IN VITRO FERTILIZATION (IVF)

IVF is one of the most well-known Assisted Reproductive Technologies (ART) in Singapore. IVF treatments have helped infertile couples conceive and bear children for the past two decades. Babies conceived via this method are known as test-tube babies. Fertilization now occurs in a dish and not a test tube. It was originally developed to help couples overcome tubal factor infertility, but has become useful in treating other factors such as immunological problems, unexplained infertility, and male factor infertility.

An IVF doctor in Singapore can help you understand whether IVF is suitable, how the procedure works, and the risks associated with it.

Who Is Suitable For IVF

IVF is recommended for couples who are unable to get pregnant despite actively trying for at least a year or 6 months for women aged 35 and older.

In Singapore, all women below 45 years old can undergo 10 IVF cycles (round of treatments), up from 5 cycles previously allowed for women over 40 years old.

IVF Procedure

Step 1: The patient takes medications to stimulate the ovaries to develop multiple follicles. This is referred to as ovarian stimulation or superovulation.

Step 2: Follicular growth to determine egg growth and uterine lining development is monitored by ultrasound. When the follicles and the uterine lining are appropriately mature, an IVF specialist in Singapore will administer a trigger shot of Human Chorionic Gonadotropin.

Step 3: Thirty-six hours after the trigger shot, the eggs are retrieved by ultrasound-guided-needle aspiration. This process is best done under light anesthesia. A sperm specimen is washed and prepared for insemination. The washed sperm is placed in a dish with the eggs and they are placed in an incubator.

After 18 hours, the embryos are observed for normal fertilization under a microscope, where the pronucleus of egg and sperm can be seen. The embryos are incubated for further development into multi-cell embryos.

Step 4: The embryos are transferred into the uterine cavity via a catheter inserted through the cervix. The number of embryos that will be transferred is decided between the patient and the IVF doctor in Singapore. It depends on the age of the patient: up to two embryos for those under 40 years old, and up to a maximum of three embryos for those 40 years old and older.

Additional embryos may be frozen and stored at the IVF centre in Singapore for future use.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

ICSI is a sub-type of IVF. With ICSI, a single motile sperm is isolated from the male partner's sperm and the tail of the sperm is cut to immobilize the sperm. The sperm is injected directly into the center of the egg. A very small percentage of eggs can be damaged by the injection procedure but this is offset by the increased fertilization rate.

While nearly two million babies are born following standard in-vitro fertilization treatment, the number of babies born following ICSI is probably a few hundred thousand.

Who Is Suitable for ICSI

ICSI is used when the male partner's sperm is suboptimal, previous IVF treatments have low fertilization rates, or only a few eggs are available.

Preparation for the IVF/ICSI Journey

The IVF process is a physically and mentally draining journey that may last for years. Couples must be prepared to expect painful injections, surging hormones, and unsuccessful IVF treatments. During this period, couples may find it useful to speak to a counselor or close friends to get emotional support. We are also here to support you throughout your fertility journey at Seng OG.

Support Available During the IVF/ICSI Treatment

At our clinic, our medical doctor and counselor will help you be aware of all available fertility treatment options. Our professional staff is dedicated to providing you with safe and high-quality medical services that suit your needs. We understand that undergoing an IVF treatment may be a difficult process.

Subsidies Available For IVF

Singaporean or PR couples can also make use of their Medisave to pay for IVF in any public or private centres, as shown below.

• 1st IVF cycle: $6,000
• 2nd IVF cycle: $5,000
• 3rd & subsequent cycles: $4,000

Do note there is a lifetime Medisave withdrawal limit of $15,000 per patient for all ARTs, including IVF.

Risks Involved In The IVF/ICSI Procedure

Certain risks are involved in IVF and ICSI such as developing ovarian hyperstimulation syndrome and having multiple pregnancies.

Ovarian Hyperstimulation Syndrome

This is a rare complication of IVF. Ovaries are larger than normal and contain cysts and fluid-filled structures (follicles), which contain the eggs. These cysts produce copious quantities of fluid, which is released into the tummy cavity. The fluid is rich in minerals and protein.

Seek medical attention if your symptoms include

1. Abdominal pain and swelling
2. Shortness of breath
3. Nausea and possibly vomiting
4. Reduction in urine output

If severe symptoms occur, hospitalization may be necessary to replace the fluid minerals and protein.

Although it is not possible to be certain which patients will develop Ovarian Hyperstimulation Syndrome, patients with polycystic ovaries are more at risk. This will be assessed during the preliminary consultation at the IVF centre in Singapore prior to starting the IVF treatment.

Patients who respond to the drug treatment by producing many eggs, particularly if they are experiencing lower abdominal pain before the time of the egg collection are also at increased risk. In these circumstances, the treatment cycle may be canceled by the IVF specialist in Singapore before the late-night Pregnyl injection or, if the egg collection is performed, all the embryos may be frozen and not transferred immediately.

Multiple Pregnancy

In couples who conceive naturally, the chance of a twin pregnancy is approximately one in every eighty pregnancies. With IVF treatment, the chance is one in every three to four pregnancies. It is also possible to conceive a triplet pregnancy even if only two embryos are replaced. This happens if one of the embryos divides into identical twins.

Pregnancy-related complications related to the carriage of two or three babies can be significant. These problems include high blood pressure, diabetes, and hemorrhage. Problems for the babies include the early delivery of premature babies who may not survive. For those who survive, they may have handicaps like brain damage.

To prevent risks of multiple pregnancies, the Ministry of Health Singapore only allows no more than three embryos to be transferred in an IVF cycle, except in exceptional cases like patients over the age of 40 years old having treatment with their own eggs.

Infection/Haemorrhage

At egg collection, a fine needle is passed through the vagina into the ovary to remove the eggs. There is a small risk of causing bleeding to the ovary or introducing infection into the pelvis. Great care is taken during the egg collection to minimize these risks. Antibiotics are also given.

In practice, while some spotting of blood from the vagina is likely after the egg collection, significant bleeding is extremely rare. The chance of infection is less than one in one hundred.