FERTILITY TREATMENT OPTIONS IVF TREATMENTS

 Fertility Treatment Options — IVF Treatments in Singapore>

At Thomson Fertility Centre, we provide IVF treatments and IUI procedures in Singapore. No
matter what your needs are, you can rest assured that each member of the friendly team at
Thomson Fertility Centre is dedicated to providing the utmost level of service. See what
treatments and procedures we can assist you with below, and call us today to schedule an
appointment.

How we can help

There are various assisted reproductive techniques that are available. The following are some
treatment options available:

1. In Vitro Fertilization (IVF) is the most advanced form of fertility treatment.

It involves the extraction of the egg before combining it with the sperm in the laboratory.
The process of superovulation involves the stimulation of two to three ovarian follicles (eggs) in
order to bring them to maturation and ovulation.
It is usually combined with intrauterine insemination in which the prepared sperm is placed
directly into the uterus. This procedure will enhance conception for the couple.

2. Superovulation Intrauterine Insemination (SO-IUI)

Improves the chances of conception for couples with fertility issues. The average success rate is
about 12-15% or 26% per patient after 3 cycles.

3. Intrauterine insemination (IUI) is a form of assisted conception.

During IUI, your doctor will place prepared sperm into your uterus (womb) at your time of
ovulation. Sperm are then in the right place at the right time when your eggs travel down the
fallopian tube. This procedure is sometimes combined with fertility drugs to increase your
chances of conceiving.

How long will treatment last?

How long will treatment last?

The insemination itself is immediate and takes only a few minutes. If you are undergoing a
stimulated cycle, you will need to take fertility drugs before you ovulate.

PRE-TREATMENT ASSESSMENT
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 Pre-Treatment Assessment>
To start your family journey, please make an appointment with our fertility specialist.

Consultation:
Our fertility specialist will diagnose any fertility issues you might have, and offer relevant
treatment options. Diagnostic tests include ultrasound and blood tests. Treatment options may
also include medication and further procedures.

Counselling:
 Our nurse will explain the treatment cycle, medications and the number of visits needed for
blood tests and ultrasound. We also offer support to couples through an emergency hotline
service which is manned by our qualified nurses.

SEMEN ANALYSIS IN SINGAPORE

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 Semen Analysis in Singapore>

What Is Semen Analysis?

Semen analysis is the most common male fertility test. Semen analysis analyzes how healthy a
man’s sperm is. Semen is the fluid containing sperm that’s released during male ejaculation.
A semen analysis measures three major factors of sperm health:
 Sperm count (the number of sperms)
 Motility (the ability of a sperm to move)
 Morphology (size and shape of the sperm)

Why Undergo Semen Analysis?

A semen analysis is often recommended when couples are having problems getting pregnant.
The test will help a doctor determine if a man is infertile. The analysis will also help determine if
low sperm count or sperm dysfunction is the reason behind male infertility. With this, a
treatment plan will be tailored for the couple.
Preparing for Semen Analysis
At Thomson Fertility Centre, we have a private room for you to produce the sample or you can
produce the sample at home in a sterile container provided by us or by your referring clinic and
deliver it to us. Do note that you need to get the sample to the laboratory within one hour after
ejaculation as the quality of the semen will be compromised thereafter.

Steps for Collection of Sample:

 Wash your hands with soap and water.
 Refrain from using lubricant, saliva, or any product that may contain spermicidal
agents.
 Ejaculate directly into the sterile sample cup. Try to capture the first part of the
ejaculate and do not attempt to collect any spilled semen.
 Cap the container as soon as you have finished.

HOLISTIC APPROACH
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 Holistic Approach>
Our holistic management of fertility treatment, enables patients to explore options towards
natural conception before treatment options with IVF are considered.

Our doctors will conduct a thorough assessment to rule out any underlying gynecological issues
causing infertility, and advice on possible lifestyle changes which empower couples to try and
 conceive naturally. This is important to ensure couples explore all possible options for natural
conception, before considering the next steps towards assisted fertility treatments.

Our holistic approach towards infertility includes:

 Reproductive Surgery for Fertility (Read More)
 Alternative Therapies for Fertility (Read More)
 Counselling for Fertility Treatment (Read More)

COUNSELLING FOR FERTILITY TREATMENT

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 Counselling for Fertility Treatment>

For any couple considering or already undergoing fertility treatment, it’s common to feel
stressed and anxious. At Thomson Fertility Centre, we have qualified counsellors to support you
throughout your fertility journey.

COUNSELLING COULD FOCUS ON

· Preparing for fertility treatment and Implications of treatment
· Providing you with emotional support before, during or after fertility treatment
· Impact that infertility and treatment may have on your life and your relationships with
other people
· Coping with stress and maintaining an emotional balance as a couple
· Understanding how to provide emotional support to your spouse, throughout the fertility
treatment journey

REPRODUCTIVE SURGERY FOR FERTILITY

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 Reproductive Surgery for Fertility>

At Thomson Fertility Centre, we adopt a holistic approach to fertility management.
Understanding the factors and causes of infertility are key to helping couples to conceive. Our
aim is to explore all other options available to couples before embarking on the path of assisted
fertility treatments like SOIUI, ICSI or IVF.
At times couples may find that they can conceive naturally after reproductive surgery to restore
normal uterus, tubes or ovary function.
Our surgeons treat a variety of reproductive problems that may lead to infertility such as
endometriosis, uterine fibroids, pelvic adhesions, tubal occlusions, ovarian cysts, and congenital
or acquired abnormalities.
It is important for an assessment with our Fertility Specialist to establish if you are one of those
couples who will benefit from reproductive surgery to fulfill your baby hopes.

Some Causes of Infertility

ENDOMETRIOSIS
 Endometriosis is a painful and chronic disease that is often mistaken for normal menstrual pain.
It occurs when endometrium tissue, which lines the uterus, is found outside of the uterus. This
tissue develops into growth or lesions which respond to the menstrual cycle in the same way
the tissue of the uterine lining does: each month the tissue builds up, breaks down and sheds.
Menstrual blood flows from the uterus and out of the body via the vagina, but the blood and
tissue shed from endometrial growth has no ways to leave the body. This could result in
internal bleeding, breakdown of blood and tissue from the lesions and inflammation, causing
pain, infertility, scar tissue formation, adhesions and bowel problems.
Treatment Options
· Laparoscopy · Mini-Laparotomy · Laparotomy
FIBROIDS
Fibroids are abnormal growths that develop in or on a woman’s uterus. It is not known what
causes fibroids. They may be asymptomatic or may cause excessive uterine bleeding, recurrent
miscarriages, pain, pressure or severe anaemia.
Treatment Option
· Hysteroscopy

PELVIC ADHESIONS
Pelvic adhesions are scar tissue that can block or distort fallopian tubes. They could be a result
of an inflammatory response to surgery, endometriosis or infection. During the process of
repairing injured tissue, organ and tissue stick to each other, causing pelvic adhesion.
Such adhesions can cause problems with fertility, pelvic tenderness, painful intercourse and
chronic pelvic pain.

BLOCKED FALLOPIAN TUBES

Fallopian tubes are the path that the sperm and egg must take to achieve fertilization and
implant in the uterus successfully. Blockages of the fallopian tubes can lead to difficulties in
conceiving as the sperm and egg cannot meet. Prior pelvic infection, surgery or endometriosis
can cause blocked fallopian tubes. Depending on the type of blockage, tubal surgery can be
done to increase fertility.
Treatment Options
· Laparoscopy · Salpingectomy · Salpingostomy
· Fimbrioplasty · Tubal Cannulation
OVARIAN CYSTS
An ovarian cyst is an accumulation of fluid within an ovary that is surrounded by a thin wall.
Ovarian cysts are very common and usually harmless, requiring no intervention. Cysts that are
large or persistent, lasting several months may require surgery.
Treatment Options
· Birth control pills · Laparoscopy · Laparotomy
CONGENITAL STRUCTURAL ABNORMALITIES
Congenital structural abnormalities that occurs during fetal development may be the cause of
infertility, severe pelvic pain or recurrent pregnancy loss.
Treatment Options
· Laparoscopy · Hysteroscopy
ACQUIRED UTERINE ABNORMALITIES
Uterine abnormalities includes polyps, scarring and fibroids. Depending on patient’s conditions,
these can be treated using hysteroscopy and/or laparoscopy. Uterine abnormalities can
contribute to decreased fertilization, miscarriage or pregnancy complication and it is common
among women of reproductive age.

ALTERNATIVE THERAPIES FOR FERTILITY

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 Alternative Therapies for Fertility>
Some couples undergoing Fertility Treatment may explore alternative therapies in the hope
that these treatments may aid in the success of IVF treatments.

Some of these alternative therapies include

ACUPUNCTURE
Acupuncture is the ancient Chinese practice in which fine needles are inserted in the skin at
specific points along meridians, which are considered to be lines of energy, with the intent of
improving the body’s functions and promote self-healing process.

Acupuncture is thought to aid fertility by reducing stress, increasing blood flow to the
reproductive organs and balancing the endocrine system, according to several studies and
research.

In a study of 160 women, published in 2002 in the reproductive journal “Fertility and Sterility”,
German researchers found that adding acupuncture to traditional IVF treatment protocols
substantially increased pregnancy success.

HERBS
Many fertility experts do not recommend using herbs as insufficient data is available on
whether herbs can increase pregnancy rates, and is not well-studied. You are advised to use
your discretion in consumption of herbs for fertility improvements.

YOGA
Can yoga really help you get pregnant? Studies have shown that yoga can help reduce stress,
which can affect fertility. Some experts also believe that certain poses can help promote baby-
making by improving blood circulation to your pelvis, stimulating hormone-producing glands,
and releasing muscle tension.

SUPPLEMENTS
Scientific research has shown that certain vitamins and minerals can increase your chances of
getting and staying pregnant. It is important that you and your partner are in optimum health
to maximise your chances of conceiving. Obtaining the right nutrients and in the right amounts,
improving sperm production and mobility can dramatically increase your chances of getting
pregnant.

Some examples of supplements:

FOLIC ACID
It is now known that folic acid can prevent spina bifida in your baby, and it is essential that you
get plenty both before and during pregnancy. And that’s not all: folic acid is undoubtedly
important, but it is just part of the very important B-complex family of vitamins that are
necessary to produce the genetic materials DNA and RNA, not only of the egg but also the
sperm. Together with vitamin B12, folic acid works to ensure that your baby’s genetic codes are
intact. Remember: it’s not enough to take folic acid alone when you are trying to become
pregnant. All of the B vitamins are essential during the pre-conceptual period. Research has
shown that giving B6 to women who have trouble conceiving increases fertility and vitamin B12
has been found to improve low sperm counts.
ZINC
Zinc is the most widely studied nutrient in terms of fertility for both men and women. It is an
essential component of genetic material and a zinc deficiency can cause chromosome changes
in either you or our partner, leading to reduced fertility and an increased risk of miscarriage.
Zinc is necessary for your body to ‘attract and hold’ (utilise efficiently) the reproductive
hormones, oestrogen and progesterone.

And it’s equally important for your partner: zinc is found in high concentrations in the sperm.
Zinc is needed to make the outer layer and tail of the sperm and is, therefore, essential for the
health of your partner’s sperm and, subsequently, your baby. Interestingly, several studies have
also shown that reducing zinc in a man’s diet will also reduce his sperm count.

SELENIUM
Selenium is an antioxidant that helps to protect your body from highly reactive chemical
fragments called free radicals. For this reason, selenium can prevent chromosome breakage,
which is known to be a cause of birth defects and miscarriages. Good levels of selenium are also
essential to maximise sperm formation. Blood selenium levels have been found to be lower in
men with low sperm counts.

OMEGA 3 FATTY ACIDS

These essential fats have a profound effect on every system of the body, including the
reproductive system and they are crucial for healthy hormone functioning. Omega 3 fatty acids
also control inflammation which may interfere with getting and staying pregnant. For men
essential fatty acid supplementation is crucial because the semen is rich in prostaglandins
which are produced from these fats. Men with poor sperm quality, abnormal sperm, poor
motility or low count, have inadequate levels of these beneficial prostaglandins.

VITAMIN E
Vitamin E is another powerful antioxidant and has been shown to increase fertility when given
to both men and women. Men going for IVF treatment with their partners have been given
vitamin E, and fertilisation rates have, as a result, increased from 19 to 29 percent. It has been
suggested that the antioxidant activity of vitamin E might make the sperm more fertile.

VITAMIN C
Vitamin C is also an antioxidant, and studies show that vitamin C enhances sperm quality,
protecting sperm and the DNA within it from damage. Some research has indicated that certain
types of DNA damage in the sperm can make it difficult to conceive in the first place, or it can
cause an increased risk of miscarriage if conception does take place. If DNA is damaged, there
may be a chromosomal problem in the baby, should the pregnancy proceed. Whether or not
DNA damage does have these effects has not been conclusively proven, but it’s worth taking
vitamin C and the other antioxidants as a precautionary measure.

Vitamin C also appears to keep the sperm from clumping together, making them more motile.
One study has shown that women taking the drug clomiphene to stimulate ovulation will have a
better chance of ovulating if vitamin C is taken alongside the drug. Clomiphene does not always
work in every woman, but the chances are often increased when vitamin C is supplemented.
BETA-CAROTENE
This is the vegetable precursor to Vitamin A and is completely safe during pregnancy. Beta-
carotene is a powerful antioxidant which helps to protect egg and sperm DNA from damage by
harmful free radicals which can affect the quality of both the egg and sperm. Free radicals are
highly unstable and set off a process called oxidation which can have harmful effects on the
every cell in the body. Beta- carotene will be contained in your multivitamin and mineral.

L-ARGININE
This is an amino acid found in many foods and the head of the sperm contains an exceptional
amount of this nutrient, which is essential for sperm production. Supplementing with L-arginine
can help to increase both the sperm count and quality.
Note: People who have herpes attacks (either cold sores or genital herpes) should not
supplement with L-arginine because it stimulates the virus.

L-CARNITINE
This amino acid is essential for normal functioning of sperm cells. According to research, it
appears that the higher the levels of L-Carnitine in the sperm cells, the better the sperm count
and motility.

FACTORS AFFECTING FERTILITY

What affects fertility?

For most people, the instinct to start a family is the most natural thing in the world. So, when
couples trying for a child run into problems, they can become anxious and even confused over
what their next course of action should be.

As a simple rule-of-thumb, the need to seek medical attention for fertility hinges on these
factors:

1. The age of the woman

The single most important factor that affects a woman's fertility is her age (Figure 1). Fertility is
fairly stable until the age of 35 years, after which there is a gradual decline. From about 40
years of age, the drop in fertility is profound. It is therefore important that women who are
reaching 35 and have not been able to become pregnant seek medical attention soon. This
becomes urgent for women who are nearing 40 years of age.
2. The length of time trying to conceive

Once you decide to have a baby, it is easy to become concerned if you do not conceive within
the first month of trying. But the fact is, even a normal, healthy woman (below the age of 30)
who is regularly having intercourse only has a 20- to 40-per-cent chance of getting pregnant
during any given cycle. So, what has gone “wrong” the other 60 to 80 per cent of the time? In
most cases there is no medical reason – the cause is usually because the quality of the egg or
sperm is insufficient to achieve fertilisation, or that fertilisation occurs but the embryo does not
survive beyond a few days. In fact, the odds of conception are actually quite good once you
look at them over the span of a year of trying, according to data from the National Center for
Health Statistics in USA (Figure 2).

Your Age Your chance of conceiving within one year

Under 25 96%

25 – 34 86%

35 – 44 78%

3. Medical problems

Do not delay seeking medical help, as your age is of crucial importance in determining fertility.
The following points will help you to decide when you should seek urgent medical advice:

1. Your age is more than 35 years

2. You have been infertile for more than two years

3. You experience irregular periods

4. You or your partner have sexual problems

5. You have had previous abdominal operations

6. You have been on more than six cycles of ovulation induction medication

7. You have had more than four cycles of SO-AI (Superovulation-Artificial Insemination)

In the absence of any medical problems, women below the age of 30 should see a
gynaecologist if they have trouble conceiving after one to two years of unprotected
intercourse. However, those between 30 and 35 should seek attention after six to nine months.
The urgency increases in women between 35 and 40 if they are not pregnant after six months;
while women over 40 should seek medical attention after three months of unsuccessful trying.

In most instances, your gynaecologist should be able to perform a preliminary fertility regime
and treat most of the problems, if any. If you have not conceived under your doctor’s care
within six to 12 months, see a fertility specialist [also called an RE (Reproductive Endocrine)
specialist, who is a gynaecologist with additional experience in fertility management], who can
guide you through the wide range of available treatments.

It is important to understand the thinking process of your doctors so a decision that is correct
for you can be made. This means that YOU actively participate in your treatment and assist
your RE specialist in formulating the best possible plan to becoming pregnant.
STAGES IN FERTILITY TREATMENT>>

Treatment Stages
Below is a guide to what you can expect throughout your journey at Thomson Fertility Centre:

1. Preliminary evaluation and ovulation induction

The first step if there is no pregnancy after the recommended time limit is to see your
gynaecologist. Some preliminary tests will be done, such as blood tests, ultrasound scans, and a
sperm analysis.

A course of fertility tablets will be prescribed to ensure that you ovulate. If a pregnancy still
does not occur within six months, a further continuation of medication is unlikely to result in
pregnancy.

2. A physical check

The next step to consider would be to check the fallopian tubes. These days, it is recommended
that this be done through “keyhole” surgery, or laparoscopy, which involves inserting a small
telescope into the abdomen through the navel. This has the advantage of checking if the
internal organs are normal and healthy; whether the tubes are blocked; and if the ovaries are
close to the “mouth” of the tube.

3. Superovulation and Artificial Insemination

Superovulation and Artificial Insemination (SO-AI) is the second phase of treatment. This
involves daily injections to boost your natural hormones. This has the aim of inducing the
growth of up to three eggs.

At the time of ovulation, your partner’s prepared sperm will be put into your womb in a simple
and painless procedure.

4. Simplified In-Vitro Fertilisation

In-Vitro Fertilisation (IVF) -- more commonly called the “test tube baby programme” -- is the
next step if SO-AI fails. IVF is the preferred treatment if the fallopian tubes are blocked or when
there is insufficient sperm for SO-AI.

Simply put, IVF involves extracting eggs from the body and mixing them with sperm in the
laboratory. These fertilised eggs, called embryos, are then placed in the womb. At most other
 centres, IVF requires frequent ultrasound scans and blood tests. In all, one can expect about 15
visits to the clinic. furthermore, a period of hospitalisation may be required afterward.

At Thomson Fertility Centre, however, a simplified IVF does away with almost all the blood
tests. The number of injections are reduced to a minimum – an average of 15 injections over
one month are required in comparison to 70 injections in other IVF centres. This allows the
number of visits to be reduced to about eight in total, and hospitalisation is rarely
required. Despite being much simpler and more convenient for you, there is no compromise to
safety, while your chances of becoming pregnant are still as high.

INTRAUTERINE INSEMINATION (IUI)

 Intrauterine Insemination (IUI)>

Intrauterine insemination or IUI, in short, is a fertility treatment that involves placing your
partner’s processed sperm sample inside your uterus, closer to the time of ovulation to
facilitate fertilization. This procedure can be performed during a natural ovulation or assisted
with hormone stimulation, Super Ovulation with IUI (SO-IUI). The goal is to isolate and
concentrate the number of motile sperm and to shorten the distance for them to reach the egg
resting in the fallopian tube and subsequently increase the chances of fertilization.

IUI may help couples who are diagnosed with:

- Unexplained infertility
- Moderate low sperm count and moderate low number of motile sperm
- Hostile cervical conditions (including cervical mucus problems)
- Cervical scar tissue from past procedure which may hinder the sperms’ ability to enter the
uterus
- Erectile dysfunction
- Non-consummation
IUI is a less invasive and less expensive option.
If you think you may be interested in IUI, speak to your doctor to discuss your options.

PROCESS OF IUI
1. The IUI procedure starts by monitoring the woman’s cycle to determine the day
of ovulation
2. Once the follicle is mature, ovulation either occurs naturally or is triggered by an
injection of a stimulation drug.
3. Husband submits semen sample which is washed in the lab to isolate and
contrite good motile sperm.
4. Finally, the processed sperm is injected directly into the uterine cavity using a
catheter closer to the time of ovulation, generally within 24 hours of ovulation.

IUI SUCCESS RATE

The success rate after IUI varies from 15% to 20% depending on various factors such as the age
of a woman, cause, and duration of infertility, etc.

WHAT IF IUI HAS FAILED?

Since IUI is a much simpler and less invasive procedure than an IVF cycle, it can be a good first
option for fertility treatment with a reasonable success rate. However, if you have had three or
more unsuccessful attempts with IUI, or if you are aged 35 or over, you are more likely to have
a greater chance of success with IVF.

RISKS FROM IUI

Although IUI is a simpler procedure, there are some risks involved in it. A low risk of infection
may occur after IUI. The risk of multiple pregnancies is also there when 3-4eggs develop when
 hormones are used in SO-IUI. You may be counseled to undergo IVF if more eggs develop due
to SO-IUI.

COST OF IUI
As the cost may vary depending on whether hormones are used or not, you may contact our
center for charges involved.

WHO IS NOT SUITABLE FOR IUI?

- Woman with disease of the Fallopian tube
- Woman with pelvic diseases
- Woman with endometriosis
- Male partner with severe low count and motile sperm

ENDOMETRIOSIS CLINIC
 >>
Many women suffer in silence during their monthly periods, assuming that painful cramps are
normal. Many endometriosis sufferers go undiagnosed until they try to conceive without
success or when the pain worsens, leading the sufferer to a gynaecologist.

Our treatment for women suspected to have endometriosis focuses on:

 Detection of endometriosis
 Management of endometriosis pain
 Optimisation of fertility

Our Specialist Dr Steven Teo, who is a Gynaecologist and IVF clinician, sub-specialises in the
management of endometriosis. He is experienced in the diagnosis and individualised treatment
of this condition, which affects about 10 per cent of the female population, with up to half of all
infertile women suffering from it.

What is Endometriosis?
Endometriosis is a disease defined by the presence of endometrial-like glands outside of the
womb cavity. When the inner (menstrual) lining of the womb “migrates” outside of its usual
location, it may result in problems and symptoms associated with endometriosis. As the “wrong
tissue” appears in the “wrong place” of the body, it will incite a chronic inflammatory reaction,
resulting in pain and scarring, which in turn can affect the proper functioning of the
reproductive structures.
Typically, sufferers of endometriosis experience pain during or just before menstruation, some
have pain during sex and occasionally, a few may complain of pain when moving bowels or
passing urine. Certain individuals with severe, long-standing disease may have constant pain
which no longer fluctuates cyclically.
Another common symptom of endometriosis is infertility. The inflammation process and
resultant scarring can adversely affect the reproductive organs, as well as distort the
reproductive structures (e.g. kinking or blockage of fallopian tubes, formation of ovarian cysts,
etc) and make pregnancy difficult. In addition, the pain from endometriosis may preclude
regular intercourse, further contributing to infertility.

Symptoms of Endometriosis
Symptoms generally develop before the age of 30 and can include any of the following:
 Menstrual Pain
 Pain during or after sex
 Pain on urination / opening bowels
 Blood in stools
  Chronic pain
 Inability to conceive

How is endometriosis diagnosed?

The only method of diagnosing endometriosis is by laparoscopy or keyhole surgery, especially
with removal of the diseased tissue removed for examination. However, it is an invasive
procedure and care must be taken to avoid unnecessary risks for women without
endometriosis. The formula for detecting the disease involves detailed interview and physical
examination, as well as pelvic ultrasound scans. Hence, we rely heavily on the specialists’
experience, clinical acumen and high index of suspicion in order not to miss cases with
endometriosis. There is no need for elaborate blood tests or high-resolution imaging studies for
most cases, which are not accurate for endometriosis anyway.

What are the management or treatment options for endometriosis?

This can generally be categorised into either surgery and medication. The choice of treatment
has to be tailored to the woman (or couple, in some cases), depending on level of suspicion for
endometriosis, the impact of the disease on the woman and the desired outcome of treatment
(pain control, fertility or both).

About Our Specialist - Dr Steven Teo specialises in advanced laparascopy to complement

fertility treatment. He is a Level 3 Minimally Invasive Surgery accredited specialist and is
actively involved in the teaching of laparascopy. Dr Teo is well-versed in reproductive medicine
and assisted reproductive techniques and specialises in general Obstetrics and Gynaecology. Dr
Teo also manages general Obstetrics and Gynaecology cases, looking after normal as well as
complicated pregnancies, and treats women with conditions such as fibroids, endometriosis
and menstrual disorders.