Our Services » Assisted Conception

 

Assisted Conception

 

Ovulation Induction and Cycle Monitoring

In most assisted reproductive procedures, the woman’s ovaries need to be stimulated to produce more eggs. This will allow the embryologist to extract and use these eggs for the needed procedure. Ovulation induction and the monitoring of the woman’s menstrual cycle is therefore extremely crucial at this stage. Ovulation induction involves the use of medications to stimulate the development of one or more mature follicles (sac-like structures that contain the eggs) in a woman’s ovaries. Women that have irregular cycles or anovulation (do not ovulate at all) usually do not develop mature follicles regularly themselves and will therefore benefit from this procedure.

Pelvic ultrasound scans are used to access the endometrium (lining of the womb) and to determine how the follicles are developing. Blood tests may also be carried out to measure hormone levels and help to determine when a woman is most likely to ovulate (a woman’s most fertile time).

The side effects involved in ovulation induction include bloatedness, lower abdominal discomfort, headaches and fatigue. Careful monitoring removes the risk of multiple births by advising the patient to abstain from sexual intercourse where indicated.

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IUI (Intra-Uterine Insemination)

Intrauterine Insemination (IUI) is a procedure often used when the cause of the patient’s infertility cannot be determined or explained. In this procedure, sperms collected from the male partner are first washed and processed before being deposited directly into the uterus via the cervix using a catheter. This was done to ensure that only the best sperm is selected and inseminated. IUI can be an effective treatment method for many causes of infertility except for the following conditions:

  • Tubal blockage or severe tubal damage
  • Ovarian failure or menopause
  • Severe male factor infertility
  • Advanced stages of endometriosis

 

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IVF (In-Vitro Fertilisation)

In Vitro Fertilisation (IVF) is a process by which eggs (or scientifically known as oocytes) are fertilised by the sperm outside of the body. IVF is the most popular fertility treatment offered to patients who do not respond to conventional medical or surgical therapy. The process includes stimulating the development of multiple oocytes which are then retrieved from the ovaries by a needle.

The eggs are then transferred to the laboratory where they are fertilised with the sperm and allowed to develop in a special culture medium. The resulting embryos from this fertilisation process are then placed back in the uterus where they will hopefully attach and result a successful pregnancy.

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IVM (In-Vitro Maturation)

In Vitro Maturation (IVM) is a procedure which is almost similar to IVF. Both IVF and IVM involve the retrieval of eggs from a woman’s ovaries, followed by fertilisation in a lab, and then implantation of one or more of the fertilised embryos back into the woman’s uterus. The crucial difference is the state of the eggs at point of retrieval. With IVF, the eggs are matured inside the ovaries, while in IVM doctors remove immature eggs from the ovaries and then mature them outside the body.

Unlike in IVF, IVM requires no hyperstimulation of the ovaries, which eliminates the need for daily drug shots. Instead patients will only need to take hormones in the form of a pill or a suppository. Once they are removed, the immature eggs are placed in a Petri dish and exposed to a combination of luteinising hormones and follicle stimulating hormones to expedite the maturation process. Once matured, they are then inseminated. The newly formed embryos are then transferred back into the uterus within four days. IVM is a cheaper treatment alternative, which requires fewer drugs and reduces the risk of Ovarian Hyperstimulation Syndrome (OHSS).

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GIFT (Gamete Intra-Fallopian Transfer)

Gamete Intra Fallopian Transfer (GIFT) is a procedure where the female eggs and male sperms are extracted out of the body, inserted into a catheter in the laboratory and later placed directly into the woman’s fallopian tubes via a minor surgery. Prior to the procedure, the woman will receive hormones to stimulate development of the ovarian follicles, (sac-like structures that contain the eggs) in order to enable the doctor to retrieve as many ripened eggs as possible. Once extracted, they will be observed and cultured in a special nutrient. Sperms extracted from the husband’s semen sample will also be obtained. These sperms are then washed and prepared for loading into the same catheter into which several of the wife's best eggs will be placed.

With GIFT, fertilisation occurs inside the woman's body and mimics the way a normally fertilised egg would begin its journey from the fallopian tubes to the uterus for implantation. GIFT however, can only be performed if the patient has normal fallopian tubes and adequate number of sperms.

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ICSI (Intra-Cytoplasmic Sperm Injection)

Intra-cytoplasmic sperm injection (ICSI) is a process in which a single sperm is injected directly into an egg cell with microscopic guidance. This procedure is often used in conjunction with In Vitro Fertilisation (IVF) in instances where the male partner has a very low sperm count, low sperm motility or poor sperm quality. This will increase the likelihood of fertilisation and pregnancy as it does not rely on the sperm to find its own way to the egg.

ICSI is an improvement of the original method of micro-injection of sperm into egg called SUZI (Sub-Zona Injection), which was invented by the team in Singapore in 1990. TMC Fertility Centre's own doctor was a part of this team.
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Blastocyst Transfer

A blastocyst is an embryo that has developed for five days after fertilisation and has divided into two different cell types. A healthy blastocyst should hatch from its "shell" ( zona pellucida ) by the end of six days, and within 24 hours after hatching, should begin to implant within the lining of the uterus. Recent studies have demonstrated that embryos that do not survive to the blastocyst stage have a high incidence of abnormal chromosome numbers.

Blastocyst culture and transfer is an excellent technique for selecting embryos with the most potential to implant. It is also useful for reducing the risk of multiple pregnancies since we will transfer only one or two blastocysts compared to the average of more than 2 embryos in the normal Day 2 or 3 transfers. In our centre, blastocyst transfer has been known to result in better clinical pregnancy, implantation and delivery rates, while reducing the risks of multiple pregnancies.

Certain criteria will be used in deciding the need and viability for a blastocyst transfer. These include; 

  • number of follicles
  • number of fertilised eggs 
  • number of good quality embryos available on day 2 or 3

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Surgical Sperm Retrieval (via MESA, PESA or TESE)

For male patients who have very little or no sperm in their ejaculated semen, sperm may be obtained by several procedures such as Micro Epididymal Sperm Aspiration (MESA), Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Extraction (TESE). In MESA the surgeon makes an incision in the scrotum and gathers the sperm an area known as the epididymis; the elongated coiled duct that provides passage of the sperm from the testes. This is a minor surgical procedure which takes a mere 30 minutes to perform and only requires local anaesthesia.

PESA is similar to MESA but does not involve microsurgery. In PESA the physician uses a needle to penetrate the scrotum and epididymis and draws sperm into a syringe.

TESE is usually performed when MESA has failed. It involves the removal of a small amount of testicular tissue in order to retrieve the sperms.

In all of these procedures, the number of sperms retrieved will be sufficient to perform ICSI and IVF.

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Assisted Hatching

Assisted hatching involves thinning or making a small hole in the protective layer (also known as zona pellucida) that surrounds the embryo in order to improve implantation rate. Before an embryo implant into the uterus it must hatch from the protective layer. However in certain women, this protective layer may have become toughened, thereby restricting the embryo from hatching. Making a small hole in the protective layer using a micromanipulation technique will make it easier for hatching to occur.

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Embryo Freezing and Banking

During IVF or most assisted reproductive treatments, the woman will undergo an ovarian hyperstimulation process. As a result, more eggs are produced which leads to the creation of multiple number of embryos. However due to the risks involved in multiple pregnancies, it is not recommended to have more than three embryos transferred into the uterus for implantation. Therefore, embryo freezing and banking is highly recommended for couples in order to avoid the wastage of good healthy embryos. Furthermore, these embryos can be thawed and used at a later time when the couple is ready to have another child. Healthy embryos are usually frozen using cryopreservation or vitrification; a rapid embryo freezing technique where embryos are frozen to look like clear hardened glass. These frozen embryos will be stored in liquid nitrogen via special chambers and can be taken out for future use.

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Fertilisation Through Oocyte (Egg) Donation

Egg donation is a treatment option for women who are unable to produce their own eggs, women with genetic diseases who might pass on a disorder to their children and also women over the age of 40 who wants to have children. Eggs collected from the donor are fertilised with a prepared sperm sample from the recipient's male partner. Usually up to three embryos from such fertilisation are transferred to the uterus. The remaining embryos are usually stored for later use.

Who are the egg donors?

Our egg donors are usually young women below 35 years old. Our centre will perform a very thorough screening process to ensure donors are free of genetic diseases and viruses. Sometimes relatives and friends can become egg donors, but they must have no genetic relationship to the recipient’s husband.

Egg donation however is not provided for Muslims and in instances where it contravenes the patient’s religious and moral code.

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Fertilisation Through Sperm Donation

Sperm donation is a treatment option for couples where the man has poor sperm quality, low or no sperm count or men with genetic diseases who might pass on a disorder to their children. Sperm collected from the donor are fertilised with a prepared egg sample from the recipient's female partner. Usually up to three embryos from such fertilisation are transferred to the uterus. The remaining embryos are usually stored for later use.

Who are the sperm donors?

Our sperm donors are usually young men below 35 years old. Our centre will perform a very thorough screening process to ensure donors are free of genetic diseases and viruses. Sometimes, relatives and friends can become sperm donors. However they must have no genetic relationship to the recipient's wife.

Sperm donation however is not provided for Muslims and in instances where it contravenes the patient's religious and moral code.

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Fertilisation Through Embryo Donation

Embryo donation is an alternative route to pregnancy. It helps couples that would otherwise be unable to conceive, carry a pregnancy to term. Embryo donation involves using another couple’s embryos to conceive. These donated embryos are then transferred into the woman’s uterus using frozen embryo transfer. Embryo donation is a suitable option for couples who are unable to afford conventional reproductive treatments or who have been unsuccessful with IVF treatments using their own sperms and eggs.

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Sperm Freezing/Banking

Sperm Banking is a service where the ejaculated semen (containing sperms) is frozen and stored for possible use in the future. The sperm can be thawed and used later for ICSI or IVF.

Sperm Banking is highly recommended in instances where the male partner is:

  • A man who is undergoing cancer treatment.
  • A man facing voluntary sterilization.
  • A man facing sterilization resulting from medical conditions or treatments such as vasectomy, orchidectomy, chemotherapy, radiation therapy.
  • A man in high risk of occupational exposure to radiation or toxic substances.
  • A man in high risk of testicular injury.
  • A man having low sperm count.

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PGD (Pre-implantation Genetic Diagnosis)

Pre-implantation genetic diagnosis (PGD) is an advanced reproductive technique used to identify genetic defects in embryos created through in vitro fertilisation (IVF). Following the technique, only embryos that are tested normal are transferred into the uterus for implantation. Because only unaffected embryos are transferred to the uterus for implantation, PGD technology improves the likelihood of a successful pregnancy and the birth of a normal baby.

Furthermore, PGD also provides a viable alternative to current post-conception diagnostic procedures such as amniocentesis or chorionic villus sampling. This eliminates the dilemma of deciding on pregnancy termination as a result of carrying an abnormal fetus. PGD is highly recommended for couples with the following conditions:

  • Women with advanced maternal age
  • Patients with inherent genetic diseases
  • Recurrent miscarriages and IVF failures
  • Sex-linked diseases

See here for more information about PGD

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FISH

Fluorescent In-Situ Hybridization (FISH) is a technique used to detect numerical chromosomal abnormalities such as Down’s Syndrome, Patau Syndrome or Edward’s Syndrome. It can also be used to detect abnormalities in the sex chromosomes (X & Y) such as Turner’s Syndrome, Klinefelter’s Syndrome and Super Female XXX.

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PGD PCR

PGD, using a technique known as Polymerase Chain Reaction (PCR) is usually performed to detect genetic disorders such as Alpha-thalassaemia, Beta-thalassaemia or Haemophilia.

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Microarray CGH - 24 Chromosome Aneuploidy Screening

Currently most fertilty centres are only able to screen 5-12 chromosomes. TMC Fertility Centre is the first centre in Asia to offer a brand new technique in PGD, the microarray CGH. Microarray CGH enables us to screen all 24 chromosomes in a single, automated investigation. This technique helps us to confirm that the correct number of chromosomes is present in an egg or embryo. As a result, only embryos with the correct number of chromosomes are transferred during IVF, leading to a successful pregnancy and increasing the likelihood for a couple to have a normal and healthy baby.

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