Treatment-Options

TMC Fertility Centre offers the full range of fertility treatments available internationally, comparable to IVF centres in Europe or America. However, not everyone needs IVF right away. Treatment options will vary according to the underlying cause of your fertility problems.

TMC Fertility Centre in Malaysia has helped many couples conceive with simple fertility treatments even though they may have been trying to get pregnant for many years.

Your doctor may suggest trying simple measures or less invasive procedures first, progressing to more complex surgeries if necessary. Every couple will be assessed comprehensively and individualised treatment recommended. Some couples may just require fertility tablets or out-patient daycare procedure, while others may need to undergo In Vitro Fertilisation (IVF).

Treatment will depend on

  • Age, as female fertility rates naturally fall after 35 years old
  • The underlying cause of fertility problem
  • How long you and your partner have had fertility problems
  • The quality of male partner’s sperm
  • Whether you have had a previous pregnancy (primary or secondary infertility)
  • Whether you have had previous fertility treatments

Fertility Treatments

Natural Cycle Monitoring

Some women, especially those with irregular menses, do not conceive because of difficulties timing their ovulation.

TMC doctors can monitor these patients to determine when ovulation occurs, and advise timed intercourse or assist by performing ‘unstimulated’ intrauterine insemination (IUI) to achieve pregnancies even without any medications.

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Ovulation Induction

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The first step in most fertility treatment is to stimulate egg production. This is known as Ovulation Induction, whereby the women will be given medications to increase the development of more mature eggs in the ovaries.

In a natural cycle, only one mature egg is produced per menstrual cycle. By increasing the number of mature eggs, her chances of conceiving would be higher.

Medications to stimulate eggs can either be

  • taken orally, ie, fertility tablets for 5 days
  • injections into the fatty part of the abdomen, from 4 days up till a few weeks, depending on which treatment regimen
  • combination of both pills and injections

Once medications have started, pelvic ultrasound scans will be done every few days to assess the development of the eggs.

Sometimes, blood tests may been done to monitor the progress as well.

Once the eggs have reached the optimal size, medication will be given to mature and release the eggs.

All patients undergoing treatment will be counselled and taught to administer their medications. Some effects of fertility treatment may be felt during this time, including bloatedness, discomfort over her lower abdomen, headaches and fatigue.

Fertility Pills and Timed Intercourse

This simple measure is suitable for women who have irregular menses, eg, PCOS, or couples who do not have any ‘major’ problems after initial assessment.

Fertility tablets are prescribed for 5 days, starting a few days after the menses. Ultrasound monitoring will be scheduled near her ‘ovulation’ day in the middle of the cycle to assess her egg development, and the best days for intercourse will be advised.

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IUI (Intra-Uterine Insemination)

IUI (Intra-Uterine Insemination) treatment is suitable for couples whereby the male partner’s sperm parameters as slightly below average, eg, low sperm count or slow swimmers.

In a normal pregnancy, healthy sperm needs to pass through the cervix, up the uterus and down through the fallopian tubes to reach the ovaries. If male factor problem is present, then chances of pregnancy is reduced.

The IUI (Intra-Uterine Insemination) procedure involves collecting the man’s semen and cleaning them to select only the healthiest ones. These are then deposited directly into the uterus of the spouse with a catheter, bypassing the cervix, and reducing the distance for the sperm to reach the egg.

At least one of the fallopian tubes need to be patent (not blocked) for this treatment to be successful.

IVF (In-Vitro Fertilisation)

In Vitro Fertilisation (IVF) is a process by which eggs (medically known as oocytes) are fertilised by the sperm outside of the body. IVF offers the highest success rates for pregnancy among the various fertility treatments available.

The process includes:

  • Stimulating the development of multiple eggs (Ovulation Induction)
  • Collection of the oocytes from the ovaries, Oocyte Pick Up (OPU), which is done via the birth canal. Patients are placed under light anaesthesia.
  • Fertilisation in the embryology lab, where the eggs are fertilised with sperm and allowed to develop in a special culture medium
  • Embryo Transfer. The best resulting embryo(s) from the fertilisation process are then placed back into the uterus after 3 or 5 days, where they will hopefully implant and progress on to a successful pregnancy.
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IVM (In-Vitro Maturation)

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In Vitro Maturation (IVM) is almost similar to IVF, involving 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 the point of retrieval. With IVF, the eggs are matured inside the ovaries, while in IVM, immature eggs are retrieved from the ovaries and then matured out of the body, in the embryology laboratory.

Unlike IVF, IVM requires no hyperstimulation of the ovaries, which eliminates the need for prolonged daily injections of medications. Instead patients will only need to take hormones in the form of a pill or a suppository.

Once harvested, the immature eggs are placed in a special culture dish containing a combination of luteinising hormones and follicle stimulating hormones. Once matured, they are then inseminated with sperm. The newly formed embryos are then transferred back into the uterus within four days of retrieval.

IVM may be a cheaper treatment alternative requiring less medications and a reduced risk of Ovarian Hyperstimulation Syndrome (OHSS).

Minimal Stimulation IVF (Mini IVF)

Minimal stimulation IVF may be suitable for patients who are unable to tolerate the side effects of fertility medications or who have had previous episode of Ovarian Hyperstimulation Syndrome.

Ovulation induction will be done with oral fertility tablets, or low dose fertility injections, and egg retrieval (OPU) done, similar to a conventional IVF. However, due to the lower number of mature eggs available each cycle, couples opting for this treatment may need more treatment cycles to achieve pregnancy.

GIFT (Gamete Intra-Fallopian Transfer)

Gamete Intra Fallopian Transfer (GIFT) is almost similar to the IVF procedure, where the woman will first be stimulated to produce as many ripe eggs as possible. Once extracted, they will be observed and cultured in a special nutrient.

Meanwhile, the man’s sperm will be collected, cleaned and selected. The best sperms will then be placed on the same catheter as the spouse’s eggs. Both eggs and sperm will then be deposited into the woman’s fallopian tubes and allowed to fertilise naturally inside the woman’s body. The process is meant to mimic the natural pregnancy process as much as possible.

GIFT can only be performed if the fallopian tubes are normal and there are adequate number of sperms.

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ICSI

Intra-cytoplasmic sperm injection (ICSI) is an additional procedure done by the embryologists, whereby a single sperm injected directly into each egg under a microscope guidance in conjunction with an In Vitro Fertilisation (IVF) cycle .

ICSI Recommendation

ICSI is recommended when the male partner has very low sperm count, motility or poor sperm quality. This extra step during the IVF process helps increase fertilisation and pregnancy rates substantially in cases of severe male factor problems by helping the sperm penetrate the egg. ICSI may also be done when there are only a few eggs available after egg retrieval.

Blastocyst Culture and Transfer

A blastocyst culture is the next evolution in IVF whereby the fertilised eggs, or embryos, are cultured to Day 5 (called blastocysts) and transferred back to the womb, instead of the traditional Day 2 or 3 embryos.

A blastocyst is a more advanced and mature stage of embryo development, which has between 70-100 cells, as compared to 8-10 cells of a Day 3 embryo. The blastocyst has already divided into 2 distinct cells types, ie, the future placental cells, and the future fetus cells.

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The benefits of doing a blastocyst transfer are:

  • Higher pregnancy rates, as embryos that developed into blastocysts less likely to be abnormal
  • Selecting the ‘toughest’ embryos that managed to survive outside the body for 5 days
  • Avoiding multiple pregnancies like triplets as fertility doctors only transfer no more than two blastocysts.

TMC Fertility Centre has an excellent track record of successful clinical pregnancy rates using blastocyst culture and transfer technique, as only the embryos with the most potential to implant will be selected for transfer to the woman’s uterus.

Blastocyst culture will be advised by the embryologist or doctor if there are a good number of embryos on Day 2 or 3.

Frozen Embryo Transfer

Studies from IVF centres worldwide are showing that IVF pregnancies following a frozen embryo transfer (healthy embryos frozen, and transferred after a few months) vs fresh transfer (embryos transferred within the same week of undergoing IVF egg pickup procedure) are similar, and sometimes even have additional benefits.

Planning a frozen transfer can reduce the risk of Ovarian Hyper Stimulation Syndrome, OHSS, a potentially dangerous complication of IVF treatment. By delaying the transfer of embryos, the super-elevated hormone levels in the body resulting from IVF medications would have time to return to normal, thus mimicking a more natural environment for the early part of pregnancy.

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Some possible benefits include:

  • Higher pregnancy rates
  • Lower miscarriage rates
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Advanced Laparoscopic Keyhole Surgery

Structural problems such as blocked fallopian tubes, endometriosis, fibroids and ovarian cysts may play a part in fertility problems. Surgery to correct these problems may sometimes enable women to conceive naturally.

During this minimally invasive surgery, the surgeon makes a small 1 cm incision at the abdominal area where a laparoscope (small telescope) and surgical instruments measuring 5 mm are inserted into the uterine cavity. The laparoscope displays the condition of the internal organs on a computerised screen to guide the surgeon remove any uterine growths or correct any abnormalities.

As the surgical wound is very small, there is less pain, smaller scars and quicker recovery time. Laparoscopic surgeries are usually conducted as a day surgery. The couple can try having a baby within 3-4 weeks of the surgery or when the woman feels comfortable enough for intercourse.

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Assisted Hatching

In order for an embryo to implant in the uterus, it will first hatch out of its shell (zona pellucida). In some cases, the shell has ‘toughened up’, preventing the embryo from hatching and implanting subsequently.

Assisted hatching is a micromanipulation technique where the embryologist thins the layer of shell or makes a tiny hole at the shell to help it hatch. Assisting the egg hatch will increase pregnancy success.

Pre-implantation Genetic Diagnosis (PGD)

Every expectant parent wonders if their babies are normal and healthy. The truth is that all women have a risk of a pregnancy with abnormal chromosomes, particularly if the woman is above 35 years old.

In the past, pregnant women above 35 may be tested with chorionic villus sampling (CVS) or amniocentesis for chromosome abnormalities, such as Down Syndrome. However, they will have to make the painful decision to either keep or stop the pregnancy when the babies are found to be abnormal. Read More →

Surgical Sperm Retrieval (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). The sperms retrieved will then be used for ICSI and IVF procedures.

In MESA, the surgeon makes a small cut in the scrotum and gathers the sperm at the epididymis, the elongated coiled duct that provides passage of the sperm from the testes. This is a minor surgical procedure which takes 30 minutes to perform and only requires local anaesthesia.

PESA is similar to MESA but does not involve microsurgery. For PESA, the physician uses a needle to penetrate the scrotum and epididymis to draw 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 sperms.