The Two-Week Wait

For women who are trying to conceive, they know how nerve-wrecking TWW is. I had been through it for close to 2 years when I was trying to conceive naturally. Had shared my journey in my earlier post here.

I was prescribed with support medications and given 10 days of medical leave until my pregnancy test. While the chance of success is dependent on the quality of the embryo, the centre did give me a few advice to increase success rate. Although there is no need for complete bed rest, I need to minimise my activities. I was refrained to do activities that may cause strain to the abdomen. 

Unfortunately, I am a very stubborn person. I started doing house chores when we got back home from the centre. The husband had tried to stop me from doing the chores but failed. In the end, he reached out to my older brother to tell me off but, guess what my brother suggested to him?

Since Horizon Forbidden West was already released that time, he suggested the husband to purchase the game for me to play. 

And it worked like magic - I started playing the game the next day until my pregnancy test! The game made it easier for me to survive the Two-Week Wait and I definitely had adequate rest.

We went back to the centre on the 10th day for pregnancy test. Had to be there early in the morning for blood test before our consultation with Dr. Eeson which would be 2 hours later. To be honest, that 2-hour wait was worse than 2-week wait.

When it was finally our turn, my mind went blank as we entered the room. When we sat down, Dr. Eeson gave us the report. I saw a smiley on it. He asked if I did any pregnancy test at home and I said no. He continued to say something to us but I was not listening anymore as I was staring at the report the whole time. 

I had not come to my senses even after we left the consultation room. It was until we were at the lobby, waiting for our turn to collect the medications, I gave a call to my older brother to share the news and broke into tears. 

Yes, my brother has always been there for me throughout this journey. He knew how difficult and stressful I was, trying to conceive. I had cried in front of him a few times too. He was also the one who spoke to my family, telling them not to bring up pregnancy topic when speaking to me. I just knew it was him even though he did not tell me. Hence, I did tell the husband that the very first person I would want to share the good news will be my older brother.

When we got back home, I took out all the type of pregnancy tests that I had purchased and peed away! I never had the joy to see 2 lines on them so I wanted to feel that great joy.

Remember I mentioned that stimulation was not the most difficult part throughout the treatment? That's because what happened next was the most difficult part - something that I had never expected.

What's next? 

More medications throughout the first trimester and on top of it, I had serious morning sickness. Fortunately, Dr. Eeson wrote a letter for me so I could appeal to work from home. I did try to ask Dr. Eeson if I could stop taking the medications during the third month but he did not approve.

This lasted until we finally graduated from the centre. We are really thankful to Dr. Eeson and the team in Sunfert @ Bangsar South. 

The Transfer

Dr. Eeson did tell us beforehand to enjoy ourselves during our trip back in Sibu. To be honest, I did not really understand what he meant until we were finally back to continue our IVF treatment.

We went back to the centre the following day after we came back from Sibu/Penang and finally set the date for Frozen Embryo Transfer (FET) which happened in 7 days.

Of course there were some preparations and medication needed for FET. Also, we had made the decision to transfer just one embryo.

On top of Progynova, I was prescribed with Duphaston and Cyclogest. Progynova and Duphaston were taken 3 times a day, after meal, whereas Cyclogest is a medication to be inserted into the vagina 2 times a day, with a fixed time which I had set at 11am & 11pm. Cyclogest was no fun - it was a huge mess when I did it the first time. From 15 minutes of lying down to 20 minutes, 30 minutes was the best option to reduce the mess.

The husband was very attentive when the nurse was explaining to us on the details of the medication. He even wrote down the instructions right after we came out from the consultation room. 

Similarly to OPU, on the day of transfer, I was not allowed to use any facial products, cosmetics and perfumes. These may affect the embryo. I was only allowed to shower with water only. Another challenge on that day was to hold my bladder until the transfer. It was not easy especially when the treatment room was really cold.

Thankfully, I had this image in front of me for distraction while waiting for Dr Eeson. This is the image of the embryo that would be transferred into my womb. The embryologist had informed me earlier that its survival rate after thawing is 100%. I was so relieved to hear that. 

Oh, I was not under sedation during this transfer. Hence, I was able to witness the whole transfer process by watching the TV in front of me. As this process was recorded in a sonogram machine, one of the nurses offered to use my phone to record the video after the transfer was completed. 

And you think I could finally empty my bladder after the transfer? Nooo.. I had to lie down for another half an hour.

However, this was nothing compared to what we had to go through next - The Two-Week Wait, which I will share in my next and last post.

The Polyps

My first menstrual cycle came on the 4th day after The Collection and hence, I was expecting my second menstrual cycle to come at the end of December. For the first time during my trying-to-conceive journey, I wished for it to come as soon as possible.

Unfortunately, for the whole month of December, everything was quiet. I started to get anxious and worried.

When it was finally here (it was already January), I went ahead to make the appointment to consult Dr. Eeson although it was not at the normal volume. After TVS, he told me that we need to remove polyps that are next to my lining which will affect the embryo's implantation. Hence, I was to admit to Pantai Hospital Kuala Lumpur the following week for this.

Although I had the room to myself, the husband could not stay back to be with me. Fortunately, the nurses took good care of me and everything went well. Hence, on the following day, I was being discharged from the hospital and was scheduled for my follow-up one week later at the centre. During TVS, it was confirmed that polyps had been removed totally and that we could prepare for Frozen Embryo Transplant (FET).

Why not immediately? 

Well, we could only start when my next menstrual cycle arrived which came three weeks later from the day I was being discharged from the hospital. As we would be heading back to Sibu for Chinese New Year, we had to postpone FET a little bit but Dr. Eeson assured us that it would still happen at the end of February. He had me started with Progynova for the next 15 days until I returned from Sibu for another check-up. 

With this line of medication on top of my daily supplements, I was still able to take it lightly. I did not know the worst will come later which I will share in my next post..

The Fertilisation

Like I shared in my previous post, we were waiting for the embryologist to contact us. A day felt like a year to us.

The centre did call me the next day after OPU but it was the nurse over the phone. She was checking on me if I was having any discomfort or worse, bleeding. I told her I was feeling fine and there's nothing to worry (I was playing Dragon Age: Inquisition on PS4 when she called).

On Day 3 post-OPU, the embryologist finally contacted us!

He updated us that out of the 17 eggs collected, 15 were matured eggs. All 15 were fertilised and here comes the grading - 4 good, 5 fair and 6 poor. All of these embryos will be cultured to Day 5 to reach blastocyst which is an early stage of an embryo which is also the ideal stage for transfer to my uterus. 

Hence, the wait continued until we received another call from the embryologist in the morning on Day 6 (1 day late). 

Out of 15, 3 reached blastocyst stage. The remaining 12 went arrested. There's one most outstanding embryo which I believed to be the first to be transferred into my uterus. Since I was not suited for fresh embryo transfer, all 3 embryos were frozen. After the call, he sent me an email on the report and time-lapse embryo imaging (shown below).

There are 15 dishes and the top 3 are dish 1, 6 and 12. They are graded as 5AA, 4BA and 5AB. I did think the embryo in dish 2 could make it but it was graded as 5XB. Hence, it was not chose to be frozen. As the embryologist did not explain to be what these grading mean, I went to look up in internet. 

The number is the size of the blastocyst (Grade 1-6), first alphabet is the inner cell mass quality (Grade A-C) that will develop into a fetus and finally the outer layer quality (Grade A-C) that will form into a placenta. After I understood a little bit on the grading, I knew why 5XB was disqualified. 

What's next?

To go back to the centre again when my second menstrual period came. Hence, another waiting game..

The Collection

D-9 had arrived and we were back in the centre again!

Dr. Eeson did an ultrasound scan on my tummy and he was quite happy with the amount of eggs he could see in both my ovaries. He started to brief us on the procedure. Apparently, he will puncture into my ovaries to collect the eggs. I'm glad that I would be sedated when this is happening. Later, the nurse went through the instructions for Oocyte Pick Up (OPU) with us which is very important. Oh, they will perform ICSI in our case.

Did you think that the injections have come to an end?

Noooo..

After the nurse had briefed us, I had to take 1 injection at the centre which, as usual, I administered it myself. Later at night, I had to take 2 injections at 9.40pm sharp! We cannot miss the timing at all as these need to be injected 36 hours prior to OPU. These injections are to ensure that I ovulate during OPU. Too early or too late will disrupt the progress. Both the husband and I were so stressed and kept looking at the clock even though both of us had set our alarms at 9.35pm. 

When 9.35pm struck, both of us were at the dining room - the husband was preparing the syringe while I was freezing my tummy with the ice pack. We did the countdown together and when the time struck 9.40pm, I started to inject the medication. I pushed the syringe slowly this time as it was painful. It was more painful during the second injection. 

Was there any side effect?

Well, I did feel nauseas and sick the next day when I was at work. I had to take Sour+ gummy every hour to feel better. At night, I had to take 2 tablets of Ducolax to clear my bladder which did not happen. I'm guessing that I am too fat for 2 tablets to take effect!

Finally, D-11 had arrived! 

That morning, I had to constantly remind myself in my mind not to use body and facial wash - water only. No facial products too. It was not easy when these are part of your routine every morning. I went into the ward around 9am and was really nervous when it was my turn to be pushed into the operating theatre. When I woke up, a nurse was next to me. She told me that 17 eggs were collected which I thought not too bad. She also prompted me that I may experience bloated, cramping or even vaginal bleeding the next day. Unfortunately, I am not suited for fresh embryo transfer as there are polyps found in my uterus, next to my womb's lining, so they had informed me to go back to the centre again on the second day of my second menstrual cycle (yes, another round of waiting game).

What happen to the collected eggs?

On the third day, the embryologist will update us on the result if the eggs are fertilised successfully (embryos). Fertilised eggs will further cultured to blastocysts (also known as Day 5 embryos) and they will update us again on the final number of good quality embryos that will be frozen for transfer later.

I named that 5-day period as The Nerve-Wrecking Period which I will share more in my next post.

The Stimulation

First step is to take medication to increase the number of eggs which is called ovarian stimulation protocols. 

I had to administer an injection a day for 4 days (D-1 to D-4). The nurse briefed us on how to mix the drug from one vial to another vial and finally, to the syringe. The husband was taking up this job so he listened to the nurse attentively. As for me, I learned on how and where to make the injection. I did the first injection in front of the nurse. She did offer to do it but I insisted to do it on my own as I wanted her to provide me feedback if I had done it in a wrong way. We were going to be on our own at home for the next 3 days so I needed to get it right. The moment I injected the medication, I could taste/smell the medication. 

Initially, I would think this is the most difficult part throughout the treatment and boy, was I wrong. Personally, I think this is the easiest part because wait till I share the later stage.

Before we left the centre, the nurse had to collect blood from us - blood test for both of us and hormone test for me. Hormone test results will decide the medication for my second stage of ovarian stimulation as we were to come back on D-5 of IVF treatment to check if my ovaries are responding well to the medication. 

Fortunately, they are responding well. Hence, for the second stage of ovarian stimulation, I had to administer 2 injections a day for another 4 days (D-5 to D-8). The second syringe's needle is longer so it was really painful when I first injected it. It bled a bit when I took out the needle. Dr. Eeson also informed us that we could do egg collection on D-11 but he will share the details with us again when we went back to the centre again on D-9.

What I really like about Dr. Eeson is he will not give you too much information on future process as he wanted you to focus on the current process since it was stressful enough. To me, it felt like 'go with the flow' kind of thing and I am never worried on what's coming next. Maybe, it's just me.

Oh, did I mention that I was craving for char koay teow a lot during these 8 days? I had CKT for at least 2 days in a row!

So, what happened on D-9 when we were back in the centre again? We were being prepped for egg collection which I will share in my upcoming post.

PS: I received questions on where did I inject and the answer is my tummy (the picture above is not my tummy). To be specific, it is the same row as your belly button but 2 fingers away from it - either on the left or right and you can go all the way down. I considered myself lucky as I had one injection a day for the first 4 days whereby I could inject on a different side each day. My trick was I would put the ice pack on my tummy until it felt numb and really red, wiped with an alcohol swab, squeeze the targeted area hard and cucuk. For the second type of medication, as the needle is longer, I put the ice pack longer.

The Decision

In my previous post, I shared about the journey that led us to learn that we are experiencing infertility. No worries, I had already gotten the consent from the husband to share this with everyone. Personally, I wanted to share our journey because I want to create more awareness to everyone that infertility is common in this age and it is not anyone's fault. 

The next popular question most people would ask - Who and why? Hence, I am using the term 'we' because it's us and we are going through this together.

Before we came into our decision, we did some research online if In Vitro Fertilisation (IVF) is the only option for us. In this research, I learned that there are two ways that an egg can be fertilised - traditional and Intra Cytoplasmic Sperm Injection (ICSI). Traditional is understandable whereby a large number of swimming sperm will be placed next to an egg in a laboratory dish. They have to race to fertilise the egg. ICSI, on the other hand, injects a single sperm directly into the egg. Some centres offer different pricing package for traditional and ICSI. I also came to learn about Intrauterine Insemination (IUI) and the cost is much cheaper simply because the procedure is much simpler - a large group of swimming sperm will be placed directly into the uterus and they have to swim their way to the fallopian tube to fertilise the egg.

A disclaimer here, I am no expert in this. I am just sharing my personal experience and the journey that I had been through with my husband.

While we were scouting and deciding which centre to go to, this particular centre's name came to me twice. There is no price difference between traditional and ICSI. Not only that, they have a team that will assist their patients to compile all the checklist, forms, medical reports and invoices needed for EPF withdrawal application. The best part is they offer cashless facility should the patients opt to use their EPF funds in Account 2 for IVF treatment. Hence, we finally made our move and made the first appointment at Sunfert@Bangsar South. I chose Dr. Eeson as our go-to doctor because I thought he would get along well with the husband. 

Making an appointment was really easy - all I had to do was to download the app and select the doctor's available time slot of our chosen date. We had to be there 2 hours before our scheduled time as the husband had to do semen analysis. This is compulsory for all first consultation. Why 2 hours before the scheduled time? The report will be ready by then when it's our consultation with the doctor. Awesome, right? No time wasting here.

We made our decision on the spot after our first consultation with Dr. Eeson. He is very kind with his words and his words are very reassuring. We do not feel uncomfortable like what we had felt with some other doctors whom we had approached before Dr. Eeson. To be honest, the only regret that I personally had - we wasted too much time and money. We should have seek help at Sunfert in the first place. 

Dr. Eeson informed us that we could start the IVF treatment on the second day of my menstrual cycle which was a week away. He shared with us what we would be going through - from ovarian stimulation to egg collection and finally, embryo transfer. Before we left the centre, we reached out to their EPF Support Team to assist us on EPF funding application and also to apply for cashless facility with Sunfert on our IVF treatment. Other than that, there's nothing much we could do while waiting for my next menstrual cycle. 

In short, numerous of waiting game will be going on throughout this journey which I will share more in my next post.

The Journey

It was not easy.

Well, I did think it is going to be easy but in reality, it was not and it came with countless of tears and heartbreaks from disappointment. This post will be full of information on our infertility journey.

I was diagnosed with Endometriosis in the middle of February 2020 when I went for a full body check-up. The last time I checked was back in 2017 and it was all good. When the gynae told me that the cyst was quite big - 4.5cm, I was really worried. 

He said it will definitely affect my pregnancy chances as the cyst was blocking the pathway to my fallopian tube on the left. Plus, we will not know which side of my ovary will ovulate during the month. On top of this, we were waiting for my blood test report on cancer marker as he also found a few fibroids in my uterus. The wait was nerve breaking but, thank goodness, my report is clean. Hence, all I needed to focus was Endometriosis.

As I did not want to opt for a surgery straight, I decided to take medication and with more workouts at home - which slowly paid off overtime. It was 2.9cm in March and less than 1cm in May. However, the gynae still wanted me to undergo Laparoscopy Cystectomy and Hysterocopy. He mentioned there were polyps that needed to be removed as well.

As it would be my second abdominal operation, I was not keen on doing it. Hence, I went to seek for a second opinion in a bigger hospital. That gynae told me that he did not see the need to do any operation as my uterus looks clear. When I told my gynae that I did not want to proceed with the surgery, he called me the morning I was supposed to admit for the procedure. He tried to convince me with the reason that MiCare had approved the Letter of Guarantee for my admission which was not easy. He said he had a patient whose Letter of Guarantee was rejected even though he had made 4 appeals. Of course, I did not listen to him and stood firm on my decision.

Later, I went to see another gynae which was recommended by a friend. As I wanted him to do his own assessment, I did not share with him on my previous consultations with my first gynae. Eventually, I did share with him but that was after he had shared his assessment with me. He, too, mentioned that my uterus is clear but suspected that I might have P.C.O.S.. He did not assess further to confirm this. I stopped getting my consultation from this gynae after my second visit and focused on the treatments since we found out another root cause to our infertility. 

It was until February 2021 when I went to get consultation from another gynae in the same hospital of my very first gynae. He is actually my sister-in-law's gynae. Man, I had seen 5 different gynae in less than 2 years.

But what triggered it?

Well, we were trying to conceive naturally so, for a few months I had been doing a lot of peeing and tested with ovulation test kits to see if I was ovulating. It was not fun when your sex life is determined by the result.

However, that month was different. I found that my LH had been on the high side with Clearblue smiling at me for close to 5 days. It was definitely not normal. The gynae told me to return on the 21st day of my menstrual cycle to conduct hormone test. Besides that, we had a long chat and I was glad that he was my go-to gynae moving forward. 

When the report was finally out, it was confirmed that I have P.C.O.S. - my LH was on the high side whereas my progesterone was really low. Hence, this was affecting my ovulation but it was not hopeless. Fortunately, there are some medications to counter this condition - Metformin to be the top on the list followed by Clomiphene (Clomid).

I started with Metformin which is commonly used by patients with Type 2 Diabetes as well as for weight loss. Weight loss? Yeah, I was not sure about this until the second day I took the medication. I was feeling alright on the first day but, things did not look good the next day onwards - headache, body sore, diarrhea and abdominal pain. I stopped fasting during this period too. Thinking that my body would need some time to accept the drug, I continued taking it. However, as these side effects had been going on for a week, I informed my gynae and he told me to stop the medication as my body was not accepting the drug. 

Thus, the next medication for me would be Clomid but this could only be taken on the first or second day onwards of my menstrual cycle and before that, both my uterus and ovaries need to be clear as well. If I ever took Clomid without proper checking and should there be any swelling or cysts in my uterus or ovaries, Clomid will worsen the situation. The only side effect I had from taking Clomid was I had a high fever during my ovulation period. As we were not sure if it was really due to Clomid or I could have been contracted with Covid-19, I went to take a swab test and fortunately, the report came out negative. Hence, we confirmed that my high fever was due to Clomid. This only happened during the first month I took the medication. It did not happen again for the next few months.

We continued to try along with me consulting my gynae and took Clomid every month. Sooner or later, I was able to take on the pressure and disappointment - I cried less. I also started going for Traditional Chinese Medication and its acupuncture. Spent a lot of money there, of course. Making baby was not sexy to us anymore. And I believed I did not mention that we found the root cause of our infertility after such a long time. Hence, coupled with that, it was more difficult.

After 6 more months of trying, we decided to take another step further - In Vitro Fertilisation - which I shall share more in another post.

My Year 2021

Just like what most of us predicted, pandemic ain't over. This pandemic had caused us not being able to go back to celebrate Chinese New Year for the very first time. We were not able to take our tradition picture as well. That's when creativity comes into handy and our brilliant cousin managed to pull it off!

This also made us to be grateful for what we have around us. Even though all of us could not go back, we had our own celebration in Kuala Lumpur. It was mostly eating, drinking and playing cards.

Compared to the previous year, I was able to meet my friends this year. I had a friend who came back from Riyadh for vacation. I had checked that the last time we met was back in 2017, oh gosh! I have known her since kindergarten time. Hope we will have that girls trip to Bangkok one day with the other three ladies.

I was able to meet up with my favourite girls too. We had just met up over dinner recently. It felt so good to see familiar faces and also to see how much Rye Liv has grown. 

The very same year, we welcomed a new member into our family and this boy has grown so much in five months. The father was not able to recognise him in his newborn picture so, you could imagine how much this boy has changed.

We did another staycation in Mandarin Oriental Hotel again to celebrate my birthday but, we have more people joining us this round as my birthday present from the husband. We booked two rooms that included MO's Club Lounge benefits to have most of our meals covered. Did you think I was the happiest girl during this staycation? The answer is no. My niece was the happiest girl during this staycation. She was so excited that she did not take her nap the day we checked-in the hotel. 

We ended this pandemic year with a lovely Christmas celebration again. However, we had the celebration this round at another unit in our condominium and we had special guests joining us - my brother's parents-in-law. Food, drinks and of course, presents (mostly for the kids). I believed it was the happiest day for the kids as they opened so much more presents compared to the previous year. It was already a chaos with two kids opening their presents. Imagine having 4 next Christmas. 

And that was how I ended year 2021. Actually, thanks to this pandemic, I had a lot of family time and that was how I bonded with my niece too. You know what they said, the first 5 years are really important. Also, I managed to pick up a few games namely NieR: Automata and Dragon Age: Inquisition. I tried picking up Spiderman but I was really bad in it. Out of these games, my favourite is NeiR: Automata and I had not moved on! You will know what I mean if you had played the game.

Anyhow, here's to a better 2022 and wishing all of us can travel out of Malaysia soon!