Did some research on the net over the past few months, decided that i better collate them in ine place. and perhaps having it all written down somewhere means i dont carry all that info in my head.
even when im writing this, i ask myself where exactly do i start? Fertility is soemthing that we all take for granted.When one is single, talking about making babies is certainly not acceptable social behaviour here. Even if one is married, specifics is still a taboo topic.
Ive always thought that getting pregnant should be a done deal. well at least almost everyone i know has kids, and those who dont have, do it out of choice. so fertility..well infertility is not something that i expect to encounter.
that brings me back to where do i start? one of the websites that i found useful was www.kkh.com.sg
it contains most of the basic terms of fertility, some treatments and procedures. its a good place as any to start.
the most common term would be test tube babies, or clinically known as IVF.
What Is IVF?
In-Vitro Fertilisation (IVF) involves putting the eggs and sperms together. By natural selection, the egg will usually allow only one sperm to enter and this usually leads to the fertilisation process in the laboratory. After fertilisation, the embryos are allowed to grow for a short period of time before being placed into the uterus. A successful pregnancy can be confirmed about 2 weeks later
Who Is Suitable For IVF ?
IVF is the only fertility treatment for women with irreparably damaged or blocked fallopian tubes. IVF is also offered when infertile women cannot conceive with simpler methods of treatment for conditions such as endometriosis, ovulatory dysfunction, unexplained infertility, sperm disorders and immunological problems.
What Is ICSI?
Intra-Cytoplasmic Sperm Injection (ICSI) involves injecting a single sperm into each egg to allow fertilisation to occur in the laboratory.
Who Is Suitable For ICSI ?
ICSI is recommended if your husband has poor quality sperms or if you have had difficulties with fertilisation in the past. If this is your first ICSI cycle, it may also be combined with regular IVF.
IVF / ICSI Prgramme
IVF programmes utilise Controlled Ovarian Hyperstimulation which results in more eggs and hence a better chance of pregnancy. Controlled Ovarian Hyperstimulation is carried out with GnRHa (e.g. Lucrin, Buserelin or Nafarelin) and gonadotrophins (e.g. Metrodin HP, Gonal F or Puregon) injections. Various protocols are used. The protocol using GnRHa and gonadotrophins is described here.
1. Controlled Ovarian Hyperstimulation and Monitoring
a.
GnRHa InjectionGnRHa treatment is given daily to prevent a spontaneous ovulation and to ensure that the ovarian follicles grow in synchronous fashion. It usually starts in the 2nd half of your menstrual cycle and continues for about 14 to 20 days. Some patients may need to take this medication for longer periods.
Blood tests and ultrasound scans will be done to ensure that the optimum response is reached. Once this is achieved, you will proceed to the gonadotrophin injections.
b.
Gonadotrophin InjectionGonadotrophin is injected daily into the muscle/subcutaneous tissue of your thigh or buttock to stimulate the growth of the follicles in the ovaries. After several days of gonadotrophin injections, an ultrasound scan is performed to determine the number and size of the growing follicles. You will need additional injections if the follicles have not reached the desired size.
When the follicles have reached the desired size, an injection of HCG is given and GnRHa and gonadotrophin are discontinued. The HCG is required for the final maturation of eggs before the egg collection. The egg collection is scheduled about 36 hours after the HCG injection.
2. Sperm Preparation
During the gonadotrophin injections, your husband need not abstain from sexual intercourse before the egg collection. On the day of the egg collection, your husband needs to produce a fresh masturbated semen sample.
3. Egg Collection (Oocyte Pick Up)
The egg collection is performed at KKIVF. The eggs are collected through a special needle attached to an ultrasound vaginal probe. A mild sedative will be given to you, as only minimal discomfort will be experienced during the procedure.
After the egg collection, you will be observed for a few hours before going home. It is important to understand that not all follicles will necessarily contain an egg and that some of the eggs may not be ripe enough for fertilisation. An overnight fast is required before oocyte pick-up procedures.
Hormonal stimulation induces superovulation; eggs aspirated from the mature follicles transvaginally with ultrasound-guided needle
4A. Fertilization
The sperms are added to the collected eggs in a dish to allow fertilisation to occur by natural selection in the laboratory. A check to confirm that fertilisation has occurred is carried out the following day.
Unfortunately, in about 10% of couples, there is no fertilisation at all. The nurse coordinator will inform the patient of any successful fertilisation.
4B. Intra-Cytoplasmic Sperm Injection
ICSI will be performed on the day of oocyte pick-up. During the procedure, a single sperm will be injected into each egg via a microneedle. On the following day, a check is made to confirm that fertilisation has occurred. The nurse coordinator will inform the patient of this result.
5. Embryo Transfer
A few days after the egg collection, you will need to return to KKIVF to have the embryos placed into your uterus. An overnight fast is recommended before the embryo transfer procedure.
Embryos are re-placed into the uterus using a fine catheter. This is usually painless and takes only a few minutes. Usually, three embryos are transferred. A smaller number may be transferred if there are insufficient embryos or in younger patients. We encourage your husband to sit in during the embryo transfer.
Eggs fertilized in-vitro (IVF) with sperms. Embryo transferred directly into uterus, bypassing tubal occlusion.
You may go home shortly after the embryo transfer. You will be given daily medications (progesterone or HCG) to support the lining of the uterus and to enhance the chances of the embryos implanting.
There is no restriction on activities including sexual intercourse.
6. Freezing of Extra Embryos
A proportion of patients may have excess good quality embryos. These may be frozen for future use. Patients do not need to undergo Controlled Ovarian Hyperstimulation and egg collection again for these future thaw cycles.
7. Pregnancy
You will need to come to KKIVF 17 days after the embryo transfer for a pregnancy test. You should call KKIVF if you are menstruating so that further instructions can be given.
If you are pregnant, subsequent ultrasound scans and blood tests will be arranged to ensure that the pregnancy is proceeding normally.
8. Useful Information
Success rates (KKIVF rates)
Our overall clinical pregnancy rate is about 30-35% per cycle and the take-home-baby rate is about 25-27%. Additional embryos frozen further enhance the pregnancy chances in many of our patients.
Generally, patients who are below 36 years old have a better pregnancy chance. However, your chances of success will depend very much on your own individual circumstances.
Besides IVF and ICSI (these are considered the final steps in the trying to concieve ladder), there are other options to try. like AIH, IUI, SO-IUI.
will post these in another entry - this entry is already far too long.
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