Treatments & Prices
Assisted conception
In vitro fertilization (IVF)
What is IVF?
IVF stands for in vitro fertilisation. In vitro literally means 'in glass' and with this form of assisted conception, fertilisation takes place in a dish in the laboratory. (At one stage, scientists also used test tubes for fertilisation, hence the term "test tube baby". Any assisted conception procedure where fertilisation takes place outside the body is a form of IVF.
IVF was originally devised to overcome infertility caused by blocked or absent fallopian tubes. Today, IVF is used to treat many more reproductive problems, including irregular ovulation, low sperm count or motility, and unexplained infertility.
How IVF works?
Depending on a woman's age, anywhere between 1 and 30 follicles, known as 'recruits', will begin to develop in each menstrual cycle. Whatever her age though, only one of these developing follicles will dominate and ovulate at the level of the hormone FSH that a woman produces naturally.
With IVF, the goal is to keep the level of FSH constant, and thus to encourage more of the recruits to develop mature eggs, which are collected surgically under vaginal ultrasound guidance. The eggs are then fertilised in the laboratory, cultured for several days, and then one, or rarely two embryos are transferred back into the woman's uterus.
If there are additional embryos, they may be frozen and stored for later use.
The steps in an IVF cycle are:
- Preventing premature ovulation (the LH surge) by shutting down communication between the brain and the ovaries, so that the eggs are not lost before they can be collected
- Stimulating the ovaries with injections of FSH
- Triggering ovulation by replacing the LH surge at mid cycle with an injection of hCG
- Collecting the eggs and sperm
- Culturing embryos in the laboratory
- Transferring the embryo/s
- Supporting the endometrium in the luteal phase with hCG or progesterone
Ovarian stimulation
Stimulating the ovaries with injections of FSH
By prescribing a carefully controlled dose of FSH and other hormones and monitoring their effects, your doctor aims to bring to maturity as many of your immediately available follicles as possible, while preventing them from ovulating prematurely.
It's important to understand that no amount of FSH will stimulate more follicles than are available to be recruited. The dose needs to be enough to stop the usual competition that takes place among them, but once that threshold is reached there isn't a lot of control possible over the number of recruits that will grow.
Secondly, using FSH injections does not use up follicles and their eggs any faster than they're already being used anyway. They actually began their development months earlier. And the non-recruits - those that don't produce mature eggs - are simply reabsorbed.
More is not better when it comes to FSH dosing. If the dose is too high it can be damaging to the eggs and may also put a woman at risk of ovarian hyperstimulation syndrome.
The duration of FSH administration is also important. The normal length of the follicular phase generally needs to be made available to the growing follicles, which takes 11 days or more. We usually check a woman's estrogen level after 3 or 4 days of stimulation. If there does not seem to be much response, the dose of FSH can be increased. If the response has been too brisk, the dose of FSH can be reduced gradually.
Patients have their first ultrasound after 7 or 8 days of stimulation. Ultrasonographers who are very familiar with follicle tracking perform the ultrasound examinations. The need for further monitoring will be determined by a woman's individual response, and may require blood tests and ultrasounds every other day until the follicles reach 18-20mm in diameter, large enough to contain a mature egg.
A 'natural cycle'
It is possible to have an IVF cycle without having any hormone treatment. This is called a 'natural cycle', and just one egg is collected for fertilisation in the laboratory. However, we want to make use of all the eggs that are developing in the month of treatment in order to give you the best chance at pregnancy with just one IVF cycle.
Ovarian reserve
It's not possible to determine precisely how many eggs a woman has left. However, a doctor can get a sense of her 'ovarian reserve' by checking an FSH level and a pelvic ultrasound early in the cycle.
Preventing premature ovulation
Shutting down communication between the brain and the ovaries so that the eggs are not released before they can be collected.
This is done using GnRH-analogs, a group of drugs closely related to the natural hormone gonadotrophin releasing hormone (GnRH), a hormone produced by hypothalamus in the brain that controls the release of FSH and LH by the pituitary gland. There are two types of analogs - agonists and antagonists - that prevent an LH surge in different ways.
GnRH agonists first cause a flare of FSH and LH as they stimulate and then inhibit, or down regulate, the pituitary. There are two kinds of agonists available in Thailand - a nasal spray and an injection forms. Your doctor will consider which form is suitable for your case.
GnRH antagonists are a newer class of injectable medication with the advantage that they drop levels of FSH and LH without first causing the flare, meaning they are given for a much shorter period of time. They are usually started on the sixth day of FSH stimulation. The antagonists, marketed in Thailand as Cetrotide® and Orgalutran®, are a little more expensive than the agonists and are no more effective in preventing the LH surge or in leading to pregnancy. Nonetheless, they may be of value in women who produce only a low number of eggs in an IVF cycle (particularly older women) or for women who prefer the convenience of a shorter treatment time. Which drug your doctor prefers to use will depend on factors such as age, previous response to treatment and convenience.
Triggering ovulation
Replacing the LH surge at mid cycle with an injection of hCG
It's not presently possible to use synthetic LH to mimic the natural surge, as the duration of action of currently available LH is too short. Using hCG (human chorionic gonadotrophin) to replace the natural LH surge sets in motion everything that makes ovulation happen, causing the egg in the mature follicle to be fertilisable and loosening it from the wall of the follicle so that it comes out with the follicular fluid at egg retrieval.
It takes just over 38 hours for ovulation to occur after an injection of hCG. Eggs are mature and can float free from about 34 hours after hCG, giving a four-hour 'window' for egg retrieval, which is typically scheduled 36 hours after the hCG trigger.
hCG is marketed either as Pregnyl®, a powder or Ovidrel®, delivered in a pre-filled syringe. Your doctor will prescribe the suitable form for your case.
Intercourse must be avoided from Day 3 of FSH stimulation, as not all of the eggs might be collected. There is then a small chance of spontaneous conception, which increases the risk of a multiple pregnancy when additional embryos are transferred.
Egg collection
Egg collection involves the aspiration or drainage of the fluid from the pre-ovulatory follicle. The procedure is carried out through the top of the vagina to either side of the cervix, and is guided by a transvaginal ultrasound.
Anaesthesia
Egg collections are fast and relatively non-invasive operations. At Superior A.R.T. we use a “light” general anaesthetic, it can be likened to a strong sedative. It invokes a minimal degree of muscle relaxation and loss of sensation, and breathing is maintained naturally, although a breathing mask is used to both administer oxygen when required, and to top up the sedation with a ‘gas’ sedation if required.At Superior A.R.T. an anesthesiologist will give you the medicine and closely follow your progress.We use a short-acting intravenous anesthetic agent for the induction of general anesthesia; it has a rapid onset (about 40 seconds) and a short duration of action, allowing patients to wake up, recover, and return to baseline activities and diet sooner than some other sedation agents.
If required we use a ‘vapor’ or ‘gas’ to maintain loss of consciousness during surgery when required, eg. where procedure is long or longer than expected. It is inhaled and is a fast-acting, non-irritating anaesthetic agent whose administration has been associated with a smooth, rapid loss of consciousness during inhalation induction and a rapid recovery following discontinuation of anaesthesia.
The procedure
Following administration of the ‘light’ general anaesthetic, the ovaries are scanned, just as they are during follicle tracking. The follicles are aspirated using a needle passed through the wall of the vagina beside the cervix and into the ovary. Your partner is not permitted in the theatre.
There’s often a small amount of bleeding from the wall of the vagina. Other complications such as major bleeding, damage to an internal organ or infection are possible, but rare.
After the follicles have been emptied they often fill up again with fluid, so the feeling of fullness may return. Some women also complain of a cramping sensation for a few days following egg collection. This can be relieved with paracetamol (with or without codeine).
Side effects are often more marked after the procedure, as the hormone processes following ovulation persist, even though the eggs have been taken out. These side effects include mood changes as before, but also physical effects indicative of heightened ovulation such as pronounced abdominal swelling, breast tenderness and lower abdominal discomfort.
Egg preparation
Your Superior A.R.T. embryologist is located in the adjoining embryology laboratory. As the follicles are emptied the collected fluid is passed to the embryologist, who using a powerful microscope, begins locating and extracting the eggs, transferring them to special plastic dishes ready to be incubated.
Recovery
After your procedure, we will take you to the recovery room. Your partner can be with you after you wake. Since you’ve had a light general anaesthesia, make arrangements for an adult to be responsible for you and to accompany you home. Do not plan to drive yourself or travel alone; it's unsafe to do so, no matter how well you feel. Be sure not to carry out any critical activities - such as driving a car, operating machinery, or signing important documents - for 24 hours from the time of your anaesthesia.
It is not usually necessary to take time off work on the days following the procedures, but if you feel that you need a medical certificate, you can discuss this with the nurses.
If the male partner has an PESA or TESA operation at the same time as the female partner has her egg pick-up, you will need a third person to take you home.
In the very unlikely event that further surgery is needed for your safety, Superior A.R.T. day surgeries are fully equipped to handle emergencies
Sperm collection
Soon after egg collection the male partner has his role to play and will be asked to proceed to one of our collecting rooms. It is also possible to collect at home, if you live within an hour of the lab. Sperm can be frozen in advance of the day of egg collection if you anticipate difficulties.
Superior A.R.T. scientists look for two things in a sperm sample - freshness, and the quality of sperm. To ensure that the sperm is fresh we recommend ejaculation on the same day as the hCG trigger. To maximise the quantity of sperm, ejaculation should then be avoided until after the egg collection.
Fertilization
Culturing the embryos in the laboratory
After collection, the eggs and sperm are brought to the laboratory where the eggs will be fertilised and the embryos cultured for 5 days. In conventional IVF, about 50,000 to 100,000 washed sperm are left in a small plastic dish with the eggs. The sperm spend the next few hours getting through the layers of cumulus cells, and hopefully one sperm will successfully fertilise the egg.
By the next day - some 15 hours after introducing the sperm to the eggs - the scientists will check to see if the eggs have fertilised by looking for the presence of pronuclei. In normal fertilisation there should be 2 pronuclei - one from the sperm and one from the egg.
Not all eggs will fertilise normally, which is common. We consider it a good result if 80% of the eggs collected have two pronuclei on Day 1.
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) can be used to fertilise eggs when your doctor thinks there is a decreased chance of fertilisation occurring with conventional IVF, either because of problems with low sperm numbers or low sperm motility, or because of other barriers to the fertilisation process such as sperm antibodies or previous failure to fertilise through IVF.
A single sperm is injected into each egg. The sperm is selected mainly on the basis of its normal shape and size.
Blastocyst culture
Once fertilisation has occurred, the embryo will divide and rapidly increase in cell number over the next few days. By Day 4, the cells have divided rapidly but the embryo has not yet increased in size. It is now compacting (you cannot distinguish the cells) and is called a morula.
If the embryo survives to Day 5 - the blastocyst stage - it will contain between 75 and 100 cells. It is a 3-dimensional ball of outer cells (the trophectoderm) surrounding a fluid-filled cyst in which an inner group of cells, the inner cell mass can be seen. The trophectoderm will go on to form the placenta, membranes and umbilical cord, while the inner cell mass will become the baby.
We cannot tell the difference between a good embryo and a bad embryo just by looking at them. Embryos at the best of times are busy transforming and repairing themselves, so can develop fragmentation (which is when small bits of cells are pinched off during division) or vacuoles, which are small spaces within the substance of the cells. The significance of these changes is not known and many fragmented and vacuolated embryos can go on to form perfectly healthy pregnancies.
While many embryos can survive 2 or 3 days to reach the 4-6 cell stage, only the strongest will have the ability to keep developing into a blastocyst and then a baby. One way of identifying the better embryos, therefore, is to let them grow a little longer in the laboratory and to transfer them at the blastocyst stage. It is a good way of determining which embryos have the most developmental potential. Our world-leading success with blastocyst culture and implantation means that blastocyst transfer is standard at Superior A.R.T. centre.
An embryo needs two things to reach Day 5: enough energy, and normal chromosomes.
Energy
An embryos energy supply comes from tiny structures inside its cells called mitochondria. The embryo needs to survive on the energy produced by the mitochondria it inherits from the egg until it has implanted and formed a placenta. Because all the mitochondria in an embryo come from the egg they are inherited from the mother. And because women are born with all their eggs for their lifetime already formed, the mitochondria in your eggs are as old as the eggs themselves.
Chromosomes
Embryos must also have the right genetic makeup to develop normally. In humans, genes are contained in 23 pairs of chromosomes. An incorrect number of chromosomes leads to failure of an embryo to implant or to progress to a normal birth. Pregnancy is a great filter of abnormal embryos. When chromosome analysis is performed on cells from Day 3 embryos, studies have shown that only one third will have the normal number.
If an embryo progresses to Day 5 and becomes a blastocyst, it has a two-thirds chance of being chromosomally normal. 90% of chromosomally abnormal pregnancies will miscarry in the first trimester. 93% of chromosomally normal pregnancies will continue to term.
Embryo transfer
An embryo transfer to the uterus is usually straightforward and painless: no more (or less) uncomfortable than having a Pap smear. After a speculum is placed in the vagina, a fine plastic catheter that has been loaded with the embryo is passed through the cervix into the uterus.
Many people think that the uterus looks like it does in most diagrams, with a cave-like interior in which transferred embryos can rattle around and even fall out! In reality, the endometrial cavity is a potential space. In fact, the front and back walls of the uterus are in contact like two slices of bread with jam in the middle; the embryo is like a raspberry seed wedged in between. No matter what you do, it won’t fall out!
After the embryo transfer
The effects of the hCG injection wear off within a week and the ovaries may not produce enough progesterone on their own to support a pregnancy. Extra doses of hCG (Pregnyl®), or progesterone (Crinone® or Cyclogest® vaginal tablet) are required until the outcome of the cycle is known.
A pregnancy test is not reliable until 16 days after egg collection. This can be the most nerve-racking time of the whole treatment cycle. Many people will feel simultaneously elated (there's a new chance of pregnancy) and deflated (there is much less to do compared with before the egg retrieval, there is less information and, unless you have specific questions, there is much less contact with people at the clinic).
"The two-week wait"
Once all the stages of the IVF cycle have been completed, there's nothing more to be done than wait for the time to pass before the results - whether or not the pregnancy has started - are known. Some refer to this time as the dreaded "two week wait", because such a protracted period of uncertainty after so much forward activity can be stressful. Our counsellors, nurse coordinators and your doctor are all available to help during this time.
Frozen embryos
After ovarian stimulation and egg pick-up, there are often more embryos than the one or two needed for transfer in that cycle. If there are healthy-looking embryos left over from the IVF cycle they may be placed in cryo-storage. By freezing these embryos, you have the chance to attempt pregnancy more than once after only one stimulated cycle. Note that not all unused embryos are suitable for freezing.
At Superior A.R.T. we use a method called vitrification to freeze and cryo-store embryos. Vitrification is an ultra-rapid cooling technique which allows embryos to be efficiently cryo-preserved without any damaging ice formation; therefore this method improves survival upon re-thawing.
Compared to conventional freezing, vitrification is cost-effective, time-effective, and shows significantly better results in terms of survival and pregnancy rates following thawing. Vitrification, used in conjunction with blastocyst culture and single embryo transfer, significantly improves the chance of a pregnancy from a single stimulation cycle while avoiding the complications of multiple pregnancies.
Vitrifying and storing embryos reduces the amount of hormone treatment you receive and also the number of times your ovaries are stimulated. Some people have two or three embryo transfers after just one stimulated cycle. Frozen embryo cycles involve either monitoring your menstrual cycle for ovulation and transferring the embryo at the right time or using sequential medication to mimic the hormones of a natural cycle.
Risks, cancellations and side effects
Things to be aware of with IVF
To help you understand what you can expect to encounter during your treatment, you need to be aware that things do not always go according to either desire or plan. Some problems are temporary setbacks or conditions; others can take a considerable emotional and physical toll.
Ovarian hyperstimulation syndrome (OHSS)
It’s normal for the ovary to produce fluid in the abdomen as a follicle grows, and to bleed at ovulation. And it's normal for a corpus luteum to form in the ovary and become cystic in the second half of the cycle. Pain can accompany ovulation and the formation of the corpus luteum, while premenstrual tension can cause bloating, irritability, depression and breast pain. When the ovaries are stimulated to increase the numbers of follicles, as occurs in IVF, all these events and their symptoms can be more pronounced than you might expect in a natural cycle. There are three classifications of OHSS severity:
- Mild OHSS - accompanied by enough pelvic pain in the luteal phase to cause a woman to want to rest in bed for a day or two. This occurs in 1 in 30 stimulations.
- Moderate OHSS - requires a hospital stay, mainly for observation and to enable us to give adequate relief of pain. This occurs in about 1 in 250 stimulations.
- Severe OHSS - in about 1 in 1000 stimulations there's enough fluid in either the abdomen or the chest to be of serious medical concern.
- OHSS is a self-limited condition and the ovaries will almost always completely recover.
Cycle cancellation
We occasionally find that the ovaries fail to stimulate, and cancelling the cycle may be recommended. Less than 5% of cycles are cancelled. A cycle might be cancelled because:
- Your follicles are not responding to hormone treatment
- Your follicles are over-responding to the hormones, risking hyperstimulation
- Uterine problems such as fibroids or polyps are unexpectedly detected on ultrasound
Personal reasons.
If you're at risk of hyperstimulation or if a problem is discovered in the uterus, your doctor might suggest that you have a freeze-all cycle rather than cancel the cycle completely. In a freeze-all cycle, the eggs are collected and fertilised then cryo-stored. Because pregnancy or further hormone injections will worsen the risk of ovarian hyperstimulation syndrome (OHSS), a freeze-all cycle is a safer option. This gives the ovaries time to settle down before attempting pregnancy at a later date. When returning for the frozen transfers, there is no need to have any stimulation of the ovaries at all.
Multiple pregnancy risk
At Superior A.R.T., we would like to help you grow your family one healthy baby at a time. So as a rule, we only transfer one embryo. The risk of a twin pregnancy after a single blastocyst transfer is around 2%. In certain circumstances, such as older age of the woman or previous unsuccessful treatment, we will consider transferring two embryos.
If you’ve had trouble conceiving, the idea of having two babies at one time might seem like a blessing. However, the death rate of twins between 5 and 9 months of pregnancy is 6 times that for single baby pregnancies, while the mortality rate from IVF twins following birth is 4.5% or nearly 1 in 20.
In 2002, Sydney IVF undertook a study in a special subset of couples who had several high quality embryos suitable for both transfer and freezing. They compared the 'take home baby' rate in women under 38 who had two embryos transferred during the fresh cycle with those who had one embryo transferred fresh. Both groups later had frozen embryo transfer cycles if they needed them. The end result was the same: approximately 70% of women in both groups took home a baby after one stimulated cycle. However, five babies died from premature delivery among the IVF treatments where fresh embryos had been transferred two-at-a-time.
Risks of medications
Since ovarian stimulation medications were first used decades ago, there has been concern that their use might increase the risk of cancer. Several large studies have now found that the rates of cancers among women who have used infertility drugs are not significantly different from the rest of the population. There is no evidence to date that the drugs used in assisted conception causes either breast or ovarian cancer.
No fertilisation; no embryo development; no implantation
Fertilisation can fail, and fertilised eggs can fail to divide or undergo cleavage properly. The reason can lie with the sperm (usually fertilisation failure rather than cleavage failure), with the egg, or both. And sometimes it can lie with the lab.
Fertilisation can fail when not enough sperm attach to the egg's surrounding coat. This can happen because the number of healthy sperm is too low, or because there are antisperm antibodies that prevent sperm from attaching. Either way, future cycles can overcome this problem by using ICSI.
In addition, fertilisation and/or cleavage might fail if the follicles from which the eggs were extracted had begun to fail prior to egg collection. This can be an inherent problem with the ovaries, or it can result from suboptimal stimulation.
Most embryos that fail to implant and/or fail to result in a baby (even though they might look normal in the lab) fail through a combination of intrinsic and extrinsic shortcomings. Intrinsic shortcomings might be based on insufficient metabolic energy or an abnormal chromosome count. Extrinsic shortcomings might occur during follicular stimulation or during laboratory handling.
Stresses associated with infertility
IVF treatment can be stressful and intrusive. There are various reasons for this including:
- Demands of stimulated treatment (daily injections, the need for blood tests early in the day, ultrasounds etc)
- Stresses associated with procedures (having an invasive procedure; the discomfort sometimes experienced; providing a semen sample on the day of the egg pick-up)
- Stresses associated with periods of waiting (such as waiting for fertilisation results; pre-embryo checks; and the long wait between transfer and pregnancy test, then the wait for the pregnancy test result)
- The possibility of treatment not being successful.
Luckily, stress itself does not jeopardise the chance of IVF working. Many people have remarked that they have felt worn down by the stresses and the losses associated with infertility. It's not uncommon for people to experience grief in response to the many losses experienced, as well as other emotional responses such as depression and anxiety. With this in mind, you should be aware that Superior A.R.T. provides counselling services that can greatly assist in managing this emotional impact.
Ovulation induction (OI)
Ovarian stimulation
Ovulation induction (OI) with controlled ovarian stimulation may be recommended for women who have normal tubes, and whose partners have a normal semen analysis, but who rarely or never ovulate. For women who do ovulate regularly, stimulation can also be used to increase the chance of pregnancy by increasing the number of follicles that develop fully and, therefore, increasing the number of eggs that are ovulated during a cycle.
Two types of hormones may be used to stimulate ovulation: tablets of clomiphene citrate (Clomid or Serophene) and injections of follicle stimulating hormone, or FSH (Gonal-F or Puregon).
Clomiphene
Clomiphene (Clomid or Serophene) is often the first choice for stimulating ovulation because of its low cost and ease of use. A synthetic hormone, clomiphene acts as an anti-estrogen, tricking the brain into producing higher levels of FSH than in an untreated cycle, which in turn stimulates ovarian follicular development.
A course of tablets is given for 5 days, usually days 2-6 or 5-9 of the cycle. Side effects can include thickening of the cervical mucus, vaginal dryness and hot flushes, while some women also complain of mood changes and irritability. Uncommonly there can be abdominal bloating, breast discomfort, nausea, a skin rash or dizziness. These symptoms usually pass after the 5 days of tablets finish.
Because it is an anti-estrogen, clomiphene can have a negative effect on cervical mucus and on the lining of the uterus, impairing conception and implantation. Pregnancy rates are 5% to 10% per month, or 35% to 40% over a six-month course of treatment.
Follicle stimulating hormone (FSH)
Follicle stimulating hormone (FSH) is the hormone necessary for the multiple follicular development required in IVF. FSH may also be used in smaller doses for ovulation induction or ovarian hyperstimulation. The FSH is made in the laboratory and is identical to human FSH.
FSH is given by injection under the skin, with a fine needle. This is because it is a protein that, if taken orally, would be digested in the stomach.
There are two brands of FSH available in Australia - Gonal-F and Puregon. Both are self-administered with pen-like devices (similar to those used for insulin by diabetics).
Using FSH to induce ovulation for getting pregnant naturally, as opposed to through IVF, can be tricky because of the risk of stimulating too many follicles and having a multiple pregnancy. This is why the body’s response is closely monitored with blood tests and ultrasounds.
When the lead follicle or follicles are the right size on ultrasound, ovulation is triggered with an injection of human chorionic gonadotrophin (hCG), which mimics the LH surge. Even with the most careful monitoring, more follicles can reach maturity than desired. Intercourse should be avoided because of the high risk of twins, triplets or an even higher-order multiple pregnancy. If this looks too likely, either the ovulation cycle that has been induced will need to be cancelled or a suggestion might be made to carry out an IVF procedure.
Multiple pregnancy is the single greatest complication in using FSH injections for ovulation induction. If pregnancy occurs, there is a 20% chance of twins. Triplets or higher occur in about 5% of pregnancies. Infertile couples might think twins are a blessing, but complications are much more common in twin than singleton pregnancies.
As it is identical to a hormone that a woman’s body makes naturally, the side effects a woman experiences with FSH are really the expected effects of the injections. These include bloating as the ovaries are stimulated and mood changes as estrogen levels rise.
Pregnancy rates depend primarily on the age of the woman, and range from around 10-20% per month, or 40% to 50% over a six-month course of treatment in women under 38.
Assisted insemination (AI)
Assisted insemination (AI) is a technique in which sperm are placed into a woman's cervix or uterus with a soft, thin plastic tube around the time of ovulation.
An insemination cycle might or might not include ovarian stimulation. The cycle is monitored with blood tests and ultrasounds so that the insemination can be timed precisely. This technique is generally used in only a few circumstances, for example when:
- there is a physical problem with sexual intercourse
- scarring of the cervix prevents sperm penetration
- donor sperm is required.
Assisted insemination is not as effective as IVF in cases where there is low sperm count, or if there is endometriosis. In addition, the fallopian tubes must not be blocked, nor is it recommended when the cause of infertility is unknown.
The success rate of AI is directly related to a woman's age, and offers no better chance than that of a couple without subfertility who are having regular intercourse. Pregnancy rates are 5% to 10% per month, or 35% to 40% over a six-month course of treatment.
Egg and sperm donation
For female patients who have no viable eggs at all, or male patients who have no sperm, the option of egg or sperm donation offers a chance to still have a child of their own.
Anonymous donation
Superior A.R.T. does not accept anonymous egg or sperm donors.
All donors must be known to the recipients; whether you've known them all your life or recruited them through a newspaper advertisement is not important - they just can't be anonymous. This is because Superior A.R.T. believes that everyone has the right to know their genetic heritage, and maintaining anonymity for donors prevents this.
Egg donation
Because of the intense hormone treatment required to collect eggs, egg donation is a serious step for anyone to consider.
Sometimes donors come from the community - women who have a family of their own and wish to share that joy with another. More often, the donor is known to the recipient - a friend, sister, or cousin. In either case, Superior A.R.T. requires that the donor and recipient couple undergo a process of implications counselling before the procedure begins.
The process begins by synchronising the menstrual cycles of the donor and recipient. The donor then undergoes a cycle of ovarian stimulation with the aim of producing as many eggs as possible.
As the donor reaches the point of ovulation, the recipient begins taking estrogen and progesterone to prepare the lining of her uterus (similar to a frozen cycle). The eggs are collected and fertilised with sperm from the recipient's partner. Resulting embryos are observed and the best chosen for transfer. Any other viable embryos are frozen for later attempts.
Sperm donation
As with donor eggs, sometimes donors come from the community, but more often the donor is known to the couple - a friend or relative. .Superior A.R.T. does not accept anonymous sperm donors.
Soon after egg collection the male donor will be asked to proceed to one of our collecting rooms. It is also possible to collect at home, if the donor lives within an hour of the lab. To ensure that the sperm is fresh we recommend ejaculation 2-3 days prior to collection and ejaculation should then be avoided until after the collection. Sperm can be frozen in advance of the day of egg collection if difficulties are anticipated. The donors sperm is used to fertilize the collected eggs. Resulting embryos are observed and the best chosen for transfer. Any other viable embryos are frozen for later attempts.
Single women and lesbian couples
Superior A.R.T. does not refuse treatment to women because of marital status or sexual orientation. Single women and lesbian couples are welcome and treated with care and respect.
Because of our policy of not accepting anonymous sperm donors, we require that single women and lesbian couples who come to us for treatment bring with them their own sperm donor.
Quarantine
Eggs and sperm, like most human tissues, can carry diseases. Donors should be tested for disease at the time of donation.
A negative test is not conclusive, as some diseases take many months to show up on blood tests. Therefore, sperm and fertilised eggs should be held in cryo-storage for six months. At the end of that time, the donor should be retested. If that test proves negative, the gametes are considered disease-free.
Some recipients choose to waive the quarantine period for eggs. In this case, Superior A.R.T. takes no responsibility for any diseases contracted by the recipient from the transferred eggs. By law, however, we must quarantine donated sperm for six months before using it to fertilise eggs.
Legal considerations
Firstly, it should be noted that it is illegal in Thailand to sell sperm or eggs (or any human tissue). Couples desperate for a child have been known to fall victim to unscrupulous people offering to sell eggs. While it is considered normal for recipients to cover their donor's expenses, if anyone you approach asks for payment beyond expenses, they should be avoided.
The second important point is about parentage. The law considers a woman who gives birth to a child to be the mother of that child. It further considers the partner of that woman to be the father of the child. Donors can be assured that they will be under no legal or financial obligation to the child, though Superior A.R.T. encourages recipients to include the donor in the child's life.
Surrogacy
'Surrogacy' literally means 'help'.
In reproductive medicine it has come to mean a special kind of help; it's when a woman gets pregnant on behalf of someone who herself can't carry a pregnancy and have a baby. This is usually because the infertile woman has been born without a uterus or has had a hysterectomy.
Surrogacy means having IVF; it's expensive, and there are no Medicare rebates. The eggs from the infertile woman are fertilised with her own partner's sperm. A resulting embryo is then transferred to the uterus of the surrogate, who carries the pregnancy and gives birth to the baby.
Genetically it's the child of the infertile couple, but it is a child to whom the surrogate (the pregnancy and birth mother) may have an understandable and ongoing attachment.
Personal considerations
No better chance, no greater care
Just as we endeavour to ensure that you’ll receive the best chance of having a healthy baby, we also endeavour to ensure that you’ll receive a high level of personal care. Part of that care is making you aware of everything that an assisted conception involves - including the costs, be they physical, emotional, or financial.
If you’ve read through the sections of this website on Fertility & Conception, and Assisted Conception, you will understand that the stresses of the treatments can be considerable. They can place strain on you and your relationships.
For a great many people, the joy of overcoming infertility and completing their family makes the stress endured worthwhile. Before you take the next step towards your dream of completing your family, you should discuss the issues you’ve read about on this website with your partner. Then, if you have any questions or concerns, feel free to contact us.
PGD
In a normal IVF cycle, the embryologist chooses which embryos will be transferred to the uterus based on a visual observation as they develop.
Preimplantation genetic testing or diagnosis (PGD) allows the Superior A.R.T. scientist to base the choice on the results of genetic tests on the embryos to exclude those that contain an obvious genetic abnormality.
Testing can involve a count of the chromosomes and/or a molecular examination for a particular gene or mutation. Either way, the testing can increase both the chance of a genetically normal pregnancy and your chance of having a baby.
Superior A.R.T. is one of the very few centres in South East Asia with the vital combination of IVF and genetics facilities to perform these sophisticated tests successfully.
Who can benefit from PGD?
PGD may be recommended for people who:
- Are affected by or carry a known genetic disease
- Have had recurrent miscarriages
- Need to choose the sex of their baby for medical reasons.
- Have an affected child and need to have a new baby with HLA matching to donate stem cells to the elderly sister / brother.
- Superior A.R.T. is evaluating the possible benefit of more routine PGD in increasing IVF live birth rates generally.
Thalassemia
Can it be prevented in your next child?
What is thalassemia?
Thalassemia is an inherited blood disorder that causes mild or severe anemia. The anemia is due to reduced hemoglobin and fewer red blood cells than normal. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body.
In people with thalassemia, the genes that code for hemoglobin are missing or variant (different than the normal genes). Severe forms of thalassemia are usually diagnosed in early childhood and are lifelong conditions.
The two main types of thalassemia, alpha and beta, are named for the two protein chains that make up normal hemoglobin. The genes for each type of thalassemia are passed from parents to their children. Alpha and beta thalassemias have both mild and severe forms.
Alpha thalassemia occurs when one or more of the four genes needed for making the alpha globin chain of hemoglobin are variant or missing. Moderate to severe anemia results when more than two genes are affected. The most severe form of alpha thalassemia is known as alpha thalassemia major. It can result in miscarriage.
Beta thalassemia occurs when one or both of the two genes needed for making the beta globin chain of hemoglobin are variant. The severity of illness depends on whether one or both genes are affected and the nature of the abnormality. If both genes are affected, anemia can range from moderate to severe. The severe form of beta thalassemia is also known as Cooley's anemia.
What is the chance of being thalassemia carrier?
Unfortunately, thalassemia is a lot more common than most people think, especially in parts of South East Asia including Thailand. Up to 40% of Thais will be a carrier of a thalassemia trait or of HbE. Carrier rates are also high in people from some other ethnic groups, for example the Mediterranean, while the carrier rate is much lower in other ethnic groups. For example a thalassemia gene is found in only 1 in 1000 people from Northern Europe. Just over 1% of Thai couples will have a child affected by thalassemia
If you have a family history of thalassemia, the chance that you are a carrier will be higher. However, some children born with thalassemia do not have a family history of the disease.
When two carriers of beta thalassemia have a child, there is a 1 in 4 chance (25%) their child will have thalassemia, a 1 in 2 chance (50%) that their child will be a carrier like them, and a 1 in 4 chance the child will have normal genes. See diagram.
It follows that just because a couple has had one or more non-thalassemia children. It does not mean that they are not carriers of a thalassemia gene and that future children will not be affected.
Thalassemia may be curable by stem cell or bone marrow transplantation, but it is preventable by screening and PGD
The key to preventing thalassemia lies in genetic screening and the first step is quick and simple. From a blood sample, scientists can determine if you are a thalassemia carrier.
For any untested Thai couple without a family history of thalassemia, the risk of carrying a thalassemia gene error is about 40% for each person or about 16% for both of the couple. The chance of having an affected child is about 1 in 100. Screening can help to more accurately assess your risk. We think it is important for you to have the option for testing if you are considering a pregnancy.
If a thalassemia mutation is identified, your doctor will discuss with you the risk of having a baby with thalassemia, and may arrange for you to have genetic counseling. Because the thalassemia gene is inherited, your blood relatives will have a high chance of also carrying the gene error. Your relatives may also want to have thalassemia screening.
In the case where both parents test positive as thalassemia carriers, there are several options. Couples can have a baby naturally and take the risk of having an affected child, couples can have prenatal testing at around 12-14 weeks of pregnancy and choose to terminate the pregnancy if foetus is affected, or couples can have PGD, preimplantation genetic diagnosis, and transfer an embryo not affected by thalassemia.
Please Click Here to request more information from Superior A.R.T.
