Edisi BM : IVF#1 CD 10 - CD 16 - Esok Egg Retrieval Day

Hari ini CD 16. To update, berikut adalah ubat yang digunakan dari CD 10 hingga CD 16

CD 10 - Puregon 150 IU + Orgalutran (0.25 mg) (done)
CD 11 - Puregon 150 IU + Orgalutran (0.25 mg) (done)
CD 12 - Puregon 150 IU + Orgalutran (0.25 mg) (done)
CD 13 - Suprefact @ 7pm + Ponstan 250mg 1biji x 3 times (done)
CD 14 - Ponstan 250mg 1 biji X 3 times + Augmentin 625mg 1 biji x 2 times (done)

Pada CD 13 (15/10/2016) - appoinment dengan Doktor Natasha jam 11.45am. Doktor P xde so, doktor N ganti. Kami scan kesemua follicle (telur), dan alhamdulilah ada lebih kurang 16 biji. Kebanyakan sudah 14mm - 20mm size in diameter. Sudah hampir matang kata Doc N. Takut risiko OHSS kerana bilangan telur yang melebihi 12 (mengikut Doc N). Maka, Doc N telah membuat keputusan untuk freeze all. Ya, bekukan kesemuanya. Tiada fresh transfer.

Sebenarnya, Doc P tidak ada consult untuk freeze cycle ni. Malah dia lebih menggalakkan untuk berbuat fresh transfer. Akan tetapi telur saya banyak, dan dinding uterus sy tidak berapa cantik kata Doc N. Maka, freeze them all! :( sigh.. ada lah hikmah nya..saya terima saja. Sy tny berapa lama kene tunggu untuk frozen embyo transfer (FET) ? Paling cepat 2 cycle menstural dan saya buat calculation paling cepat pun, bulan disember.

Xpelah, apa lah sangat 2 bulan memandangkan kami telah tunggu 5 tahun kan? Maka ER (egg retrieval) / OPU (ooctye pick up) di tentukan pada CD 15 @7 am. Selepas berjumpa doc N, kami ke level 2 untuk register ward. Saya di suruh berpuasa air dan makanan dari jam 12 pm sehinggalah prosedur ER selesai. Kami disuruh sampai ward by 6.30am tanpa memakai sebarang wangian , contact lens ataupun barang kemas.

Selepas registration kami ke level 6 semula untuk mengambil ubat. Sepatutnya bayaran terakhir RM7250. Akan tetapi disebabkan telur akan di bekukan, maka ada additional cost untuk freezing.

1) 1 -4 embyo + thawing cost
(RM 1749 + 600) = RM 2349

1) 5-8 embyo + thawing cost
(RM 2544 + 600) = RM 3144

Untuk pakej, harga 2 telur sudah dimasukkan didalam harga pakej. Maka selebihnya, additional embyo kena tambah sendiri lah ya.

Persiapan sehari sebelum OPU:

1) Kemas rumah + buat laundry
2) Beli groceries (ingat nak masak sup ikan merah day 1 dan ikan siakap stim day 2)
3) Bukakan kesemua barang kemas (rantai je pun hehe)
4) Makan ubatan2 yang di sarankan
5) Puasa starts at 12pm tapi pukul 10 sy da berehenti makan dan minum
6) Tidur awal @ 10.30pm.. dan try bangun jam 5 untuk mandi dan solat sunat / subuh

Doakan ER kesemuanya selamat dan tiada OHSS selepas prosedur. Insyallah saya akan update lagi blog ni selepas ER esok.

Wish me luck! :)

Edisi BM : IVF#1 - CD 9 (update)

Alhamdulilah.. diam x diam, dah Day - 9. Update from CD 8- CD 9

CD 8 - Puregon 200 IU (done) + Orgalutran 0.25mg (done)
CD 9 - Puregon 200 IU (done) + Orgalutran 0.25mg (malam ni)

Appoinment Dr. P (10/10/2016) - Scan telur, alhamdulilah, telur ada sebesar 8mm, dan dpat kira dalam 4-5 biji setiap ovari. Dr P turunkan stimulan dosage ke 200IU tp tambah satu lg ubat Orgalutran untuk elakkan dari ovulasi / telur menetas .

Antara kesan sampingan ubat yg sy alami

CD 3 (05/10/2016)- masa day 1 sy cucuk, bengkak tempat cucuk mcm kaler ungu, esok lusa jadi kuning. Tp 1 tempat je yg kne. Lepas tu xada sebab xnaik motor / buat keje berat lepas cucuk

CD 8 (08/10/2016) - Hari yang sangat cramp! masa ni, period dah habis. Tp disebabkan endo, cramp period pain tu masih ada. Whatsapp nurse pg tu, dia advise amk paracetomol 2 biji. Mula2 lega. Tp datang balik cramp. Makan lg 2 biji sambil msg nurse untuk minta tnykan doc kalau boleh amk arcoxia. Nurse  reply lmbat jg, sbb tunggu reply Dr. P. Dr, ckp boleh makan arcoxia sebiji.
Kol 3pg, terjaga sebab perut sakit sangat (cramps), amk arcoxia sebiji. Ubat mula rasa sejam kemudian. Baru boleh terlelap sampai pagi. Alhamdulilah, sepanjang hari esoknya, tiada cramps. :)

CD 10 (10/10/2016) - Discharge kaler clear banyak sangat. Tanya doc, dia ckp maknanya nak ovulasi sebab telur bertindak balas dgn ubat stimulan.

Esok ada appoinment untuk tentukan tarikh untuk Egg pick up / retrieval. Mungkin hari ahad 16/10/2016 atau mungkin hari selasa (18/10/2016). Kalau hari ahad, ada caj extra sebab doc kene OT dalam RM 2++ (tidak termasuk dgn harga pakej)

Nervous tunggu doc bg tarikh esok. ;)

Bil untuk 2 x bayar :

Bil 1st payment + 2 additional test untuk hepatitis dan hiv (compulsory xmasuk pakej)

Bil 2nd payment

Edisi BM : IVF#1 bermula sekarang!

Assalamualaikum!

Period datang pada hari Isnin 03 Oktober (D1). Jadi, call klinik buat appoinment untuk D3 pada hari Rabu, 05 Oktober. Doktor P xada, maka Dr. Agilan ganti. Mula-mula macam nak tangguh bulan depan tetapi selepas diskusi dengan suami, kami membuat keputusan untuk teruskan dengan doktor agilan. Ini kali pertama kami berjumpa dengan dia. Dia scan dan suruh kami buat ujian darah.

Isteri : Ujian darah untuk Hormone dan check untuk Hepatitis
Suami : Ujian darah untuk Hepatitis dan aids (compulsory)

Kami ambil darah jam 1.30pm dan keputusan ujian darah pukul 4.30pm baru tahu. Saya kembali ke pejabat dan dalam jam 4.00pm sy pergi ke klinik semula. Nurse call jam 4.30 dan inform hormone test ok. So boleh mula IVF injection harini. Alhamdulilah! :)

Disebabkan kami sampai terlewat (dalam jam 4.45pm), klinik dah nak tutup. Nasib baik, nurse tunggu juga kerana injection tu kene amk harini jgk. Nurse bg penerangan mengenai cara-cara nak masuk kan cartridge ke dalam puregon pen dan dosage yang di perlukan. Nurse juga ajar cara-cara nak inject ke perut dengan kaedah yg paling minimal sakitnya. (hint : cucuk needle masa tarik nafas. dan letak ais 5-10 min sebelum inject untuk numb kan kawasan tu)

Day 1 : 300 IU Puregon (done)
Day 2 : 300 IU Puregon (done)
Day 3 : 300 IU Puregon (done)
Day 4 : 225 IU Puregon (done)
Day 5 : 225 IU Puregon(done)

Day 6 : Appoinment semula dengan doktor P.

Puregon Pen bersama catridge untuk puregon injection

Lepas injection tu, sy balik naik moto. Sampai rumah, baru perasan bengkak tempat jahit. Dia jadi macam kaler macam purple. Esok nya kami inject di belah kanan (semalam di belah kiri), dan sebelum inject, sy tuam dengan ais. Mmg xrasa sakit dan yg paling penting, tiada bengkak di kawasan injection. So, kami buat kesimpulan, inject di waktu malam, dan lepas inject, terus baring atau jangan buat kerja berat2.

Ada side effect lepas injection? So far, tiada. Cuma disebabkan saya ada endomteriosis, cramp masa period tu masih ada. Walaupun dah makan arcoxia, masih sakit hari ke 5. Selalunya dah xsakit. Xtahu la adakah ini effect puregon atau tidak.

Bagaimana dengan perasaan saya? Rasa nervous, tapi lepas injection yg pertama baru datang perasaan..wow... dah nak start IVF ni! Macam dalam mimpi sebab kami dah tunggu 5 tahun untuk prosedur ini.

Owh bil saya untuk 1st payment , RM6500 . Total bil akan jadi RM 19500 ya kawan2..

Doakan kilang ovari saya response dengan baik melalui puregon injection. :)

List of Gynae Specialist in KL (My list)

We all have our preference in selecting the right gynae for us. Some doctor might work for us while others might not. 

Here is a list of doctors (specialist in Gynae - infertility) I had encountered during my journey. The list is in no particular order or ranking. 



1. Doctor Adilah Ahmat - Hospital Pantai KL

She was my 1st gynecology doctor I met and she was the one who diagnosed me with endometriosis back in 2011. I had a laparoscopic operation for my cyst performed by her and Dato' Dr Abdul Fahmi A. Karim.  I still am an avid follower of her blog. You can contact and make an appointment with her nurse Salina.
Specialist - Infertility (endo, pcos, etc) and IUI, IVF.
Blog / website : http://dradilah.blogspot.my/
Tel No : 03-22989836 DL (Nurse : Salina)
Address : Pantai Hospital Kuala Lumpur, 
B403, No. 8, Jalan Bukit Pantai, 
Taman Bukit Pantai, 
Wilayah Persekutuan, 
59100 Kuala Lumpur, Malaysia

2. Doctor Marista Mansor - Klinik Pakar Wanita Medina 

She was my 2nd opinion doctor. I went to her after I found out about my endometriosis diagnose. She also suggested operation but using laparotomy. I didn't do my operation with her. 

Specialist - Infertility (endo, pcos, etc) and IUI, IVF.
Blog / website : None
Tel No :  +60 3-4106 6990
Address : No. 67, Jalan Melati Utama 4, 
Melati Utama, 
53100 Setapak,
Wilayah Persekutuan

3.Prof. Dato’ Dr. Zainul Rashid Mohd Razi - Hospital UKM (Specialist Centre)

He was my 3rd doctor. I went to see him after I had my laparoscopic. I needed a 2nd opinion on Lucrin injection. He agreed on Lucrin and normally prescribe them 6 months for each of his patients. Based on his opinion and judgement, I proceeded my Lucrin shots with Doc Adilah for 3 months.

Specialist - Infertility (endo, pcos, etc) and IVF.
Blog / website: http://www.ukmsc.com.my/?page_id=508
Tel No : 03-91455540
Address : 7th Floor, Clinical Block, UKM Medical Centre

Jalan Yaacob Latif,
56000 Cheras, Kuala Lumpur

4. Dato' Dr. Prashant Nadkarni - Kl Fertility Clinic

He was my 4th doctor. I went to see him to get advise on IVF. Currently he is my doctor and will proceed IVF with him next month.

Specialist - Infertility treatment - IVF.
Blog : http://www.klfertility.com/dato-dr-prashant-nadkarni/
Tel No : 03-20933500
Address : Suite 604, 6th Floor Wisma Perintis,
47, Jalan Dungun, Damansara Heights,
50490 Kuala Lumpur, Malaysia.

5. Dr Tee SP - Metro IVF KL

Actually, I didn't get to see him. He was replace with another doctor. I can't remember her name, an Indian lady doctor. She did a full check up and got my full medical history. I was supposed to go back to see Dr Tee the following appointment. But, I cancelled. The last time I went, the clinic was at Jalan Changkat Thamby Dollah. But when i went to their website, it is not listed there anymore. Maybe it has moved to some other location.

Specialist - Infertility treatment - IVF.
Blog / website : http://metro.com.my/our-team-specialist/
Tel No : +603-3341 2277, +603-3341 1941
Address : No. 36, Jalan Pasar, 41400Klang, Selangor, Malaysia

6. Dr Aizura Syafinaz Ahmad Adlan - Pusat Perubatan University Malaya (PPUM) Specialist Centre

I accidentally found her online because I was researching about a new treatment called MR Guided Focused Ultrasound to treat uterine fibroid.  I was hoping she could refer me to the specialist Professor Dr. Basri Johan Jeet Abdullah. He is a Professor at the Department of Biomedical Imaging, University of Malaya and Consultant Radiologist at the Biomedical Imaging Unit, University of Malaya Medical Centre, Kuala Lumpur. But as it turns out, while waiting for her during our appointment, she had to cancelled due to an emergency case. I didn't reschedule for appointment after that. 

Blog / website : http://www.umsc.my/umsc_doctor/aizura-syafinaz-ahmad-adlan/
Specialist - Infertility (endo, pcos, etc) and Minimally Invasive (Key-Hole) Gynaecological Surgery
Tel No : +603 7841 4000
Address : UMSC Specialist Outpatient Clinics
Day Surgery Unit | Haemodialysis Centre | Dental Centre
UMSC Building, Lot 28,
Lorong Universiti, Lembah Pantai,
50603 Kuala Lumpur
GPS: 3°6’58.2739”N 101°39’2.6669”E

7. Dr Ahmad Zailani Hatta Mohd Dali - Hospital Pantai

I was referred to him by his wife, Dr Adilah Ahmat. He specialize in oncology gynae operations and treatment. I went to seek his opinion on my current condition if I needed any intensive surgery. I haven't decided on re-operating on my adenomyosis and has proceeded to do IVF treatment instead.

Blog / website : https://www.pantai.com.my/kuala-lumpur/doctor/obstetrics-and-gynaecology-og/dr-ahmad-zailani-hatta-mohd-dali
Specialist : Oncology Gynae
Tel : 03-22989828
Address : Pantai Hospital Kuala Lumpur,
B403, No. 8, Jalan Bukit Pantai,
Taman Bukit Pantai,
Wilayah Persekutuan,
59100 Kuala Lumpur, Malaysia

*Additional information, I did went to see alternative treatment. I went to this Traditional Chinese Medicine (TCM) for herbs and acupuncture. 

1. Master Tole -The Tole Acupuncture & Herbal Medical Centre

I met with Master Tole himself and was prescribe some herbs and acupuncture treatment. I discontinued my treatment here and went to Tung Shin Hospital instead.

Blog / website : http://www.thetole.org/

Tel No : +60 3-2141 8370

Address : Lot 2.01, 2nd Floor,

Menara KH (Menara Promet),

Jalan Sultan Ismail, 

50250 Wilayah Persekutuan, 

2. ASSOCIATE PROFESSOR YIN LI RONG (殷立荣副教授)- Tung Shin Eastern Medicine 

I continuously go and see her for treatment in nearly more than 3 years. She usually prescribe me herbs and acupuncture session for 30 mins.

Blog / website : http://www.tungshin.com.my/consultants/chinese-medical-division/gynaecology/

Tel No :  +603-2037 2288 

Address : 102, Jalan Pudu, 

55100 Kuala Lumpur, 

Wilayah Persekutuan 

Hope my list will ease you on finding the right doctor for you. 

My advice will be, 

1. Don't wait on getting diagnose. 

2. Find a specialized doctor in your condition. A gynaecologist with sub speciality (PCOS, Endometriosis, Adenomyosis, Infertility - IVF/IUI)

3. Always get 2nd opinion but when you have decided, stick to the same doctor until he/she finally has exhaust all options for you.

4. Always compare their consultant prices, ethics, hospital facilities etc before deciding.

Please let me know should you require any additional info on the doctors above. If you need reviews of each doctors, please email me directly (sarahghazali82@gmail.com).

Starting My IVF with Doctor Prashant this coming Oct 2016

Alhamdulilah. Finally I'm going to do my IVF this coming October. Currently, I'm awaiting for my period to come and we can start our cycle soon. This will be my 1st IVF and I'm very excited. Sadly, we recently change doctor (previously was doctor Adilah). I had nothing against her. She's a good doctor and always give good advice. (I found my magic pill, Arcoxia through her). But let's just say no Rezeki to have the treatment with her. :(

To recap, last appoinment with doc P,

a) Had sperm test for DH (sperm count low. Doc P gave Profortil 60 capsule)

b) No CA 125 or AMH test for me since I had it done previously with Doc A last february (19.02.2016)
 - CA 125 was 127.7 U/ml (normal range 0.0 - 35.0)
- Vitamin D was 84 nmol/L (sufficiency 75 - 250)
- AMH 26.38 pmol/L (Healthy Women 30 -34  : 6.75 - 47.84 pmol/L)

Test was alhamdulilah good and Doc P said we could proceed in Oct.

Alternative treatments & Supplements :

a)  TCM (traditional chinese medicine) & Accupunture at Tung Shin Hospital
b) Acid folic intake
c) Habbatus Sauda in oil form
d) Goat's Milk

Just to update, the cost of IVF is still RM17,000 with Doc P. But outside the package range, the consultation and tests fees has rise alot. I will put my receipt in next post.

Wish me luck.. :)

Endometriosis Center in Atlanta.

My last period which was after the failed clomid cycle, i had the most painful menses ever. The pain was excruciating that i had to have painkillers on standby. It didn't worked. Had hot water bottle (tuam) , it helped a little but then the pain is still there. I'm not so sure as why it happened, but in my opinion, it has to do a lot of hormone pills I've took for my clomid treatment. I had clomid, femostan and duphaston. All pills! And it did a lot of bad things to me in the end.

So during my painful period week, i did a lot of research on the best endometriosis specialist and this website came out , http://www.centerforendo.com/ . In Malaysia, endometriosis is new, and most doctors don't know how to treat it. They will ask for surgery, which is the same solution from this center BUT how good are the doctors in peeling/laser/excision  off the endo cells which sticks to the other organs determine the success of the operation.

Well,I'm no expert in medicine. But when i read this establish center for endo, I'm intrigued. They understand our problems, and can explain in details pre and post-op. They have the best facilities to undergo LAPEX, the best doctors available, the most extensive database on endometriosis patient from all over the world.They can even assess our case for FREE if you post it to them. 

At that time and moment, i was very much in pain and in desperate need for some relief. I was thinking of calling them out and that's when my pain stop the following day. I had cramps even after my period. There was not even blood on CD 6 but the pain was so horrible! Well, why didnt i just go to my doctor? Because i know what she will do. She will prescribe me more painkillers. Endo has no cure or any medication. Just surgery to get it all out. Even then, it can come back with a vengeance 

My case is endo stage 4. Its quite critical and after my surgery, my doctor told me, she couldn't get most of it out from my body because she didnt want to take any risk. The operation was very risky. My condition was so severe that my uterus is stuck to my bowel/intestine. It was hell when i wanted to go to the toilet after the operation. I was sad because there is not much she can do and the only solution she had for me is suppress my period after operation and GET PREGNANT! I had my lucrin treatment already. Boy, it wasn't a walk in the park for me. There was so much side effects from lucrin. 

And now, I'm waiting for the 2nd treatment..which is GET PREGNANT. This is also very difficult to achieve. Since if I take more hormone treatment, it acts like food to my endo cells. They thrive on the clomid. I know, it doesn't make any sense. But the want thing that can get u pregnant can also help to get back your disease. But if i get pregnant, then the endo will stop for awhile.Sounds confusing eh? 

So, i will consider this option again (the LAPEX center at atlanta) if my pain starts coming back again. The cost is not cheap, but if there is any alternative / centre for endo in any parts in Malaysia, i'll take it! In the meantime, please be prepare for my lovely AF arrival with painkillers. 

*For all endometriosis patient, do visit their website to learn more about your disease. I'm glad I found them. :)

  

Clomid cycle #1 FAILED...

Contemplating...

Ive been meaning to update the blog since FOREVER!haha..Guess when u had bad news, it makes your attitude less semangat!

As the tone suggest, my 1st clomid attempt has FAILED. :( I was so hoping it was a success that i sometime forget that only GOD knows when he is gonna give me the opportunity of a lifetime? But the reason im updating today is to go through the steps ive done for clomid #1.

CD# 3-7 - TVS showed there is no big size follicle. Doc prescribe clomid  for 5 days. 2 pils daily (2 x 50mg ) = 100mg daily dosage.
CD#12  - Had TVS scanned. Only 1 dominant egg on the right ovary. And also as expected, the uterus wall was very thin. <10mm. Doc's not encouraging. But we were hopefull. Doc prescribe Femostan to consume 3 times daily. morning and afternoon vaginally, while at night orally.
CD#15-16 - Had +ve OPK. BD
CD #17 -  Had TVS scanned. Already ovulated as expected. Alhamdulilah we caught it early. If we had waited, of course we missed the ovulation window which can only last from 12 - 24 hours and the Femostan  orked. My uterus wall already thick by 12 mm by this time. Doc prescribe duphaston for 3 weeks. To be consume 3 times a day. starting from CD 22. Doc advise if period comes, we have to stop taking them. Period did not come but i was hopeful for a BFP.
CD# 22 - Started Duphaston. 3 times daily.
CD# 22 -30 - BBT graphs was execellent! the temp keeps rising.
CD#31  - Temp drop! This is when i realise there is a possibility of no implantation. Already restless and tempting to do UPT test.
CD#31 - caved ! and tested. of course BFN! so sad . the pregnancy signs were all there. But then i notice duphaston can mimic pregnancy and it can make our period late! Our body is being provided with fake progesteron  daily. So I cant have the menses with progesteron on. I made my own decision to stop progesteron.
CD#33 - true enough as one of my blogger friends said, 2 days after stopping duphaston, AF arrived! This was a very sad day for me. We were so hoping for this cycle.

Now im on new cycle and on CD7. Last time we decided to proceed IUI directly after clomid failed. But since my sister is having her wedding in June, i had to postpone the procedure till after the wedding+ramadhan+raya+2 vacation trips, so its gonna be late october 2013. But who knows, maybe it sticks before my IUI? Amin..

My graph for March was so hopefull. *sigh*