Patients commonly ask us, why should I go privately for my pregnancy care?

There are many benefits to private obstetrics, the main one being continuity of care under the direct management of a single and experienced clinician. This is opposed to the public system where you may see multiple midwives and doctors, and you may be under care with medical / nursing trainees of varying experience.

The obvious downside to private care is the out-of-pocket cost (which may be around $2000 with insurance or up to $8000 without). However, this is a decision that may affect you and your child’s future health. And if you compare it to some of life’s other big expenses (like a car or holiday), it may be a decision worth considering.

Having said that, we are very fortunate to live in a country that offers free public healthcare that is a great option for many patients. Labour is a natural process meaning that most women have uncomplicated pregnancies and deliveries. Unfortunately, it doesn’t always go to plan and sometimes complex and urgent intervention is required to avoid unexpected and at times tragic outcomes. In these highly stressful times, it can be reassuring to know (and trust) the obstetrician caring for you.

The opinions of others, and doctor Google

The opinions of family, friends, others and online research are significant factors that may influence a woman’s decision on public or private care.

It is important to recognise people’s opinions (including ours!) will be biased by personal or political views, and past experiences. This is especially true for a lot of online information, and I suggest that you should always be very wary of anyone who talks in absolutes !

In this article we will try our best to provide a subjective view on the main differences between private and public obstetric care.

Continuity of Care

With private pregnancy care you will see the same obstetrician for all of your visits. This allows you, and your partner to form a bond and trust with the person who will be responsible for the safe birth of your baby.

As a clinician, knowing your patient enables you to recognise changes (sometimes subtle) when they occur. This can lead to early detection, monitoring and interventions that may improve clinical outcomes.

In the public sector, you will often see a different clinician at each visit, and these visits may be few and far between. This can make it hard to establish a relationship and recognise changes or complications when they occur. A potential benefit is that you receive multiple different opinions on your care, however this can also be confusing and frustrating for patients.

Most public hospitals offer midwifery programs where you are assigned to a small team of midwives who will also deliver your baby. This promotes continuity of nursing care but is generally limited to low risk women. Also you may be delivered by a member of their team rather than a specific midwife.

Experience Level

In order to work privately, an obstetrician must have completed their specialty training and be deemed fully independent. This usually means they have spent over 10 years working as a medical doctor. During their training, most obstetricians would have delivered over a thousand babies and gained extensive experience dealing with various obstetric emergencies.

Conversely, in the public hospital you often have no say in who you see. You may see a midwife or doctor in their first year of training, or you may see someone very experienced. Usually, the senior staff act in an overseeing role where they are only involved in event of complications. The level of supervision (of junior trainees) varies greatly between hospitals.

Access to Care

Both public and private hospitals provide 24 hour access to maternity care. One key difference with private obstetrics is that you have 24/7 access to your private obstetrician for phone or in-person advice. And you can book appointments as you need them, with flexibility to work around your personal schedule.

Depending on your location, certain hospitals may only have capacity to care for women beyond a certain gestation (e.g. >32 weeks at Buderim Private Hospital). If you deliver before this, you may need to be transferred to another private or public hospital, often in a large city.

Regular Ultrasounds

Public hospitals deal with a huge number of patients and need to consider the economical costs of healthcare. For this reason, pregnant women are often stratified as low or high risk, and this may dictate the level of monitoring they receive. Unfortunately, antenatal complications can develop even in low risk patients. One of the most common of these is growth restriction – which remains one of the leading causes for stillbirth.

Ultrasound is a fantastic tool for monitoring the growth of your baby and the majority of private obstetricians will scan your baby at each visit, tracking growth throughout the pregnancy. In the public system you will have an ultrasound only at 12 weeks (the nuchal scan) and 20 weeks (the morphology scan). After 20 weeks you will only have a scan if clinically indicated.

Post Delivery Care

In a private hospital you will have your own room where your partner can stay with you and your newborn baby. You will be cared for by your private obstetrician, in addition to hospital midwives, paediatricians and allied health staff. There is no pressure on length of stay and you will be able to go home when you feel comfortable and confident. This may be early (within a few days) or late spending on your personal situation. After discharge you will be closely followed up by your obstetrician.

In public hospitals there is often bed shortages and pressure to discharge patients as soon as it is safe to do so. Postnatal wards vary between public hospitals but often have 2 and 4 bed bays and partners cannot stay overnight. After discharge you will rarely see a doctor and follow up will be with midwives and your GP.

Out of Pocket Costs

Private obstetric fees vary greatly between doctors, and whether or not you have private health insurance. At Coastal O&G you can expect to be about $2000 out of pocket with insurance, and around $8000 if you do not have insurance. This may vary depending on your individual situation.

Many private clinics offer varying models of care to reduce costs for patients. One example is joint care with a public hospital, where you have most of your antenatal care with a private obstetrician but then deliver at a public hospital.

Full public care has no out of pocket costs and this is the major advantage of going publicly.

Pregnancy Care at Coastal O&G

At Coastal O&G you will see your obstetrician for all antenatal visits at our practice in Maroochydore. At each visit you will have an ultrasound to check on the growth and wellbeing of your baby, as well as 3D and 4D images for your enjoyment. On one or two occasions you will have a consultation with the other obstetrician (Ben or Rob) so you can meet and get to know them. We do not share on-call with any other doctors so you are guaranteed to be delivered by an obstetrician you know!

During your pregnancy you will be cared for by a close knit team of midwives, nurses, allied health staff and doctors. You will have ample time to ask questions, discuss concerns and receive education to prepare you not only for labour, but also the exciting time after. You will have contact details for 24/7 pregnancy advice. If you would like to find out more about pregnancy care at Coastal O&G, visit our website or contact our clinic today.

What is Endometriosis and how does it affect my fertility?

Endometriosis occurs when endometrial cells (that normally line the womb) grow outside of the uterus for example on the ovaries or bowel. The condition is more common in older women or those who have not yet had pregnancies. The use of the oral contraceptive pill is protective against endometriosis.

Endometriosis affects fertility in a number of ways including egg development, ovulation, fertilisation and implantation. If identified, endometriosis can be treated (both surgically and medically) to improve pregnancy rates from spontaneous conception or via assisted reproduction (e.g. ovulation induction or IVF).

Aside from fertility issues, endometriosis may cause pelvic pain (often related with periods or intercourse), or some women may have no symptoms at all.

How do I know if I have endometriosis?

Fortunately many women with endometriosis do not experience the classical symptom of period pain. Unfortunately, this makes predicting and diagnosing endometriosis very difficult.

Studies have shown that up to 50% of women presenting with unexplained fertility issues are subsequently found to have endometriosis.

The only way to diagnose (or exclude) endometriosis is via a keyhole surgery known as a ‘laparoscopy.’ This is a day procedure where we are able to directly visualise the presence, location and severity of your disease. At the same time it can be treated by burning or excising the endometriosis.

What are my treatment options?

Endometrial cells grow under the influence of the hormone oestrogen – that is produced by your ovaries. So the main principle behind treatment is suppressing oestrogen production and using progestogens that shrink and breakdown endometrial cells.

Like all things, treatment depends on your individualised clinical situation and desired outcomes. It may range from simple pain relief strategies to hormonal therapies or surgical ablation or excision. It is important to recognise that repeat surgeries are not always beneficial as this is a hormonal disease!

At Coastal IVF we believe strongly in diagnosing and treating endometriosis prior to assisted reproduction, usually with a combination of surgery and medical therapy. We have found this gives our patients the best chances to conceive, often without the need for IVF!

For More Information and Support:

If you suffer from, or suspect you may have endometriosis, come and see one of our doctors today. If you would like more information from trusted resources, follow the links below:

Coastal IVF – Patient Information Brochure on Endometriosis

Endometriosis Australia – https://www.endometriosisaustralia.org/

Jean Hailes Website for Women’s Health: Endometriosis –

https://www.jeanhailes.org.au/health-a-z/endometriosis/

Knowing Your Fertile Window

Unfortunately for some, falling pregnant can be very difficult and a highly stressful time.
Understanding ovulation and your ‘fertile window’ (the time period that you can spontaneously conceive) may help you to fall pregnant.
It is estimated that around 10-20% of couples will not conceive after 12 months of trying. Majority of these couples will have identifiable causes for their impaired or “sub-fertility”. With a proper diagnostic workup these causes may be identified and treated – most of the time without the need for IVF!

Did you know?

Sperm can be found in the fallopian tube (the site of fertilisation) as early as 5 minutes after intercourse and can survive there for up to 5 days!

An egg on other hand can only be fertilised for 12-24 hours after ovulation (the release of the egg from the ovary)

The fertile window begins 5 days prior to ovulation and ends the day after.
However, the highest pregnancy rates (~30-35% chance) occur when intercourse happens 1-2 days before, or on the day of ovulation.
Intercourse at this time results in the greatest number of viable sperm present in the fallopian tube.

How Do I Know When I am Ovulating?

Cycle Charting

• Charting your cycle is useful to estimate your fertile window. There are many free apps that do this for you.
• Ovulation generally occurs ~14 days before your next expected period. However this may vary a few days between individuals and even between each cycle.
• If you have a short, long or irregular cycle then it unlikely you are regularly ovulating. See one our doctors today to investigate why this may be the case.

Home Ovulation Tests (Urine LH Kits)

• Accuracy is usually >90%, they cost ~$2-5 per test.
• If a patient chooses to use these, we suggest starting around 2-3 days prior to expected ovulation (see cycle charting above).
• A positive test indicates ovulation is likely to occur within 24 hours.
• *Unfortunately ~7% of women may have false positive results due to high baseline levels of LH (e.g. women with PCOS).

Symptoms of Ovulation

• In the late follicular phase (just prior to ovulation), rising oestrogen levels cause an increase in stretchy clear cervical mucus.
• Some women may notice unilateral pain or cramping around the time of ovulation.

What About Timing Intercourse?

• Maximal sperm numbers (and function) occurs after ~1-3 days of abstinence (and even up to 7 days normal sperm parameters)
• Shorter intervals may be associated with lower numbers and longer intervals with more abnormal or dead sperm.
• For this reason (and those above) we generally advise intercourse every 1-3 days around the time of your fertile window.
• However, trying to conceive is already stressful enough, so we believe it is most important to focus on retain a healthy normal relationship and sex life.

Follow these links for more information on Understanding Your Menstrual Cycle and Knowing Your Fertile Window

Both without symptoms, they often go undiagnosed until investigations are made by the couple or patient.

For this reason when a couple is looking to start a family with us, we generally do a thorough investigation of both the male and female to ensure we have the best picture of what a couples fertility diagnosis is.

The good news is, after treatment up to 40% of men with these common infertility problems are able to impregnate their partner.

Male tube blockages:

This is any obstruction in the vas deferens or epididymis (the tubes that transport fertile sperm).

Possible symptoms – None.

Possible solutions – Surgery to repair the varicoceles or other obstruction.

Coastal IVF Success rates – About 40 per cent are able to impregnate their partner within a year of surgery, most within six to nine months. Results after Testicular biopsy & sperm injection are no different from standard IVF ie around 40-50% clinical pregnancy per embryo transfer.

Sperm problems:

Low or no sperm counts, poor sperm mobility, and abnormally-shaped sperm can all cause infertility.

Possible symptoms – None.

Possible solutions – Fertility drugs may boost sperm production. Other options include injecting sperm directly into the egg (ICSI) or insemination with donor sperm (AID).

Coastal IVF Success rates – Fertility drugs: About 25 per cent are able to impregnate a partner. Artificial insemination: 5-20 per cent of women become pregnant per cycle. Sperm injection: About 40 per cent of women having treatment at Coastal IVF get pregnant per attempt.

Coastal IVF is proud of it’s success with complex cases & patients who have had unsuccessful treatment at other clinics.
This makes us even prouder of our recently published success rates against national averages.

Recently, the yourivfsuccess.com.au website was launched and heavily reported on across Australian media outlets.
This was not without some controversy, as while the site helps couples and individuals seeking treatment compare clinic success rates, and determine their potential success based on a basic survey, the results & benchmarking does not take in consideration the rates in comparison to complexity of case or the individuals potential success rate based on the experience of their chosen clinic.

This means clinics who take on more complex cases may have lower published success rates, but successes in cases that are classed as more complicated or less likely to succeed compared to clinics that do not take on complicated or previously unsuccessful cases.

At Coastal IVF, we’re proud to treat complicated cases and often help patients who have not had success elsewhere see positive outcomes.
This makes us even prouder of our recently published rates.

In some cases our clinic is outperforming the national birth rate by double!

We also have far less cancelled stimulated cycles (2% vs 8% national average).

Whilst these results are exciting and something that makes our team proud of our commitment to our patients success, we still firmly advocate for couples and individuals that are seeking to start a family, to talk to a professional clinic and undergo thorough individual investigations before they allow an online test such as the one on the yourivfsucess.com.au website to determine their outcome.

At Coastal IVF, we complete a thorough diagnosis of each couple’s fertility & health to ensure the best success in treatment. Where possible, and where couples are able to succeed with other treatments, we avoid costly IVF cycles for our patients whilst still delivering the highest possible success.

See our success rates here

For these women and men fighting infertility, the experience and journey involves many hidden
losses for the individuals, their loved ones and society as a whole, including:

• Loss of the pregnancy and the birth experience;
• Loss of sharing your life and love with a child;
• Loss of a genetic legacy and loss of future contributing citizens to the next generation;
• Loss of the parenting experience;
• Loss of a grandparent relationship;
• Low feelings of self-worth;
• Loss of stability in family and personal relationships;
• Loss of work productivity;
• and Loss of a sense of spirituality and sense of hope for the future.

Because infertility often involves major personal life issues and decisions, it is often experienced as a private matter and is not ordinarily discussed
in public forums.

Infertility has a strong impact on self-esteem.

Suddenly your life, which may have been well-planned and successful, seems out-of-control.

Not only is your physical body not responding as expected but it feels as if your entire life is on hold.
Facing the disappointment of not becoming pregnant month after month can lead to depression for both you and your spouse.

The personal and often private nature of the infertility experience and journey contributes to the failure of the public, politicians, healthcare
professionals and the media recognizing infertility as a disease. This causes a lack of sound knowledge and available resources about infertility.

It is important that you don’t go through this alone & recognise infertility is not rare.

If you are concerned or not coping, speak with the team at Coastal IVF who provide support for many couples or individuals facing the same issues.

If you or someone you know is struggling with depression, please seek help and access resourced provided by Beyond Blue at:
https://www.beyondblue.org.au/