TREATMENT OF INFERTILITY

Who needs ART?

It is a staggering fact that up to one in ten couples find that at some time during their life they need assistance to become pregnant.

Initially couples may seek the advice of their own GP, who may then refer them to the infertility specialists at a fertility clinic. Fertility specialists usually work with a fertility clinic to provide fertility treatments. (See Intro section for information on fertility specialists and qualifications).

Not all couples need to embark on an IVF procedure. Many simply need to establish their fertile periods by ovulation tracking to time ovulation so that intercourse can be undertaken at the correct time. Or they may need to use hormonal support or sometimes have artificial insemination.

In a natural pregnancy the egg and the sperm meet in the fallopian tube where fertilisation takes place and the resulting embryo implants in the uterine lining. But for those women with blocked fallopian tubes or whose tubes have been damaged by infection, surgery or endometriosis, the blockage is by-passed by IVF. The IVF or ICSI procedure can also be successful where the male partner’s sperm count is too low for normal fertilisation to occur.

Preparing for ART treatment

Immunity to Rubella (German measles): Any woman attempting to become pregnant should be tested to ensure that she has immunity to rubella.

Folic Acid 500 micrograms (0.5 mg) per day: All women planning a pregnancy should be taking a folic acid supplement to reduce the risk of foetal abnormalities including neural tube defects. A GP/specialist doctor can advise individual patients on the dose recommended, but usually a supplement of at least 500 micrograms of folic acid a day is advised. This supplement should be continued for at least the first three months of pregnancy, where increased folic acid is needed by both the foetus and the mother.

Healthy lifestyle: Diet, avoidance of toxins, alcohol and smoking, normal weight and other factors have been shown to have a significant effect in achieving a healthy pregnancy. See Treatment Options>Lifestyle Factors and Male Fertility and Lifestyle Factors and Female Fertility.

Manage stress: The treatment programs that patients may undertake will often be very confusing, emotionally, physically and financially draining. It is essential that the period of treatment remain as stress-free as possible for both partners. Patients may find yoga, meditation techniques, relaxation tapes and books helpful and a counsellor can also help.

Ask questions: The fertility clinic staff are available to support and care for patients whilst they are undergoing the treatment, especially when it is not always possible to contact their doctor. If patients have any problem that they wish to discuss about their treatment or need reassurance they should call the fertility clinic and ask to discuss any concerns with a nurse or other professional at the fertility clinic.

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Programmes

Fertility treatment includes a comprehensive range of programmes for infertility including the following:

• Semen analysis (evaluation)

• Ovulation tracking/ Cycle tracking

• Hormone evaluation

• Ovulation induction (OI)

• Artificial Insemination (IUI, ICI)

• IVF (in vitro fertilisation)

• ICSI (intra cytoplasmic sperm injection)

• Extended culture of embryos (blastocyst culture)

• Embryo cryopreservation

• FET (frozen embryo transfer)

• PESA (percutaneous epidydimal sperm aspiration)

• TESA (testicular sperm aspiration)

• MESA (micro epidydimal sperm aspiration)

• Assisted hatching

• Donor sperm bank

• Oocyte donation

• Embryo donation

• Infertility counselling

• Semen storage

• Surrogacy

Emotional and physical stress

There are emotional and physical strains placed on patients. These stresses can come from many areas such as how to deal with questions from family and friends, and also the emotions associated with unsuccessful treatment cycles. Fertility clinics in Australia are required to have a counsellor qualified and experienced in fertility counselling and patients can request to see this counsellor before, during or after their treatment.

For IVF patients this counselling will usually be included in their cycle cost. Fertility clinics acknowledge that undergoing treatment and placing all your hopes on one treatment cycle can be very stressful. (See the Counselling section on this website which contains information on emotional responses to infertility and sexuality issues).

There are some procedures which are physically invasive such as daily blood tests, the injections, ultrasound, embryo transfer and especially an IVF egg pick up, all of which takes a physical toll. Apart from the financial cost, there is the time factor which is often overlooked. Taking time off work for injections, tests and procedures often leaves employees in a quandary as to what to tell their employer. Most employers, if patients feel able to tell them, will treat the situation with sympathy and understanding.

Financial stress

Some treatments can be expensive. However, from statistical pregnancy rates particularly with IVF and ICSI, a minimum of 3-4 treatments should be considered to maximise the achievement of a successful outcome.

Informed consent

In order to undertake any ART procedure, patients must be fully aware of the options for treatment, the risks and side effects, the success rates and details of the procedures they are likely to undertake. The specialist will discuss a treatment plan for the cycle with the patient. Some fertility clinics also have an information session at the fertility clinic with a nurse to further consolidate the patient’s understanding of the treatment plan.

For most treatments (except ovulation tracking, semen analysis, hormone evaluation and sometimes ovulation induction) patients are be required to sign consent forms prior to each treatment cycle so that they and the fertility clinic concur on the procedures to be undertaken.

Patients may place any specific conditions into these consents as long as they are within the policies of the fertility clinic. Patients may also vary or withdraw from these consents at any time prior to enacting the specified procedures. (See Intro>Consent and Confidentiality for further information).

All data concerning a procedure will be kept in strict confidence. Only non-identifying treatment data will be made available for studies into the long term effects of ART procedures. (Note that for donor sperm/oocytes/embryos any conceived offspring can access identifying information after age 18, please see Donor section of this website for more information.)