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IVF Round 3: The Rule of Three

After our failed Frozen Embryo Transfer (FET) last year, we took some time to get over it, and finally decided to start on the dreaded fresh IVF cycle at the end of the year.

Warning: Long post ahead!

I had hoped that we would be able to conceive naturally, but well, it had never ever happened to us before. I called Dr Loh’s clinic the day my period came, and made the first appointment for Day 2 of my period. I thought that I would be okay going for IVF, since we’ve been through it before, but the night before we started, I broke down. The reality of having to do it all again hit me, and I honestly didn’t know if I was strong enough. Yes, I knew what to expect, but that didn’t mean that I liked it.

We badly wanted another child, but I wasn’t sure I would be able to deal with the stress of the entire process. All that hoping and waiting can drive a person mad, plus this time round, I had to look after Noah too. I wasn’t sure I would be able to handle the sadness if we were to fail again. I thought about giving up many times, but I knew that I would regret it if I didn’t try again. I wondered why I was doing this to myself, and why I wasn’t content with just one child. Were we being greedy to want more kids, when there are so many others around us who are still trying to conceive their first child?

C assured me that we were in it together, and that we would try for as many times as I was willing to go through it. He reminded me that even if we failed, we already had Noah, so technically, the stakes weren’t as high. Things were slightly different this time round, also because I would be going for most of my appointments on my own. C’s workload is crazy, and there was also Noah to look after. On the days that he couldn’t take time off to stay home with Noah, my mum had to step in. It felt odd sitting in the waiting room on my own, but I knew that it made more sense this way.

At the first appointment, Dr Loh suggested trying a short cycle this time round, since I had OHSS during our first IVF cycle. He prescribed 200 IU of Puregon, to be injected at the same time every night, and I was to go back after 4 days of that to review our progress.

At the Day 5 scan, Dr Loh noted that my womb was prone to polyps, which probably meant that he saw some. (I had two removed during the FET cycle.) My left and right ovaries were producing follicles of different sizes, of about 4mm difference, which seemed rather insignificant to me, but was apparently too big a difference in follicle-terms. My Puregon dosage was increased to 300, up from 200 over the past four days, and I needed to do two jabs a night from Day 6 onwards. The additional jab was Orgalutron, to prevent me from ovulating, so that the smaller follicles had a chance to catch up.

I had been feeling nauseated ever since I started the jabs, and Dr Loh said it was a common side effect. He was concerned that I would get OHSS again, since the dosage had been increased, and I might end up producing too many follicles/eggs. I ate 1 to 2 Brazil nuts a day, tried to eat more egg whites, and drank plenty of the Gatorade powdered drink, as recommended by some of the IVF mums I got to know on Dayre. We prayed that the meds would do their job and that my follicle sizes would even out, since the ones on my left were too small to be viable, and continued with the jabs.

I went for the second scan on Day 8, and was disappointed that the follicles on my left and right ovaries were still of significantly different sizes, and not growing very quickly. They did grow a bit more thanks to the increased dosage of Puregon, but Dr Loh said that the current sizes were what he had hoped to see during the previous scan. I was to continue with the two injections for two more days, then go for the third scan. Ideally, they would be of good size and ready for retrieval on Day 12. The Orgalutron jab was surprisingly more painful than the Puregon, and I really dreaded it, but well, I just had to bear with it for a few more days. I had bruises all over my belly, to the extent that I told C to “just jab between the blue-blacks”, to you know, spread out the pain.

To make matters worse, I was at high risk of having OHSS again. Dr Loh said that if all went well, I would have at least 10 good-sized eggs. The best case scenario would be more than 30, but because those on my left were so much smaller than those on my right, that may not happen. He would retrieve everything, then see which ones would be viable. He said they might be able to grow the eggs a bit too after retrieval, but I don’t know how that works.

My appetite was really poor, but I was told to drink at least 3 litres of water a day, plus eat extra protein, such as egg white. That was really a challenge, since I was so nauseated that I could hardly eat anything by that point, but I had to try.

Noah went along with me for the third scan, and sat behind a curtain while Dr Loh did the scan. The follicles were still of very different sizes, but they looked more or less ready to Dr Loh, so I was instructed to get my trigger injection (Pregnyl 10,000iu) at the TMC 24h clinic at 9pm sharp. He said that I was probably going to get OHSS again, because the way to prevent it would be to do a different jab, but that would also mean I couldn’t do a fresh transfer, and we would have to freeze the embryos. Noah was from a fresh cycle, so Dr Loh said we shouldn’t waste the chance to do a fresh one, just to avoid OHSS. His exact words? “Just be garung, okay? After all, you didn’t die from the last round of OHSS despite pregnancy, so you should just do it.” Gee thanks, doc.

The egg retrieval was scheduled for a Friday, and I had to fast from midnight till the procedure was done. Thankfully, it went pretty well, and Dr Loh managed to get 22 eggs. I had really bad cramps after the retrieval, and had to keep drinking plenty of Gatorade and water, and eating as much protein as possible, to prevent OHSS.

I was really nervous waiting for the clinic to call on Saturday. We prayed hard that we would have a good number of embryos, and thank God that out of the 22 eggs, 16 were mature enough to be used. They did the ICSI procedure, which they did with some of the eggs during Noah’s cycle, and managed to get 14 embryos. The embryos would be monitored over the next few days, before the best two were transferred to my womb on Monday morning. It was such a relief to know that we had so many embryos, because we only had six during Noah’s cycle, despite having 16 eggs then. Of course, having embryos was just the first step, because we still needed them to implant and grow in my womb, but it was a positive first step.

On Monday, we learnt that all 14 embryos were still alive, but only 7 were Grade 2 (Grade 1 is the best). The remaining 7 that were of lower quality were being observed, and there was a high chance that they would not be frozen. They picked two out of the 7 Grade 2 embryos, and performed Laser-Assisted Hatching (LAH) on both, because their shells were a bit thick. If you look closely at the picture below, you can see a tiny white line at the top of each embryo, which is where they performed the LAH. Technology really is pretty amazing!

The remaining 5 were to be frozen that day itself, after the transfer, and they would let us know if the other 7 developed into blastocysts that can be frozen. Noah was a Grade 2 embryo last time too, so we were really praying that at least one of the two embryos would stick and grow well in my womb.

Say hello to our two beautiful embryos!


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One of the requirements for the embryo transfer is a full bladder, but I had to empty my bladder once before the procedure, because Dr Loh wasn’t at the clinic yet. The nurses loaded me up with water again after that, and you can see how huge my bladder was! We said a short prayer before the transfer, and C sat there holding my hand throughout, as we watched Dr Loh insert the embryos into my womb. The transfer went well, and it was a lot less painful with Dr Loh than with the other doctor who did my FET. I guess experience really does make a difference!

Immediately after the transfer


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After the transfer, all we could do was pray and wait. My daily meds were 1 folic acid tablet and 2 ProgyNova tablets in the morning, as well as 2 Utrogestan tablets inserted vaginally three times a day. I was also instructed to lie down for at least half an hour after each round of insertion, which meant I had to time it properly. All the steps in IVF sound so complicated, it’s really a miracle (at least to us) that so many people can get pregnant naturally.

Puregon and Utrogestan: my staples during this IVF cycle


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I experienced bad cramping after the transfer, and the cramps lasted for a few days, which got me worried, because I had bad cramps after the failed FET too. I had to go back to the clinic for a blood test to check my hormone levels four days after the transfer, and was relieved that the clinic didn’t call me back for a hormone injection after that, which meant that my hormone levels were acceptable. I asked the nurse about the cramps, and she told me that they should last for about two or three more days. As long as I didn’t have any sharp pains or bleeding, things should be fine.

Honestly, I wasn’t feeling very optimistic during the two week-wait (2ww) at all, since I didn’t seem to be having any pregnancy symptoms. I was really cranky, and snapped at Noah a lot. I felt bad, of course, because he was having his school holidays, and I couldn’t really bring him out much. I was easily exhausted, and figured it was a side effect of the meds, since I had been feeling tired since the IVF injections began.

Noah, to his credit, was very understanding, and never once complained when I told him I had to lie down to rest instead of play with him. He would either play quietly on his own, or opt to lie in bed with me. He took it in his stride when I told him that I couldn’t carry him, and even told me it was because I had embryos in my womb. (When I got back from the clinic after the embryo transfer, I showed him the photos of the embryos, and told him that the doc transferred them into my womb, so we had to pray that they would grow. I was pleasantly surprised that he could still remember that!)

The 2ww seemed like an eternity, and I was scheduled for the blood test on Day 14 post-transfer, ie on 21st December 2015. I decided that I didn’t want to wait for the blood test result, and sneakily took two urine tests on my own before that. C told me not to do it, but I just couldn’t wait any longer. I didn’t want to get my hopes up like the last round, and wanted to be mentally prepared if the nurse was going to give me bad news.

I knew there was a high chance of the test being inaccurate, since I was on so many drugs. Everything I read on the Internet told me that the blood test would be the most accurate, and there were many contradictory posts by other IVF-ers. Some said the pee test was accurate, some said it wasn’t. I decided to just go for it, since I had so many spare test kits in my cupboard anyway. (Yes, I stocked up on ovulation and pregnancy test kits because we were trying naturally for a while.)

The first test was done on Day 12 post-transfer. When the test line didn’t appear, and the control line did, I didn’t know how to react. Secretly, I thought that this round would be positive, since I felt like a whale. I stared at the test for a while more, since we’re supposed to wait for a few minutes. I told myself that even if it’s negative, it might be too early to test any way.

A faint line appeared.

I thought I was imagining things, so I put the test away for a while, and went to wash up. I told myself I would look again after I was done, but who was I kidding? I checked it every few seconds, and couldn’t stop smiling when the line became more pronounced. I woke C up immediately, but we weren’t sure if it was a false positive, so we tried our best not to get our hopes up.

On the morning of the blood test, I decided to take another pee test before going to the clinic. I didn’t tell C about it, since I figured he wouldn’t approve, but I just couldn’t resist. Initially, when the test line didn’t show up, I was stunned. I thought that the test on Saturday was really a fluke, and kept praying for the line to appear as I stared at the test, willing it to appear. When it finally did, I was relieved, and felt more confident about going for the blood test.

As we went down to the car in the lift, C asked, “So have you been taking any more of those tests?”

I grinned sheepishly and confessed, “I took one just now.”

“And?”

“There were two lines.”

He squeezed my hand tightly, but didn’t say anything. After all, we had been disappointed too many times, and knew that we would only be convinced when we heard the news from the nurse.

Noah followed me into the room for the blood test, and was even braver than me, because he watched the entire process, while I kept my head turned away. When the needle went in, he asked, “Are you scared, Mummy? It’s okay, okay? Just a while only.”

Ah, for all the pain and heartbreaks that we went through to conceive him, having this little darling was definitely worth it.

The two tests


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The nurse said they would call me by 1pm, and I brought Noah to the supermarket in an attempt to distract myself. C, for all his bravado, messaged me at 11am, and asked, “Any news?”

I told him no, but at 1230, he couldn’t take it any more, and called me. “Why don’t you call them?” he suggested.

“They said they would call by 1. It’s not 1 yet mah.”

I made him hang up the phone, in case the clinic was trying to reach me, and the phone rang shortly after. My heart skipped a beat, but it was my mum, also calling to ask if the clinic had called. Haha.

Finally, at 1237, I got the call.

“Congratulations, the blood test shows that you’re pregnant.”

The nurse told me that I had to go down again to collect more meds, as I needed to continue my daily dosage until the day of the scan, which was scheduled for two weeks later. I called C, and couldn’t stop smiling as I told him the good news, before messaging my mum and my god-sisters, and calling my god-ma.

When I called to make my appointment to collect the meds, I asked if they could tell me what my HCG levels were, and was absolutely stunned when she said, “1023.” With Noah, I think it was 600 or 900 (I’m bad with numbers), and he was part of a pair of twins. Sadly, we only heard his twin’s heartbeat once at 6 weeks, and by 9 weeks, he/she had stopped growing.

I asked the nurse, “Erm, that’s quite high right? What’s the norm?”

She laughed, “Usually 200 or 300 can already be considered pregnant.”

“Does this mean there’s a high chance of twins?”

“Haha, yes! You put two embryos in, right?”

I called C to tell him, but he was in a meeting, so I messaged him. He called me back the minute he got out of the meeting. I guess we were both in shock, but in a good way, of course.

We found out about Noah in late Nov 2011, and everyone said he was a Christmas blessing, which he really was. Four years later, we got our second Christmas miracle, and prayed fervently that the embryos would grow well in my womb too.

On the 4th of January 2016, C and I went for the first scan (at 6 weeks) together, and saw two little sacs, and two little heartbeats. They were too tiny and too high up in my womb for us to hear their heartbeats, but we were just so thankful to see them. They were of similar sizes, unlike Noah and his lost twin, so Dr Loh said there was a good chance that both of them will make it.

The first time we saw our twins


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Dr Loh showed us the “twin peak”, also known as the lambda (λ) sign, which meant that we were expecting fraternal twins.

See the lambda sign?


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The first trimester was tough, especially because we had three major scares. I experienced bleeding twice, and severe cramps on another occasion. The cramps were so bad that the pain radiated down all the way from my womb to my thighs, and I couldn’t even walk properly. We rushed to TMC’s 24h clinic on all three occasions, and I was given jabs to stop the bleeding and cramps. The doctor at the clinic is a GP, so we couldn’t do any scans, and we honestly thought we would lose the babies. Those were really horrible times, and I can still vividly remember how scared we were.

I experienced bad nausea on most days, and couldn’t really eat much. I lost almost 3kgs by the end of the first trimester, but the weight has piled on super quickly since then, and my belly has also expanded tremendously. This time round, I also started feeling the babies’ movements earlier, at 12/13 weeks, which was reassuring since our appointments with Dr Loh were no longer as frequent. (They were once a week initially since I had so many scares, but once things seemed more stable, he scheduled us for once a month instead.) I looked forward to each appointment, because it meant that I would get to see our babies again, and I looked anxiously for their tiny heartbeats each time. C couldn’t be there for the appointments, but Dr Loh kindly got the nurse to help me take videos of the scans, so that I could show them to C afterwards.

I can’t believe how much my belly grew in just one week!


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We have just reached our 20th week, and did our detailed scan last Friday. We were really anxious to see if the babies were developing well, even though our Harmony test was good, because you never really know with these things, right? The Harmony test also revealed that one of the twins is a boy, and we were curious to see if we were having two boys, or a boy and a girl. (They only test one of them for gender during the Harmony test apparently.) I was convinced that they would both be boys for some reason, and actually thought it would be easier to have all boys, since we knew what to expect with boys. I even secretly bought two sets of matching rompers for them! C on the other hand, thought that it would be nice to have a girl, since this was most likely our last pregnancy, and therefore our last chance to have a girl.

The matching rompers I bought


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The detailed scan took about an hour to complete, because there were two of them to scan, and I was so amazed to see how much they have grown. It was so surreal to see their spines, and I smiled when I saw their tiny feet and hands. They were very cooperative and active, moving and kicking a lot, which was really good to see. No wonder I can feel them moving around so much! Twin 1, ie the one below, is slightly smaller at 303g, while Twin 2 is 334g. Both are within the normal range, for which we are extremely thankful for.

Finally, the big gender reveal.

Twin 1 is a boy, as we knew from the Harmony test, and Twin 2 is… a girl! Yes, we are having a boy and a girl, and C has given me the green light to shop for our little girl. When I told him that I asked my godsis for her baby girl’s hand-me-downs, he said, “Why would you want to deprive yourself of shopping for your baby? You’re only going to have one girl. You should just buy your own!”

I knew there was a good reason why I married him. 😉

We still have another 17 to 20 weeks more to go, and Dr Loh has put me on two different types of medicine to prevent preterm labour, which is a very real concern, since I had issues during my first pregnancy with Noah too. He has also instructed me to minimise all activities, which means I have to lie down a lot more, and stop walking unnecessarily. (I think I’ll be doing most of my shopping online, so feel free to send me shopping links if you have any good deals to share!)

Our third IVF experience was tougher than the first two, but we are adding two more little darlings to our family, and THAT, is definitely worth all the tears and pain. God has given us more than what we have asked for, and we couldn’t be more grateful. Come end August 2016, we will, by God’s grace, have three children to love, and we are really looking forward to that.

Please do keep us in prayer, and we humbly ask that you pray specifically for the twins to grow well, and that they will only be born at full term, which for twins is around 37 weeks. Thank you!

PS. By the way, before you think I have an excellent memory, I really don’t. I tracked the entire IVF process on my Dayre, because I needed an outlet to write and process all my thoughts and emotions, and Dayre is perfect for that. The people on Dayre have been nothing but supportive, and I really love the community there. One of my Dayre friends even told me not to care about the grade of my embryos, because “no one ever thinks that their embryos are second grade”, and that I should think of them as “Grade Mao Shan Wang”. That really made me laugh! I’m so thankful for the support and encouragement shown by all these people, most of whom I’ve never met, because they were a great source of encouragement throughout this third IVF process.

I was hesitant about writing about it on Dayre because if we failed, our grief would be so much more public than if I had written it on a private blog, but in the end, I figured it was more convenient to blog on Dayre, and trusted that it would be relatively private, since not many of my real-life friends are on it. This blogpost is meant to “officially” document our experience, and hopefully, it will also serve as a form of encouragement for those who are still battling infertility, and going through the painful IVF process.

PPS. This is OUR personal story and experience, so please understand that this is what we went through, and how we felt through the entire process, be it about our doctor or our experience at the hospital. We are NOT promoting our doctor in any way, nor is this a sponsored post. Do choose your own doctor wisely, and proceed only if you are comfortable with him/her. IVF is a tough process, and you should always do your own research, and suss out a few doctors, if you aren’t completely satisfied with the first one you consult.

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