Scan 2

Had second scan today ... made a boo boo ... remember I was told to go back tomorrow, but I saw on my appt card that it's today, so decided to follow the card ... turned out it is supposed to be tomorrow ... so the nurses had to rush around to find my file etc

Right side 6 follicles, 8 & 9 mm .. cyst is still there

Left side 7 follicles, 6 & 7 mm

Baseline scan on CD 3 (26 June)

Did my baseline scan on CD 3 ... AFC (antral follicle count) right side 6, left side 8 ... with a cyst on the right side .. something that was never seen before but since prof didn't say anything, other than commenting that there as no previous sighting of a cyst, i guess it's just a normal cyst that would go away

On Gonal-F 150 IU for these few days, till my next scan on 29th June

Surprisingly period is significantly lighter than normal despite the lengthening of the cycle. Physician Kuai said it could be due to duphaston. But also commented that it was a little out of ordinary.

Day one!

Period started yesterday!

Day two today ... going to have my baseline scan tomorrow!

PMS

Today is day 32 of cycle.. Started feeling cramps on day 30, which is normal for me. I usually start cramping a few days before the start of the period. Only this time, my period isn't going to come for at least another week.

So just got to bear with it.

Yesterday went to visit Phy Kuai, she remembers my hand haha.. And commented it probably pricked a vessel under the skin and a little internal bleeding took place. 

She said I should stop the chinese medicine already. Reason being the medicine she's been prescribing has been to 活血, plus acupuncture these few weeks to improve circulation.. And since my period is delayed, it will be a super heavy period, so it'll only get worse if I continue chinese med. 

Didn't display it, but was doing a happy dance because I can finally take a break from mixing bitter powder twice a day! 

And she also suggested that I cut down on vigorous exercise, because that causes 子宫 to 收缩 (uterus to contract) and might induce the period to start, or have more severe cramps. :(

Little mishap at acupuncture

Was at Tcm for my acupuncture session.. There was a needle planted between thumb and index finger.. The sensitive spot that we're supposed to massage if we have a headache.

So I was reaching out for my phone as usual, but this time round the acute "suan" sensation lasted longer than normal, so I decided to put the phone away and sleep.

After the needles were removed, I noticed that the sensation still persisted and I couldn't move my thumb without feeling it. Went back to the physician, she told me to apply pressure and iced the area. Then apply heat the day after. 

And this was the state of my hand few hours later.

Update:

Two days later.. A bruise is blossoming, but I do not wish to rub or engage that area as much as I can.

But at least the pain is not present anymore. 

Side effects of duphaston?

Waist line is literally increasing. Wondering if it's due to the med.

All the gas building up. Sigh.

Suspecting it's that because I've not noticed any gain at other parts of body but the abdomen area. And I've been extremely hardworking at my exercise regime and pretty cautious with my diet.

And there's an obvious increase in waist line. Apparent from my clothes. Tsk.

Or maybe I'm just finding excuses for the increase haha

IVF - the start

Today marks the start of my IVF cycle. CD 18 of current cycle. Start to take duphaston 10 mg, twice a day, for 18 days.

Was initially 10 days of the med. But because I have examinations in early July and to meet Prof Wong's schedule, he decided that I'll take the med for 18 days. And my stims are scheduled to start 26th June.

IVF seminar by Prof PC Wong

Attended the IVF seminar conducted by Prof Wong on 30th May.

DH and I noticed that almost all present appeared young-ish (20s, 30s) and looked healthy! No weight issues, good looking also. Made us wonder what is happening to young Singaporeans and their fertility.

It was very informative and I'm glad we attended the science seminar. Something which all teaching reproductive system should attend.

Some things which I remember from the seminar ...
- Strictly no exercise, including yoga during the 2WW
- Rest, but not bed rest
- Not necessary to have high protein diet. That is for women who are down with OHSS, as they suffer a loss of protein. Otherwise a balanced diet is sufficient.
- Prof Wong does not recommend supplements which have not been well researched on ... example DHEA, royal jelly .. He said he wonders why people would read on the forum or websites and believe other people and start popping stuff into their mouths without knowing what they are
- TCM is fine, can complement, but he doesn't recommend the continuation of medicine once the injections start

Anyway I strongly recommend anyone who is thinking of, or planning to embark on ivf journey to attend this seminar, which is organized every 5-6 weeks according to prof. 

Traditional chinese medicine

Back in 2006, I went to see a TCM and she helped with my condition then.

But I think it's simply asking too much of me to visit her twice a week, and for me to travel at least an hour each time, and goodness knows how long the waiting time is going to be every visit.

Stumbled upon the information that TMC opened a clinic at NUH. Decided I should give TCM a try in preparation for the IVF treatment.

As expected, she gave me medicine which was 燥热. As a result I was slightly constipated and some pimples popped. Increased my water intake to more than 2 litre per day to counter.

I was surprised at the number of needles used during acupuncture. She used 11 needles on the tummy, 2 needles on each arm, 2 on each leg and 3 on the head. As compared to my previous experience which was in total 3 needles (1 on each leg and 1 on the tummy). And for one hour, compared to half hour.



Update: I've the habit of taking warm honey water every morning, so the little issue of "fake constipation" (as I like to call it) is solved by adding one teaspoon of apple cider vinegar to the honey water. Probably it's the acid that's working. I remember when I added lemon in the past, I had very active bowels.

IUI (Cycles 6 to 8)

Prof put me on 100 mg of clomid from CD 2 to 6. NUH protocol is to have scan on CD 12.

Jan '15: 1 follicle, trigger CD 14, IUI CD 15

Feb '15: 3 follicles, trigger CD 15, IUI CD 16

April '15: 2 follicles, trigger CD 15, IUI CD 16

All 3 times, follicle sizes were ok (all above 18 mm) and lining were at least 9 mm.

Sadly, they were unsuccessful. So we will embark on ivf.

Private gynae vs Hospital

After the bleeding corpus luteum cyst incident, I met up with the earlier gynae. She said she would recommend that I go straight to IVF, but because she's at a private hospital, would be better for me to go to a government hospital so that I could have the co-funding.

Decided on NUH since they would have my records. And specifically Prof PC Wong.

At that point of time, I knew I'll be on study leave in 2015. Thought it'll be a good time for me to go for treatments as it would not be disruptive to my work.

However, after meeting prof, he said he wanted to see how I respond to IUI first before going onto IVF. More on that later.

But after going to prof and reading up on what the others mention on SMH forum, I realised the protocols that hospitals have are definitely more structured that what the private gynae I went to had.

If anyone were to ask me if they should go to a hospital or a private gynae for infertility treatment, I would say hospital definitely. I wasted over a year with the private gynae, and there were still details which she missed about me.

After going through the procedures in NUH, I would question my previous gynae:
- why did she not monitor me when I was on clomid to see if I'd actually reacted to the medicine?
- why did she assume that I was insulin resistant and put me on metformin for more than a year?
- why did she not monitor me when I was on puregon?
- why were there no blood tests done?

On CD 2 blood test, my FSH was 8.6 IU/L and LH 8.8 IU/L (ratio almost 1:1). AMH 33.7 pmol/L. Progesterone 2.2 nmol/L.

Cycle 5 (part 2): Bleeding corpus luteum cyst

After the scan on CD 10, we were told there was no need to return and we should carry on with our normal activities. Little did I expect the drama after that.

CD 12: the bloating became unbearable. During my visit I complained that I was bloated, gynae said it was normal since my ovaries were enlarged. But on this day, gastric cramps accompanied the bloating. I called the clinic, and the nurse said since I didn't have any HCG trigger shot, there was no need for concern.

CD 17: The long awaited positive LH surge on opk. That same day, I started on dydrogesterone. And I went for a run outside, and ended up with extremely bad cramps. Had to stop the run halfway and limped home.

CD 18: Bloating plus gastric, and I was carrying a little balloon in the tummy. I couldn't sit properly because I couldn't breathe well. My waist had expanded about 4 inches that day.

CD 21: National Day. Felt better that day - not so bloated and no gastric cramps. Decided to go to the gym. Because of the cramps experienced on CD 17, I decided not to run on the treadmill, but just work on the core muscles and some resistance exercise. I probably did about 10 crunches, and I started having cramps in the lower abdomen again, like I did during that run. Rested for about 5 minutes at the gym, cramps didn't go away and I was shivering by then. Signalled to my DH who was there with me, and told him I needed to go home.

It's about a 50 metre walk from the gym back to my place (I stay at a condominium), and it took me about 15 minutes to walk back that day, plus 3 bouts of vomiting. By the time I reached home, I felt the cramps everywhere from below my ribs all the way to the anus. I couldn't pass urine nor pass motion without a sharp pain. I sneezed and I whimpered from that contraction. Vomited a few more times that evening, and decided to have an early night. I thought I was having severe stomach flu.

Woke up at about 2 am, the pain was still there, I couldn't move without feeling the abdomen. I couldn't bend forward to put on my pants anymore. Woke DH up to drive me to the hospital. Every single hump we went over was like a stab to the abdomen. Went to A&E of NUH, told them of the fertility treatment I was under, and after taking urine test, saw the doctor, the doctor on duty diagnosed that I was possibly down with UTI. Gave me a painkiller injection and prescribed antibiotics. Came out of the room to vomit again.

Reached home about 4 am, laid down on the bed and was very uncomfortable as by that time the pain was not limited to the abdomen, but there was also a sharp pain up the right shoulder blade. I wasn't able to get into any position to fall asleep. Realised the painkiller jab wasn't doing its job as the pain was getting more intense by the minute. Decided at 430 am to go back to the hospital.

Same doctors attended to me, this time round they decided to take my blood test and put me on observation for a few hours. At about 630 am, another group of doctors came to me and told me that my BT showed that my white blood cell count was unusually high, and they were suspecting that it's appendicitis and would transfer me to surgery. But before they do that, they would send me for a gynea check first, but I had to wait till 8 am.

Gynae did a transvaginal scan, and the moment she inserted the probe in she said there's too much free fluid inside and she wasn't able to see my ovaries at all. It was later that I understood free fluids referred to blood in my case. She contacted her senior and asked her to come down to the room to assess me. She did a quick scan of my abdomen from the outside, and told me I had blood all the way up to my liver which was why I was feeling the sharp pain on my shoulder blade.

So the decision was made that I had to go for a surgery to remove all the blood, but I would need to go for a CT scan to determine the site of bleeding. I left her room about 10 am, and blood pressure was monitored every 15 minutes. Realised then that my bp was dropping lower and lower. Was approximately 90/50 towards the end of the monitoring. The gynae who saw to me earlier came and said that the operation theatre was ready for me, just waiting for CT scan. If CT scan had to be delayed, they would go ahead with the operation without the scan. So thankfully the scan took place about 12 pm, after the scan, my DH had to come in to take all my belongings as they got me ready for surgery. It was confirmed that there was a bleeding corpus luteum cyst in my left ovary.

After the surgery, woke up in the ward, and was told that they removed about a litre of blood from me. The bleeding probably took place for days, and the blood covered my intestines all the way up to the liver. Apparently because I was healthy, the body had spent those few days adapting to the bleeding and therefore I had no signs of it. If it were someone unhealthy, the person could have fainted earlier.

Saw the CT scan results, and that my right ovary measured 4.5 x 3.6 x 4.9 cm and left ovary was 5.8 x 4.1 x 6.9 cm. Which explained why I was so bloated.

The picture above showed that culprit which was bleeding, and my uterus which was covered with blood. The picture below showed the cleaned up uterus.

Doctors decided not to transfuse blood despite the loss, wanted to monitor if I was ok so that there wouldn't be any risk of infection during the transfusion.

Very grateful to both the gynaes who attended to me, and the surgeon who operated on me. I stayed in the hospital for 3 nights, and was on 4 weeks of HL after that. My mum also tended to me very well during that month of rest.

Cycle 5 (part 1): Clomid + Puregon

This doomed cycle started on 20 July 2014.

Had clomid 50 mg from CD 2 to 6, and Puregon 50 IU from CD 5 to 9.

Went for scan on CD 10 and this was what was seen:

On CD 10, 8 big follicles with the largest 15.3 mm.

So the gynae told me I should not continue with any injections, and no trigger shot because there are too many follicles, but DH and I should continue to BD alternate days until CD 20.

And again no other scans, instructions were: if HPT was positive, contact the clinic to set up appointment; if bfn, then we'll decide if we should do another round.

Clomid (Cycles 1 to 4)

Gynae prescribed clomid (50 mg) to take from CD 2 to 6. Was told to BD on alternate days from CD 10 to 20, but no scans were done during each of the cycles - 2014 January, February, May and June.

The first failed cycle, AF was extremely heavy and cramps were so bad I had difficulty driving. I remember having to attend a workshop and had to sit on the floor, it was so so bad. I woke up from the cramps on the first night.

The second cycle, AF was still extremely heavy, cramps were more manageable in the day time, but again I woke up from the cramps.

The subsequent month I took a break from clomid, but instead of a period I spotted for 8 days. Following month was better.

For all the months, I was meticulous in tracking with OPK and my BBT. Kept a journal to observe the lines and the BBT charts. OPK and BBT were pretty aligned.

After the failed cycle in June, went back to the gynae and she suggested that I add injections to my next attempt. But she said it's not necessary to do IUI as the probability of success is not much higher than natural conception.

Again, in retrospect, I should have voiced out why there was no scanning done during the cycles to determine if I had actually responded to clomid, and whether ovulation actually did take place. But all these only came to me after I switched to NUH later and those came in.

Of course, some private gynaes could be more conscientious.

Sept 2013

As mentioned earlier, we got married in 2009. In 2013, I decided to see another private gynae despite the earlier two who told me there was nothing wrong with me. Because it was time to seek help since I wasn't conceiving.

Upon hearing my history, the gynae said she would do a scan. I thought it was going to be another pelvic US, but it turned out to be a transvaginal scan. The moment she inserted the probe and saw my ovaries, she said "textbook images". She asked me to take a look at the clusters of follicles at the ovaries. This scan was done on CD12.

Did HSG and results were normal, both fallopian tubes are patent.

DH did a SA, and results were "excellent".

In retrospect, gynae didn't ask me to take any blood test.

She prescribed me metformin - which I later found out I wasn't insulin resistant through a blood test. So I was told to stop metformin after taking it for more than a year.

She also asked me to lose some weight. Was 56.4kg during my first visit to her. I lost my first 4kg within the next 3 months, and have maintained the weight loss and currently 49kg. I used to dance when I was younger, until my knee got into such a bad shape I couldn't walk properly, so I stopped exercising completely for a few years. So this was a wake up call to get myself back into a healthy state, am quite thankful that I'm back to having a proper exercise regime with good diets.

early 2000s to 2009

My periods used to be regular when they first started ... about 30 days and typically 7 days long, with the first day heavy spotting, then 2nd and 3rd day heavy, and the blood would taper off for the next few days.

They started going a little irregular in early 2000s when I was in JC. No longer 30 days, they would fluctuate between 3 weeks to 5 weeks. If 3 weeks, period would be lighter; 5 weeks, period much heavier.

In a regular cycle, I would typically require to change a tampon (heavy flow) plus pad every 3 to 4 hours, during days 2 and 3. If it's very heavy, the tampon and pad would be soaked within 2 hours, worst cases about 1. And along with the heavy flow would be cramps.

By 2006, my "periods" would last between 2 to 7 weeks. Time when it was 2 weeks long, I would have 7-day long spotting, instead of a 7-day long period. But the spotting would turn erratic too, and the previously bloody discharge became black sticky discharge. Sometime in 2006, I was spotting continuously for about 3 weeks and there was no sign of it stopping. Went to my GP, who sent me for a BT. Results came back showing that I had low levels of progesterone. She prescribed me some progesterone tablets to stop the spotting, and also referred me to a gynae.

Went to the gynae, did a pelvic US. Conclusion I was normal. If I wanted regular periods, I should start taking contraceptive pills to regulate them.

Started TCM, and it helped. I went to 李睿 (who had a clinic in Bukit Batok) for about 2 years till 2008. Even though it improved my constitution and my periods were finally regular, I wasn't able to continue seeing her - I had to see her twice a week so that she's able to customise my medicine, plus acupuncture. Frankly, the waiting time was usually bearable, about half hour, but the travelling and the regular sessions took a toll on me.

Within a year, in 2009, my periods were irregular again. This time round I went to the polyclinic and obtain another referral to a gynae. Again, did a pelvic US only and concluded that I was normal, and similar to the previous one in 2006, I should start taking contraceptive pills to regulate. Which I didn't heed.

List of abbreviations

As with many forums around, the abbreviations used can be a bit too much for anyone unfamiliar to the terms ... here's a list of more commonly seen/relevant terms, non-exhaustive of course:

2WW: 2 week wait
AF: Aunt Flo (aka menstrual cycle)
AH: assisted hatching
ART: assisted reproductive technology
BBT: basal body temperature
BD: baby dance (aka sex)
BFN: big fat negative
BFP: big fat positive
BW / BT : blood work / blood test
CB: cycle buddy
CD: cycle day
CM: cervical mucus
DH: dear husband
DPO: days post ovulation
DPR: days post retrieval
DPT: days post transfer
ER: egg retrieval
ET: egg transfer
HPT: home pregnancy test
HSG: Hysterosalpingogram
ICSI: intra-cytoplasmic sperm injection
IUI: intra-uterine insemination
IVF: in-vitro isemination
LMP: last menstrual period (start date)
O: ovulation
OHSS: ovarian hyperstimulation syndrome
OPK: ovulation predictor kit
PCOS: polycystic ovarian syndrome
POAS: pee on a stick
SA: semen analysis
TCM: traditional chinese medicine
TTC: trying to conceive
US: ultrasound

Trying to conceive

Old blog deleted to make way for a new phase of life (somewhat new since we have been TTC for a while now). Thought it's about time to document this journey. Hopefully it'll graduate into a blog on pregnancy and then on babies in the near future. :) We were married in 09, but yet to be successful in conceiving. Embarking on IVF this cycle, today is D14, will start on short/antagonistic protocol with dydrogesterone on D18. I hope whoever stumbles upon this blog will find it useful ... whichever stage of TTC you are in.