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).

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

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.

Pre Frozen #2 Consultation

My appointment for a diagnostic ultrasound scan was at 9.50 am, followed by doctor's appointment in the afternoon. Actually, today's appointment was more of a miscarriage follow-up. But since the scan showed that all my old tissue is cleared from my womb and Dr Sadhana gave the green light to proceed with frozen cycle #2, I consider today's review as a pre-cycle consultation session too. I'm all good to go for a second ET.

The quiet Clinic D at 1.30 pm:

Pre Frozen #1 Consultation

Today is my review day with my IVF doctor, for post-fresh cycle #1 cum pre-frozen cycle #1. As usual, I spent a great deal of time waiting outside the consultation room, but only a short few minutes meeting Dr Sadhana. Knowing that I do not ovulate regularly, doctor decided to put me on medicated frozen cycle.

So, the plan is as such:

• Call KKIVF on CD1
• Go to KKH to collect medication on or before CD4
• Start taking mediation from CD4 onwards

Difference between natural vs medicated frozen cycle:
(This is what I've gathered from the forum.)

Natural	Medicated
- No mediation	- Start progynova from CD4 onwards
- First scan on CD11 (or CD9 / CD10)	- First scan on CD11 (or CD9 / CD10)
- Follow-up scan (and BT*) until   (1) lining is at least 8 mm and   (2) ovulation occurs	- Follow-up scans until   (1) lining is at least 8 mm   (2) (no ovulation)
- Schedule for ET	- Schedule for ET

* Ovulation determined via BT in some hospitals.

First Consultation with Dr Sadhana

Two rounds of IUI didn't work for us. Although Dr Chin had recommended trying IUI 3 times, I am quite convinced that the 3rd wouldn't work too.

And now we are at our last resort - IVF. We wait for about one month between my call to make the appointment and the actual appointment. Dr Sadhana is the IVF doctor of my close friend's sister, who became pregnant after her 2nd embryo transfer (1st frozen cycle). I brought along our reports and tests results from Dr Chin. Dr Sadhana had a quick look at them and passed them to her nurse to make a copy of each to keep in my patient file. We told her the treatments we had done so far and mentioned that Dr Chin recommended for us to visit the government hospital for IVF. After the consultation, both DH and I had to take some blood tests, which are mandatory before starting IVF treatment.

Today's bill:

Counsultation	$158
Blood tests	$415
TOTAL (including GST)	$613.11

I'm scheduled for IVF in December. Can't wait!