Four years later…

Do you ever have the intention of saying something and then kind of chickening out because you lack confidence in what you want to say? There’s something about this type of blog that feels kind of performative, I guess because I’m more used to the friends-locks and filters of LiveJournal and that type of blogging site. When I was younger (we’re talking almost ten years ago here) it felt normal to update my blog about all sorts of random waffle that only my friends could read, and now I feel self-conscious because this platform is very different! A lot of blogs have A Theme, or are the type of blog where people give advice on one topic or another, but I never feel authoritative enough to be qualified to do anything like that. 

Maybe I should stop thinking of this as “a blog other people might see” and instead just operate as though this is purely for my own amusement. Downloading the WordPress app so I can update on my phone has helped! With that said, I am now a mother, and while I don’t necessarily plan to be one of those Mummy Bloggers it is inevitable that there will be some mum-stuff here and there. 

Anyway, hello again, it’s been a while. We’ve moved house a couple of times since my last post, from Tokyo to Osaka and then back to Kanto, now in Kanagawa prefecture. We have also increased the number of legs in our family to 14 in total! Three humans (my husband, our daughter, and myself), one rabbit called Holly (turning 4 soon), and one dog called Sky (turned 2 in May). Sky and Holly do not get along – Holly dislikes Sky on principle, and while Sky likes Holly very much he would like her even more if she were to become his dinner, so their interaction is kept to a minimum out of necessity.

Since the last update I have also broken my leg, destroyed my ACL, and been hospitalised twice as a result, but absolutely none of that is the main focus of today’s post! What I want to talk about today is my experience of:

fertility treatment in Japan

or at least, as much as I can remember of the first stages of it, since my memory is beginning to fade. On the off-chance that anyone in a similar boat has stumbled across this blog looking for someone to relate to, I deeply sympathise and I hope that your difficult situation resolves smoothly. Naturally, everyone’s case is unique but I hope there’s something helpful or at least vaguely interesting here!

We started trying to conceive a few months after getting married/moving to Osaka. I – as a lot of people do these days, I should imagine – read tons of stuff online, stalking forums, getting ready to track all of the stuff people do to figure out when they’re likely to ovulate. None of the data I collected seemed to make much sense, though – there was no spike or drop in my basal body temperature, for example, and ovulation test strips never seemed to give a clear answer one way or the other – and after a few months I got pretty frustrated. How were we supposed to find the magical window of opportunity if I could never work out what was going on?

And then in early 2017 my period was even later than usual, like properly late late. I did a pregnancy test, but much like the ovulation predictor kits the result was a resounding “…eh…”

Maybe it’ll get clearer if I wait a couple of days, I thought. Since I had no idea when I ovulated, it was impossible to know whether or not I’d tested too early. So I waited, tested again, and got the same inconclusive answer. There was a faint line, but surely if my hCG levels were going up (as they should do) then the line would be stronger by now, right? Another few days, and then a couple more, and by the time another week passed my body eventually let me know that nope, it’s not happening this time.

So I guess you could say that was my first early pregnancy loss. I didn’t go to a clinic to confirm either way, and don’t know whether or not that was the right move. I vastly prefer the Japanese 化学流産 – kagaku ryuuzan, chemical miscarriage – over the “chemical pregnancy” that often gets used in English, because to me “chemical pregnancy” makes it seem like you weren’t even remotely pregnant, like it was just a technical error or a glitch, and when you’re desperately hoping to conceive, those couple of weeks of hope and the following time of crushing disappointment are very, very real.

Anyway, after crying a lot (just me; I am in charge of crying in this house!) and taking a break, we started trying again.

To no avail. As before, religiously keeping tabs on all my body’s changes simply became an exercise in frustration as there was no discernible pattern to be found. We began to doubt if it was even possible – and perhaps that miscarriage early in 2017 was a mistake, perhaps it hadn’t even really happened, perhaps we’d imagined things.

My mother had me when she was 33 years old and at the time she felt as though that was a little on the late side. I remembered her telling me that she felt it would have been “better” if she’d been able to give birth a bit earlier, and so I had this mental deadline that I wanted to have at least one child before turning 33. (I do appreciate that this is not strictly rational, and I do not apply this illogic to anyone else!) By mid-2018 we had left Osaka and moved to Kanagawa prefecture, and I had turned 31 and was beginning to feel my stress levels rising even further. I know that many people try for far longer before seeking medical advice, but after reading that the majority of people with no fertility issues manage to conceive inside 12 months, we decided to look up fertility clinics in the area. 

We ended up going to the first place nearby that had good reviews on Google – nothing more technical than that. As it happened, they were really great and we stuck with them, but I was originally prepared to search around if necessary. They ran a bunch of tests and for the first cycle they used a transvaginal ultrasound wand to see how near I was to ovulating, and basically told me when to have sex. They also got my husband to provide a sperm sample to see how things were on his side – absolutely no problems on that front. The first cycle showed that I was ovulating really quite late in my cycle, and that the post-ovulation time (the luteal phase) was kinda short. That would mean that even if the egg were fertilised, it might not be able to burrow into the uterine lining before my body decided to menstruate. Hmm. 

A blood test showed that my hormone levels were “slightly” off – not excessively to the point where they could go “ah hah! That’s the problem!” but at least enough for my doctor to mention. We started Clomid. 

No luck there. Next up, a couple of cycles using Clomid and a “trigger shot” to push for prompt ovulation. 

No luck there either.

By this point we were already getting on for half a year of going back and forth to the clinic, and the stress was really having a big impact. When you’re trying to conceive (even naturally), it isn’t something you can ever really stop thinking about. For at least half the month you’re avoiding caffeine and alcohol “just in case”, making sure you’re eating healthily, hyper-aware of anything your body does differently… And then just as you reach the most stressful, hopeful week, everything comes crashing down again and you’re heartbroken that this month too was a failure. When you factor fertility treatments into it, there’s an added layer of wasted money, and since you’re usually going to a fertility clinic after years of trying naturally as well, honestly the stress is enormous.

So my husband suggested that we took a bit of a mental health break, maybe a month or two off. I was still desperate to get pregnant “soon”, but I really couldn’t deal with this constant baby obsession any longer, so agreed. 

And then I got pregnant. 

As in, a positive pregnancy test result that you didn’t even need to squint at! Even my husband, the sceptic, agreed! We had an appointment at the clinic two days later anyway, so went in. Oh my god, finally pregnant just like that? Could it be? Did I really have a precious, tiny life in me?

…Only the test result at the clinic was much, much fainter. It seemed like my hCG levels were going down again. Another early miscarriage. Another dead almost-baby. Again.

Right, my doctor said. Time to consider IVF. 

In this interview on Kay’s most excellent blog (which I recommend following!), I was asked to give “a short overview” of the IVF procedure, and I’m just going to copy-paste the whole thing from there: 

• On day 1-3 of your cycle you visit the clinic and have a transvaginal ultrasound (which is pretty gross) and they start you off on whichever ovarian stimulation protocol you’re going for. More intensive stimulation runs the risk of ovarian hyperstimulation syndrome (OHSS) so they generally try less intense methods if possible. We personally went down a mild/medium route which involved going to the clinic every other day for injections. I also had oestrogen patches to wear on my skin for 48 hours throughout.

• On day 8-10 you get to have more tests (transvaginal, blood) to see whether or not your follicles are the right size/your body is reacting appropriately. If so, you get a trigger injection. I got to take this one home and inject myself! The timing was VERY important. It literally had to be at precisely 9pm, a day and a half before retrieval. This trigger shot is the most important and there is therefore no leeway. Other injections and procedures etc can have a bit more flexibility but this one was pretty much set in stone.

• Egg (oocyte) retrieval then happened around 7:30am exactly two days later. Sperm was also (naturally) necessary at this point, and while we had the option of me taking a sample container of sperm to the clinic with me (stuffed between my boobs to keep it at a reasonable temperature) I opted to have the husband come with me! Retrieval is definitely unpleasant and they let you have a lie down afterwards. On the same day they also tell you how many eggs were successfully retrieved – the average is 8-12, we had one (1). It was at this point that we discovered I’d been having anovulatory cycles. There are people out there with no eggs collected whatsoever, so even one was something to be grateful for! Sperm quality is also assessed and fertilisation method discussed. One friend of mine had sperm so “powerful” that more than one sperm penetrated the egg at once and messed up the whole fertilisation process for more than one oocyte, so care must be taken at this stage as well.

• A couple of days later you go back to the clinic to find out whether or not fertilisation was successful, and you also learn about the “quality” of the egg (as in, its likelihood of growing well). I was deeply pessimistic following the shock of only having one oocyte retrieved and so was completely knocked sideways by confirmation of fertilisation! That one egg!

• At my clinic they then froze/cryopreserved the embryo and let my body finish out its cycle to give my uterus a chance to recover from the retrieval procedure.

• If your body still isn’t quite ready the next cycle (mine wasn’t) they can give you birth control pills to take for a week which then triggers a false period and allows your uterus to kind of “reset” and be ready for the transfer.

• On the day of the embryo transfer they let you know if it has survived the cryopreservation/if it is developing well, and then are super careful about checking patient information (wouldn’t want to transfer somebody else’s embryo!) before pinging the embryo inside you and then just sort of… hoping it sticks! There was no specific need to lie down for a long time or take the day off work or anything but I decided to take things gently all the same.

• And then you wait. For me, I still had to have oestrogen injections for a while, which then dropped down to just the oestrogen patches (my skin was tired by this point) and I also had progesterone pessaries to insert every night.

• Finally, exactly 10 days later, I went back to the clinic for the result. I walked into the consultation room and the doctor had a piece of paper on the desk saying ご妊娠された皆様へ、ご妊娠おめでとうございます (To everyone who has become pregnant, congratulations on your pregnancy) which I just stared at for a good thirty seconds because I was so, so programmed for it to have been a failure! Me, pregnant! My one, single, tiny, average-quality egg! Of course, conception is just the start of the journey so there was plenty more to come…

Oh, how lucky we were for that one little tiny egg to successfully grow and make its way to a safe place inside me to develop into my little tiny human! So many people have to go through so much more, for so much longer. I know it’s a cliché but it really feels like a miracle. 

More to come on pregnancy later! It has taken me several months to get this post written so I can’t guarantee the highest of speeds but I do at least intend to post within the next four years 😅