CD 7 - Ivf #2 Scanning day

Assalammualaikum wbt,

So today, after 6 days of menopur injection. We had our 1st scan. We came to the clinic quite late. Scanning at hukm is always in the morning before 11am, and we arrive around 10.50am. Luckily i was not the last person to arrive. I hand over my blue planning sheet, that everybody will have when they start their assisted cycle here, to the nurse counter. This sheet is very details about your fertility and treatment that you had and currently take. The nurse will later issue a green sheet for you to pay for today's bill. Follicular tracking is about RM53 for the whole cycle. This means that you only pay once for how many scan you have for that particular cycle. After payment had been made, the nurse will give you a waiting number to scan.  By the time i got the number, it is already my turn. 

 

The scanning lady is an embryologist called fazilah. I like her very much compare to others as she is friendly and always entertain my question. I was so nervous abiut this scan. Will my follicle response well to menopur?

Fazilah sat there beside me with the scanning device. Once she inserted it inside me, she was very shocked and excited as well (i think). She repeatly said,"banyaknya...banyaknya...(so many, so many..)". There i was relieve and scared too. This is the longest scanning session i had. She said she need to properly know the place of each follicle as there were so many and they are in layers. So, this is the result:

There are about 15-20 follicles each ovaries! And the size are varries, some are ok for cd7, some are big enough to matured in a few days. No wonder i start to feel bloated and full. 1 thing i know for sure, menopur works wonders for me alhamdulillah. My endometrium lining also looks good (size: 6.5mm). And my ovaries location is assessible. This is also important as in my last ivf cycle, my doctor cannot reach the right ovary as it was very high. So only follicles at left ovary were being retrived. Below is the picture of my ovaries with follicles. 

After scanning, i handover the paper to the nurse at the counter, waiting for doctor to review my findings. Usually they just text my doctor if he is not around. After waiting for quite sometimes, finally the called my name. My doctor said to continue menopur for another 3 days as plan. So they wrote me an online prescription, and gave me syringes and needles. I need to collect the medicine at the NF pharmacy. We went to have lunch first at the hospital cafe near the emergency department because we knew the queue at pharmacy will be long, and it is already 12.30pm. 

Just as we thought, it was about 20 people waiting before my number turned up. 

This is the total cost of the injection: 

 Rm701 for 9 vials menopur. And always remember to bring along your cold box/bag with ice pack, as this medicine need to maintain its temperature. We head back home at 1.30pm.

Today's expenses:

Follicular tracking at clinic: RM53

3 days supplyof 225iu menopur injection: RM701

Valet parking: RM12 (for 3 hours)

Tolls

Total : RM53+RM701+RM12+

P/s: i will upload the reconstitution video in my next post as i am editing it a bit.

P/s/s: i am worried about ohss, as my tendency to get it is very high at this point. I have started to feel nauseatic a little. 

Cd1 - Ivf #2

Assalammualaikum wbt.

I got my period at 5pm 7/2/18. So CD1 will be counted tomorow, 8/2/17. Exactly 7 days after i stopped duphaston and proluton injection (i restrained my self from scratching the site of injection, so the lump is slowly not getting worse compare to last months').

On the 8th afternoon, we went to Medical Assisted Conception clinic (MAC hukm) to collect my medicine. I am prescribed 225iu menopur once a day for 10 days. However they will only supple me for 6 days as i need to scan on day 7. I bought the inj at NF pharmacy, which is a pharmacy that sell non-formulary items or for fully self-paid patient like me. I vial contain 75iu (RM77), so i need 3 vial per day. So can u do the math how much it cost me?

Haha that is the price for the medicine only. 

 1 vial of menopur 75iu with 1ml sodium chloride as a solvent. We need to reconstitute this ourselves. So DH is the pharmacist/nurse for reconstitution and i will do the injection myself (he insist to do the injection, but i dont trust him that much! Haha) I will record how he reconstitute this in the next post inshaAllah (he is sure very proud of his work of art)

 We only use 2 vial of sodium chloride for 3 vials of menopur. This is to reduce amount of reconstitution injected.

  And this is the final bill for 6 days injection. RM 1404.20

I wonder if menopur will shorten your menses. Today is only cd3, and my period is almost ended! This is very unusual. I got to ask my doctor during scan later. So, my scanning date will be on cd7, 13/2/2017. Wish me luck and hope my egg and follicles mature and has more than 10 each ovaries. Amin

Hai back blog! It's been a while.

Assalammualaikum wbt,

First, my apology to my blog and all my readers for not updating my ttc journey for almost half a year! I've been lazy and lack of thought ideas on what to jot down here. Huhu

Second, i will tell you guys what had i done in this past 2016. Basicly we were doing exactly what our doctor recommend us. Yes we still seeing Prof Hashim in HUKM up until now. So, the choronology was:

Mac 2016: 1st appointment with prof hashim. Started Diane 35 to regulate my period before starting any fertility treatment. I has to take it for 2 consecutive month

May-july 2016: start fertikity drug Letrozole (Femara) with self insemination (timing BD). BFN

Still no luck, then we take a break for about 2 month before starting over.

October 2016: i requested another HSG done. So we went to hospital tawakal for hsg with doctor fatimah. She was very friendly. This second-time hsg went very smoothly with zero pain at all! Unlike my first hsg, it was a nightmare, you can read that here [Hsg Experience] and here [Post Hsg Complication]. However the result was not not-ok, but not pleasing either. The dye successfully went through my womb, fallopion tubes and then out from there, but, they stay inside my abdomen cavity for quite sometime. So, doctor indicate some peritubular adhesion. This adhesion maybe at the fallopion tube-ovary cavity. In layman term, maybe my tube isnt directly connected to my ovary. Well, for fact, ovary is like floating balloon and it is not directly attach with the tube, even in normal condition. So, when egg is released, tube had to catch the egg with its fingerlike structure. However, the adhesion makes the connection much worse. So, prof hashim suggest us to try again for 2 more cycle before going to any other option. This time he prescribe femara+clomid for a month, and femara for 10 days (normal regimen will be 5 days).

December 2016: femara+clomid with timing bd. BFN

January 2017 : femara for 10 days with timing bd. BFN

So now, im tired. Our next option is IVF or adoption. My DH suggest we try another cycle of ivf. So today, we went to see prof hashim to discuss for ivf.

2 feb 2017: prof hashim agree for us to proceed with ivf, since he said it is very unlikely that any of the cycle is not a success. So maybe his theory about the adhesion is true. However he did gave us another option before starting ivf. He named it "rejuvenate cycles", where we suppress my menses for 3 month to bring my physiology to the state of before my menses first started. This is to increase receptor of the egg so that many egg will matured and release. He said from his 3 patient undergo this treatment, 2 of them pregnant naturally. So, after discussing with dh, we want to proceed with ivf and postpone rejuvenating my cycles, because it will took like 3 month (mac apr mei) then fasting month on jun, so 4 cycles to waste? I dont know. We dont know what is the best for us, but we are ready for ivf cycle this month inshaAllah.

So, we are now waiting for af to arrive, expected to show her face on 7th feb. prof already give me the names of meds for ivf. I will tell more in the next post inshaAllah.

That is all for my updates. See you guys in the next post.

Ps: consultation fees increase from rm50 in 2016 to rm100 in 2017!!! Gile. That's 100% increase!

Pss: i allergic to proluton. My injection site was red, itchy, and harden for more than 2 weeks! Oh my buttock😭 proluton basicly injected on the day i went for beta hcg, even before my result is positive (which is never was)

TTC @HUKM - Ultrasound CD13

Assalammualaikum wbt and ramadhan kareem everyone.

Today is my ultrasound day on cd13. Recap: i was on femara starting cd2-cd6 7.5mg daily. I arrived at clinic at 10.30am and the clinic was so quiet, and less people inside. I registered myself and ask am i late or something, the nurse said that less people prefer to have treatment in ramadhan month as there is no way they could do transvaginal scan or other procedur like iui or ivf.

So, i was in no queue at all. During the scan, the sonographer said she will be doing abdominal scan only as im fasting. So, as it is hard to see follicles using this scan, she had to push the scanner tool harder than usual on my stomach. And alhamdulillah, when she scan my right ovary, she easily spotted one big follicle measuring 23x18mm in her screen, while others in left ovary are very small one measuring only 7x7 each. Endometrium lining also looks good with thickness 10.1mm. After the scan, i went to the registration counter and an indian doc name dr prakash waited for me and look at my form. He said this is very good and we need to trigger this now. I was so excited as my follicle grew this fast and as prof hashim expectation. Alhamdulillah. So i trigger with pregnyl 2000iu at the clinic and will bd in the next 36 hours from now.

Also, i had started using opk the last two days, and today my opk is darker than yesterday, and i found out that my vaginal discharge also a little bit sticky and going to be egg white a little bit. I hope this is the month for us, inshaAllah. The best month for ibadah and du'a, and also a miracle soon inshaAllah. Do pray for us, and i hope for the best for u too.

Happy 8th ramadhan to all.

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. 

O

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!!

Medication review - Diane35 and Meftormin

Assalammualaikum wbt,

Lately i was thinking of starting a vlog, because i love to watch ttcian from all over the world documenting their journey through videos in youtube. However, i am a shy person, especially in front of the camera hehe. I also figure it out that no ttcian vlog are made from my country. Hurm, should i make it?

Back to the real topic for this post, it is about my medication for this time of treatment. As i mention in my previous post, my doctor, Prof Hashim from Hukmsc, presribed me with birth control pill, or oral contraceptive pill called Diane35. Actually diane35 is not a new drug for me. I was previously on this drug when i was 21, right after my first diagnosis of pcos.

Diane35 is an antiandrogen drug together with estrogen (cyproterone acetate 2mg and ethinyl estradiol 0.035mg). This drug is not solely use for contraceptive purpose only but also to prevent or reduce androgenic effect of the body such as acne and hirsutism. That is why this drug is suitable to treat pcos as we are high in androgen hormone. So as any other birth control pill, it consist of 21 tablet for a month supply and should be taken a tablet daily as a same time. Personally i dont really like this drug, well i Hate it!!! Haha. It causes me a lot of side effects that i cannot stand it any longer. Luckily i was on this drug for only 2 month before i start my fertility drug. These are some of the side effect that might occur to you when taking diane35:

• Breast tenderness/pain*-especially towards the end of finishing the pill
• Abdominal pain*
• Nausea*-worse ever in me!
• Oedema
• Headache*-for me it is more like light headache when starting the pill
• Skin rash
• Itching
• Insomnia
• Depression - i dont know if this happen to me, but i do feel a little bit emosional
• Changes in body weight*- i ate a lot and of course i blame diane35, hehe but i did not gain weight
• Change in libido

*side effect that happened to me

After 4 days stopping diane, my period came like a hero (seperti juara!) . It was heavy for about 2-4 days and spotting for another 5 days. Huu. No severe abdominal pain during period time yeayy alhamdulillah. 

Ok, next is Metformin.

Metfromin is a type 2 diabetes mellitus drug, prescribe as a first line therapy. However, since pcos is link with insulin resistant and sooner or later we will develop diabetes as well. This drug presribed ia a low dose for pcos to regulate insulin by increasing its sensivity hence reducing insulin level in the blood and also help to increase glucose uptake. In simple explanation, it makes our insulin function properly. Pcos tend to have insulin resistant becouse pcos is an endrocrine disorder. This disorder disruption endrocrine hormones like insulin and our fertility hormones.

My doctor presribe me with 850mg metformin. At first i did not manage to complete a strip because i cannot tolerate it's side effects, however, after completed my 2nd dose of diane35, i continue taking it until now. It is because the side effect of metformin and diane is slightly similar and it making g much much worse for me.

The side effect of metformin are:

• Nausea*- worse.ever.😷
• Diarrhea*- after 5 hours of taking it (i usually take it before i went to bed to reduce the nausiatic effect) it woke me up in the middle of the night and rush we go to the toilet!
• Flatulence and bloating*- they come like a package with before diarrhea. Imagine that! I barely slept at night because of this!
• Metallic taste
• Abdominal pain*- combo with diarhhea yeayy

However, all these side effect im having is slighly reduce after i start over meftormin again. And now im free from all those side effects!!! Alhamdulillah. It takes a while to tolerate with it (dont be like me), but you will get used to it. The best thing is, i didnt have a craving anymore! Usually before this, i MUST ATE AFTER 4 hours of meal. Gile x.? I think it's my hormone becoming haywired. And if i didnt ate, i will become grumpy and i feels like a hypoglycemic effect. Now, it didnt happen!.  Even did not feel hungry when it is time for meal. So, i manage to eat small portion without the 'starving' feeling anymore!.

Annndddd there is more! Metformin in conjuction with clomid or letrozole increase the chances of ovulation, then the fertility drug itself! Best kan?!! Cool isnt it?? This part i will talk about it in other post ok.

Orait that is all for now. I hope my writing benefits you. And feel free to share what is your side effects taking these 2 pills in the comment below. 

Bye..👋🏻

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