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My IVF journey started on the 11th day of my current menstrual cycle (CD11). Although my fertility started years before that (October 2021), and I started to consider IVF months ago (December 2022), I consider 22 February 2023 as the official start of my IVF journey as this is the day that I was cleared to start the IVF process. Technically, I was not cleared on that day as I anticipated, but I advocated for myself and was cleared retroactively.
The reason why I was not cleared on 22 February to proceed with the IVF the following month, as anticipated, was because my uterus lining measured only 4.6 mm. This ultrasound check was meant to check the thickness of the uterus lining as I was still recovering from a recent Hysteroscopy to remove a submucosal fibroid. The surgery was done on 23 February, and while I had just a month of recovery, the fertility clinic assured me the recent procedure would not delay my plan to proceed with IVF immediately.

Initially, I was seeing a gynecologist in Estonia (I live in Helsinki). I first visited her on December 2022, and upon explaining my fertility journey, she immediately recommended IVF, and I consented. However, I had already started considering whether it would not be cost-efficient to skip straight to the IVF even though my tubes are open, considering the low success rate of IUIs. During that consultation, Estonia Gyno brought to my attention the small submucosal fibroid on my uterus, which I have been aware of since an ultrasound that was done through the Helsinki women’s clinic in May of 2022. At the time, the women’s clinic said the fibroid was nothing to be concerned about. But, since I brought up wanting to do a Hysteroscopy due to suspicions of uterine scar tissues, Estonia’s gyno suggested removing the fibroid before proceeding with IVF. Note that my uterus is infested with intramural fibroids once again after undergoing a myomectomy to remove over ten fibroids, the largest being as large as a grapefruit (April 2021), and a Hysteroscopy to remove two submucosal fibroids that were not reachable through they myomectomy (July 2021). However, the focus of the latest Hysteroscopy (January 2023) was to remove the one tiny submucosal fibroid only as it is the only one that could impact implantation according to the Estonia gyno but not Helsinki women’s clinic gyno.

Estonia gyno recommended me to a surgeon at a hospital in Estonia. Upon inquiring whether the surgery would delay moving forward with the IVF, she assured me no. She stated you could have the surgery as early as this month and start the IVF process next month (rolling eye). Unfortunately, I could not do the surgery in December even though my cycle aligned perfectly with the surgeon’s availability because it was right around Christmas, and I already had plans to be in Germany for Christmas, where I have a second life. I should also state that a gyno at a hospital in Germany that I consulted during my Christmas trip to Germany discouraged doing a Hysteroscopy, especially if I am going through fertility treatment, as any toying with the uterus hurts the chance of a successful pregnancy, not help. It so happens that both clinics that discouraged operating on the uterus were public clinics, and the gynecologists who encouraged it were private doctors. Estonia gyno suggests that public clinic tends to be reluctant to refer certain procedures because of the burden to the state. This could be true, but on the other hand, private clinics may also have an incentive for referring certain procedures. Estonia gyno seemed to know Estonia’s surgeon very well, and the two clinics coordinated the operation.

Before the surgery, I attempted to get a concrete plan for the IVF procedure with Estonia gyno, but she (clinic staff) kept brushing me off, saying I needed to wait till after the surgery to contact them. After I suggested that since we know the date of my surgery, why can we not plan for what I should do next or when I should contact them, the nurse asked me to schedule a phone consultation that would cost me 135 euros to discuss the next step. I took this as a sign that they were extremely annoyed by my insisting on talking about the next step when they knew it would take months before I would be ready. Therefore, I believe I was misled by the doctor when she said I could move forward with the IVF procedure the cycle after the operation.

Instead of scheduling a phone call just for the doctor to tell me I needed to wait for two cycles before I could start the process, I made a cost-benefit analysis and decided that a fertility clinic in Helsinki may not be much more expensive than the clinic in Estonia after all. I contacted a clinic in Helsinki inquiring if I had to wait to start IVF since I had just had a hysteroscopy to remove fibroids. The nurse wrote back to me and said the doctor said I do not need to wait since it was a minor procedure. But of course, during the first consultation, Helsinki gyno told me otherwise: You have to wait for one more cycle before we can proceed with the IVF as your uterine lining is too thin so soon after surgery (I think that a professional doctor who has seen hundreds of patient with similar history than me knows from experience that the uterine lining would be too thin after surgery without even checking through ultrasound). The Estonia and Helsinki clinics both told a small white lie to get me into the doors because as soon as I made the initial investment and paid the hefty first visit consultation fee, they assumed I would not leave.

Now back to our present story, CD11 consultation. Helsinki gyno stated that it is best that I have an ultrasound done on CD11 to check the uterus lining to see if it is prime for a fresh transfer. She said she does not doubt that we will be able to proceed with the IVF the following cycle. My reason for rushing is the fibroids that grow like weeds; As soon as you pluck one out, it starts growing back. I also invested in a very expensive gel that the surgeon put in the uterus to prevent scar tissue after the surgery. I read many scientific journals about the efficacy of this gel, and they all found that the longer a patient waits to proceed with fertility treatment after administering the gel, the lower the success rate. The best success rate was 14 days after the surgery. I wonder if these studies took into account the uterus lining situation, but regardless, I felt like I had a small window of opportunity before the scar tissues started appearing or the fibroid grew back.

Helsinki gyno was out on CD11, so the clinic assigned me another gyno who informed me after spending an hour going over the IVF process, which has been explained to me twice already, that my uterus lining was still too thin to proceed with IVF, the next cycle, March 2023. I would not have let her waste so much of my time and essentially money (300 euros) if I knew this would have been the outcome. According to the first gyno, that appointment was supposed to be a quick 20-minute ultrasound check. The second gyno conveniently did the ultrasound last. I did not have the gut to contradict her verdict during that visit because I was still shocked. I left the clinic in tears. The receptionist noticed how upset I was and tried to cheer me up with a story of her spring break in Lapland and doing yoga with the reindeer. I choked up sobbing all the way home, but by the time I arrived home, it was clear. She said my lining measured 4.6 mm on day 11 of my cycle and recommends rechecking it next cycle closer to day 13 as it is likely to be higher closer to ovulation. I wondered then why they had me come so early. I considered asking the clinic to schedule another ultrasound on day 13 of the current cycle but dreaded parting way with another 300 euros and the circumstance remaining the same. I also remembered that she said that the lining needs to be at least 7 mm before they proceed with a transfer, and since they want to do a fresh transfer, she recommends waiting for one more cycle. One more cycle is more money on follow-up consultation. One more cycle is more chance for the scar tissues to grow and for the fibroids to return.

I put my researcher hat on and researched the efficacy of a fresh transfer versus a frozen transfer. The research suggests no difference between the two, and a CDC study found that frozen transfer has had higher success rates in patients with pylons (another gynecological disorder). So I thought, if we proceed with IVF next cycle and the lining is not thick enough for transfer, we can do a transfer at a later cycle. In that instance, I still have to wait to conceive, but at least I get to try my luck at conceiving earlier if my lining gets thicker this upcoming cycle. Helsinki Gyno #2 even stated that IVF medicine could help the lining grow.

I sent an email to the clinic with my counterargument and offered the studies I found as proof that a frozen transfer is just as effective as a fresh transfer and requested that we no longer delay the IVF process. The nurse said I would not get an answer until the following week because the original doctor was still on vacation. I told her I would start asking for a second opinion elsewhere (That was an ultimatum, but being fully prepared to go else). I did not hear back by the following Monday, so I followed up first thing on Tuesday with the intention of scheduling a consultation with a clinic in Denmark first thing on Wednesday if I did not get a response (Denmark is another story). The doctor responded that day, stating we could proceed as I suggested and start the IVF process in the upcoming cycle (tentative 12 March 2023).

• This topic was modified 2 weeks, 5 days ago by Fabienne Valmond.

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