Using natural therapies in combination with fertility treatment

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Naturopathy

Naturopathy takes a holistic approach to your wellbeing and focuses on treatments that support your body to heal itself. A naturopath may recommend a combination of therapies such as herbal remedies, nutritional supplements, and diet and lifestyle advice.

Some evidence suggests that a holistic, naturopathic approach to care can benefit aspects of reproductive health. For example, a study in overweight women with polycystic ovarian syndrome (PCOS) compared the combined effects of herbal supplementation and lifestyle changes with lifestyle changes alone.1 While the combination was not shown to specifically increase conception rates, it did improve other markers of fertility like menstrual cycle regularity (which can support ovulation) and enhanced mental wellbeing scores for depression.1

Herbal remedies

Herbal remedies are commonly used in naturopathy and include plants or parts of a plant – such as roots, flowers, bark, seeds and stems – that are often made into pills, teas or ointments for convenient consumption.

Simple acts like drinking a mug of herbal tea or using moisturisers infused with flower essences can relieve stress and create a sense of inner peace. And specifically regarding gynaecological findings, some herbal therapies have shown benefits. For instance, a study assessing the use of clomiphene (a medication that supports ovulation) combined with black cohosh supplementation in women with subfertility demonstrated increased endometrial thickness and improved hormone profiles.2 Theoretically, this can improve the chances of conception by creating a more receptive uterine environment for embryo implantation.2 However, the study findings did not specifically show an increase in pregnancy rates.2 If you would like to try a herbal remedy, keep in mind that they can affect your fertility treatment medications, so it’s essential to check if a herb is safe with your fertility specialist first.

Acupuncture

Acupuncture is a Chinese medicine practice in which thin needles are inserted into the skin at select acupuncture points. These acupuncture points mark lines of energy flow (called meridians) within the body, and the insertion of acupuncture needles at these points is intended to stimulate this energy flow.

There is limited evidence showing that acupuncture enhances fertility. However, patients may find acupuncture beneficial for stress reduction3 and overall emotional wellbeing.4

Mind-body practices

Mind-body practices are centred on the belief that your mindset can influence your health. Some mind-body practices include mindfulness meditation, yoga, music therapy, hypnosis, art therapy, aromatherapy, guided imagery and cognitive behavioural therapy.

Mindfulness meditation

A female in casual clothes performing mindfulness meditation with her eyes closed while seated on a bed next to window.

Mindfulness meditation is a type of meditation that teaches you to become more aware of what you are thinking and feeling. Over time, mindfulness meditation can help you experience each moment with more compassion and less expectation – which may help ease the highs and lows of your fertility journey.

Research has linked mindfulness meditation with fewer difficult emotions, such as depression and stress, and less rumination, which can help you bounce back more easily from the highs and lows of your fertility journey.5

Yoga

Yoga is an ancient Indian mind-body practice that guides you through various postures and stretches. There are multiple styles of yoga, from gentle movements to more physically challenging practices. However, all yoga practices are a form of mindful movement.

The focus on flowing through physical motions and synchronising your movements with your breath can help you reconnect with your body and take a step back from the thoughts passing through your mind. This was evident in a six-week yoga program for women who were waiting for IVF treatment, where yoga was associated with fewer negative thoughts and feelings about fertility and an improved sense of wellbeing.6

Reflexology

Reflexology is a form of massage for the feet, hands and ears, where pressure is applied to select points that are believed to be linked to the function of broader body parts. By applying pressure to these points, reflexology aims to relieve stress and support healing in the body part each point is associated with.

A study comparing reflexology to gentle foot massage in women experiencing infertility found that reflexology did not improve ovulation or pregnancy rates. However, reflexology was associated with lower depression scores, which can help strengthen your resilience and overall fertility treatment experience.7

Take a balanced approach

Current medical research does not directly link complementary remedies to enhanced fertility. However, if such remedies benefit your emotional wellbeing and do not interfere with your current medical treatments, they could be a positive addition.

Always explore these options in consultation with your fertility specialist to ensure that these won’t interfere with your treatment.

There are also other changes you can make to maximise your chances of getting pregnant, such as:

  • Drinking caffeine in moderation
  • Incorporating regular movement into your routine
  • Maintaining a healthy weight
  • Enjoying a balanced, nutritious diet
  • Taking the recommended supplements.

If you would like to learn more about lifestyle changes to improve your fertility, you can also read ‘What can I do differently in 2024 to fall pregnant?’ by Newlife IVF fertility specialist Dr Nicole Hope.

Still got questions?

To meet with one of our Newlife IVF fertility specialists and learn more about how you can improve your fertility, you can reach our team by calling (03) 8080 8933 or book online via our appointments page.

References

  1. Arentz S, Smith CA, Abbott J et al. Combined lifestyle and herbal medicine in overweight women with polycystic ovary syndrome (PCOS): A randomized controlled trial. Phytother Res. 2017;31(9):1330-40. doi:10.1002/ptr.5858 ↩ ↩
  2. Clark N, Will M, Moravek M et al. A systematic review of the evidence for complementary and alternative medicine in infertility. Int J of Gynaecol Obstet. 2013;122(3):202-6. doi: 10.1016/j.ijgo.2013.03.032
    HealthProfessional/#:~:text=Today%2C%20black%20cohosh%20is%20most,irritability%20%5B5%2C6%5D ↩ ↩ ↩
  3. Xi J, Chen H, Peng ZH et al. Effects of acupuncture on the outcomes of assisted reproductive technology: an overview of systematic reviews. Evid-Based Complement and Alternat Med. 2018;2018:7352735. doi: 10.1155/2018/7352735 ↩
  4. Hassanzadeh Bashtian M, Latifnejad Roudsari R, Sadeghi R. Effects of acupuncture on anxiety in infertile women: a systematic review of the literature. J Midwifery Reprod Health. 2017;5(1):842-8. doi: 10.22038/jmrh.2016.7949 ↩
  5. Patel A, Sharma PSVN, Kumar P. Application of Mindfulness-Based Psychological Interventions in Infertility. J Hum Reprod Sci. 2020;13(1):3-21. doi: 10.4103/jhrs.JHRS_51_19 ↩
  6. Oron G, Allnutt E, Lackman T et al. A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment. Reprod Biomed Online. 2015;30(5):542-8. doi: 10.1016/j.rbmo.2015.01.011 ↩
  7. Holt J, Lord J, Acharya U et al. The effectiveness of foot reflexology in inducing ovulation: a sham-controlled randomised trial. Fertil Steril. 2008;91(6):2514-19. doi: https://doi.org/10.1016/j.fertnstert.2008.04.016 ↩

Donating your eggs – what’s involved?

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Whether you intend to donate to friends or family, or anonymously, there are several things to consider before you make your decision. Although it can be an incredibly rewarding experience, donating your eggs is a physical and emotional commitment with potentially lifelong implications. It is therefore important to be fully informed before you decide to become a donor.

Things to consider before donating your eggs

Understanding the legal landscape of egg donation in Australia

In Australia, donors have no legal connection to any child conceived as a result of their donation. This means they have no parental responsibilities and are not required to pay child support. Donors also have no legal rights to the child and cannot be granted custody. If you are donating as a known donor, you and the intended parents should discuss how much involvement, if any, you will have in the child’s life. Boundaries should be worked out before you embark on this journey and you may wish to seek legal advice to facilitate this.

If you intend to become an anonymous donor, it’s important to understand that donation is not truly anonymous in Victoria. Children born from your donation can legally request access to your identifying information after they turn 18. This means you may receive contact from them. Additionally, some of your details will be shared with potential recipients – these include eye colour, height, cultural background and health. However, your identity will remain hidden from potential recipients.

Financial considerations – what to expect when donating eggs

In Australia, egg and sperm donation must be altruistic. That is, you cannot receive financial compensation for your donation. However, reasonable expenses can be paid by the recipients, including medical and out-of-pocket costs (such as travel expenses).

Emotional implications of egg donation

Before you donate, you are required to attend mandatory counselling sessions. This is to make sure you fully understand the legal, social and emotional aspects of egg donation. How do you feel about someone else raising a child who is genetically related to you? How will your decision to donate affect your family and children (if you have them)? How do you feel about the potential for future contact with one or more children or adults born as a result of your donation?

At Newlife IVF, our experienced fertility counsellors can help you consider these questions and more. You will complete your counselling feeling fully informed and reassured about your decision and its possible effects on your life in the future.

Physical health and eligibility criteria for egg donors

To become an egg donor, you must be mentally and physically healthy, living a healthy lifestyle, with no family history of inheritable disease. You are also required to be at least 21 years old before you can donate. Ideally, you should be younger than 38 years old. A mandatory health check, including blood tests and ultrasounds, will be performed. You will also be asked lots of questions about your personal and family health history. Once you are given the all-clear, you will be able to donate.

What happens when you donate your eggs

The process of donating your eggs will differ depending on whether you already have frozen eggs available – i.e. from a previous in vitro fertilisation (IVF) cycle – or need to have your eggs collected. Below we discuss both scenarios.

Donating your stored eggs

If you’ve been through IVF and your family is complete, you may have frozen eggs you aren’t intending to use. In this case, you may wish to donate your eggs to an individual or couple who also needs help to have a child. In this case, assuming you fulfil the criteria to become a donor, you will be able to donate your existing frozen eggs.

Egg collection

This process is identical to the first half of an IVF cycle. Before your eggs are collected, you will be given medication to stimulate your ovaries to produce several eggs. This medication comes in the form of a daily injection that will need to be taken for 8 to 14 days. The injection is delivered through a pen device, so it is very easy to use. You can choose to give yourself the injection or ask a friend or family member to do it for you.

Injections will begin on the first day of your period. From around day 5 or 6, a second daily injection will be added, to stop your ovaries from releasing any eggs (ovulating) before they can be collected.

From day 8, you will be monitored using blood tests and ultrasounds to check whether your follicles (small, fluid-filled sacs within the ovaries, each containing a developing egg) are large enough for egg collection. Egg retrieval is usually done at around day 13. About 36 hours prior to collection, the injection that prevents ovulation will be replaced by a so-called ‘trigger injection’. This stimulates the eggs to fully mature before collection.

Egg collection is a day procedure done under light anaesthetic. You won’t be aware of the procedure while it’s happening, nor will you remember it. Egg retrieval is carried out by a fertility specialist, who will use an ultrasound to visualise your ovaries. A thin needle will be inserted through the top of your vagina and into your ovaries to collect the eggs. The procedure takes about 20 minutes, and between 8 and 15 eggs are typically collected.

About 90 minutes after the procedure you will be allowed to go home. After resting at home for 1–2 days, you can resume your normal activities. It is common to experience some abdominal discomfort and bleeding. However, the discomfort is typically fairly mild and manageable with Panadol and a heat pack.

A COVID-19 test is also required prior to the day of the procedure. You will need to isolate at home, separating yourself from others in your household, until the results come back.

After your eggs are collected, an embryologist will look at them under a microscope. If your recipient is ready, they can use the eggs straight away. The mature eggs that are ready for fertilisation will be introduced to sperm on the same day.

If your recipient is not ready, the mature eggs can be frozen until they are ready to be used. They will also be quarantined for a period of 3 months. After the quarantine period has passed, you will be asked to come in for another round of blood tests to double-check that you are healthy. Once you’re given the all-clear, your eggs are ready to be used.

How to donate your eggs

The information in this article is certainly not exhaustive. We recommend that you refer to the information provided by the Victorian Assisted Reproductive Treatment Authority (VARTA) to gain a more complete understanding of the issues pertaining to egg donation. If you have any additional questions, please do not hesitate to contact us.

If you are ready to take the next step to donate your eggs, book an appointment at Newlife IVF. Whether you want to donate to friends or family, or as an anonymous donor, we can facilitate the process for you. To book your appointment, call (03) 8080 8933 or book online.

Single and ready to have a baby – what are my options?

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I’m a single woman – what are my options?

Donor sperm – clinic-recruited versus known donors

Essentially, there are two options for obtaining sperm: accessing donor sperm through a fertility clinic’s sperm bank, or using a sample provided by someone you know.

At Newlife IVF we have an on-site sperm bank containing samples recruited from local and international donors. The benefit of using sperm from our clinic-recruited donors is that it is thoroughly tested for infectious diseases and common genetic problems. After we freeze the sperm, it is then quarantined before donors are retested to make sure it is high quality and safe to use.

When you use a clinic-recruited donor, you also have the advantage of very clear legal boundaries. The donor has no legal connection to your child – they are not entitled to custody and do not have to pay child support. They also remain anonymous to a large extent; that is, you will not know the donor’s identity (but you will know their family medical history and some of their traits). However, your child can request that the donor’s identity be revealed to them when they turn 18.

If you choose not to go the clinic-recruited donor route, you may consider using a sperm sample from a friend or acquaintance. A benefit of using a known donor is you will likely have a good understanding of their appearance, background and traits. However, the social and legal boundaries are not as clear-cut as they are when using a clinic-recruited donor. Discussing expectations and creating firm boundaries with a known donor requires careful negotiation, and you may wish to seek legal advice on how best to proceed.

If you do decide to use a sample from someone you know, it’s best to involve a fertility clinic. That way, you can have the sample rigorously tested for safety and quality in the same way we test donor sperm.

In this video, Dr Chris Russell talks about donor sperm and its use in IVF and IUI procedures.

Insemination – how egg and sperm meet

The next consideration is how best to introduce the sperm sample to your egg. There are a few different options for insemination, and the most suitable will depend on your specific circumstances.

One possibility is home insemination. In this method, sperm is injected into the vagina using a syringe at home. As this mimics the natural fertilisation process, home insemination is effective when the donor has a normal sperm count. It is also one of the most cost-effective options. However, it does not afford the same degree of protection from infectious disease as undergoing a similar process via a fertility clinic.

The clinic-based alternative is intrauterine insemination (IUI). This is where a sperm sample is concentrated to contain a very high number of sperm. It is then injected directly into your uterus soon after your ovaries release an egg. Using a concentrated sperm sample increases the chances of a sperm fertilising your egg. Depending on your circumstances, your specialist may recommend combining IUI with a medication to stimulate the release of an egg from your ovaries, further increasing the chance of success.

The last option is in vitro fertilisation (IVF). In this process, several of your eggs will be introduced to sperm in laboratory dishes. When utilising clinic-recruited donor sperm, the best sperm may be selected and a single sperm injected directly into each egg, a process called intracytoplasmic sperm injection (ICSI). One of the best embryos resulting from IVF insemination will then be transferred back to your uterus. The rest can be frozen and stored for later use, if necessary.

Two embryologists performing the intracytoplasmic sperm injection procedure.In ICSI, a single sperm is injected into the centre of a mature egg.

There are a few reasons you may be advised to undergo IVF. If you have known infertility, you’re in your late 30s or early 40s (when female fertility naturally declines significantly), or you struggle to get pregnant through other forms of insemination, your specialist may recommend this procedure. Likewise, IVF may be advisable if you’re using a known sperm donor with low sperm quality or quantity for other methods of insemination. If you wish to do preimplantation genetic testing, which is the process of genetically testing your embryos before they are transferred to your uterus, IVF will be necessary. For more information about these procedures in relation to your particular circumstances, chat to your fertility specialist.

I’m a single man – what are my options?

To have a baby as a single man, you will need the help of an egg donor and a surrogate. According to Victorian law, these must be two different women.

You may choose to use a clinic-recruited egg donor, or a known donor, i.e. a friend, acquaintance, or a family member (note: the last is only okay if you are not using your own sperm). Egg donation must be altruistic in Australia, meaning no financial compensation is paid for providing eggs. Once the donor eggs are ready, your sperm will be introduced to them using IVF (discussed earlier in this article), and the best resulting embryo will be transferred to your surrogate’s uterus. If you are not using your own sperm, donor embryos may be an appropriate option for you.

It’s common to ask a friend, acquaintance or family member to be a surrogate. Surrogacy is also an altruistic process in Australia, however ‘reasonable’ medical costs can be paid by you. Keep in mind that in Victoria, multiple medical consultations, counselling sessions and legal advice are required for both you and the surrogate prior to proceeding. You will also need to seek permission from the Patient Review Panel (this is a legal requirement in Victoria), and the sperm or embryos must be quarantined. This process can take several months.

Seeking a surrogate overseas may also be an option. However, according to Australian law, this is only legal if it is altruistic. Be aware that this is a very expensive route and you will need to plan to potentially be overseas for a few months after your baby is born to organise their entry into Australia.

For advice related to your particular circumstances, you may wish to seek legal advice and talk to a fertility specialist. Unfortunately, Newlife IVF is not permitted to assist you in finding a surrogate (nor can any other IVF provider). However, our counsellors can certainly orientate you to the Victorian surrogacy community and provide support and information as you look for a potential surrogate.

Ready to have a baby on your own?

Make an appointment with one of our caring and experienced Newlife IVF fertility specialists to discuss the most appropriate way forward based on your medical history, circumstances and preferences. Call (03) 8080 8933 or book online and take the next step towards your dream.

  1. Victorian Assisted Reproductive Treatment Authority. Annual Report 2019. VARTA; 2019:84. Accessed June 25, 2020. https://www.varta.org.au/sites/default/files/public/6249%20VARTA_AR2019_web.pdf↩︎

Infertility, IVF and the festive season

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This post was contributed by Laura Oliver, one of Newlife IVF’s counsellors. 

Christmas often symbolises a time of joy and happiness. We plan celebratory events with family and friends, and take time to reflect on the end of another year. But this time of year can also be very difficult for women and couples who have been struggling with infertility and going through assisted reproductive treatment (ART) like IVF.

The focus at Christmas time is often on children and families, with Christmas cards and social media posts typically displaying pictures of family events or children with Santa. There can be a real sense of pressure to deliver good news at a time of year when many people are celebrating. However, if you’ve been struggling to fall pregnant or undergoing fertility treatment, the end of the year can serve as a painful marker that you have not achieved what you had hoped for this year, and for some of you, a reminder that yet another 12 months have gone by without a successful outcome.

All of this can bring up unwanted feelings of sadness, frustration, jealousy, anger and grief – and with a barrage of festive mementos and occasions around you to remind you that you’re not pregnant, it’s no wonder you feel this way!

Below are some tips on how you can manage the festive season while coping with fertility issues and undergoing treatment.

Be selective

Pre-plan and be selective about which events you attend at this time of year. If you do attend an event, consider how long to stay there for, and what you can do while there to minimise any feelings of stress or discomfort – for example, helping cook or wash up can help keep you busy and distracted, and may assist you to avoid topics of conversation you don’t want to be involved in.

Warn people in advance that you may find Christmas difficult – this doesn’t mean having to disclose information about your fertility; you can make more general references to having had a stressful or difficult year instead. Try to give your hosts time to understand that this year might look a little different for you, and to not be offended if you decide not to attend or only stay for a short while.

If you have a partner or a support person with you, plan a code word or signal to give when you need them to rescue you from a difficult conversation, or when you want to wind up and go home.

Celebrate

Celebrate how you want. Sometimes, this might feel a little selfish at a time when there are often traditions to uphold or family events to attend, but give yourself permission to celebrate in a way that is comfortable and meaningful to you at this time.

This could mean going away with a friend or just your partner (or staying home) and avoiding big family gatherings. Or starting a new tradition for this time of year. Do something that you know will bring you joy, no matter how small.

Re-charge

Use some of this holiday period to re-charge and take a break from treatment (if you feel you can). Take advantage of your time off work and prioritise self-care – pamper yourself! Get a massage, go away for a few days, plan some day trips to the beach or the countryside, or curl up with a good book.

Reflect

Take some time to reflect on your IVF journey so far, and perhaps think about your plans for treatment moving forward. Is there anything you could do differently next year? What are your expectations, and do you need to adjust these at all? Do you have questions to discuss with your specialist? Perhaps even think about how much longer you think you can continue with IVF treatment before needing to pause and reassess again.

Reflect on your own, with your partner (if you have one) or a support person. You could try using a journal to write down how you’re feeling, record the questions you may have, or come up with a list of pros and cons to aid future decision-making.

Ask for help

Use your supports (partner, family, friends) to help you work through any difficult feelings as they arise. Be open and honest with your networks about how you feel and the ways in which they can be of support to you. Be reassured that the way you are feeling, and the different types of emotions and thoughts that may be triggered at this time of year, are very normal. But we all cope in different ways, so make sure you do whatever it is you need to do to keep your heart, mind and body strong for the year to come. And above all else, remember to be kind to yourself!

Lastly, remember that the Newlife IVF counselling team is here to help. We can help you navigate and unpack your experiences and emotions. If you feel that you could benefit from the support of our counselling team, please call the Newlife IVF team on (03) 8080 8933.

My doctor says we need ICSI – how will this improve our chances of a successful IVF cycle?

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The traditional IVF approach is to allow this meeting to take place ‘naturally’, albeit in a laboratory dish: the woman’s egg is placed in a special culture medium with a prepared semen sample containing thousands of sperm. The fittest sperm fertilises the egg, mimicking what would normally happen in the woman’s reproductive tract.

As its name suggests, ICSI is far more precise. Rather than leaving the egg and sperm to meet of their own accord in a laboratory dish, this technique allows us to directly inject a single sperm into a woman’s egg – thereby, overcoming any issues that may be getting in the way of a sperm and an egg meeting and coming together naturally. Here, we consider some of the reasons why ICSI may be considered during IVF and what specific fertility problems it can help overcome.

Who is ICSI suitable for?

When a couple is experiencing difficulties getting pregnant, it can be easy to focus solely on the woman’s fertility. However, a male factor contributes to infertility in approximately 40% of couples who fail to conceive.1 ‘Male factor infertility’ typically involves an alteration in the number, shape and/or movement of the man’s sperm, all of which can affect the sperm’s ability to fertilise an egg the natural way. ICSI is most commonly used to help overcome these types of sperm-related issues.

ICSI may also sometimes be offered if a woman has very few eggs available (e.g. due to age). In this case, ICSI is used to increase the chances of successful fertilisation, thereby lowering the risk that the woman runs out of eggs before she achieves a successful pregnancy through IVF.

ICSI may also be recommended if one or more previous standard IVF cycles were not successful due to failed fertilisation, or if the reason for cycle failure is unclear but a sperm-related issue is suspected despite a normal semen analysis.2

A checklist for fertile sperm

If your doctor suspects male factor infertility could be affecting your chances of pregnancy, they will usually suggest a semen (sperm) analysis. This is the main method used to test male fertility. During the analysis, a number of different factors that could be affecting your ability to conceive naturally are studied, including:

  • The volume of semen, which needs to be sufficient to transport sperm into the female reproductive tract
  • The sperm concentration and total sperm count, which affect the likelihood that enough sperm will reach the egg in order for one to fertilise it
  • The physical shape of the sperm, as abnormally shaped sperm can have difficulty swimming to the egg or penetrating the egg’s outer layer
  • The motility of the sperm (i.e. how well it can swim) – if large numbers of sperm in the sample are ‘weak swimmers’, then a natural pregnancy will be more difficult to achieve.

Your specialist might also recommend additional testing for:

  • Sperm DNA damage or fragmentation: sperm with damaged or fragmented DNA have a reduced chance of fertilising an egg
  • Sperm antibodies, which if present, can attack and impair sperm function.

Depending on your results, your doctor may then order follow-up tests to make sure the results are accurate and/or to see if anything else is preventing the semen from doing its job.

Once the tests are complete, your specialist will discuss your results with you and explain what your options are, including whether ICSI is likely to increase your chances of successful fertilisation and the overall success of your IVF treatment cycle.

Success rates with ICSI

Because of ICSI, many previously infertile men now have a good chance of fertilising eggs with their sperm. With some couples, pregnancy rates as high as 45% have been achieved with ICSI.3 However, rates this high are not always possible because of other factors, including age and egg quality.

The fertilisation of an egg and its subsequent development into a growing embryo is a complicated process, and there are many reasons why IVF may not be successful, even with the assistance of ICSI. To aid our success rates at Newlife IVF, we:

  1. Ensure an egg is suitable for fertilisation prior to ICSI: Using polarised light microscopy, we assess a structure inside the eggs called a ‘spindle’. We call this ‘egg spindle visualisation’. This allows us to identify if an egg is at a certain stage of development (called metaphase II) and therefore, in optimal condition for fertilisation via ICSI.
  2. Select the healthiest-looking sperm for ICSI: If the genetic information in the sperm has been damaged, or if the sperm is unable to use its DNA correctly, then there is a risk that development of the embryo will fail, even if it has been successfully fertilised via ICSI.4 A number of factors can increase this risk, such as smoking and older age.5,6 It’s not currently possible to know if the sperm we choose for ICSI is completely free of genetic defects. However, by using an advanced imaging system with an extremely high-powered microscope, we are able to study the structure of individual sperm, helping us to select the optimum sperm to inject into an egg. Sometimes, we may also use another technique, called intracytoplasmic morphologically selected sperm injection (IMSI), to help us pick out a healthier sperm based on its shape. A DNA test can also provide us with more details about sperm quality.
  3. Assess the best position to inject the sperm into the egg: Our extremely high-powered microscope also allows us to very precisely inject the selected sperm into the egg, such that we avoid an important structure inside the egg called the spindle. Research has shown that injecting eggs away from the spindle results in higher fertilisation rates and better embryo quality.

Still have questions?

If you are concerned about the possibility of male factor infertility or would like more information about the role of ICSI in an IVF treatment cycle, 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.

References

  1. Agerwal A et al. Reprod Biol and Endocrinol. 2015;13:37–46. ↩
  2. Palermo GD et al. Sem Reprod Med. 2015;33:92–102. ↩
  3. Palermo GD et al. Sem Reprod Med. 2009;27:191–201. ↩
  4. Colaco S & Sakkas D. J Assisst Reprod Genet. 2018;35:1953–1968. ↩
  5. García-Ferreyra J et al. Clin Med Insights. Rep Health 2015;9:21–27. ↩
  6. Zini A & Sigman M. J Androl 2009;30:219–229. ↩

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.

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.