Miracle of delayed fertilisation when there is no time to lose. Delayed-ICSI can help women conceive even when time is running out.

Miracle of delayed fertilisation when there is no time to lose. Delayed-ICSI can help women conceive even when time is running out.

Dion’s parents, mother Peggy and father Tim, had been trying unsuccessfully to conceive naturally for some years because of persistent fertility problems. Peggy was already 38 and had almost given up hope. She was also running out of eggs.

“With us marrying in our thirties and having our careers to focus on, we began to think about having a baby quite late on in life, probably around the time when I was 35,” said Peggy.

“After three barren years, we visited an O&G specialist in the town where we live. We had been to several doctors beforehand but none of them could work out why I couldn’t conceive. The O&G specialist told us that the natural method clearly hadn’t been working and she advised us to undergo IVF treatment to give us a better chance.”

The couple were told that it might take several IVF cycles before Peggy conceived due to her age that may affect her quality and quantity of eggs, but they shouldn’t give up hope.

The IVF success rate in Malaysia is among the highest in the world, at an average of around 70 per-cent, compared to the global rate of some 60 per- cent. Some Malaysian clinics have even better results, leading it to be one of the key fertility hubs in Asia.

During IVF, eggs are collected from the mother’s ovaries and fertilised by the father’s sperm in a lab. The egg may either be fertilised traditionally or through intracytoplasmic sperm injection (ICSI).

In traditional IVF, 50,000 or more swimming sperm are placed next to the egg in a laboratory dish, and fertilisation occurs when one of them enters into the cytoplasm of the egg.

In the ICSI process, a tiny needle is used to inject a single sperm into the centre of the egg. This approach can be chosen for a number of reasons, including when eggs are not being fertilised by traditional IVF, regardless of the condition of the sperm.

With either traditional IVF or ICSI, once fertilisation occurs, the fertilised egg is then grown in the laboratory and transferred to the mother’s uterus. One full cycle of IVF takes about three weeks.

Notwithstanding, the likelihood of an IVF cycle being successful drops in tandem with the mother’s age. For instance, a woman aged under 30 is far more likely to become pregnant than one over 38, as Peggy was at the time of her treatment.

Now, after years trying to conceive with no avail, the couple realised that they might have to begin contemplating a future together without children. But with one last roll of the dice, their outlook changed completely.

Tim recalled reading about a fertility centre in Kuala Lumpur that had an IVF success rate on par with that of the best clinics in the world. Moreover, the article mentioned that it was one of the only centres in Malaysia that would culture eggs harvested from the mother a little longer than usual.

This approach allows slower developing eggs to become viable for use in IVF. Typically, embryologists would discard immature eggs under the belief that they are not suitable for fertilisation. But culturing them for a further 24 hours can help improve the chances of pregnancy. Doing so also allows older women like Peggy, who have a dwindling number of eggs available for use in fertility treatment, not to waste eggs that might be viable.

The fertility centre Tim had identified, Alpha IVF & Women’s Specialists, had carried out research into delayed-ICSI, and presented their findings from a study earlier this year to a conference of the European Society of Human Reproduction and Embryology (ESHRE).

Alpha IVFfound that one extra day in the laboratory allowed some eggs to grow into ones that could be fertilised and potentially grow into viable blastocysts. In its presentation to the conference, the fertility centre’s medical director, Dr Colin Lee, revealed that successful pregnancies had resulted from transferring these delayed-ICSI embryos from eggs that would have been discarded otherwise.

Having carried out pre-implantation genetic testing on the embryos to identify any abnormalities, Dr Lee’s team also found that blastocysts cultured this way can be chromosomally normal, and therefore safe for embryo transfer.

“It is a routine procedure in Alpha IVF & Women’s Specialists that is used in order to improve cycle outcomes of selected patients, and especially those who are poor responders,” said Dr Lee.

“Good pregnancy and implantation rates can be obtained with blastocysts derived from delayed-ICSI. Therefore, patients who are unlikely to have a good number of normally fertilised eggs in the traditional approach should have their immature eggs cultured for another day with delayed-ICSI to generate more utilisable blastocysts.”

Knowing that delayed-ICSI might offer them their last chance to become parents, Tim and Peggy travelled to Kuala Lumpur. It was difficult for them not to raise their hopes too much, but given Alpha’s high IVF success rate and its willingness to use this new approach to culturing eggs, Tim permitted himself a moment of expectancy.

“We had come so far already, only for our dreams to fall flat. But I knew there was more to this journey, just as long as we kept faith that we could still be parents,” he said.

“We just needed to have a stroke of luck and Peggy might conceive. We would never have forgiven ourselves if we hadn’t grasped this last chance.”

Finding that the prospective mother’s ovaries were almost depleted, Dr Lee ordered Alpha’s embryologists to keep her viable eggs in the laboratory and mature them in incubators for 18-24 hours. Once Tim’s sperm was injected directly into the eggs, they were cultured for up to seven days and screened for genetic abnormalities. At the end of the process, the most viable embryos was implanted in Peggy’s uterus.

“Those days are still a blur; we just couldn’t concentrate on anything else. I remember my husband telling me that he had a feeling that this would be the cycle we had been waiting for,” said Peggy.

“I dared not look at the pregnancy test when it was time to take it. I just held it up for my husband to read. His face turned into a beaming grin and I could tell straight away what it meant. I was pregnant!”

Now two months old, baby Dion is every bit the healthy bundle of joy his parents had dreamed of for so long, and now they feel their lives are complete.

“It goes to show that all things come to those who wait. For us, we didn’t just have to hold on over countless IVF cycles, we now know that by holding back fertilisation for a day longer, we were able to achieve the pregnancy that we had nearly lost hope of. We feel like it has been a miracle.”

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