IVF Protocol

In-Vitro Fertilisation (IVF) is no cure for infertility. Success rates of around 30%-35% aren’t the most encouraging statistics but I’m grateful we have a chance.

I wanted to write an informative post to give you an understanding of what is involved in IVF. There is a general protocol for treatment in the UK, however it should be noted that everyone’s treatment is specific to them and therefore the process may differ. I’m also not a Dr so this is a very high-level overview in layman’s terms.

Norethisterone

The treatment begins with a synthetic hormone called Norethisterone which is taken in tablet form for a week to induce a period. 21 days later this process is repeated for approximately 15 days so that the clinic can control the start date of your IVF treatment. This medication isn’t too troubling in the grand scheme of things. Headaches, 5-6 hours of broken sleep and hot sweaty flushes were the symptoms for me. I felt like a furnace, which didn’t do wonders for my hair – I was sporting a perm most days.

Egg stimulation

In general the ovaries produce and release 1 mature egg per menstrual cycle (month). On day 21 of my cycle, hormone injections are administered on a daily basis for a period of 7-12 days. The goal is to stimulate my ovaries to produce multiple follicles which will develop into mature sized eggs to be retrieved in the next stage. Every other day I return to the clinic for internal scans and blood tests to monitor the growth of the eggs. It’s invasive and I feel like a pin cushion. The internal scans are a little uncomfortable and the injections fiddly at first, but you get used to them. Time stands still during this time as you’re waiting for the next appointment, the next scan and hoping for positive progress each time. There’s a lot going on in your body, mentally and physically so you will feel a little sensitive. You will definitely want to eat chocolate. So go for it.

Egg retrieval

Once your eggs have reached an ‘ideal’ size, you administer a ‘trigger’ injection that will release your eggs. Approx 24hrs later a procedure called Transvaginal Ultrasound Aspiration is performed to extract your eggs. A thin needle is inserted into an ultrasound guide and the eggs are extracted from your follicles. In America I was under general anaesthetic for this, however in the UK it’s done under sedation and pain medication is provided. This procedure wasn’t pleasant for me the first time. I was in quite a bit of pain afterwards and my stomach was very sore and swollen. We haven’t reached this stage so I’m hoping for a more comfortable experience this time.

Fertilisation and Embryo Transfer

On the same day as egg collection, your partner provides a semen sample so that the eggs can be fertilised immediately after the procedure. The sperm and eggs are incubated in a laboratory over 3-5 days to develop and mature. Once they reach a certain cell level (blastocyst) they are ready to be transferred back into the uterus. The number of embryos that you transfer will depend on many factors and a decision will be made with your Dr regarding this. Any eggs that you do not transfer will be frozen at this time. The embryo transfer procedure is painless. During our last transfer we could see our embryo being implanted thanks to the ultrasound camera. It’s fascinating to watch and was a positive experience for us.

Two Week Wait

If you have done any research into IVF or read any of the forums I’m sure you’ve heard of the ‘two week wait’. It’s recommended that a pregnancy test is done two weeks from embryo transfer. This was undoubtedly the longest two weeks of my life. I was anxious and hardly slept during the two weeks. I over analysed every twinge in my gut, cramps, headaches, dizzy spells. I was looking for signs that I was pregnant and generally felt like a lunatic. There’s nothing stopping you taking a pregnancy test at home during these two weeks but it’s unlikely to be accurate. I was relieved to know either way of our result.

There are many factors that impact your treatment and it’s success along the way. How your body chooses to respond to treatment is out of your control. I have been in the position where the day before we were to transfer our frozen embryo the procedure was cancelled. My hormone levels had taken a nosedive and therefore my uterus wasn’t in the ideal condition for implanting. The chances of pregnancy were slim to none. At the time I felt like a failure, it was devastating. I have learned from all of these experiences that there is very little you can do during treatment other than be kind to yourself and keep a brave face on.

Every cycle is unique to the individual, as is their experience. The team at Aberdeen Fertility Centre have been outstanding thus far and I feel fortunate to be in their capable hands. Not to mention having the support of everyone around me. I realise the above might seem a long and daunting process and it is. But focus on the possibility that it gives you. It’s hope for you and your family.

Be Courageous

Everyone’s experience of trying to conceive is unique. Whether it’s months or years, there’s a common theme – resilience:

The capacity to recover quickly from difficulties; toughness.

At the heart of resilience lies strong relationships. A support team of wonderful family and friends that can provide a security blanket of warmth and comfort when you need it most.

When we first started treatment, a few years ago now, I kept myself to myself. It can be an alienating experience from your nearest and dearest, including your partner.  I didn’t read the baby forums or community pages. For a start there were too many acronyms and at the time I didn’t take comfort from other peoples journeys. I found it disheartening. I read of couples that had sadly separated. I could see how it could damage even the strongest relationship. Ross felt helpless and didn’t know what to say alot of the time. He wanted to solve things for us but there was no quick fix. I on the other hand wanted him to feel what I was feeling. I wanted comfort not solutions.

It can become hard to relate to one another as your experience and how you deal with it will be entirely different. I found it difficult to explain the sense of loss. An unexplainable grief. I have felt like I have lost babies that I’ve never technically had. Your partner won’t share these feelings or understand them. So try not to kill them when they say they would be happy if it’s just the two of you. I knew I needed an outlet to process what I was feeling. I was lucky to find a local psychologist that I could confide in. It was a safe and friendly environment where I knew I wouldn’t face judgement. Ross and I went together on occasion which gave him a better understanding of how I was feeling. She helped us identify each others coping mechanisms and how to talk through our feelings without it ending in tears. Literally. It was such a valuable and positive experience for us. I’m not ashamed to admit that I had a therapist. Sometimes it’s not always possible to get through the hard times on your own. Sometimes we don’t know how to. Find that support group, person/s or therapist who you find to be understanding, nonjudgmental, and supportive. Let these individuals know when you need help and support. Let them know how changeable these feelings can be day to day during your treatment. Reaching out doesn’t make you needy or weak. It makes you COURAGEOUS.

A person who has more recently become a friend of ours took my hand a couple of weeks ago and told me he had read my blog and offered his support to us in any way we should need it. There was a genuine connection in that moment. I had that feeling of being held up and comforted. I wasn’t feeling down or upset at the time but regardless I felt like I could stand taller. I can’t explain it anymore than that.

The more I talk about infertility the less I fear. I talk about appointments or procedures like I’m going to the dentist. This is my normality and for so many others it is too. I have found it to be empowering supporting others, even when I feel in need of support myself. It’s a real reminder of my own strength when facing adversity.

I promise you will be in awe of the support that is around you if you just open yourself up to it.

Ready.. steady.. IVF

I remember saying to Ross only a few weeks ago, “I don’t think I’ve ever felt so calm.” I had a glass of wine in hand, chilled tunes on and was feeling very zen. After the last course of treatment we packed up the car and took a trip to the West Coast for a week. It did us the world of good. The hormones, anticipation, frustration and tiredness to name a few, is a huge strain on your relationship (understatement). Timeout together is really important, whether it be before or after treatment. It’s an opportunity to talk through how you’re feeling and make future plans. I’m not sure why but I always feel like we can talk more openly and calmly out of our home environment. Less distraction.

Literally as soon as our IVF appointment and paperwork came through my nose started twitching. I have this annoying twitch that started during our first round of IVF. It’s like a tingly feeling over the bridge of my nose that comes and goes depending on my stress levels. It’s not visible to anyone else but to me it feels like my nose has a heartbeat. I felt like I had all of this under control, but the feelings quickly come flooding back. I kind of expected it to though, I don’t think you ever really rid yourself of anxiety, more keep it at bay.

We have two appointments scheduled in June. The first being a patient information evening, which is compulsory for all patients and partners that are embarking on the IVF programme. There will be approximately 30-40 in attendance for further information about the treatment and to meet the staff. This is a good opportunity to make some IVF buddies! When you’re in the clinic during treatment it will be nice to see a familiar face. Someone to make small talk with to pass the time whilst you wait to be seen. Warning: there’s so much waiting. The second is a consultation with the Dr/Nurses for initial tests. There are fairly strict guidelines in place for IVF treatment under the NHS. This includes being a healthy BMI and a non-smoker. You can find more info here: IVF criteria. Tests will be done to cover these (height, weight, smoking status assessed) and routine bloods to check my hormone levels. That’s what I expect to happen. Our first round of IVF was carried out privately in the States so protocol will be different I’m sure. We should receive our treatment plan and know our exact start date at that point. The butterflies are growing by the day!

During my first round, I gave it my everything and threw all my energy into being the perfect IVF candidate. I had to make it a success. But the reality is that it is out of your control. It’s down to science and luck. It’s not natural for your body to harvest multiple eggs, nor is it natural to be implanted with a fertilised embryo, so it’s not surprising that your body would reject it. I can’t solve my problem. My health has always been a priority of mine and I don’t think there’s anything else I can change or want to change that will actually make a difference.

If you are overweight, drink excessively, don’t exercise and your stress levels are high then yes there’s an abundance of things you can do. The majority of recommendations that I see for IVF patients regarding diet and wellbeing are those that I give to all of my clients. Eat a balanced diet, avoid processed foods, limit sugar intake and so on. There are several alternative healing therapies that are also recommended for IVF treatment that will help you throughout your journey. Acupuncture, Reiki healing and morning meditation all help me mentally and emotionally so they have become part of my life and routine.

My approach this time is a relaxed one! It actually makes me laugh (nervously) to think about how crazy you get from all the hormones. It’s so stressful. There will be no complete bans on things. Away with the no caffeine, no added sugar, no dairy, no alcohol, no high intensity training sIMG_6063.jpgessions, no heavy weights sessions. Undoubtedly my gut would be singing “hallelujah” if I stuck to the above, but mentally it’s too much. This doesn’t mean I’m going to drink a bottle of wine every night. Far from it. I don’t drink much anyway. But I’ll leave any alcohol for special occasions and during injections I won’t drink at all. I’ll continue to have my morning dark roast coffee until the day I’m pregnant because I enjoy it and I don’t want to deprive myself from life’s pleasures. It’ll only stress me out more.

In January I met with a Registered Dietician and discovered I had the following food allergens: eggs, wheat, carrots, cows milk, sesame, peanuts and hazelnuts. I’ve eaten eggs everyday for the last 5 years!! Initially I removed these foods completely and followed an elimination diet to reduce inflammation and heal my gut. My stomach troubles definitely improved. Secretly I hoped that a healed gut would lead to fertility. Sounds silly I know. But it was stressful to maintain and it affected social situations. 30% of the time I don’t worry about food intolerances/allergens and I enjoy eating out with friends/family. The rest of the time I cook from scratch and avoid them. Having a cream tea scone (my fav) will NOT be the cause of a failed round of IVF. If you have set some ground rules then I suggest giving yourself a break and stop being so hard on yourself. If you set too many boundaries you will fail. Feeling like a failure will only add to your stress.

Look at your work-life balance and how much time you’re taking out for yourself. A few months back I changed my working hours. Since I became a PT, I’ve trained clients from 6am. Early mornings have never really bothered me but this last year I’ve felt them taking their toll. Now I begin clients sessions from 8am and I’ve noticed a big improvement in the quality of my sleep, energy levels and generally I feel happier. I’m more in sync with Ross too. We relax in the evenings watching tv or workout together before dinner. I was always conscious I needed to be in bed for 830pm so I never fully relaxed in the evenings. I’ve no doubt lost potential clients because of this but I’m allowing myself to come first. Be selfish and look at your routine. Are you putting others before you?

Whatever the outcome of the treatment, I want to feel like I have given it my best shot, that I’ve given it my all. I don’t want to blame myself anymore than I already do. Spend time revelling in the positive things in your life in the lead up to treatment. Create a more calming environment and be kind to yourself because it’s having the mental power to get through IVF that’s key. Other than that you are in lucks hands.

Diagnosis:

As the Dr spoke, all I heard was that it was my fault. I felt ashamed. He told me my lifestyle was the cause. I was the reason we couldn’t have a baby. What was I doing wrong?

I was diagnosed with Polycystic Ovaries (PCOS) at 20 after discovering cysts on my ovaries. I’ve had issues over the years but thankfully nothing too sinister. My lack of cycle (period) I assumed to be a side effect of the contraceptive injection, Depo-Provera which I had been using for 10+ years. When we decided to start trying for a family, I stopped the injections and waited for my cycle to return. I was advised that it could take up to 12 months after the last injection but it never arrived. To be honest I didn’t really know how conception worked. I didn’t know about the signs of ovulation. I didn’t know there was a tiny window (3-5days) during your cycle that you could conceive. I thought it would be easy. It appeared that people were ‘falling’ pregnant all around me. But the chances of conceiving in any given cycle is actually very low. I’ve learnt that pregnancy is undoubtedly one of life’s beautiful miracles. After 18 months of waiting and trying we met with the Fertility clinic.

After some simple routine tests for both of us I was diagnosed with Hypothalamic Amenorrhea (HA). It is the technical name for when the hypothalamus stops sending “go ahead and reproduce” signals to the pituitary gland. There’s a disconnect somewhere! This results in absent menstrual cycles, along with other symptoms such as failure to ovulate, troubled sleeping, depression, anxiety, low libido, low energy and always feeling cold.

The crux of it is I have a hormonal imbalance. Medication can help to a degree but there’s an underlying problem that it won’t solve. That is why other types of fertility treatment don’t work for me. My hormone levels are hard to control and they can’t provide my body what it needs to conceive. I’ve researched both of my conditions and a common factor is diet and gut problems. This encouraged me to meet with a Dietician for food allergen tests as mentioned in a previous post. Irritable Bowel Syndrome (IBS) has troubled me for as long as I can remember. I do wonder how detrimental my early 20’s were to my health. For a few years I followed a scarily low calorie diet with very little carbohydrates. I couldn’t digest them so I avoided them like the plague. I was very thin and despite exercising alot I was probably very unhealthy. I didn’t know any better. The last few years my IBS has been at it’s worst. I believe this to be because of the stress of treatment, moving countries, moving house… lots of moving!

The Dr’s advice for HA was – “eat more and exercise less”

I looked at my life and panicked. My body fat percentage was low, but I never felt it was too low. Eating more sounds like a ‘fun’ prescription to many I’m sure. Who doesn’t want to eat more? But gaining fat as a Personal Trainer scared me. I had worked hard to get to the condition I was at. Add to this less exercise and I was having palpitations. Exercise is my life, it’s what I thrive on, it’s my medication. I looked at my regime and knew I could reduce the intensity and frequency of my training. I felt gutted that what I was doing was apparently wrong and damaging. But I focused on the bigger picture and made the changes as advised.

I follow progressive strength based programs to stop me from going hell for leather in sessions. I still push myself to a degree as I wouldn’t be happy if I wasn’t hitting goals. It isn’t about aesthetics anymore. I want to feel good and strong in body and mind. I am approximately 10lbs heavier than I was when we first started treatment. I don’t measure my body fat %. I don’t care. The less strenuous activities such as running or practicing slower paced yin and restorative yoga is a welcomed break from the gym. It enables me to focus on breathing, stretching and calming the mind. I watch my calorie intake to make sure I’m eating plenty for my activity but I am very aware of not becoming obsessive or overly restrictive with my diet. Initially I felt like my diagnosis sent me in a downward spiral. I over-analysed everything – food, drink, exercise, sleep. It was soul-destroying.

I gently remind myself that I’m not to blame for this. I live day to day as I know how. Knowledge is power and I feel I’ve learned so much about my body since we started this. I don’t know when doing everything at 100mph became a habit. Embracing peace and quiet has been nothing but good for me. I cook, bake, enjoy a glass of wine with a trashy book and more quality time with family and friends. I have bubbly aromatic baths which are definitely more enjoyable with a gin! I also treat my body to a relaxing massage every other week. Despite doing all of the above I still have no cycle. I try not to let this deflate me despite always feeling like I am waiting for something. I have read countless stories of women in the same shoes who haven’t successfully regulated their cycle. I take peace from that.

I have come to the realisation that it’s not in my power to reverse my diagnosis. The exact cause of my infertility as I see it is unknown. Maybe it’s not in my destiny to have a baby. I’m not being negative, I’m being realistic. Please don’t tell me not to give up because I won’t allow infertility to define me. I have the most wonderful husband, a loving family and a beautiful circle of close friends who all support me 100%. This may be what I choose to be my version of family. My diagnosis won’t dictate how I live my life anymore.

Mission impossible?

One of my wonderful clients shared some words of wisdom with me today (thank you Cindy) 

Difficult doesn’t mean impossible

This is so true. So many of us, me included, can find something so difficult that it can SEEM impossible and so we give up. But we are in control of the outcome of our difficulties. I truly believe that if you want something badly, you can make it happen. Nothing in life is easy, we all have our battles but it’s how we deal with them and overcome them that determines our success.
Regardless of the goal, whether it be related to health, career or life in general, it is up to the individual to make things happen. However the environment that you immerse yourself in is just as important. Recently I have felt a great deal of love and support from family and friends and it has been so powerful in keeping me motivated and in a positive frame of mind.
Here are some tips to making the impossible, possible!
Talk it out
We’ve all heard the saying ‘sharing is caring.’ Share your struggles. Confide in a trusted friend or family member about your difficulties. It is highly likely that someone will be able to relate to your struggles or know of someone who has experienced something similar. Knowing that you are not alone can bring so much comfort and feelings of positivity.
Goals
As a trainer I encourage my clients to be really open with me about their goals. What do they really want and why.  WHY do they want to be thinner?, WHY do they want to be a size 6? It may lead to uncovering an underlying goal that runs a lot deeper. Once you’ve established these goals, write them down. Be specific. If you have a weight loss goal to lose 30lbs, it’s ain’t going to happen in 3 months.. unless you get a gastric band. Create small and realistic goals i.e. aim to lose a lb a week. This is a far safer and more achievable approach to weight-loss.
Plan!
How annoying, another saying… ‘failing to plan, is planning to fail.’ You have your goals, now it’s time to build a plan and break it down into steps. How are you going to tackle the goals? Who do you need to recruit to help you? Include a timeline for accountability and track your progress as you go. Always refer back to your original goals as a point of reference.
Be accepting of setbacks
It’s very normal for things to not quite workout as planned. Be aware that this is a possibility and try not to feel discouraged of becoming side-tracked. Stop, refocus on your goals and view these ‘road blocks’ as learning curves. How can you do things differently moving forward so you don’t come up against them again.
Support
Surround yourself with supportive people and remove as much negativity as possible. There’s always someone hanging around that just has to stick their nose in and drop a bit of negativity in your life. Remove them, see less of them. They are probably dealing with their own issues. Share your goals with your loved ones, their support will provide motivation and determination. Hey you might even find you’re working towards similar goals and can really help each other!

Sets & Reps – what’s right?

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Here’s a simple guide to follow when selecting the number of sets and rep ranges for resistance training. Ultimately the GOAL of your training will determine the number of sets, reps and rest time.
Building MUSCLE (Hypertrophy): 3-5 sets of 6-12 reps, resting 0-60 seconds between each set.
In order to increase the size of your muscle you MUST lift heavy. Aim for 75-85% of your maximum. The last three reps of your set should be really tough. No amount of body weight lunges will build a juicy butt!
Increasing STRENGTH: 4-6 sets of 1-5 reps, resting 3-5 minutes between sets.
Strength exercises should be performed fast and explosive at 85-100% of your maximum. So go heavier and do less!
Muscle ENDURANCE: 1-3 sets of 12-20 reps, resting up to 90 seconds between sets. 
To build endurance, keep the intensity lower than your strength and hypertrophy training at approx 50%-70% of your max. This will allow you to perform a higher number of reps. This is a good range for beginners to resistance training. Exercises should be performed slow and controlled!
BUT WHAT ABOUT FAT LOSS I HEAR YOU CRY!!!
Fat reduction is generally what the ladies are aiming for. Reduction of body fat will be a result of combining strength and hypertrophy training… and absolutely your DIET.
FAT LOSS: Aim for 4 to 5 sets of 12 to 15 reps of each exercise. Keep the intensity high with shorter rest periods of 30 seconds between sets. 
Incorporate circuit training into your strength-training program for increased fat loss. Circuit training consists of performing a series of exercises, back-to-back, with little rest. Because of its intense, fast-paced layout, circuit training can help your body burn calories throughout the day. Utilise a high rep range and multi-joint exercises for maximum caloric burn and efficiency. Try a full-body circuit-training routine.
Engage in resistance training 3-5 times per week with a couple of cardio sessions on your off days AND of course a rest day is compulsory! Do not forget that increasing lean muscle mass will result in more calories being burned during exercise and throughout the day, promoting fat loss. Do not be afraid to pick up some heavy weights and keep your workouts varied. Try alternating days between hypertrophy and strength using  the ranges described above to keep your workouts challenging!  I hope this helps!!

Get toned.

clementine_pumpitup_barbellWant to build some muscle and create a lean and toned physique? If you do, then you’re going to have to ditch the daily cardio routine and pick up some weights for strength training. For any physical changes to occur and increase muscle size, you will need to focus on high levels of volume with short rest periods. Increasing the intensity of your training as you progress will be fundamental to seeing results. I speak to lots of women that are afraid to lift weights as they don’t want to get ‘bulky’ – they just want to be toned. The ‘toned’ look that you see, admire and want IS muscle. So to see it you need to build it. The reality is that you can’t and wont build muscle doing cardio.  You also need to eat a substantial amount of the right foods to ‘bulk’ up. So if you’re going to pick up some weight, KB/dumbbells/barbell, select exercises that target multiple body parts – multi-joint exercises. i.e. man makers, renegade rows, squat to press. You want to hit your shoulders, arms, chest, back, legs and core. The more muscles you use, the more calories you will burn. The amount of time you have to train will dictate the number of exercises you can get through. I would suggest spending UP TO 45mins per session on your weight training, plus 15 mins for a good warm-up and cool-down.There’s no need to spend any longer. Any longer and you’re risking overtraining. Plan your workout and keep your session intentional. Hit the following variables –
  • 6-20 reps (big variable, dependent on the weight selected) Super heavy = less reps.
  • 3-5 Sets / Rounds
  • 75%-85% max effort weight – so quite heavy and uncomfortable! You’re last 3 reps should be a real struggle. If you are doing a high number of reps, the load will need to be lighter.
  • Perform your chosen exercises in a circuit fashion – performing 1 set of an exercise and then moving onto the next with as little rest time as possible between i.e. 12 reps squat to press > 12 reps renegade rows 
  • Allow 1-2 minutes rest between circuits
  • Do circuit training every other day
These circuits will be intense and will build strength as well as improve your cardiovascular health. I like short and intense circuits that hit my entire body. IF IT DOESN’T CHALLENGE YOU, IT WON’T CHANGE YOU!!!

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Try this simple circuit out –
5 Sets / Rounds:
12 Dumbell squat, to press
12 Renegade Rows
20 Full KB Swings