My IVF injections doctor followup #3 @ Hk Sanatorium

6th August 2013 (Tues)

I had to get my blood work out on Tuesday morn for Dr Ingrid. So I had to go in at 8am.

I had to wait till 11.30am before the report was out to see Dr Ingrid. She apologised for the wait but it was ok since I brought my books to read.

My third followup on scan to see how my growing follicles are doing. Apparently they are doing great! I was so happy that they are about 17-18mm in size for both sides! Talk about happy about being uniform growth. It's credit to Dr Ingrid. She must have controlled my stim injection dosage well. And strangely, this is the first and only session that Mr Probing Wandy did not hurt me like hell when she was scanning the right ovary. Normally, it was a searing tearing pain but this time because it was swollen, so it makes it easier for her to scan without having to probe so far in. Yes, I think I have deep seated ovary and my inverted uterine did not help.

So when we went to her room and to my surprise, she said she would go ahead with my egg retrieval on Thursday! Yeah brought forward by 1 day and NO MORE stim drugs or suppression drugs! During the review, she did mention that my readings E2 was slightly on the high side but she said not to worry.

I looked at my report and it said E2=10848 pmol. I dont know what is the norm but since she said not to worry, I wont.

Instead, I had to go to the outpatient to get my DECAPEPTYL INJ 0.1MG 1ML [0.2MG] injection at 9pm that very night. So that means I will have my operation on 9pm on Thursday morning. I prob will be her first patient for the day. Yeah!

So that night, after dinner, I walked to HK Sanatorium at 8.30pm and waited for my Jab. What they didnt tell me was that Ovidrel was prefilled and it takes 2 jabs!!!

This is the MOST PAINFUL jab of them all. Pain level at 8-9. I dont know if its the nurse, or the med itself, or the fact that the jab was done half a finger length away from the belly button instead of the usual full index finger length away. Anycase, I really couldnt move after the jab as the pain was spasming  thru my lower body to my ovaries. Good thing i brought my ice pack and it felt better after 5 mins with the pack laid over the injected area, The coldness must have took the edge away.

I couldnt walk home, so I grabbed a cab back.

During the whole 9 days of Ivf stim injections, my body seemed to react fine to it. No bloating, no funny feeling. My ovaries felt fine too. I am thankful since I read ALOT of horror stories about sore ovaries etc.

After injection, my body was fine too thankfully. In fact, I continued to maintain a healthy appetite! However, I definitely did increase my intake of boiled filtered water. Maybe my physiotherapy back massage helps too since my back was still sore during the first 6 days but its better now thank god!

During all these time, life goes on as per normal. I didnt ask for extra pampering from my husband nor do I need him to company me. I felt fine to do things as per normal with minimal change in lifestyle. I'm used to being independent so if I had him tagging along, I would be more stress. My husband still have no clear idea how this IVF works except he did feel sorry for my tummy bruise and did ask if there is anything he can do. He did do one thing I hate, he helped washed up the dishes and pots after I cooked dinner since I really dont want to stand by the sink for prolonged period due to my back recovery. He was sweet.

I told him to clear his sperms by yesterday which he did (since we thot the retrival was on Friday). So hopefully they will be alright on thursday...fingers crossed. Dr Ingrid didnt do another check since the last report 2 years back, and his sample last year for IUI was graded to be very high on motility. So I really hope this batch will be good too.... Go boys go!

My IVF injections doctor follow up scan #2@ HK Sanatorium Hospital

3rd August 2013. (Sat)

Comes my 2nd evaluation and scan.

Progress looks good. The follicles are growing nicely and they are about 11mm now on both sides. It seemed as if my right ovary has one more in quantity than my left, though its my left that I felt occasion twinge.

However, because it looks as if there are MANY other follicles there, so Dr Ingrid told me she will reduce my Gonal F dosage to 100mg instead which works for me. At the same time, she told me she will start me on the suppression drug to prevent ovulation for 3 days, starting today on Sat. We were anticipating egg retrieval on Friday if all goes well!

Excited!

So as usual the nurse prepared me for the jabs but no one had pre warned me that the suppression jab Orgalutran (0.25MG) hurts like hell!!! OUCH! It makes the Gonal F jabs pales in comparison! The pain level was at 7 for the suppression jab. Plus, it definitely left a nasty purple black dark bruise. However it was localised to a small penny size due to icing. Important reminder, do NOT rub on the injection. It will cause bruising. I forgot since it hurts like hell and I shook on it. BAD mistake...

My IVF injection doctor followup #1 @ HK Sanatorium

1st Aug 2013.

Time to meet Dr Ingrid for my first followup after 4 days of stim. injection.

The oddest thing about the procedure here is that the nurses will prep u for the scan first before seeing the doctor. So that means, I will greet my doc with my legs wide open each time. I just found it kinda weird and rude to say hi with legs wide apart but that's just me being a prude. Hahaha.

Jokes aside, we were both happy to see each other. I assume Dr Ingrid is happy too since she had such a lovely smile. She looks very pretty when she smile actually:) Her trip was good and I was happy to hear that.

So begins the investigation and knowing how much ultrascan hurts for me, she went in gently with Mr Probing Wandy. On the screen, I could see round follicles. I could see quite a few actually Yeah. More than 3 for sure as compared to IUI process. She took the measurements and it was about between 7-8-9mm wide on both sides on Day 5. I think there are about 10-11 follicles on each side if I rem correctly, but I tend to forget since we didnt talk about it.

What we did discuss was that she was happy with the growth rate, and that she would continue with the same dosage for the next 2 days until she sees me on Sat 3rd Aug to review my progress. Again, she shared that because of PCOS, that's why we started on low dosage but it seems to work for me. I trust her implicitly.

She asked me as well if my partner will be freezing his sperms and i told her prob not, since he can produce on demand so long he has his porn. We all had a good laugh:)

So my injection resumes..

My blood work report on Day 2 of my period came back.

FSH = 4.1
Estradiol = 64

My first 4 days of IVF Gonal F injection@Hk Sanatorium begins!

During my IUI cycle, I had performed the injections myself at home. However, I cannot say it was stress free and so this time round, I decided to just go easy and have the nurse to do the daily injection for me. Sure it was expensive (extra HK$90 per injection) and adding to the cost, but seriously, making baby shouldnt be a stressful thing, not to mention I have to endure the physical pain of it!

So I had my first injection at HK Sanatorium outpatient on sunday afternoon. On Sat, the nurse had asked me what time I had wanted to do the injection and I just instinctively told her 1pm. So she booked me in for Dr Ingrid at 2.15pm on Thursday 1st August for my first evaluation after the injection. THANK GOD my doctor is back!

The injection was relatively uneventful, except that I get to have a good chat with the nurses.

On some days, the injection hurts when the med is being pumped in, on some days I hardly felt it. Strange huh. Some nurses are better than others at the injection. One gave me my first bruise on Monday. After my previous self injection, I learned to ice the area before and after the injection to contract the blood veins, to minimise bruising and locality in event they do hit a blood vessel.

The nurse Julie was very very nice when I first requested for ice, after the bruise I had on Monday. She even reminded me to bring the ice pack during my jabs on outpatient days since they dont provide ice. Sometimes when they are not too busy, we have a few laughs here and there. It's nice not to be stress.

I read somewhere that Arnica gel helps with bruising but I didnt bother. Instead, I used Hiruroid cream instead. Lol. Then one has to alternate hot and cold pack on bruise area just to get the blood moving. I love simple methods.

As for the after effects, I was pleasantly surprised that I didnt suffer as much this time as compared to the IUI jabs. The last time, I felt so bloated and tired all the time! My waistline previously really balloned that even my husband was taken back.

This time round, even though the dosage was higher, yet I didnt suffer from bloating or weight gain. However, on the 1st and 2nd day of injections, I did feel immediately sleepy after the first hour but it will pass. The subsequent jabs, barely had much impact which I was really happy about!!

I'm just praying and praying that I will not overstimulate since I have PCOS and having too many eggs will be bad. Wish me luck!

The start of IVF journey with HK Sanatorium Hospital

After my Pap Smear was pronounced normally on 22th July, I was finally relieved!!

The next thing I embarked on was to get my dental checked, to make sure all was good. Since it is impossible to get Xray on teeth when one is pregnant.

I wanted to get other stuff in order before my Gyn returns from her hol and before my period. It was running 2 weeks late. I had joked with my Gyn that it will probably wait for her return! Lol!

Also, I had to get my physical fixed. Somehow, I tore my thumb ligament, pulled a back muscle, pinch a nerve on my shoulder arm joint. It's crazy. It was all happening on the right side! So I had my X ray done to confirm my spine was fine. It was fine except my spine was completely straighten instead of  S shape due to inflammation. I was ready to check into my therapy.

Just after I got my back sorted out, my period arrived on Friday 26th July.
However, because it arrived about 4pm+, I couldnt get anyone from HK Sanatorium Gyn ward to answer my phone since I am supposed to call them on Day 1.

So on Sat 26th July, I called them at 10am, and the nurse told me my "substitute" doc was not available from 11am since she is going to an op to retrieve eggs and not coming back. The nurse said "oh its too late, you should have called us yesterday. Maybe I asked doc if u can come in on day 4"

I was annoyed. I told her its NOT MY FAULT that no one picked up the phone when I called yesterday. She asked me what time and I replied 4pm+. She had to cheek to reply that they dont answer the phone then since they knock off at 5pm. Well its NOT my fault. She kept emphasizing that I should come back on Monday but I told her firmly I do not accept that. I was also surprised actually because in my last 2 years dealing with nurses at this hospital, I never had ONCE a bad experience. They are usually quite polite, understanding and nice. So this one came as a nasty reality jolt.

I explained that I KNOW the DRILL. I need my blood test on day 2 or day 3, which is independent of the clinic time since HK Sanatorium hospital has a 24hr blood lab clinic. I told her that is the most impt because they need to know my FSH and E2 levels etc. I told her I honestly dont care which other gyn doctor I see since Dr Tang is NOT my original doc and just a stand in, and that it's also NOT my fault that she is not coming in after 11am since the OFFICIAL clinic time ends at 1 PM.

The nurse sounded very reluctant like as if I was a petulant child but she said she will checked with the doctor. I was quite very rightly pissed and wont back down since I explained I dont want to miss a WHOLE cycle just because it was inconvenient for them. As if I have a say in what time my period comes?!!

By 10.45am, I was very anxious. By 11am, the nurse called me back and asked where do I lived. I told her nearby and she told me to rush down for my blood test immediately and the doctor will come back to see me. AMEN!

So I went in for my blood works and waited for over an hour to see the doctor. She wasnt as nice as my usual gyn Dr Ingrid. Dr Tang reminds me of a disciplinary mistress of few words. I did say thank you to her for "coming back" for me and she just replied its ok as she did my ovaries scan. We went back to her room and all she said was that she will prescribe low dose of 150mg dose of Gondal F injections to start off for 4 days starting Sunday owning tat I have PCOS. That's it.

No explanation of the scan etc or information or what to expect. I couldnt be bothered to ask her as well so I just up and left. Luckily Dr Ingrid had made the extra effort to give me a quick run trhough before she left for her vacation.

Seriously, I have never felt as if the doctor was doing me a service before until today. I mean I know u are busy, but hey, you really could be nicer. Maybe because she is a standing for my ob gyn so she doesnt feel like she needs to have any bedside manners. Oh well, I am just GLAD that I didnt PICK Dr Tang from the start. I really like Dr Ingrid because I like her smile and even though she is busy and serious, she still have a bright smile for me every visit I had with her. Sometimes, she will also laugh a little at my self deprecating joke and I geniunely like her.  I read from some forum that Dr Tang is supposed to be armed with "credentials" from another hospital but frankly, I rather have a doc i can click with than someone who seem to think patients are like factory products. However, I know there are mothers to be who prefer to work with experienced doctors, so to each her own.

I realised there isnt much blogs and post about IVF doctors from HK Sanatorium, so hopefully my post helps as I document my IVF process!  

Strict Post Op Diet

I just thought I would share alittle on the diet I had after my LEEP op.

I supposed in western culture, they would resume back to their usual eating habits and lifestyle. In chinese culture, we believe that any invasive operation is "damaging" to the body and we need to aid the healing of the wound to have a smooth recovery.

While I am not a hard core Chinese herbs person but taking advice from my TCM doctor previously, as well as my friend's mum, I formed my own diet.

In general, after any op, we are not supposed to consume any seafood except fish for the inital 2 months. So throughout the first 1 month, I religiously kept to a lean diet. Pro chicken, pro vegetable soup (eg: watercress, carrots, black beans) and lotsa greens & fruits.

Basically, I made chicken carrot soup, with basic chinese herbs primarily with dried scallop so that I can go salt free, Chinese yam (5-6 slice), Honeyed dates, red dates, wolfberries, eucommia bark.

Things I avoided.
1. Seafood : Fresh Crab, prawns, shellfish
2. Milk
3. Sugar (white, brown, refined, raw)
4. Salt. (only very minimal 1- 0.5 teaspoon max is used if I cannot use dried scallops)
5. Package fruit juice.
6. Anything that says "fructose or sucrose or sugar" in ingredient list.
7. Processed ham
8. Bottled Sauce
9. Ice cream/ chocolates / cakes (my only vices when it comes to snackies)
10. Winter Melon (too cooling)
11. NO COLD WATER INTAKE at all times. Only warm.
12. Potato in all forms
13. Pasta
14. Cheese

Things I increased intake
1. Steamed Brocoli.
2. Steamed Asparagus
3. Steamed carrots
4. Mushrooms
5. Chicken soup with red dates and ginger
6. When I needed to fix my sweet craving, I made "Red dates, dried longan with Ginger" tea.
7. Made chicken braised with Apple cider and honey, with garlic slices.
8. Alot of salmon baked, lightly salted with pink salt.
9. Pork rib soup with carrots, cabbage, maize.
10. Apple. Cherries. Strawberries. Grapes. Orange.
11. Avocado.

In Chinese culture, we believe red dates helps to nourish the blood and ginger is "warm" in properties which will aid the body to recover better. Normally the red date tea, the ratio is 15 deseeded red dates, 10 longan and 2 chuck of ginger about 2 cm thick. Fill a 14 inch pot to 3/4 full, boil and add the ingredients and boil at high heat for 15mins, simmer low heat for 15mins and let it sit. For excess, I stick it into the fridge and drink it in the morn after heating it up. It ususally taste sweeter next day so I will add more water to dilute the sugar content. I would eat the red dates too.

Occasionally, I would add lemon to my plain water but I dont think it did much for me.

During my 1st checkup, my doctor was impressed at how quickly I healed and the 2nd checkup, she remarked it was very speedy progress. So I figured changing my diet definitely did help, plus drinking lotsa of water help too. Since I dont take coffee at all, I still have my usual green Japanese tea AFTER my first month. I would interchange it with Chamomile+Peppermint tea, rosehip+wild chrysanthemum tea.

Progression to CIN III (CIN 3) and Leep Op experience with HK Santorium Hospital

My Cin II has aggravated within a year to Cin III, even though the 2 pap smears within the year has no indication that it has worsen...makes u wonder if pap smear is like playing russian roulette...

So it was unavoidable that LEEP op must be performed.
My fate is sealed.

I oped for G.A for my LEEP op even though it's more expensive. There are several reasons why I choose to do the more expensive version

Reasons
- I squirm alot even just during pap smear. I find it hard to keep my legs wide open without sliding up.
- I have low tolerance for discomfort. Since I do not have cramps during period, even coloscopy is very very uncomfortable for me.
- I cannot be confident that I wont move during LEEP, which in my personal view may result in more complication. The doc may cut the wrong area when I moved, or the doc is so stressed by all the movement interruptions that the doc cannot concentrate on what needs to be done. A doc can get stressed too...and a stressed doc is not the one u want operating on u.
- I read all about the burning flesh smell and pain experience and I would like to skip all that...

I spoke to my doctor Dr Lam and she left the decision to me, though she did agree that in my case, GA would def take the pressure and stress off her during the op but she said in the end, its entirely up to me if cost is an issue.

The Op

So came April 12th and I checked myself into the HK Santorium hospital into the day ward. Surgery is performed by Dr Helena Lam. I like her. She is nice, friendly and upbeat but also serious when required.

My op is at 1pm but they wanted me there by 12pm. No food and drinks by 5am the day before.

Before I was wheeled into op room, the anesthesiologist came over to say hi, and to tell me to relax. He asked if I have any allergies, or if I have a tendency to get motion sickness. I replied yes and he told me in that case he will adjust his medication injection accordingly so that I will not feel nauseous when I wake.

Inside the op, I sat myself onto the bed and the anesthesiologist poke the needle into my hand and that hurts. In less than a min, everything blacked out.

POST Op

I woke up at 2.15pm. The op took about 25mins.
I feel groggy but fine. However I was cold. So the nurse gave me a hot blanket.
My doc came by to say the op is over and told me to avoid ginseng.
I was to expect some bleeding, or brown discharge.
I asked her if it had worsen but she said no.
I asked her under what situation is considered abnormal, she told me excessive bleeding.
I would be given antibiotics for a week to combat any possible infections during the cervix healing.
Also, she told me she would see me in the followup in 2 weeks time.

With that, I was wheeled into the day ward at 2.45pm. I was still cold. So I asked for another hot blanket.

While lying there, my head was still groggy and suddenly a mild cramping hits me.
I went back to sleep and by 3.30pm, the cramp was gone and i was feeling better.

The nurse came over and told me they cannot release me unless I can consume some food and pee normally.

So about 4.30pm, I took some minced pork congee and finished it coz I was starving.

At 6pm, I was discharged. I felt fine really.
I changed into my own clothes and I didnt see any bleeding.

****************

Post Op Day 1

Date: 13th April.
Nothing much happened.

Post Op Day 2

A watery discharge happened. It was clear. The smell was like mild disinfectant but nothing bad.
Needed a change of panty liner twice. No cramps

Post Op day 3

Still watery discharge, volume increased. Needed change of panty liner 5 times a day.
No change in smell or visual, except the discharge is very very faint pink almost undetectable.
No cramps

Post Op day 4

Watery discharge volume increases. I cant use a panty liner anymore. I need a light day pad to hold the watery discharge. It is still faint pink. Only need a change once a day
No cramps

Post Op day 5- 7

Still using light day pad. Still change once a day.
No cramps.

Post Op day 8

Date: 20th April.
Signs of my period coming. I was spotting. It's pretty easy to tell it's period because the blood texture is just different.

Post Op day 8 -14

Date: 20th - 26th April 

Still spotting and no real sign of normal period.

Post Op day 14 : FIRST POST CHECKUP

Date: 26th April

Dr Lam did a quick check and she proclaimed I was healing nicely. That's where my good news stop.

At the same time, she also reviewed my specimen analysis with me.

There is no good news, only some worrying news.

She had to go deeper but she didnt want to overdo it as she know I was going to try for pregnancy. However, she discovered my CIN has spread to the inner cervix canal and she can only hope that the op which burnt the skin will also burn the cin affected area inside. Other than that, the rest of the affected area was fully removed. She said, only the next pap smear will determine if I have any CIN virus left after op.

Was it depressing news. What do you think? Of course it feels shitty.

I was paranoid about my healing so I requested for a second checkup in 6 weeks.

Post Op day 15 : 

Date: 27th April.

Period finally arrived. No unusual symptoms. No cramps etc.

However, it lasted 8-9 days instead of the ususal 6-7 days.

However, there were smaller blood clots which I normally dont get in normal periods.

It felt strange to have jelly thing passing out.

Post Op day 21: The BIG scare. HUGE blood clot.

Date: 3rd May.

This friday night I had the weirdest thing happening. At about 9pm, I realised I was started to bleed. It soaked through my panty liner but I still didnt think much of it. So I just grabbed my stuff to go have a shower and to my HORROR, a HUGE LUMP of blood clot the size of a pig's liver just gushed out of me. I am not kidding. The sheer size of it freaked me out, the fact it was bigger than my whole hand was enough to send me into panic mode. Having read so many "sudden heavy bleeding" posts on internet forum, I thought to myself, this is IT. It's happening to me too.

The color was simply liver red. Dark red and jelly form. The next part that had me panicking was the fact that bright red blood was streaming out of my vagina NON STOP. I mean literally like a turned on tap. So I sat (I have a sitting ledge in the shower area) in the warm shower for at least 20mins or so. It was subsiding but the volume was exactly scary. I just assumed when the blood clot was released, the fresh blood could flow. I had to wait a while longer before I could get out of the shower wipe dry and put on my pads. 

This time round, I knew it was just blood and NO blood clot. It was almost as if the clot had all been amassed and passed out as a huge lump.

I was still wondering if I should head to ER but thankfully, the gush of sudden non stop blood flow ceased to normal within 2 hours. I was relieved!

My period dwindled to nothing in the next 2 days.

Life went back to normal finally but at this point, I am determined to watch my food intake and cut out as much refined sugar as possible.

Post Op day 14 : SECOND POST LEEP OP CHECKUP

Date: 24th June

Dr Helena Lam took a quick look and was very satisfied with the wound healing nicely.
She advised me to do a Pap Smear before I embark on my IVF so that we will know the CIN status before any pregnancy journey. Normally, the 1st Pap is done 4-6 months after the Op but since I want to start my IVF asap, I booked in for my first Pap on 19th July. That is about 3 months after. I was told no fast and hard rules as to when I can get tested so it was fine but only reason I brought it forward instead of early Aug was my IVF doctor was going away on 2 weeks vacation leave so I thought better to catch her before she leaves so that i can have my result while she is away. I figured if all is well, i can get started soon.

Dr Helena Lam also advised me to have one normal round of period first before I start IVF so that means I have to forgo my June window. However, I took her advice because I really trusted her.