Infertility is defined as not being able to get pregnant after one year of trying; in women over 35, some doctors consider six months of trying to be long enough for exploring other options for conceiving. Up to 12 million Thai people are currently experiencing infertility.
Table of Contents
- Get to know ‘Infertility’
- Causes of Infertility
- Fertility Treatment
- Assisted-reproductive Technologies for infertility
- Fertility Treatment Procedures
- Fertility Treatment Success Rates
- Risks and Side Effects of Fertility Treatment
- Fertility Treatment Costs
- Fertility Treatment Services at Beyond IVF
- Final Thoughts
Get to know ‘Infertility’
In generally accepted terms, it’s couples who are unable to conceive naturally after at least 1 year of trying. Additional factors include women entering advanced maternity age (35 years and up), women with pre-existing reproductive issues such as tubal blockage, women that experience irregular periods and/or other related medical conditions that negatively impact fertility.
Causes of Infertility
In 40% of cases of infertility, it is due to a problem with the female partner, in 25% of cases it is because of the male partner, and in 20% of cases it is due to both partners. The rest of the time the cause of infertility is unknown.
Seeking medical advice as soon as possible for diagnosis and treatment of the cause of infertility will increase the chances of the successful pregnancy.
Female Factor Infertility
There are many female factors that affect fertility. Most aspects of reproduction occur in the woman’s body. Two main causes of infertility in women have to do with the:
The egg is where reproduction starts, when it is fertilized by sperm. Eggs are healthiest during a woman’s ideal reproductive age, usually under 30. As a woman ages, her eggs do as well. They decrease both in quantity and quality, limiting how many eggs are healthy enough to be fertilized in the small window of ovulation each month.
The uterus is where the egg meets the sperm and where the fertilized egg implants so any problems with the fallopian tubes will prevent sperm from meeting the egg. (Fallopian tubes can be visualized using a dye in a procedure called hysterosalpingography.) Fibroids or cysts in the uterus can also prevent pregnancy. The uterus can be visualized through ultrasound.
Male Factor Infertility
Male factor infertility usually has to do with the health and quality of sperm, such as low sperm production, abnormal sperm function, or blockages that prevent delivery of sperm.
A semen analysis can be done to check if infertility is caused by the male partner and usually assess the number of sperm and the function of sperm in its ability to fertilize the egg.
In some cases no specific cause of infertility can be found, even after carrying out all standard tests for infertility, including ovarian assessment, semen analysis, and hysterosalpingography to examine the fallopian tubes.
This occurs in 10-15% of infertility cases. Sometimes the cause of infertility is revealed during treatment. For example, problems with fertilization may appear during in vitro fertilization.
There are currently many options available for the treatment of infertility, each with its own sets of pros and cons, including intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI).
There is also the option of freezing eggs when they are of highest quality to be used down the road when you are ready for pregnancy.
Assisted-reproductive Technologies for infertility
1. Intrauterine insemination (IUI)
IUI, or intra-uterine insemination, is typically the first option chosen for couples who are first experiencing infertility issues, but have not entered advanced maternity age. This non-invasive process replicates the performing of actual intercourse, in which the man’s semen is first collected, prepared and is then injected directly into the uterus during ovulation.
IUI is suitable for patients who have tried and failed to conceive naturally over the period of 1 year, for men who experience pre-mature ejaculation or are impotent and for women with potential ovulation issues or irregular periods.
IUI is unsuitable for women that are of advanced maternity age, along with women diagnosed with (fallopian) tube blockage, ovarian failure and/or severe endometriosis.
- Inexpensive vs IVF.
- Process not as involved as IVF.
- Less time required overall for treatment.
- Completely non-invasive.
- Lower success rate than IVF.
- Pre-existing reproductive issues can potentially disqualify the use of IUI.
- Not recommended for women of advanced maternity age.
- Initial Consultation: The initial consultation will result in a treatment plan and recommendations from our Doctor on how to best prepare for the IUI treatment.
- Hormone Stimulation: Take the prescribed hormone medications as instructed starting on day 2/3 of your cycle.
- Ultrasound: An ultrasound will be performed at the mid-way point, allowing the doctor to evaluate the quality of the eggs during the hormone stimulation period.
- Semen Collection: On the day of the IUI procedure, semen is first collected from the male patient, then is prepared in our lab to ensure that mostly healthy, fast-moving sperm are used for insemination.
- Intra-uterine Insemination: After the semen sample is prepped, the actual IUI procedure can commence, with the Doctor injecting the semen directly into the woman’s uterine cavity.
- Monitor for pregnancy: After 3 weeks post-IUI, the Doctor will schedule another follow-up to check for pregnancy.
2. In-vitro Fertilization (IVF)
IVF, or in-vitro fertilization, is the process of fertilization where a female patient’s egg is combined with the male patient’s sperm outside of the body, or in vitro (“in glass”).
Similarly to IUI, the female patient must first take prescribed hormone medications to stimulate the production of additional eggs for typically a period of at least 10 days. Once the Doctor deems the patient’s eggs to be ready, the eggs will then be collected at our center and fertilized post-collection.
- Significantly higher success rates vs IUI.
- Effective for couples that already have had vasectomies or tubal litigation done.
- Allows for in-depth genetic screening of embryos prior to transfer.
- Non-invasive, no surgery involved.
- Appropriate for male patients with severe infertility issues, including low sperm counts and low sperm motility.
- More expensive vs IUI.
- More frequent doctor visits/appointments.
- More involved process vs IUI.
- Initial Consultation: The initial consultation will result in a treatment plan and recommendations from our Doctor on how to best prepare for the upcoming IVF treatment.
- Hormone Stimulation: Take the prescribed hormone medications as instructed starting on day 2/3 of your cycle.
- Egg & Semen Collection: After the stimulation phase completes, the Doctor will schedule the egg collection (“Ovum Pickup”) procedure along with semen collection.
- Embryo Culture: Once fertilized, our embryologists will monitor the embryos’ development for 5 days until they reach the Blastocyst stage.
- Embryo Transfer: Transfer of 1 or more embryos that have been a given a clean bill of health through prior genetic testing.
- Monitor for Pregnancy: Post-embryo transfer, blood tests will be scheduled every 3 days to monitor hormone levels, with clinical pregnancy typically occurring within 14 days.
3. Intracytoplasmic Sperm Injection (ICSI)
To aid in increasing fertilization rates, modern IVF treatments also take advantage of ICSI, or Intracytoplasmic Sperm Injection, an advanced form of IVF in which one single sperm is injected directly into a mature egg using miniature glass needles.
Once fertilization occurs, our lab will then culture the embryos for 5 days, allowing the embryo to reach the optimal stage of development (a “blastocyst”), at which point the patient can choose to implant the embryo immediately (called a “fresh embryo transfer”), or freeze the embryos for transferring at a later date.
- It is currently the ART with the highest success rate.
- It can treat a variety of problems.
- No surgery is required.
- It can be done even after a tubal ligation.
- It can be done even with low sperm motility.
- Genetic testing (next-generation sequencing or NGS) of the embryo can be done before it is transferred.
- ICSI costs significantly more than IUI.
- It has a more complicated procedure.
- The procedure lasts many days.
- Some patients may experience side effects from egg collection, such as abdominal discomfort.
- Doctor consultation: The doctor will explain the procedure and preparation and set up the treatment plan. (Please see the doctor before your period.)
- Ovarian stimulation: The doctor will check your hormone levels and carry out an ultrasound to start. You will receive an ovarian stimulation injection on the second or third day of your cycle. The doctor will then schedule ultrasounds and blood tests to monitor the growth of your eggs and check your hormone levels. This process takes approximately 10 days.
- Egg and sperm collection: Once the eggs have reached the desired sizes, the doctor will remove them from the ovaries. The procedure is done under sedation and a needle is inserted through the vagina into the ovaries to collect the eggs. This procedure takes 20-30 minutes. Sperm also needs to be collected and only the best quality sperm are kept to be used in the fertilization process in the laboratory.
- Embryo development: Embryos are kept in the laboratory until they become six- to eight-cell embryos and then on to strong blastocysts.
- Embryo transfer: Once ready, the doctor and patients will select an embryo to be transferred into the uterus. This is done through the vagina and does not require anesthesia.
- Pregnancy test: The doctor will schedule blood tests every three days after embryo transfer to check hormone levels. Pregnancy can be tested for 14 days after the transfer.
4. Egg Freezing
Egg freezing involves harvesting of eggs from the ovaries and freezing them to preserve them for future use. As a woman ages, egg quantity decreases and their quality declines, with higher risk of chromosomal abnormalities. Infertility is on the rise in developing countries and one reason for that may be that couples are waiting longer to get married and have children. Freezing eggs when they are healthiest is becoming a popular option for women these days.
Egg Freezing Pros
- The best quality eggs can be harvested and frozen, essentially stopping the aging process.
- Reduces the risk of Down syndrome and other chromosomal abnormalities caused by pregnancies later in life.
- Can be a treatment for infertility when done in conjunction with IVF.
- Is a relatively painless out-patient procedure that does not require a recovery period.
- Provides agency in family planning.
Egg Freezing Cons
There are costs associated with storing your eggs (at Beyond IVF, the cost is 2000 baht a year per egg)
Some people may experience discomfort after the egg collection procedure, but your doctor will provide recommendations on how to best manage any temporary discomfort
Egg Freezing Process
- Meet the Doctor: One of our infertility specialists will ask you about your medical history and provide information and recommendations regarding egg freezing. Consultations are free at Beyond IVF, so feel free to make an appointment, even if you’re just curious about the process!
- Physical examination: A vaginal ultrasound will be done to assess the uterus and ovaries, including blood tests to check your initial hormone levels. This allows our doctor to determine the timeline for the egg collection procedure and the dosage required for the stimulation medication.
- Ovarian stimulation: Follicle-stimulating hormone (FSH) is injected to stimulate the ovaries and increase the size and quantity of eggs (also called controlled ovarian hyperstimulation). This injection must be administered in the abdomen at the same time every day for 10-12 days. This process replaces natural ovulation and uses medication to bring it on instead.
- Monitoring the eggs: Approximately seven days into the ovarian stimulation process you will return to see your doctor for a second ultrasound to monitor your response to the hormones. Dosage will then be adjusted if needed as recommended by our doctor.
- Trigger ovulation: Once the eggs have reached the desired size (18-20mm in width) by approximately day 10-12, the doctor will administer a trigger shot to force ovulation, which typically occurs thirty-six hours after the trigger, leading us into the next step, egg collection.
- Egg collection: Thirty-six hours after receiving the trigger shot, your doctor will make an appointment for egg collection, during which you’ll be sedated (twilight anesthesia) by a certified anesthesiologist. Vaginal ultrasound is used to guide a needle to collect the eggs individually from each ovary. There is no incision and one to two hours of rest is typical after the procedure before you’re allowed to return home.
- Egg freezing: Once the eggs have been collected they will be sent to our certified embryologist to screen for quality before being graded, prepared and frozen in liquid nitrogen at -195 degrees Celsius.
Fertility Treatment Procedures
If you are worried about your fertility or exploring treatment options for infertility, please stop by to see our doctor to carry out a thorough examination of both partners before confirming a diagnosis of infertility and planning treatment.
Tests for the Female Partner
- Ultrasound to examine the reproductive organs for any abnormalities as well as measure the uterine lining (endometrium)
- Blood tests to measure hormone levels, including Anti-Mullerian hormone (AMH) that is produced in egg follicles and provides information about ovarian function and reserve (how many eggs are in your ovaries at the time). Measuring your AMH level is currently the most accurate test for ovarian reserve.
Tests for the Male Partner
Semen analysis to measure the number and health of sperm
Fertility Treatment Success Rates
1. Intrauterine insemination (IUI)
The success of IUI depends on many factors, including:
- The age of the female partner
- The number of healthy eggs that can be fertilized
- The concentration of the semen that is injected into the uterus and the thickness of the uterine lining on the day of insemination
All these factors will be carefully managed by the doctor to ensure the highest chances of success. IUI is an ART that is widely used. It is fairly successful, very safe, and more affordable than other techniques.
2. In vitro fertilization (IVF)
The success of IVF depends on:
- How the female partner responds to ovarian stimulation
- Health of the embryos
- Age of the female partner (being over 40 decreases the chances of success in comparison with someone younger than 40)
- Health of the female partner, including ovarian function
3. Intracytoplasmic sperm injection (ICSI)
ICSI is about 70% successful in helping sperm fertilize the egg; as with most fertility treatments, the older you are, the lower your chances of success in comparison with someone younger.
However, even after fertilization, there is always the risk that the egg may become damaged, the embryo may not develop, or the embryo may stop developing before it can be transferred.
4. Egg freezing
The chances of a successful pregnancy with egg freezing is the same as with natural conception. The ideal age for reproduction in women is between 20 and 35 as the eggs are of highest quality then.
When eggs are harvested and frozen, and then thawed using vitrification, 90-95% of them survive. So the more eggs collected, the higher the chances of pregnancy.
Risks and Side Effects of Fertility Treatment
Risks and side effects of fertility treatment depend on the type of ART used, but can be categorized as follows:
- Side effects of medication and of ovarian stimulation
- Side effects of the procedure itself, such as anesthesia, egg collection, and embryo transfer
- Complications of pregnancy, such as twin pregnancy, ectopic pregnancy, etc. These complications are rare.
Fertility Treatment Costs
- Intrauterine insemination (IUI) is a popular option because it is affordable. At Beyond IVF, each round of IUI is 30,000 baht. It is recommended for those who are just beginning to investigate treatment for infertility and who, after assessment by the doctor, don’t have a complication diagnosis.
- In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are more expensive and can range in price from 200,000 to 500,000 baht, depending on where it is done. These options are more appropriate for complex cases of infertility and have higher chances of success. If IUI is unsuccessful, this is often the next option. At Beyond IVF, the cost for IVF/ICSI begins at 300,000 baht.
- Egg freezing is like taking out an insurance policy. When you are ready to become pregnant, you know that you have high quality eggs waiting to be fertilized, for the best chances of pregnancy and healthy embryos. At Beyond IVF, egg freezing starts at 89,900 baht.
Fertility Treatment Services at Beyond IVF
At Beyond IVF, our doctor is a highly trained and experienced fertility expert, with credentials and expertise on top of being a renowned obstetrician and gynecologist.
Furthermore, our clinic prides itself on its high standards for cleanliness and safety. We offer several options to treat infertility, including egg freezing to prevent problems conceiving down the road.
Our team is knowledgeable and professional, and we use the best technologies in the world comparative to the big international hospitals.
If you are having trouble becoming pregnant, it is important to see a specialist as soon as possible to discover exactly why you are not able to conceive. This allows for more specific treatment that will increase your chances of a successful pregnancy.
If you have any questions or would like more information, please contact us on Line at @beyondivf.