A new world called hematology..

Hematologi adalah cabang ilmu kedokteran yang mempelajari penyakit-penyakit yang berhubungan dengan darah. Mencakup pengobatan terhadap penyakit-penyakit yang mempengaruhi produksi darah dan komponen-komponennya antara lain hemoglobin, protein darah, serta mekanisme pembekuan darah
Wikipedia : Hematology is the branch of medicine concerned with the study, diagnosis, treatment, and prevention of diseases related to the blood. Hematology includes the study of etiology. It involves treating diseases that affect the production of blood and its components, such as blood cells, hemoglobin, blood proteins, and the mechanism of coagulation. 

Hari ini saya berkonsultasi dengan hematolog bernama dr. Aru Sudoyo di RS Medistra, Tebet. Appointment sudah dibuat sejak lebih dari 1 minggu lalu. Dokter mulai praktek jam 7 malam, nomor antrianku 10. Berdasarkan cerita beberapa teman yang sudah pernah bertemu dengan dr. Aru, durasi konsultasi per pasien sekitar 20-30 menit. Berarti, aku diperkirakan akan masuk ruangan dokter jam 10 malam ke atas :D.

Setelah sengaja berlama-lama di Plaza Semanggi, saya dan suami berangkat menuju RS Medistra sekitar jam 8.30 dan tiba di sana jam 9 lebih. Setelah mendaftar, kami naik ke lantai tempat dr. Aru berpraktek dan menyerahkan berkasku ke suster di depan ruangan dokter. Suster menginformasikan bahwa saya bisa masuk setelah pasien yang berada di dalam keluar, yeayyy...di luar ekspektasi! 

Setelah kurang lebih 20 menit, kami dipanggil. Wawancara singkat dengan dokter seputar riwayat kesehatan dan treatment yang sudah pernah dilakukan, kemudian dilakukan pemeriksaan fisik.

Hasilnya :
- Tidak ada kelainan fisik
- Hasil ANA Profile tidak menunjukkan kelainan autoimun
- Dokter memberikan surat pengantar untuk melakukan tes tambahan di Laboratorium Hematologi, RSCM Kencana (lokasi di Lantai 2) meliputi :
a. Darah Perifer Lengkap
b. Agregasi Trombosit
c. Fibrinogen
d. Prothrombin Time/INR
e. aPTT (Activated Partial Thromboplastin Time)

 Apabila hasil tes tersebut sudah keluar, saya diminta untuk mengirimkannya via email ke dr. Aru dan nanti beliau akan memberikan instruksi apakah saya perlu meminum obat (resep Ascardia dan Simarc sudah diberikan lebih dahulu).

dr. Arie Polim, second meeting

Hari ini d14, waktu untuk cek telur :D
Yang bikin stres, hari ini setelah selesai jogging sore, di pakaian dalam kutemukan darah segar, sedikit memang..tapi merah..meresahkan.. :(
Begitu sampai di BIC, terasa darah mengalir sekali lagi.
Tetap sedikit, sama sekali tidak seperti haid.
Namun berbeda dengan flek yang selama ini sering kualami di antara haid, flek biasanya berwarna coklat..tidak berupa darah segar seperti kali ini.

Hasil USG transvaginal :
- Telur tidak ada yang membesar :( (tapi aku lupa bertanya, kalau begitu apakah perlu minum Metformin lagi?)
- Dicurigai ada polip di endometrium, kira-kira berukuran 7 mm. Again?? Sebelum IVF ke-2, di bulan Juni 2014, aku sudah melakukan histeroskopi untuk mengangkat 2 buah polip. Disarankan untuk melakukan histeroskopi 1 minggu sebelum mulai IVF, bersamaan dengan tindakan endometrium scratching.

Dokter memberiku surat pengantar untuk berkonsultasi lebih lanjut perihal hasil tes darahku dengan hematolog bernama dr. Aru Sudoyo yang berpraktek di RS Medistra, Tebet.

OK, new project then, let's do this!!

New doctor, new hope...

Akhirnya..setelah sekitar 7 bulan (September 2014 - April 2015) "libur panjang" dari urusan perdokteran, saya memutuskan untuk konsultasi ke dr. Arie Polim di Bunda International Clinic (BIC), Menteng. Setelah mendengar beberapa review positif mengenai dokter ini, saya ingin mencoba peruntungan kembali.

Hari itu adalah hari ke-3 haid (d3). Sempat drop juga karena waktu praktek diundur hampir 3 jam akibat si dokter masih stuck melakukan laparoskopi yang berlangsung lebih lama dari perkiraan. Akhirnya, sekitar jam 8 kami dipanggil..padahal saya sudah tiba di sana sejak jam 4 sore..fiuhh..

Kesan pertama, dokternya cukup ramah. Yang membuatku cukup impressed, dia terlihat serius berpikir dan menganalisis data-data dan riwayat treatmentku, dia juga menggali informasi tambahan dengan beberapa kali mengajukan pertanyaan. Dilakukan USG transvaginal seperti biasa, ovarium masih PCO :D, rahim tipis, sekitar 5mm.

Berikut beberapa pertanyaan penting yang sudah kusiapkan beserta jawaban dokter :

1. Q : Bagaimana meningkatkan kualitas embrio yang dalam 2x IVF terdahulu bisa dibilang kurang baik?
A : Disarankan menggunakan teknik IMSI. Pembesaran yang lebih tinggi membantu pemilihan sperma dan juga memungkinkan inti telur dapat terlihat dengan lebih jelas. Diharapkan dapat diperoleh lebih banyak embrio dengan kualitas lebih baik.

2. Q : Protokol apa yang sebaiknya dilakukan? Apakah dosis Gonal F perlu diturunkan?
A :
- Dosis mungkin bisa diturunkan ke 112.5 atau 137.5 IU, namun penurunan dosis memiliki risiko telur tidak merespon stimulasi.
- Pada kedua IVF terdahulu, nilai E2-ku menjelang OPU selalu tinggi, berkisar 4000-5000. Apabila hal tersebut terjadi lagi, disarankan untuk menunda ET dan membekukan seluruh embrio.
- Karena saya cenderung high responder, trigger menjelang OPU sebaiknya tidak menggunakan Ovidrel melainkan Suprefact untuk menghindari OHSS.
- Ada pilihan untuk menggunakan stimulasi yang mengandung LH untuk membantu pematangan telur (hal ini perlu didiskusikan lebih lanjut dengan dokter karena dari yang kubaca, LH pada orang PCO sudah cukup tinggi sementara eksposur LH yang berlebihan menyebabkan rendahnya kualitas telur).

3. Q : Persiapan dan tes apa yang perlu dilakukan sebelum memulai IVF berikutnya?
A : Disarankan melakukan Endometrium Scratching sebelum IVF, kira-kira 1 minggu sebelum. Tindakan ini bertujuan untuk menyiapkan dinding rahim agar lebih "gembur" dan mendukung implantasi embrio. Dapat dilakukan bersamaan dengan histeroskopi.

4. Q : Tes apa yang perlu dilakukan sebelum memulai IVF berikutnya?

A : Diberi surat pengantar untuk melakuan panel tes seputar kekentalan darah dan autoimun yang 

mencakup :
- D-dimer
- INR
- ACA IgG dan IgM
- Anti Beta2 Glikoprotein1 IgG dan Igm
- ANA If dan ANA Profile

5. Q : Apakah Metformin perlu diminum?
A : Perlu apabila telur tidak bisa membesar tanpa obat, akan dicek di d14.

8 days post BFN

Today I chatted with a friend who also went through IVF at the same hospital as I did. We had the same doctor, we even had our egg retrieval and embryo transfer at the same dates. We both had 2 embryos transfered, and we both got negative results :(.

She went back to the doctor yesterday and were explained about the possible reasons why her IVF cycle failed. She was suggested to have laparoscopy next Tuesday to check her endometrium because all the data pointing at the possibility that maybe her endometrium was not receptive enough for implantation.

After having a chat with her and hearing all the informations she got from our doctor, I found myself getting the courage to think about having the follow up consultation. Before today, I didn't even want to think about it. The thought of it was too much to bear. But today, the curiosity finally overpowers my exhaustion. So I phoned the hospital asking for an appointment. I got scheduled for next Monday, March 4th, 8 pm.

God, give me the serenity to accept the things that I can't control.. Give me the ability to accept Your plans in my life. Give me the courage to embrace reality and look at tomorrow with a hear filled with hope and joy. I ask for Your strength..because it's the only possible way for me to get through this..

7 days post BFN

It has been 1 week since the day our IVF result came back negative.

Yesterday we went back to our home after spending almost 3 weeks at my parents' house. In general, I feel OK. I love that me and my husband get to spend time together just the two of us again, like the way it used to be.

I try not to feel anything when my eyes caught the sight of Gonal-F that is still laying there inside my fridge. I even tried to deny my eyes telling my brain that they saw it. I didn't want to see, I didn't want to remember. But the thought manage to creep into my head. I remember those times when that injection was a source of hope. Injecting myself every evening, thinking to myself that every injection leads us even closer to our dream of having a baby. Praying and hoping that it's doing its job, helping me superovulating with good and big eggs to harvest.

I try not to feel anything when people tell me not to get too carried away with my disappointment, to get back to my feet, and to carry on with our effort on having a baby. Go back to the doctor, ask for explanations, get checked, etc etc etc. I know they mean well. That's why I try not to feel anything. I know it's not easy for other people to comprehend how it feels. How exhausted I am..physically and mentally. How fed up I am with all the visits to the hospital, the blood checks in the lab, the ultrasounds and the consultations with the doctor, the waiting, the wondering, the hoping, the worrying. How disappointed I am that all of that hasn't been a success. I know that God has everything planned for us and that His timing is the best. But that doesn't spare me from feeling exhausted and fed up. I need some time to not thinking about anything that has to do with "trying to have a baby". I need to be able to free my mind. I need a break. I need to get myself back first. But I know, it's not that easy for other people to understand.

2 days post BFN

We got our failed IVF result on Monday, February 18th, so it has been 2 days. Am I feeling better? I think so.. Have I stopped feeling sad? I guess not.. I still find myself crying from time to time. I'm also having trouble sleeping. When I'm alone, 1 minute I feel OK, but the next minute I feel empty and the sadness, disappointment, and heartbreak hit me.

I already know the result would be negative 1-2 days before my scheduled blood test. First, I got little spotting Friday afternoon, February 15th, it was mainly brownish but with some red streaks. That's when I really panicked. But after a moment, I thought maybe it was implantation bleeding. My hopes were rising even higher than before. But in the evening, I spotted some more. I flipped back and forth from feeling scared to hopeful, and then to scared again.

The next morning, the spotting was very much like what I experience every time I'm about to get my period. I cried..and told my husband. We tried to accept the fact that it's almost certain now our IVF is not successful. It hurts a lot..thinking of all the process we have gone through, the injections, the early morning visits to the hospital for blood checks, the waitings for doctor's consultation in the evening, yet ending up with NOTHING. My husband kept trying to make me feel more positive..and I do feel a bit more positive every time we discussed and shared our feelings with each other. But still, the disappointment stays..

When I woke up on Sunday morning, I found quite a big clot of red blood on my undies, and that's when I knew it for sure, it's my period. That time, I actually felt relieved. At least I got the answer, no more questions, no more doubts. Only shattered hope. I was sad, but relieved. I went back to our room, woke up my husband and told him. We hugged in silence, trying to process and accept everything.

On Monday morning, we went to the lab for my blood test. They told me I would get the result in the afternoon, about 1-2 PM. Me and my husband had lunch together. When it was 1 PM, we nervously waited for the news. It was so hard to stop hoping. At almost 2 PM, the text message we were waiting for finally came. As predicted, the doctor said my beta HCG result was < 1, which means I was not pregnant. I felt a sharp pain in my chest. Finally, it was closure.

Up until today, my mood swings from feeling sad, disappointed, accepting, exhausted, empty, angry, and a whole other emotions I can't even put my finger on. Some people tell me not to cry and not to be sad because it has negative effects. Even after everything that I've been through, I'm not entitled to cry??? Some people think that I'm perfectly OK, just because I don't cry in front of their faces, and ask me such innocent yet insensitive questions like "You're not on bed rest anymore now, are you?". I feel envy, thinking of other people who get pregnant sooo easily. They say not to ask why, but I can't help myself. I ask why me? Why us? Why it has to be this difficult for us? But then I remember other people who have been and are still waiting even longer than us to have a baby. And then I thought, what we are going through is nothing compared to their struggles.

I'm trying to cope with all these feelings. I'm hoping that I can move on from this phase soon..and be completely OK again.