1.	IVF and ICSI (In-vitro fertilisation and intracytoplasmic sperm injection) This is the most advanced form of fertility treatment. In essence it involves the extraction of the egg and combining it with the sperm in the laboratory. Fertilisation can be achieved naturally when a sperm penetrates the egg ‘shell’ or with assistance in the case of ICSI. In ICSI, a single sperm is injected into the egg with a fine glass needle. Diagram A Diagram B
2.	Blastocyst Culture and Transfer A blastocyst is an embryo that has developed after about 5 days after fertilization. By this time it has developed from a single cell to a hollow ball of cells, with a ‘clump’ of cells in the cavity. In Blastocyst transfer, embryos are cultured in the laboratory for five days after fertilisation. Only one or two Blastocysts are transferred to reduce the risk of multiple pregnancy as they have a greater ability to implant. It is important to note that many embryos die before they reach the blastocyst stage. You should first discuss with the doctor whether Blastocyst transfer is suitable for you. Diagram
3.	Assisted Hatching (AH) AH benefits women who are over 40 or women who fail to fall pregnant despite repeated embryo transfers with good quality embryos. Implantation occurs after the embryo ‘hatches’ from the gel-like shell and attaches itself to the wall of the womb. In some women, the shell may be too thick or tough and traps the embryo inside. Making controlled cuts on the shell of the embryo just before replacing them in the womb, makes it easier for the embryo to hatch thereby improving the chance of pregnancy. Diagram
4.	Embryo Freezing Patients who have spare embryos after embryo transfer can choose to freeze their remaining good quality embryos for a subsequent embryo transfer. The cost of a thaw cycle is much less than a fresh cycle with no decrease in chance of pregnancy if 3 embryos are transferred.
5.	MESA/TESE Some men who had been vasectomised previously or have an obstruction in their spermatic ducts will have no sperm in their ejaculate. Sperm can then be surgically extracted by an operation such as micro-epididymal sperm aspiration (MESA) or Testicular sperm extraction (TESE). Testicular sperm has very poor motility and must be combined with the ICSI procedure to fertilise an egg.
6.	Donor egg programme Women who fail to produce any eggs or produce eggs of poor quality may consider using donated eggs. The commercial transaction of eggs is not permitted by the Ministry of Health in Singapore. Therefore availability of donor eggs depends on the altruism of egg donors and these are generally scarce. However, if a donor has been identified, the success rate in achieving a pregnancy will depend on the age of the donor.