Hope is hard (1dpEPU)

Yesterday I was on such a high..

I had my EPU and, despite a little cramping, was feeling pretty good afterwards. I was buoyed by the fact that we had 9 eggs collected this round! This was awesome news and more than we'd had collected the last few rounds. The scientist called me that afternoon to say, of the 9 eggs, 7 were mature enough to inject.

Then today happened.

DH & I had a rare day off together with our toddler and it was a beautifully sunny, albeit crisp day. We decided to use some vouchers we had to go the Powerhouse Museum and let DS check out the Wiggles exhibition. He's had a lingering cold which seemed to flare up a bit today but he still enjoyed it. He ran around looking at all the old steam trains and old planes on display and absolute loved those. We had just headed back into the Wiggles section for a last look when I had a call from the Bump lab. I had to move outside as the music was too loud to hear.

The scientist said he was going to upload the information about our embryos on the portal (online webpage) shortly, but wanted to chat to me briefly about it first. It was ominous. He didn't sound positive. I always try to get a feel for the sound of the scientists' voices straight away when they call me with updates... and I could tell this wasn't one of those "good news" days.

He went through the fact that we had 9 collected, and that 7 were subsequently injected. He went over the fact that they had a bit of trouble finding suitable sperm during DH's testicular extraction, but eventually did find some that were "twitching". Apparently the fact that the quality of the sperm wasn't great, and some of my eggs were abnormal or also just not great quality, only 2 fertilised.

Two. On day one.

He could tell I was disappointed (duh) so started babbling on about how they don't check on them for a while now and that I'm booked in for my transfer on Friday afternoon and to get there about 15 mins earlier than my allocated time blah blah blah.... unless they need to contact me before then.

Yep. There's a very real chance we won't have anything to transfer. This has never happened in 12 cycles. How did things get so crap so fast? And how did DH's & my "gametes" age so bloody quickly???!!! It's only been 3.5 years since we conceived DS. Was he really our last chance? Will I never feel those amazing cartwheels in my belly again? Will I never get the chance to use the knowledge I gained during those long and delirious nights with DS and do a better job? I thought I'd just be so grateful to have him (which I am) and be ok with only having one. But I'm not. Not yet.

This "hope" thing is hard.

Bump IVF Sydney - my review

I am currently on my first IVF / ICSI cycle with Bump IVF, a new bulk-billing clinic in Mosman, Sydney NSW, and I couldn't find any independent reviews or information about them beforehand. So here’s my experience with them so far, and how it differs to my experience at a private large-scale clinic. Although I was generally happy with my treatment at the large clinic, I felt like I was just a number in the end and it was sending me broke. I hope this helps someone out there!

* After making the initial call, they emailed me a bunch of information and some pathology forms when we said we wanted to go ahead. We had to get blood and urine tests done at any Douglass Hanly Moir pathology collection centre prior to our first appointment (we didn’t have our records from IVFA at that point, but as most initial tests were done a few years ago it was best we got them done again). They test for things like your AMH, FSH, STDs, Chicken Pox, Rubella etc. I also had to get a pelvic ultrasound done at any Sydney Ultrasound For Women clinic to check for follicle count and OPU access. These were done on day 6-12 of my menstrual cycle. DH could get his tests done any time. He didn’t have to produce a semen sample as he had a previous vasectomy and we had frozen sperm as a back-up which we had transferred from the IVFA clinic to Bump before I started my cycle. We had to pay $85 for the AMH part of my blood test (no Medicare rebate) and $320 for my ultrasound (of which I received $285 back from Medicare = $35 out of pocket). We have also reached the Medicare Safety Net threshold for this year which means more of a rebate.

* Once they received all of our test results we had a consultation at Bump’s clinic in Mosman (which cost $205 each with a rebate of $185 each). The clinic is very small. The waiting room is tiny but looks very modern and high-tech. There are just two small consultation rooms attached. There’s no reception desk – you ring a buzzer then take a seat until someone comes to see you. We were the only patients there and were seen within five minutes (as opposed to being just a sheep in the herd and having to wait well past your appointment time). We met with Dr Jamie Sharkey who went through all of our results and explained the whole process. We then went through all of the costs with one of the staff named Dan. We have to pay $7480 up front for my ICSI cycle fees, EPU day surgery fee and Embryo Transfer day surgery fee. Of that, I should get $6680 back from Medicare and my private health fund. Therefore out of pocket $800. We also have to pay $1050 up front for DH’s Surgical Sperm Retrieval and lab fees, of which we’ll get $743 back from Medicare, meaning $307 out of pocket.

* We decided to go ahead there and then, so signed a whole bunch of consent forms on the day. You can take them home and think about it if you want. Dan also gave us a login to their patient portal which is a private webpage used to communicate everything to you. I found it a bit impersonal however they stress that you can always call them if you need to discuss anything or ask questions. They usually send you an SMS to indicate if they’ve updated or added anything to your portal so you know when to look at it.

* After this consultation I followed up on getting DH’s frozen sperm transferred from our old clinic to this new one. We had to sign and return a few forms to both clinics and then the two clinics liaised from there. Bump organised pick-up of the sperm at their own cost. I also had to pay a fee (I think around $35?) to get our fertility records sent to us to forward onto Bump. It wasn’t necessary, but useful for Dr Sharkey to know how we’d been treated previously and how long I usually stim for.

* I called Bump a few days out from the expected start of my period and they organised a courier to get my medications to me. Once my period actually started (& it was dead on time!) I had to log onto the portal and “book on” for my cycle. This sends them an alert to say I’m about to start an IVF cycle. You follow the information on there and proceed with your medications from day two of bleeding.

* Bump gave me Puregon as my stimulating drug instead of the Gonal-F which I was used to. They basically do the same thing.. but some people can respond slightly differently. I was a bit thrown as I hadn’t used the Puregon pen before but I read the little booklet & it was super easy to use. I was also a bit excited to try something new, as my IVFA specialist had me on exactly the same drugs for about the last five cycles with no change in results. Bump also gave me Orgalutran to prevent ovulation, Ovidrel as my trigger (same as IVFA), and a sharps container.

* Something else which threw me was their suggested timing of injections.. I had been trying to work out the best time of night to do it as I’m a shift worker in TV production and not always able to go somewhere in private at a particular time, so this side of things is always difficult. The morning of day two, I logged onto the portal quickly before work to double check something & noticed that they say to inject between 7am and 9am everyday! IVFA always said to do it at night. At this point it was about 9.10am so I ran to the kitchen, madly skimmed through the info booklet again and then injected. It was a rocky start.. but all good in the end. As it turned out, 9.15am was a very convenient time which fitted perfectly into all my shifts for the coming week and a half. The nurse later said it wasn’t crucial to be between 7-9am, as long as it’s exactly the same time every day.

* I was instructed (via the portal) to begin Puregon on day two of my cycle, and add Orgalutran on day seven. On day 11 of my cycle I had to get a blood test done at any Douglass Hanly Moir pathology centre before 9am and a pelvic ultrasound done at any Sydney Ultrasound for Women clinic before 10am. I had to make an appointment in advance for the scan to make sure I could get in at the right time. It was all a bit tricky as the two aren’t located in the same place. I had to drop my toddler off at daycare at 8.30am then drive to a DHM centre and get the blood test done, then drive to the SUFW clinic for 9.30am. Luckily I got in straight away for the blood test and it didn’t take long, and I also found parking quickly before my scan. The blood test was bulk-billed and therefore free but the scan cost me $80 which I don't think attracts a rebate. Interestingly the portal instructions also said not to take glucosamine or high dose fish oil which IVFA had never mentioned despite me listing it on my forms every cycle. I called Bump and after consulting with a doctor, they told me high dose fish oil can increase the chances of bleeding so I should stop taking it. 

* That afternoon (a Friday) I received an SMS telling me to check the portal for theatre information and trigger instructions. The portal outlined when I was to inject the trigger (Sat night at 9.30pm), when I was to stop the other medications (no more from Sunday) and when we were booked in for our procedures (Monday 9.30am). I had to print out and complete a questionnaire asking questions about any other medications I had been taking and my recent health, and bring this with me on the Monday. On Saturday afternoon I received a text warning me how long until I had to take the trigger. I received another text about 9 minutes prior as well. This was great as a back-up in case my alarm didn’t work. I never had that at IVFA.

* On Monday we had to arrive at Bump by 9am. We caught a cab but DH could have driven home as his procedure ended up only being minor, and he only had a bit of local anaesthetic. Oh well. We had a babysitter come around to look after our toddler and he was happy to have someone new to play with.

* We waited about 5 minutes max in the waiting room before the lovely nurse Rosie came and asked a few questions and filled out a bit of paperwork. She then took us through to a change room where I had to empty my bladder & change into the fetching backless robe, hat and booties. DH also had to put a hat & booties on but stayed dressed until a while after my procedure. We were given a locker to put our belongings into. We were then led around the corridor to a small recovery room. The whole place was a lot smaller than the day hospital at IVFA in Greenwich, but it was very modern and clean. The nurse sat me down, hooked me up to a pulse and blood pressure monitor and left us to our own devices for maybe 10 minutes. My only complaint about the place is that there were no magazines or television to amuse us, nor a radio playing. It was three white walls and a curtain so extremely boring. I can see other women going through this for the first time getting very anxious just sitting there with their thoughts. I didn’t even have my handbag with me so I could check Facebook and waste some time that way.

* After answering a few questions, having a bit more monitoring and then getting the cannular placed in my arm, we were led through to the operating room. It was a medium-sized room featuring a chair with stirrups, some equipment trolleys, cupboards and a microscope. It looked fairly empty. Nothing like the theatre at IVFA with the whole operating bed and vast amounts of equipment. There were also only two doctors, two nurses and then the scientist in Bump’s room. There seemed to be so many more people in theatre at IVFA.. I guess they also had an anaesthetist and more nurses. DH laughed and pointed out that the song playing on the radio was “Big Girls Don’t Cry”.. they all thought that was hilarious. I just hoped to hell that I didn’t have to!

* I sat with my bum at the edge of the bed, laid back and put my legs in the stirrups (humiliating as always but Rosie draped a bunch of sheets over me which helped). Dr Sharkey sat on a stool at the business end whilst the other doctor (can’t remember his name but quite a bit older and apparently very experienced) administered a sedative called Fentanyl through the cannular. He then held my other hand & talked very gently to me. He asked if I felt different and I said no. He upped it a tiny bit more and then I started feeling light-headed. I closed my eyes & listed to the music. Dr Sharkey asked if I was ready to go and then inserted the old dildo-cam followed by a needle to numb the ovary. He said I might notice a prickly feeling but I hardly felt a thing. He then went about retrieving eggs from my follicles. The older Dr kept asking me how I was feeling and commented that I wasn’t sending him any messages by squeezing his hand so I must be ok. I actually just wanted everyone to stop talking to me so I could concentrate on the music, but it was also reassuring that they were checking I felt ok at each stage. Dr Sharkey then numbed and worked on the other ovary. He apparently counted them as he went along but I couldn't hear.. DH kept updating me. The whole process took maybe 15 minutes? I honestly didn’t feel any pain.. just the usual discomfort of a pelvic scan! The worst part was when he cleaned up my insides with gauze at the end! But that wasn’t that bad either. Both doctors kept commenting on how well I did and Dr Sharkey said I was his easiest patient for quite some time... He later told me his last patient asked for more drugs before they had even done anything, and then got really anxious during the procedure and almost leapt off the table! They said it really helped that I was so relaxed to start with. It honestly was no big deal but I can understand some people may find it a bit daunting.

* When they moved me back to the recliner on wheels (which older Dr kindly referred to as the “wheelbarrow”) I noticed a bit of blood on the floor. Eek. They took me back to the recovery room and Rosie prepped a heat bag for my tummy. The drugs started to wear off and I felt a bit of period-type cramping so she gave me some panadeine. This took the edge off and I felt fine after that.

* Not long after I was back in recovery, they took DH away to get changed. He popped back with my phone so I had something to play with (god love him) and then dashed off to theatre himself. He said he was in a different room and was disappointed there was no music playing. They tried extracting sperm from the epididymis but didn’t get any motile ones so then tried the teste instead, after numbing it. The scientist later found a small amount of good sperm from that. He walked back into recovery fully clothed and not in much pain. His procedure was a lot less full on than the last one he had at IVFA where another specialist insisted on doing a full biopsy (making an incision rather than using a fine needle). He says his “nutsack” still hasn’t recovered from that one!

* Once I stopped feeling dizzy we were led back to the change room where I got dressed, and then led out back to the waiting room to wait for our taxi.

* This afternoon I received a text to say they had updated our portal again. I logged on and it said out of my 9 eggs collected, 7 were mature and injected with sperm. We will receive another update tomorrow morning on their fertilisation progress, another update on Thursday and hopefully proceed to transfer on Friday (day 5).

* All in all I was very impressed with Bump. Every time I called them with a question they knew me by my first name – Rosie later told me that’s because I’m the only person on cycle there at the moment! Such a massively different experience to IVFA where I had to give both names and date of birth, and they had to look me up on the computer (even if it was the same nurse who saw me that morning). This may change as more people hear about Bump and they get busier. The staff are all very friendly and helpful. Fewer appointments means fewer interruptions to your day-to-day life. I think getting tests done at DHM and SUFW clinics near you will make it easier for a lot of people and getting the drugs couriered to you nominated place makes it more convenient too. You only have to attend the clinic for your initial consultation, EPU and ET. The portal means all information is right there in writing, and accessible anytime you want to double check. The EPU procedure was far less of a big deal as you’re not “knocked out”. It was hardly painful at all. And the doctors were awesome. On a side note, it turns out I had met Dr Sharkey about three years ago on a work trip.. I knew he looked familiar! We had a good chat about that and he was very personable, as was the older Dr who administered my sedative and performed DH’s sperm extraction.

TOTAL OUT OF POCKET ICSI CYCLE FEES: $1382

The above amount includes all tests & scans, cycle fees and day surgery fees, as well as the cost to obtain our records from IVFA. I stopped adding up my out of pocket fees for a cycle at IVFA.. it was too depressing.. but I think it was around $4-5K.

Sorry this was such an essay but I wanted to jot everything down for anyone interested in trying this organisation. I can definitely recommend them.... and they’re cheaper!! Good luck x

EDIT: Apparently I wasn't meant to pay the $80 follicle scan during this cycle - it should have been charged to Bump. Also, in retrospect, I'm not sure I feel overly confident with the lack of scans & monitoring.. there's a fair bit of "educated" guesswork that goes into choosing your EPU date. I wonder if mine should have been pushed back a couple of days so that my eggs grow & mature a little more. Who knows?

A new clinic. A new beginning. Cycle #13

A new clinic. A new beginning.

I needed to stop simply filling the pockets of our fertility specialist and try something new. He just kept putting me on the same protocol and same dosage over and over again with the same results. OK, we got "pregnant" again.. but it was over before it started so obviously not a high quality embryo.

I started seeing a recommended fertility acupuncturist.
I never believed in all that "mumbo jumbo".. but it was time to look outside the square and be open to new approaches. She's fantastic. I don't know if she's making a difference to our outcome yet, but she has offered me new ideas and, to be honest, it's just great talking to someone so understanding and caring about me. Not just caring about my uterus, my ovaries, my follicles... but me. I find it relaxing too which I guess is a major benefit. She encouraged me to try a new FS within our clinic, put DH on some vitamins (Menevit), and scale back on work stress. A colleague, whose wife was also going through IVF, told me they were considering trying Bump. They're a new bulk-billing clinic in Mosman, Sydney NSW. They bulk bill. That's all I had to hear! They are associated with Monash so they are reputable. Funny thing is - they decided to try my FS at IVF Australia, and I decided to leave him and try Bump. A change is as good as a holiday, as they say. I also quit my job and have gone freelance. I just wasn't happy there and my boss was less than accommodating when it came to my IVF cycle commitments. Now I can call the shots & say I'm unavailable around EPU time. And I get paid way more. Bonus.

So here we are - cycle number 13! That’s our 10^th cycle trying for baby number two. I never thought I would still be trying at this stage. But I said I would stop by the time I turned 40, and that’s only five months away.

I tried to do some research into the Mosman Bump clinic but couldn’t find any reviews online. They only opened in November and the nurse today told me they have probably performed around 70 egg collections there so far. I was too scared to ask what their success rate was.. ie. how many pregnancies had been achieved. Let’s just hope I can add to their tally. I'll post a more in-depth review of our experience with Bump shortly which may help others in my situation.

Basically they keep cycle appointments to a minimum as they don't deem it necessary. They also communicate with you through a patient portal (private webpage) and have all medications couriered to your home or work. Although I'm an IVF veteran, I felt a bit nervous not having that constant contact with a nurse to keep an eye on me & explain the medications... however I worked it all out fine. They put me on Puregon instead of Gonal-F but used Orgalutran which I was on before. I was excited to try something different, even though it does the same thing.

Today I had my egg pick-up. It was the first time I didn't have it done under a general anaesthetic. I was a bit nervous about it but the nurse assured me most clinics are moving towards this sedation method instead. It actually wasn't too bad. DH also had his testicular sperm retrieval just after my procedure. They retrieved 9 eggs (my best result for quite a few cycles!) and some wriggly sperm. The Bump doctor encouraged us to use fresh sperm again but keep the frozen as a back-up in case they didn't find anything suitable.. but all was good.

Out of those 9 eggs, 7 were mature and therefore injected with sperm. Tomorrow we'll be updated with their fertilisation progress and hopefully proceed to embryo transfer on Friday. For now I'm going to rest as I don't have to work for another three days. I have another acupuncture appointment on Wednesday to hopefully prepare me for the transfer.

As I said, I'll post again shortly with more details about our Bump experience.