In Cervical Incompetence (CI), the cervix is weak & will open before the baby reach term and hence delivered prematurely at less than 37weeks. Preterm babies may not survive, require respiratory support, feeding support, and are also at risk of infection. Managing preterm baby is stressful and costly for a couple. CI is diagnosed by past history of fetal loss or preterm delivery, shortening of cervical length & opening of internal cervix canal in the absence of labour.
Treatment is aimed at prolonging the pregnancy to 37 weeks by lifestyle changes, adequate rest, progesterone injection, progesterone pessary, cervical cerclage, dexamethasone injection (mature baby’s lungs). The cervical cerclage will strengthen the cervix by lengthening the cervix and closing the internal os. If detected before 24 weeks, a McDonald cerclage can be inserted and after which, an Arabin cerclage is used.
Patient VN, a doctor at government hospital had her 1st IVF at Metro IVF. She had low ovarian reserve (AMH=5). So, she had a fresh embryo transfer cycle using day 2 embryo to avoid loosing her 2 embryo. She successfully conceived.
However, at 26 weeks, her cervix shortened to 21mm and internal os was opening. She was diagnosed to have CI & advised lifestyle change, rest, given progesterone injection weekly. An Arabin cerclage was inserted encircling the cervix (see pic). The Cervical length increase from 2.1cm to 2.8cm & internal Os closed.
Her pregnancy continued for another 9 weeks when she went into active labour at 35 weeks. She had an emergency Cesarean surgery and delivered a healthy baby girl, photo below.
The combined treatment including Arabin cerclage has prolong her pregnancy for 9 weeks and prevented all the problems associated with preterm baby. Thus, saved her stress & cost.
AMH: hormone that measures egg reserve
Arabin cerclage: Silicon ring device inserted vaginally to encircled the cervix
ET: Embryo Transfer
Internal Os: opening at the inner end of cervical canal
McDonald cerclage: a tape that is tied around and strengthen the cervix
A well coordinated IVF cycle for overseas couples will ensures the comfort of the travelling couple, ensuring that the high success rate is maintained.
IVF treatment requires frequent visits & monitoring (blood tests & ultrasound scan). Frequent visits to an IVF center may not be possible for overseas patients. They can reduce travelling frequency by knowing their treatment schedules & coordinating with the IVF center and yet produce good success rate. The Overseas Phases for IVF Treatment (OPIT) can reduce travelling to Metro IVF to 2 or 3 times.
Phase 1. Appointment & online counselling via email/WhatsApp (in overseas)
Phase 2. Pre-IVF assessment & consultation (3 days in Malaysia)
Phase 3. Starting egg stimulation (in overseas)
Phase 4. Monitoring of egg growth, ovulation trigger, egg pick-up, embryo transfer (8 days in Malaysia)
N.I. , from Singapore contacted Metro IVF in 2011 after trying for 8 years. She went though the 4 OPIT phases (above), visited Metro 3 x & had her 1st IVF cycle in October 2011 with a fresh day 3 embryo transfer. She successfully conceived and delivered a healthy baby boy at the National University Hospital S’pore (NUH) in 2012.
Then, in Aug 2019, N.I.’s husband contacted us again to plan for a 2nd child. N.I. went through the 4 OPIT phases and again had a fresh embryo transfer cycle in December 2019. It was another successful cycle. She continued her pregnancy check-ups in S’pore.
On 20th August 2020, the IVF team was delighted to receive the good news; their 2nd IVF child (see photo) was safely delivered at NUH S’pore. We are glad to have the opportunity to assist this wonderful couple to have 2 children, a boy & a girl via 2 cycles of IVF.
If you have any questions on travelling to Malaysia for IVF, please feel free to reach us via
Ectopic pregnancy (EP) is when an embryo implants in the fallopian tube instead of in uterus.
All ectopic pregnancy must be removed or else it will burst and cause severe bleeding. After an EP, 65% of couples will have successful pregnancy within 18 months after which they should seek fertility treatment because the other tube could be partially damaged or there are other fertility factors which when corrected will results in successful pregnancy, as seen in patient YXH below.
YXH, married for 9 years has been trying for over 3 years to have a child. Once pregnant 6 years ago but it was an EP which was operated & removed before it rupture.
She then tried naturally for another 2 years without success. She visited Metro IVF, 4 years ago and was found to have PCOS. She was advised & did her 1st IVF + FET. She successfully conceived and delivered a baby boy (3 years old boy in picture above)
In 2019, she came back for her 2nd FET cycle. She’s pregnant again and delivered a baby girl on 19th August 2020 by Cesarean surgery. Metro IVF team members are delighted to have the opportunity to assist her in building a family.
Congrats to YXH, her husband and family members.
FET: Frozen Embryo Transfer
PCOS: PolyCystic Ovarian Syndrome