Thailand Medical Agency
Infertility
Infertility treatment in Thailand is one of good choice destination with the advance technologies and best services for anyone who is looking for the IVF program.
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What infertile is mean?
Infertility is medically defined as the inability to conceive following one year of regular sexual intercourse without contraception or after six months for the woman who is over age 35.
The definition also includes women who are unable to carry a pregnancy to live birth. There are two general types of infertility. Primary infertility is defined as difficulty conceiving for a couple who has never before had a child while secondary infertility describes a couple who is having difficulty conceiving when at least one of the partners has previously had a baby. In 40% of the cases the problem is attributable to the man, and for 40% of the couples the difficulty is traced to the woman. In about 10% of the cases, infertility is linked to both partners. The remaining 10%, despite exhaustive testing, remains unexplained.
Female infertility may result from various factors in the ovaries or uterus or from other medical and life style factors. Sometimes it is because the ovaries cannot be able to produce eggs, or eggs that are produced can not move from ovaries to the uterus wall(womb). In some case, the infertility result by a fertilize eggs or embryo does not ATTACH to the womb. Ovulatory disorders are one of the most common reasons why women are unable to get pregnant.
The causes of failed ovulation can be result from;
> Hormonal problems are the most common causes of anovulation. The process of ovulation depends upon a complex balance of hormones and their interactions to be successful. The disruption in this process can effect the ovulation or failure to produce the mature eggs.
> Poor function of ovaries, scarred ovary; Physical damage to the ovaries may result in failed ovulation. For example, extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles and egg cannot mature properly and ovulation does not occur.
> Behavioral factor, some habit and life style factors can impact the overall health and may limit couple's ability to get pregnant.
> Diet and exercise, optimal reproductive functioning requires both proper diet and appropriate levels of exercise. Women who are significantly overweight or underweight may have difficulty becoming pregnant.
> Smoking and alcohol abuse can increases the risk of miscarriage, premature birth, and low-birth-weight babies for women. Smoking by either partner reduces the chance of conceiving with each cycle, either naturally or by IVF.
Male infertility has many causes; from hormonal imbalances, physical problems, psychological and/or behavioral problems. Men who live a healthy lifestyle are more likely to produce healthy sperm.
The following list highlights some lifestyle choices that negatively impact male fertility;
> Smoking--significantly decreases both sperm count and sperm cell motility.
> Prolonged use of marijuana and other recreational drugs.
> Chronic alcohol abuse. · Anabolic steroid use--causes testicular shrinkage and infertility.
> Inadequate vitamin C and Zinc in the diet.
> Tight underwear--increases scrotal temperature which results in decreased sperm production.
> Malnutrition and anemia.
> Excessive stress!
Modifying these behaviors can improve a man’s fertility and should be considered when a couple is trying to achieve pregnancy.
How will doctors find out if a woman or her partner have fertility problems?
>> Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes blood test, a semen analysis, the trans-vagina ultrasound to evaluate the uterus and ovarian physical function. So that we can differentiate the infertility causes, then create the proper treatment plan by individual conditions.
Infertility treated by Intra-uterine insemination (IUI)
IUI is an infertility treatment that is often called artificial insemination. In this procedure, the doctor will uses a catheter to place a number of special prepared sperm directly insert to the uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.
IUI is often used to treat;
- Unexplained infertility.
- Low sperm count.
- Decreased sperm mobility.
- Requirement of donor sperm.
- A cervical condition, such as cervicalmucus that is too thick.
- Cervical scar tissue from past procedures or endometriosis.
- Ejaculation dysfunction.
How often is assisted reproductive technology (ART) successful?
Success rates are varies and depend on many factors, including the infertility diagnosis, and the age of the woman undergoing the procedure, the oocyte quality and amount of sperm. In general, the average percentage of fresh, nondonor ART cycles that can be success to live birth are this following below ;
- 40% in women younger than 35 years of age.
- 32% in women aged 35–37 years.
- 22% in women aged 38–40 years.
- 12% in women aged 41–42 years.
- 5% in women aged 43–44 years.
- 1% in women aged 44 years and older.
What is IVF ?
IVF or In Vitro Fertilization is the procedure that place the woman's egg and the man's sperm in the laboratory dish, then let get fertilize itself on the dish. After that the fertilize cell will be divided itself, we called mitosis and become embryos. Then the doctor will transfer 1or 2 embryos into the women's uterus where the embryos will be implanted at the uterine wall and develop to be fetus.
What is ICSI ?
ICSI or Intracytoplasmic Sperm Injection is the procedure that use the glass needle to hold one selected healthy sperm and inject it into a fully mature woman's egg. It will be fertilized and become cell division, then doctor will transfer 1 or 2 embryos into the uterus where it would be implanted and develop to be the fetus. ICSI is often used in married couples with infertility caused by low sperm count in male spouse. Moreover, ICSI is used to be alternative for couples who have had poor or failed fertilization in the previous treatment cycle.
Pre-Implant Genetic Diagnosis (PGD)
PGD will start with embryo biopsy which can be performed on day 3 or day 5 of development after fertilization. This special procedure is performed by the experienced embryologist using micro-manipulation technique to remove 1-2 cells from day 3 embryo(Blastomere biopsy) or several placenta cells from day 5 embryo(Blastocyst biopsy) without damaging or impacting with the embryos.
Genetic analysis will then be performed on the cells that take from the biopsy and screen for genetical disease and also can know the gender before transfer into the woman's uterus.
The reasons to do PGD(preimplantation genetic disease).
>> To ensure the conception of baby would be free from genetic disease.
>> To screen the embryos for chromosomal abnormality to avoid Down's syndrome.
>> To check the embryo's quanlity before transfer in order to reduce the risk of miscarriage.
>> To know the baby's gender
1. FISH or Fluorescence In-Situ Hybridization is a technique that chromosomre stained with fluoresce dye which attach to specific part of specific chromosome. But this technique has limitation the amount of chromosomes can be tested in each hybridization round. FISH can test for only 5 chromosomes which are 13, 18, 21, X, Y from the total 24 chromosomes in human cell. However, the FISH technique is helpful in gender selection. It can tell us whether an embryo cell has two X chromosomes ( female ) or one X and one Y chromosome (male) and FISH can also be used to detect specific chromosome problems such as Down syndrome.
2. PCR or Polymerase Chain Reaction is another technique which can be used to test single gene disorder such as thalasscemia, color blindness, polycystic kidney disease and also can be designed to test for the chromosome number(aneuploidy). However, for the use of PCR technique to test for the chromosome number, only a specific number of chromosomes can be tested and still have the rest of chromosomes remain untested.
***** Currently, there are 2 new techniques that allow embryos to be tested for all 24 chromosomes. These techniques are CGH and SNPs. It can deeply check the genetical abnormalities and also the number of chromosomes. This is expected better select embryos with highest implantation potential for transfer that will improve pregnancy success. Moreover, the ability to test for the chromosome number, both CGH and SNPs can also give information on the details of the chromosome pairs, either missing part or duplicated part in which can cause diseases or being a reason for implantation failure.
3. CGH or Comparative Genomic Hybridization is used to count the numbers of all human chromosomes (aneuploidy) and observe how they are arranged and check the detail of each individual one. CGH can be used to identify the sex of embryo, as it can determine the chromosome X (girl) and Y(boy) in the embryo's cells. But this technique can not check for the abnormality in the gene level which is single gene disease(such as thalascemia). This technique is suitable for the couples who do not have the risk of thalascemia and the cost is cheaper than SNPs.
4. SNPs or Single Nucleotide Polymorphisms is a newest technology which can test all 24 chromosomes and the results are >99% accurate. SNPs is the most advance technique use in treating infertility through PGD(pre-implantation genetic diagnosis). This technique is enable to diagnose for all amount of chromosomes (aneuploidy) and can check the detail or abnormality of each chromosomes in the embryo's cell. Moreover, SNPs can be able to diagnose the genetic disease cause by abnormality of single gene disorder(such as Thalascemia). This technique is expected to enable the selection of better embryos with maximum implantation capacity which will increase pregnancy success rates.
These 2 techniques are recommended for the couple who are under this following conditions ;
- Recurrent implantation failure (past IVF cycle fail).
- Recurrent miscarriaged - Women older than 38 years old.
- Known case of chromosome abnormality in parents such as balanced translocation.
- Previous pregnancy rate chromosome abnormality.
In conclude, all 4 types of these techniques can screen for embryo' s gender. And also can screen the abnormalities of different type of genetic problems as the following details;
>> FISH can check only main 5 chromosome that may indicate the risk of Down syndrome disease or mental retardation. But cannot check the actual number of chromosomes that might be effect the implantation capacity.
>> PCR can check the single gene disease (such as thalascemia) and the number of chromosomes, but can not check the detail in each chromosomes.
>> CGH can check the number of each 24 human chromosomes(aneuploidy) and its detail that may help to increase the implantation capacity rates. And also can check for the main genetic diseases such as Down syndrome, mental retard or congenital defect. But its can not check for the single gene disease(such as Thalascemia).
>> SNPs can check the number of each 24 human chromosomes(aneuploidy) and its detail that may help to increase the implantation capacity rates. And also can check for the main genetic diseases such as Down syndrome, mental retard or congenital defect. The function seem like CGH, but SNPs also can be able to check for the single gene disease(such as Thalascemia). Moreover, the SNPs result are >99% accuracy. SNPs is the best solution for the couple who is really hard and complicated conditions of infertility.
The steps on IVF program are included the following process:
1. Basic check up;
Male:
- General physical examination.
- Blood test: CBC, ABO Bl.Gr., Rh Bl. Gr., Anti HIV, Anti HCV, VDRL, HBsAg, Hb typing.
- Semen analysis.
Female:
- General physical examination and BMI measurement.
- Pelvic examination and Pap smear of cervix.
- Transvaginal ultrasound to check the uterus, ovaries or uterine cavities condition.
- Blood test for: CBC, ABO Bl.Gr., Rh Bl.Gr., Anti HIV, Anti HCV, VDRL, HBsAg, Hb typing, Rubella IgG, Thyroid function fest, and hormone profile.
2. Ovulation induction (egg stimulation) This process would start on day 2-day3 of your menstrual cycle.
- Blood test for hormone profile (Estradiol, LH, Prolactin, FSH).
- Trans vaginal Ultrasound to monitor the eggs and follicles.
Then;
- Start take the medication for ovarian stimulation around 8-9 days.
- Trans vaginal Ultrasound monitoring to check the size and amount of eggs and follicles about 3-4 times during the stimulation period.
3. OOcyte collecting (egg pick up) Egg pick up would be arranged when the eggs is mature enough and become 18-20 mm. of egg size.- Male partner / Husband is required for sperm collecting on the day of egg pick up, or he is available to come in any other day before egg pick up for sperm collecting, then the technician will do freezing in the lab sperm.
4. Fertilization and embryo culture The fertilization would be done on the egg pick up day and then be cultured in the laboratory by the expert embryologist.
5. Embryo biopsy for genetic and gender screening This process or PGD (Pre-implantation genetic diagnosis) would be done on day 3 or day 5 of embryo development (we count the egg pick up day as day 1 of embryo development or 2pn stage).6. Embryo transfer and implantation This process mostly will be on day 5 after egg pick up day. Doctor will choose the best 1 or 2 embryos to transfer to uterus. And the rest of embryos (if have) will be frozen in the lab. If the couple want to transfer again, the embryologist will thaw the frozen embryos(melt the frozen embryo)for the next transfer, this we call "Frozen embryo transfer".
Infertility treatment facillities
Medical Tourism Services
- First consultation about the overall process of doing IVF in Thailand. And discuss about the general information about the infertile conditions.
- Provide recommendation about the resources of professional IVF center in Bangkok Thailand which might be proper with your personal need.
- Become your health assistant help you to co operate with your preferable hospital and make your personal arrangement.
- Planing your personal program, expected the date(IVF treatment period ), estimate the budgeting.
- Arrange the accommodations , living place/hotel up to the treatment expected date.
- On your coming day, pick up you at Airport and send to the hotel we've prepared.
- Assist for any necessary needed during your long staying.
- On the hospital appointment day, take you to hospital and be your health secretary, assist you to manage your IVF plan detail from doctor.
- Assist you to handle your self-injection program(during egg stimulation)
- Recommend and guide you the small nice trip in Bangkok, Thailand or some nearby, so that you can relax and enjoy during the treatment period.
**Our services will be handle by IVF co-ordinated nurse and Bangkok local staff If you are interesting our holistic care service for IVF program in Thailand, do not be hesitated to contact us.