Gynaecology

INFERTILITY INVESTIGATION & MANAGEMENT

  • The majority of healthy couples do not suffer from female fertility or male fertility issues. Couples are said to suffer from infertility (female infertility and / or male infertility) if they have not been able to conceive after 12 months of regular intercourse without the use of contraception. Infertility affects 15% of couples.
  • As infertility is a very sensitive and delicate problem, our fertility clinic offers a comprehensive personalized infertility service in a warm, caring and holistic environment. If you and your partner are experiencing some difficulty in getting pregnant, you may wish to have an infertility assessment by our fertility specialist to discover the cause of the problem. The basic evaluation for infertility at our fertility centre includes:.
    • Medical history and physical examination
    • Ultrasound and hysterosalpingography (HSG)
    • Semen analysis
    • Ovulation assessment
    • Laparoscopy may be used to diagnose and treat endometriosis, pelvic adhesions or ovarian cysts. The patency of the fallopian tubes can also be assessed during laparoscopy.
  • Based on the results of these tests, treatments like ovulation induction, surgery to remove growths (polyps or fibroids) or adhesions, superovulation intra-uterine insemination (SO-IUI) or in vitro fertilization (IVF) can be commenced.

 

SUPEROVULATION INTRA-UTERINE INSEMINATION (SO-IUI)

  • Intra-uterine insemination (IUI) is a procedure in which prepared sperms are placed directly into the uterus and is usually combined with superovulation (SO) to enhance the chances of conception for couples who are having problems conceiving. In superovulation intra-uterine insemination (SO-IUI), several ovarian follicles (eggs) are stimulated and brought to maturation and ovulation.
  • Superovulation intrauterine insemination (SO-IUI) is offered for mild male factor infertility, mild endometriosis, cervical factor infertility, unexplained infertility and after several failed clomiphene (ovulation medication) cycles. Normal fallopian tubes are essential for this procedure.
  • Fertility medicines are given to stimulate follicular (egg) development. Ultrasound scans are done at close intervals to determine the number and size of eggs within the ovary.  On the day of the insemination (IUI), the husband produces a fresh semen sample if possible at our fertility centre.  The semen undergoes special preparation and the healthy portion of it is then inseminated (IUI) into the womb using a very fine tube by our fertility specialist.  The patient will then be given medications to improve the chances of implantation and pregnancy.  Women should return to our fertility clinic 14-17 days after the insemination (IUI) procedure for a urine and blood pregnancy test. 

 

IN-VITRO FERTILIZATION (IVF) AND INTRA-CYTOPLASMIC SPERM INJECTION (ICSI)

  • Since In-Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI) need more monitoring compared to other infertility treatments, couples need to undergo a detailed consultation with our IVF specialist / IVF doctor before commencing the treatment at our IVF centre so that they have a more thorough understanding about what to expect.  This helps to reduce patient anxiety when they realise that modern IVF treatments are now relatively stress free.
  • In-Vitro Fertilization (IVF) is a technique in which the egg cells and sperms are fertilized in the laboratory of our IVF centre outside the woman’s womb, in-vitro. IVF is offered to women with irreparably damaged or blocked fallopian tubes. IVF is also offered to women who cannot conceive naturally because of severe endometriosis, ovulatory dysfunction, unexplained infertility, sperm disorders and immunological problems.
  • IVF regimes employed in our IVF clinic involve controlled ovarian hyperstimulation with hormonal injections which results in the development of more eggs (follicles) and hence better chance of pregnancy. Once the eggs are mature and reach the desired size, they are collected using a special needle attached to a vaginal ultrasound probe. Women are sedated during this egg retrieval procedure (minor IVF surgery).  The sperms are combined with the collected eggs and allowed to fertilization by natural selection.
  • Intra-Cytoplasmic Sperm Injection (ICSI) involves injecting a single sperm into each collected egg via a microneedle to facilitate fertilization. ICSI is recommended for cases in which there is very poor sperm quality or when there are very few eggs retrieved in an attempt to increase the number of fertilized embryos available for embryo transfer. ICSI can be offered alone or in combination with IVF to increase the success rate of pregnancy. For ICSI, there is no natural selection involved in the fertilisation process between the sperm and egg.

    ICSI

    Embryo Transfer

  • Once fertilization has occurred by IVF and ICSI, a maximum of 2 embryos are transferred (embryo transfer) into the womb a few days after fertilization using a fine catheter which is usually painless.  Any extra embryos that are not transferred may be frozen and stored for later use (embryo freezing).
  • Hormonal support is given to improve the chances of implantation and pregnancy. A pregnancy test (urine and blood) is then performed 14- 17 days after the embryo transfer at our IVF clinic.
  • The pregnancy success rates for IVF and ICSI treatments at our fertility clinic varies depending on patients age (woman in particular), quality of eggs and sperms, duration of infertility and general state of health of the couple amongst the other male and female infertiliy factors.