KEEP IT IN THE PHAMLY: real life

When people find out I'm pregnant, there are one of two questions they will ask first:

When is baby due?
Do you know what you're having?

When is baby due? Well, nobody really knows because estimated due dates based on the start of your last menstrual period are based on a very non-inclusive formula some German obstetrician named Franz Nagele concocted hundreds of years ago, assuming all menstrual cycles are 28 days long and you conceived on day 14. This excludes most pregnancies because menstrual cycle lengths vary and you can conceive on a number of fertile days each cycle. In short, this method is stupid and I don't understand why we still use it.

Healthcare professionals realise this, which is why some medical practitioners use your Week 12 growth scan to estimate a new due date that they deem more accurate. But this method is also flawed because the angle the sonographer decides to take the measurement on any given day changes, your fetus's position could also be tricky to measure and you end up with a measurement that can be a little or a long way off the reality.

Lastly, we started the IVF process and my hormones were all over the shop when we became pregnant naturally. My menstrual cycle was a whopping 49 days or so the month before we became pregnant as opposed to my usual 28-day cycle. I tracked my body's symptoms and knew when I had spot bleeding, which I thought was my period coming in a few days, but it turned out to be Baby Pham in embryo form embedding into my uterus lining so if I use another formula that assumes the embryo implants 6-7 days after fertilization then my current estimated due date is off by over a week.

So when people ask me when baby is due, I say it'll be a summer baby.

This turned into a long rant, so I will talk about gender reveals in my next post.

Our fertility and pregnancy experience

There are three main ways that gestational diabetes seems to be managed:

Not at all - pregnant woman ignores medical advice, goes rogue and eats whatever she wants and doesn't test her blood glucose levels.
Diet-control and exercise - Moderating blood glucose levels through balanced meals and snacks, with moderate movement/exercise after each main meal to help process the blood glucose.
Diabetes medical intervention with insulin injections or Metformin pills, or a combo of both.

So far, I have been on Option 2: Diet control and movement. On bad days, I wish I could do option 1 and indulge in hot chips and ice cream without the crippling guilt I know I'd feel after. On exhausted days, I consider asking my diabetes team to stick me with multiple daily needles already so I can be less strict with my diet. Then I remember that I am doing option 2 for baby and get back to it!

Going on insulin, I'm told, risks placental deterioration while taking Metformin pills passes through the placenta and impacts baby's insulin production and growth. Both are safe enough to be used on pregnant women, obviously, but diet-controlled is what the medical teams prefer if you can to avoid further medical interventions that come from going on medication. Diet control doesn't always work especially towards the end of your pregnancy because of wild pregnancy hormones produced by the placenta.

I am writing this at Week 30 when the placenta starts to kick up its insulin-resistant hormones so I may write about insulin and metformin experience in future. But for now, I am diet-controlled.

I went from two meals a day, and an afternoon snack of fruit to:

3 main meals a day - breakfast, lunch, dinner - 30g-45g carbs
2 snacks - 2-3 hours after breakfast and lunch - 15g-30g carbs
Supper right before bed - 15g or less carbs

I focus on low-GI carbs that take longer to break down into blood glucose, and adding lots of veggies and protein will also help slow the conversion to glucose. Some women find it easier to go low-carb because there's little to no risk of spiking your blood glucose levels (BGLs), but my dietitian recommended 175g minimum a day for baby's development so that's what I target.

I have this with low GI brown rice that's not pictured

For those on diet control, this generous Melbourne dietitian is a godsend - Robyn Compton shares her GD expertise and I couldn't have figured out my new, balanced diet without her. Even my hospital dietitians recommended her to me after I'd found her through an online support group: https://www.instagram.com/gestationaldiabetes_dietitian/ The hospital dietitian's few pages of info on carb portions and whole foods vs processed foods is not enough to build meal plans for however many months until baby arrives. But with Robyn Compton here to save the day, I have plenty of meal and snack options from here until I deliver.

The Gestational Diabetes Australian Support Group on Facebook is also really helpful: Lots of women sharing their personal experiences and supporting each other through this often baffling diagnosis and treatment. I don't normally have a good time with Facebook groups because I find people get catty, judgemental or sarcastic when they're allowed to post anonymously. But this group is full of pregnant women who genuinely care and are trying their best to navigate the murky areas of gestational diabetes management.

I also binged the Gestational Diabetes Club podcast by nutritionist, Helena. There is one particularly helpful Q&A episode with a GD educator that I wish they'd recorded a couple months earlier when I was starting my GD learning. It's super helpful: https://open.spotify.com/episode/1AaAKDKl7kOC1hOWQzzoLh?si=e0a1418b664b452b

I've found my 'safe' meals after about 4 weeks of a crash course on how my body processes different food combinations. I'll occasionally try something new now I'm 11 weeks into my new diet but often I don't want the anxiety of eating something different and waiting two hours to test my BGLs to see if it's within limit. My diet is getting boring and I have another 9-11 weeks to go if baby arrives around the estimated due date, but better safe than sorry. I talk Baby Pham through our daily menu each morning so he's prepared for yet another bland day of eating.

I have a few 'cheat' meals coming up for Babymoon and over the holiday season where I'm pretty sure I'll spike so I want to avoid having too many spikes now. Consistent spikes over time is the real danger to baby whose body then gets used to producing more insulin to compensate for my high glucose diet so I don't feel so bad about the odd cheat meal I have coming up in the next couple months.

Our fertility and pregnancy experience

Not fun fact: There isn't a national standard for diagnosing gestational diabetes (GD), as stated on the Royal College of Pathology Australia's website and also by my gestational diabetes educator. She opened our education session by stating, "This won't help you ladies, but if you were having your baby next year you may not have been diagnosed with GD because they're easing the diagnostic levels." Great. Just great!

It gets dumber. Each hospital has varying blood glucose limits and guidelines. So you can be in the same city as another pregnant GD mumma and get different medical advice. For example, I am trying to keep my levels within:

Fasting - 5.0 or under
1 hour after meals - 7.6 or under (only if I know ahead of time I can't test at 2 hours then I should test at 1 hour if I can)
2 hours after meals - 6.7 or under

Other women's fasting numbers range in the 5.3-5.5 range that I've seen. Some women are told to test at the 1-hour mark, while others are told to test at 2 hours. Gestational diabetes guidelines are a bit of a joke, yet it impacts many pregnancies in Australia. I can see why they're loosening the GTT gestational diabetes diagnosis guidelines because it puts more strain on pregnant women who are already struggling with all the quick bodily changes. Though, let's face it - the motivator for diagnosing fewer women with gestational diabetes is probably the cost to the healthcare system. The number of appointments I had scheduled more than doubled when I was diagnosed with GD.

Anyway, it's 2023 and they haven't changed the Glucose Tolerance Test (GTT) gestational diabetes diagnostic ranges yet so I am being treated for gestational diabetes. You can read about my GTT experience and results for a bit of background.

In my early pregnancy, I was counting down to Trimester 2 in the hopes that I'd feel less nauseous and fatigued. Though, once Trimester 2 arrived so did my gestational diabetes diagnosis. This has taken over my pregnancy and overshadowed sciatica and pelvic pain that seem like molehills compared to the mountain I'm now climbing learning how my body's insulin and blood glucose levels relate to the foods I eat, the exercise I do and stress factors like work, hot weather and poor sleep.

I'll be honest. Gestational diabetes management has put a huge dampener on my pregnancy. I can't sit back and enjoy not feeling nauseous for a few months before reflux and indigestion take over in Trimester 3. Instead, I have a tonne of daily logistics and duties to try and prevent my glucose levels from spiking and causing baby harm. I am juggling 3 meals, 2 snacks and 1 supper each day and testing my blood glucose levels (BGLs) 2 hours after every main meal, and my fasting level first thing when I roll out of bed. This is the most discipline I've had around body and health since... well, ever.

The diet isn't really a diet. It's basically healthy eating with a balance of protein, veggies, fruit and carbs that is recommended for all adults. The difference is I actually have to follow it strictly because straying into simple carbs and highly processed foods like white bread or hot chips spikes my blood glucose levels. Why is this bad? Because if I can't keep blood glucose in check, then my baby overproduces insulin to compensate for my high blood glucose levels. Why is that bad? Because insulin is linked with weight gain in adults and babies leading to macrosomic babies.

Why is big baby bad? They may be harder to birth vaginally, though I've heard of plenty of women birthing big babies who didn't have GD so I'm not worried about that. The main problem with having a big baby in our medical system is the hospital policies. They will want to induce you early (Week 38-39 at my hospital) instead of letting you go into labour naturally when the baby is good and ready to come out. What if they don't want to come out until Week 40-41? Women in my GD support group also seem to feel pressured into elective C-Section to avoid risks. In case you can't tell from my language, I plan to decline offers of early induction or elective C-section unless a good medical reason arises such as I develop preeclampsia or placenta deterioration or baby has health issues. I'm not scared of trying to push out a big baby.

What I am scared of is what could happen after birth if I don't control my BGLs and baby gets used to over-producing insulin. Once bub is earthside, they'll no longer have my blood glucose passing through the placenta to them, and could end up a severe blood glucose level crash, end up in NICU and we won't have skin-to-skin time in our first days together-apart. I want to do everything I can to be able to hold my baby even if it means going on insulin injections or taking metformin tablets. There's only so much you can do to manage your BGLs with diet and exercise. If my placenta decides to produce lots of insulin-resistant hormones as my pregnancy progresses, then medical intervention will be the way forward.

So... this fear is how I am getting through the monotony, strict schedule and firm diet of gestational diabetes. Any time I've slipped up like eating mango, or having a late meal, my BGL has spiked to remind me to get back in line. On days when I don't feel like jabbing my finger for the two hundredth time or meal prepping yet again or eating another hard-boiled egg for supper, I either say my affirmation out loud or loudly in my head, "For baby!" I'm doing it all to give Baby Pham a chance at being as healthy as possible.

My dreams of an easy Trimester 2 before I got extra bloated in Trimester 3 is long gone. I'm now dreaming of Trimester 4 once baby is out and I can bite into a banh mi. Soft, fluffy, crunchy white bread and all the things I don't currently eat for risk of salmonella or listeria - deli meats, raw egg mayo, liver pate. Oh man... I haven't told The Phamly yet but whoever visits me from Brisbane's southside first has to bring at least two banh mi for me and maybe one for Boyfriend Pham.

I have roughly another 250 finger jabs to go before our due window. Sigh... For baby!

Our fertility and pregnancy experience

The glucose tolerance test (GTT) is a stress test on your body to see if your insulin is managing your blood glucose levels well when you consume 75g of glucose syrup on an empty stomach. All pregnant women are offered the GTT around Week 27-29 when the placenta produces more of the hormones that cause insulin resistance. High risk women like me who have a family history of Type 2 Diabetes and Chinese-Vietnamese descent are given the GTT around Week 14-16 once the placenta has formed. From what I've gathered, women who had gestational diabetes are given the GTT in Trimester 1.

If you're going for a GTT, make sure you follow the preparation guidelines carefully so you don't accidentally skew the results and get misdiagnosed. Your pathology lab should give you an info sheet specific to their testing requirements, but here is a general guide if you want to learn more: https://www.healthdirect.gov.au/blood-glucose-test

The irony is I was working in a product team building a pathology booking system when I got pregnant. Pregnant women are treated like pin cushions we are sent for so many blood tests in Trimester 1. I went from researching what pathology patients need to being a regular pathology patient.

The GTT is a 2 hour+ test. When you arrive, usually first thing in the morning as you need to fast for 8-12 hours. If you fast for longer, your body may do a glucose dump and cause you to fail the fasting blood glucose level test and be diagnosed with diabetes, pre-diabetes or gestational diabetes depending on why your doctor sent you for the test and your medical condition.

Some people abhor the test and feel sick from the glucose syrup. I was thankfully not one of these people. After my fasting blood vial was taken, I sipped my 75g of glucose in a 10 minute window without issue. The pathology collector set a timer for 1 hour from my fasting test and at the one hour mark, another blood vial was taken. Another 1 hour timer was set and at the 2-hour mark from drinking the syrup, my third blood vial was taken and after checking I was feeling OK, they sent me on my merry way with cotton balls taped to both arm nooks. They rotate arms for the GTT so one arm gets pricked twice at the fasting and 2 hour mark, and one arm gets pricked once at the 1 hour mark.

I failed my GTT at 16 weeks pregnant, and have been diagnosed with gestational diabetes due to my 1 hour test results based on the diagnostic criteria below, as I had a 10.7mmol/L result. My fasting and 2 hour results were fine.

International Association of the Diabetes and Pregnancy Study (IADPSG)

0 h ≥ 5.1 mmol/L
1 h ≥ 10.0 mmol/L
2 h ≥ 8.5 mmol/L

Our fertility and pregnancy experience

When people say you're glowing in Trimester 1, it's the sheen of sweat that is reflecting light off your nauseated forehead. The good news is that for some of us, including me, this sweat does actually become a glow in Trimester 2 once you stop feeling sick all the time and are instead flushed with the 40%-50% extra blood circulating around your body, making you feel overheated, and putting you at risk of varicose veins, high blood pressure and other fun, potential pregnancy symptoms.

My early pregnancy symptoms in brief:

Sore boobs - a constant dull ache and they keep on growing
Sleep deprivation - I used to sleep like a log but no more
Frequent peeing - including at night, which added to lack of sleep
Fatigue - the most tired I've ever been in my life. Pulling all-nighters and 6-day camping music festivals have nothing on pregnancy fatigue
Gas - constantly bloated and gassy. Farting myself awake was a fun, new experience
Nausea - constantly needed plain carbs to settle my belly
Pimples - a smattering of hormonal pimples along my chin line
Sciatica in both legs - this is why they recommend sleeping with a pillow between your knees to alleviate pressure on the hips during pregnancy. Learned the hard way. D'oh.

I only vomited twice and that was before I knew I was pregnant. The first time I threw up was during a Diablo 4 gaming session. I don't normally get tension headaches but Boyfriend Pham does so we assumed I'd just been tense at the computer for too long. The second time I threw up was the night I found out from the GP via an email that we were pregnant. I went out to dinner for Girls Night, ate pho, had indigestion all night then finally threw up in the morning and took the next day off work.

This is what I craved early on:

Breakfast - must have cereal as soon as I get up to combat nausea
Oranges - 3kg bag nearly every week
Bananas
Kiwi - out of season so that was an expensive phase
Strawberries
Vegemite on toast
Eggs and toast
Plain crackers
Crackers and cheese
Hot chips
Cheese and butter sandwiches, later I craved pickles and cheese sandwiches
Vinegar - on salads mostly, but sometimes I'd drink a mouthful
Could not stomach red meat for 2+ months

Of the girls night crew, I had the worst Trimester 1 experience. In hindsight, I think it was the gestational diabetes / pre-diabetes because my pregnancy cravings were all high GI, mega blood glucose spiking foods like plain cheese sandwiches with butter and white bread, or plain hot chips soaked in tomato sauce. Fatty foods made me feel sick, flavoursome foods like curries made me feel sick. I somehow managed to not throw up, though, even when I thought I might. I was mega nauseous and plain carbs seemed to be the only thing to settle my stomach. But then I'd feel tired and exhausted after food and need a nap.

Our fertility and pregnancy experience

Our 2cm bean at 8 weeks.

For someone trying to get pregnant for a number of years, I sure was oblivious to what pregnancy actually entails. I knew that you did an at-home pregnancy test and then should get a blood test to verify any positive results. And then...?

I went to my regular general practitioner doctor (GP). He is very considerate and attentive when diagnosing general health problems but he is not an antenatal specialist so wasn't across the nuances of early pregnancy. I've since come across a checklist that would have been handy for both of us to know and work through together.

I am in Queensland, Australia and at my first public hospital midwife appointment, I was given a printed version of the Pregnancy Health Record and told to take it to every medical appointment from now on. Pages 12 to 13 are a handy breakdown of what you'll be chatting to healthcare professionals about during the different weeks of pregnancy. https://clinicalexcellence.qld.gov.au/sites/default/files/docs/clinical-pathways/pregnancy-health-record.pdf

A summary of my pregnancy scans and tests up to Week 20 (the halfway mark!):

Blood test to verify pregnancy.
Blood test to check immunities and potential risks if not immune.
Scan 1: Early pregnancy scan to check embryo growth. My GP recommended week 8-10 to also get bub's heart rate.
Scan 2: The "Week 12 Scan" is a Nucheal Transparency (NT) to check the fetus' growth.

This one is a biggy because your baby has developed vital body parts and functions and the remainder of your pregnancy is further developing what's been established. The risk of miscarriage dramatically drops if your baby has all its bits and bobs in order.

Before your scan, you need to do a PAPP-A blood test 4-5 days in advance so the radiology team can get a copy of the blood results before your scan.

Optional NIPT genetic screening blood test that is not covered by Medicare. Cost ranges from $500-$700 from the few pathology companies I looked up in Queensland. NIPT blood test needs to be done up to 7 days in advance as it's a specialist test and may take longer to process. I opted to pay for the NIPT for peace of mind but to also learn the baby's sex (finding out the gender is an opt-in tick box on the request form, you don't have to find out if you don't want to).
Hospital referral from your GP - You need to decide whether you're going public or private and nominate your preferred hospital.
Hospital care options - You need to choose a maternity care option. I was offered shared care with my GP and hospital midwives, midwives only, or specialist care. I went with midwives only since I was a fairly low-risk pregnancy. That, and my GP seemed glad to refer me away from his care because I had questions he sometimes couldn't answer. I later got bumped up to Specialist Care with a little more involvement from the hospital's obstetrics team. More on that another time.
Scan 3: The Week 20 Scan is the last major milestone for the first half of pregnancy.

The scan checks baby's growth and takes measurements and images of the baby. You can also learn the baby's sex at this scan if you didn't learn earlier. If baby is healthy and mumma is healthy then I'm told women are mostly left to their own devices until the Week 26-28 glucose tolerance test (GTT). Then don't continue growth checks until Week 32+ onwards.

Me? Unfortunately, I got diagnosed with gestational diabetes in Week 17. I did my GTT early because being part Chinese put me in the high-risk category. I will write about gestational diabetes another time though, because it adds a whole new dimension to my pregnancy experience.

My left ovary that gave us two frozen embryos and our miracle 'natural' pregnancy embryo.

Our fertility and pregnancy experience

We decided to freeze our 2 viable embryos rather than do an immediate embryo transfer because I was so bloated from the IVF medications in March. Then in April, I had food poisoning, head colds and aching ovaries; it was just not a good time to schedule an embryo transfer because I wanted to be in good health to improve our chances of success. Even though I've heard from women who fell pregnant while they were sick as a dawg.

We let April come and go. My cycle was warped from all the IVF hormones and my usual 28-day menstrual cycle was a whopping 39 days. We decided my next cycle would be our first attempt at an embryo transfer. I had progesterone meds stocked up in the fridge - it is used to thicken your uterus lining to increase chances of the embryo embedding successfully, and got my medication plan from the fertility clinic in anticipation. But then my 28-day cycle came and went. Then my new 39-day cycle came and went. I had spot bleeding the weekend V came to visit and that usually means my period will start a few days later. But it didn't.

Then one Girls Night, Little Sissy Pham suggested I take a pregnancy test. She'd given me the tests she had from when she got pregnant with Nephew Pham. That Saturday morning I peed on the stick and was shocked to see the little plus symbol. Part of me couldn't believe it so I read the instruction box and saw that IVF medications can mess with results. I went downstairs to tell Boyfriend Pham. We were both surprised and happy, but unsure. I wish I'd researched it further before I told him that IVF meds can cause a false positive, which dampened our celebration somewhat. But IVF hormones stay in your system for approx. 10 days. It had been over a month since I was on those meds so we were very likely pregnant and could have been less reserved in our happiness!

Anyway, I went to the GP and asked for a blood test to confirm. One evening while taking the train home together I read an email from my doctor. He'd circled something on my blood test results and had scrawled, 'CONGRATS!' And that's how we learned we were definitely pregnant at 7.5 weeks. The doctor was surprised I hadn't tested sooner, but honestly, I was so focused on the embryo transfer, and in denial because we'd been trying for years without success - why would I be lucky enough to get pregnant now?

I am so blessed that we got pregnant 'naturally.' I put that in quotes because I am convinced the IVF hormones helped our cause. The only other life change was Boyfriend Pham left a toxic work environment for a very supportive new workplace. Maybe it was a combination of both - my body needed the fertility hormone boosts and Boyfriend Pham needed less stress. Whatever it was, I am so very grateful for our miracle embryo. My spot bleeding from a couple weeks back had been the embryo embedding into my uterus lining.

Next up: Pregnancy scans, tests and holding my breath between key milestones, willing my little embryo to stay healthy and keep growing.

Our fertility and pregnancy experience

The egg and sperm collection process was straightforward. The hormone injections were physically challenging but it was the wait for viable embryo news that was mentally challenging because it's out of your hands at this stage. It's up to science and luck.

I had my egg collection on a Wednesday and flew to Melbourne that Saturday to visit Phamly because Little Sissy Pham wanted her son to meet the Aunty we lived with for 2-3 years to finish high school after The Phamly moved to Brisbane. I didn't need to be there, really, but Little Sis is sentimental and wanted me there so why the hell not? I was mega bloated still from the meds but the soreness was gone.

On Friday, I received a call from the clinic to say of the 19 eggs they collected only 8 were mature enough to progress. Boyfriend Pham and I had opted for ICSI where they inject the sperm into the egg rather than placing the egg into a culture with the sperm to naturally try and fertilise, because we wanted to control as much of the process as we could. However, of the 8 mature eggs, they only injected 2 successfully, another 3 failed to survive the injection because they weren't mature enough and were too soft. The last 3 eggs they put in a culture to fertilise naturally.

It was disheartening to learn less than half the eggs collected were usable and we only had 5 chances at a viable embryo. I kept telling myself that we just need one good one to proceed, even though, mathematical me knows our odds are better with more than one shot. And so, it was a blessing that I had an impromptu trip to Melbourne with my nephew and his parents to distract me. Our next update would be on Monday. The weekend days were fine because they were filled with family, travel and feasting, but when I went to bed at night I missed Boyfriend Pham and was anxious about embryo news.

On Monday, I missed a call while on my way to visit Little Sissy's friend and her new bub. I called back and got the happy news that one of the eggs had developed into a healthy embryo, and there was one more they were monitoring its development. Unfortunately, the other three did not fertilise. They would update me the next day. One out of 19 so far. Sigh. Still, I told myself. Better than none.

The next day, Tuesday, we flew home. Our flight was delayed over an hour so we were stuck at the airport with a 1.5-year-old to entertain. Fortunately, our flight wasn't on time because while we were sitting in the food court trying to convince Nephew Pham that his Happy Meal box was the most entertaining toy in the world, I got a call from the clinic.

I remember this moment so clearly because Nephew Pham was watching me intently while I was on the phone and as I started to smile, he started to smile. By the end of the call, I was grinning from ear to ear and when I happily thanked the scientist for letting me know that we have 2 viable embryos, Nephew Pham read my emotions and started to cheer and wave his arms. It was such a happy memory. We'd doubled our chances for an embryo transfer, and Nephew Pham was cheering for what could be his future cousin!

Two out of 19 is not a great result, but we'll take anything we can get. I'm 39 years old and next year my fertility takes a statistical nose dive, which will make the odds forever not in our favour. I've had friends go through multiple egg collections with no embryos at the end of it. I've had friends who go through egg collections and get 5-8 viable embryos. Results feel random because there are so many factors that impact fertility.

Next up, scheduling an embryo transfer...

Our fertility and pregnancy experience

We had our first round of IVF egg collection in March 2023 after 11 days of not-very-fun belly injections for the wannabe mum. We had the option of doing the egg collection knocked out in the hospital or mild anaesthetic at the Life Fertility clinic. I opted for mild anaesthetic at the local clinic because I'm not particularly fussed by a pap smear, colposcopy or any other procedure that some women find invasive and distressing. Also, I am cheap and do not want to pay hospital and anesthetist fees unless I really have to.

On the day, I had to fast since nobody wanted me throwing up from the green whistle (anesthetic) I would have before the procedure. Boyfriend Pham drove us there since I'd be too woozy to drive after and he had to provide a fresh sample of sperm - double duties. I just had to rock up, strip off my bottom half, put on a medical gown with an open back and sit in a chair.

We arrived an hour before my procedure was scheduled, and Boyfriend Pham went first. When they called his name, another guy stood up and also approached the nurse. We were very confused since the guy's name turned out to be Ryan, which didn't sound anything like Boyfriend's name. The nurse took Boyfriend to a private room and checked his name and DOB a half dozen times to be sure she had the right person before he was left to produce sperm.

A half-hour later, it was my turn. I was taken to a second waiting area where my blood pressure was checked. The nurse then walked me through the post-procedural area where I saw a handful of dazed women in recovery chairs. I was quite happy to see them eating snacks. I was hungry. Then I was in the procedure room where there was a chair, screens, trays of medical devices and two friendly nurses. One was there to give me the green whistle and help me through the procedure. The other was there to assist the doctor. A scientist in the room adjoining popped his head in to say hi and let me know he'd be checking the eggs as they were collected.

When the doctor and his student doctor arrived, the nurse gave me the green whistle. I quickly started to feel light-headed and was soon giggling away. The doctor showed me the many follicles I'd grown on both ovaries. Once it was clear I was feeling the effects of the green whistle, the doctor applied the local anaesthetic. The injection hurt a bit but not much.; I barely noticed the procedure had started. The doctor started retrieving the contents of the follicles using needles. A nurse would take each tube to the next room where the scientist would check the contents for eggs and call out the count as we went.

Once the doctor was done and gone, the nurses packed up while I sat there for a little bit. I was still lightheaded but felt OK to walk so told the nurse I was ready to get dressed. They provided pads in case there was any spot bleeding but I'd worn my period undies so didn't need one. In the recovery area, I sat in a comfy lounge chair, applied a heat pack to my lower belly and stared longingly at the packet of potato chips I was given but couldn't eat because I was too tired.

At some point, the doctor walked through with another patient and called out that I must be OK because I was smiling. I don't know what I was smiling about - maybe dreaming of eating. After a short rest, I told the nurse I was ready to go home. She gave me a take-home heat pack and instructed me to take Panadol at home if needed for the pain. Boyfriend Pham greeted me in the main waiting area and I made him do a pit stop at a fish & chip shop where we dined in with my little heat pack and a funny walk. At home, I curled up on the couch and took some Panadol. I was a bit achey but it was similar to a bit of bad period pain. Nothing major.

One more thing worth mentioning is the anaesthetic makes you mega constipated so make sure you have poop-friendly foods like prunes.

All up we retrieved 19 eggs, which I'm told is on the higher end of the scale. Though, what matters most is the quality. That will come in my next post about the wait for embryo news.

Our fertility and pregnancy experience

After spending 2022 trying to figure out why we weren't pregnant, we started this year trying to make viable embryos.

2023 did not start off well for me. In January, I had my initial IVF appointment and had to get some blood tests. In February I had a hives breakout that wiped me out and then because my immune system took a beating, I immediately got a cold as soon as I started to overcome my allergy symptoms, followed by a bout of food poisoning. The worst part was, during the initial appointment, my new fertility doctor was baffled as to why my previous doctor put me on thyroid medications when my blood results showed I had normal thyroid function. Serenity now!

I had to delay my egg collection because my blood results came back with a high level of a stress hormone, which was explained away by my allergies but we still had to wait until I was well enough to begin the IVF medications. The nurses sent my script to a specific pharmacy in Spring Hill, Brisbane. I could either pick it up in person or have it couriered. I opted to go get it and I'm glad I did because the pharmacist ended up stepping me through the injection process. I still watched instruction videos but I always feel better with in-person demos.

There would be 10-12 days of injections depending on my cycle and when the doctor was available for consultation. Keep in mind when reading the below that there are different types of IVF hormones and doses - it's all catered to your specific needs so don't read this as a standard medication plan - it is what was best for me.

I had 11 days of Ovaleap 600IU injections to grow my follicles and increase the number of eggs to increase my chance of having some healthy eggs. I did not enjoy the injection pen. It had a sliding mechanism that made it go from 1 to 100 in speed, and the sudden shot of fluid into the belly hurt. This one gave me bruising most of the time.

From days 8-11, I started a second injection of Ganirelix / Orgalutran 250mcg to stop my eggs from being released from their follicles. This medication came with a slightly bigger needle tip but thankfully was a regular push syringe so I could control the speed at which I injected myself. By now, I was very bruised and tender so while I don't think this one bruised me, I was achy overall from the pen injections.

I am grateful my cycle meant I could get my scan on Day 11 and I skipped the last day of injections. On Day 11, my doctor did an ultrasound to confirm the meds had worked a treat and I had many follicles on both my left and right ovaries. He booked me in for an egg collection two days later. The night of the scan I injected myself with 2 syringes of Decapeptyl exactly 36 hours before my collection was scheduled.

Even though I dread the thought of doing another IVF round, the bruising and tenderness were probably the best of the side effects from the hormones. I experienced every common side effect listed on the warning labels and the severe and rare side effects as well. My symptoms ranged from standard bloating and gas to redness, soreness then my favourite: hives on my chest and neck. I contacted the clinic about the hives and ended up taking antihistamines and an ice pack. After the first couple of days, my body adjusted and the hives went away.

The scariest side effects were on the night of Day 8 when I first injected the Ganirelix. I injected myself at 7am each morning, and by 3pm that day I was feeling nauseous and bloated. By 6pm I was short of breath and had developed huge cankles to the point where when Boyfriend Pham came home, I got up to greet him and he said, 'Whoa, I think you should sit down.' So I did. I sat back on the couch and elevated my legs and pondered whether this was the rapid weight gain that I was meant to seek immediate medical help for.

I decided that if I went to emergency now on a Friday night and I wasn't in immediate danger then I'd wait around for hours while people with more urgent health issues were seen before me. So I would go in the morning after some sleep. I'm glad I did because I woke up to find my swollen legs and ankles had started to deflate. The next injection of Ganirelix didn't have the same side effects so I assume my body had just needed a bit of time to adjust to my new hormone levels.

As always, if you have any questions about my experience, feel free to email me via the email icon top-right if you aren't comfortable commenting.

Our fertility and pregnancy experience

Fun fact: Boyfriend Pham sent me the 'how is prangent formed' video while we were office buddies and we both laughed deliriously - who knew we'd be trying to get prangent together a few years later. I was clueless about how is prangent formed when Boyfriend Pham and I first started trying beyond the general birds and bees talk. By ‘trying’ I mean we stopped avoiding pregnancy. My first GP doctor said to try for 6 months before seeking help. My second GP said to try for 12 months. All in all, we tried for over a year before getting a referral to see a fertility specialist.

The first fertility specialist we went to was part of the Monash IVF group as one of my friends was using Monash IVF at the time and recommended them. She put Boyfriend Pham and me through a bunch of blood tests. Boyfriend Pham did a sperm test and I had the fun experience of having contrast fluid shot up my uterus in a hysterosalpingography (HSG) X-ray to see if my fallopian tubes were blocked. All our results came back good. There wasn't anything obvious stopping us from falling pregnant naturally.

After 8 months, I still didn't know why we couldn't become pregnant. Even though there's a lot of information out there about fertility and ways to boost fertility, I figure there isn't much research into the root causes of infertility because IVF exists as a workaround.

We were given the option to do artificial insemination as a next step, but during the paperwork process, the fertility specialist encouraged me to jump straight to IVF because I was 38 and about to turn 39 soon. Age 40 is an egg quality cliff for women better to sign up for IVF now in case it took a while. She specialised in private IVF but knew money was a concern for us so told me to get a referral to a bulk bill IVF clinic.

I went home and picked a bulk bill IVF centre based on location. I'd heard good things about Adore Fertility but they were across town, and I wanted convenience so I picked Life Fertility in Bowen Hills as it was closest to home. I read reviews that had mixed vibes about Dr Glenn Sterling, but I figure I'd judge for myself when I met him. At my first appointment, I realised why he may rub some people the wrong way. Dr Sterling has a great sense of humour and is big on Dad jokes, which is allowed because he's a father. I can see how some couples felt he was disrespectful or confronting for making light of a serious life situation. However, I love that he can share his medical knowledge while making me laugh because I'm someone who prefers to laugh at uncomfortable things than stress or cry. I really enjoyed the humour and the lighthearted way he explained how my body works and the somewhat daunting process it was about to go through.

It wasn't until we started IVF that I began to understand the timing, logistics, and magic that goes into creating life.

Next time on Keep it in The Phamly... IVF hormone injections and symptoms. Spoiler: I did not have a good time.

Our fertility and pregnancy experience

There are some experiences in my life that I don't fully understand, and this is one of them. I used to love supernatural, ghostly, ghastly movies as a kid, but at some point, I stopped being able to stand the creepy feeling and it's because I had my own unexplained paranormal experience. Horror movies, I can do. But paranormal especially when it's in the home or modern-day buildings? No, thank you. Nah-uh.

It was definitely not sleep paralysis, which is a common scientific explanation for what I saw. I've had sleep paralysis where I knew I had been asleep and woke up and felt like I was sinking into the mattress and couldn't move. This was different.

I was wide awake reading the latest Wheel of Time book by Robert Jordan. It was 2-3 am in the morning (uni life, I didn't have to get up early unless I had a morning class) and ever since I'd gone to bed that night at about 1 am to read I'd had this creepy feeling that something wasn't right. At one point I noticed a gross, giant cockroach in the corner of my bedroom and thought maybe that creepy feeling was from that - I loathe cockroaches, I'm just glad even though they can fly that they usually prefer to scamper around on the floor where I can evade them.

I tried to brush off the feeling but it wouldn't go away. I was laying on the left side of my bed by the bedside table and lamp. I continued reading and at one point, something told me to look to my left to the open floor space next to my bed. That's when I saw him. Somehow I identified him as he. He had no definable features - no face and no hair. He was like a 2D flat black shadow figure that didn't cast a shadow. He had a clear outline that wasn't a hard line or blurred, instead, his edges seemed to shift with energy even though he stood completely still. I could make out a bald head and chin, and I'm not sure if I saw the ridge of a straight nose as my head moved angles.

I saw his black shadowy waist first standing next to my bed. My head and eyes travelled upwards until I was looking at where his face would have been. His head was angled and his neck curved in a way that made me feel he'd been standing there a while observing and assessing me. And I'd only just been able to see him now after sensing him all night. I don't know what he was assessing me for but I had a dreadful feeling in the pit of my stomach that I did not want to match whatever criteria he was searching for.

We stared at each other for maybe 10 seconds before I looked down at my book and snapped it closed and hit him with it, but when I looked back to take a swipe he'd disappeared and the feeling of dread went too. It was like a weight suddenly lifted from my shoulders. I kept the book closed, only a little aware that I'd lost my place, shoved it on my bedside table, and dived under my blankets. I slept with the light on that night with my head underneath the blanket and peeped out now and then even though I felt he wasn't coming back I just wanted to make sure.

The creepiest part of this experience was later that week, we were chatting with my neighbour and her daughter, whose bedroom faces mine, had a similar encounter. This Shadow Man seemed to be moving from house to house that night hunting something - perhaps weakness? - in young people. A way inside to possess or influence us in a bad way? I don't know.

I've since learned that Shadow people are fairly common sightings. Though, other reports commonly include red eyes, hat and cloak or jacket. My Shadow Man had no apparel, no hair, and no eyes. He was just an outline and even though he was very still, the blackness seemed to be energised and moving. It's hard to describe. I can still visualise the shadow that wasn't shadow. It wasn't still. It felt like it was moving sharply and sporadically - there was no discernable pattern to how the blackness shifted.

I've been thinking about him lately after listening to the first episode of the Otherworld podcast and being reminded about Shadow people. I try not to think about this experience because I don't want to invite this type of energy back into my life. I like my world to be simple and not scary and unexplainable.

Written February 12, 2023: Oh boy. Did I have an un-fun lesson to learn in February this year. I thought I was doing so well looking after my health proactively, and then one day of back-to-back Zoom meetings in peak Brisbane humidity and heatwave - BAM! That itch on my chest, which I thought was just my sweaty tee rubbing my skin the wrong way turned into what I assumed was a heat rash, which turned out to be the beginning of a massive hives breakout, which could have been a lot quicker to recover from if I'd just made the time to go to the doctors instead of putting it off for work meetings. Ah! Why do I never learn?!

The first doctor looked at me and immediately knew I was having an allergic reaction to something. Most likely food because it started along my chest and neck. He sent me home with an order to get Zyrtec and an eczema cream for eczema that had started forming in my sweaty inner elbows.

That night, as if to punish me for not seeing the doctor sooner, my hives spread to my arms and legs and belly. The only safe zone was my back - thank god, I had an angle to sleep on even though it meant that I snored. Sorry Boyfriend Pham! I took a day off work to sit on the couch and feel terribly itchy and uncomfortable in my own skin but it kept getting worse. I tried to see my doctor again but he was booked out and not available for another 5 days. No way was I waiting that long!

I went to another doctor and he also immediately knew I was having an allergic reaction to something. He speculated it could be something in my environment since it was my whole body and advised me to wash my bedsheets and cotton tees in plain hot water since it could be a change in the formula in my washing detergent that set me off. He then told me to ditch Zyrtec and go with Claratyne as that antihistamine is stronger (the first doctor said the same thing about Zyrtec... does anyone know? Or are they stronger for different things?). Anyhoo, the second doctor also sent me home with steroids (Prednisolone) to help reduce my inflammation and calm my immune system down.

I had almost instant relief with the steroids. A few hours after my first dose I stopped wanting to claw my way out of my own skin. The next day my raging red hives faded to pink and no longer burned hot to the touch. I am only on Day 3 now and am learning that I have to do everything I can to avoid feeling warm and getting sweaty because it triggers the dreaded itch and irritates the hives.

I have a week-long work trip to Sydney tomorrow. It's going to be an uncomfortable work trip and, while I wish I could postpone, literally everyone in my team is flying in for the event. I don't want to put work first all the time, but for the most part, I'll be sitting comfortably in air conditioning in a training room or an air-conditioned airport or plane or taxi. I will let you know how the rest of my recovery goes and whether I am forever like this once I'm off the course of steroids.

I strongly suspect my allergic reaction was to excessive sweating on that fateful Wednesday when I didn't turn on the fan let alone the air-con unit while I jumped from one Zoom meeting to the next without a break. My body has been running hotter and sweatier since I started taking thyroid meds and I think that contributed to this mess.

But boy, being allergic to sweat in humid Brisbane is not going to be a fun life if this is my new normal. Wish me luck!

April 22, 2023 update: So, when Doctor 2 asked me if I had any recent changes in medicine I didn't realise that 'recent' in health terms meant 3+ months ago. I'd started thyroid meds approx. 3 months before my hives appear and someone at work (in healthcare, he's not an unqualified mansplainer) said it takes about 3 months for meds to update blood levels. So, yup. I don't think I'm allergic to my environment. I'm allergic to whatever the thyroid meds triggered in my body. Fun! I am now off those meds.

Once upon a time, my casual clothes were my work clothes because people in the fashion and music industries avoid having to grow up. I've since changed industries and gone from one wardrobe to three. Casual clothes, work clothes and Zoom video conferencing clothes.

When I'm in the office, I wear semi-corporate wear. Pencil skirts, blouses and brogues. It's not mandatory in my office; people wear a range of casual to corporate outfits. Semi-corporate is my preference after a lifetime in casual wear. It's fun to try new things. That said, I don't quite blend in with the rest of the work crew. A project sponsor introduced me to someone recently and explained I used to work in fashion, that's why when you look around the office I stick out like, "Bing!" he points his index finger straight up, with my colourful outfits and make-up. Glad you know you can take the girl out of fashion but you can't take fashion out of the girl.

When I work from home, I wear my Zoom outfits. Zoom outfits include mini dresses and skirts that I used to wear to work because I was into less modest fashion. Now I'm rounder than I used to be the same dresses and skirts ride up more than they used to, and I don't feel professional flashing my undies around the office. But on Zoom? People wouldn't know if I didn't have pants on so minis are good. They also don't know that this is Rei Pham's Zoom position. She will eventually lay down but she likes to start our day off blocking my screen.

Some folks wear tees verging on pyjamas when they work from home but I did that once upon a time and after a while felt really frumpy. So, I wear Zoom work outfits where I look professional on top to work from home. The only time I've gone extra casual was yesterday when I was recovering from allergies and had all-over body hives and swollen face (a story for another time) - no way was I putting on anything but a loose cotton tee and loose gym shorts.

My casual clothes are now just casual for weekends and the odd weeknight evening out. Though, usually, weeknights are gym gear then PJs.

I have spent this year collecting all the viruses and bugs I avoided during lockdowns and social distancing. I am just coming out of a bad run of COVID-19, then gastro (why is vomiting so ew, where is this gas coming from? I'm not even eating!), then a not COVID-19 virus (where my head and feet were freezing cold then burning up but my body was fine - it was super weird). Days turned into weeks, then weeks turned into over two months of feeling sick. Thank golly I can work from home because that would have been a lot of unpaid sick days. The irony is I caught my viruses each time I tried to get healthier by going to the gym. Joy!

It's not really the gym's fault. It's mine. Over the past couple of years, I've not been taking good care of my health. Generally feeling rundown was written off as lockdown blues but when Australia started opening up again and life returned to somewhat normal, I was still feeling like crap. I had moved away from home turf in the south to the north side, was avoiding medical services because of COVID fear, and didn't have my local anythings including a General Practitioner. So for a number of lame reasons, I didn't get my health checked for too long.

When I finally went to a GP, the doctor did a general health check including blood and urine test. I learned I've been Vitamin D deficient, low in B12, iron, zinc and more. I'm now on a concoction of vitamin supplements and also taking melatonin at night to help me get better quality sleep. I have my fingers and toes crossed it'll help, but it's early days and also hard to tell if I'm improving when I've had back to back viruses.

If you haven't connected the dots already... I keep getting sick because my immune system is shot. Now, I'm not saying this as an employee of a healthcare company that offers pathology services. I'm saying this as someone who believes getting diagnosed leads to treatments that will better your health. If you haven't had a general health check in a while and feeling a bit off, listen to your body and go see a doctor. I wish I'd done it sooner and given my immune system a chance to help me recover quickly from illness or fend off the viruses altogether.

Sigh. You live, you learn, right?