Wednesday 30 October 2013

Cost of IVF at KKH, KKIVF

So far, these are my costs. I will continue to update them as it comes


Description Cost Receipt Number Covered by Medisave Covered by Govt Subsidy Cash
 
Registration 95.76 2 95.76
Counseling and Sign Consent 203.30 2 203.30
Screening Blood Test 266.97 1 266.97
1st consultation (26 Sep) 101.65 1 101.65
Supplements 39.50 3 39.50
Transvaginal Scan 127.33 4 127.33
Medication (1st) 1561.76 5 780.88 780.88
 
 
2396.27 780.88 780.88 834.51


Note:
1) I need to verify on the Medication (1st). I am pretty sure it is 50% medisave and 50% government subsidy, I will check with nurse the next time.
2) The costs will not YET include the cost for IVF procedure, doctor's consultations, scannings etc. These costs will only be provided later when I either get the BFP or ......
3) Ignore the column "receipt number" cos that is for my own records
4) Last row is the total paid so far.
5) I have medisave and subsidy columns as I qualify for both. Read this post




Lucky me.....for being able to use Medisave and qualifying for subisdy

This is what H and I qualify for!


1) Co-fund for Assisted Reproduction Technology @ Restructured Hospitals

ART co-funding parameters per treatment cycle (with effect from 1 Jan 2013)
SC-SC Couple
SC-PR Couple
SC-Foreigner Couple
Fresh
75%; up to $6,300
55%; up to $4,600
35%; up to $3,000
Frozen
75%; up to $1,200
55%; up to $900
35%; up to $600


As this is our first fresh cycle as a SC-SC couple, we qualify for a subsidy of 75%, up to $6300. This is really cool cos it saves us the total amount of $6300! Gosh.....

For more info, this is where you can read up about Co-Fund for Assisted Reproduction Technology (ART) at Restructured Hospitals

Note:
1) It only applies to Restructured Hospitals like KKH, NUH etc
2) It is only for 3 fresh and 3 frozen cycles
3) There are conditions such as age
4) It does not cover the total cost of IVF. Out pocket expenses maybe about $2000-$3000?
5) I am monitoring my bill. I read somewhere that medication is subsidy of 50%.
6) You cannot use it for IUI.


2) Medisave for Assisted Conception Procedures

1st cycle - $6,000
2nd cycle - $5,000
3rd and subsequent cycles - $4,000 (with effect from 1 Oct 2013)

Note:
1) There is a lifetime Medisave withdrawal limit of $15,000 per couple
2) You can use it for IUI but it might not be worth cos IUI is around $2000.














Day 3 of Menses

Today is day 3 of menses and I had to report to KKIVF to start on my IVF program. My cycle is termed "Antagonist Cycle", meaning, the short cycle.

I did some reading up on the procedure @ KKIVF and after reading a few blogs, I decided to go earlier to get my Q-number. For those who are going to KKIVF for the first time for the first scan, here are some tips and process!

1) You will need to do an ultrasound. It's a transavaginal scan, so do empty your bladder.
Anyway, the scanning starts at 8am, but you can go at 7.30am to start q-ing. 7.30am suits us cos we can avoid the morning peak jam as well as the hefty ERP charge. so we went to get a q number and I was 2nd in queue! (Number 1001 is sample and the real queue number starts 1002). You will be allowed to sit at the IVF centre even though they have not begun seeing patients. So don't worry that you go there early and there's no chairs for you to rest. You can even go and have your breakfast cos the scanning will only start at 8am. There are 4 options on the queue machine. Press Button "1". It will print out 2 labels. One for you to keep and the other for you to staple your appointment card (you got it when you first when to see the doctor at the Fertility Clinic). Or if you have papers to bring, you can staple it with your printed label and place it into the box outside Room 5. In case you forget to bring your papers, no worries. You can just indicate your IC number on the label. Staple, staplets, pens are all provided at the station you got your Q-number. I went on a Tuesday morning so it was not crowded and I did the scanning at 8.05am!!  Scanning is done at Room 5. Only 1 scanning room but super fast. Approximately 5 minutes per patient.

2) After the scan, the nurse (counter 6) will call your number. There are some forms for you to complete for Medisave purposes. At the same time, she will also hand you your medication prescription which you will have to go to the pharmacy at level 1 to purchase. That should take another 15-20 minutes.


3) Come back and press button 3 for treatment. You will go into the nurse room (Room 1) and the nurse will show you how to do the injections. I have done it before but I just let her go through the protocol. She was very thorough and clear so you will not miss it. Then you are done!

4) Do note, these medication needs to be refrigerated. Unlike Raffles Hospital (they gave me a cooler bag and a big pack of ice), KKH only gave me that small packet of ice (see left of the below picture). Gosh....and they told me that I will need to return the packet and they will give me a new one the next time??? Duh...I will bring my own ice instead.
From others' experience, I brought my own cooler bag but I did not realize the pharmacy would only provide such a small packet of ice. I guess that small packet is enough, but how do you feel adequate? hahahah.  Thus, instead of going for lunch, I went straight home!

5) Today's time at KKIVF is quite short - 2 hours but costed me $6 in parking fees. Another point to remember. Scanning is from 8-10am only. They don't scan after that.

6) Okay, if you qualify for the Medisave withdrawal and government subsidy, the below cost will not scare you. Medication today for just those 2 boxes of Puregon 900 and the 3 sticks of Orgalutran below...... $1,561.76. I did not pay a cent. Thank goodness for the Medisave and goverment subsidy. That is why I chose to do my IVF at KKH. Previously, at Raffles Hospital, the Puregon for just Puregon 300 was already $287.11. And the Orgalutran was $95.40. If I had paid for these medication at Raffles Hospital, I would have paid about $2000 in cold hard cash. But at KKIVF, slightly cheaper and it does not come out from my pocket. Huge difference even though the money is still part of my money (Medisave). But well, I would not have seen that money till I am 60 anyway.

My dosage is quite high. Doctor ordered Puregon 450 for Day 6-8....seems kinda high. I used 175 previously. Let's see what happens. However!!!!! I was told to take the Orgalutran today??? From Day 3 to 5. Weird. Orgalutran is to suppress ovulation? I wonder why I need to take this when I have not even ovulated? I am only Day 3. I asked the nurse and she said it's a new protocol.....Shall follow instructions then. The thing is.....Orgalutran is pain....the needle seems blunt and you have to use more strength to poke than the Puregon. When you handle Orgalutran, you will find Puregon a breeze. Previously, I reflected to the doctor that it hurts. She told me I could apply this medication to numb the area before I inject. I mentioned to the KKIVF nurse (the one that showed me how to do the injections) and she told me I should have asked earlier. Cos now I have to go back to the pharmacy to get it. Hmmm....pharmacy quite a torture cos it means another wait. She told me the small bottle costs $13++ and she feels it's expensive. Instead, she asked me to numb the area with the ice! I decided to try her method cos I did not want to wait for the doctor to sign the request then wait again at the pharmacy. Anyway, I tried and it works!!!

To digress a little. The nurse who showed me the injection was a Senior Staff Nurse (SSN). She looks near retirement age. Actually, I think it's great that the hospital deploys the older nurses to these positions. Not so tough on the older ladies cos this SSN gets to sit most of the time. Rather than have them leave nursing due to working hours and conditions, these kind of jobs still allow them to have contact with patients and yet, not too hard on them! In addition, their age seems to add some stamp of authority to what they say. Hahahahaha








Tuesday 22 October 2013

3 more days....

And my next menstrual cycle will start. We will be starting IVF on this cycle.....scary.....
please.....one shot one try.....

Saturday 12 October 2013

Running Man

heheheh. I am a fan of Running Man. They are so spontaneous and fun to watch. Bad thing....I can laugh till I start to whizz......really bad....

For the fans of Running Man and those who are following the Monday couple, check this scene where Gary Kisses Ji-Hyo!

Enjoy!

Tuesday 8 October 2013

Transvaginal Ultrasound Scan


What is this?
Transvaginal  - cos it is via your vagina. It is invasive
Ultrasound - The machine uses sound waves to form images.

Why do this?
For people wanting to attempt IUI/IVF, we do it to
1) Check on abnormal stuff like cysts, fibroid. This is also how a polyp is discovered. In this way, you can rule out infertility because of this causes
2) For me, it was also done in addition to the abdominal ultrasound scan - to give the sonographer and doctor the best picture of your reproductive organs.

How is this done?
1) You do NOT need to drink up. You need to have an empty bladder. I did the abdominal scan first, followed by this scan. The trick is to pee. Wait. Wait till you have 1-2 more gushes of pee. You need to be really empty. If you do not wait, you will notice that your next pee will come pretty soon.
2) Once in the room, you will need to remove your panties. You should be given a towel to cover up :)
3) Sonographer will wear condom for the probe! Funny! This time, the probe is in a stick form. She will then add gel on top of the condom. For the first time, you might want to ask the sonographer to add more gel. Apparently it helps.
Note: My advice is targeted at the first timers like myself. 
4) You will lie down, with your knees bent (soles are faced down on the bed). You could get a cushion to be placed under your butt so that it helps.
5) The sonographer will then insert the probe via your vagina.
Note: Do not tense. Your thighs and butt are usually the ones that gets tensed. When you are tensed, the sonographer cannot get the probe in. 
What helps?
-breathing in and out
-coughing (yes!!! it helps) But becareful. At certain spots, she needs you to be still.

How long?
About 5-15 mins? Depending on the needs for the scan.

Any pain?
It is not painful. It is just uncomfortable. Once the probe is in, it is ok in most regions. It is uncomfortable once in a while when she moves over certain regions.
Note: The probe looks almost intimidating. But actually, only a small part of the probe is inserted. 

Who is a sonographer?
This is the professional name for the person who does the ultrasound for you. In hospitals, it is mainly done by a sonographer. In a private practice, the doctor does it for you.
The only difference is that when done by a sonographer, you clean up the gel on your own!
With a private doctor, his/her nurse will clean up for you! :)

Cost in 2013:
1) Gynae at Raffles Hospital (Fertility clinic) - $96.30 (just abdominal scan)
2) Sonographer at KKH  - $127.33 (please note that this is for abdominal and transvaginal scan)




Abdominal Ultrasound Scan

What is this?
Abdominal  - cos it is non-invasive and the scan is just over the area just above your bush.
Ultrasound - The machine uses sound waves to form images.

Why do this?
You definitely do it when you are pregnant.
But for people like us who are waiting for the stork to drop, ultrasound is done for a number of reasons:
1) to check on your uterus lining, number of follicles.
2) Checking on the development and when is the best time to do IUI/IVF
3) For me, it was also done in addition to the transvaginal ultrasound - to give the sonographer and doctor the best picture of your reproductive organs.

How is this done?
1) You need to drink up. Yes, drink till your bladder feels really full and you need to go to the toilet. When you lightly press just above your bush and you can feel that urge to pee. That should be just about right. Do note....everyone is different. I have done this through trial and error. I start drinking 2 hours in advance of my appointment. In this way, I can take my time and not have to gulp down too much in a short space of time. Water becomes yucky when you have too much and too fast, even ribena!
2) In case your bladder is too full and you cannot wait for your turn, just go ahead to pee. But you will need to start drinking again. So give it another 20 - 30 mins to build up again.
3) Okay, if I am not clear about this. You need a full bladder to perform this scan. Without a full bladder, the sonographer cannot see anything.
4) You will lie down, there is no need for any special actions. You just lie there! Easy!
5) The sonographer will squeeze this gel thingy on your belly. Most times it is warm and a hand-held probe (something like your computer mouse) and she will just move around the top and try to get some images on her screen. The sound waves will create the image.

How long?
About 5-10 mins? Depending on the needs for the scan.

Any pain?
This really should not have any pain at all. I am super sensitive to pain and it is not even pain for me. There might be a slight discomfort when she presses the probe down harder, but that's it.

Who is a sonographer?
This is the professional name for the person who does the ultrasound for you. In hospitals, it is mainly done by a sonographer. In a private practice, the doctor does it for you.
The only difference is that when done by a sonographer, you clean up the gel on your own!
With a private doctor, his/her nurse will clean up for you! :)

Cost in 2013:
1) Gynae at Raffles Hospital (Fertility clinic) - $96.30 (just abdominal scan)
2) Sonographer at KKH  - $127.33 (please note that this is for abdominal and transvaginal scan)





My Virgin Transvaginal Ultrasound Scan

Wow! It was mind blowing.....I have fallen behind in blogging about my KKH experience, but I need to blog about this to get it out of my mind. I just had a transvaginal ultrasound (TU). Let's call it TU for short. What is  TU? It is a probe (a stick) that enters your body via your vagina to look at a woman's reproductive organs like womb, uterus, ovaries, cervix.

Many years ago, I have rejected the TU because, well...I do not like the idea of that stick in me. 
no no NO.

Why you need to do a TU? The sonographer (the person that does all the ultrasound) needs to reconstruct a picture of your womb for the doctor. Don't ask me what is this for....why reconstruct? I will ask the doctor when I next see him. But I guess it's also to check if you have any polyp, endometriosis, any worrying sign for infertility etc.

The sonographer was soooo nice. She had that stick in me for 20 mins. I guess she could have completed it under 12 mins, but cos it was my first time and I kept on tensing up (thighs and butt), she went very slowly, gently and followed my pace. She will stop once in a while to check on me and to let me relax. Wonderful sonographer.....Jia Yun from KKH. The funny part was I had already spoken to doctor and he agreed to just do an abdominal scan but when she found out it was for IVF, she told me it is okay if I do not want to do it, but it's really useful and important. Some people are like her....she makes you feel comfortable, she earns your trust. In the end, I did the scan cos I knew I can trust her, that she will be slow and follow my pace and not pressure me. She was very comforting and patient ALL THE WAY....I am so glad I met her today. Gosh....I think I spent about 40 mins in her room? For the abdominal and transvaginal scan. 

To those who have not had and have to do TU, fret not. It is really not that bad. Pain is definitely not an  apt adjective. There is some discomfort cos there are parts she touch that will feel weird (like your bladder) and some other motions. But generally, once the probe is in, it is good. The worst is to be tensed as once you tensed up, the probe cannot go in. 

Oops....this post is too long. I will continue in another post on the how-to for a TU.
Abdominal Ultrasound Scan
Transvaginal Ultrasound Scan

But even with this blog.....I really hope I do not need to do another scan. I am feeling damn damn damn sore.....and there is no pain when I brush my hand across my vagina (from the outside). I guess it's more of a memory thingy.....