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Infertility
In-vitro fertilisation (IVF) is a popular type of assisted reproductive technology (ART) that involves the fertilisation of an egg with a sperm outside the body to form an embryo. The embryo is then transferred into the uterus.
Medically reviewed by Dr Christopher Ng, Consultant Obstetrician & Gynaecologist
IVF is the technique in which the egg and sperm are artificially fertilised together outside the woman’s womb in the fertility centre. The fertilised embryos are allowed to grow for a few days before being placed into the uterus.
IVF is the only treatment recommended for women with irreparably damaged or blocked fallopian tubes. It is also suitable for couples with conditions like endometriosis, ovulatory dysfunction, unexplained infertility, failed SOIUI, sperm disorders, and immunological problems.
As IVF requires more monitoring than other treatments, couples need to undergo a detailed consultation with our IVF gynaecologist before commencing treatment. Any questions regarding the entire IVF process can be raised at this point. This helps to reduce patient anxiety when they realise that modern IVF treatments are now relatively stress free.
Before the IVF procedure, the couple will need to undergo various blood tests and health screenings for infectious diseases, semen analysis, ovarian reserve determination, and nutritional advice.
Couples seeking IVF will first undergo a detailed medical evaluation to assess their reproductive health and identify any underlying causes of infertility. The IVF doctor will then determine if they are suitable for the procedure.
IVF is usually recommended to couples experiencing infertility caused by:
The success of IVF depends on the patient’s overall health, the quality of the embryos, and the skill of the IVF doctor. After the couple is deemed eligible for IVF, the doctor will recommend several preparatory measures. These include eating a balanced diet, maintaining a healthy weight, eliminating smoking and alcohol consumption, and taking prenatal supplements.
To increase the number of eggs, daily fertility hormonal injections are given for a 10- to 12-day period to stimulate the ovaries to produce multiple mature eggs during a stimulated cycle. Patients usually administer these injections at home. Ultrasound scans and blood tests are done every few days to assess the growth of the eggs. The dose of the hormones injected may be adjusted accordingly to ensure optimal growth of the eggs.
Eggs of the desired size are collected trans-vaginally using a special needle attached to an ultrasound probe. The patient will be sedated during the retrieval process to minimise any discomfort.
At the time of the egg collection, the husband will have to produce a fresh semen sample. He is advised to abstain from sexual intercourse for three days beforehand to improve sperm quality. The best-quality sperms are selected and prepared for insemination (fertilisation). Intracytoplasmic sperm injection (ICSI) is used to increase the number of fertilised embryos available for embryo transfer and involves injecting a single sperm into each egg via a microneedle.
The embryologist will carefully monitor the growth of the embryos for the next few days and select the most suitable ones for embryo transfer. A maximum of two embryos can be transferred into the uterus using a fine catheter. Any extra good-quality embryos will be frozen and stored for future use.
The patient will be given daily hormonal support to maintain the lining of the uterus (endometrium) and to enhance the chances of the embryos implanting. A pregnancy test is then performed 14 to 17 days after embryo transfer at our IVF clinic.
The pregnancy rates for IVF-ICSI treatments at our IVF clinic vary according to various factors, such as the patient’s age (woman in particular), the quality of eggs and sperms, the duration of infertility, and the general state of health of the couple, among the other male and female infertility factors. Generally, women below the age of 35 have a higher chance of conceiving.
While IVF is a safe and established procedure, there are still some risks to take note of. These include:
The fertility drugs taken during IVF treatment can cause temporary side effects, including:
Patients may experience light vaginal bleeding or spotting in the first few days after embryo transfer. The IVF
doctor will prescribe hormonal supplements, such as progesterone, to support the uterine lining and improve the
chances of implantation.
About 14–17 days after the embryo transfer, the patient will return to the IVF clinic for a pregnancy blood test
which is more sensitive and accurate than a urine test. It measures the level of human chorionic gonadotropin
(hCG) in the patient’s bloodstream, a hormone secreted by the placenta during pregnancy.
If the test results are positive for pregnancy, the mother will be managed by the obstetrician until her
successful delivery. However, if IVF is unsuccessful, the gynaecologist may recommend another IVF cycle, explore
alternative fertility treatments, or discuss the next steps tailored to the patient’s situation.
The success rate of IVF treatments varies depending on specific factors, with the main determinant being the
woman’s age. Generally, women under 35 years old have a 32% to 55% chance of conceiving through IVF, while women
over 40 will have a success rate of only 1% to 10%.
Other factors that may affect the success rate of IVF include:
To optimise one’s chances of success with IVF, doctors recommend that one should maintain a healthy weight, have a balanced diet, exercise regularly, reduce stress, quit smoking, and limit alcohol consumption. In addition to these healthy habits, consulting an experienced fertility specialist is important, so that patients can receive tailored medical advice and care for the best possible outcome.
No, IVF does not increase the risk of birth defects compared to natural conception. Furthermore, IVF in some countries (but not Singapore) include genetic testing, which further ensures a higher chance of normal foetal development.
Sex selection prior to embryo implantation is not allowed in Singapore. However, it may be allowed for certain medical reasons, such as if there is a hereditary, sex-linked chromosomal disorder that is present.
If an IVF cycle is unsuccessful, most fertility specialists advise waiting until a full menstrual cycle has occurred, before attempting another cycle. This waiting period allows the body to recuperate.
The IVF procedure can be uncomfortable in some stages, such as during ovarian stimulation (ovaries enlarge due to the hormone injections needed) and egg retrieval, which may result in some cramping. However, these are temporary and usually manageable.
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