1st IUI - Let's begin

I arrived at Dr. Prashant's clinic at 3pm, for my 3:15pm appointment. There were 3 patients ahead of me, all accompanied by their husbands. I was alone since Bernard is conducting a training today, thus impossible for him to come out from the office in the middle of the day.

I went in to see Dr. Prashant at 3:30pm. Initially, he intended to do a abdominal ultrasound on me to make sure there is no cycst or any unusual imagery before the IUI takes place. Well, after a few attempts, the Dr. couldn't figure out the images on the screen  as my bladder was not full enough for the scan. So, a pelvic scan (transvaginal scan) was done instead to check my uterus and ovaries. Well, things were in order, other than plenty of immature follicles were seen in the ovaries of PCOS patient like me.

I was given Letrozole 2.5mg to stimulate the maturity of my eggs. The consumption will be 2 tablets, twice a day for the next 5 days (Day 3-Day 7).

On Day 6, I am required to go to the clinic again to take an injection of Folliova 150iu.

This will then be followed by the doctor's consultation on Day 9 to monitor the progress of the eggs.

The nurses guided me through the steps, things are actually not that complicated. Since today is my Day 3 and it was already afternoon, the nurse asked me to swallow 2 tablets of Letrozole on the spot.

When I walked out from the clinic, I felt a bit light headed, couldn't believe that I was already on the 1st attempt of IUI.

Total Expenses RM 840 

• Consultation         RM   80
• Ultrasound           RM   80
• Letrozole 2.5mg  RM  500
• Folliova 150iu     RM  180

Making appointment for my first IUI

My period came yesterday, which was after 4 days I finished my Duphaston course. Hmm...I was attending a book launch and seminar by one of my favourite author, Liu Xuan (刘轩), when I felt a little bit of warm discharge flowing out. Wow, lucky that I already have a sanitary pad prepared in my handbag:)

During the last few days, Despite feeling slight premenstrual cramp on the tummy, I was feeling more energetic compared to when I was under Duphaston. So, I guess the fatigue that I experienced earlier was indeed the side effect of Duphaston.

On my last visit, I was told to call the clinic on the 1st day of my next period, in order for me to begin the IUI procedure on Day 2. Since yesterday was a Sunday, I called up Dr. Prashant's office today to make an appointment. The nurse schedule me to see the Doctor at 4:15pm, but shortly after she called to change the time to tomorrow after lunch.  Well, I guess as a patient there is not much space for you to bargain when it come to fixing an appointment with a well-sought-after doctor. Once, I was also told by the receptionists that the doctor and the nurses do not go out for lunch.  

As a working woman, one should be extra patient when it comes to this kind of situation. Be objective and be calm, adjust your time flexibily, so you can follow through your treatment. It it never been easy, but what choice do we have? Just do it.

Hit by Unusual Fatigue

As per Dr. Prashant's prescription, today is the 9th day of me taking Duphaston. After tomorrow, my period is expected to come within the next 5 days.

I have been feeling very lethargic lately, especially in the afternoon. My eye lids are so heavy and my whole body feels like wanting to shut down.

When the night comes,  (normally I am able to stay up to 11 plus), my brain starts to feel numb and my eyes become so dry and tired even before the clock hit 10:30 pm. I have no choice but go to bed early and I will doze off in just a few minutes. This seems to be unusual as most of the time I am a light sleeper as by default it will take up to an hour for me to fall asleep. The weight shown on my scale has also gone up 1kg, I do not notice I have been eating more than usual. Will it be the water retention?

Despite conquered by sleepiness and fatigue, I still force myself to do an hour of exercise at least 4 days a week. I either brisk walk and slow jog on the treadmill or practise yoga in the morning. The endorphine from exercising will keep me energetic for 2-3 hours, after that I feel fatigue again.

Last Sunday, Bernard and I went walk up to Kiara Hill. We used to do this once a week. In fact, the 45-minute journey of walking up and down hill is not something very challenging. But guess what? My right ankle and tibia ached the next day. I have to walk very slowly as my right feet feels so painful when pressure is imposed on it . I still cannot understand why this can happen since I exercise regularly and it is a routine activity for us to walk up Kiara Hill. Since then, it has been 2 days I skip my daily exercise, hope that my feet will recover soon.

I also feel some pain on my right ovary occasionally, especially after I carry something heavy. So, not only I cannot walk properly, I also cannot carry heavy things now. One thing good about this is now I have excuses not to do many things at home. Hahah, poor Bernard has to do all the house work.

Well, would all this 'weird' things be the side effects of consuming Duphaston? Will see how I feel after tomorrow, when I finish this course of Duphaston.

Decision Made for IUI

13 May 2011 (Fri)

Friday the thirteen marked my 2nd consultation with Dr. Prashant, after I underwent my HSG procedure 2 days ago at Pantai Hospital Kuala Lumpur.

To avoid driving 2 cars and to pay the rather expensive car park rate at Wisma Perintis  (RM 6 per hour, with 1st hour complementary by KL Fertility Centre), I picked up Bernard from his office at KL and headed back to Damansara for our appointment.   We arrived at the clinic at 11:40 am, it was crowded. After registering ourselves, the waiting routine began.

Unlike many other clinics that provide outdated worn out magazines, this clinic has the latest issue of popular magazines in English, Chinese and Malay. These magazine certainly makes the waiting easier.

We also bumped into a well known Malaysian Singer, the talented and cheerful Mr. R ( name to remain anonymous) in the clinic. As far as we know, he and his wife already have 2 lovely sons. However, since he did mention that he wanted to build a soccer team in a newsspaper interview some times ago, I guess that is the reason he and his wife appeared in Dr. Prahsant's office.

Not too long after that, Bernard's name was called, but not by the nurse. It was his ex-colleague. She and her husband were there to have their 2nd IVF. Prior to this, RM15K was spent to remove her endometriosis at Tropicana Medical Centre. Then, she completed one cycle of IVF, which costed her another RM20K ++.  Unfortunately, luck was not on their side. She was calm and peaceful while telling us her experience. I guess this is how infertility patients feel after they have gone through many turns and corners in their journey of attempting for a child.  Well, which couple in this waiting room did not have their unique experience in the path of treating infertility? There is nothing you can do, except continue to look at the bright side and keep trying.

Half way through sharing her experinece, my name was called by the nurse. It was 12:20 pm.

After looking at my HSG report, Dr. Prashant was certain that both my Fallopian tubes were in normal condition. Thus, my only problem now is PCOS. He suggested IUI first. If the result remains unsuccessful after 2 to 3 cycles, then IVF comes along. Well, since IUI is less complex and will cost less, Bernard and I agreed to the suggestion without further consideration.

To end the consultation, Dr. Prashant delightfully told me to call the clinic on my next menstrual cycle in order for us to begin my 1st IUI. Well, teasefully I told him that I wouldn't know when I can see him again because I am clueless when my next menstrual cycle is (since I am a PCOS patient!).  Caught off guard, he graciously smile and quickly prescribed me with 10 days of Duphaston. So now I am able to forecast when is my next menstrual, which is after 2 weeks.

After staying under the dark clouds of hormonal imbalance (which caused aovulation) and having both blocked tubes for nealrly a year, I started to see the sun beaming through the cloud.

At least now I am moving forward with my 1st attempt to meet my angel. No one will know or guarantee the end result. But you have to believe that good things will happen if you have good thoughts and do good deeds. This is what life is.

Total Expenses RM140

• Consultation
• Duphaston x 20 tablets (10-day course)

HSG, the 2nd time!

11 May 2011 (Wed)

Today I went for a HSG procedure to check the condition of my Fallopian Tube.

Technically, this is already my 2nd HSG. The 1st one was done July last year at Damansara Specialist Centre. The report conclusion was both my tubes were 'invisible', despite 2 doses of contrast was injected . Honestly, I was not very happy with the result of 'invisible'. Did that mean I don't have a Fallopian tube or my tubes were blocked? According to my doctor at that time, Dr. Abdul Ghafar at LPPKN (Jalan Raja Laut, Kuala Lumpur), 'invisible' is directly interpreted as 'blocked'. I was told that If I am not convinced with the result, I have a choice to do another HSG after 3 months or proceed for a Laparoscopy to confirm the condition of my tubes. Chose to live in denial, I did not do anything to find out the truth until last week.

This time, my HSG was scheduled at 10 am at Pantai Hospital Kuala Lumpur. Bernard decided to accompany me this time. We arrived at the imaging department at 9:50am.

Pantai Hospital Kuala Lumpur (The picture was taken from inside of the car, so there was a reflection at the bottom right corner)

The Imaging Department

After submitted the referral letter from KL Fertility & Gynaecology Centre (which specially requested for Dr. Vimalah to perform the procedure), I got myself registered and was soon instructed to make the payment at the cashier counter. The charges was RM436.60. Pantai was obviously dearer than Damansara Specialist, which costed me only RM250.

At 10:30 am, my name was called. The procedure began after I changed into the OT robe.

Well, was it painful? I guess it all depends on the endurance level of an individual. To me, the pain was bearable. It felt like a slight cramp at the ovary area when the contrast was injected into the uterus. Dr. Vimalah directed me to make slight turn to the left and the right to assist the contrast to flow better. The whole process took about 20 minutes. I couldn't wait any longer for the outcome of the X-ray, thus decided to ask Dr. Vimalah immediately after the procedure. She told me both my tubes were clearly seen and they were both patent! The only negative side was the free spill was very small in amount. This could due to my tubes were very fine. Honestly, I was delighted to get a different result from the 1st HSG but at the same time, I tried to keep myself calm as nothing is confirmed until I receive the film and the final report which will only be ready an hour later.

As per instructed by Dr. Prashant' nurse last week,  I made a call to Dr. Prashant's office after the procedure to make a consultation appointment on the same day. Unfortunately, Dr. Prashant was not available for the next 2 days. So, the earliest appointment available was made at 11:45 am on this coming Friday (13 May). I am aware that it will be a black Friday, but to me, if things are progressing forward, everyday is a good day!

Total Expenses:

HSG RM436.60

My 1st Visit to KL Fertility & Gynaecology Centre

Finally, my period came, 4 days after I finished a 10-day course of Duphaston. This was my 2nd longest cycle, 85 days. The longest record was 5 months, which happened back in 2009.

Having surveyed the Internet since the past few months, I made my initial call to Dr. Prashant's office at KL Fertility & Gynaecology Centre.

This 1st call wasn't easy for me. Thoughts like "Call on the next cycle when you are more ready'", "Why rush?", "Why Dr. Prashant?" kept haunting me. 

Well, these thoughts have their own justifications.  Just thinking about the money that a couple has to spend to treat infertility makes many patients hesitate. We are not talking about a couple of hundred or thousand here. The figure can easily hit 5 to 6  figures, and is unclaimable from any medical insurance coverage. There is also no limit for the amount to rise until 'infertile' becomes ' fertile'. Very often, a couple finally realizes that the financial drainage is no longer bearable and they have no choice but to reluctantly put a stop to the treatment. 

Sadly, in Malaysia there is no financial subsidy from the government to take care of the infertile group, even though statistic shows that 1 out of 5 married couples experience infertility.  The success rate of IVF is about 30%, meaning that on average a couple has to go through 3 cycles of IVF to conceive a baby. Each cycle will cost around RM 16K to RM 25K, depending on the condition of the patient. Lately, there was a proposal to allow people to withdraw money from EPF's account 2 for infertility treatment. It was a very good news indeed. However, no one knows when will the law be set. By that time, I might already hit menopause. Just something to share here, I have a friend in Australia who recently went for her 2nd attempt of IVF. Each cycle costs about AUD 7K but the Australian government subsidizes 50% of the cost.

Putting financial issue aside, the physical and emotional stress are always the key factors that weigh you down. Ultimately many unsuccessful couples have no choice but to accept the fact that  'making babies is in God's hand, not human's'.

However, when you are in your mid 30's, when you have gone through some ups and downs in your life, you learn to look at the bright side of life. So, the story leads back to me calling Dr. Prashant's Office for the 1st time :)
 



A very friendly and cheerful voice answered my call. After expressing my intention to make the 1st consultation appointment, she immediately asked if I could come in at 12:30 pm, which is just 2 hours away. I did not expect for the appointment to come so soon. While I was hesitating, the lady told me that she could slot me in solely because a patient just called in to cancel her appointment, normally the doctor's appointment is very packed. I then asked when is the best time of the menstrual cycle for a patient to see the doctor, she answered "Day 2". Well, since it was coincidentally my Day 2, I was in the clinic 2 hours later.



Dr. Prashant's clinic is situated at the same building as Kuala Lumpur Sports Medicine Centre at Jalan Dungun

The reception counter



The waiting area



Bernard and I arrived sharp at 12:30 pm and waited for 45 minutes before it was my turn to see Dr. Prashant.  After looking at my previous medical reports inclusive of  a series of hormonal blood test, pelvic ultrasound and HSG report, he was very certain that I have PCOS (Polycystic Ovarian Syndrome). He then performed a transvaginal ultrasound to check my ovaries. It was quite humorous for him to count the black spots (the ovums) on the screen while I was lying down. Although I have done 4 times of pelvic ulrasound previously, this was the 1st time I got so up-close with my ovaries where you can see the eggs so clearly.

Well, I have about 16 and 20 ovums respectively in my right and left ovaries. When he told us that a normal lady will have 5 visible ovums at most, I asked him does this mean that I was 'abnormal'. It was very kind of him to say: " I cannot say that you are abnormal, you just need some medical help." 

After proving that I have PCOS, he suggested for another round of HSG to check on my fallopian tubes. Although the 1st HSG that I have done at Damansara Specialist Centre about 10 months ago showed that both my tubes were blocked, Dr.Prahsant still think that the chances for a lady to have 2 infertility factors (PCOS and block tubes) at the same time is very low. I told him my initial intention was to go for a laporascopy to confirm if the HSG results was accurate. He said he normally doesn't encourage laparoscopy as it is still a surgery process that carries risk. Comparably, the impact of HSG to the body which is just an X-ray procedure ( althought it is more complicated than a chest-X-ray) is lower than laparoscopy.

Asking if IVF was my only choice if we decided to have baby, we were told that 50% of PCOS patient can conceive naturally after taking medication. If not,  a few cycles of IUI would be next. If all these fail,  IVF will come in. After all, it all depends on the result of my HSG, which is scheduled next week at Pantai Hospital, Bangsar. 

I then proceeded to the lab at level 3A to do a blood test. 3 nurses took turn to pat and tie my arm for nearly 20 minutes, just to find my vein. This happens every time I do my blood test. I'm sorry, I just happen to have very fine veins. Maybe this is the true reason why my first HSG showed that I have blocked tubes. Maybe I have very fine tubes too until the fluid injected have difficulty to flow through quickly. To clarify, it was not me who say this, my mum did!

We then bought the medications prescribed to prepare my body for HSG from the pharmacy at the lobby of Wisma Perintis.



The pharmacy located at the lobby of Wisma Perintis



After this, we had lunch at Chillax, a very cozy corner at the ground floor of Wisma E&C, located just behind Wisma Perintis.

I coudn't stop laughing when Bernard revealed that he was in fact very delighted to see I have so many eggs during the ultrasound until the doctor said a normal lady should not have that many visible eggs.

We went back to work after lunch. I somehow felt happy that day, at least things were moving forward, although I do not know what would the outcome be. But that is what people always say:" move, rightly or wrongly, otherwise you will stay stagnant!"

Total Expenses  RM 535 

·         Consultation

·         Transvaginal ultrasound

·         Blood test (Hormonal)

·         Zinnat 250 mg x 10 tablets

·         Cardiprin 100 mg x 7 tablets

·         Ventolin 4 mg x 2 tablets