TTC @ HUKM - Second attempt with femara

Assalammualaikum and good day everyone!

Looks like last month's attempt is a total bfn. Well it is ok, coz we didnt expect much on the 1st attempt right. Well let me recap what have we done last cycle.

We took femara for 5 days starting day 2-5. Then we had a tvs on day 10 with 2 potential follicle with size 10mm on the right ovary and 1 follicle with size 11mm on the left ovary. Then another tvs on day 13, but with only 1 potential follicle sized 18mm on the left. So after discussing with doc maiza (a phd student under prof hashim), we triggered with ovidrel the next day and BD 36 hours later. However, doc maiza noted that since i had questionable ectopic pregnancy on my left tube last ivf, maybe my tube is not healthy enough to done its job or worse, not function anymore. But doc maiza asked us to have faith and just try. We had our beta hcg done on 10dpo and the result is less than 2. Af came on cd32.

So, we just came back for another visit to prof hashim, and despite of the left tube issue, he is very satisfied with my cycle last month as my af came 14 days after i ovulate. So he said that im ovulating, that is the good news. I also asked him whether we need another HSG done for the left tube, but he said, if it is blocked, u still have another tube functioning. So, we postpone the HSG procedur to try for another cycle as we are very optimist about my body for now. 

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Prof provide me with another femara, same dose 7.5mg, to be taken starting today (cd2-cd5) and come back for a scan on cd14. However since this month will be the month of ramadhan, tvs will not take place, just a normal abdominal scan will do. I dont know if the sonographer can actually sees the follicle grew using this abdominal scan. It is hard to see. Hurm..

Well, do pray for this cycle to be a miracle one! May this bless month give us hope and joy of ibadah and also, babies! Amin.. Happy celebrating ramadhan my fellow friends! Keep ttcing and keep praying for us too!!

TTC @HUKM - 1st appointment

Assalammualaikum and good day everyone.

Today i decide to write in 80% english language. Another 20% will be in my mother's tougue language, which is Malay Language. It is because i want any information writen to be useful for all my friends around the world. *ntah ade ke pembaca dari omputih ni..kih3..biaq pi lah*. And also, i want to improve my english writing skills, so if there is any grammatical mistakes, please, do guide me ok.

It's been a while since my last entry. After about a month break from ttcing, we went to prof hashim's clinic at HUKM private wing. FYI, hukm provide 2 clinics for fertility, one in the Medical Assisted Conception (MAC) clinic, which is the government sector part, one in private sector at level 7. We chose to go to private sector since our record is already there, when we sought for a second opinion on my ectopic, and also to cut all the other procedur needed in MAC (well this one i didnt know much about, maybe they need you to do certain test or queue up or something).

The first visit was very simple and quick, appointment was made 1 month before the appoitnment date because Prof is going overseas for about half a month, so we didnt manage to see him before he go. Usually, if you are lucky enough, the 1st appointnment will be around 2 weeks. I was schedule to see him at 3pm. So we arrive at 2.30pm, register at nurse counter and i got number 5 out of 7 patient during 3-4pm session. Not bad. So we went for solah first, and wait in front of his room. The queue was rather quick actually. By the time i came back from solah, there is already 3 patients had seen him. So, i waited for about another half an hour and our name were called.

Upon seeing him, he smile at us and ask what is our plan. We said that we wanted to try again after the miscarriage and we will do whatever he suggested. He then said that the key treatment for pcoser like me is to regulate my period back. According to his experience, with 3 cycle of period, and proven ovulation, pcoser can get pregnant naturally. So he suggested for me to take diane for 2 cycle, and start fertility drugs in the 3rd cycle. We agree. He also put me on metformin 850mg daily for my insulin resistant, although i do not have this yet but pcoser tend to have this sooner or later, and metformin can improve my hormonal imbalance during fertility treatment. I will explain about this further in other post about drugs ok.

So no ivf this year i think. Just back to basic. Well, i actually relieve because i know we are in a care good hands. Prof Hashim is the head of MAC and had experience in consulting many couples and also teaching in UKM. As according to doc adilah, he is a practical person, he may not do what exactly the book said, but he knows how to apply them, and he knows what he is doing. Tq doc adilah for suggesting him.

Ok, some of you may worries on him being your fertility doctor since he is a male. Well, i will discuss this matter in other post ok.

Until then.. Byeee

Study pre treatment

Assalammualaikum wbt

Tak sabar rasenye nk start treatment. So sblm kita mula kena ada pengetahuan psl possible treatment kan.

Selongkar la balik nota2 lama..so here it is:

Paham ke?? Haha..

Ok meh sini sy terang sikit2..

Secara amnya, kitaran haid kita bermula bila hari pertama dtg haid, atau bahasa TTC nya CD1. pada waktu ni, hypothalamus di otak akan sgt aktif utk rembeskan hormon Gonadotropin releasing hormone (GnRH) iaitu GnRH akan ransang kelenjar pituitari di sblh hypothalamus utk rembeskan hormon Follicle Stimulating hormone (FSH). FSH akn masuk dlm salur darah dan pergi ke ovari lalu menggalakkan pertumbuhan folikel. folikel akan membesar dan matang. folikel yg matang akan merembeskan hormon estrogen, dan hormon ini akan memberhentikan perembesan FSH bagi menunjukkan folikel tidak lagi diperlukan. fasa folikular ini berlangsung sewaktu anda period dan selama lbh kurang 14 hari.

bila telur matang, bermula fasa ovulatory iaitu hormon Luteinizing (LH) akan dirembeskan dan selepas 32-36jam telur yang matang akan keluar dari ovari. sarung telur atau corpus luteum akan tertinggal di dlm ovari dan ia berfungsi utk perembesan hormon progesterone. hormon progesterone sgt penting utk penebalan dinding rahim sebagai persediaan utk penempelan. waktu ini digelar waktu subur. waktu subur boleh diukur 14 hari sebelum datang haid utk sesiapa yang mengalami kitaran tetap

selepas itu, bermula Luteal phase dimana telur yg dilepaskan akan bergerak ke rahim melalui tiub fallopio dimana persenyawaan mungkin berlaku di sini. waktu yg diambil utk telur yg disenyawa bergerak ke rahim ialah dlm 6-7 hari. waktu ini hormone progesterone adalah tinggi. jika tiada persenyawaan, 14 hari dari telur keluar, hormone progesterone akan berkurang kerana corpus luteum mati dgn sendirinya dan dinding rahim akan luruh sbg darah haid. jika ada bersenyawaan, telur akan menempel di dinding atas rahim dan perembesan hormon progesteron akan diambil alih oleh placenta.

jadi, pengambilan ubat subur juga berkait rapat dengan kitaran hormon kita. sila rujuk gambar rajah:

1. clomiphene sulphate (clomid)
ubat clomid ialah ubat yang paling murah dalam bentuk tablet dan selalu digunakan utk rawatan kesuburan. clomid bertindak sebagai perancang hypothalamus utk merembeskan GnRH. so GnRH tinggi, FSH tinggi, peluang untuk folikel matang pun tinggi.

2. Letrozole
ubat ini pada asalnya digunakan utk merawat kanser payudara pada wanita yg menapouse. secara amnya ubat ini menurunkan kadar estrogen dalam badan. ia guna sebagai alternatif kepada clomid kepada pesakit yang tidak memdapat kesan darinya.

2. Gonadotrophin (FSH/LH)
ubat ini biasanya dalam bentuk injeksi dimana ia boleh gabungan antara FSH & LH atau berasingan. biasanya Dr di sini akan bagi Brand Puregon utk FSH. hormon ini adalah mimik kepada FSH dan membantu utk pertumbuhan folikel secara direct (xperlu diransang oleh GnRH)

3. Human Chorionic Gonadotrophine (HCG)
hormon ini mimik LH iaitu utk pelepasan telur yg matang ke dalam tiub fallopio.

4. Lain2 ubat yang berkaitan
terdapat beberapa ubat yang bukan ubat hormon tetapi membantu dlm kesuburan, seperti metformin. metformin pada asalnya adalah ubat kencing manis yg berfungsi utk mengawal kadar gula dlm darah. PCOS amat sensitif pada gula dan kebanyakkan mereka akan mengalami insulin resistance. bila pasa insulin berterabur, ia mempengaruhi hormon2 lain juga. jadi doc biasanya akan beri metformin sekali dengan clomid jika rawatan dengan clomid kurang berkesan. bromocriptine dan carbegoline ialah ubat untuk mengawal hormon prolactin yang menyebabkan penghasilan susu berlebihan atau hyperprolactenimia. ini disahkan melalui simptom penghasilan susu di puting. apabila level prolactin tinggi, progesterone akan rendah.

ok itulah secara ringkas apa2 yg teringat kat kepala ini..huhu..mencabar jugak jadi gynae ni..mcm2 kne ingat..aduiyai..

so, skrg saya tgh on Clomid 100mg OD dan inj Puregon (FSH) 50iu EOD. wish me luck! aminn