In-Vitro Fertilisation (IVF) in Singapore

IVF (In Vitro Fertilisation) refers to the assisted reproduction technique (ART) in which the process of fertilization occurs outside of the body. The mature eggs extracted from the ovaries are manually combined with retrieved sperm in a laboratory dish. Then, when a healthy embryo (fertilised egg) develops, it is cultured for a few days before it is implanted in the uterus.

Why is IVF Treatment Used?

IVF is frequently used to treat fertility problems. However, it is usually a reserved treatment when other fertility methods like fertility drugs and artificial insemination do not work. On the other hand, IVF is recommended as a primary option if you or your partner have certain health or genetic conditions like the following:

	Absent, Blocked or Damaged Fallopian Tube
	Endometriosis
	Genetic Disorder
	Impaired Sperm Production
	Ovulation Disorders
	Premature Ovarian Failure
	Preservation of Fertility
	Previous Tubal Ligation or Vasectomy
	Uterine Fibroids
	Unexplained Infertility

IVF Treatment in Singapore: What are the Steps Involved?

In Vitro Fertilisation requires a preliminary health assessment to determine the fertility potential of both parties. This is also done to make sure that possible conflicting medical problems are discovered and treated before beginning an IVF cycle so that any negative impact of the procedure will be prevented.

Once both parties are proven ready for an IVF cycle, here are the steps that they need to follow: Step 1: Stimulation of Ovulation Oral or injectable hormonal medication is used to stimulate ovulation or egg production. The medication causes the ovary to produce multiple eggs, instead of a single egg every month. Multiple eggs are needed as some might not develop or fertilise after the retrieval process. Your IVF doctor will work closely with you to prescribe suitable medication. One to two weeks of ovarian induction is normally needed before harvesting the mature eggs. The following procedures will be performed to know if the eggs are ready for retrieval:
	Vaginal ultrasound - an imaging test of the ovaries used to observe the growth of a follicle (fluid-filled ovarian sacs where eggs mature).
	Blood tests – used to measure the estrogen levels or the hormonal response to ovarian stimulation medications.

Step 2: Extraction of the Egg

The most common method of egg extraction is the transvaginal ultrasound aspiration. This process involves an ultrasound probe that locates the follicles and a fine needle attached to a suction device that extracts the mature eggs. The patient will be sedated during the egg extraction and pain medications will be given after the procedure to lessen any possible discomfort. The procedure usually lasts from 20 minutes up to an hour, depending on the accessibility of the ovaries and the number of mature follicles.

If transvaginal ultrasound aspiration is not applicable, laparoscopy is an alternative. It is the creation of a small incision near the navel and a laparoscope that guides the needle is inserted. The retrieved eggs are placed in a culture medium and are incubated.

Step 3: Retrieval of the Sperm

On the same day of egg extraction, a fresh sperm sample will be obtained through a testicular sperm aspiration. It is when the sperm is directly retrieved from the testicle through a small surgical procedure. A frozen sample is opted when fresh is unobtainable or when the sperm comes from a donor.

Step 4: Fertilisation

There are two possible methods that can be used for the fertilisation process:

	IUI (Intrauterine Insemination) – the mature eggs and sperm will be combined, immediately after the retrieval. It will be stored in a laboratory dish to assist with the fertilisation and will be incubated overnight.
	ICSI (Intracytoplasmic sperm injection) - is when a single healthy sperm is inserted directly into every mature egg in order to attain fertilisation. This method is commonly used if there is a lesser chance of fertilisation due to low sperm number/quality or when prior IVF cycles fail.

The eggs will be thoroughly observed to make sure that the embryo is developing and cell division is occurring.

Step 5: Transferring the Embryo

The embryos are usually transferred into the uterus 3 to 5 days after the fertilisation procedure. The procedure involves a catheter (a long, fine, and flexible tube) that is inserted into the uterus and a syringe to transfer the developed embryo. It is usually painless, but mild cramping is sometimes experienced. It may be performed under mild sedative.

The embryo will implant in the lining of the uterus normally around 6 to 10 days after the egg retrieval if the transfer is successful. In most cases, women can resume normal activities, but rigorous actions should still be avoided after the embryo transfer.

IVF is typically recommended for two groups of patients:

	Couples below 35 years old who are having difficulties conceiving after 1 year of regular sexual intercourse, without the use of contraception
	Couples above 35 years old who are having difficulties conceiving after 6 months of regular sexual intercourse, without the use of contraception
IVF may also be recommended for couples who experience the following problems:
	Blocked, damaged or missing fallopian tubes
	Ovulation disorders such as premature ovarian failure and polycystic ovary syndrome (PCOS)
	Endometriosis
	Male factor infertility such as low sperm count and abnormal sperm function
	Unexplained infertility

IVF is a complex but established procedure composed of a series of steps, including ovarian stimulation, egg maturation and retrieval, sperm extraction, fertilisation (insemination), embryo development and embryo transfer. Taking into account consultations, test preparations, medications, monitoring and waiting times between steps, one IVF cycle typically takes about 4 to 6 weeks—similar to the duration of a normal ovulation cycle.

Some women may experience these common side effects after undergoing an IVF cycle:

	Breast tenderness
	Constipation
	Headache
	Hot flashes
	Ovulation Disorders
	Mild cramping or bloating
	Mood Swings

As with all medical procedures, some steps of the IVF process may cause some discomfort. During ovarian stimulation, fertility medications have to be injected on a daily basis for up to 12 days, which may be painful or stressful to some women.

The egg retrieval process is usually manageable as it is done under IV sedation. Mild cramps may be felt following the egg retrieval but this should subside by the next day.

During the embryo transfer step, the embryo is implanted into the uterus through a small catheter. This step rarely requires sedation nor is it painful, though you may experience mild cramping.

Overall, it is generally recognised that the chances of conceiving a baby with birth defects through IVF are the same as that of natural conception.

The success rate of IVF is determined by several factors such as:

	Reproductive history
	Maternal age
	Cause of infertility
	Other Lifestyle Factors

The cost of IVF treatments in Singapore performed in private hospitals typically cost around 10,000 to 20,000 SGD per cycle. This price range usually includes the consultation fee, fertility drugs, medical tests, the procedure itself, and the embryo transfer.

It is also important to note that prices may vary depending on various factors, such as the specific IVF procedure, the clinic, the IVF specialist, the age and health of the patient, and any additional treatments and medications that may be required.

There are some government grants available that can help Singaporeans alleviate the cost of IVF treatment, provided that certain criteria are met. Our clinic staff will work with you closely to aid you in managing your costs.

Consultant Obstetrician and Gynaecologist
MBBS (S’pore), MRCOG (UK), M Med (O&G) (S’pore), FAMS (O&G) (S’pore)

Dr Jonathan Wee Yeow Sherng is a dedicated obstetrician and gynaecologist, and an experienced IVF clinician who is dedicated to treating a full range of issues relating to women’s health and fertility. Our IVF clinic offers Assisted Reproductive Technologies (ART) and other fertility treatments alongside compassionate, patient-centred care.

Aside from these factors, seeking help from an infertility expert may also contribute to the success of an IVF procedure.