Assisted Reproductive Techniques

Advanced methods to help conception.

Assisted Reproductive Techniques or ART refers to the use of Laboratory techniques to bring the egg and sperm together outside of the woman’s body. ART may atso be referred to as In-Vitro Fertilisation (IVF).

ART generally involves several treatment stages. Firstly, in order to increase the number of eggs produced by her ovaries, woman has to undergo hormonal injections. Secondly, ultrasound scans and blood tests are needed to assess the growth and maturity of the eggs. Once the eggs are ready, they are retrieved with the help of a vaginal ultrasound white the woman is under anaesthesia. The eggs are then fertilised with the sperm in the laboratory to form embryos before they are transferred back into the woman’s womb several days later.

Because it is a fairly complex and stressful process with some risks involved, IVF is usually recommended only if simpler fertility treatment procedures such as fertility drugs or intra-uterine insemination have not worked.

For some couples, IVF may be recommended earlier if, in view of the couples’ condition, it would give them the best chances of conceiving. These conditions include severe male factor infertility due to abnormal sperm count or quality, as well as gynaecological conditions such as disease or obstruction of the fallopian tubes, and endometriosis. If the woman is near the age of 40 years, IVF may also be recommended earlier as pregnancy success rates fall marked ty over 40 years.

In Singapore, ART and IVF procedures can only be carried out on married couples who have both been counselled and who have both consented to the procedures. Another condition is that the woman should be aged below 45 years.

MEN AND ARTS

ART has made fertilisation and subsequent Live birth possible for men with impaired sperm count and quality. Nowadays, intra-cytoplasmic sperm injection (ICSI) is often utilised to enable the sperm to be directly injected into the egg with the aid of a glass needle and this can help to overcome fertilisation failure.

Initial concerns that assisted fertilisation with apparently defective sperm may Lead to birth defects have not been founded. However, for men with severe mate factor infertility (sperm count of Less than 5 million per millilitres), genetic testing is appropriate so that in the event that any genetic condition is found, counselling may be recommended prior to assisted reproduction treatments.

For couples going for ARTs, they should enhance their health as much as possible. Any chronic medical conditions e.g. diabetes, should be brought under control. A healthy diet and Lifestyle should be observed. Couples should not smoke and should reduce their intake of alcohol and caffeine. A regular exercise regime can help to control their weight and provide stress reduction benefits.

IMPROVING FERTILITY

Men should avoid gonadotoxic factors such as exogenous heat from hot baths and saunas. They should also avoid medications that can adversely affect their sperm function. Antioxidant supplements with vitamins A, C and E should be taken to improve sperm quality. Men should avoid gonadotoxic factors such as exogenous heat from hot baths and saunas. They should also avoid medications that can adversely affect their sperm function. Antioxidant supplements with vitamins A, C and E should be taken to improve sperm quality.

Women should ensure they are immune to rubella because infection during pregnancy can Lead to congenital birth defects. They should also take folic acid to prevent birth defects such as spina bifida.

A thorough gynaecological evaluation should be undertaken before commencing on ART. Laparoscopic or minimally invasive key-hole surgery may sometimes be recommended before ART for the treatment of swollen fallopian tubes, fibroids, ovarian cysts and endometriosis. A hysteroscopy involving the use of a camera device to assess the uterine cavity may also be needed to ensure a heatthy environment for the implantation and growth of the embryos transferred.

UNSUITABLE CANDIDATES

ART is not suitable for women who are already in menopause and therefore have no more healthy eggs left. It may also not be suitable for women who have repeated failed cycles. Although with some patience, Luck and perseverance some patients do successfully conceive only after multiple IVF attempts, repeated failures may indicate a problem with the eggs, sperm or embryos which may make ART unlikely to be effective in these cases. In such situations, couples may turn to egg or embryo donation, or adoption. In Singapore, women under 40 years are allowed a maximum of 10 consecutive IVF cycles reaching the stage of embryo transfer. For women between 40 and 45 years of age, a maximum of 5 cycles reaching the stage of embryo transfer is allowed.