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
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).
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.
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.
- 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%.
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.
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.
我们所提供的服务生育率基本评估
- 精子检测
- 促卵泡激素（FSH）/ 促黄体生成素（LH）/ 催乳素/ 孕激素血液检查
- 子宫腔检查与子宫内膜活检
- 输卵管与子宫检查（HSG）
生育治疗与疗程
- 试管婴儿 (IVF)
- 宫腔内人工受孕（IUI）与捐赠者授精
- 刺激排卵后定时行房
- 取卵、冻卵
- 卵胞浆内单精子注射（ICSI）
- 非整倍性胚胎植入前基因检测（PGT-A）
- 手术取精（SSR）- 显微镜下附睾精子抽吸术（MESA）/ 经皮睾丸精子抽吸术（TESA）
生育实验室服务
- 准备精液样本
- 储存精子、卵子与胚胎
- 精子与卵子捐赠计划
- 胚胎捐赠计划
- 非整倍性胚胎植入前基因检测（PGT-A）
试管婴儿（IVF）什么是试管婴儿 ？试管婴儿（IVF）是一项卵子与精子在人体外的人工控制环境中（通常在实验室内）结合受精的过程。试管婴儿通常是以下情况的治疗首选：
- 需使用来自捐赠者的卵子
- 需使用代孕服务
- 男性不育症的严重案例
- 输卵管堵塞
- 曾储存的冻卵正被使用
试管婴儿如何发挥作用？
试管婴儿将从向我们的医生咨询并进行一系列的检测及血液检查开始，以确认您与您的伴侣适合接受这项疗程。一旦检测结果出炉，我们的医生将与您讨论可行的治疗方案；若您不适合接受此项治疗，医生将会建议您在接受咨商辅导后回家。然而，若确认您适合接受试管婴儿，我们的医生将会开出生育药物处方，让女性患者透过每日注射的方式刺激卵巢中的卵泡，以让更多卵子成熟。患者可选择自行注射或由槟榔医院的急诊室人员代为完成。在此期间，我们建议您依序完成所有注射以及所有预订好的检测程序。试管婴儿的下一个步骤是触发卵母细胞（未成熟的卵子）完成最后的熟成阶段。为此，人绒毛膜促性腺激素（hCG）需在确切的时间内被注射，以确保卵母细胞能够妥善熟成。当它们已完全成熟，该女性患者将接受轻微镇静及被送往手术室取卵。与此同时，精液样本将被收集并洗涤以准备受精。我们的胚胎学家将在每个培养皿中放置约1万个精子及一个卵母细胞。在被置入特殊培养箱后，它们将会在12至24小时内被持续观察受精迹象。3至5天之后，我们的胚胎学家将鉴定出看起来最为健康的胚胎，并准备将它用于胚胎移植。患者也可选择进行胚胎植入前遗传学诊断（PGD），以鉴定出可能遗传给孩子的任何基因遗传疾病。与宫腔内试管婴儿相似，胚胎将透过一个轻薄、柔韧的塑料管，轻柔地经过子宫颈开口被植入子宫内部。在患者不适合接受胚胎移植的情况下，胚胎将被冷冻并用于下个周期。您需要等待两周才能到诊所进行验孕。若检验结果呈阳性，我们的医生将会在两周内为您安排复诊与超声波检查。
第1天：向医生咨询
为判断您与您的伴侣是否适合接受疗程，您可事先于所在国家完成一系列的检测与血液检查，并请您携带检测结果一同前来我们的生育中心，与我们的生育专科医生进行咨询。
我们的医生将会与您或您的伴侣讨论可行的治疗方法。若确认您并不适合接受疗程，医生将会建议您在接受咨商辅导后回家。
第2天至第16天：使用助孕药物
我们的医生会开出合适的生育药物处方，让女性患者透过每日注射的方式刺激卵巢中的卵泡，以让更多卵子成熟。患者可选择自行注射或由槟榔医院的专业护士代为完成。
在此期间，我们建议您依序完成所有注射以及所有预订好的检测程序。
第15天：取卵
为此，促性腺激素释放激素 （GnRH analogue）需在确切的时间内被注射，以确保卵母细胞能够妥善熟成。该女性患者将被送往手术室接受轻微镇静，然后取卵。
第15天：受精
精液样本将被收集处理，与浓缩精液。我们的胚胎学家将选一只精虫，直接注射入成熟卵子胞浆内。它们将会在隔天被观察受精迹象。
第16天至第21天: 胚胎陪养胚胎将在被置入特殊培养箱，继续陪养三到五天。
第21天：四个选项： 在疗程初段决定
- 胚胎移植
胚胎将被置入子宫通过一个轻薄、柔韧的导管，胚胎将经过子宫颈开口被植入子宫内部。
- 胚胎储存
若您不适合接受移植，胚胎将被冷冻直到下个周期再进行移植。
- 非整倍性胚胎植入前基因检测（PGT-A）
胚胎学家将抽取胚胎中的少许细胞进行检验。从检测报告中，我们可以得知胚胎的健康以及获得更高的怀孕机率。
所有胚胎将被储存。一个星期左右，PGT-A报告出炉后，医生将安排胚胎移植。
- 单基因疾病的植入前遗传学检测
PGT-M或单基因/单基因缺陷的植入前遗传学检测是适用于那些拥有风险或有特定遗传病的人。 PGT-M可以在怀孕前进行，以大大降低怀有受影响儿童的风险。
第35天：验孕移植后的两个星期， 您需要前往诊所进行眼在前往诊所验孕。若检验结果呈阳性，我们的医生将会在两周内为您安排复诊与超声波检查。如否，医生将建议进行第二次胚胎移植（若有储存）或安排新的疗程。
先进的试管婴儿技术
在槟榔医院，我们所使用先进卓越的囊胚培养体系与转移技术以及囊胚玻璃化冷冻法（胚胎冷冻技术）不仅提高了我们患者的生育效果，也让每个人试管婴儿周期的活产婴儿数量明显增加。
- 囊胚培养
此项专业的试管婴儿技术将把处于囊胚发育阶段（受精5天后）的卵子移植到子宫内，并让它在植入过程中开始附着在子宫内膜上。
此项程序的其中一项主要优势，在于可让囊胚在最接近自然受孕成长的阶段时植入子宫，进而增加成功移植胚胎以及减少替换胚胎的几率。它也可减低多胞胎妊娠的风险。在槟榔医院，能够达到囊胚发育阶段的卵子比例介于50%至60%之间。然而，此成功率也需取决于卵子和精子的健康程度。
- 囊胚玻璃化冷冻法
此项程序由以下三个部分组成：首先，胚胎将被曝露在高水平的冷冻保护剂中（一种防止胚胎细胞在冷冻过程中受损的物质），此项举措将让胚胎细胞在不遭受任何损伤的情况下快速脱水；第二，胚胎将被装置在一个小型的储存设备中，该储存设备通常皆采用吸管形状设计，以帮助促进快速冷却的过程；第三，所述吸管形状设备将在2秒至3秒内冷却至攝氏零下196度。
极高的冷却速度再加上配合使用的高浓度冷冻保护剂，将让胚胎转换成非冰块的玻璃状物质。通过避免结冰，它可保护胚胎不受伤害，并让胚胎可接受后续的加温，从而获得了超过90％的连贯存活率。
我们的优势我们的妇产科专科医生、胚胎学家、护士与技术人员将随时做好准备，为与不孕症斗争的患者提供专业咨询、诊断以及治疗计划管理。槟榔医院生育中心是一家致力于实现每对夫妻生儿育女的梦想、不提供不必要服务的专业生育中心。截至2018年，我们取得了高达40%至50%的胚胎植入成功几率范围，而试管婴儿的出生比率则从30%至40%不等。
临床结果在槟榔医院生育中心，接受生育治疗的女性平均年龄为38岁至45岁。以提供可靠且高品质的生育治疗为目标，我们也透过执行适当的辅助生殖技术（ART）取得了高达40%至50%的胚胎植入成功率，以及高达30%至40%（出生于2018年）的试管婴儿出生率。
宫腔内人工受孕（IUI）
宫腔内人工受孕（IUI）是一种在排卵期间直接将精子引入子宫腔的试管婴儿程序。宫腔内人工受孕的治疗目标在于提高可抵达输卵管的精子数量，从而增加卵子成功受精的机会。我们通常会建议面对以下问题的夫妻选择宫腔内人工受孕治疗：
在进行宫腔内人工受孕之前，可使用刺激排卵的药物如克罗米芬（Clomid）、人绒毛膜促性腺激素（hCG）及促卵泡激素（FSH），并伴随密切监测以确定卵子何时会成熟。子宫将会在促黄体生成素（LH）激增的24至36小时后开始排卵。
至于男性的部分，我们会建议他在提取精液样本之前的2至5天内避免进行性行为或手淫。当事人必须在我们的生育中心或自己家里将精液排在一个采集杯内，并必须确保在保持室温的情况下将精液样本于时限一个小时内送返给我们，而此精液样本将被送到实验室洗涤，以将精子与精液分开。
在进行宫腔内人工受孕的疗程期间，精子将透过导管被直接植入子宫。此项举措可将植入子宫的精子数量最大化，从而增加怀孕的可能性。
卵胞浆内单精子注射（ICSI）卵胞浆内单精子注射（ICSI）与试管婴儿非常相似，而两者之间的唯一区别为受精方式。在此疗程中，胚胎学家将会在实验室内把单一精子直接注入卵子中。多亏了此项技术的辅助，男性患者不仅不再需要提供大量精子，精子穿透卵子的能力也已不再重要。由于精子被植入卵子后仍需自然结合，卵子是否能够成功受精也因此而无法得到保证。卵胞浆内单精子注射将适用于以下状况：
- 精子数量过低
- 精子异常或无法正常移动
- 透过附睾外科手术（MESA/ PESA）、睾丸外科手术（TESE/ TESA）、尿液或电激取精术所取出的精子
- 精液中含有高水平的抗体
- 曾在接受传统试管婴儿时受精失败
卵子与胚胎冷冻技术
进行卵子与胚胎冷冻技术的程序与试管婴儿非常相似，并且需要约2周时间才能完成。女性患者需接受一系列的每日荷尔蒙注射以刺激卵巢产生更多卵子，患者也需要频繁前往我们的生育中心以透过验血及超声波检测卵泡的生长情况。一旦卵子已达到可被采收的阶段，它将按照您与您的伴侣打算在日后使用的决定之下被安排采收及冷冻。
若您或您的伴侣面临以下情况，卵子和胚胎冷冻技术将会是可行的选择：
- 具有可影响生育的身体状况
- 正在服用治疗癌症的药物
- 正在接受试管婴儿
- 希望保留卵子或胚胎以备将来使用
捐赠精子与卵子
也被称为“第三方生殖”，也许会有那么一天，您与您伴侣将需使用他人所捐赠的精子或卵子以协助完成您的生育之旅。捐赠者可以是自己认识的人或匿名人士。在决定捐赠之前，捐赠者必须确保自己符合以下数个标准：
- 精子捐赠者的年龄必须介于20岁至40岁；卵子捐赠者的年龄必须介于20岁至30岁
- 必须确保没有患上艾滋病及C型肝炎等传染病
- 必须确保自己并非患上基因遗传疾病的高风险群
- 必须接受心理筛查
然而，在您考虑捐赠精子或卵子之前，我们强烈建议您与您的伴侣将所有可能因此捐赠程序而牵涉的法律与情绪影响考虑在内。
为了确保捐赠者符合以上标准，所有卵子或精子捐赠者都会在捐赠前被要求接受传染病与基因检测筛检。这些筛检程序均遵照美国食品与药物监督管理局（FDA）对于组织建立制造人体细胞及组织相关产品的要求。
然而，在您考虑捐赠精子或卵子之前，我们强烈建议您与您的伴侣将所有可能因此捐赠程序而牵涉的法律与情绪影响考虑在内。
EN
