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The ART Programme
ART (Assisted Reproductive Techniques) encompasses both Invitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI). The initial part of both IVF and ICSI is the same. The difference is only in the laboratory, and this is covered in the Assisted Conception section of the website.
Every treatment protocol is individualized and your doctor will be able to advise you as to which protocol is suitable for you. It is not possible to use the same protocol for ALL patients, as every patient is different. Be rest assured that your doctor will choose a protocol that gives you the least discomfort and has the shortest duration yet accords you the highest chance of success.
The Long Down Regulation Protocol (LDR)
This is one of the commonest protocols that is employed in Sunfert IVF. The suppressive effects of the initial injections (busereline) seem to be beneficial for women with endometriosis which sometimes can be undiagnosed. Studies have shown that success rates with LDR protocol are marginally better than other protocols.
Your first visit to the clinic is roughly about a week before the onset of your menses (usually Day 21 of your menstrual cycle). During this visit, you will undergo a scan to confirm that you have ovulated. Sometimes, your doctor may have given you some oral contraceptive pills (OCPs) from the beginning of your menstrual cycle (usually Day 2 or Day 3) and you commence injections on your own a few days before the last pill. The first type of injection is called busereline (Suprefact) and is given as a daily dose in the morning before you go about your usual daily activities. These injections are well tolerated though sometimes the patient may have hot flushes. You will still have a menstrual period though it may be lighter or prolonged.
After about 2 weeks of injections, you will be seen in the clinic for a repeat scan to confirm down regulation (ovaries that are quiet). The dose of busereline is subsequently reduced and approximately a week later, you will commence on stimulation of the ovaries. This involves the use of a daily hormonal injection called FSH (Gonal F or Puregon) for about 10 to 12 days.
In total, the LDR protocol takes about 4 weeks plus in total.
The "Short " GnRH Antagonist Protocol
This protocol is gaining prominence due to its shorter duration and is commonly employed in Sunfert IVF. It is particularly useful in women with polycystic ovaries, as there is a lower risk of ovarian hyperstimulation syndrome.
Your doctor may sometimes give you several days (up to 3 weeks) of OCPs from the onset of your menses. Then on the second or third day of your withdrawal menses after the pill, you commence the daily FSH injections immediately. A scan would be repeated on Day 5 of injections after which another injection called GnRH antagonist (Cetrotide or Orgalutran) is commenced. This injection which is also done daily prevents premature release of the eggs. In total you will do about 10 to 12 days of injections.
The Microflare Protocol
This protocol is reserved for older women, women with low ovarian reserve or who have responded poorly with previous protocols. This protocol involves a pre-treatment with OCPs and subsequently a low dose busereline injection from Day 2 of menses, which acts to flare up the ovaries. You will subsequently be commenced on daily FSH injections. The entire treatment protocol takes about 10 to 12 days.
During the period of stimulation, you are expected to visit the clinic about 3 times. You are advised to carry on with your usual routine of work or house duties to minimize your stress levels. All injections are self-administered for your convenience, and our fertility nurse will teach you how to perform the injections. It is important to keep the injections in the refrigerator to preserve their effectiveness.
In Sunfert IVF, you are given an option to undergo specialized counselling to help you cope with the potential stress of fertility treatment. The MindBody Fertility Programme (provide link) provides you with 4 free sessions with a qualified life coach and hypnofertility practitioner on-site at our fertility centre.
The Egg Collection Procedure
You will subsequently undergo egg collection, which is a minor procedure performed under sedation as a daycase. This procedure is sometimes carried out under general anaesthesia if the the patient is unfit. The egg collection is performed in our specialized IVF Operating Theatre (OT). A very fine needle is inserted through the vagina under transvaginal ultrasound guidance. The needle punctures through the vaginal wall and into the ovaries to harvest the eggs. The eggs which are now in a test tube are handed over to the embryologist for processing. The laboratory is located next to the IVF OT to ensure minimal exposure to the external environment. The entire procedure takes only about 15 minutes and you will wake up immediately after that. After you are fully awake, you will be served some refreshments and will be allowed to go home after 2 hours.
The Embryo Transfer
The eggs are fertilized and are now called embryos. The embryos are cultured for between 2 to 5 days, depending on the number of fertilized eggs available. Embryo transfer is a minor procedure where the fertilised eggs are transferred into the womb via a very fine flexible catheter. The number of embryos to be transferred depends on several factors such as the age of the woman, the quality of the embryos and the wishes of the patient. Sunfert IVF endeavours to transfer the optimum number of embryos to achieve the best results with the least risk of multiple pregnancies. Good embryos that are not transferred will be frozen for use in the future.
Most women would take about a week of rest from work or strenuous house duties to maximize the chance of success, though strict bed rest is unnecessary. If you wish, your doctor will be able to provide medical leave for this purpose. During this period of time, you are required to insert progesterone pessaries (Cyclogest or Uterogestan) as well as two more injections to support the womb and the resulting pregnancy.
A blood pregnancy test is carried out approximately 2 weeks after the transfer. If you are pregnant, you will be required to continue the progesterone support for another month or so.
If unfortunately you are not pregnant, your doctor will review your entire treatment with you and discuss your options again if you would like to try again. You are also entitled to another session with the life coach if you need, to help you cope with it.
Fortunately, the commonest outcome of ART in Sunfert IVF is a pregnancy. Be assured that, we will try our very best to ensure that you have a favourable outcome. Remember, your success is our success!
If the treatment was unsuccessful and you have excess embryos frozen, you may undergo a Frozen Embryo Transfer (FET) about 2 months later.
We wish you every success!