If you and your partner have been struggling to get pregnant after having regular unprotected intercourse for over a year, you may be one of the 10-15% of couples in Malaysia facing infertility. Infertility affects both men and women, and not only partners who have yet to bear any children. There are also couples with secondary infertility, in which they have had at least one successful pregnancy but are unable to conceive again. This type of infertility affects 23% of couples in South East Asia.
How is infertility diagnosed?
When assessing infertility, a couple’s health history, such as past pregnancies, miscarriages, menstrual cycle, and injuries to sexual organs, are taken into account. Initial screening will be done and may include physical examinations to check for abnormalities in the reproductive system. Depending on the prognosis, further laboratory tests will be conducted. Women will have their hormone levels, Fallopian tubes, and the insides of their uterus checked, while men will have their hormone levels and semen analysed.
Exploring different options
Sometimes, despite all the tests and assessments, the cause of infertility is unexplainable. It can be frustrating to hear, but before deciding on invasive treatments, lifestyle changes involving stress management, incorporating exercise, and stopping smoking could help increase the chances of conceiving. However, should you opt for fertility treatments, there are plenty of alternatives to explore in Malaysia. The type of treatment will depend on factors that may include the cause of infertility, age, budget, and personal preference of treatment.
Here’s a handy summary of some available options:
1. Fertility Drugs/Medication
Women with ovulation issues may be prescribed fertility drugs that will help induce ovulation. The types of drugs available that should be taken during a specific time in your menstrual cycle could be oral or injectable. Oral drugs are less potent and work by inducing or correcting irregular ovulation. Injectable drugs, however, are an option for those who do not find success with oral drugs or preparing for intrauterine insemination (IUI) or IVF.
- Pros: Inexpensive and convenient.
- Cons: Side effects depend on the type of medication taken and may consist of (but are not limited to) nausea, headaches, mood swings, weight gain and hot flashes. There is also a risk of conceiving multiples.
- Success Rates: Depends on the type of medication taken – 32% for injectable drugs, 28% for Letrozole, 23% for Clomid and 18% for Femara.
2. Surgical Procedures
Infertility caused by a blockage in the reproductive system or congenital abnormalities can be corrected via surgery. For women, this could mean removing polyps, fibroids, or the opening of blocked Fallopian tubes. Typical procedures that you may have heard of are laparoscopy, hysteroscopy, and microsurgery. For men, surgery can correct blockage that prevents sperm from being released, retrieve sperm and also reverse vasectomy.
- Pros: Correct underlying health problems, and may increase chances of conceiving.
- Cons: Some surgeries can be invasive.
- Success Rates: Depends on type of surgery and cause of infertility.
3. Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is the process of inseminating sperm cells into the uterus during ovulation, increasing the chances of fertilisation. The female may be on fertility medication to stimulate ovulation. Semen is collected and goes through ‘sperm washing’, where a healthy amount of sperm is collected. The procedure involves inserting a small tube through the cervix and into the uterus. The collected sperm is then pushed using a syringe, via the tube that goes directly into the uterus. A pregnancy test should be taken after two weeks of the procedure.
- Pros: Less invasive and less expensive than IVF. Fairly quick procedure.
- Cons: Small window to provide eggs and sperm sample. Greater chance of conceiving multiples if taking fertility drugs.
- Success Rates: 10-12% per cycle.
4. In-Vitro Fertilization (IVF)
Women who have gone through tubal ligation, or couples with health issues such as damaged Fallopian tubes, semen, or genetic abnormalities, are ideal candidates for IVF. A woman typically releases one egg during ovulation. However, in IVF, ovaries are stimulated with the help of fertility drugs to produce multiple eggs. These eggs are retrieved and fertilised with collected semen in a lab. The fertilised egg(s) or embryo(s) are transferred into the uterus via a catheter. Within the next 9 to 12 days, a pregnancy test should be taken to determine if the procedure was a success.
- Pros: With genetic screening, there is an increase in chance of having a healthy baby.
- Cons: Invasive and expensive. Multiple births, ectopic pregnancy, ovarian hyperstimulation syndrome (OHSS) where ovaries overreact to fertility drugs.
- Success Rates: Varies. Dependent on maternal age, number and stage of embryos transferred, and type of embryo selection.
5. Intra-Cytoplasmics Sperm Injection (ICSI)
With a procedure similar to IVF, Intra-Cytoplasmic Sperm Injection (ICSI) offers hope for those with weak, low, or poor sperm qualities. In a typical IVF procedure, multiple healthy sperm are placed with an egg for fertilisation. In the instance where multiple sperm retrieval is not possible, ICSI can be done alongside IVF, where a single sperm is picked up, injected into the egg, and then transferred into the uterus, increasing the chance of fertilisation.
- Pros: Individuals with severe male infertility could benefit from ICSI.
- Cons: Besides the risk of multiple births, there is also a slightly increased risk of congenital abnormalities with this process.
- Success Rate: 50-80% fertilisation rate. ICSI does not guarantee fertilisation even when a sperm is injected directly into an egg. Once fertilisation occurs, ICSI-IVF success rates are similar to IVF treatments.
6. Donor eggs and sperm
If you or your partner are ideal candidates for IVF or IUI, but aren’t producing eggs or sperm, you could consider conceiving via donor treatment. Couples choosing this method will have donor eggs or sperm fertilised with their eggs or sperm and implanted into the uterus. In Malaysia, however, this type of treatment is strictly for non-Muslims only.
- Pros: Ideal if you have genetic concerns that you do not wish to pass down to your child.
- Cons: Some couples may not be comfortable with the fact that the child will only be genetically related to you or your partner.
- Success Rates: For those undergoing IVF and struggling with treatment using their own eggs or sperm, the success rates with donor eggs or sperm are generally higher.
7. Fertility Preservation
There may be instances where a couple could preserve their fertility by freezing sperm, eggs, embryos, or reproductive tissue for future use. Men undergoing cancer treatments such as chemotherapy, deciding on a vasectomy, or prostate surgery can have their sperm frozen. As fertility declines with age, women undergoing cancer treatments and those not ready for pregnancy can also decide to freeze their eggs. Embryo freezing is a part of IVF and provides couples another chance at pregnancy without going through another full cycle of IVF.
- Pros: Preservation of fertility due to sickness or age.
- Cons: Some sperm, eggs or embryos may not survive the freezing and thawing process.
- Success Rates: Higher success rates if eggs and sperm are extracted before 35.
Fertility treatments can be expensive, but there are affordable options. LPPKN provides counselling and tests for couples seeking subfertility advice. They offer IUI, ovum pickups, embryo transfers, freezing, and frozen embryo transfers in Kuala Lumpur. There is IVFKasih, a low-cost IVF program that performs IVF for a fee of RM8,800 net. It is all-inclusive and includes medications, laboratory, embryo freezing, nursing, operative room, recovery room charges, and doctor’s fees. The government has also allowed couples to withdraw from their Employee Provident Fund (EPF) under Budget 2020 to fund IUI, IVF, and ICSI procedures.
Infertility can be a psychologically impacting and daunting journey for couples but will be well-worth it when you finally get to hold that miracle in your arms. If you are currently dealing with infertility and infertility treatments, try finding yourself a support group that will provide you with a sense of assurance that you are not alone in this journey.