Embryo Transfer

Well...I am officially in my two week wait now. So much to digest in so little time. I must admit, I am just too lazy and not in the mood to write earlier. I guess I'll backtrack to where I stopped. Ha!

24/2/2014: So we were happy with the 13 eggs collected and boy, excited I was! I was given another instructions sheet on Embryo Transfer which was scheduled on 27/2/2014 at 12noon. There were more prescriptions too:-

(i) Cardiprin 100 (contains Aspirin 100mg & Glycin 45mg) half tablet a day for 8 weeks! Yes, 8 weeks.

(ii) Cyclogest 400mg twice a day, one pessary at 11am & one at 11pm starting on 25/2/2014.

(iii) 2 vials of IM Proluton Depot 250mg, one vial to be injected on 25/2/2014 & one on 28/2/2014.

My tummy felt sore and bloated immediately after OPU and I remembered feeling the pain as I walked. This bloatness and tightness in my lower abdomen was really uncomfortable but thankfully it finally resolved the following night.

So on 25/2/2014, I took the first intramuscular (IM) injection of Proluton Depot 250mg at the hospital near my house at 7.40am before I left for work. There's really no particular timing for the shot but I'd prefer to do it in the morning...just in case.

Then, I started with the Cyclogest pessary at 11am in the office toilet...rectally, of course. A vaginal insert would require at least an hour of lying down after the insert so as to prevent it from dropping back out. I did the vaginal inserts at night instead. It wasn't that difficult for me because I've done this too many times before. To be frank, those pessaries are really gross and it's such a mess down there! Eeew...

I took half day leave to have a session of the mind body fertility theraphy with Mr Ong. Yeah, I've never mentioned about this earlier too. His centre is in Petaling Jaya. I had totally forgotten about the four sessions which come free with the Sunfert IVF package. I was so grateful that Mr Ong was able to allocate time for me at the very last minute.

The intended 2 hour session was extended to 4 hours! I was skeptical at first but I had a wonderful experience with the hypnotherapy session. It taught me how powerful a human's mind could be...and how to trust that my body is healthy to carry a baby to term.

That night, I listened to a few tracks given by Mr Ong and it were so soothing and relaxing I couldn't remember when I'd actually fell asleep! I tried the instructions for self-hypnosis too but don't think I'd managed because I was so very sleepy! Haha!

Anyway, I had another 4 hour long session the following morning (26/2/2014). It is very important to be stress-free especially during and after the embryo transfer. Mr Ong asked me to request for the mp3 that he has prepared for the use of patients during the embryo transfer from the Sunfert nurses before my transfer. It'll help me to relax. I'd certainly hope so.

The day finally came. It was 27/2/2014, the day for my embryo transfer! Yay!

I'd showered with water only (no perfumes, no cosmetics) in the morning and was ready to go.

Hubby was outstation. So my mom accompanied me to Sunfert. We reached at 10.15am and since we were early, we both had breakfast together. I emptied my bladder at 11am and started drinking the 250ml water as instructed. I'd also inserted the Cyclogest pessary at 11am, rectally again and tried not be anxious but it's really tough.

At 11.20am, I was called into the consultation room. I felt like a young student, eager to get my examination results! Haha! The nurse calmly informed that 13 eggs were earlier retrieved but only 12 were matured. ISCI performed on those 12 eggs but only 6 fertilised. I was hopeful...

She continued, however, although the fertilisation rate was not fantastic, 4 out of the 6 embryos were of good grade while 2 others were of average quality with 5% and 10% fragmentations respectively. My heart was racing with joy as we have never had any good grade embryos in all our previous IVF attempts.

The plan was to transfer 3 good embryos and freeze the rest. Sounded good to me. Fingers crossed!

I was in the theatre again by 12.15pm. I saw a monitor screen on the wall which showed 3 handsome-looking embryos and the nurse told me they were mine. It's so amazingly beautiful. I've never seen any of my previous embryos before. They were all between 9 to 10 cells embryos. And I found myself smiled and smiled...and smiled! ;)

There were 8 scheduled procedures by Dr Wong that day so they couldn't afford much delay. The nurses were busy scanning my tummy and gosh, it was so uncomfortable I felt I could burst anytime! The pressure on my semi-full bladder continued and I heard someone mentioned that this was going to be a little difficult. Well, I have a retroverted uterus.

I tried my best to stay calm and asked for Mr Ong's mp3 again. The nurses told me that they're getting it ready for me. But Dr Wong was already in the theatre then. He told me that he will transfer 3 day-3 embryos. He said he had decided that maybe day-3 embryos would be better of than blastocysts after all and again, asked me not to be worried.

A nurse then whispered into my ears informing that they couldn't get the batteries for the mp3. I was rather disappointed but politely asked if I could actually use my mobile phone instead? The nurse quickly got me my mobile and I'd immediately played one of the music tracks shared by Mr Ong earlier in his sessions.

I'd just closed my eyes and let my mind wandered with the music, not forgetting to breathe slowly. I'd visualised how comfortable the embryos were when they were inside my womb and before I knew it, the procedure was over! I think I did great! For the first time ever, I felt my lower abdomen was totally relaxed during the whole procedure. I was pushed out of the theatre at 12.40pm on a slightly slanted (30 degrees maybe) bed to the recovery bay where I was required to rest in that position for 1 hour. So I continued listening to the music with my legs slightly raised.

More than an hour later, I got dressed up in my own clothes and made a bee line to the toilet. Luckily it was only 250ml of water! Otherwise, I couldn't imagine how I could handle more than 1 hour without bursting! Haha!

I was given yet another instructions sheet titled "Pregnancy Test". There was a part that states the following:-

(i) refrain from strenuous activities such as exercise, intercourse or other physical activities that may cause undue strain to the abdomen.

(ii) take a healthy and balanced diet with lots of fruits, vegetables and fluids. Avoid traditional herbs, alcohol and smoking.

(iii) try to have adequate rest and sleep over the next two weeks though there is no need for complete bed rest. You may wish to resume work after one week unless your work is extremely stressful or involves traveling.

The nurse also told me not to take bananas, papayas, watermelon and pineapple as these fruits may encourage uterine contractions which may affect implantation.

Again, more prescriptions:-

(a) Duphaston 10mg, one tablet twice a day until beta testing.

(b) Dexamethasone 0.5mg, dosage to be increased to one tablet twice a day until beta testing.

(c) Cyclogest 400mg, to be continued twice a day until beta testing.

(d) 3 vials of IM Proluton Depot 250mg, one each to be injected on 3/3/2014, 6/3/2014 and 9/3/2014 at any time of that scheduled day.

My mom and I went for late lunch near my house while on our way back home. I couldn't be bothered much as we were both very hungry. We had economy rice. I took only the green vegetables and tofu. It's a satisfying meal! :)

I lied down once we got home. I'd only showered later that night. I felt some cramps too that late evening and at night on my lower abdomen, somewhere near my ovaries I would say. But it's bearable.

So, here comes the dreaded two week wait...

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...

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?! ;)

Endometrial Scratching

The term alone actually scares me tremendously! I have never heard of this term until I met Dr Wong for the first consultation on 10/1/2014.

Endometrial scratching is exactly what it sounds like. It is a procedure where the doctor intentionally injures the inner lining of the uterus by taking a small sample from the lining. Yeah, just like having a pap smear. "It has to bleed a little though", Dr Wong explains. This procedure is to be carried out after ovulation but before the planned IVF program. It is reported that the damage caused by the scratch gets the uterus to regenerate and repair itself which increases the implantation rates by as much as 20%, thus raising the odds of pregnancy and life births.

However, it is advisable not to have unprotected intercourse in the four weeks before the planned endometrial scratch procedure, to avoid the risk of a possible pregnancy as the physical procedure is detrimental to any early pregnancy.

Today is day 14 of my menses. My appointment with Dr Wong is at 8am. We reached Sunfert at 7.45am and our queue number is already a 6! By the time I was on the surgical table, it was 10.10am. I told Dr Wong that I believed I'd ovulated on 27/1/2014 and from the vaginal scan, he agreed. By 10.20am, the endometrial scratch was performed! I felt a sudden cramp and an almost immediate tummy discomfort similar to period cramps but the pain is bearable. Hopefully, it is also worth it.

Dr Wong also informed that my AMH ("antimullerian hormone") testing (or simply the ovarian reserve testing) results is slightly below the normal range with a reading of 9.6 pmol/l. The normal range as per the report dated 11/1/2014 is between 14.3 - 48.6 pmol/l. However, Dr Wong explained that such results is expected for ladies of my age. If it is below 6 pmol/l, then I may require further medications. For that alone, I am happy.

When I reached home, there were blood stains on my liners but it was minimal. I rested in bed the whole afternoon and the pain was gone before I'd realised it!

My next appointment will be on day 2 or day 3 of my next menses which is likely during the second week of February 2014. I am anxious to start...fingers crossed.

Semen Analysis

A day after our visit to Dr Wong's clinic (11/1/2014 at 5pm), Dr Wong personally called me on my mobile.

For a moment, I was very worried as I thought that my hormonal test or hubby's semen analysis ("SA") must be real bad to warrant a call from Dr Wong himself. But I calmed down to digest what Dr Wong had to say.

Dr Wong said the results of hubby's SA is slightly below the normal range. My heart sank but he quickly added that it is still fine.

Volume: I was not informed.

Count: 14 million sperm/ml [15 million sperm/ml for normal count].

Motility: I was not informed of the percentage of the sperm that should be swimming or motile but was told that the sperms are mostly very active.

Morphology: 1% of 'normal formed sperm' is found as opposed to at least 10% to be considered normal morphology.

When asked if we will require ICSI ("intracytoplasmic sperm injection"), Dr Wong says we will decide then and not to worry.

Well, a quick simple call but it made a big impression on me.

First Official Visit to Sunfert

Yes, we have decided to have our next ivf treatment at Sunfert under Dr Wong Pak Seng. I am very excited. Hubby is calm though.

Our initial appointment on 13/1/2014 was re-scheduled to 10/1/2014 at 2pm. The clinic was not very packed as I would have imagined as I was later told that Dr Wong had to perform a surgery at 5pm. We don't have to wait long before my hubby was asked to provide his sample for semen analysis ("SA") and we were then both asked about our previous medical history and our TTC journey thus far. We were asked whether we smoke or drink and when was the last time I did a pap smear or a blood test. My hubby confessed that he smokes an average of 13 sticks of cigarettes per day and I only managed to shake my head. I know it is hard for hubby to quit smoking so my only hope is that he smokes less. But 13 sticks are a lot! Sigh...

Anyway, I have done a hormonal blood tests on 9/1/2014 (I had a free voucher from Sunfert from an infertility forum conducted by Sunfert on 15/12/2013 which I had attended) at Gribbles laboratory but unfortunately the results have not reached Sunfert.

Dr Wong did a tummy scan, vaginal scan and pelvic check. We saw about 3 to 4 eggs on each side of the ovary and it looked like 1 egg had been released. Dr Wong commented that my ovaries do look slightly smaller than normal but everything else looks fine. The possible reason being that I had gone through 3 fresh ivf programs thus far and my ovaries may have been 'injured' during the oocyte retrieval (egg collection) procedures.

In our discussion later, the issue which concerns Dr Wong is the quality and quantity of my eggs. So, Dr Wong had suggested that I do an ovarian reserve testing which is AMH ("antimullerian hormone").

Another advice is to undergo an endometrial scratching procedure before we start the next ivf program. I have never heard of this before so when Dr Wong explained it to us, I find it very scary indeed!

Hubby was asked to take multivitamins called Bio-Selenium Plus as he is a smoker. It's selenium with zinc and vitamins A, E, B6 & C. I was asked to take co enzyme Q-10 which I am already currently taking daily. However, no Chinese herbs for me such as dong quai and pat chan. I then specifically asked if I could take bah kut teh and Dr Wong said "Why not?". I was beaming as I had craved for bah kut teh for so long! There are considerable Chinese herbs in bah kut teh and therefore I have chosen to avoid taking it altogether.

We left the clinic before 5pm without waiting for the SA results. We were both very hungry as we both had not had our lunch!

So off we went for dinner. Yes, we had bah kut teh! ;)

Happy New Year 2014!

Happy New Year 2014 to everyone!

No countdown for me last night but my mom and my sister stayed the night at my place so we weren't sleeping until the sounds of fire crackers 'died-down' in the distance. :)  Don't I sound like an old lady?! Hahaha!

Anyway, my car windscreen cracked yesterday morning as I was on my way to my office. Well, apparently a stone fell off a lorry as I was driving past it and the stone hit hard on the windscreen. The crack was seen almost immediately and it's about 30cm long! I've never experienced this so it kind of scared me and I had to drive real slow all the way to my office. I'll be taking my car to my friend's workshop today and hopefully the repair work will be swift.

Tonight I have a friend's wedding dinner to attend to but until now I still can't decide on which dress to wear. Frankly, I haven't really gone for any wedding dinners for months. In fact, I've grown sideways with at least one size up now! So most of my dresses are so tight-fitting that I feel it could burst anytime if I were to wear them the whole night! Ha!

I haven't given much thought on any new year resolutions yet but I guess one of them has to be to get pregnant soon. Does that count as a new year resolution?! ;P

I wish everyone a fantastic year ahead! Good luck!

"TODAY, is the first blank page of a 365 page book. Write a good one!"