The Grief that is hard to understand

PGD becomes Mainstream Clinical Service

Here's a good news for those seeking PGD at private clinic/ hospitals. I don't see any significant difference for those at public hospitals, but I'm definitely not the best person to comment on this since I have not gone through it myself.


(Click on image to go to website.)

PGS Statistics

Who is eligible for PGS trial?
[0:25] (1) 35 years old and above, (2) suffered 2 or more recurrent implantation failures, or (3) experience 2 or more pregnancy losses

How much does it cost the government?
[1:07] $1.7 million

How much does it cost the patient?
[1:23] $1,100 per test on average for consumables + $2,500 to $4,500 for embryo biopsy

What is the success rate?
[1:56] 367 patients signed up
[4:02] 104 patients had embryo biopsy done
[4:38] 60 patients completed embryo transfer
[4:42] 15 live births
[4:44] 8 miscarriages
[4:45] 8 ongoing pregnancies

My thoughts:
The news about PGS trial was released in the press back in Nov 2016. At that time, I fulfilled two eligibility criteria and was qualified. Back then, it was before I had my 2nd miscarriage and before I had karyotyping done on my pregnancy tissues. Therefore, I was not aware of my actual problem. Before embarking on my 2nd fresh cycle, I asked my IVF doctor if I could be enrolled for PGS trial. However, at that time, there was a delay in the commencement of the trial and hence this was not an option for me if I didn't want to wait. By the way, PGS can only be done during a fresh cycle (at least in Singapore's SOP).

On hindsight, it was a blessing in disguise. Based on the karyotyping done in Oct 2017, my implantation failures and miscarriages were not likely due to chromosomal abnormalities. Also, based on the result of my recurrent pregnancy loss investigation, these were more likely due to thrombophilia aka sticky blood. Cost wise, it was way cheaper to do karyotyping (about $600) compared to PGS (about $3000) to find out that my embryos were normal. Ultimately, PGS would not have changed any outcome for me.

Looking at the statistics provided by MOH, at best 23 live birth out of 60 embryo transfer (38.3% success rate), doesn't seem very worth the investment. But to a couple wanting their own kid, all these numbers may not matter at all. I would try everything that somewhat make sense, until I have exhausted all options within my means.

One question that is significant to me - of these 15 lives births, how many had recurrent failed IVF or miscarriages? If these 15 patients are only 35 years and above, and not had failed IVF or miscarriages, it could be very possible that they would be successful without PGS. Considering the high out-of-pocket cost involved, I would think that they are more than just "35 years old and above".

I strongly believe that there needs to be more investigation before attempting PGS. But because there are so many unknowns and so many under-researched areas or research with conflictling/ inconclusive results, many OBGYN and IVF doctors remains doubtful of autoimmunity issues (perhaps with the exception of thyroid). But guess what, the controversial protocol worked for me!

$1.7 million of tax payer's money can be used in so many other ways to help the vulnerable groups and the under-privileged. I don't mean throwing out PGS all together because this may just be the answer, if there is no other explanation for the infertility after a truely thorough investigation including autoimmunity, sperm DNA fragmentation test, etc. And yes, my personal opinion is that the investigation at public hospitals are not thorough enough.

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?

Helpful?

No increase in MediSave withdrawal cap. No additional frozen cycle grant.

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.

Unusual Lawsuit

First in the world to be sued by her own embryos!

Criteria for PGS Trial (& Stupid Comments on Facebook)

See what stupid comments some people wrote! So fuming angry to read those idiots writing like as if they are so wise! They are so ridiculously ignorant and still dare to judge people going for IVF! You morons better beware, even if it's not infertility that comes after you, karma will surely come around and give you a tight slap in the face!

Catching up on Medical Advances

For the past months, there has been rumours spreading in the IVF community that government hospitals could be allowing PGS (pre-implantation genetic screening) for more patients. Singapore tends to be rather lacking behind in offering newer technology because of the really long approval process, which is often due to the need to have enough evidences to proof its benefits and, in this case, due to the fear of abuse.

One thing for sure, this addition procedure will bring up the total cost of each fresh IVF cycle quite significantly, in the range of thousands. Would government provide more co-funding? Can the patient make payment using Medisave? If there's no co-funding and Medisave can be used, would there be a need to revise the current lifetime withdrawal limit of $15,000? Also, having PGS would mean that the embryo(s) will only be transfer in a subsequent frozen cycle, which again, is additional cost.

News - First Time Mum at 63

Not as crazy as the Indian woman who gave birth at 70 years old. But still shocking enough to be features in newspaper.


(Click picture to go to website.)

In The News

(Click picture to go to website.)

Extremely unbelievable.

Panda Mating Season

Even Kai Kai and Jia Jia are doing IUI.