Gonal-F

Khamis lepas (26/5/2011) was CD 22, aku baru nak gi dr delaila untuk follow-up, sepatutnya aku pegi CD15, tapi sebab aku dah gi on CD12 and leading follicles was only 13mm, then doc soh dtg balik...(tunggu gaji la gamaknye baru leh dtg balik)

so lepas dah gaji baru leh dtg.

mase scan tu, the leading follicle that was found on CD12, was gone. doc ckp maybe dah shrink balik, OR dia dah pecah. tapi my temp doesnt show any ovulation signs or anything, as well as my cervical mucus. and as well as mu uterus lining. 9.4mm je! so doc ckp, i may not having my period this month, OR this will be a longer cycle.
i started to worry again, but keep positive that bende ni baru lagi kalau nak sedih pon. selagi belum period and belum due period, takyah sedih sgt. SABAR BYK2!

lepastu aku pun google, and aku search BBT charts kat fertilityfriend yang on Letrozole mcm aku. oh rupenye beratus2 org OVULATE lambat on letrozole. ada yg ovulate on CD30! and got pregnant. ada yang period on day 40. so, i have to be a little bit more patience.

sbenanye semua ni utk sejukkan hati sendri sbb Dr Delaila kata haritu, I MAY NOT respond on letrozole this time. and i should not wait longer. dia suruh proceed to injectable meds. it is called GONAL-F.

lastyear dah penah dr sudha suggest, aku penah google and bende ni ialah sebentuk Pen, yg kite kene cocok sendri kat perot. dia ada hormon FSH, the same hormon as Clomid/Letrozole suruh brain kite buat but it work differently. Fertility Pills trick our brain and tells that we are lack of the reproductive hormones, so our brain hantar signal (FSH) byk2 to our ovary utk buat byk2 lagi follicles. kan.





skang ni my brain doesnt care less to send that signal. mgkin dia kata, "WHAT EVA!" so my ovary doesnt receive any signals (FSH) the name is enoughsaid, Follicle Stimulating Hormone. without it, our ovary doesnt know what to do. skang ni Pen yg kena inject ni, teros inject direct and die akan pegi ke ovary teros utk buat benda tu. so kite skip signal2 drp Brain sbb Brain aku malas. kenape tah ? =)) adekah aku mengalami masalah OTAK?

Dr Delaila bagi surat utk aku mintak GL drp HR. Mesti benda tu mmg mahal, sbb tu dia suruh mintak GL...

aku dah call HR smlm, rupenye GL just utk spital gomen jek...so kalau SJMC mmg xdpt.kene byr sendri mcm biasa and claim kemudian. (50%)...

aku try gak google price dia..range dlm 300engget sekotak n aku pon tattau brape kotak aku kena guna nnt. satu kotak tu ada 1 pen je. ade dosage2 tertentu lah.. ade yg aku tgk org gune sampai 3 kotak...so skg tattau bende tu brapa.

i decided to wait for this cycle to end. lepastu baru pikir nak buat apa. sbenanye mmg takmampu kot nak afford pen tu. risk dia pon kene tanggung gak, kalau tak berjaya, ovary plak bengkak sbb takot ter-OVER stimulate..

aku kalau leh nak cube sedaya upaya utk taknak hurt my ovary. dah la tak function normally, nak dera dia plak lagi..adoi..

so kesimpulannya adalah satu, aku kene bersabar dan mmg lambat lagi agaknya utk aku mengandung dan dpt anak sendri. aku redha kerana Allah yg tahu kenapa aku masih takboleh lagi. Dia adalah yg Maha Adil.

Allah telah memenuhi keperluan kite. Dan tak semua keinginan kite itu dipenuhi sebab MUNGKIN kita tidak memerlukannya buat masa skarang. Jadi aku bersyukur kerana keperluan aku buat masa ni sebenarnye telah dipenuhi oleh Allah.

So GONAL-F ni, aku kene fikir panjang dulu..alang2 gonal-f tu baik IUI je terus. tapi, takpe. aku nak bagi masa kat diri aku sendri utk rileks dan fikir.

takyah rush!! hehe..rezeki tu takyah RUSH..usaha je yg penting.

mcm cantek plak Gonal-F tu kan. hehe!

Cycle Day - 2

Hari ni dah Cycle Day 2. So pukul 10am tadi dah start ambik letrozole 2.5mg.

Semalam aku halfday, sebab taklarat n taktahan sakit sgt. dah lame tak kene period pain sbb dah lame tak period. kalau nak diikutkan, last period aku mase sebelom buat hSG tu. awal feb. means dan 3bulan tak period :(

Nasib baik smlm takde benda urgent nak kena buat, so aku takde la rase bersalah tibe2 pegi halfday plak. Bos aku pon kate takpe je kalau xtahan leh la balik.

aku singgah klinik UMRA untuk beli letrozole. haih, payah beno laa nak beli ubat. die mcm nak soh aku jumpe doc gak. tapi lepas aku tunjok note kecik yg dr delaila tulis tu, diorg cam "oh, dr delaila ahmad." diorg soh la aku dok jap.
ade la stengah jam baru aku dpt ubat tu. jakgi nurse tu leh lak tanye aku

"kenape 2.5mg je eh? sebab kite normally bagi 2biji tau..so 5mg, ni mmg doctor u nak bagi sebiji je sehari?"

"ha dah dia prescribe i mcm tu, camtu la"

"oh, takde la sbb normally kite bagi 2biji, takpe lah"

eh dia ni, awak dokter ke?  ade normally normally plak. ikot prescription doctor la. arituh mmg mase kat UMRA dr sudha bagi aku 2bijik. maybe die nak boost stimulation aku untuk produce telor agaknya.

lain doc lain la opinion, bile dr delaila tgk rekod aku yg aku penah ambik 2 bijik letrozole on day 2-day6, die ckp "banyaknya, 1 is enough"

pulak. so maybe lain doc lain cara diorg. maybe dr delaila rase aku ni PCOS so kena start dgn 2.5mg dulu utk tgk response aku mcm mana, takleh teros nak boh 5mg. maybe la.

jadi memandangkan dr delaila ini lebih experience jadi baik aku ikot je advice dia.

letrozole 5biji = RM50. wah sebijik RM10 beb.

----

then aku terbace lak arinih combination of letrozole-metformin, ramai PCOS women yg clomid resistant, percentage nak achieve full-term pregnancy is higher kalau combine letrozole with metformin.

http://www.ijrm.ir/library/upload/article/af_35393486)%2089-43-4-1e.pdf

i'll be keeping my fingers crossed this time! ;D

BBT as of April - Today



Start dari 3 april, aku nye temps tgk la weh mcm tu, turun naik turun naik, sah sah la hormon tak stabil lansong.

BBT temp kite kalau tinggi, means progesterone tgh tinggi, kalau temps low, estrogen tgh tinggi. so kalau normal cycle, BBT kite patut low start drp hari 1st period, then hari ke 14/15 temp akan drop lagi sikit, and kalau esoknya dia melonjak naik, itu tandanya kite dah ovulate n progesterone is in charge! and kalau progesterone tu remain tinggiiii je for more than 20days, insyallah kita dah pregnant. kalau tak, BBT kita akan drop balik sebelom period, so it shows yg kite tak pregnant n akan period dlm beberape hari lagi.

simple je sbenanya, kalau try guna benda ni mmg sng nak agak psl badan kite sendri. so takyah la dok asik beli pregnancy test je (walaupon aku nak gak beli) hahaha...

ini yg mcm textbook lah tulis, sebab aku penah je google yg ade org pregnant tapi BBT die low. itu maksodnya dia low progesterone n perlukan injection untuk tambah progesterone so leh protect kandungan dia dari gugor.

mcm chart aku atas ni, yg ada tulis P tu start aku ambik Norethisterone (NE) tu. dia progesterone pills. tgk, lepas aku ambik for 5days, temp aku teros naik. then bile stop, temp aku jatoh n period. FE tu indicate Femara (letrozole).

akan update lagi sampai aku scan eggs hari ke 12 nnt. :D

Make an ovulation ticker

Metformin, a must must must

Semalam aku download a full detailed info about penyaket aku Polycystic Ovarian Syndrome ni kat sini www.jarrettfertility.com/PCOS%20patient%20handout.pdf

and baru la aku betol2 paham condition diri aku nih. yg penting METFORMIN (GLUCOPHAGE) tu sbenanye mmg ubat yg tepat utk PCOS. huwaaaa so kene makan jugak jugak jugakkk. ini petikan drp article tu:

Glucophage has several mechanisms of action. It does
increase peripheral insulin sensitivity. In other words, it
decreases the lack of responsivity of the tissues to insulin.
More importantly, it dramatically reduces the production of
sugar by the liver. If sugar levels are decreased, insulin levels
will decrease. With decreased insulin, the production of male
hormone from the ovaries decreases and the PCOS improves.
Glucophage also works very well in thin women without
significant insulin resistance. Almost as a side effect, it
increases the activity of an enzyme call aromatase.
Aromatase increases the conversion of male hormones to
female hormones – less androgens and more estrogens result.

and about the side effect, mmg betul kene ciritbirit tu part of side effect dia tapi ada cara utk elakkan! nape doc tak ckp ponnnnnn...haih! ye la kdg2 kite mmg kene wat research sendri doh kalau nak mintak dr delaila terangkan semua aku rase lg mahal la charges nye nnt :P aku prasan yg charges dia naik ikot brape lame kite consult dgn die. die takde standard rate. kalau ckp biase2, RM60. kalau lameeee je sket RM75..lagi lama..leh sampai RM150 (especially kalau baru 1st time jumpa, sbb die nak collect history kite semue kan. so kite jgn nak dok harap doctor bagi 100% info kat kite, kite kene ade usaha cari sendri gak..

The major side effects of glucophage are diarrhea and abdominal cramping- these can be avoided if one eliminates carbohydrates from the diet. Thin women can slowly add carbohydrates back into their diet as tolerated. Heavier women should not – our goal with them is to lower insulin levels andit doesn’t do much good to decrease the production of glucose by the liver if one keeps eating carbohydrates which are converted to glucose. It takes about three months for glucophage to have maximal effect on the ovaries. Many women conceive with no other intervention than glucophage,and couples should go ahead and try to conceive during those three months.

so, aku takleh makan CARBS. mungkin kene kurangkan la. wah so NASIK camne? waaaaa...xpe2 ini utk kesihatan diri. byk je benda lain leh makan. ape yg aku paham drp artikel tu ialah, org PCOS ni release satu benda ni name dia MIS (Mullerian Inhibiting Substance) drp ovary kite yg buat androgrens ni lebeh drp estrogens..so sbb tu follicles ni semua tak elok.

MIS decreases aromatase activity, which results in an
increase of androgens and a decrease in estrogens. This
perpetuates the PCOS changes.
While glucophage treatment will lower androgens rather quickly (androstenedione in this slide),
MIS really does notdecrease significantly for almost three to four months.

so kene laaa makan ubat nih jugak...then dlm artikel ni ade psl LETROZOLE, yg works utk aku last september. yg resulted in 2 mature good eggs. mmg PCOS dgn CLOMID susah nak work together. even with metformin, kdg2 still gak ade org xberjaya. but with Letrozole, the chances increases.

please note that: It is pretty clear that if pregnancy does not result within the first four cycles of clomiphene use, it
probably is not going to – something else has to be tried. 

I've tried clomid ONCE, last year somewhere in May. 100mg. after 12days period, when we scanned, takde mature eggs lansong. semue polycystic. so it shows that it doesnt work. glad i met dr sudha of klinik umra (the only doc yg best katsitu) yg suggest Letrozole (brand name: Femara). dia mahal sket drp clomid but no side effect n no long term side effect. 3 cycles of CLOMID akan buat kite under the risk of ovarian cyst, which is , kalau kena terok, ovary kena buang teros so selamat tinggal the journey of trying to conceive, it ended with you not able to conceive forever! dr sudha prescribe me with Letrozole 5mg perday. for 5days. mcm clomid gak cara nak makan dia. on 2nd day of period. for 5 days.

on day 12, we found 18.3mm mature follies and 21mm mature follies. mmg perfect utk ovulate. dr sudha inject aku dgn HCG, utk trigger ovulation for the next 36hours. thats what we call 'timed intercourse'.

but, takde rezeki aku mase tuh. aku period heavily the next 2weeks walaupon mase dah nak due period tu, aku dpt positive pregnancy test. it was all chemical pregnancy je sbenanyer. but aku bersyukor sbb aku period, drp aku tak period lansong n tak pregnant.depress gile kot gitu.

So after bertukar doctor, Dr Delaila is aware of me not responding to clomid so die tanye aku nak letrozole tak? aku mmg nak la sbb dulu penah ambik n body aku respon well kat ubat tu. Aku takot kerane aku ni PCOS, walaupon aku dpt telor yg mature pon nnt nextmonth, kalau lekat pon, aku ended up miscarriage lagi sbb PCOS women mmg risiko tinggi utk keguguran. kebanyakan org PCOS akan miscarriage a few times before mengandung betol2...

artikel yg aku paste link atas ni mmg bagos..skang aku dah faham aku mmg kena makan metformin gak. teringat polycystic follicles aku aritu, sgt ngeri. byk drp dulu..kene gak makan ubat. aku nak try to avoid carbs tgk ciritbirit lagi tak. kalau tak, so aku leh continue metformin ni. its good for me. i have have have to!

Metformin

Metformin seems to be not so friendly with me.

hurmm..

astu dah missed period lagi.

hpt negative.

hate this feeling.not bcoz of the negative hpt, but the feeling why is ms.period late for nothing!

Proluton & Duphaston

ini definition injection & ubat yg doc bagi arituh:

Proluton

proluton is a hydroxy progesterone hormone which is usually secreted by placenta continuously throughout the duration of pregnancy and needs for maintainance of pregnancy for the following reasons:

• Makes the endometrium develop and secrete fluids after being primed by estrogen


• Maintains the functions of the placenta and fights off unwanted cells near the womb that could cause damage to the placenta or foetus.


• Keeps the endometrium in a thickened condition


• Stops the uterus making spontaneous movements


• Stimulates the growth of breast tissue


• Prevents lactation until after the birth (with estrogen)


• Strengthens the mucus plug covering the cervix to prevent infection.


• Strengthens the pelvic walls in preparation for labour.


• Stops the uterus from contracting (thus keeping the baby where it is)

Duphaston

How does it work?
Dydrogesterone is a synthetic hormone similar to the naturallyoccurring sex hormone, progesterone. It is used in a wide range ofmenstrual disorders that are thought to result from a lack ofprogesterone in the body.
In women, progesterone is responsible for the development of ahealthy womb lining (endometrium) that is necessary for pregnancy.The body produces progesterone at certain times of the menstrualcycle, causing the womb lining to flourish. If a fertilized egg doesnot attach to the womb lining by the end of the monthly menstrualcycle, the levels of progesterone in the body decrease. This causesthe body to shed the womb lining (a menstrual `period'). If afertilized egg successfully attaches to the womb lining by the endof the monthly cycle, progesterone levels in the body remain high.This helps maintain a healthy womb lining for the ongoing pregnancy.
As dydrogesterone helps regulate the healthy growth and normalshedding of the womb lining, it may be used in the treatment ofmenstrual disorders such as absent, irregular or painful menstrualperiods, infertility, premenstrual syndrome and endometriosis. Itmay also be used to minimise the overgrowth of the womb lining dueto oestrogen (the main female sex hormone) in hormone replacementtherapy (HRT) following menopause. By maintaining the womb lining,dydrogesterone is also useful in helping prevent miscarriage(spontaneous abortion) in women who have suffered repeatedmiscarriages or who may miscarry.
Dydrogesterone is usually taken on selected days during themenstrual cycle, depending upon the disorder that is being treated.

What is it used for?

• Abdominal pain and bleeding during preganancy (threatenedmiscarriage) or history of miscarriages (habitual abortion)


• Abdominal pain associated with menstrual periods (dysmenorrhoea)


• Absence of menstrual periods when taking oestrogens


• Endometriosis


• Female infertility


• Irregular menstrual bleeding when taking oestrogens


• Irregular menstrual cycles


• Premenstrual syndrome


• Preventing overgrowth of the womb lining due to oestrogen in hormonereplacement therapy (HRT)