The Natural Cycle

DECEMBER 2017

My knuckles were white as I clutched at the steering wheel on my drive down to the Fertility Centre.

I had an appointment to see the doctor, and being the public system I had no idea who I was going to see as it was a different doctor every time. Whoever it was, I was going to DEMAND that they be brutally honest with me: I was tired of the CASUAL approach of this clinic and my gut was telling me that I was more complicated than their usual patients.

I rehearsed and repeated the questions in my mind, adamant that I was NOT going to pussyfoot around the difficult questions.

There is such an intense power differential between patient and doctor, and even I felt it- an ICU Nurse and Midwife who is very comfortable with doctors.

I cannot even imagine how the average woman feels whilst sitting in the patient seat, especially considering how intensely vulnerable I felt whenever I was in that position. But regardless of my vulnerability I felt the need to ask further questions because I viewed this as a decision of life or death; the life or death of my children, my family, my dreams and my hopes.

Life or death – that is EXACTLY how I viewed it, which explained my intense emotional response as I drove to the clinic. I wanted to be taken seriously; this “casual” approach was making me furious.

I sat anxiously in the small waiting room and was relieved when I was called into the office by one of the Consultant/Attending Obstetric doctors that I happen to work with at the Mothers hospital.

“I want the honest truth Dr. P,” I demanded, “Don’t sugar coat it! Am I a severe case? Do women like me rarely have success? Am I too complicated for this clinic? Should I go private?”

He laughed and shook his head. “Not at all,” he said, trying to ease some of the tension in the room.

“Going private won’t be any different,” he assured me, “they won’t do anything different for you than what we are doing here.”

I eyed him suspiciously.

He said it so confidently that I wanted to believe him, and yet I had my doubts – I had a feeling that Private IVF specialists would do things very differently.

He flipped through my chart.

“Look,” he tried to reassure me again, “you are still in what we consider the golden years, 20-35.” He smiled and continued, “Your endometriosis has been removed, so that’s no longer a problem, and you don’t seem to be responding like a typical PCOS patient, so that’s less of a problem than what we thought.”

A typical PCOS (polycystic ovarian syndrome) patient usually has a high AMH (egg count) due to the fact that they don’t ovulate regularly, and they can have very sensitive ovaries and are at higher risk for OHSS (Ovarian hyperstimulation Syndrome) – thus needing lower dose therapy.

I, on the other hand, had a lower AMH and had not responded well to the low FSH (follicle stimulating hormone) doses – which is why it took me nearly a MONTH of injections until my ovaries were ready for egg pick-up during my first IVF cycle.

My AMH count was also on the lower end because a portion of my right ovary had been removed during my last surgery (in order to get rid of the huge endometrioma/chocolate cyst that was bigger than my uterus).

“Your AMH isn’t too low, considering the circumstances,” the doctor was obviously trying his hardest to reassure me and maintain some level optimism.

I appreciated his efforts, though I was at a point in my journey where I didn’t want false hope anymore – I wanted the ugly truth. My fragile emotional state may have craved optimism, but my intellect yearned for the hard truth regardless of the emotional consequences.

I tried to relax, convincing myself that perhaps I was being overemotional and dramatic.

“You’re young and healthy,” he continued (I immediately cringed at that statement as I felt like that was one of the reasons I was NOT being taken seriously), “You just have to keep going. It’s a lottery system. You can’t win it unless you’re in it. Sometimes it works, sometimes it doesn’t,” he shrugged, “We don’t know why, but the only way you’ll get pregnant is if you keep going with IVF.”

He encouraged me to try again for a natural cycle and to go ahead with the embryo transfer.

I thanked him for his reassurance and felt conflicting emotions as I drove home. What he said made me feel better, and yet something didn’t feel right. I couldn’t name it, or put my finger on it, but I tried my hardest to focus on the positive things he had said – reprimanding myself for being so negative.

So, according to the doctors advice, I tried again for a “natural cycle”.

It was December now – coming up to Christmas – and I desperately wanted to start the new year with good news. New Years was always a difficult time for me; a painful reminder that yet another year had passed without success and we would now be facing our 6th New Years Eve without good news.

Deja vu smirked at me a few days later when I got the very same phone call I had received in November.

“I’m sorry hun, it looks like your estrogen levels are really low again and your LH levels are still quite high,” the nurse reported.

Disappointment surged through me again and I felt a desperate hopelessness.

“Is there anything you guys can do about my hormones?” I asked the nurse.

“Unfortunately, it’s just your PCOS,” she wrote it off, “there’s nothing we can do about that. This is probably just your baseline.”

I repeated my bloods a few days later, but they still hadn’t improved. My estrogen levels remained flat, and it didn’t look like I was going to ovulate this month: I was hesitant to continue with the cycle.

The nurse, though, still encouraged me to go ahead with the embryo transfer – following the advice from my doctor’s visit.

“It’s a lottery system,” she advised the same, “You don’t know if you’ll have success unless you actually try honey.”

I knew this statement was due to my history; it had been eight months since my last cycle, and even now I was dragging my feet (which could easily be labeled as a “non-compliant patient”).

It is complicated when they treat you as though IVF is the beginning of your journey – it’s quite the opposite; IVF was the END of our journey……..after YEARS of trying, of disappointment, of investigations, surgeries and heartache. We were completely worn out after the two traumatic stimulated cycles, so we took a much needed break. This round, though, was different – it was not exhaustion that made me hesitant to proceed, it was my gut feeling.

Out of the two IVF cycles that I had done earlier in the year I had only ONE precious frozen embryo and I was terrified to use it. I felt intensely repulsed at the idea of “just chucking it in” and wasting it.

“I just can’t do it,” I said again, re-living our conversation from last month. “I need my levels to be perfect, I can’t gamble like this.”

I could hear her shrugging on the phone, “It’s up to you hun, but I think you should go ahead with the transfer.”

She sounded so lovely and supportive and yet I couldn’t understand why she was pushing me to go through with this cycle. I felt pressured to say yes (and my intense, irrational, desperate desire to have success before the New Years was so strong that I almost gave in), and yet I was so repulsed by the idea of proceeding with the cycle that I just….couldn’t…..do it. My gut feeling had not failed me yet in this journey, and I wasn’t about to ignore it right now – regardless of the medical advice from the doctor and nurses.

“I’m going to hold off on the cycle,” I informed the nurse. “We’ll try next year, and hopefully my hormone levels will be better then.”

She sighed, but respected my decision.

Cognitive Dissonance consumed me again, as it had so many times over the last few years: sitting in this space is unpleasant and uncomfortable, and yet I was becoming strangely comfortable with this torturous roller-coaster of conflicting emotions; it’s amazing how you start to learn to filter your feelings more efficiently as the journey progresses and you pay less attention to certain emotions that, if encouraged, would gladly overwhelm you.

I sadly and stoically accepted the fact that we would have to face our 6th New Years of infertility with not only grit and resilience, but with a generous allowance for grief.

I immersed myself in journaling over the next couple of weeks, reflecting on the recent medical advice that was given to me. Anger began to consume me again (as it had so many times in this journey) and I was furious that I was not getting the advice, care and attention that I felt I needed for my serious conditions. I began to research different fertility doctors in Australia – vowing to not stop until I found the right doctor for me and get the answers that I needed.

Little did I know that, once again, following my gut instinct (and not going through with the natural cycle) would change my future forever.