If not IVF, then what? Fertility treatments explained

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In vitro fertilisation (IVF) is the most widely known fertility treatment, but it is not the only option available to help couples with fertility issues. This is due to the fact that there are many different reasons why an individual or couple may be experiencing fertility problems and treatment should be tailored accordingly. Thus, fertility treatment actually encompasses quite a wide range of methods, each of which can help people to overcome specific challenges and ultimately, conceive. We explain the different options below, including when they might be suitable.

First-line treatments

Ovulation induction

Ovulation induction may be recommended for women who are not ovulating regularly or who are not ovulating at all, and is commonly used for those suffering from polycystic ovarian syndrome (PCOS).

As its name suggests, ovulation induction involves the woman taking medication to increase the level of follicle-stimulating hormone (FSH) that causes ovulation. These medications may be in the form of tablets (clomiphene or letrozole) or direct injections of FSH. This stimulates the growth of ovarian follicles (fluid-filled sacs containing an egg). Once the follicles are large enough, another hormone is then given to release the egg from the follicle. Couples are advised to have intercourse at this time to increase their chances of conceiving.

Intrauterine insemination (IUI)

Intrauterine insemination (also known as artificial insemination) may be considered when a couple has difficulty having intercourse. It may also be appropriate for women with scarring or defects of the cervix that prevent sperm penetration, and for men with mild reductions in either sperm count or sperm motility (i.e. sperm that don’t move properly) where concentrating the semen sample and placing it in the uterus is likely to be of benefit. IUI may be used in combination with medications that stimulate ovulation – this combination can increase the chance of pregnancy in some cases.

During a treatment cycle, patients are monitored closely with blood tests and ultrasounds. At the time of ovulation, sperm are placed directly through the woman’s cervix and into her uterus (womb) using a long, thin plastic tube that is similar to a straw (hence, the name artificial insemination).

Laboratory treatments

In vitro fertilisation (IVF)

IVF is a form of assisted reproductive technology (ART) in which eggs are retrieved from the body of a woman and combined with sperm outside the body to achieve fertilisation. If this is successful and the fertilised egg continues to develop into an embryo, it is transferred back into the uterus (womb) in the hope that it will implant and grow, thereby achieving a pregnancy.

Intracytoplasmic sperm injection (ICSI)

ICSI is a technique where a single sperm is directly injected into an egg to achieve fertilisation. This technique may be recommended when the male partner in a couple has been diagnosed with fertility issues such as low sperm count, abnormal sperm morphology (shape) or motility (movement), has had a previous vasectomy or an unsuccessful vasectomy reversal. The ‘best’ sperm – based on size, shape and movement – is selected for the ICSI procedure.

Sperm retrieval procedures

Some men have no sperm in their semen (a condition known as azoospermia) due to a sperm production problem or a blockage that prevents the sperm from getting into the semen. These men may need to have sperm taken directly from the testis or the epididymis (a coiled tube that stores sperm and transports it from the testis).

  • Testicular sperm aspiration (TESA) is done by inserting a needle into the testis and taking a small amount of material from the seminiferous tubules – a network of tiny tubes where sperm is produced. The procedure is done using local anaesthesia in an operating theatre.
  • Percutaneous epididymal sperm aspiration (PESA) can be an option for men who have obstructive azoospermia from a previous vasectomy or infection. Under local anaesthesia, a small needle is inserted into the epididymis to extract sperm. PESA is also usually performed in an operating theatre.
  • Microdissection TESE (microTESE) may be used for men who have a sperm production problem. This procedure is done under general anaesthetic. The testis is first opened with a small incision, then an operating microscope is used to identify the seminiferous tubules most likely to contain sperm and take tissue samples from them.

Pre-implantation genetic testing (PGT)

PGT is a way to reduce the risk of an individual or a couple passing on a specific genetic or chromosomal abnormality to their child. It may also be used to check for genetic problems in older women (e.g. over the age of 38 years), women who have experienced several miscarriages, or cases of repeated IVF failure.

In PGT, embryos are produced through the usual IVF process and then cells taken from the embryo are tested for genetic conditions. If the embryo is unaffected, it is then transferred to the woman’s uterus.

Egg or sperm freezing

There are two main reasons for freezing eggs. Some women need to freeze their eggs for medical reasons such as impaired ovarian function or impending chemotherapy or radiotherapy for cancer. Other women choose to freeze their eggs because they want to give themselves the option to have children in later years.

A man may be advised to freeze his sperm if he is about to undergo treatment for cancer, or if he has decided to have a vasectomy but may potentially want to have children later on. Men also can freeze sperm prior to either IUI or IVF if they cannot be present on the day scheduled for the respective ART procedure.

Donor treatments

Donor insemination

Donor insemination may be used as part of IVF for a single woman or for women in a same-sex relationship. The process is the same as artificial insemination, but the sperm used is from a donor rather than a male partner.

Donor insemination may be considered when the male partner does not produce sperm (or the sperm is abnormal) or when there is a high risk of the man passing on an illness or abnormality to a child.

Donor eggs

Donor eggs may be an option when a woman is unable to produce eggs or her eggs are of a low quality. This may be due to age or premature ovarian failure (a condition in which a woman stops producing eggs earlier than usual).

Donor eggs may also be appropriate in cases of recurrent miscarriage or if there is a high risk of the woman passing on an illness or abnormality.

Donor embryos

In some cases, some people choose to donate frozen embryos they no longer need. Treatment using these donated embryos may be suitable for a person or a couple who need both donor sperm and donor eggs.

What is the best option for you?

If you would like advice about the next steps to take on your fertility journey, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933 or by booking online via our appointments page. We’ll complete a comprehensive assessment before explaining the options available to you and your partner.

“So, when are you having a baby?”

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If you’re finding yourself in this situation more and more, it can be helpful to think ahead about how you and your partner (if you have one) might respond. By considering what information you are willing to share with others and who you are happy to share this information with, you’re less likely to feel at sixes and sevens when people raise this topic with you.

And if you do find yourself put on the spot, humour can be a great form of defence. Along these lines, we did some asking around and here are some serious and not-so-serious responses our patients reported giving when they had been confronted with this question in the past:

  • “I don’t know, but I’m starting on my list of free babysitters now. Can I put your name down?”
  • “As soon as I figure out how. Have you got any suggestions?”
  • “I knew there was something I’d forgotten to do!”
  • “I have a cat/dog – that’s enough responsibility for now.”
  • “I don’t know but wouldn’t it be nice if it was sooner rather than later!”
  • “Oh, we’re trying. Every day and twice on Sundays, since you ask.”
  • “We’re focusing on our careers for the next little while, then we’ll think about kids.”
  • “We’d love to have a baby but for whatever reason, it’s not happening for us yet. In the meantime, I’d prefer if you didn’t keep asking me about it. But we’ll be sure to shout it from the rooftops as soon as we are.”
  • “I’m sorry but that’s quite a sensitive issue for me/us. I’d rather not talk about it if that’s okay.”

We also asked these patients what they had found most helpful in terms of dealing with the emotions that these kinds of conversations can trigger. Here are some of their suggestions:

Allow yourself 15 minutes to dwell, then let it go

A common strategy for dealing with any stressful event is to put a time limit on how long you allow yourself to dwell or perseverate on what has happened. So, if you find yourself in this situation, set the timer on your phone for 5, 10 or 15 minutes – whatever you think is reasonable. But when the alarm goes off, do a Taylor Swift and commit to ‘shake it off’. If it helps, give your brain a physical cue to move on and think about something else: push the thoughts away with your hands, vigorously shake your head free of its thoughts, brush the load off your shoulders, dance off the negative vibes around the kitchen bench – then get on with your day.

Use the art of distraction

Distraction is a wonderful way to quickly shift negative or unpleasant thoughts. Immerse yourself in a jigsaw puzzle, watch a movie, try a new recipe, read a book – the task can be joyful or meditative or intensely difficult. It just needs to take you out of the present and transport you to a different place for a little while. This will give you some time out from your thoughts and help you to focus your mind elsewhere.

Find an outlet

Physically, emotions can leave us feeling uptight and strung out. Exercising is a great way to release some of the physical tension and reboot your energy. It also has the additional benefit of stimulating the release of feel-good endorphins, helping to lift your mood in a healthy way.

Or you may prefer to seek comfort in a creative outlet instead. If you like writing, keeping a journal can be a great way to process your feelings and document the ups and downs of your fertility journey. You could also use a journal to keep a list of questions you want to ask your doctor – questions that come to mind in the heat of the moment but you then forget when your thoughts and feelings settle down.

Consider opening up

And last but not least, it can be helpful to remember that people who ask you about having a baby are likely to be well-meaning family or friends who have no intention of hurting your feelings. If you are comfortable doing so, you can use this opportunity to open up and talk to them about your experiences – whether it’s the pressure of trying to fall pregnant, the challenge of dealing with a miscarriage or the loneliness of going through the process by yourself. Talking about your journey and its emotional toll can give people a better understanding of what you are going through. As the old adage goes: a problem shared is a problem halved. Being asked this question might just be the best form of therapy.

Help to fall pregnant

If you are struggling to conceive and would like professional advice on the next best steps to take on your fertility journey, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933. You can also book online via our appointments page.

You may also find the following information useful:

Comparing the merits of fresh versus frozen embryo transfer: is fresh really best?

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Once here, it must ‘implant’ in the wall of the womb and grow before we can say that IVF has resulted in a successful pregnancy. The timing of embryo transfer can vary, depending on whether the embryos being transferred are ‘fresh’ or ‘frozen’. Fresh embryo transfer refers to embryos that are transferred to the uterus 3–5 days after a woman’s eggs have been collected and fertilised by sperm. Frozen embryo transfer refers to embryos that have first been frozen before being thawed at a later date for transfer into the womb.

In the early days of IVF, fresh embryo transfer was the favoured approach. However, the techniques used for freezing and thawing of embryos have since improved to a point where more than 90% of embryos will survive the process. Consequently, a ‘freeze-all’ strategy has become more common, whereby all embryos are frozen following successful growth. They generally remain frozen for at least a month before the best embryos are thawed and transferred into the womb.

Understandably, people undergoing IVF are often eager to get pregnant as quickly as possible – and may assume that fresh embryo transfer is both faster and more effective. But is one approach better than the other?

To appreciate the pros and cons of fresh versus frozen embryo transfer, you first need to understand the so-called ‘window of uterine receptivity’.

The window of uterine receptivity

The success of embryo transfer depends on a number of factors, one of which is uterine receptivity – that is, how ready the uterus is to ‘receive’ the embryo. Outside this window of receptivity, the embryo may fail to implant in the wall of the uterus.

To receive the embryo successfully, the uterus must be ‘primed’ by the hormones oestrogen and progesterone. Under natural conditions, the priming of the uterus is perfectly timed with a woman’s monthly cycle, such that if an egg is released from the ovary and fertilised by sperm, the uterus is ready to receive the embryo. In the IVF setting, however, this timing may be less than perfect.

During IVF, the ovaries are stimulated via self-injectable medication so that the highest possible number of eggs can be collected. By artificially driving the release of so many eggs, the levels of oestrogen and progesterone skyrocket – they can rise to 10 times higher than normal peak levels. This may cause the uterus to prematurely prepare itself for embryo implantation, bringing forward the time frame in which the uterus is receptive. The problem with this is that by the time a fresh embryo is grown and ready for transfer, the window of uterine receptivity may have passed.

Frozen embryo transfer overcomes this problem by delaying the transfer process. This gives the hormone levels time to return to normal and the embryo is then transferred at a later date, when the uterus is receptive again.

When is frozen transfer best?

There are some situations where frozen embryo transfer may be considered the best option, including:

  • High levels of progesterone: When progesterone levels are high at the time of egg retrieval, there is a higher chance that the window of uterine receptivity will shift forward. In these cases, it is generally better to freeze the embryos and transfer them later when the uterus is receptive again.
  • Polycystic ovary syndrome (PCOS): Studies have found that women with PCOS tend to have better results from frozen versus fresh transfer. Frozen transfer reduces the risk of ovarian hyperstimulation syndrome (a complication of egg retrieval), and is also associated with a higher chance of ongoing pregnancy.
  • Embryos that require genetic testing: The genetic testing of embryos takes time. Consequently, by the time a tested embryo is ready for transfer, the window of uterine receptivity is likely to be over. In this scenario, frozen embryo transfer is usually more appropriate.

What are the arguments for fresh transfer?

On the other side of the coin, fresh transfer avoids the need for the freeze-thaw process. While current technology enables a greater than 90% survival rate for frozen embryos, this level of risk may not be acceptable for some patients – especially if they already have a low number of embryos. Fresh transfer potentially also results in a shorter time to pregnancy.

Which is the best option for you?

When choosing between fresh and frozen embryo transfer, there is no one-size-fits-all approach. As with all aspects of fertility care, the decisions need to be personalised to your individual circumstances. Our fertility specialists will assess the specifics of your situation and tailor their advice accordingly.

If you would like professional advice about the next steps to take on your fertility journey, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933. Alternatively, you can book online via our appointments page.

Mind-body techniques that can help manage stress during your fertility journey

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How is this related to fertility? Individuals and couples dealing with fertility issues typically experience very high levels of stress and anxiety.1 Unfortunately, studies have shown an association between anxiety, elevations in cortisol (your body’s stress hormone) and fertility problems.2  This suggests that the actual stress of infertility may further hinder an individual’s or couple’s chances of conceiving. Mind-body techniques aim to address the mental and emotional wellbeing of an individual or couple trying to conceive and in doing so, help to reduce any role that stress may be playing in preventing them from falling pregnant.

Before I go on to explain some of the more common mind-body techniques, it’s important to be aware that high-quality evidence to support the use of these techniques in the setting of infertility is currently limited. This is because the effects of how we think and feel on our health can be difficult to measure. However, the research that does exist is certainly thought-provoking. There are also many passionate testimonials from individuals and couples who believe these techniques improved their overall health and wellbeing, and contributed to their success in getting pregnant by helping them to cope better with the challenges they were facing. Thus, while these techniques may not directly improve pregnancy rates, fertility specialists often offer them as an adjunct to other treatment in order to help patients/couples better manage the emotional toll and relationship stresses of fertility treatment, including IVF.

Some of the more popular techniques include:

1. Relaxation training

These techniques involve refocusing your attention on something that is calming to help relax the mind and body. There are many ways to achieve this, including breathing exercises, mindfulness, meditation and progressive muscle relaxation. These techniques have been linked to reduced negative emotions in a range of patients, and more specifically, have been shown to reduce levels of anxiety in women undergoing fertility treatment.3 They are a good option because they can be practised almost anywhere and at little or no cost.

2. Cognitive Behavioural Therapy (CBT)

CBT is a form of psychotherapy (‘talking therapy’) that focuses on how our thoughts influence how we feel and what we do. It involves helping the patient to recognise negative and often repetitive thought patterns like “I can’t have a baby” or “It’s my fault that we aren’t conceiving”, and challenging them. In doing so, it encourages the individual to assess how realistic or rational their thoughts are, to be aware of the impact their thoughts may be having on how they are feeling, and to try and replace these thoughts with more helpful, positive ways of thinking. CBT may not directly change your ability to conceive but it may help to improve your perspective on the challenges you are facing and your overall outlook – thereby reducing stress and anxiety.4

3. Mindfulness

Mindfulness refers to a state in which we are able to maintain a very clear focus on our present thoughts, feelings, bodily sensations, and surrounding environment. It teaches us to be ‘in the moment’, so that we are less overwhelmed by past experiences and future concerns. A recent study demonstrated higher rates of pregnancy with IVF when women practised mindfulness, compared to those who did not.5  There is also strong evidence that mindfulness-based stress reduction can lower the levels of stress hormones in our body, and that being ‘more present’ can help a woman to better frame and process her experiences with fertility treatment.6

4. Social support

Infertility is often a silent struggle and despite its prevalence, many women choose not to share their story with friends or family. If you are experiencing this, it can be helpful to identify someone who can empathise with you and provide a healthy outlet for any confusion and sadness you may be feeling. Social support has been found to be particularly helpful in cases where women are feeling isolated as a result of their infertility. There are now also many organised groups where people with fertility issues can come together to discuss and share their experiences, including face-to-face groups, peer support programs and online discussion forums. There is good evidence that participating in support groups can reduce distress and anxiety, improving both your quality of life and chances of pregnancy.3

5. Exercise

It is well recognised that physical activity can reap huge emotional benefits through the release of ‘feel-good’ hormones called endorphins. These hormones can act as both a pain reliever and happiness booster. Australian guidelines recommend at least 30 minutes of moderate-intensity physical activity, such as walking or dancing, on most days of the week. If possible, some vigorous exercise, like cycling or running, should be performed at least once a week. Research into the effects of exercise on fertility has found that moderate exercise decreases the risk of miscarriage and increases the chances of conceiving in women undergoing assisted reproductive technology.7 Vigorous exercise has also been shown to reduce the risk of ovulation problems.7 Regular exercise can also lead to weight loss, which can help improve fertility if you are carrying extra weight.8

In conclusion, while further research is clearly needed in this area, using mind-body techniques throughout your fertility journey can certainly contribute to your physical and mental wellbeing as you strive to become pregnant. Here at Newlife IVF, we aim to provide individuals and couples with a genuinely supportive experience as they undergo fertility treatment. Our class-leading IVF counsellors are also available to meet with patients 1:1 and/or in organised group sessions over the course of their treatment journey. To make an appointment with one of our fertility specialists or to get a second opinion, call Newlife IVF on (03) 8080 8933. Alternatively, you can book online via our appointments page.

References

  1. Lakatos E et al. BMC Womens Health2017;17:48.
  2. Cwikel J et al. Eur J Obstet Gynecol Reprod Biol2004;117:126–131.
  3. Domar AD et al.Health Psychol 2000;19:568–575.
  4. Faramarzi et al. Int J Fertil Steril 2013;7:199–206.
  5. Li J et al.Behav Res Ther 2016;77:96–104.
  6. Nery SF et al. Stress Health2019;35:49–58.
  7. Homan G, Norman RJ Hum Reprod2012;27:2396–2404.
  8. Best D et al. Hum Reprod Update 2017;26(6):681–705.