Tuesday, 30 April 2013

Summary Buku Ini

2013
IVF ICSI #1
Hospital Wanita Metro IVF, Klang Selangor
Dr. Tee Swee Peng

26/03/2012 - Hubby suruh tengok web Metro IVF


31/03/2012 - Register. W: pap smear, external scan, clomid, blood test. H: Semen analysis (SA).

28/04/2012 - W: Period D6, result semua ok. H: Result SA nil. W: Cek tiub fallopio, pil tahan sakit. H: Blood test.

30/04/2012 - H: 2nd SA.

05/05/2012 - H: Results 2nd SA (same), blood test (OK!!). Dicadangkan buat biopsy testes &IVF - ICSI.

18/05/2012 - H: Discuss Biopsy testes dan kos.

25/05/2012 - H: Biopsy testes operation.

01/06/2012 - H: Result biopsy testes OK! There's sperm! See embriologist for explaination of IVF.

01/02/2013 - Confirm tarikh untuk IVF (April), dibekal Suprefect.

09/03/2013 - Day 21. Start morning Buserelin (Suprefect) Injection. 20 iu.

18/03/2013 - Officially in IVF cycle! Yeay! (Day 1)




19/03/2013 - Day 2. Blood test and scan. All OK.

21/03/2013 - Day 4. Start Gonal F night injection. 225 iu.

02/02/2013 - OPU dan TESE

04/04/2013 - Embrio Transfer. InsyaAllah.

11/04/2013 - Implantation bleeding.

13/04/2013 - Bleeding again!

15 - 25/04/2013 - Warded. Bleeding & clots everyday! :'(

25/04/2013 - Misscaried. It's very devastating...

26/04/2013 - Going home. Masih berdua.

Monday, 29 April 2013

The Result!

So okay,

4/4 - ET day! Seronok Allah saja yang tahu. Akhirnya our little miracles is on their way! Untuk prosedur ni saya tidak memerlukan bius. Jadi masa doktor transfer embrios tu ke dalam uterus, saya dapat lihat on live screen. Dalam hati tak putus-putus berdoa, semoga Allah survivekan mereka dan kekal dalam rahim saya.

Lepas transfer saya dibawa berehat di ward. Seperti biasa ini adalah prosedur sehari,jadi petang dah boleh balik. Nak berjalan pun rasa takut2. Takut the embrios will fall out!

Ok now, the 2ww!

2 minggu untuk menunggu keputusan. Positif atau tidak. Dalam masa tu saya perlu masukkan pil progesterone ke vaginal, 2 biji 4 times a day. Ia adalah ubat paling penting dalam tempoh ni, untuk proses penempelan embrio.

5/4 - 11/4 - Most of the activity adalah baring je. Sampai boring baring. Tapi kadang2 bangun la juga untuk ke toilet, mandi, solat dan makan. Dalam tempoh ni saya solat duduk aje, sebab tak nak bagi sebarang tekanan pada uterus.

So far it's all okey sampai la satu pagi 11/4 tu....

Saya terkejut bila terjaga dari tidur pagi tu, ada darah di kain saya. Tak banyak, tak juga sikit. Kalau di pad boleh staining la 1/3 kot.

Pergi toilet pun nampak lagi saki baki keluar, tapi pinkish in color. Saya panik!! Sangat takut kalau haid dah datang.

Kebetulan pagi tu memang ada appointment 4 hari sekali dengan doktor. So i told him. Bila dia tanya warna apa, dan saya jawab merah, saya dengar dia mengeluh....

something is wrong isn't it...?

Dr Tee tekpaksa buat blood test awal dari biasa untuk check. Dan saya dibenar pulang. Hari tu memang dah takde mood, saya muram je.

Tapi petang, doktor tee call with good news! beta hcg saya sudah ada bacaan! naiknya sikit saje 7.9 tapi itu bermakna our embrio sudah menempel!!

That is implantation bleeditng kot.

I'm happy now.

13/4 - No blood in sight. So i'm pretty sure that was an implantation bleeding, until...

14/4 - Darah ade balik, masih belum banyak but RED in color! I called Dr Tee, and again bila dia tanya warna dan saya jawab merah, dia keluarkan perkataaan "Ayyoo" saja.

I know, something is wrong. Sebab dari pembacaan, implantation should be brownish or pinkish in color je, not fresh blood.

Tapi doktor tee masih minta saya bersabar, jika darah tak stop juga dia minta saya ke metro

15/4 - Appointment lagi, kali ni blood test dibuat lagi untuk ukur paras hcg. Pagi darah tu ade sikit2 tapi saya cuba ignore, bila balik dari hospital dia datang lagi.... saya dah tak keruan. I call Metro dah mereka minta saya rest di ward.

15 - 25/4 - so i'm warded. lama tuuu, 10 hari. Dan dalam tempoh tu saya asyik bleeding with fresh blood and clots. Takut nak searching the info dah. Ade yang kata, implantation bleeding kan last for a week. Ade yang kuar clots tapi baby survive. Tapi saya.... saya bukan rasa itu saja, saya rasa sakit di ari-ari. Every night!!

Setiap kali beta hcg result menunjukkan peningkatan, dan double every 48 hours, saya rasa gembira. Means the baby is growing. Tapi muka hubby nampak biasa saja, dia langsung tak gembira walaupun secara sahnya saya memang dah pregnant.

Rupanya dia dah tau, kalau in early pregnancy, kalau ade bleeding with sakit, that means 'threaten miscarriage'

Saya tak tahu, saya tak mahu tahu.

Patut la bila saya tanya dia, "Abang tak hepi ke? Macam tak hepi je..." Dia jawab, "Kalau bleeding stop, sayang sihat, boleh keluar wad baru abang lega."

Boleh dikatakan dalam tempoh 10 hari tu, setiap hari selepas asar ke tengah malam, saya akan mula rasa sakit. sakit macam period pain, senggugut kot. Entah la, saya tak pernah rasa period pain. Tapi ia memang sakit!

Seksanya Allah saja yang tahu. Dan berserta dengan sakit tu, fresh blood akan keluar, with clots.

Ada satu malam bila saya sakit sangat, doktor perempuan melayu yang bertugas datang, and said the things i really don't want to hear.

"Ini akan gugur ni. Awak berdoa sajalah."

Remuknya hati saya.... Kot ye pun beralas la sikit.

Saya tahu, Dr Tee pun dah tau perkara ni akan berlaku, tapi dia masih jaga perasaan saya, dia cerita pada hubby saja, patut la hubby saya tak berharap pada kandungan ni... katanya kandungan walaupun scan dah nampak, tapi sangat kecil.

Pada 24/4 petang seperti biasa, rasa sakit datang kembali. Saya dah pasrah, dalam keadaan baring 24 jam tu saya angkat tangan berdoa pada Allah...dengan linangan air mata.

Saya minta pada Dia, kalau rezeki anak ini memang ingin diberikanNya pada saya, saya minta dihentikan bleeding, kandungan sihat dan tiada masalah lagi. Tapi jika ini bukan rezeki kami, saya minta Dia kurangkan sakit saya, dan ambillah semasa kandungan masih kecil, supaya kami tak teruk kecewa dan mengharap.

Jadi malam tu saya dah hilang rasa sakitnya, cuma ada sakit ari2 yang boleh terima lagi, saya boleh tidur agak lena.

25/4 - Subuh2 nurse kejutkan seperti biasa nak bersihkan tut dan tukar pad saya. Saya tengok pad tu ade darah saje takde darah beku, then bila buang air kecil di bedpan, terasa macam ade sesuatu yang agak besar keluar. Macam darah beku yang besar.

Saya tanya nurse, ada darah beku ke keluar? She just said yes, dah berlalu. Saya sangkakan seperti biasa. Tapi saya sempat menjeling bad pan tu sebelum dia bawa keluar. Banyak merah.

Tak sampai 10 minit nurse tu datang balik dan suruh saya makan antibiotik. Katanya sebab saya buang air ade darah jadi dia dah report dr tee, and he ordered to give me antibiotik.

Lepas tu saya cuba pejam mata balik sebab masih awal pagi, 6.30 pagi saya tengok kelibat orang berjalan laju.... dan kain langsir ward saya dibuka, Dr Tee.

Awal pagi dah datang, ada benda yang tak kena.

The he said, "Norliza, nurse cakap ada daging sudah keluar. Dia sudah gugur. Jadi kita scan untuk tengok dia gugur semua atau tinggal baki."

Jadi pagi2 lagi saya sud.ah ditolak ke clinic untuk scan, masih ade baki. so prosedur D&C akan dilakukan pagi itu juga.

Remuk hati saya. Mata saya bengkak kesan menangis sejak doktor perempuan tu cakap macam tu. Saya rasa dada saya sesak.

Tapi takpe lah, saya redha.

Sekurang2nya saya dah mengandung. Saya berjaya mengandungkan hasil cantuman benih kami. Saya berupaya mengandung.

Cuma masih belum rezeki.

Nurse cakap, ade orang yang langsung tak mengandung after embrio transfer. Embrios tak implan, tak tahu ke mana. Tapi saya berjaya, cuma nasib tak baik lagi.

Ye, hcg saya naik dari 7.9 to 47.8 to 102 to 241 to 520 dan akhirnya stop doubling at 600.

Walaupun hati masih kecewa dan serik. Saya percaya rezeki itu akan ada nanti.

Kami akan cuba lagi nanti. Lepas saya fully recover emotion and physical.

Jalan dah ada. Cuma Dia belum izinkannya.

Thats all.

Tuesday, 9 April 2013

IVF Treatment Step Nine: Pregnancy Test and Follow-Up


About nine to twelve days after the embryo transfer, a pregnancy test is ordered. This is usually a serum pregnancy test (more blood work) and also will include progesterone levels testing. The test may be repeated every few days.

If the test is positive (yeah!), you may need to keep taking the progesterone supplementation for another several weeks. Your doctor will also follow up with occasional blood work and ultrasounds to monitor the pregnancy and watch for miscarriages or ectopic pregnancies.

During IVF treatment, miscarriage occurs up to 15% of the time in women under age 35, 25% of women age 40 and up and 35% of the time after age 42.

Your doctor will also monitor whether or not the treatment led to a multiple pregnancy. If it's a high-order pregnancy (4 or more), your doctor may discuss the option of reducing the number of fetuses in a procedure called a "multifetal pregnancy reduction." This is sometimes done to increase the chances of having a healthy and successful pregnancy.

When IVF Treatment Fails

If the pregnancy test is still negative 12 to 14 days post-transfer, however, your doctor will ask you to stop taking the progesterone, and you'll wait for your period to start. The next step will be decided among you, your partner and your doctor.
Having a treatment cycle fail is never easy. It's heartbreaking. It's important, however, to keep in mind that having one cycle fail doesn't mean you won't be successful if you try again.

Saturday, 6 April 2013

IVF Treatment Step Eight: Progesterone Support and The Two Week

On or after the day of your retrieval, and before the embryo transfer, you'll start giving yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots!) Sometimes, though, progesterone supplementation can be taken as a pill, vaginal gel or vaginal suppository.

Besides the progesterone, there really isn't much going on for the next two weeks. In some ways, the two weeks after the transfer may be more difficult emotionally than the two weeks of treatment. During the previous steps, you will have visited your doctor perhaps every other day. Now, after transfer, there will be a sudden lull in activity.

Friday, 5 April 2013

IVF Treatment Step Seven: Embryo Transfer


About three to five days after the retrieval, the fertilized eggs will be transferred. The procedure for embryo transfer is just like IUI treatment. You won't need anesthesia.

During the embryo transfer, a thin tube, or catheter, will be passed through your cervix. You may experience very light cramping but nothing more than that. Through the catheter, they will transfer the embryos, along with a small amount of fluid.

The number of embryos transferred will depend on the quality of the embryos and previous discussion with your doctor. Depending on your age, anywhere from two to five embryos may be transferred. Recent studies have shown success with just one embryo transferred. Speak to your doctor to find out if this may apply to you.

After the transfer, you'll stay lying down for a couple hours (bring a book) and then head home.
If there are "extra" high-quality embryos left over, you may be able to freeze them. This is called embryo cryopreservation. They can be used later if this cycle isn't successful.

Wednesday, 3 April 2013

IVF Treatment Step Six: Egg Fertilization


While you're at home recovering from the retrieval, the follicles that were aspirated will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.

Once the oocytes are found, they'll be evaluated by the embryologist. If the eggs are overly mature, fertilization may not be successful. If they are not mature enough, the embryology lab may be able to stimulate them to maturity in the lab.

Fertilization of the oocytes must happen with 12 to 24 hours. Your partner will likely provide a semen sample the same morning you have the retrieval. The stress of the day can make it difficult for some, and so just in case, your partner may provide a semen sample for backup earlier in the cycle, which can be frozen until the day of the retrieval.

Once the semen sample is ready, it'll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best looking sperm," placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.

With the exception of severe male infertility, 70% of the oocytes will become fertilized.
In the case of severe male infertility, ICSI (pronounced ick-see) may be used to fertilize the eggs, instead of simply placing them in a culture dish. With ICSI, the embryologist will choose a healthy-looking sperm and inseminate the oocyte with the sperm using a special thin needle.

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Saat-saat paling genting, tapi kami yang duk di rumah ni cuma bleh berdoa saja la supaya ade rezeki untuk mengandung nanti. Tak sabar rasanya menunggu hari Jumaat for the ET.

Tapi dalam pada tu duk perhatikan henpon juga kot-kot ada call dari metro.

Hm, macam ditakdirkan pulak, dekat pukul 11 pagi henpon saya berbunyi dan tertera nombor yang tak dikenali. Ikutkan hati malas nak angkat sebab takut pihak nak promosi insurans, iklan macam-macam. Tapi jawab je jugak...

Rupa-rupanya Cik Nurul, embriologist metro yang call.

"Puan, datang ke metro esok untuk ET ye."

"Oh, okey. Cepat la pulak kan?"

"Ya, sebab tempat yang terbaik untuk embrio adalah rahim, bukan lab. Jadi dah ada 5 yang fertilised, kami nak masukkan secepatnya."

"Okey, okey."

Tak tahu nak cakap ape sekarang ni. Berdebar pun ade. Cepat la pulak kan? Tapi takpelah, yang penting Alhamdulillah, ada juga Cepat yang berjaya disenyawakan. Cepat matang la ni.

Hehe, doakan kejayaan kami ye.

Qolarobbi habli minladukan zurriyatan toyyibatan innaka samiuddua. Amin.

IVF Treatment Step Five: Egg Retrieval

About 34 to 36 hours after you receive the hCG shot, the egg retrieval will take place. It's normal to be nervous about the procedure, but most women go through it without much trouble or pain.

Before the retrieval, an anesthesiologist will give you some medication intravenously to help you feel relaxed and pain free. Usually, a light sedative is used, which will make you "sleep" through the procedure. This isn't the same as general anesthesia, which is used during surgery. Side effects and complications are less common.

Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle in to the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.

The number of oocytes retrieved varies but can usually be estimated before retrieval via ultrasound. The average number of oocytes is 8 to 15, with more than 95% of patients having at least one oocyte retrieved.

After the retrieval procedure, you'll be kept for a few hours to make sure all is well. Light spotting is common, as well as lower abdominal cramping, but most feel better in a day or so after the procedure. You'll also be told to watch for signs of ovarian hyperstimulation syndrome, a side effect from fertility drug use during IVF treatment in 10% of patients.

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Egg retrieval atau oocyte pick up (opu) dan tese dah berlaku semalam seperti scheduled.

Tepat pukul 7 pagi kami dah sampai di metro bersama-sama ummi dan abah. Proses ni memerlukan kami dibius, jadi bilal balik nanti tak boleh drive sendiri dan of course tak boleh jaga diri sendiri la kan. So umi abah akan jaga masa kami tak sedar.

Lepas register kami masing-masing dipakaikan tag nama kat tangan kanan masing-masing. Kemudian di bawa ke katil wad, bersebelahan. Ade baju hospital (yang ikat belakang tu, dan extra things on my table, pad. Haha) Pad tu nanti kena pakai lepas operation sebab mungkin akan ada slight spot kesan amik egg.

Dalam pukul 9 pagi nurse datang jemput saya dulu untuk proses opu. Sebelum tu baju yang dipakai, perlu ditanggalkan semua, cuma pakai baju hospital tu je. Saya disuruh duduk atas wheelchair, cover kepala and then dibawa ke operation room.

Nervous jugak rasanya. Maunya tidak, tengok doktor bius pun dah biul rasa. Ha5. Kidding.

Mula-mula doktor suruh saya baring atas katil tu, kemudian dia berusaha cucukkan jarum di tangan. Kemudian terasa macam dia masukkan sesuatu sebelum saya mula rasa pening.

"Doktor masukkan ubat ke?" Eceh, sempat lagi saya bertanya.

"Yes, ada rasa pening?"

"A'ah..." zzzzzzzzzzz

Tu je yang sempat saya record, lepas tu out. He5. Ape yang doktor buat memang I have no idea.

Sedar-sedar je dah sampai wad, dibaringkan atas katil dan dengar suara nurse panggil "Norliza"

Tengok katil sebelah, suami dah takde. His turn for tese.

Prosedur siap lebih kurang pukul 11 kot. Tapi saya tidur sepanjang hari. Kesan bius buatkan kepala pening. Nasib baik takde muntah2.

Tapi saya punya effect pening tu memang agak lama, sebab dah sampai malam pun masih tak boleh berdiri lama. Terus kena baring, siap muka pucat bagai.

Kami balik around 5 petang, berbekalkan macam-macam ubat. Untuk saya yang banyak, 3 jenis telan, 1 yang vaginal insert, suami 2 jenis je.

Tiga tu - vitamin E, antibiotik, hormon progesteron telan. Dan yang perlu masukkan ke vaginal tu hormon progesterone jugak, untuk rahim support. Sebagai persediaan hamil.

Dalam kad appointment, kami perlu datang balik pada hari Jumaat 05/04/2013 untuk embrio transfer. Tapi nurse ade cakap, kalau ada perubahan ambriologist akan call. Mungkin kalau cepat matang, perlu lakukan embrio transfer lebih awal.

Monday, 1 April 2013

IVF Treatment Step Four: Final Oocyte Maturation

Step ni adalah untuk trigger the oocytes to go through the last stage of maturation sebelum it can be retrieved.

Pembesaran terakhir ni akan menggunakan HCG (human chorionic gonadotropin). Shot ni sekali je. Yeah!
Dan perlu diambil di klinik. So malam tadi saya dan husband ke metro for the appoinment.

Tepat 10:05 malam kami dah tercongok di 2nd floor metro. Ada 2 orang nurse tengah tunggu dengan fail kami di depan mereka.

Tanpa lengah terus mereka suruh saya masuk ke dalam satu bilik for the injection. Sebelum tu kena amik darah dulu. Kemudian baru suntik. Hmm, nurse buat lagi sakit dari inject sendiri kan? Ha5.

Jarum besar dan panjang kot??

So that's all. Hari ni kosong, esok opu & tese.

Nurse pesan datang jangan pakai make-up, perfume, gel rambut atau ape saje. Sama juga untuk suami. Lepas mandi terus sarung pakaian the keluar.

Check Up Day 12

29 Mac 2013.

Appointment lagi  untuk pantau saiz telur. Seperti biasa saiznya doktor sebut, nurse catat. Masih jugak saya lupa nak kira ade berapa sebab asyik tengok di skrin telur-telur tu. He5

Lepas siap doktor Tee beri tarikh untuk OPU dan TESE iaitu 2 April 2013. Huh, berdebarnya rasa. Kena balik siap sedia, dan habiskan saki baki Suprefect & Gonal F injection.

Masa di kaunter sebelum balik, nurse terangkan lagi apa yang perlu dibuat.


Saya memang suka kalau diberi note tulisan tangan macam ni. Boleh rujuk anytime. 

So, Last dose Gonal F (malam) adalah 30/03/2013.
Last dose Suprefect (pagi) adalah 31/03/2013.
Suntikan HCG perlu amik di klinik pada 31/03/201 malam. Yang ni kena gi metro dan nurse yang injectkan, di punggung. He5.