D&C in Malaysia

So, I mentioned in my previous post that I was recommended to do a D&C in JB, Malaysia.

Considering the costs and under the reassurance from Angela that I will be taken good care of, I went for it. By the way, Angela has also a clinic in JB, Malaysia housed in Johor Specialist Hospital. So, considering the fact that I’ve been to her clinic here in SG, and that she chose to have her clinic in that hospital, it can’t be that bad (although I was still very worried because there were just too many scare stories I’ve heard from people who visited public hospitals in Malaysia). Johor Specialist Hospital is not public, it’s private so as with all privatisation, it’s more expensive hence should provide better quality healthcare. I was really skeptical throughout but I chose to place my fears aside and trust in her.

Angela usually accompanies her patient but unfortunately in my case, she was unavailable on the day of my operation. Never mind, I thought. At the end of the day, her presence may add on reassurance but also pressure. There’s also nothing much she can do except for being there as she will not be the one carrying out the op. I arranged for my mum to go with me instead.

Once I decided to go for the op in the hospital in JB, I had to produce a copy of my passport as well as my blood test report – the one you would have to do anyway before you embarked on IVF. It was scanned over to the clinic and I had to go in one day before the operation to register. Angela’s staff have experience arranging for these trips so just do as you are told and everything should work out well. (Fingers crossed – You can’t really be sure about things being done in Malaysia…)

On the day prior to the operation, Mum and I took the bus in. The customs was packed as usual. We cleared it (after a 2-hour wait!) and checked in before we went to the hospital for registration. We stayed at KSL for the convenience – it was 5-minute taxi ride away from Johor Specialist Centre. The operation at Johor Specialist Centre actually included an overnight’s stay in the ward and you can even opt for a family member to stay with you through the night but we preferred to stay in a hotel instead. After all, I would not be able to choose who’s my neighbour in the ward and although it will be a all-woman’s ward, it’s not the maternity ward. On the day of registration, I was actually freaked out seeing 2 cockroaches in the room where I took my blood pressure, height and weight. The cockroach crawled out from nowhere and then crawled back under the wall. Mum joked that the cockroach came to see the doctor too. When I told this to Angela, she mentioned that we should have complained. I did, to the nurse who tended to me, and she gave me a weak smile. Maybe it was her pet.

On the day itself, I reported to the clinic at 7:30 am and they brought me to the bed that had been allocated for me. I changed into the surgical gown and waited for the doctor as well as the surgical theatre to be available. At about 9:00 am, Dr. Mohanraj Krishnasamy came to have a few words with me before he went off to get ready for the operation. At about 10:30 am, I was pushed in a wheelchair to the operating theatre. By the way, Dr Mohan does operations only on Thursday but I could only make it on Friday so special arrangement was made hence the long waiting time –  I was slotted in on the Friday schedule at 11:00 am.

When I reached the entrance of the operating theatre, I had to get on a surgical bed from my wheelcar instead and was pushed into a waiting area. The anesthetist came to check on me and not long after, I was pushed into the operating theatre. It’s pretty spacious and looked sterile (the typical whitewash walls and filled with equipment). I was pretty annoyed though, that the anesthetist did not do a good job putting in the IV line the first time that he had to take it out and do it once more, causing a major bruise on my hand.

Of course, I did not have the time to get angry or complained because before I knew it, I was knocked out.

When I woke up, it was already 12:30 pm and I was back at the waiting area. The nurse came over to check on my blood pressure twice and once she’s certain that it’s alright, I was pushed back to the ward.

As I woke up pretty early that morning, I went to sleep and woke up about at about 2:00 pm. The doctor came around that time to tell me that the operation went well but as the entrance to my uterus has been microscopic, he did all that he could in his means to carry out the op. It was my first time hearing that kind of description and honestly, it made me doubt the doctor’s ability. I haven’t had that kind of feedback before but as I mentioned previously, anything could possibly happened in Malaysia.

Thereafter, he mentioned once I’m fully awake, we can check out of the hospital. We had made arrangement with Angela’s recommended driver to leave the hospital at 5pm but the service after my operation has been nothing other than slow. At 3pm, my mum asked the nurse if we could leave, only to be greeted by puzzled faces. I changed and got ready to leave, whenever the nurses come back with a definite reply that I can go off. One of the nurses then came back to inform us that we need to make payment at level 1 before going off. We then went down to Level 1 make payment at the cashier, only to be told that they have not received any notice of payment from the wards or doctor.

Mum pressed on and insisted that they contact the ward for the notice of payment so that we could be in time for the vehicle. She even went over to the next room to collect the medication for me in the meanwhile though the nurse was pretty reluctant to release the drug without the receipt from the cashier. The whole chain of work flow is super inefficient. By the time the notice of payment was finally received, the cashier who was attending to me had a bad news for me – the operating system was down! She had to restart the system and get another of her colleague to attend to me. I was just dumbfounded at how slow and inefficient things can go… Finally, we paid and managed to get on the car just in time. In fact, we were told to hurry if we want to avoid the jam.

Johor Specialist Centre was only a 10-minute drive from the causeway but because we clashed with the crowd leaving JB, we only cleared customs at 6pm. It was not bad by the usual standards but if we had spent less time at the cashier waiting, we could have reached home earlier.

All in all, the experience was mediocre. Unimpressive but acceptable. At least the operation went well, there wasn’t haemorrhage post-operation and the cost is one-fifth of what it would have cost me in Singapore – The total sum that I paid was about RM 2,500  (~850SGD) but it would have been close to S$5,000 in Singapore.

Here’s a rough estimate of the amount of the procedure if it’s done in Singapore:

Doctor’s Fee: $1,000 – $1,800
Hospital Charges: $1,400 – $1,800
Anasthetist Charges: $350 – $450
Inpatient Fees: $200 – $300

These charges exclude the free one night stay that’s also included in the package price I paid.

Hope this post has been able to shed some light for people who are keen to go for a similar op in JB.

 

Unfazed…

Unknowingly, it’s almost a year since I last wrote. Since then, we’ve embarked yet again on another IVF cycle. This time, with Angela Ho from C.A.R.E.

When we first visited her, she was honest about how difficult our case looks – We failed multiple times and it does not help I’ve an existing condition that could possible complicate matters.

She recommended having me on daily injections of Saizen to “rejuvenate” the eggs for 3 months before retrieval and transfer. We went with it. Afterall, we would give any possible treatment a go if it could help us fulfill our dream of having our own child.

3 months went past and egg retrieval was performed. It was very unfortunate that my body gave wrong signals. Post-egg retrieval, Angela revealed that the bigger follicles shown in the scan were all empty and only 4 eggs were retrieved. As expected, I never had the opportunity to produce many anyway. She did, however, shared that the egg conditions were great and now we will just have to wait till I’m ready.

We forgo a fresh transfer also because I was on a long simulation cycle in a bid to get more eggs. Although I wasn’t successful, I was grateful at least 4 were retrieved and they were not bad.

After I had my menses, Angela recommended for me to go for a D&C, again in a bid to improve the chances of conceiving. A Dilation and curettage (D&C) is a brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining. Previously, she did noticed that there was a kink in my lining and she is concerned about any thickened lining that did not shed properly from my uterus.

I was concerned about the costs as it’ll add another S$5K to the overall costs. So, Angela recommended me to go for the op in Malaysia which I did. On the hindsight, it’s something I would still consider though I might have just done it in Singapore if I have the money. I’ll cover this in a separate post.

So now, I’ve started on medication to prepare for the egg transfer. Despite still trying physically and trying to remain as positive as we can, I guess both Poh and I have almost exhausted our hope of becoming parents. I’ve turned to superstition and even tried being religious in my bid to become mum. Will that bear us fruits? I don’t know. I can’t see the future and I’m no God. All I can do is pray and continue with the medication I am prescribed, hoping that it will yield a positive result I believe we will be overwhelmed if we are really blessed with it.

P.S. Yes, the featured image has half of all the injections I took from my stimulation.

Exhausted

In every ways.

Financially, mentally, physically and emotionally.

While I’ve read that going through artificial child-bearing procedures are tough and draining, I didn’t know it could possibly empty me out in all aspects.

Financially

I went through a third fresh cycle with SGH but without success again. This time round, instead of Puregon or Gonal-F, I had Menopur injections instead. All seemed to progress well. There were 14 embryos retrieved, 7 fertilised, 5 made it to day 3 and 3 made it to day 5. While 1 of the Day 5 embryos did not survive, I transferred 2 of the better day 5 embryos with a endometrial lining of 11mm. It’s said that a 10-12mm lining is suitable for implantation. After which, there were twice daily vaginal inserts. All of these, with the last subsidy from the government and deduction of medisave (=$10K) will cost me approximately $5-6K out of the pocket.

But I did not succeed. That means if I were to embark on yet another cycle, the out of my (or rather his because he forks out more) pocket amounts easily to $15K minimally. It’s exorbitant. It’s easily equivalent to a trip for 2 to Iceland and back. Worst, supposedly we have that amount of cash and spend it and did not succeed again (The success rate for IVF IS only 30% for ladies below 35.), then what?

And the amount is excluding all the other treatments we’ve went for, including accupunture, intralipid transfusion, doctor visits to my endocrinologist to ensure my thyroid levels were in check, transportation costs to all these various clinics that’ll easily add up to another few grands…

Mentally

Going on repeated cycles can break down even the toughest or most resilient woman.

After the first cycle, we thought to ourselves, there’s always the 2nd.

After the 3rd, we were already close to wondering if it’s even possible at all. If it is, we would have had some glimpses of hope, especially after trying all sorts of treatment. But, no. We didn’t. Even though there were traces of hcg detected, the pregnancy is obviously not viable and had terminated in the early stages.

How many times must I go through the disappointment, frustration, only to have to pick myself up again? Never mind the negligible pricks and bruises from the daily, and sometimes multiple injections. The fear of going through the entire cycle, and the possible outcome of a negative pregnancy blood test result is enough to turn my world upside down. Let’s not even begin with the tormenting thoughts that’ll bang themselves hard against my head, telling me what a failure I am for not being able to do what a woman is supposed to naturally, blaming myself for not taking enough care of myself and for ignoring his want to have children earlier. I blame myself, also, for giving up the one pregnancy I had a shot at, when I was given an opportunity to, all because I wasn’t ready. He blames himself for not getting me to try for children earlier and for allowing me to have my ways and insisting of wanting kids at a later stage in life.

All these thoughts just made us accumulate bitterness gradually.

While I could easily take up a sport or join a community to distract myself, all these gathering and sports need money which I would rather save for the next cycle. I also began to be extremely watchful of what I spend on because of the impending hefty cost. All these carefulness and watchfulness eats up the positivity in me.

Physically

Travelling to and fro the various clinics where I receive the assortment of treatments is extremely tiring. The unpardoning weather just makes it worst.

Besides that, when you are going through a cycle, the swollen ovaries were enough to drive you nuts.

During the 2-week wait, the stuffing of progesterone up the vagina caused me 2 bouts of yeast infection.

When the pregnancy blood test is negative and the progesterone is cut, the plunge in the hormones caused huge amount of hairfall. Locks choked the gutter and made him gawked. We were in disbelief and could only pray it’s temporary. Boy, we were glad it was.

The subsequent menstruation is also nowhere near comfortable as large amount of blood would literally gushed out periodically. I had to change pads at leas 4 times a day to ensure I was dry and prevent leak.

Emotionally

No words would suffice. Each cycle is a rollercoaster ride that starts with being hopeful, then anxious of the outcome, trying to stay calm and stress-free but only to be greeted with disappointing result that would break my heart apart. With every cycle, abit of me died. So did him. So did the love between my husband and I. Both of us hurt so much we couldn’t talk. Sometimes, it even hurt to get intimate because the act simply reminds us of how inadequate we are. On our last try, the atmosphere between us was so tense conversations became heated quarrels, finger-pointing and a lot of resentment, bitterness and tears. There were so much pent-up frustration that’ll snowball and surface after each failed cycle.

On top that, announcements of pregnancies of friends and family members around us just add salt to the wound.

Feeling isolated and lonely became a norm. No one could really understand (not that I would want anyone to since that would probably mean that the person has been through all that I had to and I definitely would not want any of my close ones to.) and no matter who you confide in, you’ll feel it’s pretty pointless at the end of the conversation because it’s either they feel sorry for you, which is not helpful, or they’ll give you weird advice which you’ve probably tried and also does not find helpful.

It has gotten to a point that talking about it would just bring tears to my eyes.

So here I am, pretty emptied in all aspects.

I begin seeking solace in reading the bible and immersing myself more in work whenever possible. Beside numbing my wounds, they distract me and allow me to focus on other aspect in life.

Yet despite all these pain, I would continue to try. Why?

Solely because we desire, that one day, we can have children we call our own. To hold and to love. To cuddle and to kiss.

Perhaps the one day would come.

And even if it doesn’t, at least we know we’ve tried, as hard as we could and as much as our shallow pockets have allowed us to.

Acupuncture

So the session on saturday concludes my acupuncture treatments (for the time being).

After a conversation with an an ex-colleague, I learnt about how she conceived successfully with the help of acupuncture. She has failed her first IVF with KKH, switched to a private practitioner, and underwent Lucrin injections before she began another cycle of IVF. For her 2nd cycle, she added acupuncture as part of her infertility treatments. Miraculously, she succeeded hence highly recommended me to give a try.

The TCM practitioner is none other than Zou Yu Min who practices acupuncture at a small TCM hall with her name at Blk 505 Ang Mo Kio Ave 8. I too, decided to give it a shot,  hoping that it will also help me succeed in my attempt to conceive.

While I will still stick to SGH (because I’m still eligible for government subsidy and I have 1 more shot with my 2nd and also last embryo which is frozen and kept with SGH), I hope this additional treatment will improve the environment aka my womb for my egg to implant. Apparently, this treatment does that, improves the quality of eggs and reduce undesirable side effects that comes along with the monthly affair such as aches, bloatedness e.t.c.

Each session lasts 40 minutes – 20 minutes for the abdomen and calves, and 20 minutes for the back. If you are worried about the pain, you should be comforted to know that the needles are so thin that the prick is hardly felt and if felt, gone in a split second. When I’m distracted, I would not have noticed the prick too.

However, being the nervy me, plus the insertion is done one by one, and there’re about 10 for the front and 6 on the rear (not concurrently but first front first then back), I tend to be uptight, no matter during which session, and stayed exceptionally still so that she don’t miss the acupoint.

Please don’t get me wrong. She’s definitely experienced and has helped many, even those in their forties conceived. While there may be more than one success factor, she definitely does her best for each patient.

The waiting time is abhorrent though. It could stretch between half at hour at its shortest to 1.5 or even 2 hours at its longest. Most of the time, it’s waiting for a vacant bed for the acupuncture to take place. An appointment is necessary, although you may not always get through the line. Try to book at least 3 days in advance as her slots are filled up very quickly with both existing, repeating and new patients. She’s often packed to the brim, seeing up to 8 patients an hour. There’re only 5 beds in that puny space she owns so waiting is inevitable.

Ladies who wish to get pregnant typically do not undergo acupuncture when they visit her the first time as they are often having their menstruation. The practitioner usually recommends commencing treatment on the 4th or 5th day of menses, where the flow has lessened significantly. The effect of each treatment typically last 2 – 3 days so she usually encourages female patients to undergo the treatment twice, or even thrice, a week if time permits.

I started in May and went for my FET last week. On the day of FET, I went back after my procedure to have acupuncture done. As undergoing acupuncture post FET is said to help the egg implant, I took no chances and returned every alternate day for the same treatment that week.

Now, all that I could have done is done.

Today’s the 2nd week of my two-weeks wait. We shall know the outcome by the end of this week.

 

 

:(

We were on our way home after dinner when a nasty thought appeared in my head.

Me: “I have a bad feeling we will not be successful this time round again.”

P: “If we are not successful again, we will have to move on, like how we did previously.”

 

What haven’t I heard?

We were watching TV one day when we saw an advertisement for a health seminar by Channel News Asia.

It’s not like we haven’t heard enough but P nudged me to go for it together.

We went. Each presenter share their expertise but we were particularly intrigued by Dr. Joan Thong because of the topic she presented on: Surgical Treatments for Fertility.

I scheduled an appointment with her after the talk for 2 simple reasons:

1. Hear her out about my condition as well as get a xth opinion
2. Know if my condition has improved.

My heart cracked yet a little more after the consultation with Dr. Joan Thong.
The endometriosis in my uterus is still there. So is PCOS.

She did a vaginal examination for me: using the tips of her fingers, she prodded gently on the walls of my uterus. I jerked a few times when the area her fingers landed on shot a few pangs of pain through me.

She’s of the opinion that any endometriosis affects fertility hence highly recommend I undergo laparoscopy. There were also a lot of fluid present that she claimed were anti-fertility.

The catch is there could also be nothing. You see, endometriosis can occur within the womb or outside the womb. While the scan showed little traces of endometriosis within the womb, a laparoscopy is necessary to see if there’s anything outside of the uterus. Anyone going for the surgery to remove supposedly growth or fibroids growing out of the uterus is taking a gamble.

While it’s easy to tell that she’s an advocate of surgery to promote the ideal environment to host the embryo, she’s also all for conceiving naturally. As such, she also questioned if I wanted to try naturally or via IVF and if P’s sperm are swimmers and if they are, are they swimming in the right directions.

I don’t doubt her professionalism but P and I have all along been against surgery.

To make matters worst, her charges are exorbitant. Unlike most doctors, her clinic does not offer patients a lower consultation fee for subsequent visits. Seeing her for the first time costs me $383.90. Even if that’s expected of a private clinician, we were worried about the price tag that could come along, especially if we decide to proceed with the surgery.

She also asked for medical reports so that we can save on tests we have done.

But getting the medical reports is another story altogether. Besides the costs involved (getting the reports from both SGH and KKH takes about 6 – 8 weeks and I’ll have to spend between SGD200 – 300 to lay my hands on them, depending on the type of medical reports, details, and who’s doing it.), I might end up having to go through the tests she wanted to put me through because I’ve not taken them before or if it’s been done too long ago or if the measurement were not something she would prefer.

She’s a strong advocate of couple conceiving and emphasise that there’s no reason why I can’t if I have a healthy egg reserve. That’s probably the reason why she strongly recommends surgery to improve both the quality of egg and environment for the egg, provided there’s no issue with the sperm.

I was undecided but P refused t that, especially when my condition is not the worst of the lot.

We sought the opinion of the traditional Chinese practitioner we frequented. While she’s not an advocate of surgeries, and she usually lets her patients decide, she shared that many couples who succeeded after trying many times, even with just 1 embryo had some work done i.e. underwent surgery. In our case, we have to decide on our own.

Photo credits: http://www.channelnewsasia.com/news/events-seminars/seminars/fertility-issues-explained

Relapse

I had written this some time back, after the failed FET following the 2nd fresh cycle.
I haven’t had time to edit or post it but since I chanced upon it, here goes.

Today (whichever day it was) was horrible.
I had gone for my checkup with my endocrinologist and was greeted with a solemn look when I entered her room.
“The readings were all red. It’s likely due to the injections you’ve been taking. The surges, including spikes and dives in your hormonal levels might have turned on the autoimmunity function again…” As she quipped, my heart dropped. I can’t believe the only possible method of getting me impregnated is causing me to fall sick again.
“This situation is often highly unlikely in most cases because estrogen mops up T4. Another reason I can think of is that you are pregnant.” she continued. Despite desperately hoping the latter is true, deep down I knew that the truth can’t be any further than that.
“We’ll have to quickly get your levels back to normal ranges before you can try again, be it egg transfer or a fresh cycle. In this 2 months, I’ll try to bring down the levels of all these readings. If you were to try again now, it’ll be wasted. The possibility of miscarrying is high.”

Wait… that means that the reason for the failure of the 2nd IVF cycle could be due to the relapse?! I was both furious and exasperated. Why hadn’t I thought of that, especially in face of an increase hairfall and loss in weight?

Thinking back, I thought those were side effects of the injections, and a probably early onset of being pregnancy. I couldn’t have been more wrong.

If only there is an endocrinologist who also specialises in obstetrics and gynaecology.

 

 

2nd FET – 4 July 2017

A 14 cell 3 day-old embryo in an uterus with lining 10 mm.

I wish for a successful implantation and a healthy pregnancy.

 

The anniversary

Intending to blog, I logged into my account.

A mix of feelings washed over me, then came flooding the memories, alike the downpour that happened this afternoon, when a notification wishing me Happy Anniversary popped up.

One year ago, P and I embarked on the TTC journey. I wanted to document the journey and started this blog.

One year later, we are still trying.

I’m not sure how long will we persist in this endeavour.

P used to say he’ll stop trying till he’s 35. He turned 35 this year.

Deep inside, I hope we will continue until we succeed.

Cheers to all who have not given up the past year.
Stay steadfast in pursuing what you have set out to.

Feeling Immune

​Yet again, I was not successful.

This recent cycle was worst than the one I had at KKH in November.

Not only was there no implantation, I also encountered severe side effects due to the sudden decrease in hormones since I was no longer having injections. I experienced hot flushes and worst, the bleeding happened before the pregnancy blood test date. The outbreak was also unimaginable.

P and I had planned a holiday in hope to distract and enjoy ourselves. Unfortunately, I had the ominous bleeding on the 2nd last day before we returned home and was heartbroken.

We had no idea what went wrong despite increased dosages of injections. The doctor did not prescribe Crinone, the topical pessary that I had to use the previous cycle. She was confident that Duphaston would do the trick of providing my body with the progesterone it needs. Quite the contrary, the outcome was far from ideal.

We had sought another doctor’s help but was told that he would have to put us through all the tests and examinations again to ensure he takes the best course of action. While we understood his viewpoint, afterall, the way the tests are conducted and measuring unit could differ, we weren’t exactly enthusiastic about going through all those tests we already did at the 2 hospitals. He also ended with telling us that the whole conceiving matter may boil down to costs and having it at the private clinic would definitely cost much more, since there would not be any subsidy.

We returned to a consultation with Dr Yu who told us that she was, too, puzzled with the outcome and would try another medication for the next round, if I’m not successful during the upcoming frozen embryo transfer (FET).

I could only wish for the best.