Trying for Mini J #2

pre-cycle	Start 100mg aspirin* + 2mg (2 tabs) methyl folate* + 1000iu vitamin D*
CD2	Start 8mg (4 tabs) progynova
CD5	Start 10mg (2 tabs) prednisolone*
CD12	Scan - lining 8.2mm trilaminar
CD14	Start crinone twice daily + 0.4ml clexane* nightly
CD19	ET at 2pm. Increase to 20mg (4 tabs) prednisolone*
14dp5dt	beta-hCG - 1731.7 IU/L Received 1 shot of proluton^ + Start 10mg duphaston^ twice daily
15dp5dt	Minor bleeding in the late evening. Increase to 20mg (2 tabs) duphaston twice daily. Stop clexane and aspirin
18dp5dt	Received 1 shot of proluton
19dp5dt	Spotting reduced. Restart clexane
22dp5dt	Spotting stopped. Reduced to 10mg duphaston twice daily.
31dp5dt	First fetal scan. No sac found. Chemical pregnancy.

*Prescribed by Dr Sheila Vasoo
^Prescribed by Dr Marianne Hendricks

This round, perhaps due to COVID-19, KKIVF was rather empty every time I visited, a vast contrast to the crowd and long wait in the past. The pharmacy, however, was still as crowded as ever.

I was totally caught by surprise that I wouldn't be issued an MC on the day I have to return to KKH for beta-hCG blood test (which is compulsory by the way). Reason? Because I didn't see a doctor. It seems that this is not unique to KKH, NUH doesn't issue MC for the same reason. Didn't need the MC in my last cycle because I took no-pay leave. But I don't know why I only realise this in my 9th cycle; I can't recall if I ever asked for MC in my earlier cycles. If BFP, you have to go back in the afternoon to collect the papers for the next appointment and collect the medications, which meant another 2 hours spent at KKH. Anyway, no biggie for me, but I imagine some may get caught in a stressful situation.

I thought I should explain here that KKH typically prescribe duphaston after beta-hCG if BFP, but for me, Dr Sadhana agreed to my request to continue crinone but this also meant that duphaston wouldn't be in my protocol. Based on my previous pregnancy experience, I went to Dr Marianne Hendricks to ask for more support medications, in hope to prevent bleeding. But this time, bleeding started much earlier at week 4+ than my previous pregnancies (week 5+).

The first pre-natal scan (or dating scan) is typically scheduled 2 weeks after beta-hCG BT. I decided not to waste anymore time at KKH and went straight to my private doctor. At KKH, you have to see the sonographer for scan, then see the doctor to tell you the scan result and issue prescription, and finally queue at the pharmacy to buy medicine. This is too much waiting time for me.

What's the biggest difference between my previous pregnancy and this one? Back in 2018, I had very bad nausea, indigestion and tiredness, starting from around week 5, but all these symptoms have yet to surface at week 6. I was right to be paranoid and worried. How can I be so lucky not to have any major morning sickness this time round. Indeed, something went wrong.

At week 7 (or maybe almost week 7), there was no sac. It was a chemical pregnancy.


Goodbye my angel baby...

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

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.