Most couples dream about having children once they get married. Unfortunately, this natural biological process isn't as simple or straightforward for some. Sometimes, medical intervention is needed in order to achieve the goal of getting pregnant. And the most common process that couples go through is In Virtro Fertilisation, better known as IVF.

IVF is an assisted reproductive technique (ART) that is safe and gives couples who can't conceive naturally a glimmer of hope of becoming parents. Some common reasons why couples will need to use IVF to conceive include but are not limited to: endometriosis, ovulation issues (eg. Polycystic Ovarian Syndrome (PCOS)), damaged or blocked fallopian tubes, male factors (eg. low sperm count) or unexplained infertility.

Couples who decide to go through IVF treatments could be rewarded with a bundle of joy. You will need to see a fertility specialist, who will determine if you need IVF treatment and what your chances are of getting pregnant.

IVF is an intimidating process and can be a long, arduous journey for some . It also costs a lot and takes a lot of time, with multiple doctor appointments. Also, depending on your age and cause of infertility, your chances of conceiving can be low in some of these brackets (women under 35 have a better chance at success). And, sometimes, it won't happen at all. This is an outcome that you need to prepare for psychologically before you embark on the IVF journey.

Here are some important things you should know about the process before getting started.

What happens in IVF?

As its name (in vitro) suggests, IVF is a series of procedures that take place outside the body – in a laboratory, in this case – that ultimately lead to fertilisation. Every time you go through one set of IVF procedures is known as a ‘cycle’. Day one of a cycle starts on the day you get your period and your treatment begins on day two or three of a cycle.

These are the five main steps in an IVF cycle.

Step 1: Egg stimulation 

You'll need to inject yourself daily (into the subcutaneous tissue of your thigh or abdomen) in order to stimulate follicle (eggs) growth in your ovaries. Women's bodies naturally produce one egg each month but the IVF process encourages the growth of more eggs so as to ensure better success of fertilisation and then pregnancy.

The injections contain hormones that stimulate the development of eggs. The type of hormones you inject depends on the protocol that the clinic follows and your individual circumstances too - but the goal is the same, to stimulate follicle growth. You'll need to go for ultrasound scans every few days, to check on the number and growth of these eggs. There might also be blood tests involved, to measure your hormones.

After eight to 12 days of injections - once your doctor has decided the size of the follicles are satisfactory - you'll take one final injection that triggers the final maturation of the eggs.

Step 2: Egg collection 

You'll be booked in for this procedure to take place 34 to 36 hours after you have taken your trigger injection. This process is done under anaesthesia and lasts 15 to 30 minutes. A special needle attached to an ultrasound vaginal probe is used to collect the follicles.

Note that not all follicles will contain eggs and not all eggs may be suitably developed for fertilisation. You will be required to fast a few hours before the day surgery but will be able to return home soon after the procedure. You might experience slight abdominal discomfort but this shouldn't last for more than 48 hours. Slight vaginal bleeding could also occur after the procedure.

Step 3: Fertilisation 

Your husband will need to produce a sperm sample on the same day as your egg collection. Once your eggs are retrieved, the sperm is added to them in a dish where fertilisation is allowed to take place through natural selection. In cases where there may have been sperm issues, an Intra-Cytoplasmic Sperm Injection (ICSI) procedure is done, where a single sperm is injected into each egg via a micro-needle, to aid fertilisation.

If fertilisation takes place, they are now known as embryos and their development will be monitored in a laboratory for a few days.

Step 4: Embryo Transfer 

Between day two and five after fertilisation, embryos that have been deemed healthy are transferred into your uterus through a fine catheter. In Singapore, usually only a maximum of two embryos are transferred at one time. This process takes only a few minutes and no sedation is required.

You will then be given some hormones to take to support the lining of the uterus, for better chance of embryo implantation. These can be either oral, vaginal or via injection. If there are any healthy embryos leftover, your doctor will ask if you'd like to freeze them to perhaps be used for future cycles.

Step 5: Pregnancy test 

Between 14 and 17 days after your embryo transfer procedure, you will take a pregnancy test. Pregnancy is confirmed via a blood test, which measures the pregnancy hormone. If you're pregnant, you'll then be guided through the regular steps of a pregnancy. If the result is negative, you may choose to try another cycle, either with fresh or frozen embryos.

How much does IVF treatment cost? 

This would depend on where you get treatment. A public hospital will charge between $10,000 and $15,000 per cycle. Such hospitals are: KK Women's and Children's Hospital, National University Hospital and Singapore General Hospital.

Private hospitals or medical centres' fees start at around $13,000 per cycle and could go up to $20,000. Some popular private IVF hospitals and medical centres include Thomson Fertility Centre, Raffles Fertility Centre, Gleneagles IVF Centre and Mount Elizabeth Fertility Centre.

Note that other costs such as laboratory fees might not be included in the IVF packages as some couples might need special tests or procedures.

The Ministry of Health (MOH) has a co-funding scheme for couples going through IVF, for up to 3 fresh and 3 frozen cycles. Treatments must be done at a public hospital and the percentage of funding depends on whether one or both are Singapore citizens, Permanent Residents (PRs) or foreigners.

Couples who are Singaporeans or PRs can also use their Medisave to help pay for treatments - they may withdraw $6,000 for the first cycle, $5,000 for the second cycle and $4,000 for the third and subsequent cycles. A lifetime Medisave withdrawal limit of $15,000 per patient applies.

More information can be found here.

Are there any other rules I should know about? 

IVF counselling is mandatory under MOH guidelines, and sex selection is not allowed in Singapore unless medically indicated.

ALSO READ: 7 IVF questions you're too shy to ask

This article was first published in Her World Online.