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[ Our ART Programmes ]
[ Before Starting Treatment
]
[ Commencment Of The Programme
]
[ Side Effects Of Treatment
]
[ Result & Review
]
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This write-up here will tell you about
the treatment that CHRISTOPHER CHEN CENTRE FOR REPRODUCTIVE
MEDICINE offers with regards to IVF-ICSI. Our aim is to
ensure that you are given care in this most important
venture towards your goal of parenthood.
The first thing to mention is that it does not work every
time. Our staff members keep in constant contact with
those from other units and regularly attend medical and scientific
meetings to share information and new ideas.
Your IVF programme will be under the direction of the Infertility
Specialist together with his multidisciplinary
team consisting of Laboratory Scientific Director, Embryologist,
Technologist, Nurses and Customer Service Officers. All these
individuals will at some point be involved in your care.
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| Before Starting Treatment |
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Consultation
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The first step is a consultation with the Specialist.
He will do a thorough medical assessment of you and
your spouse and discuss your fertility problem, and
discuss anything you are concerned about. If it seems that
IVF is not the most appropriate form of treatment, he
can advise you about treatment that may be more suitable
and make arrangement for you to receive it. If there
are underlying gynaecological problems that need to
be corrected surgically to ensure a better chance of
success, the
Specialist will advise accordingly.
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Financial Considerations
& Counseling |
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- Couples considering IVF should become thoroughly
familiar with their health insurance policy to know
which medications and IVF-related procedures, if any,
are covered.
- They should also be informed of the Medisave claim
entitlement for first 3 cycles.
- It is important for them to know the costs involved
in each treatment programme.
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General Counseling |
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- Couples embarking on the programme will receive
a detailed counseling session by the Registered Nurse
together with a video presentation. The videotape,
produced by the Ministry of Health, covers all the
important aspects of assisted reproduction including
risk of multiple pregnancy, etc.
- Various written consents for procedures and investigations
will be taken from the couple prior to the commencement
of the programme.
- The Laboratory Scientific Director separately speaks
with the couple on the laboratory aspects of his involvement,
and provides counseling when needed.
- There is compulsory neonatal insurance scheme that
couples (Singaporeans & foreigners) would have
to take up if they wish to have to deliver their baby/babies
in Singapore.
- 3 embryos are the maximum number permitted to be
implanted at any one cycle.
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| Commencment Of The Programme |
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Preliminary Investigations
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- Baseline ultrasound scan of abdomen & pelvis
for the wife
- Semen analysis for the husband
- Laboratory investigations including mandatory tests
such as HIV, Rubella, etc
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Down Regulation
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Every month, a woman develops several eggs in her ovaries
but usually only one is chosen by the body to be released
into the fallopian tube. In IVF we make women produce
more than one egg and in this way, we have a greater
chance of collecting at least one which is healthy.
There are several ways in which we stimulate egg production
and we will choose the most suitable method for you.
For most women, we use a combination of drugs first
to switch off the pituitary gland from suddenly deciding
to initiate ovulation during the stimulation treatment.
This phase of treatment is known as the 'Down Regulation'.
With this, the body thus responds in a more controlled
way to the fertility hormones that follow. We will perform
an ultrasound scan on you before the start of the fertility
hormone to ensure that 'Down Regulation' has been achieved.
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Stimulation of
the ovary to produce egg (Ovulation Induction) |
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Next, fertility drug is given to stimulate the ovaries
in order to induce the production of several eggs. This
increases the odds of success and allows for freezing
(cryopreservation) of remaining pre-embryos for use
at a later stage. We will use the drug, which needs
to be given for about 14 days.
On the day after the last daily hormone injection,
you will be given an injection of the hormone Human
Chorionic Gonadotrophin (HCG). This matures the eggs,
which should be ready for collection.
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Egg Recovery
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36 hours after the HCG injection, we collect the eggs
from your ovary.
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Embryo Transfer
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3 days after the eggs have been taken out, if they
are fertilised and are developing normally, we put them
into your womb. This procedure is quick and simple.
A fine plastic tube containing the embryos is passed
through the cervix (the neck of the womb), and the embryos
are placed high into the womb. After the embryos have
been transferred you have to stay lying down for about
4 hours, but after that you can resume your normal activities.
The cavity of the uterus is so sticky on the inside
that there is no danger of the embryos "falling
out".
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Supporting the
luteal phase |
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Your embryos have
been returned to the uterus. You are probably feeling
very happy but also rather anxious. What if something
goes wrong now? Such questions are entirely understandable.
At this point in time, while it is really up to nature
to take its place, we can of course help by making sure
sufficient hormones are circulating in your blood, so
that a resulting pregnancy will be promoted. The most
important hormone for pregnancy is progesterone. The
Specialist will prescribe this hormone in the form of injections
or vaginal gel. The gel is introduced into the vagina,
where they will largely be absorbed. Still a small amount
of vaginal loss is not unusual and you are advised to
use a mini sanitary pad. You must begin to take progesterone
right after the extraction of eggs and you must continue
to take the prescribed dose until the result of your pregnancy
test is known, which is usually 9 days after embryo transfer. |
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| Side Effects Of Treatment |
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There is no drug that is absolutely
safe and completely free of side effects, but with the doses
of drugs we use you should notice few. For example, some drugs are designed to stop your ovaries working temporarily and so
has an effect rather like that of 'menopause'. This means that
you might get hot flushes, or night sweats, mood swings, etc.
Most women experience few or no side effects; and all the problems
are reversible and will disappear when you start the fertility
injections and your ovaries begin to work again.
With all fertility drugs, the biggest worry is that they
will do their job too well and produce an exaggerated response
called "hyperstimulation". This sometimes happens
and is accompanied by some pain, swelling and discomfort in
the abdomen.
It is important that should you attend any doctor or hospital
during the course of the programme, you must inform them of
the drugs you are receiving. You must also draw their attention
to any discomfort experienced.
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You have gone through much in the
programme right up to the embryo transfer cycle. Unfortunately,
the day of the pregnancy test is usually the most difficult.
It is filled with much anxiety and can conclude with extreme
emotion. This can be bliss or deep sadness. A negative pregnancy
test can lead to an understandable temporary "reactive"
depression. It is important to use your support system (husband
or close family and friends) during this difficult day. If your
result is positive then you must make an effort to control your
excitement and remain calm. The reason for this is that despite
an initial positive pregnancy test, the possibility of a miscarriage
still exits. The initial pregnancy test will be repeated in
48 hours. Additional tests will be ordered on an individual
basis.
Whatever happens after the result of the pregnancy test,
we will spend time talking things over with you. If you are
pregnant, we will be able to offer pregnancy advice and support,
and once we have determined that your pregnancy is progressing
without any complications, we will continue with the management
of the remainder of your pregnancy and the delivery of the
baby or babies.
If the treatment has not worked, we will do a complete review
of your cycle and will conclude with a discussions of options
based on insights gained from your cycle.
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