Posted on January 21 2022
For some, having a child may require some medical aid, such as IVF procedures.
If you’ve blocked tubes, or endometriosis with small cysts, you may want to consider in-vitro fertilisation (IVF) to conceive a child. Here’s what you need to know about doing the procedure in Singapore.
What is IVF?
It's a procedure where an embryologist fertilises a woman's eggs and husband's sperm in a laboratory and the fertilised embryo is placed back into the womb. Prior to this, you’ll need to take hormonal injections to produce more eggs and thicken your uterine lining. Other instances where you might consider IVF are if you can’t ovulate or get pregnant with ovulation induction, have unexplained fertility or require donor egg or sperm cycles.
Public or Private
Couples may withdraw $6,000, $5,000 and $4,000 from Medisave for the first, second and third Assisted Conception Procedure treatment cycles respectively, and a total of $15,000. Get up to 75 per cent in government co-funding for treatments at KK Women and Children’s Hospital, National University Hospital and Singapore General Hospital,. This covers Assisted Reproduction Technology treatment, including IVF, for up to three fresh and three frozen cycles. Women aged 40 and above who have already attempted assisted reproduction or intra-uterine insemination procedures before age 40 can also receive this co-funding. At least one spouse must be a Singaporean citizen to qualify for this co-funding. Costs for one IVF cycle range from $12,000 to $20,000 in private hospitals, and $11,000 to $15,000 in public hospitals.
According to the Ministry of Health, the success rates are 26.6 per cent for women below 30, and 24.6 per cent for those 30 to 34. This drops to 17.1 per cent for those 35 to 49 and 6.7 per cent for women 40 and above. The live birth rate of success varies across hospitals. For example, Mount Elizabeth had a live birth rate of about 42 per cent for women 30 to 44 years old. Meanwhile, KKIVF’s single blastocyst transfer for suitable patients has a pregnancy rate of 43 per cent. However, these statistics serve only as a rough reference and may not reflect your personal chances of success.
You can likely start your treatment within a month or two at private clinics. For public hospitals, however, the wait can take months starting from the day you get a referral from the polyclinic.
For those in public hospitals under the subsidised route, you may see different doctors throughout your IVF journey. Going the private route allows you to choose your doctor, though the waiting time may not be significantly shorter in public hospitals. Some of the most popular IVF doctors are Dr Tan Heng Hao at Alpha IVF Centre, Dr Roland Chieng at Virtus Fertility Centre and Dr Sadhana Naharajah at KKH. Choose a doctor you fully trust and feel comfortable with to guide you through the process.
The IVF process will require several hormonal injections for about two weeks to thicken the uterine lining and stimulate the follicles to produce more eggs.
The IVF clinic will first do the necessary blood tests and blood work, and test your husband’s sperm. Results of the blood work can assess the level of follicle-stimulating hormone in your system, to determine the quality and number of eggs you may have. After counselling, you should be able to start treatment in your next cycle. Depending on your situation, you and/or your spouse may have to take oral medication or injections. You’ll also have to return to the clinic every few days to monitor the growth of your follicles.
Once they’ve grown sufficiently, you’ll administer the trigger shot to prime the eggs for fertilisation. Next, the gynaecologist extracts your eggs with an ultrasound probe while you’re sedated. You can go home after two to three hours of monitoring. The embryologist then fertilises your eggs and your husband’s sperm sample.
Depending on your body and its response to the hormonal injections, your doctor will advise you to do either a fresh or frozen transfer. During the embryo transfer, the doctor will insert a speculum into the vagina to hold the vaginal walls open. The doctor then passes a catheter from the cervix into the womb and implants the embryo inside the womb. Usually, you might feel a bit of discomfort from the speculum, and because you’ll have a full bladder for the ultrasound. Uncommon risks include bleeding, infections, perforation of the uterine wall, and injury to nearby organs. Out of all these risks, perhaps the most common is the embryo failing to implant into the uterus.
If your doctor recommends a frozen transfer, the embryologist vitrifies your eggs, removing the cells’ water molecules. After replacing the water molecules with cryoprotectant, it’s plunged into liquid nitrogen. On the day of your embryo transfer, the embryos will be thawed and transferred to your uterus. After the fresh and frozen transfers, you’ll need to wait about two weeks more before returning for your blood test. This will detect your human chorionic gonadotropin or hCG levels to determine if you’re pregnant.
In Singapore, would-be parents who might pass on inheritable diseases to their offspring can undergo pre-implantation genetic diagnosis. Previously only available under a pilot programme, patients requiring these services now can access a larger range of providers. These services are only available for couples who might pass on genetic disorders like harlequin ichthyosis, beta thalassemia and Huntington’s disease. Such testing for IVF allows the embryologists to select embryos unaffected by these conditions. A biopsy of the blastocysts can also test for chromosomal anomalies and genetic mutations, reducing the chances of a misdiagnosis.
Excess embryos will be frozen and stored for up to 10 years from the date of fertilisation. You may choose to extend the storage for another decade, donate these embryos to another couple or have them disposed of.
Women 40 and above
Currently, two of the six co-funded ART cycles can be carried out after age 40. Your doctors should also assess if you can carry a pregnancy to term. However, the chances of conceiving through IVF drops to single digits, but you can use your remaining frozen embryos to try to conceive another child.
Conceiving via Donors
If you have problems with your eggs or sperm you may want to consider egg or sperm donation. In Singapore, you cannot have a transactional arrangement for sperm, eggs and embryos. The law currently also states that a child born from a donated egg or sperm belongs to the child of the birth mother - donors have no legal or financial obligation to the child.
Sperm Donors and Male Fertility
In instances where the husband has azoospermia, poor sperm quality or inheritable diseases, for example, couples may require a sperm donor. Singapore’s guidelines for sperm donors limit them to establishing only three families and they have to clear the mandatory health screening process. As only a few donate their sperm in Singapore, try Mount Elizabeth and Virtus’ IVF clinics, which use reputable US sperm banks. Otherwise, a urologist can retrieve sperm from the husband’s testicles, or try intracytoplasmic sperm injection or ICSI. The embryologist injects a sperm into a harvested egg, with fertilisation rates up to 70 per cent. Some eggs may not survive the injection process however, and some may not be suitable for ICSI. Up to 3 per cent of babies born after ICSI have been reported to have chromosomal abnormalities.
Finding Local Egg and Embryo Donors
For egg donors, a good option might be friends or family unrelated to the husband. She will also have to get daily hormone injections to stimulate her ovaries for about two weeks, and then retrieve her eggs. Women using eggs from donors aged between 20 to 30 have about a 30 to 50 per cent chance of getting pregnant. Otherwise, try using leftover frozen embryos from other IVF patients who have already completed their families. Whichever option you choose, it’s best to be honest with your child on her origins as early as possible.
Health Risks for IVF
Women going for IVF have a 12 to 18 per cent chance of having multiple foetuses.
There are a number of low risks associated with the IVF treatment cycle. For example, you may have too many follicles developing (3 to 8 per cent), putting you at risk for Ovarian Hyperstimulation Syndrome (OHSS), about a 1 per cent risk. With Ovarian Hyperstimulation Syndrome, patients may have kidney failure, pulmonary embolism, and deep vein thrombosis. To avoid this, the embryos are frozen and then transferred later after the risk of OHSS has resolved. Other risks include insufficient or no follicular development, no eggs are retrieved, have poor or no fertilisation or poor embryo development. In extremely rare cases, the doctor may have difficulty or be unsuccessful in transferring embryos.
Complications Associated with Hormone Stimulation
One of the risks include multiple gestational pregnancy, about 12 to 18 per cent depending on the number of embryos transferred. All the transferred embryos may successfully implant, or an embryo might split into two. This poses a few risks to the foetuses and mother, including risk of miscarriage, and preterm labour, for example. Some patients may also have adverse reactions to the medications taken.
Older patients may have a harder time getting pregnant, and they may also be more susceptible to developing complications. For women above 40 years old, they might get hypertension, diabetes or need a caesarean section delivery. Women above 35 years old may also have an increase in foetal genetic anomalies. There’s also a risk of ectopic pregnancy (about 2 to 11 per cent), a higher rate of miscarriage (12 to 40 per cent) and fetal abnormality (5.5 per cent).