Poor egg quality - what does it mean?

I read an analogy somewhere - that our pool of eggs is like an apple.  When we are young, the egg pool is like a fresh apple - white and juicy.  As the apple is being exposed to air over a period of time,  it would start to brown and we have less edible white areas.  Similar, as we age, the number of good quality eggs would decrease in the pool.  In my case, I may be 33 years old but my body is growing rusty and aging faster than my real age.

From my research, there seems to be 2 things that we need to know about egg quality when it comes to IVF: mitochondria and chromosomes.

Mitochondria - the battery pack for the embryo
Good eggs supposedly have high levels of mitochondria.  Upon fertilisation, the cells in the embryo needs to divide and multiply and that needs energy.  Mitochondria provides the embryo with the energy to grow, especially in the first week from fertilization to successful implantation.

Poor quality eggs basically have battery packs that are flat or half-full.  I had 9 eggs that were fertilised through ICSI but 5 did not develop further.  Their battery packs were possibly empty. 

Chromosomes - the soul of the embryo
If there are abnormalities in the chromosomes, the egg would not be able to develop properly. Out of the remaining 4 eggs that grew, 2 had abnormalities in the chromosomes.

That only leaves me with 2 eggs - 1 of which was growing well while the other had a half-pack battery pack. 

So, back to the analogy of the apple, there is no way to reverse and make the apple all white and fresh again.  Similarly, there are currently no proven ways to improve egg quality.  But this doesn't mean that all hope is lost.  There are still edible white areas, just much lesser.  We could try to slow down the 'browning of the apple' by taking better care of our health.  Will share in later posts on my findings.

Review with TCM Doc

I am very thankful to my TCM doc throughout the 1st IVF journey because she was really there for me.  I could check with her whenever there was pain or worrying symptom e.g. gastric attacks, spotting etc.  She was just a phone call away.  Even if it was her day-off, I could email her and she would reply me.

When I shared the diagnosis that poor egg quality was a possible cause for the failed IVF, her immediate reaction was a frown.  Yes, it was indeed true that there are no western medication that can help egg quality.  Were there any chinese remedies then?  I didn't ask this most important question.  But I am guessing, yes there are things we could try since there is no harm trying.  I spent an hour with her and these are some of the things we discussed:

• Would growth hormones work? - Medically it is not proven.  Growth hormones are largely predominant in young children during their formative years, which is the time when our eggs are being formed and nourished.  With the growth hormone injections, it is trying to bring our body back to our formative years and hopefully help produce better eggs. 
• Would royal jelly work? - Not in the TCM point of view.  It is more for beauty purposes rather than something that supports fertility.  Instead, my TCM doc prescribed me with 3 months' supply of organic soy isoflavones.  She says this may be more helpful.
• What are soy isoflavones? - They are compounds in soybean and soyfoods with a chemical structure that is very similar to estrogen.  However, according to some internet research, these isoflavones choose the tissues it binds to.  This means that  isoflavones may mimic the effects of estrogen in some tissues and yet blocks the effects of estrogen in other tissues.
• What about CoQ10 and DHEA? - These are short-form of some western medicine, so my TCM doc wasn't too sure.  I would need to check what they are in chinese before she could give me more advice.  But my IVF doc did say that I should avoid DHEA as it may also increase egg quantity.  In my case, this would mean higher risk for OHSS which is undesirable.
• I had a failed pregnancy and went back to work the next day, is that ok? - The IVF doc confirmed that in the technical term, I did not suffer a miscarriage, as it was in the early stages where there was no sac or foetus.  But in TCM perspective, I did miscarriage and should have a mini confinement.
• What is a mini confinement? - Take red date + longan + ginger drink in place of water.  Stay covered up with long-sleeve tops and pants.  Avoid walking too much.  Continue my daily/alternate day dose of black chicken soup with generous amounts of eucommia bark.
• Can I start exercising?  Yes, but stay covered up and cool down in natural settings (without aircon/fan).  Bath after the perspiration has stopped and evaporated.
• So what are the plans ahead? - Let the body recover.  Baby dance with a rubber mask for the next 2-3 months, as the body would not be able to handle another pregnancy in the short term.
• Should I quit my job when doing the next IVF? - My TCM doc usually will not advise patients to resign.  Instead, she advised me to get to the root of the problem.  It is about priorities.  If having a baby is your priority, you have to be prepared to reduce your work commitments.  You have to be prepared to say no to tasks and assignments if it compromises the interest of your family plans.  It is not about changing jobs.

Coincidentally I saw a quote from my friends' facebook -
If everyone is happy with you, then surely you have made many compromises in my life.

Perhaps, as I consider my work arrangements, it is also time to re-examine my priorities and pray for courage to stay true to those priorities.

IVF review with Doc - Poor egg quality

I had expected a quick 5-minute session with my IVF doctor, which was the usual length of our visits with him.  It isn't that he doesn't care, it is just that time is a very rare gem that he can only sparingly provide to his patients.  As it was a Saturday and his appointments for the morning had overrun past the usual working hours, I was already prepared that it was going to be a 2-minute session.

But we had a surprisingly long session.  Humans are, by nature, a very instinctive breed of creatures - we can never guess when happiness will fall upon us, but we can always sense when sadness is round the corner.

And when your doctor speaks in a nice and cautious tone, it usually bodes bad news.  So here it goes: I had just experienced a biochemical pregnancy during my 1st IVF where the embryo had implanted but did not grow or implant further.  This is usually a result of poor egg quality. And so my questions starts:

• Can we improve egg quality? - Medically, no.  Poor egg quality is a common medical condition in patients with PCOS and there is nothing scientifically proven to help egg quality.  Doc suggested including growth hormones in the next IVF cycle, but the results vary according to individuals.  At best, growth hormones would offer us a ray of hope; something we could try but with no guarantees. 
• Can royal jelly and coq10 help? - Medically, no. There is no evidence to support claims that these health supplements improve egg quality.  It is the same case as having brazil nuts to aid implantation.  But people do try them because there is no harm in trying.
• I had early bleeding (from day 9).  Can this be prevented? - No.  The progesterone support provided is usually sufficient.  Any additional support will not help the embryo to grow better or faster.  If bleeding occurs, the body is showing signs that the embryo is not of good quality and is trying to expel it from the body.
• Can I prevent OHSS? - No.  If I had OHSS in my first cycle, it is very likely that I will have OHSS during the next cycle.  If I really want to avoid OHSS, I could consider reducing my dosage (which is already quite low), but it results in less eggs.  With lesser eggs and my poor egg quality, I may end up with no good embryos.
• Would having isotonic drinks and eating egg whites reduce the OHSS symptoms? - No.  OHSS cannot be treated, neither can the symptoms be reduced.  The only treatment is time - the body will eventually flush the fluids out of the body.  Drinking isotonic drinks or increasing protein level are not meant to help the symptoms, rather they are needed to replace the electrolytes and protein lost because of the OHSS.   
• So there is nothing I can do about OHSS? - Itsy bitsy yes (FINALLY!).  With the experience from the first IVF that I had gastric attacks, gastric medicine or panadol could be provided to relieve the pain.  But nothing can be done about feeling bloated, pukey, giddy etc.  

So what is next?  Well, don't be stressed and rest more, relax and have an open mind.  The body needs to recuperate, so there is no need to rush into the next cycle.  Doc says he has seen enough cases where couples do conceive naturally.  He has prescribed me with 3 months of clomid at maximum dose of 3 tablets/day with the next appointment in 3 months' time.  In the meantime, I am going to research on egg quality so keep a look out for more posts on it.

Work and IVF - Can they co-exist?

It is a question that has been in my mind. Why this question?  Because I am wondering if I should go for another round of IVF.  My buddy asked me what was holding me back?

• Was it money? - It wasn't the biggest stumbling block.  With the government subsidies, we practically don't have to fork out any cash if we were to have the IVF done in public hospitals.  We might have to tighten our belts more with only 1 source of income, but it should be something manageable for a short period of time.
• Was it the fear of the whole procedures? - An itsy bitsy yes, but not the main factor.  As many of us can attest, we are more than willing to go through the pain and emotional roller-coaster again.
• Was it the fear of another failed IVF? - No, at this moment, this is not even on my mind.  To me, each try is a hope and a chance. 
• So what was it? - It was work commitments.  How to achieve fairness to the organisation and the teammates, how to arrange for leave again and make time for it without majorly affecting work projects, how to broach the topic to the office again and seek some form of understanding/arrangement etc.

My deepest dilemma - Can women really be able to continue working while going through rounds of IVF.  Honestly, I was really complacent during my 1st round of IVF.  I really thought we would be successful at 1st try.  After all, the doctor said IVF is a very suitable approach for people with PCOS.  My husband's health is good and I am below 35 years old.  Never crossed my mind that I would have to do another round.

So now, I am seriously thinking, with a little longer term perspective.  What if I would need more rounds?  Should I continue to pace it amidst work commitments, and be stretched emotionally and physically on both ends?  Would this kind of stress affect the chance of the IVF?  Should I take the bold step of resigning and focusing on IVF plans?  If IVF plans really succeed, then the bigger question is who would hire a preggie person?

What are your thoughts on this?  The good thing is it is not something that I have to decide today or tomorrow or next month.  Hopefully, the path would become clearer soon.

When I hear baby bump news...

I used to be more affected when I hear news of friends' pregnancy.  Being human, it does take a bit more effort to smile and congratulate them.  It is not that I am not happy for them, just that the news tend to make me question once again why my baby journey is harder than most people.

After much effort, I managed to truly congratulate my friends.  I psyched myself to prepare for life without kids; to focus on the benefits of not having kids.  I could sleep late.  I could party the night away.  I could go on holidays whenever I wish.  I could eat sashimi and get drunk on ice cold coke.  I could play mahjong all night.  If a kid comes by, then it is a bonus.  If not, I will just enjoy this freedom while it last. 

But after this IVF journey, the pain of hearing pregnancy news seemed to have come back.  I guess this is an inevitable dilemma.  From psyching myself to focus on the freedom of having no kids to wishing with all my might that we are going to have a family, I now need to re-find my footing again.

This time, I guess it could be easier.  It is not about changing perspectives, not about seeing the cup as half empty or have full.  It is about putting faith and trust in God and his plans, whatever it may be.  It is about accepting whatever plans he has for me.

Sounds easy?  Well, yes and no.  You will always envy the pastures on the other side.  But there is always the power of prayers.  And as long as my loved ones remain happy and healthy, nothing else matters.

The Aftermath Feelings

It has been 24hours since I heard the news of failed pregnancy from the doctor.  Even my closest buddy was concerned and called me just to make sure I wasn't putting up a front so that everyone around me feels better.  But this time, I am really ok and I am thankful for that.

I think the plus point of going through this experience is that I have allowed God to come in a little more to help me heal my heart.  So this time, I am not acting fine.  I think I really am fine.  And honestly, I had given this IVF my best effort and because of that, I am able to move on quicker than expected.

I think it also helped that I have stopped asking why for a long time.  I had experienced some difficult times when growing up.  Through repeated incidents, I had learnt that asking why doesn't give me answers.  I am not sure if I am ready to re-open my heart to those who have hurt me, unless I am sure they won't trample on it.  But at least this is a start.

If you ask me now, I am possibly more bothered by the fact that my hubby was out partying 2 days in a row.  Hahaha!  But it was his birthday and he had been 'barred' from partying for 3 weeks.  But what can I say - I have no control over that boy and he has been such a sweet soul.

Adieu for now, at least about IVF.  I will update on other stuff again, and of course the results of the post review with my IVF doc on 20 Jul!

17dp3dt: The results - BFN or BFP?

Yesterday we went to see the doc and he confirmed that with no increase in the HCG level, the baby has stopped growing.  So the result is considered as a BFP but it is also a failed pregnancy. In my case, the quality of embryo is likely to be not good, resulting in the lack of growth.

Unconvinced as there is still HCG level in my blood, I asked if the baby would rest today and continue to grow tomorrow.  Doc said it was impossible.  Baby cells have to grow and multiply every minute, every hour and every day.  He advised to stop the progesterone support and allow the strawberry monster to come.

So that is really the end of this IVF journey.  On hindsight, God had given me a long runway to prepare myself mentally for the outcome.  In fact, the constant cycle of seeing new strawberry surprises, the effort to calm my emotions and regain my foothold had taken a toil on me.  Yes, I remained hopeful til the very last minute.  But in some ways, I am glad to have closure on this.  It is not an outcome that I would prefer, but I am also partially relieved to be able to make my own plans.

Honestly, I was very concerned about my work in the event if I needed prolonged bed rest to arrest the constant bleeding.  With a weak embryo, there was possibility of bed rest for the whole 1st trimester and at the back of my head, this would be a huge problem.  I was also worried if the baby may also develop health problems.  So having that burden off my shoulders really did add a spring to my walk.  Possibly too much walking and shopping that afternoon resulted in an avalanche of strawberry jam.  It totally overflowed a brand new sanitary napkin.  The strawberry monster gave its finale burst of power.  I was more embarrassed by the outflow and didn't have time to grieve or think too much into this.

16dp3dt: Feeling a bit of everything

We are all humans, not superheroes.  We just try our best that's all, but we are also not perfect.  It is not like I am always positive and hopeful.  I will also face a myriad of feelings, and that was especially poignant today.

This morning I went for my blood test and the results of my superman baby versus the strawberry monster (aka bleeding) is that it is a STALEMATE.  The HCG levels have dropped slightly but my baby is still in the game.  It is not the end yet!  He is still fighting and holding on.

In the late afternoon, I started to feel the sudden release of clots of strawberry jam.  Previously I just see it in the liner or when I wipe.  Now I can feel it.  This means the clot of jam is getting big - at least 1inch in diameter each time.  In about 6 hours, I have felt at least 7 clots.

What are the kind of feelings that surrounded me today?  I would say, it is really a bit of everything.

THANKFUL - I was very thankful to hear that my baby is really a fighter.  He is still hanging on to me.  He must really like us and would really wants to come to this world.  His tenacity is truly admirable.  I also feel that he will make it.   Because God was the one who gave him life and he will not take it away from him so quickly.

ANGRY - The clots of strawberry jam really hit me hard.  I felt angry why God would give life to my embryo and yet take him away from me.  I even had thoughts that God was punishing me - giving me miracles twice in a week and taking it away from me now.  But I also came to realise - no one told me my baby is gone.  I just assumed.  Why did I release my anger on God?

CHEATED - I had very clear plans.  If IVF is positive, we would do this.  If IVF was negative, we would do that.  And I thought the answer will be clearly revealed before 11 July.  But why am I in a grey area?  Why didn't God give me a definite answer?  End of the day, I also realised that those were my plans.  Those were not God's plan for me.  As much as I don't like it, it is his plan for me.

GUILT-RIDDEN - I felt bad that my IVF plans had affected many people - my hopeful parents, my patient hubby, my understanding colleagues (who now have to cover my duties for me until further notice).  All of them have to deal with the uncertainty.  And especially for my loved ones, they may to deal with the fragility of these miracles.  That it is a bubble which may burst anytime.

This journey is longer than I had expected and it is taking a toil on me, the baby and everyone as well.  But I will continue to pray for faith, for strength, for miracles and for hope.  Because everything is really in God's hand, whatever his plans for me.

15dp3dt: The Waiting Game and the Superheroes in my life

Last night, the cramping got worse and I was bleeding more.  I actually stained my liner and my shorts in less than 3 hours.  We decided to go the A&E for additional support.

We were told that at this point, there was nothing we could do.  No additional support will help.  Low HCG levels usually indicate that the embryo is not growing well.  The body automatically would remove the weaker link, similar to the theory of the survival of the fittest.  If so, the embryo will just flow out of the body, without any pain to me.  This is a very strong possibility.

There is a small glimmer of hope that my embryo will continue to grow, survive through the clots of strawberry jam that is so common now.  All I can do is pray and God has given me a peace of mind.  I didn't cry, perhaps not yet.  Sometimes, I am worried that I am too calm.  But I am a fighter and I hope my baby is also a fighter.  In fact, I hope he is a better and stronger fighter than me.  My baby is a superman egg.  He will be able to overcome the odds and cling tightly on to me. 

Throughout this difficult 2 weeks, there are a lot of superheroes who have helped me and I would like to convey my deepest appreciation:

• My daddy - who will spend time every day to read relevant verses in the bible and conduct family prayer sessions.  He also lends me his car to facilitate my doctor's appointments and in turn, he sacrifices his comfortable ride and takes the public transport.

• My mommy - who wakes up at 5am to prepare my daily tonics of black chicken soup and my meals.  I was treated like a queen.  She took time away from work (which meant a drop in her daily income), accompanied to almost all of my doctor's visits and refuses to let me do any housework.  I wasn't allowed to wash the dishes or pack my bed.  All I did was to rest in bed

• My hubby - who never once made me feel inadequate.  I never sense the stress from him.  He was just quietly and patiently by my side.  He is one who never spends foolishly but he sent me straight to the most expensive A&E last night and had no qualms about the possibility of spending close to $1,000 just to hear a IVF specialist advice on how to stop the incessant bleeding.

• My colleagues and boss - who have given me their best empathy for my situation and allowed me to rest with a complete peace of mind.  They have held the fort on my behalf and I can't wait to go back to the team.

• My brother - who tries to comfort me in his own odd ways.  He definitely tries to make me laugh and always wants to be updated on my latest development.

• My best buddies - who would always be available on whatapps and to comfort me and be with me every step of this journey.  If not for the constant messages and yakking, my days would have gotten a lot harder. 

• My TCM doctor - who has entertained my incessant calls and emails and provided whatever help and advice.  She doesn't sugar coat the reality, yet has a way of making you feel assured.

• My friends -  those who keep me in their thoughts, prayed for me, comforted me, asked about my progress. Friends on the forum who were matching side by side with me, always ready to help one another to make this road so much easier for me.

• And the last and most important person, God - Many will know that you experience a lot of intense emotions and feelings during this period.  It can be difficult to share your inner thoughts and fears with your loved ones.  Because you really want to be strong in front of them, so that it is easier for them too.  I really knocked on his doors countless times each day.  And he has been there for me, giving me peace, giving me renewed faith, giving me strength, giving me a miracle yesterday.  And I await another miracle from him again tomorrow.

 No matter what is the outcome, all of us have done our best. 

14dp3dt: Giving thanks with a grateful heart - Seeing red but it is not the end!

Every visit to the toilet frightens me.  First, it was the chocolate fudge, then the strawberry juice and even clots of strawberry jam.  Every visit I will see red and it shakes my faith.  But I will try my best to pick myself up - pray a little more, pray a little harder.  Finally, I started to give thanks to see spotting and light bleeding. Because this means that my period is not here.  This means there is hope.

I experienced more cramping this morning so decided to call the hospital to update that I still see red even after 4 days of additional duphaston support.  They asked me to come in for a blood test (2 days before my scheduled date).

As I drove to the hospital and back home, I prayed and sang non-stop. There was nothing I could do, except to pray.  I prayed that he will give me positive news.  I prayed that he will answer my prayers.  I prayed that he would give me children that I will bring up in accordance to his words.  I don't know how many times I prayed and how many times I sang.  It was the only way to keep me sane.

Back home, I was having lunch with my brother and we were both preparing ourselves for the worst case scenario.  I was going to ask my hubby to take urgent leave tomorrow and mourn together before I head back to work.  We will implement our 'two-of-us' plan of eating sashimi, drinking cold coke and booking our air tickets to shanghai for a getaway.  As such thoughts fill my mind, my cramps became worse as well.  It made me feel really guilty.  What if our baby hears that I have already given up hope?  It is a thin line whether I should accept reality or ignore the signs and be obsessed with the small hope that there is really a baby in me.  Honestly, it feels like I am schizophrenic.

My handphone finally rang and I was surprisingly calm when I answered the call, bracing myself for the worst.  The nurse said, 'There are small traces of hcg in your blood but it is very very low.  Come back on Wed for another blood test and continue with your inserts.'.  I couldn't believe it.  Almost cried, or maybe I really did cry.  I am still in the fight.  All is not lost.

Love this song that I heard on Sunday, the song I kept singing while I was driving:

For every time I pray

I move the hand of God

My prayer can do things

My hand cannot do

For every time I pray

The mountains are removed

The paths are made straight

And nations turn to you

Honestly, this is a miracle, made possible by prayers and faith. I hope that my story can inspire more sisters to stay strong in this journey.  To keep our chins up and not lose hope.  And for those who believe, to continue praying and believing amidst the darkness.  As we slug in bed, hold tight to the hope that we will become butterflies, glowing with a baby bump.

11dp3dt: Spotting strawberry juice, praying for faith

Most people would agree that the 2ww period is a roller-coaster ride.  To me, I think it is a roller-coaster in pitch darkness.  Because you really don't know what is at the next turn. Is it a sharp corner, a sudden downward drop, an accelerated surge or light at the end of the tunnel?

I was groping in the dark initially because of the OHSS syndrome - not knowing when it will end.  I sought solace in God (after a lapse of many years) and he gave me peace.  My faith was shaken shortly at 4dp3dt when my TCM doc told me that my pulse was not giving good vibes.  I prayed harder and restored my faith in him.  My faith did not dent even when my TCM doc said my condition has worsened on 8dp3dt.

But I took a plunge again on 9dp3dt when I saw strands of chocolate fudge after a visit to the toilet.  I prayed again and felt strong once more.  I read that brown discharge and spotting was quite common during 2ww.  It doesn't mean anything.  Even when chocolate fudge became strawberry juice the next day, I was calm; proud of my belief in God.  As it was too early for a blood test, the hospital gave me duphaston for additional progesterone support.  It is not the end yet.

This morning, I saw my first blood clot.  Just when I thought it couldn't get worse, I fell even deeper.  The first thought was that it was my embryo and I couldn't get those thoughts out of my head.  I kept praying for faith, for miracle, for peace, for hope.  While I am feeling better now, slowly regaining my faith again, there is still that little voice that tells me to prepare for the worst.

Am I afraid of a BPN?  Not really, but my tears flow every time I imagine the disappointment on the faces of my loved ones.  But I will hold strong, together with the hopes of my parents and my hubby, that there is still hope.  And I will do my best for my embryos.  I still have time, before my blood test in 5 days' time. Also, it is July now, the month we celebrate my birthday, my hubby's birthday and my daddy's birthday.  I am sure God will answer our prayers and is preparing our birthday surprises.  Let's hold on to hope together and be stronger together.  I must not let that little voice get into my head.

9dp3dt: I am a slug with a vengence against the black chickens

I am officially a slug now. My TCM appointment was on 12dp3dt, but I wanted to know my progress.  Did my body react well to her medicine?  Was my plan of going out to distract myself better than staying cooped up in bed? 

So off I went to my TCM doctor yesterday.  She frowned more this time, explaining that my pulse was worse now, compared to the last visit on 4dp3dt.  She suggested a daily dose of black chicken soup with eucommia bark.

This time, the words didn't hit me as hard.  Maybe I am really stronger now.  After all, it is all in God's hand and all of this is part of his plan.  I no longer ask why or how?  I just want to do what I can and leave the rest to him.  Honestly, quite proud of myself for being so composed.  I went to the DVD shop on the way home and bought myself a couple of korean drama serials.  I am going to be a good girl now - slugging in bed and overdosing on black chicken soup.

Well, honestly I can't stay in bed too long.  I realise that every 30 mins, I would be out of bed e.g. getting a drink, going to the toilet, getting some fruits or just tossing and turning.  I am really not born to be a slug.  But all I can do is to be a slug, the best that I could offer to my babies.

Summary of symptoms: 0dp3dt to 7dp3dt

It has been quite an eye-opening experience for me since Egg Transfer.  I suffered quite majorly because of the OHSS symptoms.  At that point, I could only think of trying to get myself better.  I didn't even dare to think of BFP as it would worsen my symptoms.

Luckily, the OHSS subsided with the help of my chinese medicine, immunocal and lots of prayers.  Then the guilt started to kick in.  I felt like a very selfish person who could only think about myself.  I even thought that as long as I felt better, that was all that matters.  I told everyone that this was my first and last IVF, no matter what the outcome was.

As I got better, paranoia visited me.  Like many of the sisters doing IVF, I started to read into the symptoms.  But I realise it just doesn't mean anything.  I am a natural pessimist.  If there are no signs, I would be thinking that implantation failed.  If I have cramps, I would be thinking that my period is coming.  Honestly, there is no basis for such thoughts.  Refusing to let these thoughts rule my life, I started to go out to distract myself.  These thoughts will still creep up on me, especially when I am alone or in the night.  I will try my best to shake them off - sing a song or say a prayer - whatever that works.

I will remain hopeful and I know I will have the strength to handle the outcome.  Because I am not alone.

In any case, part of me still wants to document down my journey and the symptoms.  Here's a table summarising the symptoms in the last 7 days.