“Fer­til­ity tests, di­ag­no­sis and treat­ment can be an ex­tremely emo­tional jour­ney”

BioSpectrum (Asia) - - Bio Talk - Dr Liow Swee Lian Clin­i­cal Em­bry­ol­o­gist, Min­istry of Health, Sin­ga­pore and Sci­en­tific Direc­tor of Vir­tus Fer­til­ity Cen­tre

Dr Liow Swee Lian is an ac­cred­ited Clin­i­cal Em­bry­ol­o­gist, Min­istry of Health, Sin­ga­pore and Sci­en­tific Direc­tor of Vir­tus Fer­til­ity Cen­tre. Dr Liow joined the Depart­ment of Ob­stet­rics and Gy­nae­col­ogy at the Na­tional Univer­sity of Sin­ga­pore in 1990, where he worked with a pi­o­neer­ing group of re­pro­duc­tive bi­ol­o­gists and clin­i­cal em­bry­ol­o­gists in Sin­ga­pore. Over the past two decades he has helped many cou­ples achieve their dream of hav­ing a baby, and has en­joyed high suc­cess rate in the first cy­cle with frozen em­bryos. Priyanka Ba­j­pai from BioSpec­trum Asia re­cently talked to Dr Liow Swee Lian on cur­rent ef­fec­tive treat­ment op­tions for in­fer­til­ity and lat­est sci­en­tific tech­niques along­side strin­gent stan­dards in the ‘clean room’ em­bry­ol­ogy lab­o­ra­tory for fer­til­ity care.

Ex­cerpts of the in­ter­view

What fac­tors should some­one con­sider when choos­ing a fer­til­ity spe­cial­ist?

When try­ing to de­cide on a fer­til­ity spe­cial­ist, cou­ples should first un­der­stand their needs and fa­mil­iarise them­selves with the cur­rent treat­ments avail­able. One of the most im­por­tant de­cid­ing fac­tors is the level of com­fort and trust be­tween a cou­ple and the fer­til­ity spe­cial­ist, to al­low for open con­ver­sa­tions.

Com­pli­ance on safety stan­dards and clean­li­ness of the clinic and lab­o­ra­tory as well as the ex­per­tise should also be taken into con­sid­er­a­tion as this would as­sure cou­ples of re­ceiv­ing op­ti­mal care and com­fort at the clinic.

Suc­cess rates of a clinic may re­flect the ef­fec­tive­ness of its treat­ments to an ex­tent, but cou­ples should keep in mind that ev­ery clinic has its own way of cal­cu­lat­ing suc­cess rates and that each in­di­vid­ual case is unique. Last but not least, while cou­ples should not base their en­tire de­ci­sion on fi­nan­cial costs, it is also an area that should be con­sid­ered ahead of time.

What was the im­pe­tus to launch the clinic?

Prior to the launch in 2014, Asia has pre­dom­i­nantly been an un­der­ser­viced and frag­mented IVF mar­ket. Sin­ga­pore is also recog­nised as a med­i­cal hub within the re­gion and as the de­mand for IVF ser­vices were ex­pected to grow, and more women are de­lay­ing preg­nancy, we opened the clinic with the aim to pro­vide ex­pert and com­pas­sion­ate care for cou­ples ex­pe­ri­enc­ing dif­fi­culty get­ting preg­nant with a team of lead­ing fer­til­ity doc­tors, em­bry­ol­o­gists, nurses, coun­sel­lors and sup­port staff.

Are there any unique fea­tures of your clinic?

At Vir­tus, we un­der­stand that fer­til­ity tests, di­ag­no­sis and treat­ment can be an ex­tremely emo­tional jour­ney. There­fore, we of­fer coun­selling ser­vices that is unique in Sin­ga­pore such as sci­en­tific and emo­tional coun­selling ses­sions. Sci­en­tific coun­selling is con­ducted by an em­bry­ol­o­gist who will guide the cou­ple through the IVF pro­cesses and dis­cuss and an­swer queries from the cou­ple. Emo­tional coun­selling pro­vides sup­port for all IVF pa­tients as well as spe­cial­ist coun­selling for our donor pro­grammes and ge­netic test­ing.

The great­est chal­lenge is to find a healthy sperm to fer­til­ize an egg par­tic­u­larly from men with nonob­struc­tive azoosper­mia where there is dys­func­tion in sper­mato­ge­n­e­sis. The man will need to have a biopsy taken from his tes­ti­cles (TESE) and sperm from the tes­tic­u­lar tis­sues are then used for ICSI.

Com­mit­ted to rais­ing the stan­dard of fer­til­ity care in the re­gion, we have an ISO-cer­ti­fied clean room IVF lab­o­ra­tory that is cus­tom-built for pa­tient care and com­fort. The lab­o­ra­tory is con­structed us­ing clean­room pan­els without any gaps cou­pled with ded­i­cated air con­di­tion­ing sup­ply and pos­i­tive air pres­sure within the lab­o­ra­tory to elim­i­nate en­vi­ron­men­tal fluc­tu­a­tions and en­sure good, clean air qual­ity, es­sen­tial for op­ti­mal em­bryo devel­op­ment.

In ad­di­tion to dou­ble-wit­ness in ver­i­fi­ca­tion on ev­ery step of the IVF process, we also use ra­diofre­quency iden­ti­fi­ca­tion (RFID) to au­to­mat­i­cally iden­tify and track tags that are at­tached to dishes and tubes con­tain­ing pa­tient’s eggs, em­bryo and sperm. As the tags elec­tron­i­cally stores pa­tient in­for­ma­tion, this will al­low for the move­ment of the pa­tient’s sam­ples through­out the IVF process to be mon­i­tored to avoid mis­match.

What are the most cur­rent ef­fec­tive treat­ment op­tions for in­fer­til­ity?

This is de­pen­dent on the cause of in­fer­til­ity that one is di­ag­nosed with. For male in­fer­til­ity cases such as azoosper­mia and se­vere olig­oter­a­to­zoosper­mia, In­tra­cy­to­plas­mic Sperm In­jec­tion (ICSI) and In­tra­cy­to­plas­mic Mor­pho­log­i­cally-se­lected Sperm In­jec­tion (IMSI) can help cou­ples con­ceive with IVF treat­ment. For high sperm DNA frag­men­ta­tion, the pro­ce­dure, Fine Nee­dle Tes­tic­u­lar Sperm Ex­trac­tion (TESE), is usu­ally called for by fer­til­ity spe­cial­ists. IMSI uses high mag­ni­fi­ca­tion mi­croscopy to iden­tify a healthy sperm be­fore in­jec­tion into the egg. This pro­ce­dure helps to im­prove the chance of get­ting a healthy preg­nancy.

For fe­male in­fer­til­ity, cur­rent most ef­fec­tive treat­ment op­tions in­clude IVF and ICSI, sur­gi­cal in­ter­ven­tions to re­move fi­broids and hor­monal treat­ments amongst oth­ers. At the end of the day, it is key that cou­ples seek help from fer­til­ity spe­cial­ists to­gether to al­low for a holis­tic treat­ment course.

What is your ap­proach to SET (Sin­gleem­bryo trans­fers)?

My favoured ap­proach to SET is do­ing a sin­gle blas­to­cyst trans­fer in a frozen cy­cle. Rea­son be­ing, blas­to­cyst is the fi­nal stage of pre-im­plan­ta­tion em­bryo devel­op­ment. At this stage, the im­plan­ta­tion po­ten­tial is much higher, at 60 – 70%, ver­sus cleav­age stage em­bryos at 30 – 40%. Vitri­fi­ca­tion is the lat­est and most ef­fec­tive method of em­bryo freez­ing. It has been shown that sur­vival rates of em­bryos that have un­der­gone vitri­fi­ca­tion is at least 95% as com­pared to 50% for em­bryos that have un­der­gone slow-freez­ing method. In frozen em­bryo trans­fer (FET) cy­cle, con­di­tions for im­plan­ta­tion are op­ti­mized and we have seen that ma­jor­ity of ba­bies born from frozen cy­cle are as healthy as ba­bies who are con­ceived nat­u­rally.

When would you trans­fer more than two em­bryos?

I will choose to trans­fer more than two em­bryos if the woman is 40 years and above, or for women who have at least one failed em­bryo trans­fer.

What is the cost of treat­ment? Cost of drugs? Cost of tests?

The cost of treat­ment is de­pen­dent on the type of treat­ment un­der­taken and varies from clinic to clinic.

What do you find is the great­est chal­lenge in in­fer­til­ity?

The great­est chal­lenge is to find a healthy sperm to fer­til­ize an egg par­tic­u­larly from men with nonob­struc­tive azoosper­mia where there is dys­func­tion in sper­mato­ge­n­e­sis. The man will need to have a biopsy taken from his tes­ti­cles (TESE) and sperm from the tes­tic­u­lar tis­sues are then used for ICSI. Very of­ten, it will be like look­ing for a nee­dle in a haystack. Some­times, very im­ma­ture sperm cells such as round sper­matids are used when there is no tes­tic­u­lar sperm.

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