Monday 24 February 2014

Days Leading to Egg Retrieval or Oocyte Pick Up ["OPU"]

So much has happened in the past few days.

I had the following injections since 14/2/2014:

14/2/2014 to 22/2/2014: Menopur 150iu & Bravelle 150iu mixture in 1.5ml of sterile water for 9 days.
18/2/2014 to 22/2/2014: Cetrotide 0.25mg with 1ml of pre-filled sterile water for 5 days.
22/2/2014: Pregnyl 10,000iu which is the hCG trigger shot.

The morning injections of Menopur, Bravelle and Cetrotide were uneventful. I was rather relaxed and for the first time compared to my previous IVF attempts, I've not experienced any bruises! There were times when I may hit a capillary or two but they were just fine thereafter.

Our second appointment with Dr Wong was on 18/2/2014 at 11am. We reached Sunfert at 10.20am, got registered and went to the laboratory to get hubby's blood drawn for the required tests: blood group, Hepatitis B, HIV-1 & HIV-2 and VDRL. It was a long queue at the laboratory and hubby got really anxious. As his turn approached, he became so uneasy that I couldn't help but laughed away! Well, he had this little fear with needles. Haha! So a quick prick was all it needed and it was over before he'd even realised it! :D

I had lunch at one of the cafes in Sunway Medical Centre as hubby again had a lunch appointment. Hubby left after I'd finished lunch. I had my scan at 1pm. We saw 4 follicles on my right ovary with the biggest being 10mm while my left ovary saw 5 follicles with the biggest being 13mm. Dr Wong seemed pleased though and he prescribed an additional drug starting on 18/2/2014 i.e. Cetrotide 0.25mg.

After getting the fresh 5 days' supply of Menopur & Bravelle and the new Cetrotide, I made a beeline back to my office for work.

My next appointment was on 22/2/2014 at 1pm. It was a Saturday and Sunfert opens half day on Saturdays. So I must be one of the last patients of the day. Hubby was not able to accompany me that day. I took my time and reached Sunfert at 12.50pm! There were still many couples waiting for their turns so I went for lunch alone at the cafeteria.

Very soon, most of Dr Wong's patients left and it was already 3.40pm when I finally had my scan. So, 5 follicles with the biggest being 20.5mm on my right ovary while the left ovary had 6 follicles with the biggest being 20mm. Dr Wong was happy with what he saw and I'd texted hubby straight away!

I was then briefed by one of the nurses as to what to do next. The following were the extracts of the contents of a chart given to me with specific instructions prior to egg retrieval or oocyte pick up ["OPU"]:-

1) 22/2/2014
- to administer subcutaneous Pregnyl 10,000iu at 7.30pm sharp.

2) 23/2/2014
- to take Curam 625mg (antibiotics tablet) one tablet twice daily (after meals) for 2 days i.e. 23/2/2014 & 24/2/2014.
- to take 2 tablets of Dulcolax (laxatives) at 11pm.
- no food or drinks after midnight (not even plain water!).

3) 24/2/2014
- OPU at 8am.
- to shower with only water in the morning without the use of soap, perfume or make-up.
- to arrive at Sunfert at 7.30am.
- husband will be required to provide semen sample at the same time unless otherwise instructed.
- OPU will be done under sedation and it will only take about 15 - 20 minutes.
- after OPU, I should be able to leave Sunfert after 2 hours and I will need to have an escort to accompany me home.
- to complete the antibiotics.

In addition to the above, I was further prescribed with Dexamethasone 0.5mg tablets, one tablet daily for 3 weeks from 22/2/2014. I was told to take Dexamethasone to prevent miscarriage as I had a history of previous miscarriage.

So off I went to the pharmacy for the supply of Dexamethasone and left Sunfert at 5.10pm. I was totally exhausted! My tummy felt heavy and uncomfortable.

Once I got home, I had my dinner and got busied collecting water. My house was without water supply since 10/2/2014! We are surviving from whatever that was left in the water tanks and the supply from the Syabas water trucks. While I was at that, it suddenly struck me...the hCG trigger shot!

I looked at the clock and I couldn't believe myself! It was 9.25pm! I ran to get ready the mixture of 2 vials of Pregnyl 5000iu with one vial of sterile water. My hands were shaking and I just couldn't think properly. I managed to inject myself with Pregnyl 10,000iu at 9.30pm sharp. That was exactly 2 hours late! Gosh! How could I have missed it?! I must have messed things up terribly at the very last minute...I knew I had!

I frantically called the nurse careline but it all went to voice mail so I left a message for them to return my calls. I called hubby and he tried to calm me down. I felt ridiculously stupid... and as I'd expected, I couldn't really sleep.

As early as 9.40am yesterday, 23/2/2014 (a Sunday!), I'd called the nurse careline again and thankfully a nurse answered at my second attempt. She said she will call me back as soon as possible and said not to worry. I kept checking my mobile and the nurse finally called me at 12.30pm. She assured me that Dr Wong said I shall continue with the rest of the instructions with OPU on 24/2/2014 at 8am as planned. What a relief! Phew!

I woke up this morning (24/2/2014) at 5am. I had stomach discomfort since last night after taking the laxatives (Dulcolax) at 11pm but I just couldn't empty my bowel. I showered as instructed and we both reached Sunfert at 6.50am. The clinic was still closed so we waited at the hospital lobby. I was hungry and thirsty as I'd fasted since 11pm last night but that was no big deal. To my surprise, I had a sharp stomach pain at 7.15am and I was so glad that I'd managed to clear my bowel before the OPU. Hahaha!

Dr Wong arrived at 7.45am and saw us waiting at the clinic. He asked me again if I had administered the hCG trigger shot at 9.30pm on 22/2/2014 and I'd affirmed that. He went on to explain that OPU at 35 hours after the hCG trigger shot is acceptable and in fact, practiced by many IVF clinics. His words made me calm as I'd read that OPU should be performed between 34 to 37 hours after the hCG trigger shot.

Within minutes, hubby was asked to complete a consent form and I was asked to empty my bladder. Hubby then went away with a mischievous look to get his semen sample done while I waited. Before I could see hubby again, I was asked to change into a fetching hospital gown and waited at the recovery bay for OPU.

A clock on the wall ticked 8.20am and I was excited. By 8.40am, I was lying on the operating table in the theatre with the intravenous device duly attached on my left hand which I knew will be used to administer anesthesia and I had an oxygen mask on my face. There were 2 nurses in the theatre with me.

Dr Wong came and gave me a pat on my shoulder to inform that he will start the OPU procedure and assured me not to be worried. I managed to peek at the wall clock again...it was 8.50am. The next thing I remembered was I saw the nurse injecting anesthesia drug into the intravenous device and she asked me if it hurts. I said no and immediately felt dizzy. I felt that the operating table was lifted so my head was lowered and my legs were slightly raised. There goes my dignity...hahaha! Anyway, the room continued to spin and when I opened my eyes again, something told me the procedure was over. Yes, I managed to see Dr Wong leaving the theatre and it was just 9am!

Ironically, I couldn't recall how I got back to the recovery bay which is located just outside the theatre. I woke up at 10am and I still felt a bit dizzy so the nurse asked me to lie down for another 10 minutes. Then I got dressed up and waited outside for further instructions.

Hubby had left once I was in the theatre and he said he will be back shortly. I was given some biscuits and hot Milo drink. Later, at the consultation bay, I was informed that we had 13 eggs! That was an amazing number! I was so pleased. So were hubby. :)

Deep inside, I am hoping for at least 50% fertilisation...

Sunday 16 February 2014

Antagonist Protocol

The day has finally came. I have my menses on 11/2/2014 late at night and Dr Wong took my day 1 to be on 12/2/2014.

We reached Sunfert at 8.20am on 14/2/2014 and got a queue no. 17. Did a vaginal scan at 10.20am. Dr Wong saw an image that looked like a corpus luteum or a corpus luteal cyst. My heart sank while waiting for Dr Wong to decide whether to start the injections that day which was my day 3 of menses. "Let's do a blood test," Dr Wong scratched his head.

So off I went to the laboratory to have my Progesterone levels checked. It has to be really low. As the results could take about 2 hours to complete, I had to wait for the blood test results alone as hubby had to leave for a work appointment. The waiting time was really bad as we were subsequently told that Dr Wong had to perform an emergency caesarean delivery! Then there was another procedure to be attended to thereafter. Finally I get to speak to Dr Wong again at 2pm.

The test results were very good indeed. My Progesterone level was less than 0.2 ng/mL and I was given the green light to proceed with the antagonist protocol or a short protocol. The corpus luteum was expected to resolve on its own and I hope there will be no further complications.

I then waited again for consultation on how to administer the injections.
The prescription: 150iu Menopur & 150iu Bravelle for 5 days (commencing on 14/2/2014).

Menopur contains two naturally-occurring female hormones, follicle stimulating hormone (FSH) and luteinising hormone (LH), extracted and purified from the urine of post-menopausal women whereas Bravelle contains FSH.

After a demonstration by a nurse, I was asked to repeat her steps using the 'demo kit'. Immediately thereafter, I had to repeat a second time using the actual drugs and administer the first injection on myself under the nurse's supervision. I did it with some struggles though. Haha! These drugs are new to me as I was previously given Gonal F straight from pens which do not require the mixing of powders.

We are scheduled for oocyte retrieval or egg collection on 25/2/2014. It could be one day earlier or one day later i.e. on 24/2/2014 or 26/2/2014. In between, we have to go to Sunfert again on 18/2/2014 and 22/2/2014 for further scans on egg follicles and uterine lining. Embryo transfer date will depend on the development of the embryos after egg collection. It will either be a day 3 or day 5 transfer. However, I have informed Dr Wong that based on my previous experiences with long protocols, all my previous three fresh IVF transfers were day 2 embryos. Dr Wong has his reservations and would like to wait and see.

I was also informed by the nurse that the clinic's usual practice is ICSI and not just IVF alone. That sounds good to me.

As I was getting ready to make payment (the first instalment of the IVF/ICSI package of RM15,500-00), I was told that I have to do yet another blood tests! It was already 4.30pm and I was starving! Sigh...

There are four other tests that both myself and hubby needs to take before oocyte retrieval. We both need to test on our individual blood group and get clearance on Hepatitis B, HIV-1 & HIV-2 and VDRL. The venereal disease research laboratory (VDRL) test will determine whether or not one has syphilis, a sexually transmitted infection.

To the laboratory again I went. The nurses there recognised me immediately but unfortunately, they had to draw my bloods again as the earlier collection was insufficient. I managed to finally leave the hospital by 5pm. What a way to spend Valentine's Day...

Yesterday (15/2/2014), I'd panicked as I'd almost forgotten all about the injection! Nearly missed the morning jab! Haha! Managed to inject the mixture of Menopur and Bravelle at 8.15am. Phew!

Today, my third injection was done at 8am. Each time, I will experience a slight pain/cramp around the injection site immediately after the jab but it subsides after a while and nothing unbearable.

Fingers crossed for at least 5 good quality eggs...am I being too greedy?! ;)