If you have been trying to conceive for more than a year and you are under 35, it is wise to see your local doctor with the view to starting some investigations. If you are over 35 and you have been trying to conceive for 6 months, it is wise to be looking for a reason for why a pregnancy has not occurred. Fertility problems are relatively common and occur in around 15% of the population. If you have irregular periods or any other medical conditions, we would normally begin investigations sooner, to get a head start on addressing these issues for the future.
The age and quality of the eggs and embryos are important factors in the success of a pregnancy as are genetics. I work as part of The QLD Fertility Group – a fertility company that has the highest standards when it comes to laboratory control and the highly skilled scientists working with your embryos.
Which investigation should we do?
A basic screen for immunity to Rubella, infectious diseases and a test for ovulation are some of the initial tests we do. There is a non-invasive test called a HyCoSy which involves putting some dye through the fallopian tubes. This is done under ultrasound control and does not require any anaesthetic. It is important that males have a semen analysis done. We encourage checking of chromosomes of both male and female partners.
What are the options when it comes to fertility management and treatment?
Fertility is normally managed in a graduated fashion. Most of the time you don’t need to go as far as IVF, although we run a very successful IVF unit at North West Private Hospital, with the Queensland Fertility Group. Treatment usually depends on the cause of the fertility problem. If the problem is polycystic ovaries, simple things like weight loss and exercise help the patient begin ovulating again. There are also oral medications such as Clomiphene or Letrozole that we can use to help the ovaries to produce more eggs. Other causes of fertility can be addressed with a minimum amount of intervention. If the problem is the fallopian tubes, simply flushing them through with some dye can help. If Fibroids are the cause, oral medication such as Ulipristal may help shrink them down, so that they are no longer affecting fertility. Endometriosis is another common concern which can be treated surgically usually through the telescope. If there is a problem with the cervix this can usually be addressed with minor surgery.
Intrauterine insemination (IUI) is another intervention method that can help with fertility. This involves obtaining a semen specimen from the male and washing it so that the most normal and most active sperm remain and then inserting it through the neck of the uterus. This is done in the examination room in my practice and is just like having a Pap smear done. It doesn’t involve an anaesthetic.
If the fertility problem is a more complex one, more advanced procedures involving IVF, PGD (pre-implantation genetic diagnosis) and ICSI (intra cytoplasmic sperm injection) including surrogacy may be needed. Donor sperm and eggs or embryos may be offered.
I advise women with a fertility concern to find a Specialist who is empathetic and highly experienced in the Infertility field. Most of the time only fairly simple measures are required and we don’t actually need to go as far as IVF but I can certainly offer this treatment if it is required. I can offer this with Queensland Fertility Group of which I am a member. This is the most established fertility service in the state.
Success rates with IVF have improved enormously over time. Although it is a safe procedure, it is not without its risks – as is the case with any medical intervention. Hyperstimulation of the ovaries is a complication that some women experience when undergoing treatment. Occasionally a pregnancy may occur in a tube instead of in the uterus itself – this is called an ectopic pregnancy. If you have any concerns, it is important you contact me as soon as possible so that we can check that everything is going smoothly and address any problems.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS for short) is a common condition – affecting up to 10% of Australian women. It is related to genetics and lifestyle factors and seems to be associated with insulin resistance. This means a higher level than normal of insulin is required to control the body’s blood sugars. This can result in high levels of male hormones coming from the ovaries such as testosterone. Women may have a variety of symptoms including acne, increased body hair, infrequent periods and difficulty getting pregnant. Multiple small cysts can be seen on ultrasound and there can be an increase in weight, particularly of abdominal fat. There is a higher risk of diabetes and abnormal blood lipids.
Other than these initial problems there can be long-term risks such as an increased risk of diabetes during pregnancy, heart disease, metabolic syndrome, endometrial cancer and diabetes itself.
We do a number of blood tests and ultrasounds when investigating patients and often find that the simple lifestyle changes such as diet and exercise make a big difference. Occasionally, bariatric surgery may assist in fertility. If achieving pregnancy is a problem, medications such as Clomid or FSH or even IVF may be needed. For increased body hair, agents such as the oral contraceptive, anti-androgens or insulin lowering drugs such as Metformin may be useful. Non-medical methods such as laser, electrolysis, bleaching and waxing can be helpful to reduce body hair. For acne, medications include the oral contraceptive, Metformin, anti-androgens such as Cyproterone and some topical creams. If insulin resistance or diabetes occurs, weight loss, dietary change, exercise and medications such as Metformin may be helpful.
Endometriosis
Endometriosis is a common condition in which the lining of the uterus is found in areas outside the uterus. In these areas it can cause problems with anatomical distortion, scarring, pain and problems with achieving a pregnancy. Some of the symptoms of endometriosis include pain with periods, pain before periods and pain with intercourse. We can diagnose this by putting a very fine telescope in through the patient’s navel. Often we can both identify and treat endometriosis at the same time. This surgery has proven to improve endometriosis in over 70% of cases and requires a general anaesthetic. Endometriosis can be continually suppressed by using medications such as the oral contraceptive, the Mirena intrauterine contraceptive device or a short course of medications called G.N.R.H. analogues. The main reason Endometriosis causes problems is because it has a negative effect both on eggs, embryos and implantation – but the good news is that with the above treatments and management women can often achieve pregnancy.
Ovulation Induction
If a patient is not producing eggs, there are a number of ways in which we can overcome this, depending on the cause. Sometimes oral medications such as Clomiphene or Letrozole can be used to help the ovaries to produce more eggs. Follicle Stimulating Hormone injections (FSH for short) can also be used to induce ovulation and an Ovidrel injection will help to release the egg.
IUI (Intrauterine Insemination)
Intrauterine insemination is a technique whereby the healthy sperm from the partner’s or donor’s specimen is inserted through the neck of the uterus (cervix). This is used for both minor and major male factor infertility issues.
IVF (In Vitro Fertilization)
For couples who are struggling to conceive naturally, IVF is an option which provides much hope. The process involves hormone injections for about 2 weeks, which help to produce more eggs. These are then collected at the hospital (through the vagina). A semen specimen is then added to each egg in the lab with the aim of fertilization. After 2-5 days of growth, an embryo is then transferred into the woman’s uterus, which then ideally results in a full term pregnancy. The success rate of IVF in women under 38 is quite high at over 40%.
