Infertility – the long and winding road to motherhood

This post is my experience of fertility treatment in China.

It’s not meant to be witty or funny, just an honest account of what we went through. I’m posting it here in the hope it will help other couples who are pregnantly challenged, show them that they are not alone and give them some options to explore for their own fertility treatment.

It was early 2008 when we realised something was wrong. We’d been trying to get pregnant for three years without success. Like many couples who are ‘pregnantly challenged’ we never expected to have any difficulties. But it was clear after a year that nothing was happening so I went to my local doctor and he performed some tests on us both, checking my hormone levels and the husband’s ‘tadpole’ count. The results showed that he was fine but I had Hyperthyroidism; a condition where the thyroid gland doesn’t produce enough of the right hormones for your body. This can cause weight gain and fatigue but I’d had no symptoms at all. My doctor started me on a course of Thyroxine which stimulates the Thyroid gland. I’d be on this medication for the rest of my life but I was glad that we’d found a possible cure for our inability to conceive. We went back to trying and I started using ovulation test kits to learn more about my cycle and when the best days were for us to ‘get together’.

Some months later, with no success despite the fact that I was clearly ovulating, my doctor referred me to a specialist gynaecologist for more tests. The consultant performed an ultrasound and discovered that I had a 6cm fibroid growing on the side of the uterine wall, just behind one of the ovaries. This could have prevented a pregnancy, so he scheduled a laparotomy operation (similar to a caesarean) to remove the growth. At the same time he did a histrosonogram; injecting dye into my fallopian tubes to check that there were no blockages. (There weren’t.)

After a two month recovery period, and four more months of trying naturally, I started taking the fertility drug Chlomid. Finally, some action. Convinced we’d solved our problems and full of high hopes, we were disappointed when three months later the drug seemed to be having no effect. My gynaecologist told me that some people don’t respond to Chlomid and that there was nothing more that he could do. Our next step was to start the more complex (and expensive) insemination process, either by IUI (Intrauterine Insemination) or IVF (In Vitro Fertilisation). (See below for a brief explanation of these two procedures.)

We were very disappointed that all our efforts so far had failed but we were determined to keep going and explore the IUI and IVF routes. Life often seems to throw us two curve balls at once and suddenly the husband also had an offer to work for a while in China. It was a great opportunity that we couldn’t miss. Frenzied planning, resigning and packing ensued so we decided to postpone any further treatment in the UK and hopefully start again when we arrived there.

China

As soon as we were settled in our new apartment I made an appointment with one of the doctors at an International hospital in our city. At our first meeting the doctor did a complete review of my medical history and booked more tests for both of us to rule out any other conditions that could cause fertility problems. It felt good to be doing something proactive but when the results came back clear again I realised we were no further forward. I was in good physical health with no apparent reason for not being pregnant. I had what is known as ‘unexplained infertility’.

As we’d already used Chlomid with no results and had been trying for three years at this point, the doctor recommended attempting an IUI procedure. She explained that there was a 15-20% success rate for IUI but that we could have four or five attempts before moving onto IVF. But first she wanted to monitor one month’s ovulation to act as a baseline for the rest of my treatment. She started me on a course of oestrogen tablets plus ovulation stimulation shots that were (painfully) injected into my hip each night, and scheduled regular ultrasounds to monitor my ovaries. It turned out that I had a longer cycle than was optimal for IUI (c.30-40 days vs. the more typical c.28 days) but I was ovulating. For two months we repeated this process, waiting for the perfect time to do the procedure; when my ovaries were full of eggs at the right time in my cycle and when the lining of my uterus was thick enough to support the fertilised egg. I looked like a pin cushion by this time, bruised and sore. Although the lining was never quite as thick as our doctor would have liked it we were excited when in early September she confirmed that we could go ahead and schedule the procedure at a local Chinese hospital for the following day. That night I had a special injection of HCG that would stimulate ovulation ready for the procedure.

Our first attempt

The following morning our doctor, the husband and I travelled together to the Chinese hospital with our original marriage certificate (thank God I’d brought it from the UK), passports, blood test results, a special report for him written by a urologist plus the official medical reports which were done when we first arrived in China as part of our residency VISA process. This was my first experience of the local Chinese health service and I was so not prepared. First of all we had to pay a small fee to register with the hospital and complete a registration card. As neither the husband or I could write characters our doctor and the hospital staff did this for us. Then we went upstairs to the fertility department. There were four or five rows of chairs full of Chinese women, plus their Moms and the odd friend, waiting for treatment. We were the only Western couple and we attracted a lot of attention. Our doctor filled in all the necessary forms and then took the husband to the cashier to pay. The cost seemed very reasonable compared to our expectations of treatment in other countries.

Soon enough our turn was called and we were taken into a long room of cubicles to talk to the hospital consultant. He went through my pre-prepared file and asked me a couple of questions, then we were despatched for an ultrasound to check the status of my ovaries. The small room was divided into two by a curtain and I was ushered in with our doctor. Thankfully she knew the man who was to perform the ultrasound so while she chatted away to him I perched on the small bed waiting to be given a gown to wear. This was to be my first lesson in Chinese hospital etiquette. No gown appeared and I was asked just to take off my underwear and put my feet in the stirrups. Thankfully I’d worn a skirt that day so it was fairly easy to do without too much blushing. It was over very quickly and the results were good apparently so we could continue.

Next I was seated back in the waiting room and our doctor took the husband to a small room to give his sample. I did feel a little guilty but so proud watching him walk away with the small plastic pot in his hand. When he returned it was a matter of waiting for an hour or so while the technicians cleaned the sample and removed any tadpoles that weren’t viable. Then it was my turn. The husband waited behind while our doctor walked me to another set of small rooms where we were both given a gown and slippers and asked to remove our clothes and shoes. Then she and I were shown into the procedure room. We weren’t alone. Facing towards me on a gurney was a Chinese patient waiting for her own IUI. No curtain. Errr…hello? But to be honest I was so focussed on what was going to happen next I let it wash over me.

I hopped up on to my gurney and lay back with my feet in the stirrups. Three new doctors came in, masked and in gowns and our doctor had a quick talk with them. Then she came and stood by me and explained everything that they were about to do. First, I was washed ‘down there’ thoroughly with warm water and cotton wool. Then a small hatch opened in the wall and our little pot of viable tadpoles was passed through in a sort of syringe. One of the doctors used a speculum just like during a Pap smear test and then popped in a catheter. Our doctor had warned me the next bit might hurt a little as the tube has to pass through the cervix. Well that had to be the understatement of the year. I gasped and everyone stopped to look at me. Then the sample was injected and we were done. I had to lie still for twenty minutes to give the tadpoles the best possible start on their long journey. It was at this point that I realised that my room-mate had been watching the whole procedure from her bed. At least she was prepared for what would happen to her, I reasoned. Some sisterly solidarity in a moment of madness.

Finally we were allowed to go home and I had to rest for the rest of the day. Then two long weeks of waiting  until another blood test to see if we’d been successful. I kept popping pills every day, hoping, hoping. But when the blood test result came back it was negative. It was so upsetting after everything we’d been through but we knew that we wanted to try again. We decided to wait a month for my body to recover and then start again.

Second time lucky?

Our first doctor left before we started our second IUI attempt, so we were moved to another doctor. A little unsettling but she seemed very experienced. We continued with a similar regime as before with regular shots, blood tests (to check my estradial, LH and progesterone levels) and ultrasounds. This time I started off injecting myself with the stimulation drug Gonal F each night into my stomach with a special pen-like syringe, but as we lived so close to the hospital it was easier to walk over there each night and have a nurse do the injections. Our new doctor had a relationship with an another Chinese fertility hospital with different procedures so the husband and I had to go to the hospital ourselves much earlier – him for more tests and me to have regular ultrasounds so that this hospital’s consultant could see the results for herself. All my blood test and drugs were still prescribed at my hospital but I had to travel to the local hospital by myself, equipped with my introductory letter, medical file of test results and history and a couple of sentences written on a piece of paper that one of the wonderful nurses had written out for me in Chinese characters and Pinyin (in English with special markings to show how to pronounce the words).

It was a very experience going on my own without a Chinese ‘chaperone’ and when I didn’t get anywhere with my Pinyin at the reception desk I almost walked straight back out again. But I persevered and kept repeating what I’d been told to say and eventually the receptionist and I seemed to understand each other. I was sent to stand outside the consultant’s room to wait my turn along with a number of other women. I soon realised that there was no appointment system here and even ‘first come, first served’ didn’t apply. It seemed to be a matter of pushing your way to the front or talking louder than the person next to you. After waiting for about twenty minutes the consultant called me into her room and went through my file. Then with her few words of English (so much more than my poor Chinese) she filled in a booklet for me and told me to go and pay for and then have an ultrasound. She pointed in the direction I needed to go and another patient was in my seat before I’d even left the room.

Once I’d paid it was time for an ultrasound but I couldn’t read any of the signs so I didn’t have a clue where to go! I tried to ask at the nurses station, along with the hundred or so other women who were clearly doing the same thing but with the benefit of being local. Eventually after some time waiting and some basic Pinyin, one of the nurses took pity on me and pointed me to the room directly behind me with a long row of chairs outside it. I took my seat alongside the other women and was eventually called into the ultrasound room. Having had no privacy at the first hospital I wasn’t expecting this one to be any different, and I was right. I could even see the other women’s feet in the stirrups sticking out from behind the curtain that divided the room! Remembering why I was there, that I was in another country where cultural norms are different, and repeating the mantra ‘what doesn’t kill me, makes me stronger’ got me through that first ultrasound and by the time we were ready for our second IUI procedure the lack of privacy had become second nature to me.

Our second IUI was very similar to the first, except that we had to navigate it all ourselves.  Once again the husband disappeared into a room for his important role and emerged with a plastic pot containing all our hopes. We waited until they cleaned the sample and then we and a young Chinese couple (whose parents were there with them) went back downstairs for the procedure. The husbands were left in the small waiting room and the Chinese lady and I entered the procedure room. Thankfully this time the room had been divided by a curtain so we had a measure of privacy. As before a nurse cleaned and prepped me for the procedure and then my consultant arrived to do the insemination. This time it didn’t hurt at all, just a little discomfort and I was told to lie completely still for thirty minutes. That afternoon my doctor prescribed progesterone pills for me to take daily as well as a cream pessary called Crinone.

The Chinese hospital does two IUI procedures on consecutive days as standard procedure so we were back the following day for more of the same. By now we were both old hands and it was a lot less stressful. This time the hospital consultant prescribed me yet another pill to take – Duphaston. So now I was on Crinone and Progynova in the morning, Duphaston at lunchtime and more Duphaston and Progynova at night. I started to rattle when I walked. A few days later I had another appointment with my doctor to check my uterus lining. It was a little too thin still so we upped my dosage of the necessary drugs.

On the morning of 21 November, I walked over to the hospital for the blood test that would confirm whether we had been successful this time or not. I wasn’t that hopeful as I’d managed to get the flu in the previous two weeks since the IUI. The nurse was very kind and promised to call me personally with the result within a couple of hours. It was amazing to think that the small vial of blood in her hand could be so important to us.

The husband was at work and I didn’t want to go back to an empty apartment so I wandered around for a while before getting a pedicure. I figured I deserved it and besides, it was a good distraction. I was in the middle of having my toenails buffed when my mobile vibrated in my pocket. The nurse’s excited voice filled my ears as she shouted ‘Congratulations!’. We’d been successful this time. Tears coursed down my cheeks. Finally, after almost four years, we were pregnant. Everything that had come before this moment disappeared. Our daughter was born 36 weeks later, one month premature, weighing 4 pounds. She is the most precious thing in the whole world to us – our miracle baby.

What happened next: read our birth story part one and part two and the aftermath – my postnatal depression.

 

Disclaimer: I am not medically trained and have written this post from my personal experience. Facilities and treatment options may have changed since my procedures took place. Any treatment options should always be discussed with a qualified fertility specialist.

Photo credits: Blue sky by hinnamsaisuy , a syringe isolated by m_bartosch and Pills by worradmu all at freedigitalphotos.net