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Questions on what happens in an IVF lab that were not answered during Know Your Fertility Wellness Seminar on 10 March 2023? Dr Ethiraj Balaji Prasath, Chief Embryologist, Thomson Fertility Centre answers those questions in this article.

1. What are the factors that could have affected implantation of a good grade embryo?

The embryo may have abnormal chromosomes or numbers of chromosome. This is the most known factor to affect implantation even if the embryos are graded good. These embryos may not grow further to result in a pregnancy. They may result in very early miscarriage even if they implant. The lining of uterus (endometrium) may not be receptive to embryos in some cases.

 

2. How to improve implantation after failed fresh and frozen embryos transfer?

A good review of failed attempt must be done by your IVF doctor. Generally, it is believed that the embryo failed to grow in the most of the failed cases where endometrial lining is ideal at the time of embryo transfer. it is difficult to identify chromosome abnormality of embryos unless preimplantation genetic screening was done. However, the causes of failed attempt need to be identified. Your IVF doctor will either modify your treatment protocol based on causes identified. Try to have a healthy lifestyle. Avoid or minimize alcohol intake and smoking. Your IVF doctor may tailor make protocol for you.

 

3. How many eggs that can be frozen during 1st try of IVF? Subsequently, does this considered 2nd cycle if we use the frozen eggs if 1st cycle did not succeed.

Currently eggs can not be frozen in Singapore except for medical reasons. I take it as freezing of embryos. Thenumber of embryos frozen depends on number of mature eggs collected at egg collection and how many of them fertilized. As these numbers vary from patient to patient, it is difficult to say how many embryos can be frozen. On an average of 15 eggs collected, around 5 to 6 embryos may be frozen. Again, this is only an estimate based on average number of eggs collected. The actual number may vary from none to all.

 

4. After embryo transfer, is it ok to go pee immediately?

It is Ok to pee immediately after embryo transfer procedure, as the embryos are transferred to uterus through cervical opening and urine comes from a different opening (Urethra). Therefore, the embryos will not be washed away by urinating.

 

5. How long is the IVF process?

It takes about 10-12 days of injection of ovarian stimulation hormones, followed by a maturation trigger injection and egg collection at 36 hours after trigger injection. Bringing sperm and egg together happens on the same day followed by fertilization next day and embryonic growth for another two to five more days. Embryo transfer to uterus happens after this. A blood test will be done around two weeks after embryo transfer procedure to test whether pregnancy is positive. This whole program lasts for approximately 35 days from the day of first injection to pregnancy test. Another two weeks later, an ultrasound scan will be done if pregnancy test was positive. The duration mentioned above does not include days spent on initial consultation and follow up, counseling, consent signing and screening tests related to your IVF program.

 

6. Can chromosomal abnormalities or defective genes be detected prior to implantation to reduce miscarriages and increase success of pregnancy via IVF? Can embryo be tested before implantation?

Yes. Pre-implantation genetic Screening or pre-implantation genetic testing for Aneuploidy (or PGT-A in short), can detect abnormal chromosome numbers in the embryos before transferring them. However, PGT-A is allowed in research setting in restructured hospitals in Singapore. Defective genes can be detected by pre-implantation genetic testing for monogenic disorders (PGT-M) or translocation disorders in chromosomes (PGT-Sr). These two testing are allowed in Singapore in all IVF Centres.

 

7. How do we know whether IVF or ICSI is more suitable for the couples? What is the cost difference for IVF and ICSI?

Although the term IVF encompasses both IVF and ICSI, IVF generally is the term given to conventional insemination method where, hundreds and thousands of good moving sperm are kept together (inseminated) with eggs in laboratory dish. This method may not be feasible when very low number of sperm available or sperm motility is weak, as such conditions may lead to fertilization failure and thereby no embryos available in conventional insemination. ICSI is applicable in such situations. In the method of ICSI, a single viable sperm is injected into an egg and hence just a few sperm are needed to inject the eggs. For instance, if there are 10 mature eggs available, 10 viable sperm are required to inject 10 eggs. IVF is not feasible and only ICSI to be done when none of the sperm is moving or sperm is obtained from testes (in cases of azoospermia, a condition of no sperm in the ejaculate).

ICSI is the only prescribed method of fertilization when PGT should be done even if the sperm quality is good.

The difference in cost between IVF and ICSI may vary from Centre to Centre. This must be verified with Centre where you seek treatment.

 

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