Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a procedure where a sperm is introduced directly into the uterine cavity around the ovulation period. The goal of IUI is to increase the number of sperms reaching the fallopian tubes, thus increasing the chances of fertilisation. IUI is commonly recommended for couples who experience:

• Low sperm count
• Unexplained infertility
• Thick vaginal mucus

Before IUI is conducted, ovulation-stimulating medications like Clomid, hCG (human Chorionic Gonadotropin), and FSH (follicle stimulating hormone) may be used, along with close monitoring to determine when the eggs will be mature. After 24 to 36 hours in a surge of LH hormones that indicate ovulation will occur soon.As for the male counterpart, he is advised not to have sex or masturbate 2 to 5 days prior to providing a semen sample. The sample is taken when he ejaculates into a collection cup in a private room at our fertility centre or at home, which must be kept at room temperature and sent back to us within an hour, where it be washed by the lab to separate the semen from the seminal fluid.

During the IUI procedure, a catheter will be used to insert the sperm directly into the uterus. This will maximise the number of sperm placed in the uterus, thus increasing the possibility of conception.

In-Vitro Fertilisation (IVF)

What is IVF? In-vitro fertilisation (IVF) is a process where an egg is combined with a sperm outside of the body, usually in a lab. It is often the first option if:

• An egg donor is used
• A surrogate is needed
• In severe cases of male infertility
• The fallopian tubes are blocked
• Previously frozen eggs are being used

Patient Journey

IVF Procedure Details

Day 1: Consultation with Doctor

A series of tests and bloodwork will be carried out to determine whether you and your partner are suitable to undergo the procedure. Our doctor will then discuss with you/your partner regarding the possible treatment methods.

Day 2 – Day 16: Taking Fertility Medication

Our doctor will prescribe suitable fertility medications to the female fatient in the form of daily injections to stimulate the ovary’s follicles to mature more eggs. It can be self-administered or done by the A&E staff at Island Hospital. You are also advised to be present for all injections and scheduled monitoring processes.

Day 17: Egg Retrieval and Fertilsation

The next step is triggering the immature eggs to complete the final stage of maturation. To achieve this, human Chorionic Gonadotropin (hCG) is injected at an exact time to ensure that the immature eggs mature properly. Once they have done so, the female patient will be lightly sedated and sent to the operating theatre to retrieve the eggs. A semen sample will be collected and washed for fertilisation. Our embryologist will then place around 10,000 sperms with an oocyte in each culture dish. After placing them into a special incubator, they will be inspected for 12 to 24 hours for signs of fertilisation.

Day 17 – Day 22: Pre-implantation genetic testing for aneuploidy (PGT-A)

During the PGT-A, a few cells will be removed from the embryo’s cell layer 5 days after its development. While the embryo is frozen, these cells will be inspected for any chromosomal abnormalities which may lead to genetic disorders such as Down’s syndrome. PGT-A can also determine the embryo’s gender. Once the test clears the embryo of any chromosomal problems, it will be placed into the uterus. Additional embryos will be frozen for future use.

Day 22: Embryo transfer

The embryo is placed into the uterus via a thin, flexible plastic tube, which is gently passed through the opening in the cervix leading to the uterus’ interior. If you’re not suitable for a transfer, the eggs will be frozen to be transferred on to the next cycle

Day 36: Pregnancy test

You are required to wait for two weeks before taking a pregnancy test. If the test is postivie, our doctor will schedule a follow-up/ultrasound session within two weeks.

Outcomes

At Island Hospital Fertility Centre, the average age of women undergoing IVF is 38 to 45 years old. With the objective of providing reliable, quality infertility treatments by performing suitable Assisted Reproductive Technology (ART), we have also recorded a significant success rate, with a rate of 40% to 50% for implantation, and a 30% to 40% rate for babies born (as of 2018).

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection (ICSI) is rather similar to IVF, with the only difference being the method of fertilisation. In this procedure, a single sperm is injected directly into an egg by an embryologist in the laboratory. A high amount of sperm is not required and its ability to penetrate the egg is no longer of importance thanks to assistance from this technique. But, fertilisation cannot be guaranteed as it still needs to occur naturally once the sperm has been placed in the egg. Circumstances that deem ICSI as appropriate include:

• Low sperm count
• Sperm is unable to move properly or is abnormal
• When sperm is retrieved surgically from the epididymis (MESA/PESA), testes (TESE/TESA), urine, or electro-ejaculation
• High levels of antibodies in the semen
• Past fertilisation failures using conventional IVF

Egg and embryo freezing

The procedure for egg and embryo freezing is rather similar to IVF and takes around two weeks to complete. The female patient will undergo a series of daily hormonal injections to stimulate the ovaries to produce more eggs and will have to come to our centre frequently to monitor the growth of the egg follicles through blood tests and ultrasounds. Once the eggs are ready to be harvested, it will be collected and frozen if you and your partner opt to use it at a later date.Egg and embryo freezing is a viable option if you/your partner:

• Has a condition that affects fertility
• Is taking medications for cancer
• Is undergoing IVF
• Wishes to keep the eggs/embryos for future use

Sperm and egg donation

Also known as “third-party reproduction”, there may come a time when you and your partner choose to have another individual donate sperms or eggs to aid you in your fertility journey. Donors can be either a known or anonymous individuals.

There are several criteria that must be met by the donor before the donation can take place:

• Sperm donors must be aged between 20 to 40 years old; egg donors must be aged between 20 to 30 years old
• Must be free of infections such as HIV and Hepatitis C
• Must not have a high risk of genetic diseases
• Must undergo psychological screening

To ensure this, all egg/sperm donors are required to undergo an infectious disease and genetic testing screening. These screening processes are in compliance with the Food and Drug Administration (FDA) as a Tissue Establishment manufacturing Human Cells and Tissue products.

However, before you consider sperm/egg donation, it is highly recommended that you and your partner take into account all legal and emotional implications that may arise as a result of the procedure.

Advanced IVF Technology At Island Hospital, we use advanced technology to enhance the results for our patients such as blastocyst culture system and transfer, and blastocyst vitrification (embryo freezing) which have significantly increased the number of live births in each IVF cycle.

1. Blastocyst CultureThis is a specialised IVF technique where an egg in its blastocyst stage of development (5 days after fertilisation) is being transferred into the womb, where it will begin to attach itself to the uterine lining during the implantation process.

One main advantage of this procedure is that it increases the chances of implantation as the blastocyst phase matches the uterine environment, thus allowing fewer embryos to be replaced. It also reduces the risk of multiple pregnancies. At Island Hospital, the rate of eggs able to achieve the blastocyst stage ranges from 50% – 60%. However, this is dependent on how healthy the egg and sperm is.

2. Blastocyst vitrification

The procedure involves three components: first, the embryo is exposed to high levels of cyroprotectants (a substance that prevents damage to the cells during freezing) that allows the cells to dehydrate quickly without suffering any damage; two, the embryos are then loaded into tiny storage devices, usually in the shape of a straw, to help facilitate the rapid cooling process; and third, the straws are cooled to -196°C in 2-3 seconds.

The high cooling rate, combined with the use of high concentrations of cryoprotectants allows the embryos to turn to a glass-like substance instead of ice. By avoiding ice formation, it protects the embryos from damage and allows them to be warmed later, thus reaping consistent survival rates of above 90%.

Advantages: Our gynaecologists, embryologists, nurses, and technicians are always ready to render help in the form of sound counsel, diagnosis, and management of treatment plans for patients struggling with infertility as part of our commitment in fulfilling every couple’s dream of having a child.