Mr. Sim Seng Keat

Obstetrician & Gynaecologist / Fertility Specialist

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1. Do you really need IVF programme to get pregnant?

Though it is also equally important that IVF should not be attempted without good justification, it should not be delayed very long either. Unfortunately the public’s idea that IVF to be tried as the last resort has delayed the decision making of many couples and hence most of them have reached their late thirties and even late forties before trying for IVF- assisted pregnancy.

Attempting to try for IVF must be a timely decision by the couples. Incorporating fertility status into annual checkup early in your married life will give a perspective idea about your fertility status. Then it will be more realistic to decide on when to enlist for fertility assistance and /or when to have a timely attempt for IVF amidst your busy daily routine. 

The following time proven approaches still stand true:

• It is better to have the first child early
• Couple should decide to go for a checkup with Fertility specialist when there is failure of pregnancy after actively attempting for one year in women less than 35 years old and half a year of active attempt in women more than 35 years old.
• It is strongly recommended to have early fertility consultation in couple with preexisting gynecological or male fertility related disorders.
  

2. How long is the duration of IVF injections and is it easy to self-administer injections?

Though earlier IVF injection schedules were longer & lasted for 4-5 weeks, with the advent of recent methodologies, newer injection schedules are shorter lasting which is less than two weeks. It has been proven that the chance of having successful IVF pregnancy has been equally good even in couple adopting shorter injection schedule!

This has not only reduced the stress and time spent in keeping to the schedule but also the number of injections. Moreover, the shorter injection schedules tend to be equally flexible to plan for egg-retrieval procedures and better in reducing the risk of ovarian hyper stimulation.

With the development of newer user friendly injection pens, self-administration of injections deliver dosages precisely and are also easier to use reducing the likelihood of errors and mistakes. 

3. Is it possible to plan / prefix earlier for all appointment dates for couples adopting to go for attempt of IVF pregnancy?

Yes, all the appointment dates from the first day of the injection to the end of IVF procedure including the dates of blood tests could be planned and fixed much in advance and can be made known to the couple even during their first day of consultation. This usually helps the couple to plan their leave or allocate time and be available for all appointments in the midst of their busy work commitments, holiday plans and family obligations.

Treatment plan includes 6 appointments, first three are for collection of medications after pelvic ultrasound examinations. Fourth appointment is for semen collection from husband and day case admission for wife for egg retrieval. Fifth appointment is for admission as day case for wife to have the embryo transfer and sixth appointment is for wife to have the blood test to detect pregnancy status. 

Hence husband must be present for the fourth appointment unless he has already preserved frozen sperms to be used for IVF procedures. It is needless to say wife must be present for all appointments. It is highly recommended to have the presence of an accompanying adult with the wife for day-care admissions for fourth and fifth appointments since these admissions are for the wife to undergo minor procedures.

Schedule of appointments depend on the day of onset of menstruation and hence for women with regular menstrual cycles, appointment dates are very much predictable and easier to fix. 

Women with irregular menstrual cycles require oral contraceptives or progesterone-only pills to induce menstruation to get the date of onset of menstruation to plan for all future appointments.

4. How is the egg retrieval procedure performed? How true are hear-says about pain during and after undergoing egg retrieval procedures?

From the feedback from many patients, egg retrieval procedures are relatively painless though very few of them might experience minor lower abdominal discomfort for a shorter duration after the procedure.

Most egg retrieval procedures are performed easily with minor sedation though some of them might need light general anaesthesia or spinal anaesthesia.

Newer well designed needle tips are very small in diameter with finer needles causing lesser trauma and as such these procedures are relatively painless. Hence most of them do not even require paracetamol for pain relief though very few patients require paracetamol for a day or two.

5.  Are these dreadful stories of Ovarian Hyper Stimulation (OHSS) true?

5 to 20% of women undergoing IVF procedures with longer injection schedules develop OHSS while chances of developing OHSS is much lesser in women with shorter injection schedules. OHSS developing after egg retrieval in women produces a bloated abdomen, poor oral intake, shortness of breath, abdominal pain, reduced urine output, nausea and vomiting.

Occurrence of  OHSS can be reduced to less than 1% by the introduction of deliberate efforts such as use of agonist medications  as triggers and with the approach of new technique of freeze-all embryos.

With the advent of well researched methodologies the incidence of OHSS has reduced significantly while the success rate of IVF pregnancy has increased satisfactorily.

6. What are the factors to be considered before deciding the chances for getting successful pregnancy after IVF procedures?

Everyone would like to know the chances of getting pregnant through IVF procedures though there are many factors that decide the success after such procedures.

Basically in sub fertile women of less than 35 years, transfer of two good quality embryos in fresh IVF attempt confers more than half the chance of getting pregnant. In established IVF centre with good “Freezing and Thawing Program”, transfer of 2 good quality thawed embryos also provides good outcome.

80% of fertile couple conceive naturally through active attempts within a period of 12 months.

Direct comparison of chances of getting pregnant of sub fertile and fertile couple might not be appropriate. It is very encouraging and overwhelming to note the uptrend in the increasing pregnancy rates after fertility techniques, with the advent of research proven technologies and procedures.