Anti-Mullerian Hormone (AMH)

tadi jumpa Dr lagi on D11(28/6)..utk scan size ovum and amik result blood test D3 hari tu..baru tadi tahu blood test tu tujuan dia utk Anti-Mullerian Hormone (AMH)..haaa ape plak nii...??
 
 AMH Test...ni term yg baru pernah dengar & belajar hari ni..Dr suruh balik dan baca pasal AMH ni...so far apa yg saya faham bila dah baca sikit² pasal AMH ni adalah untuk check berapa banyak remaining quantity of eggs yang kita ada and berapa tahun lagi tahap kesuburan kita...so we should know our AMH level utk tahu tahap ovum yang dihasilkan oleh badan kita....from AMH level will help us to evaluate woman's current fertility status and may predict the onset of menopause.
 

so indication dia mcm ni...
 
if between 0.1 to 4.9pmol : Low Ovarian Reserve--Low AMH means low egg numbers or decrease in the number of eggs..the production decreases and then stops as follicles grow..and indicate a potentially poor response to medicine..it also may be useful in predicting menopause (dalam kata lain our ovum berkurangan..so kita ada potensi yang tinggi utk menopause) and so Doctor akan suggests the need for extra stimulation medication as  (increase dose ubat ker dll)..
 
if between 5 to 19.9pmol : Normal Ovarian Reserve--mean that the production of eggs is stable ikut umur kita..orang normal should get within this level..

if more than 20pmol : High Ovarian Reserve--mean excess follicles/eggs..normally PCOS people they will high level of AMH..it also indicate an exaggerated response to the medication and sensitivity to stimulation medication and higher risk of OHSS...if monitor closely..high potency to get pregnant..inshaaAllah..

so agak² berapa level AMH saya???

p/s:-byk lagi kena baca pasal AMH ni...korang bole baca kat sini utk lagi faham..

my remark:
3rd appointment on CD11(28/6)

Cost incurred:

TVS  & Consultation Dr =RM184

TOTAL =RM184

 

agak sedih :(

As Salam,

Appointment semalam dengan Dr agak sedih laa..result yg di harapkan tak berapa ok..level estradiol sgt rendah..sedih sgt..hanya 104ml je..Dr nak lebih 1000ml..kan jauh tu..makin penin dgn badan sendiri..apa sebenarnya yg berlaku eh...Allah jer yg mengetahui kan..mungkin ni ujian utk aku agar spend masa dgn Dia lagi byk kan..maaf ya Allah..aku redha segalanya..

masa cuti CNY hari tu on CD14-CD17 (22-25/1/12) aku bleeding..consider as 'ovulation bleeding'..nak kata period tapi terlalu awal laa plak..sbb baru CD14..ingat spotting sikit jer..tapi takde la sikit sgt..sbb masa tu tgh masa ovulation..dalam hati fikir, nak melekat kot...tgh process implantation kot..penuh pengharapan..mdh pun bg positive hope..dia siap search lagi..igt kan sehari dua je bleeding..tgk2 sampai 4 hari..so confirm ni bukan ovulation bleeding..sbb kalau ovulation bleeding dia cuma 1-2 hari je dan hanya spotting je..soooo dah risau..ni darah ape plak..period ker bukan..nak solat ker tak? haiii confuse confuse..so amek jalan selamat, solat je..maybe istihadah rasanya..darah penyakit..

bila jumpa Dr, scan ovari, tgk perkembangan ovum lagi..last appointment size 14-15mm, so Dr expect the size will growth laa dan akan matured ker..tp sangat sedih follicle2 yg byk2 tu diharapkan membesar, tapi semua dah mengecil..saiz paling besar pun cuma 9mm..kan pelik..dan uterus pun menipis..maybe tu sbb bleeding kot..Dr kata kemungkinan cycle kali ni tak berjaya..:((..something wrong with my body/hormon...so kena amik darah lagi..Dr nak study dulu my case..agak lain macam..

lagi satu Dr kata ovum/follicle2 yg byk2 tu kebanyakannya hanya kantung kosong yg lama ada dlm ovari dan telah diransang oleh Gonal-F utk membesar..bila dah stop suntikan Gonal tu, ovum tu pun mengecut semula..kalau ovum baru, dia akan terus membesar sendiri setelah diransang oleh gonal dan akan mengeluarkan hormon estradiol...agaknya tu sbb level estradiol rendah kan.

then tanya Dr, dlm ovary saya ni hanya ada ovum2 lama yg tak matured2 ker? period kali ni ada produce fresh ovum tak?...she soooo positive..dia kata jgn fikir bukan2..insyaAllah dlm byk2 follicle ni mesti ada yg fresh & ovum baik..doa byk2 yer..jgn byk fikir, biar saya je yg fikir case awk ni...oohh Dr, i think to much!..

Ya Allah, besar harapanku agak Dikau kurniakan aku kesihatan yg baik..hormon yg stable..ovari yg baik untuk menempatkan ovum yg baik..ovumku yg fresh, matang & sempurna untuk disenyawanya dengan benih suamiku..Dikaulah yg menjadikan semuanya Ya Allah..Anugerahkan aku zuriat ya Allah..Engkau maha berkuasa atas segala sesuatu..Ameen

so, consider this cycle is unsuccessful..will continue next cycle in Feb..

my remark:

26/1/2012 (Khamis):  4rd appointment on CD18

Cost incurred:

Blood test & investigation = RM 130

TVS  & Consultation Dr =RM160

TOTAL =RM290

hormon estradiol

As salam..

term baru lagi ;)..setiap kali jumpa Dr akan dapat satu ilmu baru..alhamdulillah..suka sgt Dr..very informative..she will explain for almost everything..because she want me n mdh to understand and know what happen to my body..tp kadang2 tu tak paham gak..faham2 laa term2 yg dia guna kita tak pernah dengar kan..so kita kena tanya laa..

hari ni jumpa Dr..all the way dari Melaka ke KL pukul 5 pagi..solat subuh kat Seremban..masuk KL dlm 6.45pagi..huh dah jam..kagum dgn org KL ni..awal betul keluar pergi kerja..kalau aku sure tak sanggup..skrg ni pun pergi ofis ikut masa class..kalau kelas start kol 9 pagi..maka kol 8.50 baru gerak keluar dari rumah..syukur sgt tak face jam jam ni..balik pada cerita tadi, bila sampai KL awal, maksudnya sampai clinic Dr awal laa..maka tercapai hasrat nak jadi org pertama lagi..alhamdulillah..

so hari ni Dr nak monitor lagi perkembangan ovum..mcm biasa bykkkk sgt ovum..yg paling besar hari ni saiz 14mm-15mm..lining of the uterus pun cantik..tebal 9mm..Dr cakap bila uterus agak tebal, elok untuk embrio melekat nanti (mean ready for implantation)..tp Dr risau tgk byk sgt..walaupun saiz telur ok..uterus ok..tp kalau byk sgt merbahaya..Dr pelik kalau dah buat laps dulu, supposely telur tak byk mcm ni..lagi satu kali ni Dr tak nak bagi injection Ovidrel (utk pecahkan telur yg dh matang), sbb kalau telur yg matang byk sgt, lagi high risk nak kena OHSS..so kitorg duduk discuss dgn Dr mcm mana..dia suh try dulu secara natural..dia kata kalau tak ok, maybe kena buat laps & monitor Gonal F dgn dose lagi rendah (37.5 iu)..

sekali lagi dia suh amik darah..kali ni utk test 'homon estradiol'..dlm otak dok fikir ape plak ni..lagi lama buat treatment lagi expert agaknya pasal fertility ni ek..masa Dr ckp pasal estradiol ni tak berapa nak faham, sampai je Melaka (kami sampai melaka pukul 12.45 hari yg sama..mcm dekat je kan MLK-KL)..terus search apa tu estradiol, utk apa? end up jumpa ni sket2..kalau nk baca detail dekat sini yer..sangat bagus tau..

Estradiol levels also give important information on the functioning of the ovaries. This can help doctors evaluate menstrual problems, including abnormal bleeding or missing periods. The test may also be used in boys or girls to check for damage or disease of the testes, ovaries, or adrenal glands.

Blood estradiol is also used in combination with ultrasound scans. Taken together they help indicate how (and if) the ovaries are responding to stimulation. Is there a response? Is it adequate? Is it excessive? To tell us this, the blood level has to be viewed in relation to the stage of pregnancy and the day in the cycle in which the level is being taken.

For example, a level of 1500 pg/ml on day eleven might be considered acceptable in a stimulated cycle, as reflecting the presence of a reasonable number of mature follicles. However, if this level were present on day eight, it would be considered unacceptably high. It would almost certainly reflect the presence of an excess of follicles. At this stage (day eight) they would still be Immature ones. Their quantity, however, would suggest that continued stimulation would carry an unacceptable risk of developing OHSS-- ovarian hyperstimulation syndrome. 

maybe because of my experienced on OHSS, Dr suh check estradiol level kot..takut it will happen again & Dr mmg ckp pun, possibilities nak kena OHSS mmg ada kalau silap sikit..Ya Allah takutnyaa..oh btw hari ni dah CD11..hopefully result test ni at acceptable level laa..Dr nak tengok level hormon estradiol bawah or atas 1000ml..Ya Allah harap2 semua ok..takut nya nak hadapi mcm mcm lagi..

errmm..kali ni Dr advise pasal pemakanan & jaga kesihatan badan..dulu diri ni selalu perasan sihat jer..rupanya mcm2 yg tak kena kat badan ni..so apa yg kena mkn/minum & buat:

• minum 2 little air setiap hari
• makan 2 biji putih telur setiap pagi (tak kira nak goreng ke..rebus ker..separuh masak ker..tak kisah)..
• timbang berat badan setiap hari
• ukur lilit perut setiap hari..kat tempat yg sama (ni utk monitor for OHSS..sbb kalau perut bloated tu salah satu tanda laa)
• jaga badan/jalan elok2/perlahan2..(no lompat2/no lari2 or jogging/no sport/jgn angkat berat)..Dr suruh assume masa ovulution period ni, badan kita bawa 2 buah apple/limau yg fragile (ovari la ni)..ovari akan membesar bila telur yg byk2 tu diransang & mengembang..kalau aktif sgt takut ovari akan terpintal..tau je laa ovari kan hanya di pegang oleh tiup fallopio yg halus tu..

Ok tu dulu utk kali ni yer..

my remark:

19/1/2012 (Khamis):  3rd appointment on CD11

Cost incurred:

Blood test & investigation = RM 63.10

TVS  & Consultation Dr =RM160

TOTAL =RM223.10

Ya Allah besar harapanku agar semua berjalan lancar..tolonglah hambamu Ya Allah..

shock news on CD3

mula bercerita.. ;)

Setelah lebih 6 bulan AF tiada khabar berita, terpaksa laa pergi jumpa Dr untuk ambil ubat turun darah. Itu pun lepas baca blog Dr Adilah..dia kata jgn tunggu sampai setahun utk tggu AF dtg..

Selalunya ambil norculut utk turun darah, tp kali ni tak tau nama ubat hormon tu..that my mistake tak tanya..takpe laa..dlm hati doa byk2 cepatlaa AF ni dtg..baru laa bole continue TTC journey balik..after rest for one year..2011 tahun utk berehat dari segala treatment after minor operation & laproscopy in Feb 2010 (warded for 4 days), trying to conceive thru IUI on June 2010..dan kena moderate OHSS on July 2010 (warded for 11 days)..Hanya Allah jer tahu perasaan masa tu..ingat dah takde kat dunia ni lagi..Alhamdulillah Allah masih sayang..ok ok back to CD on this months

CD1: 09.1.12 - AF dtg..suka sgt..

CD2: 10.1.12 - call Dr to set appointment (tukar Dr baru yer from the same hospital)

maka bermulalahTTC journey in 2012..

CD3: 11.1.12 - Jumpa Dr..Dr read semula segala history..& Dr query few things about the result of minor operation & laproscopy in Feb 2010 & why OHSS happen to me..Dr informed me SHOCK news!!!

• 1st news : my previous Dr telah ambil/potong part of my left ovary..WITHOUT my notice..Dr pun terperanjat mcm mana aku tak tahu..bak kata Dr, macam belah durian gitu..can u imagine..aku hanya boleh menangis bila Dr inform pasal tu..oh aku tak kuat utk tidak menangis dengar berita mcm tu..dalam otak ni ligat berfikir bole ke pregnant ni..Ya Allah tolong laa permudahkan segalanyaa..

•  2nd news: Dr tanya berapa batang pen Gonal F was given to me before i go for IUI on June 2010? i said 5 batang..sekarang Dr pula terperanjat!! dia kata biar betul..cuba awak ingat betul2..betul ke 5 batang pen? itu dah dose yg sangat tinggi..buat apa nak tipu kan kalau itula yg kita dapat..ermmm Dr pula yg speechless..Dr kata org PCOS kurus mcm aku akan mudah terdedah kepada OHSS jika diberi dose yg tinggi dan perlu dimonitor dengan teliti..maybe that is the reason kenapa aku kena OHSS..moderate OHSS plak tu..lucky me it is not severe OHSS..kalau tak takde laa aku kat dunia fana ni lagi...Ya Allah perliharalah aku dalam usahaku mendapatkan zuriat ya Allah..

semua cerita yg berlaku pada aku on 2010 diceritakan kepada Dr..dan Dr mcm tak terkata apa2..Dr hanya mampu ckp jangan sedih lagi yer..kita usaha lagi..InsyaAllah peluang masih ada lagi..

to cut the story..MDH ask the Dr to start new chapter for 2012...the past is past..we will start treatment again..with new hope..but i'm sure this time aku lagi takut & lebih berhati2 on whatever medicine given to me..insyaAllah akan dapatkan sebanyak maklumat yg mungkin dlm process TTC ni..dulu tak sabar kot..huhu..

ok utk this cycle of treatment, Dr suruh amik darah..sejuk tangan aku takut..dah lama tak kena cucuk2 ni kan..darah ni utk test 3 items..
1-full blood clot (FBC)
2-test hormon level
3-test lung & liver ( nak tau kesan dari OHSS)


dan Dr proceed with Gonal F with lower dose (75iu per day for 5 days) to stimulate the ovum
D3 : 11.1.12 (75 iu)--> masa ni takut nak cucuk..MDH pun sama..so meleleh air mata nak cucuk..takut :((
D4 : 12.1.12 (75 iu)
D5 : 13.1.12 (75 iu)
D6 : 14.1.12 (75 iu)
D7 : 15.1.12 (75 iu)
D8 : 16.1.12---> jumpa Dr balik utk tengok progress ovum & check result darah..

nanti kita sambung cerita ok..

my remark:

11/1/2012 (Rabu): 1st appointment

cost incurred:

Gonal F  = RM 614

Blood Test,TVS  & Consultation Dr = 528

TOTAL =RM1,142

byk kan kena..takpe laa selagi mampu, kita usaha kan..kalau tak mampu..lagi kena double usaha kan..kena rajin solat Dhuha & sedekah byk2 kan..peringatan untuk diri sendiri..


P/S: utk kwn TTC..make sure korang tau apa nama ubat yang korang amik tau & kesan2 terhadap body kita..esp for those yg ambil ubat kesuburan..risiko utk dpt OHSS tinggi (PCOS terutamanya yang kurus/bersaiz kecil) because severe OHSS can affect the kidneys, liver, lungs, heart etc and can cause death..moga Allah pelihara kita semua & makbulkan hajat kita yang satu ;)