FREQUENTLY ASKED QUESTIONS

HOW MUCH IS IT GOING TO COST?

The cost depends on the type of ART programme that you undertake, the amount of drugs used, the class of ward that you choose to stay, the length of hospital stay, the procedures completed and whether microinjection techniques (ICSI) have been necessary. The total cost can range from about S$9,000 for a younger woman around 30 years old, as she needs fewer Gonal F injections, to $12,000 for a more mature woman of 40 due to the need for more injections. This figure can vary from time to time as it depends on the individual's response. Local patients with Medi-Save can use $6,000 for the first cycle, $5,000 for the second cycle and $4,000 for the third cycle.

DO I NEED TO STAY IN HOSPITAL?

You do not need to stay overnight in Hospital. The length of stay in the Day Surgery ward depends on the type of programme designed for you. You normally would stay just for the morning during the egg collection. It is done first thing in the morning and you would normally be well enough to go home at lunchtime. When it is time to have the embryo replacement, you have to come back to hospital in the morning but can go home in the afternoon.

HOW MANY TIMES CAN I DO ART?

In Singapore, the Ministry of Health (MOH) normally limits the number of ART attempts to 10 cycles if they are younger than 40. For those above the age of 40 when they enter the programme, a maximum of 5 cycles is permitted. The success rate of each attempt is the same and the more you try, the higher the chance of eventual pregnancy. Most couples undergo several cycles before a pregnancy is obtained. If you are over the age of 45 then we will need to seek approval from the Ministry to continue.

WHAT ARE MY CHANCES OF SUCCESS?

The chances of successful pregnancy will be affected by your age - the older you are, the lower the chances of success. For a woman less than 35 years of age, her chances of success will be approximately 40% for each cycle. As she gets older, the chances of success fall and by the age of 40 the chances of pregnancy fall to 10%. Poor semen or sperm quality will also lower the pregnancy rates. Please click here to see our results (2004-2007).

Results collected from the USA, UK, France and Australia show a remarkably similar clinical pregnancy rate of about 28-36% for those cases where eggs were retrieved. In these cases, the number of deliveries was about 25%.

The take-home baby rate is lower than the pregnancy rate because some pregnancies are complicated by miscarriage, ectopic pregnancy (where the pregnancy develops in the tube) or premature deliveries. However, once you get past this risk period of approximately the first 12 weeks, the chance of delivering a live baby is about 70%.

WHAT ARE THE POTENTIAL COMPLICATIONS OF ART?

1) Excessive response. The most important complication of the test tube baby programme is excessive response of the ovaries to the Gonal F hormone injections. This is called ovarian hyperstimulation syndrome (OHSS) and occurs in about 1% to 2% of the cases. Most cases are mild and we further minimise this problem by careful selection of the doses of drugs used and also close checking of follicle development through blood tests and ultrasound scanning and readjusting the dose as necessary. Most women going through the programme will experience some bloating and discomfort due to the ovaries enlarging. You only need worry when these symptoms get very severe, which will affect only 1-2 % of women. If this does happen you will need to come into hospital for a few days for monitoring and some blood tests.

2) Multiple births Since more than one embryo is usually replaced there is a slightly increased chance of multiple births. These are mainly twins (25-30%) but occasionally, triplets occur (5-6%).

3) Cancellation. Although all care is taken to ensure the success of your programme, sometimes it is necessary to cancel the cycle halfway. This could be due to many reasons including inadequate follicle development, premature ovulation, poor semen quality or abnormal fertilisation. Modification of egg stimulation regimes could prevent the recurrence of some of these problems in subsequent treatment cycles. Only about 10% to 15% of cases are cancelled prematurely. The majority go on to the stage of embryo replacement.

4) Miscarriage: The rate of spontaneous miscarriage is 20% to 25%. It is important to realise that pregnancies in normal couples without infertility have a slightly lower miscarriage rate. The rate of spontaneous miscarriage increases with age and is about 40% in women 40 years and greater of age.

5) Ectopic pregnancy. In about 5-10% of pregnancies the embryo develops outside its normal position in the womb. This condition is diagnosed by an ultrasound scan which would be arranged for you early in pregnancy. A pregnancy outside the womb cannot survive and an operation may be required to remove the pregnancy.

6) Genetic problems There is some worry that certain types of congenital abnormalities are increased in ART births but they are still very rare. Your doctors will always look out for these problems.

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