Buying live prawns in Jakarta (Warning ahead: TMI)

Whenever I go to the wet market in Mayestik, I'm always fascinated by the fishmongers who have live prawns for sale. Of course these are pretty small prawns. We are talking about a cooked size of between 2 - 2.5 cm in diameter, but I love to have them in stir-fry dishes with vegetables for instance. So last week when I was there, I decided to buy 1kg which cost me IDR 60k.

When I got home, I gave them a rinse (and they are still alive!) and begin to peel off their heads. Took awhile to get over my own initial awkwardness of "beheading" them (and thinking that they must be saying "Don't peel my head off"), but kinda got used to it. One thing I noticed that with live prawns, their heads is surprisingly very strongly attached to their bodies. A very different tension compared to "beheading" dead prawns. And of course, there were a couple of them walking and swimming legs that were still twitching out of involuntary reflexes after they have been beheaded!

Well you can't get any fresher than these...

Before:

The aftermath: 

The Birds of Jakarta

A very reliable way to get around Jakarta is via the Blue Bird Taxi Group. With Blue Bird, one hardly goes wrong. Drivers are courteous, they apologize if they accidentally took a wrong turn and had to make a longer route (happened to me!) and all major shopping malls in Jakarta usually have a dedicated queue for Blue Bird taxis.

For economy prices, go for the blue color taxis. I remembered once I decided to fly into Jakarta quietly without telling Hubs, with the intention to surprise him. That was really my first time of taking a public transport over here. As soon as I exited the airport, I feverishly searched for the turquoise blue bird logo. At the airport, hailing a taxi can be chaotic. And if you don't keep your wits around you, you may end up with a less reliable taxi service. I nearly got touted but stood my ground and insisted my blue bird. Phew! Close call...

If you have a bit more cash to spare, there's the executive class called Silver Bird. These taxis are almost exclusively Mercedes Benz. And they go back black colour with white "Silver Bird" wording. Pretty executive I would say. Price-wise, slightly more premium, but I don't think it's a lot. Maybe after USD, it's probably few bucks more premium that the blue ones. Personally, I have not sit in any of these, but I heard some of the drivers can speak some English. So not too bad a way to travel, if you need some local commentary. 

I have also found out pretty recently that Blue Bird group have apps supported by iPhone and Android for you to order your taxi. I have since downloaded it for just-in-case, but have not personally experience its reliability. But from what I heard, it was quite ok.

And this is one sure way to travel.  What happens when you need a big people carrier? Well fret not, coz Blue Bird has just the solution. Say Hello to Big Bird! :))

Kopi Luwak Reeducated

Last Thursday, I was lucky enough to tag along Hubs to meet up with his friend to understand more about kopi luwak supply here in Indonesia. This friend i.e. Pak B. was the same person whom we bought our first packet of kopi luwak from.

After braving the usual traffic congestion (what else?!) we finally made it to the meeting point, which was Pak's office-cum-cafe for potential business contacts to taste coffee samples. After the usual pleasantries, we finally got down to some kopi luwak tasting session. Me likey! :)

And so here they are. First up is kopi luwak robusta beans. I didn't realise that they classify them to this extent. My previous understanding of kopi luwak was just well.. kopi luwak - where coffee beans are just fed to the civet for them to be "processed" by the digestive juices of the civet to get that special taste that is kopi luwak. Personally I didn't quite like this. It had a kinda flat/neutral with a slight burnt taste to it. In fact, it reminded me of the Vietnamese weasel coffee that Hubs bought previously, which unfortunately we still have 4 packets sitting in the kitchen and nobody knows what to do with it. So probably the Vietnamese ones were produced using robusta beans.

And since we have kopi luwak robusta, we definitely must have kopi luwak arabica right? So here it is, and it had a very contrasting difference in taste compared to the robusta brew. It's difficult to describe exactly how it taste like but the arabica brew had a rounded taste that's both rich and delicate and definitely smooth and mellow. I took out my camera to snap both cups of coffee with flash just for fun and noted a difference in the colour of the brew. With the arabica - it was a clear brown liquid while with the robusta i was almost black. You can see it at the edge of the coffee cup, indicated by the yellow arrows.

Pak B also showed a few samples of the dried up kopi luwak beans. Ta-da...

It definitely looked a lot more processed compared to the ones I've seen in the farm in Bali. According to Pak, the civets are very picky eaters. Of course, these days we are talking about farmed kopi luwak for hygienic processing purposes. Once the berries are picked, they have to be served up fresh to the civets. And these peculiar animals will only eat the freshest (maybe in their taste buds, the highest quality) berries. If the berries are set aside overnight or even a couple of hours - sorry, it's reject goods.

I reckon this is probably the novelty surrounding kopi luwak - that these cats"pick" out the freshest beans that produce what is probably known as the most expensive coffee in the world.

Our IVF journey - Results day...

"Have you ever loved somebody so much, It makes you cry"
"Have you ever needed something so bad, You can't sleep at night"

Well the last line of this song sang by Brandy described me exactly the night before we were due to go to the clinic for our beta hCG test. I couldn't sleep at all, and can't help but to think how the day would be. Hubs had arrived from Jakarta that night to be with me when we go to the clinic the next day. I had some mild spotting that night but didn't think much of it since we were going to the clinic already.

On the morning of results day, things didn't look good. The spotting has progressed to mild bleeding. I informed Hubs immediately and begin to cry. After calming myself down, we went to the clinic anyway for my test. A visit to the toilet after the test revealed more bleeding. We went back to the clinic and informed the nurses. They gave me another progesterone injection and we begin our 2 hours wait for the lab results. I didn't even dare to go to the toilet because it meant that I have to face up to what I feared most in my heart. But I had to go anyway, and it just didn't look good.

I told Hubs that the bleeding has progressed to what I usually experience on Day 1 of menstruation. We even joked that probably it's best to know our fate like this, rather than hear it from the doctor. I just can't help tearing again.

Finally we heard my name being called. And it's a confirmatory no when we finally saw Dr Wong. He explained that probably the genetic makeup of the embryos may have been defective. Unfortunately, we won't really know that because we did not have enough quality embryos to start with. If we had more, the clinic could wait two more days and perform Day-5 transfer where for almost certainty, these Day-5 embryos would have better chance of implantation. Since we only had two viable embryos, the clinic couldn't risk waiting another 2 more days.

I've always thought that gynaecology clinics are such happy and joyful places, filled with beaming proud parents who are eagerly looking forward to that first confirmation of pregnancy, the first glimpse of the tiny beating heart on the ultrasound, the first visual confirmation of a baby boy or a girl, and so forth... However, this joy is not ours to bask in. Not yet anyway. 

Our IVF journey - The 2 weeks wait

I left the clinic with more ventolin tablets, progesterone pessaries and progesterone oily injections to ensure the uterus is conducive to support implantation and pregnancy. Our 2 weeks wait has started.

For the first 2 days after the transfer, I did not do anything heavy. My mom continued to stay with me to help me out at home with cooking and household work. On a daily basis, I had to take my ventolin tablets and progesterone pessaries. And every three days, I drove to a nearby clinic to get a doctor to administer the oily injections on my buttocks. Now that is one really painful injection. But Dr Ho, the lady doctor who did my injections was really nice, careful and gentle throughout the injection.

The nurses at the fertility clinic told me to eat normally, don't overstress myself and no heavy work. They also told me not to eat four types of fruits i.e. bananas, papayas, watermelons and pineapples. Apparently, these fruits have high level of serotonin that may cause uterine contractions.

Other than that, I begin to write from home, and try not to think too much or even reading too much into every symptoms or the lack of it that is indicative of pregnancy. But still I can't prevent the gamut of feelings that I went through - hope, anticipation, excitement, anxious, wondering and at times doubtful whether we would be successful.

Our IVF journey - Embryo transfer

Before we left the clinic after the eggs collection, there were more medicines to take. Specifically, they were Ventolin tablets to control uterine contraction, progesterone pessaries and progesterone oily injection to prime the body with lots of progesterone that is essential to support successful implantation and pregnancy.

My embryo transfer was scheduled 2 days from the eggs collection day, and in the meantime I had to start taking these medication to prep my uterus. As explained by the clinic, they will perform a routine Day-3 embryo transfer and if let's say there are a few fertilised eggs to select from, the clinic may do a Day-5 transfer where the embryos are more mature. Unless the clinic call me over the next few days to inform of a change, they will proceed with the routine transfer.

I had a Day-3 transfer. On the day of transfer, no prior fasting was required and since Hubs can't extend his stay, I had my parents came up to KL and to help me out during this period. Just before it was my turn to go into the procedure room, the embryologist explained to me that the clinic will transfer two Day-3 embryos.

We only had these two viable embryos because out of the 6 eggs initially collected, two of them were not mature enough and only 4 made it to ICSI fertilisation. After fertilisation, two of them did not get fertilised while the remaining two did and have already developed into 4-cells embryos of grades 8/10 and 9/10. I can't help to feel disappointed that we only had two but the embryologist explained that they were good grades embryos, so hopefully they will stick to the uterus.

About 45 minutes before the procedure, I had to drink 500ml of water. Apparently the reason for this is to ensure that the bladder is full enough (but not too full) so that when I lie down, the full bladder will help "straighten" out the uterus for ease of transfer. No anesthesia was required for the transfer and I was able to observe the whole procedure through the ultrasound. First the nurses showed me my embryos. And they were beautiful! Like in medical textbook. I was hopeful.

Then Dr Wong arrived for the procedure. When he saw the ultrasound scan, he had a "oh man" look on his face. He then explained to me what the procedure involves and that my uterus was a bit S-shaped and would be a bit tricky to maneuver. And then the procedure started. One of the nurses pointed out to me a blinking light on the ultrasound which is the transfer catheter containing my two embryos. And I watched them slowly making their way through the cervix and finally into the uterus where two small 'x' appear on the ultrasound, marking where Dr Wong finally deposited the embryos. I was overjoyed! We made it!

Our IVF journey - Eggs collection day

About a week before the scheduled eggs collection date, the ultrasound scan revealed that I had about 8 egg follicles of various sizes. Some were at about the right sizes already, although there were a few that were a little bit small. Hence Dr Wong up my dose of Gonal-F for all the eggs to reach the right sizes.

Hubs had to fly into KL for eggs collection because that was the day that the clinic had to collect his semen sample for fertilisation as well. The eggs collection procedure is almost like a mini-surgery, which meant that the night before I had to take some meds to completely empty my bowel and no liquids after 12am and no breakfast on the day itself. In the procedure room, the nurse helped me up onto a bed with an attached stirrup, which after that they tilted the bed to a certain angle until my legs were at a higher level than my head. As soon as the Dr arrived for the procedure, the nurses put me under gas anesthesia and that was the last thing I remembered.

The next thing I knew when I woke up was the end of the procedure where they have taken away the anesthesia. The nurses helped me onto another bed before pushinge into a recovery room where I promptly fell asleep again. I don't think I slept for long because I woke up suddenly, remembered that Hubs had to catch a flight later that day, promptly got dressed and made my way to the reception area to meet Hubs. In the end, the clinic collected 6 eggs that were of good sizes for fertilisation.

A small compliment

Well, I just couldn't resist putting this up, after such a long and hard day of work that also saw me meeting the ultimo CLIENTZILLA!

A small complimentary note for an article well-written by moi! :)

Our IVF journey - Finally it's IVF!

The Zoladex injection caused me not to experience any mestruation close to four months and this is really to temporarily stop any hormonal stimulation which is basically what endometriosis feeds on. When I finally got my period, I was so happy, and immediately called up the clinic to schedule an appointment.

After some explanation from Dr Wong about the protocol that he was going to use on me, and some discussion with Hubs, we decided to start our first IVF in September. Dr Wong put me on the long protocol which involved down-regulation of the ovaries first using a combination of oral contraceptives pills followed by daily injection of buserelin. After one month of this, I started another injection i.e. Gonal-F which is to stimulate the ovaries to produce more eggs. In a normal unstimulated cycle, a woman typically produces one to two eggs only.

I had to learn to administer these injections by myself. After the first few attempts, I kinda got used to it, although the Gonal-F injections were slightly more painful to administer. Hubs was supportive all the way because I had to take these injections in the early morning. He tries to wake himself up every now and then to be an observer most of of the time. LOL! The only down bit with these injections is that I have very sensitive skin, which resulted in a lot of scarring at the injection sites.

Roughly about 2 weeks into the egg stimulation phase, I had to go into the clinic for scans just to check that everything is going as planned. These visits became more frequent as egg collection day approaches, so that Dr Wong can adjust the dosages of the injections which he did in order for us to harvest more eggs.

Our IVF journey - Recovery from a very thorough laparoscopy

After some adjustment of schedules and such, I went for my second laparoscopy in May. And Dr Wong did a very thorough job. So thorough that 2 hours later when Hubs came to see me, the nurses told him that I was still in surgery and according to the nurses, "Dr Wong's surgery can take awhile coz he's very thorough."

Physically, I felt the thoroughness of the surgery because it felt like someone took a blunt knife and gutted and scraped my insides. During my first laparoscopy, my parents who came and visited for the weekend, saw that I was still independent. However, for this second one, my mom decided to stay with me during the recovery period and noted that I was a lot more immobilised.

Anyway, 2 weeks later, I went back to the hospital for the post-surgery follow-up and was presented a video recording of the entire surgery. Dr Wong explained that during the surgery itself, he found that I actually had stage 4 endometriosis. On top of the 4 cysts in my ovaries which he removed, he also had to surgically snip of endometrial tissues that have caused my uterus to stick to my bowels.

So I'm pretty happy that he did a good job, but we couldn't start our IVF process immediately. In order to ensure that the endometriosis has less chance to recur at the next menstual cycle, Dr Wong started me on first, a one-month zoladex injection, followed by a second dose which lasted close to 3 months. So more waiting...

Our IVF journey - Getting to the bottom of things

Our journey into IVF started sometime between Oct/Nov of last year, when I had my first laparoscopy to remove a cyst in one of my ovaries which my first gynae thought could be the reason of unexplained infertility. After the surgery, we were given green light to try naturally again but no pregnancy. At my next cycle, even after ovulation induction with Clomid, we just couldn't get pregnant. And that was when in February of this year, we decided to see a IVF specialist to really find out what is wrong.

Dr Wong came highly recommended through a friend of Hubs who works in the pharmaceutical industry. We also did some internet scouting of our own and after comparing some rates between fertility centers, we decided to pay Dr Wong a visit. Through that connection, we managed to squeeze ourselves in 2 weeks earlier than my original appointment. Dr Wong sure runs a very busy clinic!

At our first visit, the news we received weren't good. Ultrasound scan showed that despite my earlier laparoscopy, I still have 2 cysts each in both my ovaries. Because of the cysts, Dr Wong strongly advised us against going ahead with the IVF treatment, and instead recommended me to go through another laparoscopy.

We were kinda disappointed because we just didn't want to wait anymore. However, according to Dr Wong, the presence of cysts greatly reduces the IVF success rate from 50% to 30%, and it would be pretty pointless. In the end, we decided to go for another laparoscopy.