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
Primary ovarian insufficiency or POI is when the ovaries stop producing eggs before a woman turns 40. POI happens in 1% of women and can be confirmed with a scan (no eggs in ovary) along with low AMH levels in her blood. Women with POI will suffer infertility and if she wants to bare a child, the option is undergoing IVF with door eggs (OD – oocyte donor).
Alicia from Australia has POI when she was only 20 years old. She had 5 unsuccessful cycles of IVF with OD (using sequential protocol). However, she was determined & did not loose hope.
Day 3 embryos were transferred and Alicia was pregnant.
She traveled to Malaysia in 2017 to continue her treatment. Her 6th cycle was at Metro IVF (using concurrent protocol) with fresh embryo transfer (photo above). She was finally pregnant on her 6th cycle and delivered a healthy baby.
Alicia’s perseverance has paid off. She and her husband are blessed with a cute baby of their own.
“Never give up on your dreams” is one of those old clichés we often hear. Couples undergoing fertility treatment in particular IVF go on an emotional roller coaster ride. No words can describe the anxiety a couple has to face during a cycle which is emotionally, physically and financially taxing.
Mdm A and her husband had their first IVF cycle in another center. The first cycle was not successful and she undergone a myomectomy subsequently. Her subsequent 2nd and 3rd IVF at the same center ended up in failure too, that is when they decided to switch to a center with known high success rates – Metro IVF.
Putting their hopes in Metro IVF, a stimulation protocol was curated to suit the couple, coupled with close monitoring by the fertility team and counsellors. On her 3rd attempt at Metro IVF, the couple is blessed with a pair of baby boys and delivered on the 27th of February 2020. After going through 6 years of trying, 6 IVF cycles, countless injections and emotional stress, they are finally blessed with 2 health children of their own.
When you have your heart set on something, dreams can become a reality.
The inspirational story of Pn. Lina’s perseverance and grit which led her to conceive a child of her own with the help of IVF using her own eggs at 46 years old was recently picked up by local newspaper – The Star. Read the full article here.
JW Li had been trying to have a baby since her marriage of 10 years duration. She tried 3 cycles of IVF in her homeland without success. Then, following advice from a friend, she came to MetroIVF for her 4th IVF treatment. Her treatment was faced with many challenges including travelling to and fro from China, leaves and Immigration barrier. It was all worth it when her result came. She conceived with twins!!
And just before Chinese New Year, she delivered, just in time to usher in the New Year.
Mr and Mrs LML are a lovely couple from Singapore. They got married at 40 years old and have been trying for a child since. They had 3 failed IVF cycles and their fertility specialist in Singapore did not recommend her to try again with her own eggs as her FSH level was already very high. Her AMH levels (ovarian reserve indicator) were low which confirmed that she was nearing menopause.
Mrs LML went to numerous centres for a second opinion but decided to finally settle for Metro IVF as she had read and heard many good reviews. She finally decided to have an IVF with Egg Donor cycle with Metro IVF as she was very comfortable with the doctor and staff here.
Mrs LML commenced her cycle in March 2016. Her donor produced 16 mature oocytes which was then matched with her husband’s sperm via ICSI. 2 Grade 2 and 1 Grade 3 embryos were transferred on ET day and 3 embryos were frozen for future use.
In early April 2016, Mrs LML informed us that her BHCG was 116.4IU/L. When she repeated BHCG after another 4 days, it increased to 402IU/L. We advised her to go for a scan to detect the gestational sac and heartbeat. Unfortunately fetal heartbeat was continuously not detected till 8 weeks and D+C was scheduled.
Mrs LML was advised to rest for a few months before attempting FET with her remaining embryos.
In September 2016, Mrs LML started her FET cycle. FET was done with 2 Grade 2 and 1 Grade 3 embryos.
2 weeks later, she informed that she was pregnant again. Her BHCG was 238.8IU/L and progressed to 1355.2IU/L 4 days later.
Their family life is finally complete when she delivered her baby boy in June 2017.
Madam Fama and her husband are from Libya and were married in 2010. They are expatriates currently residing in Pahang and came to us in 2013 seeking treatment for infertility following recommendations from their friends. Madam Fama attempted to try for pregnancy a few times with Clomid as she was wary of doing too many injections during IVF. Her previous experience of doing IUIs in Pakistan also made her wary as she was uncomfortable being probed and scanned as she was a bit shy in nature.
Two years later, after numerous unsuccessful tries with Clomid, we finally managed to persuade her to reconsider IVF. Her IVF cycle commenced in August 2015. 10 oocytes were harvested and ET with 3 embryos was done 3 days later.
Her luteal support appointment was uneventful when she was suddenly admitted to ward as she was displaying symptoms of OHSS. Blood was taken to confirm OHSS and to check for her BHCG level. Her BHCG was 373IU/L which indicated that she was pregnant and it was probable that her pregnancy might have aggravated her mild OHSS symptoms.
Initially, one gestational sac was detected but as her pregnancy went along, we detected two sacs with heartbeats. Her pregnancy progressed well and further scans showed that she was carrying twin girls!
She has recently delivered and the couple is happily enjoying the presence of their little girls..