A Happy Ending

And there they are. The yellowy one was a couple of days old - and you can see the hcg was less strong than the control line. A couple of days later and the hcg was stronger than the control!

I'm now 16 weeks pregnant with twins. And we are on a different journey now, but an equally challenging one. If all goes well our babies will be born around February 18th. So I close now and if all is successful, I'll post pictures. We still have some very good eggs left and so we have a safety net too. Fingers crossed we won't need it.

Info to help anyone going to L'viv

INFORMATION TO HELP YOU MAKE IT THRU A WEEK

1) FOOD
Ok. You may need to bring some food with you. If you only like your Tetley tea or Nescafe then pack some tea bags and put some granules in a plastic bag. You won't get brand tea bags here, but you can get Nescafe at a whopping price. Having said that this town is famous for its tea and coffee. I only drink rooibos and amazingly, the top coffee/tea houses have it. Nb Rooibos is one of the few teas that is entirely safe to drink in quantity while ivf-ing and in pregnancy - most tea has caffeine (this does not) and many herbal teas are dangerous.

A word on milk. Like Moscow, they don't have fresh milk as we do. It's not as bad as uht, but it's close. It comes in cartons and sachets, but get the type in the fridge section of the supermarket. It will say Moloko (looks like monoko in Cyrillic) and don't what ever you do get kafir - same kind of packaging, looks like milk, but is in fact a yoghurt drink the Ukrainians are fond of.

In some places a cup of chocolate is exactly that, a cup of melted chocolate that you eat with a spoon. The best place for this is, Lvivska Maysternia Shokoladu which is on 3 Serbska Str. their webpage is http://www.chocolate.lviv.ua/, literally round the corner from Rynok Square. They are L'viv's own chocolatier and you can watch it being made and moulded in the window, while you sit outside and eat and drink. There is also the Cafe Dukat, which is worth a visit for it's wonderful underground cafe and intriguing panoramic reliefs set in the walls. The chocolate is nowhere near as good as LMS, rather bitter and over flavoured. Their cakes look gorgeous though!

We tend to eat out occasionally as DH at work during day, so I have a light lunch of rice cakes (have to make some concessions for all the chocolate I get thru when here). We also stock up on bread and cheese, salami, fruit and veg from the local shops, so we can do a salad type thing in the evening if we want to stay in.

The Casanova has a small menu, but the food is really excellent. One of our favourite places to eat - we always ate outside in the Moroccan style canopies. I recommend the mozzarella salad and the beef carpaccio, followed by their delicious home made pistachio ice cream and yes, they do have a Menu Anglisky. Nb inside turns into a strip bar later in the day, so be warned. Other good places to eat are ....
the roof top Restaurant of the Hotel Opera, next to the Opera House (mostly Mediterranean and in English if you ask), spectacular views, bit pricey;
Dublin, Irish pub, odd interpretation of some Italian food, but good otherwise, Guinness imported from Ireland so actually tastes better than the crap we have brewed in UK - You can find the Dublin pub in the busy courtyard just off Doroshenka St.;
Amadeus (Katedralna sqr. just off Rynok) is a posh restaurant that does do some very nice food, good wines to drink before ET, worth a visit;
Cafe 1, just off Rynok Square, good for snacks etc, cheese platter is very good; It is also right next to the Boymes memorial - a big black building, fantastically carved and absolutely stunning inside. Hang around in Cafe 1 and then as soon as the doors open get in. It's worth it!
There are lots of sushi bars, which are very popular in L'viv. All are every bit as good as the UK ones, but you may have a long wait for food if you go later than 7.


2) SHOPPING
There are lots of small supermarkets around and about. There are some nicer and larger ones near the opera house on Svobody Avenue. There is a posh indoor shopping centre, called Opera Passage, and downstairs is a very nice Waitrose style supermarket. There are also some super posh dress shops etc and even a Lush (which was very weird, as the place began just down the road from us, in Poole, and the flagship store is still there). Clothes can be more dear than here and probably not the best thing to buy. Electrics are about the same, perhaps a little cheaper.

3) GETTING ABOUT
There are always plenty of taxis on Svobody Avenue (the far end from the Opera House) and you can flag them down. Try to have where you want to go printed (do before you go) on a postcard in Latin and Cyrillic. InLviv can organise a taxi for you and the clinic will always organise one to go back for you. Also try to have an idea of how much it's going to cost - they will charge you more if they can. There is a fabulous tram service, but it's very tricky to use if you have no Ukrainian language. Again, the postcard might help. It's very cheap!!

If you are staying in the 12, Rylyeva apartment take walking shoes. You will never make it into L'viv centre in heels. All the roads are either potholed or cobble stones!! The path in the park is brilliant as it's brand new - but the rest!! Go downhill to the end of the road and walk through the park, it will take you to L'viv and then head straight, but slightly to right to get to Rynok Square (Plosha Rynik) and the Opera House (ask for them if you get lost). Remember that it's downhill there and uphill back - don't get worn out and then struggle home. Although, to be fair I did and my little ones are here to tell the tale!

4) SAFETY
Like any City that has it's fair share of visitors (mostly Ukrainian and Russian it has to be said) there are those who will take advantage. Don't walk through parks late at night and certainly not on your own. My DH was mugged when returning alone from a night out with friends, in Rynok Square, so it can happen. I suspect it was because the Ukrainians are very religious and very anti-gay (there were rallies while he was there) and they thought he was gay (he has long blonde hair). Be as sensible as you would in any UK city and you will be fine.


5) WHERE TO GO
You must have done your own research, but I would recommend
Kriyivka ('Bunker' in Ukrainian) - this is a bar next to the apartment in Rynok Square. You must go through a bunker style door and you will be met by an armed guard. You must say Slava Ukrainie, which is the password and he will let you in. You will be given a shot of vodka which you must drink and then you can enter the bar - great fun. The food is good, but it gets very busy so go early. In the picture below you can see the shield symbol (it appears next to my chair) which is above the door. Our last apartment was nearly next door to it!
The Opera House - Svobody Avenue, do try to get to see a show (InLviv can organise tickets for you) but if nothing else, go and have a look around. It is stunningly beautiful..On some days (not sure which) there is an excellent open air market just behind the opera house, with loads of fabulous souvenirs and bargains to be had.
Rynok Square - the architecture is amazing and well worth a look at. There are several excellent tourist shops, with one very large one. There are a few museums on the square and they are all good value. You can go into the town hall in the centre and climb to the bell tower at the top - well worth it as the view is spectacular
Lvivska Maysternia Shokoladu, 3 Serbska Str - my lovely chocolate shop. If you find Kriyivka, just walk to the nearest corner and Serbska Str is on your right. You will see the two little open air cafe style places next to each other. The first is the chocolate shop, the second is an excellent tea shop.


6) MONEY
There are ATMs (bankomats) everywhere and nearly all accept visa and mastercard. They took my debit card too which made things easy. The notes tend to be 100uah minimum. They also have an English language option, which is fab.

A little white lie

Have told everyone at home by email that this time was not a success and we will try again later. DH not at all happy with telling untruths, but he accepts and respects my reasons, which are thus. The last two times I have had to tell those rellies and friends that know (my 2 best friends, all 3 of my children + partners, and our parents) that it was not a success, which is very hard and usually makes me cry. DH's parents are longing for a grand child and suddenly i have all the guilt of that too. And of course, once we get back home its the inane but not unkind requests for update on symptoms etc - which really doesnt help.

This way we will simply be allowed to get on with our lives and deal with the results (either way) on our own. I don't want to have to deal with their sadness to; mine and my lovely DH's is quite enough thank you. And if we are lucky enough to find we are expecting, then I don't want to let the world know until I am past 12 weeks at least. I waited the last time and boy was that the right decision. We lost our little one at exactly 12 weeks to the day, I was so glad I told so few. I found our grief was hideous, but to have to constantly explain or even just accepting comfort was much harder.

So I'm not being negative, I've just put a bit of a bolster cushion down for the inevitable shock either way. Let's hope this time we get those seemingly unattainable 2 red stripes!



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PUPO

Did all the houseworkey tasks before we left. Guy at DHs work got taxi for us. Arrived at Intersono and saw very serious looking couple from Ireland, but they left as we arrived, so no real chance for chat. I thought how frivolous we were compared to them and it occurred to me that they might have had bad news and we might yet. As indeed we did.

Usual routine and there I am in stirrups. Told the good news that we have 3 blasts to put in and 3 to freeze. Then ultrasound lady chats to dr lubov. Dr Lubov takes a good look and says "have you been taking progynova?" "no", I reply. "not the little blue pills?" "no, I have been taking divigel.". She looks unhappy and says that my lining is too thin, but they will transfer the eggs as they are ready. She seems quite depressed and says we can try progynova but it may be too late for 5 day blasts. I try not to be worried.

They then leave me for the 10 mins, but forget about me (or maybe they expected me to go to recovery by myself?) So I happily lay there thinking good thoughts and assuming that it was better to stay there really than move too soon. After over 20 mins, a nurse says curtly, Please Move. So I get down and walk to recovery. Lie down and read my book. Text DH that all ok, but lining thin. After another 30 mins am told I can go to loo; again, left to find my own way. For girls who are going, you go left out of recovery and walk along corridor, past seated area on right and just after are two toilets marked Toilette (I think) on the right. The first one is usually locked and you need to walk past that to the next on the right. Clear?

So back to room, much relieved, and lie down again. Still thinking positives as I read book. Eventually after further 20 mins am told I can go downstairs. Have by now signed consent for freezing (and DH paid the £250) and given pics of our embies. Find DH in waiting area and explain about thin lining, he is clearly mortified.

Eventually, Lyucyna fetches us to get the progynova and I gobble down one immediately. I ask Dr Lubov how thin was my lining and she again looks quite sorry for me and says 7. She asks me if I can get scans in uk and I explain my dr is useless but I could go private at £300+ a pop. DH queries why this would be an issue with so much paid out already, but I explain it won't just be the one ultrasound. And I know it's being careful with my savings, but after they're gone that's it. No more tries. Full stop.

Back to apartment and go mental, searching for any evidence that women can conceive with a 7mm lining. Found 2 thoughts.

First, embryos can implant and mature in the Fallopian tubes ie no effing lining whatsoever. Second, this from an enlightening blog by a Fertility Doctor in New York University....it's a long read, but very enlightening and Dr Licciardi is well qualified, so it gives me hope.


The Endometrium Part III
Last time we went over some of the conventional methods used to increase the lining thickness. What about the less conventional?

Well there’s Viagra. I had a patient try it and she had a baby. I have had many others try without success. The linings measured no thicker on Viagra than off. As with many things there was some initial interest when it was first described, but we never were able to conclude that Viagra does anything. I do not suggest it to my patients.

What about baby aspirin? The studies are also limited, but the results are not compelling enough to convince us that baby aspirin is worth anything. I have heard that some doctors have all of their patients take it regardless of history. Why I don’t know. It seems benign enough, and is probably used by many women who keep it a secret.

What about using blood flow as an indicator? Why look for bad news? If someone could tell you it’s almost impossible to get pregnant with a certain blood flow, fine, but they can’t, so why torture yourself. We don’t know enough about this.

Is there a minimal acceptable thickness and is thicker better? My colleagues and I did a study looking at donor egg recipients and compared pregnancy rates in women with thin and thick linings. The pregnancy rates were the same in women with linings less than 6 mm compared to women with linings 7 mm or greater. Dr. Noyes also did a study looking at recipients and found that there were plenty of pregnancies in women with thin linings, but the rates were a little higher when the lining was greater than 9 mm. Other authors have shown there is no correlation between thickness and pregnancy rates, and others have shown that the pregnancy rates are higher with a thicker lining.

I do not think the pattern matters. The odds of pregnancy don’t seem to be different if the pattern is ring (or triple) or homogenous. I have found that if the uterus is sharply retroverted, the pattern is commonly homogenous, probably just having to go with angle of the ultrasound waves.

If I had to summarize the general feelings of most infertility doctors, I would say that we are a happier when the lining is thicker, and we may try things to thicken things up a bit, but in the end we take what we can get. Many patients have told me they heard that the target lining is over 9 mm. This I can say is not the case at all.

So let’s say for example I have an IVF patient whose maximum lining is 6 mm. I am not overly worried about this, but will review things and see if there is anything that can be done. I may mention to her that the lining looks a little thin, but would also say it’s not a cause of great concern. Any thicker does not even get a mention. Thinner will get more of a discussion. If her cycle does not work I will try to get it thicker next time, probably using estrogen patches early in the cycle. In many cases the lining remains the same.

For IVF, some doctors freeze all of the embryos and try to get the lining thicker in a high dose estrogen frozen cycle. I have never done this because I do not think it helps. I think you may hurt some embryos with the freeze, and I doubt the lining will get much thicker or much better in the frozen cycle.

This all sounds OK until we have a patient who is not getting pregnant, and also has a thin lining. Question: is it really the lining? Maybe yes and maybe no. I currently have a woman who has tried IVF 5 times with average embryos and a 9 mm lining. Why isn’t she getting pregnant? The point is some women have a thin lining, but a different reason for not getting pregnant.

Some women bail out and go to a gestational carrier, and are successful. In their case it seems the problem was the lining. But few women want to or can afford to go with a carrier.

In summary, the thickness of the lining is not as important as many doctors and patients make it out to be. However, there are some women with thin linings who cannot get pregnant, and for some of them, the lining is the reason for their infertility. Because the treatment of infertility is a game of odds, trying, even when it looks like there are factors against you, is the best thing to do. After that, it’s time for third opinions and opening up to the less conventional options.

That’s it for

Dr. Licciardi

ABOUT ME

DR. LICCIARDI
I have been practicing infertility at NYU for 17 years. Basic infertility, reproductive surgery, ovulation induction, IVF, and egg donation are all areas of my expertise. Most of my patients are from New York , but people come to see me from other states and other countries. You can read all about me at my website, DrLicciardi.com.


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The day before ET

So far all has been good. We arrived on thursday and settled into our new apartment. The good things are rooms are nice and large, with lots of light; the balcony gets the sun most of the day; the bed is large as is the tv screen, and all is clean and new; bedding bright; only 15 mins walk to town centre & mostly thru park; shower good. The bad things are only 2 of all cutlery, plates etc; no tea towel; argumentative smoking Ukrainian neighbours; no colander; wooden spoons; salt & pepper needed; no washing powder and other niggles.

DH and I went to clinic for 10 next morning ( catching taxi not so easy as we walked toward clinic and not toward L'viv centre where there are lots of taxis.). Won't do that again. He did his deed and I played with little Ukrainian boy on my iPad - at first he wouldn't touch it, but soon he was gaily joining in with a mad spot the difference app (he was just as good as me, if not better, for all his 4 or so years). DH Has foul mind and sees that last sentence as something disgusting. Pah.

Donor aspirated while we are there and 20 eggs harvested. Lyucyna very excited and says we should be able to freeze some for siblings. I love her confidence.

The following days spent doing a bit of work I brought with me as DH at work here in office near apartment. Met his Ukrainian colleagues for lunch at nice restaurant (Valencia) nearby. The menu was Ukrainain but the guys explained what it all was. I had borscht (not bad) and a salad anglisky, which tho not very "English" was delicious, a pile of finely shredded lettuce, lashings of mayo, mustard, chicken and mushrooms. Yum. DH had borscht with pancakes filled with chicken and stuff - they were light and crispy and really yummy.

TV here ok. Watch the English Club mostly as they have some good films and they are titled in Ukrainian and not dubbed, so you can enjoy them. Meant to help the guys here learn English of course. It's channel 22. Channel 7 is the BBC world service and you can keep up with the uk news that way- should you care!

So today is the day before ET and I still had not heard from Lyucyna about times etc. So I texted her mobile and she answered straight back. I'm due at 2. She also said we have 10 eggs frozen and 14 fertilized. Amazing. Will know about quality tomorrow. Of course, the same happened in Moscow's Altra Vita and the 20 eggs were all poor quality and died really quickly, only 2 put back and none for freezing. So I'm not getting my hopes up just yet. Still, 10 frozen already means we can come back for a cheaper try and maybe if we're lucky we might have a blast frosty too, so I could come back alone (even cheaper).

Only one problem so far. I have woken up in the morning (normal time) with excruciating pains in my lower abdomen/groin area. Going to the loo (either way) eases the pain and it stops 30 mins or so after. And then free of pain all day! I have no idea what this is. I nearly passed out with it this morning, only realizing the symptoms (nausea,sweating, dizziness) at last minute and lying down sorted that. I thought it could be kidney stones, appendicitis, constipation. But in the end I think it's probably swollen ovaries screaming with pain after a night of being squashed by a heavier than usual bowel. That explains the symptoms, otherwise the other possibilities just don't fit.

Oh well. Praying I'm pain free when I wake up tomorrow.

Am really looking forward to being PUPO tomorrow.


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Off tomorrow for second attempt at Intersono

This is the reason of course we return to L'viv. The chocolate. For pure decadence, buy some lovely homemade chocs to eat with your melted chocolate.

Proof that our hair is weird. We will be chased out of L'viv with flaming torches I'm sure. Burn the witch!






Some views of Rynok Square and night time view from our balcony.

One cup of the melted chocolate.


More views from our balcony, when we were there in May. NB it looks busy, you can see in the one on the right there was an accident and the tram had become derailed - amazing.

DH in opera house. Saw Pagliacci - a real experience - the performers were fab, with mature operatic voices, but the direction was hopelessly amateur. All proclamatory style



Our lovely apartment. One long room, but clean and modern.

Off tomorrow - have to get up at 4.45 (yuch) and then we get ferried by taxi from Poole to Heathrow (thank you DH's work). All meds sorted, decapeptyl is now finished and just on multi vit, extra folic acid, aspirin and divigel. Start next drugs on Friday. Still a bit worried about taking divigel on belly, when that is contra-indicated on the web by all. However, it's only a few weeks, so should be ok.

And off we go again

Most bizarre. Husband's company is outsourcing in the Ukraine. They began at the start of this year. But so so so much more bizarre is that they are not going to the capital Kiev, but to the lesser known L'viv. Which just happens to be where we are having our ivf tx. Some would say that this was fate. Some would say it's my recently lost dad trying to help from beyond the grave. All I can say is thank you.

So a few weeks ago with DH out there doing his job, I managed to combine a trip to see him with a hysteroscopy at Intersono. This was a total godsend. His company kindly paid for me to go (he was out there for 6 weeks) for a week's visit and of course, I stayed in his apartment. So all I had to pay for was the op - which was £230 as opposed to £2k here.

The op went well. I was nervous about having gen anaesthetic in a foreign country, but it was all fine. DH waited outside for me and I was only under just over 30 mins. The Dr did a D&C while there and I think that will be a great help toward conception - a new fresh womb lining!

So now back home and on the drugs. I started the divigel when I got back and then the decapeptyl injections daily. I also took utrogestan pessaries for a week. Now on nothing except the injections and folic acid. The main meds start this sat with the build up to leaving for L'viv in 2 weeks time. Can't wait.