FAQ

Low number of sperm produced, or not at all (Azoospermia is a term used when there is a complete absence of sperm in the ejaculate)

Blood tests to investigate hormone levels may be required. A testicular biopsy may be required to determine the ability of the testicles to produce normal sperm.

According to World Health Organization (WHO) on infertility definition, couple should seek fertility treatment after 12 months of unprotected intercourse, with the same partner, without resultant pregnancy.

For Her

• AMH

• Vitamin D

• Hysterosalpingogram                                 

• Ultrasound scan

For Him

• Semen analysis                               

• Blood test (if require as recommended by Fertility Specialist)

The cost of treatment depends on the options of treatment. Please contact Star Fertility Group for further information.

No insurance coverage for fertility treatment is available.

The EPF allows all members to make withdrawal from your Account 2 for reimbursement to your fertility bill expenses for below treatment :

1. IVF Treatment

2. ICSI Treatment 

3. IUI (Intrauterine insemination) Treatment

The egg retrieval (also known as Ovum Pick-Up procedure, or OPU), will be performed under sedation; our patients are asleep. The beauty of this approach is that you will feel absolutely nothing, remember absolutely nothing, and will have few of or none of the typical side effects of sedation such as nausea and vomiting. The OPU procedure lasts approximately 20 to 30 minutes. You will be discharged several hours after procedure within the day of OPU.

For IVF treatment, two methods of fertilization are available: 

1. Conventional In-Vitro Insemination (CIVI) 

2. Intracytoplasmic Sperm Injection (ICSI)

CIVI, formerly known as conventional IVF, involved co-incubation of oocytes with sperm in culture dish with the goal to produce in-vitro fertilization, which mimic the natural way of fertilization in the women's reproductive tract, in which the sperm will have to penetrate the egg's wall (known as the zona) in order to reach the egg's cytoplasm to establish fertilization.

On the other hand, ICSI is a procedure in which a single spermatozoon is selected and injected directly into the mature oocyte cytoplasm by embryologist.

For both of the fertilization techniques, determination on the successful of fertilization (define by formation of pro-nuclei from both sperm and egg) can only be done on the next day after insemination.

In general, 

Day-1 Zygote, 

Day-2 & Day-3 cleavage stage embryo, 

Day-4 morula and 

Day-5 or Day 6 blastocyst can be transferred.

The successful of IVF treatment is depending on several factors from both partners including age, weight and emotional stress. It is generally accepted that women's age play a crucial role in determining egg's quality, and eventually, fertility treatment outcomes.

But, did you know that putting more than one embryo back in the womb could increase the health risk to both the mother and the babies? Twin or triplets babies might seem wonderful, but the reality could be much more complicated than what you can expect, the likelihood of your babies born prematurely is six times higher compare to a singleton pregnancy, which can lead to long-term health problems such as difficulty breathing, cerebral palsy and other physical and learning difficulties of your babies.

We encourage couple to transfer not more than two embryos, preferable single embryo transfer for women aged below 35 years old to reduce the risk of multiple pregnancy.

'One at a Time' Concept

Multiple pregnancy in fertility treatment can be reduced with elective Single Embryo Transfer (eSET) - having one embryo transfer back in the womb. The remaining good quality embryo (s) can be frozen for future use in later cycle.

Complications of Multiple Pregnancy

Multiple gestations can have many of the following complications:

• Increased rate of spontaneous abortion

• Two to three times greater risk of developing severe hypertension or preeclampsia (increased blood pressure)

• Maternal anemia due to increased fetal demands

• Premature rupture of membranes (bag of water)

• Incompetent cervix (cervix opens due to pressure)

• Intrauterine growth restriction of one or more fetuses

• Preterm labor due to overstretched uterus

• Abnormal fetal presentations

• Need for cesarean section

• Rare complications with twins, such as twin-to-twin-transfusion syndrome (one fetus receives more nutrients than the other due to more blood vessels perfusing one baby)

• Conjoined twins

• Postpartum hemorrhage

Controlled Ovarian Stimulation during IVF treatment caused suboptimal uterine environment that negatively impact embryo implantation, and thus clinical pregnancy outcome.

Conversely, frozen-thawed embryo transfer cycle allowed sufficient period of rest from hormonal stress due to controlled ovarian stimulation during IVF, thus, cultivates better environmental condition within the uterus during embryo transfer, and enhance implantation with subsequent higher clinical pregnancy outcome compared to fresh transfer.

A pregnancy blood test (βhCG) is usually done 12-14 days after embryo transfer, while a confirmation of clinical pregnancy test via ultrasound scan will be done 19-21 days post embryo transfer.

We would recommend at least one full menstrual cycle of waiting before undergoing IVF a second time. We know that it can take up to 6 weeks for inflammation to resolve; therefore, it is reasonable to wait a similar amount of time before restarting the process.

1. Reaction to fertility hormones

2. Ovarian Hyper-Stimulation Syndrome (OHSS)

3. Adnexal Torsion (Ovarian Twisting)

4. Complications from Egg-retrieval Procedure

5. Ectopic Pregnancy

Reaction to fertility hormones

You might develop a mild reaction to fertility drug during IVF cycle which include:

• Hot flushes

• Feeling down, irritable or mood swing

• Headaches

• Restlessness

Talk to your fertility specialist if the intensity of the reaction gets worse, she may be able to adjust your dosage or switch to another drug.

Occasionally, the side effects of fertility drugs could be serious. We advise you to contact your fertility clinic directly if you notice:

• Allergic reaction - these include difficulty in breathing and tightness in your chest

• The symptom of severe ovarian hyperstimulation (OHSS)

Ovarian Hyper-Stimulation Syndrome (OHSS)

OHSS occurs due to over reaction to fertility drug use in egg triggering, known as hCG trigger in IVF cycle. OHSS is characterized by enlargement of ovaries with presence of multiple corpus luteum cysts and shift of fluid into the extravascular space of abdominal cavity.

The chances of OHSS increase in women with:

• Polycystic ovarian syndrome

• Young age

• Low body weight

• Previous episodes of OHSS

• High number of follicles

OHSS can be classified as mild, moderate, or severe according to the degree of symptoms which include abdominal distention, ovarian enlargement, respiratory, hemodynamic, and metabolic complications.

The symptoms of OHSS usually develop during the week after egg retrieval. Most cases of OHSS are mild and without any serious or prolong complication (usually lasts within a week or two). In some cases, your fertility specialist might consider delaying the embryo transfer by freezing the embryo and transfer at a later date. Occasionally, in rare severe cases, OHSS can be life threatening.

It has been proven that the risk of OHSS can be reduced by using GnRH Agonist triggering during IVF cycle. Consult the fertility specialist on the treatment regime associating with OHSS. Star Fertility Group takes into consideration of the risks and safety of OHSS seriously, and as a result, GnRH Agonist triggering is applied as a strategy to reduce your risk of developing OHSS.

Adnexal Torsion (Ovarian Twisting)

The term refers to when the stimulated ovary twists on itself, due to high number of follicles in the ovary, cutting off its own blood supplies. The overall risk is 0.2%. In a normal condition, the ovary is meant to carry only one mature follicle, however, due to stimulation in IVF cycle, the number of mature follicles increase, causing the ovary to become heavier and lead to twisting. Treatment is surgery to untwist the ovary and even removing it sometimes.

Complications from Egg-Retrieval Procedure

Egg retrieval or ovum pick-up (OPU), is a medical procedure to surgically remove eggs from a woman's ovaries transvaginally for IVF purpose.

Common complication post OPU includes:

• Vaginal bleeding/spotting

• Mild bloating

• Mild cramping

• Breast tenderness due to high oestrogen levels

• Constipation

• In rare occasion, pelvic infection might occur

OPU is a simple procedure; you will be allowed to go home several hours after completion of procedure with some antibiotics to prevent infection.

Ectopic Pregnancy

Ectopic pregnancy happens when the fertilised egg implants outside the uterus, usually in a fallopian tube. The incidence of ectopic pregnancy seems higher with IVF treatment, especially if you already have problems affecting your fallopian tube. However, it has been proven that blastocyst transfer is associated with lower risk of ectopic pregnancy compare to cleavage stage transfer (Day 2 or Day 3 transfer) in IVF treatment.

The symptoms of ectopic pregnancy may include:

• One-sided low abdominal pain

• Vaginal bleeding

• Dark brown vaginal discharge

The pain intensifies as the pregnancy progresses. The major risk of ectopic pregnancy is rupture of the fallopian tube causing internal bleeding. You should talk to your doctor if you experience sharp abdominal cramp or vaginal bleeding in early pregnancy.