General guidelines concerning those couples to be considered for IVF have been established in Singapore:

Suitable candidates for IVF are:

• Tube pathology
  If both fallopian tubes are completely blocked, IVF is directly indicated. If the function of the fallopian tubes is reduced, IVF is only considered after other treatments.
  
  
• Endometriosis
  Depending on the severity, drug or surgical treatment will be the indicated treatment in the first instance. IVF is considered if a pregnancy has not occurred after treatment. For mild forms of endometriosis, the guidelines for unexplained subfertility are applied.
  
  
• Male subfertility
  ICSI is also considered in severe cases of subfertility. In less severe forms, IVF is considered after a number of IUI cycles.
  
  
• Premature ovarian failure
  
  
• Unexplained subfertility
  No cause found after full investigation, at least three years of marriage, and having completed alternative approaches to fertility management for at least 1 year. However, this will not apply to female above 35 years old.
  
  
• Other conditions acceptable to the local obstetric/gynaecologic community.

IVF shall only be carried out on a married woman and only with the consent of her husband, whether or not her husband’s semen is used.

The most important reason for considering a couple for IVF at an earlier stage is the age of the woman: the chances of a pregnancy over the age of 35 rapidly reduce, and with them the chances of success after IVF.

The doctor treating you will assess when and if IVF is an option for you. A strict selection is justified given that IVF is an invasive and intensive treatment with associated risks.

When does IVF not make sense?

• Age
  The success rate of an IVF treatment reduces with age. As the age of the woman increases, there is a greater chance that the ovaries will no longer react fully to the stimulation. This can be assessed from certain blood results, including the FSH level. In addition, the quality of the egg cells reduces and the risk of miscarriage is greater as age increases. This is therefore the reason why women over the age of 40 are generally no longer considered for IVF treatment. In Singapore, women aged 45 and above should not be accepted into an IVF/ICSI programme.
  
  
• Weight
  Being seriously overweight not only has an effect on fertility, but also on general health and therefore on a possible pregnancy. In addition, ovaries for IVF have to be accessible for puncture. Sometimes this is scarcely possible in heavier women. Therefore, weight loss is a necessity in some cases before a possible treatment.
  
  
• Sperm quality
  Limitations caused by conditions relating to sperm quality have been enormously relaxed by the introduction of ICSI.
  
  
• Pregnancy
  The woman has to be able to carry a pregnancy to term.

The IVF clinic concerned will carefully map out your situation, after which it will decide whether you can be considered for IVF.