My IVF Journey Part 2: My Public Cycle Experience and Failure

• You can keep track of only IVF related posts using the IVF tag. 
• Timelines are rough estimate based on my memory. They differ from person to person due to peak/low periods, longer queues during holiday season or lab closure for cleaning, etc. Note that this was also in 2021, and sequence of procedures may have changed. 

Part 2 Takeaway: Advocate for yourself and ask lots of questions. Do not shortchange yourself and your experience by keeping quiet. You deserve to know what the doctors are putting you through. I wish I had asked more questions, but I kept telling myself that I was going through the subsidised route and I should just follow the protocol. I finished the cycle (spoiler alert: no baby)  understanding things only on hindsight, and I ended the cycle feeling all the What Ifs, like I did not do everything I could. 

~~~~~This is a very lengthy post!~~~~~

First Appointment & Routine Tests (including HYFOSY)

After getting a polyclinic referral, I waited about 2-3 months for my first appointment at KKH, which I chose mainly for its proximity to home. I went for my first appointment sometime in end-August 2021 where I met the Senior Consultant handling my case. 

TIP: If you have past medical records, already did recent blood tests, etc., bring them all along!

The first appointment was a pretty fast and seamless one because my partner and I already had several tests done at the private clinic which made it clear we were not suitable for IUI (which is sometimes recommended first as it is much less invasive), and should proceed directly to IVF. I only needed to proceed with a HYFOSY (~September) to check if my tubes are blocked, and some routine blood tests, including one to check my AMH levels. I could book my follow up checkup concurrently. I wrote about my HYFOSY experience on Instagram if you want to read about that. It was not a pleasant experience for me but if you have to do it, please have some food before you do since it's a non-fasting procedure, or you might almost want to peng san like me!

Second Consultation and Booking My Slot

Thankfully, we found out at our second appointment that results for both were good. AMH levels were healthy, and my tubes were clear. 

After the second consultation, I was handed a paper listing all the next steps, and was told to wait for the KKH IVF clinic nurses to call me to book an appointment for the briefing session. The paper stated that this would be in 2 weeks. I was also told in the same breath to call the clinic myself if I do not hear back. 

I waited, and on the last day of Week 2, I called the clinic to ask about it, only to be told that they were busy and I might have to wait a week more. So I waited. If this was an indication that I should be more proactive in my journey, I clearly missed the memo and continued to remain passive throughout the rest of the cycle. 

TIP: Though you've not started your IVF procedures at this point, I know the wait itself is already quite draining since you have no idea how things are progressing. Providing ample information isn't always public healthcare's strongest suit. Try to channel your focus and energy into prepping your body for the upcoming cycle through eating the right foods, reading up lots on what to expect, and joining a support group.

When I finally got the call from the IVF clinic, they asked me when my next cycle was expected. This is to help them see where they can fit me in the queue. It was not possible for me to start the next month, so they scheduled me for December. This meant that my briefing session appointment was scheduled for November, approximately one month to my estimated cycle date. 

Briefing, Counselling, Consent Taking and Consult Session

This was a group session with several other couples conducted via Zoom (due to Covid). Both husband and wife need to attend. There is a non-subsidised fee that needs to be paid, and the validity is for a limited time (I can't remember how long though). After taking us through some aspects of the process, including cost and subsidies, we were split into breakout to go though some details and documents. 

After this session, you'll be all set to start your cycle. It was quite scary not knowing the details of my cycle, what medications I was going to take, etc. All I was given was a flow chart stating to call IVF Clinic on Day 1 of my cycle. 

If I knew then what I know now, I would have asked the nurse briefing me for a sense of what to expect instead of just going in cold. 

Stimulation Phase

TIP: If you are able to, always try to get the early morning appointments. The waiting times always seem to lengthen exponentially at the later appointments. I brought my work laptop to every appointment and could get work done because the wait times go for at least 45 minutes unless you're the first few in line.  

As briefed, I excitedly called the IVF Clinic n the day I started spotting. The nurse told me to call back again only when my full flow arrived. I did, and was asked to come down at 7.45am the following day. I'm not sure if this still applies, but partners were not allowed to go in with you to your appointment then. They had to wait outside.

Scan 1: At the first scan, they will do transvaginal scan (yes, in all your full flow period bloody glory) to check on your follicle growth. I comforted myself by thinking well, they must have seen this a million times... I made a mental note not to wear a tampon next time, and to wash up before I go in for my scan.   

I was told that I had 4 follicles on each side, and that my lining was at the correct measurement. These were supposedly the correct conditions for me to proceed with my cycle. 

After that, I was sent to another room to be given my protocol (Puregon, Orgalutran) and learn how to inject myself. The nurse was extremely sweet and patient. 

All in all, this took just over 3 hours. I was told my next appointment would be a week later, and was surprised by the long interval. 

Scan 2: On my second scan (Day 8), I was told that my eggs were not growing fast enough and were not big enough yet, so the initial egg retrieval day would have to be pushed back. I think this was one of the first instances I felt a bit helpless, and lost a bit of confidence and optimism. I wasn't told why, or what I can do to improve the growth. I was only given a top up of meds and asked to come back on Day 10.

Scan 3: My Day 10 scan proved to be another disappointment with not enough eggs at the optimal size. Only 2 follicles were >17mm. I was referred to see the doctor on that same day. At this juncture, I was relying heavily on the support and advice of the IVF Support Group I was in. The doctor had a look at my measurements, didn't say much and asked me to come back on Day 11.

Scan 4: Maybe it's willpower or the sheer amount of protein I was loading up on in desperation, but the doctor finally cleared me for my trigger shot on Day 11. I remember running around KKH once I got the go ahead (from clinic to pharmacy back to clinic to see the nurse, then to take a final blood test, etc.). After that, you wait for yet another call from the nurse who will tell you a) When you take your trigger shot exactly and b) when to come in for the egg retrieval (during which your partner will also be depositing sperm). 

Egg Retrieval Day

TIP: Dress comfortable because they are going to strip you down anyway! 

I was a little nervous going into this procedure as I'd never been sedated or put under GA before, but the nurses and anesthetist were all very nice and patient. After getting prepped, I was wheeled into the OT, put on the IV, asked by the doctor if I knew which day Christmas was that year...I tried to answer but I was knocked out...

...Next thing I knew, I wake up surrounded by curtains. A nurse comes to ask me how I'm feeling and gave me milo and biscuits. Even up till now, I still feel that was the best milo I'd ever had in my life.  As I slowly regain alertness, I realise how many people were getting wheeled in after me. I remember thinking that I felt like I was in some baby making farm. 

The nurse made sure I could pass urine before she allowed me to go to the waiting room to be discharged. You can take your phone out from the locker to use when you're in the waiting room waiting for the doctor.  They only come in intervals and discharge several patients at a time, so if you miss that interval, you'd have to wait for the next doctor doing their rounds. During my discharge debrief, I was told that 16 eggs were retrieved, and that I would be scheduled for a fresh transfer that coming Thursday because of the Christmas long weekend.

I was not given a choice whether to do a fresh or frozen transfer, and I was not briefed about the pros and cons of either earlier on by any nurse or doctor, so I just said okay and accepted it. Such is how it's like when you go through the public route I guess. You don't know how or why doctors are making these decisions for you, and you just need to trust they are doing their best if you don't speak up and ask, and then ask somemore. I was so lost, but at the same time, optimistic and hopeful, that I just let everything get decided for me.

Over the next few days, I felt bloated from the procedure but having a lot of electrolytes helped.  

Embryo Transfer Day

TIP: The nurses will tell you when to drink water. If you know you are not great at holding your pee, follow the nurse's instructions. Expect your doctor to be late and your bladder to be bursting!

On 23 December, as I lay in the transfer chair for my procedure, the doctor entered the room to let me know that he will be transfering not one but two 3-day embryos. I was shocked. This was not a decision that I was asked to make and I was mot preparing for the possibility of having twins. You do actually sign a consent form that allows the doctor to make this decision for you, but for me, it's one of those fine print things that you don't think about until you suddenly have to think about it.

The doctor explained that since we are doing a fresh transfer and the Christmas weekend was coming up, it was not possible for us to wait for a 5-day embryo, so he was putting two 3-day embryos in to increase our chances. This was scientific and logical, so I just went along with it. We would leave the rest of the embryos in the lab (there were 8 in total) over the Christmas break to see if we had any frozen ones. Nothing about any of this raised alarm bells.

At this stage, I did not know about embryo grading (AA, AB, etc.), differences in 3-5-day embryos, or anything to do with embryo quality. Nobody told me anything and I was blissfully unaware and trusted in the process, even though interactions with the doctor were few and far between. I felt great after the transfer, maintained a pregnant until proven otherwise mindset, and was convinced I was going to have my Christmas miracle. I took pride in the fact that I was healthy enough for a fresh transfer despite a decent egg yield of 16. I took care of myself and I felt great. 

The Failure

For almost a week, I felt like I was already mother. I talked to my embryos every day, naming them Emma and Emmett, and made all my decisions around them. 

On New Year's, I suddenly just...didn't feel like it anymore. Halfway through the day, I suddenly realised wait a minute, I've not spoken to my embryos.

Then I began to spot. Everyone told me there was still hope. On 2 January, during one of my visits to the toilet, a gush of blood flowed out. I knew it was over and called KKH to let me take my blood test earlier so I could get it over and done with. I went in the next day, and got a call later that they're sorry it was not successful. I promptly got an SMS for a follow up checkup in February. 

I remember sobbing every day for the next few days, but also putting on a brave face and telling close loved ones that it's alright, we had quite a few fertilised eggs, and we will probably be able to do a frozen transfer cycle. Alas, a few days later, the embryologist called me to tell me that all the embryos failed to progress, and none were frozen.

None. Zero. I would have to do this all over again.

Recovering and Next Steps

The next few weeks, I drowned myself in my work as if nothing had happened, but spent a lot of time thinking about the entire cycle when I was alone. I often wondered, and I still do, whether my embryos were allowed to progress over the Christmas break past 5 days and hence died because they could not be frozen in time. Was anyone watching the embryos over the public holiday? How could this have happened? I was healthy, below 35, I had a sizeable yield. How can EIGHT fertilised eggs amount to NOTHING? 

It took me several months to recover emotionally, and my partner gave me my space to decide what I wanted to do next. When I was finally ready to plan again, we both went through our finances, and decided that with my anxiety about all the unknowns in the first cycle, and how we wanted to be more involved in our next cycle, we would go private.