IVF: the two week wait (2WW)

You have just had your embryo transfer, taken a home pregnancy test and told which day to do the test now what?

Well the first day or two you are likely just recovering from the procedure. You may feel tired, bloated and have some abdominal discomfort similar to period pain. You may also suffer from mild to severe Ovarian Hyperstimulation Syndrome (OHSS).

You can use a hot water bottle to help with the pain but remember not too hot and not directly in contact with the skin.

You can take baths but not too hot. Sometimes it is recommended to resist the use of bubble bath during the next two weeks. Some research suggests that bubble bath can irritate your already delicate vagina and cause thrush or another form of infection.

Common questions:

I’m so bloated / Am I pregnant already?

It is normal to feel the size of a house and look about 5 months pregnant during the two week wait. You can thank good old progesterone for that.

You can drink herbal teas like peppermint to help combat the bloat. It is recommended to up your intake of water as this can help flush out any trapped fluids / constipation.

I’ve got terrible pain / discomfort in one or both my ovaries.

You’ve been through a lot the last few days and weeks. The stimulation medication will have left your ovaries slightly larger than normal (think tennis balls). This can cause discomfort and or pain on one or both ovaries. This symptom shouldn’t be ignored entirely as it could be mild OHSS. Sometimes (but it is rare) OHSS can be severe and lead to serious illness or death. Mild OHSS should resolve itself within 7-10 days (or by your next period if you are not pregnant)

If you are experiencing severe pain and any of the following seek medical attention:

  • rapid weight gain 15 – 20kg (33-44 pounds) within about 5-10 days
  • severe abdominal pain
  • severe or persistent nausea and vomiting
  • blood clots in one or both legs
  • decrease in urination
  • shortness of breath
  • tight or enlarged abdomen.

You can self-help with mild OHSS by increasing your fluid intake preferably with electrolytes. Rest as much as possible and increase your daily protein (at least an extra 60grams).

I have sore boobs / itching nipples

Once again our friend progesterone and the HCG trigger show injection are to blame. This may feel like a very very early sign of pregnancy which is driving you mad. Whatever you do refrain from doing you home pregnancy test. You could get a false positive due to the trigger shot days before.

I feel so sick is this normal

Remember you’ve been through a lot the last couple of days / weeks. You are likely to feel nauseated from the hormones you are still using. That combined with nervous excited can leave a nauseous butterfly sensation in your stomach. Try to eat little but often and plain foods if easier like toast. Also it is worth noting that early pregnancy can cause a decrease on your immune system making you susceptical to germs, coughs and colds.

It’s been a week and I feel like I’m about to have my period

Early pregnancy and your period have a lot in common with each other. Try not to focus too much on the cramping sensations just yet. It could be implantation which usually occurs about day 9. Implantation can cause bleeding (but not everyone gets this). It is usually brown in colour. Some ladies have a little spot of blood in their pants and others a little bit more. Bleeding can last a couple of hours to a day or so. If the flow has increased and / or you are starting to fill a pad every couple of hours unfortunately it is likely your period has arrived. Still wait until test day just to confirm.

Try not to focus on the implantation bleeding if you haven’t had any and your on day 10-12. Not everyone gets this.

I feel pregnant already should I do my test early?

You should only do your test on the day that the clinic told you. This is because they have worked out approximately 14 days after transfer is when the artificial trigger shot of HCG should be out of your system. If you have fallen pregnant your ovaries will take over the production of HCG and this is what is picked up on a urine home pregnancy test.

Can I go on holiday during my two week wait?

Yes, why not. You may feel a tad uncomfortable first couple of days after the transfer. Whether you want to go abroad for a week or just have a long weekend away with your significant other anywhere where the two of you can focus on one another is nice.

Can I have sex during two week wait?

Yes, however if it is uncomfortable hold off for a bit until you feel ready.

Is it true I should only use the first pee of the day for my test?

Yes and no. If you are pregnant the test will say so regardless of when you pee on the stick. It is true that the concentration of the pregnancy hormone HCG is slightly higher in your first urine of the day.

Help the line is really pale does this mean it’s negative?

No. Some tests are much more sensitive than others. If you can see the additional line regardless or dark or pale you are likely to be pregnant.

Some ladies rush out and get brands such as clear blue with digital indicator. These tests are the same as the cheaper versions but actually say pregnant or not pregnant.

My test was positive now what?

Congratulations you are pregnant. Now you need to ring the clinic. You will be asked to pop in. You will be given your maternity file notes and additional progesterone if required. You will likely be booked a viability scan for around week 7.

My test was negative

Unfortunately for some this can happen. You will still need to phone your clinic and let them know the outcome. You will still need to take your progesterone until advised when to stop.

I feel alone and ignored by my clinic

Now that you are in the two week wait you are left in natures hands. You have likely had daily contact with your clinic over the last few weeks and now feel abandoned. It is true that you don’t really speak to the clinic but the nurses are available to answer any queries you may have.

There are several support groups on social media available from Facebook to instagram. You may enjoy the silence and peace or you may wish to speak to ladies in a similar situation.

Katherine xo

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IVF: embryo transfer

Whether you have had a fresh cycle or frozen cycle the procedures are very similar.

Progesterone

You will have likely started using progesterone pessaries with the first one inserted just after egg collection. The pessaries are normally recommended for rectal insertion until after the embryo transfer. This is due to them leaving a waxy residue which can make embryo transfer difficult if this is in the vagina.

The progesterone is provided to help keep your endometrium (uterus lining).

The procedure

You will speak with your embryologist prior to going down to theatre to discuss the quality and quantity of embryos for transfer. It is recommended for one embryo to be transferred regardless of age to minimise the chances of a multiple pregnancy. (Read here for more information of choosing number of embryos)

You will arrive at the clinic once again and escorted to a cubicle with your partner in attendance. You will require a half full bladder for this procedure and depending on the length of wait can become uncomfortable.

You will walk down to theatre (or wheeled depending on the clinic). You will remove your dressing gown and pop onto the bed. You will be asked to lay down and place legs into the stirrups. Your bottom half will be covered with sheets and your abdomen temporary exposed whilst they pop some lubricant on for the ultrasound scanner. Your bladder will be checked at this stage to make sure it is full. The full bladder helps with embryo transfer. You will feel some slight discomfort from the pressure applied.

Your partner is able to attend theatre with you and they will sit just next to your head and hopefully hold your hand throughout.

The embryologist will repeat several times the process and ask you to confirm your full name and date of birth a couple of times throughout.

You will be shown your embryo(s) on a television screen just before transfer.

Will it hurt?

Yes, it could hurt depending on your personal threshold of pain. For most women the procedure is like a very uncomfortable invasive smear for others its sharp or dulling ache in the lower abdomen.

You won’t be given any medication or sedative prior to embryo transfer.

The transfer

You you have a practice transfer using saline solution before the actual insertion of the embryo(s). This is to check that the tubes are clear. Once you have confirmed your details and seen your embryo(s) on the screen the transfer will begin. You won’t actually feel them insert the embryo(s) as it is so tiny.

Afterwards the tube and vagina clamp will be removed. Don’t feel ashamed if at this stage you feel like you’ve just relieved your bladder all over the bed. It is actually the residual saline flush escaping.

You will be helped off the bed and shown an ultrasound of your uterus before and after the embryo transfer. This may look like a little flash of light on a dark background. You will probably be thinking of nothing other than going to the toilet at this stage so probably I’d your head and go ‘oh yeah, wow’ it’s not that your ungrateful but you are likely uncomfortable from needing a wee so badly.

You will pop back into your cubicle and asked to rest for a little while. Have a drink some biscuits pop to the loo again and the. You will be allowed to return home (or to work).

You will need to continue taking your progesterone pessaries and can start vagina insertion if rectal had caused discomfort from constipation.

You are now on your official two week wait (2WW).

Katherine xo

IVF: egg retrieval process

You’ve done your stimulation injections and now you’re going onto the next step but what it is?

Up to 48 hours before your procedure you will self-inject with HCG hormone to help release your eggs.

You will arrive at the clinic about an hour before your allotted time slot. Change into a theatre gown and have a cannula fitted and left to wait. You will hopefully have a partner there for support. Your partner (if applicable) will provide a sperm sample whilst you are in theatre, this will be cleaned and combined with your eggs for fertilisation latter in the day.

You will likely walk down to theatre and be asked to remove your dressing gown and lay on the bed. The anesthetist will inject several items through your cannula one is a saline solution to flush and make sure your vein is ok. You will be given anti-sickness medication and some sedative. The sedative is designed to help you relax and doesn’t take away any pain. For some ladies the sedative can make you groggy or fall fall asleep but not everyone is lucky to experience this.

Will there be pain?

Yes, you could experience pain or mild discomfort this is very much dependent upon your personal pain threshold.

You will be given some sedative which is designed to help relax you and is not actually pain relief. If you experience some significant discomfort you may be topped up.

What will it feel like?

The procedure itself starts of feeling like a very invasive smear test. The consultant will use long medical needles to extract your eggs from their follicles. These are inserted into the vagina and up to your ovaries guided by ultrasound. The first needle may take you by surprise and can be uncomfortable or painful. Depending on the number of follicles (which would have been stated during your intravaginal ultrasounds days before) will depend on how many times the needle is inserted. Remember if you have follicles on both ovaries the procedure is repeated on both sides.

If you are not great with pain please speak with your consultant before the procedure. You will find it better to try and relax during the procedure. The more relaxed you can try and make yourself the less tense your uterus will be. You could be in theatre for up to 20 or so minutes.

What happens after?

Your stomach will be wiped down from the petroleum jelly used for the ultrasound. You will then be wheeled round to your cubicle to your awaiting anxious partner. You will be helped from the bed into a reclining chair / bed (depends on your clinic). You will be given a couple of blankets to keep warm and left to rest for a little while.

You may fall asleep which is a normal side effect from the sedation. You will likely feel cramping from the procedure which ranges from mild to severe menstrual type cramps. You can take some paracetamol for this later if not already provided some. Some ladies are given a small dose of codeine with paracetamol. Again the combination depends on the clinic.

Once you’ve rested a little while you will be asked to drink and eat something as well as go to the toilet. Only when you are able to do these will the cannula be removed and you will be able to go home. Before you finally go home the embroyogist will speak with you to remind you how many eggs they were able to collect and let you know the next step.

Some ladies are able to go back to work but it is recommended that the day if egg collection you are able to go home and rest. You will likely feel sore and uncomfortable – a bit like the build up to Aunt Flow (AF) arrival. You can use a hot water bottle on your stomach just make sure it’s not too hot or making direct contact with the skin.

The following days afterwards

You should be able to resume normal duties the next day albeit using some mild form of pain relief like paracetamol.

You should receive a phone call from the embryologist (usually between 9-10am) the next morning to let you know how many eggs fertilised over night.

You will then receive regular telephone calls to give you an idea of how your embryos are developing. The embryologist will inform you or the days they will call and then next steps. If you have any questions don’t hesitate to ask them.

Some outcomes are not as positive as others so you will need to be prepared for all types of answers which include:

  • Unfertilised eggs
  • Low quality of eggs fertilised
  • All eggs fertilised
  • All eggs fertilised to move straight to freeze cycle
  • Embryos not developing as well as should or stop cell division altogether
  • Embryos develop well and cell division is in line with expectations.
  • Embryos forming to day 3 / 4 morula
  • Embryos left to progress to day 5 blastocyst

Should you progress to the next stage you will need to prepare for embryo transfer. Read the next article on IVF: Embryo transfer

Katherine xo

PCOS: My story – our IVF journey

Since February 2016 we have been up and down the emotional roller-coaster that is life. We have slowly come to terms with infertility but that still doesn’t mean it hurts any less. I still feel utterly useless as a woman.

Between February and November 2016 we had to attend the hospital for multiple meetings and tests. Most of the meetings were pointless exercises of reviewing the paperwork which was posted to us for completion.  In the June we were given a start date for October but it was literally too short notice especially as they wanted us to attend an appointment 3 days after the letter was issued which was actually a date we were on holiday.

Finally, on Tuesday 25th November we attended what we thought was the start of the process hospital appointment. Unfortunately, for us our consultant was running an hour and a half behind schedule. The weather outside was dreadful so we were left with no option but to sit in the waiting room. Thankfully the TV was on just a shame it was something to do with buying rubbish from other people and trying to sell it for a profit at auction. Ah well I suppose one mans rubbish is another’s treasure…

Anyway after a long stressful wait that seemed like an eternity we finally met our consultant for the IVF. When you’ve had your first IVF clinic appointment you would have left feeling deflated and a bag full of more paperwork. Honestly after an hour a half wait to be told by the consultant you’ve been accepted for IVF was both happy and sad news. After that hour and a half we started inventing snippets of what we thought our meeting would go like. We thought we would leave with some dates to not on the calendar and know exactly what was happening.

So what did our appointment go like I hear you ask. Well we were escorted into the consultants office where we took a seat. We were presented with lots of paperwork and told that we would be asked questions that we have already answered. The responses were typed into the computer. After half an hour of going through the same questions and answers about past medical procedures, periods etc we were told yes you are eligible for IVF. The consultant then went through more paperwork telling us the procedure we would go through (a very short summary) anti-sickness tablets, daily injections, scans, small operation procedures etc. Once again we left the hospital with a bag of paperwork and anxiety. The only difference this time was a prescription for the contraceptive pill.

January 2017, nearly a year after been told I couldn’t have children I was now sat at the IVF clinic upstairs in James Cook University Hospital. I had been taking the contraceptive pill for nearly 2 months (seems a bit weird taking anti-baby meds to have a baby). Apparently this is to help control your natural cycle or in my case control an artificial version of it.

I had seen a lovely nurse and been given quite a lot of information to absorb between now and February including a bag full of bizarre named medication and lots and lots of needles plus a sharps bin. It looks like I am finally starting the IVF journey.

 IVF: the journey so far (weeks one, two and three)

It was Wednesday 22nd February. I had officially been using Menopur for the past 18 nights and Cetrotide for 4 mornings. I was taking 2 powder vials of Menopur to one solution for the first 7 days and then onto 4 powders to one solution.

On Monday 20th I went for a scan to see how things were progressing and the follicles were still quite small. So I was asked to continue the Menopur and have another scan and blood tests on the Wednesday. Well Monday morning driving back from the hospital was a rather emotional affair. For some unknown reason the tears started to roll down my face stinging my eyes. I just felt utterly useless as a woman. I just kept repeating the nurses words over in my head and para-phrasing the bits my downside wanted to hear. What the nurse actually said;  “Looks like we’re a week behind. The follicles are not big enough yet so we need to keep you on the Menopur a bit longer. We will see how it goes on Wednesday and make a decision then” versus what my head heard “you’re useless and your body doesn’t work give up and go home stop wasting everyone’s time”.

I woke up  on the Wednesday feeling a little hopeful and in high spirits. I got to the hospital early for my bloods had a lovely chat with Alison about all things Beagle related. Popped down to the x-ray department for scan number 3, again all went well. Heard the numbers and thought oh these have grown a lot since Monday. 21, 17, 16 then there was a few 14, 12, 10. Feeling a little better than Monday I leapt through the corridor back to reproductive medicine. Sat my ass on the seat in the waiting room waiting to see the nurse. My name was called whoop lets put the game face on. So I sat waiting for the nurse to come back, which she does quite promptly carrying an A4 sheet and my scan. Inside I’m feeling happy as this looks promising. On the sheet of paper it says egg collection Friday. As you can imagine at this point my insides are swimming in a sea of nervous excitement. Even more so when the nurse goes through the next stage and when to stop eating etc.

Then bam she throws in the curve ball that pretty much shites all over my parade. “I’m not sure if we should call this plan A or B. Your follicles are still pretty small, but Mondays bloods were good so we will have to see how your bloods are today”. With that I’m out the hospital and on my way home via Sainsbury’s to get one of those hideous passport ID photos taken for my IVF file. Later that afternoon about 15:30 the mobile rings – the call. Bad news, no procedure on Friday the consultant wants me to continue the Menopur and Cetrotide for another two days.

Friday arrives; blood test number (no idea as I’ve lost count) and scan number (a lot). The nurse was happy with the follicle sizes and number so now the scary and exciting part of the process. The trigger shot! I  left the clinic with yet more medication and paperwork this time I did’t have to inject Menopur and Cetrotide on both days but I did have to inject the trigger shot (HCG) on Saturday evening which was approximately 36 hours before my procedure. Getting real now, only downfall is I wasn’t allowed to eat anything from midnight on Sunday but to be honest I was so nervous about what was to come that I probably wouldn’t have been able to eat anyway.

Egg Collection Day

It is Monday 08:30am, the weekend has been and gone and I am now sat in the IVF clinic with my husband. We were both so nervous about the coming hours. He had to pop off and do his business in a sample jar whilst I went into theatre and have some eggs extracted. I’m not going to lie it hurt like hell even with a double dose of sedative. That stuff is useless; its not pain relief it’s just designed to make you less aware but I was very very aware of everything and every needle.

Afterwards I returned to the cubicle to see an anxious husband waiting for me. I was left with him for an hour (I actually fell asleep during this time). We were then brought a cup of tea and some biscuits and once I had popped to the loo and collected some more medication we were able to go home. It was about 1pm by the time we got out of the hospital. I didn’t go back to work as I had booked the day off as annual leave and so glad I did because I just felt uncomfortably bloated and exhausted.

The day after the egg collection felt like weeks. 09:30 am I got a call from the embryologist 5 out of 13 of our lovely eggs had fertilised. Over the next couple of days I received daily calls to let me know the condition of my little eggs. Thursday’s call was to inform me that we were going to have embryo transfer first thing on the Friday.

Transfer Day

Doesn’t sound as exciting as football transfer day but when you’re at this stage in the IVF process it feels so much more exciting! This time there was no nil by mouth rule as there is no sedative given for this procedure. Hubby was allowed into the theatre with me. We got to see our little bean on the screen before it was artificially inseminated (another really uncomfortable and painful procedure). We once again had a duty cup of tea and biscuits and sent home with yep you guessed it more medication.

The two week wait

OMG what an horrendous and tortuousness period of time. That first week I was soooo uncomfortable, bloated and in pain. It felt like my ovaries were going to burst out of my abdomen at any minute. I tried to pre-occupy myself with work and TV and actually ended up watching the whole box set of call the midwife. Not a programme I would really recommend to anyone wanting a baby but it didn’t really affect me. Towards the end of the first week and beginning of the second week I started to feel really unwell. I developed a chest infection. I was coughing constantly and felt like an 80-odd year old woman when I tried to walk up the stairs.  My test date was for the Friday (17th March) but by Wednesday I felt so ill that I couldn’t resist I just needed to know if it worked or not. If it hadn’t I could take some night nurse or anything just to feel better.

Taking the test

EEEKKKKKKK it says positive! For the first time in over 5 year freaking years i have a pregnancy test in my hand that says positive. Shit! I can’t take any night nurse, or anything other than paracetomol. I was so happy but so sad at the same time. At least I was off work (on the sick) I just literally stayed in bed for the next 5 days. I did take the test again on my official test day and it was still positive so I phoned the parents to tell them the good news that the cycle had worked first time.

7-8 week Viability Scan

The first week of April was the longest week of our lives. I had developed a stomach bug over the previous weekend and beginning of the week (thanks to the husband for bringing home the germs). So far I had not experienced any morning sickness just this nasty bug. Unfortunately, on the Monday I started to bleed. I have never cried so much in my life and had a feeling of utter helpfulness. I rang the early pregnancy unit but because our viability scan was for the Thursday we weren’t offered an appointment any sooner. That three day wait was longer than the whole two week wait put together. 15:00 Thursday James cook ultrasound department we sat waiting desperately hoping our little miracle was still arrive.  We had a student sonographer in the room and I explained that I had had a bleed and we were worried so the fully trained technician did our scan. She popped the probe on my stomach moved it around a few times then exhaled and said oh can’t see much. Our hearts descended to the depths of no return. quickly she looked at us and said there’s something but hard to see could you pop to the loo and we will do an internal scan instead. Quick toilet trip and I’m back on the bed. Probe goes in and within seconds she says with a smile there’s a heartbeat. Joy sprung to my heart I looked over to my husband and he grabbed my hand. The sonographer started talking saying there was measurements and stuff that needed to be taken. By this point I was on cloud 9 she could have spent the next hour taking measurements we had a heartbeat!

Now we are classed as officially pregnant with our first child however, we held onto that news for another 3 weeks until our 12 week scan. We then told the parents again but with a scan photo and then also told our nearest and dearest.

 Katherine xo

Further reading: IVF: The real story about what it’s like to go through IVF