Fertility Treatments

TMC Fertility 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 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).

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.

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.

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 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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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 →