As part of the preliminary assessment, our specialists will require hormone tests to be done in order to establish a baseline as well as monitor hormone levels during the course of fertility treatments. These tests simply require getting a blood sample.
The hormone levels that need to be determined include that of Estrogen, Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Thyroid Stimulating Hormone (TSH), Progesterone, and Prolactin.
Ovarian Reserve Test
Although a woman is born with a lifetime supply of eggs in her ovaries, with age, these eggs gradually decrease in both quantity and quality.
The Ovarian Reserve Test is performed to determine how much eggs a woman has left. This is done by measuring the levels of Anti-Mullerian Hormone (AMH), a hormone which is being secreted by follicular cells. However, this test does not determine the quality of the eggs.
This test is done if a woman has been trying to have a baby for six months or more, and would want to know if their store of eggs is appropriate to their age. It is also important to perform this test prior to fertility treatments since low AMH levels is an indication that IVF may not work. Other indications for Ovarian Reserve Test include women who have undergone chemotherapy or ovarian surgery and those who want to have a child at a later age.
Post Coital Tests
As the term implies, these are tests that are done after a couple has sexual intercourse, usually within 24 hours after they have sex.
In this test, a woman is advised to monitor the onset of ovulation through the use of a home ovulation predictor kit. On the day that the kit registers positive for ovulation, the couple must have intercourse. Within 24 hours, the woman goes to our specialist, who then inspects her cervix with a speculum. Using a syringe, cervical mucus is aspirated and a sample placed on a microscope slide. Our specialist will then count the number of moving sperm that is present in the sample.
If there are more dead or slow moving sperm, this is indicative of an antigen-antibody reaction. The woman’s body has recognized the sperm as a harmful pathogen and has released antibodies to kill them. In these cases of “hostile mucus”, the appropriate treatment will be prescribed.
Vaginal and Abdominal Ultrasound Scanning
Throughout the course of fertility treatments, our specialists will have our patients undergo vaginal and/or abdominal ultrasound scanning.
The vaginal ultrasound involves the introduction of a small, thin and lubricated transducer into the vagina. With the abdominal ultrasound, the hand-held transducer is gently moved over the skin of your abdomen.
Both procedures are useful in assessing the condition of your uterus and ovaries during the course of fertility treatments. They can also be used to identify possible causes of infertility, such as ovarian cysts.
Follicular tracking is a type of ultrasound scan. It is used to determine with greater accuracy when ovulation will occur in order to improve the chances of natural fertilisation of the egg taking place.
Around one to three scans are taken transvaginally every other day starting at Days 7 to 9 from the last menstrual cycle. The scan enables our specialist to count the number of follicles and measure their maximum diameter in millimetres. It is also used to assess the size and condition of your ovaries, uterus, endometrium, and the whole pelvic area.
Follicular tracking takes only 15 minutes to perform.
Our specialist may advise that an endometrial assessment be performed if a woman complains of abnormal vaginal bleeding, irregular or heavy periods, and the presence of a misplaced intrauterine contraception device.
The procedures that may be included in an endometrial assessment include a pelvic ultrasound, hysteroscopy, and a biopsy. All of these procedures will enable our specialists to check the condition of the lining of your uterus.
Laparoscopy and Hydrotubation
Laparoscopy and Dye Hydrotubation are procedures that are used by our specialists to examine the inside of your pelvis.
A small incision is made through which a small scope is passed so that the outside of the uterus, fallopian tubes and ovaries can be inspected for possible causes of infertility, including endometriosis, ovarian cysts and fibroids.
With dye hydrotubation, a blue dye is inserted through your cervix. Again, using a small scope, the flow of the dye through the fallopian tubes is checked for any signs of blockage.
Performed under general anaesthesia, this procedure has a duration of 20 to 30 minutes.
Oocyte recovery is a procedure that involves removing the oocyte or immature egg cell from a woman’s ovary for fertilisation outside her body.
Using ultrasound as a guide, our specialist inserts a long, thin needle through the wall of the vagina and into an ovarian follicle, making sure that they don’t injure any organs that are situated between the vaginal wall and ovary. On the other end of the needle is a suction device which gently sucks out cellular material, including the oocytes, and fluid from the follicle. This procedure is then repeated in the other ovary. Oocyte recovery takes 20 to 60 minutes to perform, with an estimated 20 oocytes obtained per procedure.
For better results, ovarian hyperstimulation is done prior to the procedure. This involves subcutaneous or intramuscular injections of Human Chorionic Gonadotropin (hCG) 34-36 hours prior to oocyte recovery to stimulate maturation of the eggs.
Both In Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI) involve fertilisation of the egg outside the body. There are major differences in these two techniques.
IVF has the eggs and sperms being cultured for 16-20 hours in a laboratory dish and checked periodically for signs of fertilisation. Once fertilisation has been detected, the resulting embryos are further grown in an incubator for six days. After six days, our specialist chooses the best quality embryos for transfer back into the woman’s body or are frozen for future use. IVF is recommended in cases of unexplained infertility, fallopian tube blockage, and having had no success with other treatments, such as fertility drugs or intrauterine insemination (IUI).
ICSI is a delicate procedure which involves directly injecting a best quality sperm into the egg to achieve fertilisation. This procedure is done when the man has a low sperm count and/or abnormal sperm. ICSI is also performed when there is failure of fertilisation or a very low fertilisation rate with previous attempts at IVF.