7 IVF questions you're too shy to ask

In-vitro fertilisation (IVF) offers hope to couples who have trouble making babies. If you're too shy to find out more about the treatment, we help you ask the hard questions.

Our experts: Dr Roland Chieng is a specialist gynaecologist, and director of Virtus Fertility Centre. Dr Loh Seong Feei is a medical director at Thomson Fertility Centre.

We desperately want to have a baby. At what point should we try IVF?

Dr Loh: Generally, you should seek medical attention if you do not conceive after one year of regular, unprotected intercourse. Your specialist will then evaluate the condition of your husband's sperm, your fallopian tubes and whether you are ovulating or not.

Depending on your condition, the specialist will recommend the appropriate course of treatment.

But it is important to identify the problem that causes infertility in each individual case, to maximise the success of fertility treatment.

Although treatment programmes such as IVF may offer the highest success rates, simple measures like inducing ovulation, surgical correction of endometriosis and the removal of polyps may help certain couples conceive naturally.

Is IVF a guaranteed way of helping us conceive?

Dr Chieng: IVF is not a sure-fire way of helping you to conceive, but it is the most recommended in certain situations or when all other ways have been unsuccessful. The clinical pregnancy rate is over 50 per cent per embryo transfer.

I heard that IVF is an arduous and painful process that requires daily injections. Is that true?

Dr Chieng: It involves daily injections of follicle-stimulating hormone under the skin. These are similar to the insulin jabs that some diabetics have to perform every day.

The entire process can range from two to three weeks - sometimes longer - depending on individual requirements. The injection needle is very fine and pain is often much less severe than the initial apprehension.

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With IVF, what are some health risks my hubby and I face?

Dr Chieng: The process does not pose any risk to the husband. Women, however, face risks such as ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. OHSS is where the woman shows excessive response to IVF medication, producing a high number of eggs and high hormone levels.

In severe cases (about one per cent of IVF treatments), there will be excessive bloatedness, and water accumulation in the abdomen and lungs. Hospitalisation might even be required.

Will my test tube baby be normal? We've heard that babies conceived via IVF have a higher risk of birth defects and problems later in life.

Dr Loh: They do have a slightly higher risk of birth defects or congenital malformations. But this phenomenon may or may not be due to the process of IVF.

Many women who undergo IVF are older, and therefore have a higher risk of chromosomal and structural abnormalities in their newborns.

Many husbands of women who undergo IVF also have abnormal sperm. They may have underlying genetic problems, which may be passed on to the newborns conceived through IVF.

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IVF always means multiple births. We're not prepared to have so many babies at one go!

Dr Loh: IVF treatment can result in multiple pregnancies and births (twins or triplets). In order to increase the chance of conception, more than one embryo is usually replaced into the womb during IVF.

Under the Singapore Ministry of Health's regulations, no more than three embryos are transferred back into the woman's womb.

Under the Ministry's co-funding regulation, couples are encouraged to replace only two embryos in the womb. This has reduced the risk of higher-order multiple pregnancies and birth of three or more babies.

What if we can't use our own eggs or sperm?

Dr Chieng: It is possible to use donated eggs, sperm or embryos. Donor eggs will be required when the mother can't produce her own eggs because of very poor ovarian function.

Donor sperm will be needed when there is a severe genetic disorder in the husband, rendering him unable to produce adequate sperm for treatment.

If he has poor testicular function, the doctor can perform an operation to extract sperm directly from the testes. But, sometimes, this is unsuccessful if he has severely deficient testicular function.

This article was first published in Young Parents.