What should I expect during my first visit to a fertility doctor? | During your first visit, the fertility doctor will discuss your and your partner’s (if applicable) medical histories, which may include previous pregnancies, miscarriages, treatments and any other medical information that has been shared by your previous obstetrician-gynaecologist. This is a necessary approach and will assist your fertility doctor in deciding what fertility tests need to be done on you and your partner to diagnose the causes of infertility and move the process forward.
Tests on your first visit often include: - semen analysis for evaluating the quality and sperm count of the male partner
- uterine ultrasound to evaluate the structure and overall health of the uterus and ovaries of the female partner
- hormonal tests on both partners to determine if there are any hormonal imbalances
- evaluation of the ovarian reserve of the female partner
- hysterosalpingogram or uterine X-ray to evaluate the structure and patency of the female partner’s fallopian tubes
Based on the results of these tests, your fertility doctor will be able to provide a diagnosis and suggest treatment options suitable for you to achieve your goal of a healthy and safe pregnancy.
Since the tests are required on both males and females, it is best to have your first visit to your fertility doctor with your partner. |
I am not ready to have a baby. Should I freeze my eggs? | | Yes, you can, but before that, you should be familiar with the term egg freezing and what it means for you. Egg freezing, or 'oocyte cryopreservation’ in medical terms, is a technique used to preserve a woman’s fertility. Eggs are extracted from the ovaries and frozen so that they can be used when you are ready to have a baby. Deciding on having a baby or freezing your eggs solely depends on you. You should consider several factors in your life, such as your career, finding the right partner or going through any other important phase of life that can be affected by your pregnancy. In such cases, freezing your eggs is an ideal option, as it allows you to preserve some of your fertility on your own. | If you are not sure about having a baby right now, freezing your eggs gives you the option, especially in your mid-to-late-thirties, to have more chances to get pregnant at that age. One thing to keep in mind is that egg freezing does not come with any guarantee of pregnancy, as your fertility also depends on other factors, such as your age, health and medical conditions. Unfortunately, at the moment, public funding is reserved for certain medical conditions only to freeze the eggs. Therefore, you should make up your mind and have a thorough discussion with your fertility doctor to consider all factors before making a decision if you would like to freeze your eggs for other non-medical reasons. | |
What is intrauterine insemination, and is it as successful as in vitro fertilisation? | | Couples who are having trouble conceiving may be offered two common procedures that help couples who need fertility assistance: intrauterine insemination (IUI) and in vitro fertilisation (IVF). During IVF, the eggs from the female ovaries are extracted surgically using a needle inserted at the back of the vagina under general anaesthetic. Then, those eggs are fertilised outside of the body. IUI is a procedure in which the sperm from the male partner is introduced directly into the uterus of the female partner using a speculum, and is less invasive than IVF. Generally, IVF has higher success rates than IUI in a single cycle. It is the most highly recommended procedure for women wanting to conceive, even in their mid-to-late-thirties. IVF gives you the advantage of having more control over the number of embryos transferred into the uterus. This is beneficial as it reduces the risk of multiple births. IVF also may provide you with more embryos that can be utilised and transferred in the future if you have surplus embryos that are stored. However, IVF is more expensive than IUI. It demands more medical tests, fertility medications and other associated factors that can be costly. | Before you decide to conceive, it is important to consult with your fertility doctor to determine the cause of infertility and decide whether IVF or IUI is right for you. 
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In vitro fertilisation vs intracytoplasmic sperm injection – what should I expect? | | During in vitro fertilisation (IVF), eggs are extracted and fertilised by sperm outside the body. This process occurs in a laboratory dish, allowing the sperm to naturally home in on and penetrate the eggs. Intracytoplasmic sperm injection (ICSI) is also a form of IVF, where a single sperm from a man’s semen sample is manually injected into the centre of an egg to enhance the chances of fertilisation. It is often recommended for treating male-factor infertility. Both IVF and ICSI are similar in that they involve the same ovarian stimulation and egg retrieval process. Originally, IVF was introduced to the medical world to overcome female fertility issues like fallopian tube blockages or endometriosis or when previous artificial insemination cycles were unsuccessful. | ICSI, on the other hand, was designed to assist men with low sperm counts or immotile sperm in fertilising their partner's egg, as the embryologist manually selects the best sperm. Couples diagnosed with certain male-factor infertility are often good candidates for ICSI. The choice between IVF and ICSI depends on the unique circumstances of each case and the specific causes of infertility in one or both partners. In cases with limited eggs, ICSI may be preferable as it increases the likelihood of fertilisation by selecting the most viable sperm. Similarly, ICSI is often favoured in cases of male infertility or when your previous IVF procedure has resulted in few to no fertilised eggs. | |
Fresh vs frozen embryo transfers – how do they differ? | | For a fresh embryo transfer, a fertilised embryo is implanted into the uterus within three to five days of retrieval. With a frozen embryo transfer, embryos are frozen and can be implanted weeks, months or even years after retrieval and fertilisation. If you are ready to conceive, you may prefer a fresh embryo transfer because it saves you time to get pregnant, which is one of the main advantage of a fresh embryo transfer. However, there are certain situations that require your health provider to recommend freezing the embryos for a later transfer. For example, a fresh embryo transfer does not allow time for genetic testing of the embryo or if you are at risk of Ovarian Hyperstimulation Syndrome (OHSS). | A frozen embryo transfer is often chosen because it allows the body to recover from ovarian stimulation and provides the option to test embryos for those who are recommended genetic testing (PGT). These factors can lead to a healthier embryo being implanted and a more conducive environment for successful implantation. One disadvantage of frozen transfers is that not all embryos survive the freezing and thawing process. Nevertheless, advancements in technology have significantly reduced this risk, resulting in a higher survival rate for frozen embryos. | |
I just had a miscarriage. Why did this happen? | It is important to note that if you experience a miscarriage, this is NOT YOUR FAULT. Unfortunately, 15% of pregnancies will result in a miscarriage. Often, these miscarriages do not have a recurrent reason, and hence, for a first early miscarriage, the odds of this happening again are generally similar to the population. The most common reason in this case will be a one-off, and usually nonrecurrent, genetic and chromosomal abnormalities. A recurrent consecutive miscarriage, on the other hand, may indicate that there is an underlying reason that could be contributing to the pregnancy loss. Your doctor should be able to guide you through investigating the possible causes and developing a plan and recommendations for your subsequent pregnancy. In general, most women, including those with multiple recurrent miscarriages, will have a live birth of a healthy baby once all possible causes have been addressed. |
What are the management options for a miscarriage? | When you are diagnosed with a miscarriage, there are multiple options available for you. One option is expectant management while you wait for your body to deal with the miscarriage naturally. This process can take weeks to months. Another option is medical management using tablets called Misoprostol. These can improve your success rate compared to expectant management. You will be required to visit your healthcare provider for at least two ultrasound scans to confirm that the pregnancy tissue has been completely expelled. This process can take 2–3 weeks, with the possibility of needing a repeat dose of misoprostol if the first was not sufficient to complete the miscarriage. The third option is surgically using suction and evacuation under anaesthesia. You will be asleep while the doctor gently dilates the cervix, enabling access to the tissue and using a suction tube that often removes the tissue completely up to 98% of the time. If you experience a miscarriage, talk to your healthcare providers so they can help you choose the best option to suit your needs. |
