Fertility Screening & Treatment

Conceiving a child can be challenging for couples facing fertility and reproductive specialist. Fortunately, the continual advancements in medical science provide opportunities to realise the cherished dream of parenthood. In Singapore, there is a diverse range of fertility screening and treatment options.

Fertility screening consists of a spectrum of medical interventions to address challenges in conception and improve the health and reproductive capabilities of both partners. The following are some procedures that may be recommended to help you achieve pregnancy.

Every female is born with a fixed number of eggs in her ovaries and this declines with time. There are typically about 1 – 2 eggs at birth, and this falls to 300, 000 – 500, 000 at the start of puberty. The number continues to decline, with a sharp drop seen after age 35 until it reaches around 1,000 at 51 years old. A woman’s ovarian reserve is the number of remaining eggs in her ovaries. Some women have a lower ovarian reserve compared with others in the same age group.

In conjunction with a drop in egg count, there is also an age-related decline in egg quality. The egg quality refers to whether the woman’s eggs have the normal number of chromosomes (genetic material). inA 30-year-old woman generally has around 75% of her eggs chromosomally normal. By age 35, this drops to approximately 50%. Around age 40, only 25% of eggs are chromosomally normal. Women with poor egg quality struggle to conceive or have a higher chance of miscarriages.

There is no available test to determine the woman’s egg quality. On the other hand, the woman’s egg count can be easily assessed. Ovarian reserve testing is a crucial part of fertility screening because it is an important determinant of the success of reproductive treatment. It can help to predict the woman’s response to ovarian stimulation medications and can help to guide treatment decisions.

Imaging the pelvic organs identifies structural abnormalities in the womb and ovaries that may hinder conception, such as fibroids, polyps and ovarian cysts. For fertility assessment, it is typically performed internally through the vagina (transvaginal ultrasound).

Once the preconception screening identifies potential challenges, various fertility treatment options can be explored.

Ovulation induction involves stimulating the ovaries with medications to assist follicular development and maturation and release of the mature egg (ovulation) for potential fertilization in the tube. The medications are given in the form of oral tablets (Letrozole or Clomiphene) or injections (Gonadotropins). Medications are generally taken at the beginning of the menstrual cycle and the body’s response will subsequently be monitored through ultrasound and/ or blood tests. Your doctor will advise you on the best times for sexual intercourse based on your ovulation stimulation treatment and ultrasound monitoring results (Timed Sexual Intercourse). Alternatively, ovulation can be combined with Intrauterine Insemination (IUI).

Intra- uterine insemination (IUI) is a procedure that entails preparing a sperm sample using a sperm enhancement technique in the laboratory and placing concentrated amount of prepared motile sperm directly into the womb close to the time of ovulation. This brings, the sperm closer to the egg, thereby increasing the amount of sperm available for fertilisation. IUI is a simple, minimally invasive procedure often used in conjunction with ovulation induction to improve conception rates.

In vitro fertilisation (IVF) is an assisted reproductive technique where eggs and sperm are combined in a laboratory to fertilise outside the body. The resultant embryos or fertilised eggs are then transferred into the womb for inplantation. IVF involves the following steps:

• Ovarian stimulation – Medications are injected for 10 – 14 days to stimulate development of a cohort of ovarian follicles. Follicular development is monitored by ultrasound scans and blood tests.
• Egg retrieval – At the appropriate time, the eggs are retrieved by a minor surgical procedure under sedation. A long thin needle is passed through the vagina under ultrasound guidance to collect the eggs.
• Fertilisation – The eggs are combined with sperm in the laboratory to produce embryos. The embryos are cultured in the laboratory for 2 – 5 days.
• Embryo transfer – The embryos are placed into the womb by passing a fine catheter into the womb. The embryo transfer is usually a simple procedure which is less invasive than the egg retrieval. Sedation is not needed in the majority of patients.

Intra-Cytoplasmic Sperm Injection (ICSI) is a laboratory technique in which an individual sperm is directly injected into an egg. It is performed in conjunction with In-Vitro Fertilisation (IVF) to address male infertility or improve fertilisation rates. ICSI enhances the likelihood of successful conception in cases with male factor.

Sperm or egg donation makes it possible for a couple to have a child when one partner is not able to provide his/ her own sperm/ eggs. With appropriate medical and psychological preparation, sperm or egg donation can help to give these couples a chance to build their own family.

About 1% of men have azoospermia or absence of sperm in their ejaculate. This is due to either an obstruction in the reproduction tract or problem with sperm production. Previous vasectomy surgery, a congenital absence of sperm transporting tubes from the testes, y- chromosome, previous testicular infection, Klinefelter syndrome (condition in which the man has an extra x chromosome) and Y chromosome deletion (missing genes in the Y chromosome that are control sperm production) are some condition that can cause azoospermia. Men with azoospermia may still be able to father a child by undergoing surgery to retrieve sperm from the testes. The sperm is then used to fertilise eggs that are retrieved from the female partner through IVF. There are different techniques for surgical sperm retrieval depending on the cause of azoospermia and patient preference.

Egg, sperm, and embryo cryopreservation involves freezing reproductive cells for future use. In this fertility preservation method, eggs, sperm, or embryos are carefully frozen and stored. The process prevents ageing and preserves fertility potential, allowing individuals or couples to use the stored cells for conception later.

Cryopreservation is the process of freezing sperm, egg or embryos to sub-zero temperature. When needed, they are warmed for use in a fertility treatment cycle.

Sperm Cryopreservation

Sperm freezing services are available for men undergoing surgical sperm retrieval, those with poor sperm count who may need a back-up sample stored, or in cases where the man may not be available at the time of egg retrieval. Men with medical conditions that require treatment which may put them at risk of infertility are encouraged to store their samples before undergoing treatment.

Egg Cryopreservation

Generally, there are two main reasons for choosing to undergo egg freezing. The first is medical egg freezing where women with medical conditions choose to freeze their eggs before starting treatment that can put them at risk of infertility.

The second is elective egg freezing, which is an option for women who wish to delay childbearing and combat age- related infertility. In Singapore, women at the age of 21 – 37 yo are allowed to freeze their eggs to preserve fertility, regardless of marital status. Women who undergo elective egg freezing and choose to use their frozen eggs later on may do so only within the confines of marriage.

Embryo Cryopreservation

Embryo freezing or embryo cryopreservation is often used to store good quality excess embryos resulting from an In-Vitro Fertilisation (IVF) treatment cycle.

Unlike men who are able to produce sperm for their whole life from puberty onwards, every woman has a biological clock. Elective egg freezing may be able to help women who are not ready to start a family until they are of a later age. The woman’s eggs are extracted, frozen, and stored for later use. The process involves stimulating the ovaries with hormonal medications to produce multiple mature eggs, which are then retrieved from the ovaries using a needle guided by ultrasound. The eggs are then rapidly cooled to a very low temperature, which halts all biological activity and preserves them for future use.

Blastocyst culture and transfer is an IVF technique where embryos are cultured until they develop into blastocysts before being transferred into the uterus. This extended culture period allows for better embryo selection, enhancing the chances of successful implantation and pregnancy during assisted reproductive treatments.

Before implantation, the embryo must hatch from its shell to attach to the womb. Laser-assisted hatching is an IVF technique in which a laser creates a small opening in the outer layer of an embryo. This technique facilitates the embryo’s hatching process, increasing the likelihood of successful uterine implantation.

Gynaecology surgery can help women to treat gynaecological conditions such as endometriosis, uterine polyps and uterine fibroids to improve their fertility and give them the opportunity to conceive naturally. It can also be performed to optimise the outcome of assisted reproductive treatment.

Endometriosis can be a barrier to conception. It is a condition where tissue akin to the uterus lining grows outside the uterus. Treatment options for endometriosis-related infertility may include the following procedures.

1. Laparoscopic Surgery: Surgical removal of endometrial tissue, cysts, or adhesions can improve fertility by restoring normal pelvic anatomy.
2. In-Vitro Fertilisation (IVF): Assisted reproductive techniques, such as IVF, can be used to bypass endometriosis-related obstacles and enhance the chances of conception.
3. Ovulation Induction: Medications to stimulate ovulation may be prescribed to improve fertility in women with endometriosis.
4. Hormonal Therapy: Birth control pills, gonadotropin-releasing hormone (GnRH) agonists, or progestin therapy are very effective in relieving endometriosis pain but  have a contraceptive effect . GnRH agonist or progestin therapy can help suppress the growth of endometriotic lesions and may be given on a short- term basis to improve outcomes of subsequent assisted reproductive treatment.
5. Fertility Preservation: In severe cases where fertility is compromised, options like egg freezing may be considered before or after surgery.
6. Pain Management: While not directly related to fertility, managing pain associated with endometriosis can enhance the overall well-being of individuals undergoing fertility treatments.

Your fertility and reproductive specialist will plan the ideal treatment approach based on the severity of endometriosis and your fertility goals.

Success Potential: Fertility treatments in Singapore offer varying success rates. The chance of success with any fertility treatment depends on several factors such as the woman’s age, the cause of infertility, whether there are any underlying health conditions etc.

CARE IVF offers personalised consultation to discuss your unique situation. Contact us today to learn more about your fertility options and schedule a consultation.

Emotional and Physical Considerations: Fertility treatments can be physically and emotionally challenging for females due to the pressure to conceive, and the possibility of failed cycles. Additionally, procedures like egg retrieval can be uncomfortable, and hormone medications may come with side effects.

Open communication is crucial to building a supportive team with your partner, and having a healthcare provider like CARE IVF on your journey can also be helpful.

Ethical Concerns: IVF can sometimes lead to multiple births, which can pose health risks for both mother and babies. It is important to balance the desire for children with potential health complications.

Financial Costs: Fertility treatments in Singapore can be expensive, couples should openly discuss costs, and expectations before starting treatment.

At CARE IVF, we understand the financial toll from the cost of IVF or other fertility treatments. Contact us to learn more about the estimated pricing for your treatments and the use of MediSave.

Dr Serene Lim

Dr. Serene Lim is a distinguished Obstetrics and Gynecology specialist with many years of experience. Renowned for her expertise in reproductive health and IVF in Singapore, she has become a leading figure in the country’s fertility landscape, offering comprehensive treatments including ovulation induction, artificial insemination, in-vitro fertilisation, embryo and egg freezing, ovarian tissue freezing as well reproductive surgery.