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)

4rd Appointment Hosp Pantai - good news!

Assalammualaikum wbt,

isnin lepas, 21/7/14 saya pergi check up time cd12. ok mari imbas kembali apa saya buat this cycle:

10/7/14- CD1
11-19/7/14- Tab Clomid 100mg
21/7/14- appointment

ok basicly cycle ni regimen clomid agak berlainan, which biasa clomid amik time cd3-cd7 (5hari), but doc nk pnjgkn time sy amik clomid sbb last 2 cycle clomid xberi respon. jadi saya kena makan dari cd2-cd9 (8hari). dan alhamdulillah, time scan tu ade 2 biji follikel yg besar 15mm! ya Allah gembira xterkata mcm dpt berita pregnant. doc pn mcm teruja sbb sy bgtau ni 1st time nmpk besar. mmg nmpk besar gile kat screen tu..haha..jakun!

doc kate mungkin saya ni lmbt respon kat clomid dan mungkin juga sbb saya amik vid D. but sadly my endometrium lining baru 3-4cm shj. untuk penempelan bagus 8cm ke atas. so doc precribe ubat hormon femoston, amik yg estrogen pil shj(warna merah) dan bukan makan, tp insert kat vagina setiap 6 jam! huhu..1st time dpt ubat insert kat vagina.. jakun lg! haha

so, hari ni appointment lg nk tgk progress pembesaran telur. sebab telur boleh membesar 1-2mm sehari. jadi estimated paling x telur akan besar dlm 18mm paling kurang. Ya Allah besarkanlah telur2 ku.. Kurniakanlah kami rezeki anak2 soleh di bulan ramadhan yg mulia ini..amin..

2nd Appointment: Hosp Pantai

Assalammualaikum wbt,

Setelah dapat call dari nurse ida tentand vit d, esoknye mmg ade appointment dgn doc adilah. this time appointment sangat cepat 10 mins je jmpe docs..huhu.

so hari ni review all the lab result..keputusan sangat mendukacitakan:

1. vit D mmg rendah

2. insulin sangat tinggi (18.8!)

so doc suspect insulin resistant kot eventho doc xmention pun. but doc plan to start ubat turunkn gula dlm darah, mungkin metformin lepas pose nanti sbb takut hypo bile amik time pose. n of cos vit D supplement 1000iu 2 kali sehari..banyak kan?? huhu..

then TVS again nk cek telur sbb aritu time cd3-7 ade amik clomid 100mg. so, as usual, cyst sgt banyak n ade 1 telur 12mm the biggest among other but doc ckp still kecik utk cd13..biasanya 12mm ni cd6..huu..xpe doc kate mungkin die membesar so hari isnin 23rd ni dtg lg cek telur. but i couldnt manage to come that day, so doc kate dtg sehari lmbt pun xpe tp tkut da ruptures la telur tu xdpt monitor, xpe yg penting kena bersama selang sehari. ok doc!

sblm jmpe doc sempat lg melawat kwn kat wad, dia nk wat laps ptg tu..first time jmpe biasa wassup je..hehe..hope u r doing fine sis.. n dpt conceive lepas ni! amin..

hurm, cmne nk turunkan level insulin ek? da la nk pose ni..eksesais mcm tak je..huhu.

1st appointment: Dr Adillah Pantai Hospital

Assalammualaikum wbt..

lepas seminggu appointment baru berkesempatan nk tulis blog. 

btw, pade sesiapa yang baru follow blog saya (ade ke?perasan..hehe) saya baru je tukar doctor yg sebelum ni saya wat ngn doc hamizah LPPKN..but due to certain reasons, kami beralih arah ke Dr Adillah di Pantai Hospital Bangsar.

kisahnya bermula, pada pertemuan pertama..

memandangkan ini kali pertama jumpa doc adillah, so kena dtg awal untuk tau cmne flow hosp pantai ni. so we manage to reach there at 7.30am. parking kat basement than pegi ke lobby hospital. tanye receptionist mane klinik doc adilah. so, if sesiapa yang xtau lagi, cari atm then nnt nmpak starbuck, terus lagi nmpk lift. naik tingkat 4 than keluar nampak kaunter pendaftaran belah kanan. kalau dtg pepagi cam saya ni, of coz xde org dtg keje lagi..tp no giliran dah boleh ambik.. rupenye nombor giliran manual. hehe..so pegi cari bakul isi nombor giliran atas kaunter tu, cari ikut name doctor anda tau sebab kat situ ade byk lagi klinik run by other docs. so bila da ambik, utk 1st timer, kena isi borang pendaftaran, if yg regular, just kepilkan nombor giliran anda dengan kad appointment. 

hari tu kami dapat no 7. ingatkan kejap, lama jugak tunggu, dlm kol 10 lebih baru jumpe doc. nak di pendekkan cerita, bilik doc adillah sangat comel dan cantik! i like the furniture, ala2 english gitu. well, she seem very serius and tired jugak kot haritu, tp die layan kami sangat superb!. die tnye history semua, review balik semua result saya buat kat lppkn, tgk balik HSG xray. dan buat TVS. so mcm full assessemnt la. 

upon TVS examination, saya n suami terkejut dgn ape yg doc bgtau which never ever any doc mention this to me ever before. doc kate my uterus is flex! usually normal uterus is flex towards bladder, but mine is flex backward!. but doc kate this is not a major thing, it is like some people is right handed and some people is left handed. but ade sebab kenapa jadi flex. so doc suspect endometriosis. suspect shj sebab doc kne wat further test utk confrimkan. 

after that doc kire ketebalan rahim. doc kate rahim saya kecik macam budak kecik..maybe sebab dah lame xde stimulation dari estrogen sbb xde folikel. then doc tgk ovaries. sekali tgk je doc mmg ckp pcos sbb 1 ovary je dah ade 14 cyst..belum masuk yg sebelah lg. utk diagnose pcos kena ade lbh kurang 10 cyst sekurang2 nya.

dan bila doc review blood work dr lppkn, byk rupenye test yang xberapa nak penting diambil dan yg paling sadis, rupenye tarikh blood taken kat lab result tu semua die tulis tarikh yg sama! padahal blood amik time cd3 lah, cd 21 lah..kan tarikh lain2 tu..hish...but result sperm husband is valid. so saya kena amik blood semula dan kena cek Vit D level jugak. 

dan HSG xray pun xberapa nak cantik sebab doc prefer result yg ade time frame per second time dye tu di inject.. so bole tau part mane ade occlusion ke or part mane sempit..hurm...

so kesimpulan pertemuan kami hari ini:

1. saya confirm ade PCOS

2. baru tau rahim flex or kate org melayu, rahim terbalik

3. propability ade endometriosis

sebelum balik doc bagi ubat clomid makan time cd3 smpai habis. then duphaston untuk induce period bulan ni, then doc nasihat mkn multivit n folic acid.

total bil: RM250 full assessment consultation, RM250 blood lab work, RM40 clomid, RM 150 consultation. 

Sekian. 

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

4th & 5th appointment LPPKN

Assalammualaikum wbt

baru balik dari LPPKN terus semangat nk tulis..ok dah lame xupdate ye x..meh imbas kembali rawatan saya

so 3/4/14 (khamis) merupakan hari CD21 so g lppkn pagi2 utk amik darah. then nurse kate tunggu next period, bila 1st day period datang terus call lppkn utk set appointment jumpe Dr Hamizah CD2-5.

expected period around 12-14hb ni, tp yela pcos mmg dijangka2 datang period bila kan.. nk dijadikan cerita, ahad lepas (6/4/14) tgh syok cuci toilet tiba2 gedebuk! tergelincir jatuh...lebam jugak la punggung n sakit senak perut..risau jugak jatuh2 ni kan..then maghrib tu tiba2 ade spotting..sudah..awal sungguh period ini kali..ke sebab jatuh :(..tunggu punya tunggu esok pagi darah mmg banyak so mmg period..maybe jatuh tu induce period nk kuar kot.. jadi ptg isnin call lppkn utk set appointment..dlm hati doa byk2 nk set hari selasa sbb ptg selasa smpai jumaat kena outstation plak ke sabah..dan alhamdulillah dapat appointment selasa pagi 8/4/14 kol 7.30 (CD3).

8/4/14 (selasa)
so as usual, husband punya nk elak jam kat kl, kol 6.15 lps subuh dah bertolak. smpai lppkn kol 6.45am..haha mcm pelesit bwk..tido jp dlm kete, dlm kol 7.15 baru naik..masa nk naik amik pas tu guard xbagi naik sbb blum kol 7.30..so bila dapat naik..sampai je klinik dapat no 1 sekali jumpe dr Hamizah yeayyy..xsabar n berdebar2 pulak. then dlm kol 7.45 cmtu da kne panggil ngn dr..cepat sungguh!.. dr hamizah mmg sedap mata memandang, die terangkan result2 lab yg buat dulu..

1. Husband sperm analysis:

Concentration: 60 (normal: >15) GOOD!
Total Count: 84 (normal >39) GOOD!
Motility (pergerakan sperm): 66.6 (normal >40) GOOD!
Normal Morphology: 32 (normal >4) GOOD!

Kesimpulan Sperma husband sangat bagus..hehe

2. Wife Hormone Analysis

FSH: 6.42 (normal: 3.5 - 13) GOOD!
LH: 12.53 (normal: 2.4-12) too much NOT GOOD :(
Progesterone : 2.21 (mesti >80 utk ovulate) NOT GOOD :(

kesimpulan dr kate mmg simpton biasa bagi pcos LH tinggi dan progesterone rendah.

jadi dr bagi option untuk start treatment: natural with clomid or iui

kitorg pilih iui sebab nk ekspress terus..huhu..so dr kate bole start rwatan hari ni. jadi mula dengan clomid 100mg OD  for 5 days dan Inj Puregon (FSH) 50 IU EOD (every other day) for 3 days.

Clomid makan pkul 10pm dan inject pkul 10.15pm. scary ok nk inject ni..time nurse tu ajar cmne nk inject die tnye sape nk inject, berebut2 husband n wife nk inject...haha..gelak je nurse tu.

then 15/4/14 ni ade appointment lagi utk cek telur matang ke x.

Kos hari ni:

Rawatan: RM10
Tab Clomid 50mg 10 biji: RM36
Inj Puregon 50 iu 3 kotak: RM226
Syringe x 3: RM1.80
TOTAL: RM274.00

"Ya Allah, Matangkan lah telur2 ku...dan mudahkan lah urusan iui kami ya Allah"

thanks reader sebab doakan kami :)