an (in)fertility journey – good to see you again, too, I think?!

First of all, my period was late. After my previous covid vaccines I also suffered from later but heavier periods, but when I asked on twitter about other people’s experiences with their periods and the booster, many people said theirs was heavier but earlier, and that is foolishly what I had expected to happen for me too. 

And so it was that on days 37, 38, 39 of my cycle I began to get a little bit… not concerned, but curious. I didn’t really believe that I was going to be so lucky as to magically get pregnant literally just before I restarted IVF, but the thought did briefly cross my mind – enough for me to go and buy a pregnancy test “just in case”. 

The morning I took the test, my period came. Cycle day 41. Typical. 

Okay then, I thought. Time to go back to the clinic. I made an appointment for the early evening of the following day. 

Despite the fact that I have been there so many times, I know most of the staff, and I still remember most of what the process entails, by the time the afternoon rolled round I felt weirdly nervous. Maybe it was my post-booster period making me feel worse? Maybe it was a bit of both. I felt sick. My husband came home from work slightly earlier than usual to take over looking after our daughter and I cycled off to the clinic. 

Of course, the last time I actively received treatment at this facility was in that far distant Time Before Covid, and various things have changed. These days, the appointment system is much more precise, and you must of course now arrive exactly on time (instead of slightly early and waiting, for example, which is what I usually did). The main purpose of your visit is also to be selected from a list of available options on the appointment-booking website, so that they can reduce face-to-face contact that little bit more by being pre-armed with the necessary information before you even walk in the door. That’s fair.

So I arrive at the clinic, change from my shoes to the slippers they provide at the door, hand my registration card to the lady at the front desk, receive my patient number from her and go to sit in the corridor that serves as a waiting room. Every other seat is covered by a large white sign on which is printed “Do Not Sit Here” and an anthropomorphic cat in a nurse’s outfit bowing and apologising for the need for social distancing. I still feel sick; my mouth is dry but I forgot to bring any water with me and would have felt uncomfortable removing my mask to take a sip there anyway. One of the doors along the corridor opens and a nurse calls out my number – some regular/non-fertility clinics will call people out by name, but I quite like the privacy this way offers. 

First, they draw some blood and tell me it will take about half an hour to process. Then, back out into the corridor. Called again, this time for a transvaginal ultrasound. Bearing in mind I am on the second – and therefore heaviest – day of my period, this is a particularly icky experience. But! Just as I get myself into that awful chair and the nurse has tilted it back and got my legs open, the doctor walks in. This is the doctor who also works at the actual birth clinic I went to for my daughter’s birth, so I know him pretty well.

“Hello!” he says. “Long time no see! How are you doing?”

I, on my back with my legs in the air wide open, try to remain composed. Long time no see, indeed. What a first meeting after two years! “Relax,” he says, and shoves the ultrasound wand into my vagina. Relax, yes, absolutely, will put that on my to-do list. 

After that, it’s back out into the waiting area while my blood test results come back (I don’t actually remember what they were testing for/forgot to ask, but there clearly seem to have been no new problems) and then finally get to have a proper face-to-face talk with the doctor. 

“I think we’ll be putting you on the medium follicle stimulation programme,” he says, flipping through my file. I frown.

“I thought we were doing a more intense course this time round? Since we only got one egg last time…?”

“I mean, you could,” he says, “if you want to! It will cost a lot more though, and I doubt the result would be any different.”

We talk around this for a bit, and the doctor eventually realises that my understanding of the process is a little off. 

“Ah,” he says. “No, you’re right that last time we took the ‘medium’ route to minimise stress on your body. But last time was also a test, in one sense, so we could understand the functionality of your ovaries. 

“Imagine your ovaries are a factory. A factory with poor functionality, with poor equipment and problems along the production line isn’t going to be able to make a lot of any given product. Even if you have lots of people telephoning every day and yelling “Make more!!” it isn’t going to make any difference to how much product the factory is able to make, because they only have the equipment that is currently there. Your ovaries are like this factory. So we can go the more expensive route, with injections every day, or we can go a cheaper route with injections every other day, but the end result will most likely be pretty much the same.”

Okay, so my ovaries are a crap factory. Adjective, not noun: a crap factory, as opposed to a crap factory, which would be an entirely different problem. Got it. 

“Also,” he says, “we’ve changed the medicine that we use now. You used clomiphene, Clomid, before, yes? That has an impact on your endometrium, so we recommended freezing eggs and taking a bit of time off before implantation to give your body time to recover, right? Well, now we are using Letrozole.” He handed me some papers with information about it, and an approval form to sign. “It has fewer side effects and does less damage to your endometrium, so that wait time you had last time disappears.”

“Wait,” I need a minute, there’s quite a bit more new information than I had anticipated receiving in this session. “You mean that implantation would happen this cycle?” 

“Yes!” He points at the calendar. “So you are here today, yes? And you are coming tomorrow morning for your first injection, then again on Saturday, then again on Monday, and then next Wednesday you are coming for another consultation. At that time, we will see how your ovaries are doing and be able to prepare for your trigger shot. Retrieval will happen on the 17th, 18th or 19th, depending on how your ovaries are doing. Then, depending on the day of retrieval, implantation can happen on the 22nd, 23rd or 24th.”

Good lord. That means, if, if, if things actually work out, I could theoretically be pregnant before the end of the month. That’s much sooner than I had even optimistically programmed for. Not only was I expecting at least a several-week break after retrieval, but since last time I was going to the fertility clinic for getting on for a year before we successfully managed to get a positive pregnancy result that stuck, I now realise I was mentally allowing for several more months than was in any way necessary. Things feel like they’re rushing around me and it all feels a bit of a blur. 

“And I could get the eggs frozen, if I wanted to?” I ask. “If there are any.”

“Of course,” he says. “If that’s what you want.”

Back out in the main waiting room, I use my phone to schedule Thursday morning’s injection appointment while the staff put all the necessary data into their system and calculate how much I have to pay. The bill for today alone comes to over ¥50,000, ouch. 

“You can pay by card now!” the receptionist tells me. Well, that part is better than last time, I guess. The card reader is smooth with rounded edges, glows with a soft white light and looks like something out of a sci-fi movie. An egg that takes my money. How appropriate. I find my shoes where I’d left them on the shelf and begin to head home.

The next morning I went back with the signed permission form (permission? agreement?) regarding me taking the Letrozole. I didn’t blink at it before, because I’m now so used to Japan requiring the husband’s permission before the wife undergoes x y or z medical treatment regarding the reproductive organs. ‘My body, my choice’ is still a long way off! But out of curiosity, I asked the nurse who gave me my injection: “If the reverse were necessary and my husband needed to take some medication for fertility treatment, would you require my signature too?”

She paused to think for a moment. “Yes,” she said. “It doesn’t happen often here, but I think we do. Or we should, at any rate. I don’t know about other clinics, though.”

So there we have it! The rundown of things thus far. Both a lot and not very much have happened. I spoke with my parents over FaceTime on Wednesday night and after I told them about how I appreciated being armed with more knowledge and having a clear idea of what is going to happen next, my stepdad said, “This sounds positive!” He’s right, this is positive, logically I know this and yet I don’t feel it. I can already feel myself drawing back into practical mode: what’s the next step, the next step, the next step. There’s no point in being excited or optimistic yet – there’s nothing to be excited or optimistic about. Will the Letrozole do its job properly? Will there be any eggs to collect? That’s the next part I’m waiting for, I guess. Watch this space!