Today, on Easter Sunday, it feels appropriate to be sharing a story of a different kind. A story of trial and tribulation, and ultimately hope and joy, that begins on a microscopic scale. This is not a birth story; it is in fact a conception story, a very special one because it comes from my dear friend Ruth with whom my teaching career began.
“Let me start by saying that I'm a secondary science teacher. Every year a brand new intake of year 7 students arrive and we embark on a unit all about human reproduction. Each time we learn that when 2 people have sexual intercourse at the 'right' time in the woman's monthly cycle, one lucky sperm will wend its merry way through the reproductive equivalent of the Krypton Factor and find itself gaily burrowing headfirst into the lucky egg. Nine months later, bish bash bosh - you have yourself a bonny baby boy or girl.
Only it doesn't always happen like that. You find this out at GCSE, but that's another story.
Having decided that we were at the right stage in our lives to start a family and all clued up on the ins and outs of the reproductive process (if you'll excuse the turn of phrase), we set about procreating. For the first few months we laughed and joked about the fun we were having trying and our monthly failure to 'catch on', but the jokes soon began to sound forced.
"Stop thinking about it and it'll happen" was the frequent advice we read for struggling would-be parents. As if it were that simple. Having waited until our mid-thirties to get cracking on Project Family - and knowing I had wanted kids since my teens - thinking about it was pretty much ALL I did. Every month I felt that familiar 'tug' in my uterus and knew that I had yet again failed to provide a hospitable environment to nurture a tiny human being. At least that's what I went through my head each time. I felt each and every period was Mother Nature taunting me and that the stumbling block must be something within me. I felt let down by my biology.
After a year (ok, slightly less, we were getting impatient), we went to our GP and were immediately referred for tests and to our local Assisted Conception Unit (ACU). Amazingly, one of the blood tests I had took six weeks to complete, so we faced an agonising wait until we could get the results. As it turned out, (a) there were far more agonising waits ahead, and (b) my GP had sent me for the wrong tests, so I had to have a second set and wait another six weeks.
In fact, in the end, the second tests were fairly academic. My OH's sperm tests came back and revealed a sperm count "lower than a badger's ball sack" (his words). He was advised to quick smart it to the nearest freezer and get a sample in the chiller ASAP before his count hit rock bottom. Meanwhile, we were added to the IVF waiting list.
Never has a list been more aptly named. Waiting is pretty much all there is too it. At this point, many couples suddenly conceive as the responsibility has been taken out of their hands. I suppose in the back of my mind (ok, the front, let's not split hairs...), I wondered if we'd be among them, but waiting is what we were destined to do. Further tests on my OH revealed an army of antibodies clinging to the tails of his sperm, effectively hobbling them and stopping them from getting anywhere near a sniff of egg action. We discovered later that this is likely to be due to exposure to mumps as a child. In a nutshell (literally), the mumps virus causes breakdown of the barrier protecting the testes from the body's immune system. This means the body effectively attacks the sperm, as a strange quirk of nature is that they are treated as "foreign" by the body.
Cut to 9 months later (if ONLY we'd been able to do this in real life...) and we received the call we'd been waiting for - we had reached the top of the list. We were both elated and nervous for what lay ahead. I did a bit of "IVF maths" and worked out that we could complete a cycle of treatment and find out if I was
pregnant just before Christmas. With this in mind, we booked Christmas away - at my Uncle's chalet in the Alps - to console or congratulate ourselves, whatever the outcome.
At our first appointment at the ACU, we realised that my calculations were overly optimistic. The Christmas shutdown was far longer than I anticipated and we would have to delay starting the fertility drugs to avoid clashing with the festive lull. Regardless, we left having signed a huge pile of paperwork, with instructions to call in a month or so to be booked in for a "day 21" (of my cycle) appointment.
This was the big one. The beginning of treatment proper. We were given a purple case full of needles, syringes, alcohol wipes, a sharps bin and a vial of the first drug - Buserelin. For the medically-minded amongst you, Buserelin is a gonadotropin-releasing hormone agonist (GnRH agonist). In English, this means it prevents the production of hormones in your body that control the manufacture and release of eggs from your ovaries. This sounds counter-intuitive, as you *want* to produce lots of eggs, but that comes later. For now, the idea was to effectively trip the switch and shut down my natural cycle.
There are definite down sides to the Buserelin. For one, you have to inject it. I think this was the thing I was most apprehensive about. The first time we were shown how to do it, my fiancé did the honours. This decision was based on the fact that he had previous experience in this area. Well, he had injected our pigs on occasion, but this was still better form than I had, so he was deemed the expert. Having administered the first dose at the hospital, I immediately burst into tears. Not because he had hurt me, but because I was so overwhelmed by having finally started the journey. After that, I realised having someone else inject me daily was going to be somewhat prohibitive, so I resolved to do it myself. To be fair, it's not fun, but it's doable. As long as you have an inch to pinch, there are few nerves to interfere and you work out quickly enough what works for you. You have to do it at the same time every day, wherever you are. I think a low point for me was "shooting up" in the toilets of a train station, but you get used to working around it. On the plus side, there are no contraindications with alcohol, so I took advantage by having a few Christmas tipples.
The shut down process takes around 2-3 weeks. After this time, you start another set of hormones, this time to stimulate your ovaries to mature enough eggs for harvesting. The second drug was a synthetic version of a hormone called follicle stimulating hormone (FSH) called Gonal-F. It does what it says on the tin - it stimulates your ovaries to produce mature follicles containing eggs. However, joy of joys, you have to keep taking the Buserelin, so I was now doubling up the number of daily injections. There then followed a period of a week or two where we had to keep returning to the ACU for ultrasounds to determine the progress of follicle development. The first time you get to see your own ovaries on screen is quite interesting, but by the 11th time you are strapped into the chair with your legs up in stirrups, the novelty has passed.
I think this was the most stressful time work-wise for me. As a teacher, I was unable to take flexitime and was still responsible for setting cover work for my classes when I had to go to the hospital. There was a week where we had to go to the hospital to be scanned every day and the stress of running backwards and forwards while trying to keep on top of work commitments was taking its toll. On top of that, I was tanked up to the eyeballs on hormones, so I was incredibly emotional and found everything overwhelming. Luckily my head of department was brilliant and having had a bit of a meltdown after one of my Year 10 boys pushed one too many buttons, I told my department who rallied round to support me. Of course, they'd all noticed that I'd been off a lot, so we're somewhat relieved to find out the truth - they all assumed I was seriously ill.
At each ultrasound they were looking for my follicles to be large enough to initiate harvesting. If I remember rightly, this was around 17mm per follicle and they are looking for around 6-8 on each ovary. Many more and much bigger than this, and you are at risk of ovarian hyper-stimulation syndrome (OHSS), so I was relieved to have managed 9 on one side and 8 on the other. At this point, we were given a lethal looking device housing the final injection. This contains human chorionic gonadotropin (hCG), a hormone that in the normal scheme of things matures the egg and stimulates it to be released. Obviously timing is
crucial, as you don't want to release the eggs, just finalise them ready to go. We were told to administer the shot 36 hours before our harvesting appointment. This meant that for a noon appointment, we had to wait up until midnight to do the injection. Jab done, we handed responsibility over to the professionals.
Despite being NHS funded, we were sent to a private hospital in Manchester to have my eggs harvested. We were settled in a private room where I was told to get into a slinky backless number, which I nattily accessorised with my own dressing gown and slippers. I felt distinctly odd shuffling down the corridor to the theatre. It's certainly the first time I've been in a lift in a nightie. Once in theatre, the anaesthetist told me he would be sedating me with Propofol. I just about had time to think "I'm sure this is what killed Michael Jackson" before I blacked out. The egg retrieval is quite a delicate procedure. The doctor uses ultrasound to guide a hollow needle through the back of your vaginal wall into each follicle in your ovaries (don't think about it too hard). They then vacuum both the liquid and egg out of each follicle and place it in the famed test tube (actually it's more of a Petri dish, but "Petri dish baby" obviously never caught on).
When I came round, I was back in the room upstairs. I turned over to see my other half sat next to the bed. "Have you done your bit yet?" I said. "For the LAST time, YES!" Came the reply. Apparently, I had been asking him the same question repeatedly for the previous 15 minutes. I have absolutely no recollection of this. That Propofol is seriously strong stuff!
The next bit all happens behind closed doors (much to my geeky disappointment), but the gist is this. In traditional IVF, a set concentration of sperm is added to each egg-containing dish and nature (insofar as possible) is allowed to take its course. We were advised to go for a slightly modified version of this procedure called ICSI (intra-cytoplasmic sperm injection) whereby a single sperm is injected into each egg, but the desired outcome is the same - as many fertilised eggs as possible.
As a scientist and an engineer, we were all about the numbers and statistics, so having produced a good haul of 17 eggs, we were slightly downbeat on finding out that, despite physically injecting the sperm into the middle of each egg, only 14 had fertilised. However, this still seemed like good odds. But over the next few days, each morning brought news that several more fertilised eggs (now called embryos) had dropped off the proverbial perch. Day 5 is the usual timeframe for transferring the embryo(s) back into the uterus as this is the day they enter the next phase of growth, called the blastocyst stage. Incidentally, growth beyond about day 6 is currently not possible as the nutritional needs of the blastocyst become more complex than scientists can currently simulate in the lab.
