After Hours Medical Emergency Only
Page Dr Gareth Weston
Fertility Treatment Options
One in six Australian couple will have difficulty achieving a pregnancy. If you have been having unprotected intercourse for more than twelve months and have not achieved a pregnancy, you should see a doctor. If the female partner is over the age of 35, you should see a doctor after six months of trying.
There are many and varied reasons why a couple may have difficulty conceiving, including no apparent reason at all (idiopathic infertility). 40% of infertility is male factor, 40% female factor and 20% combined or idiopathic.
Just as the causes of infertility are many and varied, so are the treatment options. Minor disorders for example, mild endometriosis, ovulation disorders (including Polycystic Ovarian Syndrome), mild sperm defects and sexual (including erectile) dysfunction can be treated by relatively simple measures.
We do not do IVF in this facility or offer Donor Sperm. The majority of our treatment is Controlled Ovarian Hyperstimulation (COH), Ovulation Induction (OI), Intra Uterine Insemination (IUI) or Natural Cycle tracking and timing of intercourse.
For women whose cycles are irregular or absent, ovulation is either happening infrequently or not happening at all. In this instance ovulation may be induced.
OVULATION INDUCTION (O.I) refers to medication being given to help you grow and ovulate an egg when you do not usually ovulate.
CONTROLLED OVARIAN HYPERSTIMULATION(COH) refers to medication being given to enhance ovulation in women who normally ovulate.
It can be done in two ways;
1) TABLETS (Clomiphene Citrate, Clomid, Letrozole)
Comes in an oral tablet form and is usually taken from day 2 or 3 of the menstrual cycle (or induced bleed) for 5 consecutive days. Clomiphene/Letrozole stimulates the hypothalamus (part of the brain), which in turn stimulates the pituitary gland to produce Follicle Stimulation Hormone (FSH) and Luteinising Hormone (LH), which then stimulate the follicles within the ovaries to grow eggs.
A response is usually seen after a week, but this may vary. City Babies can monitor the ovarian response using vaginal ultrasound and blood tests thus determining the best time to have intercourse or insemination of sperm. In some instances an injection of Human Chorionic Gonadotrophin (HCG) may be given to release the egg(s).
Side effects include hot flushes, stomach upset, visual disturbances and irritability. The risk of multiple pregnancy is increased to approximately 7%.
Clomiphene/Letrozole is successful in inducing ovulation in about 80% of women and about half will conceive within 6 cycles (age depending).
If you do not fall pregnant within 6 cycles, or Clomiphene citrate/Letrozole is ineffective in inducing ovulation for you, medication containing Follicle Stimulating Hormone (FSH) may be prescribed as the next step.
TYPICAL CYCLE INCLUDES:
2) GONADOTROPHINS (THESE ARE SYNTHETIC FORMS OF FSH,LH AND HCG)
These are all hormones found naturally in humans.
FSH (PUREGON, GONAL F)
Is a hormone produced by the pituitary gland at the base of the brain. It acts directly on the ovaries to enhance the growth of follicles (fluid filled sacs that contain the eggs).
It is administered as a subcutaneous injection (under the skin in to the fatty tissue) into the abdomen (below the navel and above the pubic line). These injections are either self administered or given by your partner (or other person). FSH begins the 3rd day of the period and is continued daily until 1-3 mature follicles are ready to be ovulated. On average this takes about 8-10 injections, but response varies depending on age and diagnosis.
Side effects are usually mild and include bruising at the site of injection, abdominal bloating and tenderness and backache.
HCG ( OVIDREL, PREGNYL)
Once mature eggs are visualised on ultrasound, the FSH is ceased and an injection of HCG is given. This aids in the final maturation process and causes the release of the egg from the ovary approximately 36-40 hours after the injection is given. Again this injection is administered at home in the same manner as the FSH. You will then be informed by the staff when the most appropriate time is to have intercourse or insemination of the sperm.
Side effects include sore breasts, nausea, fatigue, mood swings and backaches.
Is only used in cases where the woman is shown to produce very little or none of her own LH. It is again, self administered in conjunction with FSH during the stimulation of the ovary.
For instructional videos on how to inject, see use ful links below.
TYPICAL CYCLE INCLUDES
Both forms of OI and COH usually commence after a period begins. If cycles are irregular or absent, a period can be induced using a progesterone tablet (Primolut or Provera). This medication is usually taken for a period of 5 (or more) days then stopped. A withdrawal bleed usually commences within 3-5 days of stopping the tablet.
A cycle can also be commenced without a period if conditions are favourable following blood test and vaginal ultrasound examination.
ARTIFICIAL INSEMINATION refers to sperm being placed directly in to a woman's reproductive tract.
Intra Uterine Insemination (IUI) involves sperm being inserted directly in to the uterus around the time of ovulation to reduce the distance travelled to the egg(s).
This procedure is commonly used in conjunction with OI or COH in the female partner when there may be problems of endometriosis, minor problems with semen volume, concentration and motility, physical problems with intercourse, poor or absent cervical mucous and idiopathic infertility.
Firstly the sample must be produced by masturbation. This can either be done at home , or in the purpose designed room at City Babies. The sample is assessed for initial count and motility before being prepared for insemination. City Babies uses swim up technique for sperm preparation, allowing gentle separation of the most motile sperm from the liquid part of the semen. This takes about 1 ½ hours. A special culture medium is used during this procedure.
A speculum is inserted in to the vagina (similar to a pap smear) so the opening to the uterus (cervix) is visualized. A thin catheter containing the sperm is passed through the cervix and in to the uterus. It takes only a few minutes to do with minimal discomfort usually. The woman then reclines for 5-10 minutes then is able to leave the clinic.
Side effects include mild abdominal cramping and vaginal spotting. In rare cases, feeling faint, nauseas and clammy may occur but disappear relatively quickly after the procedure.
The pregnancy rate at City Babies around 15% per cycle started. 70% of our pregnancies end in a live birth. This includes women of all ages and causes of infertility.
The success rate is cumulative and increases if 3-4 cycles of treatment are done in a 6-12 month period.
As women get older, the chances of conceiving decrease. In women over 40 years old the success rate is less than 10% and live birth rate of 5%.
Similarly, when men are over the age of 45, their partners will take 5 times longer to conceive.
RISKS AND COMPLICATIONS
Every care is taken to prevent this complication caused by multiple eggs being produced and ovulated at one time.
Cycles are monitored closely with ultrasound and blood tests to reduce the risk. If there are more than 3 follicles that may contain mature eggs, the cycle maybe suspended and appropriate precautions must be taken to avoid pregnancy. Approximately 5% of cycles are stopped for this reason.
In OI and COH cycles the risk of twin pregnancy is 15-20% and
OVARIAN HYPERSTIMULATION SYNDROME.
Excessive stimulation of the ovaries from FSH combined with the use of HCG can lead to the production of large amounts of follicles and a resulting high level of oestrogen in the blood. This leads to severe pain, nausea, vomiting, diarrhoea, shortness of breath and weight gain caused by retention of large amounts of fluid.
This is a totally preventable complication. If the condition is suspected from ultrasound and blood monitoring during the cycle, the HCG injection must be withheld. Without the HCG the condition cannot develop. This complication is rare in OI and COH due to the small doses of medications given.
CLOMID/LETROZOLE OR NATURAL CYCLES $150
Includes all monitoring with ultrasounds and blood tests.
CLOMID/LETROZOLE OR NATURAL CYCLE WITH IUI $350
Includes all monitoring with blood tests and ultrasounds, sperm preparation and IUI.
If a trigger injection is required it will be an additional fee to the pharmacy of around $62.
OVULATION INDUCTION WITH GONADATROPHINS (INJECTIONS) AND TIMED INTERCOURSE $650
Includes all monitoring with ultrasounds and blood tests. Medication is additional and will cost approx $130
CONTROLLED OVARIAN HYPERSTIMULATION AND INTRAUTERINE INSEMINATION $950
Includes all monitoring with ultrasounds and blood tests, sperm preparation and insemination. Medication is additional and paid to a pharmacy and will cost around $85.
Useful links for more information regarding these fertility issues and more, click on the following links :