This article discusses in vitro fertilization (IVF) and infertility, covering the causes, risks and success factors. Before you can become pregnant, three primary 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; third, the female passages have to be normal enough to enable the sperm and the egg to come together.
If you seek professional help, these are the three major areas that will be explored. If there is a problem with any of these, there’s no need to worry; natural fertility programs and assisted reproductive technology will most likely be available to help you achieve a successful pregnancy.
90% of couples conceive within twelve months of having unprotected sex. If you are concerned that you have not yet conceived, you should see your doctor. Couples who have trouble conceiving might increase their chance of pregnancy through assisted fertility techniques, such as natural fertility programs, intrauterine insemination, and IVF treatments.
Causes of infertility
Some of the causes of infertility in women are: 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.
Male factor infertility is an area that has only been researched during the past few years. The exact causes of male infertility are still not known; however, some causes that have been identified are: 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 gynecological problems as women age. Endometriosis, fibroids and pelvic infections can reduce fertility; however, the aging of the eggs is thought to be the major physical cause of female infertility. Girls are born with about 400,000 eggs in their ovaries.
The eggs mature and one mature egg is released (ovulation) during each menstrual cycle. For every egg that is released many more mature eggs degenerate and are re-absorbed into the body.
Eventually, the ovary no longer responds 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, which reduces their quality.
By contrast, in male reproduction, sperm are constantly manufactured and replaced. The aging of the eggs, however, reduces their ability to be fertilized and to divide properly, leading to possible chromosomal abnormalities, birth defects and a higher risk of miscarriage. Older women who receive eggs from a younger egg donor have a much higher chance of conceiving; this confirms that the age of the eggs is crucial in achieving a pregnancy.
With regard to IVF, age has a number of effects on the success of the treatment. In older women, the rate of quality egg retrieval is lower, higher doses of hormones are usually required and there is a higher risk of not collecting an egg, due to poor or no response to the fertility medications during the IVF process.
Unfortunately, there is no way to reverse these effects of age on fertility. However, there are alternatives. Some women freeze their eggs, in their youth and, later in life, if they suffer from infertility and need fertility treatments, they can have their own frozen embryo transfer.
Using donor eggs is a good option to treat infertility.
Although age is not an absolute barrier to pregnancy, factors such 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. Statistics indicate the outcome of IVF treatment at Monash fertility clinic for women in different age groups.
Numbers in some age groups are small and this might affect the interpretation of the results. Your clinician is available to discuss these results with you and explain the option of ante-natal testing to detect chromosomal abnormalities if you become pregnant.
For some women, whose own eggs are not an option, donor eggs treatment could be the best chance of achieving a pregnancy. Information about the Donor Egg Program at Monash IVF is available from your nurse, counsellor or clinician.
In vitro fertilization happens outside the woman’s body. Once the egg is fertilized in the lab via intracytoplasmic sperm injection, the fertilized egg becomes an embryo.
The embryo transfer takes place at the most favorable time (induced by fertility medications) and, in a successful transfer, the embryo implants in the uterine wall.
Increasing your chance of success (with acupuncture)
Two recent studies have shown that acupuncture increases IVF success rates. The members in our forums have discussed the studies in the article Acupuncture Can Double The Chances Of IVF Success, Finds Study, and have shared their success stories. Some acupuncturists specialize in IVF support and fertility, so make sure you choose an appropriate, experienced practitioner.
Acupuncture can help with egg retrieval, embryo implants and also prior to your partner’s sperm collection.
In vitro fertilization – the procedure
Women entering a treatment cycle have daily blood tests to determine the maturity of the eggs that have developed in the ovaries. The reason why more than one egg is produced is ovulation induction, where women on IVF cycles 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 might mature – that is, be ready to release the egg. The ultrasound, combined with twice daily blood tests to monitor hormone levels, enables precise timing for egg retrieval 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 into the vagina and a very fine needle is threaded through a guide that is attached to a probe. Via a monitor, the ultrasound 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 fluid is examined and an egg is found, the scientist informs the doctor, who will then move on to 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 the in vitro fertilization 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 retrieved egg is washed in a special fluid where it might remain for several hours to mature further. A couple of hours after the egg collection, the man 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 fertilized 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 through the vagina. This procedure, known as ’embryo transfer’ (ET), is quite painless and requires no aesthetic.
Following embryo transfer, the woman lies still for about one hour before returning home to continue her normal daily routine. She must wait two weeks before blood tests indicate whether or not the embryo has successfully implanted, in which case the woman is pregnant.
IVF and legislation
Legislation varies from country to country. In Australia, it varies from state to state.
In 1981, the Victorian Government established a committee to consider the social, ethical and legal issues arising from in vitro fertilization. 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 Fertilization’.
In November 1984, the Victorian Parliament passed legislation to regulate the use of IVF and infertility. It was the first legislation of its kind in the world.
In Victoria, Monash University and Epworth Hospital 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 1 baby in 20 born in Victoria will have a birth defect. There is no clear evidence that infertility treatment, if properly used, increases this risk.
Cancer
Tragically, cancers occur in mothers and 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 review some of these matters briefly.
Anyone taking medication for any reason should be aware of the possible side effects and should report adverse effects to their reproductive medicine team. The drugs used for IVF and GIFT (Gamete IntraFallopian Transfer) are known to create some minor side effects in 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 risk of serious complication or death is approximately 1 in 5,000 operations.
We emphasize 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 are drugs used to encourage the development of a group of large follicles in the ovaries. Because the ovaries are swollen with follicles, some tenderness and swelling of the abdomen might be experienced.
The increase in the hormone estrogen, as a result of multiple follicle growth, can cause breast tenderness. Other common symptoms include slight nausea, dizziness and slight abdominal swelling or a bloated sensation, as with pre-menstrual syndrome.
Read more about this in Gonal F – Side Effects, Success Rates And More.
Ovarian hyperstimulation syndrome (OHSS)
Occasionally, too many follicles develop and a condition called Ovarian Hyperstimulation Syndrome (OHSS) might occur. This is an unpleasant experience that varies in severity. Rarely (1 in 100 patients) it results in hospitalization for treatment of the symptoms, which include marked abdominal swelling, nausea, vomiting and diarrhea, lower abdominal pain and shortness of breath.
Please contact your doctor 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 the hospital, but you must contact your doctor if you notice any of the above symptoms so that you can be monitored 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 might 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 has 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 in IVF Friends
- Complete all the necessary preliminary tests organized 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. Monash endeavours to provide treatment in the month of your choice.
However, in order to treat every couple with the attention they deserve, Monash 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 receives copies of these tests prior to commencing your injections to avoid any delay with your treatment.
Preliminary routine investigations
Some of the preliminary tests can 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, Monash 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
- Estrogen, 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 the 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 might 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 makes it possible 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 your fertility program 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 counseling 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: The last pill; continue Synarel or Lucrin
Day 28: Blood test for estrogen level. This test may be done locally and faxed to your Coordinator. You will need to contact the Coordinator for your Metrodin start date.
Patient management system
The 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 will give you support and encouragement, answer questions, provide test result, makes appointments and liaise with your doctor. By ensuring you deal with a familiar face and voice at all stages of your treatment, Monash hopes 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 are there to encourage and support you each step of the way. Everyone in Monash’s program is encouraged to continue with 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 in each treatment cycle – rarely more than a couple of days for women and a couple of hours for men.
Some women might feel tired, bloated, nauseous and moody, as a result of the hormone treatment, and might need more rest than usual.
Most couples also 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, Monash fertility clinic offers a range of support services. Individual and couple counselling is available to help you overcome any difficulties you might 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 specialized psychologists and are free to all those in the program. Active support groups hold regular meetings, produce newsletters and organize fundraising activities.
Natural fertility program
For those who don’t have any physical problems conceiving, a natural fertility program could be all they need to boost their fertility and become pregnant successfully, without medication.
We suggest you this natural fertility program ; Natural Fertility.
Read more about IVF in BellyBelly’s articles:
10 Ways To Support A Friend Going Through IVF
