IVF with ICSI Malaysia

SUMMARY: In Concept Fertility Centre (Malaysia) CO Damai Service Hospital (HQ) we offer standard IVF with ICSI cycle. The basic IVF bundle costs 16000 RM. This fee does not cover pre–treatment screening tests. Pre–treatment screening bundle is charged separately. Pre–screening package approximate fees are 1100 RM—21100 RM.

PRICE: 16000 RM

BASIC IVF PACKAGE FEE COVERS:

• pre–treatment consultations and basic screening tests (pre–treatment evaluation (for the couple): (1) Serology: Hemoglobin, RBC, PCV, MCV, MCH, MCHC, RDW, Blood group. **(2) These tests that can be done in the home country: RPR (VDRL); HIV 1&2 Ab/Ag, Hepatitis B antigen, Hepatitis B antibody, Hepatitis C antigen, Hepatitis C antibody. (3) The screening tests for partner/husband: Semen Analysis: Total count/ml; Motile count/ml; Progression %; Normal morphology (shape) %; Count after washing. ***Please advise if husband needs PESA/TESA. (4) Baseline Reproductive Hormone (to be done once between Day 2–Day 6 of the cycle): Follicle Stimulating Hormone (FSH); Estradiol (E2); Lutienizing Hormone (LH); Progesterone (P4); Thyroid Function Test; Prolactin. (5) Pelvic examination and ultrasound assessment report; (6) Menstrual cycle pattern; (7) Medical history of the couple: Drug allergy (if any), Previous surgery (if any), Illnesses (eg. Asthma, if any).
• controlled ovarian stimulation protocol;
• monitoring of ovarian stimulation cycle;
• anesthesia for egg collection procedure;
• ultrasound–guided oocyte retrieval (egg collection) procedure;
• sperm collection and sperm preparation for further fertilization;
• fertilization of every mature oocyte with ICSI (intracytoplasmic sperm injection) technique in the laboratory;
• embryo culturing (embryos are left to grow up to three days);
• embryo transfer;
• embryo freezing;
• pregnancy test and scan.

THE TIME FRAME: IVF cycle’s approximate full time frame (with pre–treatment screening) is 30 days.

More details about IVF package and IVF cycle in Concept Fertility Centre (Malaysia) c/o Damai Service Hospital (HQ).

Pre–treatment screening bundle’s fees: 1100 RM—21100 RM.

Semen analysis (male) — RM 120.

Requirements: Patient is required to abstinence 3–5 days from the last ejaculations/intercourse. Time frame: Test is performed from Monday to Friday 9am to 11:30am; Saturday from 09.00AM to 11.00AM.

Baseline Hormone Screening Tests (female) — RM 198.

Requirements: Test can be done between day 2 to day 6 of periods. Time frame: During office hours.

Anti Mullerian Hormone (AMH) — RM280. 

Requirements: No specific requirements. Time frame: During office hours.

Liquid Based Cytology and HPV Screening — RM230. 

Requirements: Test can be done after menstruation. Time frame: During office hours.

Hysterosalpingogram (HSG) — RM280++.

Requirements: Test can be done between day 6 to day 10 periods. Patient will need to ensure total off from periods before coming in for the test. Time frame: Test can be performed every Monday, Tuesday, Thursday and Friday from 01:30PM till 02:30PM. Advanced appointment needed.

Diagnostic Laparoscopy — RM15000++. *This test is performed only if recommended by a fertility expert.

Testicular Biopsy(TESA)/ Percutaneous Sperm Aspiration (PESA) — RM5000++. *This test is performed only if recommended by a fertility expert.

Once all tests and data have been completed, the patient can proceed to start their treatment (ovarian stimulation protocol can be implemented on Day 2 of the next period).

Stimulation of the ovaries

In a natural menstrual cycle, a woman produces only one egg, but in order to increase the chances of pregnancy in IVF it is desirable to stimulate the ovary to produce several eggs. This is done by giving you hormone injections for about 12 days to make the eggs grow. The eggs need to be exactly “ripe” at the time of their collection and so their development must be carefully monitored. The drug treatment varies slightly to suit your circumstances such as age and FSH level, but this will be fully discussed with you beforehand.

Monitoring of egg development

Development of the eggs is monitored by 2 methods. First the size and number of egg follicles growing in the ovary are observed by ultrasound scanning.

The second method of monitoring is by measuring the hormones produced in the ovary This is done by a blood test. The blood test and scan will be done about 2–3 times during the 2 weeks before egg collection. At least three eggs must be growing before we can proceed to egg collection. Sometimes treatment will therefore fail at this stage. If the stimulation treatment has been successful, the eggs will be ripe at the right time and a final, different injection will be given to complete the ripening. Egg collection will be planned for about 36 hours after this injection. On rare occasions a complication of this treatment can occur (Hyperstimulation Syndrome). The ovaries may become large and painful and if severe, admission to hospital may be necessary. This usually only occurs if you become pregnant and gets better within a few weeks.

Egg collection

Eggs 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 anesthesia 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.

Sperm preparation

We will inform you of the approximate sperm collection time once the ovum pick–up time has been arranged. It will be approximately 3 hours after the operation. Three days’ abstinence from intercourse will be necessary prior to ovum pick–up. Instruction will be given to couple prior to ovum pick up. The sperm sample is produced by masturbation at the Centre or by other means by arrangement. There is a room for this purpose. You are asked to wash your hands beforehand to minimize the chance of contamination. Lubricants are NOT to be used.

It can be very difficult for some to produce a sperm sample on request under these conditions. If you are worried about this aspect of the programme, please discuss it with us at or before the start of the treatment cycle, so that arrangements can be made to freeze some semen if necessary – freezing must be done at least a week before egg collection. Sexual activity may be continued as usual until three days before the time of the wife's egg collection. Abstaining from then on is important to allow the sperm to reach optimum quality.

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.

Fertilization

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.

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 then 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 outcome

After 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.