At Sunfert, we take a problem-based approach as opposed to diagnosis-based approach to design individualised treatment plans that will help to achieve a pregnancy at minimum cost in the shortest time.
Assisted conception is often considered when couples have spent a long time trying for a baby without success and have decided to move on.
Artificial Insemination (AI)
Artificial Insemination (AI) is a form of fertility treatment whereby the male’s washed/prepared semen sample is deposited into the female’s reproductive tract to maximize the chance of the sperm meeting the egg without sexual intercourse. Artificial insemination is performed for individuals dealing with issues such as:
Mild male factor infertility
Needing to use donor sperm to get pregnant
Centrifugation of semen sample
Insemination of washed sperm into uterus
There are two different artificial insemination procedures:
Intrauterine insemination (IUI)
which is the most common today
Intracervical insemination (ICI)
also known as intravaginal insemination
For many infertile couples, IUI or ICI is less invasive and more affordable when compared to IVF or ICSI treatment. However, there are limitations to these techniques. Success rates for AI are expected to be lower than IVF or ICSI due to many factors, for example, age of the recipient, sperm quality, timing of the insemination and outcome of the ovarian stimulation.
In Vitro Fertilisation (IVF)
IVF is the process of fertilization outside of the human body by manually combining the eggs and sperm in a laboratory dish. This treatment is attempted when couples are diagnosed of having blocked and/or damaged Fallopian tubes, severe male infertility and/or when other forms of fertility treatments options had failed. When the IVF procedure is successful, the treatment process is combined with a procedure known as embryo transfer, which involves physically placing the embryos into the womb.
There are five basic steps of an IVF treatment:
It involves administration of fertility drugs to stimulate the ovaries.
This procedure is also known as Ovum Pick Up (OPU).
On the same day of the OPU, the spouse’s semen sample is obtained and prepared aseptically in the Andrology laboratory to attempt fertilization by culturing the sperm and eggs together.
The basic steps of an IVF treatment
Fertilization attempt and embryo culture
Once all of the eggs have been inseminated, the eggs are cultured in the IVF laboratory, which provides a conducive environment for embryo growth.
Fertilized eggs are then identified and cultured in the IVF laboratory for several days to select the best embryos with the highest chance of development and implantation potential. An embryo transfer procedure is then carried out to replace the embryo into the woman’s uterus.
Intracytoplasmic Sperm Injection (ICSI)
This is also another form of IVF treatment whereby a single sperm is injected microscopically into a mature egg by forced entry performed by a qualified embryologist, using a special instrument called micromanipulators. ICSI procedure is performed for the following conditions:
- Low sperm count
- Unexplained fertilization failure by conventional IVF or poor fertilization in previous IVF cycles
- Severe structural abnormalities of the sperm
- Low sperm motility or total sperm immotility such as Kartagener’s Syndrome, an inherited condition where defective sperm tail that hampers tail movement.
- Epididymal or testicular sperm obtained from azoospermic males (no sperm present in the semen).
- Retrograde ejaculation (where there is a reverse direction of ejaculate into the bladder)
After ICSI, the eggs are then checked to see if fertilization had occurred. Fertilized eggs are then separated from unfertilized eggs for further culturing.
On the day of embryo transfer (which can take place 2 to 5 days later), between 2 to 3 embryos are chosen to be replaced into the uterus.
MESA / TESE and PESA / TESA
(Microsurgical testicular sperm extraction and Percutaneous testicular sperm aspiration)
Different techniques in retrieving sperm from the testis
These procedures are carried out together with ICSI and when the male partner is diagnosed with azoospermia (absence of sperm in the ejaculate). It involves microsurgery of the testis by an experienced urologist or fertility specialist. During the surgery, a small fraction of the testicular tissue is removed under anaesthesia. From the testicular and/or epididymal tissues, the embryologist will extract the sperm cells from the tissues and are processed for ICSI.
Two causes for azoospermia are non-obstructive and obstructive. Non-obstructive azoospermic males have either Sertoli-cell-only syndrome or development arrest of the sperm cells. On the other hand, obstructive azoospermic males generally have reasonable sperm production capacity but the sperm could not be deposited in vagina due to obstruction in the tubes that transport sperm into the penis. Success rates for ICSI with non-obstructive azoospermia are generally lower than ICSI with obstructive azoospermia.
Laser Assisted Hatching
In the initial stages of development, the embryo is protected by a “shell” or layer of proteins, known as the zona pellucida and the embryo needs to “hatch out” to attach to the walls of the womb.
In IVF treatment, exposure of embryos to in-vitro (external) culture conditions may cause the zona pellucida to be abnormally thick or hardened, compromising its ability to implant onto the womb wall. At Sunfert, we use a laser beam to perform assisted hatching to enhance the chance of implantation. The indications for assisted hatching include advanced maternal age, thickened zona structure, diminished ovarian reserve or previous failed IVF attempts.
Intracytoplasmic Morphologically Selected Sperm Injection (IMSI)
This is a technique whereby sperm samples are examined under a microscope which is almost 6000 – 7000x more powerful than normal ICSI. IMSI enables us to choose the very best quality sperm without any defect to inject into the egg, thereby increasing the pregnancy and implantation rate. Once the best sperm has been selected, the IMSI procedure is carried out in exactly the same way as ICSI.
IMSI procedure is suitable for:
- Patient for whom has a high number of abnormally formed sperm during semen analysis
- Patient with a history of recurrent miscarriages
- Patient with previously unsuccessful treatment cycles or have not achieved good quality embryos in previous cycle provided it is not related to eggs quality