted with the job anyway!

Interestingly today I had a scan showing that my cervical length is actually 2.3 cm, which is better than expected. It  may be that all the scar tissue that has caused me problems has actually helped by re-creating some of the old structures of the cervix. This makes me slightly wonder if this surgery is totally necessary, but the results are good and the extra security is worth it.

Surgery and Recovery:

I’m headed into Chelsea and Westminster hospital tomorrow (28 March) and will be there for 2-4 days, then back to recovery at home.  Under the care of Nick Wales. I’ve been advised to take 4 weeks off work, I think partially to recover from the surgery, but also then to give the cerclage a few extra weeks to 100% heal and gain strength before the baby gets bigger and puts pressure on it.

I have to say I am not in the slightest bit apprehensive about this surgery, other than the risks to the baby. The baby will get some of the anesthetic, but it will be proportionate to it’s body weight, as my body will spread everything equally to all the cells, and the baby obviously has less cells. They say the baby will just fall asleep, and will be monitored all through the surgery as well as after.  I’ll try not to go crazy on the painkillers after, which is a pity as I love a good opiate!

I just want to get this done and get to week 16 with a safe and secure baby, and then have a boring and uneventful pregnancy. The baby is due on our wedding anniversary 8/10/14, although it will probably come earlier. A lovely coincidence.

p.s  Sorry for all the postings! I’ve been holding back for a while!

Pregnancy and cancer

27 Mar

I’d like to add a little something here. I have listened to so many pregnancy announcements which for me were tinged with pain and sadness (and bitterness if I’m honest) as we have been through this process, so I know this news can be hard to hear. Especially for ladies who have been through cervical cancer and haven’t been as lucky as I have.

I’m not going to say ‘it’ll be fine’, or ‘just smile through it’, because sometimes you just want to punch someone who says that! Just know I’m thinking of so many of you, and I know this may be bittersweet.

 

IVF3

27 Mar

Bet you thought you had heard the last of me! This is a post that I wrote a few weeks ago, but only uploading it now.
IVF 3:

You may remember IVF 1, and there was an IVF 2 in October this year that didn’t work. IVF 2 didn’t fail in the normal way, as there are still 3 little embryos that were created, but the cycle was cancelled after egg collection as they couldn’t find a way to return them into the uterus. This was despite a recent operation to dilate the opening. So we now have a dozen frozen embryos living in the Lister hospital!

I referred to these operations and IVF 2 in this post, but the operations were both for fixing the problem I had with my monthly cycle as well as getting access for IVF.

IVF number three really started early in December. I had another dilatation operation with Professor Shepherd on December 3, and he stitched in part of a small catheter to try to keep the cervical canal open. All went well (I’m used to that operation now!) but just a few days later, while we were out on a Santa pub crawl, I suddenly felt something strange, and the catheter basically had fallen out. It was like a punch in the stomach. Made harder by being out having fun, when I just wanted to go home and have a good cry. I was also a bit lost as to what to do. I knew insurance wouldn’t pay for another operation, but if the clinic couldn’t get access then they just wouldn’t try again. Anyway, we had an appointment back at the Lister Clinic a few days later and had a chat to the IVF doctor. She was disappointed to hear it had fallen out, but said we could think about a frozen emrbyo transfer in Janary anyway. But, since very little had really changed, I didn’t really see the point! We left feeling pretty deflated without much hope.


 What is the problem? A little bit of info about IVF will help.

IVF is a three step process. 

  1. The woman injects a combination of drugs for somewhere between 2-6 weeks, depending on whether you are doing a long or short protocol. These drugs force the ovaries to produce lots of follicles, each hopefully containing a developing egg. They do this to give you the best chance of one sucessful embryo. Normally you just have one single egg a month. You are monitored by regular scans, usually every 2-3 days towards the end. Then you are given a ‘trigger shot’ which pushes the final development. 36 hours later the eggs are surgically removed via a giant needle through the side of the vagina. They drain the fluid from each follice, and hope they catch the egg. This is done under anaesthetic, sometimes a general and other times ‘sedation’ where you sort of drift away but are awake. 
  2. The eggs are taken to meet sperm ‘in vitro’ (in glass). Either just by putting them together and letting them get jiggy with it, or via ICSI where an embryologist picks a specific sperm and injects it into the egg. That is known as day zero. On day 1 you find out how many fertilised to create embryos, then wait for 3-5 days biting your nails and going insane. 
  3. The best embryo(s) is chosen and put back into the womb. This procedure is similar to a smear test. They gently push a catheter through the cervix, and place the embryo in the right place.

My problem is step 3. The cervix is easy to find normally, but since my surgery it seems the normal markers are gone, and for a while there was scar tissue that had actually blocked it. The small operations were to try to open it up further, to clear out scar tissue, and try a few options to hold it open so that scar tissue will form around the istmus (cervical canal) instead of closing it up. Until they doctors can get access to do step 3 they refused to start the IVf. Then in November they said they could get access, did step 1 and 2, but by step 3 said it had blocked up again! Frustrating…


Back to the story! Co-incidentally, at the same time I actually had a long awaited appointment for IVF on the NHS. I met then on 13 Dec, and came back on  20 Dec for another dummy embryo transfer, which is when the doctors try to get access to the womb as per step 3 above, but without the embryo. The doctor there was on a mission to prove he could do what the Lister clinic could not! The process took about two hours, and ended up with me taking a fair bit of gas and air as it got more and more painful. BUT – it worked! They suddenly found the access, and the doctor virtually high-fived the nurse!! An odd experience if I’m honest… They then tried to talk to me, but I was pretty out of it by that stage, but very pleased. I saw later on my notes that there is a little map with an x marking the spot!

XmarksthespotSo, after so many months with the Lister, we decided to give this new clinic a go. I liked the strong optimism and hope they managed to re-create, which had been beaten out of us for a while. Plus this was a fully funded cycle, meaning we decided to do one more fresh cycle. Starting on 1 January I did a short protocol, using a very high dose of Menopur, and Centrotide. I think it was 2 shots each day, and things went as normal. 2 weeks of stimulation, trigger shot and EC took place on the 15th of January. EC wasn’t under general anaesthetic which was a new experience. They sedated me, which makes you very hazy, but I do remember the process. Not too bad, although I was pretty nervous about it.

Then we entered the unchartered territory of letting the embryos grow. I had 9 eggs, 8 of which were mature. They were all ICSI’d, and one didn’t survive the process. Of the remaining 7, 2 didn’t fertilize properly, so we were down to 5 by day 2. It’s so stressful!

By day 3 there were still 5, but only 3 looked ‘right’. Normally with only three they would put a couple of them back there and then, but I am only allowed a single transfer (long story), so we took the scary decision to give them 2 more days to get to Blastocyst. You can’t transfer on day 4, not sure why.

On the 20th we didn’t get a call and I was convinced they had all died. When we arrived they told us we had 1 little embryo which had made it to Blastocyst. It was a surreal experience really. The embryologist talked us through where the embryo was at, and showed us some general images, but not our own embryo. I was convinced they were all quite poor, but they decided to put one back anyway just to give something a chance. Then next thing I’m signing a form agreeing to allow the remaining 4 to ‘perish’. Its sounds so silly, but it felt sad to say goodbye so soon!

5 Day blastocyst

5 Day blastocyst

The actual transfer was a non-event after all that prep! The map clearly worked, although I was encouraged to take some nitrox anyway just in case it was painful.

Then you are sent home to relax for a day, then go back to normal. Normal?!!?? Let me tell you that there is no ‘normal’ in the 2 week wait. The first week I was ok, lots of strange cramps, but that can be caused by your body just recovering a bit from the IVF process. The cervix has to relax back and close, and your womb is dealing with something going on… hopefully…

The second week I was a wreak. I was taking progesterone, which is the hormone that causes all the normal pre period symptoms (bloating, breast changes, headaches, moodiness) and also all the normal early pregnancy symptoms (bloating, breast changes, headaches, moodiness) so it’s very hard to know if any symptoms are pregnancy or period!! And I was analysing every twinge, every feeling, every minor change going on in my body. It drives you slowly insane!

The day before I’d decided to test I was also on a strange work course all about maximising your potential, where we were expected to talk about what personally motivated us, what crisis we have faced and how we recovered. I can tell you with certainty that is the LAST thing you should do when charged up on hormones, stress and fear! There may, ahem, have been a very embarrassing moment of near tears in front of my colleagues… followed by a proper cry on the tube. I realised I had to test to sort out my sanity if nothing else.

My official test day was meant to be 2 weeks after the transfer, but I knew that I should get a result one way or the other a few days earlier. Plus the OTD was a Monday, and I couldn’t face a negative test and then going to work. So, 1 Feb, I woke up at 6am and worried for a while. Then worried a bit more, and procrastinated. Finally I had to get up (largely driven by an impatient bladder), had another little cry, and then pee’d on a stick. And I watched nothing happen… I watched that stupid control line appear that I had seen many times before, and then… and then… amazingly, miraculously, wonderfully, a second line slowly began to appear. Pale, but definatly there.

FRER

Shock

With shaking hands (not a cliche in this case) I got out the posh digital test, and tested again.

Digi

OH MY GOD! This is an everyday, perfectly normal event that the vast majority of women will experience in their lives, but still a wonderful overwhelming magical moment. After almost 4 years of heartbreak, 3 IVF’s, a little bit of cancer – there was that elusive second line. I didn’t quite believe it, so a checked a few extra times. 😉

Tests

Baby brain already kicked in by the last tests. Date should be 6/3/14, and the last one who knows!

So here we are! I’m 10 weeks pregnant now, and just had another look at my little resident. I’ve had a few scans, a bit of a scare with some bleeding, but now he or she seems to be settled in (its definitely only one). There is still lots going on medically, and I will blog about the upcoming next steps, which are unconventional to say the least, but right now I’m just an everyday normal pregnant woman and we are both so happy to have this chance. It’s just so amazing and wonderful (and scary, and stressful and terrifying) but mainly wonderful!

Update: Actually I’m now 12 weeks, I couldn’t bring myself to post this until this latest round of tests were completed. I still can’t really believe it. But the baby passed all tests today with flying colours, and operation ‘lock that baby in to cook for 6 more months’ starts tomorrow. Literally an operation… which I will post about soon.