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MESSAGES TO

In Vitro Fertilisation (IVF)

A DxD Session with Dr Paul Tseng


Ended on Wed Jan 23 2019
Ended

Top Answers


We used to resort to surgery to unblock damaged and obstructed tubes. This was a time when IVF was in its infancy and results unpredictable. The situation has since changed for the better.

IVF results are much better and the discomfort much less than undergoing surgery to unblock a tube.

It is also now not recommended as first line treatment as the damaged tube would most likely have many areas of damage and blockages that it would be very difficult to retain a healthy portion of the tube-hence the reason you have had 2 ectopic pregnancies.

Unblocking the tube surgically would unfortunately predispose you to an unacceptable risk of recurrent ectopic pregnancies.

The safest and most reasonable option would be to bypass the tube through IVF.

3 Aug 2018

It is not unusual to have some episodes of vaginal spotting when using the progestogen(Crinone) inserts. They can dry the vaginal skin and cause superficial abrasions which bleed when the pessary is inserted.

In addition, some centres also use low-dose aspirin as a supplementary drug to enhance blood flow to the endometrium. These have the effect of thinning the blood and cause minor bleeds which seem to be worse then they actually are.

The vaginal bleeds are not necessarily a sign of failed implantation. The true test of a successful implantation would be a positive pregnancy test as early as 10 days after the Embryo transfer.

3 Aug 2018

I am happy to say IVF in this day and age carries very few risks to the women undergoing such treatment. The most dreaded was the Hyperstimulation Syndrome where the number of eggs retrieved was in the region of above 30.

The present protocols are safer and reduce dramatically the incidence of these complications.

The single most important difference was the introduction of “freeze all” and transfer in a later cycle rather than at the fresh cycle. This is because of better freezing and thawing methods.

3 Aug 2018

There are different protocols that are used for different types of patients. It is best you attend the Counselling sessions that are held by the IVF Centres to understand more about how they conduct their programs, as each fertility specialist has his/her own preferences.

I think many patients have different concerns and misinformation about what IVF entails. Some think its very painful, some think it is very time consuming and others are concerned about the cost of the procedure.

That is why in Singapore it is mandatory that potential patients undergo a counselling session where all these concerns are addressed.

3 Aug 2018

I personally believe that the success of IVF is directly dependent on the health of the Woman and her husband.

Eating well, as in eating nutrient rich foods helps to ensure proper cell function at every level. Minimising toxic chemicals, quitting smoking and not consuming contaminated foods and drinks helps reduce cell damage.

I also believe that complementary Medicine such as those offered by TCM and acupuncture contribute positively to a successful outcome.

I am loathe to quote results because it really depends on the medical reasons for doing IVF. Reasons like blocked tubes with healthy normal uterus and Normal sperm can carry a 40-50% success rates.

Conditions where the eggs are of poor quality can carry dismal success rates of less than 5%.

3 Aug 2018

Many large scale studies have been conducted and so far the consensus is that there is no difference in health between naturally conceived babies and IVF babies.

3 Aug 2018

Costs differ between IVF centres but a ballpark figure of $10-15K per cycle would be an estimate. 

The variance is because of Professional fee differences, laboratory fees and amount of drugs used. You will have to request this from the centres that you are interested to have your IVF done in.

You can read this article to find out more about the costs of IVF in Singapore.

3 Aug 2018

Hopefully, two weeks after your Embryo transfer. This would depend on whether it was a fresh transfer or Frozen embryo transfer. A fresh transfer is one where the transfer is done on the same cycle as the egg retrieval.

3 Aug 2018

The only painful part of the whole IVF process is the Oocyte retrieval and this is very often done under a light General Aneaesthetic.

The daily injections of the stimulant are very often bearable-like an “ant-bite”.

3 Aug 2018

This is not necessarily a true statement. It all depends on the reason for the Infertility.

The success in achieving a pregnancy can be as high as 40-50% if it is purely due to blocked or damaged tubes, but the quality of the eggs and sperm are good and there is no abnormality to the uterus. 

However, in many instances, this is not the case. There are a combination of adverse factors that influence and dictate the success rates.

The more problems you have the higher the failure rates. For example:

  • Poor quality eggs from age
  • Damage from previous surgery or
  • Damage from unknown toxic and infective causes, combined with uterine abnormalities like Adenomyosis, Endometriosis or large uterine fibroids will jeopardise the success of the problem.

Extremely low and poor quality sperm also influences results. It is therefore important to identify these problems and try to rectify them as much as possible before embarking on IVF.

5 Aug 2018

Like I have mentioned in a previous answer on IVF failure in Singapore, you need to try and identify the cause of the failures.

The most difficult to rectify is the poor quality Oocyte. There are experimental techniques like transplanting the nuclear material to a healthy donor cytoplasm before fertilisation. All still very experimental, but promising techniques.  They have not been approved for clinical use yet.

Empirical treatments like the use of Growth Hormone in those found to be deficient have shown variable results.

5 Aug 2018

Age has a direct correlation to the quality of the eggs in a woman.

The older the woman, particularly above 35 years, the higher the chance of the eggs losing their quality.

The quality of the eggs also dictate the quality of the embryo, and hence the success in achieving a healthy pregnancy.

In Singapore, the maximum allowable age to undergo IVF is 45 years. Personally, I feel this may need to be changed to 50 years instead, as the general health of the woman has improved this last decade and I have anecdotally seen a higher number of women above the age of 45 years being able to produce good quality eggs.

5 Aug 2018