Infertility can be treated successfully

By P.C. Wong

This health column is jointly run by The Jakarta Post and the Singapore-based Parkway Group Healthcare. Readers are encouraged to e-mail their questions to features@thejakartapost.com.

SINGAPORE (JP): For many married couples, having children is one of their shared dreams. But for many reasons, not all couples are lucky enough to have a baby after their first year of marital life.

Infertility is one of the reasons why married couples have to wait for years to cuddle their baby. According to Serono Symposia in the United States, the term infertility is simply defined as: The inability of a couple to achieve conception after a year of unprotected intercourse, or inability to carry a pregnancy to its full term.

Infertility could solely be a problem in the female or male. However some cases, problems are found in both members. Only a few cases of infertility remain inexplicable after a thorough evaluation of both partners.

Infertility becomes all the more harder because it is often the first crisis a couple face in their marriage. It tests their ability to communicate and may threaten their sexuality in a way few other crises could.

Cases of infertility has been increasing in Singapore and in other big cities in the region because of rapid social, economic and technological development.

More and more young married couples delay having babies, waiting for the right time and financial condition. Heavy work schedules and working couples have also contributed to the increasing cases of infertility because they may have passed their reproductive ages.

The evaluation and treatment of infertility requires a commitment of time, energy and resources by all concerned. Infertility is not merely a physical condition, it is an emotional and social condition as well, carrying with it intense feelings which need careful support from physicians, nurses, counselors and technicians.

To properly treat infertile couples, the Mount Elizabeth Hospital set up a fertility center in late 1988.

This article will summarize the development of the fertility services and programs provided by the Mount Elizabeth Fertility Center during the ten-year period of 1988 to 1998.

The first phase of the fertility center saw the introduction of an in vitro fertilization (IVF) program.

IVF is the original "test-tube baby" technique, and probably the most widely practiced assisted-conception procedure in the world.

It got up to a good start and for a three year period from 1988 to 1990, the pregnancy rate was a respectable 28 percent per embryo transfer.

As the center got more confident in IVF, it decided to proceed with the second phase of its development by introducing embryo freezing. Spare embryos generated in IVF programs are cryopreserved to be used if the first cycle fails or if the couple wants another child.

The first thawed frozen embryo transfer was carried out in 1991 and the numbers picked up gradually year by year. In its eight years, a total of 372 thawed cycles were carried out at the center involving 966 embryos. A total of 848 embryos were transferred. This showed an embryo survival rate of 88 percent. Of these, 86 women conceived, a pregnancy rate of 24 percent per embryo transfer.

Laparoscopy

By this time, it was felt that the GIFT procedure did not provide a higher pregnancy rate, but on the other hand increased the cost in view fact that the patient would have to be placed under general anesthesia and undergo a laparoscopy for oocyte recovery and genetic transfer.

GIFT differs from IVF because the eggs collected from the ovary are transferred back to the fallopian tube almost immediately, together with a small sample of sperm.

With this in view and because of IVF good success rate, the GIFT procedure was hardly carried out after this period. In the early 1990s, however, IVF results showed low fertilization rate especially when dealing with severe male factors.

The year 1993 saw the advent of intracytoplasmic sperm injection (ICSI). This provided the incentive for the center to go on to phase three of its development by the introduction of ICSI for the management of severe male factor problems. ICSI was introduced in 1995 and with it we were able to achieve a higher fertilization rate in male factor cases and the fertilization rates were as good as IVF with nonmale factors.

With the availability now of both IVF and ICSI, pregnancy rates of between 18 percent and 43 percent have been obtained for IVF per embryo transfer while the results for ICSI vary from 12.2 percent to 18.9 percent per embryo transfer.

Recent development in IVF technology seems to be directed at growing embryos to a later stage or delaying the transfer. This would mean transferring embryos between the third and fifth dayafter oocyte recovery.

Initial reports have shown very encouraging results and we are looking seriously into the introduction of delayed transfers as the next phase of our development. Hopefully the introduction of this newer procedure will further improve our pregnancy rates for the benefit of our patients.

The writer is a consultant obstetrician and gynecologist at Mount Elizabeth Medical Center.