Filling in the Gap

What happened in 2018? It was a year of many changes. Most importantly, it was the year my rainbow baby was born.

After my 2nd miscarriage Oct 2017 and knowing that my angel baby is chromosomally normal, I went for a blood test to check my progesterone level during luteal phase and did a sonohysterography as suggested by Dr Sadhana. Conclusion, progesterone level wasn't ideal to try natural FET (with ovulation medication), while sonohysterography result came back normal.

In Apr 2018, I embark on yet another medicated frozen cycle. By then, I have exhausted the 15k Medisave limit and this cycle was fully pay by cash. In May 2018, my beta-hCG was at 1893 IU/L, much higher than frozen #5, but it wasn't time to celebrate yet. True enough, I started bleeding at around week 5, just like previous miscarriages. For the sake of familiarity, I went to KKH 24-hour O&G, and it turned out to be a complete waste of time. Out of desperation, I asked for an urgent appointment to see Dr Sheila Vasoo, who referred me to Dr S F Loh and I saw him on the same day. I was given a proluton jab and my bleeding stopped. However, the bleeding started again about 1 week later and Dr Loh gave me another jab. It happened again at week 8 and thankfully, that was the last episode. The following months went on peacefully, except for the very bad morning sickness that finally went away in 2nd trimester, and the very bad itchy rashes in 3rd trimester.

What was different between frozen #6 and the earlier ETs?

	FET#1 to FET#4	FET#5	FET#6
Progynova	✔	✔	✔
Crinone (pre beta-hCG BT)	✔	✔	✔
Crinone (post beta-hCG BT)			✔
Duphaston	✔	✔	✔
Proluton			weekly from week 6 to 8
Aspirin		✔	✔
Clexane		0.2 ml	0.4 ml
Prednisolone		10 mg	20 mg
Folic Acid	✔	✔
Folate			✔
Vitamin D		✔	✔

I wouldn't know if it was the higher progesterone support or the higher doses of clexane and prednisolone (or both) that helped. Most O&G doctors view that all these are not neccessary; they don't believe in Dr Sheila's protocol. "Duphaston is sufficient" they said. "You don't need the blood thinners and prednisolone" they said. They are right, based on scientific evidences which probably wrote that 95% of the candidate showed positive outcome with duphaston twice daily. But they could be wrong, for the minority who do not fall within the statistic.


Day 2 embryos x6, Day 5 blastocysts x3, Clexane jabs x276 (from 0.2 ml to 0.4 ml to 0.5 ml).

Government Support for IVF

(Click on image to go to CNA website.)

Summary of Mr Louis Ng's proposals:

1.	Increase number of subsidised IVF cycles from 6 to 8 [2:53]
2.	Introduce subsidy for PGD and allow balance to paid out of Medisave (subjected to a limit) [5:13]
3.	Remove quota on number of fresh and frozen cycles for subsidised IVF treatment [7:19]
4.	Introduce "fertility leave" for both husband and wife [8:30]

My thoughts:
Firstly, I deeply appreciate Mr Louis Ng's consistent and persistent push for the government to provide better support for couples undergoing fertility treatment. It is through him that our difficulties can be heard at a wider platform. Unfortunately, this year really isn't a good year to expect the government to put in more budget for this; we are already in budget deficit due the covid-19. And of course, from the government's perspective, the more cost-effective way to sustain or improve birth rate is by dishing out more baby bonus (effective or not, is a debate for another day). I believe Mr Louis Ng knows that the chance is slim for his proposals to be adopted this year, nonetheless, it is a topic important enough to be tabled in Parliament.

It is interesting to note that there is flexibility to request for government co-funding beyond the 3rd fresh or frozen cycles, if the couple have used co-funding for less than 6 cycles, but 4th and 5th fresh cycle co-funding limit follows frozen cycle at $2,200 [23:36]. In my case, after I have used up co-funding for 2 fresh and 3 frozen cycles (and 3 frozen without co-funding), I can request for my next frozen cycle to be co-funded (as I still have 1 blastie in the freezer now). However, there is no granted success, I think it is safer to reserve my very last co-funding for a 3rd fresh cycle, which is a lot more expensive than frozen cycle, just in case frozen #7 turns out to be BFN.

Personally, I feel that simply increasing the number of subsidised cycles might not help. I think the medical team needs to be more aggressive in the treatment. My 8th cycle was successful because I was on a whole lot of medications. No one likes to pop 10 pills or get injections everyday for months. But if this is necessary, many of us would be willing to do it just so that we can have children. If the hospital SOP encourages more tests to be done or provide more support medications after a failed cycle, I wouldn't have to go through as many as 3 BFN and 2 miscarriages, which not just waste the government co-funding and medisave funds, but also bring more disappointments. If I have not met Dr Sheila Vasoo and Dr S F Loh, I would not have my mini J today. (I have yet to share the details of my successful frozen #6 and perhaps it is time for me do so soon.)

After 8 IVF cycles, I have used up the $15k cap from Medisave. So, my wish is to allow me to tap on my excess Medisave funds. Every year, there would a decent amount being transferred from my Medisave to Special account, because there is a maximum balance for Medisave account (current is $60k). And so, my money is locked away in Special account, collecting interest and waiting for the day I retire. This is one logic that I cannot appreciate because the government already has measures in place to ensure a comfortable retirement.

I count myself lucky to have a secure and stable job, and luckier that I have an understanding boss. At the start of my 8th cycle, I applied for one year no-pay leave. When mini J was 4 months old, I returned to work. Whether "fertility leave" is useful or not, probably depends on one's circumstances. Applying for "fertility leave" outrightly reveals that you are going for fertility treatment, which still carrys a negative connotation and not everyone is ready to share at that point in time. Would it make the situation worst? Some people lose their jobs after returning from maternity leave. Would the company take the opportunity to axe the staff knowing that she is planning to have a child?