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In-Vitro Fertilisation (IVF)

In-Vitro Fertilisation (IVF) - What it is

WHAT CAUSES OF INFERTILITY CAN IN-VITRO FERTILIZATION (IVF) TREAT?

IVF may be an option if either you or your partner has been diagnosed with any of the following conditions which may contribute to infertility:

  1. Tubal factor – eg tubal damage from previous infections / previous ligation / salpingectomy
  2. Endometriosis
  3. Ovulatory problems and/or anovulation – eg in Polycystic Ovarian Syndrome (PCOS)
  4. Early menopause (premature ovarian failure)
  5. Male factor – eg low sperm count / absent sperm (azoospermia) / inability of sperm to penetrate or survive in the cervical mucous
  6. Unexplained infertility

Causes of infertility IVF can treat.

HOW DOES IVF WORK?

How does IVF work.

Video: http://www.youtube.com/watch?v=GeigYib39Rs

During the process of IVF, fertilization of the eggs with sperm occur in a laboratory—“ in vitro”. Before fertilization, hormonal injections are administered for about 2 to 4 weeks to stimulate the follicles within the ovaries. Eggs are then collected and inseminated (IVF) or injected (ICSI) with the husband’s sperm in the laboratory. After fertilization, the embryos are incubated for 2-5 days before being replaced into the womb in a process called embryo transfer. A successful pregnancy can be confirmed 17 days later via a blood test. There are other procedures involved in IVF which are suitable for specific problems. Your doctor will advise you if any of the following are necessary for you:

1 ) Intra-Cytoplasmic Sperm Injection (ICSI)
ICSI involves injecting a single sperm into each egg to allow fertilization to occur in the laboratory. This is recommended if the man has poor quality sperm or if you have had difficulties with fertilization previously.

2) Blastocyst Culture

Embryos are cultured for 5 days to become a blastocyst. The chances of pregnancy are much higher with a blastocyst transfer. This may be helpful for couples with repeated IVF failure, multiple eggs and if Pre-implantation Genetic. Diagnosis is required.

TYPICAL IVF CYCLE

Typical IVF cycle from ovulation to implantation.

1) Ovulation Induction Controlled Ovarian Hyperstimulation and Monitoring (Bold) Hormone injections are administered to stimulate the production of multiple eggs in each ovary (versus the usual production of a single egg per month). This stimulation process usually requires the initial use of a GnRH agonist injection to suppress the body’s spontaneous ovulation, and to ensure that the ovarian follicles grow in a synchronous fashion. Daily gonadotropin injections are then added to stimulate growth of the follicles in the ovaries. When the follicles have reached the desired size, an injection of hCG is given, with the discontinuation of GnRH agonist and gonadotrophins. The hCG is required for the final maturation of eggs before egg collection.

2) Oocyte Pick-up (Egg retrieval) Oocyte Pick-up (OPU) is performed under sedation by placing a special needle into the ovary and removing the oocyte-cumulus complex (containing the egg). Multiple eggs may be retrieved at a time depending on the success of the stimulation process.

3) Fertilization Following egg retrieval, sperm is added to the eggs in a dish to allow fertilization to occur by natural selection in the laboratory. For sperm abnormalities, ICSI (intra-cytoplasmic injection of sperm) is performed.

4) Embryo Transfer Fertilized embryos are transferred into the uterus between day 2- day 5 of fertilization using a fine catheter. Usually, a maximum of two embryos are transferred at a time. Up to three embryos may be transferred under exceptional circumstances (please ask your doctor for more information). You will be given hormones either oral, vaginal or even by injection to support the lining of the uterus for implantation of the embryos.

5) Freezing of Extra Embryos A proportion of patients may have excess good quality embryos. These may be frozen for future use. The survival rate for thawing these embryos is about 83%. An annual storage fee will be subjected for these frozen embryos, and they can be stored up to 10 years at our facility.

6) Testing for Pregnancy You will need to come back between 14 to 17 days after the embryo transfer for a pregnancy test, which measures the pregnancy hormone b-hCG in the blood. If you are pregnant, subsequent ultrasound scans and blood tests will be arranged to ensure that the pregnancy is proceeding normally. If you are not pregnant, you may consider proceeding to a frozen (thaw) cycle of IVF if you have additional frozen embryos in storage.

In-Vitro Fertilisation (IVF) - Symptoms

In-Vitro Fertilisation (IVF) - How to prevent?

In-Vitro Fertilisation (IVF) - Causes and Risk Factors

WHAT ARE THE POSSIBLE COMPLICATIONS AND RISKS OF IVF TREATMENT?

Ovarian Hyperstimulation Syndrome (OHSS)

OHSS refers to excessive stimulation of the ovaries during ovulation induction.

It is a side effect of the medications that are given to you.

Symptoms include

  • Abdominal discomfort and/or pain
  • Nausea and vomiting
  • Bloatedness or swelling of the abdomen and genital area
  • Shortness of breath
  • Dehydration
  • Reduction of urine volume

OHSS is usually mild and causes no more than slight lower abdominal discomfort in most cases. However, immediate medical attention is required should the symptoms persist or worsen. They include

  • Vomiting
  • Urinary problems
  • Severe discomfort from abdominal bloating
  • Chest pain or any difficulty in breathing

A small percentage of patients undergoing IVF may need to be admitted due to severe symptoms of OHSS. If you experience any of the above symptoms, please inform your doctor.

Multiple Pregnancy

Although the prospect of twins or triplets may seem attractive to some couples, multiple pregnancies are associated with increased risks of maternal and fetal complications. These include an increased risk of

  • miscarriage
  • premature labour which can result in a child with physical or learning disabilities
  • pregnancy associated problems such as bleeding, diabetes and high blood pressure
  • caesarian section and its complications
  • stillbirth

Failure of Treatment

The likely reasons for the failure are

  • cancelled cycles
  • failure to collect eggs
  • failure of fertilisation
  • failure of the embryo to implant

This can be due to a significant portion of embryos poor quality or abnormal.

Failure of treatment can lead to emotional strain and depression. Psychological counseling and support is available. Do not hesitate to inform your doctors if you require help.

Ectopic Pregnancy

IVF increases the likelihood of an ectopic pregnancy. Patients who become pregnant through IVF treatment are advised to schedule an early scan to make sure that the pregnancy is correctly positioned. If an ectopic pregnancy is detected at an early stage, a medication called methotrexate can be used to dissolve the pregnancy tissue. Otherwise, surgical procedures will be considered to treat the ectopic pregnancy. Your specialist will discuss the appropriate treatment should this happen to you.

Miscarriage

Miscarriage is a common complication of pregnancy. You will experience some abdominal cramps and bleeding. This diagnoses needs to be confirmed by your doctor. Depending on your condition and assessment by your doctor, surgical procedures may be required. Please consult your specialist for further information.

In-Vitro Fertilisation (IVF) - Diagnosis

In-Vitro Fertilisation (IVF) - Treatments

 

In-Vitro Fertilisation (IVF) - Preparing for surgery

In-Vitro Fertilisation (IVF) - Post-surgery care

In-Vitro Fertilisation (IVF) - Other Information

Regulatory and Funding Matters

For In-vitro Fertilization (IVF):

1) IVF counseling is mandatory under Ministry of Health (Singapore) guidelines.

2) There may be waiting time before starting program.

For IVF and Frozen Embryo Transfer (FET):

Government co-funding and Medisave can be used for Singapore Citizens, subject to conditions. For more details, please refer to Ministry of Health (Singapore) website: http://www.pqms.moh.gov.sg

Under Ministry of Health (Singapore) guidelines, our institutions do not practise:

  • Sex selection unless medically indicated
  • Social storage of gamete or embryos unless medically indicated

FREQUENTLY ASKED QUESTIONS (FAQ)

1. How much does in-vitro fertilization (IVF) treatment cost?
Currently IVF costs between 10,000 to 12,000 SGD depending on your selected treatment.

There are government grants available for Singaporeans below the age of 40 to help cover the cost of your treatment provided you fulfill other criterias.

Our staff will work closely with you to help you manage your costs.

Please refer to the following website for more information regarding using your MEDISAVE for assisted conception procedures.

Click here to read more.

2. Can I travel during my IVF treatment?
No. It is imperative that during the monitoring phase of the treatment cycle, patients should be available as multiple appointments will be made for mandatory tests and treatments.
Our nursing staff will work closely with you in scheduling the appointments.

3. Can we choose the sex of the embryo?
This is not allowed as Government of Singapore forbids sex selection procedures.

The sex ratio is almost identical to that seen in the general population following standard IVF treatment.

4. Will my age affect my pregnancy chances with IVF treatment?  
Pregnancy rates decrease and the incidence of miscarriage increases for patents above 40 years of age.

5. Does weight affect pregnancy chances with IVF treatment?   
IVF is not recommended if Body Mass Index (BMI) is more than 30 or less than 19 as the chance of success is significantly lower with higher risks.

6. Is there something we can do to improve our chances of success in IVF? 
Although IVF treatment is a medical process, some lifestyle and dietary modifications may improve the success rates of IVF. Patients should stop smoking and avoid inhaling passive smoke. Alcohol consumption and having an extreme Body Mass Index should also be avoided.

A daily intake of 5mg of Folic Acid is recommended for all patients trying to conceive as this prevents neural tube defects in the baby.

7. What to expect after oocyte pick up (Egg retrieval)? 
It is not unusual to experience slight abdominal discomfort and/or bloating, which will usually subside in 48 hours. It is usually tolerable. If necessary, medications may be prescribed.

Patient may also experience slight vaginal bleeding after the procedure which will subsequently resolve.

However, please contact us if you have heavy vaginal bleeding or severe abdominal pain.

8. What should a patient take note after the embryo transfer?  
Please avoid strenuous and high impact activities and exercises.  You will be provided medical leave for rest.

9. Is it normal to experience vaginal bleeding after embryo transfer?  
Light vagina bleeding often occurs within the first few days after an embryo transfer. This can be present as light bleeding (pink/red/brownish) or spotting/staining. In this instance, no intervention is usually required.

Common causes include the implantation of the embryo onto the lining of the womb. The use of vaginal progesterone causing the cervix to be more delicate and thus cervical bleeding is another common cause.

Patients may continue using vaginal Progesterone tablets as directed. If the bleeding lasts longer than 3 days or becomes very heavy, you are advised to call the IVF center.

10. Is it normal to experience pain after embryo transfer? 
Many women complain about non-specific abdominal discomfort after embryo transfer. If the discomfort is mild and not constant, it is unlikely to be of concern.  Simple pain relief medications should be sufficient. If the pain is severe with or without heavy bleeding, please call IVF center for advice or seek medical attention in hospital.

11. When will I be able to tell if I am pregnant?  
A pregnancy test is normally scheduled 14 to 17 days after the embryo transfer. It is mandatory that you return for this test even if you are bleeding.

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