By Dr. Roland Chieng
Obstetrician and Gynaecologist
MBBS (S'pore), MRCOG (UK), GDip (Acu)
What is IVF treatment?
IVF treatment is the very first treatment tried when an egg donor is being used, there are severe cases of male infertility or a womanâ€™s fallopian tubes are blocked. Still, this comes after years of trying to get pregnant, followed by a slew of fertility testing. According to the World Health Organisation, incidence is about 10 percent worldwide. Another 10 to 12 percent of all the other couples have only one child and wish to have more. The incidence of infertility is gradually increasing all over the world. For many people going through infertility treatment, the level of distress and tension can be very high. Mutual trust and faith in the doctor can help the couples to enquire about different types of treatment for both the male as well as the female partner, and make informed decisions of their reproductive status.
How is fertility assessment done?
Assessment of the female fertility includes traditionally, the assessment of ovulation and the physical condition of the fallopian tubes. Various methods are available for ovulation. The most reliable one remains the direct assessment using ultrasound tracking of the egg development in the ovaries.
Serial ultrasound visualization of the ovaries will be done to follow the development of eggs from about Day 10 of the cycle till the day of ovulation. Actual ovulation can be confirmed and timed intercourse advice will then be more precise for a possible natural conception. â€œThe gold standard for assessment of tubal condition is still by laparoscopy or keyhole operation,â€ says Dr Roland Chieng. However, in the absence of other indication, x-ray or ultrasound assessment of the fallopian tubes is usually adequate. These can be done in the clinic setting.
1. Blood test For Follicle-stimulating Hormones (FSH) Level at the time of Menses
â€“ It dictates the amount of medication required for successful stimulation of the ovaries for egg development.
2. Antral Follicular Count (AFC)
â€“ This is done by 3-D ultrasound examination of the ovaries.
It has to be done at Day 2 of menses and measures the number of new egg follicles before stimulation is started.
3. Trail Cannulation
â€“ This is a process whereby a trial run embryo transfer is done before the actual procedure.
Assessment of the male is of equal importance before IVF. Full assessment goes beyond just semen analysis or sperm quality assessment. There are numerous conditions in the man that are amenable to treatment which will restore the chances of spontaneous pregnancy.
01 Semen Analysis and Culture
â€“ A detailed semen analysis is necessary to determine the method of obtaining sperms at the time of IVF, whether obtaining sperms normally through masturbation or surgery.
02 Sperm Function Test
â€“ Sperm function test includes DNA fragmentation test, Hyaluronon Binding Assay (HBA), egg penetration test and others. Besides providing an explanation for the infertility, these tests also help to confirm the need for Intracytoplasmic Sperm Injection (ICSI) or microinjection of the sperm into the egg for fertilization in IVF.
What is involved in IVF treatment?
There are basically four steps in the IVF and embryo transfer process which include:
Step 1: Ovarian Stimulation
Injections are used during ovarian stimulation to stimulate multiple eggs to grow in the ovaries instead of having a single egg that normally produces each month. Some eggs will not fertilise or develop normally after fertilization. With multiple eggs, the chances of successful treatment become higher. With the use of ultrasound examination, the follicles can be identified and assessed serially till the appropriate day for egg retrieval.
STEP 2: Egg Retrieval
Egg retrieval is a minor surgical procedure that is performed via the vagina route. During this time, both ovaries will be enlarged with egg follicles and they will be right next to the vaginal wall. A small injection using an aspiration needle is made through the wall under ultrasound guidance. The needle is connected to a suction device.
Eggs will then be aspirated from all the follicles. Multiple eggs can be aspirated in less than 15 minutes.
Step 3: Fertilisation
Once the retrieval of eggs is completed, they are observed in the laboratory for maturity and quality. Fertilisation is achieved either through Insemination, where the motile sperm are placed together with the eggs incubated overnight or through ICSI, where a single sperm if directly injected into each mature egg. Successful fertilisation can be assessed the following day.
Step 4: Embryo Transfer
Embryos are fertilised eggs. Embryo transfer is the last step in the IVF process.
One or more embryos suspended in culture medium are drawn into a transfer catheter with a syringe on one end. The tip of the transfer catheter is guided through the cervix, and embryos are placed into the uterine cavity.
The number of embryos transferred is the most important factor for the development of multiple pregnancies. Commonly, Dr Roland Chieng advises only for two embryos to be transferred at any one time.
How effective is IVF treatment?
IVF treatment is often successful, though it may take more than one try. Studies show that the potential for success with IVF treatment is the same for up to four cycles. Generally, the live birth rate for each IVF cycle is 30 to 35 percent for women under age 35, 25 percent for women between the ages of 35 and 37, 15 to 20 percent for women between the ages of 38 and 40, and 6 to 10 percent for women after the age of 40.