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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.

What does the Lymphatic system do? And how does it spread cancer?

7 Feb

First posted 3 Feb:

http://community.macmillan.org.uk/blogs/b/kaths_cervical_cancer_blog/archive/2013/02/03/what-does-the-lymphatic-system-do-and-how-does-it-spread-cancer.aspx

I’ve never really understood the lymphatic system. I know it exists, and I’ve vaguely tried to find out in the past, but it never really understood. However, as I about to lose part of it, I have made myself learn about it. Maybe most people know… but anyway, here is what I found out.

The Lymphatic System: 

 

The lymph systems includes a number of different thing that we all know about. Bone Marrow, spleen, various glands and the lymphatic vessels. They are like blood vessels, but apparently much thinner, and carry a clear fluid called Lymph.

Lymph fluid comes originally from blood. When the blood gets to your cells, some of the plasma ‘leaks’ out of capillaries to surround all the cells in liquid, and also to transfer food to the cells. This fluid then drains back into the lymph system, and waste from the cells is cleared out. The lymph system then brings all this fluid back up to somewhere near the base of your neck, and puts it back into your bloodstream.

Lymph Nodes

As the lymph is on it’s way back to the neck, it passes through various nodes, which perform a cleaning function. The nodes fight infection, which is why they swell up when you are sick, as they will be making lots of extra white blood cells to fight the infection in the various nodes.

All this is going on constantly, to ensure your cells are healthy and well fed, and that your blood is nice and clean. Another one of those quite amazing processes that are just part of our everyday living.

How does this relate to cancer. 

When the fluid goes past the cells, it picks up waste, but if your cancer cells are not well differentiated, parts of the cells also get picked up and can escape into the lymphatic system. If the cells are well differentiated, they are unlikely to ‘leak’ too many cancer cells, if they are moderately differentiated, then some ‘leak’, and if poorly differentiated then you have a higher risk of the cells leaking.

Mine are moderately differentiated.

This is technically a blood vessel, but the concept is the same. 

They then travel to the lymph nodes, and as this area is very densely packed with cells to clean the lymph fluid, the cancer cells can can stuck, and will then start to grow. I think it tends to get caught in the small lymph vessels leading into the lymph node, and will start to create a new cancer there.

So, clearly that is why the lymph nodes are checked. The tumor itself can only grow so far, but by hitching a ride in any fluid in the body it gets to other areas and can grow there.

This is a complicated process, and the body is keeping an eye out for rogue cells, so very few survive to make cancer in other locations. But as the cancer will keep leaking cells, obviously the risk increases over time. Also, as the cancer increases in size, it has more cells to leak.

Removing the nodes:

Here are the nodes I believe they are removing. The ones around the sides of the groin, which are the first stop for lymph fluid when it leaves the cervix are.

In this area are also some important nerves, and one of the risks is that they will damage these nerves. I believe this is normally a temporary thing as the nerves will regenerate, but it may mean some numbness when I wake up. I’ll still be able to control everything, just maybe not feel it properly.

So what happens if you don’t have lymph nodes?

I’m finding it hard to get a clear answer on this. The best I can find it that the lymph system will find it harder to drain, and lymph fluid may build up in the legs.

I suppose that happens because the vessels need to find a new way to get the fluid back to the neck. So I think the removal of the nodes isn’t really a problem, it’s more that channels have been cut. The nodes won’t grow back, but I guess the lymph vessels must regenerate, otherwise the fluid would go nowhere.

To me ‘swollen legs’ doesn’t sound too bad, but as so many people mention it I guess it must be quite a problem. The stockings you wear put pressure on the vessels, which assists it in moving the fluid around. (But.. how does that help if the vessels have been cut?? I’ll ask tomorrow. There must be more vessels left that it’s get re-routed to, but they are taking extra load so it needs help. Sound plausible?!)

This is a really long post, so I’ll stop here!