Infertility, Ivf

Are we done yet?

When I embarked on this journey, I never would have thought that I….


First of all, I never would have thought I would embark on this journey… Could have never seen this happen to myself, or myself being able to cope with it.

This infertility struggle is hard, unfair and hurts you precisely when you expect it the least. I still to this day wonder how come women who do not have any wish for children find themselves pregnant as soon as they are sneezed upon, while others have to fight for years to an end to achieve a dream that should be their birthright. I certainly asked myself the same question not that many years ago, from a different position-the position of the one getting pregnant on the pill. Little did I know life would soon place me on the other side of the barricade. Not that back then I felt less frustrated, mind you :))

Anyway, the point is that these days I am bitterly celebrating three years in Assisted Reproduction hell. Is it enough? Is it too much? Should I go on? When should we say enough is enough and frankly, ARE WE DONE YET? Cause I would love to make my life again about other things than OPKs, 2WW, BFNs and you name it.

At this point in my life I would have completed (please sit down) 7 IVF cycles, 6 IUI cycles with full IVF protocol, 2 Clomid cycles, 5 Femara cycles, and numerous natural TTC cycles. All those in a 3 years bracket, with all the hope, deception, rage and frustration they brought upon me. My last IVF cycle is barely over, and I am still into my 2WW-so you will say I am jumping the gun and speaking as if I knew this cycle too was doomed. The truth is, at one point it’s getting harder and harder to keep your spirits up, positivity starts to appear silly and at the end of the day it’s probably an instinct, as if to save you from the heartache that invariably follows the broken dream of yet another month passed with nothing to show for it.

For the last couple of cycles I have been telling myself: this one is my last. And yet I would find rays of hope and the courage (or craziness) to try again, for (yet another) last time.

But when do we say “no more”?

Some stop when they run out of funds to finance their journey. This is a very important aspect because infertility is not only heartbreaking and a burden on one’s mind and body, but it also destroys your budget and eats up your savings. For them in this category, the decision is easier made, for once you’re out of cash, there’s no point in asking when to stop, you know you have to do it, and here is your bank account making your decision for you. Frustrating but undebatable.Some stop when they can’t take no for a pregnancy test anymore. Repetitive failures to conceive may dig deep into your self esteem, damaging the zen of your couple and your relationships with other people around you (especially the luckier ones, and especially those who were not even remotely interested in having yet another baby, and keep whining about “these things happening to them”)

Some stop when they realise this hunt for the golden egg takes too hard a toll on their marriage. Because this is another taboo people usually do not wish to discuss: a process supposed to bring a couple together gets people apart. Intimacy is lost, desire diminishes, pressure builds up, and what was supposed to be an act of love in the pursuit of the fruit of love itself, becomes-let’s face it-a fixed schedule of lovemaking, timed by hormone levels and subcutaneous shots. And this is hard. What may start as being funny (we have to have sex NOW, I have a positive OPK) becomes a self imposed task a couple of cycles later. You eventually begin to forget yourself as a couple, and your sex life starts to be measured in ovulation tests, sperm morphology counts and number of follicles retrieved. And that’s harsh!

We are not trained for that, we grow up being told getting pregnant is easy peasy, why… everyone gets pregnant, especially when they don’t want to, so when it doesn’t happen for us, and we have to fight for it and pay for it too, it appears unfair and frustrating.

I know for me this is my last time doing IVF. Luckily it is not a matter of money, French basic insurance covers fertility treatments, or I would have never been able to have so many cycles so far. For me, having previously been confronted with loss and mourning, this infertility journey had me passing through all the stages of grieving, once more.

First, I was shocked. By shocked I mean I cried for two days in a row and lost a few pounds in the process. Don’t laugh at me, but this actually happened when I found out my AMH was 0.2….Now I know better but back then I was a sucker :))

Then, I was very excited for my first cycle, and perfectly sure it would work. How many times have you been told “never mind if you don’t get pregnant, you can have IVF”? Exactly! People outside this journey believe IVF is THE golden solution and it is infallible. Meh…Anger hit me hard when my first cycle failed. I was angry at my body, angry at my age, angry at the timing, angry at all pregnant women, angry at God. As if the whole Universe was against me.

A few failed cycles later anger left place to depression. I wouldn’t say I was depressed in the medical sense of the word, for I never needed medical assistance for it. But I guess I was this close…

And then a sort of shell built around me, and I became numb. I lost my positivity, for frankly how many times in a row can you fool yourself that this time is gonna be the good one? And I became convinced that it will never happen to me. And I didn’t care anymore. I mean I would do everything that needed to be done, like a robot, like a little infertility soldier heading towards another defeat.

Emotionally, I am sorry to report, I am still there. Numb, indifferent, unable to care anymore. But this time the little soldier lost its dedication. This time I surrender and I am neither ashamed nor do I feel guilty. I did my part, we both did our best. We have been together in this journey and we have supported each other but it is time for us to find ourselves again. If the Universe cares to surprise us with a (natural) miracle, we won’t say no to it 🙂 And if it’s not meant to happen for us, we surely will find other ways to grow together and love each other and enjoy what we have including those two wonderful children of mine that he adopted and loves as his own flesh and blood.

He deserved more, and I will forever be bitter about not being able to offer it to him. But I believe there are stronger forces than us up there, and they may know better than we do. And that what is meant to happen, will eventually happen.

For once I give up control, and boy do I feel free 🙂

Love and peace and baby dust to you all ❤


The CD 3 tests-how important and what do they predict?

If you are familiar with fertility treatments or  if you just had an assessment of your ovarian reserve because you are trying to conceive, the term “3 day tests” rings a bell to you.

Day 3 testing (can also be done and day 2 or 4) consists of bloodwork used to measure hormone levels (FSH, Estrogen, Progesterone, LH) and a scan, meant to measure the number and size of your Antral Follicles. Your AMH level can be measured anytime and if you need to have it measured more than once, it is preferred to do so using the same laboratory, because measurement scales vary for every lab.

E2 (Estrogen) is the main female reproductive hormone, it is being secreted by the ovary and helps to stimulate follicle growth and prepare the lining for implantation, in case conception occurs. The majority of the fertility clinics would want you to have an E2 level under 50 (some under 80) on your day 3. Too high an estrogen level on this day might suggest you have a cyst producing estrogen, in which case stimulation might not be advised. Feeding it stimulation meds, the cyst might not only “eat up” the meds destined for your other normal sized antrals, but also grow and grow until it bursts. A too low estrogen level is not ideal either, suggesting diminished ovarian reserve and possibly  peri/premenopause. Also, very important, when your Estrogen levels are high, the value of the FSH is artificially lowered.

FSH (Follicle-stimulating hormone) as the name tells us, is the hormone that stimulates the ovary to make the eggs grow. Released by the brain, the FSH tends to get higher and higher as we age, and our ovaries struggle more and more to produce an egg. The ideal FSH level is under 10, the lower the better. Some clinics would accept you for fertility treatments with an FSH under 15, but there are tons of studies out there showing success rates diminish seriously as 3 day FSH levels increase. That might explain why older women with high FSH have better chances getting pregnant naturally than with IVF treatments. This being said, if you need help to procreate, there are lots of clinics who offer natural IVF for women with high FSH-meaning no meds, egg retrieval for possibly just one egg, and fertilisation as needed (normal or ICSI, IMSI etc)

LH (Luteinising hormone) helps mature the follicle and eventually, when an LH surge occurs in the end of the follicular phase, helps the release of the mature follicle. The ideal level is under 7 mIU/ml with a ratio LH:FSH of 1:1. An LH much higher than the FSH might be an indication of PCOS (Polycystic Ovary Syndrome).

P4 (Progesterone) should remain low during the follicular phase (under 1ng/ml) and rise after ovulation, as proof the ovary released the egg. The low limit used as indicator for ovulation at 7dpo is 5, but the higher the better. Some women with low progesterone might need progesterone supplementation in order to maintain pregnancy.

AMH (Anti Mullerian Hormone) is a free circulating hormone released by the small antral follicles present in your ovaries, and it is used to assess your ovarian reserve, as in “how many eggs do you still have”. Taken alone, it doesn’t amount for much, and it is far more reliable when discussed in conjunction with the other day 3 levels, and most important, with the day 3 scan. Also, it is important to know that the AMH level has been proven to be artificially lowered by low Vitamin D levels.

Ovarian ultrasound/scan: it is meant to count and measure the antral follicles. The antral follicles are small follicles (between 2-10 mm) found in your ovaries at the beginning of the follicular phase. They are an extremely important and very useful assessment of the way your body might respond to fertility treatments. Each antral contains an immature egg that might develop and ovulate. During natural cycles, the body recruits what is thought to be the best follicle, and makes it grow and eventually ovulate once the Estrogen level is high enough (200-600 E2 level/mature follicle) and the LH surge occurs. In stimulated cycles, all antrals have potential to grow, and even sometimes, some more follicles pop up during stims.

Those are the main tests performed during the day 3 assessment. The list is not exhaustive, though. Depending on your clinic and your health issues, you might have your prolactin and thyroid levels checked, or any other test your doctor might consider appropriate.

Unfortunately, there are some clinics who perform this testing once a year, and consider it available in subsequent cycles. Whether for logistic or financial reasons, this is bad. Hormones fluctuate every God given month, and once you have your period, they are reset and you start the new month with a clean slate. It is possible to have an FSH of 6 in January, and an FSH of 14 the next month, and you surely won’t have the same response to meds during those two months if you are to cycle. Hence the importance of demanding those 3 day tests at the beginning of each and every cycle using stimulation meds, to spare you the heartbreak, the false expectations and yes, the waste of money.

In a future article I will bring to your attention a list of supplements with great effects on your fertility, and the links to the medical studies that attest it.