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Building a family or bringing children into the world is an exciting phase of life for most couples. But for some, being unable to bear children can prove to be a painful reality to handle. Here at Island Fertility Centre, we seek to provide couples experiencing infertility with reliable quality treatment by practising the most appropriate Assisted Reproductive Technologies (ART). As we understand that it is an emotional encounter for most couples, we also guide and counsel couples through their journey in fulfilling their dreams of having children with our team of doctors and nurses.

Our Services

Basic Fertility Assessment

  • Sperm test
  • Follicle-stimulating hormone( FSH)/ luiteinizing hormone (LH)/ prolactin/ progesterone blood tests
  • Uterine cavity inspection and endometrial biopsy
  • Fallopian tubes and uterus checkup (HSG)

Fertility Treatment and Procedures

  • In-Vitro Fertilisation (IVF)
  • Intrauterine insemination (IUI); donor insemination
  • Timed intercourse with ovarian stimulation
  • Egg harvest, egg freezing
  • Intracytoplasmic Sperm Injection (ICSI)
  • Pre-implantation Genetic Testing for Aneuploidies (PGT-A)
  • Surgical Sperm Retrieval (SSR) – MESA (Microepidydimal Sperm Aspiration) / TESA (Testicular Sperm Aspiration)

Fertility Lab Services

  • Sperm preparation
  • Sperm, egg, and embryos banking
  • Donor programme for egg and sperm
  • Donor programme for embryos
  • Pre-implantation Genetic Testing for Aneuploidies (PGT-A)
  • Pre-implantation genetic Testing for Monogenic Diseases (PGT-M)

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

How does IVF work?

It all begins with a simple visit our doctor who will carry out a series of tests and bloodwork to determine whether you and your partner are suitable to undergo the procedure. Once the results are released, our doctor will discuss possible methods of treatment. If you are not fit for the procedure, you will be counseled and advised to return home. However, if you are suitable, fertility medications will be prescribed to the female patient in the form of daily injections to stimulate the ovary’s follicles to mature more eggs. The injections can be self-administered or done by the A&E staff at Island Hospital. During this period, you will be advised to be present for all injections and scheduled monitoring processes.

The next step in the IVF procedure is triggering the oocytes (immature ovum) to complete the final stage of maturation. To achieve this, hCG is injected at an exact time to ensure that the oocytes mature properly. Once they have fully matured, the female patient will be lightly sedated and sent to the operating theatre to retrieve the eggs. At the same time, 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. After three to five days, our embryologist will identify the healthiest looking embryos and prepare it for an embryo transfer. Sometimes, genetic screening known as pre-implantation genetic diagnosis (PGD) is done to identify any genetic disorders which may be passed down to the child.

Similar to IUI, 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. In cases where a patient is unfit for an embryo transfer, the eggs will be frozen to be used for the next cycle.

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

IVF Patient Journey

Day 1: Consultation with doctor

  • Examination
  • Possible treatment plans will be discussed

    A series of tests and bloodwork will be carried out to determine whether you and your partner are suitable to undergo the procedure, which can be done in your home country. Do bring your test results to our IVF centre during your consultation session with our IVF doctor.

    Our doctor will discuss with you/your partner regarding the possible methods of treatment. If you are not fit for the procedure, you will be counseled and advised to return home.

Day 2 – Day 14: Taking Fertility Medication

  • Daily injections of fertility medication
  • Can be self-administered or done by staff nurse

    Our doctor will prescribe suitable fertility medications to the female patient in the form of daily injections to stimulate the ovary’s follicles to mature more eggs. The injections can be self-administered or done by the staff nurse at Island Hospital.

    During this period, you are advised to be present for all injections and scheduled monitoring processes.

Day 15: Egg Retrieval

  • Injection of GnRH analogue
  • Eggs will be retrieved

    GnRH analogue is injected at an exact time to trigger oocytes maturation. Later, the patient will be sent to the operating theatre to retrieve the eggs under light sedation.

Day 15: Fertilisation

  • Collection and washing of semen sample
  • Create embryo via ICSI

    A semen sample will be collected and washed for fertilisation. Our embryologist will then picks up the single sperm and injects directly into the mature egg. The eggs are checked the following day for evidence of normal fertilization.

Day 16 – Day 21: Embryo Culture

The embryos are culture in the incubator until day-3 or day-5 depending on the quality of the embryos.

Day 21: 4 Options: To decide at the beginning of the treatment

  • Embryo transfer
    • Embryo will be placed into uterus

      The embryo is placed into the uterus via a thin, flexible catheter, which is gently passed through the opening in the cervix leading to the uterus’ interior.

  • Embryo freezing

    If you’re not suitable for a transfer, the embryos will be frozen to be transferred on to the next cycle.

  • Pre-implantation Genetic Testing for Aneuploidies (PGT-A)

    PGT-A is genetic test performed on embryos’ cells. It gives information about the embryos’ genetic health to help the embryo selection for transfer and improve the chance of achieving a successful pregnancy. PGT-A was formerly known as Pre-implantation Genetic Screening (PGS).
    All the embryos will be frozen after the biopsy procedure. It takes up to a week for the PGT-A result to be ready. The frozen embryo transfer will then be scheduled.

  • Pre-implantation Genetic Testing for Monogenic Disorders (PGT – M)

    PGT-M, or pre-implantation genetic testing for monogenic/single gene defects, is for people who know they are at increased risk for passing on specific genetic conditions. PGT-M can be performed prior to pregnancy to greatly reduce the risk of having an affected child.

Day 35: Pregnancy Test

After two weeks of embryo transfer, a pregnancy test will be done in the clinic. If the test is positive, our doctor will schedule for a follow-up and ultrasound session. If the test is negative, plan for another embryo transfer cycle if there is embryo in storage. If not, plan for a new cycle.

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 culture

    This 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. Island Fertility Centre is a no-frills fertility centre which is committed in fulfilling every couple’s dream of having a child. As of 2018, the success rate in implantation was recorded at a range of 40% to 50%, while the success rate of babies born ranged from 30% to 40%

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).

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.

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. 

What is the cost of treatment at Island Fertility Centre?

The cost is about 3 times cheaper than a private hospital in Singapore without pre-implantation diagnosis (PGD) and 13.4% cheaper than fertility centres in Kuala Lumpur. Kindly email us at info@islandhospital.com for an initial cost estimation. Please note that the figures provided are estimates only and may vary based on your condition.

Are there any risks involved with IVF?

There are several risks associated with the procedure, such as:

  • Multiple births
  • Ovarian hyperstimulation syndrome (OHSS)
  • Miscarriage
  • Egg-retrieval procedure complications
  • Ectopic pregnancy
  • Birth defects
  • Cancer
  • Financial and emotional stress

Will I experience any side effects from IVF?

While IVF is a relatively safe procedure and most women can usually resume normal activities almost immediately, you may experience some side effects such as mild cramping, bloating, constipation, breast tenderness, and passing clear/blood-tinged fluid after the procedure. Fertility medications can also bring about other side effects including mood swings, headaches, and hot flashes.
However, if you experience heavy vaginal bleeding, pelvic pains, blood in your urine, or high fever, contact your doctor immediately.

Is an IVF procedure painful?

Generally speaking, IVF is a relatively painless procedure. However, some may be overwhelmed by the prospect of injecting themselves daily with fertility medications. As such, you will be taught how to administer the injections or allow our A&E staff to do so instead. Light sedation will also be given to you during the egg retrieval procedure, where you may experience slight cramping in the ovaries which can be treated with appropriate medications.

How long is the entire IVF journey from 1st consultation to conceiving?

An IVF cycle typically takes around four to six weeks to complete. If you choose to undergo a PGD testing, this would add another four to five weeks to the process. 

How can I increase my chances of getting pregnant through IVF?

Here are a few ways you can boost your chances of pregnancy:

  • Maintain your weight with a body mass index (BMI) between 20 and 25
  • Quit smoking
  • Reduce your stress
  • Consume alcohol/caffeine in moderation
  • Have a diet that is rich in vitamins and minerals (e.g. vitamin A, B, zinc, magnesium etc.)

How soon can I undergo IVF again after having a miscarriage?

From the physical perspective, doctors would usually say that you will be able to attempt another IVF cycle following the first normal menses after a miscarriage, though some might recommend two menses or more. However, the first menses’ onset is variable and unpredictable, taking place any time from four to eight weeks after the miscarriage. Furthermore, it takes several days for all fetal tissues to exit from your body and around two weeks for the cervix to close after the miscarriage. Thus, it is best for your body to fully recover before going for another IVF cycle.

As for the emotional perspective, it is best for you and your partner to take some time off before considering having another go at IVF as the procedure can place a huge emotional and financial strain.

Will my child have birth defects due to IVF/ICSI?

Multiple researches have suggested that between IVF and ICSI, children conceived through ICSI have a higher chance of suffering birth defects, especially in the heart, eyes, reproductive organs, and urinary systems.

If you are concerned that your unborn child may be at risk for birth defects, you can opt for a pre-implantation genetic diagnosis (PGD) test to determine any possible genetically-linked disorders. You are also strongly encouraged to consult your doctor about the risks related to IVF/ICSI.

How does pre-implantation genetic testing for aneuploidy (PGT-A) benefit the pregnancy?

PGT-A, also known as PGS (Pre-implantation Genetic Screening) is a procedure that allows the determination of the chromosomal status of IVF embryos by screening all 23 pairs of human chromosomes.

This test helps these couples identify embryos carrying a genetic disease or a chromosome abnormality, thus avoiding diseased offspring. PGT-A (Pre-implantation Genetic Testing for Aneuploidy) also known as PGS (Pre-implantation Genetic Screening) is a procedure that allows the determination of the chromosomal status of IVF embryos by screening all 23 pairs of human chromosomes. Only embryos with the correct number of chromosomes will be able to implant and develop into a healthy baby and the gender is also revealed.

What should I do if my embryos were to get mixed up?

At Island Hospital Fertility Centre, we strive to practice the highest standard of safety and accuracy in ensuring that the correct embryo is implanted into the intended parent. As such, you can be assured that no errors will occur in the embryo implantation process.
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Eric Soh Boon Swee Dr.

Specialty
Obstetrics and Gynaecology
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Mah Siew Lee Dr.

Specialty
Obstetrics and Gynaecology
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Narinder Singh Shadan Dr.

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Obstetrics and Gynaecology
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