Being diagnosed with infertility has been an extremely confronting & challenging experience, described as a roller coaster of ups & downs of emotions. It is extremely normal for me to feel stressed & overwhelmed about this life crisis. I feel hope but at the same time shock, anxiety, exhaustion, distress, fear, sadness, frustration, panic, isolation, a sense of loss & grief & other normal emotions & am managing my stress to my best ability with strength & support from my mum & friends. I know what is happening but it is hard to know what to feel & how to react. It is important for me to regularly discuss how I feel with my loved ones & allow you to offer your understanding & support of my challenge. Together we must attack the problem, not each other. I have gathered as much information to make me feel more in control of my situation, information is power & explain my knowledge to others. Talking with others helps me clarify & identify my areas of concern & this is a form of a stress management technique which is effective for me to help, which is healthier than bottling things up. I'm trying not to think too far ahead & deal with my current issues rather than worrying about too many what ifs & am preparing myself to deal with each issue & outcome as they arise. I have found that starting treatment has been a positive experience because I have something to focus on, something that is finally happening for me, but I do also find the waiting process the most difficult part. My days seem to pass very slowly & it is a time of acute vulnerability & sensitivity, I am not able to concentrate on ordinary life, as this process is not a single event but a series of hurdles where each stage has to be crossed before I can tackle the next one & is a very tiring & disappointing time. I feel as though I have lost control of my future, not being able to achieve pregnancy that seems so easy for other people. My emotions are very intense & I take less interest in other peoples lives & am confused whether to avoid or encounter friends with babies or who are pregnant. In addition to me dealing with my uncertainty & trepidation, I'm also experiencing hormonal changes in my body, responses to medications used to stimulate my ovaries. Having my mum & friends to confide in is important while I go through this difficult patch, especially if I receive worse news. It is important for me not to take on too many other things in others lives when undergoing this process. It is important for me to keep busy with distractions, therefore getting out of my home with friends to hang out & exercise will help me. It will take me some time to come to terms with my emotions & I have good days & bad days. Good communication is essential in our relationship, but this can be strained when I'm undergoing this procedure. I am be dealing with all of this in ways you may not understand & I often think you should know how I feel or be able to read my mind but this is unfair of me to assume this if I haven't talked to you about my process, this is why I share with you. I tend to confront this problem directly by talking it out & will not take well to anyone who trivialises my issues with a just relax, you'll get pregnant, you're trying too hard, you'll be right attitude. While well meaning, these statements are very hard to hear as this is a medical condition & no amount of relaxing will help. Some responses you may like to use could be "I am sorry to hear you are going through this, I am here for you, Could you use a hug, Is there anything that I can do, I'll call you if you want to talk". Despite any strains, I hope my experiences lead to stronger relationships. If you are going through your own personal problems, letting me know when a good time I can share with you about my problems will be essential to avoiding conflict. Expressing how I feel releases my stress & it's important for me to reach out for support. It is a sensitive subject & I understand you may be weary as to how to react, as fear of saying the wrong thing. I will try my best to guide the conversation to avoid topics that may cause additional stress. It is important for me to talk to you about the role you can play so you know what I need. This may be just to listen & acknowledge my words, opposed to giving advice or trying to fix things for me. My expectations of you I will make clear, so you can provide me with comfort. Baring in mind that it is very hard for me to hear about others children, as it seems that everyone around me has kids, is pregnant or are pushing prams. Feeling distress from this does not make me a bad person, so avoiding these topics will respect my mixed feelings. Just having you here for me as an impartial, non-judgmental ear, will help me cope. If you are interested in coming to appointments with me, this will be helpful to share my situation & compare understandings. Getting out of the home, walking together, will also help release my tension. You can play a very important part as an emotional rescuer during my infertility as a single woman.
Polycystic ovary syndrome (PCOS) is the name given to the condition in which I, with polycystic ovaries have an associated hormonal imbalance within my ovaries. PCOS also describes the appearance of my ovaries when they were seen on an ultrasound (cyst-like). Being of the reproductive age, PCOS is the most common endocrine disorder, affecting approximately 5% of women. Normally the ovaries produce estrogen, progesterone & testosterone. In PCOS, estrogen is usually produced in excessive amounts & progesterone, which is released after ovulation (the release of the egg from the follicle), may be produced irregularly or not at all. It is still unclear what causes PCOS. While PCOS is not curable, there are several approaches to achieving hormonal balance. I have had irregular or no menstrual cycle, infertility due to lack of ovulation, acne & weight gain (disproportionate to kilojoules intake). I am noted to have a higher than normal miscarriage rate if I become pregnant. 75% of women with repeated miscarriages are reported to have PCOS. I have a BMI of 28.3. Women who have a body mass index (BMI) >29 will take longer to conceive (normal BMI ranges from 20-25). Other related symptoms may include mood swings & chronic fatigue-like symptoms. My lack of ovulation with PCOS results in continuous exposure of the uterine lining to estrogen. This may cause excessive thickening of my endometrial lining of my uterus & has resulted in irregular bleeding. The incidence of uterine cancer may be increased due to years of continuous stimulation of the endometrium by estrogen unopposed to progesterone. I also have an increased risk for developing the metabolic syndrome which is characterised by abdominal obesity, hypertension & impaired blood sugar regulation. I have an increased risk for developing non-insulin dependent (type 2) diabetes & possibly heart disease. Diagnosis was made by a careful medical history & examination, ultrasound of my ovaries (noted to contain many cysts) & measuring hormone levels by a blood test. Obesity is common in women with PCOS. Diet & exercise that results in weight loss has been shown to improve the frequency of ovulation, improving fertility & lowering the risk of associated problems common to PCOS. Overweight women are also noted to have a higher miscarriage rate. Prophylactic b-group vitamins have been noted to reduce homocysteine levels, implicated in cardiovascular disease in women with PCOS. Since fertility is my main goal, treatment with medication, such as metformin, can increase my bodies sensitivity to insulin, leading to regular ovulation. Ovulation may also be induced with clomiphene citrate (clomid which I have been prescribed, or serophene) an orally administered fertility drug. I will be required to inject a fertility drug also, administered at a low dose (FSH) to help induce ovulation. The aim of these drugs is to produce only one mature egg, similar to a natural menstrual cycle. FSH injections however are associated with a greater chance of multiple pregnancy & side affects. Ovarian drilling or diathermy has been used to treat women with PCOS & is a minimally invasive operation performed through a laparoscope. The ovaries are "drilled" or cauterised. This procedure has been shown to induce ovulation in some women with PCOS, as an alternative to IVF, if having not responded to oral or injectable fertility drugs. The normal reproductive cycle is principally controlled by hormones released from several organs in my body. At the base of my brain, the hypothalamus gland produces a hormone called gonadotrophin releasing hormone (GnRH). This hormone stimulates another gland known as my pituitary, which is situated just below my hypothalamus. My pituitary releases two important hormones which are involved in reproduction - follicle stimulating hormone (FSH) & luteinising hormone (LH). Both these hormones have a direct affect on my ovaries during my menstrual cycle. The amounts of LH & FSH released & their specific functions change as my cycle progresses. FSH stimulates my growth of small sacs in my ovary known as follicles. Each follicle contains an egg & produces additional hormones. LH helps FSH to stimulate the production of these hormones, both before & after ovulation. At a time roughly half way through my menstrual cycle, a sudden surge of LH & FSH causes the rupture of the dominant follicle & release of my egg from within. LH is now, at this stage of the cycle, the most important hormone, because it enables my egg to become mature & ready for fertilisation by sperm. I have two ovaries, located at the pelvis alongside the uterus (womb). Their main functions are to release eggs & produce hormones. At birth my ovaries contain thousands of eggs, each surrounded by cells which develop into a small fluid-filled blister (follicle). Each month, when I had regular periods when I was ovulating normally, one of these follicles would grow to about 20 millimeters in diameter & then released an egg (ovulation), which passed into my fallopian tubes. Here, fertilisation should take place, after which the fertilised egg (embryo) continued to my uterus to implant in my lining (endometrium) & is supposed to develop as a pregnancy, but due to my PCOS none of my eggs respond to being fertilised. My ovaries produce many hormones, those most important being oestrogen & progesterone. Oestrogens promote growth of my follicles & development of my endometrium, which progesterone which is released after ovulation, is important in preparing my endometrium for pregnancy. It is estimated that as many as one in six women are unable to have a baby due to infertility. Few are infertile beyond all hope but most can be helped by medical treatments. The cause of my sub-fertility might lie with me having blocked fallopian tubes & doctors may not be able to detect any obvious cause, therefore call some infertility 'unexplained'. One common detectable cause of infertility is a hormonal disorder which upsets or even shuts down, the normal reproductive cycle. If the output of reproductive hormones from my pituitary or hypothalamus is insufficient or wrongly balanced, follicles will not develop properly & ovulation will not take place. This is known as anovulatory infertility. A common cause is PCOS, which is my disorder of ovarian hormones. In my rarer case hypothalamimc or pituitary disorders, I do not produce any gonadotrophins (GnRH) at all, therefore I do not experience the follicular development necessary for ovulation. In my case, ovulation can be induced by fertility drugs. These will be ingested as a tablet & a series of gonadotrophin injections. Ovulation induction is one of several therapy options in the treatment of my infertility. The principle of the treatment is to stimulate my ovaries to produce a single mature follicle to induce ovulation & to allow fertilisation to occur. After blood tests, my hormones were shown to be normal therefore this disorder was ruled out, though PCOS was my diagnosis. The reason I can not become pregnant is because I am not ovulating. Fertility drug treatment can usually solve this problem. Climiphene citrate, the most common drug used in the induction of ovulation, which I will take as a tablet for five days from my second day of my menstruation. Results show that four out of five women given this, do ovulate but only about one in three actually become pregnant. The starting dose is usually 50 milligrams which may be increased to 100 milligrams. This can cause thickening of mucus in my cervix so a post-coital test will tell my specialist how well the sperms are surviving in my genital tract. A possible, rare & of short duration, side effect I may experience could be bloating, nausea & sometimes difficulty in breathing. Multiple pregnancy is a risk whenever ovulation is induced with fertility drugs statistics are one in twenty, whereas women who are blessed with unassisted conception have a risk of one in eighty. There is no increased risk of birth defects from any fertility drugs. My ovulation induction treatment due to my infertility to ovulate normally, will hopefully give me the chance of conceiving. Crucial to my success, is that insemination is timed to coincide with my ovulation which treatment will been achieved. Monitoring of my responses to treatment will be a vital part of the programme, to maximise my chances of a successful pregnancy & minimise any risks. Careful monitoring will hopefully prevent the development of too many eggs & thus hopefully reduce my chance of multiple pregnancies & the development of my ovarian hyper-stimulation syndrome. My treatment may be suspended if there is a danger of either of these two conditions occurring. The best way my specialist will monitor my ovaries response will be via ultrasound. My scan may be performed either through the lower part of my abdomen in which case it will be essential I have a full bladder, or more commonly with a probe in my vagina. Whichever way, the scan will show on the ultrasound screen how many follicles are growing in each of my ovaries. Each of my follicles should contain one egg & this is considered me being ready for ovulation if it has reached a diameter of at least 17 millimeters. Similarly, my womb lining (endometrium) will thicken in readiness to receive an embryo & this should reach a thickness of at least 8 millimeters by the time of ovulation. My specialist may back up this ultrasound monitoring with further measurements of my hormone levels in my blood. My oestrogen levels will be the most important because they will indicate how well my follicles are growing, however only ultrasound can reveal how many there are. Midway through a successful, healthy cycle, my pituitary will hopefully secrete a surge of LH which will encourage the dominant follicle to release its egg. This natural process is mimicked in ovulation induction treatment by injecting another hormone. This preparation will be given to me once my ovary contains one or more mature follicles. This process will take between 36-48 hours to work, so if given in the morning ovulation should be expected during the following night. This & the following evening is the best time to be inseminated. My specialist will hopefully be able to confirm that ovulation has occurred by taking a blood test to measure the levels of progesterone around seven days after ovulation. The chance of having a miscarriage or a baby with abnormalities is the same after ovulation induction as if were after natural conception. What risks there are depend upon my age & genetic factors. If I do become pregnant after this treatment, no special measures are necessary, my pregnancy would be treated just like any other. Labor & breastfeeding would not be affected in any way & my folic acid supplement in my daily Elevit tablets will reduce the risk of some birth defects. The chance of having a healthy baby after assisted conception treatment is difficult to estimate because it depends so much on my age & the severity of my PCOS. It is certainly fair to say that the average chance of conception after one cycle of treatment is between 15-25%, 1 in 7 to 1 - 4. So it is often necessary to have more than one treatment cycle before pregnancy occurs. The mucus barrier that exists in my cervix definitely reduces the number of sperm that can pass into my uterus & fallopian tubes. Normally about 15% of ejaculated sperm succeed in passing through my cervix. Intra-uterine insemination (IUI) involves preparing; warming & 'washing' (treating) the sperm in the laboratory, which a large amount of the best performing sperm is then artificially inseminated directly into my uterus in order to improve the opportunity for conception. No more than ~0.5mL of prepared sperm is placed in my uterine cavity. This technique involves separation of the seminal plasma from the spermatozoa & selection of the more morphologically normal & motile sperm for insemination. The potential improvement in fertility in this time of treatment may yield depends on the initial male semen analysis, in my case frozen sperm opposed to fresh. In my case, clomiphene citrate ovulation induction will be the use of a medication in combination with IUI, shown to increase pregnancy rates over natural cycle IUI & the most recent studies have suggested that this is the best option to achieve results. Being under the age of 38, my infertility is unexplained. My donors semen is stored in liquid nitrogen & will be thawed on the day of my procedure. The sperm will be gently inserted into my uterine cavity using a speculum so my cervix (neck of my uterus) can be seen & a narrow tube & syringe attached to a disposable catheter to bypass my cervix. This procedure takes just a few minutes & feels much like a pap smear, no pain, I may be asked to remain laying down for up to 20 minutes then normal daily activities & routines can be resumed. I will need to give myself a booster injection of hCG which can be done at home, around seven days after insertion. If successful, my child will have half-siblings in up to 9 other families, as each donor can donate to 10 women.
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