Assisted Reproductive Technology in Malaysia: Guide

You are a good candidate for ART if:

• You are a couple aged 18-45 who have trouble conceiving a baby. If you and your partner have tried for more than a year to conceive, it’s wise to get tested and consider ART.
• You don’t currently take any psychotropic or psychoactive drugs.
• Your weight is in a healthy range (not overweight or anorexic).

Additionally, if you are a female:

• Your fallopian tubes are not working properly. ART treatments like IVF can help unblock the fallopian tubes to enable conception. Your doctor may need to extract the egg from the ovaries and place it into the fallopian tubes.
• You have ovarian issues. If you have ovarian problems such as low egg count or ovarian damage, you are a good candidate for ART.
• You have limited uterine function. If you have poor uterine function due to disease or other factors, you may look into IVF and other methods.

If you are a male, the following conditions make you an ideal candidate for ART and particularly IVF:

• You have a low sperm count and quality. If recent tests have shown that your sperm count and quality are low, you may consider ART.
• You have anatomical difficulties. Some anatomical difficulties e.g. testicle damage may prevent the production and delivery of sperm. ART may help correct these blockages to enable sperm delivery and conception.

In-Vitro-Fertilization (IVF). IVF is currently the most common form of ART in Malaysia. IVF is a procedure where eggs get fertilized by the sperm outside the body in a laboratory. The process includes:

• Cultivation of several eggs.
• Collection of eggs from the ovaries (oocyte pick up) through the birth canal.
• Fertilization of a chosen egg in the embryology laboratory with active sperm.
• Development of the fertilized egg in a special cultivation medium.
• Transfer of the fertilized to the mother’s uterus within 3-5 days after fertilization.
• Monitoring of the pregnancy progress through follow-up visits.

In-Vitro-Maturation (IVM). IVM works similarly to IVF. The main difference is that the fertilized egg matures in the lab first.

It doesn’t need any hyperstimulation of the ovaries to produce and collect an egg. This prevents the need for repeat injections and trials. In IVM, the only medication you need to take is hormones in pill or suppository form.

The doctor will collect immature eggs and place them in a special cultivation medium. The dish will feature a mixture of luteinizing hormones and follicle-stimulating hormones. After they reach maturation, the doctor will combine them with sperm for fertilization. The doctor then transfers the formed embryos back to the mother’s uterus.

According to research, IVM is a safer and simpler alternative compared to IVF. It is also a cheaper alternative to IVF.

Frozen Embryo Transfer (FET). FET is a procedure where the doctor transfers a frozen embryo from a previous IVF cycle to the mother’s uterus. Unlike others, FET doesn’t need an extra cycle of hormone activation and egg collection.

The transfer usually takes one week. The advantages include a lower risk of ovarian hyperstimulation, prevention of excess hormone levels, and higher success rates.

Minimal Stimulation IVF (Mini or Gentle IVF). Mini IVF is a less invasive, low-risk version of conventional IVF.

It is suitable for patients who can’t tolerate possible IVF implications. It is also suitable for women who have suffered from ovarian hyperstimulation.

The doctor induces ovulation through the administration of fertility pills and egg retrieval. The latter works similarly to regular IVF.

The only downside is that couples may need repeat treatments to experience results. There is also no evidence that Mini IVF produces a better quality of eggs compared to regular IVF.

Other supplemental ART methods include:

Surgical Sperm Retrieval (MESA, PESE, or TESE). It aims to collect sperm from males who have insufficient sperm in their semen. The doctor will then check and use this sperm in IVF and sperm injection treatments.

Blastocyst Culture & Transfer. It refers to the development of embryos in the laboratory before IVF transfer. The process takes only 3-5 days for embryos to develop. The embryologist will choose the best embryos that have survived through the 5th day. Finally, the doctor transfers the embryos to the mother’s uterus.

Assisted hatching. It is a micro-invasive technique where the doctor thins the layer of the embryo shell, or makes a microscopic hole to help it hatch. This procedure increases the odds of a successful pregnancy.

Preimplantation Genetic Testing (PGT). This procedure involves checking the embryo’s DNA to detect potential genetic defects. Although not a fertilization treatment, PGT can reduce the risk of pregnancy termination.