Tuesday 31st August 2010
One year ago.
Suse is all over the shop.
In the last two days, she’s smashed the Pyrex jug, made a cup of tea with cold water, left me several unexpected presents in the toilet, and strewn an entire box of used tissues all over the house. She’s got a constant headache, her skin has broken out, she feels increasingly bloated and nauseated, and her memory is shot.
This morning when we woke, I could tell she was on edge.
“Remember I’ve got my phone thing this morning?” I said.
“Sure. But you’ll be done by 9.15?”
“No, it might take till 9.30.”
“But last night, you said you’d be done by 9.15.”
“No, last night, you heard that I’d be done by 9.15. I very definitely said it might take till 9.30, because I thought it might be an issue.”
“But you’ve got to give me my injection!”
“Which I’ll do at 9.30.”
“But I’ve got to go to work!”
“And I’ve got to be on the phone.”
“Don’t you want to have a baby?” she said, breaking into tears.
It’s like a dose of turbo-charged PMS.
* * * * *
PMS is the acronym for Pre-Menstrual Syndrome. We all know what it is, but approximately 5% of the female population know better than most. According to Wikipedia, PMS is ‘a collection of physical, emotional and psychological symptoms that are related to a woman’s menstrual cycle’, above and beyond the normal discomfort expected of menses.
There are well over two hundred symptoms that have been attributed to PMS. And these don’t include any of those experienced by their partners. As an interesting aside, there is thought to be an evolutionary function to PMS, as it only occurs when a woman is about to menstruate, thereby reminding all around her that she has not fallen pregnant. If her male suitor fails to impregnate her on a monthly basis, then irritability, tension and mood swings are potential motivators for rejecting him out of hand, making way for a more virile partner to move in, get her knocked up, and get on with the breeding.
Ain’t nature grand.
Technically, PMS is a phenomenon isolated to the final days of the Luteal Phase, the period between ovulation and menstruation. And right now, thanks to our suite of injections, we are well and truly in the trenches of the Follicular Phase.
So, I can’t truly say that this is PMS. While the symptoms may be similar, it’s a slightly different beast. In fact, what’s going on here is a fully-fledged dose of POS: Pre-Ovulation Syndrome. Or, as I like to call it, thanks to the drugs, PT-COS: Pre-Turbo-Charged Ovulation Syndrome.
With Suse, PT-COS has been triggered because they are totally messing with her hormones. She’s getting extra doses of some, and antagonists to others. And while this may sound counterintuitive, it’s not. It’s actually fascinating.
Unless you’re Suse.
The system in the body that controls hormones is known as the endocrine system. The adrenals, the thyroid and the testes and ovaries, among others, are examples of endocrine glands.
Endocrine glands receive messages in the bloodstream from other organs further upstream. At the top of the message system, unsurprisingly, is the brain. A part of the brain known as the hypothalamus releases a whole bunch of hormones, including one called Gonadotrophin Releasing Hormone (GnRH). This then floats downstream to the pituitary gland, which sits right at the base of the brain. When the pituitary gets the GnRH signal, it releases two more hormones: Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH). These, in turn, circulate in the blood stream until they reach the ovaries. The arrival of FSH and LH is like the green light for ovulation, and on getting this message, the ovaries begin to release their own hormones, estrogen and progesterone. These enter the blood stream, and float all the way back to the hypothalamus, like a messenger letting headquarters known that the signal got through.
The whole thing is a finely tuned balancing act.
Except in IVF.
* * * * *
With IVF, we’re messing with the whole project. We’re deliberately unbalancing the whole act. For the last five days, we’ve been injecting FSH straight into Suse’s belly. Her ovaries, being obedient little things, have start to ripen the follicles. This is all good and well, except that it means we’ve got extra estrogen and progesterone leaching all around the circulation, having a right old party. The messengers are telling the hypothalamus to slow down the GnRH release, but with two of the follicles already at 16mm, the message isn’t getting through quite quick enough.
So this is where the Orgalutran comes in. If you read the pamphlet, you’ll see that it’s ‘a GnRH antagonist, modulating the hypothalamic-pituitary-gonadal axis by competitively binding to the GnRH receptors in the pituitary gland’.
And while it sounds more like something that might occur to insurgents in Afghanistan, what it really means is that we’re blocking the release of anymore GnRH from the brain. We are competitively antagonising those receptors. And we wonder why my wife is moody.
LH is the enemy here. If LH levels get too high, then the follicles will burst early, and we’ll lose the eggs. So we’ve highjacked the system. We’ve closed down the natural release of FSH and LH by stopping the GnRH with Orgalutran, and yet we’re continuing to pump her full of pharmaceutical-grade FSH to ripen her up like a battery hen.
And then, in two day’s time, we’ll give her one last jab of artificial LH, to get those grapes good and ripe, and thirty-eight hours later, they’ll pounce. They’ll grab the biggest needle they can find, and suck out as many as eggs as they can.
But only after she’s knocked unconscious.
* * * * *
So, it’s semantics, really. Whether this is technically PMS or not, we’re messing with Suse’s hormones. We’re blocking the messages to her brain, and we’re overdosing her with messages to her womanly bits.
And if there’s one thing I have learnt about my dear wife, it’s that when we mess with her hormones, I will surely know about it.
* * * * *