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EmbryoScope Time-Lapse system is an innovative technology that is used to closely monitor the development of embryos. It pairs with an incubator, a high resolution camera with an integrated computer software that can provide up to 135-hours, minute-by-minute microscopic video, documenting the growth of an embryo without disruption.

The benefits of using an EmbryoScope includes:

• Reduce disruption and handling of embryos

  Embryos incubated inside the EmbryoScope will never need to be removed for analysis thanks to the time-lapse system.

• Comprehensive analysis and close monitoring

  Development and key morphological features of embryos can be monitored by and analysed by embryologists via high quality images and video (up to 7200 mins) captured by the built in camera. Abnormalities such as Anomalies that may not be visible during standard embryo culture can be shown in EmbryoScope.

• Better embryo selection and better outcome

  In-depth and accurate data obtained via EmbryoScope (facilitated by Artificial Intelligence-based tools) provides comprehensive visual development of an embryo to aid in embryo selection and ranking. Our embryologists are able to identify the highest quality embryos for transfers or for cryopreservation and subsequently increase the chances of healthy pregnancies.

We provide sperm selection using magnetic-activated cell sorting (MACS) Annexin V system, which is designed to separate healthy sperm from those that have begun apoptosis (cell death) due to a high level of DNA fragmentation.

Semen samples will be in contact with magnetic beads that have Annexin V attached and then passed through a magnetic column that retains poor quality sperm. As a result of this technique, sperm with intact biological potential will be recovered and concentrated for ICSI/selected assisted reproduction.

The purified sperm population shows a higher overall quality in terms of morphology, motility, DNA integrity and cryosurvival rate – thus yielding an improved sperm fertilisation potential and good embryo or blastocyst.

Indication for MACS:

• Low fertilisation rate in previous cycles
• Poor embryo quality in previous cycles
• Abnormal sperm parameters
• Varicocele (enlargement of the veins within the scrotum)
• Cancer patients (fertility preservation before and/or after chemotherapy or radiotherapy)

Beyond the parameters that we look at in a normal semen analysis, there are other diagnostic tests that can provide more insights into sperm health. These tests include:

DNA fragmentation test

DNA fragmentation of sperm correlates to the integrity of the genetic material in sperm, and high DNA fragmentation can be an explanation for infertility, recurrent miscarriages and poor IVF outcomes. The major contributing factor for high DNA fragmentation is oxidative stress associated with advanced chronological age, alcohol, diet, increased testicular temperature, infection, occupational pollutants, smoking, stress and varicocele (an enlargement of the veins within the scrotum).

A DNA fragmentation test can provide a reliable sperm analysis at a molecular level by detecting abnormal genetic material within the sperm, which in turn helps to identify men who are at risk of subfertility.

Hyaluronan binding assay (HBA)

Hyaluronan binding assay (HBA) assesses the maturity of sperm. Hyaluronan (HA) is a sugar molecular surrounding the egg and only mature sperm can bind to it. Sperm that binds to HA have enhanced levels of developmental sperm maturity, including fewer chromosomal abnormalities and higher sperm DNA integrity.

The HBA test is another component of the sperm analysis that is reliable in the diagnosis of suspected male infertility, to predict sperm performance and fertilisation potential.

Oxisperm test

The Oxisperm test assesses the oxidative stress levels of sperm. High level of oxidative stress in sperm indicate an elevated level of reactive oxygen species (ROS), which have a direct negative impact on sperm DNA integrity and motility. Exposure to substances such as tobacco, alcohol, household appliances, radiation (from laptops, TV and UV rays), and heavy metals can lead to elevated levels of ROS.

Oxidative stress refers to an imbalance between the generation of ROS and the body’s ability to neutralise their harmful effects through antioxidants. Sperm is highly susceptible to oxidative stress and when in this state, peroxidative damage will be induced in sperm plasma membrane resulting in DNA fragmentation. High oxidative stress has been associated with poor sperm motility and function, leading to poor embryo formation, miscarriage, and infertility. Conditions such as varicoceles, infection, inflammation, and spinal cord injury, have also been associated with oxidative stress-induced infertility.

These pre-diagnostic tests provide information that can help in clinical diagnosis, management and treatment of male fertility, and increase favorable outcome for assisted reproduction procedures.

Patients who may benefit from these tests may have indicating factors such as:

• Advanced chronological age
• Multiple failed IVF/ICSI treatments
• Poor blastocyst development
• Recurrent miscarriage
• Unexplained infertility
• Varicocele

Traditionally, embryos are cultured for 3 days to reach a cleavage stage with 4 to 10 cells, before being transferred back to the mother. However, embryos that look healthy and well developed by day 3 do not always have the best potential for implantation and a healthy pregnancy. Advances in blastocyst culture, a technique developed for in vitro fertilisation (IVF), now allow embryos to undergo an extended culture period of 5 or 6 days to reach the blastocyst stage.

By the time an embryo reaches the blastocyst stage with up to hundreds of cells, the embryo has already undergone several cell divisions and achieved its first cell differentiation. This allows us to identify with increased certainty the embryos with high potential for implantation (meaning that they are more likely to attach to the uterine wall and develop into a healthy pregnancy), therefore leading to higher chances of successful pregnancy and reducing the risk of multiple births.

At Mount Elizabeth Fertility Centre, our strict laboratory standards with ideal culture conditions allow us to support the growth of embryos to the blastocyst stage. Our ability to develop embryos to the blastocyst stage allows us to select the healthiest embryos with the highest potential for implantation at the time of transfer.

Only 1 or 2 blastocysts will be transferred, versus the traditional transfer of 3 or 4 early-stage embryos, back to the mother. This reduces the risk of multiple births from IVF due to fewer embryos being transferred back to the mother, while improving pregnancy rates.

Patients with poor ovarian response while undergoing IVF treatment can have renewed hope with the double stimulation protocol. Poor ovarian response could be due to multiple factors, including diminished ovarian reserves or older age.

In classic IVF procedures, only 1 oocyte retrieval (egg collection) is performed using mild ovarian stimulation during the early follicular phase of the menstrual cycle. The double stimulation protocol is where a 2 ^nd oocyte retrieval is performed during the luteal phase. This technique, where double stimulations are performed during both the follicular and luteal phases in the same menstrual cycle, leads to higher opportunity in retrieval of more oocytes. Retrieval of more oocytes allows for better chances in obtaining quality blastocysts and therefore higher pregnancy success rates.

Talk to your fertility specialist if you would like to understand more about IVF treatment and the double stimulation procedure.

A sperm donor may be required in a case where the husband has azoospermia (a condition of a man whose semen contains no sperm), poor sperm quality, inheritable diseases or other medical indications.

Mount Elizabeth Fertility Centre has a dedicated donor sperm programme to assist couples who are unable to achieve pregnancy due to male infertility. We will guide you through the process of selecting a sperm donor, handle the importation and shipment of the donor sperm, and manage the storage of the frozen sperm specimens.

Currently, MEFC is working with 3 of the largest sperm banks based in the United States. All sperm donors are screened for genetic diseases, chromosomal abnormalities and infectious diseases prior to sperm donation. These sperm banks are licensed and inspected by the Food and Drug Administration.

Before undergoing treatment, you will go for a psychological counselling session with our counsellor. This session will help in your consideration and discuss the legal, social, genetic and moral aspects of conceiving a child from the donor sperm programme.

For more information on the donor sperm programme, email ivf@parkwaypantai.com or call +65 6731 2693 / 2626.

Mount Elizabeth Fertility Centre is working with one of the largest egg donor banks in Europe to import donor eggs.

The egg donor selection process can be complicated. We understand that the safety and quality of the donated oocytes are major concerns for patients trying for a successful pregnancy.

To ensure this, all egg donors undergo infectious disease and genetic testing screening. In addition, the screening processes are in compliance with the European Union Tissues and Cells Directive (which sets and regulates the standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells) as well as Human Fertilisation & Embryology Authority's (HFEA) regulations on egg donation.

MEFC will facilitate and coordinate with the overseas egg bank to handle all the shipping logistics for you when you are ready to embark on our donor egg programme. Our team of IVF physicians, embryologists, psychologists and staff nurses are dedicated to supporting you in every way as you begin the journey to fulfilling your dreams of parenthood.

To get started, please email ivf@parkwaypantai.com or call +65 6731 2693 / 2626 for an appointment where we can help to answer all your questions.

At Mount Elizabeth Fertility Centre, we routinely apply a laboratory technique known as freeze-all IVF. In the past, the standard protocol was transferring fresh embryos during IVF. Now, advancements to the freezing process give couples more options than before.

Vitrification is a method for the safe freezing of blastocysts, where the process produces a glass-like solidification of living cells that avoids the formation of ice crystals. This is important in the embryology world as ice crystal formation can be extremely damaging to frozen embryos.

Vitrification in IVF allows for better survival rates of thawed embryos and improved pregnancy rates after frozen transfer procedures. This translates to better pregnancy outcomes, along with a lowered chance of obstetric complications such as pre-term labour or fetal growth restriction.

Quality blastocysts (advanced day 5 or day 6 embryos) that remain after the end of a treatment cycle will be saved, via vitrification, for future use. When needed, the frozen blastocysts are thawed for transfer, leading to ideal chances for a positive outcome upon harvesting of the eggs.

The freeze-all blastocysts strategy is especially beneficial for women who are diagnosed with low ovarian reserves or women who encounter poor ovarian response during IVF treatment. Older women, or even cancer patients who wish to preserve their fertility prior to undergoing gonadotoxic treatments, may also choose to benefit from this procedure.