Fertility Associates offers a range of options for fertility treatment. From lower technology treatment such as Ovulation Induction (OI) and IntraUterine Insemination (IUI) through to high tech treatments like In Vitro Fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI) with technology like Pre- Genetic Screening (PGS) and Time lapse Imaging (TiMi)

It is important to look after yourself and your partner before and during treatment, from eating well to minimising stress. Our team can help you with practical advice and our information magazine Pathway to a child, is full of useful information.

Non-IVF Treatment

Often couples need is a little help. Rather than undertaking a complex treatment like IVF, we will try lower technology treatments such as Ovulation Induction (OI) and IntraUterine Insemination (IUI).

Ovulation induction (OI) uses medication to induce ovulation in women who do not have periods or whose menstrual cycles are not regular.

OI usually involves taken pills for 5 days to help start the growth of follicles in the ovary, followed by a few blood tests and often one or two ultrasound scans to see whether the pills are working as planned.   Results from the blood tests and ultrasound scans can help decide the best days to have intercourse to become pregnant.

The main risk for this treatment is having a multiple pregnancy such as twins.

IntraUterine Insemination (IUI)can be used for a variety of types of infertility, such as mild problems with sperm quality, mild endometriosis or unexplained infertility. Often medication is given to increase the number of follicles growing the ovary.  Follicle growth is followed by blood tests and often ultrasound scans.

At the time of ovulation, sperm is prepared and is placed into the uterus using a fine catheter.

When medications are used, the main risk is multiple pregnancy, but this can be reduced by stopping if too many follicles develop. 

For more information, read the pages on ovulation induction or IUI in our information magazine Pathway to a child.

Did you know?

There are many pathways through
fertility treatment and everyone experiences if differently.

To help you navigate your way through the possible paths, take a look at our ‘Pathways to a child‘ section.

IVF

In vitro fertilisation

Many causes of infertility can be successfully treated with IVF – male infertility, tubal damage, endometriosis, ovulation problems and unexplained infertility.

STEP 1 - Ovulation Induction and Monitoring

Hormone drugs are given to the woman to increase the number of eggs developing in her ovaries. Fertility specialist doctors keep an eye on the eggs’ development by using the results from blood tests and ultrasound scans. At the appropriate time, maturation of the eggs is triggered by another drug so the doctor can retrieve the woman’s eggs at the right time. Usually the eggs will be used ‘fresh’, but sometimes eggs are frozen to be thawed and used later.

STEP 2 – Sperm Collection

A sperm sample (pictured above) is produced by the man and given to the laboratory. If a man doesn’t have any sperm in his semen, sperm can sometimes be surgically retrieved.Sometimes the sperm will be used ‘fresh’, and sometimes it will be frozen to be thawed and used later.

STEP 3 – Egg Collection

The doctor uses an ultrasound scan and a long needle to collect eggs from the ovaries. This procedure takes about 15 minutes and pain relief is used to help with any discomfort.

STEP 4 - Fertilisation

The embryologist takes the eggs and sperm and places them into a solution containing nutrients in a Petri dish, which is placed in an incubator. If / when a sperm joins the egg, fertilisation has occurred.

STEP 5 – Embryo Development

All going well an embryo will develop. This is a pronuclear embryo that is 1 day old (pictured below left). Embryos are then cultured for a further 1-5 days. During this time a series of checks helps identify the embryo(s) with the greatest developmental potential. Embryos may be left to develop or frozen to be thawed and used later.

Below middle is pictured a two cell embryo that is 1-2 days old .

1 Cell Embryo

2 Cell Embryo

8 Cell Embryo

STEP 6 – Embryo Replacement

The embryo continues to develop into an eight cell embryo (pictured above right) at 3 days old. This is a normal pace of development, and sometimes embryos are replaced back into the uterus on this day.

By 4 days the embryo forms a morula (pictured below left) which means Mulberry in Latin – simply because it looks like a berry.

By day 5 the embryo has developed into a blastocyst (pictured below middle). Nowadays, it is increasingly common to replace blastocysts into the uterus. Usually one or, if the woman is older, sometimes two embryos are selected for transfer back into the uterus. In the past, two or three embryos were replaced at the same time to increase the chance of pregnancy. That also increases the chance of twins and even triplets. That is why so many IVF-lings from earlier years are twins.

Morula – 4 day old Embryo

Blastocyst

A Embryo ‘hatching’

STEP 7 - Pregnancy

By day 6 the embryo is in the uterus and it will ‘hatch’ (pictured above right) – which literally means it will pop out of its shell. It needs to do this in order to implant in the uterus.

14 days after the original egg collection the woman has a blood test to check for signs of pregnancy.

Latest Technology

At Fertility Associates, we’re committed to bringing world leading fertility technology to Malaysia to ensure our patients have the best chance of having a healthy baby.

Pre-Implantation Genetic Screening (PGS)

PGS checks the number of  chromosomes in each blastocyst and can be useful for:

  • women 36 and older with good ovarian reserve, 
  • people who have had recurrent miscarriage,
  • people not pregnant despite the transfer of several embryos – PGS may uncover a higher than expected
    chromosome abnormality rate
  • patients who are willing to go through more than one egg retrieval cycle to obtain a normal embryo

Time Lapse Morphometry Imaging (TIMI)

Photographs embryos every 10 minutes to capture developmental milestones in the embryo’s life that
are missed when embryos are only inspected once a day.

TiMI can be useful for:

  • people who expect to have several good quality embryos
  • people who have had low quality embryos previously may experience better embryo development or learnwhy embryo development is poor.

High magnification ICSI (IMSI)

When there is significant male infertility, the embryologist injects a sperm into each egg using a technique called ICSI. IMSI is a variation of ICSI using high magnification. ICSI can be useful for 

  • Men with poor sperm morphology. Poor morphology makes sperm more susceptible to oxidation damage
  • Men with a higher level of DNA fragmentation in their sperm. DNA
    fragmentation is a sign of oxidation damage
  • People with few embryos developing to the blastocyst stage 
  • People not pregnant despite the transfer of several reasonable quality embryos.

PGS (Pre-genetic Screening)

GS checks the number of chromosomes in each embryo at the blastocyst stage (a blastocyst is an embryo that has been developed in the laboratory for five or six days after fertilisation).

Because many blastocysts have the wrong number of chromosomes (a condition known as aneuploidy), PGS is a powerful tool for selecting a good embryo for transfer. Aneuploidy can lead to miscarriages, birth defects and other complications.

Benefits of PGS:

  • Birth rates can be as high as 65-70% for normal embryos
  • Lower miscarriage rate
  • More certainty for people about the likely outcome of treatment.

Who can particularly benefit from PGS?

  • Women aged 36 and over.
  • Women who have had recurrent miscarriages.
  • Women who have not become pregnant despite the transfer of several embryos.

How PGS works:

  1. About 5-6 cells are biopsied from each blastocyst using a fine glass needle.
  2. The blastocysts are frozen for later use.
  3. The cells are sent to a specialist genetic laboratory for analysis.
  4. Chromosomally normal blastocysts are transferred at a later date after thawing.

Useful to know

Embryo selection with PGS does not increase the overall chance of a baby from all the embryos available, but it can reduce the time to pregnancy by giving a better choice of which embryo to use first.

The Cost of PGS

The fees for using PGS are covered in our fees section.

  • The PGS fee is a per embryo charge and covers the embryo biopsy and testing from the IVF cycle.
  • To do PGS, you need to use ICSI as part of the IVF cycle, and you will need to have frozen embryo transfers to use suitable embryos. The costs of these are separate to the cost of the PGS testing.

Donor Egg Treatment

Using an egg donor may be an option for couples where their religion and their values allow these treatments, and there is little or no chance of pregnancy without the use of a donor.

Donor treatment is just IUI or IVF using somebody else’s eggs but there are important social, ethical and legal aspects to using a donor.

Donor Egg

Donor egg is an option when a women has undergone early menopause, when her eggs do not fertilise or develop normally, or when the chance of pregnancy is low because of her age. A women’s age is the most important factor in determining the quality and quantity of her eggs. It is common for people who have tried unsuccessfully to have a child by IVF using their own eggs to consider donor egg.

What is involved in donor egg

Donor egg treatment splits a traditional IVF cycle in to two parts. the first part involves your egg donor and the stimulation of her ovaries, followed by the egg collection. The second part involves you as the recipient of the donated eggs, adding sperm to eggs, embryo transfer and the subsequent pregnancy test.

Donor Egg is a pathway offering hope when couples have tried unsuccessfully to have a child by IVF using their own eggs

Fertility Cover

We understand that having a baby is what it’s all about

Fertility Cover gives you two chances to have a baby and the comfort of knowing in advance what the cost of your treatment will be. If treatment should prove to be unsuccessful after 2 cycles of IVF we will support 50% of the cost of the programme. 

There are a number of evaluation factors that are taken into consideration to assess eligibility for entrance into the Fertility Cover programme. 

Complete the form below for more info on Fertility Cover:

Counselling and Support

It’s common when you’re having difficulty conceiving, for ‘getting pregnant’ to become your most important goal.

Many of our patients find talking to one of our counsellors an important experience. It can help with understanding your emotions. Talking in a safe environment, can minimise stress and anxiety.

A free consultation is included with most IVF treatment options, and we encourage you to discuss this with your medical team.

Seeing one of our counsellors can help you to:

  • Gain a better understanding of your emotional responses.
  • Explore your existing coping responses to help you feel more in control.
  • Better understand the treatment decisions.
  • Understand your partner’s responses to treatment.
  • Develop support and communication tools for friends and family.
  • Deal with negative results and planning for what next.
  • Provide support around pregnancy loss.
  • Understand implications around using a donor.
  • Improve emotional wellbeing – especially if you are feeling it is hard to enjoy life at the moment.

Thaw cycle of IVF

When there have been embryos frozen following in vitro fertilisation, they can be thawed and transferred into the uterus at a later stage. This usually entails several bloods tests to time ovulation during a natural cycle. In some cases it is necessary to control a cycle using drugs to prepare the uterus for implantation. Embryos are transferred into the uterus at the appropriate time, as they are in an IVF cycle.

Embryo Freezing

Often more than two or three embryos are produced in an IVF cycle. Good quality ‘spare’ embryos can be frozen, and later thawed to give another chance of pregnancy. Freezing and thawing have to be done under special conditions; about 60-70% of embryos can survive the procedure. When embryos are to be thawed the woman’s menstrual cycle is monitored with blood tests to make sure the embryos are replaced at the right time of the menstrual cycle.

IVF problems, risks and solutions

IVF treatment is a complex medical and scientific procedure so it is not surprising that unexpected things can sometimes happen even with the best knowledge in the world and lots of experience. If things do not go as well as expected, we will always discuss the options with you before any decision is made.

Surgical Sperm Retrieval - Mesa, Pesa, Tesa & Tese

These are the various techniques to obtain sperm from the epididymis or testis from men who have no sperm in their ejaculate (azoospermia). If the cause of the azoospermia is an obstruction then the sperm retrieval procedure is usually simple and can be done under local anaesthetic with sperm being frozen for future use. If the cause is “non-obstructive” then the procedure will be more complex and best results are achieved with microsurgical techniques.

Backup sperm

If you or your partner are concerned about producing a semen sample on the day of IUI or IVF treatment or that you might be away, we can usually freeze a back-up sample. You need to arrange this well in advance so we can see how well your sperm survive freezing and thawing. There is a separate charge for sperm freezing unless it is needed for medical reasons as part of a publicly funded treatment. If you are having IVF with frozen back-up sperm, we suggest you consider using ICSI to maximise the fertilisation rate of the eggs.

Sperm will only be frozen if you request this service and complete a consent form for sperm freezing.

Options you may want to consider with IVF:

  • ICSI is a variation of IVF. Instead of the sperm and eggs being mixed in a test tube, a single sperm is injected into each mature egg. ICSI is used when sperm quality is too poor for conventional IVF to work. ICSI allows almost any man with sperm, either in his semen or in his testis, to try IVF. 
  • IMSI: When there is significant male infertility, the embryologist injects a sperm into each egg using a technique called ICSI. IMSI is a variation of ICSI using high magnification.
  • PGS: checks the number of  chromosomes in each blastocyst.
  • TiMI: Photographs embryos every 10 minutes to capture developmental milestones in the embryo’s life that
    are missed when embryos are only inspected once a day.

Success Rates

Different clinics report success in different ways. We use the chance of a baby from a single treatment cycle

When selecting a clinic, it’s important to check what measure they use when reporting their success rates. Many use ‘clinical pregnancy per embryo transfer’, which excludes:

  • People who do not have any eggs
  • People whose eggs don’t fertilise
  • Pregnancy loss or miscarriage

Clinical pregnancy rate per transfer can also be increased by transferring more than one embryo at a time, which carries the risks and complications of twins and even triplets to the mother and children.

Modern fertility treatments give you the same or better chance of a baby per month than nature does for fertile couples.

The chart below shows the chance of a live birth by age – highlighting the differences between IVF, IUI and natural fertility.  The IVF data is based on birth rate from fresh embryo transfer and the use of any frozen embryos within 6 months from the same egg collection.

How do we compare?

Fertility Associates has excellent success rates that are well above the American average, embryo for embryo.

We compare our success rates with clinics in the USA, as they have some of the highest pregnancy rates internationally and their clinic results are published with enough detail to allow accurate comparison. 

The graph below shows the chance of a single embryo giving rise to a baby at Fertility Associates compared to the USA average*, following fresh embryo transfer.

Egg Freezing

Women can preserve their fertility :

  • Before cancer and other treatments that might impact fertility. Eggs, embryos and ovarian tissue can be frozen for people who face losing their fertility because of cancer treatment or another reason. We can offer fertility preservation at short notice prior to cancer treatment.
  • Or if they think their fertility may decline before they are ready to have children.

Egg freezing

Eggs can be frozen by women who have not yet found a partner and/or are concerned that their fertility will decline before they are ready to have a baby.

Egg freezing involves all the steps of an IVF cycle, up to the egg collection. Eggs are then frozen, usually by a method called vitrification. When the woman wants to use the eggs, they will then be thawed, and she will resume the second half of an IVF cycle– adding sperm to the eggs, embryo transfer, and freezing any spare embryos.

If you are freezing eggs or embryos, then you will need to have a doctor at Fertility Associates look after you during treatment.

Embryo freezing

If a woman has a partner, it is better to freeze embryos than eggs. Embryo freezing has been around longer than egg freezing and clinics have a lot more experience with embryo freezing as it is part of routine IVF treatment.

Ovarian tissue freezing

This technique involves removing one or both ovaries surgically and freezing thin slices of ovarian tissue. The slices are transplanted back to the women once cancer treatment has finished.

Seeing a counsellor

Our counsellors are here when you want to explore issues arising from storing sperm, eggs, or embryos, and when you need support.

Costs

Egg freezing for social reasons and ovarian tissue storage, prices can be found on our treatment fee sheet.