'I risked my life to have my baby'

Long nights at the office were the norm for 35-year-old architect Pamela Krisna, while her husband, Wahyu Hidayat Ng, 38, travelled frequently for work. Despite their demanding careers, they were keen to start a family immediately when they got married in 2005.

Pamela didn't foresee any difficulties - her menstrual cycle was normal, although she often experienced pain during her periods. But after trying to conceive for a year without success, she consulted a doctor and found out that she had endometriosis.

Two operations in two years

A condition where tissues that normally line the uterus attach to other organs, endometriosis may cause the formation of cysts, lesions and scar tissue.

"My doctor advised me to undergo an operation to remove the abnormal tissue and two cysts on my ovaries, to improve my chances of conceiving," says Pamela. However, more than a year after the surgery, she still couldn't get pregnant naturally.

An ultrasound then revealed that the cysts had come back. In 2008, she underwent another round of surgery helmed by a different doctor, to remove the cysts. Following her recovery from the second operation, Pamela and her husband tried intrauterine insemination (IUI) in 2009. The procedure involves using a catheter to place sperm inside the uterus, to increase the chances of fertilisation.

Dashed hopes

After one cycle of IUI, Pamela thought she was pregnant when she missed her period, but a blood test showed that the IUI had not been successful.

Pamela and Wahyu were dismayed at the result. "It was difficult when well-meaning friends and family asked us when we were going to have a baby," recalls Pamela.

"And it happened all the time at family gatherings or when we visited friends in the hospital after they had a baby. We would always downplay our predicament and reply that we were trying or just too busy. It got especially hard during Chinese New Year gatherings.

"Once, an uncle even shoved a baby into my face and said: 'See how cute she is? Are you sure you don't want one?'"

Staying resolute

Pamela and Wahyu's doctor advised them to use donor eggs to conceive, but they refused. Both their families were not keen on the idea of adoption either.

By 2010, Pamela and Wahyu decided that in-vitro fertilisation (IVF) was the only option left. But further complications arose.

"An ultrasound revealed that not only had the cysts returned, they were embedded in my bladder this time round," says Pamela.

"My doctor told us it would be more difficult to remove the growths because of where they were located, and referred us to his colleague.

The last thing I wanted was to go through more surgery, but to try IVF, we had to first remove the cysts."

Pamela's third operation in four years was over eight hours long and she needed a longer recovery period. But her husband and family were completely supportive throughout the entire process. Six months later, the couple tried IVF, only to have it fail at the fertilisation stage.

They went for a second round the next year - Pamela took a long break from work and tried acupuncture therapy too, hoping for a miracle. But it was not meant to be; the IVF failed again.

"It was so disappointing and frustrating. If only we knew why it didn't work, we could have looked into alternative therapies," she says.

Third time's the charm?

After the anguish of two failed IVF attempts, the couple took a year-long break from the pressure they'd been facing. They decided to try IVF again in January 2013.

But this time, before beginning the third cycle, Pamela was found to have an autoimmune disorder - she had high levels of antinuclear antibodies (ANA), which could affect her chances of getting pregnant.

She had to undergo a procedure called intravenous immunoglobulin therapy, which is given over four hours through an intravenous drip, and aims to combat the antibodies that might sabotage the IVF process.

Finally, their perseverance paid off when their third IVF attempt was a success. But instead of being able to heave a sigh of relief, the couple had to worry about the complications of Pamela's high ANA levels, history of endometriosis and multiple operations.

Her doctor suggested that she consult a gynaecologist specialising in high-risk pregnancies, to see her through the rest of her term.

"After eight years of surgeries and procedures to get to where we were, this baby was so very precious to us. We met with the doctor and were comforted by his extensive experience, so we decided to put our trust in him," says Pamela.

A risky pregnancy

Following a thorough consultation, the doctor ran a blood test on Pamela.

"When he got the test results two weeks later, he gave me a call and requested that I see him immediately, ahead of my next appointment. I knew right away something was wrong," says Pamela.

She was diagnosed with thrombophilia, also known as sticky blood syndrome, a condition where there are insufficient levels of anticoagulant to prevent the blood from overclotting.

The doctor explained that this could put the baby's life at risk, since thrombophilia has been linked to miscarriage and stillbirth. But that was not all: Pamela was also at risk of deep-vein thrombosis (DVT), heart attack or stroke.

"I couldn't believe what was happening," shares Pamela. "After overcoming so many hurdles and finally getting pregnant, we were told the baby was at risk, and so was I.

It was too much to take in. But we had to be grateful to the doctor for ordering the blood test. If he hadn't, the consequences could have been even more severe.

"Despite the diagnosis, the doctor assured us that there was no reason to be unnecessarily anxious, but we had to look out for signs like spotting or pain, and to contact him any time if we had concerns," says Pamela.

"I also had to keep a foetal movement chart to track how often the baby moved, so I could notify him if the frequency was lower than normal."

The doctor advised Pamela to take extended leave from work; thanks to an understanding employer, she was able to take a 14-month-long sabbatical. But this didn't mean she had to be confined to bed rest.

Instead, her complex condition made it imperative for her to move around to keep her circulation up and prevent her blood from clotting.

Other risks were involved too. In any pregnancy, when the foetus starts to grow, the placenta develops and is fed by very fine blood vessels.

Thrombophilia heightens the risk of clotting in those narrow vessels, which could cut off the supply of oxygen and nutrients to the foetus.

In the last trimester, there is an additional danger of placental abruption - separation of the placenta.

Taking extreme measures

To counter Pamela's thrombophilia, anticoagulation to thin the blood was necessary. The doctor gave her an oral dose of aspirin, and she had to inject the drug heparin into her abdomen daily.

"The dosage was very important," discloses Pamela.

"He had to test the heparin levels regularly to find the right dose for me. The initial dose wasn't enough so he saw me every fortnight and tweaked it until we got it right."

That wasn't the end of their troubles. Pamela also had placenta previa, which meant that her placenta was lying too low. Patients with this condition have a higher chance of bleeding in pregnancy as well as during and after labour.

Being on anticoagulants meant that Pamela's case had to be managed extremely carefully, because if she started bleeding, it could be torrential, and possibly deadly.

"It was a delicate balancing act. Apart from regular examinations, I had to go for ultrasound tests to check for placenta separation," says Pamela.

The last stretch

The doctor anticipated further complications as Pamela progressed into the third trimester of pregnancy.

So once he thought it was safe for the baby to leave the womb, he gathered his best team and opted for a C-section at 36 weeks - two weeks later than he had initially predicted.

Carrying the baby to full term could have been too risky for Pamela because of the placenta previa.

If she started contracting, she could suffer massive bleeding because of the anticoagulants she was taking; on the other hand, she couldn't stop the anticoagulant medication because of the blood-clotting risk.

The surgery presented its own set of challenges. Because Pamela's placenta lay very low, a large number of blood vessels were in the lower segment of her uterus, limiting access to the baby.

Cutting any of those vessels could mean heavy bleeding. Scar tissue from her previous operations also made manoeuvring more difficult, and it didn't help that the baby was in a breech position.

"As a precautionary measure before the surgery, my doctor asked me to consent to a hysterectomy in case of uncontrollable bleeding," says Pamela.

"He also explained that he might need to do a classical C-section, where a longer, vertical incision was made, instead of a normal horizontal one, so he could reach in above the placenta. It meant greater blood loss and a higher chance of infection, but he said he would have an adequate blood supply in case I needed it. We just had to hope for the best, but prepare for the worst."

Blissful payoff

In the end, a hysterectomy was not necessary, and Jessica Grace, Pamela's first child, was born a healthy 2.7kg, oblivious to the trauma her mother had gone through to have her.

"All the difficulties we had faced - three surgeries, one round of IUI, three rounds of IVF, treatment for autoimmune disorder and thrombophilia - vanished the second I held this precious angel in my arms," says Pamela.

"I'm so glad we persevered, and I'm grateful that we found the right doctor too. Now, we're just enjoying our baby and savouring each day. We don't have plans for another IVF cycle, but if I were to get pregnant again, it would be a wonderful blessing."

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