Introduction To Infertility
Spontaneous pregnancy is always a matter of chance. A normal healthy couple in their 20s, having regular sex, have about a 20% chance of conceiving in any particular month. For the same couple in their 30s, the chance is about 10%. You may have infertility if you do not conceive after one year of regular intercourse without the use of contraceptives. It is important to seek medical attention as quickly as possible. Infertility can often be treated. It is a common problem, affecting at least one in 8 couples at some time in their lives.
In 1983, KK Women’s and Children’s Hospital produced Asia's first in-vitro fertilisation (IVF) baby. Today, the KKIVF Centre (KKIVF) is one of Singapore's largest infertility centers and offers a wide range of testing, diagnostic and treatment procedures. KKIVF believes in utilising the least invasive treatment for the best possible outcome for each individual patient, provided with personal care and at a competitive cost.
The KKIVF Centre has helped many people, both locals and foreigners, experiencing various infertility problems and these include:
- Couples with reproductive problems
- Unexplained infertility
- Genetic problems
- Recurrent pregnancy loss
- Sexual dysfunction
- Women with reproductive problems
- Ovulatory dysfunction
- Polycystic ovary syndrome (PCOS)
- Ovarian cysts
- Blocked fallopian tubes
- Previous tubal ligation/sterilisation
- Uterine abnormalities
- Men with reproductive problems
- Low sperm count
- Absence of sperms (azoospermia)
- Previous vasectomy
- Sperm storage prior to cancer treatment
- Sperm storage for other reasons
Assisted Reproductive Techniques (ART) Services
- In-Vitro Fertilisation (IVF)
- Intra-Cytoplasmic Sperm Injection (ICSI)
- Superovulation & Intrauterine Insemination (SO-IUI)
- Embryo & Sperm Cryopreservation
- Donor Sperm/Egg/Embryo Programmes
- Blastocyst Culture
Involves extending the culture of the embryos for 3 more days with a separate medium. It mimics more closely the natural stage of the embryo (i.e. blastocyst stage) during implantation. This programme aims to help patients who have many eggs and yet cannot conceive to increase their chances of implantation and hence achieve pregnancy. KKIVF has started this programme selectively on suitable patients.
- In-Vitro Maturation of Oocytes (IVM)
As the term IVM implies, in this treatment, immature oocytes are retrieved from the ovary and are matured in the laboratory. Once they mature, IVF or ICSI is then performed to assist in fertilising these oocytes.
- Laser Assisted Hatching
Involves breaching the outer layer of an embryo by piercing a hole to facilitate its hatching out and implantation. The hatching process can be impaired by the increased thickness of the outer layer and advanced age of the woman. This programme aims to increase the chances of implantation for the older woman.
Since its inception, KKIVF has performed more than 7,300 fresh assisted reproductive technique (ART) treatment cycles and more than 3,700 thaw ART treatment cycles. In the year 2009, the ART treatment cycles exceeded 1,300 fresh cycles and 550 thaw cycles. KKIVF Centre has achieved a consistently good clinical pregnancy rate over the past 6 years, comparable to international fertility centres. The success rates in KKIVF are expressed as the percentage of embryo transfer procedures which result in a clinical pregnancy. A clinical pregnancy is determined when a pregnancy sac with a heartbeat is visible on ultrasound at around 4 weeks after the embryo transfer procedure.
Clinical Pregnancy Per Transfer
|ART fresh cycle
|ART thaw cycle
In general, the most critical factor in determining a couple's fertility is female age. At KKIVF, the clinical pregnancy rate per fresh transfer in the years 2008 was:
||Clinical Pregnancy Rate
|< 30 years
|30 - 39 years
|40 - 44 years
Women are born with all their eggs for their lifetime already formed (unlike men, who produce sperm constantly for most of their lives). By the time women approach the age of 40, the eggs tend to lack the energy they need for the early stages of development. Also the chance of producing abnormalities such as Down Syndrome increases with age. These can result in failed fertilisation, failure of the embryo to implant, and early miscarriage. In addition to age, results will depend on the condition of the uterus, the number of eggs obtained, the number of eggs fertilised, and the number of eggs or embryos transferred. If spare eggs are fertilised and stored, the overall chance of pregnancy from one stimulation will be higher.
Other Clinical Services
In addition to ARTs, we also emphasis a “One-Stop” fertility management concept. With a group of well-trained experts incorporating ARTs, endocrinology therapy and advanced endoscopic reproductive surgical techniques, we aim to provide a holistic approach to help increase your chance of having a healthy baby!
As reproductive surgeons with expertise in advanced microsurgery and pelvic reconstructive endoscopy, we can improve your chance of a spontaneous pregnancy or improve the success of subsequent IVF in properly selected patients. Some of the surgeries we commonly perform include:
- Endoscopic assessment of infertility
- Laparoscopy – key-hole surgery to assess the pelvis
- Hysteroscopy – to assess the womb cavity
- Transvaginal Hydrolaparoscopy
Assessment of the tubes and ovaries via the vaginal route as a Day Surgical procedure in selected individuals. Compared to laparoscopy, this will reduce the risk of post-surgical pain and scarring.
- Laparoscopic reversal of previous ligation
Over the last 10 years, we have accumulated the most experience in this locally and have achieved a cumulative pregnancy rate of about 80% in properly selected patients, with an average time to pregnancy at less than 1 year.
- Laparoscopic drainage of a fluid filled fallopian tube (hydrosalpinx)
In our center’s experience, this can help achieve a 34% chance of pregnancy. In addition, the drainage of the fluid can help improve the success of IVF.
- Laparoscopic treatment of endometriosis
- Laparoscopic and hysteroscopic removal of fibroids
- Surgical correction of congenital anomalies of the female genital tract
Through a combination of laparoscopy and hysteroscopy, our team has successfully treated numerous cases of congenital defects in the womb and vagina including rarely seen conditions such as an obstructed double vagina or womb. If necessary, cases are co-managed with our aldolescent gynecology or endocrinology experts.
Up to 50% of infertility is due to sperm abnormalities. Our centre provides holistic management in male infertility.
Investigations conducted in our centre include:
- Semen analysis
- Hormonal assessment
- Genetic studies
- Testicular biopsy
Most couple with infertility related semen abnormalities are ultimately managed by assisted conception. However, surgical sperm retrieval may be needed in azoospermia (absence of sperm in semen). Sperm retrieval is successful in almost 100% of obstructive azoospermia. The procedures are performed through the skin using microsurgical techniques.
- Surgical sperm retrieval procedures
Microsurgical Epididymal Sperm Aspiration (MESA)
A process of harvesting sperm from the epididymis, a sperm rich tube at the back of the testis in men who have no sperms in their ejaculate due to an obstruction in the ejaculatory passage or absence of the ejaculatory passage.
Testicular Sperm Extraction (TESE)
A process of obtaining sperm directly from the testis. It involves removing small samples of testis tissue for processing and eventual extraction of sperm. This is useful in cases of extremely low sperm production.
- Sperm storage prior to cancer treatment
- Sperm storage for other reasons
- Electroejaculation Programme For men with ejaculatory disorders or spinal cord injury / disease.
- Donor Sperm Insemination Programme
A holistic management of PCOS.
Women in the various age groups in their reproductive cycle to meet their various needs
- regulation of mestrual cycles
- fertility issues (clomid telephone services, SO-IUI, IVF/ICSI/IVM)
- laparoscopic ovarian drilling
- treatment of hirsutism
- weight loss programmes
- screening and prevention of long term sequelae of PCOS (diabetes, hypertension, endometrium hyperplasia or cancer, etc)
This clinic offers a range of family planning options, which includes the following:
- provides advice and information for patients, as a form of education
- treatment for complicated cases with medical disorders
Currently, the range of family planning options available includes
- Hormonal methods
- Intrauterine contraceptive devices
- Physical barrier methods
- Chemical barriers / Spermicides
- Natural methods
- Post- coital contraception
The gynaecological endocrinology clinic offers clinical services for the diagnosis, treatment and management of hormonal problems interfering with fertility and/or menstrual cycle regularity. The common conditions are seen at the clinic include:
- thyroid problems (hypothyroidism and hyperthyroidism)
- hirsutism (increase of face and/or body hair growth)
Sexual dysfunction can affect any couple, preventing them from experiencing satisfaction from the sexual activity.
Common problems related to sexual dysfunction in men include erectile dysfunction, ejaculation disorders and inhibited sexual desire, while in women, the most common problem is that of pain during intercourse.
The Paediatric and Adolescent Gynaecology clinic deals mainly with the gynaecological health of children and adolescents.
This area involves menstrual abnormalities, polycystic ovary disease, genital tract abnormalities, genital infections, endocrine disorders affecting the female reproductive tract, adolescent sexuality, etc.
The range of cases seen at the clinic includes the following: menstrual disorders in girls aged 19 and below
- polycystic ovarian disease in teenagers
- primary amenorrhoea and delayed puberty
- secondary amenorrhoea in girls aged 18 and below
- vulvovaginitis/vaginal discharge in girls aged 18 and below
- uterovaginal dysgenesis/agenesis
- gonadal dysgenesis/agenesis eg. Turner’s Syndrome
- precocious puberty
You can get a referral from the polyclinic to KKH's infertility clinic. Alternatively, call the Central Appointments desk (tel: +65 6294 4050) to make an appointment with one of our IVF specialists.
At this initial consultation with the specialist, he will establish with you and your husband what the best form of treatment is. He may also conduct blood and hormone tests to try to find out why you are not getting pregnant. A semen analysis test will be ordered for your husband. Once results of tests are reviewed and discussed, and if you are referred to the KKIVF Centre for fertility treatment, you and your husband will be briefed by our nurse coordinator. This is your opportunity to get as much information as you need before making a decision about treatment. At this briefing, the proposed treatment programme will be explained to you, including the side effects and costs - how much will be Medisave claimable, the government co-funding scheme (if eligible) and how much will be the out-of-pocket-expenses.
Remember, the actual cost of the entire treatment cycle also depends on the amount of medication you need which varies from patient to patient.
If you decide to start the programme, a pre-treatment blood test to screen for HIV, hepatitis, rubella and syphilis will be taken. A counselling session with the counselling psychologist will also be arranged.
The couple will then meet with the IVF specialist for medical counselling. The doctor will go through and explain the medical aspects of the programme, before the couple signs the consent forms. The patient will be instructed to call the nurse coordinator on the first day (day one) of her menses of the scheduled month. Subsequent instructions on the treatment schedule will be given during that first phone call.
Recognising that infertility can be painful and the treatment programmes can be emotionally and physically draining, emphasis on patient care has thus been a focus for KKIVF Centre. The centre has responded by being sensitive to our patients' needs by simplifying the treatment programmes and providing counselling support.
Each patient is given individual and personalised attention to reduce the emotional turbulence that is common during fertility treatment. Prior to the fertility treatment, a counselling session with a specialist in reproductive medicine and a counsellor psychologist is arranged. Counselling helps couples to understand the treatment options, evaluate their decisions and prepare them physically and psychologically for the treatment.
The moment the couple steps into the KKIVF Centre, our nurse coordinators are their primary contact to provide personal support and guide them through the cycle treatment. They are available to answer any questions and will be there to take the patient step-by-step through the treatment programme.
In this modern era of medical practice where the public has ready access to the internet and news reports, our centre recognises the importance of public education. The KKIVF Centre organises and conducts regular forums for the public and general practitioners on various aspects of reproductive medicine and infertility issues.
Apart from offering services to the infertile couples, it is also the centre's aim to share its knowledge and expertise with doctors and scientists in the region.
A comprehensive program comprising of personalised teaching and hands-on experience is in place for visiting fellows. Each training session lasts six to 12 months.
Since 1996, KKIVF Centre has trained clinical fellows and embryologists from various countries including the United Kingdom, Seychelles, India, Indonesia, Vietnam, Bangladesh and Malaysia.
Research forms an integral part of the KKIVF Centre. Several clinical and laboratory research projects are conducted every year with yearly presentations at international and local conferences.
The KKIVF team was one of the first in the world to report on sperm motility parameters in the Asian population with male factor infertility and the correlation with superovulation induction and intra-uterine insemination (SO-IUI) outcome.
The team also participated in a multi-centre clinical trial to investigate the efficacy and efficiency of a fixed daily dose treatment regimen of follitropin beta in pituitary-suppressed infertile Asian women undergoing controlled ovarian hyperstimulation.
We have also completed an international multi-centre clinical trial on selective single embryo transfer to reduce multiple pregnancy rates.
|Dr Sadhana Nadarajah
||Director, KKIVF & Senior Consultant (Reproductive Medicine, IVF & Adolescent Gynaecology)
||MBBS, MRCOG (UK), FAMS
|Dr Tan Heng Hao
||Head, Reproductive Medicine & Senior Consultant (Reproductive Medicine, IVF, Laparoscopy & Hysteroscopy)
||MBBS, M Med (O&G), MRCOG (UK)
|A/Prof Chan Kok Yen Jerry
||Senior Consultant (Reproductive Medicine, IVF)
Director, KK Research Centre
Associate Professor (Clinician Scientist)
|MB BCh BaO(Hons), MA, FRCOG, PhD (London), FAMS
|Dr Lau Sie Kuei Matthew
||Consultant (Reproductive Medicine, IVF, Andrology, Level 3 Laparoscopy and Hysteroscopy)
||MBBS (Melbourne), MMed (O&G)(Spore), MRCOG (UK), FAMS
|Dr Veronique Viardot-Foucault
||MD (Endocrinology, France), FAMS, Msc
|Dr Teo Boon Li Steven
||Consultant (Reproductive Medicine)
||MBBS, MRCOG (UK), M Med (O&G)(S'pore)
|Dr Phoon Wai Leng Jessie
||Associate Consultant (Reproductive Medicine)
||MB ChB (Auckland)(O&G), MRCOG (UK), MMed (O&G)(Spore)
|Dr Tan Tse Yeun
||Associate Consultant (Reproductive Medicine)
||MBBS (U of UNSW, Australia), MRANZCOG (RANZCOG, Australia)
|Dr V Atputharajah
||Visiting Consultant (Sexual Dysfunction)
||MBBS, M Med (O&G), FAMS
|A/Prof Chia Seng Joo
||Visiting Consultant (Andrology)
||MBBS, FRCS (Edin), FAMS (Urology)
|Dr Kon Yin Chian, Winston
||Visiting Consultant (Endocrinology)
||BSc (London), MBBS (London), MRCP (UK), FAMS (Endocrinology)
|A/Prof Li Man Kay
||Visiting Consultant (Andrology)
||MBBS, FRCSI, FRCS, FACS, FAMS
|Dr Shelia Loh
||Visiting Consultant (Infertility)
||MBBS, M Med (O&G), MRCOG
|Dr Colin Teo Chang Peng
||MBBS (Singapore), MRCSEd, M Med (Surg) (Singapore), FEBU
The KKIVF Centre has been awarded the Reproductive Technology Accreditation Committee (RTAC) Certification.
Basement 1, Women's Tower
- +65 6294 4050 (Appointment)