Disappointed

I thought I could start my frozen cycle. But, no! AF came this morning and I called KKIVF. I was told that I have to wait for the next cycle, as I have missed the cut off date for ET because of CNY holidays! Now, I have to wait another month. So upset!

Pre Frozen #1 Consultation

Today is my review day with my IVF doctor, for post-fresh cycle #1 cum pre-frozen cycle #1. As usual, I spent a great deal of time waiting outside the consultation room, but only a short few minutes meeting Dr Sadhana. Knowing that I do not ovulate regularly, doctor decided to put me on medicated frozen cycle.

So, the plan is as such:

• Call KKIVF on CD1
• Go to KKH to collect medication on or before CD4
• Start taking mediation from CD4 onwards

Difference between natural vs medicated frozen cycle:
(This is what I've gathered from the forum.)

Natural	Medicated
- No mediation	- Start progynova from CD4 onwards
- First scan on CD11 (or CD9 / CD10)	- First scan on CD11 (or CD9 / CD10)
- Follow-up scan (and BT*) until   (1) lining is at least 8 mm and   (2) ovulation occurs	- Follow-up scans until   (1) lining is at least 8 mm   (2) (no ovulation)
- Schedule for ET	- Schedule for ET

* Ovulation determined via BT in some hospitals.

Do's and Don'ts during TWW

One sister in Singapore Motherhood forum posted this today. It's probably going to come in handy, so I shall "bookmark" the information here.

• Eat healthy balanced diet. No extreme shifts in diet even when including foods suggested to benefit TTC.
• Drink at least 2L of water to keep well hydrated.
• Have ample good rest.
• Do light exercise like walking to enhance blood flow.
• Continue pre-natal supplements (min. 4mg folic acid or otherwise as per doctor's advice) and post transfer support meds.
• First week post transfer ie. hatching and implantation window, take things easier. Talk to and encourage your embie to attach, implant & stick! (If have, can listen to hypno/meditation cd for post transfer)
• Can take foods that support implantation as suggested by IVFers sisters on the forum - brazil nuts, walnuts, avocado, double-boil chicken essence (http://jewelpie.com/homemade-chicken-essence-to-relief-tiredness/)
• Ensure adequate protein to support growth, regeneration and esp. in fresh cycle, to prevent OHSS - e.g. Egg whites, fish, chicken
• Take fruits & leafy vegetables that are not too cold/cool - e.g. can take golden kiwi, broccoli, cai xin, etc.
• If not heaty, can take warming foods/ drinks, otherwise cut down (e.g. take less or do not take daily) or stop - e.g. longan red date tea, durian (signs of heatiness include heavy headed feeling, swelling tongue that is more red than usual, sweating too easily, very warm palms and soles to extent of discomfort, constant thirst; don't let heatiness escalate to constipation)
• Avoid cold and raw foods - e.g. NO papaya, banana, watermelon (any melons), sashimi, salads, ice-cream
• Avoid pineapple which may cause uterine contractions
• Avoid dairy foods esp. if you hv phlegm-damp constitution (see http://www.maryzhang.com/food_function.htm)*
• No unpasteurised milk which causes risk of listeria infection
• Avoid eating mould-ripened soft cheese, e.g. brie and camembert, and blue-veined varieties, such as stilton or Danish blue, etc as these are usually made with unpasteurised milk.
• Limit soy foods (GMO corn crops very prevalent in soy foods; also very high in phytoestrogen so higher risk of excess)*
• Avoid seafoods high in mercury, e.g. mackeral, shark
• Avoid spicy stuff esp. even more so for those with poor digestion
• Avoid caffeine - no coffee, tea, chocolate (caffeine is not good for blood flow and may restrict absorption of nutrients)
• Avoid alcohol - may affect kidney function and hence metabolization of meds, affects fetal growth & health.
• NO soaking in hot baths, no sauna, no massage, no spa.
• Avoid smokey/hazardous areas.
• If red spotting or bleeding during 2ww, no need to panic, just call clinic & follow advice.
• In case of constipation, can take some prune juices along with daily intake of vegetables, fruits and lots of water. If no improvement, check with clinic/ doc for advice and before taking any OTC laxatives.
• Keep feet warm - can wear house slipper / socks
• Laugh a lot!
• If in doubt, take the path of least regret.
• Breathe, be positive and hang in there.

* It is ok to have a bit of milk or tofu sometimes. We don't usually eat these excessively so it will be fine. The key is overall healthy balance diet, adequate hydration and rest so that our bodies function optimally.

SMH Forum WhatsApp Group

One lady in the Singapore Motherhood forum suggested starting a WhatsApp group chat for IVF-ers cycling this month. When I saw her post in the forum, I wanted to join but was rather hesitant. What if I meet someone I know in the chat group? It's the same fear that I'll bump into someone I know whenever I visit KKH. I sat on it and pondered. In the end, I still decided to join. When I was added to the group, the first thing I did was to check through the list of participant. It was a great relieve that they are all strangers.

Post IVF Fresh #1

AF appeared today, 6 days after ER, 8 days ahead of schedule. I'm not complaining, because it means that I am one week closer to reuniting with my baby(s). I wish I can fast forward time.

The embryologist has called and reported on the status of my embryos. Out of 24 eggs retrieved, only 6 embryos made it to the freezer. I couldn't really hear him very well over the phone and I think he said something like this: some eggs were fertilised using the natural method, none got fertilised, the remaining eggs were fertilised via ICSI, 11 were fertilised but only 6 continued to grow, 5 embryos are grade 4 and 1 embryo is grade 3.

Doctor's review is scheduled on 16 Jan. I'm getting impatient already.

Book Recommendation

A lady wrote a post in the forum recommended this book for reading:
It Starts with the Egg by Rebecca Fett



The author also struggled with infertility and she put her degree in molecular biology and biochemistry to good use to research on what lifestyle changes and supplements would help to improve her chances.

I don't think I'll venture into taking supplements. Maybe I'll start with changing my plastic containers to glass ones.

IVF Fresh #1 Day 15

It's ER day for me today! I fasted since last night and slept early. DH and I woke up really early this morning (probably even earlier than our usual work days), got ready and head down to KKH. In the early hours, KKIVF is almost empty. Shortly after registration, a nurse brought me to the changing room. I put on the surgery gown and kept my clothes and belonging inside the locker. I had to change into their slippers too. Then, the nurse inserted the IV cannula into the vein of my left hand. The diameter of the needle looks big! It wasn't really pain, but I was still scared to move my hand too much. While I was getting ready for the surgery, DH was in another room busy providing his troops.

I was scheduled as the second patient for the day. However, the first patient was somehow not ready and I get to go for the surgery first. The nurse led me into the surgery room. It's my first time in such a place; my first time being put on general anesthesia. It was really cold in the surgery room. I was shivering as I was walking in. Thankfully, the nurse quickly gave me a blanket without having to ask for one. Once I lie down on the operating table, I was hooked up to the blood pressure and heart beat monitoring equipment. I also had an oxygen mask over my nose and mouth. Dr Sadhana had not arrive yet, so the team of nurses and I waited for awhile. The anesthesiologist arrived and introduced himself. Once Dr Sadhana walked into the room, every one got into action immediately. My hand was in pain when the anesthesia was pumped through the cannula. I managed to tell the nurse about it and she assured me that it'll be fine. Then, I was totally knocked out.

The next thing I know, I was wheeled out into the resting area. In my semi-consciousness, I heard someone tell me to shift myself over to the bed. I have no idea how I did it. I fell asleep again. Every time a patient gets wheeled in, I sort of got awaken for a brief moment. I have no idea how long I was there for. Finally, a nurse came along and gave me a pack of biscuits and hot milo. Although I wasn't feel very hungry, I ate them all up! At the same time, I was watching what's happening at the opposite bed. The poor girl was very much in pain and the nurse had to bring some painkillers for her to take orally. Soon, a doctor came in and made her rounds. After she checked on me, I was allowed to get out of bed.

The nurse accompanied me to the changing room, told me to pee and change back to my own clothes. In my mind I was thinking "I only drank a small cup of milo, how to pee?" But I still managed to! It was only later then I realise that it was the drip that was keeping my hydrated while I was unconscious on the bed. Another nurse removed the cannula and gave me the medical certificate for HL. She told me that I have 24 eggs retrieved and explained that I have more follicles because I have quite a high AMH. (I think she mentioned my AMH is 7, not sure if I heard correctly, not sure what the unit is.) She instructed me to drink more water and reminded me that all my embryos will be frozen.

DH was already waiting for me in KKIVF when I came out around 11.30 am. We went home, ate lunch (DH bought food back) and I slept till it was time for dinner. I couldn't really walk straight because of the bloated. The ladies in the forum suggest drinking isotonic drinks, so I bought two 500 ml bottles.

IVF Fresh #1 Day 13

Some ladies in the Singapore Motherhood forum are really religiously feeding on egg whites to grow their follicles. (A case of 以形补形; eat eggs to grow eggs?). As for me, I'm getting complacent and I ate eggs only when DH brings me out for Ya Kun breakfast. Then, there's also other fertility superfood like avocado, brazil nuts, etc. I didn't eat any of those; I just don't have the discipline to follow through. I hope I wouldn't have any regrets later.

Anyway, I'm back at KKIVF for yet another scan. Today, DH couldn't take leave and this is the first appointment that I am going on my own. Although I have more than 12 follicles on each ovary, the sonographer only measured the biggest 12 on each side. After she's done, she made a final count under her breath. The largest follicle measured at 18 mm.

As usual, I had to wait to see the doctor on duty. When I was called into the room the first time, she asked me if I was feeling bloating. Then, she said that she needs to consult Dr Sadhana on my case because I have many follicles and is at risk of OHSS. So, I was sent outside to wait. Meanwhile, I was feeling distraught at the possibility of a postponed ET, which means that I would not have ET for this fresh cycle. I message DH about the news. The doctor called me back to the room and confirmed that I would not have ET and all my embryos will be frozen in storage. I'm really upset that it turned out like this! But DH thought about it and concluded that maybe this arrangement is better. He still trust Dr Sadhana's judgement. Well, not that I don't trust her, but I'm just really disappointed.

Tonight, I'll be going back to KKH 24 hours O&G clinic for my trigger shot. Typically, patients who go on to have their ET done in their fresh cycle will be given Pregnyl. I am given Lucrin instead. It would prevent me from getting OHSS, but at the same time, it would affect my uterine lining and therefore making it unconducive for embryos to implant.

My IVF fresh cycle timeline:

CD1	Call KKIVF
CD3 / Stim Day 1	Baseline scan. 300 IU Puregon jabs daily for 4 days
CD7 / Stim Day 5	300 IU Puregon & 0.25 mg orgalutran jabs daily for 2 days
CD9 / Stim Day 7	Largest follicle at 11.5 mm. Jabs with same dosage
CD10 / Stim Day 8	Largest follicle at 13.5 mm. Jabs with same dosage for 3 days
CD13	Largest follicle at 18mm. Final 0.25 mg orgalutran jabs Lucrine jab at night.
CD15	ER
CD17	ET cancelled due to risk of OHSS

My IVF injections. Puregon was injected using the fine pen needles, while orgalutran came in glass syringes.

IVF Fresh #1 Day 10

Scan result of the day: largest follicle at 13.5 mm on the right ovary and another at 12.5 mm on the left.

My updated IVF timeline:

CD1	Call KKIVF
CD3 / Stim Day 1	Baseline scan. 300 IU Puregon jabs daily for 4 days
CD7 / Stim Day 5	300 IU Puregon & 0.25 mg orgalutran jabs daily for 2 days
CD9 / Stim Day 7	Largest follicle at 11.5 mm. Jabs with same dosage
CD10 / Stim Day 8	Largest follicle at 13.5 mm. Jabs with same dosage for 3 days
CD13	Visit KKIVF for scan

IVF Fresh #1 Day 09

I'm back at KKIVF for my first scan after starting on the injections. DH took leave and accompanied me just like every other appointments. As told, I brought along my remaining medication in a small cooler bag, with the small ice packs inside. (I'm not going to lug a "sweating" plastic bag and drip water all over.)

Today's ultrasound scan will tell how well I responded to the medication. And I anxiously waited for my turn, not knowing what result to expect. During my scan, the sonographer read out numbers to the assisting nurse, who will record them in my file. She measured the sizes of 20 follicles and obviously, I cannot remember all the numbers. However, I took note that the largest measurement was at 11.5 mm and there were 3 of follicles at this size.

After the scan, I waited to see the doctor on duty in either Room 3 or Room 4. The doctor said that it's hard to judge the growth rate of my follicles, because this is my first IVF cycle. This meant that I will have to make another trip here tomorrow for another scan. She gave me the prescription with the same dosage. When we went to the pharmacy to collect my injections, the pharmacist was nice enough to replace my "melting" ice pack with new frozen ones.