Friday, December 30, 2005

2 months and some down the road

it has been some time since i last updated this blog.

i posted somewhere that YV is preggy, so is her unmarried sister. what luck!

It all started with Yv good intentions to try out TCM as it worked for her. What it resulted for me was 2 weeks of abdominable powdered chinese medicine and stomach upset and nausea.

forget abt the 2 months, the 2 weeks were enough to put me off TCM for life.

not to mention, being told that her sister is preggy too.

oh well, life do suck that way.

time really flies when one is busy. i can;t believe that it is almost the last day of the 2005. it has been almost one month since i started on this job.

The learning curve is steep and there are loads of details to take care of, but it sure is a good learning experience.

it also kept my mind off the negative stuff and hey, life seems brighter after all.

will post more later.

Saturday, November 19, 2005

exactly 1 month since the d & c

it was exactly one month since the d&C yesterday. i felt the loss more acutely these couple of days.

had a review with LA, he says everything looks pretty ok. and i can start to TTC anytime soon once the first AF comes which shd be by the next 4 weeks. If it doesn't, then to take AF inducing medicine.

He doesn't recommend metformin at this point in time. metformin alone does nothing much to help ovualtion, it's only metformin with clomid that works. He recommends starting metformin one month before TTC, and to continue with clomid.

something i found out is that high LH and FSH levels is common in PCOS women and those will lead to poor quality eggs being released, hence the higher risk of miscarriage.

clomid + metformin helps to achieve ovulation but not neccesarily good quality eggs.

being on injectibles (synthetic FSH jabs) on the other hand works to create better quality eggs. as the proctocol requires suppression of own levels of LH and FSH via medicine/jabs.

at this point in time, there is nothing much LA can do as first AF have not come and i don't intend to TTC now s i will be starting a new job in a couple of weeks time.

in the meantime, i decided to see TCM and see where that takes me. hopefully, the TCM will be able to tame the hormones and restore balance.

we see where TCM takes me in a couple more months.

Thursday, October 27, 2005

follow u_ today

keyboard is still s_oiled.

guess which key?

was at LA at 11.30am, only to be told that he had to go away for an emergency delivery for an hour. by chance met Y who was there to get an MC as well. Y is now in her 8th week.

In the end, we had lunch and talked abt stuff in general. having gone thru a miscarriage before, she said something very striking - when commenting abt a friends friend who became hostile after knowing her friend was regnant not once but twice.

what she said was, there is nothing one can do to ease the erson out of her misery, only she herdelf can walk out of the (self constructed) cage. indeed how true. one can only move on by means of one strength.

LA did a scan and said that the inside is retty clean, excet for the bleeding everything seems fine.

he gave some medicine to sto the bleeding as well as the same dose of the other medicine to make the womb contract.

i was retty wary abt taking that other medicine, it was just last week that the same medicine caused such awful cram_s.

He gave me some _ainkillers to take at the same time.

Y was still waiting for me, and we went to NTUC to get some grocery. I got the feeling she didnt want to leave me alone. I did tell her i am ok, and she waited till i got a cab before heading home.

total damage
62 for just medicine alone.

Tuesday, October 25, 2005

exactly one week since the loss

It is exactly one week since the D & C. i thought i would have gotten over it already. whether Physically or mentally or emotionally.

Physically i am still having cramPs and bleeding from time to time. the doc said it will be like this for the next 2-3 weeks until the womb is clear of any remaining tissues. at tmes, i feel light headed and at other times just Plain tired.

mentally, i have accePted the fact that the baby no longer exists. and i should move on and concentrate on new job as well as other areas in life. like PerhaPs learning new reciPes, make some new dishes, Plan an excercise routine, etc etc.

emotionally, at certain times, i feel that i am ok, coPing with the loss well, after all i reasoned that the loss is still early and if its healthy then nothing i do could make me lose the baby. its Precisely that its unhealthy and not meant to be. hence i should feel better emotionally.

yet unlogically, i wondered if we could have waited and PerhaPs, just PerhaPs, soemthing would have haPPened and the baby will survive.

then the thought that we forced nature to haPPen via forced ovualtion and IUI and all those jabs and medicine made me wonder if we didnt just ask for all this suffering. PerhaPs we arent meant to have children, hence therefore we are forcing nature by medical intervention. all that talk abt survival of the fittest, PerhaPs theres something innately wrong with our genes that isnt suPPosed to be rePlicated in the next generation.

emotionally, i asked myself..what did we do wrong? mentally, i KNOW that we did everything Possibly anyone could have done.

the blame is on no one, but the guilt is hard to bear. the Physical side effects is a constant reminder of what haPPened. i hoPe it go away sooner.

Friday, October 21, 2005

an article from the doctor - ExPlaining miscarriage

this is an article from the doc, i thought i tPye it here so that it can be found.

Each year more than 50,000 Pregnancies end in miscarriage or stillbirth, in Australia. Hannah Dahlen exPlains that while it is hard to make sense of miscarraige, there can also be life after tragedy.

I will never forget the look of emPtiness on my mothers face, tear streaked face, after she lost what would have been her seventh baby. And she will never forget the thoughtless words of the doctor who Patted her hand and said *you ahve nothing to cry about, you have six healthy children*.

Miscarriage imPacts the lives of so many women and their Partners but this imPact is so often underestimated by health Professionals, family and friends. Just because miscarriage is a relatively common event doesnt mean it is a minor exPerience or that it should, or will, soon be forgotten.

Why does miscarriage haPPen?
Miscarriage is a term used for the loss of a baby before 20 weeks of Pregnancy. It tends to be divided uP into early miscarriages (before 12 weeks) and late miscarriages (between 12 to 20 weeks). Every year in Australia more than 50,000 Pregnancies end in miscarriage or stillbirth. It has been estimated that-
*half of all concePtions end in miscarriage before 12 weeks, although many women will not be aware that they are even Pregnant.
*around 2-25 Per cent of known Pregnancies end in miscarriage. Eight er cent of these occur in the first 12 weeks of Pregnancy.
*around 1-2 Per cent of couPles exPerience recurrent miscarriages.

*Common causes of miscarriage
The majority of spontaneous miscarriages are due to major fetal or genetic abnormalities. Other causes are an unusually-shaped uterus, exposure to certain drugs, early opening of the cervix, hormonal imbalances, immunological factors, direct trauma to the lower abdomen, poorly controlled illness like diabetes, and environmental factors such as smoking, alcohol, radiation, infections and exposure to certain chemicals. As a woman's age increases so does her risk of miscarriage, mainly due to the fact that the incidence of genetic abnormalities increases with increased age.

It is important for women to realise that it is very rare for a miscarriage to occur because of something they have or have not done. Unfortunately, for the majority of miscarriages the cause will not be known and this can make dealing with the unanswered questions difficult. This lack of information can make couples feel frustrated and fearful about future pregnancies. Tests can be done to determine some causes but in most instances no cause is found.

Types of miscarriage.
The most common signs of miscarige are vaginal bleeding followed, or preceded by cramping. Many women also reported a decline in pregnancy symptoms such as nausea or the softening of previosuly tender breasts. There are several different types of miscarriages-
*a threatened miscarriage is where vaginal bleeding may occur over several days or weeks in the first half of regnancy. The cervis remains closed and the baby remains in the mothers uterus. Bleeding occurs in around 30 er cent of regnancies and roughly half of these women will miscarry. The rest will continue the regnancy.
*An inevitable miscarrige is where the cervix starts to oen but the baby is still in the uterus.
*an incomlete miscarriage is where some of the tissue from the baby stays insides the uterus and some is assed through the vagina. Bleeding and craming will continue where this has occured and an ultrasound will reveal the remaining tissue in the uterus.
*a comlete miscarriage is when the baby, membranes and lacenta have come out of the uterus. Bleeding and craming occur as the uterus emties and then the cervix will close and bleeding eases off over the next few days.
* a missed miscarriage is where the baby died but it continues to stay in the uterus. The cervis is usually closed and the size of the womans uterus does not grow. The babys heart beat will also be absent and the woman may notie that her symtioms of regnancy have disaeared (nausea, sore breasts etc)
* a miscarriage can also be unnoticed as it resembles a heavy eriod and goes unnoticed, escially if it occurs early on in regnancy and the woman isnt aware she is regnant.
*a blighted ovum is where an egg is fertilised bit it doesnt go on to divide or develoe into an embryo. The regnancy test will be ositive and miscarrige usually occurs around seven to 12 weeks.
*Ectopic pregnancy can also result in miscarriage and is potentially quite serious for the mother. It occurs when the fertilised ovum implants in the fallopian tube or some other place outside the uterus (1:100 pregnancies). pain is almost universal with ectopic pregnancy. The affected fallopian tibe will not need to be surgically removed but this is still the mainstay of treatment.
*in rare cases the lacenta develoed into a mole full of fluid filled sac and no baby exists. This occurs in 1:1000-1500 pregnancies.

WHat happens with miscarriage?
The general course followed when miscarriage occurs is - a missed eriod, regnancy symtoms, a ositive regnancy test (followed by days or weeks of vaginal bleeding), lower abdominal craming, backache and miscarriage of the baby.

Generally a doctor will take your history and examine you. They will take blood for a regnancy test and suggest an ultrasound to see if there is a baby in the uterus, if there is a heartbeat or whether there is tissue left inside.

Most miscarriages in the first few weels of regnancy are comlete and women rarely need admission to hosital or intervention. After 6 weeks there can be an increased tendency for some tissue to remain in the uterus causing continued bleeding and infection.

*management for miscarriage
For years, the routine management for women having a miscarriage, where some tissue was susected to remain in the uterus was to have a surgical emtying of the uterus (commonly referred to as D & C - dilation and curretage). This aroach is now being challenged and women have three otions-
* they can wait and see if all the tissue asses throgh the vagina ont heir own. where the wait and see aroach is used, articularly when the women are less than 12-13 weeks regnanct, around 80 er cent of women will not need surgical intervention.
*the medical evacuation aroach - where hormones like rostaglandins are used to encourage the tissue to be assed.
*surgical evacuation where the tissue is removed by gentle scaring or suction to the uterine lining, under a general or local aneasthetic. When suction is used, rather than traditional scraing of the uterus, the rocedure seems to be faster, less ainful and associated with less blood loss.

any tissue from the regnancy assed through the vagina or removed during d & C is usually sent to athology for examination to see if they can determine the cause of the miscarriage. Unless you request for the tissue to be return to you, it will be disosed of by the hosital after it has been examined. It is imortant that you know you may not be able to identify the baby in the tissue after a d & C.

* identifying the baby
whether or not you will will able to identify the baby following a miscarriage deends on how big the baby was before the miscarriage, how long it may have been dead for and whether it came out by itself or through a d & c. A baby will be aroximately 7-9cm in length at 12 weeks and 16-17 cm long (the size of an adult hand) at 16 weeks.

Seeing the baby and sending time with it can hel you exress your feelings and deal with the reality of the miscarriage. you may be able to take a hoto or even obtain rints from the babys hands and feet if it miscarries late in the forst 20 weeks of regnancy. This is entirely individual and arents need to do what is right for them in their circumstance.

What haens after miscarriage?
It is imortant to have medical follow u a coule of weeks after the miscarriage to ensure you are healthy. If you lost a lot of blood during your miscarriage then the iron levels in your blood can be checked. It will also enable you to ask questions and talk about your feelings and the future, if you feel ready.
*breast milk
Breast milk is roduced from 16 weeks onwards so if you had a late miscarriage you may find your breast roduce milk. This can be very distressing for some women but for others it can actually be comforting. The best way to suress breast milk is to avoid stimulating your breasts, wear a firm bra and use cold comresses.
*vaginal bleeding
Vaginal bleeding continues for 1 to 3 weeks and rogessively becomes lighter. Women who exerience ongoing heavy bleeding, ass clots or have ain should seek medical advice. Sanitary ads are better than tamons for the first coule of weeks after a miscarriage to reduce the risk of infection.

Generally waiting ti ahve sex a coule of weeks until the bleeding has ceased reduces the risk of infection. After this, some coules gain great comfort from resumtion of sexual intercourse, whlist others refer to exress their love in other ways for a while.

*regnancy symtoms
regnancy symtoms should subside two to three days after the miscarriage and disaear within one week.

Coing with loss
It has been said that while the loss of an adult reresents the loss of the ast, the loss of a baby reresents the loss of a future. It is not just memories that cause grief but lost hoes and dreams can have a huge imact.

Miscarriage often reresents a major loss to women and their families, and reactions can be very similair to those that follow the death of any close friend or family member. arents describe the feelings of disbeleif, sorrow, anger,ain, guilt, exhaustion and confusion. It is common for hysical changes to occur such as roblems with sleeing, eating and concetrating. These are all normal grief reactions to loss.

*different aroaches to grief.
It is imortant to remember, though, that the range of emotions is vast, and while one woman may be feeling devastated over the loss of her baby, another woman may be feeling guilty that in fact this wasnt a wanted regnancy and erhas her emotions even caused the miscarriage. It can also be hard when one artner aears to be getting on with life and resolving their grief and the other is not.

arents often have feelings of sadness resurfacing around the date the baby would have been born. Getting regnanct again, or someone else announcing their regnancy, can also bing back ainful memories. Seeing regnant women, or families with babies can also be distressing for some arents.

One of the hardest things for many arents following miscarriage is the lck of societal rituals such as a funeral, hotos, hand and footrints (esecially if the baby is too small). arents can be left wondering if they were really regnant. They often feel there is no way to mark the significance of the event or cature the memories.

*do what is right for you
arents ahve the right ti mourn for their baby as they see fit. This may involve lanting a secial tree, or even a lant that flowers around the time of the exected birth date, or time of the year the miscarriage occurred. Naming the baby that was lost can hel, as can deciding on the babys sex if this is unknown. While you do not have to have a funeral for a baby that miscarries under 20 weeks, you can if you choose to.

Journals, eotry and drawings can all hel arents to work through their grief. For some arents, however, moving on is the most imortant and this may mean doing none of these things. There are no right ot wrong ways to mourn or coe with your loss there is only your way and you know best what that is.

Future regnancies.
One of the most common questions women ask following a miscarriage is *will it haen again?* the good news is womens chances of not miscarrying agin are excellent. Around 97 er cent of coules who exerience a miscarriage end u having a baby in the future. Even after several miscarriages your chances of having a sucessful oregnancy are higher than miscarrying again. It is advisable though if women have had three consecutive miscarriages to see a doctor who will recommend further investigations to try and determine a cause.

As to when to get regnant again following a miscarriage, this is entirely u to you. There is no evidence that waiting for a certain eriod is advantageous, unless you have been advised to do this by your doctor. future regnancies do not negate the losses of the ast. They give hoe and meaning to our lives and a reason to move on beyond grief and into joy once more.

Thursday, October 20, 2005

creid myself to sleep again

i dont know what i am crying for?

the loss of our baby?
the emotional pain we went through?
the physical pain i went through?
the fear of whether it will happen again?
just plain hormones?

all i know is that there is a hard mass in my chest that prevents me from breathing. and the only way to release it is through crying.

am i going crazy?

i cant sleep but i can eat though, i take comfort in eating, though when it comes to night fall, my appetite just disappears. dinner always forms a lump in my throat and i cant wait to vomit it all out again.

Tuesday, October 18, 2005

there is pain and THERE IS PAIN

you cant believe the excrutiating pain that 2 tiny pills can cause.

i took the pills at 8.30pm and the cramps started coming in at almost 11pm. tried hot pack, tried painkillers, nothing worked. then started vomitting everything out over a period of an hour, everything that ive eaten yesterday went out into the toilet bowl.

even water and the ponstan that i took. well, the painkillers never got a chance to work.

started to panick, and got hubby to call LA. The doc response - it will get worse before it gets better. after vomitting for the 4th time, and 2 hours later. hubby got worried and called LA again, LA then said theres still another day of this to go as i have to take another dose tomorrow night.

two days and nights of this?? there is no way i am going to survive the pain and the vomitting. my throat is rubbed dry already and i feel as if someone caught my inwards in a vise and twisting it.

LA then say theres always D & C, which will clear up the cramps and the bleeding. he said that the medicine i took, is the same one which D & C patients take anyways, so if i want to , i can go for D & C and end all this pain.

it wasnt until the third time when LA said that whether i had taken the pills or not (let it come naturally) the pain will still be the same, it is either tolerating it for 2 days with the pills, or 2 weeks + dun know how many days letting it come on its own, or a D & C which means the pain goes away in 2 hours. i wish i had known this earlier, nothing he said could have prepared me for tis pain i am experiencing now.

given a choice when one is doubling over the toilet bowl, well, it wasnt too much of a difficulty.

the D & C is arranged at 8am today. i am supposed to be at the hospital by 7am. it is 6.20 am and i am here typing this down while waiting for hubby to change and get ready to drive me down.

the D & C is surprisingly painless, the joys of GA. Its the waiting part thats pretty terrifying. alone on the hospital gurney, placed at the side of a busy passageway, with no spectacles, and blurred images of people in green rushing to and fro, some pushing carts that clang with metal instruments, the alternative was staring at the ceiling boards and the bright overhead lights.

it was all over in 2hrs, the d & C was scheduled at 9.15am and by 11, i was already back at the ward and getting over the GA. the first thing i felt was no pain, thats a huge relief. the pain didnt come back either, even better.

i got two weeks MC, and a follow up next week to make sure everything is ok.

actually physically, one only need 2 days of recovery time, but the womb will take time to contract as well as the emotional and psychological aspects of getting over a miscarriage.

going for a D & C after a miscarriage is the same physically as going for an abortion. The only difference is the pschological effect, the former doesnt give you a choice, the latter is YOUR own choice.

the physical risks are the same
A perforation of the uterine wall caused by the tip of the surgical instrument. This injury rarely requires treatment (additional surgery) and heals on its own.
Excessive bleeding is always a risk during surgery.
Another rare complication is infection with pain and fever.


as to psychological fears of a D & C affecting fertility...that one i need to ask the doc abt it.


cost tracking
D & C - $798.15
of which should be able to claim from insurance - or otherwise will be paid via medisave.

there was a hiccup during initial registration whereby we found out that we had to place a 400 deposit. thk goodness, i brought along credit card. never leave home without it, even if you are doubling over in pain at 6am in the morning.

we were told there is no cash required, everything shd be done via medisave. the woman at the counter said we got our information wrong, being in pain, i couldnt be bothered to find out more. you need 400, heres the card and get it over with.

it was only after the D & C, during discharge, that another lady realised the mistake made that a rebill was printed, so all that hassle this morning was just a hassle.

Monday, October 17, 2005

its not going to happen

just got the blood tests results for sat back. hcg has dropped to 141.1 and progesterone has increased to 122.6 due to the jabs and the medicine.

from 202 to 141 is not good news.

despite all that puking.

now waiting for FY to call back with advice.

the doc called back and said to stop all medication and let AF come, it should come within 2 weeks.

this should be the end of this saga.

will take a break from TTC and concentrate on new job.

some of the gals where saying that a D & C will ensure that everything is cleared out and pave the way for a better next pregnancy.

went to see LA for advice, he said at this stage a D & C is not neccesary. he gave some medicine called cytotec which will induce AF. the bleeding will be about a week, then all things should return to normal physically.

at this point in time, reality sets in.

i wont have a chance to name this baby
i wont have a chance to talk to him
i wont be able to hold him in my arms ever

Sunday, October 16, 2005

spotting or no spotting, pantang or not pantang

keeping track is driving me out of my mind.

imagine having to fear going to the loo, just in case one sees the spotting again.

like the above, this other thing has been on my mind as well. pantang or not pantang.

some gals are pantang (superstitious) about telling people whether or not they are pregnant before the pregnancy is stabalized at week 12 (3 months down the road).

the fear rises from soemthing happening to the baby if the announcement is made before the three months.

in my view, this is just plain hogwash. but if it makes one feel better to believe in it, then go ahead and believe in it.

one website states this -

When to tell others is a hotly debated topic. Sharing the joyous news of your pregnancy is a very personal decision. Some choose to share the good news early and often. They will tell anyone who will listen. Before the pregnancy test stick has dried they are on the phone calling their friends and family.

The other extreme is to tell no one. This group may also wait to tell until they have reached a predetermined point in their pregnancy. Then they may tell only on a need to know basis, often waiting until their expanding abdomen shouts the news for them.

Both sides of this coin have a point. Here is a break down of some of the issues on each side:

Advantages to Telling Early
Lots of support early in pregnancy
Able to share your good news and excitement
Earlier offers of physical help
More advice from others about practitioners
Help with early decisions
If you miscarry, you will have support from everyone

Disadvantages to Telling Early
Too much advice
Good news travels fast, you may not be the first to tell someone
If you miscarry everyone knew you were pregnant

Advantages to Waiting to Tell
Time to digest the news
Make decisions without input of others
If you miscarry you don't have to retract the pregnancy announcement

Disadvantages to Waiting to Tell
No help/support from others
If you miscarry everyone wonders why you are sad, and you have to backtrack your explanation

As you can see there is not a clear-cut answer. You might choose to tell early, knowing that if you had a pregnancy loss that you would need the loving support of family or friends in the grieving process. You may wish to wait until the risk of miscarriage or ectopic pregnancy has past before sharing the news of your pregnancy. There is not one right answer. What works for your family is the right way for you to share the good news.

so dont be influence by other people on whether to tell or not to tell. like in Y case, she told another friend first before telling me knowing that my pregnancy is not stable and not sure how i would react to the news. but yet on the hand, she has not told her family members yet as she is not sure of their reactions and their support.

Saturday, October 15, 2005

had a long chat with Y last night

found out that she is pregnant as well and is now 7.5 weeks along into the pregnancy. if calculated correctly (based on first day of last menses 24/08), she shd deliever on 03/06/06. I am so happy for her and hope she will be able to see the baby heartbeat at LA next week.

actually she found out before her trip to genting, but didnt know how to break the news to me in case mine didnt work out. whether mine work out or not, i am genuinely happy that she is on her way to her second baby. if all things goes smoothly, we may have kids that will grow up the same time together. How nice.

things are not looking good for me. from the gynae visit on thur till today, there have still been some spotting as well as cramping, almost as if AF is coming. This cant be good.

Had blood drawn as well as another jab (on the other side of the butt). and another 2 days MC with a stern warning from the gynae not to go anywhere this weekend.

Will know the blood test results next Monday. I hope that it goes up. double, quadraple, shoot up, just bloody go up.


cost tracking
$147.00

Thursday, October 13, 2005

start of twice weekly jabs

official start to the twice weekly jabs.

had the first jab this afternoon, i am getting used to the jabs now.

clarified with FY abt the hcg level thingy, he said that 10,000 is the value to see a viable sac & feotus.

the sac can be seen at 1,000 but it may not be viable.

another interesting information to keep somewhere.

felt giddy this afternoon after the jab, had slight spotting as well. came home and fell into bed.
called FY in the evening and he said the giddiness could be to the jab and it shd not reoccur again.

as for the spotting it could be due to walking a bit too much, and i jokingly reply that it was just a bit only. he then say that we are doing whatever we can for the pregnancy, so just hope for the best.

on the practical side of matters
the jabs cost 26.30 each, at twice weekly till week 12.
the pills which cost like 50 for 5 days supply.
blood tests $70 twice a week
scans done weekly at 40 each
consult at 40 each week

estimated cost till week 12
jabs $400, pills $250, blood tests $ 840, scans $240, consult $240
total cost $1970 (wow)

cost tracking
26.30

serious discussion last night with hubby

from what we know, at this present point in time, what are the chances that the baby? foetus? embroyo? will have a growth spurt from 202 to 10,000 in terms of hcg within this week?

i asked hubby how long do we want to keep trying to prolong the inevitable. He didn't want to give up, neither do i. but i dare not have raised hopes that he/she/it will survive and grow well.

we agreed to wait till week 8 before deciding whether to continue on with the expensive injections and the agony of waiting.

have to go back to the doc for another jab later today.

Wednesday, October 12, 2005

blood test results

HCG at 202 as of 11/10/05 and progesterone at 45 (which is on the low side) which means i need jabs twice a week to support the pregnancy.

oh boy.

HCG is still low but at least it did doubled.

Tuesday, October 11, 2005

Saw FY today - no reassurance given

i am so tired, so tired of this waiting and uncertainty.

FY ruled out ectopic pregnancy based on the blood HCG results, he said that its unlikely that it will be an ectopic pregnancy as the numbers did double, although its a little on the low side. I think he was very much understating the situation.

anyways he did another blood test, this time for beta HCG as well as progesterone. an interesting fact * synthetic progesterone like Duphaston cannot be measured in the blood stream, hence the progesterone blood test will really show the actual (natural) level of progesterone in the body.

The idea is that progesterone will help support the pregnancy, if one has insufficient progesterone, there will be indications like cramping and spotting, both very bad signs. He also gave me utrogestan (which is a natural progesterone).

FY was unable to giveme any reassurance as to how the pregnancy will developed other than saying that the numbers are really too low. I asked him how low is it actually, he hesitated a bit and then replied that at this stage (of about week 5 and a half) - the HCG level is supposed to be at the 10,000 plus range (mine is only 88 as of 07/10 fri).

Only when the HCG rises to above 10,000, then the sac can be seen. and the sac is usally seen at around week 5. heartbeat at week 6.

he said that the baby could be developing slowly, as long as the HCG levels do double very other day, there is still hope that it will catch up.

I asked if it will affect the baby development in the future, he hesitated a bit before replying that its unlikely so long the baby continues to developed and be monitored in the next couple of months. for that moment, the thought of having a mentally slow child because of us trying too hard to keep the pregnancy scared me out of my wits.

i am so tired of the waiting and the uncertainity. i need to talk to the other company about the job offer. i need to sign and return the letter by the mid of next week. what should i tell them? what shd i do?

on a bit of humour, FY suggested just sign and accept the offer first, they will never know u are preggy as it wont show yet. eh great advice from a gynae. lol.

on another bit of humour, this morning hubby tried on his suit made for the wedding, the suit shrunk quite a bit from the dry cleaning - until we realised that we got the wrong suits back. and this was like almost a year back.

We sent the suit for dry cleaning at the bridal salon and didnt checked it when it was returned to us. after a frenetic search for the invoice, we then sheepishly realised we got the wrong suits back.

Thk goodness, we managed to contact the gal at the salon. she kept our suit and we did an exchange. that was hubbys boo-ha number 1.

subsequently we went for breakfast at that food centre in chinatown. hubby got up to get additioanl ice and then when he returned, sat down at a completely different table and startled not only me but also the poor woman at that table.

poor hubby, i couldnt stop laughing, neither could the woman too. we looked at each other and just continued laughing. fortunately we finished our breakfast already and quickly left. boo ha number 2.

it was still early for the gynae appt, even after we ran all the errands we started to do. so we went shopping at paragon. We got some nice checked boxers from M & S, hey they do carry super sizes.

We then decided to head to toy r us, and we walked together to the escalators upwards, and of course hubby walked onto the one leading downwards and look startled when i am going up and hes well not going anywhere on a down riding one. boo ha number 3.

the caucasian guy who was sitting at the bench opposite the escalator just laughed and laughed, i m glad we made his day. *wryly*

i will be going back to work tomorrow, the spotting has already stopped and the rest is just up to fate. i never did believed in fate and i still dont believe in fate. whatever will be, will be. nothing more nothing less.

a couple of the gals sms me just now. i really appreciate their concern. Thks S and J. tks for your thoughts.

tracking cost
FY 156.50

Saturday, October 08, 2005

some technical stuff about Beta HCG

From all the websites i have covered, the general idea is that one HCG blood test is not enough to indicate the status of the pregnancy.

Normal HCG blood levels vary widely between different women and in different pregnancies for the same woman. Be very careful when trying to 'interpret the numbers'. During the first 12 weeks of pregnancy, the level itself is NOT as important in how much it is rising every few days. Some normal pregnancies will have quite low HCG levels and still progress, ending in the birth of a healthy baby. The best way to confirm if a pregnancy is progressing is to repeat the blood test in 2 to 3 days time, and perhaps again 2 to 3 days after that. This is aimed at seeing if the HCG level is rising adequately.

what exactly is the indicative range, normal HCG blood levels vary so widely that the indicative range can be quite meaningless. For eg, these are the values i got from different websites. (all are measured in terms of miu/ml or iu/l)


Weeks of pregnancy after last period
Days after conception
HCG level for single baby (mIU/ml or IU/L) (i havent figured oout how to do tables here- so bear with this)

Week 3 - 7 - 0 to 5
Week 4 - 14 (next period due) - 5 to 426
Week 5 - 21 - 18 to 7340
Week 6 - 28 - 1,080 to 56,500
Weeks 7 to 8 - 35 to 42 - 7,650 to 229,000
Weeks 9 to 12 - 49 to 70 - 25,700 to 288,000

(taken from http://www.birth.com.au/class.asp?class=6620&page=8)
as compared to this other one taken from (http://www.babyhopes.com/articles/highhcglevels.html)

Normal Human Chorionic Gonadotropin (hCG) levels:
0-1 week: 0-50 IU/L
1-2 weeks: 40 - 300
3-4: 500 - 6,000
1-2 months: 5,000 - 200,000
2-3 months: 10,000 - 100,000
2nd trimester: 3,000 - 50,000
Non-pregnant females: <5.0
Postmenopausal: < 9.5

which one to follow? - the best guide will still be your gynae.

some reassurance needed

Fri 7 Oct 2005 - hit the big 3-0

after a sleepless night and waking at 3am to test if the line is still there, i decided that i cant wait till next tuesday. tues is like another 5 days to go which feels like 5 years to me.

I recalled what LA said about normal HCG levels doubling every two days. and called him to make an appt. i think i got him on the phone while he was brushing his teeth. in between gurgles and what not, i got an appt to see him at 9.45am and got the blood test done.

i got it right abt the HCG values doubling every other day, but the best indictation of a healthy pregnancy is when the HCG level hits 100. whcih means that my original estimate of 60 is way far off the healthy mark (mon 03/10 was 15, so if the HCG is suppose to double every 2 days, by fri it shd hover around 60)

by the time the blood sample was done, it was close to 11am. results are expected within 4 hours. though it wasnt till almost 5pm when i got the results.

it was 88. below 100 but it did more than double since Mon. the doc called and suggested i visit his clinic in the evening for another jab. he reinforce that if its a healthy pregnancy, HCG will continue to increase.

He did point out something that the jabs and medicine may not aid in keeping the pregnancy if its unhealthy to begin with, but at least we are doing everything we can to keep this precious one.

Those words strike a deep chord in me. After all that we been thru, this pregnancy is so very precious to us. while i hope and wait that it will be healthy as the days pass by, there is always a real and persistant nagging fear that it will leave us.


how much it cost us so far in follow up
LA Mon blood test $45
KL Wed visit $211
LA Fri AM $35
LA Fri Eve jab $60

Thursday, October 06, 2005

faint positive again

i know KL said not to test again but i did anyways.

the line appeared faster this morning, it is still faint but appeared with the control line.

i am just thankful that it did not disappear.

Wednesday, October 05, 2005

Day 17 - faint positive HPT

i cant believe it, its a faint HPT when i tested this morning at 6am. i didnt realise the faint line till 15 min when i saw it again.

i couldnt believe my eyes. didnt even tell hubby incase it was a false alarm.

decided to see the gynae. called FY emergency service and got KL at woodlands. went to see him around 10.30am

did a v scan and he cant see the sac yet. he then did a UPT and the faint line was still there. He then gave a progesterone jab and hormones pills to take. advice to take a weeks rest and see FY again on next wed.

all in all, quite a out of the mind experience.

will update some more later.....been told by the gals that bed rest means ..exactly that resting on the bed - not sitting upright and chatting.

ok, i heard you gals.

thks for all your thoughts and prayers.

Tuesday, October 04, 2005

Day 16 - blood test results

called the clinic at 3pm, results not in yet

got a friend to call at 3.30pm, results still not in yet

called at 4.15pm, result not in yet.

clinic called back at almost 5pm, saying that the results is with LA and to call back in half an hrs time.

i called back at 6pm, result is between 10-15. now normal result is supposed to be below 2, LA explained that it could be residual from the HCG jab before the IUI.

to confirm, HCG levels are supposed to double every day, so a HPT by tomorrow or thursday should confirm the result.

a normal HPT shd be able to trace min 20, so if am really preggy, HPT shd be positive by tomorrow or by the very latest Thursday.

found an article which clarifies some doubt. (http://www.babyhopes.com/articles/highhcglevels.html)

Do high HCG levels always mean you are pregnant?

Human Chorionic Gonadotropin (hCG) is the "pregnancy hormone" or "announcer of pregnancy" that keeps the corpus luteum producing progesterone when you conceive. It is produced by the placenta during pregnancy and is measured by
home pregnancy tests (HPTs). A woman normally produces 25 milli-international units per milliliter (mIU/ml) of Human Chorionic Gonadotropin (hCG) 10 days after conception. As a general rule, Human Chorionic Gonadotropin (hCG) levels should double every two to three days after conception. Accordingly, the concentration of Human Chorionic Gonadotropin (hCG) rises rapidly, frequently exceeding 100 mIU/ml by the first missed menstrual period and peaks in the range of 30,000-200,000 mIU/ml by 8-10 weeks into pregnancy. A Human Chorionic Gonadotropin (hCG) level of less than 5 mIU/ml generally indicates that one is not pregnant.
There is great variation in Human Chorionic Gonadotropin (hCG) levels. It isn't the absolute value that matters in these results, but the change in values. In a normal pregnancy, the level of this hormone approximately doubles about every two days during the first 10 weeks. However, high levels of Human Chorionic Gonadotropin (hCG) may indicate choriocarcinoma of the uterus, ectopic pregnancy, Downs syndrome in fetus, hydatidiform mole of the uterus, normal pregnancy, or ovarian cancer. Once you have had an ectopic pregnancy, you have an increased risk for another, so your HCG numbers may be monitored more carefully.

Normal Human Chorionic Gonadotropin (hCG) levels:
0-1 week: 0-50 IU/L

1-2 weeks: 40 - 300
3-4: 500 - 6,000
1-2 months: 5,000 - 200,000
2-3 months: 10,000 - 100,000
2nd trimester: 3,000 - 50,000
3rd trimester: 1,000 - 50,000
Non-pregnant females: <5.0
Postmenopausal: < 9.5

Injections
If you have been given an Human Chorionic Gonadotropin (hCG) injection (Profasi, Pregnyl) to trigger ovulation or to lengthen the leutal phase of your cycle, trace amounts can remain in your system as long as 10 days after your last injection. These can give you high Human Chorionic Gonadotropin (hCG) levels. Two consecutive quantitative Human Chorionic Gonadotropin (hCG) beta blood tests can circumvent this problem; if the level increases by the second test, you are likely to be pregnant.


geez, after the nerve wrecking wait and its still not 100% confirmed, and another blood test??

let me think abt it.









Monday, October 03, 2005

Day 15 - Mon - blood test

found out that FY is overseas, hence decided to go to LA for a blood test.

that test will be more definitive than waiting another week till FY returns on 7 oct.

will know the result by 4pm tomorrow.

Sunday, October 02, 2005

Day 13 Sat - well, still negative HPT

been having cramps and slight spotting on Sat - guess thats AF on its way.

While i was prepared that this cycle may not work, its a totally different feeling KNOWING that it didnt work.

DH said something very touching - despite his urgent need for offspring, he suggested that we should take a 6 mth break to relax and pursue other things.

the past 6-8 weeks have been ultra stressful due to news of company closure as well as TTC leading to short tempers and insomnia - all mine and poor DH.

We had a wedding dinner in the evening to attend, but i really do not feel like socialising today - in the end DH went alone.

and came back still hungry.... which meant I had to get him something to eat at 11pm on a saturday night that doesnt include instant noodles.

He got a loaf of garlic bread.

Friday, September 30, 2005

Day 12 - still negative HPT

Was chatting with a grp of friends about symptoms of pregnancy and we concluded that sore breasts means a high chance of being positive.

but no, tested this morning at 5am and its still a negative.

i wish i could know earlier.

The earlier i know, the earlier i can make the decision as to which job offer i should take up.

Job Offer 1
  • established co - no worries of it closing down
  • new job scope/position - no precedent (as good as being in a start up)
  • sales - targets - stress
  • travelling SEA - not good if pregnant
  • will not pay maternity benefits (as per employment act in singapore)
  • higher pay - cld use it
  • good benefits - perks of the job

JOb Offer 2

  • New start up - prospects?
  • familar work - setting up an office/systems etc
  • no travelling - a definitie plus
  • lower pay - 20% less - we cld do with more money
  • willing to pay 3rd mth maternity benefits even if not covered by govt
  • nearer to home
  • flexible working hours

after listing down the points, im still undecided.

Tuesday, September 27, 2005

Day 9 - negative HPT

tested this morning at 6.37am.

did i say i was on mC today? oh yes, the GP gave me a couple of days off - the cough mixture is supposed to make me sleepy - think it works, i woke up at 6.30 instead of 4am, major improvement.

the first thing i did was to test, the test is negative. (as expected) - its a little bit too early.

oh well.

prepared breakfast for hubby, and got online to blog. oh dear, can it be called obssessive blogging?

i noticed that 1 got a blog almost every day and sometimes twice in a day.

Night 8 - baby names

just before bedtime, out of the blue, DH started talking abt testing HPT...it is only Day8, i think its too early to test, decided to do it tomorrow morning instead.

the talk then went on to baby names. the conclusion was if its a gal, she will be called le qi, kelly, and if its a boy jun hui, ??.

now both of us couldnt agree on what the boy english name will be...i suggested kieran, which hubby says sounds like ki xiao (i was like huh), i like the name kelvin, and he said all the kelvins he knows are yandao arragont (spello).

he suggested Gavin (which sounds like brand), might as well call him Louis V. we tumbled thru derrick, calvan (from not having kelvin), solomon (might as well call him methusaleh), we went thru a few more names but cant remember them off hand now.

one name we sort of agreed on was kaeran (doesnt that look like kieran - my original choice?) ha ha.

and we drifted into sleep.......Zzzzzzzzzzzzzz.

Monday, September 26, 2005

Day 8 - went to see the GP

thats it, another night of waking up at 4am and not being able to get back to sleep.

add to that a mix, a cough that wouldnt go away and only appears at night *arghs*

went to the GP, he refuses to give me anything for the insomnia, diagnose it as *stress* and it will go away.

but he gave me cough mixture and advice me to take that to go to sleep instead. *right* i guess i am going to need more than 1 bottle.

Sunday, September 25, 2005

day 7 - nightmare

When am i going to get really some nice uninterruppted sleep?

had a nightmare that woke me up. I dreamt that i shot someone in the afternoon and hid him rolled up in a carpet under my mums bed. and when it comes to nightfall, tried to dispose the body by chopping him into sashimi slices - nicely arranged on a platter.

of yeah, i even dreamt that i couldnt finsihed the job and then decided to confess to the police. thats when i woke up. traumatic decision. *wryly*

i wonder what can those professional dream interpreters read into that??

weird, really weird

Saturday, September 24, 2005

2ww The language of babymaking

It is Day 6 of the 2 week wait (2ww), and hell it has been a long 6 days, how am i ever going to survive the next 8 days?

random thoughts
all over the online forums, women who are ttc form support groups with other women who are also in their 2ww. i now can fully empathise the need to express every single thought, fear, wish during this period of time - otherwise how else to survive the emotional roller coaster ?

sore nipples, pre PMS symptons or cld it be conception? tender breasts, PMS or BFP? loss of appetite, sleeplessness, pimples, moodiness - whart does all those symptons fall under?

the language of babymaking
its a whole new world out there, hell a whole new species of womankind, which i am slowly evolving into.

lets put it this way, i am beginning to understand the language. and use it. too.

for those who are reading this blog and have no idea what i am talking abt, let me give you a sample of the abbreviations that is used.

starting with something relatively easy like

2ww
BFP
BFN
LP
O
BD
ML
DH
DS
DD
RE
AF
IUI
IVF
SOIUI
HCG
BHCG
AIH

im sure you get the picture now.

if anyone wants to know what they mean, write me. lol.

i got the time to reply and explain during this 2ww, perhaps it can keep my mind off the 2ww.

Monday, September 19, 2005

sperm enhancement and IUI

D day is today. couldn;t sleep well (obviously) so what's new??

We got a 9.30am appt at CARE to produce the sample. Hubby was directed into a room with oh yes, porn videos and porn magazines....now this must be the only place in singapore where the men are encouraged to do porn.

thk goodness hubby did not have performance anxiety, he did it pretty fast while i was in the reception area reading thru the informative booklets (btw i got some pretty informative reading material on fertilty and mtds)

after producing the sample, we were told that it takes 2.5 hrs for it to be processed. ok, we decided to go for breakfast. we went over to centrept for breakfast. we finished breakfast 10am. we took a stroll at centrepoint 10.15am. we walked to robinsons (ground floor; still not open) 10.17am. we walked to marks and spencers (3rd floor; still not open). we went to the loo 10.30am (the loo is open). sat at macdonalds for another 10 min. went up to robinsons (finally opened 10.45am. shopped a bit, looking at everything and not registering anything 10.55am.

we decided to go back to CARE. now the nice lady at the counter did say 11.30am and we are half an hour early. but nvm abt that, hubby insisted we go up at 11am. so we went up, and the nice lady said it's not ready, will call us once it's ready for collection.

fine, 11.10am, Metro is open, we went shopping (or i went shopping and hubby tagged)...in the space of 20 min, i managed to get 2 shirts for work. LOL. call it retail therapy but it works, time flies. the lady called at 11.30am and we paid for stuff in a hurry and got up to CARE.

With the sample came a report and a bill of $147. now, i was a bit curious abt how we were going to transport the sample there. it has to be kept at body temperature. well i found out soon enough - the lady said just stuff it in yr bra. i was like ???? well ok.

she directed me to the same room hubby was in earlier - the porn room. ooh..interesting, the porn video was still showing..japanese porn...kinky.

got the sample stuffed in bra and left CARE to proceed to TB. in the meantime, we were vry curious about the report we got abt hubby's sperm sample.

The report wasn't good. the volume barely made it to 20, the normal form is only at 4% pre treatment. but then it's a 100% improvement compared to the last sperm sample at 2% normal form. Hubby was very worried that the sample is so bad that IUI cannot be done.

Our worries were for nothing, Dr Fy went ahead with the procedure. first the nurse prepared me for the procedure, which means removing clothes and getting into a hospital like gown, positioning into that gynae chair.

she got me quickly enough and then we had to wait about 10 min for Dr FY. The procedure itself took less than 10 min, i know i am very tensed then and it didn't make things better, in fact, the doc had to reposition the instruments again as i was so tensed that i kept pushing it out.

the procedure itself was painless, the doc then left the room and i was told to rest for 20 min. hubby then came in and sat besides me while we waited. after 20 min, the nurse came back in and hubby got to go out while i got dressed.

i was telling the nurse that i could feel wetness and she said it's normal. some of the sample is expected to flow out. i hope that not all of it flowed out. *cross fingers*

we waited for a while to see the gynae for him to explain abt the sperm sample results. the results aren't good per se. having a normal count of 4% for form is definitely not good. but he said he has seen instances where the gal got pregnant anyways.


He said there are various reasons why the form is not good, some of which are genetic factors, lifestyle factors (losing weight), overly tight pants, and swollen veins called varicoleous or soemthing like that. which cld be determined via a physical exam and an operation.

i asked what shd we do next, whether he can do the physical or shd hubby be started on some medicines. both the guys said they will start with the medicines first. lol. now hubby knows how awkward it is, having another person up yr privates.

anyways, dr Fy prescribed some male hormones for hubby and it's expected to take 2 months before any results can be seen.

back to the IUI, it will take 14 days before the results are out. and it's going to be a long long 14 days wait.

we got the medicines and the bill of $ 270 and left the clinic with hopes that this cycle will work.

on other matters, we got some good news - i got a job and i got credit card approval as well. so far, cross fingers, things are looking up.







Sunday, September 18, 2005

Virgin Posting

wow, another new blog..i wonder who has babymaking.blogspot.com

brb

I'm going to transfer some/most of my previosu blogging into this one. This blog seems more user friendly. *cross fingers that i dun mess it up*

Saturday, September 17, 2005

CD16 Sat & jab

was very anxious, so much so that i couldn;t sleep well for the past 4 days, been waking up at all times.

it's hard not to worry, though the circumstances is beyond our control. tahnkfully, i met a group of gals online who are facing thru the same problems and they offer great support thru out this trying time.

organsing a gathering online for a grp of 15 persons who mostly have not met each other before takes a lot of worry off my mind about TTC. (btw the gathering was this afternoon and 4pm, and it went off swell {if i may say so})

so eh back to the gynae visit, we were there very early, at 9am although we had a 9.30am appt and had to wait for a couple of patients before being seen.

Dr Fy didn;t say much till after the scan. he said there was a follicle that is big enough at 20mm which can mature. and then he became a lot more approachable as he talked what to do next.

next step
i'm supposed to get a hcg jab to encourage the egg to release from the follicle. and there's specific timing to follow which is between 9 to 9.30pm tonight. The jab can be done at any GP since FY clinic is close and most GP are not open at 9 plus, we decided to go to a 24 hr clinic instead.

my next qn was, will the jab be painful? Dr FY said no, it will not be as the jab is supposed to be on the butt which is fleshy, to which i joked that i'm fleshy all around. which kinda lightened up the mood.

so the plan is that i get a jab on sat nite, and the egg will be released on Mon. Hubby has to produce a sample on Mon Am at CARE, and then bring the sample to TB, where Fy is at on Mondays and he will perform the IUI procedure.

we got the stuff we needed from the recept and off we go. did i mentioned that we got a gathering at 4pm this afternoon?...that really took our minds off the jab that evening.

evening time came round, we went to the 24 hr clinic at yishun. Dr FY said it wouldn;t hurt rite? in a pig's eye, that jab is bloody painful. and it took a bloody long time to administer as well. It cost 36 bucks for the GP's service as well.

Tuesday, September 13, 2005

CD12

appt with the FY on CD12 for ovulation monitoring - he couldn't cfm the growth of the follicles - the largest is only 9mm and it's already CD12 - not very good considerng that i'm already on the maximum dose of clomid this cycle.

made another appt to see him on CD16 to see if the follicles did develop - if it didn't grow any more, this cycle is shot as well.

i really dun know what to do if this cycle is shot as well, with the news that the co will be closing down means that i am in the market for a new job by nov. and in singapore law one need to be employed for at least 180 days before maternity benefits kicks in.

i hope that this cycle works, or not.....

Friday, September 02, 2005

of course it doesn't take 3 days with me

rite..3 days after last dose of AF inducing med - the doc said..

well AF didn't come till almost 8 days later (today) - while PMS symptoms started like 2 weeks earlier. duhz really.

in the end called FY to chk why..and if it still doesn't come by the following week, to go back and see him.

the next day, it came. and here we go, starting on the 3rd cycle in 5 months. I can't believe that we have been trying for 5 months with medical intervention.

It has been a very trying period.

p/s: of course since AF is late, i got to change the appt already made on my last visit to the gynae. and yes, it's a painless process. no dragon lady, no hang up..and guess what, even personalised reminders one day before the appt to ensure that you do turn up. now that's service.

next appt 13 Sep tues - CD12

Sunday, August 21, 2005

Starting on 3rd cycle in 5 months

Started taking med to induce AF today - this will tkae 5 days instead of the usual 10 days. AF supposed to come within 3 days.

Tuesday, August 02, 2005

CD 15 Tuesday

Saw LA in the morning at 10am, surprisingly didn't ahve to wait long as i was the 1st appt of the day.

He did a scan and said the largest follicle he could see is only 6mm, which is not good news as they need to be like 18mm and above to mature.

i asked him about puregon and he said that could not help in my case. after suggesting metformin and ovarian drilling, he suggested that i see a sinseh instead, that really put me off him. he has not even exhausted the medical means, and yet he already want to give up.

i headed off to paragon. spent half an hr walking about paragon since i was too early.

reached the clinic at 11.30, in the end got to wait while he sees another patient. the waiting area is so spacious compared to LA, no longer that claustrophobic feeling. the recep is so friendly and professional. that really sounds like a good start.

FY himself is rather well aloof...he doesn't seem as approachable as LA. and perhaps because i'm nervous and stressed as well, the exchanges were kinda awkward.

in the end, he did another scan, and found that both ovaries are PCOS, the womb/lining is fine. He printed the scans for me to keep. He said the largest follicle he sees is about 8mm and since it's already CD15, it's unlikely this cycle will work, hence this cycle is shot as well.

He gave me med to induce AF to be taken 14 days later after testing with HPT. He also prescibed clomid at the max dose which is 4 tabs per day.

If this time, it doesn't work, then it's going to be a huge problem

Friday, July 29, 2005

CD 11

Friday

took the day off, went to LA for scan, still no visible follicles - to return next tues for another scan.

it doesn't look good.

decided to look up Dr FY clinic. made an appt to see him on Tuesday after LA. If LA offers good news, then i can skip FY, if not, then i need a second opinion.

Tuesday, July 26, 2005

CD 8 and well life goes on

saw LA yesterday, did a scan, classic PCO ring of cysts around ovaries but none of them mature big enough to be distinguishable.

got to go back on Fri to re scan, hopefully by then got some visible follicles.

Talked abt metformin and ovarian drilling.

metformin is a medication used to treat insulin resistance. supposedly can also used in PCO cases to correct hormonal inbalance as well as weight control. side effects includes nausea n stomach upset.

Ovarian drilling is done via Laparoscopy, where a portion of the ovary is burn away by laser to adjust hormonal imbalance. side effects include ovarian failure.

advice from LA regarding IUI, skill of doc involved will affect chances of success.

Monday, July 11, 2005

sleepless nights

been having sleepless nights, full of dreams. ever since realisedt that both e and l are on clomid, and conceived, yet lost both their babies in 1st trimester is scary to say the least.

pple say that miscarriage happen because it's not meant to be or because of some genetic fault which makes the foetus unvaible to life.

sometimes i can't help but think perhaps it's because in our search for a baby, we are forcing nature by medical intervention.

perhaps we really shouldn't force things, and then suffer unneccesarily the pains of a threatened pregnancy and ultimately a miscarriage.

Monday, July 04, 2005

CD donkey days

saw the gynae tonight, reached his clinic at 8.50pm and didnt get to see him till almost 10pm for a short 5 min visit.

conclusion: got medicine to induce AF - the same one as before - 2 tab a day for 10 days. and then start cycle 2 of clomid - same as before - from CD2- CD6.

this cycle however will do ovulation monitering (a great improvement) - from CD7 - which means that got to fix appt to see gynae from CD7 to CD14 every other day?? for scans.

if everything goes to plan, means that ovulation will occur at CD14 which will be like 29 days from now.

10 + 5 + 6 (cd1 + cd2-6) + 8 (cd14) = 29 days. which is on 3 Aug + 14 days = 17 Aug will know if this cycle works or not.

total cost $12.50 for med. gynae didnt charge for consult. :)

Friday, June 24, 2005

Fertility Procedures - Part 2 (AIH, IUI, SO-IUI,clomid)

Before one consider IVF & ICSI, there is AIH, IUI, SO-IUI and clomid to consider.

Clomid is basically hormone medicine to trick the brain into ovulating. this is the cheapest form of fertitlity treatment and the only non invasive one, and also the first course in treating fertility issues.

Taken from kkh website.

How Is Clomid Given?
Your doctor will usually start you off on the smallest dosage which is 50 mg (1 tablet) daily. This is taken for 5 days either from the 2nd or the 5th day of your menstrual cycle.
The doctor will check for the effectiveness of this dosage by taking a blood test (serum progesterone) on the 21st to 23rd day of your menstrual cycle. The dosage can then be increased if necessary.

You are advised to have sexual intercourse between the 6th and 21st day of your menstrual cycle.
After 4-6 cycles of clomid, one has to consider other alternatives, which involves artificial insemination. There are various types to consider depending on the situation one is in.

AIH - Artificial insemination by Husband.

IUI - Inter utarine insemination (not neccesarily using husbands sperm)
and SO-IUI - which involves taking hormones to ensure super ovulation where more eggs are produced.

AiH and IUI basically work the same way as SO-IUI without the super ovulation bit.

What Is Superovulation & Intrauterine Insemination (SO-IUI)?
Superovulation is a procedure where two to three ovarian follicles (eggs) are stimulated and brought to maturation and ovulation.
It is usually combined with intrauterine insemination in which the prepared sperms are placed directly into the uterus. This procedure will enhance conception for the couple.

Who Is Suitable For SO-IUI?
Any couple who has unexplained infertility, mild male factor infertility, cervical factor infertility and mild endometriosis can undergo this procedure. The patient must have normal fallopian tubes and her husband should have sufficient good quality sperms.
If the husband requires chemotherapy or radiotherapy for cancer treatment, he may have his sperms cryopreserved (frozen) for future use by this procedure.

How Is The Procedure Done?
The procedure is done on an outpatient basis.
Fertility drugs are given for 10 days or more to produce between two to three mature follicles. These drugs may be either injections (gonadotrophins) alone or a combination of tablets (Clomiphene) and injections. Ultrasound scans are done at intervals to determine the number and size of the follicles before another injection (HCG) is given for final maturation and subsequent ovulation of these follicles.

On the day of the insemination, the couple has to bring the husband's semen sample to the hospital. The semen is prepared and the motile fraction is then placed into the uterus using a fine catheter through the cervix.

The patient is then started on medications to help improve the chances of implantation and thus pregnancy. A blood test (serum progesterone) is taken seven days after the insemination to monitor the effectiveness of these medications. The patient should return to KKIVF 17 days after the insemination for a pregnancy test.

Useful Information

Success rates (KKIVF rates)
Natural conception in a fertile couple aged about 35 years old occurs about 15% per month. When infertility factors are present, this is much reduced.

SOIUI improves the chances of conception for infertile couples and the average success rate is about 12-15% per cycle or 26% per patient after 3 cycles.

The overall success rate varies with the cause of infertility and the age of the female partner. For some conditions, the pregnancy rate can be as high as 36% per patient.

Fertility Procedures - Part 1 (IVF & ICSI)

Did some research on the net over the past few months, decided that i better collate them in ine place. and perhaps having it all written down somewhere means i dont carry all that info in my head.

even when im writing this, i ask myself where exactly do i start? Fertility is soemthing that we all take for granted.When one is single, talking about making babies is certainly not acceptable social behaviour here. Even if one is married, specifics is still a taboo topic.

Ive always thought that getting pregnant should be a done deal. well at least almost everyone i know has kids, and those who dont have, do it out of choice. so fertility..well infertility is not something that i expect to encounter.

that brings me back to where do i start? one of the websites that i found useful was
www.kkh.com.sg

it contains most of the basic terms of fertility, some treatments and procedures. its a good place as any to start.

the most common term would be test tube babies, or clinically known as IVF.

What Is IVF?
In-Vitro Fertilisation (IVF) involves putting the eggs and sperms together. By natural selection, the egg will usually allow only one sperm to enter and this usually leads to the fertilisation process in the laboratory. After fertilisation, the embryos are allowed to grow for a short period of time before being placed into the uterus. A successful pregnancy can be confirmed about 2 weeks later

Who Is Suitable For IVF ?
IVF is the only fertility treatment for women with irreparably damaged or blocked fallopian tubes. IVF is also offered when infertile women cannot conceive with simpler methods of treatment for conditions such as endometriosis, ovulatory dysfunction, unexplained infertility, sperm disorders and immunological problems.

What Is ICSI?
Intra-Cytoplasmic Sperm Injection (ICSI) involves injecting a single sperm into each egg to allow fertilisation to occur in the laboratory.

Who Is Suitable For ICSI ?
ICSI is recommended if your husband has poor quality sperms or if you have had difficulties with fertilisation in the past. If this is your first ICSI cycle, it may also be combined with regular IVF.

IVF / ICSI Prgramme
IVF programmes utilise Controlled Ovarian Hyperstimulation which results in more eggs and hence a better chance of pregnancy. Controlled Ovarian Hyperstimulation is carried out with GnRHa (e.g. Lucrin, Buserelin or Nafarelin) and gonadotrophins (e.g. Metrodin HP, Gonal F or Puregon) injections. Various protocols are used. The protocol using GnRHa and gonadotrophins is described here.

1. Controlled Ovarian Hyperstimulation and Monitoring
a.
GnRHa InjectionGnRHa treatment is given daily to prevent a spontaneous ovulation and to ensure that the ovarian follicles grow in synchronous fashion. It usually starts in the 2nd half of your menstrual cycle and continues for about 14 to 20 days. Some patients may need to take this medication for longer periods.
Blood tests and ultrasound scans will be done to ensure that the optimum response is reached. Once this is achieved, you will proceed to the gonadotrophin injections.
b.
Gonadotrophin InjectionGonadotrophin is injected daily into the muscle/subcutaneous tissue of your thigh or buttock to stimulate the growth of the follicles in the ovaries. After several days of gonadotrophin injections, an ultrasound scan is performed to determine the number and size of the growing follicles. You will need additional injections if the follicles have not reached the desired size.

When the follicles have reached the desired size, an injection of HCG is given and GnRHa and gonadotrophin are discontinued. The HCG is required for the final maturation of eggs before the egg collection. The egg collection is scheduled about 36 hours after the HCG injection.

2. Sperm Preparation
During the gonadotrophin injections, your husband need not abstain from sexual intercourse before the egg collection. On the day of the egg collection, your husband needs to produce a fresh masturbated semen sample.

3. Egg Collection (Oocyte Pick Up)
The egg collection is performed at KKIVF. The eggs are collected through a special needle attached to an ultrasound vaginal probe. A mild sedative will be given to you, as only minimal discomfort will be experienced during the procedure.
After the egg collection, you will be observed for a few hours before going home. It is important to understand that not all follicles will necessarily contain an egg and that some of the eggs may not be ripe enough for fertilisation. An overnight fast is required before oocyte pick-up procedures.
Hormonal stimulation induces superovulation; eggs aspirated from the mature follicles transvaginally with ultrasound-guided needle

4A. Fertilization
The sperms are added to the collected eggs in a dish to allow fertilisation to occur by natural selection in the laboratory. A check to confirm that fertilisation has occurred is carried out the following day.
Unfortunately, in about 10% of couples, there is no fertilisation at all. The nurse coordinator will inform the patient of any successful fertilisation.

4B. Intra-Cytoplasmic Sperm Injection
ICSI will be performed on the day of oocyte pick-up. During the procedure, a single sperm will be injected into each egg via a microneedle. On the following day, a check is made to confirm that fertilisation has occurred. The nurse coordinator will inform the patient of this result.

5. Embryo Transfer
A few days after the egg collection, you will need to return to KKIVF to have the embryos placed into your uterus. An overnight fast is recommended before the embryo transfer procedure.
Embryos are re-placed into the uterus using a fine catheter. This is usually painless and takes only a few minutes. Usually, three embryos are transferred. A smaller number may be transferred if there are insufficient embryos or in younger patients. We encourage your husband to sit in during the embryo transfer.

Eggs fertilized in-vitro (IVF) with sperms. Embryo transferred directly into uterus, bypassing tubal occlusion.

You may go home shortly after the embryo transfer. You will be given daily medications (progesterone or HCG) to support the lining of the uterus and to enhance the chances of the embryos implanting.

There is no restriction on activities including sexual intercourse.

6. Freezing of Extra Embryos
A proportion of patients may have excess good quality embryos. These may be frozen for future use. Patients do not need to undergo Controlled Ovarian Hyperstimulation and egg collection again for these future thaw cycles.

7. Pregnancy
You will need to come to KKIVF 17 days after the embryo transfer for a pregnancy test. You should call KKIVF if you are menstruating so that further instructions can be given.
If you are pregnant, subsequent ultrasound scans and blood tests will be arranged to ensure that the pregnancy is proceeding normally.

8. Useful Information
Success rates (KKIVF rates)
Our overall clinical pregnancy rate is about 30-35% per cycle and the take-home-baby rate is about 25-27%. Additional embryos frozen further enhance the pregnancy chances in many of our patients.

Generally, patients who are below 36 years old have a better pregnancy chance. However, your chances of success will depend very much on your own individual circumstances.

Besides IVF and ICSI (these are considered the final steps in the trying to concieve ladder), there are other options to try. like AIH, IUI, SO-IUI.

will post these in another entry - this entry is already far too long.

CD 64 supposed to pick up med to induce AF

it has been a while since i last updated this journal.

where did we stop? on CD42 - where we saw LA and he said to wait 2 more weeks.

about 2 weeks later 17/06, LA called to enquire on status, still perplexed over it. in the end, went to
see him the next day and got 2 blood tests done. one for HCG and the other for progesterone.

got the results on tues. confirm no pregnancy, no hcg at all. progesterone level has dropped so AF is suppose to be due soon.

LA suggested if it doesn;t come by Fri - to get some medicine from him to induce.

i think it's the same medicne that took 15 days to work, if that's the case, have to time it to take it later as DH is not around till thrid week of July.

will discuss with LA later.

Saturday, June 04, 2005

CD42 No AF still, saw LA

AF is now two weeks late. saw LA again to get medicine to induce AF. He didn't give me any and wanted to wait for another 2 weeks before seeing him again.

He's baffled that AF did not come at on its own as it should as i have ovulated.

Three possible scenarios - 1) KKH mixed up the blood test results 2) spontaneous miscarriage (should have AF though) or 3) i may really be pregnant even though the HPT is negative.

A blood beta HCG test is unlikely to detect hormone if a HPT cannot do so, as the strip ones are already very sensitive.

so well, it's back to the waiting game again.

Wednesday, May 25, 2005

CD 33 and no AF, negative HPT

looks like AF is not going to turn up on time. tested a couple of time on CD28, CD29 and CD33, negative HPT.

this cycle is shot.

emailed KKH, got a terse reply to continue with clomid and get duphaston to induce AF.
will wait till this sat CD36 and then decide what to do.

dun know how this duphaston thing work and how long it takes effect - if it takes too long to work, then the fertile period will fall when hubby's on reservist and then it all goes to waste.

CD 33 and no AF, negative HPT

looks like AF is not going to turn up on time. tested a couple of time on CD28, CD29 and CD33, negative HPT.

this cycle is shot.

emailed KKH, got a terse reply to continue with clomid and get duphaston to induce AF.
will wait till this sat CD36 and then decide what to do.

dun know how this duphaston thing work and how long it takes effect - if it takes too long to work, then the fertile period will fall when hubby's on reservist and then it all goes to waste.

Monday, May 16, 2005

CD21 blood test results is out today

got the results for the blood test this morning from KKH IVF.
I've ovulated. the numbers are 72.3 nmol. no idea what that means but i'm glad that i've ovulated nevertheless.


did some research on the net and came up with these links. will keep them here.
http://www.findarticles.com/p/articles/mi_m3225/is_n5_v44/ai_11666518

PROGESTERONE
Serum progesterone testing has been used as a screening tool to identify patients at risk for ectopic or other abnormal pregnancy. [16,17] With follow-up ultrasound scanning used for definitive diagnosis, a quantitative serum progesterone level of more than 25 ng per mL (80 nmol per L) proved 99 percent accurate in predicting a living intrauterine pregnancy. Sixty percent of the patients with progesterone values below 25 ng per mL had abnormal pregnancies.
and this other one
http://www.fertilityplus.org/faq/hormonelevels.html#progesterone
which has a chart with all the blood work required and the intepretation.

saw LA this evening as well. He said that almost 99% of his patients husband have low sperm count and they can still get pregnant. oh well, let see how it goes.

he named 6 factors of infertility. can't remember them all - no ovulation, blocked fallopian tubes, low sperm count, fribriods, unexplained infertility. can't remember the 6th one. he suggested to try a couple of months on clomid and if it doesn;t work, to go for a HSG to check for blocked tubes. he eliminated all except for fallopian tubes which he doesn't know till after the HSG.

(it was some time later with a new gynae that we found out that the CD21 blood test is an inaccurtae mtd to confirm an ovulation)

Friday, May 13, 2005

CD21 KKH sperm test results

went to KKH to get hubby sperm test results - the results are not promising. both density and form is way below normal. density at 6% per 10 million and form is 2% per 10 million. am rather shell shock by the results, and it's worse off for hubby.

saw a different doc this time round - Dr S. She's very professional and eh not very encouraging though in terms of what we can do to improve sperm quality. She suggested we do another sperm test in three months (late july) and we see what we can do from there.

was suppose to do a blood test for protestergone on CD23, but she said we can do it today which is CD21. so we headed to IVF for the blood test.will get results on mon afternoon.

after doing the blood test, we are suppose to make payment and get the next appt, we got a number and there were like 20 pple ahead of us in the queue. i didn't want to q and suggested that we go to the cafeteria instead, he refuse and i almost blow up in tears at that point in time.

in the end, he found a seat at the waiting area and after waiting 10 min, the q only moved by one person. i gave up and spoke to the counter gal to make fast payment. will get an appt via phone.
we headed back to see Dr LA with the intention to tell him about the sperm test results.

despite being told that we didn;t need an appt, his clinic was full. and we were told to wait for another half an hour. hubby was upset as the queue doesn't look like it will disapte within 2 hours, much less than half an hour. We left the clinic and i was upset.

anyways to make a long story short, i manage to call the doctor later in the afternoon, explaining to him the results. He claim that in his nine years of experience, he had only 5 good results from SA, and yet the gal still got pregnant. I donlt know if he's trying to reassure me or what. but i do know that this is a huge blow for darling. but nevertheless i told darling what LA said, hopefully this will kick him to start leading a healthier lifestyle.

Friday, May 06, 2005

CD14 Ovulation?

making love last night was just like having sex - didn't feel like it at all and feeling like crying after it all.

this is not working at all. i don't know why i am feeling this way. perhaps it's the idea of 'having' to do it. perhaps it's the stress of knowing that one 'have' to do it.

Thursday, May 05, 2005

CD13 and baby names

today is CD13, well we were supposed to start badydancing every other day since CD10. but then as i got a bad case of UTI and then subsequently got a sore throat and flu, hardly in the mood to baby dance.

got a scare last week, sun, got high fever and pain in lower back. saw the doctor at 5am in the morning, got a urine test done and then realised i got a bad case of UTI, well so much for following advise not to wash up immed after baby dancing. how embarrassing to see a doctor for that sort of infection.

anyways he gave some antibiotics and turned out im allergic to those as well, had a rash through to monday. what a lousy weekend.

the only up side? - got an MC for 2 days.

and well, it;'s CD 13 and we really should not waste this cycle. so maybe tonight is when we make our baby.

if it's a gal, her name will be leqi, if it's a boy, his name will be lei something (i've haven't really think this through yet)

other names which are already taken, kai ling & kai wen

Friday, April 29, 2005

AF finally here - end of clomiphene cycle

this should be posted like a week ago but hadn't got the time to do it.

well, AF finally came on Fri 22/04, for once in my life, i was jumping with joy that it came. surely there's some irony there.

anyways, full bleed started on Sat, and i'm suppose to take clomiphene on the second day. started first dose on Sunday, no symptoms whatever, so far so good.

symptoms started kicking in during the working week, AF stopped by Wed, which is rather startling as mine never stops when it should.

A nagging pain in the lower right abdomen and blurred vision by Wed made me panic. not to mention a total lethargic, not enough sleep me walking in the office.

gave a call to the gynae to list out symptoms - he said he had never in all his years of practicing had patients who experienced these symptons before and laughed it off.

i jokingly replied that perhaps i've been reading too much into it.

but then after i put down the phone, i felt kinda silly. am i imagining it all?

a post on a online forum, however came up with other women who have experienced blurred vision/mood swings/ sainzness etc. Thank goodness. i'm normal.

Perhaps it's really time to change gynae.

CD0 AF started Fri 22/04 (late at night)
CD1 Sat 23/04
CD2 Sun 24/04 - CD6 Thu 28/04 clomiphene 2 tabs per day
Most fertile period CD10 - CD20Mon 02/05 - Thu 12/05 - loads of baby dancing in store.

Friday, April 22, 2005

AF still not here yet. What cld be wrong?

finished the last dose of medicine on 18/04 Mon, and was hoping to see AF within the next couple of days - it's Friday 22/04 and still no sign or symptoms.

called the gynae yesterday but no reply from him or his office. as usual the dragon woman gets on my nerves.

called at 10am plus, she said will pass on msg, called at 2pm plus, said already passed msg to doc, called at 4pm plus said will remind doc, called at 6pm, kena tsf to voicemail, called at almost 8pm, someone answered and said doc in surgery till10pm, guess that's it. another sleepless night.

went to KKH with DH to give the SA. and it took us 41 min to drop off the sample. arghs. talk abt efficiency and following previous instructions given.

poor hubby, took ages to produce the sample at home...that despite not doing it for the past 3 days. i guess it doesn't help that i was laughing :P

by the time i reached the office, i decided to wait till 10am to call my gynae. in the end, called him at 945am, couldn;t wait any longer. he gave all reasons why he didn';t return call. i already guessed so but didn't have the patience to reassure him. LOL. i need assurance here.

anyways, he said to wait a couple more days and to do a UPT before heading to his office on Mon. so i could be pregnant - i asked abt the probability and he says he won;t know. right, i can;t wait for the weekend to be over.

oh yes, he said the medicine i've been taking is not of any harm to the baby if i;m really positive.

Thk goodness. IF.

a bit puzzled though, we did a UPT on the 08/04 and it was a negative, last week 15/04, the KKH gynae did a scan and he said the uterine lining is thick - as it shld be due to the AF inducing medicine - so how can be pregnant?

and if not pregnant - then why didn't the AF induce medicine work as it should work the last time?
will know by monday i suppose.

anyways anyways do i ahve a choice. someone suggested a blood test, shd i go for that?

still deciding or can we wait till monday? arghs.

actually didn't wait till monday to find out, during lunch time, wen to get a HPT form watsons and did a test - it's a negative, so there goes the hope. for a short time on friday like for 3 hours after the doctor's phonecall, i got high hopes that perhaps i didn't need to go thru all those fertility medicine,

oh well, it's not to be.

http://www.babycenter.com/pregnancy-calendar/getinfo?_requestid=326251

anyways i found this amazing website, all you need is to input some stuff and it give a day to day break down of what is happening now.

AMAZING.

Friday, April 15, 2005

Appt at KKH

Friday 15 April 2005

Was debating whether to go or not for this appointment after the horrendous polyclinic wait and feedback from posters in TTC that nothing much will be done as referred patients will be seen by a MO (medical officer).

in the end, i've still decided to go - my rationale was perhaps the diagnosis would be different (better?) - illogical. or perhaps the other doctor will confirm on what LA said and give the go ahead for treatment which will reassure us that LA knows what he's doing. anyways it's kinda convoulted.

been cranky and moody for the past few days, not sure if it's the medicine or just the waiting.Oh well, in the end did see the doctor at KKH. Lucky me, despite being a subsidised case, the doc on duty that day was the senior consultant. and he's really efficient and straight to the point. the type of doc i like.

despite waiting for over an hour to be registered, i reach there at 8.45am for a 9.10am appt, i didn't get to see the doctor till about 11am. by the time he's through with me and i got to collect prescription and stuff, i left the hospital close to 1pm. a looong looong day. i was totally exhausted by then.

how did the appt go?well, after being registered, you are suppose to go to another station where they take yr ht/wt and blood pressure. so you queue for that. 20 min or so.and after they done that, you go and wait for the doctor. eh this one is like an hour or so, judging that i got the first appt of the day.and then consultation is like 20 min (which is long, considering that other doctors are going thru their patients like 2 every 15 min)consultationThe doc is a nice guy, straight to the point and efficient. i don;t know why, but i wasn;t expecting efficient. maybe the concept of public hospital. therfore i wasn't expecting to be examined physically, expecting the first visit to be basically 'taking of medical history etc etc'The gynae said he will do a scan to confirm diagnosis. and his nurse appeared to tell me what to do. i was expecting a abdominal scan until the nurse told me to strip and put underwear 'in that drawer' - whoops.

I wasn't expecting a internal scan and frankly was rather embarassed. and certainly not mentally prepared for it. while being in that vulnerable position, he asked if i had a pap smear done before and i said no. He asked me why not? the gynae i'm seeing now says it's low risk hence not necessarily. He wanted to do one and called the nurse, and then asked me if i wanted one now?

in that position, the last thing i wanted is a pap smear. and i told him i will go back to my gynae for that. He nodded and inserted the probe in. He mentioned that the uterine lining is a little thick (which is normal as i'm taking medication to induce AF).he showed me the left polycyctic ovary and said that he can;t see the right one clearly. He ended up manipulating the probe about, trying to see the right ovary and was casuing me some pain. to his credit he did asked, if he was causing me pain. and i said yes, he gave up saying that my right ovary was too far away, and then printed some ultraounds.He then took the probe out. finally. The total scan didn;t take that long, maybe 5-10 min max but it felt like aeons to me and i ended up feeling brusied for the next couple of days.

the nurse came in and helped me off the table. got dressed and got his diagnosis. well he confirmed that i have PCOS (great surprise).he suggested that i see my currnet gynae for the clomiphene treatment for 3 months, and if that doesn't work to come back and see him for other alternative methods.

He then prescibed some vitamins for hubby, clomiphene for 3 months at 1 tab per day. and oh yes, a sperm analysis for hubby. I;m sure hubby is jumping with joy at the prospects of doing the sperm sample.

the sperm sample appointment.so after the consult, i'm suppose to go get a appt for hubby to deposit his sperm. to KKH credit, i am allowed to choose an appt, i wanted to know the results as soon as possible and picked the earliest appt next friday 830am. got detailed instructions and a small plastic container.

to anyone who is reading, it's nothing gross. just awkward. Hubby's suppose to clear his stuff on the 18/04, no activity for the next 3 days and produce the sample on 22/04 am into the sample before bringing it in within an hour.

The drop off is suppose to take less than 10min, all you need is drop of the sample and go. results will be given to ya via the doc at the next appt.

remember these instructions. so well, so i thought.

as you can imagine, hubby's like...into that small container, oh well, got to do what a man got to do.