Fertility Services

The centre offers a complete range of the most advanced fertility treatments available, comparable to international fertility centres in Europe and United States, including IUI, IVF, ICSI, PGD and MESA/PESA for male factor fertility issues. Of course, not all couples need IVF straight away, as we have helped couples conceive with simple fertility measures. Some have conceived after helping them track their ovulation period.

Please visit our Fertility FAQ section for answers to common fertility questions

Fertility assessment (both men and women)

A thorough assessment of a potential mother’s menstrual cycle, physical well-being, pelvic organs (womb, fallopian tubes and ovaries) will be carried out. This will include clinical examination, pelvic ultrasound, and maybe even some blood tests. For the future father, this consists of clinical examination, and seminal fluid analysis. An overall outlook of conceiving can be determined, and treatment options outlined.

Fallopian Tube Checking

A healthy pair of fallopian tubes are essential to allow sperms to meet the eggs that ovulated every month, and also to guide the developing embryo back into the womb for implantation. The tubes may been injured due to repeated infections of the womb or tubes (which may be painless), or conditions such as endometriosis (commonly known as blood cyst or chocolate cyst). If a tube is found to be swollen, likehood of the fallopian tube being abnormal and blocked is high. Further confirmatory tests such as a hysterosalpingogram, HSG, or a laparoscopic dye test may be required.

Fertility counselling

Fertility awareness is something that has to be learnt, either through experience or from internet, etc. We will guide you through the essential knowledge needed regarding the fertile periods, signs of ovulation, tracking of menses, etc. Lifestyle changes may be advised to further optimise you and your partner’s health to get ready for conception.

Natural Cycle Monitoring

In a natural monthly menstrual cycle, one egg will be released. In women with irregular cycles, or women who wish to conceive with minimal medications, we can track the growth of the follicle (sac containing the egg) and predict the timing of ovulation.

Ovulation Induction

Ovulation Induction simply means giving medication to stimulate the growth of more eggs, which may consists of fertility tablets, or injections of FSH (follicle stimulating hormones), which occurs naturally in the body, but at higher doses.

Patients on fertility treatment will be advised on safe administration of their medications. Some side effects of fertility treatment may be felt including tiredness, bloating, headaches, increased acne may happen. These are temporary and will resolve upon stopping them.

Fertility Pills and Timed Intercourse

Fertility pills are given for 5 days, usually starting on 2 or 3rd day of menses. Follicle tracking via ultrasound examination to look at the sizes of follicles (egg sac) will be done a few days before the predicted ovulation day to see the ovaries’ response to medication. Based on the sizes of the follicles, best days for intercourse can be advised.

IUI (Intra-Uterine Insemination)

Intra-Uterine Insemination is suitable for couples whereby the male partner’s sperm parameters are below average, eg, low sperm count or slow swimmers.

The IUI 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 the eggs (as 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:

  • [Ovulation Induction] Stimulating the development of multiple eggs with daily injections between 10 to 12 days, depending on speed of egg growth
  • [Oocyte Pick Up,OPU], ie, collection of the oocytes from the ovaries, which is done via the birth canal. Patients are placed under light anaesthesia.
  • [Fertilisation] Done in our embryology lab, eggs are fertilised with sperm and allowed to develop in a special culture medium placed in an incubator that simulates the condition inside the womb
  • [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.

Minimal Stimulation IVF (Mini IVF)

Instead of daily injections over 10 to 12 days, egg stimulation will be done with a combination of oral fertility tablets and low dose injections. Egg retrieval (OPU) will be done, similar to a conventional IVF once the eggs reaches mature size. The number of mature eggs retrieved will be less than a convention cycle (on average 4-8 eggs, vs 10 to 15 eggs).

This is suitable for women who have a history of OHSS, or do not wish to receive too much medication. Also Mini IVF may reduce the cost of IVF up to half due to less medications used, and not having surplus embryos to freeze. Do note that due to the lower number of mature eggs developing with Mini IVF, couples opting for this treatment may need more treatment cycles to achieve pregnancy.

ICSI

Intra-cytoplasmic sperm injection (ICSI) is an additional procedure done during an IVF cycle. The embryologists will inject a single sperm into each egg under microsopic vision.

Considered the 2nd evolution of IVF, this extra step helps increase fertilisation in cases where the sperm quality is suboptimal, ie, low count, abnormal shaped or reduced movement, by helping the sperm penetrate the egg. ICSI may also be done when only a few eggs are available after egg retrieval

Blastocyst Culture and Transfer

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

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. Advantages of blastocyst culture include:

  • Choosing the ‘fittest’ embryos that managed to survive longer outside the body, with higher pregnancy rates
  • Option of avoiding twins or multiple pregnancy by transferring only one embryo back to the womb without reducing pregnancy rates by too much.

Frozen Embryo Transfer

Separating the embryo transfer procedure from the initial IVF cycle until a few months later (instead of within the same cycle) is the latest evolution of IVF treatment. Instead of transferring the embryos back into the womb with an environment with super-elevated levels of hormones (during a fresh cycle), good quality embryos are frozen, and placed back into the womb a few months later, after the body have returned to a more natural environment.

Initially used to prevent OHSS (an uncommon complication of IVF treatment), latest research have confirmed that pregnancy rates are higher in frozen embryo cycles, compared with fresh cycles.

Egg Freezing & Banking

Egg freezing is fast becoming a popular way among women who want to preserve their fertility capability while delaying actual pregnancy until suitable 5 to 10 years later (ie, due to work commitments, unsuitable partner, etc).  Apple and Facebook are but a few companies that are offering to sponsor their women employees, so that these ladies can continue to work, without sacrificing their dream of becoming mothers later on.

Women who are diagnosed with cancer may have to undergo chemotherapy (which may affect ovary function permanently). They have an option store some eggs for future use.

Please see the article on Egg Freezing here

Sperm Freezing & Banking

As above, men have the option of freezing their sperms for future use. Although the biological clock doesn’t affect men as early as women, sperm parameters throughout the world has been declining steadily for the past 20 years.

Embryo Freezing & Banking

The technology for embryo cryopreservation (freezing) has entered a new era with the latest ‘flash’ freezing method, ie, vitrification process, whereby the embryos are freezed almost instantly to prevent formation of ice crystals inside the embryos. This technique ensures maximal embryo survival of over 95% for use later on.

As such, couples can be assured that the embryos frozen with the latest technology will be available even 5 to 10 years down the road.

Pre-implantation Genetic Diagnosis (PGD)

Pre-implantation Genetic Testing (which includes PG Diagnosis or PG Screening is the 4th evolutionary step of IVF treatment. There are 2 types of genetic testing available:

  1. Chromosome abnormalities
    • This is the most common cause of unsuccessful IVF treatment, and also miscarriages
    • Humans have 23 pairs of chromosomes, 23 from mother, 23 from father, totalling 46 (ie, 23 pairs of) chromosomes
    • If the embryo has less than 46, eg 44, 45, or more than 46, eg, 47, 49, etc, then high likelihood the embryo will not result in a pregnancy.
    • Down Syndrome is a common example of chromosome abnormality, whereby the baby has 47 chromosome (extra one chromosome)
    • Current technology allows use to check for the completeness of 46 chromosomes in the embryo before replacing back into the womb, thereby increasing pregnancy success and reducing risk of miscarriage
    • As the sex chromosome are checked, we are able to avoid sex-linked diseases, such as haemophilia, and duchenne muscular dystrophy
  2. Abnormal gene sequences
    • Some diseases happen because of problems at a particular ‘gene location’ of the chromosome, eg, thalasemia patients have faulty haemoglobin (red blood cells) production due to abnormal part of haemoglobin code of their genes.
    • Other examples are cystic fibrosis and osteogenesis imperfecta

Surgical Sperm Retrieval (MESA, PESA or TESE)

In male patients who have very little sperm in their semen, several techniques can be used to collect the sperms directly, either from the sperm storage (epididymis) above the testes via a needle through the skin (PESA), or surgically opening up the epididymis (MESA), or from the testes itself (TESE). These procedures will be done with adequeate anaesthesia, of course.