6 August 2012, by Tan Yi Lin
1 August 2012
We were scheduled for the embryo transfer procedure at 9.30am. Today, we would find out how many embryos made it from the 22 eggs that were introduced to the hungry army of sperm on 30 July.
The weather was nice and sunny. I was feeling great. Rather hungry. So I chowed down on a bowl of cereal. Mmmmm. Good.
Oh wait. Oh crap. I forgot to fast. Panic.
The husband was unsympathetic: “You had better confess to the nurse that you ate!”
On the way to the hospital, the radio deejays generously doled out shout-outs to all nurses, “HAPPY NURSES’ DAY!” Dan took it upon himself to wish the nurses at KKH when we saw them later. What better way to show our appreciation to these wonderful people than to wish them in person?
At KKH IVF Centre
We bumped into my friend again, who was waiting to have her ultrasound scan to track the size of her follicles for her upcoming IUI procedure. Isn’t the IVF clinic becoming such a friendly place? Lots of familiar faces now!
The nurse at the reception warned us that it was going to be a long wait. Nonetheless, I gulped down cup after cup of water. A full bladder is required for the embryo transfer. I hadn’t read the patient instruction sheet too carefully the night before and forgot that I was suppose to have drank all that water before I left home for the hospital (Note to Self: Being a repeat IVF patient does not give one the excuse to get complacent and not read the instructions given!)
“HAPPY NURSES’ DAY!”, announced Dan. The nurse looked surprised – and pleased.
I got my blood sample drawn, which the nurse explained was to test for OHSS – Ovarian Hyper-Stimulation Syndrome, a possible uncomfortable side effect of the IVF drugs.
The minutes ticked by. Oh.My.Gosh. This was going to be a long wait indeed. My bladder was bursting. Dan told me to summon up the memory of how I lasted 20 hours on a bus journey in South America without a toilet break (because I absolutely refused to use the one and only toilet on the bus.) But that was different. I don’t gorge myself with water on long bus rides.
My guess was that my doctor probably had a delivery (not of the pizza kind) to attend to. My thoughts floated back to when Coco was born – 9.27am on a Monday. I must have pissed off my doctor’s patients by holding her up in the delivery room on a typically crowded Monday morning. There must have been more than one anxious woman waiting for an embryo transfer while clutching a watermelon-sized bladder.
So it’s true. What goes around, comes around.
A nurse finally called my name and escorted me into the procedure room.No sexy pink bare-backed gowns for this round. Just strip off your undies, hike up your dress/skirt and you’re ready to go.
The Embryo Transfer
The nurse scanned my tummy:
Nurse: Wah, bladder very full.
Me: Yes! But… *squinting at the screen*... how do you tell? What am I looking at?
Nurse: *pointing* The black area pressing down on the white part – that’s your bladder pressing onto your womb. When lying horizontal, the womb usually pops up like a little hill, which makes inserting the catheter (containing the embryos) difficult. A full bladder presses the womb into a horizontal shape, allowing catheter to be inserted straight in.
Aaaahhh. *realisation* All these years and months where I had been obediently sitting around, with bladder bursting at the seams, I never asked. Now I know.
I decided to confess that I had breakfast.
Me: I, erm, forgot to fast today. Is that okay? What’s the reason for fasting since no sedation is required? (I’ve no idea why I have never asked this question either.)
Nurse: Fasting is a precautionary measure just in case you need to have the procedure done under G.A., which requires a fasting period of minimum six hours before the surgery. But since you didn’t have any problems for your previous embryo transfer, you should be alright.
Phew. Minus points for greediness. But other than that, I was going to be okay.
Me (to Dan): You do know what your job is, right?
Dan: *nods enthusiastically* Yes! To check your name and IC number when it appears on the screen!
Me: And you do know what my IC number is right? It’s not 8888. Nor is it 1234567.
Dan: Yes, yes, I know. And my other job is to scan your head! What do you think will appear on the screen? *grabs the scanning-thing that the nurse was using on my tummy and TRIES TO SCAN MY FOREHEAD*
Me: *silent scream* STOP IT! YOU SCAN YOUR OWN TUMMY LAH!
My doctor arrived before he could unbutton his shirt (thank god).
Doctor (to nurse): Happy Nurses’ Day!
Dan: Happy Nurses’ Day! Aiyah. I forgot to wish her earlier! Must show initiative, you know? (To nurse) You all had a party already right? Will you still be celebrating today?
Nurse: Yes, there will be another party later.
Dan: Wah. You are quite party animals here ah.
The doctor informed us that we have FIVE usable embryos from this cycle (yaaay!) She intercom-ed the embryologist (in the adjacent room) to feed ‘live’ video footage of the first two embryos to the screen in our room.
Dan (exclaims): WOW! SO MUCH HAIR! (which is utter rubbish of course. There is no such thing as a hairy embryo.)
Me: Oh hello babies! You look like your father already. Oh joy.
On a serious note, the embryos from this cycle appear to be of much better quality than the four from the previous cycle. You can see from the photo below how cleanly-divided the cells are (at the four-cell stage) and how translucent the embryos are.
The ones from the first cycle look so fragmented and dark in comparison. One of them was Coco.
The embryologist later told us that the embryos transferred on 1 August were of Grade 4 and Grade 3 (I assumed that Grade 5 was the best, thus this was meant to be good news). I didn’t even know the grades of my first four embryos. The embryologist then didn’t tell me. Nor did it occur to me to ask. I didn’t even know there was such a thing as embryo grading. Not that the scores really mean anything. There have been IVF attempts using top-grade embryos that failed. There have also been occasions where low-grade embryos miraculously blossomed into beautiful, smart and funny babies. Coco is a living, breathing example of the latter.
After Dan verified that my name and IC number were correct, the embryologist brought the embryos, sucked into a catheter, to my doctor.
My doctor proceeded to insert the catheter and release the embryos into their new home.
Dan: *hums The Imperial March from Star Wars. Also known as Darth Vader’s theme* den den den dendenden dendenden….
Doctor: Oi. Don’t make me nervous lah.
Nurse: *pointing to screen* See, you can see the embryos inside the womb.
Dan: *squinting* Errrrrr. Okaaay. Whatever you say. I believe you!
With the embryos safely in, the embryologist popped out again to give us the IVF report:
22 eggs extracted
15 successfully fertilised
5 embryos suitable for transfer
2 embryos transferred
3 embryos frozen for future use
It’s not a bad haul. In fact, very similar to my first cycle. But look at the pattern here: out of the 14 and 15 fertilised eggs from each cycle, only one third made it to become usable embryos. This is why IVF is not a sure-win solution to fertility issues. This is what most people don’t understand. The numbers, while not exactly dismal, don’t promise anything.
“HAPPY NURSES’ DAY!” Dan chimed to the embryologist. He glanced at her name tag.
Dan: Oh wait. You’re not a nurse. Ooops.
Embryologist: It’s okay. We have Embryologist Day too, coming up soon.
We thought she was half-joking. My friend sent me a photo of the new display at the IVF centre two days later. Apparently, the embryologist wasn’t bluffing:
The doctor prescribed the same progesterone supplements as the last round to support the uterine lining during this critical period. I asked why KKH prescribed that Utrogestan be inserted vaginally, instead of consumed orally as per the manufacturer’s instructions. My friend’s gynae (from a private clinic) had told her to eat them and she was quite grossed out to discover that she had been swallowing, what to other women are, vagina pills.
My my, I sure was in an inquisitive mood that day. The explanation was that, if swallowed, the capsules would first have to be digested and then further processed by the liver, thus reducing the actual dosage of progesterone reaching the uterus. When used as suppositories, the pills dissolve and the progesterone is absorbed through the vagina walls, which are rich in blood vessels, directly into the bloodstream, and reaches the womb through a more direct route.
So now you (and I) know. Utrogestan: Best Shoved; Not Swallowed.
By now, it was almost noon and Dan had to rush back to the office for a meeting. But not before proudly flashing the photo of the embryos at a nurse, declaring, “See! My sons!”
We fed our new babies with a hasty, calorie-rich meal from Macdonald’s and willed them to grow. I know, burgers, fries and soft drinks are not the most nutritious of foods. The natural food purists and old folks will just flip at the act of drinking ice-cold Coke after an embryo transfer. But hey, if these babies are anything like their big sister, they’re going to grow up without a fear of cold temperatures, even if they weren’t frozen babies like Coco was. Plus, I went with the relatively healthier option of a Fillet O’Fish in hope that it’ll grow us some brainy babies.
Before we left the clinic, the nurse remarked that it was heartening that our frozen cycle had succeeded and that it was not common for IVF to yield baby girls. Assisted reproduction techniques favour male babies, as the fastest and strongest sperm – usually the ones carrying the male chromosome – would penetrate the best eggs to form boys.
This makes me realise how heavily the odds were stacked against Coco, even before her life began. A sperm carrying the female chromosome had won the fight against its stronger, faster competitors. She was (what most embryologist might call) a poor quality embryo. She was deemed to be second choice and relegated to the freezer, to standby as our extra hope. She was frozen for three months before being thawed – with no guarantee of survival. Coco, to us, embodies Hope – and as her name means, Victory (no, Cho Colette didn’t really stem from Chocolate. That’s just Dan’s idea of a brilliant pun). Not just our Hope, but others’ too. Even before her first birthday, this little girl has shown other couples that they, too, have a shot at becoming parents, even if the odds are against them. I received an email from a reader last week telling me that our story inspires others and gives them hope. That is one of the nicest things that anybody could ever say. This is what makes keeping this blog meaningful and worth every minute that I’ve spent on it.
The pregnancy test is scheduled for 17 August. So now, we wait.
And talk to our future babies:
Dan: Hello Kenobi!
Me: You only said hello to one of them! How about the other one?
Dan: Erm, hello Kenobi! Hello Obiwan! You are Cho Bi Wan, Kenobi and you are Cho Bi Two, Obiwan.
Me: What?!?! What sort of crappy name is Cho Bi Two?!?!
Dan: What? I am only expecting one of them to make it. I hadn’t prepared another name yet!
Yes, my husband is quite THE Name Master.
I have more faith than he does. I want both of them to make it. And if they do, we have a good 36 weeks to come up with better names.
In the meantime, would anyone like to engage Dannie’s naming services for their newborns? $88 only.