Where knowledge and experience make little miracles possible.
Fertility problems affect 1 in 6 couples. If you have been trying to get pregnant for 12 months without any contraceptive techniques with no success (or 6 months for women over the age of 35), you might need the help of assisted reproductive techniques to complete your family. LSC fertility is one of the state of the art fertility centre in Penang.
We are here to help you in achieving your dreams of becoming parents. We provide advanced infertility treatment in a caring and stress free environment. The fertility treatment provided in LohGuanLye SPECIALISTS CENTRE is individually designed for each patient, and the services may include intra- uterine insemination (IUI), In-vitro fertilization (IVF), ICSI, blastocyst transfer, sperm, egg or embryo cryopreservation, egg and sperm donation program.
There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.
Will scar tissue around my ovaries make it impossible to retrieve the eggs?
Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic (ultrasound) or surgical methods.
What if I ovulate before oocyte (also called egg or ovum) retrieval?
Once ovulation has occurred it is impossible to retrieve the eggs. The entire team of physician, nurse and embryologist will monitor your cycle very carefully to avoid premature ovulation.
If an egg is not retrieved or if the technique does not produce a pregnancy on the first attempt, how soon can the procedure been repeated?
This depends on the individual. The primary reason for delay is to allow the patient's normal menstrual cycle to resume, which may take 3 cycles.
How many times will IVF been repeated per couple?
There is no specific number. This is determined by the couple together with the physician.
After the IVF procedure, how long must we wait to have intercourse?
Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation.
What about other activities? How soon can I resume my normal routine?
The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.
How soon will I know if I'm pregnant?
Pregnancy can be confirmed using blood tests about 2 weeks after egg aspiration. Pregnancy can be confirmed by ultrasound around 6 to 8 weeks after aspiration.
I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?
Perhaps, in certain situations, IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes.
What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the pre-embryo?
Four to five medications normally are given:
1. Suprefact, an injectable drug that blocks secretions of the pituitary gland, thereby optimizing the number of oocytes retrieved;
2. Follicle Stimulating Hormone (Metrodin or FSH), hormones that stimulate ovarian activity, are injected daily for about 6-10 days prior to the procedure;
3. Human chorionic gonadotropin (hCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production;
4. Progesterone, a natural hormone that enables the uterus to support pregnancy, is used as a pessary after egg retrieval.
What side effects, if any, can these drugs cause?
No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.
Will I have an egg in every follicle?
It varies from patient to patient.As many as half of the follicles may not contain an egg in some patients.
Is there a possibility of multiple births with IVF?
Yes, when multiple pre-embryos are transferred.
Is there an increased chance of birth defects if I become pregnant through IVF?
There are no known ill effects. However, any long-term effects of IVF remain to be determined.
How much time does the entire procedure require?
Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.
What happens to any extra pre-embryos?
Normally, 2 to 3 pre-embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for your later use. Other options are to donate or simply dispose of them. Excess pre-embryos, if any, belong to you, and you will determine what is to be done.
Puberty is the period in your life when you become capable of sexual reproduction. For female, they start puberty between the age of nine to fourteen. During puberty, a female role in sexual reproduction begins when the hypothalamus sends a hormone, gonatotropin releasing hormone (GnRH) to pituitary gland. The pituitary gland produces 2 hormones which is FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone that travel to the ovaries. The growth of follicles in the ovaries is induced by the level of FSH. This starts day 1 of the menstrual cycle. Out of 5 follicles, only one will become dominant. The dominant follicle is surrounded by granulose cells. This granulose cells will release estradiol which act upon the hypothalamus to continue secrete GnRH, a self perpetuating mechanism. At around day 14 of the menstrual cycle, LH and FSH reach their peak level, this is called 'LH surge'. This phenomenon leads to the release of the egg to peritoneal cavity and this is called ovulation.
After the ovulation, the increased level of LH causes the follicle to form a different structure called corpus luteum. The corpus leteum are responsible for secreting large amount of progesterone and estrogen; both hormones now inhibit the release of GnRH. The corpus leteum produces progesterone for about 12 days, the second half of the menstrual cycle. Progesterone causes the lining (endometrium) of the uterus to thicken and to be prepared for the implantation of the fertilized egg.
The corpus luteum begins to degenerate if pregnancy does not occur. The degeneration of theses cells results in the formation of the corpus albicans and the production of estrogen and progesterone stop at this stage which triggers the shedding of the unneeded lining of the uterus and called menses. The whole menstrual cycle will start all over again.
Vagina - a canal that leads from the outside of the body to the cervix, the opening to the uterus.
Uterus - a hollow, pear-shaped organ located in the lower centre of a woman's pelvis. It is a muscular organ with nourishing lining called endometrium where a fertilized egg implant and develop until birth.
Fallopian tubes - the fallopian tubes extend from the top of the uterus down over the ovaries.
Ovary - an organ located just below the fallopian tubes on each sides of the uterus, the ovaries produces eggs.
Fertilization of the egg must occur at exactly the right time. Any interruption to the necessary steps can interfere with the fertilization or implantation and result in infecundity.
The female produces an egg from one of the two ovaries every month. After the ovulation, the egg travel from the ovary and into the fallopian tube. During intercourse, the male sperm deposited at the vagina. The sperm swim from vagina through the cervix and uterus and finally meet the egg at the fallopian tube. Fertilization occurs when a sperm finds and penetrates an egg as it waits in the fallopian tube. Once the egg is successfully fertilized, it continues to move through the fallopian tube and into the uterus where it will implant in the uterine wall.
Failure to conceive affects both partners equally. There are a few causes that effect a women fertility.
1. Endometriosis
A condition in which the endometrial tissue (uterine lining) grows outside the uterus. The reason of this incident occurs is remain unknown. The symptoms are painful menstrual period, heavy flow, possible repeated miscarriages. Treatment of endometriosis can be performing laparascopic to remove abnormal tissues.
2. Ovulation problems
Any conditions (hormonal) that prevents the release of a mature egg from an ovary. The patient could experience absent or infrequent period, excessively heavy or light bleeding. Ovulation induction such as clomiphene, follicle stimulating hormone and in-vitro fertilization could help in such patient.
3. Polycystic Ovary Syndrome (PCOS)
The ovary contains many small cysts. The patient is having hormone imbalance and do not ovulate regularly. The symptoms include irregular menstrual, excessive hair growth, weight gain and acne growth.
4. Tubal blockages
Block or damage fallopian tubes prevent sperm from getting to the egg. This is caused by pelvic inflammatory diseases such as Chlamydia. Laparascopic surgery can be done to clear the blockages of the tubes. If the tubes are damage, proceed with IVF treatment.
1. Male tube blockages
Obstruction of the vas deferens
2. Sperm problem
a. Low sperm count - < 20 million sperm/ml of semen
b. Poor sperm motility - sperm unable to swim through the cervix to the fallopian tube to meet the egg.
c. Poor shapes - abnormal sperm or unable to fertilize the egg
3. Ejaculation problem
Erectile dysfunction - unable to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.
If testing indicated an ovulatory problem, hormonal therapy will probably recommended. Several pharmacological agents initiate, augment, or modulate the hormonal and gametogenic responses of the ovary. These include clomiphene citrate (CC), FSH,and luteinizing hormone-releasing hormone (LH-RH) analogues (LH-RHa). hCG, and occasionally LH-RHa, are given to induce ovulation when follicles are fully grown, although an endogenous LH surge may induce ovulation in some patients.
Ovarian stimulation is used for:
(i) Women with severe oligomenorrhea (infrequent or light menstrual periods)) or frank amenorrhea (absent of menstrual periods) without premature ovarian failure.
(ii) For oligo-ovulation (infrequent or irregular ovulation) or anovulation (absent of ovulation) associated with polycystic ovarian disease (PCOD), hypothalamic and pituitary dysfunction, luteal phase defects, and for cyclic patients undergoing assisted reproduction.
Controlled ovarian hyperstimulation in normal cyclic women is used for:
(i) Patients with unexplained infertility, cervical factor, immune-related infertility, endometriosis.
Intra-uterine insemination has been practiced since the late 1800's, primarily for idiopathic (unexplained) infertility in men with deficient semen parameters. It bypasses the cervix, so it is used for cervical factor infertility, including abnormal cervical mucus, aberrant interactions due to antibodies against spermatozoa and other factors, cervical stenosis, cystic fibrosis with inspissated mucus, and deficient mucus production secondary to surgical manipulation of cervix. It may help to alleviate oligoasthenozoospermia (poor sperm quality). It can be performed during natural or stimulated cycles. But the success rates is higher with the stimulated cycles.
Couples undergoing timed ovulation and IUI must complete a basic fertility investigation. The wife must have one patent tube, respond to ovarian stimulation, have no peritoneal factors impeding ovum release and pickup, and have a uterus capable of implantation.
In-vitro fertilization (IVF) is a process by which oocyte cumulus complexes (OCCs) are fertilized by sperm outside the womb, In-vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technologies (ART) have failed. The process involves hormonally controlling the ovulatory process, retrieving oocyte(s) from the woman's ovaries and letting sperm fertilize them in a culture medium. The fertilized zygote(s) will further cleave to embryo(s) and subsequently transferred to the patient's uterus with the intent to endeavor a successful pregnancy.
Absolute indications for IVF include:
(i) Problems of the fallopian tube
(ii) Require healthy ova, sperm that can fertilize, and a uterus that can maintain a pregnancy.
(iii) Females who have already gone through menopause by using donated oocytes.
Procedure necessary for In-vitro fertilization and Embryo(s) transfer (IVF-ET):
(i) Control ovarian stimulation with fertility drugs
(ii) Ultrasound/ laparoscopic oocyte(s) pick-up from the patient
(iii) Fertilization of oocyte(s) with sperm in laboratory environment
(iv) Transfer of embryo(s) into the body of patient
(v) The administration of any drugs and/ or anaesthetics which may be found necessary in the course of procedure(s)
Male subfertility has been one of the most important indications for assisted reproduction. However it was soon recognized that conventional In-vitro fertilization (IVF) (mixing sperm and oocytes in a dish) was relatively ineffective in patients with hopelessly poor sperm counts and with zonal problems and that such patients could only be treated if the zona pellucida barrier could be overcome. Some of the methods used initially were zona drilling (ZD), partial zona dissection (PZD) and subzonal insemination (SUZI). In Loh Guan Lye Fertility Unit, ICSI (Intra-Cytoplasmic Sperm Injection) is done to help the couples with poor sperm quality . The success for this technique was introduced and has been utilized predominantly to overcome severe male subfertility, giving fertilization and birth rates similar to conventional In-vitro fertilization.
Absolute indications for ICSI include:
(i) Poor or total previous fertilization failures with conventional IVF
(ii) Oligoasthenoteratozoospermia (poor sperm count, motility and shapes)
(iii) Use of epididymal, testicular sperm or spermatids for obstructive and non-obstructive azoospermia (a surgery to collect sperm from epididymal or testicles)
(iv) Couples with antisperm antibodies in the female sera or in the seminal plasma
(v) Perform in couples requiring preimplantation genetic diagnosis (PGD), in order to avoid the risk of DNA contamination
The cryopreservation of human embryo(s) helps to overcome the wastage of "spare embryo(s)" resulting from ART programs. It improves the chances of pregnancy by permitting a series of embryo replacements into the patient following fertilization In-vitro after only a single oocyte recovery. It allows for greater flexibility in the synchronization of cycles between donors and recipients in an embryo donation program and is also a means of preserving embryos for patients who are at risk of losing ovarian function through pelvic disease, surgery, radiotherapy or chemotherapy.
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