:(

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.

 

 

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.

The truth hurts.

I was warm, then hot, then warm, then hot again. Sometimes, I feel that my entire body’s close to burning. Deep down in me, this newfound warmth gave me hope, one that I wouldn’t dare dream of.

Even as I’m typing this post, I’m still feeling the heat. But it’s all a false sense of security, I realise.

The all-too-familiar bleeding started last Friday, on the fifth day post embryo transfer. I panicked, so did that worried Mr. P. I called the hospital who told me to go down the Monday which had passed. I was also told to go to the A&E in case the bleeding became worst. I monitored and noticed it being significantly lesser. I felt relieved.

Nonetheless, I went down to the clinic to have my blood taken and tested on Monday. My heart palpitated and my head was in a mess.

After a more than 2-hour wait, the results were out. The HCG-level was 0.9. The result is inconclusive and the nurse told me to return on 20th March. That would means that while we were in Taiwan, we will not be able to know how we should go about planning our trip. Can I walk for long distance? Should I walk less?

I had asked the nurse if I can take my blood again before I fly on Wednesday but I was refused.

After discussing with Mr. P., we decided I should have my blood tested again. I call a few laboratories such as Parkway Health and Quest Laboratory. Then, the guy who picked up the phone at Quest told me to try Pathlab. I did and was elated they do individual blood test!

I had initially wanted to test it on Wednesday instead but they had told us that the blood test results would be available one day later. Hence I went on Tuesday instead. There was a small room where they took my blood. They also have an in-house doctor so I was assured someone professional took my blood.

A call to the laboratory just now shattered the little bit of hope that I have. My Beta HCG test showed that my HCG levels were still lower than 2. A confirmed pregnancy should return a level > 25 with at least >5 being detectable through a blood test.

It was devastating.

I had prayed alot to God recently even though I’m not Christian. I thought I found peace but guess I was never at peace.

 

 

It was a hot night.

Yesterday night, I lay in the bed with my eyes closed, trying my best to sleep.

I struggled, slept for a couple of hours, woke up, fell back to sleep after tossing and turning, only to wake up really early in the morning.

The reason for my disturbed sleep? I was burning.

Yep, you read it right. And all this while, I was lying directly under the fan and was facing the air conditioner.

I was experiencing hot flushes, or so I thought.

I tried sleeping without the blanket but it got a little chilly. When I covered myself up, the heat built up so much I had to pull the blanket away. Talk about dilemma.

I called CARE this morning to ask if I do anything about the condition. Nurse T picked up.

“Take it as a good sign. Maybe it’s a sign of implantation. It’s likely the hormones raging. There’s nothing you can do about it. Just bear with it ok?”

Even though she didn’t really give me any useful advice I could use to relieve the heat, I thanked her and ended the call.

While trying to sleep, I prayed to God that he would do what’s best for me, to prep my body or to purge the toxins or whatsoever, do what’s best for the embryo that I had transferred into my uterus on 6 March, and do what’s best for my family.

I’m not a Christian. Yet I felt calm and peaceful when praying to God. Maybe it’s time to pay the church a visit, attend a service or cell group. Meanwhile, I’ll learn to be contented with these newfound changes my body is going through.

The room which the embryo transfer took place is within CARE. In fact, it was the same room which they had sedated me for the follicle extraction. This time round, with a dosage of 200IU of Puregon, I had 6 eggs.

They did ICSI on all 6. One did not survive, 3 grew. Out of the 3 which grew, one stopped growing on day 2 while the other 2 blossomed. Not wanting to risk it, Mr. P. and I decided to just have 1 embryo transferred. It was a Grade 2 embryo. In SGH, there are 5 grades, grade 1 being the best, and 5 being the worst. In KKIVF, it’s reverse. I am reliefed that the embryo is of good quality. I wished it would thrive, survive and blossom into a beautiful and healthy child.

 

Maybe… Maybe not.

Prior to the follicle extraction, Nurse T informed me of a research Dr Yu is carrying out.

There is an alternative method which is used to curb the pain and discomfort during the procedure. It was acupuncture. Unlike the usual sedation required to put patient into a state of semi-comatose during the procedure, the patient who chose acupuncture would have a consultation session, some pins attached to several acupoints and remain fully alert throughout the procedure. She also briefly mentioned that the success rate were coincidentally higher. Anything to increase the possibility, I thought. I immediately expressed interest.

However, the catch to this option was that the patient would have to draw lot. It’s still under the research phase hence it cannot be made readily available. I picked a card that has an ‘S’ on it. I wasn’t lucky enough to get acupuncture.

Fast forward to the day I was due for follicle extraction.

After positioning myself on the bed in the operating theatre, to my amusement, disgust and also a little horror, I saw a reflection of the lower half of of my body on the ceiling. I could not have imagine myself being alert throughout the process since I could see clearly what’s going on. At that moment, I heaved a sigh of relief and drifted to la la land as the sedative kicked in.

P.S. A few interesting facts about SGH:

  1. The husband is allowed to watch the procedure and accompany you into the operation theatre if he wishes to. So if you are keen to have your husband with you throughout your operation, feel free to get him in.
  2. If the husband decides to produce the semen sample at home, he can come much much later. My operation was scheduled at 8:30 a.m on a Friday but Mr. P. preferred more sleep since he had to return work in the afternoon. He was originally scheduled to produce a semen sample at the hospital (there’s a room in CARE itself for that called the specimen collection room, next to the washroom) but he decided to do it at home so that he could come to the hospital at 9 a.m. Turned out he could have come even later at 10:30 a.m. because I wasn’t even done by 10 a.m. and there’s nothing they could do with his sample anyway.
  3. The husband will be sent to buy medication, pay for insurance etc. basically run errands that is required while you remain asleep.

I feel the husband is a pretty poor thing, having to run around etc. but having Mr. P. around sure helped, especially since the dizzy spell was with me, even an hour after I woke up. I went back home and continued sleeping. 🙂

Experience with Singapore General Hospital

Pardon me for my absence.

After my failed IVF with KKH, Mr. P and I decided to switch to SGH. This decision was triggered by 2 main reasons:

First, if we had continued to seek treatment in KKH, we had to wait till April due to the sheer large volume of cases in queue.

Second, we wanted to give ourselves better chances at succeeding with Dr Yu Su Ling. The astute TCM practicioner we frequent recommended her because not only is she committed to helping couples conceive, she is also more willing to try new measures to increase success rate.

I had met Dr Yu. in January for our first session. She is approachable and resolute in her resolve. The most impressionable part of my visit was when she remarked,” I specialise in cases which people fail at.” I felt reassured and believed she would do what she can do help me achieve my dream of becoming a mum.

Today was my fourth, if not fifth visit to CARE (Centre for Assisted Reproduction) in Singapore General Hospital.

Please note that what I’m about to say is not a complain but more like a feedback to what CARE can improve on. If you are reading this, I hope it serves as a prep for you and also manages your expectation, especially if you have been to other IVF centres and is considering doing procedures with CARE at SGH.

The nurses there operate much lesser like clockwork as compared to the nurses in KKH. They were personable but could be lacking in terms of attentiveness at times. Not all nurses were as detailed and informed and at times, I felt that the centre was rather disorganised. Let me list a few examples.

After meeting Dr Yu, she ordered some tests for us to know what’s our baseline. One of them was to have Mr. P produce a sample and run a sperm analysis. On the day of submission, Mr. P went to CARE and told the nurse on duty what he was there for. Instead of directing him to the room within CARE, she pointed to the O&G clinic opposite and told him to go over for the submission. Puzzled, he then went over to the reception counter and repeated himself again to the nurse on duty. She had also no idea what that was or where it should be done. He ended up telling 4 other nurses what he was there for and was eventually directed all the way to the far end of the O&G clinic. Luckily, before he began, I managed to contact him. I quickly accompanied him back to CARE where I had called out to one of the nurse on duty, However, she had to consult another nurse, who came to our assistance. The 2nd nurse who attended to us knew what was going on and required but the first did not. Furthermore, my file was already pulled out and left on the cabinet. It meant that they were expecting us to be there but apparently, there was some miscommunication. Great that the test was finally done but the experience made really unpleasant, especially being shoved from place to place despite having made prior appointment.

When we were at CARE for the counselling session, the nurse who attended to us did not seemed as knowledgeable about the forms that we are required to sign on. She is a senior staff nurse but she did not share all necessary information with us readily. Instead, she went in and out of the room a few times, consulting other nurses on what are the forms or instruction sheets we should have. I felt that was not very professional, as compared to the nurses in KKIVF, who would have all forms prepared, either in a file or stack for us. The nurses at KKIVF dishes clear instructions and if you missed or forgot them, you could easily find them in the forms they passed to you. Here, it was not that clearly spelt out.

As part of the IVF procedure, I had to take some injections. The nurse, upon hearing that I have taken them before, did not go through in detail all that I needed to know. It should have been protocol to advise every patient who undergo the treatment, whether or not it had been repeated, just in case. Afterall, the safety of patients should be their topmost priority.

The nurse who attended to me today also seemed overly cautious. I was prescribed a medication that comes in a vial containing 0.48ml. The box also indicated 300IU/0.36ml. This would mean that each vial actually contains 400IU. However, she told me that she cannot advise me according to that calculation as she would not know that the vial would contain an extra 100IU since it was not explicitly stated on the box. I was dumbfounded.

Nonetheless, I counted my blessings and was glad that both Mr P. and I had prior experience that helped us navigate through uncertainties that were not addressed by the nurses.

Overall, there were some really experienced nurses in CARE who knew what was going on but there were also others who can leave you wondering if you are in good hands.

When in doubt, please ask. It’s also possible to push for what you need but again, ask firmly and politely. The nurses can make things work, even if they have to make a few more trips and ask a few more colleagues.

A few more things that differ between SGH and KKH:

  • In SGH, you have to pay for all medication collected. You have to keep all the receipts intact and submit them on the day of egg retrieval. They will be submitted for reimbursement and you’ll receive a cheque probably a month later. In KKIVF, you do not have to pay a single cent once you’ve begun the treatment.
  • In SGH, the nurses may recognise you because the volume is generally lower. It’s also slower-paced than KKIVF so expect longer wait. I waited close to 20 minutes for an ultrasound scan.
  • The nurses start going for lunch break at 12 and it last till 2. My appointment was scheduled at 2pm but despite reaching at 1:50pm, I was 2nd in queue because either someone had reached the clinic earlier than I did and grabbed the queue number before me or she did not had her turn before the nurses went for their break so do take note of that.

I’m going back for a blood test and 2nd scan on Wednesday. Looking forward to the end of the week. One nurse had shared with me that I might be due for egg retrieval on Friday, Saturday or Monday. (I was attended to by 4 different nurses today.)

I’ll share more of my experiences as I continue my TTC journey with SGH.

P.S. CARE & KKIVF are both not open on Sunday.