Assisted Reproductive Technologies or Foetal Maternal Medicine

Ads

Most couples have an 85 per cent chance of successful conception within a year of attempting to achieve a pregnancy. For the 15 per cent who are not so lucky, a series of assisted reproductive technologies (ART) can be employed to help them achieve their goal.

In-Vitro Fertilisation (IVF)

In-Vitro Fertilisation (IVF), more commonly referred to as the 'test-tube baby', is the latest and most commonly used technique in reproductive technology to help women who are having problems conceiving.

For cases where there are severely reduced numbers of normal motile (healthy and active) sperms and possibly an accompanying problem of reduced ovarian function due to female age issues, or previous endometriosis, pelvic inflammation and possibly a tubal blockage or disease, the best option would be to consider IVF/ICSI.

Intra-Cytoplasmic Sperm Injection (ICSI)

Sometimes, this procedure is performed to assist the fertilisation. Instead of allowing the sperms to fertilise the eggs in the normal way, help is provided. After extracting a sperm sample from a man and eggs from a woman, a single sperm is injected into each egg to allow fertilisation to occur in the laboratory.

Superovulation & Intrauterine Insemination (SO-IUI)

This is a procedure where two to three ovarian follicles (eggs) are stimulated and brought to maturation and ovulation. Intrauterine Insemination is placing prepared sperms directly into the uterus. When the two procedures are combined, it increases a couple's chance of pregnancy.

Foetal Maternal Medicine

Many factors constitute a high-risk pregnancy. Medical technology however can help to detect and closely monitor the situation.

Ultrasound is the most common investigative modality in pregnancy and has become a standard feature in antenatal care in Singapore. Advances in ultrasound technology and digital imaging have increased the ability of doctors to identify abnormalities during pregnancy.

First Trimester Pregnancy Screen (FTPS) and Nuchal Translucency (NT) Scan

This scan (also called the nuchal scan) is performed between week 11 and 14 of pregnancy. It is a painless test that employs an abdominal ultrasound scan to measure the clear or translucent space in the tissue at the back of the foetus' neck. The baby's length is measured to confirm its gestational age and the thickness of the nuchal translucency is measured.

Using the International Fetal Medicine Foundation algorithm, an individualised risk of Down Syndrome is given to the parents for their consideration and counselling is provided to assist in the comprehension of what the test results mean. This combination of NT and biochemical tests detects 90 per cent of Down.

Syndrome Cases

In Singapore, this test is called the First Trimester Pregnancy Screen. This test is currently the best universal screening test for all pregnant women regardless of maternal age. Major defects of the heart, skeletal defects and other structural or chromosomal anomalies can also be detected through the scan.

Chorionic Villus Sampling (CVS)

A small amount of the placenta tissue from the mother is obtained. Under direct visualisation and guidance from an ultrasound to prevent injury to the foetus, a biopsy needle is safely inserted through the mother's abdomen into the placenta.

This procedure is usually carried out between week 10 and 12 of pregnancy and is useful in detecting chromosomal disorders and excluding genetic diseases such as Thalassaemia (an inherited blood disease). It is likely to be recommended to women who were found to have an increased risk through FTPS, have had an affected child or who are carriers of genetic diseases e.g. Thalassaemia.

Amniocentesis

Amniocentesis is a prenatal test carried out between week 16 and 20 of pregnancy. It allows a doctor to obtain valuable information about a foetus's health and development and detect genetic or chromosomal disorders. With the aid of an ultrasound, the procedure involves inserting a thin hollow needle through the abdomen and uterine wall into the amniotic sac. A small sample of amniotic fluid surrounding the foetus is withdrawn and sent to the laboratory for special tests.

Maternal Serum Screening (MSS)

MSS is an optional blood test done between week 15 and 21 of pregnancy. The test helps identify pregnancies which may be at risk for Down Syndrome or Open Neural Tube Defect (NTD) such as spina bifida (incomplete closure of spine) or anencephaly (absent skull bone). This test detects 65 per cent of Down. Syndrome and can be offered to women who are past the window for the FTPS and wish to have some form of biomedical screening.

Foetal Anomaly (FA) Scan

This scan is done between 18 and 22 weeks of pregnancy and helps to exclude the majority of structural deformities and give clues to exclude chromosomal disorders if other screening methods were not offered before.

Growth Scans and Doppler Studies

Growth Scans and Doppler Studies are performed to document foetal growth and development and to detect if there is any shift from the centre i.e. either intrauterine growth restriction or macorsomia.

Fetal Blood Sampling (FBS)

FBS is usually done between week 20 and 23 of pregnancy. A thin hollow needle aided by ultrasound is guided through the mother's abdomen into the umbilical cord where umbilical blood is drawn for testing. FBS is done for the rapid detection of chromosomal and genetic disorders particularly when a foetal anomaly is detected at the midtrimester scan.

Blood disorders and viral infections can also be excluded using the foetal blood directly to assess for infections. Administration of medications directly to the foetus is also possible through this route.

Ectopic Pregnancy

An ectopic pregnancy occurs when the location of implantation is outside the uterus. It can occur in several places, e.g. ovary, abdomen, cervix, etc. The majority of ectopic pregnancies however, occur within a fallopian tube. To help with the diagnosis, blood tests of your pregnancy hormone levels and an ultrasound may be carried out. However, confirmation is usually obtained through an operation. 5-7 in every 1,000 pregnancies will be ectopic and it tends to mostly affect women who have had a previous ectopic pregnancy and those with a history of pelvic infection. n

Courtesy
Parkway Group Healthcare PTE Limited, Singapore.

Similar of Assisted Reproductive Technologies or Foetal Maternal Medicine