If ovulation isn’t occurring naturally , despite modifications to lifestyle, hormone medication can be used to stimulate ovaries to develop and release eggs while building a healthy lining of the uterus. This technique can also be used to increase the chance of pregnancy for women who are ovulating regularly.
Blood tests and scans will be required to predict ovulation and the timing of intercourse. Depending on the woman’s age and the medication used, pregnancy rates can vary from 35% to 50% over a six-month course of treatment.
If there are any issues that reduce or prevent the sperm reaching the egg efficiently, assisted insemination (AI) is a technique which places sperm directly into a woman’s cervix or uterus with a soft, thin plastic tube around the time of ovulation. The process can only take a few minutes and most women find it quite painless. It may be appropriate to combine this with treatment with ovarian stimulation. Generally this technique is used if there is a physical problem with intercourse, donor sperm is required or if there is a combination of mild infertility issues for either partner.
Intra Cytoplasmic Sperm Injection (ICSI)
Approximately 30% to 40% of all infertility is associated with a male factor. ICSI is a laboratory technique which can be particularly useful if there are severe semen problems or if a vasectomy is irreversible. Much like IVF, eggs are collected and taken to the laboratory. Individual healthy sperm cells are selected and injected directly into each individual mature egg. Not all eggs fertilise, and not all fertilised eggs become good quality embryos. The best quality embryos are selected – those most likely to develop into a healthy pregnancy. Pregnancy rates are similar to those of standard IVF and vary with the age of the woman.
Surgical Sperm Retrieval
If blockages are preventing sperm from being released, they can be collected directly from the epididymis or testes. The procedure is performed under local anaesthetic. A fine needle is inserted through the scrotal skin into the narrow tubes (the epididymis) on the surface of the testis. A gentle suction is applied and sufficient sperm can be obtained in 80 percent of procedures. In cases where the man is not producing enough sperm in the first place, the sperm can be obtained from tissue samples (biopsies), taken from inside the testes itself. If possible, we will obtain enough sperm for freezing as well. This may mean you will not need another sperm recovery procedure if future IVF cycles are undertaken.
Freezing and Storage of Sperm
Sperm can be frozen and stored for up to 10 years, includes sperm retrieved by surgery or biopsy. However, not all fertile men have sperm that are suitable for freezing. Many samples collected during an illness, or following an operation can be of poor quality. The freezing and thawing process may also have a damaging effect. Freezing sperm before cancer treatment optimises the chance of preserving fertility, however there is no guarantee the future use of frozen sperm will result in a pregnancy.
Donated Eggs or Sperm
For women who have no viable eggs at all, or men who have no sperm, the option of egg or sperm donation offers couples the hope of having a baby after all.
This is also an important option for women with a high-risk of passing on a serious genetic disease through their own eggs. Egg donation is also the best hope to older women with pre-menopausal ovarian failure.
Sometimes donor eggs are supplied anonymously by women wanting to share the joy of having a child, but more often the donor is known to the recipient – a friend or family member. Because of the intense hormone treatment required to collect eggs, egg donation is a serious step for anyone to consider. We recommend counselling in advance to ensure everybody understands all the implications. The process begins by synchronising the menstrual cycles of the donor and recipient. The donor then undergoes a cycle of ovarian stimulation with the aim of producing as many eggs as possible. As the donor reaches the point of ovulation, the recipient begins taking estrogen and progesterone to prepare the lining of her uterus.
The eggs are collected and fertilised with sperm from the recipient’s partner. Resulting embryos are observed and the best chosen for transfer. Any other viable embryos are frozen for later attempts. Donated sperm is used less often these days, thanks to progress in developing the ICSI technique. However, donated sperm may still be necessary when a man has a high risk of transmitting a genetic disease through his own sperm, or is producing no sperm at all.
We believe that everyone has the right to know their genetic heritage, so we recommend that sperm donors should be known to the couple. Out of care for the ensuing child, our policy is to not accept anonymous sperm donors.
Single women and lesbian couples
We believe that everyone should have the right to enjoy the gift of having children and we welcome all women, regardless of marital status or sexual orientation.
Because of our policy of not accepting anonymous sperm donors, we ask that single women and lesbian couples who come to us for treatment bring with them their own sperm donor. There are various legislative requirements which have to be met before a single woman or lesbian couple can receive IVF treatment. We can explain all the details during your first visit.
IVF (In Vitro Fertilisation)
Approximately 30% to 40% of all infertility is associated with a male factor. ICSI is a laboratory technique which can be particularly useful if there are severe semen problems or if a vasectomy is irreversible.
Much like IVF, eggs are collected and taken to the laboratory. Individual healthy sperm cells are selected and injected directly into each individual mature egg. Not all eggs fertilise, and not all fertilised eggs become good quality embryos. The best quality embryos are selected – those most likely to develop into a healthy pregnancy. Pregnancy rates are similar to those of standard IVF and vary with the age of the woman.
The IVF process starts out by encouraging the ovaries to develop more mature eggs, which are then collected surgically. The eggs are then fertilised in a laboratory and cultured for several days before one, or rarely two, embryos are transferred back into the woman’s uterus. If there are additional embryos, they may be frozen and stored for later use.
The stages in an IVF cycle
1 – Stimulating the ovaries
The ovaries are stimulated to develop a number of eggs using fertility hormone injections. Daily injections are usually given by the woman herself, or by her husband or partner, just under the skin, using a very fine needle. The injections normally need to be given for 10-15 days for the eggs to develop fully.
2 – ‘Triggering’ ovulation
During that time you will be asked to visit the clinic to be monitored by an ultrasound scan. This is mainly to check the number and size of the developing egg sacs. You may need one or more visits to the as your ovarian follicles approach the best time for stimulation and egg collection.
3 – Preventing premature ovulation
Medication in the form of a nasal spray is used to inhibit communication between the brain and the ovaries and prevent premature ovulation. This ensures the eggs aren’t lost before they can be collected. When the ovarian follicles are ready, you will be asked to have an HCG injection. This will need to be given at a particular time, late in the evening. This HCG injection will trigger the final important stages of development of your eggs and your egg collection will be arranged for two mornings, about 36 hours later.
4 – Collecting the eggs and sperm
The woman will need to be admitted for a morning. Her eggs will generally be collected under a short, light sedation. If surgical sperm recovery is required, the man will usually be admitted as well for collection of his sperm under a local anaesthetic.
5 – Culturing embryos in the laboratory
An embryologist will combine your eggs and sperm in the laboratory on the same day as your egg collection. They are then stored in an incubator where we expect them to fertilise to form embryos. You will receive a phone call after your egg collection to update you and, hopefully, to arrange your embryo transfer.
Most couples will reach the stage of having an embryo transferred. Additional embryos can be snap-frozen for later treatment in case this is required.
6 – Transferring the embryo
An embryo is transferred back to the woman’s uterus as an outpatient procedure. The embryo transfer is similar to having a cervical smear test.
After the embryo transfer, there is a two week wait before you will know whether or not your treatment has been successful. You’ll always be welcome to contact us for advice or support during this time. You will need to do a pregnancy test 14 days after your embryo transfer.
7 – Monitoring progress
If your pregnancy test is positive, we will arrange an early pregnancy scan two weeks later to ensure your pregnancy is developing normally. If a pregnancy does not occur we will spend time with you to review your treatment details and to advise on future options.
Frozen Embryo Transfer (FET)
If an IVF cycle has not been successful, there may be enough embryos produced to freeze for use at a later time.
A frozen embryo transfer has a number of advantages. It is less costly than another IVF cycle, there’s a significant chance you will not require drugs for the cycle and there is less change of a multiple pregnancy resulting.
If you have previously had embryos frozen at another clinic, it is an easy process to arrange for the frozen embryos to be transferred to our clinic.
Just For Men
The blokes would probably remember that old ad; oils ain’t oils. Well when it comes to fertility, sperm ain’t sperm. In other words, successful fertility outcomes can be very much influenced by the QUALITY of the sperm produced by the male.
That means men have such as much responsibility in ensuring good health through lifestyle choices if their partner is having difficulty in conceiving. If you are concerned about your fertility, would like a fertility check up or have been diagnosed with cancer or planning vasectomy and want to discuss sperm storage just make an appointment.It’s that easy. If you want to find my views on the natural remedies that may help, check out the link to our Cochrane review.
Contact us today,
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Suite 22, Level 4
57-59 Anzac Highway
Ashford SA 5035
Fax: (08) 8351 1091
Klemzig Village Medical Centre
280 North East Road
Klemzig SA 5087
Munno Para Family Medical
Shop 2 600 Main North Road
Smithfield SA 5114