1. Introduction
2. Team
3. Range of services

• Baseline Infertility Investigation
• Assisted Reproductive Technologies (ART)

4. Assisted Reproductive Services (ART)

• In-Vitro Fertilisation (IVF)/Intracytoplasmic Sperm Injection (ICSI)
• What does IVF involve?
• ART Program for Foreign Patients
• Stimulation of Ovaries & Monitoring of Egg Development
• Egg Collection
• Sperm preparation
• Fertilisation
• Intracytoplasmic Sperm Injection (ICSI)
• Embryo transfer
• Pregnancy test and scan

5. Disappointments
6. Why choose to do your treatment abroad?
7. Clinical pregnancies for January 2007 – December 2007 (per TVOPU)

1.   Introduction

Concept Fertility Centre (Malaysia) which was established in 2002 in Malaysia is a division of Damai Service Hospital (HQ) working in association with Concept Fertility Centre, Perth Australia. Concept Perth has been a leading fertility centre in Assisted Reproductive Technologies (ART) in Western Australia since 1982 with ISO 9001:2000 accreditation. It also has links with University of Western Australia, Department of Obstetrics & Gynecology and King Edward Memorial Hospital for Women in Perth, Australia. The establishment of Concept in Kuala Lumpur means that patients now have the option to seek quality fertility treatment with the latest technologies from abroad.

Because of the complex nature of infertility treatment, we have a team of trained multidisciplinary team that works together to aid couples in building a family with proper and integrated guidance, care and support throughout their treatment. Heading our team is a group of leading infertility specialists, physicians and scientists, whose research and clinical work spans the field of reproductive biology, endocrinology, gyneacology, embryology, diagnostic imaging and reproductive surgery. To ensure total quality control at Concept, our scientists from Australia are overseeing all technical aspects at our centre. We also have patient coordinators trained in ART patient management and counseling to facilitate and support each patient’s treatment in a comfortable environment.

MissionStatement

• To provide patients state-of-the-art infertility treatment, combined with the highest quality care and service, in a compassionate environment where the well-being of the patient is of paramount importance.
• To assist childless couples to achieve the most precious gift of all – a healthy baby.
• Further, to provide our staff with a dynamic, fulfilling, challenging and positive work environment.

Vision Statement

• To maintain and build upon our reputation as leader in the field of infertility treatment, and to engage in research which will further the field of infertility treatment in Malaysia and abroad.

2. Team

Concept’s multidisciplinary medical approach has made us one of Australia’s most successful centers treating infertility and we strive to continue our good track record here in Malaysia. Our team members have all trained in the treatment and support of people facing infertility issues and approach their needs with depth, respect and the most advanced technology available. We understand that the needs of each couple are unique; that is why at Concept, we tailor our program to suit the needs of each individual and couple.

3. Range of Services

Baseline Infertility Investigations

Assisted Reproductive Technologies (ART) Services

• IIn Vitro Fertilization (IVF)
• Intracytoplasmic Sperm Injection (ICSI)
• Cryopreservation of embryo
• Cryopreservation of sperm
• **Sperm and oocyte donation
• Shared IVF/ICSI cycle
• Intra-Uterine Insemination (IUI)
• Blastocyst Transfer
• Assisted Hatching (AH)

4. Assisted Reproductive Technologies (ART)

In-Vitro Fertilisation (IVF)/ Intracytoplasmic Sperm Injection (ICSI)

IVF is the technique of mixing the women's eggs with sperm from her partner in a small dish or test-tube in the laboratory to allow fertilisation to occur. Once the eggs are fertilized (at this stage known as embryo), one or more embryos are placed into the woman's womb through the cervix.

What does IVF involve?

Below is a short outline of the steps involved in IVF. These include:

• Pre-treatment evaluation
• Stimulation of the ovaries
• Monitoring of egg development
• Egg collection
• SSperm preparation
• Fertilisation
• Embryo transfer
• Pregnancy test and scan
• Pre-treatment evaluation

ART Program for Foreign Patients

To make it cost effective for the patients, they can choose to make only one trip to Kuala Lumpur, which are a few days before the Trans-vaginal Ovum Pick-up. They can leave once they have done the embryo transfer (approximately 9-14 days).Appointment with local O&G for the following tests (to be done a month before IVF/ICSI treatment):

Stimulation of Ovaries & Monitoring of Egg Development

IVF/ICSI SAMPLE CYCLE

• The treatment protocol is known as FLARE, as we will start both the Gn-Rh analog (Lucrin) and Follicle Stimulating Hormone-FSH (Puregon, Gonal-F) on Day 2 of the patient’s cycle.
• On Day 1, patient will inform the coordinator and will commence injections on Day 2.
• Husband will also start antibiotic – Doxycycline for 14 days (once daily) on Day 1 of wife’s cycle.
• Monitoring of egg development will start on Day 8 of the cycle. Tentatively patients need to come for ultrasound on Day8, Day 10 and Day 12 to monitor the growth of the follicles.
• The dosage of FSH used on patient will depend on her age and baseline hormone.
• Patient can choose to return to country of origin after embryo transfer and can do the pregnancy blood test in her country. This will cut short her time in Kuala Lumpur.

*Patients are needed to be in Kuala Lumpur from Day 8 to Day 16 (yellow boxes)

Egg Collection

EEggs are collected from the ovary by suction through a fine needle. This needle is inserted into the ovary through the vagina using the ultrasound picture as a guide. You have a choice of full general anaesthesia or sedation, depending on your current health status and medical history. We hope to obtain at least 3 eggs but usually larger numbers are obtained.


Trans-vaginal Ovum Pick-up Procedure in the theatre.

                       
An embryologist will promptly check if an egg was collected.                         A mature egg. 

Sperm preparation

A fresh sperm sample is needed for IVF so that the sperm are of good quality. The sperm are specially prepared so that only the best, cleaned sperm are put with the eggs.

Fertilisation

In-Vitro Fertilisation

After collection the eggs will be put into the incubator for a short time. A relatively small number of sperm are then added to each egg. They will then be kept in the incubator for about 2 days. They are looked at daily and we will keep in touch with you by telephone and advise when to attend for embryo replacement.

Placing the eggs and sperm in the incubator.

A fertilised egg

Embryo with two cells

Embryo with four cells

Embryos with eight cells

Intracytoplasmic Sperm Injection (ICSI)

For ICSI, fertilization is done by injecting a viable sperm to each egg. The mature egg is held with a specialized holding pipette. Then, a very delicate, sharp and hollowneedle is used to immobilize and pick up a single sperm which is injected in to the cytoplasm. The injected eggs are placed in an incubator and will be checked the next morning for fertilization.

The mature egg held with a pipette.
Then, a very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.

Sperm is injected into the cytoplasm.

Embryo transfer

An opportunity to discuss how many embryos should be replaced will already have taken place. The chances of pregnancy increases with the number of embryos replaced, but so does the risk of multiple pregnancy. There is an increased chance of losing one or all of the babies in a multiple pregnancy and we are therefore anxious to avoid this complication. We usually recommend no more than 3. The procedure for replacement of the embryos is virtually painless and is little more than an internal examination. You will not need to lie down afterwards and you can return to normal (but not too strenuous) activity.

Sometimes there are more embryos available than we can replace. In this case, you may consider freezing and storing your surplus embryos for future use.

Pregnancy test and scan

AAfter IVF further injections or pessaries may be needed to support the lining of the womb. You can do a pregnancy test about 2 weeks after egg collection in your home country. If this is positive, a scan will be performed 5 weeks after egg collection to confirm that it is a good pregnancy and that a baby is growing. Miscarriages can occur in any pregnancy but there is also no increased or decreased risk after IVF. There is a small (7%) chance that the pregnancy may stick in the tube (ectopic pregnancy). If this occurs an operation is required to remove the pregnancy and possibly the tube as well. We see everyone who becomes pregnant regularly at the hospital until we are sure that the pregnancy is growing normally and we hope you would be able to see your doctor in your home country for further follow-up.

5. Disappointments

Clearly these methods of treatment are complicated and stressful and they may fail at any stage. Sometimes we can explain why it has failed but often it is for reasons which we don't understand. If you are not successful we will arrange for you to discuss what happened in detail via phone or email. If you have any further questions about these treatments, the medical and nursing staff at the centre are available to answer them.

You will be asked to attend a further counseling/ information session at the Fertility Centre before treatment begins which will give you both an opportunity to discuss any problems.

6. Why choose to do your treatment abroad?

Infertility and its treatment are stressful by nature. At the same time, stress is certainly a factor in fertility. Stress can interfere with normal function of the hypothalamus and the pituitary glands involved in regulating ovulation. In severe situations, this may block ovulation completely; in other cases, stress may merely interfere with hormone production. Stress may also interfere with the immune system, which plays an important role in implantation and the body's recognition of the pregnancy.
The magnitude of this adverse effect varies from individual to individual. As such, testing for stress does not tell us whether your stress levels are affecting your fertility.

The best thing to do is to take steps to minimize the role stress plays in your life by recognizing what are the main causes (apart from the problem – infertility itself). So, when people say “Take a holiday, maybe you’ll get pregnant” it is becoming quite literal. Choosing to do your IVF program abroad not only gives you the opportunity to travel and have a bit of fun, but it also helps you to focus your energy and commitment on your treatment and cutting out stress factors such as:

• Overly concerned family members and friends
• Work, chores, etc
• Finance

7. Clinical pregnancies for January 2007 – December 2007 (per TVOPU)