KEEP IT IN THE PHAMLY

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:

1. Sore boobs - a constant dull ache and they keep on growing
2. Sleep deprivation - I used to sleep like a log but no more
3. Frequent peeing - including at night, which added to lack of sleep
4. 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
5. Gas - constantly bloated and gassy. Farting myself awake was a fun, new experience
6. Nausea - constantly needed plain carbs to settle my belly
7. Pimples - a smattering of hormonal pimples along my chin line
8. 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:

1. Breakfast - must have cereal as soon as I get up to combat nausea
2. Oranges - 3kg bag nearly every week
3. Bananas
4. Kiwi - out of season so that was an expensive phase
5. Strawberries
6. Vegemite on toast
7. Eggs and toast
8. Plain crackers
9. Crackers and cheese
10. Hot chips
11. Cheese and butter sandwiches, later I craved pickles and cheese sandwiches
12. Vinegar - on salads mostly, but sometimes I'd drink a mouthful
13. 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!):

1. Blood test to verify pregnancy.

2. Blood test to check immunities and potential risks if not immune.

3. Scan 1: Early pregnancy scan to check embryo growth. My GP recommended week 8-10 to also get bub's heart rate. 

4. 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).

5. Hospital referral from your GP - You need to decide whether you're going public or private and nominate your preferred hospital.

6. 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.

7. 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

Let's take a break from my IVF and pregnancy experience to talk about stupid home automation. We have lights and hub from the Phillips Hue range on a tech friend's recommendation. The Phillips Hue Bridge connects to and controls the Phillips smart bulbs - there are more advanced options with motion sensors, but we wanted to start with the basics.

I love the idea of home automation in theory. The reality is, that you probably need programming skills to set up actually smart home automation. The current settings and rule options in our "smart" lights remind me of clunky eCommerce store sales rules logic where a programmer built what they could and not what they should, limiting the options to end users like me.

We wanted to set up smart lights that would:

1. Turn on at sunset each day. Tick.
2. Fade and turn off by a certain time of night. Took 5 routines to set this fading effect up, but - tick.
3. Turn on when one of us comes home after dark. No tick.

I didn't think it'd be impossible to set the lights to only turn on when it's dark / after a certain time but apparently, it is. The option was to turn on the lights regardless of the time of day whenever one of us arrived home, or nothing at all. Our house is bright and we don't use lights during the day so we opted for nothing at all. Otherwise, we'd end up turning the lights off multiple times a day instead of turning the lights on occasionally when we arrive home after the fade and turnoff routines have run at night.

Hopefully, the software will improve over time. For now, we've settled with having dumb smart lights with limited usage and Boyfriend Pham just yells at Google to turn the lights on. I'm waiting for maternity leave to remove work apps from my personal phone so I can enable Google Assistant voice activation - currently, they're disabled for work security reasons and I'm too lazy to carry around two mobile devices so I sacrifice my right to Google voice. Dumb, smart me.

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