Do you or a loved one of yours have difficulty in conceiving a child?
I, too have a friend who has been married for about 3 years now, but has been facing pregnancy problems no matter how hard she tries.
I found a chance to talk to Dr. Selva, an experienced obstetrics and gynaecology cum reproductive medicine doctor, who is also the former president of the Obstetrical and Gynaecological Society of Malaysia (OGSM).
We talked into detail regarding infertility and In-vitro fertilization (IVF), and so I compiled our conversation into these FAQs about IVF for you, with answers provided by Dr Selva!
Dr. Selva has had 26 years of experiences in the medical field, having held positions as the Past President of The Asia-Pacific Association for Gynaecologic Endoscopy, Past Malacca Branch Chairman of Malaysian Medical Association (MMA), as well as Past President of Obstetrical and Gynaecological Society of Malaysia (OGSM). Dr. Selva is currently based at Malacca Mahkota Medical Centre IVF Centre as Consultant Obstetrics & Gynaecology.
First off, let's ask ourselves a few questions:
How do I know if I am infertile?
The medical definition of infertility is failure to conceive a child after regular unprotected sexual intercourse for one year.
For couples above the age of 35, this is reduced to six months.
What are the main factors of infertility?
Many factors can affect fertility, including age, stress, body weight, smoking and alcohol intake.
In addition, the cause may be due to factors affecting both the husband and wife. Therefore, the couple should seek medical advice together, so as the best possible treatment can be identified and offered.
Infertility is not necessarily the wives’ responsibility. Studies find that men and women face 50% of infertility respectively.
When infertility occurs, both husband and wife should seek medical consultation together, so that the doctor can provide the best diagnosis.
What is In Vitro Fertilisation (IVF)
What is IVF?
IVF is a procedure to treat fertility problems and help in the successful conception of a child.
During an IVF process, mature eggs are retrieved from your ovaries and is fertilised by sperm in a laboratory.
Once fertilised, the egg, now an embryo, is implanted into your uterus for the pregnancy to take place.
Once cycle of IVF takes approximately 2 weeks.
How successful is an IVF procedure?
The success rate of IVF is approximately 50%, mainly due to the age factor of female patients – the younger the age, the higher the success rate for pregnancy via IVF.
Besides that, gynaecology related diseases such as Endometriosis and ovarian cysts also affect IVF success rate.
Is IVF suitable for all women who have pregnancy difficulties?
Unfortunately, there are a few factors in which IVF wouldn't be useful.
Women with no uterus, who are above the age of 45 and who are unable to produce eggs, or have male partners with azoospermia (inability to produce sperm) cannot undergo IVF.
These couples may have to consider a surrogate mother and/or sperm donation.
Currently, these two options are not permitted in Malaysia due to religious and regulatory policies.
Are there any physical differences between babies born using IVF and natural childbirth?
Contrary to some beliefs, babies born through IVF are exactly the same as those born naturally.
Since “test-tube” babies are “man-made”, is it possible to predict the gender of the babies?
Preimplantation genetic screening (PGS) are a series of tests done to screen embryos for any genetic diseases related to the embryo’s sex.
This can be used to predict the child’s gender, but there are many legal and ethical issues surrounding it.
Currently it is only legal in the United States of America. Most other countries (including Malaysia) have restrictions against the use of PGS.
Many successful IVF cases involve twins and multiple babies, why is this so?
Doctors will normally insert two embryos into the womb in IVF to increase the chances of pregnancy with at least one child. But this also means that there would be some cases where both embryos are carried to term and produce twins.
However, there are more risks with twin pregnancies compared to single pregnancies, so there are generally more successful cases of IVF with a single child.
Currently in Western countries, IVF is carried out mainly with single embryos to reduce twin pregnancies, but this can affect the success rate of the procedure.
Is it true that IVF procedures increase the risk of premature childbirth?
There is a higher risk of premature childbirth with ‘test tube babies’ compared to babies conceived naturally, but the cause is yet to be proven.
Each pregnancy is unique and you should consult with your doctor if you have any concerns.
IVF FAQs for mothers - what you should do
For a mother who has gotten pregnant after a successful IVF, is it better to go for a normal childbirth delivery or a Caesarean section delivery?
For single babies, there is no difference between natural childbirth or Caesarian section - it is entirely up to you to decide on your method of delivery.
For twins and multiple pregnancies, your doctor may recommend a Caesarian section to reduce the risk of complications.
If you wish to understand more, check out Natural Labour VS Caesarean Section.
How should expecting mothers take care of themselves before, during, and after IVF procedures?
Women looking to become pregnant should take folic acid (Vitamin B9) daily. It is important for the baby’s growth, and taking it will help prevent the baby from developing major deformities, such as cleft lip and neural tube defects.
You should consult your doctor for professional advice before starting any supplements.
Planning for IVF will vary depending on the individual, and as such, you should consult with your doctors for specific details.
If the IVF procedure fails, how long does it take to start a new session? Is there a limit to the number of IVF procedures received?
Usually, the couple is given a two to three month interval between IVF cycles. This allows the couple to rest and to prepare themselves both physically and emotionally from the unsuccessful cycle.
Any advice regarding lifestyle changes should be taken into consideration in this period.
Women produce a limited number of eggs throughout their lives. Will IVF cause premature menopause?
‘Test-tube babies’ will not cause premature menopause.
While women will produce a limited number of follicles (eggs) monthly, eventually only one will mature and be released. The others will naturally shrink and be destroyed.
FSH will allow these shrinking follicles to grow and mature as well, without making the ovary produce more follicles than necessary.
I've heard about Intrauterine Insemination (IUI) as well. What's the difference between IUI and IVF?
Intrauterine insemination (IUI) is carried out by inserting the husband’s sperm into the wife’s womb, where the sperm will fertilise the egg on its own.
On the other hand, in-vitro fertilisation (IVF) is where the wife’s egg is extracted from the ovary and combined with the husband’s sperm in a laboratory. The fertilised egg (or embryo) is then inserted back into the wife’s womb.
Not every couple seeking treatment will have to undergo IVF. If the husband has a normal sperm count, the wife is producing healthy eggs, and if at least one of the wife’s Fallopian tubes is not blocked, the couple can consider IUI.
IVF will usually be considered if the husband’s sperm count is low, the wife is above the age of 40, if both tubes are blocked and if she has not conceived after several attempts of IUI.
Final tips on pregnancy problems
Before we ended the conversation, I asked Dr Selva for some final advice to couples struggling from infertility.
Avoid getting married late!
If things turn bad, there will still be time to solve the problems and receive treatment if you are young.
For women above the age of 36 and facing difficulties getting pregnant, it would be best to undergo IVF as soon as possible.
On another note, somebody who has endometriosis should receive treatment as soon as possible, even if she is not married, as it will help improve her chances of becoming pregnant in the future.
If you have any questions regarding infertility and the treatments for it, you should speak with your doctor.
If Melaka is not too far away for you, you may fill up a simple enquiry here, and DR. Selva, together with Mahkota Medical Centre’s professional medical group, will try their best to assist you!
A short story about IVF
Dr Selva also shared a story of his patients, David and Leela (not their real names).
Leela, who is 27 years old, had a disease known as endometriosis. This is a disease in which the inner lining of the womb (or uterus) is found in other places, such as the ovary or outside the reproductive system. This lining will bleed during menstruation, and causes pain as well as infertility.
Leela undergone several tests and treatments for her endometriosis - a hysteroscopy to view the inner lining of her uterus, which revealed that her left Fallopian tube was blocked, and a cystectomy (removal of ovarian cyst) for an endometrial cyst.
She also tried intrauterine insemination (IUI), which was unsuccessful.
In Dr Selva's centre, a full medical examination and ultrasound scan were carried out. Leela’s hormone levels were found to be normal, but the ultrasound scan revealed that both her ovaries had cysts, which were most likely due to her endometriosis.
She was advised to not undergo surgery for the cysts, as they were small, and to go directly for in vitro fertilisation (IVF) instead. This was successful, and Leela gave birth to a healthy baby boy.
I hope that this interview session with Dr. Selva helps to clear your confusion regarding infertility. If you're interested, just get in touch with Mahkota IVF centre here!
If it is inconvenient for you to travel to Melaka, check out all of our listed Malaysian IVF centres here. If you find this article helpful, do like our post and share them with your friends, or share your thoughts with me in the comments below!
Mahkota Women Specialist and IVF Centre commenced its service in July 1997 and since then we have helped more than 950 families to fulfil their dreams with more than 1188 take home babies including 203 pairs of twins, 19 sets of triplets and 1 set of quadruplets. With a 50% success rate, the centre is on par with many infertility centres in countries such as the United Kingdom and the United States of America.
Armed with experience and dedicated Consultant Obstetricians Gynaecologists with IVF training, Embryologists and nursing staff, the IVF Centre is a one-stop centre equipped with in-house laboratories for Semen Purification and Embryo Culture, Counselling and Follow-Up Room, IVF procedure rooms, Semen Collection Room, Intrauterine Insemination (IUI) Procedure and Recovery Room to promote patients’ convenience and privacy.
Services provided in IVF Centre include IUI programme, IVF, Intracytoplasmic Sperm Injection (ICSI) and gamete freezing programme. Since the year 2002, we have extended embryo culture to Day 3. By doing this, we managed to increase our pregnancy success rate for both IVF and ICSI programme to 50%. The younger the patient is, the higher the chances of success and these pregnancy rates are also comparable to the success rates of renowned fertility centres in Europe and US.