What happens after embryo transfer

According to this www….

http://www.nyufertilitycenter.org/ivf/embryo_transfer

3-Day Transfer

Days Past Transfer (DPT)	Embryo Development
One	The embryo continues to grow and develop, turning from a 6-8 cell embryo into a morula
Two	The cells of the morula continue to divide, developing into a blastocyst
Three	The blastocyst begins to hatch out of its shell
Four	The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus
Five	The blastocyst attaches deeper into the uterine lining, beginning implantation
Six	Implantation continues
Seven	Implantation is complete, cells that will eventually become the placenta and fetus have begun to develop
Eight	Human chorionic gonadotropin (hCG) starts to enter the blood stream
Nine	Fetal development continues and hCG continues to be secreted
Ten	Fetal development continues and hCG continues to be secreted
Eleven	Levels of hCG are now high enough to detect a pregnancy

5-Day Transfer

Days Past Transfer (DPT)	Embryo Development
One	The blastocyst begins to hatch out of its shell
Two	The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus
Three	The blastocyst attaches deeper into the uterine lining, beginning implantation
Four	Implantation continues
Five	Implantation is complete, cells that will eventually become the placenta and fetus have begun to develop
Six	Human chorionic gonadotropin (hCG) starts to enter the blood stream
Seven	Fetal development continues and hCG continues to be secreted
Eight	Fetal development continues and hCG continues to be secreted
Nine	Levels of hCG are now high enough to detect a pregnancy

As of today, I am day 13 past embryo transfer date. So…...if I do a pregnancy test today, it should start showing a positive? I read another lady's blog and she started testing from day 10. She pasted all the test strips on a page! So amazing how the positive line just got darker and darker with each passing day. She is sooo brave. I am worried that by testing, I am jinxing myself. And what if there's still HCG in me? This lady was doing the vaginal depositories, but I am doing the Pregynl injections. Although I do not remember being injected anything after my embryo transfer, I read that the Pregynl injections I have been taking also contain HCG. My last injection was on 25th November (Monday). So…..since we have different protocol, I better not take the risk. Not only about jinxing myself, but a false positive is more heart breaking than a real negative.

And….. I am really tired of hoping. Each time I hope and hope, even plan, nothing comes true. Even as of now, I am so worried my menses will arrive. If this is a negative, my menses should arrive Saturday (tomorrow) or Sunday. It is always pretty much on time and I doubt the Pregynl injections would delay it.

So…. day 17 past embryo transfer date, which is a Tuesday, I will be back at KK for my blood test. It it often referred to as the "beta" test. This is because it measures a beta chain portion of the human chorionic gonadotropin (HCG) hormone emitted by the developing embryo. I will give H's number for KKIVF to contact, cos I dun think I can take the news. Apparently the "news" will be out between 1-4pm, but often before 1pm. I don't know how I am going to keep myself occupied!!!! That is if menses dun arrive before Tuesday. 

Embryo transfer

Another milestone hit.

Wow……today is Monday and I did the embryo transfer (ET) on Saturday. Still feeling overwhelmed…….2 little embryos in me?!?!?!? I hope they are multiplying well. So many things beyond my control. I can only hope for the best outcome.

ET day was a breeze. Why? Cos I chose to be sedated. I just want to sleep and not know what is happening. Wise choice for me!

Same thing happened as the egg retrieval day.
I needed to fast from 11.30pm the night before. No food nor water.
I arrived at the clinic around 7.30am, but only got to the counter at 8am. After signing some documents, I was guided to the changing room. This time, I was told not to empty my bladder (I only emptied the first morning pee). You see, normal ET is done when the patient is awake. So, the lady still has to abstain from food, but she has to drink up to fill her bladder. During the "awake" procedure, the doctor is guided via abdominal scan so that he can judge where to place the embryos. Since I cannot drink as I will be sedated, I was told the nurses will attach a tube and fill me up. How they attach? I seriously don't care. As long as they do it while I am asleep and give me pain killers. Heehee, that was what I told the anesthetist. She told me nicely it should not hurt! Oooh…she is soooo nice. Dr Lim. I think we are fated! She's only there this week on Thursday and Saturday and yet, both days I got her. She really cheers me up cos she is ready to talk to anyone and the last thing I need is silence or a stern medical worker.

Oh, I was ready and changed by 8.30am. I was wondering why the recovery room's nurse is so free but she did not prepare me for the IV. Later, I realized that Dr Lim gave instructions not to do for me yet. She wanted me on the bed before the nurses do for me. Super sweet!!!! She knows I fractured my leg and for the egg retrieval day, I took a while to hobble cos the IV was on my left hand which made it quite impossible for me to use the crutches. And because I was just sedated on Thursday, this time, they did the IV on the right side of my left wrist. How considerate!!! I was contemplating to ask if I could do on my right hand cos my left hand was still hurting a little.

Once on the bed, I was a little disappointed cos I did not see Dr Tan, so I asked Dr Lim if Dr Tan is here today. She replied "Yes, he is already here."I was super duper happy! I never thought I would still get him since he is on reservist. So I laid down and the nurses started getting me ready by getting me to spread my legs and covering up with some sheets. I felt soooo conscious….and a little uncomfortable cos the sheets that were covering me was constantly touching my little flower. hahahha

Then Dr Tan came in and I said good morning to my favorite doctor (of the moment)! He is lovely as usual. He told me I had 5 fertilized embryos!!! I was really happy. I was a little down when I had only 6, but to hear that 5 of them got fertilized, it was like I have been nominated for some award. He had a cheerful voice when he first spoke to me, but I did not want to get my hopes up….anyway, wow 5!!!!! He did not give me any other information and I figured the embryologists would give me more info. I should not bother him with it! I got to view my 2 little embryos via this small screen near the ceiling. Wow…….H did not get to view cos I chose sedation. Otherwise, hubbies will get to view the embryos as well as the embryo transfer. I showed him the photo though!

Ok, this comes the funny part. He sat down in front of me. Yes, facing my little flower. Oooh…..and I panicked….cos Dr Lim only just injected the sedation into me. I was not even out yet. I sort of jerked and told him I am not asleep yet. He SOOOO nicely told me, "dun worry, I will not do anything yet". I tell you…where to find this kind of nice doctor???

The next thing I knew was I woke up about 9.15am. I guess the procedures as about 15-20 mins? Cos I chatted quite long with Dr Lim plus the viewing of the embryos. As soon as I woke up, I drifted back to sleep again. By 10.30am, I was pretty much awake and Nurse Saw gave me a cup of milo. Chatted with her a while. Hope I am not too noisy. Once I was quite awake, she got the embryologist to speak to me.

I had 5 eggs that got fertilized. The best 2 which was grade 4 have been transferred into me. The remaining 3 - 2 of them are grade 4 and 1 of them grade 3. But depending on how they develop, not all 3 might be frozen. So although I have got 3 embryos, I might have 3 or lesser embryos transferred. I was a little sad and I asked her….if grade 1 is the best, mine is not so good huh. Then she perked and almost in a small shout, told me that grade 5 is the best! WOW!!! and I had 4 grade 4!??!??! WOW…..was really happy that day. First, I got Dr Tan for both the procedures, Sweet Dr Lim, 5 fertilized eggs even though Dr Tan only managed to retrieve 6, and now the grading! I hope my luck goes on…...

Anyway, by 11am, I was ready to be picked up by hubby. So happy, no pain, no giddiness. And you know what Dr Lim did!??!?! She asked the nurse to get ready a wheelchair for me!??!?! How sweet is that!!!!! Gosh…….anyway, it came in handy cos I felt giddy soon. This time, I stayed longer at the clinic. Cos hubby had to go to the pharmacy to collect medicine. I was to be injected with 0.2ml of Pregnyl and the nurse had to show me how to do it. Hhehehe, was happy I got the briefing from Nurse Wendy. The other nurse is very long winded and hmmm….she would rank last among all the nurses. Not very nice lady. Curly short hair. Nurse Wendy is very nice! :) She taught H to mix the medication and I told her I want to do the injection at home. How to ice myself there? Plus I need H to do slow mode for me….oooh….the nurses there are so swift with the injections. I was injected by this malay preggy nurse. Gosh….it hurt so bad that I wanted to tear.

Oooh, I also made payment for the insurance. So glad I can pay $291.04! It's the cost for transferring 2 embryos. If only 1 embryo, it would have been relatively cheaper - $68.48. I was thinking, why dun the insurance company just round up…..4 cents, 48 cents? Then H told me it's due to GST. Wow!!! H is sooo smart!!!

That should be the end of my story for ET day…..a breeze and I am glad that I have hit another milestone. I feel like I have been nominated for an award…..everyone wants to win but there can be only 1 winner. So it's either you win, or you lose. H told me not to think so much…..just take one day at a time. Next milestone…... 3 Dec. I have 15 more days to go!

Day 14 - Egg Retrieval Day

Day 14 of my Antagonist IVF Cycle

This is the day for egg retrieval! I could only pen this today (one day after) as I was so tired and drowsy from the sedation.

I was supposed to report to the clinic @ 7.30am. By the time I got a q number and ready to say good bye to hubby, it was already 8am! And hubby produced sperms at 7am (at home)!!! I was kinda freaking out but told myself to calm down. We should have produced at the clinic cos today, there were only 6 people doing the egg retrieval which means no rush for the room. :(
Note: Although the clinic opens @ 7.30am, you would be allowed into the waiting area from 7.20am.

So…...I entered the room. It's termed as "Changing room" from the outside (as in from the KKIVF clinic). I was told to remove all my street wear and change into the this white gown. Then I had a pink kimono cos the white gown was bare back! Nurse called it a pink kimono. Hhahaa. I had to empty my bladder again (just in case). Kept all my personal stuff in the locker (including phone), said good bye to hubby over whataspp, then, I walked through the other door and into the waiting area. It is one huge room with only an enclosed room which I later learnt was the procedure room. This huge room is also where I will be recovering after my sedation. I sat down on the chair (just next to the door I had to go through with 4 chairs). There were already 2 ladies there. I had no mood to make small talk and I guess same for them. Waited for Nurse Lee (this all all the nurses wears the blue garb) to prep me. She had to insert a needle into my left hand cos this is where the anesthetist (wearing the green garb) will insert the lovely sedation for me and any other pain killers or drip that I might need. Within 5 mins of the Nurse Lee prepping me, my name was called and I proceeded to the procedure room. I think it was about 8.30am?

My doctor is Dr Tan Heng Hao. He was supposed to be on reservist but he comes back every morning to do the procedure! I was so happy to see him!!!! I think he really loves his job huh. He could have a free and easy time, but choose to come back! Not like the hospital is paying him extra.

Anesthetist was nice and was so chirpy which really puts me at ease. At this point, I do not even recall if I saw Dr Tan before I was knocked out. It was that fast! Wahahaha.

The next time I woke up, it was 9.15am and I drifted in and out of sleep. I seemed to take longer than the rest to recover. When I was more awake, I was given a cup of warm milo. Again, after finishing my drink, I drifted back to sleep. It was quiet and peaceful and I did not have any cramps (based on what I read from the internet and I was so happy!). 3 girls were already discharged before me! In any case, hubby was not ready to pick me up, so I told the Nurse Lee and she told me to rest a little linger. There are 2 nurses running the recovery area. They were really quite good. Always checking in on everyone.

By 11.45, I felt so much better and more alert, decided to tell Nurse Lee I was ready to go home. Cos you see….I had to call hubby and my phone was in the locker. So, if I continued to stay on the bed, my hubby will never know to come pick me! I still felt good even after I changed and sat down to wait for hubby. It is a rule that someone must accompany you home and the nurse has to confirm. Nurse Lee came over to explain some stuff about the egg retrieval and the signs I will be experiencing. She told me my vaginal bleeding is slight and doctor has checked (gasp! so shy…) and I am doing fine. I had 6 follicles picked up. Then she gave me instructions for the procedure on Saturday and some documents to sign. I was already getting drowsy again. In fact, I actually felt sick.

Hubby arrived around 12.30pm! He insisted that I have something to eat and he suggested Macs which I could not resist. It was a good move. Felt so much better after having fries!!!! Tried a bit of hubby's Ebi burger and it was not bad and it came with the banana pie! I still fancy the apple pie! I still felt good when I arrived home but decided to rest. Changed into home clothes and got a hot water bottle for myself and climbed into bed. By this time, cramping had already started. Oh….I felt a little weird down under my little flower. 

Next woke up @ 3pm when hubby came home and he told me I told him to lower his voice. Oops….I have NO recollection about this!!! Slept again and woke up @ 6pm. Watched some tv and had my dinner @ 7pm. Waited till 9pm to take my antibiotics cos I had pizza for dinner (no milk contents 2 hours before/after antibiotics), played some candy crush and I was snoozing by 10.30pm! Note: Cramps at this time was kinda bad. Was contemplating Panadol but because it was bearable, I decided to sleep it off. Woke up this morning @ 8.30am and felt so much better. No more cramps!

To sum off my experience at KKIVF. It felt like I was part of a factory assemble. From the reception to the changing room, to the needle insertion to the procedure. It was patient after patient. BUT…..surprisingly, I find comfort in this. Previously, I had to wait 2 hours for the doctor to start the procedure. Waiting so long actually makes you even more scared. So…I was glad that it was like an assembly line and I did not had to wait long for my turn. Gave me less time to think about anything. 

Tomorrow…..the day of my embryo transfer. I only had 6 follicles retrieved which I think was quite low. But…with low ovarian reserve, I should be lucky for this. The consultant doctor told me that some people could only produce 1-2 follicles. I am hoping for quality….at 2.36pm on a Friday afternoon, I have not received any call from KKIVF, so I guess no news is good news? I am afraid that no eggs have been fertilised…… :(

Oh, as of day 12 of my cycle, these were my readings:
Right - 18,17.5,15,15,12,12,10.5
Left - 18,17.5,15,15,12,12,10.5
Lining - 11


Another milestone achieved

Things to prepare for egg retrieval Day

Also known as Oocyte Pick Up

Things to prepare

1) IVF documents (you would have been given some documents. Bring it along). Oh, please read it and  be aware of what to expect

2) Own medication (I brought along Panadol as I have drug allergy. It would act as my pain killer)

3) Sanitary pad or panty liner (I was good with just a panty liner)

4) Heat pad (to help release cramps)

5) Sperms! If you are producing at home) 

Note: This applies only to KKIVF patients

Oh, I did a list of items to watch out for after the egg retrieval.

My list:
To contact clinic if:
1) Fever greater than 39 degrees for more than 2 hours
2) Excessive vaginal bleeding
3) Unusual and increasing pelvic area discomfort
4) Difficulty with urination or change in bowel activity
5) Nausea, vomitting or diahorrea
6) Sharp or shooting pains
7) Pain or burning during urination
8) Abdominal swelling
9) Unusual back pain

Day 7 of Antagonist Cycle

Back to KKIVF again today (after 3 days). Going to head back again tomorrow cos the doctor wants to monitor the growth of the follicles.

Right ovary - 13,10,10
Left Ovary - 10.5, 9.5
Uterus Lining - 8

I am so happy that the sonographer could detect 2 more follicles. I was worried that something might be wrong with my left ovary but seems like I should be at ease now……
Ok, so the weekend is approaching and because KKIVF does not do any procedures on Sundays, and the doctors need to monitor the speed of my follicle growth so that they can better gauge what they need to do next, and also when the egg retrieval will be, as such, I will need to head back tomorrow for another ultrasound. This time, still the same French doctor! You see my follicle size, most are around the same size, except for 1 that is growing ahead of the rest. As such, they need to monitor how fast the other 4 are growing, to obtain an optimal result.

Hmmm…she mentioned that my egg retrieval looks likely to be either Tuesday or Wednesday. That means hubby should start monitoring his sperms!

I am still on super high dose of medication - 450 units of Puregon. Geesh…..when i read blogs of other IVF-sters, they are on 150-200. I am way over their dosage….

Today, I was number 4! I arrived KKIVF about 7.40am. Doctor only started work around 9.10am. Plus, she could not go as fast as Monday cos she was guiding another doctor who still needs to polish on her delivery. When she first explained to me, it sounded like she was giving up on the other 4 eggs and just banking on the biggest egg. hhahahah. I had to collect medication, so I was done by 9.45am today. Collected 1 Puregon and 1 stick of Orgalutran today. Damage = $740.29. Lucky for medisave and subsidy.

Another early morning and sleepy day for me tomorrow….

Cost of IVF at KKH, KKIVF

So far, these are my costs. I will continue to update them as it comes

Description	Cost	Receipt Number	Covered by Medisave	Covered by Govt Subsidy	Cash
Registration	95.76	2			95.76
Counseling and Sign Consent	203.30	2			203.30
Screening Blood Test	266.97	1			266.97
1st consultation (26 Sep)	101.65	1			101.65
Supplements	39.50	3			39.50
Transvaginal Scan	127.33	4			127.33
Medication (1st)	1561.76	5	780.88	780.88
	2396.27		780.88	780.88	834.51

Note:
1) I need to verify on the Medication (1st). I am pretty sure it is 50% medisave and 50% government subsidy, I will check with nurse the next time.
2) The costs will not YET include the cost for IVF procedure, doctor's consultations, scannings etc. These costs will only be provided later when I either get the BFP or ......
3) Ignore the column "receipt number" cos that is for my own records
4) Last row is the total paid so far.
5) I have medisave and subsidy columns as I qualify for both. Read this post

Day 3 of Menses

Today is day 3 of menses and I had to report to KKIVF to start on my IVF program. My cycle is termed "Antagonist Cycle", meaning, the short cycle.

I did some reading up on the procedure @ KKIVF and after reading a few blogs, I decided to go earlier to get my Q-number. For those who are going to KKIVF for the first time for the first scan, here are some tips and process!

1) You will need to do an ultrasound. It's a transavaginal scan, so do empty your bladder.
Anyway, the scanning starts at 8am, but you can go at 7.30am to start q-ing. 7.30am suits us cos we can avoid the morning peak jam as well as the hefty ERP charge. so we went to get a q number and I was 2nd in queue! (Number 1001 is sample and the real queue number starts 1002). You will be allowed to sit at the IVF centre even though they have not begun seeing patients. So don't worry that you go there early and there's no chairs for you to rest. You can even go and have your breakfast cos the scanning will only start at 8am. There are 4 options on the queue machine. Press Button "1". It will print out 2 labels. One for you to keep and the other for you to staple your appointment card (you got it when you first when to see the doctor at the Fertility Clinic). Or if you have papers to bring, you can staple it with your printed label and place it into the box outside Room 5. In case you forget to bring your papers, no worries. You can just indicate your IC number on the label. Staple, staplets, pens are all provided at the station you got your Q-number. I went on a Tuesday morning so it was not crowded and I did the scanning at 8.05am!!  Scanning is done at Room 5. Only 1 scanning room but super fast. Approximately 5 minutes per patient.

2) After the scan, the nurse (counter 6) will call your number. There are some forms for you to complete for Medisave purposes. At the same time, she will also hand you your medication prescription which you will have to go to the pharmacy at level 1 to purchase. That should take another 15-20 minutes.

3) Come back and press button 3 for treatment. You will go into the nurse room (Room 1) and the nurse will show you how to do the injections. I have done it before but I just let her go through the protocol. She was very thorough and clear so you will not miss it. Then you are done!

4) Do note, these medication needs to be refrigerated. Unlike Raffles Hospital (they gave me a cooler bag and a big pack of ice), KKH only gave me that small packet of ice (see left of the below picture). Gosh....and they told me that I will need to return the packet and they will give me a new one the next time??? Duh...I will bring my own ice instead.
From others' experience, I brought my own cooler bag but I did not realize the pharmacy would only provide such a small packet of ice. I guess that small packet is enough, but how do you feel adequate? hahahah.  Thus, instead of going for lunch, I went straight home!

5) Today's time at KKIVF is quite short - 2 hours but costed me $6 in parking fees. Another point to remember. Scanning is from 8-10am only. They don't scan after that.

6) Okay, if you qualify for the Medisave withdrawal and government subsidy, the below cost will not scare you. Medication today for just those 2 boxes of Puregon 900 and the 3 sticks of Orgalutran below...... $1,561.76. I did not pay a cent. Thank goodness for the Medisave and goverment subsidy. That is why I chose to do my IVF at KKH. Previously, at Raffles Hospital, the Puregon for just Puregon 300 was already $287.11. And the Orgalutran was $95.40. If I had paid for these medication at Raffles Hospital, I would have paid about $2000 in cold hard cash. But at KKIVF, slightly cheaper and it does not come out from my pocket. Huge difference even though the money is still part of my money (Medisave). But well, I would not have seen that money till I am 60 anyway.

My dosage is quite high. Doctor ordered Puregon 450 for Day 6-8....seems kinda high. I used 175 previously. Let's see what happens. However!!!!! I was told to take the Orgalutran today??? From Day 3 to 5. Weird. Orgalutran is to suppress ovulation? I wonder why I need to take this when I have not even ovulated? I am only Day 3. I asked the nurse and she said it's a new protocol.....Shall follow instructions then. The thing is.....Orgalutran is pain....the needle seems blunt and you have to use more strength to poke than the Puregon. When you handle Orgalutran, you will find Puregon a breeze. Previously, I reflected to the doctor that it hurts. She told me I could apply this medication to numb the area before I inject. I mentioned to the KKIVF nurse (the one that showed me how to do the injections) and she told me I should have asked earlier. Cos now I have to go back to the pharmacy to get it. Hmmm....pharmacy quite a torture cos it means another wait. She told me the small bottle costs $13++ and she feels it's expensive. Instead, she asked me to numb the area with the ice! I decided to try her method cos I did not want to wait for the doctor to sign the request then wait again at the pharmacy. Anyway, I tried and it works!!!

To digress a little. The nurse who showed me the injection was a Senior Staff Nurse (SSN). She looks near retirement age. Actually, I think it's great that the hospital deploys the older nurses to these positions. Not so tough on the older ladies cos this SSN gets to sit most of the time. Rather than have them leave nursing due to working hours and conditions, these kind of jobs still allow them to have contact with patients and yet, not too hard on them! In addition, their age seems to add some stamp of authority to what they say. Hahahahaha