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Treatment with us

Treatment types

Here at Fertility Associates we offer a range of options for fertility treatment. From lower technology treatment such as Ovulation Induction (OI) through to high technology treatments like In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI).

In Vitro Fertilisation (IVF)

In Vitro Fertilisation (IVF) is useful for people with infertility issues such as poor quality sperm, endometriosis, antibodies to sperm or ‘unexplained’ infertility. There are several other treatments that are often used in conjunction with IVF when needed.

We have likened IVF treatment to the tropical house in the garden because IVF depends on well-controlled conditions to give eggs and sperm the highest chance of getting together to cause a pregnancy. Almost every cause of infertility can be successfully treated with IVF – male infertility, tubal damage, endometriosis, ovulation problems and unexplained infertility. IVF starts with medications to increase the number of eggs, then moves to adding the sperm to the eggs in the lab.

The embryologist selects the best embryo for transfer into the uterus, and any other good quality embryos can be frozen for another chance of pregnancy. Because IVF typically makes 6-10 eggs available, younger women have a 40-50% chance of having a baby from a single treatment. This is double the chance of pregnancy which couples with normal fertility have per month.

While most people think about IVF one cycle at a time, the overall chance of having a child depends on the number of cycles you are prepared to do.

 

IVF with ICSI

ICSI is a variation of IVF. Instead of the sperm and eggs being mixed in a test tube, a single sperm is injected into each mature egg. ICSI is used when sperm quality is too poor for conventional IVF to work. ICSI allows almost any man with sperm, either in his semen or in his testis, to try IVF.
 

Thawed Embryo Replacement (TER)

When there have been embryos frozen following in vitro fertilisation, they can be thawed and transferred into the uterus at a later stage. This usually entails several bloods tests to time ovulation during a natural cycle. In some cases it is necessary to control a cycle using drugs to prepare the uterus for implantation. Embryos are transferred into the uterus at the appropriate time, as they are in an IVF cycle.

Single Embryo Transfer (SET)

From the early days of IVF people have tried to increase the chance of pregnancy in IVF by transferring more than one embryo. But transferring more than one embryo also raises the possibility of multiple pregnancies. As IVF methods improved, clinics stopped transferring three embryos in younger women to limit the chance of triplets. Now that the chance of each embryo implanting in the uterus has improved even further (see the diagram), Fertility Associates is encouraging Single Embryo Transfer (SET) in younger women. SET is also a trend in Australia and northern Europe.

The implantation rate (chance of implanting in the uterus per embryo transferred) for women up to the age of 37 having IVF at Fertility Associates’ clinics

What is so bad about twins? Having a twin pregnancy triples most risks associated with pregnancy – such as stillbirth, a serious brain haemorrhage, serious infection, respiratory distress and cerebral palsy. Overall about 20% of twin pregnancies have some problem compared to 6% of singleton pregnancies. Until recently, the problems associated with twins were considered a reasonable compromise for the increased chance becoming pregnant when two embryos were transferred.

The following table summarises a vast amount of information from medical and scientific studies about twins. The actual numbers can vary somewhat from study to study, but the table gives an average picture.

In the table, the figures for stillbirth and death soon after birth come from the register of Australian-New Zealand IVF pregnancies, but most of the other information is about twins in general.

 

Risk Singleton Pregnancy Twin Pregnancy Risk for Twins
To the mother
Hospitalisation for ovarian hyper-stimulation syndrome (OHSS) in an IVF pregnancy 4.6% of pregnancies 9% of pregnancies 2 times higher
Mother dying in childbirth 5 per 100,000 births 15 per 100,000 births 3 times higher
To the children
Stillbirth or death soon after birth (neonatal and perinatal death) 2.8% of children 6.3% of children 2.5 times higher
Baby admitted to neonatal intensive care unit (NICU) after birth 15% of children 48% of children 3 times higher
A serious brain haemorrhage around birth     5 times higher
Serious infection     3 times higher
Respiratory distress     6 times higher
Cerebral palsy 0.23% of children 1.3% of children 5 times higher
Some handicap 2.5% of deliveries 7.4% of deliveries 3 times higher
Overall
Estimate of any problem (death, abnormality, or some handicap) 6% of deliveries 20% of deliveries 3 times higher


 

Having twins also carries considerable costs for public hospital care, with the average hospital cost of birth and neonatal care in New Zealand being approximately six times higher for twins than a singleton birth.

Of course the large majority of twins are fine and many of the problems around birth are temporary or, if ongoing, not too severe. Nevertheless, a twin pregnancy carries significant extra risks that can be eliminated by SET.

When we reviewed Fertility Associates’ results for the years 2000-2002, we found that 47% of women aged 25 to 35 had a delivery after the transfer of two good quality embryos, with over a third of the deliveries being twins. An alternative would be to transfer only one embryo (SET) and to freeze the ‘second’ good quality embryo, instead of transferring it fresh. If this was done, we calculated that the overall chance of delivery in this group of patients from the same two embryos would have been a very respectable 40%, but only 2% of deliveries would have been twins (due to identical twins).

Fertility Associates now very strongly recommends SET for women 35 and younger having their first or second IVF cycle, who have at least one good quality embryo on the third day after egg collection and this is a requirement for publicly funded treatment. We are pleased to report that the preliminary pregnancy rates from people choosing SET in 2004 is as high as we expected.

Surgical Sperm Retrieval

These are jargon for various techniques to obtain sperm from the epididymis or testis from men who have no sperm in their ejaculate (azoospermia). If the cause of the azoospermia is an obstruction then the sperm retrieval procedure is usually simple and can be done under local anaesthetic with sperm being frozen for future use. If the cause is “non-obstructive” then the procedure will be more complex and best results are achieved with microsurgical techniques.

The testis and epididymis, and ways of retrieving sperm

Ovulation Induction (OI)

Ovulation induction (OI) is drug treatment to induce ovulation in women with irregular or absent cycles. It can involve taking pills or giving subcutaneous injections of drugs (the way diabetics receive insulin). It nearly always involves blood tests and ultrasound scans to monitor progress, both to time intercourse and to reduce the chance of multiple pregnancy. Usually the couple has intercourse when ovulation is predicted or triggered by the ovulatory hormone (LH) injection, but artificial insemination using partner's sperm can be used, especially if the drugs affect the ability of sperm to make their way through the woman's cervix. The major risk for this treatment is multiple pregnancy.

Intrauterine Insemination (IUI)

A simple treatment used in cases where there is deficient cervical mucus, mild male-factor infertility or mild endometriosis or unexplained infertility. Cycles are tracked using blood tests and sometimes ultrasound scans. At the time of ovulation a prepared sample of sperm is placed into the uterus using a fine catheter. Sometimes modest amounts of drugs are given to increase the number of eggs maturing, ideally two or three.

We will look after you everystep of the way

Fertility Associates is committed to ensuring each patient receives the care and attention they deserve while going through fertility treatment.

Our Pathways magazine takes you through all the aspects to treatment and how your needs are taken care of throughout the pathway to a child.

Pathways to a Child Magazine

Click below to read through our magazine which covers all aspects of treatment with us and what to expect at each stage of  treatment