Second Trimester

My second trimester is generally more relaxed compared to the first trimester. The cervical cerclage reassured us that my cervix won't open prematurely and cause a sudden miscarriage-- just like what I have experience during my previous pregnancy. We have also asked my parents to come over so I won't need to move around the house to cook or do the household chores. They came here just before my cervical cerclage operation. So from then on, I was on bed rest. I was confined in the four corners of our house, leaving only when it's time for our hospital check up. Per doctor's advice, I limited myself on my internet usage and refrained from reading too much regarding pregnancy complications. Looking back, I can't imagine how I spent this trimester with limited activities on house-arrest and kept my sanity!

I guess what kept me from losing my mind is having this positive thought that in a few months time, we will be with our healthy baby! At 17 weeks, I also started to feel his movements. I am so thrilled whenever I feel them. But I think it's only around 20 weeks when the movements were more pronounced that my husband can see/feel them too.

My hospital check ups were scheduled every 4 weeks. I had an anomaly (detailed) scan by the radiologist at 20 weeks. She made a thorough scan of everything. We're very happy that the results are all normal and our baby is healthy. During the scan, our baby's legs are closed so she can only confirm with 80% accuracy that our baby is a boy. My husband is so glad upon hearing this, although honestly, the gender is not that important. What matters is that we have a healthy and normal baby!

At week 20, I stopped taking Prednisolon. But I am still taking Duphaston, Aspirin and Clexane injections daily, together with my prenatal vitamins and calcium. I have experienced getting heartburn again so I am taking Gaviscon when needed.

At week 24, my OB is on leave so I consulted the other high risk doctor instead. The ultrasound scan showed that our baby is healthy with healthy heartbeat. All measurements are normal, the chambers of the heart are normal and blood flow is normal. He also said that our baby's gender is boy. I stopped taking Duphaston as per my doctor's instructions.

Cervical cerclage

Cervical cerclage or cervical stitch is a non-invasive operation for cervical incompetence or insufficiency. My doctors are convinced that I have a weak cervix after having a miscarriage at 17 weeks. Therefore, in order to prevent another miscarriage, they are recommending that I have my cervix stitched. Yes, literally "stitched" (but of course under a general anesthesia)!

So after passing on all my clinical tests, I was scheduled to have my cervical cerclage at 12 weeks GA. I was asked to fast from 12 midnight and discontinue taking aspirin, prednisolon, and clexane injection.

My operation is at 9am but I was asked to check-in at 7am. After changing to the hospital gown, I was injected progesterone oil in the butt and allergy-check shot in my forearm. The nurse also fixed my IV. The nurse tried to check baby's heartbeat via doppler but failed to hear it. I felt nervous but tried to stay calm. She ordered an ultrasound machine instead so my baby can be checked before the operation.

I was wheeled to operating room at 9am. The operation started past 9am because we waited for the ultrasound machine to arrive first. I was given general anesthesia and was down before I finished counting from 1 to 10!

I was wheeled back to the private room after an hour or 2. I was on strict bed rest-- no sitting, standing or walking. I may pee using a bed pan only (while lying down). I had minor bleeding but no disturbing pain. I continued with all my medicines except for Clexane, Aspirin and Prednisolon. I have new medicines for recovery: Coamoxiclav (2x daily), Metronidazole (2x daily), Duphaston (3x daily).

The next day, I was still on strict bed rest but I can go to the bathroom with assistance. My doctor came by to check me up. She described how terrible my cervix was and that she has to put a more sturdy stitch. She said that there was also a lot of bleeding when she put the stitch that she has to press for a while in order to stop the bleeding (perhaps this is due to the blood thinners that I am taking). But overall, the operation went well. She told us that she checked on our baby before and after the operation.

I was discharged from hospital the following day around noon. We went to see our baby at my doctor's office. Our baby is doing well-- kicking and jumping! I was advised to continue with all my meds except for Aspirin and Clexane (but continue taking after 1 week). I was also advised to continue bed rest, drink plenty of fluids and avoid constipation.

First trimester

9-Jun-14
First ultrasound scan @ 5w1d

In the beginning, there were two! We are very thrilled when we saw two gestational sacs on the screen. But our worries never stop at this positive confirmation. After experiencing a miscarriage (at 17 weeks), our anxiety ends only when our baby is born.

14-Jun-14
Second ultrasound scan @ 5w6d

One gestational sac (right) has a visible yolk sac already. Thank God, my doctor told me that I can stop taking the Progesterone injection (my butt rejoices)! Although, I still have to continue taking all my medicines including the "bee sting" Clexane injection!

25-Jun-14
Third ultrasound scan @ 7w3d

There are still two visible gestational sacs (one GS is not shown in the picture). However, my doctor still cannot find any developments inside one of the GS. The picture shows our Baby A, together with the yolk sac inside the GS. This is my last appointment in the IVF clinic.

8-Jul-14
First OB appointment (outside the IVF clinic) @ 9w2d
I tried to search for an OB who specializes in high-risk pregnancy and has background in IVF. I found two doctors in the hospital where I plan to give birth. One of them is a male doctor, so I chose to see the lady doctor. The first time I saw her, I knew that she is good. It's also comforting that she listened with concern on my pregnancy history. She said that we have gone through a lot and we need to be more careful and take all the necessary precautions in order to achieve a safe delivery. She agreed to my IVF doctor's advice on all the medicines that I am taking (aspirin, prednisolon, clexane injection and progesterone suppository) including the plan to put a cervical cerclage at the end of the first trimester (12 weeks). We asked about the bad side effects of the medicines especially on our baby(ies). She said that the negative effects (if any) outweighs the advantages. She also testified that other high risk pregnant women delivered healthy babies with the aid of these medicines. My doctor said that it's good that I am not working and asked me to take extra care especially after having a sudden miscarriage on my last pregnancy. She prohibited me on staying too long on the internet and reading too much or stressing myself. She advised me to just take it easy and pray.


My ultrasound scan still showed two GS. The other sac is still empty and its growth has slowed down. Our doctor said that there is only a minimal risk on the other embryo and normally, my body would just absorb the empty sac as my pregnancy develops. She also observed some bleeding, which might be because of the empty sac.

22-Jul-14
Targetted scan @ 11w2d
The purpose of this appointment is to check my baby's status before I undergo an operation for the cervical cerclage.

This scan is more detailed and was performed by a radiologist. My baby is healthy, active (yes I saw him moving!), and perfect! Nuchal translucency (NT) is 14mm, which is on the normal range. NT is used in the early detection of down syndrome. So we are glad that our baby is normal and healthy.
My blood and urine test results are all good. Although my swab test showed that I have some infection. Therefore, I was advised to take betadine suppository in addition to all the medicines that I am taking.

The 2-week wait (for IVF #4)

Just like in my previous IVF cycles, the two-week wait (to know if I am pregnant or not) is one of the most suspense-filled weeks throughout our journey. After the embryos are transferred in my uterus, all I can do is to pray for a miracle to happen. And when I am praying, I am already claiming for my baby/ies. I am thinking of positive thoughts. I am dreaming of holding my baby/ies while breastfeeding.

Based on the current status of embryo development (refer to my previous blog entry: 2-week wait (for IVF#2)), I am trying to live each day by imagining how the embryos inside me grow, develop, and divide into multiple cells. I would caress my belly and talk to them. I would tell them how excited I am to take care of them. I would tell them to stick inside my uterus and hold on.. hold on until the end.. hold on and never leave me.

I also eat the recommended foods for implantation -- pineapple and nuts. I drink plenty of water, sleep early, and eat well. I am getting hungry easily because of the medicines that I am taking. My medicines are: Cyclogest 400mg suppository (3x daily), Progyluton white tabs (2x daily), Aspimed 75mg (once daily), Prednisolon 5mg (2x daily), and Clexane 20mg injection (once daily).

Five days after the embryo transfer, I was given Pregnyl and Progesterone injections. These medicines were recommended in order to boost my hormones to support the implantation and supposed pregnancy. Since I'm already used to receiving daily shots, Pregnyl injection doesn't hurt anymore. However, the progesterone shot does hurt because it seems like oil. After receiving the shot on my buttocks, it feels like one butt is heavier than the other! At night, I need to massage it and sometimes put hot compress so it won't feel solid and heavy. The bad news is that I need to take this injection every other day! Ouch! Anyway, I'm prepared to take anything just to have a positive pregnancy!

Eight days after the embryo transfer, I had light spotting (pink reddish) especially after inserting my suppository. I also experience minor cramping on my right side during the night. I often feel hot especially in the evening. I read that spotting is sometimes a good indication for positive pregnancy. It is called implantation bleeding. However, it may also be a sign that my period is just around the corner. But I try to think of it as implantation bleeding.

There were times that while touching my tummy, it seems like I'm feeling a pulse that I associate with my embryos' fetal sound. I know that they don't have heartbeat yet because it's still too early, but I just can't help but feel more positive that our embryos are growing and developing inside!

Ten days after the embryo transfer, I had my blood tested for pregnancy. We went to the clinic first thing in the morning and have to wait for their call in the afternoon for the result. I try to suppress my excitement and nervousness by diverting my time to other things and of course, by trying to talk to my embryos. I usually bring out the ultrasound copy of my transferred embryos and imagine them waving at me. At 6pm, my mobile phone rang and the Filipina nurse is on the other end of the line. She told me that my beta Hcg is 109 -- definitely a BFP (Big Fat Positive)!! Yey! Thank you Lord! I was told to continue to take the same medicines and next blood test will be after 4 days.

Four days later, I had my blood test again. This time, I was not nervous anymore because I am confident that the numbers will be good. Normally, the beta Hcg should double every 2 days. So I am expecting the result to be around 400+. The nurse called in the afternoon saying that my beta Hcg is 829! Yey! Super thank you Lord! It seems like the number is quite high so I got more excited as we might have twins!

Eighteen days post embryo transfer, my blood test resulted to a bHcg of 3,982! Wow! I am really pregnant! I am scheduled to have my ultrasound after two days. We are super thrilled to find out how many are there. Although having just one is more than enough for us!

IVF #4

We started IVF #4 in May after having a cancelled cycle (IVF #3) in February. We waited for two normal menstruation period before we decided that we're ready for our next IVF cycle. Going through our fourth IVF cycle feels like a routine already. The staff especially the Filipina nurses seem like old acquaintances. I was booked to a new doctor because my doctor's schedule is full. Since I already know the protocol, I agreed to see her.

The doctor performed an ultrasound scan and saw 3 small follicles on my ovary (a good sign!). I had my blood test and then received my first injection (Ceftriaxone antibiotics). I took home the Gonapeptyl injections (once a day for 2 days) because I want to take the shots at around the same time each day. I was also prescribed to take folic acid 5mg (daily) and antibiotic (Duradox 100mg 2x a day for 5 days).

I went back on Day 4 and saw my original doctor. We insisted that we follow the same medications as IVF #2 since that was the cycle when I had a positive pregnancy. My doctor agreed. I will start Pergoveris 300 IU injection on Day 5 and be back for appointment on Day 6.

If you haven't read my IVF #2 blog entries, Pergoveris is used to increase the number of growing follicles and stimulate their development. Follicles contain the egg cells. The aim of stimulating the ovaries in IVF is to ensure the simultaneous development of several follicles instead of just one in order to be able to collect several oocytes (immature egg cell) and to thus obtain several embryos so that at least one of them with a good morphology can be transferred back to the woman's uterus.

On Day 6, my ultrasound scan is looking good. Four follicles are seen, the biggest measuring 10mm. My endometrial lining is 6.3mm. My blood test results are also good. My doctor prescribed the same medicine (Pergoveris 300 IU) for 3 days.

On Day 9, 5 follicles are seen with the biggest measuring 14mm. My lining is 10mm. My blood test results are still great. It's good that we decided to stick with the same medication as IVF #2. My doctor prescribed the same medicine (Pergoveris 300 IU) for 2 days. I met with the anesthesiologist before leaving the clinic. They now require the patients to see the anesthesiologist before the Egg Collection procedure (also called OPU - Ooctyte pick-up). The doctor took note of my height and weight (if you're curious, I'm weighing 55kg that time). She also asked about medical history, etc.

On Day 11, 5 follicles are seen with the biggest measuring 17mm. My blood test is still good. My doctor prescribed the same medicine (Pergoveris 300 IU) for 2 days. 

On Day 13, 5 follicles are seen with the biggest measuring 19mm. I need to take one more shot of Pergoveris tonight and then the trigger shot (2 injections of Ovitrelle 0.5ml) will be the next day at 10:20 PM. 

The trigger shot is used for the final maturation stage of the follicles. I took 2 injections – left and right tummy. Timing is very important when taking this medicine. The OPU or Egg collection should be done 34-36hours after the trigger shot. Mine is scheduled on Sunday (Day 16) 10.20AM. I was advised to come to the clinic an hour earlier for the preparations before the procedure. Some precautions were also advised such as: no perfume, lotion, nail polish and feminine wash before the procedure and fasting for at least 8 hours before the procedure.

My OPU or egg collection procedure is the same as what I had described on my IVF #2 blog entry. I will leave out the details regarding the procedure so please refer to my earlier post for more information. The entire procedure is painless because I was under general anesthesia. Seven follicles were collected (this is a good number!). I was prescribed to start taking Cyclogest suppositories thrice daily. By the way, on the same day, my husband gave his semen sample in the clinic.

The next day, the embryologist called me and gave me an update. Out of 7 eggs collected, 5 are matured and out of those, 4 are successfully fertilized.

My Embryo Transfer is scheduled on Day 19. I was initially booked with another doctor but when my original doctor recognized my name on the list, she asked to be assigned to me instead. My doctor showed me the picture of my "babies" on the monitor while I was lying in the operating theatre. She asked me how many embryos do I want to be transferred. During my previous IVF cycles, they transferred 2 embryos only. But my doctor is saying that 3 embryos are still safe so that I would have a higher chance of getting pregnant. At that time, I was thrilled to have twins and very much okay with having just one; but the idea of having triplets terrified me! She said that the probability of having 3 is very slim. I never really thought that I would have to decide on this alone. Even if I wanted to consult my husband, I wasn't given enough time ask him. So, I gave the okay to transfer 3 embryos while praying that God will give us at least one but not all 3. I was prescribed with the same medications as my previous cycles - Cyclogest 400mg suppository (3x daily) and Progyluton white tabs (2x daily). Being aware of my previous miscarriage (after IVF #2), my doctor prescribed additional medicines that are believed to have helped other patients with similar case. So in addition to my usual medicines, I have to take Aspimed 75mg (once daily), Prednisolon 5mg (2x daily), and Clexane 20mg injection (once daily).

So, here comes the agonizing two-week wait (waiting till we find out if we are pregnant or not).

Before IVF #4

So after our cancelled cycle (IVF #3), I started spotting 12 days after our last appointment. It lasted for 4 days and didn't get heavy at all. So I don't think it is a proper menstruation period. My spotting was on and off on the next 3 days so I booked an appointment with my doctor. I had a blood test and ultrasound. My blood test resulted to negative pregnancy. (Although it is highly unlikely, they have to rule out that I am pregnant.) My doctor has seen some small dots on my uterus and suggested another scan by a radiologist.

After a second opinion from a radiologist, I was cleared. Though my scan still contained those small dots. My doctor suggested that I undergo hysteroscopy again so she can check my uterus first before starting the next cycle. My husband and I discussed about it first because it means that we need to take an additional expense again, not knowing if this will be beneficial to the success of the next IVF. So after thinking about it, we decided to risk it and proceed with the next IVF cycle without undergoing hysteroscopy.

My doctor prescribed Progyluton tablets so my period will be regularized. She said that as soon as I have my regular period back, we could start the next cycle. We decided to have 2 regular menstruation period first before undergoing IVF #4.

IVF #3

It has been a few months since I last created an entry. It’s actually good that the months flew by so quickly and before I knew it, we are back again in the IVF clinic for our IVF#3. 

When the nurses and assistants saw me, they thought that I have already delivered my baby. I told them about my miscarriage and they all felt sad. My doctor was also shocked when she saw me and she told me that I should have called her before. I actually thought on giving her a call but then after postponing (and hesitating because she seems to be always busy), I totally forgot about it. 

Just like my previous IVF cycles, IVF#3 begins with an ultrasound scan. On the first appointment, I had my trans-V scan and after checking my uterus and ovary, my doctor said that I could start immediately. For 2 days I will be injected with Gonapeptyl and then be back after 4 days for another scan.

After 4 days, I was back in the clinic. I had my blood test and ultrasound and then was prescribed to take Gonal300 for the next 4 days. Since we paid for the full package, we are getting all the medicines from them and my husband administers the shots on my tummy (after 2 IVF cycles, I am still afraid of seeing the needle enter my skin!).

We were back on Day 9 and only one follicle was seen. This is not a good indicator. The goal in IVF is to harvest more than one egg/follicle so that there's a greater chance of success. My doctor is still hopeful that on the next days, more follicles will grow and mature. I was prescribed to continue taking Gonal300 for the next 3 days.

On Day 12, there's still only one dominant follicle. My body did not respond well on the medicine. My doctor suggested to cancel the cycle as there is a lower chance of conception with only one egg. There is also no point of going through the complete cycle (the egg collection, fertilization, and embryo transfer).

Accepting the failed IVF #3 is easier that IVF #1 where we completed the cycle but resulted to negative pregnancy. We were of course sad of the outcome but still determined and looking forward to the next IVF cycle (IVF #4).

Since the cycle is cancelled, my doctor said that I will go through the normal menstruation period. She also said that we can start the next IVF cycle as soon as I get my period. We also asked if there's a way to boost my ovary so I can have healthier eggs. She prescribed supplements called DHEA 50mg (twice daily) and L-arginine 1g (daily) for a month.