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.

Is egg freezing right for you?

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In principle, egg freezing sounds simple enough – have some eggs collected, freeze them for storage, then thaw them when you’re ready to undergo fertility treatment – providing you with a chance to store your eggs while you’re still young and beat the biological clock. But what exactly does egg freezing involve and are you an appropriate candidate?

Why freeze your eggs?

You may want to consider freezing your eggs if you’re worried about your fertility declining but your life circumstances mean that you’re simply not ready to start a family. Alternatively, you may have a medical condition or be receiving medical treatment that could affect your fertility. If you’re a female transitioning to a male, you may wish to preserve your fertility before starting reconstructive or hormonal therapy, which can lead to a loss of your fertility.

What does the egg freezing process involve?

The first stage of egg freezing is ovarian stimulation, which involves 10–14 days of hormone injections to stimulate your ovaries to produce multiple eggs. There are various techniques used for stimulation and your fertility specialist will decide, together with you, which is most suitable for you. The developing follicles, which contain your eggs, are monitored by ultrasound and sometimes by blood hormone levels to determine when they are ready to be collected.

When mature, your eggs are collected (usually while you’re under sedation rather than general anaesthetic), frozen and put into storage. In most cases, frozen eggs can be stored for up to 10 years.

When you’re ready to have a baby, the eggs are then thawed and used in IVF treatment. This involves fertilising your eggs with sperm using a method called intracytoplasmic sperm injection (ICSI), whereby sperm is injected directly into the egg. The embryos are then grown in the lab for up to 6 days and then transferred to your uterus (womb).

Factors to consider when deciding whether to freeze your eggs

1. Success rates

Egg freezing is an established procedure. It has now been two decades since the world’s first pregnancy using frozen eggs and over this time, there have been notable improvements in the technology and processes we use. High rates of success can now be expected when circumstances are optimal. A 2017 study showed that freezing 20 eggs before the age of 35 gives a 90% chance of having a baby.1

When considering these statistics, it is important to note that the number of women who actually go on to use their frozen eggs is still quite low. In 2017–18, less than 1% of IVF cycles in Victoria involved the use of a woman’s own thawed eggs.2  The data on egg freezing success rates are challenging to compile because many women choose not to use their eggs for many years after freezing and some may not use them at all. Furthermore, current figures may not reflect advances in egg freezing technology because the results are from a period when clinics were using different ‘slow freezing’ techniques.

In terms of understanding the success rates for frozen eggs compared to ‘fresh’ (recently retrieved) eggs, a study published in the Journal of Human Reproduction in 2010 examined the success of IVF in 600 women, half of whom were assigned ‘fresh’ eggs while the other half were given frozen and thawed eggs.3 The study found no significant difference in pregnancy rates between the two groups of women, concluding that freezing eggs and thawing them for later use has no effects on success rates. According to these findings, the likelihood that your eggs will result in a pregnancy will be the same whether you choose to freeze and use them later or use them straightaway.

2. Age

The age at which you choose to freeze your eggs is key to your chances of having a baby – the younger you are, the better. Egg quality declines more rapidly after the age of 35, so the best time to freeze your eggs is in your 20s and early 30s.4 Unfortunately, eggs collected from older women are less likely to form viable embryos and are also less likely to successfully implant in the wall of the womb. Thus, if you decide to freeze your eggs when you are older, we typically need to collect more eggs to ensure at least one egg is of suitable quality to result in a baby. However, as women age, they also have fewer eggs, so only a small number of eggs may be available for collection and freezing. If this is the case, you may need more than one treatment cycle to collect an adequate number of eggs for storage.

Both the number and quality of eggs available for freezing are important, because at each step in the freezing and subsequent IVF process, there is a risk that some are lost. Of the eggs that are collected, some may not be appropriate for freezing, some may not survive the thawing process, and some may not be fertilised or successfully develop into embryos.

3. Costs

In Australia, fertility treatment is only covered by Medicare and other government subsidies when there is a medical need for the treatment. If you freeze your eggs for non-medical reasons (i.e. ‘elective egg freezing’), you won’t be eligible for Medicare assistance.

For detailed information about the costs associated with egg freezing, please visit our fees page.

*Does not include hospital fees; †Does not include medications or hospital fees.

What are the alternative options?

If freezing your eggs is not a suitable option for you, other potential options include:

When considering your fertility and the options for extending it, there is no one-size-fits-all approach. As with all aspects of fertility care, the best decision for you is the one that is personalised to your individual situation.

Learn more information about Newlife IVF’s egg freezing services. If you would like to discuss your options with one of our fertility specialists, please call Newlife IVF on (03) 8080 8933. Alternatively, you can book online via our appointments page.

References

  1. Munné S et al. Human Reprod 2017; 32(4):743–749.
  2. Victorian Assisted Reproductive Treatment Authority. Annual Report 2018.
  3. Cobo A et al. Human Reprod 2010; 25(9):2239–2246.
  4. Saumet J et al. J Obstet Gynaeocol Can 2018; 40(3):356–368.