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This is one of those posts where, if you’re here for travel stories, you might want to head over to the travel section instead. However, lots of people have written to me expressing interest in my fertility journey. I struggled to find stories when I was going through all of this, so I’m sharing mine with you. So, here’s the personal and somewhat technical story of how I came to be pregnant. It also explains why our trips were so last-minute in 2017! The first part is about the journey, and the end gives my advice for people going through something similar.
I always knew that getting pregnant might not be easy for me. My periods were slow to start as a teenager and have only ever been regular when I was taking the pill. Like my Mum, I have polycystic ovaries, which means my ovaries contain lots of fluid-filled sacs (follicles) that surround the eggs. Despite the name, they aren’t cysts, but under-developed sacs where eggs develop but then struggle to be released. That results in irregular periods, which can in turn result in difficulty getting pregnant. No-one knows how many people have PCOS, but the estimate is as high in one in every five women in the UK. You also don’t necessarily have PCOS if you have polycystic ovaries: they tend to diagnose you when you have two of three symptoms: irregular periods, polycystic ovaries or excess androgens in your body.
PCOS and fertility
Not everyone with PCOS struggles to get pregnant, but it does tend to make things more difficult. One of the hardest things is knowing when you might be fertile. Steve and I had a year of trying before we started treatment, and as my periods were so irregular, it was hard knowing where I was in my cycle. That raises two issues: first, you don’t have the advantage of being able to optimise when you have sex at the most fertile times; and second, you can’t be sure if/when you’ve ovulated, so there are periods of time where you have no idea where you’re at: pregnant, waiting to ovulate, about to get your period, or in the middle of a cycle where you failed to ovulate at all! The not knowing is difficult, but we remained pretty relaxed about it for that first year, travelling often, staying healthy and trying not to get consumed by it all. During that time, I had six periods, so even though we were trying for a year, in reality we only had six chances rather than the 12 that one would normally have.
Temperature tracking and OPK sticks
One of the things I tried during that time was tracking my temperature to map my ovulation. Your basal body temperature (BBT) rises slightly after you’ve ovulated, so by taking your temperature as soon as you wake up each morning, you can, in theory, track when you ovulate. The problem is, this doesn’t always work if you have PCOS. On some months I could see a pattern, whereas other months I couldn’t. In the end I decided to stop as looking for a non-existent pattern was somewhat crazy-making!
I also tried using ovulation predictor sticks, which are meant to tell you when you’re having an LH surge (a hormone that peaks just before ovulation). However, these tend to be unreliable for people with PCOS, and I definitely found that to be the case.
I did, however, try both of these things again when I started fertility treatment and I was able to see patterns and positive OPKs then.
When we decided to get help
As soon as Steve and I started trying for a baby I went to my GP to let her know and she referred me to a pregnancy specialist immediately, which is quite unusual. The specialist did an ultrasound, confirmed I had polycystic ovaries, but that everything else was okay, and said to try naturally for about a year before going to a fertility specialist for treatment. In that time, I also saw the hormone (endocrine) specialist who said that despite my polycystic ovaries, my hormone levels were in the normal range.
So, after a year if trying unsuccessfully, we went to the fertility specialist. Straight away I was prescribed Metformin, which is a drug often given to women with PCOS. It’s primarily a diabetes drug, but women who have PCOS also often have insulin resistance, so it’s used to control the symptoms. I didn’t notice a tangible difference for the three months I was on Metformin alone, but I stayed on it until I got pregnant as it’s recommended alongside the other treatments. It’s well known for having side effects, but I only felt a little nauseous for the first month of taking it, or if I ever took it without eating first.
At that first fertility appointment, we were also sent for tests: Steve for sperm tests and I for a series of blood tests, mostly testing my hormones. Steve’s were normal and the only one that was unusual for me was the AMH test, which measures your ovarian reserves (how many eggs you have left). Mine was sky high, which is typical for people with PCOS, and meant that any fertility treatment I did would need to be gentle so I didn’t get overstimulated, releasing too many eggs and being at risk of a multiple pregnancy.
Our treatment journey
Other than trying Metformin for a few months, the first course of action prescribed by the fertility specialist was to try clomifene, a drug also known as Clomid. Clomid encourages monthly ovulation, so, if it works, it gives people with irregular periods more chances to conceive. You take it for five days, from day 2-6 of your cycle, although some doctors vary this slightly. You then have to go in for regular ultrasounds from about day 11. This is so that the medical team can monitor how many follicles are developing. If more than two start to mature then the cycle has to be cancelled as you are at high risk of having a multiple birth, which is dangerous for both the mother and babies. If you have just one or two follicles, they monitor you until one of them reaches around 20mm. At that point, they say that ovulation is imminent and send you off to do your business and hope for the best. It’s also possible to get a HCG injection at that point, which stimulates the follicle to release the egg, meaning you know for sure you’ll ovulate in the next couple of days. I did six rounds of Clomid in total and had different experiences each time. Here’s a summary of what happened. I started on 50mg of Clomid per day.
For my first cycle, I went for three scans, every other day, starting on day 11. On the first scan, my biggest follicle was 14mm, and on the second scan, I had two big ones of 17mm and 18mm. For the final scan, even more follicles had developed/grown, and I had four measuring 18,19, 15 and 14. It was deemed that all four follicles could potentially release eggs, so the cycle was cancelled.
I also had three scans for the second cycle, with a dominant follicle appearing at the second scan, measuring 19mm. But he third scan, I had three follicles: one at 23mm and two at 17mm. A different doctor was on duty this time and they said that it was highly unlikely the two 17mm ones would release, and they gave us the go ahead to try. But we didn’t get pregnant.
The third cycle was odd. I only went for two scans, an the biggest follicle at the second scan measured 14mm. The doctor was happy with this as that was the only dominant follicle, so said I didn’t need to come back for more scans and could continue with trying that cycle. I used OPKs throughout my Clomid cycles, and on this one I never got a positive result and my temperature didn’t rise. My period was also very light, so I’m not sure if I even ovulated for this cycle. Whatever happened, I didn’t get pregnant.
Cycle four was the worst. When I went for my first scan, there was already a follicle measuring 29mm, which was more than likely a cyst, potentially created by a follicle that didn’t release in the last cycle. I also had two 15mm follicles, so had to cancel the cycle as the risk of multiples was too high. I was pretty fed up at this point and booked a last-minute trip to Iceland!
Cycle five was another bad one to start off with. Because of the situation last time, I had to go in for a scan on day four to check that the cyst had gone. Unfortunately, it was still there, so I couldn’t start taking the Clomid and was told to go on the pill for three weeks to make it shrink. We were fed up again so this time we went to Lapland!
Happily, on day four of my next cycle, I went for the baseline scan and the cysts had gone, so we were able to take Clomid again. This time they reduced my dosage, so I alternated 50mg with 25mg for five days. I went for two scans on day 11 and 16. On day 11, there were no dominant follicles, but by day 16 there were two juicy ones measuring 20mm and 17mm. I was given the HCG trigger injection and given the green light to try. But alas, no pregnancy
My final cycle of Clomid was the most straightforward. I went for one scan on day 15 and had a 19mm follicle already, so they gave me a prescription for the HCG shot to administer the next day at home. My OPK showed positive for ovulation and my temperature went up, but no, I didn’t get pregnant.
Some thoughts on Clomid
The plan was always to only do six rounds of Clomid. I could have opted to do more, but I found the whole process pretty draining, especially when I kept getting overstimulated and had to cancel a cycle or when I got a cyst and had to go on the pill. I also found the side effects quite tricky as it tended to make me very emotional for the five days I was taking it and for a few days afterwards. It was manageable but unpleasant.
While monitoring the size of your follicles on Clomid, they also measure the thickness of your womb lining. I noticed that mine was getting thinner with every cycle, which isn’t a good thing as you want it to be nice and thick for the egg to implant. A thin womb lining is a common side effect of Clomid.
Transferring to Bristol
All of my Clomid cycles were done at Kings Hospital in London as that’s where I was living when I started treatment. However, I moved to Bristol half way through, so had to travel up to London for cycles 4-6. Most of the time I was able to time it with other appointments in London, but when I couldn’t, it meant a lot of time and money spent on trips to London. I could have transferred to Bristol at any time, but I knew that would mean a disruption to the treatment. The hospitals aren’t joined up, so I’d have to start again with the investigations and so on. I decided to do all six cycles in London and then transfer to Bristol. I started the process of transferring while I was still in treatment in London as I wanted to try and avoid any long breaks or delays. This involved getting a referral to Bristol’s fertility centre from my GP, waiting for an appointment with the specialist and then doing all the tests again. It took about six weeks. So here’s what happened in Bristol…
I was given the option of continuing with Clomid for a few more cycles or trying another type of of treatment called gonadotropins. Interestingly, in London, they had intended to move me straight to IVF after Clomid, so I was pleased to hear there was an intermediary option. Like Clomid, gonadotropins stimulate ovulation. They are the same hormones (LH and FSH) that stimulate ovulation naturally, and they’re also used at the start of an IVF cycle to stimulate egg production. Gonadotropins are given via an injection, which you do yourself at home, and the one I used was called Gonal-F.
[How many injections and how much?] I went for four scans during this cycle, ever other day from days 8-14. By the fourth scan, I had two follicles measuring 17mm and 21mm, and my womb lining was 8.4mm, which was thicker than it had ever been when I taking Clomid (on my last round the womb lining was 6.5mm). I was given the HCG injection that day, and as before sent home to try and hope for the best.
A positive test!
The HCG injection is the same hormone that you produce when pregnant, so if you do a pregnancy test in the two weeks following that injection, the test will show up positive. That means you have to try hard not to test too early. I failed on that account and tested on day 13 after the injection. I couldn’t wait! But, of course, when it then showed positive, I couldn’t be sure it was the real thing. I got Steve to buy a less sensitive test and that one showed negative. I then used the less sensitive one the next day, and this time it showed positive! I still couldn’t believe it, so had to double check for the next few days, but each time the line got stronger. It had actually worked – I was pregnant!
Early scan and pregnancy care
If you’ve been in fertility treatment, you can go for an early scan at seven weeks to check everything is okay. All we could see was a little pulsating blob, but it was probably the to exciting thing I’d ever seen. There was the beginning of our baby! Following that appointment, we were discharged from the fertility clinic and from then on, we followed the same protocol as anyone else who gets pregnant, visiting our community midwife and having scans at our local hospital. I also have hypothyroidism and a few digestive issues, so had to see a consultant a few times, and as I’m writing this, I’m 34 weeks and waiting for an appointment to find out if I should have a c-section. But other than that, the pregnancy so far has been straightforward. I can write more about that side of things in the future.
Some thoughts on my fertility journey
As you can see from this post, it took us about 20 months to get pregnant and at times those months were slow. But in the grand scheme of things, we were lucky. For some people it takes years, and for others it doesn’t happen at all. Sitting here, 34 weeks pregnant, it’s been interesting to revisit the journey that got me here, and I feel immense gratitude for where I am.
It’s hard not to get consumed by the desire to get pregnant and the disappointment of so many negative tests. That day when you see your period appear is the saddest one of all. And when things don’t go to plan with treatment, it’s difficult not to lose hope. A lot of people say it puts a strain on their relationship, but I don’t think this was the case for Steve and I. We made sure to keep in good communication throughout the whole thing, talking through our fears and concerns. We also kept ourselves busy, continuing on with all the other parts of our lives, so that becoming pregnant didn’t become our only focus. We tried to keep the perspective that even if we couldn’t have children, our lives were still full and happy.
Telling other people
For me, I think it also helped not to talk to too many people about what we were going through. It’s certainly a good idea to have some key confidantes, but I found that when I told too many people, I started to feel the weight of them waiting for news. Some people also say the wrong thing. I had one friend who instantly asked if I’d thought of surrogacy, which wasn’t helpful as it’s kind of akin to telling someone you’re going through some relationship issues and them saying ‘Have you thought of meeting someone else instead?’. You want encouragement and understanding that what you’re trying to do might work out, rather than a suggestion that implies no hope.
Travelling during treatment
Travelling during our Clomid cycles was a challenge. If we could have known exactly when our scans would be happening then it would have been much easier, but I ovulated on different days with every cycle. Plus on some cycles, we also had to have a baseline scan (to check for cysts) before I started taking the next round of Clomid, and that was dependent on when I got my period, which was another unknown factor. This meant that during that period of time, our trips were all last-minute. We booked and planned our Iceland trip just five days in advance after finding out our cycle had been cancelled. With Lapland, we had a little more time because the cycle was cancelled right at the beginning, so we knew we had four weeks that were free of scans. We booked that trip three weeks in advance. And for our road trip in Europe, we made a gamble and booked it for the two-week wait (the time after ovulating and getting your period), desperately hoping that I I wouldn’t ovulate too late or my period wouldn’t come early! Luckily it worked out, and I started my gonadotropin treatment the day after we got back. If you’re interested in how we travelled once pregnant, I’ve written a post filled with tips for how to travel pregnant.
Let me know if you have any questions
If you’re going through something similar and have questions to ask, I’ll be happy to try and answer them. Fertility is a personal journey, so what works for one person might not be good for another, but I can answer general questions you have. I’d also love to hear your own fertility stories. And good luck to everyone going through this.