The Evie Slow Release Insemination (SRI) technique: A breakthrough in fertility treatment
You might be someone who has been yearning to conceive and faced difficulties for the longest time. But here's an alternative way, mums and dads, with the Evie Slow Release Insemination method.
There are many reasons for couples to wait longer before trying for their first child: financial constraints, career and more. However, the longer a couple wait, the harder it is to conceive. In fact, once a woman enters her late 30s to early 40s, her chances of getting pregnant drop to 10 percent, from 20 percent in her late 20s.
For such couples, fertility treatments like Intrauterine Insemination (IUI) and In-Vitro Fertilization (IVF) are options. But, the success rates of the former are quite low. And IVF can be taxing financially, emotionally and physically.
What if there was a treatment option that was much cheaper and less invasive than IVF, and had higher success rates than IUI?
Introducing the Evie Slow Release Insemination (SRI) treatment, and the story of the very first Evie baby in Asia (conceived right here in Singapore), that will undoubtedly bring hope to all couples trying to conceive.
We will also glean insights from fertility specialists, Dr. Sheila Loh and Dr. Seng Shay Way on this newly introduced Evie treatment by Raffles Fertility Centre, which is currently the first and only hospital in Asia that offers this procedure.
Macedonian-born Dr. Fanija Panovska was already 41 when she came to Singapore to seek treatment for infertility issues.
But it’s not that she has not gotten pregnant before. In fact, Dr. Fanija has a six-year-old child with her husband.
Three years ago while trying for a second child, they found themselves struggling to conceive for a year.
And that was when the Macedonian-born and her husband, who have been living in Singapore for nine years now, came to realise that they were facing troubles conceiving.
According to The World Health Organisation, “infertility” is defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse.
Dr. Fanija, a Medical Doctor who specialises in Reconstructive Microsurgery, Burns and Aesthetic Surgery, and her husband are just one out of the many couples out there facing this problem.
And it’s more common than we think — one in seven couples experience problems trying to conceive.
Dr. Fanija even went through two cycles of Intrauterine Insemination (IUI), a standard first-line fertility treatment. But both rounds were unsuccessful.
She was “healthy” and “IUI has been advanced”, so what could be the problem?
Dr. Fanija recalls having met Dr. Seng Shay Way, a Specialist in Obstetrics and Gynaecology & Consultant from Raffles Fertility Centre.
Impressed by Dr. Seng’s expertise in helping couples conceive, she decided to seek his help.
“That was the first time he mentioned about Evie,” said Dr. Fanija.
According to her, the amount of data was very “limited” when it came to the treatment back then.
But after going through two unsuccessful cycles of standard IUI, Dr. Seng explained more about the Evie slow release insemination (SRI) technique to Dr. Fanija.
Apparently, Evie works just like natural conception. It is a device that gently releases and delivers prepared sperm into the uterus over a period of four hours.
With that, it maximises the opportunity for the sperm to reach the egg. In other words, it increases the duration of potential contact between the sperm and the egg for fertilisation.
Besides, there are reduced risks when it comes to the “slow and gradual process” in releasing sperm into the uterus.
This slow and gradual process reduces the risks of triggering an immune reaction and polyspermia — a process whereby too many sperm fertilise an egg, rendering it non-functional.
And clinical studies have shown that the SRI technique more than doubles the pregnancy success rate for women under 35 years old when compared to standard IUI.
But of course, Dr. Fanija had her concerns and doubts, just like other couples trying to conceive might have.
“After trying for so long and going through so many unsuccessful IUIs, my husband and I were initially very skeptical whether it would work,” she said.
But after hearing about the slow release insemination technique and the Evie device, Dr. Fanija was “convinced about the advantages of Evie”.
For women under the age of 35, SRI doubles the pregnancy success rate as compared to the conventional IUI.
During normal intercourse, sperm can hide inside the cervical crypts (these are hundred of glands that line the cervix) and slowly swim up into the womb over a period of 72 hours.
But in standard IUI this gradual swim-up by the sperms is lost as the sperms are immediately deposited inside the womb, by-passing the cervix. Although this can help the sperm reach the egg, sometimes timing is an issue and the sperm may completely miss the egg.
“In the case of an inaccurate timing, the sperm could swim past and there would be no egg to fertilise,” said Dr. Sheila Loh, Specialist in Obstetrics and Gynaecology & Consultant from Raffles Fertility Centre. “That’s why the efficiency of standard IUI is actually quite low ranging from 5 to 15%,” she added.
As such, with Evie that releases the sperm in a slow and gradual process, it increases the likelihood of the sperm actually hitting their “target”. In other words, it assists sperm to bypass the cervix and enter the uterus straight, hence improving pregnancy success rates.
It is also less invasive as compared to more complex procedures such as IVF.
For patients with mild infertility, Dr. Sheila recommends SRI as a first line treatment before considering IVF as SRI is simpler, convenient and a fraction of the cost of IVF.
A cycle with the Evie treatment could cost between $2,700 to $3,700 that is inclusive of medications for stimulation, scans, consultations with doctors and blood tests.
Not only is Evie cost-effective and efficient, it generally requires lesser cycles as compared to traditional IUI.
However, that does not mean that Evie treatment is a substitute to IVF or standard IUI in any way.
The recommendation for Evie treatment is also dependent on one’s age and cause of infertility.
“Overall, my patients had a great experience with Evie and I think this is a very exciting new alternative to standard IUI,” elaborated Dr Seng.
He recommends at least three cycles as it accounts towards cumulative success rates. “The more the better but usually between three to six cycles. More than that, it wouldn’t be cost effective,” Dr. Seng added.
“Evie can be recommended as a first line of fertility treatment for couples who are experiencing mid fertility issues. This includes men having anti-sperm antibodies and mild male factor infertility, as well as women suffering from cervical mucus problems and endometriosis.”
Apparently, he says that “patient selection” is always key in recommending Evie, which works best for patients under 35.
“Even if they are above 35 years old, it’s still important,” said Dr. Fanija.
The Evie treatment consists of an IUI catheter set, Evie device, 3ML syringe, elastic leg strap and disposable bag.
“Evie is a very, very easy procedure, apart from having a higher chance for conceiving,” according to Dr. Fanija.
It involves a device (Evie) that would be strapped onto a woman’s right thigh, delivering the prepared sperm via a small pump over four hours.
The catheter tube goes into the uterus and the sperms will be delivered through the tube. A button is pressed to activate the tiny disposable pump with a timer attached.
As shown in a clinical study, it is as comfortable as regular IUI.
The Evie device will be fitted by a fertility specialist in the clinic and the actual procedure will take around 15 minutes.
One could leave the clinic afterwards, go to work, home and go about their day as per usual — such as driving and walking around.
Four hours later from having the Evie device fitted, Dr. Fanija could remove the device herself. All she had to do was “press the second button”, which injects any leftover sperm.
After this, she removed the device as instructed by her doctor prior leaving the clinic.
The device being able to be removed at home, once proves its convenience factor.
Like traditional IUI, only a mild cramping sensation could occur when using the device. But the intensity could be dependent on the sensitivity of the patient.
But Dr. Fanija says she did not feel any pain during the procedure.
However, there are some things to note with proper use of the Evie device. Dr. Sheila advises against sudden vigorous movement such as jumping or even swimming. Leaving the device strapped on for more than four hours or overnight is a definite no.
At 42 years old now, Dr. Fanija successfully gave birth to her second child, Damian Verheyen, on 7 September 2018. It was through a natural delivery.
When told by Dr. Seng that Damian is the first Evie baby in Asia, she started crying.
“He’s very happy and healthy,” Dr. Fanija said.
She is one of the 10 patients under Dr. Seng’s pilot test on the Evie slow release insemination.
A 30% pregnancy rate was achieved with three out of 10 of them getting pregnant only after just one cycle, according to Dr. Sheila.
She wants to let those who are finding ways to conceive that the Evie slow release insemination treatment is a “new, affordable and relatively painless procedure”.
And she is very thankful for Dr. Seng’s support in her Evie journey.
Whether or not you are below or above 35 years, Evie is ideal for women who are considering to have a baby. And Raffles Fertility Centre is the first in Asia to offer the Evie Slow Release Insemination technique.
Evie may be recommended as a first line fertility treatment for non-tubal problems if one or more of the following apply:
- A couple with unexplained infertility
- Mild male sub-fertility
- Women who have endometriosis (Grade 1 or 2) and have intact fallopian tubes
- Women who have cervical mucus problem
- Men who have anti-sperm antibodies
- Ejaculation is not possible due to impotence or vaginismus
- Retrograde ejaculation (where the semen travel backwards in the bladder)
Advantages of Evie
- More than doubles a patient’s chances of success, compared to standard IUI, for women under the age of 35.
- Costs less than conventional IVF treatment.
- As comfortable as regular IUI
Any possible side effects afterwards?
- They are likely to be very minor. These may include spotting and mild cramping
- There is a very small risk of infection following any procedure of this nature (if you feel unwell, please telephone the clinic for advice)
Estimated costs of fertility treatment procedures in Raffles Fertility Centre
Estimated Costs Per Cycle
(Inclusive of fertility medications)
S$2,700 to S$3,500
S$1,800 to S$2,500
S$15,000 to S$20,000
Mums and dads, perhaps there is a better alternative out there like the Evie Slow Release Insemination treatment if you’re seeking to conceive after being unsuccessful for a long time. However, always check with your fertility specialist on what works the best for you. Ultimately, we can only provide you with the information but you hold the cards!
Our heartiest congratulations to Dr. Fanija Panovska and her husband for successfully conceiving their second child.
For more information on Raffles Fertility Centre and their services, please visit their website here.
Source: All information and pictures from Raffles Hospital, unless stated otherwise.