Ice Ice Baby

by Dr Agilan Arjunan

frozen embryo transferfrozen embryo transfer

Just a few days ago an article about frozen embryo transfer was published in The Star .

In summary, the article mentioned about the advantage of deferring embryo transfer to a later date (ie freezing the embryo first and do the embryo transfer later). It says that by doing so, the miscarriage rate was lower and this leads to a higher live birth rate.

I completely agree with the findings and it concur with my own clinical experience.

Currently, IVF cycle can be broken into 2 segments :

a) Stage 1: Ovarian stimulation, egg collectian and fertilisation

b) Stage 2: Embryo transfer

Traditionally, Stage 1 & 2 are done in the same period cycle (fresh embryo transfer). We can get reasonably good pregnancy rate with fresh embryo transfer.

We used to freeze embryos when we are unable to transfer embryos in the same cycle (such as when the woman is at risk or developed ovarian hyperstimulation). Embryo freezing are not done electively.

Over the last few years, more research data supports elective embryo freezing. Furthermore, this method become more popular after introduction of a better embryo freezing technique.

But why frozen embryo transfer is better ?

To understand this , you must first understand what happens naturally in a woman’s period cycle. Every month, a number of eggs are ‘prepared’ to grow but eventually only one egg will grow (and growing egg produces hormones to prepare the womb) and ovulate. After ovulation, the womb (uterus) makes the necessary changes and become ready to accept the embryo.

In an IVF, medications are given to grow many eggs. This process eventually produces high level of hormones which are not natural for the womb. Thus, eventhough fresh embryo transfer gives a reasonably good pregnancy rate, we can potentially achieve a higher pregnancy rate with frozen embryo transfer.

In a frozen embryo transfer, the woman ovulates herself, which means her hormones levels are in check and her womb gets ready naturally. The embryo/s is/are transfered after ovulation (typically Day 3 or 5 after ovulation).

Well, I guees it is time for us to break IVF into 2 stages and do the necessary to optimise each stage of an IVF to get the maximum outcome out of 1 IVF cycle.

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How To Choose a Better Sperm ?

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by Dr Agilan Arjunan

Gone are the days where infertility is mainly a women’s problem. Men contribute about 40-50% of causes of infertility.

Majority of men have sperm but the problem lies with the total number and quality of their sperm. Some men have  oligospermia (low sperm count) , asthenospermia ( less motile sperms) or teratospermia ( abnormal sperms). Vast majority of men has a combination of these problems.   A minority of them has no sperm at all , known as azoospermia.

In any fertility treatment , the objective is always to get the best sperm possible to fertilise the woman’s eggs. This gives rise to a better quality embryo and a higher pregnancy rate.

But how do we choose the best sperm? Current standard of sperm sorting is called centrifugation. In this method the sperm sample is spinned in a centrifuge and the motile sperms are selected. In this process , the dead and abnormal sperms are discarded. However, this still does not guarantee that the best sperm has been selected.

A recent development in sperm sorting technique is the utilisation of ‘microfluidic technology’.   In a natural sperm selection in a woman’s womb, only about 10 sperms managed to reach an egg. What started with millions of sperms boils down to just a few sperms. There appear to be a ‘natural filtration’ process taking place where all the dead,abnormal and slow moving sperms are filtered out.

The microfluidic technology utilises the same concept.  In this technique, the researcher from Florida Atlantic University has designed a simple filtration mechanism using a porous membrane.

In this method, the semen sample will be filtered through a porous membrane . Only the best sperms will be able to swim through the porous membrane and will be collected for fertility treatment.

I hope this device will be available commercially very soon and thus help to choose the best sperm and directly improves pregnancy rate.

You can read more here :

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Tips To Reduce Cost of Fertility Treatment

by Dr Agilan Arjunan

cost ivf


Worldwide statistic shows that about 1 in 7 couples suffer from infertility. These couples need some form of fertility treatment in their journey towards parenthood.

Fertility treatments can be as simple as ovulation induction to more sophisticated treatment such as IVF (In-Vitro Fertilisation) and ICSI (Intra-Cytoplasmic Sperm Injection).

IVF/ICSI gives the highest pregnancy rate and it can treat most causes of infertility, both male and female related. However, the biggest concern among couples is the high cost of an IVF.

How can you reduce your overall cost of an IVF ?

The following tips may solve this problem. In fact, several tips can lead to natural pregnancy with no further medical intervention. For those who need fertility treatment, these tips increases success rate of an IVF cycle.

Here are 12 tips to do that .

  1. Empower yourself 

Knowledge is power . This strategy also works when it come to fertility treatments. There are lots of informations on fertility treatments, either printed or online. Couples should empower themselves with basic knowledge of why they have difficulty and what are their options. For beginners, they should know about fertility tests and a where they can get that done. This will invariably save them cost in terms of money, emotional stress and time.


2. Reduce weight

Optimal weight for height (Body Mass Index, BMI) is important for general health for both women and men. This is also true when it comes to fertility health for both sexes.

For a man, obesity can reduce his sperm quantity and quality. This is because obesity reduces his male hormone level (testosterone) by converting it into female hormone oestrogen. Furthermore, obesity can increase temperature around the testicles which can directly affect sperm production in the testicles.

For a women, obesity leads to irregular ovulation and are related to a medical condition called PCOS (Polycystic Ovarian Syndrome). This can lead to poor or no ovulation of her eggs.

Thus, weight reduction can significantly affect the outcome of IVF treatment for both women and men, saving their overall cost of treatment.


3. Reduce stress

Any form of fertility treatment especially IVF can cause a lot of stress among couples. Available evidence suggest that fertility-related and non-fertility stressful life events can have a negative impact on outcome of an IVF treatment.  Any method of stress reduction can improve the overall outcome of IVF treatment. Furthermore, this can preserve marital harmony and relationship between the couple and with others. IVF cost is not only monetary, but also emotional.


4. Eat well

A winning formula for an IVF does not begin the day you start your IVF medications. It starts months before the actual IVF . Maintaining a well balanced and a healthy diet supplies all the essential nutrients for the development of a healthy eggs and sperms which directly improves IVF success rate.


5. Get fertility help early

General medical advise is to get fertility assessment after trying to conceive for 1 year. However , couples should not fall into this ‘ 1 year’  trap. This advise is for younger couples (< 30 years old) in whom, if given adequate time, 80-90% of them will conceive naturally. The remaining 10% may need some help.

When the female partner is older or she has any known medical conditions ( such as endometriosis or irregular periods ) that may impair her fertility, early fertility assessment is mandatory. The 1-year rule does not apply for this group of women because the longer they wait, their fertility declines. They should see a fertility specialist after about 6 months of trying naturally.

For example, a women with endometriosis may have an ovarian cyst or a blocked tubes in which case a laparoscopic surgery (keyhole) maybe needed. If they have waited for 1 year , the endometriosis may have worsen and impaired her fertility further.


6. Go to the right place

This is particularly important if you are ‘novice’ in your journey towards parenthood. In this era of modern medicine, couple can sometimes get lost in their pursuit. They may undergo various fertility tests and sometimes repeated tests with different ‘fertility experts’. This long journey of fertility assessment can take a toll on couples. They not only suffer emotional stress but their pockets are drained.

The best strategy would be to first decide whether you are ready to seek fertility assessment. Once the answer is a “Yes”, go directly to a centre which specialises in fertility assessments. A basic fertility assessment can be offered by many centres but you need to see one that suits your expectation and level of fertility assessment needed.

Consulting the right doctor will save you time, emotional stress and money.


7. Do yearly health screen 

Journey towards parenthood does not start in a day. The couple need to nurture their mind and body well in advance. One way to do this is by keeping tab of your health. If you have yearly health check plan from your employer , use it . When your general health is good, the likelihood of  successful fertility treatment is high. Thus, this will save your overall cost of fertility treatment.


8. Minimal stimulation IVF

IVF involves usage of injectable medications to stimulate egg growth. A bulk of IVF cost is due to high cost of the medications. Minimal Stimulation IVF has been developed to reduce the overall IVF cost. In this method, for a suitable women, less medications are needed to boost their egg growth and this significantly reduces their overall IVF cost. A word of caution, not everyone is suited for minimal stimulation IVF and not all minimal stimulation IVF offered gives a good pregnancy rate. Thus it is important to choose a centre that excels at minimal stimulation IVF.


9. Right Fertility Centre

Generally all fertility centres offer a standard IVF treatment. However, the centres may differ in terms of their packages and their success rate. Financial packages offered must be balanced with the success rate of the centre. Even if the package is very cost effective, if it does not give a high pregnancy rate, you may end up repeating IVF cycles which invariably increases your overall cost.

In a good centre, for a women less than 35 years of age, the overall success rate per IVF cycle is more than 50%. In summary, a good centre may cost more initially, but it saves your overall cost due to high pregnancy rate.  Scout around and find the centre that offers you the best combination for you and your partner.


10. Plan your fertility budget

For some IVF is affordable but for many it needs careful financial planning. Couple tend to stretch their reserves for a treatment which does not guarantee success. So, get detailed informations about every aspect of IVF cost. Get the values on paper and if time permits,  plan your savings for the next 4-6 months before actual IVF starts. This will lessen the burden of payments and can help to reduce stress of going through an IVF treatment.


11. Credit card benefits

Some major credit cards offers easy payment or interest free payments for IVF treatments. It will be wise to also consider this benefit to ease the burden of payment for an IVF treatment.


12. Fertility grants

Fertility grants are given to selected couples based on several criteria. In Malaysia, the only known fertility grant is Tunku Azizah Fertility Foundation (TAFF). This organisation offers financial support for an IVF treatment to eligible couples.

These are the 12 tips on how you can make IVF affordable, cost effective for you and a reality to achieve your dream of parenthood.

Good luck.

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