Easter eggs

Is there a better time of year to discuss egg stimulation?

With my 36^th birthday slowly approaching and an NHS appointment still TBC, Matt and I have had some deep conversations about where our IVF journey goes next: physically, emotionally and financially.

Our private clinic very kindly gave us the option of moving onto a multicycle package, but this would mean fitting in two more egg collections before July. This would be not just a huge physical strain but also potentially close the door on a round with the NHS if timetables clashed.

We went back and forth for a while on the best course of action that would give us the best chance of collecting as many 35-year-old eggs as we can. Finally, we settled on doing another private round of egg collection with London Women’s Clinic (LWC) so the ball is at least rolling with the genetic testing on any potential embryos while we await the NHS.

It says a lot about the private system that I confirmed with them on a Wednesday that we wanted to go ahead in line with my next period, which would be likely to start the following Monday, and they had an appointment in the diary by the Friday for a consultation on the medication protocols.

During this consultation, our doctor looked at our previous egg collection and the medication used. In light of the additional drop-off of viable embryos caused by the genetic testing, she recommended stimulating for longer and doing a double trigger, with the hope that we would retrieve not only a larger number of eggs, but more mature ones.

The science of stimulation

Normally in each cycle, one egg matures. In IVF, you obviously want to up the numbers because one egg to fertilise does not a good chance make.

The stimulation phase of IVF therefore is growing all your ovarian follicles through the use of follicle stimulating hormone (FSH). For me (more below), all of this medication was done through self-administered injection, although pills and patches are also options, depending on the medication you’re given.

The FSH stimulation happens over a period of around eight to 14 days, until the follicles are all around 18mm in size in both ovaries. This is usually the size your one dominant egg-producing follicle grows to each cycle. So be prepared to feel…heavy. In my first cycle, my ovaries ended up basically touching each other, which is exactly as unpleasant as it sounds.

During this growth period, you’ll have regular monitoring scans to measure the follicles, before introducing lutenising hormone (LH) into the mix. This prevents you from ovulating too soon and disrupting the cycle.

When your follicles are all the right size (the clinic will know by measuring, you’ll know by feeling like you’re about to burst), it’s time to add in the trigger shot: human chorionic gonadotropin (HCG), which will mature the eggs in preparation for retrieval. This will happen exactly 36 hours before egg collection.

Retrieving the eggs

Or as I like to call it, harvesting the eggs. Because it sounds more like I’m the star of Alien and anything that makes this more fun is welcome.

Egg retrieval day involves not eating or drinking anything for the previous seven to 12 hours (depending on what your clinic tells you), not wearing any deodorant, perfume, make-up or jewellery, and having either a self-administered or nurse-administered anal suppository for pain relief. It’s not a glamorous day, basically.

The good news is that you’ll be sedated – so you won’t notice any of the lack of glamour, or what happens next, which is a nerve-wracking 20 minutes or so. But you’ll be asleep! And while you’re asleep, the doctors put an ultrasound probe with a fine needle into the vagina. The needle passes through the vagina wall into the ovary and drains each follicle to collect the eggs within.

You won’t know (I promise! The first time, I was terrified) until you wake up back on your hospital bed and are given water and some biscuits. And they’ll be able to tell you there and then how many eggs they managed to collect.

By the next day, they’ll be able to tell you how many eggs have successfully fertilised – and then it’s a five-day wait to hear how many have reached blastocyst: the cluster of dividing cells that are making an embryo. This is the stage when you can either try a fresh transfer, or freeze the embryo for PGT-A/PGT-M/future transfer.

…and that’s where we are

We reached blast(ocyst)-off day yesterday. See what I did there?

On 8 April I had my first scan and LWC confirmed I was ready to start the FSH, which in my case was a daily evening injection of 275IU of Pergoveris. After five days of this, we introduced daily morning injections of 0.25mg of Fyremadel as the LH.

The hope was that I would be ready for egg collection on Good Friday, after 11 days of stimulation – but my ovaries had different ideas. The scans showed that they were responding well, but needed a little longer to reach the desired 18mm minimum follicles. Returning for a final scan on Good Friday, the consultant decided to push it just one day more. This meant continuing both the Pergoveris and Fyremadel until Easter Sunday, followed by a double trigger at 10pm that day: 0.2ml of Buserelin and 5000IU of Zivafert.

After a pretty achy Easter Monday, we went (I staggered) to the Harley Street clinic for a 10am egg collection on the Tuesday. By 11am it was all over and they had collected a whopping 25 eggs. For context, the average is usually around 15 mature eggs. Which would explain why I was feeling quite so heavy and exhausted. Quite the delivery (if a little later than planned) by the Easter Bunny.

The next day, we heard that 14 had fertilised, which, bearing in mind the attrition rate, was a really pleasing number.

Yesterday, B-Day if you will, the embryologist called us to say that two had reached blastocyst and could be frozen for PGT-M biopsy. This was a bit of a gut-punch as we’d been hoping for a few more given how long we’d stimulated and how many eggs we’d collected. During the day, they phoned back to say a third had matured adequately for freezing and biopsy.

And this morning, day six after fertilisation, they phoned again to say six more had reached blastocyst. This is HUGE news in the world of IVF.

So as we speak we have nine tiny balls of cells in the freezer to undergo genetic testing. Bearing in mind that we have a 50% chance of passing on the NF1, we’re hoping for maybe three to be viable and not carry the gene. That would be the dream. So now, we wait (again).