IVF and Infertility – Causes, Risk and IVF Success

Before you can become pregnant, three basic conditions have to be fulfilled. First, you have to be ovulating (producing eggs); second, the right number of sperm from your partner have to be in the right place at the right time; and third, the female passages have to be normal enough to enable the sperm and the egg to come together.

These are the three major areas that will be explored should you seek professional help.

90% of couples conceive within twelve months of unprotected sex. If you are concerned that you have not yet conceived, then you should see your doctor. Couples having trouble trying to conceive may increase their chance of pregnancy through assisted fertility techniques.

Causes Of Infertility

Causes of infertility in women can include endometriosis, idiopathic (unknown cause) infertility, pelvic inflammatory disease, sexually transmitted diseases such as Chlamydia, hormonal imbalance, problems with ovulation, tubal dysfunction and hostile cervical mucus, just to name a few.

Male infertility is an area which has only been researched over the past few years. Exact causes of male infertility are still not known, however, some causes which have been identified include exposure to heavy metals, extreme heat, excessive alcohol and tobacco, childhood diseases such as mumps, infections, congenital deformities, hormonal imbalance, varicoceles and failed reversal of vasectomy.

Reasons For Decline In Fertility

There is an increased incidence of gynaecological problems as women age. Endometriosis, fibroids, and pelvic infections all may reduce fertility; however the ageing of the eggs is thought to be the major cause of reduced fertility. Girls are born with about 400,000 eggs in their ovaries. The eggs are matured and ovulated during each menstrual cycle. For every egg that is released many more degenerate and are re-absorbed into the body. Eventually the ovary does not respond to the hormones that mature and release eggs and the woman experiences menopause. Because the eggs are present in the ovaries from birth, they age as the woman grows older, reducing their quality.

This is in contrast to male reproduction where sperm are constantly manufactured and replaced. The ageing of the eggs reduces their ability to be fertilised and to divide properly, leading to chromosomal abnormalities and a higher risk of miscarriage. Older women who receive eggs from a younger donor have a much higher chance of conceiving, confirming that the age of the eggs is crucial in achieving a pregnancy.

In IVF, age has a number of effects on the success of the treatment. The number of eggs collected is lower in older women and the quality of the embryos also generally decreases. Higher doses of hormones are usually required in older women and there is also a higher risk of not having an egg collection due to poor or no response to the stimulating drugs. Unfortunately there is no way to reverse these effects of age on fertility.

Although age is not an absolute barrier to pregnancy, such factors as regular menstrual cycles, unexplained infertility or having had children before do not necessarily indicate that pregnancy is possible in the late 30s and 40s.

IVF Success Rates

It is most important that you are aware of the success rates of the treatment you are about to undertake. The following tables indicate the outcome of IVF treatment at Monash IVF for women in different age groups. Numbers in some age groups are small and this may affect the interpretation of the results. Your clinician is available to discuss these results with you and the option of ante-natal testing to detect chromosomal abnormalities if you do become pregnant.

For some women donor egg treatment may be the best chance to achieve a pregnancy. Information about the Donor Egg Program at Monash IVF is available from your nurse, counsellor or clinician.

Increasing Your Chance of Success (Added In By BellyBelly)

Two recent studies have shown that acupuncture increases IVF success rates. The members in our forums have been discussing the studies HERE and also sharing their success stories. There are acupuncturists who specialise in IVF support and fertility so make sure you choose an appropriate, experienced practitioner.

IVF – The Procedure

Women entering a treatment cycle have daily blood tests to determine the maturity of the eggs which are developed in the ovaries. The reason why more than one egg is produced is that women on the IVF programme are given hormones to stimulate the ovaries.

When the blood tests indicate that the woman’s eggs have reach a certain degree of maturity she will have an ultrasound to find out exactly how many follicles (blisters on the ovary containing the egg) are developing. The ultrasound will also show how soon the follicles may be maturing, that is, about to release the egg. This ultrasound combined with twice daily blood tests, which monitor hormone levels, enable precise timing for egg pick-up to occur.

At this stage, the woman is taken to the operating theatre where she is given sedation prior to an ultrasound egg pick-up. The ultrasound is inserted in the vagina and a very fine needle is threaded through a guide which is attached to a probe. The ultrasound via a monitor shows exactly where the follicles are located. The fine needle then pierces the follicle and the follicular fluid, which contains the egg, is extracted.

This fluid is immediately taken to a laboratory adjacent to the operating theatre. As soon as the scientist examining the fluid finds an egg he informs the doctor who will then move onto the next follicle and repeat the procedure.

This process continues until each follicle has been punctured and the fluid removed. Because hormones are administered to stimulate the ovaries, several eggs can be expected to mature. The chances of collecting at least one egg are therefore increased.

Precision timing is vital. If the ultrasound egg pick-up is performed too early, the eggs will not mature and fertilisation is unlikely to occur. If it is too late the eggs will have passed into the abdominal cavity from which retrieval is almost impossible.

Each egg is washed in a special fluid where is may remain for several hours to mature further. A couple of hours after the egg collection, the husband provides a sample of semen. Great care must be taken to keep the egg and sperm at body temperature so they are placed in separate tubes in an incubator.

When it is decided that the eggs have reached the appropriate stage of maturity a droplet of semen containing 50,000 sperm is added to each test tube and these are returned to the incubator. If an egg is fertilised by a sperm, a zygote or pre-embryo will begin to develop. The pre-embryo remains in the incubator for one or two days until it has divided into two or four cells.

At this stage, the pre-embryo is transferred into the woman’s uterus, using a fine tube called a catheter, which is passed via the vagina. This procedure, known as “embryo transfer” (ET), is quite painless and requires no anaesthetic.

Following embryo transfer, the woman lies still for about one hour before returning home to continue her normal daily routine. It is two weeks before blood tests indicate whether the embryo has successfully implanted, in which case the woman is pregnant.

IVF and Legislation

Legislation does vary from state to state.

In 1981, the Victorian Government established a committee to consider the social, ethical and legal issues arising from in vitro fertilisation. The Chairman of the committee was Professor Louis Waller, the Victorian Law Reform Commissioner. The Waller Committee produced three reports: an Interim Report, a Report on Donor Gametes in IVF and a Report on the Disposition of Embryos produced by In Vitro Fertilisation.

In November 1984, the Victorian Parliament passed legislation to regulate the use of IVF. It was the first legislation of its kind in the world.

In Victoria, Monash University and Epworth Hospital both have Ethics Committees that consist of people from a variety of backgrounds.

In Queensland, Ethics Committees attached to their clinics have also been established.

All research requests must first be approved by these Ethics Committees, the National Health and Medical Research Council and the State Government.

Other groups, such as the Monash University Centre for Human Bioethics, the St. Vincent’s Hospital Bioethics Centre, the Anglican Church’s Social Responsibilities Commission and the Right to Life Association, continue to consider the social and moral implications of IVF.

Doctors and scientists involved in the treatment of infertility welcome community debate about their work.

Possible Risks With IVF

Birth Defects

It is important to remember that any medical or surgical treatment has risks, adverse effects and side effects. Couples should be aware that one baby in 20 born in Victoria will have a birth defect. There is no clear evidence that infertility medicines, if properly used, increase this risk.

Cancer

In addition, cancers tragically occur not only in mothers, but also in babies. For example, every year breast cancer is newly diagnosed in approximately 150 Victorian women, 40 years or younger. There is also no evidence that infertility medicines increase this risk.

The aim of this section is to briefly review some of these matters.

Anyone taking medication for any reason should be aware of the possible side effects and should report adverse effects to those managing their treatment. The drugs used for IVF and GIFT are known to create some minor side effects in the women, but there is no evidence of increased risk to a baby born as a result of a properly managed treatment. The operations and anaesthetics used in IVF and GIFT carry similar risks as for gynaecological operations. For gynaecological operations, the usual risks of serious complication or death are approximately 1 in 5,000 operations.

We emphasise again that this information is aimed at providing realistic and accurate advice for you at this stage of your reproductive life.

FSH (Puregon or Gonal F)

These drugs are used to encourage development of a group of large follicles in the ovaries. Because the ovaries are swollen with follicles, some tenderness and swelling of the abdomen may be experienced. The increase in the hormone oestrogen as a result of multiple follicle growth can cause breast tenderness. Other common symptoms include slight nausea, dizziness and slight abdominal swelling or bloated sensation as with pre-menstrual syndrome.

Ovarian Hyperstimulation Syndrome (OHSS)

Occasionally too many follicles develop and a condition called Ovarian Hyperstimulation Syndrome (OHSS) may occur. This is an unpleasant experience which varies in severity and rarely (1 in 100 patients) may result in hospitalisation for treatment of the symptoms. These may include marked abdominal swelling, nausea, vomiting and diarrhoea, lower abdominal pain, and shortness of breath. Please contact us if you have these symptoms. The treatment is directed at easing the symptoms with bed rest, medication for nausea and pain, and correction of the imbalance of body fluids caused by the condition.

There have been individual case reports of blood clotting and stroke as complications of severe OHSS and four deaths have been reported in the world medical literature. No deaths have occurred in Australia.

The condition is often marked by weight gain, as excess fluid is retained. It is important to note your weight at the beginning of the IVF cycle.

Hyperstimulation varies in severity and rarely requires treatment in hospital, but you must contact the Clinic if you notice any of the above symptoms so that we can monitor you closely.

Synarel

Synarel has been approved by the Commonwealth Health Department in Australia for use in patients undergoing IVF and related procedures. It is given as an intranasal spray.

It causes an initial rise and an eventual suppression of hormones from the pituitary gland in the brain. When the ovary does not receive messages from the pituitary gland, it is in a reversible menopausal state. Like menopausal women, you may experience hot flushes. This is temporary and will not occur once the normal hormone balance is restored at the completion of treatment.

Seeking Treatment

Monash IVF have clinics located in Melbourne and regional Victoria, Northern New South Wales, Brisbane and the Gold Coast. The Monash IVF Overseas Program offers a range of treatment options for those who reside outside of Australia. Before you begin treatment with Monash IVF, there are a number of important steps to take:

  • Ask your doctor for a recent, specific referral for both you and your partner to an IVF clinician
  • Complete a registration form and pay a registration fee which includes automatic membership of IVF Friends.
  • Complete all the necessary preliminary tests organised by your IVF doctor.
  • Complete a pre IVF counselling session with one of their registered psychologists.

Once test results are available, your IVF Clinician will fill out your Treatment Activation Sheet and forward it to the clinic.
When these steps are completed your treatment can then commence.

Waiting time?

Treatment will normally commence after all the preliminary investigations are completed. We endeavour to provide treatment in the month of your choice. However, in order to treat every couple with the attention they deserve, we can accept only a certain number of people each month. It would be unusual to be denied treatment in the second month of your choice.

Overseas Patients

Below are the steps you will need to take in order to pursue treatment. They are designed to work in cooperation with your local doctor/clinic so that your time spent in Australia can be kept to a minimum.

Prerequisites

Listed below are the investigations that are required to have been done within the last 12 months. Please ensure Monash IVF receive copies of these tests prior to commencing your injections to avoid any delay with your treatment.

Preliminary routine investigations

Some of the preliminary tests may be done in your own country. If it is possible to have them done locally, it can save the amount of time spent in Australia prior to starting. If copies of the test results are unavailable to you, we will be able to repeat the investigations on your arrival in Australia. Please note HIV, Hepatitis B and C will be repeated regardless on arrival.

Blood Tests and Semen Analysis required:

  • Rubella
  • Oestrogen, Progesterone, Prolactin and Follicle Stimulating Hormone
  • HIV
  • Hepatitis B and C
  • One semen analysis

Telephone consultation

You will then be contacted within 7 days in order to arrange a telephone consultation with one of their Monash IVF clinicians. After reviewing your case on the telephone, you will be sent a consultation report which will outline a recommended treatment plan along with additional recommended tests. The report will include a registration form which should be forwarded to the clinic marked “Attention Overseas Patient Coordinator”. Once you have received the material, you may wish to have another phone consultation with your clinician or go ahead with booking a treatment cycle. Both of these options can be arranged by the Overseas Patient Coordinator.

Arrival in Melbourne

The use of the oral contraceptive pill allows us to predict in most cases exactly when you will be required in Australia. You will find an example of a routine treatment cycle below. Please note this is an example only and every patient’s treatment does vary. The following medications will be used in your cycle and you will need to let the Coordinator know if you can access them:

  • A combined monophasic oral contraceptive pill
  • Synarel Nasal Spray OR Lucrin
  • Follicle Stimulating Hormone Injections (FSH).

Your arrival in Australia will depend on access to the medications and how much of the monitoring can be done in your own country.

Once in Australia, you will meet with your clinician and nurse and continue treatment. At this point a mandatory counselling session will also be scheduled. Egg collection will be done following approximately 10-14 days of Follicle Stimulating Hormone Injections (FSH) depending on your response to the medication. You will be able to return home the day after the embryo transfer.

Example of Pill Down Regulation Treatment Cycle

Day 1 – Phone clinic to report day one
Day 3 – Start contraceptive pill
Day 17 – Start Synarel or Lucrin
Day 20 – Last pill continue Synarel or Lucrin
Day 28 – Blood test for oestrogen level. This test may be done locally and faxed to your Coordinator. You will need to contact her for your Metrodin start date.

Patient Management System

Their Monash IVF clinics have a unique system of care where each couple is linked to a particular nurse who is the primary contact throughout the IVF program. Your nurse gives you support and encouragement, answers questions, provides test results, makes appointments and liaises with your doctor. By ensuring you deal with a familiar face and voice at all stages of your treatment we hope to make IVF less stressful for you.

All Monash IVF staff are available to support couples throughout the Monash IVF program. Administration, nurses, clinicians, counsellors, scientists and support staff – we are there to encourage and support you each step of the way. We encourage everyone on their program to continue with their normal life, as this is the best way to deal with the extra stresses. You will only need to be away from work for a short time each treatment cycle; rarely more than a couple of days for women and a couple of hours for men.

Some women may feel tired, bloated, nauseous and moody as result of the hormone treatment and may need to get more rest then usual.

As well, most couples experience a “roller coaster ride” of emotions, particularly when a treatment cycle is not successful. This, and other factors, can place great strains on your relationship, so it is very important that you and your partner receive understanding and support throughout the program.

To help you deal with the stresses of trying to achieve a pregnancy, we offer a range of support services. Individual and couple counselling is available to help you overcome any difficulties you may be experiencing with your treatment, feelings or relationships.

Group counselling is also provided and gives couples an opportunity to share experiences and concerns with others. Counselling sessions are run by specialised psychologists and are free to all those on their program. Active support groups hold regular meetings, produce newsletters and organise fundraising activities.

 
Last Updated: April 18, 2015

CONTRIBUTOR

BellyBelly.com.au


One comment

  1. My experience with Monash IVF via Dr Lolagtis was not as encouraging as you describe in your web post. He encouraged me to use donor eggs and referred me to his colleaque in Greece, Dr Pantos. He provided no prior counseling when I asked for it and yelled I wasn’t pregnant over the phone and simply hung up rather than tell me an appointment in his office, There was no follow up or suggestions for other options. This was 4y ago and I have since been in contact with a clinic in the US but it may be too late for me now. If Dr Lolagtis and his colleague Dr Pantos were more professional and less insensitive and flippant about my journey I may have a child now or if not feel that I had done my best and get on with my life. It was okay to take my money but not okay to care about me as a patient. I wouldn’t recommend him to anyone.

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