Today I wanted to write a little about my experience with patients doing IVF and their 2 week wait. Where for some its the worst 2 weeks of their lives…. And for others it becomes the most amazing two weeks. How can so many people have so many different experience within the same 2 weeks. And how does it affect the outcome of their IVF cycle.
Its been a long few weeks, between all the scans, medication, sleepless nights and now today, finally the transfer. As you leave the clinic everything seems to change, from having an amazing medical team get you through each of the stages through to today. Everything has had a purpose and meaning, from down regulation, stimulation to collection. There was always that guiding support available whether it be a face to face chat or a simple phone call to your nurse. And now it seems its up to you. You have been given your test date.
The two week wait has the ability to be the most amazing two weeks or the worst two weeks of your life, the dreaded two week wait.
So let us imagine two friends Jennifer and Aine, both have been on the fertility journey together with similar difficulties in trying to conceive. They say good bye with a loving huge and promise to ring each other on the test date. As Jennifer and her partner leave the clinic, they turn left, where suddenly Jennifer, feels this pain in her stomach, its a dull ache and its getting worse and worse as gets closer to home. Jennifer starts to cry as she tells her partner, it hasn’t worked, she describes the pain and how this is always a sign of her having her period. The next few nights she finds it hard to sleep, worried about the pain she experienced, every time she eats the pain comes back, she hasn’t slept properly in 3 days, work is stressful and her boss is not helping her in any way, he’s actually making it really difficult, asking her to stay late. Jennifer is not eating or sleeping properly. Every night, before her partner falls asleep she tells him that it hasn’t worked, and what are they going to do, she is too afraid to think it could have worked, why would it, look at all the bad things that have happened to us while trying to have a baby. She is afraid to believe, if it doesn’t work she will be devastated. She doesn’t want to tempt faith. This has become the worst two weeks of her life.
Aine and her partner, leave the clinic and turn right, she starts to feel a twinkle, almost like a dull ache, she smiles and turns to her partner, ‘I think implantation is happening!!!!!, Im getting a dull ache, I bet thats implantation’ Every day, Aine has a quiet little word to her two embryos, she’s even given them a name, Rocky 1 and Rocky 2, and every night before she goes to bed she asks them to keep fighting, she so wants them in her life. Her partners sends her regular texts about how the two ‘Rockys’ are doing.
So if we look at the two patients after transfer, could it be that the mind can have such an impact on the body. Well to be honest, there is no black and white answer. If you take a logical approach to mind and body, then stress would not effect the potential for implantation, well that’s what the medical community would say. But what if you looked deeper into what’s happening within a persons body, could we show it effecting a potential implantation during the two week wait. Personally, I think yes.
We all know that stress is a word that has different meanings for different people. For some its getting a parking ticket, for others its a life or death situation. But we still attach the same word to everything, stress. And we really have forgotten that it does impact us daily, we are just better at handling it or sometimes better at just ignoring it. Some people are very sensitive to stress, others less sensitive to it. Our stress sensors are very like the sensors of an alarm system in a house. You don’t want the alarm system going off for every gust of wind that blows. It needs to be adjusted to deal with real situations, where the alarm system should go off.
As a word, its not a problem, but when we drill down a little deeper into how the body responds to stressful situations, its a little different. If we take an example in nature, where an animal is in ‘Heat’ it can usually conceive with relative ease. And nature supports conception in a safe natural environment. Allowing for life to flourish, develop, grow. For those moments, an amazing potential for the creation of life. For 90% of people trying for a baby, its not a problem, conception happens easily. However there is the other side of life, where nature and the body has an amazing ability to focus on maintaining life when it is in immediate danger, I’m not talking about the ability to conceive, Its more about the animals ability to survive.
So lets say an animal is in ‘Heat’ its relaxed and calm, and suddenly one day from the corner of its eye, it notices something in the distance, its not too sure what it is yet, but somethings not right, its in the distance, its not really an issue, but the awareness is now there, again it spots movement, slowly creeping in, over time as the object gets closer the animals heart rate increases slightly. Now however, It knows what the object is, it spots a tiger in the distance, heart rate increases rapidly, there is a surge of adrenaline into the blood stream. The animal prepares to escape, to survive, where an amazing system of survival kicks in, focussing all the energy to the vital systems within the body to keep it safe, disconnecting all secondary systems.
Internally the following is happening.
As the system becomes ‘stressed’ the hypothalamus activates two of our internal systems: the sympathetic nervous system and the adrenal-cortical system. The sympathetic nervous system uses nerve pathways to initiate reactions in the body, and the adrenal-cortical system uses the bloodstream. The combined effects of these two systems create what we call the fight-or-flight response. This is no longer just a word, stress, the body is now reacting internally to this perceived stress. At the same time, the hypothalamus actives the pituitary gland, activating the adrenal-cortical system. Interestingly, the pituitary gland, is a major gland for fertility, producing FSH, LH and Prolactine, plus many more hormones. With this perceived stress it secretes adrenocorticotropic hormone, moving through the bloodstream until it arrives at the adrenal cortex, where it activates the release of approximately 30 different hormones that get the body prepared to deal with this perceived danger and induced stress.
In parallel, we have changes in the autonomic nervous system, Its main job is to regulate many of our organs, controlling heart rate, breathing, sweating, digestion and most importantly our reproductive system. Now I know this is after getting a little technical, however its so important to appreciate whats happening here. Its not just stress, we can too often negate what is actually happening. If we we to look at Aine and Jennifer, both having left the clinic at the same time, having two very different experiences:
– Jennifers, HPOA Axis is now secreting cortisol and adrenal into the blood stream, the hypothalamus is communicating with the pituitary, the sympathetic nervous system is active, heart rate increases, the body is in fight or flight, decreasing blood supply to the reproductive system. Anxiety and Fear is increased. And we now have a situation where her body is in stress.
– Aine, with the flow of endorphins and serotonin, her parasympathetic nervous system is active, a slowing of her heart rate, dilating blood vessels and allowing for a healthy flow of blood into her reproductive system. Hope develops and the belief of a positive out come grows day by day.
We have two very different experiences happening with Jennifer and Aine. Honestly if this is for a moment in time, it really is not an issue, however, over a two week period. Its going to have an effect. Enough to prevent a pregnancy, possibly not.
I do appreciate that a lot of couples will be afraid to tempt faith, thats it better to believe its not going to work as it won’t hurt so much when it doesn’t work. Why would you blame them for having this thought process, its been years, their whole lives have been consumed by this journey, month after month, negative results, tests after test, holidays cancelled to save money for the next step, nothing has worked. Where no one has real answers. They are physically, emotionally and financially broken. And this could be the last time. Everything has been put into this last transfer. But you do have a choice, you either leave and turn left or turn right. That is still in your control.
The thing to remember here is that, whether you believe its going to work or you decide to protect yourself from believing, your heart is going to be ripped from you no matter what you think. If the cycle does not work, believing it will work, and it not working and believing that it won’t work and it doesn’t. With the devastation, there is no difference, its the same devastation . I promise you.
What if that 1% of hope, grows inside, reducing the stress hormones, allowing you to eat a little more, where you sleep a little better during the 2 week wait, where it doesn’t become the worst two weeks of you life. Could that 1% make the difference between success and failure, well no one will know for sure. But for me that 1% is huge and worth taking the chance and turning the worst 2 weeks of you life into the most amazing 2 weeks, where by definition as soon was you leave the clinic, you are pregnant, whether you have 1 or 2 little embryos on board. You are by medical definition, ‘Pregnant’ yes. I know its hard to say, its hard to believe, but you are. And everything you do from now to test date, can support this pregnancy. Allowing for implantation to occur, growth and development of the pregnancy. It is not out of your control, you can do so much to help maintain this pregnancy, day by day, week by week. And when you test date is here. Knowing that you have done everything. Holding your breath as you wait for the next step, the potential, the possibility of a positive result.
By the way the worry doesn’t end there, but you are a step closer, and this is about taking steps, one at a time. From being on the pill through each of the stages of your IVF cycle, with each stage increasing your chances of success. I understand this is all easier said than done. But every 1% counts and hope goes a long way.