If you have been trying to conceive for sometime without success, you may be wondering if IVF is suitable for you.
IVF stands for in-vitro fertilization, which is a form of assisted reproduction technology. Although conceptually it may sound simple, that is removing an ovarian egg and fertilizing it outside, followed by implanting the fertilized egg back into the uterus, IVF comes with a lot of stress, is costly and there is also no guarantee of success. IVF may not be suitable for everyone nor will it increase the chances of conception in all cases – let’s take a close look at IVF.
Suitability for IVF
In general, IVF is not always a first option. There are other options such as oral and injected fertility medications. There would be various factors that affect the possibility of trying for natural pregnancy or opt for other less costly treatments first.
Your age – If you are below 35, you may be advised to wait for another six months and meanwhile, to time your sex at the time of ovulation to increase the chance of the sperm fertilizing the egg.
Your egg reserve – You may be tested for your egg reserve and if it is high, more options are available as opposed to low egg reserve, i.e. there is limited time to explore other options as you have a limited store of eggs.
Your spouse’s sperm – For low sperm count or quality, it would lean more towards IVF options as you need to increase the chances of the sperm fertilizing the egg.
Your uterus – Tests may be conducted to examine your uterus, including the fallopian tubes, to see if there is any tubal blockage. Medical conditions that would prevent the sperm from reaching the egg, or the egg to stay implanted, may require IVF or even having a surrogate as your uterus may not be able to bring the fetus to full term.
Here are the things you NEED to know before Starting IVF!
#1 Assess the couple’s fertility
It is crucial to investigate why conception has been difficult in the first place; as the fertility issue can lie with both the man and the woman, it is important for both your spouse and you to undergo tests. For the male, if the sperm count is low and thus natural conception is difficult as the sperm may not reach the egg for ovulation, IVF can assist as the sperm is directly extracted for fertilization with the egg. The quality of the sperm will also make a difference in how the egg is fertilized by the sperm during IVF, whether it requires injecting the sperm directly into the egg. For the female, it is good to know your egg reserve and assess whether you can wait and try other methods.
#2 Your chances of IVF success still rest on your age
There is no guarantee that IVF will work all the time, and IVF is also more successful for those in early 30s (about 30 plus percent) than those in 40s (whereby the success rate drops to below 20 percent). The ability of the egg to be fertilized successfully partly rest on its age, and therefore, it is important to discuss with your doctor and understand the medical guidelines on what can be done for your case, for instance, the number of embryos that can be implanted. (In Singapore, social freezing of eggs is not allowed.)
#3 IVF is costly
IVF costs about S$8,000 in public hospitals, co-funded to up to 75% by government if the IVF cycle is started before the woman reaches the age of 40. Payments can by made by Medisave whereby S$6,000 can be withdrawn for the first cycle, S$5,000 for the second cycle, and S$4,000 for the third and subsequent cycles up to a lifetime cap of S$15,000. For private clinics, IVF can cost more than S$15,000. As the embryo (fertilized egg) can be genetically tested, there are also add-on costs to it and also for freezing of the embryo which increases the success rate of IVF.
#4 IVF takes time
Again for older women, it generally takes more cycles for IVF to be successful. A cycle normally takes about two weeks, starting with oral or injected medications to stimulate the ovaries to make more than one egg. Examination and tests are required to check whether the eggs are mature and also to check the condition of the egg follicles. After weeks of medication, the woman has to undergo outpatient surgery to retrieve the eggs. The egg is then exposed to the sperm to be fertilized. During this time, the woman has to take progesterone supplements to prepare the uterine lining. The embryo can be frozen first before placing back into the uterus as recent advancements in freezing technology point to higher rate of IVF success if the embryo is frozen first. Freezing the embryo first gives time for the woman to have her period and build a better uterine liming, compared to the environment right after the fertility medication. All these cost money and take time, and can be emotionally stressful due to the wait.
#5 Set time for a healthy lifestyle
Similar to natural pregnancy, the health of the mother plays an important role. Although age remains a major factor, other lifestyle habits such as a healthy diet, cutting down sugar, alcohol, smoking and reducing stress and workload can help improve the quality of the egg and embryo, as well as the environment for the fetus to grow.
#6 Complications, risks and side effects
There may be side effects during the injections or oral medications, which will introduce an excess of estrogen to your body to stimulate more ovulation. There is a higher risk of blood clots, incorrect puncturing of the needles and over-stimulated ovaries. After the embryo transfer, some women may also experience breast tenderness, cramping, constipation or infection. There are also higher risks associated with postpartum depression, and mothers having gastric reflux after birth.
#7 Questions to ask
Since IVF takes time, cost and also carries risk, it is important to be confident and comfortable with your doctor and the fertility clinic. For instance, you can ask questions such as their success rate, experience with couples of your age group or with your type of fertility problem, their costs, their storage facility program and whether they have access to donor banks.
When IVF doesn’t work, what are the available option?
When the first IVF cycle doesn’t work, you can discuss with your doctor whether to go for another cycle as it normally takes more than one cycle for IVF to be successful. There are other options available that you can discuss with your doctor, depending on the doctor’s assessment of why the IVF has not been successful. It could be an issue with the egg, sperm, egg follicles or uterus.
If it is a problem with the egg or sperm, you may want to consider using donor eggs or sperm. While there are sperm banks, getting eggs from commercial transactions are not allowed in Singapore. It is therefore more difficult to obtain donor eggs, and likewise, clinics are not allowed to make surrogate arrangements for patients in Singapore. A lot of the decisions also depend on the couple views (which may also change during/ after the IVF treatment), such as how important it is to have a biological child as opposed to adoption.
