IVF Frozen #5 Day 24

It was long while since my last consultation with Dr Sadhana. Between then and today, DH and I met Dr Sheila Vasoo who figured out that I have sticky blood due to MTHFR genes mutation. She drew up a plan for me to start aspirin, vitamin D and folic acid right away. Few days before ET, I am to add prednisolone and clexane on top of the usual FET medication (progynova).


This is what I have to deal with every morning until hCG BT.

As for the nights, I have to take another 1000IU vitamin D from day one and start injecting myself with clexane from CD19 (5 days before ET). The very first self-injection already gave me small bruise on my tummy. Oh yes, the jab is painful! Not unbearably painful; kind of like the same level of pain as the orgalutran jabs.


My 4-week supply of clexane that costed $490.

Today, DH and I reached KKIVF at 8.30 am as instructed. Unfortunately, my blastie didn't survive the thaw and the embryologist had to spend another 3 hours thawing another blastie.


Here's my little blastie. My darling, please grow well. Mummy hopes to see a bigger you and see your flickering heartbeat in 4 weeks' time!

My 5th frozen cycle timeline:

CD1	Call KKIVF
CD4	4 mg progynova daily for 5 days
CD9	6 mg progynova daily for 5 days
CD13	Visit KKIVF for scan. Uterine lining 6.9 mm
CD14	8 mg progynova daily for 3 days
CD17	Visit KKIVF for scan. Uterine lining 9.0 mm Continue with 8 mg progynova daily for 4 days
CD19	Crinone gel inserts twice daily until BT 0.2 ml Clexane injections once daily until BT
CD21	6 mg progynova daily until BT 10 mg prednisolone daily until BT
CD24 / 0dp5dt	ET. 1 blastocyst transferred. TWW begins!
CD38 / 14dp5dt	BT

Which Hospital?

Just to share (and a bookmark for myself): detailed comparison between KKH and NUH by a forum member for those who cannot decide which hospital to go to. After I've used up all my frozen embryos from my Fresh #1, I've also considered switching to another hospital. But I didn't because I'm already used to the KKH "SOP". Everyone's situation is different; just have to figure out what suit you best.

If you're selecting only betw these 2, I'll strongly recommend NUH. Not that NUH is optimal, but I think there are many areas which KKH can do better in.

1) Safety. KKH prescribes med at start of stim, and your next and possibly only scan is around day 8. If you're someone who over-responds to medicine like me, not good at all because I already had 40+ follicles fr 87.5IU or 112.5IU of med. For first timers, usually they'll prescribe at abt 150IU. NUH's first scan is abt day 4, so adjustment could be made accordingly, depending on how you respond to the med. On the other hand, if you don't respond well, you might end up wasting money. Case in point: I always thought my friend wasted a lot of money for stim, because they waited for 8 days for first scan before realizing that the med didn't work well for her. She ended up having to stim for an additional 7 days. That would have set her back hundreds of dollars as we all know the stim med is not cheap.

2) Support given after BFP. This one both hospitals seem to be on extreme ends. NUH gives progesterone in excess, from the recent posts you can read for yourself that KKH is not as liberal with that. I have another friend who had a miscarriage her first transfer. Her second transfer BFP again, she went to see a private gynae on top of KKH, and private gynae did a blood test and found out her progesterone levels were too low to support pregnancy. So she was getting support from private gynae instead of KKH. And she's still suspecting till today she lost her first one due to the same reason - lack of progesterone.

3) Ownership of scans and prescription - in NUH, scan is done by doc, on the spot will give you a preliminary prescription and actions to be taken (still need to wait for BT results to make sure your estradiol levels are good). The doc will look out for things during the scan to make the decision. In KKH, scans are not done by the doc. Sonographer scans, records down the number and measurements, then pass the document to "a team of docs" who makes the decision.

4) Mentioned by someone else, waiting time is a factor. Related to point 3. In NUH, doc scans, decides and talk to you, then you can go meet the nurse to collect med. In KKH, there's at least one more station at the start which you have to wait (sonographer, then doc).

5) Update of your embryos. To me it's an added service that NUH lab called me every morning to update me on the fertilization and growth of all my embryos. Even on New Year's Day (1 Jan). My friend with KKH, had no idea if her embryos made it, went for her transfer, waited for close to 4 hours in the hospital in the hospital gown, before her doc told her none of her embryos made it.

Angel Gowns Singapore

(Click on image to go to Facebook page.)

Update 8 Feb 2018:
They are now known as Angel Hearts.

Instead of IVF

If only it is this easy...

Ask any IVFers, how many of us have already changed our lifestyle, followed a fertility diet, tracked our ovulation, drank that horrible bitter TCM herbs and got poked by countless acupuncture needles. If any of these worked for us, we wouldn't be going through IVF. It's not a matter of choice.

Problem Found

Back track a little, this is what happened between my last post and now: As recommended by Dr Roland, DH did the sperm DNA fragmentation test and the result came back as high fertility potential (i.e. low DNA fragmentation). Now that this issue is ruled out, I need to get myself checked. I pondered for a long time and decided not to go for SIS nor laparoscopy. Instead, I went to see Dr Sheila Vasoo at her ARC Clinic in Mount Elizabeth Novena. As expected, she ordered a series of blood tests for auto-immunity investigate. Total cost including consultation: $1455. Dr Sheila's staff gave me a slip of paper to bring to ParkwayHealth Laboratory (at ground floor of the same building). The phlebotomist drew 6 tubes of blood on the day of my first appointment and another 6 tubes on CD5.



We returned to see Dr Sheila Vasoo on Saturday to collect my blood test results. Turns out, I have sticky blood. Although this is not a good news, I feel relieved that we at least have a clear solution to our infertility now. The plan is for me to start taking aspirin, folic acid and Vitamin D right away. Then, I'll go back to Dr Sadhana for the frozen transfer in my next cycle. I'll have to start taking clexane jabs nearing ET too.

Pre-Frozen #5 Appointment with Dr Sadhana

Met my doctor yesterday and it was probably the most fruitful 10 minutes in her room since I started IVF. DH said the consultation fee was totally worth it because I asked so many questions. At first, I just wanted to go through the motion of seeing her so as to move on to the next cycle, but I ended up pouring out all my questions.

Dr Sadhana views that there is very low possibility that I have implantation issue because Frozen #1 was successful. Thus, it is more likely the embryo(s) that were not able to continue growing. According to her, there is no way to determine if the problem is with the egg or the sperm. The PGS trial is currently on hold because of the withdrawal of the test kits, so I don't have this option to test the embryos too. As opposed to Dr Roland's suggest for me to go through laparoscopy, she advised that the procedure diagnoses endometriosis and even if I indeed have endometriosis, the solution is still to go for IVF without the need to correct the problem. Thus, laparoscopy is not going to be useful for me. She would only give me the option to go for saline infusion sonohysterography (SIS) to check for polyps.

Interesting, the forum was actively discussing about Dr Roland Chieng only recently. (In the past, it's always Dr HH Tan and Dr SF Loh who are often mentioned.) Dr Roland's staff called yesterday too to inform that DH's sperm DNA fragmentation test result is out. Next appointment with him at the end of the month. At the same time, as advised by several ladies in the forum, I've also booked an appointment in early July with Dr Sheila Vasoo to check for auto-immunity problem.

First Consultation with Dr Roland Chieng

After KKIVF called to inform me of the negative beta-HCG result, I called Dr Roland Chieng's clinic at Mount Elizabeth Novena. I could have gotten an earlier appointment last week if not due to my work schedule. In other words, the wait between the call to book an appointment and the actual appointment could have been only one week. There has been many good reviews of Dr Roland mentioning that he is patience and has good success rate. Anyway, I've already used up all the government grants for frozen cycles, hence cost wise, there's not going to be any difference between continuing at KKIVF and going to a private practice.

My original appointment slot was at 2.45 pm yesterday but a staff called a day before to change it to 3.30 pm because doctor need to perform a surgery. The traffic along the 2-lane roads leading to Mt E Novena was terrible (as usual) and we arrived 10 minutes late because we made a wrong turn. There wasn't anyone else in the waiting area and I jokingly told my friends that the clinic staff outnumbered the patients. We waited about 15 minutes before we were called into his room (after he's done with another patient).

Doctor took down our IVF history and did an ultrasound scan. His first comment was why not just continue with KKIVF with the remaining 4 blastocysts? But of course, he understood our frustration of repeated failures. His conclusion: (1) check for sperm DNA damage and (2) check my abdominal for abnormality. When we were in his room, I didn't hear him use the word laparoscopy, but his staff told us to check if my insurance covers laparoscopy procedure. At this point, I was confused because I thought he was referring to hysteroscopy! (Read about laparoscopy and hysteroscopy in this NUH article.) Today's consultation took less than half an hour and it cost us $150 (1st consultation) + $100 (scan) + GST = $267.50.

DH has been scheduled for the sperm analysis on Saturday and it's going to cost $320+GST. As for me, I guess I can still ask him about the laparoscopy procedure in the next consultation after the sperm analysis result is out. I didn't expect myself to be so disturb by the idea of having to go for laparoscopy, so much so that I couldn't sleep well last night. The procedure seems very scary because it is done under general anesthesia and the camera will be inserted through the belly button!

The FMR1 Gene

"...different sub-types (called genotypes) of the so-called FMR1 gene (also called fragile X mental retardation gene) are statistically associated with distinctly different chances to conceive with IVF."

"The genotype associated with the lowest pregnancy chance was also statistically associated with a specific form of a common ovarian condition called polycystic ovaries, and with evidence of abnormal function of the immune system, reflected in autoimmunity (immunity against oneself)."

Source: https://www.centerforhumanreprod.com/fertility/first-genetic-test-predictive-of-pregnancy-chances-with-ivf/

Dr Sadhana says that there's evidence I have PCOS. Do I need a check on my autoimmunity?

Food to avoid?

I was chewing on my soon kueh during breakfast just now and I remember someone advised against eating turnip while on TCM. (Haha... random thought.) I've been taking TCM everyday since September last year until the day for trigger shot, but I've also been eating soon kueh pretty often for breakfast at my office cafeteria! I googled "turnip is cooling?" and this is one of the articles that appeared: Five foods to avoid taking with traditional Chinese medicine. Great... maybe this is one of the reasons why this cycle didn't work? Then again, Dr Sadhana believed that it was the TCM that boosted the number of eggs for my 2nd fresh cycle. She was expecting to retrieve less eggs as compared to the 1st, since I was on a lower dosage of Puregon. Also, Dr Lim didn't stress about avoiding turnip too. So, perhaps, there's nothing to worry about and I am thinking too much again?

IVF Frozen #4 Day 34 (14dp5dt)

It's official. BFN. Beta HCG reading is only at 1.5.