Friday, June 3, 2016

Part 1: My journey to motherhood: The Chronicle of an IVF mother-to-be


“I prayed for this child, and the LORD has granted me what I asked of him.”  1 Samuel 1:27 (Hannah’s prayers for a child were answered).
10 Jan 2015: Our appointment day with the gynaecologist to start the IVF treatment. A month before this, we already had our talk with the fertility nurse and the gynaecologist to discuss the treatment plan in details, the step by step process of an IVF treatment cycle, what is expected of me, what is expected of the treatment, what are the do’s and the don’ts, the what’s and the when’s and the how’s. I was already given my supply of hormone injection medications that I would inject myself in the course of the treatment, so I was already prepared physically and mentally for what is about to happen. The appointment with my GYN is for a routine check (transvaginal ultrasound and blood sample) before the actual IVF treatment cycle starts. Oh talking about blood sample, flashback around 4 months back (October 2014), before any treatment has to start, we are required to undergo blood screening, blood typing, genetic screening and all that hullabaloo to make sure you are healthy and your cells are healthy. If you get the go signal from the screening committee, then you can proceed with the treatment.
So going back to day 1 of the treatment cycle (which is the second day of the menstrual period), after the appointment, I was given the instruction to start the injections that evening.

I have to do two sets of subQ injections to my tummy every evening for the next 10 to 14 days. The first hormone injection is the Menopur which contains follicle stimulating hormone and luteinizing hormone. These hormones stimulate the ovaries to make eggs. The more egg cells produced, the better because that means more chances of eggs being fertilized, which means big chance of embryo transfer. The second injection is Gonapeptyl which prevents premature ovulation during ovarian stimulation.
Stimulation is supervised through regular monitoring which consists of carrying out ultrasound scans and hormone level test. This means going back to the gynaecologist after 4-5 days (depending on the availability of the doctor) after starting the first day of hormone injection. The doctor checks how many follicles are present and if it is stably growing. Blood test are also done to monitor hormone levels in the blood. This is needed in case where dosages has to be adjusted depending on the reaction of body to the hormone injection. This goes on for the next days until my day 11 of the cycle wherein Pregnyl has to be injected. When the follicles are ready, you get a "trigger shot," the Pregnyl, which is an hCG hormone injection that causes the eggs to mature fully and become capable of being fertilized. About 36 hours after the hCG injectuin, the eggs are ready to be retrieved.

22 January 2015: The day of the egg cell pick up. We have to be in the hospital at exactly 7:30 am. I have to be "nuchter" which means no food or drinks from 9 p.m. the evening before. At 7:30 a.m. we were escorted in to our room for preop. When all documents were filled in, IV lines were in placed, blood pressure and O2 sat were monitored, I was then brought to the operating theatre. The egg cell retrieval was performed under general anaesthesia, so I was asleep during the procedure.
     
In the meantime, while I was in the OR, Patrick also has to do his share of fatherhood by giving his sperm cells, which is not much of a painful procedure.  I woke up 2 hours after the procedure feeling light-headed and the need to pee. The first thing I asked was how many eggs were retrieved. They told me they were able to pick up 2 healthy egg cells. It was not much as I hoped it would be, (I was actually expecting 4 egg cells because during the check-ups, there were 4.) But it was then explained to me that the other 2 egg cells were not mature enough. After checking my vitals, and making sure that I have already gone to the toilet, they discharged me before noon. They gave a prescription of Utrogestan, a progesterone pill to be administered vaginally 3 times a day, and Dafalgan for pain relief. I was also given another 2 days more of vacation days to recuperate. We were told that we should be expecting a call from UZ Ghent, (where our egg cells and sperm cells were brought into for fertilization) the day after to confirm how many eggs were fertilized and when the embryo transfer would take place.
We went home with high hopes that the eggs will be fertilized and that there will be an embryo transfer.
The 2 more days of recuperation is actually needed because as soon as the anaesthesia wore out of my system, pain began. It was so painful I cannot even get up of our bed. The pain began as a cramping pain at the lower abdomen, something like menstruation pain but worse because after some time the pain is all over my lower back. The painkillers does not seem to help and I just felt so helpless. Pain eventually subsides after the second day and it's a good thing because I need to get back to work. The day after the pick up we received the most anticipated call from UZ Ghent. We are scheduled to go to Ghent for the embryo transfer on the 25th of January on 12 noon. Both the 2 eggs were fertilized. Patrick and I were ecstatic! We are now a step further to having our little miracle.

25 January 2015
Geared with so much excitement and anticipation, Patrick and I drove to Ghent and arrived there an hour before our appointment. I was advised to have a full bladder during the embryo transfer and when I'm too much excited, I tend to pee a lot so good luck to me. After registering at the registration office, we were told to go to the fertility department which was in another building. Upon arriving at the waiting hall, there were already four couples waiting. I have then the realization that we are not the only one going through the same ordeal. For one or other reasons, we need science to assist us. There were even younger couples in the waiting hall and English speaking at that, which means they are not originally from Belgium. Anyway, going back to the embryo transfer, the exact procedure that was used by the embryologist to fertilize my egg is a technique called intracytoplasmic sperm injection or ICSI. With ICSI, a single sperm is injected directly into the mature egg. The embryologist then selects the most viable embryo to place into the uterus 3 to 5 days after the egg cell pick up. Extra embryos, if there are any, may be frozen and used for future IVF cycles. In our case, two were fertilized but only one was viable for embryo transfer.
Both Patrick and I were escorted to the operating room for the embryo transfer. This time, no anaesthesia was needed to carry out this procedure. An ultrasound-guided catheter was passed through the cervical canal to deposit the embryo in the mid-portion of the uterine cavity. The bladder must be full to facilitate the transfer. We saw everything in the screen. There was a big screen in front of us and the doctor explained to us every step what she was going to do. It was an amazing feeling knowing that there's already an embryo inside me. I was even afraid to stand up in fear that it will fall off! But the doctor assured me that once the embryo is caught between the endometrium, there is no risk of it falling out. I was then advised to return to normal activities, avoiding lifting heavy objects, and not be stressed out. The next appointment to the hospital is 12 days after the embryo transfer for the pregnancy test. It was the longest 12 days of my life...


Until now, going back to what we have gone through the past year, after four unsuccessful IVF treatments, makes me wonder how I was able to survive it all. Patrick and I have been closer than ever, his support was invaluable. And we have been closer to God, His love is immeasurable. If not for that, and the support of family and friends, I would have lost it. I can take the physical pain, but the emotional and mental pain was way harder and heavier. There were times when I just wanted to give up, but then Patrick would remind me why we're doing this in the first place. Our desire to have a child/children outweighs all the miseries that we encounter or will encounter. We are given six chances to try the IVF. Here in Belgium, we are lucky enough to be covered by the insurance for six IVF tries. Although we still have to pay part of the gynaecologist fee, lab works and some medications like painkillers, a big bulk of the expenses are already shouldered by the government, so it's actually an opportunity you cannot turn your back on. After fiur unsuccessful IVF treatments, we decided to move to another provider. It is not that I don't trust the gynaecologist in Roeselare and a great institution like UZ Ghent, but part of me wants to believe that there are other ways to make it work, that part of me wants to try another protocol treatment. Maybe a change can make a difference. It was not easy convincing Patrick to go to another healthcare provider especially when firstly, logistically it will be a hassle (I plan to transfer to Jette in Brussels, which is an hour and a half drive from where we live). Secondly, after our third embryo transfer (fourth IVF cycle treatment) I was already tested positive but the hCG was low, then two days later got massive bleeding which is so devastating, so Patrick does not want to go to another doctor for the hope that the next IVF treatment cycle would yield better results. It is already straining our relationship as it is going through this ordeal so I did not push it until after the new year of 2016.

2 February 2016 when we had our first appointment at the Centrum voor Reproductieve Geneeskunde (CRG) or Center for Reproductive Medicine, UZ Brussels in Jette. We were then met by Dr. De Brucker who explained to us how it is done in CRG. We were then referred to Prof. Stoop, who would then be my fertility gynaecologist who would do all the follow ups during the course of the IVF treatment.
15 February 2016, our appointment with Dr. Stoop. He made sure all lab works are done that day for both Patrick and me. Another round of blood tests for routine check. We talked about our previous IVF cycle treatments and we were told that he would be needing my old files from the previous hospital, but he will be the one to communicate with them. Then after the consult with Prof. Stoop, we were assisted by midwife Nathalie who explained to us step by step the hormone treatment protocol that we will be doing. We also needed to sign some administrative papers and then we are good to go.


Coincidentally, Feb 15 is also Patrick's birthday, so after our appointment with Prof. Stoop, we celebrated his birthday in a stone-grill themed restaurant and a movie date. We are so looking forward for this new beginning.




































6 April 2016: We went back to Prof. Stoop's office to get my hormone medicine kit and do the initial blood test. Today is the second day of my menstrual period, and if all is well on the blood test, they will call me before 5 p.m. today to tell me if I may begin with the first hormone injection. Later that day, I got the go signal to start with the injection of Cetrotide that evening.

9 April 2016:  After injection of Cetrotide for three consecutive evenings, we had our appointment in CRG in the morning for our first follicle measurement and blood test. We were told that there were two follicles, one at each side of my  ovaries, but they are still small and it's still early to tell how many more there will be. With my age, they don't really expect more than five, but we will still hope it would be more. Later that same day, patient monitoring called me up to inform me that I have to start that evening Gonal-F, which is a follicle stimulating hormone and to stop the Cetrotide. I have to do that for the next 5 days. Then on the 10th day of the cycle which falls on the 14th of April, I have to do two injections, instead of one, and that is Cetrotide in the morning and Gonal-F in the evening.


16 April 2016: We went back to Jette for our second ultrasound for follicle measurement and blood test. No additional follicles were seen. There were only two follicles, one is good in size and growing, and the other one is a little bit smaller than expected for this time after the hormone stimulation. The news did not dampen my mood that day. Still I have high hopes that it will turn out good eventually. You only need one good fertilized egg to conceive right? Although I was kind of expecting more, I am still feeling optimistic about the whole thing. Later that day, patient monitoring called me again to inform me that I only need to do one more injection of Cetrotide in the morning the next day, 17th of April. Then on the 18th of April at exactly 3:10 a.m., yes it is in the wee hours of the morning, I have to do the last injection, Pregnyl, which is an hCG injection to trigger ovulation. This hCG injection has to be carried out at an exact time so that egg cell retrieval can take place 34-36 hours later.
Arrived 9:30 a.m. and we are assisted in our room

19 April 2016: We are scheduled to be in the clinic on 10:30 a.m. for Patrick's appointment to give his share of the deal. Then 2:30 p.m. for the egg cell retrieval. It was a whole day affair in the clinic, and I have to be "nuchter", so I have to be NPO from 9 a.m. Good thing, I was still allowed to have breakfast, but no more food and drinks after 9 a.m. Time seems to be going so slow when you are waiting, and stress is not helping at all. The same feeling all over again. The feeling of excitement and anticipation. So many questions running inside my head, a lot of if's.. I am confident that things will come out good after this, but I have doubts as well.. I have to be ready for both the positive and the negative outcome. But for now, all my heart say is to just let things be and trust in the Lord..
This is it! After reciting a prayer, I was rolled in to the operating room.
This time I was not put into general anaesthesia like the one in Roeselare. In Jette, the retrieval procedure is carried out under assisted local anaesthesia. Unlike in Roeselare where I just slept and when I woke up, it is done, here in Jette, I saw, heard, and felt everything. I was only given an oral sedative before entering the OR. Once settled in the operating theatre, I was draped and the perineal and intimate areas were disinfected. The gynaecologist who was going to perform the operation was not Prof. Stoop, but another one. He introduced himself to me but because I was so nervous, I cannot remember his name anymore. I was instructed to relax because it seems like I was tensing all my muscles. I cannot help it when you see all those instruments in front of you. I tried to relax and I was told that he is now going to administer the anaesthetic injections. I felt it all! And I gather all the courage I could master so as not to shout or cry there. Retrieval is then performed under ultrasound guidance. It took him not more than 30 minutes for the actual procedure. He was able to collect 2 egg cells, but he told me that the other one was still small. I was then rolled back to the recovery area, where they monitor my blood pressure and O2 sat. After making sure that all was stable, I was brought back to our room, and I was so relieved to see Patrick there waiting. I was given toast and jam to eat after the operation. Patrick was so attentive and caring, giving me the toast with the jam and making sure I eat. He knew I was hungry because my last meal was from the morning and it was already almost 4 p.m.  After eating, I felt nauseous, so I asked Patrick to get me a basin, and there goes my lunch. I vomited it all! It was an awful feeling! The nurse said it was the side effect of the anaesthesia so I don't have to worry about it. It was already past 5 in the afternoon when we were finally discharged. They will call us the next day to tell us when we should be back for the embryo transfer. I was also given 2 vacation days to recuperate.
The day after the egg cell pick up, I was anticipating for a phone call from the hospital. Hoping and praying that at least one egg cell was fertilized so there will be an embryo transfer. Flashbacks of the past IVF treatments made so restless I cannot keep myself calm. I remember our second try of the IVF cycle when only one egg was collected and the next day they called me up just to tell me that there would be no embryo transfer because it was not a good quality embryo. I felt so helpless that time but we have to move on. Now this waiting for the phone call from the hospital gave me the same feeling of fear and anxiety.  I lighted a candle and prayed that whatever the result would be, that the Lord may give me the strength to carry on. In the afternoon around 2 p.m. I got the most anticipated call of the day! One egg was fertilized and embryo transfer would be on Friday, the 22nd of April. I cried tears of joy hearing that news!

22 April 2016: The vicinity of the hospital has become so familiar already by now - going back and forth here for the blood test and ultrasound and egg cell retrieval, and now for the embryo transfer.
Our appointment was 2:15 p.m. and we were there already an hour before. Unlike the egg cell pick up, I don't have to be "nuchter" and anaesthesia was not needed. It was a simple procedure of putting the embryo back to the uterus with the use of an ultrasound-guided catheter. Patrick and I were both very nervous. This would be our fifth attempt in getting pregnant through IVF, but actually only the fourth time for an embryo transfer. Every time is the same feeling...We were called around 2:30 in the afternoon to dress up to go to the operating room.
We are so nervous but it does not show...
There were like five of them in the operating room, one is the embryologist who would perform the embryo transfer, the nurse beside me who would be holding the ultrasound in my lower abdomen throughout the procedure, another nurse to assist the embryologist to give the instruments, the laboratory assistant (I assumed) to get the catheter with the embryo from the laboratory (which is just beside our room), and I guess the fifth one is an intern observing all what is happening in the OR. The embryologist introduced herself and told us that she is going to transfer one very good quality embryo. She showed us the monitor from our left side which will be our guide to see the inside of the uterus. I was draped, disinfected, and prepped. She is telling me beforehand what she is about to do before she does it. The procedure itself was pain-free but it left me still feeling a little bit uncomfortable with my vaginal orifice wide open and long catheters were being pushed in. She has a little bit of a problem inserting the initial catheter because my cervix is a little bit curved and the uterine wall is somehow oblique in position, or something like that. Her technique is very precise leaving no room for error. Once the uterine wall was prepped, the laboratory assistant came with another catheter with the embryo. We were watching the screen the whole time she is inserting the catheter inside and we saw a tiny flicker in the screen. I heard her say "perfect" and told us that the tiny flicker was the embryo nestled in my uterus. I was so relieved hearing her say the word "perfect". I am also not superstitious but when I checked again the monitor I saw the number 111 in the screen. I don't know what it means in the screen but I took it as a good sign. Before going home, I told Patrick I want us to drop by a church to say a thanksgiving prayer. We went to the National Basilica of the Sacred Heart in Koekelberg in Brussels, which is not very far from the hospital.

Now after the embryo transfer, the burden of two weeks wait was again upon our shoulders. Believe me, this two weeks was torture. Two weeks of sleepless nights. Two weeks of the same things going through inside my head. I was told not to stress myself out, to just live each day as usual and to think positive. But it is always easier said than done.  Every day I am lighting three candles and praying that it will yield to a positive result this time. Positive thoughts gives positive results because your thoughts become you. That is actually my mantra. Your thoughts become you. We were scheduled to do the pregnancy test on the 5th of May. The days went nearer and nearer and I felt more and more anxious. The day before the pregnancy test, I still went to work doing my routine activity. I remember being so tired that day and feeling sore all over. When I went home that evening I had a little bleeding. It was a streak of a light red in color blood like that when you are about to have your menstruation. I was in panic! I told Patrick when he got home but he just reassured me that it could just be an implantation bleeding, so we don't have to worry for now and just wait for the result of the pregnancy test. To ease my nerves, I lighted a candle and prayed to accept the result tomorrow. Then I lift up everything to Him for His will be done. That intimate prayer with God comforted me that night.

5 May 2016 is Ascension day, and here in Belgium it is an official holiday. So luckily, no work, no school and no traffic. We arrived early around 8:30 a.m. in the hospital for the blood test. There were not much people in the lab so we were done in less than 15 minutes. They will call us before the day ends they said. So this day is another long day for me. I was already so stressed out from the day before because I had a little spotting. It is already nearing 5 p.m. and I have not received any phone call yet so I called the hospital myself. I was on hold for like ages and then a busy tone. I tried calling again for three more times and still the same on-hold tone. I was going out of my wits trying to do things in the house and looking at my phone every 5 minutes wondering what's taking them so long to contact me. If this is their way to torture people, then it is working. At 7 p.m. my cellphone rang! Finally! I put it on speaker so Patrick can also hear what she is going to say. The hCG level she said was very good. That we have to go back next week 12th of May for another blood test. I asked if it means I am pregnant. She congratulated me and said "yes you are pregnant!" I was shaking when I finally heard it. Patrick and I were hugging each other. All emotions were flooding us both..I was crying and Patrick, I know, was teary-eyed too. We just hold each other there for I don't know how long. Absorbing the good news that we just heard and what it means to us. It was a euphoric feeling. Something I could not find a word to describe.
Days flew by so fast and the succeeding blood tests were all good. The hCG levels were constantly increasing, which means that the embryo has successfully implanted and is now growing steadily into a baby. We were then scheduled for our first ultrasound on the 27th of May.


27 May 2016: An exciting day for us! Every day I am finding it hard to sleep good at night. It can be from the excitement of this day or it can be from all the pregnancy symptoms that I have to go through for the first trimester. My breasts are sore which is also difficult for me to find a comfortable sleeping position. I constantly need to pee, even at the wee hours of the night. I would feel warm in the middle of the night so I will take the duvet off, then feel cold again, so I would put it back on again. My morning sickness is not only in the morning. It strikes any time of the day or night. So this special day of our ultrasound appointment, I woke up feeling so drained, but at the same time feeling giddy for this is the day we would be hearing the heartbeat. I still need to go work in the morning because our appointment is on 12 noon. I just left early, at 10 a.m. to be on time for our appointment. When it was our turn for the ultrasound, the doctor told us that I am already 7 weeks and 2 days pregnant and heartbeat is very much audible now. It was an emotional moment when we first heard it! It was amazing how so little tiny flickering light on the monitor could be the heart. I cried right then and there. It was different when you can actually see and hear the growing life inside of you..
7 weeks and 2 days

Fetal Heartbeat: 153 bpm

Crown-rump length of our little one is 8.3 mm

The gestational sac and the yolk sac

The gestational sac

Every day is a blessing. Every day I thank the Lord for this great blessing that He bestowed upon us. We have prayed for this for so long, and now that He entrusted this miracle to us, we will make sure that no harm will come his/her way. We love you already anak!
To be continued...

 
                  Coming soon...January 2017 😍