Wednesday, October 25, 2006
ovarian drilling
PCOS AND INFERTILITYPCOS (Polycystic Ovarian Syndrome) is a condition that affects as manyas 10% of all women, or more. While researchers have been able todefine a fairly consistent set of symptoms for PCOS, they have notfound a singe cause, as of yet. It is a leading cause of infertility,and no cure has yet been found. The most common symptoms include:* Irregular menstrual cycles, or even the lack of cycles* Multiple ovarian cysts in many cases* Elevated blood pressure* Acne* Insulin resistance, or even diabetes* Infertility* Increased body and facial hair, along with alopecia (loss of hair)* Weight problems(From the Polycystic Ovarian Syndrome Associationhttp://www.pcosupport.org/medical/whatis.php)Other conditions that a physician may consider are “Cushing’s disease(overactive adrenal gland), thyroid problems, congenital adrenalhyperplasia or increased prolactin production by the pituitary gland.”Blood tests ordered may include thyroid functions, prolactin levels,17-hydroxyprogesterone, and a dexamethasone suppression test. In manycases PCOS sufferers will have elevated androgen (male hormone) levelsso these hormones will be tested as well. Insulin resistance is also aproblem so a two-hour glucose tolerance test will probably beperformed. Women with PCOS also have a number of cardiac complicationsso tests such as cholesterol, homocysteine, CRP, and PAI-1 levels maybe obtained to assess their cardiac risk factors.(From the Georgia Reproductive Specialists, http://www.ivf.com/pcostreat.html)Both of these sites have information regarding basic treatments forPCOS as well as brief introductions into various reproductivetechnologies. Since you have asked about a few things in particular, Iwill focus my detailed explanation on these three.- - - - - - - - - - - - - - - - - - - -OVARIAN DRILLINGOvarian drilling is a laparoscopic procedure, where instruments areintroduced through very small incisions in the abdomen, and thesurgeon uses a camera to guide him or her. A small needle puncturesthe cyst in the ovary, and then an electrical current is used todestroy part of the cyst. At Pregnancy-info.net, they state thatsuccess rates are less than 50%, but they do not specify what outcomesdetermine “success” in their opinions. At any rate, side effects, suchas scarring, could further impact the ability to become pregnant inthe long run.http://www.pregnancy-info.net/infertility_PCOS.htmlA study published in the British Journal of Obstetrics and Gynaecologyin March 1998 discusses success rates in achieving pregnancy afterovarian drilling. The study enrolled 118 women with documented casesof PCOS and then performed the procedure on them over a five-yearperiod. The total conception rate within the first 12 months after theprocedure was 54%. Women who successfully conceived had had “a shorterduration of infertility, were treated with diathermy (rather thanlaser), had higher pre-operative luteinising hormone [LH] levels, wereyounger and were more likely to have ultrasonographic evidence ofpolycystic ovarian disease.” When considering only women who had beeninfertile for 3 years or less prior to the procedure, the success rateincreases to 79%.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9532997&dopt=AbstractIn March 2005 a study regarding laparoscopic ovarian drilling (LOD)was published in the European Journal of Obstetrics, Gynecology, andReproductive Biology. In this study 45 women who had beenunsuccessfully treated with clomiphene (Clomid) were selected toundergo LOD. “Serum testosterone (T), follicle stimulating hormone(FSH) and luteinizing hormone (LH), fasting insulin and glucoselevels, body mass indexes, modified Ferriman Gallwey (FG) hirsutismscores of the subjects are recorded before and after the procedure.”After LOD, 93.3% of the women reported normal menstrual cycles, and64.4% achieved pregnancy spontaneously. “The serum levels of T, freeT, LH, LH:FSH ratio, insulin and FG scores were significantly reducedafter LOD, although glucose levels and glucose/insulin ratio remainedunchanged.”http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15734089&dopt=AbstractA smaller study was performed in 2002 at the Ayub Medical College inAbbottabad and the Khyber Medical College in Peshawar, both inPakistan. Sixteen women with PCOS were selected to undergo LOD. Theyall had a full infertility workup before the procedure, including a6-month trial of clomiphene. After the procedure 14 (87.5%) women hadregular menstrual cycles and 11 (68.8%) achieved pregnancy.http://www.ayubmed.edu.pk/JAMC/PAST/15-4/Azizun.htmIn a study published in 2004 in Human Reproduction, they list factorsrelated to pregnancy success after LOD. They state that, “markedobesity, marked hyperandrogenism and/or long duration of infertilityin women with PCOS seem to predict resistance to LOD. High LH levelsin LOD responders appear to predict higher probability of pregnancy.”http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15178663&query_hl=6&itool=pubmed_docsumA study reviewed in the Cochrane Database in 2006 shows no significantdifference in pregnancy rates after LOD versus treatment withgonadotropins (LH, FSH, HMG, etc.). About 50% of women will have alive birth and about 16% will have a miscarriage after achievingpregnancy. There were fewer multiple births associated with LOD,however.http://www.cochrane.org/reviews/en/ab001122.htmlA 2003 review article in Reproductive Biology and Endocrinologydiscusses various treatment options for infertility and PCOS. Theauthors reviewed multiple studies and compiled the data to determineoverall success rates. They report that 82% of women in the studiesexperienced ovulation following LOD and 63% achieved pregnancy. Thisdata compares favorably with a similar Cochrane review. The authorsalso state that if ovulation has not been achieved spontaneously after2-3 months following LOD, adding an ovulation stimulator (likeclomiphene) is more successful at this point than it would have beenbefore LOD.http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=14617367Other patient information sites seem to report the same 50% successrate for LOD (although I did see rates as high as 75% after 3 years).For the most part, it looks as though they are using birth rate ratherthan pregnancy rate to determine this success. This is the statisticthat will be most important to patients.http://www.womens-health.co.uk/infertility6.asphttp://www.ivf-infertility.com/infertility/treatment/ovarian11.phphttp://www.conceivingconcepts.com/medical/askthedoc/polycystic_ovaries/http://health.ivillage.com/gyno/gynoovaries/0,,677r,00.html
Thursday, June 08, 2006
random post - poem
oh little one
i wish i knew when i will be caring you.
feeling your kick hearing that heart beat.
knowing that you are mine.
oh little one.
How long do i have to wait
When will be our time to be Mommy and Daddy
to love someone else so much
with all our love and care
Oh little one
if you only knew how much we want you
to concieve you to make you
we love you so much
even if your only in our thoughts
Oh little one
I wanted to say.
Some day someday soon,
I believe i will be caring you
until than.. I just want to say I love you!
i wish i knew when i will be caring you.
feeling your kick hearing that heart beat.
knowing that you are mine.
oh little one.
How long do i have to wait
When will be our time to be Mommy and Daddy
to love someone else so much
with all our love and care
Oh little one
if you only knew how much we want you
to concieve you to make you
we love you so much
even if your only in our thoughts
Oh little one
I wanted to say.
Some day someday soon,
I believe i will be caring you
until than.. I just want to say I love you!
Wednesday, May 24, 2006
random post - incomplete d & c
been in the a & e for 3 nights consecutively for pain
i have never ecxpierenced such pain before (other than the last time, the night before the d & c)
finally, on the 3 rd night, the a & e doc was able to tell me what's wrong...it's due to an incomplete d & c that causes the pain as the body is trying to expel the remaining tissue.
yes, sf loh did tell that the d & c is not thourough as it will be the second one i am doing in about less than half a year, and he said the body will expel the remaining tissues but i NEVER expected the pain to be beyond what i can bear; and i know i have a high threshold of pain.
it's been one week since the d & c, and the pain has not abated, will be seeing him again today, been reading on the net and came across this article.
i think i will ask him about this.
http://www.reproline.jhu.edu/english/2mnh/2pa/pac_proc/broek1.htm
Postabortion Care Workshop Proceedings: Workshop Presentations
Issues in Establishing Postabortion Care Services in Low-Resource
Settings: Workshop Presentations
Use of Misoprostol for the Management of Bleeding in Early Pregnancy
Fredrik F. Broekhuizen, MD University of Wisconsin
Background
Misoprostol is a synthetic PGE1 analogue which is available in tablet form. It is closely related to other prostaglandins used in obstetrical practice such as Dinoprostone (PGE2), Carboprost (15 methylPGF2alpha), Gemeprost (PGE1) and Sulprostone (PGE2 analogue). Misoprostol was developed and marketed
for prevention of peptic ulcer disease caused by prostaglandin synthetase inhibitors, but with its potent uterotonic and cervical ripening activity has found applications in the management of gynecological and obstetrical problems. In the United States it has been marketed as Cytotec, with 100 and 200 mcg tablets available.
Misoprostol:
is inexpensive (US$.36 per 100 mcg);
is easily stored (shelf life 7 years);
has, in comparison with other prostaglandins, minimal effects on
cardiovascular and bronchial tree smooth muscle (can be safely
used in hypertensive patients and asthmatics);
is not affected by ambient temperature; and
needs no refrigeration, needles or syringes for its storage and
administration.
Mechanism of Action
Misoprostol is a myometrial stimulant which binds to E-2 and E-3
prostanoid receptors. Its active plasma metabolite is misoprostolic
acid. It is rapidly absorbed after oral, vaginal and rectal
administration. With oral administration the half life is less than
30 minutes, and peak level is at 15 minutes. After vaginal
administration, there is a gradual rise to a maximum level at 60–120
minutes, but at 240 minutes the level is still at 60 percent of peak
level (see below).
Comparative Effectiveness of Vaginal and Oral Administration
of Misoprostol
More side effects with oral use
At similar dose:
95% (vaginal) success vs. 87% (oral) in first trimester
Failure 1% (vaginal) vs. 7% (oral)
Abortion within 4 hours: 93% (vaginal) vs. 78% (oral)
Source: El Refaey et al 1995.
It is assumed that rectal administration results in a similar
profile. Vaginal dosing therefore can take place with longer
intervals than oral dosing for similar desired uterine effect, and
accumulation above "safe" levels with undesirable side effects can
take place. With oral and vaginal dosing of up to 400 mg every 8
hours, no accumulation has been noted and no accumulation has been
seen with a maximum of three doses of 400 mcg 3 hours apart.
Potential hypertonus as a result of drug accumulation could lead to:
uterine rupture in the second or third trimester,
fetal distress in the third trimester, and
high rates of nausea and diarrhea in all trimesters.
For obstetrical use, the vaginal application has been studied the
most. Misoprostol in the first and second trimesters is an effective
pregnancy termination agent either as a single agent or as an
adjunct to methotrexate or mifepristone. Misoprostol will
effectively dilate the cervix prior to surgical abortion.
Misoprostol has been studied as a cervical ripening and induction
agent in the last two trimesters. Its use as an alternative to MVA
or suction curettage for management of incomplete abortion (first
trimester), as a uterotonic agent in the active management in third
stage and as a treatment of postpartum hemorrhage are currently
being studied.
Applications of Misoprostol
Cervical priming prior to surgical abortion
Labor induction 24 weeks to term
Alone/adjunct for medical abortion
Management of spontaneous abortion?
Management of uterine atony
Misoprostol offers a potentially inexpensive treatment for life
threatening bleeding in pregnancy in developing countries in the
hands of frontline healthcare workers.
Research Results
The following section summarizes the status of misoprostol use in
early pregnancy.
Fong et al (1998) demonstrated that 400 mcg vaginal misoprostol
will dilate the cervix to more than 8 mm in 96.7 percent of
patients when it is given up to 3 hours or more prior to suction
curettage in the first trimester.
Carbonell et al (1997b) demonstrated that for gestations less than
63 days, misoprostol, given in a dose of 800 mcg vaginally and
repeated at 48 and 96 hours, resulted in a 92 percent complete
abortion rate, with 77 percent complete after one dose and an
additional 13.7 percent after the second dose; there was a failure
rate of 8 percent. Hausknecht (1995), Creinin et al (1995) and
Carbonell et al (1997a) all reported a 90–96 percent complete
abortion rate with methotrexate followed by misoprostol at 3, 5
and 7 days in a dose of 800 mcg; 20 percent of patients required
two or three doses.
In a review of the literature, Grimes (1997) concluded that class
I evidence and class A recommendations for first trimester
abortion existed for misoprostol as the most effective
prostaglandin, either as a single agent or as an adjunct (most
effective at the seventh day) to mifepristone or methotrexate.
El Refaey et al (1995) compared oral and vaginal doses and found
vaginal misoprostol use resulted in fewer failures.
These studies clearly establish misoprostol as an effective agent to
"empty" the pregnant uterus in the first trimester. One could assume
similar effectiveness when it is given for a "failed" pregnancy or
missed abortion. Blood loss in all of these studies was acceptable
and comparable to blood loss during surgical abortion.
Misoprostol is associated with birth defects in "continuing
pregnancies," and this is an obvious concern with unsupervised use.
Failed Induction Using Misoprostol
Congenital defect
Moebius Syndrome
Limb reduction defect
Mechanism of action
Placental bed ischemia
Embryonic vascular disruption
Source: Gonzalez et al 1998; Hofmeyr et al 1998; Pastuszak et al
1998.
This association is confirmed by several studies in Brazil, where
misoprostol is readily available over the counter. Moebius syndrome,
characterized by equinovarus, cranial nerve defects, arthrogryposis
and terminal limb defects, has been described with exposure to a
failed single dose of 800 mcg. Localized ischemia in the placental
bed and vascular disruption in the embryo are postulated as the
operational mechanism for causing the congenital anomalies.
Misoprostol Use in Incomplete Abortion
So far, only five studies regarding the use of misoprostol for
incomplete abortion have appeared in the peer review literature.
Studies regarding the management of incomplete abortion must be
considered against the natural history and expectant management of
this condition and its complications. Nielsen and Hahlin (1995),
comparing surgical evacuation and expectant management over a
72-hour period, reported that completed abortion occurred in 70
percent of cases in the expectant management group. The complication
rate was also lower in the expectant management group (3 percent)
compared to the surgical treatment group (11 percent). In a pilot
study of 20 patients, Creinin, Moyer and Guido (1997) found an 800
mcg vaginal dose more effective than a 400 mcg oral dose, with 88
percent complete evacuation. As shown in Table 1 below, Chung et al
(1997) in two prospective observational studies (none prospectively
randomized) found that 66 percent and 79 percent of patients managed
over a 48-hour period with 400 mcg misoprostol orally in three doses
did not require a curettage. A reference group had immediate sharp
curettage (D&C) and the complication rates (infection, repeat
curettage) were higher in the curettage group. Blood loss was not
systematically evaluated.
Table 1. Misoprostol for Incomplete Abortion
PROTOCOLRESULTS
354 cases by ultrasound
225 products of conception (POC)
102 empty uterus
137 reference cases
Misoprostol
Orally
400 mcg every 4 hours for three doses
D&C if incomplete after 48 hoursCompletion rate: 70.6%
101 in <>
i have never ecxpierenced such pain before (other than the last time, the night before the d & c)
finally, on the 3 rd night, the a & e doc was able to tell me what's wrong...it's due to an incomplete d & c that causes the pain as the body is trying to expel the remaining tissue.
yes, sf loh did tell that the d & c is not thourough as it will be the second one i am doing in about less than half a year, and he said the body will expel the remaining tissues but i NEVER expected the pain to be beyond what i can bear; and i know i have a high threshold of pain.
it's been one week since the d & c, and the pain has not abated, will be seeing him again today, been reading on the net and came across this article.
i think i will ask him about this.
http://www.reproline.jhu.edu/english/2mnh/2pa/pac_proc/broek1.htm
Postabortion Care Workshop Proceedings: Workshop Presentations
Issues in Establishing Postabortion Care Services in Low-Resource
Settings: Workshop Presentations
Use of Misoprostol for the Management of Bleeding in Early Pregnancy
Fredrik F. Broekhuizen, MD University of Wisconsin
Background
Misoprostol is a synthetic PGE1 analogue which is available in tablet form. It is closely related to other prostaglandins used in obstetrical practice such as Dinoprostone (PGE2), Carboprost (15 methylPGF2alpha), Gemeprost (PGE1) and Sulprostone (PGE2 analogue). Misoprostol was developed and marketed
for prevention of peptic ulcer disease caused by prostaglandin synthetase inhibitors, but with its potent uterotonic and cervical ripening activity has found applications in the management of gynecological and obstetrical problems. In the United States it has been marketed as Cytotec, with 100 and 200 mcg tablets available.
Misoprostol:
is inexpensive (US$.36 per 100 mcg);
is easily stored (shelf life 7 years);
has, in comparison with other prostaglandins, minimal effects on
cardiovascular and bronchial tree smooth muscle (can be safely
used in hypertensive patients and asthmatics);
is not affected by ambient temperature; and
needs no refrigeration, needles or syringes for its storage and
administration.
Mechanism of Action
Misoprostol is a myometrial stimulant which binds to E-2 and E-3
prostanoid receptors. Its active plasma metabolite is misoprostolic
acid. It is rapidly absorbed after oral, vaginal and rectal
administration. With oral administration the half life is less than
30 minutes, and peak level is at 15 minutes. After vaginal
administration, there is a gradual rise to a maximum level at 60–120
minutes, but at 240 minutes the level is still at 60 percent of peak
level (see below).
Comparative Effectiveness of Vaginal and Oral Administration
of Misoprostol
More side effects with oral use
At similar dose:
95% (vaginal) success vs. 87% (oral) in first trimester
Failure 1% (vaginal) vs. 7% (oral)
Abortion within 4 hours: 93% (vaginal) vs. 78% (oral)
Source: El Refaey et al 1995.
It is assumed that rectal administration results in a similar
profile. Vaginal dosing therefore can take place with longer
intervals than oral dosing for similar desired uterine effect, and
accumulation above "safe" levels with undesirable side effects can
take place. With oral and vaginal dosing of up to 400 mg every 8
hours, no accumulation has been noted and no accumulation has been
seen with a maximum of three doses of 400 mcg 3 hours apart.
Potential hypertonus as a result of drug accumulation could lead to:
uterine rupture in the second or third trimester,
fetal distress in the third trimester, and
high rates of nausea and diarrhea in all trimesters.
For obstetrical use, the vaginal application has been studied the
most. Misoprostol in the first and second trimesters is an effective
pregnancy termination agent either as a single agent or as an
adjunct to methotrexate or mifepristone. Misoprostol will
effectively dilate the cervix prior to surgical abortion.
Misoprostol has been studied as a cervical ripening and induction
agent in the last two trimesters. Its use as an alternative to MVA
or suction curettage for management of incomplete abortion (first
trimester), as a uterotonic agent in the active management in third
stage and as a treatment of postpartum hemorrhage are currently
being studied.
Applications of Misoprostol
Cervical priming prior to surgical abortion
Labor induction 24 weeks to term
Alone/adjunct for medical abortion
Management of spontaneous abortion?
Management of uterine atony
Misoprostol offers a potentially inexpensive treatment for life
threatening bleeding in pregnancy in developing countries in the
hands of frontline healthcare workers.
Research Results
The following section summarizes the status of misoprostol use in
early pregnancy.
Fong et al (1998) demonstrated that 400 mcg vaginal misoprostol
will dilate the cervix to more than 8 mm in 96.7 percent of
patients when it is given up to 3 hours or more prior to suction
curettage in the first trimester.
Carbonell et al (1997b) demonstrated that for gestations less than
63 days, misoprostol, given in a dose of 800 mcg vaginally and
repeated at 48 and 96 hours, resulted in a 92 percent complete
abortion rate, with 77 percent complete after one dose and an
additional 13.7 percent after the second dose; there was a failure
rate of 8 percent. Hausknecht (1995), Creinin et al (1995) and
Carbonell et al (1997a) all reported a 90–96 percent complete
abortion rate with methotrexate followed by misoprostol at 3, 5
and 7 days in a dose of 800 mcg; 20 percent of patients required
two or three doses.
In a review of the literature, Grimes (1997) concluded that class
I evidence and class A recommendations for first trimester
abortion existed for misoprostol as the most effective
prostaglandin, either as a single agent or as an adjunct (most
effective at the seventh day) to mifepristone or methotrexate.
El Refaey et al (1995) compared oral and vaginal doses and found
vaginal misoprostol use resulted in fewer failures.
These studies clearly establish misoprostol as an effective agent to
"empty" the pregnant uterus in the first trimester. One could assume
similar effectiveness when it is given for a "failed" pregnancy or
missed abortion. Blood loss in all of these studies was acceptable
and comparable to blood loss during surgical abortion.
Misoprostol is associated with birth defects in "continuing
pregnancies," and this is an obvious concern with unsupervised use.
Failed Induction Using Misoprostol
Congenital defect
Moebius Syndrome
Limb reduction defect
Mechanism of action
Placental bed ischemia
Embryonic vascular disruption
Source: Gonzalez et al 1998; Hofmeyr et al 1998; Pastuszak et al
1998.
This association is confirmed by several studies in Brazil, where
misoprostol is readily available over the counter. Moebius syndrome,
characterized by equinovarus, cranial nerve defects, arthrogryposis
and terminal limb defects, has been described with exposure to a
failed single dose of 800 mcg. Localized ischemia in the placental
bed and vascular disruption in the embryo are postulated as the
operational mechanism for causing the congenital anomalies.
Misoprostol Use in Incomplete Abortion
So far, only five studies regarding the use of misoprostol for
incomplete abortion have appeared in the peer review literature.
Studies regarding the management of incomplete abortion must be
considered against the natural history and expectant management of
this condition and its complications. Nielsen and Hahlin (1995),
comparing surgical evacuation and expectant management over a
72-hour period, reported that completed abortion occurred in 70
percent of cases in the expectant management group. The complication
rate was also lower in the expectant management group (3 percent)
compared to the surgical treatment group (11 percent). In a pilot
study of 20 patients, Creinin, Moyer and Guido (1997) found an 800
mcg vaginal dose more effective than a 400 mcg oral dose, with 88
percent complete evacuation. As shown in Table 1 below, Chung et al
(1997) in two prospective observational studies (none prospectively
randomized) found that 66 percent and 79 percent of patients managed
over a 48-hour period with 400 mcg misoprostol orally in three doses
did not require a curettage. A reference group had immediate sharp
curettage (D&C) and the complication rates (infection, repeat
curettage) were higher in the curettage group. Blood loss was not
systematically evaluated.
Table 1. Misoprostol for Incomplete Abortion
PROTOCOLRESULTS
354 cases by ultrasound
225 products of conception (POC)
102 empty uterus
137 reference cases
Misoprostol
Orally
400 mcg every 4 hours for three doses
D&C if incomplete after 48 hoursCompletion rate: 70.6%
101 in <>
so many things have happened since....
it has been a while since i updated this blog, so many things have happened since. i am totally numb, emotionally as well as mentally
i came across something that strike me just and i thought i post it here
i came across something that strike me just and i thought i post it here
Tuesday, April 25, 2006
cd 27 dpiui 13 blood test results
i didn't make any sense out of this result despite googling it on the net.
HCG is 29
Progesterone is 180
E2 is 3156
to return on thursday to take another blood test in the morning.
HCG is 29
Progesterone is 180
E2 is 3156
to return on thursday to take another blood test in the morning.
results, YES IT WORKED
yes yes yes it worked!!!!
the iui actualy worked. i was so weary of this cycle as i had bad cramps after the procedure, PT suggested i up the dose of the progesterone to 3 times a day, that made me really grouchy and tired and sleepy and the cramps didn;t completely go away as well.
met M for lunch the day of her IUI. and she is very encouraging. btu i didn;t have much hope for this cycle at all. the last 3 days of the 2www was hell, i couldn;t concentrate at work at all, i think effeiciency at work was down to 5%.
i tested on dpiui 10, which of course was a total BFN, dpiui 11 on sat which gave a super faint line 15 min after the test which hubby said he can;t see, dpiui12 on sun which gave a faint line that hubby could see...and dpiui13 on mon which has a faint line that both of us could agree we can see.
straight away i made an appt with PT to see him that afternoon, the cramps i am feeling can;t be good.
i was in two minds about telling my boss about the pregnancy since it;s still in such an early stage but i figured that it's harder finding excuses to stay off work and the numerous MC so far. also i figured it will give both of us more time to make alternative arrangements. between the baby and the job, needless to say when push comes to shove, the baby will come first.
thereforre i am so so glad that she is amendable to me working from home. that's a super huge relief off my mind.
the appt at 3pm went smoothly, the clinic took some blood and now i am waiting for the results. the nurse did ask if i want the results urgently, she said that it will cost an add $20 plus whether or not urgent, will onyl get results the next morning. as such i decided might as well save the money.
i called the clinic this morning but the results are not out yet, will only be available this afternoon, i sure wish i paid that add 20 bucks. i'm now sitting at my desk, un able to concentrate on anything, my attention span is like maximum 5 min, i don;t have appetite to eat either...arghs.
i really should ahve paid the additional 20 bucks!
the iui actualy worked. i was so weary of this cycle as i had bad cramps after the procedure, PT suggested i up the dose of the progesterone to 3 times a day, that made me really grouchy and tired and sleepy and the cramps didn;t completely go away as well.
met M for lunch the day of her IUI. and she is very encouraging. btu i didn;t have much hope for this cycle at all. the last 3 days of the 2www was hell, i couldn;t concentrate at work at all, i think effeiciency at work was down to 5%.
i tested on dpiui 10, which of course was a total BFN, dpiui 11 on sat which gave a super faint line 15 min after the test which hubby said he can;t see, dpiui12 on sun which gave a faint line that hubby could see...and dpiui13 on mon which has a faint line that both of us could agree we can see.
straight away i made an appt with PT to see him that afternoon, the cramps i am feeling can;t be good.
i was in two minds about telling my boss about the pregnancy since it;s still in such an early stage but i figured that it's harder finding excuses to stay off work and the numerous MC so far. also i figured it will give both of us more time to make alternative arrangements. between the baby and the job, needless to say when push comes to shove, the baby will come first.
thereforre i am so so glad that she is amendable to me working from home. that's a super huge relief off my mind.
the appt at 3pm went smoothly, the clinic took some blood and now i am waiting for the results. the nurse did ask if i want the results urgently, she said that it will cost an add $20 plus whether or not urgent, will onyl get results the next morning. as such i decided might as well save the money.
i called the clinic this morning but the results are not out yet, will only be available this afternoon, i sure wish i paid that add 20 bucks. i'm now sitting at my desk, un able to concentrate on anything, my attention span is like maximum 5 min, i don;t have appetite to eat either...arghs.
i really should ahve paid the additional 20 bucks!
Monday, April 24, 2006
the rest of this cycle
It has been a while since i have updated on the status of this cycle. After the scare of a stuck ovary and the mini lecture by LA, i realised that a gynae is still the best person to analyse the situation.
made an ppt to see PT at TMC and got scanned, yes the ovary is behind the womb but it's not stuck and it's un likely to be stuck cause of no previous history of addominal surgery. a huge phew. a little knowledge is a dangerous thing. remind me to get a christmas hamper for LA!
follicles at 18mm and not ready to do IUI yet, will re schedule another scan on Monday at CARE.
on Mon, PT deems ready to go with the IUI the next day, i didn;t ask about the follicles size, figured whether i knew or not doesn't make any difference. anyways got the HCG jab done by eileen, ouch it's as painful as the last time.
i got back to work, but didn;t feel so good, took half a day off and went home to rest.
the next day is the big day. went to CARE in the morning at 830am with hubby to provide the sample, paid the bill of 500 plus and had a couple of hours to while away. we had breakfast at delifrance, then went down to sph to collect the free fryer....and it took us all of half an hour. at 9am, we still have 2 hrs to spare.
in the end we went down to borders and spent the next hour or so browsing, i ended up buying 2 books, a novel by robin cook and guess what a infertlity book, the latest one to print. a flip thru it is pretty informative, will update more later. during this time, another friend sms me saying she's going for IUI the next day. good for her.
we still got half an hr to go, so we decide to head back to paragon, went to metro and decided to look at shoes, well i didn't get any shoes but i got a blouse from dorothy perkins. :P shopoholic u may say but hey retail therapy always worked.
finally 1130am, got the sample and headed straight to TMC. we waited about 10 min before i was told to prepare for the procedure. like the last time,n it was done in a separate room. i was all prepped and ready when PT came in. the procedure itself was pretty fast with the usual equipment not staying where it should stay. the doc commented that i had a lot of CM which i suppose is good rather than bad.
anyways after the procedure, hubby came in and we rested for 20 min. settled the bill of 257 and took the medicine before going home. now is the start of the 2ww.
the 2ww is the worst part of the whole cycle. it's a waiting game from now onwards.
made an ppt to see PT at TMC and got scanned, yes the ovary is behind the womb but it's not stuck and it's un likely to be stuck cause of no previous history of addominal surgery. a huge phew. a little knowledge is a dangerous thing. remind me to get a christmas hamper for LA!
follicles at 18mm and not ready to do IUI yet, will re schedule another scan on Monday at CARE.
on Mon, PT deems ready to go with the IUI the next day, i didn;t ask about the follicles size, figured whether i knew or not doesn't make any difference. anyways got the HCG jab done by eileen, ouch it's as painful as the last time.
i got back to work, but didn;t feel so good, took half a day off and went home to rest.
the next day is the big day. went to CARE in the morning at 830am with hubby to provide the sample, paid the bill of 500 plus and had a couple of hours to while away. we had breakfast at delifrance, then went down to sph to collect the free fryer....and it took us all of half an hour. at 9am, we still have 2 hrs to spare.
in the end we went down to borders and spent the next hour or so browsing, i ended up buying 2 books, a novel by robin cook and guess what a infertlity book, the latest one to print. a flip thru it is pretty informative, will update more later. during this time, another friend sms me saying she's going for IUI the next day. good for her.
we still got half an hr to go, so we decide to head back to paragon, went to metro and decided to look at shoes, well i didn't get any shoes but i got a blouse from dorothy perkins. :P shopoholic u may say but hey retail therapy always worked.
finally 1130am, got the sample and headed straight to TMC. we waited about 10 min before i was told to prepare for the procedure. like the last time,n it was done in a separate room. i was all prepped and ready when PT came in. the procedure itself was pretty fast with the usual equipment not staying where it should stay. the doc commented that i had a lot of CM which i suppose is good rather than bad.
anyways after the procedure, hubby came in and we rested for 20 min. settled the bill of 257 and took the medicine before going home. now is the start of the 2ww.
the 2ww is the worst part of the whole cycle. it's a waiting game from now onwards.
Thursday, April 06, 2006
Cycle 4 - CD9
06 April 2006 Thur
angela did the scan this morning, commented the following:
retroverted uterus - that's new!
one of the ovaries stuck behind the womb - no known cause, no way of prevention, not due to d & c, will affect egg retrival if doing IVF.
the good news
2 follicles on L/R? ovary - 10mm each
1 follicle on the L/R stuck ovary - 13mm
lining is thin for CD9 - at 5.7mm, ideally should be 9mm by now. she prescribed estrodiol to be taken 3 times a day.
clomid can cause anti estrgenic effects which means that there is not enough estrogen in the body to make a thick lining.
the body creates further resistance to clomid after each cycle, hence even after a break of a few months, clomid will no longer work to induce ovulation.
this is where it becomes anti estrogenic and cause the cervical mucus to be hostile to sperm and as well depreciate in quanity.
to return on sat for scan, to test LH surge on fri, twice a day, AM and Eve.
IUUI probably on Mon or tue depending on Sat scan, will update later.
angela did the scan this morning, commented the following:
retroverted uterus - that's new!
one of the ovaries stuck behind the womb - no known cause, no way of prevention, not due to d & c, will affect egg retrival if doing IVF.
the good news
2 follicles on L/R? ovary - 10mm each
1 follicle on the L/R stuck ovary - 13mm
lining is thin for CD9 - at 5.7mm, ideally should be 9mm by now. she prescribed estrodiol to be taken 3 times a day.
clomid can cause anti estrgenic effects which means that there is not enough estrogen in the body to make a thick lining.
the body creates further resistance to clomid after each cycle, hence even after a break of a few months, clomid will no longer work to induce ovulation.
this is where it becomes anti estrogenic and cause the cervical mucus to be hostile to sperm and as well depreciate in quanity.
to return on sat for scan, to test LH surge on fri, twice a day, AM and Eve.
IUUI probably on Mon or tue depending on Sat scan, will update later.
Friday, March 17, 2006
The Private Suite at KKH
Called on Mon 13 Mar to make the appt to see Dr SF Loh. He had very good reviews at the Motherhood forum for successful IVF cases. I was prepared to do IVF.
After being put on hold for ages, i was half expecting that the appt would be 3 weeks down the road (KKH efficiency) but was pleasantly surprised that there's an available slot that Wed evening. confirmed the appointment.
Was pretty impressed with TPS, the set up is so totally differnt from the normal clinics at KKH, for 6 bucks more, you get shorter waiting time, a beautiful and comfortable waiting area replete with magazines and hot drinks, a sms system that inform you of your appointments, the designated doctor that you want to see and super friendly nurses and service staff. overall impressed by the service rendered.
the doc was good, i;ve seen him before almost exactly a year back, this time round he didn't suggest IVF but to continue to try with clomid and IUI. He started me on metformin, 3 tabs of clomid and med to induce AF.
basically he put me on ovualtion monitoring at KKH IVF centre..and thats' where things start to go wrong.
When i called KKH IVF, i found out that they didn;t have a evening or a weekend clinic, the clinic which opens at 730am doesn't do scans till 8.30am and it takes approximately 1 hour waiitng time in the morning.
for ovulation monitoring, each cycle will need approx 3-5 scans, i cannot possible afford the down time from work. i am relunctant to take time off from work nor prepared to let my colleagues know about this yet.
enquiring further, I found out that besides the infelxibility in fixing appointments for scans, th scans are done by the sonographer on duty and the results reviewed by the team of doctors, not necessarily the designatd doctor.
the IUI procedure itself is also not necessarily done by the designated doc but by which ever doc who was on duty on that day. i wasn't prepared for that. the reason why i chose KKh was because of the good reviews about SF Loh, i trust his expertise not the rest of his team!
the last factor was cost. The package to do IUI at KKH IVF is not at any way subsided, which means one pay full price.
The scanning package is $300 for unlimited scans, urine tests at $15 per test (usually need about 3-4 tests), for IUI procedure which includes sperm washing (enhancement) and hcg jab cost another $300.
Before IUI can be done at KKH IVF, both parties need to go for blood tests to screen for AIDS, STD and rubella for the female, that will cost another $50 per pax plus $23 for the rubella test.
add together, the full package will cost about $780.
that sounds very expensive as compared to being done elsewhere or perhaps even in the private practice.
because i can't take that much time off from work, i got to look for other alternatives.
I thought of the CARE centre at paragon where we did the sperm washing for the last IUI, i remembered that they did IVF procedures as well, surely they do IUI as well.
and bingo they do. Their package comes to about $600 which includes everything above plus they do a additional scan at CD2 to rule out cysts. fantastic, this seems especially value for money, since they are able to scehdule the appointments before i start work or even during my lunch time. it helps that the centre was 10 min walk away from my working place.
according to the lady, each scan should take less than 30 min from stepping into the clinic to stepping out. thank goodness, indeed this is a lifeline. this would mean that i only need to take one day off which is on the day of the IUI itself.
Angela from the CARE centre was an absolute help. She suggested that since we were on 3 cycles of clmoid and still not preggy, we should consider other options. I would agree if the last IUI had not worked, but since it worked on clomid the last time round , i am willing to give it a try again, esp since i am now on metformin as well.
so currently my plan is as such
taking medicine to induce AF - for 10 days starting 15 Mar Wed
AF expected within 3 days
CD2-CD6 - 3 tabs of clomid
on CD2 to go to CARE for scan
total expenses so far
$90 for first time consult at the TPS
$42 for 3 months worth of metformin, clomid and folic acid (hoping that I donlt need 3 months of supply)
expected expenditure
$600 for CARE package
After being put on hold for ages, i was half expecting that the appt would be 3 weeks down the road (KKH efficiency) but was pleasantly surprised that there's an available slot that Wed evening. confirmed the appointment.
Was pretty impressed with TPS, the set up is so totally differnt from the normal clinics at KKH, for 6 bucks more, you get shorter waiting time, a beautiful and comfortable waiting area replete with magazines and hot drinks, a sms system that inform you of your appointments, the designated doctor that you want to see and super friendly nurses and service staff. overall impressed by the service rendered.
the doc was good, i;ve seen him before almost exactly a year back, this time round he didn't suggest IVF but to continue to try with clomid and IUI. He started me on metformin, 3 tabs of clomid and med to induce AF.
basically he put me on ovualtion monitoring at KKH IVF centre..and thats' where things start to go wrong.
When i called KKH IVF, i found out that they didn;t have a evening or a weekend clinic, the clinic which opens at 730am doesn't do scans till 8.30am and it takes approximately 1 hour waiitng time in the morning.
for ovulation monitoring, each cycle will need approx 3-5 scans, i cannot possible afford the down time from work. i am relunctant to take time off from work nor prepared to let my colleagues know about this yet.
enquiring further, I found out that besides the infelxibility in fixing appointments for scans, th scans are done by the sonographer on duty and the results reviewed by the team of doctors, not necessarily the designatd doctor.
the IUI procedure itself is also not necessarily done by the designated doc but by which ever doc who was on duty on that day. i wasn't prepared for that. the reason why i chose KKh was because of the good reviews about SF Loh, i trust his expertise not the rest of his team!
the last factor was cost. The package to do IUI at KKH IVF is not at any way subsided, which means one pay full price.
The scanning package is $300 for unlimited scans, urine tests at $15 per test (usually need about 3-4 tests), for IUI procedure which includes sperm washing (enhancement) and hcg jab cost another $300.
Before IUI can be done at KKH IVF, both parties need to go for blood tests to screen for AIDS, STD and rubella for the female, that will cost another $50 per pax plus $23 for the rubella test.
add together, the full package will cost about $780.
that sounds very expensive as compared to being done elsewhere or perhaps even in the private practice.
because i can't take that much time off from work, i got to look for other alternatives.
I thought of the CARE centre at paragon where we did the sperm washing for the last IUI, i remembered that they did IVF procedures as well, surely they do IUI as well.
and bingo they do. Their package comes to about $600 which includes everything above plus they do a additional scan at CD2 to rule out cysts. fantastic, this seems especially value for money, since they are able to scehdule the appointments before i start work or even during my lunch time. it helps that the centre was 10 min walk away from my working place.
according to the lady, each scan should take less than 30 min from stepping into the clinic to stepping out. thank goodness, indeed this is a lifeline. this would mean that i only need to take one day off which is on the day of the IUI itself.
Angela from the CARE centre was an absolute help. She suggested that since we were on 3 cycles of clmoid and still not preggy, we should consider other options. I would agree if the last IUI had not worked, but since it worked on clomid the last time round , i am willing to give it a try again, esp since i am now on metformin as well.
so currently my plan is as such
taking medicine to induce AF - for 10 days starting 15 Mar Wed
AF expected within 3 days
CD2-CD6 - 3 tabs of clomid
on CD2 to go to CARE for scan
total expenses so far
$90 for first time consult at the TPS
$42 for 3 months worth of metformin, clomid and folic acid (hoping that I donlt need 3 months of supply)
expected expenditure
$600 for CARE package
restarting the TTC process
The last attempt at TTC was the IUI done in Sep 04, the d & C was done on 18 Oct, since then, nov was a shattering month, coping with the loss as well as coping with the loss of the job, the company having closed down, tying up loose ends.
Started the new job in Dec with great enthusiasm and throwing myseklf in work to get over it. got confirmed in the job in early Feb and toyed with the idea of restarting the TTC process again.
in early march, had a bout of stomach flu which triggered the thought that perhaps i got miraculously pregnant as i was throwing up a lot. turn out that well it was stomach flu after all. that got me to seriosuly think about TTC again.
Started the new job in Dec with great enthusiasm and throwing myseklf in work to get over it. got confirmed in the job in early Feb and toyed with the idea of restarting the TTC process again.
in early march, had a bout of stomach flu which triggered the thought that perhaps i got miraculously pregnant as i was throwing up a lot. turn out that well it was stomach flu after all. that got me to seriosuly think about TTC again.
Subscribe to:
Posts (Atom)