* Author Topic: Carpe ovum (seize the egg) - sibling journey (ICSI cycle 2 w/ PGS = baby boy!)  (Read 16358 times)

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Offline Liz3511

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A bit of background ...

DH and I started TTC when I was 24 (he was 28). In the first year, we had 3 consecutive miscarriages, with no reason found. Finally, our luck turned and we had our first live birth in 2008. Amazingly, two more live births followed in 2010 and 2012. All pregnancies were extremely high risk, and have included a mixture of premature birth, pre-eclampsia and IUGR.

We thought we were done - and we have no doubt how astoundingly blessed we are with the family we have.

However, DH had always wanted a 4th. I declined until I had a permanent job (I finished my PhD in 2012 and worked on short term research contracts for several years until getting a permanent role last year).

My chief concern in starting TTC was the risk of further miscarriages and high-risk pregnancies, and my body 'rejecting' pregnancies. I never imagined there might be something wrong with DH's sperm. However, after 5 months of trying and one early miscarriage, we had a SA to rule out any issues ... and received the news that the sample's motility and morphology was so poor that ICSI would be necessary. His count was 22 million/ml - not 'low' but not far off the threshold for low.

So we embarked on efforts to improve his results using lifestyle change and supplementation, and began to search for a clinic for our first ICSI cycle.

Story to be continued ...

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    Offline Liz3511

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    I had an appointment with a local clinic and left it feeling as if I hadn't learned anything new (but paid 200 for the privilege). I looked at the likely cost of treatment at the clinic - about 6500 for ICSI, without the extras - and thought about the awkwardness of cycling there, a busy NHS clinic albeit as a private patient. Decided to think about options abroad.

    I'd heard of Serum years ago on a fertility forum I used to frequent (Taking Charge of Your Fertility - TCOYF/Ovusoft - no longer running) so I followed some of the Serum threads here and decided to contact them. They advised a period blood sample and hysteroscopy so I went ahead with both. Hidden C was detected in the sample of period blood so DH and I took antibiotics for about a month, and in April I flew out to have the hysteroscopy with implantation cuts.

    I found the clinic staff so, so lovely and the hysteroscopy showed a small amount of inflammation and some fluffy white tissue which was cut away - the surgeon indicated that this was likely due to the hidden infection. They suggested I was likely to conceive naturally - this seems to be advice given to a lot of women - but when pressed they were happy to write up a 'draft' protocol for a cycle. I loved their flexibility and warmth.

    DH flew out for a follow up sperm analysis in May (as he put it: I went to Greece for a w*nk!!!). This showed increased count (44 million/ml vs 22 last time), improved motility and morphology which was better than last time - but still below normal. In the period between the analyses he had given up coffee and started taking Proxeed, omega 3/6, selenium, vitamin C, vitamin E and zinc. He had also switched entirely to boxer shorts and decreased the amount of time he spent on the stationary bike. His sample was frozen for use in any future cycles.

    By June I knew that I didn't want to spend the summer 'trying' naturally. The pressure of timed intercourse was getting to both of us and I felt that we just needed to move forwards. 

    I travelled to Athens on the 26th of June for our first cycle. I was on the short protocol with 150MIU Puregon, aspirin, melatonin and clexane. On the plane over there - stimms day 6 - I was feeling pretty uncomfortable and wondering uneasily how much worse it was going to feel. The answer, as it turned out: lots!! I was really, truly uncomfortable and felt ill for all of the time I was in Greece before egg collection. I was completely on my own for 12 days, as DH was at home with the children, and I desperately tried to work / make myself eat but it was a complete struggle. I know it sounds pathetic but by the time EC came I could barely keep anything down, not even water, let alone the 8/9 egg whites I was apparently meant to be eating.

    It was clear at my first scan that I'd developed a lot of follicles, well beyond the initial 13 viewed at my baseline scan, and they just kept growing. At my last scan before EC, they counted more than 20 mature eggs ... I triggered on stimms day 9 or 10, with egg collection on day 11 or 12 (it's amazing how you forget the details already). They retrieved 26 eggs and decided to leave a few harder to reach ones behind as well.

    I was delighted at the number of eggs collected and hoped against hope that this would mean I'd have enough for a couple of FETs. I had begun to suspect that I wasn't going to be well enough to transfer in a fresh cycle and the doctor agreed. However, I went a couple of days with no meds (not even progesterone - which I now think might have been a mistake?) and began to feel well enough to talk about transferring fresh.

    Of the 26 eggs, 16 were mature. 12 fertilised with ICSI - but DH's frozen sample had not defrosted very well, and the sperm were looking ropey. At day 3 we had 2 grade 1 embryos transferred, with another 6 at grade 2 carrying on to day 5. At day 5, however, none of them had reached blastocyst - two got there on day 6, and were frozen on the same day I travelled back to the UK. They were a 5aa and 4ab.

    I got home and tried to forget about the cycle as much as possible. I had been surprised by how tough I found the experience, and how isolated and unwell I felt. I'd imagined popping out to do some sight-seeing, and having lunch in nice cafes, not lying on the sofa of my air bnb for hours, being sick and missing my family.

    In the event, I did get a positive result, but HCG was low and stopped doubling at around 1200. A gestational sac was seen via scan at 5 weeks just before the doubling stopped and the HCG plateaued. I had medical management, which worked within a few days.

    The saddest thing was the feeling of (slight) relief once I knew that it wasn't viable - I wanted a viable pregnancy more than anything, but hovering in the limbo of HCG tests and waiting (let alone trying to find somewhere to get your HCG drawn repeatedly - I don't live in London) is a nightmare I had inhabited on 4 previous occasions and I have PTSD from the experiences of one of my previous miscarriages in particular. Knowing for certain that it wasn't going to work was horrid, but it's the hope/fear push-me-pull-you that truly sends my anxiety off the scale.

    The miscarriage was about 3 weeks ago now. I think I ovulated a couple of days ago but we didn't have it in us to 'try'.

    We now have to work out what to do next.

    The day I found that the pregnancy wasn't viable, I applied for a consultation with the ARGC.

    I don't even know what made me do it, other than a flippant comment I made to DH of "ah well, it was our most expensive miscarriage yet but can you believe that the best UK clinic charges more than 10k per cycle, so at least we haven't spent that?" - and his reply, rather than horror at the price, was to ask me, "but does the clinic get results? Because if it does, maybe we should talk to them".

    So ... the consultation is tomorrow!!! At 4pm, with another SA before it at 3.30pm.

    I will update when it's over.

    Before then, I feel like I should explain why I'm considering other options. Frankly, I love the people at Serum. They clearly know how to get me to grow eggs and the fact that my Dr emailed my directly throughout to answer any questions was beyond my wildest dreams! Even the lovely Penny came to see me on the day of egg collection, to see how I was feeling. On the other hand, actually staying in Athens was incredibly difficult for me emotionally / socially, and I do have some slight worries that I was at pretty high risk of OHSS / my endometrium was overly mature at transfer due to my high levels of oestrogen (I assume - I didn't have them tested at all). I feel that some closer monitoring might have been reassuring, if only to set a first-timer's mind at rest.

    However, I don't know what I think about the immunes that ARGC offer. I'm a scientist and I like well-tested treatments with good RCT evidence behind them BUT these are almost impossible to get in the world of fertility, and I completely understand why, so we have to trust out clinicians to interpret the imperfect literature for us and to take 'best guesses' based on experience and emerging mechanistic evidence. And obviously the thought of the cost makes my head hurt.

    Roll on tomorrow ...

    Offline Liz3511

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    Trying to work out what to wear! Surprisingly hard - I spend 98% of my non-work life in jeans ...

    Offline Liz3511

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    First of all, the answer to the most important question: I wore a smart pair of jeans, Boden ravello top, Joules jacket and pair of scruffy sneakers because we were running late and I didn't have time to change my shoes. DH was wearing his work clothes: a crumpled shirt that appeared not to have been ironed, and chinos, which may/ may not have had a patient's blood on the right knee.

    In the waiting room people were wearing all sorts and I really shouldn't have wasted any thought on clothing.

    Assuming you'd like to know about the appointment itself, having satisfied sartorial concerns, please read on ;)

    I was expecting awful things from the waiting room (see, for instance, this hair-raising article: ]https://www.independent.co.uk/life-style/health-and-families/health-news/my-ivf-and-the-clinic-from-hell-432334.html]) but it turned out to be at least 300% posher than any previous waiting rooms I'd ever been in. In reference to the linked article, I also quizzed DH about the state of the 'production' room in which he generated his sample, but he had selfishly failed to notice any pertinent details and steered well-clear of any provided literature (as that is his usual way). Someone told me there was 'sheikh' p*rn and I would have dearly liked to know if this was correct. However, the room clearly wasn't ridiculously grim or even DH would have noticed, I think.

    We began with the usual HFEA welfare of the child paperwork and data sharing agreements, then it was upstairs for our appointment with Mr R - we didn't know in advance who we'd see, and I was momentarily blindsided to hear a name I'd read about here on FF (I'm clearly easily starstruck).

    In easily the biggest consulting room I've ever been in, Mr R looked through our file as he talked to us and seemed to be familiarising himself with our details then and there, which I was fine with (it's an approach I take when I see students - rarely enough time to read the file in advance). The key thing he seemed to know about us ahead of time was that DH is a doctor. I think this explained why most of the dialogue was addressed to me, although possibly my endless list of questions had something to do with it. Overall, he was grave but professional. We did not feel rushed at any point. Part way through the consultation, DH's initial SA results arrived (more on that later) ...

    We ran through medical and fertility hx, previous births and losses, and then came to my previous (first) cycle. He was relatively diplomatic but appeared surprised that my estrogen / progesterone etc. hadn't been measured during stimms (I suppose that's basically ARGC orthodoxy and other clinics differ!). He hypothesised that high estrogen might have affected egg quality or endometrial receptiveness. He basically didn't raise any concerns that I, or Newlife, hadn't picked up already but it was helpful to know that the same things were picked up.

    Regarding the immunes, it's clear that ARGC don't trust the Locus Medicus tests. I'm imagining an underworld of immunology labs having ongoing beefs with one-another at scientific conferences  ^bigbad^ - maybe they sabotage each other's powerpoints or something. At least it would add some interest to the average conference (I speak from experience, albeit not in the immunology field). Anyhow, they want to re-do the immunes (sigh!) and I am grudgingly willing to do this so long as they come back clear.

    Hmmm, there's a flaw in the logic there.

    What I mean is, if I don't do the tests then the clinic may blame any future failure on them. If we can just rule them out, then that allows us to focus on the nuts and bolts of the cycle.

    If they come back high ... then that's another thing, and at that point I'll be asking them to show me the published evidence supporting the suggested treatments and entering into a robust discussion. DH felt that the medical risks of humira had been rather brushed over (he's seen it go wrong, in low / infrequent doses, as part of his clinical practice) but it is definitely impossible to cover all of this in a face-to-face meeting so I'm fine with that. Cross that bridge when I come to it.

    Thanks, by the way, to two members who got in touch to share their experiences and views of immunes at ARGC. You have really helped me gain courage in my convictions.

    I'm going to post this and then carry on with the story ... I'm incredibly verbose and worried that FF will magically delete this partway through ...


    Offline Liz3511

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    Okay phew, first post worked.

    So, as I anticipated thanks to FF, the next step is a monitoring cycle with bloods on CD3ish, mid-cycle scan with bloods (and wallet-draining immune tests), and bloods at 5-7dpo. Hoping I can convince my GP to do the blood tests at either end of the cycle to save at least a little money. Assuming my temping / billings method is correct, my period is due on 31st August, putting the mid-cycle scan on around the 10th Sept. Fingers crossed that we can sort out logistics for that day (DH generally works rather late .. he won't be at the scan with me but would need to retrieve the children from after-school club).

    The proposed protocol is likely to be, again as anticipated, long - downregulation with Suprefact then various ratios of stimms a while afterwards. I've never down-regulated before - hope that it doesn't result in an exaggerated version of my usual pre-menstrual symptoms as that will be a bit grim. The good thing is that I don't have to play the CD1-3 bloods lottery with ARGC that I've read about here, where a cycle will only go ahead if the FSH/ estrogen levels are good at the start of it: this seems to be confined to those on the short protocol.

    I don't know if I'm right on this, but I would imagine the LP also gives one a little more flexibility on start dates / planning ahead ... could be totally wrong!

    The only remaining bit of info we discussed was DH's SA results. Previous count from the analysis in May was 44mill/ml and the jammy bugger had increased that to 100mill/ml, giving a total count of 330 million. Motility was 52% (about the same as last time, but good as over 32% I think) and this time morphology was 4%, increased from 1%. Still on the borderline of bad, but I can forgive DH for grinning like an incredibly smug Cheshire cat overall. Agglutination was apparently present but Mr R didn't seemed particularly concerned and I have uncharacteristically refrained from searching for it in the medical literature. I don't subscribe to the idea that ignorance is bliss (as if!) but even I admit that my ever-increasing volume of knowledge in the area hasn't brought a single iota of bliss either, nor much wisdom (i.e. knowing what to do with the knowledge that I have, and when to stop gathering more).

    Mr R recommended DH continuing the antioxidants (and increasing the 400MIU of vit E to 800) but didn't pass comment on anything else supplement-related. The only thing he asked me about is folic acid (I take metafolin and B12 because I couldn't be bothered paying to be tested for MTHFR, so am behaving as if I have it). He mentioned inositol (which I have been taking for about 2 weeks now) but nothing else.

    After the appointment, we had a wander 'round the incredibly lovely streets surrounding the clinic, before heading back towards St Pancras and the train home (stopping for a drink at a nearby pub, and dinner). I know that cycling there must be a pain and incredibly intense (I'm not a morning person. I can't overstate how much I'm NOT a morning person). However, I can see myself heading to the British Library to work, or my Northern university bizarrely has a 'campus' in London I could hot-desk at, and I have many friends because I used to live there ... I could imagine coping with a prolonged time in London better than in Greece, assuming that I don't feel like utter cr*p again.

    And I've already resolved to buy one of those fold-out, carry-around stools for use in the sardine-like waiting room, as I can quite believe that it runs out of seats rapidly.

    Of course, after that SA, DH is now all motivated to try again naturally!!

    I just  :o ... am happy to do that between assisted cycles but I NEED to feel that we are moving forward and making the most of the part of the year in which I have much more flexibility to work away from the office (in February and March, then May, I'm pretty much tied to my place of work). I realised that assisted fertility is a veritable exercise in patience (I don't have any!), but actually when it comes to eggs that get older every month, surely this is a field in which some measure of haste has a basis in fact?

    I will update with more coherent thoughts when they come ...

    L xxx




    Offline Liz3511

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    Received an appointment follow-up email from ARGC today. Really wavering on doing the immune testing at all now. 980!!! That could almost buy the difference in cost between IVF and ICSI!!

    I am trying to figure out what, if anything, is the difference between the ARGC testing and that performed at Locus Medicus, since Mr R has requested we get them re-done. FF seems to suggest that the only difference is that the cells are tested in an intralipid medium for killing power not in IVIG, the latter being more expensive?!! If so, and I really wouldn't consider using IVIG, is there any point? Or are there other differences I'm not aware of?

    I also had to smile at the following excerpt from 'Precautions' for treatment. My first instinct was to scribble 'citation needed' in the margin ;)

    "Positivity: ARGC will do everything medically to help you along with your success. According to quantum physics, our thoughts have a frequency and a corresponding unique vibration that attracts similar frequencies into our lives. So negative thinking attracts negative energy; positive thinking attracts positive energy."

    !!!!

    Offline Liz3511

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    Had a slightly sad day today - probably PMS, but generally feeling like this isn't going to work out.

    I know that the few friends who know that we are trying again are mystified as to why. They wouldn't put it in so many words, but they see this as a vanity project that will only result in expense and emotional pain. Sometimes I agree with them.

    I feel terribly guilty about being on FF, even. Everyone is just lovely, and would not say anything critical to me (well, unless I went around weeping and wailing as if I was the least fortunate person in the world ... then I think someone would put me straight sharpish). However, I already have kids. I am incredibly, incredibly fortunate and I am pushing my luck further.

    I am also traumatised by the losses. I have had such difficult, unfeeling treatment from health care workers, and the 3 losses I had in my 20s very nearly broke my marriage because they consumed me with grief to such an extent. By miscarriage number 5, the doctor commented that I dealt with the loss "very professionally". She meant it as a compliment ... but no, that's not a normal or a good thing, to be so proficient at miscarriage that you don't let any human emotion show through at all...

    Consequently, when people on FF write about the envy they feel towards those who simply get pregnant, and happily / innocently expect to (and do) receive a baby at the end of it, I can relate to that envy up to a certain point. For me, a positive pregnancy test spells utter terror, panic, anxiety, dread, hope (the hope is the killer!!!) but I have never been under the impression that it spells a baby :( And yet, incredibly, miraculously, three times for me it has spelled a baby, albeit not without an extremely high risk pregnancy and pessimistic doctors.

    So yes - at the moment I am the very dictionary definition of pushing my luck.

    And the only explanation for why I'm doing this is that I love my children so much and would really love them to have a sibling. They have asked, plenty of times. They made a list of reasons why. A lot of the reasons, I agree with. I long to breastfeed a baby (and toddler) again, to introduce them to their siblings for the first time, to imagine them all growing and playing together. 

    My existing children are worth every tear, every sleepless night, every negative test, every surgery, every depressing ultrasound scan, every awkward doctor trying to break bad news gently. I would do it all again, ten times, to have them. They joke about the fact that I stare at them in their sleep and seize every chance for a cuddle, but they will never know what drives me to think of them as I do - understanding their miraculousness is the biggest gift the 'reproductive process' has given to me. They will never be taken for granted. They will always be celebrated.

    And if our efforts at number 4 fail, they will be enough. They always have been 'enough', completely and utterly, and they always will be.

    Offline Liz3511

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    This is not the most interesting diary entry - more like record keeping!!

    Have been steadily working my way through the list of ARGC-required tests and results, and thought it would help to record these here (for my reference, so I don't miss anything, and in case they help anyone else beginning treatment with ARGC).

    This is the list of tests/ results they have asked us to get personally ... other people's lists probably vary!

    HIV 1& 2 antibodies - I got this done privately with my GP in June. DH got it done by occupational health when he started his job.
    Hepatitis C antibodies - as above
    Hepatitis B surface antigen - as above
    Hepatitis B core antibody - slightly annoyingly, my GP didn't include this in the private testing and I didn't realise I needed to ask. Not sure what to do ...

    Follicle Stimulating Hormone, Lutenising Hormone, Oestrogen, Prolactin and Progesterone (day 1-3) - GP has kindly agreed to do - hoping period shows up tomorrow!
    Midcycle scan* - Day 10-14 of your cycle (if you have regular cycles) Ovulation Tracking - do at ARGC around 10th/11th Sept
    Mid-luteal phase progesterone - GP has kindly agreed to do
     
    AMH - done last November; looked fine.
       
    Vitamin D (for me and DH) - GP has kindly agreed to do for me; DH says it is pointless for him so I'm trying to work out how to convince him to do it anyway. We've been taking supplements for 9 months so seems highly unlikely DH is deficient ...

    Hysteroscopy - I had one of these at Serum in April. Really, really hoping not to have to pay out for another ... I have looked at the hydro report that Serum sent me and unfortunately the uterus measurements are not noted anywhere in the paperwork. Surely they measured it - surely?! I need to investigate further.

    Full Immunology screen
    I asked for more details from one of the ARGC nurses, and apparently this includes:
    TSH, free t3 , free t4, anti-thyroid antibodies - had these done in April with GP. Unsure if I need to get repeated but hoping to get it done on NHS if so.
    Cytokines, NK cells (full assay), th1/ th2 ratio - done by Locus Medicus in April, I think.
    Cardiolipin antibodies - tested by NHS RMC clinic, but need to get hold of results. Secretary on holiday, but hoping to reach her next week.
    Anti nuclear antibodies - tested by NHS RMC clinic, but need to get hold of results.

    DNA AB / DNA ABD - not 100% clear on what these are (!) as the only thing I can think of is that these would be tested if the ANAs came back positive. These tests look for lupus (SLE) - the first one is also known as IgG...
    Histone - anti-histone antibodies seem to be linked with drug-induced SLE but I have no idea why this would be tested for.
    IgA - randomly tested by my GP last year, looked fine.
    Wondering why IgM isn't (apparently) tested as part of the panel if IgG and IgA are?

    When I phoned to get the details above, the nurse wasn't able to explain the function of the immune tests (I sympathise!) but I will be looking at Agate's immunes FAQs thread later in the hope that I get some clarity. Failing that, I will ask more about it all at my mid-cycle scan. Current stance: decline full immune panel. We can always change our mind later on I suppose!

    L xx










     

    Offline Liz3511

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    CD1 today as period finally started around 11pm yesterday. I turned up at the phlebotomy appointment today only for the HCA to suggest I might want to come in tomorrow for them instead as it would be closer to CD3. It was a great idea and I accepted; I just wish the receptionist had suggested Saturday appointments when I phoned up to make this one and tried to explain the predicament of having CD1/2/3 potentially fall over the weekend.

    Sitting in the waiting room brings back a lot of memories of sitting waiting to have blood drawn for (falling) HCG over the last 12 months. I hated waiting 24-72 hours for each result even more though ... if we go with ARGC at least their lab is extremely fast!

    I have booked my train to London for the 11th for the mid-cycle scan. Hoping that it doesn't show up any surprises and it will be interesting to know which side I'll ovulate from this month and whether my usual symptoms line up with the US result (I usually feel lateralised pain at ovulation).

    I realise that I essentially overthink EVERYTHING but I'm slightly worried that my ovaries will still be really swollen after June's IVF ... I can't seem to find out how long they take to go down if you're not pregnant. I know my ovulation this month was a bit crap - barely a positive surge on the LH tests - which for me has always correlated with having an overly-large follicle early in my cycle. This would make sense the first cycle after IVF, but I do hope it gets back to normal soon ...

    I also have a streaming cold and found myself irrationally glad of it, because all the (pointless) reading I've done about immune overactivity on message boards seems to suggest that people with 'strong' immune systems don't tend to get colds so much and that was seeming to line up with my experience. Mind you, after 3 kids' worth of viruses, I also suspect I am simply immune to a lot of things because I caught EVERYTHING my firstborn caught and almost nothing from number 3.

    It's a lovely late summer evening here - low sun streaming through the windows, the sky is clear and the neighbourhood, quiet. I am going to submit a paper this pm and then reward myself by watching the Bake Off 'Extra Slice' programme :)

    Offline Liz3511

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    I've had a good, busy few days with much less time to think about fertility than over the summer. In particular, we went to a village sports day on Sunday, and had a brilliant afternoon. Everyone took part in various things, the weather was amazing, and I came home feeling so incredibly appreciative of Paul and aware that I will probably remember that day for the rest of my life - it just felt so 'right' and the memories felt so vivid. I still have rope burn on my hands from the tug of war competition though!

    I got my cycle day 3 (actually CD2) results back today, after a bit of chasing around because the GP who ordered them is on holiday.

    FSH - 8.4 (similar to 8.3, in April; last August it was 7.9 so hasn't gone up loads in a year)
    Estradiol - 83 (better, and lower, than 223ish in April, although that was a month with an early ovulation)
    LH - 7.6
    Prolactin - 206 (normal range)
    Progesterone < 2.5 (as it should be)
    Vitamin D - 76 (converts to 30 in the units typically used to measure it) - seems to be normal range but could stand to be a little higher.

    I haven't bothered getting my AMH done again. Last November it was somewhere between 21 and 22 so I really hope it hasn't plummeted since.

    All in all there were no nasty surprises, so I'm relieved. Booked in for my mid-cycle scan on the 10th Sept (which will be CD11) and an eye-waveringly early train has also been booked. Have chosen the quiet carriage in the hope of sleeping for some of the journey!

    The reality of what a cycle with ARGC might mean in terms of separation from my family is beginning to hit home. 3 weeks away ... the train ride is just under 3 hours (5 hours' drive) so I could in theory get back for a few short visits but it's so expensive - is it worth it? Possibly ... but then there is the pain of having to say goodbye again. I could also try to get my family to stay in London for a few days at the start - this would work if we went for half term, and would mean we could see some sights/ go to the zoo etc ...

    Provisionally, I'd like to start my cycle on or around 22nd October (hollow laugh at the futility of planning!) - that is when my period would usually be due. However, I have a feeling that down regulation might disrupt my usual cycle somewhat. And I have no idea whether ARGC would even have room for me around that date. I have so many questions - looking forward to asking them at my mid cycle scan. Not least - please don't make me have another hysteroscopy (okay, that's more like begging than a question).

    I had another wobble about using ARGC this week, because of cost and the amount of time away from home - started looking at London Women's Clinic in Darlington, which is nearby and which offers the money back / multi cycle schemes. Their success rates aren't bad either. However, interestingly Paul re-focused me on ARGC, saying that if we're going to put my body through stimulation etc. then we should do it at the place with the absolute best chance of minimising the number of times I go through it. And he reassured me he could hold the fort in my absence...

    None of this is simple!! I wish I wasn't so indecisive. Every time I start discussing these issues, Paul looks bewildered and says "but I thought you'd reached a decision?". Yes, I thought I'd reached a decision too ...