In-Vitro Fertilisation (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI)

What are the possible complications and risks of IVF fertility treatment?

• Cancellation of the treatment cycle may occur due to various reasons, including poor follicular development. Our cancellation rate is approximately 5%.


• Ovarian Hyperstimulation Syndrome (OHSS)
  OHSS refers to excessive stimulation of the ovaries during ovulation induction. It is a side effect of the medications given to you. Symptoms include:
  • Abdominal discomfort and/or pain
  • Nausea and vomiting
  • Bloatedness or swelling of the abdomen and genital area
  • Shortness of breath
  • Dehydratio
  • Reduction of urine volume
  
  OHSS is usually mild and causes no more than slight lower abdominal discomfort in most cases. However, immediate medical attention is required should the symptoms persist or worsen. This includes:
  • Vomiting o Urinary problems
  • Severe discomfort from abdominal bloating
  • Chest pain or any difficulty in breathing
  
  Less than 1% of our patients undergoing IVF may need to be admitted due to severe symptoms of OHSS. If you experience any of the above symptoms, please inform your doctor.


• Multiple pregnancy
  When three embryos are replaced, there is a 10% risk of twins and a 3% risk of triplets. Although the prospect of twins or triplets may seem attractive to some couples, multiple pregnancies are associated with increased risks of maternal and foetal complications.
  
  These include an increased risk of:
  • Miscarriage
  • Premature labour which can result in a child with physical or learning disabilities
  • Pregnancy-associated problems such as bleeding, diabetes and high blood pressure
  • Caesarean section and its complications
  • Stillbirth
  
  With the increased risk of multiple pregnancies, babies born as a result of the assisted reproductive programme have a greater chance of being hospitalised in a neonatal ward or intensive care unit (ICU). Hence, as required by the Ministry of Health, all patients undergoing this treatment in Singapore must subscribe to neonatal insurance.


• Failure of fertility treatment
  The likely reasons for failure are:
  • Cancelled cycles
  • Failure to collect eggs
  • Failure of fertilisation
  • Failure of the embryo to implant
  
  This can be due to a significant portion of embryos being poor quality or abnormal. Failure of treatment can lead to emotional strain and depression. Psychological counselling and support is available. Do not hesitate to inform your doctors if you require help.


• Ectopic pregnancy
  IVF increases the likelihood of an ectopic pregnancy. The ectopic pregnancy rate is about 5%. Patients who become pregnant through IVF treatment are advised to schedule an early scan to make sure that the pregnancy is correctly positioned.
  
  If an ectopic pregnancy is detected at an early stage, a medication called methotrexate can be used to dissolve the pregnancy tissue. Otherwise, surgical procedures will be considered to treat the ectopic pregnancy. Your specialist will discuss the appropriate treatment with you, should this happen.


• Miscarriage
  Miscarriage is a common complication of pregnancy. The miscarriage rate is about 10-15%. You will experience some abdominal cramps and bleeding. This diagnosis needs to be confirmed by your doctor. Depending on your condition and assessment by your doctor, surgical procedures may be required. Please consult your specialist for further information.


• Risks of oocyte collection
  The risks of oocyte collection are very rare. As the procedure involves a needle entering the ovary, it may be complicated by bleeding from the ovaries, uterus or adjacent blood vessels and injury to the intestines. In such an instance, further treatment may be necessary.

What are the success rates?

At KKIVF

Our overall clinical pregnancy rate is about 40-44% per cycle and the take-home-baby rate is about 30%. Generally, patients who are below 36 years old have a better pregnancy chance. However, your chances of success will depend very much on your own individual circumstances.

At the SGH Centre for Assisted Reproduction

The centre reached an average of 41% pregnancy rate for fresh IVF cycles and 38% for frozen cycles in 2018, in comparison to the average of IVF pregnancy results in 2018 of 36% for Europe.

Regulatory and funding matters

For IVF:

IVF counselling is mandatory under Ministry of Health (Singapore) guidelines. There may be a waiting time before starting the programme.

For IVF and frozen embryo transfer (FET):

Government co-funding and Medisave can be used for Singapore Citizens, subject to conditions. For more details, please refer to the Ministry of Health (Singapore) website: http://www.pqms.moh.gov.sg

Under Ministry of Health (Singapore) guidelines, our institutions do not practise:

• Sex selection unless medically indicated
• Social storage of gamete or embryos unless medically indicated

Frequently asked questions (FAQ)

1. How much does IVF treatment cost?
   Currently, IVF costs* between $10,000 to $17,000 SGD depending on your selected treatment. There are government grants available for Singaporeans below the age of 40 to help cover the cost of your treatment provided you fulfil other criteria.
   
   Our staff will work closely with you to help you manage your costs. Please refer to this website for more information regarding using your MediSave for assisted conception procedures.
   
   *accurate as of 31 Dec 2023
   


2. Can I travel during my IVF fertility treatment?
   No. It is imperative that during the monitoring phase of the treatment cycle, patients should be available as multiple appointments will be made for mandatory tests and treatments. Our nursing staff will work closely with you in scheduling the appointments.


3. Can we choose the sex of the embryo?
   This is not allowed as the government of Singapore forbids sex selection procedures. The sex ratio is almost identical to that seen in the general population following standard IVF treatment.


4. Will my age affect my pregnancy chances with IVF fertility treatment?
   Pregnancy rates decrease and the incidence of miscarriage increases for patents above 40 years of age.


5. Does weight affect pregnancy chances with IVF fertility treatment?
   IVF is not recommended if body mass index (BMI) is more than 30 or less than 19 as the chance of success is significantly lower with higher risks.


6. Is there something we can do to improve our chances of success in IVF fertility treatment?
   Although IVF treatment is a medical process, some lifestyle and dietary modifications may improve the success rates. Patients should stop smoking and avoid inhaling passive smoke. Alcohol consumption and having an extreme BMI should also be avoided.
   
   A daily intake of 5 mg of folic acid is recommended for all patients trying to conceive as this prevents neural tube defects in the baby.


7. What should we expect after oocyte pick-up (egg retrieval)?
   It is not unusual to experience slight abdominal discomfort and/or bloating, which will usually subside in 48 hours. It is usually tolerable. If necessary, medications may be prescribed.
   
   The patient may also experience slight vaginal bleeding after the procedure which will subsequently resolve. However, please contact us if you have heavy vaginal bleeding or severe abdominal pain.


8. What should a patient take note of after the embryo transfer?
   Please avoid strenuous and high-impact activities and exercises. You will be provided with medical leave for rest. Is it normal to experience vaginal bleeding after embryo transfer? Light vagina bleeding often occurs within the first few days after an embryo transfer. This can be present as light bleeding (pink/red/brownish) or spotting/staining. In this instance, no intervention is usually required.
   
   Common causes include the implantation of the embryo onto the lining of the womb. The use of vaginal progesterone causing the cervix to be more delicate and thus cervical bleeding is another common cause.
   
   Patients may continue using vaginal progesterone tablets as directed. If the bleeding lasts longer than three days or becomes very heavy, you are advised to call the IVF centre.


9. Is it normal to experience pain after embryo transfer?
   Many women complain about non-specific abdominal discomfort after embryo transfer. If the discomfort is mild and not constant, it is unlikely to be of concern. Simple pain relief medications should be sufficient. If the pain is severe with or without heavy bleeding, please call your IVF centre for advice or seek medical attention in hospital.


10. When will I be able to tell if I am pregnant?
    A pregnancy test is normally scheduled 14 to 17 days after the embryo transfer. It is mandatory that you return for this test even if you are bleeding.