Ovulation Induction and Intra-Uterine Insemination
Ovulation induction (OI) is often used for women an ovulation defect, which is one of the most common causes of sub- or infertility. Ovulation issues are especially prevalent in women with polycystic ovaries, endometriosis and older age.
OI uses oral medications to increase the brains natural production of FSH (follicle stimulating hormone). FSH recruits and grows ovarian follicles, and this is monitored by regular ultrasounds. Once a dominant follicle is large enough, ovulation may occur spontaneously or will be induced with an injection.
Intrauterine insemination (IUI) is then performed a day later (around the time of ovulation). This is done by preparing sperm (to concentrate the healthy spermatozoa) and placing them in the uterus via a soft catheter.
Pros and Cons of OI/ IUI:
- Less invasive and less medications than IVF
- Much lower cost than IVF
- Minimal laboratory involvement (closely simulates normal physiology)
- Lower success rates (per cycle) compared to IVF
- Less diagnostic information than IVF (not able to assess fertilisation or embryo development)
In Vitro Fertilisation
IVF is often promoted as the only option for patients seeking fertility treatment or assistance becoming pregnant. Whilst effective and popular, IVF is more invasive, has greater risks and costs compared to alternatives such as OI/ IUI. At Coastal IVF we don’t push patients into IVF and we believe it should be reserved for those that need it.
Coastal IVF has one of the highest success rates with IVF in the country, and we are so confident in our processes that we offer a second cycle guarantee – this means no out of pocket costs on a subsequent cycle (if you need it)!
IVF – The Process
- Down regulation
- Various medications and regimes may be used to ‘quiet’ your ovaries and stop the normal cyclical recruitment and growth of ovarian follicles. This is an essential step so that when we start stimulation, we can recruit as many follicles at similar sizes.
- Ovarian stimulation
- Injections of FSH (follicle stimulating hormone) are used to recruit and grow ovarian follicles. The goal is to have around 10-15 dominant follicles at the time of oocyte (egg) retrieval.
- Oocyte retrieval (egg pickup)
- Under anaesthesia, a long needle is used to retrieve eggs from each follicle.
- In vitro fertilisation and embryo culture
- Retrieved oocytes are fertilised with sperm in the laboratory and then incubated and monitored until around day 5 of life. At this stage they are known as a ‘blastocyst’
- Embryo transfer
- Embryos are transferred usually 3-5 days after egg retrieval into the women’s uterus and hopefully an implantation occurs.
- Luteal support and monitoring for pregnancy
- Medications are often given to support the early pregnancy and a blood test (b-hCG) is performed around 12-14 days after transfer to check for pregnancy.
Key requirements, pros and cons of IVF
- More demanding than OI / IUI
- Suitable for almost all forms of infertility
- Better success rates per cycle than OI / IUI
- More diagnostically informative than OI / IUI
- May need sperm injection (ICSI) to assist fertilisation
Did you know? Reproductive techniques were revolutionised by the birth of Louise Brown in 1978. This was the world’s first IVF birth and Louise was delivered by a mother who did not have fallopian tubes. This is the routine treatment now offered to patients whose tubes are not suitable for tubal surgery or if tubal surgery has failed.
Intracytoplasmic Sperm Injection
ICSI is a technique in which a single sperm is captured using a fine needle and injected into an egg to cause fertilisation. This is used in cases of male factor infertility where usual fertilisation is impaired.
It is important to recognise that ICSI is an addition to conventional IVF, not an alternative.
- Used to assist fertilisation in cases where it cannot be achieved using conventional in-vitro fertilisation techniques (e.g low sperm count, poor sperm motility or where a vasectomy has previously been performed)
- With ICSI, fertilisation and pregnancy rates in these cases may be comparable to conventional IVF with normal sperm parameters.
- This service is now covered by a Medicare rebate
Testicular Sperm Aspiration
This is a procedure for azoospermic (no sperm in the ejaculate) men. Under local anaesthetic, sperm are extracted directly from the testicle using a fine needle biopsy technique. ICSI is then used to achieve fertilisation.
This procedure can enable some couples (who would otherwise need donor sperm), to achieve a pregnancy with their own genetic material. This is useful in men with prior vasectomy or certain conditions that affect spermatogenesis.
The male requires initial investigations to see if this is an appropriate procedure for him, this involves a physical examination and hormonal profile (a blood test). There may also be a role for chromosome analysis and/or genetic counselling.
TESA is the biopsy technique of choice in men with obstructive azoospermia and replaces the more invasive open biopsy technique. It has a very low complication rate and a rapid recovery.
Frozen Embryo Transfer (FET) Cycle
After a stimulated IVF cycle, there may be a surplus of embryos that can be cryopreserved and used for future cycles. Frozen embryo transfer (FET) cycles begin by preparing the lining of the uterus (the endometrium) to receive a pregnancy. This is done by the natural cycle, ovulation induction or hormonal replacement therapy (HRT).
Once the endometrium is ready, the embryos are thawed and then transferred into the uterus and hopefully implantation occurs. With the advancement of freezing and thawing technologies, FET cycles now have similar success rates to fresh transfers.
Pre-implantation Genetic Testing
- Pre-implantation Genetic Testing (PGT) involves the removal of one or two cells from an embryo to examine the cells for specific chromosomal abnormalities.
- The embryos are biopsied in our laboratory but the cells are sent away to genetic laboratories for analysis. This takes time so PGT requires all embryos to be frozen until the results are received and then a FET cycle can be performed.
- PGT allows us to identify the unaffected embryos for transfer in order to increase successful pregnancy rates (per transfer).