A quick guide on IVF in Singapore: Is it for you?

If you have been trying to get pregnant but are experiencing some infertility issues, there is another option that has been successful for a lot of couples who want to start a family. Learn more about in vitro fertilisation (IVF) in Singapore in this article.

What is IVF?

The most successful type of assisted reproductive technology is IVF. A set of complex treatments known as IVF are used to help with fertility, prevent genetic issues, and aid in child conception.

The process is possible with the use of the couple's own sperm and eggs. A known or unknown donor's eggs, sperm, or embryos may also be used during IVF. A gestational carrier, a woman who has had an embryo implanted in her uterus, may occasionally be employed.

In IVF, mature eggs are removed from ovaries and fertilised in a laboratory using sperm. The fertilised egg (or eggs) is/are then transported to a uterus. IVF cycles are completed in roughly three weeks. When these steps are divided into separate steps, the process can sometimes take longer.

IVF is expensive and invasive - but if you are trying to get pregnant, it often works.

In vitro fertilisation: Why it's done

IVF is chosen by people for a variety of reasons, such as infertility problems or when one couple has a pre-existing medical condition. Some people will try IVF if other fertility treatments haven't worked for them or if they're past the prime of pregnancy. IVF is an additional reproductive option for same-sex couples or individuals who want to become parents on their own.

IVF is a possibility if you or your partner has:

• Fallopian tubes that are damaged or blocked
• Endometriosis
• Low sperm count or further sperm defects
• Other ovarian diseases, such as Polycystic Ovarian Syndrome (PCOS)
• Fibroids in the womb
• Issues relating to your uterus
• The possibility of passing on a genetic condition or disease
• Unexplained infertility
• Are using a gestational surrogate or an egg donor

IVF vs IUI

For couples facing fertility challenges, two common assisted reproductive technologies to consider are IVF and intra uterine insemination (IUI). IVF involves fertilising the egg outside the woman's body and then transferring the embryo into her uterus, while IUI involves placing prepared sperm directly into the woman's uterus.

IVF is generally more complex and offers higher success rates, making it a preferred option for those with more severe infertility issues. On the other hand, IUI is a less invasive and more affordable option, suitable for couples with less severe fertility problems.

Ultimately, the choice between IVF and IUI depends on individual circumstances, and it is best to consult with a fertility specialist to determine the most suitable treatment approach for your specific needs.

IVF procedure

In contrast to normal conception, which occurs when sperm fertilise eggs in a woman's womb, IVF literally means that the woman's egg is fertilised outside the human body.

The IVF method will involve steps to harvest the egg from the woman and the sperm from the male before the sperm and egg meet in a test tube for fertilisation to occur since the sperm and egg meet outside the body. Here are the steps a couple takes to get an IVF procedure:

Step 1: Egg stimulation

In order to produce a large number of eggs at once, the ovaries are first stimulated by a hormone injection. Beginning on Day 2 of the menstrual cycle, the patient can administer the injections at home. 

Step 2: Assess egg maturation

The gynaecologist will next conduct a quick ultrasound exam on Days 8 or 9 of the cycle to see whether the stimulated eggs are mature.

Step 3: Egg retrieval

Once a mature egg has been seen, the woman will undergo a day surgical operation at the reproductive clinic in Singapore to remove it. This surgery is carried out while sedated. The time span is roughly 10 to 12 days from the initial injection to the egg retrieval.

Step 4: Fertilisation with sperm

On the day of the egg retrieval, an embryologist carries out IVF in a lab using the collected sperm and eggs. Embryos are the resultant products of successfully fertilising eggs. The defective or unhealthy embryos are subsequently culled over the subsequent three- to five-day growth period. In order to track the development of the embryos in the IVF lab over these five days, an embryoscope may be employed.

Step 5: Freezing of embryos

Those embryos that are deemed to be in the best condition are then frozen and returned to the mother's womb one to two months later. Before the transfer is done, the woman must take hormone pills every day.

Step 6: Transfer of embryos

A quick operation is performed in the IVF clinic to place the embryo back into the woman's womb. This transfer procedure won't require anaesthesia and will last for 20 to 30 minutes.

Step 7: Verify the success of IVF

A pregnancy test (blood test) will be performed two weeks following the embryo transfer to determine whether the lady has successfully conceived.

What to expect after IVF procedure

After the IVF procedure, there are several things to expect and precautions to take to increase the chances of a successful pregnancy. The embryo transfer is a crucial moment in the IVF process and can be an emotional high point for many individuals.

Following the procedure, it's essential to take care of yourself both physically and emotionally.

Firstly, pamper yourself for a few days and engage in some self-care activities. While you don't need to go on complete bed rest, taking it easy can help with the emotional rollercoaster that often accompanies the wait for the pregnancy test results. Indulge in activities that help you relax, such as reading, watching movies, or laughing at funny videos.

Secondly, continue taking any medications prescribed by your doctor. Progesterone is commonly used in the early weeks after the transfer to support pregnancy. It helps the embryo implant and stay implanted in the uterus. Similarly, if your doctor recommends baby aspirin, stick to the prescribed dosage as it may improve implantation and pregnancy outcomes.

Thirdly, focus on maintaining a healthy diet rich in fruits, vegetables, calcium, protein, B vitamins, and iron. It's also advisable to start taking a daily folic acid supplement, which is vital for preventing neural tube defects and has other potential benefits for the baby's development.

Additionally, pay attention to household products and gear that may contain endocrine-disrupting chemicals (EDCs). These chemicals can interfere with hormonal functions and may have an impact on the baby's development in utero. It's best to avoid or reduce exposure to such substances.

What to avoid

On the other hand, there are certain things to avoid in the hours and days after the embryo transfer. Refrain from having sex to allow the embryo to settle in the uterus without disruption.

Similarly, resist the urge to take a pregnancy test right away, as it can take some time for pregnancy hormones to be detectable. Instead, wait for a couple of weeks and have a test done at your doctor's office to confirm the pregnancy.

Finally, be vigilant about any concerning symptoms, such as severe abdominal pain or bloating, which might indicate ovarian hyperstimulation syndrome (OHSS). If you experience troubling symptoms, don't hesitate to contact your doctor for guidance.

In conclusion, the days following the embryo transfer can be filled with anticipation and anxiety. While some precautions are essential, it's crucial to take care of yourself and engage in activities that help you relax and distract from the waiting period.

Remember that each individual's journey is unique, and the most important thing is to follow your doctor's advice and be patient until you can take a pregnancy test to determine the outcome of the IVF procedure.

Is there a limit on the number of IVF cycles a woman can undergo

There is currently a limit on how many IVF cycles a woman can have. For women under the age of 40, this is set at 10 cycles, and for women over 40, it is at five. On the other hand, this cap was lifted on January 1, 2020.

The first three stages of an IVF cycle, from the beginning of the hormone drug injection through the egg retrieval, typically take 10 to 12 days. 

Your age and the underlying cause of your infertility are only two of the many factors that can affect IVF success rates. IVF may be demanding, time-consuming, and expensive. If more than one embryo is inserted into the uterus during IVF, it may result in a pregnancy with several foetuses (multiple pregnancy).

Your doctor can go over how IVF works, any risks, and whether it's a good option.

Risks of IVF

The following risks are connected to IVF treatment:

1. Premature labour

Premature labour is more likely in pregnancies that result in multiple deliveries.

2. Premature birth

Your baby may be born earlier or with a lower birth weight, which could put you at a little increased risk.

3. Miscarriage

The rate of miscarriages is similar to that of natural conception pregnancies.

4. Ectopic pregnancy

The disorder known as ectopic pregnancy occurs when your fertilised egg implants outside of your uterus.

5. Egg retrieval complications

This might include bleeding, infections, and injury to your bladder, bowel, or reproductive organs.

6. Ovarian hyperstimulation syndrome (OHSS)

A rare illness that results in shortness of breath, difficulty breathing, bloating, nausea, vomiting, diarrhoea, stomach pain, and the inability to urinate.

IVF in Singapore: Success rate

IVF has success rates that vary between 50 to 60 per cent. In recent years, it has been shown that freezing the embryos before implanting them back into the woman's body improves IVF success rates. The fundamental hypothesis is that frozen embryos are more robust and therefore have a better chance of becoming pregnant. These days, many IVF doctors routinely transfer frozen embryos.

According to a 2002 report by the Singapore Ministry of Health, 1,569 couples underwent IVF in Singapore. The majority (around 70 per cent) of them sought treatment in public hospitals, with the most popular hospital being KK Women's and Children's Hospital.

The report indicated that the average success rate of IVF in Singapore, treatment ranged from 16 to 28 per cent across the various institutions, with the highest success rates coming from Gleneagles Hospital and National University Hospital.

Factors affecting IVF success

IVF can be a game-changer for couples struggling to conceive naturally. But success rates can vary, and it's essential to understand the factors that influence the outcome. Here are some tips to increase your chances of IVF success:

1. Age matters: Age is a crucial factor in IVF success. Women under 30 have higher pregnancy rates (around 25.4 per cent per egg transfer) compared to those aged 31 to 35 (17.7 per cent) and 36 to 40 (9.7 per cent). Younger age generally means better chances of success.
2. Embryo count: The number of embryos transferred affects the likelihood of success. In Singapore, up to two embryos can be transferred in one procedure. However, transferring more embryos increases the chances of multiple births.
3. Number of treatment cycles: Success rates can decline with each IVF treatment cycle. The cumulative effect of three full cycles raises the chances of pregnancy to about 50 per cent.
4. Healthy weight: Maintaining a healthy weight is vital. Both being obese and underweight can negatively impact IVF success rates. Obesity can also make monitoring ovaries difficult and lead to complications during egg retrievals.
5. Optimise sperm health: Male infertility accounts for 40 per cent of infertility cases. Improving sperm quality through lifestyle changes, such as using multivitamins, maintaining a healthy weight, and quitting smoking, can positively affect IVF outcomes.
6. Manage stress: High stress levels can interfere with the reproductive system. Reducing stress can enhance your chances of success, so consider relaxation techniques and self-care during the IVF journey.
7. Quit smoking: Smoking can impair egg and sperm quality, leading to lower success rates in IVF.
8. Consider supplements: Supplements like DHEA and CoQ10 have shown potential in improving egg quality and ovarian response during IVF cycles.
9. Vitamin D: Adequate vitamin D levels have been associated with better IVF outcomes, increasing the chances of positive pregnancy tests, clinical pregnancies, and live births.

IVF in Singapore: Cost and where to have it

As part of the government's ongoing initiatives to promote and support marriage and parenthood, the Ministry of Health of Singapore announced in August 2019 that Singapore would be removing the age restriction for women undergoing Assisted Reproductive Technology (ART) procedures, such as IVF treatments.

In addition, more government co-funding for ART procedures was announced.

Both governmental and private hospitals and medical facilities in Singapore offer IVF treatments. The three public hospitals that now provide IVF services charge between $10,000 to $15,000 per cycle for IVF treatment:

1. KK Women's and Children's Hospital;
2. National University Hospital; and
3. Singapore General Hospital.

IVF treatment packages may be available from private medical facilities for between $7,999 to $20,000 each cycle. The following services could be included in their treatment plans:

• Fees for medical consultations during follicle scans
• Follicle ultrasound scans
• The cost of a doctor's services for egg transfer and collecting
• Laboratories' fees
• Charges for the use of the operating room, standard supplies, and the recovery area.

Nevertheless, keep in mind that some IVF packages might not cover initial doctor consultation fees, medicines, and other optional treatments that come at additional expense.

To find the most economical choice for you, compare the prices for IVF treatment at both public and private clinics.

In Singapore, a couple may only commence IVF procedures if there are justified indications for the procedure mainly:

• Tubal disease and/or obstruction
• Endometriosis — failed alternative approaches to treatment
• Idiopathic sub-fertility where no cause to be found after full investigation, at least three years of marriage, and having completed alternative approaches to fertility management for at least one year (this will not apply to female patients over 35 years of age)
• Premature ovarian failure
• Other conditions acceptable to the local medical obstetric/gynaecology community

You should speak with a specialised gynaecologist who is an accredited IVF clinician if you are thinking about IVF therapy. They will be able to answer any questions or address any concerns you may have regarding IVF in Singapore.

Now that you have a better understanding of the procedure, the risks and the cost, you can now make a decision with your partner if IVF is worth a try. It can be emotionally challenging, so have open discussions with your partner about the process, potential outcomes, and support each other throughout the journey.

Consider joining support groups or connecting with others who have gone through the IVF process. Support from friends, family, or a counsellor can be valuable during this time.

While IVF can be unpredictable, maintaining a positive attitude can be beneficial. Focus on self-care and finding ways to manage stress during the process.

Remember, each IVF journey is unique, and there are no guarantees. However, being well-prepared physically, emotionally, and financially can give you the best chance of a successful IVF procedure.

ALSO READ: Basic ovulation test kits: All you need to know about using OPKs

This article was first published in theAsianparent.