FERTILITY TREATMENT

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Fertility Treatment

Timing SI

Timing SI is timing sexual intercourse which is relative to ovulation day. This method is suitable for young couple who has ability to pregnant naturally. It can perform in both of natural cycle or egg stimulation cycle.

To find the best time for having sexual intercourse in natural cycle, this treatment will observe the egg by performing transvaginal ultrasound scan in the mid of cycle. Once the size is reaching the state of ovulation then apply the injection to trigger ovulation.

This method uses oral medicine from day 2 or 3 of period and sometime combine with additional injection after finished oral medicine to stimulate the eggs and observe the growing egg follicles by transvaginal ultrasound scan in the mid of cycle for trigger ovulation.

Intrauterine insemination (IUI)

This treatment help sperm fertilize the egg naturally by inject sperm directly into uterus during ovulating period. IUI is more commonly done to couples with unidentifiable causes of infertility or male patients with moderate infertile problems or female patient suffering from irregular ovulation. To achieve this treatment, at least one side of tube must not be blocked in order to let sperm travel and fertilize an egg. The IUI treatment can apply in both of natural cycle and stimulation cycle.

Inform the clinic on 1st day of period.
Perform the ultrasound scan to observe follicle size on 12th-13th day of the period.
Trigger ovulation and schedule IUI.

Inform the clinic on 1st day of period.
Start taking egg stimulation medicine on 2nd-3rd of the period
Perform the ultrasound scan to observe the follicle size on 12th-13th day of the period
Trigger ovulation and schedule IUI.
The treatment shows success rate around 10%-15% in each treatment cycle.

In Vitro Fertilization (IVF/ICSI)

In Vitro Fertilization or commonly called IVF which means fertilization outside the body is UpToDate innovation on assist reproductive technology which shows successful pregnancy rate about 30%-40%, the highest success rate if compare to other treatment. However, the success rate can be varied by many factors such as age, embryo quality etc.

The treatment starts from using injection every day for 8-10 days to stimulate the ovary to produce multiple eggs. The eggs are then collected and fertilized with the prepared sperm under proper environmental controlled conditions in the laboratory. The fertilized eggs develop into embryo and continue incubated for 5-6 days until reach the blastocyst stage of embryo. Then the embryo is will be transferred into uterus or frozen.

ICSI is a technique to assist fertilization for men with high level of defect sperms, low ability for fertilization. ICSI is generally performed under a microscope using a single good quality sperm directly injection into an egg and then let the fertilization happens.

The difference between IVF and ICSI

The difference between IVF and ICSI is in the method of fertilization. IVF fertilization methods are closely natural fertilization which a sperm get into an egg and fertilized itself. The embryologist will release prepared sperm around the egg, only the strongest sperm can get into an egg for fertilization.

For ICSI (Intracytoplasmic Sperm Injection, selected healthy sperm only 1 sperm and injected into 1 egg by specialized equipment under a microscope for achieve fertilization. The ICSI method can increase the fertilization rate and reduce abnormal fertilization problems.

IVF treatment with embryo chromosome screening

Abnormality of embryo may cause the implantation not to occur, incomplete implantation or pregnancy with an abnormal fetus. This problem is usually found in mothers older than 35 years. Nowadays we bring technology is used to screen abnormalities of embryo chromosome (Preimplantation Genetic Test for Aneuploidy: PGT-A) and select only the embryo with normal chromosomes transferred back into the uterus. This will increase the pregnancy rate, reduce the risk of miscarriage and reduce the chance of fetal abnormalities.

PESA, TESA/TESE

The severe cases of male infertility such as anejaculation, the absence of sperm on semen analysis may be due to azoospermia, congenital bilateral absence of the vas deferens, vasectomy or no viable sperm after ejaculation. To overcome severe male infertile problem there are treatment options depending on the sperm source available and patient preference such as the following:

Percutaneous Epididymal Sperm Aspiration (PESA): This is the technique that sperm are aspirated from the epididymis through the skin
Testicular Sperm Aspiration (TESA): This technique collects sperm from the testicle by needle aspiration
Testicular Sperm Extraction (TESE): This is an open surgical biopsy technique to remove a few testicular tissues and extract to find the sperm.

As there are very few amounts of sperm from these retrieval techniques, the doctor will recommend the patients to undergo ICSI for the higher chance of fertilization. Unfortunately, if there is a problem identified that the testicles are incapable of sperm production, we may retrieve premature sperm subsequent to rather low success rate.

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