Fertility

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First comes love.
Then comes marriage.
Then comes baby in a baby carriage.

 

Sounds familiar? You probably used to tease your friends in school with this rhyme about ‘sitting in a tree, K-I-S-S-I-N-G’ and the consequences that followed.

 

Boy meets Girl. Sperms meet Eggs. Baby follows.

 

Or not?

 

For some couples, sperms and eggs have a little difficulty meeting inside the female body. There are many reasons for this. Sometimes, it could be due to low sperm count or weak sperm on the male’s part. In other couples, it could be blocked fallopian tubes in the female that prevents the sperm from getting to the egg. Or due to certain medical conditions such as Poly Cystic Ovarian Syndrome, where it is difficult for ovulation to take place naturally and regularly without the aid of medication.

 

In such situations, couples who have difficulty conceiving naturally can turn to Assisted Reproductive Technology (ART) for help. Although there are a few forms of ART available, the most comprehensive treatment that can address most infertility problems plaguing otherwise healthy couples is in-vitro fertilization (IVF).

 

IVF is the technique of letting fertilization of the sperm and egg occur outside the female body.

 

In most cases, the sperm and egg samples are collected separately, mixed together and fertilization is left to occur naturally. For cases where the sperm count is very low, or fertilization fails to occur, the hospital will carry out intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the centre of an egg.

 

Agnes and her husband Navin, both 35 years old, conceived baby Tya through IVF. The couple married at 24 but waited four years before trying to conceive. They tried for another four years before deciding to seek medical advice. A series of fertility tests revealed that Navin had a low sperm count and that sperm motility (speed and mobility of the sperm) was rather low. This meant that there was very low chances that the sperm could swim close enough to the egg to enable natural conception.

 

Agnes recalls her reaction to the disappointing news, “I was pretty upset that we needed to seek fertility treatment. I spent three weeks crying over it. I couldn’t understand why we couldn’t conceive like everyone else. It didn’t seem fair.”

 

She is thankful that her husband took the news in stride and did all he could to console and comfort her. The couple took the hospital’s advice to try IVF. However, before embarking on IVF treatment, Agnes needed to undergo an operation to remove fibroids in her womb which may hinder or complicate pregnancy if she were to become pregnant. This additional step furthered the delay in the couple’s baby-making plans.

 

How much does IVF cost?

 

IVF is an expensive process, costing about $10,000 per cycle on average.

 

Fortunately for couples in Singapore, co-funding for ART was introduced in August 2008. Agnes and Navin spared no time in researching and taking advantage of the financial assistance scheme. Their daughter Tya, now 17 months old, was the first IVF baby to be born under the ART co-funding scheme.

 

Under the scheme, the Government subsidises the cost of IVF treatment conducted in public hospitals for a maximum of three cycles. However, couples must meet the following criteria before they can qualify for the subsidy:

 

a. Either the patient or her husband must be a Singapore Citizen at the start of the ART cycle;

 

b. The patient has no more than one living child with her husband.

 

c. The patient is below 40 years of age at the start of the cycle;

 

d. The patient has been assessed by her doctor to have met the clinical requirements for ART;

 

e. The patient’s treatment is a fresh cycle;

 

f. The patient has no more than two embryos transferred during the cycle; and

 

g. The patient has not received three co-funded cycles in the past.


For Singaporean couples, 50% or up to $3,000 is co-funded. However, initial consultations and investigations (such as blood tests, urine tests and ultrasound scans) are excluded from the co-funding. Medisave can be used to foot the remainder of the bill to a maximum of $6,000 for the first cycle, $5,000 for the second cycle and $4,000 for the third cycle.

 

The process

 

Each cycle of IVF takes approximately six weeks. This does not include the preceding two to three months needed to conduct the preliminary tests and waiting time for treatment to commence.

 

During the first four weeks, the patient has to administer self-injection once or twice a day usually on the abdominal area. This is to stimulate the development of multiple egg follicles and to prevent the onset of ovulation. Possible side effects of the medication include headaches and bloated-ness in the tummy. Agnes recalls, “One of the challenges I faced in the IVF process was learning to overcome the fear of injections, which I had to administer on myself.”

 

After the four weeks, egg collection takes place. The process is conducted under local anaesthesia. The eggs are fertilized with a fresh sperm sample produced by the patient’s husband – embryos are then formed.

 

Two to three days later, one or two (the maximum allowed under the ART co-funding scheme) embryos are transferred into the womb in a painless procedure that does not require the use of anaesthetic. Remaining embryos are frozen for future use.

 

The patient is given two weeks of medical leave to rest at home, so as to aid the embryos’ chances of implanting in the uterine lining. This is commonly referred to amongst IVF patients as ‘the dreaded 2WW’ (two-week wait). “This was a very emotionally-challenging period,’’ says Agnes. “There was a lot of anticipation as to the outcome.”

 

What are my chances of conceiving successfully through IVF?

 

Agnes and Navin were fortunate to have conceived on their first attempt. Their first cycle of IVF yielded a sole usable embryo which was implanted into Agnes and eventually grew to become a healthy baby girl.

 

 

The couple were both under 35 at the time of the IVF treatment. Their chances of conceiving were considered to be higher and this was at only 33%! Once over 35, the success rate dips considerably whereby women over 40 have only 10% chance of conceiving through IVF.

 

When is the right time to try IVF?

 

Agnes’s advice to couples planning to start a family is not to take conception for granted. General medical advice dictates that if a couple has been trying for a year and has not yet conceived naturally, they should go for a medical check to assess their fertility health.

 

“The IVF journey certainly wasn’t easy for us but I would say that it was ALL worth it,” says Agnes. It certainly helped that ART subsidies have made a complex medical process such as IVF available to a wide spectrum of couples who have difficulty conceiving naturally. She adds, “With Government incentives available, this is now the time to try.”

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