Diagnosing Infertility

AFC Counseling Services

We offer counseling session which allows you to have the opportunity to have an in-depth understanding on the implications of the treatment suggested as well as necessary information, guidance and support.

Counseling aims to help you understand exactly what the treatment will involve and how it might affect you and your family.

  • Counseling allows you:
  • The opportunity to talk freely and openly without being judged.
  • To have in-depth understanding of the factors that may be contributing to your difficulties before and after your pregnancy.

Anything you share with your counselor will be treated as private and confidential.

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YOUR FIRST VISIT

What To Expect
Making an appointment to see a fertility specialist is a big step. We know how difficult this is for most patients considering the many misconceptions associated with fertility issues and to cross that bridge can be one of the most difficult choices to make for some. To that end, having an idea of what happens during a patient’s first consultation might be helpful in aiding you to make an informed decision.

Below is an illustration of what typically happens during a patient’s first consultation:

Pre consultation

  • Be Early
    We strongly encourage patients and their respective partners to arrive at our centre at least 2 hours prior to the scheduled appointment as there are processes to undergo before your consultation with your doctor.
  • Bring along your existing reports (if any)
    If you have any existing relevant reports, it will be useful to bring them along with you on this visit.
  • History Taking
    After registration, you will meet one of our experienced nurses. The nurse will then ask you several questions including – but not limited to – your medical history, your day to day lifestyle, previous reproductive experience and more.Once the nurse has gathered enough information, she will then take you through the basic idea of infertility, the various treatments available and the state of the art technologies that our centre offers to patients.
  • Semen Analysis
    The male patient will then have his sperm examined via a sperm analysis test. This will determine the health and viability of his sperm and the test determines the number, shape and motility of the sperm among others and the report will take about two hours to be generated. Patients are best to abstain from any form of sperm release for about three to 4 days before their respective appointment.

Consultation
You will then meet your doctor for the first time. He will have a discussion with you about your medical history, expectations that you have for your family and you can ask any questions that you have prepared to fully benefit from this visit. The consultation will usually last 20 to 40 minutes or even longer in a complex case.

The female patient will then be examined. Then, an ultrasound will be performed on the lower abdomen to give an overall view of the patient’s pelvic organs. A transvaginal ultrasound is then done to obtain a closer and cleaner view of the patient’s reproductive organs including the uterus and the ovarian.

Sometimes a blood test is required. The doctor will then discuss with you the treatment options appropriate for you, weighing the pros and cons, advantages and disadvantages, benefits and risks, and success rates for each option.

Tips:
Do not be afraid to ask our doctor or staff to repeat information that you do not understand.

Do not be afraid to ask questions, our doctors and staff are more than happy to assist you as we understand that this experience can be overwhelming.

Also, if you have any questions you would like to ask the doctor we recommend you prepare a list before coming so as not to miss asking any important questions you may have.

Before you start your treatment

A combination of drugs is prescribed to stimulate the ovaries to produce eggs. There are several different treatment regimes for ovulation induction, but most common practice at Alpha International Fertility Centre is to  ‘down regulate’ or ‘switch off’ the hormonal signals sent from your brain to your ovaries.

A complete instructions sheet on how to administer all of your drugs will be explained and given. After down regulation is achieved, Gonal-F is self-administered subcutaneously by injection. Gonal-F stimulates the ovaries to produce multiple follicles, the majority of which will contain eggs.

Towards the end of the treatment cycle, you will be asked to self-administer a one-off dose of recombinant choriogonadotrophin alfa in the form of ‘Ovidrel’. This is also called the ‘HCG injection’. This is used to induce the final maturation of the eggs in the follicles and is again administered subcutaneously by self-injection. You will be prescribed a progesterone supplement to help support the embryos after your embryo transfer. This will usually be in the form of a vaginal gel or vaginal pessaries.

Other drugs may be introduced into the treatment depending on individual requirements.

What is “Keyhole Surgery?”

With the advent of technology, major surgery for certain problems can now be done in a manner which is less invasive, less traumatic and requires virtually no hospitalization.

This miraculous surgical method is aptly called keyhole surgery where incisions are literally the size of a keyhole, if not smaller. The surgeon peeps into the human body with sophisticated aid of a camera which can magnify the internal organs and their problems up to 30 times.

Keyhole Surgery, also known as laparoscopic surgery, is a way of gaining access to the pelvis to correct and treat certain conditions without having to open the abdomen.

Laparoscopy (Diagnostic & Therapeutic)

Diagnose and Treat

Laparoscopy used for diagnosis includes investigation for infertility, suspected ectopic pregnancy and pelvic pains, assessment of the Fallopian tubes, confirmation of endometriosis, and examination of cysts and tumours. Doctors say laparoscopy also allows the problem to be rectified immediately. Problem includes endometriosis, cysts, fibroids and ectopic pregnancy. Adhesions of the ovaries, Fallopian tubes, and intestine can be divided; blocked Fallopian tubes can be relieved; and tubes can be ligated. According to Dato’ Dr. Colin Lee who specializes in fertility and is an experienced laparoscopic surgeon, laparoscopy can also be used to help patients undergoing Assisted Reproductive Techniques like GIFT and IVF e.g to relocate the ovaries and or free the Fallopian tubes.

Quick recovery

Laparoscopic surgical treatment of endometriosis can also eliminate the need for six months’ course of drugs. The drugs to treat endometriosis can cost from RM 1,650 to RM 5,000. Moreover one of these commonly used drugs can cause weight gain, acne, skin pigmentation and even voice change. In addition, six months of precious time is lost as during this time, the patient cannot conceive.

Hysteroscopic Surgery

What is Hysteroscopic Surgery?

A hysteroscopy is a way for your doctor to look at the lining of your uterus. A thin viewing tool called a hysteroscope is used during the surgery. The tip of the hysteroscope is put into your vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera attached to it to allow your doctor to view your lining (endometrium) on a video screen.

Why need Hysteroscopic Surgery?

A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to see if there is a problem in your uterus that is preventing you from becoming pregnant (infertility). On top of that, a hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps.

Another surgery, called a laparoscopy, may also be done at the same time as a hysteroscopy if infertility is a problem.

Treatment Options

Intra-Uterine Insemination (IUI)_bg

What is IUI?

Intrauterine insemination (IUI) is a procedure that involves placing of sperm inside a woman’s uterus to facilitate fertilisation. It usually only requires the insertion of a speculum and then the cannula. This fertility treatment does not involve the manipulation of a woman’s eggs. The goal of IUI is to increas the number of sperm that reach the fallopian tubes and subsequently increases the chances of fertilisation.

Timing of IUI

Timing the IUI is very important – it must be done when the egg is in the fallopian tube.

During an intrauterine insemination, the sperm are released into the uterus. The sperm do not remain viable for a long period of time. Consequently, the sperm must be inseminated close to the time of ovulation.

One of the methods to time an IUI is with an ovulation predictor kit. The kit measures a woman’s LH surge. The surge peaks about 12-24 hours before the egg is released. A woman will test her urine in the morning. If the test is positive, she should have the intrauterine insemination the next day.

Another method for timing an insemination is to artificially trigger ovulation. A medication called hCG (human chorionic gonadotropin) can be injected when ultrasound determines that the egg or eggs developing in her ovaries are mature enough to be released. Ideally, an IUI is performed about 36 hours post hCG injection. The egg is only viable for a maximum of 24 hours after it is released.

Success rates for IUI

The success rate of IUI depends on several factors.

  • Age of the female, ovarian function, fallopian tube blockage, pelvic adhesions and other additional causes of infertility.
  • Amount of motile sperm that are inserted into the uterus. Several studies have indicated that if a man has a lower number of progressively motile sperm after sperm wash, the chances for pregnancy is lowered.
  • High number of sperm with abnormal morphology will also lower the chances for pregnancy.
  • The timing of IUI.
Intra-Uterine Insemination (IUI)2

How is IUI performed?

It is not necessary to abstain from intercourse before doing an IUI. However, our recommendation is to have intercourse on the day that an ovulation kit turns positive or on the day that the hCG trigger injection is given. The IUI is then timed as indicated above.

The semen sample is collected through ejaculation into a sterile container. Ejaculate is usually collected at the clinic in a private setting. In situations where the male partner fails or unable to produce the semen in the clinic, he is allowed to produce it at home and the specimen must arrive at the clinic within half an hour. It is also possible to use a specialized nontoxic collection condom. Please note that ordinary condoms cannot be used for IUI treatment.

We will schedule the male partner for semen collection approximately 1-2 hour before the IUI treatment. This allows time for the laboratory to wash the sperm prior to the treatment. When a man ejaculates, the fluid that is emitted is composed of two main components: seminal fluid and sperm. Seminal fluid contains many types of hormones and chemicals. One group of chemicals in particular can cause problems and are known as prostaglandins.

Sperm processing/ washing allows the doctor to concentrate the actively motile sperms into a small volume of culture fluid. Sperm do not remain alive in the culture medium for very long unless they are maintained at the right conditions – hence a prompt insemination after sperm processing is important.

Following the wash, it is time for the insemination procedure, which only takes a few minutes and does not cause much, if any, discomfort for the female. The doctor will insert a small catheter into the uterine cavity through the cervix and inject sperm directly into the uterus. The patient is able to resume normal activity following the IUI procedure. If pregnancy does not result from the initial IUI, the procedure may be repeated during the following cycles.

Difficult IUI Procedures

Sometimes, it will be difficult to pass the IUI catheter all the way into the uterus. Hence, the physician can either use a catheter which contains a flexible wire inside or a tenaculum can be used. This wire allows the physician to bend the catheter into a shape that will follow the path in the cervix more easily. It also gives a little bit more rigidity to the catheter which is normally very soft and floppy. Often this is all that will be needed to allow the IUI catheter to be inserted into the uterus.
Apart from that a tenaculum can be used to grab a hold of the cervix. The physician performing the insemination can tug on the cervix and thus straighten the angle between the cervix and uterus. This will also make it easier to pass the IUI catheter through. Having the patient fill her bladder before the procedure can also help straighten the angle.
Finally, ultrasound can be used to help the physician guide the catheter into the uterine cavity.
Usually, an IUI does not cause much discomfort for a woman. There can be some cramping afterward, but what is felt is probably due to ovulation rather than from the IUI itself.

In-Vitro Fertilisation (IVF)_bg

What is In-Vitro Fertilisation (IVF)?

In-vitro fertilisation is commonly referred to as IVF or “test tube baby”. It is a process of fertilisation occurred outside the body which involves manually combining an egg and sperm in a laboratory dish. An embryo will be formed if the fertilisation is successful. Then, followed by an embryo transfer into the mother’s womb, a procedure which involves physically placing the embryo in the uterus. The remaining excess of good quality embryos may be frozen and cryogenically stored for future use in a procedure called – frozen embryo transfer.

How it works?

There are 5 basic steps in IVF:

There are 5 basic steps in IVF

What is PIEZO-ICSI

PIEZO-ICSI is an advanced ICSI technique which minimizes damage to the egg and increases egg fertilisation rate compared to conventional ICSI. To date, studies demonstrated that PIEZO-ICSI has the lowest egg degeneration rate (1%) and the highest fertilisation rate (89%).

Compared to conventional ICSI, PIEZO-ICSI uses a finer injection tip and the injection tip is blunt rather than sharp, hence the possibility of damaging the egg is reduced.

Is it safe?

Study demonstrated that PIEZO-ICSI does not affect oocyte cytoskeleton and has no effect on oocyte chromosomal segregation during cellular division. It was also demonstrated that the aneuploidy rate of blastocysts derived from PIEZO-ICSI was comparable to conventional ICSI.

PIEZO-ICSI

With the latest revolutionary technologies and skills, Alpha Fertility Centre achieved high blastulation rate* of 72.5%** and has successfully established a Blastocyst Transfer Program with IVF pregnancy rate of 70-80%. In this blastocyst transfer program, fewer embryos are transferred, and hence reducing multiple pregnancy risks. With this achievement, blastocyst transfer is now done routinely in AFC.

What is Blastocyst transfer?

Blastocyst is an embryo that has developed for five to six days after fertilisation and has developed 2 distinct cell types, the trophectoderm and inner cell mass and a cell cavity filled with fluid (blastocoel cavity). Trophectoderm will later develop into placenta and inner cell mass will later become the fetus. With blastocyst transfer, embryos are cultured in the laboratory to the blastocyst stage before they are transferred to the womb.

What are the chances of having a baby with blastocyst transfer?

Please click here for the success rates of Blastocyst Transfer Program at AFC.

Blastocyst

What is the disadvantage of blastocyst transfer?

Not all embryos will develop to blastocysts. Therefore, there is a possibility of having no embryo transfer if no embryos develop to blastocyst. Depending on how many embryos you have after fertilisation, your consultant will advise you to consider a Day 2 or Day 3 embryo transfer than risk having no blastocyst transfer on Day 5 or Day 6.  On average, patients with six or more high quality embryos on Day 3 are the best candidates for Blastocyst Transfer Program because there is a higher chance of more embryos develop to blastocysts.

What is the advantage of blastocyst transfer?

Not all embryos have the potential to develop into a blastocyst, either in the womb or in the laboratory. Therefore, blastocyst culture is a valuable tool to facilitate the selection of the best quality embryos that most likely give rise to a pregnancy. In a typical non-blastocyst in vitro fertilization (IVF) cycle, embryos are transferred into the womb three days later. Due to the fact that it is difficult to predict on Day 3 which embryos are more likely to produce a pregnancy, three or more embryos are frequently transferred in hopes that at least one will result in a live birth. With our latest revolutionary techniques, we can now culture the embryos in the laboratory till the blastocyst stage. Because blastocysts are more advanced and more likely to implant, one to two blastocyst(s) are transferred. This reduces the risk of multiple pregnancy such as triplets. However, there is still a high likelihood of a twin pregnancy being established if two blastocysts are transferred.

Is blastocyst transfer for me?

At AFC, you will be offered to take part in the Blastocyst Transfer Program if,

  1. You have produced good quality embryos in a previous IVF cycle but they failed to implant in the womb.
  2. You are concerned about risk of multiple pregnancy and wish to have only one embryo transferred.
  3. You have six or more good quality embryos on Day 3.
  4. You have explored all other treatment options and want to access the developmental potential of your embryos.
  5. You are young with a good prognosis for pregnancy from IVF.

* Blastulation rate = The percentage of fertilized embryos that develop to the blastocyst on day 5 or day 6.

**Lee, CSS.; Lim YX; Low SY. High Blastulation Rate and Blastocyst Utilisation Rate at Alpha Fertility Centre. Presented at the 23rd Congress of the Obstetrical & Gynaecological Society of Malaysia, 5-8 June 2014, Malaysia

Egg Donation_bg

When female infertility is attributed to insufficient ovarian response, leading to poor egg production (e.g. a woman who goes through IVF but her ovaries fail to produce eggs), or when eggs are produced but fail to fertilize properly, a possible solution is egg donation.

Who needs egg donation?

Egg donation is a possible solution for women:

  • Who cannot produce eggs due to menopause or have been diagnosed with premature ovarian failure (POF) – also referred to as premature menopause or early menopause
  • Above age 37 who have been repeatedly unsuccessful with IVF, particularly if it is known that the infertility is not male factor
  • Who carry a genetic disorder they do not wish to pass on to their child
  • Who have had multiple unexplained miscarriages

About egg donors

At AFC, all egg donors are anonymous. Eggs from a variety of young, pretty and intelligent donors are available at AFC’s Egg Bank.

Sperm Donation

When male sperm analysis yields very poor results, multiple tests and treatments are considered. Unfortunately, in some cases, even with attempts to aspirate sperm directly from the testicles, treatment is not always successful..

If treatment has not been successful, you may decide to use donor sperm. Fortunately, sperm donation is a relatively simple procedure (physically, not necessarily emotionally) and in most places, there are ample sperm donors.

At AFC, all sperm donors are anonymous.

What is Laparoscopic Surgery?

A laparoscopic procedure basically involves general aneasthesia and two to four puncture holes of about half to one centimeter at different sites on the abdomen depending on the problem. The abdominal cavity will then be instilled with carbon dioxide to allow the surgeon to view the probe on screen. The laparoscope is rather like a narrow telescope about the width of a pen. If required, further instruments may be inserted through small punctures near the pubis hairline.

When the procedure is completed and the instruments are removed, the carbon dioxide gas is released and a stitch may be put in each of the small incisions. When these stitches heal, they can be as small as half a centimeter, with a scar that resembles a long pimple mark.

The patient will be allowed to go home a few hours after the operation. The following day, she may go about her normal routine and full activity including games and exercise is allowed a week later. She may assume intercourse two weeks after surgery and try for a baby if fertility had been her problem.

Laparoscopic Surgery

Laparoscopic Surgery

According to Dato’ Dr. Colin, patients may experience the following symptoms which may last a day to two. However, these post-surgical symptoms are minor and usually resolve themselves. The symptoms are:

  • Mild nausea and muscle pain. An ache in the shoulder area and sometimes under the ribcage is caused by a small amount of gas or fluid remaining under diaphragm. The pain usually disappears within 24 hours as the gas is absorbed.
  • Pain at the site of incisions, usually minor.
  • Cramps similar to menstrual cramps.
  • Mild bleeding or vaginal discharge for a few days.

No surgery is without risk, but the risk associated with laparoscopy is very small. Complications such as bleeding within the abdomen or damage to the bowel or adjacent organs can occur although rarely so. Anaesthesia itself involves a small degree of risk. Laparoscopy can also be applied to a majority of patients no matter how many times they have previously undergone major surgery.

Ovulation Induction_bg

Drugs required for IVF treatment

After you have been accepted for an IVF treatment at Alpha International Fertility Centre, you will be given a prescription of drugs and an instruction sheet. Our physician will assist you to plan your treatment program and you will be advised of the approximate dates that you are required to come to the Clinic. Hence, you and your partner can make the necessary arrangements.

Before you start your treatment

A combination of drugs is prescribed to stimulate the ovaries to produce eggs. There are several different treatment regimes for ovulation induction, but most common practice at Alpha International Fertility Centre is to  ‘down regulate’ or ‘switch off’ the hormonal signals sent from your brain to your ovaries.

A complete instructions sheet on how to administer all of your drugs will be explained and given. After down regulation is achieved, Gonal-F is self-administered subcutaneously by injection. Gonal-F stimulates the ovaries to produce multiple follicles, the majority of which will contain eggs.

Towards the end of the treatment cycle, you will be asked to self-administer a one-off dose of recombinant choriogonadotrophin alfa in the form of ‘Ovidrel’. This is also called the ‘HCG injection’. This is used to induce the final maturation of the eggs in the follicles and is again administered subcutaneously by self-injection. You will be prescribed a progesterone supplement to help support the embryos after your embryo transfer. This will usually be in the form of a vaginal gel or vaginal pessaries.

Other drugs may be introduced into the treatment depending on individual requirements.

PGD / PGS with ION Torrent NGS

MicroSort® X & Y Sperm Sorting

Sperm Sorting_bg

What is MicroSort®?

MicroSort® is a scientifically proven sperm sorting technology which separates the sperm into X and Y. Semen samples usually contain 50% of sperm carrying the Y chromosome that will produce a boy and a 50% of sperm carrying X chromosome that will produce a girl.

What is the MicroSort® technology based on?

MicroSort® is a method based on the difference in the amount of genetic material in the sperm, where the X chromosome has approximately 2.8% more DNA material than the Y chromosome.

How can the sorted sperm be used?

The sorted sperm can be used with a wide variety of assisted reproductive techniques, such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and preimplantation genetic diagnosis (PGD-MaCGH) or NGS.

What tests are required and performed before scheduling the sort?

There are two different tests required, at least a few days before the day of the procedure to ensure that you are a candidate for the procedure.

  • Semen Analysis: It is very important that semen analysis is done in advance to determine if the specimen will have enough sperm cells for a sort. Semen analysis is done after 3-4 days of ejaculatory abstinence, to determine the amount of sperm, motility and progression.
  • Blood Test: including HIV-1 and 2 antibodies, Hepatitis B surface antigen, Hepatitis C Antibody and Syphilis.

For more information, please visit www.microsort.com

Time Lapse Embryoscopy

Time Lapse Embryo Monitoring System_bg

A new approach to embryo culture using an advanced time lapse embryo imaging system to identify the BEST embryos for transfer enabling even higher chances of pregnancy.

How does Time Lapse work?

The selection of embryos for transfer is crucial to the success of IVF. Time Lapse Embryo Monitoring System has the capability to visualize the progress of embryo development continuously from Day 0 to Day 5 or Day 6 of the development with a photograph taken every 5 minutes in the incubator allowing embryo development to be assessed and observed as a time lapse movie. This video enables us to identify the best embryos with the highest chances of creating a successful pregnancy.

Failure in selecting the most viable embryo in a given fertility treatment cycle limits the success rates of current procedures.

Currently, the standard selection of embryo involves microscopic assessment at a specific moment in time once outside the incubator. However, because embryo development is a dynamic process, critical stages between morphological observations can be missed. The shortcomings of current procedures in standard embryo selection can now be overcome using time lapse embryo monitoring system. Another added advantage of this imaging system is we can view the embryos continuously without the need to remove them from the warm and stable conditions of the incubator, hence embryos develop in undisturbed culture under strict environmental control.

timelapse_table

Other Services

Preserving Your Fertility

eggbanking_bg

AFC’s Egg Bank offers women the opportunity to freeze their own eggs. Egg banking is made possible through the use of the most effective and safest freezing method known as Cryotec Method (Japan). This tremendous breakthrough allows AFC to attain close to 100% post-thaw survival rate for eggs and hence, improving your chances of conception with your own eggs at a more advanced reproductive age. We are proud to achieve the WORLD’s 1st successful pregnancy following the use of freeze-thawed sperm, freeze-thawed eggs, and freeze-thawed embryos (10th Royal College of O&G International Scientific Congress, June 2012). (Click here for the full article).

What is Egg Freezing?

Egg freezing, also known as oocyte cryopreservation is a procedure in which the eggs from a woman are retrieved, frozen and stored for future use. The frozen eggs can later be thawed, fertilized and transferred into the uterus when desired.

The Technology

Vitrification is the latest method for freezing eggs and the survival rates using vitrification are much higher compared to previous freezing methods like slow freezing.  With recent major improvement in the vitrification solutions, Cryotec method has been developed with certain distinct advantages over all other existing methods of vitrification. Now, AFC is able to attain close to 100% post-thaw survival for eggs.

How do you have your eggs frozen?

Before you are eligible for egg freezing program, you must first be screened for evidence of transmissible diseases. Then you will be given 8-10 days of injections to stimulate your ovaries to produce multiple eggs for collection via simple procedure using thin needle. Once the eggs are collected, they are cultured in the incubators for 2-4 hours to encourage egg maturation. The eggs are then vitrified and stored until ready to be thawed.

Who needs Egg Freezing?

You may wish to consider egg freezing if

  • you wish to delay childbearing;
    you are single and haven’t met your Mr. Right;you have medical conditions such as
  • cancer requiring chemotherapy or radiotherapy.

Storing frozen eggs gives women the opportunity to preserve their fertility until they are ready to start a family.

Why need egg freezing?

A woman’s fertility is largely dependent on the quality of her eggs. It is no secret that fertility declines with age and unfortunately, there is no medicine or technology that can turn poor quality eggs into good quality eggs. Diminished egg quality significantly impacts one’s ability to conceive. Advancement in medical technology can help women to preserve their eggs while they are still of good quality.  We recommend you to freeze your eggs in your 20′s or by the age of 35. However, there is no age limit as long there are eggs retrievable from your ovaries.

One Incubator, One Patient_bg

At AFC, we dedicate one incubator for each patient during IVF treatment.
Before transfer back to the mother’s womb, your precious little darlings
(your embryos!) will have their own dedicated incubator for optimal
development from fertilization to blastocyst culturing process.

What is the significance of having an incubator dedicated only to your
embryos? This is because embryos are extremely sensitive to changes in
temperature, pH value, humidity and gas mixture concentrations, while
the ooptimum development of embryos depend greatly on these conditions.
For example, each time when the incubator door is opened, these
condition in the incubator will be affected. Hence, it requires time to
regenerate energy to recover the temperature inside the incubator.

In IVF process, if an incubator contain more than one patient’s embryos,
the incubator’s door will need to be open several times for
embryologists to do examination. By doing so, it would affect the other
patient’s embryos in the same incubator.

By dedicating oonly 1 incubator for your embryos, your little darlings
are protected from unnecessary distress. And due to the high cost of
incubators, usually other IVF laboratories will be sharing the
incubators to accommodate several patient’s embryos at one time. While
at AFC, we have heavily invested in numerous incubators to ensure that
each patient can get their own dedicated incubator.

The “One Incubator, One Patient” system at AFC thus minimizes harm, and
promotes the most optimum conditions for the development of embryos,
resulting in healthtier embryos and in return promotes higher pregnancy
rates. At the same time, ”One Incubator, One Patient” system
eliminates the chances of mixing up with other patient’s embryos.

Gamete Intrafallopian Transfer (GIFT)_bg

What is Gamete Intrafallopian Transfer (GIFT)?

GIFT is an assisted reproductive procedure which involves removing a woman’s eggs, mixing them with sperm and immediately placing them into a fallopian tube. One of the main difference between this procedure and the in vitro fertilization (IVF) procedure is that the fertilization process takes place inside the fallopian tube (through laparoscopic procedure) rather than in a laboratory. However, healthy tubes are necessary for GIFT to work.

GIFT is an assisted reproductive procedure that is a possible solution for any infertility problem except the following:

  • Rubal blockage
  • Significant tubal damage
  • An anatomic problem with the uterus, such as severe intrauterine adhesions
  • Male factor infertility

Our doctor in AFC has produced the world’s first GIFT baby for women with Mullerian Dysgenesis (a woman born without vagina).

In-Vitro Maturation (IVM)_bg

Conventional Assisted Reproduction Technology (ART) involves injections of high doses of follicular stimulating hormones. This may lead to ovarian hyperstimulation syndrome (OHSS) for patients with polycystic ovary (PCO) or polycystic ovarian syndrome (PCOS). In vitro maturation (IVM) of oocytes is an innovative ART applicable for selected couples with male factor, tubal factor, unexplained infertility and PCO/PCOS. Immature Germinal Vesicle (GV) stage oocytes are retrieved during the woman’s natural cycle without or minimal preceding hormone treatment. Oocyte maturation to Metaphase II stage oocytes takes place in vitro using the specially designed IVM culture medium. Standard ICSI or IVF protocols are used after maturation has been obtained or after subsequent insemination and fertilization.

Intra-Cytoplasmic Sperm Injection (ICSI)_bg

What is ICSI?

ICSI was developed in 1991 and the first baby conceived following ICSI technique was born in 1992.

ICSI is a technique that has been developed to assist fertilisation when sperm quality is particularly poor. Intra-cytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg in order to fertilise it. The fertilised egg (embryo) is then transferred to the woman’s womb. The procedure for ICSI is similar to that of IVF, but instead of fertilisation taking place in a dish, the embryologist selects sperm from the sample and a single sperm is injected directly into each egg. The injected eggs are checked the day after to see if fertilisation has occurred.

ICSI is a time-consuming procedure. It requires skill and high technology equipment. The whole process is done under microscopic visualization and manipulation. Before the sperm is injected into the egg, it is immobilised. The egg is held in place and the sperm is injected into the egg by puncturing a tiny hole in the zonapellucida of the egg using a micro injection needle. The needle will go through this hole and deliver the sperm in the cytoplasm. The tiny hole will seal by itself and recover.

When is ICSI used?

ICSI is often recommended if:

  • The patient has a very low sperm count.
  • The patient has a very low sperm motility (movement).
  • The patient has poor sperm morphology (abnormally shaped).
  • The patient’s sperm has been collected from the testicles or epididymis.
  • There are high levels of antibodies in the semen.
  • During previous IVF attempt, there was either failure of fertilisation or an unexpectedly low fertilisation rate.
  • The patient has had problems obtaining an erection and ejaculating.
  • The patient sperm count is zero and donor insemination is not wanted.

What are the disadvantages of ICSI?

  • Not all eggs collected may be of suitable quality or mature enough to undergo the injection procedure.
  • Due to the nature of the procedure, on average, 10% of the eggs will be damaged and therefore cannot fertilise.
  • It is possible that none of the eggs will be suitable for ICSI.

What is Laser Assisted Hatching?

A human embryo has a soft outer ‘shell’ called the zona pellucida (or zona for short). When an embryo is five or six days old and is at the stage known as a blastocyst, it needs to escape or hatch out of the zona. Once the embryo has hatched out of the zona, it is able to implant into the lining of the womb. If the embryo does not hatch a pregnancy cannot occur.

Laser Assisted Hatching

How it works?

Laser Assisted Hatchin-how to

Laser assisted hatching is a technique whereby a small artificial hole is made in the zona of an embryo using a laser system. It is thought that the embryo can then hatch more easily through this hole and hopefully increases the chance of the embryo implanting.

Laser assisted hatching is performed just before the embryo transfer procedure and can be performed on embryos at the early cleavage stages (that is two or three days after the egg collection) and at the blastocyst stage (five or six days after the egg collection).

What is 4D Ultrasound Scanning?

In AFC, we always pamper our patients and ensure them to receive the best services they deserved. With the high end 3D+4D and high resolution ultrasound machine, the fertility and antenatal assessments become a joyful experience for both clinicians and patients.

For fertility patients, clear images are crucial for an accurate diagnosis and thus play its part to contribute on a correct fertility planning and a better treatment outcome. Furthermore, with the latest automated ultrasound technology, the time taken during follicular assessment is shorten and also minimises the discomfort during vaginal scans.

For antenatal patients, 4D Ultrasound Scanning allows us to produce live action images of the unborn child.

4d

Since July 2013, AFC started using Cryotec Method which achieves 100% survival rate for embryos and blastocysts. This had led us to achieve clinical pregnancy rates (CPR) comparable to fresh IVF cycles (CPR>60%).

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With new advancement in embryo cryopreservation, AFC is helping more and more couples to achieve success in pregnancy. Embryos that are not used during your fresh IVF cycle can be frozen and thawed at a later date and transferred back to the womb after suitable preparation of the lining of the womb. Transfer of these embryos may represent a second or even third chance to achieve a pregnancy without having to undergo the full course of injections to stimulate the ovaries and the egg recovery procedure. It costs less than starting a new IVF cycle and often with minimal medications.
(Click here for the success rates of Frozen-thawed Cycles at AFC).

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