Q. I am 38 years old and my husband is 40. We have been married for five years and have been trying to conceive naturally.
As age is catching up on us, we have been advised by friends to consider in-vitro fertilisation (IVF).
I would like to know about the process and what are my chances of conceiving.
A. In general, after one year of trying to conceive, doctors will strongly advise a couple to seek some form of medical assessment.
IVF is one of many ways to help a couple conceive.
The factors causing infertility can be largely divided into male and female factors.
Female factors include blockages in the fallopian tubes, ovulation problems and endometriosis.
Male factors include varicocele (dilated veins around the testicles), infection and hormonal problems which cause an abnormal quantity or quality of sperm.
Optimisation of the womb's condition and its surroundings is important in order to maximise success with IVF.
For example, a fibroid distorting the lining of the womb would need to be removed to give the embryos the best environment to be implanted.
Similarly, attempts can be made to correct sperm abnormalities in order to maximise a couple's chances of pregnancy.
In my opinion, it is very important to identify and correct various factors causing infertility and not to rely solely on IVF when we deal with the problem of infertility.
Sometimes, after a simple surgical procedure to, for example, unblock the fallopian tubes or remove a polyp, the woman can conceive naturally after just a few months.
If the causes of infertility are severe, say, the sperm quality is very poor, IVF is a good option.
It involves stimulating the ovaries to produce follicles (egg-containing sacs) in a controlled manner. Once the follicles attain a good size and quantity, an injection is given to mature the eggs within.
The woman then undergoes a simple procedure to extract the eggs, which are inseminated with the husband's sperm in the laboratory.
Sometimes, it is necessary to inject the husband's sperm into the cytoplasm of the eggs in a process called ICSI (intra-cytoplasmic sperm injection) to increase the rate of fertilisation. The fertilised eggs are then cultured in the laboratory for two to five days. Good-quality embryos are then transferred to the woman's womb.
Hormones are used to stabilise the womb's condition until the pregnancy is confirmed.
Part of the IVF treatment involves the use of injections to control the pituitary (a central regulator of hormone production located at the base of the brain) before the stimulation of the ovaries can begin.
The daily injections usually last for 20 to 30 days in one treatment cycle.
Recently, with new medication, we are able to shorten the duration of these injections to about nine to 11 days, without compromising the success rates.
A woman's ovarian reserve decreases with age and the quality and quantity of her eggs will deteriorate. The success of IVF therefore depends on one's age.
In my centre, the success rate is more than 45 per cent per cycle for women below 35 years of age.
The rate falls to about 12 to 14 per cent for women over 40.
DR LOH SEONG FEEI
Medical director of Thomson Fertility Centre
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