What to do when and IUI treatment produces 8 follicles*?
Either cancel the IUI cycle or convert it to IVF.
Patient NS chose to convert to Permata Care IVF. Her UPT test indicated positive & Bhcg level is at 773iu/l, 12days after her transfer. NS & husband were delighted they have made the right choice.
*8 follicles: during IUI treatment, the aim is to have 2 or 3 matured follicles to avoid multiple pregnancy
Travelling per se, either by land or air will not affect IVF success. Should you need to travel for IVF treatment, avoid vibrations such as speeding or travelling over bumpy roads.
Patient NH, has been wanting a child for over 16 years and had been to several centers and finally came to Metro IVF in December 2020 for her 1st IVF.
Her husband would start driving with her at 7.00am from Kuala Lipis for 4 hours to reach Metro IVF. He drove smoothly and avoided speeding as well as bumps.
She had her in the middle of March 2021. Her UPT was positive, and bhcg test indication 650iu/l, indicating she is pregnant.
She said “sudah lama tunggu, 16 tahun, dekat 17” (It was a long wait. 16 years, almost 17)
Congratulations to NH and her supportive husband.
In a uterus, the inner cavity is lined with healthy endometrium where an embryo can stick and implant. As the baby grows, the cavity will expand to fit the growing fetus.
In Uterine synechiae (adhesion*), the wall of the uterine cavity are “glued” together and there is little healthy endometrium for embryo to implant.
The treatment is to removed the adhesion and during ET, to placed the embryo on the surface with healthy endometrium.
Patient BT has been trying to have a baby for 4 years. In her initial years, she conceived naturally a few times but unfortunately all her pregnancies ended in miscarriage.
She then tried 2 cycles of IVF with PGS at another center without success.
BT then came to Metro IVF in early 2020 for opinion. Ultrasound showed that her endometrium is thin and her HSG showed uterine synechiae. All other fertility factors are normal. She was advised IVF & removal of synechiae.
BT had OPU and had all 6 embryos frozen. While waiting for FET, she was referred to a hysteroscopic gynaecologist in Pudu, KL and had the synechiae removed. She was noted to have 25% healthy endometrium remaining. Ultrasound scan showed only a local patch of healthy endometrium. The Location* was identified.
6 weeks later she had FET and her frozen embryo was dropped at the Location identified earlier. 2 weeks later her urine test was positive. Her pregnancy progressed smoothly and she delivered a healthy baby girl.
Congratulations to BT and her husband.
On discharge, she said “I’ll be back” (Saya akan pulang)
*Adhesion: the front and back wall of uterus are stuck together
**FET: Frozen embryo transfer
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.