Services

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.

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.

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.

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 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.

Intra-Cytoplasmic Morphologically-Selected Sperm Injection (IMSI) is very similar to ICSI. What makes IMSI different from ICSI is that the sperm sample is carefully assessed under a microscope with a higher magnification and a digital imaging system. This microscope will not only detect abnormalities in the shape of the sperm. It will also show structures called vacuoles in the sperm’s head, which is related to a lower or abnormal embryo development. IMSI ensures that sperms of the best quality are injected into the egg for fertilisation. IMSI is the procedure of choice for men above 40 years old and whose semen analysis showed a higher percentage of sperms with abnormal forms, unsuccessful treatment cycles which are not related to egg problems, and a history of miscarriages.

Pre-Implantation Genetic Screening (PGS) is a procedure wherein cells are obtained from embryos conceived through IVF or ICSI and the chromosomes examined for abnormalities. Detection of chromosomal abnormalities is vital since they are a frequent cause of implantation failure and/or miscarriages. PGS is recommended in the following cases: Woman is age 35 and above and with a higher risk of conceiving a baby with chromosomal abnormalities (Ex. Down’s Syndrome) Family history of chromosome problems History of recurrent miscarriages Numerous unsuccessful IVF cycles wherein embryos transferred to the uterus failed to implant or miscarried In men, sperm has been found to have chromosomal problems This procedure begins in the early stage of IVF or ICSI treatment wherein the woman’s eggs are collected and fertilised with the sperm of her spouse. The embryo is grown for two to three days in a laboratory (Other labs prefer to wait for the embryo to develop within five to six days). After this period, cells are obtained from the embryo. Their chromosomes are carefully examined for abnormalities. Embryos without chromosomal abnormalities are transferred to the woman’s uterus while those that are found abnormal are allowed to die naturally.

Cleavage Stage Transfer is one of two embryo stage transfer procedures that are being done in GSARTC. Cleavage Stage Transfer involves the transfer of an embryo that is on its Day 2 or 3 of fertilisation inside the uterus of the woman. Prior to transfer, our specialist examines the embryos to see if it has the right number and evenness of cells, and are exhibiting signs of fragmentation. At this stage, the maternal genome is still at play so it is necessary for the embryo to be of good quality to ensure implantation in the uterus.

Assisted Embryo Hatching is an adjunct procedure when two or more IVF cycles have failed. In these women, implantation of the embryo is difficult to achieve because the outer protein shell called the zona pellucida is too thick. Fertility experts have determined that there is a better rate for embryo implantation if the zona is thinner. Assisted Embryo Hatching involves creating a small defect in the zona pellucida with an acid Tyrode’s solution during the fourth day of embryo development. The embryos are immediately rinsed of the excess acid solution and stored in an incubator for a few hours before transferring into the uterus. Although this is considered one of the more difficult and delicate ART techniques, our specialists have acquired extensive training and experience in performing Assisted Embryo Hatching to ensure the best results.

Blastocyst Transfer involves the transfer of an embryo that is on its Day 5 or 6 of fertilisation inside the uterus of a woman. A blastocyst is the stage of an embryo wherein it has formed a one-layered sphere of cells (trophoblast) enclosing a fluid-filled cavity (blastocoele) with a dense inner cell mass (embryoblast). The trophoblast ultimately forms the placenta while the embryoblast grows into the fetus. Unlike Cleavage Stage Embryo Transfer, studies have shown that Blastocyst Transfer has a higher chance of successful implantation in the uterus. It is best to consult with your GSARTC doctor on which embryo stage transfer is recommended for your condition.

Oocyte cryopreservation is a procedure which entails freezing human eggs in liquid nitrogen. This procedure is utilized in women who are diagnosed with cancer but have not yet started chemotherapy and/or radiotherapy. Freezing their eggs will enable them to bear children after they have concluded their cancer treatments. It is also used in women who are currently undergoing ART but do not want to undergo embryo cryopreservation and yet still desire to have children in the future. Oocyte cryopreservation is also done on single women who don’t want to marry yet or just wish to preserve their eggs for medical or personal reasons.

Women who are afflicted with cancer ultimately face the possibility of losing their fertility. It is also a big risk for young girls who develop this dreaded disease before reaching puberty. In order to preserve their fertility, ovarian tissue containing eggs are surgically removed and frozen. When a woman is ready to have a child, the ovarian tissue is thawed and the eggs are retrieved. Through IVF, these eggs are matured and fertilized and transferred back into the woman’s uterus. Another procedure has the ovarian tissue being later thawed and then implanted near the fallopian tube. The tissue begins to produce new eggs so that natural conception can occur.

Frozen Thaw Embryo Transfer involves placing a Day 5 embryo in a solution and then rapidly freezing it in liquid nitrogen. The rapid freeze provides a higher survival rate and prevents the formation of ice crystals which may break and damage the embryo. Prior to the transfer, the patient is advised to have oestrogen and progesterone injections every three days for two to three weeks in order to prepare the uterine lining for implantation. The uterus lining is also checked for readiness via ultrasound. Once the uterus is found ready, the embryo is thawed and transferred into the woman’s womb. Frozen Thaw Embryo Transfer is recommended for women who will be undergoing IVF and would want additional embryos as backup in case of failure. It is also an ideal procedure for couples who have infertility problems but would want to have a child at a later date.