Treatment and Fertility Preservation Options

Treatment Options

Your personalised fertility journey starts with an investigation of both partners health.

Your personalised fertility journey starts with an investigation of both partners’ health.

We take a holistic (whole of body) approach, which includes assessing the influence of physical and lifestyle factors on your fertility. Working closely as a team, your fertility specialist will create a customised treatment plan outlining the ideal laboratory and clinical approaches for you.

Our team will be with you every step of the way to provide support and advice so we can achieve our shared goal: for you to take home a healthy baby. It’s important to know you are not alone in seeking fertility treatment. It is probably much more common than you think.

Assisted reproductive technology (ART) refers to the scientific methods that are used to unite sperm and eggs. The most common ART procedures are:

There are also some lower intervention ART procedures such as:

Many couples require minimal intervention to achieve a pregnancy, while others need to undergo procedures such as IVF or ICSI. In recent years, more than 70,000 cycles of treatment with ART have been performed in Australia each year, resulting in one in every 24 babies born in Australia a result of some form of ART – that’s approximately one child in every classroom.

After more than 30 years of helping couples and individuals realise their dream of having a baby, we are here to provide advice that is suitable to your needs. If you are ready to embark on treatment, the next steps in your fertility journey are explained here.

In vitro fertilisation (IVF)

This technique involves placing an oocyte (or egg) and sperm together in a laboratory. Once fertilisation takes place, the embryo is transferred to the uterus to hopefully implant and become a pregnancy.

IVF is used to treat a range of fertility issues including:

  • low sperm count
  • fallopian tube damage, for example as a result of endometriosis
  • female’s age
  • ovulation problems, for example, caused by polycystic ovary syndrome (PCOS).

Your Westmead Fertility Centre fertility specialist along with our embryologists will determine if IVF is the right course of treatment for you, based on your specific situation.
In standard IVF treatment, a couple’s own sperm and oocytes are used. In certain circumstances when this is not possible, donated eggs or sperm will be used.

Intra-cytoplasmic sperm injection (ICSI)

This is a laboratory technique used when successful fertilisation of the oocyte (or egg) cannot be achieved with standard IVF.

While IVF allows the sperm to penetrate the egg of its own accord, in ICSI, a single sperm is directly inserted into the oocyte.

ICSI may be used if:

  • the number of sperm available is too few to expect fertilisation with IVF
  • fertilisation has not occurred in previous IVF cycles despite a high number of sperm being present, or
  • the only sperm available are those that have been collected directly from the testis.

It’s not always possible to say in advance whether IVF or ICSI will be necessary to achieve fertilisation of your oocytes. After taking into account the outcome of the sperm assessment, preparation and your relevant history, our embryologists, along with your fertility specialist, will decide whether to proceed with IVF or ICSI. Generally, if we believe that the sperm has the ability to fertilise the egg without assistance, we will proceed with IVF. If the sperm needs help, our embryologist will proceed with ICSI.

Our recommendation will be discussed with you following oocyte pick-up (OPU) procedure. Unfortunately, not all oocytes are suitable for sperm injection. Some may be immature and may not survive the injection process.

Embryo cryopreservation

After embryo transfer in either an IVF or ICSI cycle, any remaining good quality embryos can be frozen and stored for later use through a process known as cryopreservation.

If pregnancy does not occur in the IVF or ICSI cycle, your frozen embryos may be thawed and transferred in a later cycle – this is called a frozen embryo transfer (FET) cycle. Frozen embryos may be thawed and transferred in an FET cycle, even several years later.

Embryo cryopreservation is an essential part of a comprehensive fertility service. This allows embryos to be placed into the uterus at the optimal time (at a later date) and allows full use of all good quality embryos. Around half of our patients at Westmead Fertility Centre generally have embryos available for freezing. We successfully freeze embryos on Day 1, Day 2, Day 3 and Day 5 of their development.

At Westmead Fertility Centre, we have invested in the latest vapour phase tank technology to provide the optimal storage environment and we have a very successful freezing and thawing process.

The success rate from frozen embryo transfers is on par with fresh embryo transfers. This is why freezing your embryos is an obvious option. It means you will undertake fewer fresh cycles if you need future treatment and you’ll be using embryos created while you are younger – which can make a difference to your success.

Embryos being frozen and stored for future use in our vapour phase tanks
Embryos being frozen and stored for future use in our vapour phase tanks

The importance of transferring one embryo at a time

Intrauterine insemination (IUI)

This process, also known as assisted insemination (AI), involves placing specially prepared semen directly into the woman’s uterus. Sperm can be provided by the woman’s partner or from a sperm donor.

IUI may be used if:

  • the couple have unexplained infertility and wish to try a lower intervention form of assisted reproduction technology
  • the couple need to use donor sperm
  • the male partner is unable to ejaculate into the vagina near the cervix
  • sperm may not be able to move from the vagina, through the cervix, into the uterus or
  • there may be emotional or psychological problems which prevent normal sexual intercourse despite appropriate counselling.

Frozen embryo transfer (FET)

Embryos can be frozen and stored for later use through a process known as cryopreservation. At Westmead Fertility Centre, we will customise your cryopreservation process and offer either slow freezing or vitrification, depending on your circumstances and the stage of development of the embryos.

If pregnancy does not occur in the original fresh IVF or ICSI cycle, the frozen embryos may be thawed and transferred in a later cycle – this is called a frozen embryo transfer.

Frozen embryos may be thawed and transferred at the appropriate time in a subsequent FET cycle, even many years later. If your menstrual cycles are normally regular, medication to stimulate the ovaries is not required in a cycle in which thawed embryos are transferred. It is only necessary to ‘track’ that cycle for a few days prior to the expected day of ovulation, to find the optimal time to transfer the embryos.

Freeze-all cycles

Sometimes when patients are undergoing an IVF or ICSI cycle, it is discovered that the uterus lining (endometrium) may not be optimal for a fresh transfer in that particular cycle. In this circumstance, we use our highly successful freezing methods to store all of the embryos created – we call this a freeze-all cycle.

Westmead Fertility Centre is leading the way in offering freeze-all cycles as a chance to maximise your treatment outcomes. Our research demonstrates that sometimes it’s best to hold off on a fresh transfer and wait until your body has recovered from the effects of ovarian stimulation before attempting to implant an embryo. In this scenario, the embryo will be transferred during a subsequent natural frozen embryo transfer cycle – without the need for additional drugs.

More than 95 percent of embryos frozen using this method will survive and cleave after thawing at a later date and a single blastocyst will be transferred. As a result, we are able to help you achieve success in the fewest number of stimulated cycles possible.

For some of our patients this will mean just one stimulated cycle and a number of frozen embryo transfer cycles to achieve a pregnancy. If a freeze-all cycle is best for you, our team will recommend it to you while your cycle is progressing and ensure you are informed of your options along the way.

Ovulation tracking and ovulation induction

Ovulation is the process of an oocyte (or egg) being released from one of the ovaries. This usually happens once every month in women between the ages of 13 and 50 years, except when she is pregnant or taking the oral contraceptive pill.

However, in some women, ovulation does not occur regularly. Ovulation may occur only once every six to eight weeks, once every few months, once or twice a year, or perhaps never, unless they are given treatment to stimulate the ovaries.

It is also quite common for women who have regular periods to have one or two cycles a year in which they do not ovulate, but still have a period of bleeding around the expected time.

Many couples want to know what they can do to improve their chance of conceiving. Your fertility specialist will discuss with you if ovulation tracking is right for you as a first step. It is a simple option that involves conducting a series of tests to help you understand your natural fertility and plan when to have sex to maximise the potential of getting pregnant.

The term ‘ovulation induction’ (OI) is used to describe the process of stimulating the ovary to produce a mature oocyte (egg) and causing the release of the oocyte (ovulation). If sexual intercourse occurs at this time and the oocyte is fertilised by the sperm, a pregnancy may occur.

The common medications used to induce ovulation can be either in the form of oral or injectable medications and may include:

  • Clomiphene Citrate (Clomid, Serophene) and Letrozole (Fenara). These are oral medications used for five days in the early stage of the menstrual cycle. The dose may vary, depending on your history or previous response (if applicable).
  • Metformin (Diabex, Diaformin). This is an oral medication which can help control insulin resistance or impaired glucose tolerance in women, a common finding in women with irregular cycles caused by polycystic ovarian syndrome (PCOS).
  • Gonadotrophic injections (Gonal F, Puregon, Menopur). These are given by subcutaneous injection into the lower abdomen. Either medication can be used on a daily basis or until a mature follicle or follicles are seen by ultrasound monitoring. Due to the increased risk of multiple pregnancy, this treatment option will require frequent monitoring by testing hormone levels and ultrasounds. Once the chance of a multiple pregnancy has been excluded, ovulation will be triggered by an injection of another gonadotrophin (Pregnyl, Ovidrel).

Preimplantation genetic diagnosis (PGD)

Certain genetic conditions can cause birth defects or start to show up as a child develops. Knowing you have a family history of a genetic disease or being of advanced maternal age, can increase the likelihood of your baby having such a condition.

In a standard IVF or ICSI fertility treatment cycle, a choice must be made about which embryo to transfer to the uterus based on the morphology (or appearance) of the embryos.

Advances in scientific techniques mean preimplantation genetic diagnosis (or PGD) gives us another factor on which to base our decision – the genetic health of your embryo. PGD is a treatment that may be recommended for couples whose children are at risk of inheriting a specific genetic disease or an abnormality associated with the chromosomes. PGD allows us to avoid embryos that contain an identifiable genetic abnormality.

Testing generally involves a molecular examination for a particular gene or genetic mutation that has been identified in your family. To make sure the embryos don’t carry the genetic disease, a few cells are taken out of the embryo (biopsied) and genetically tested. A healthy embryo will be transferred, based on the result of the test.

Preimplantation genetic screening (PGS)

This is similar to preimplantation genetic diagnosis (PGD), but instead of testing for a genetic disease or abnormality, the cells taken from the embryo are genetically screened to make sure the embryo contains the right number of chromosomes (46).

Oocyte (egg), sperm and embryo donation

There are various reasons why a couple or an individual may need to access donor oocytes (or eggs), sperm or embryos. Westmead Fertility Centre facilitates ‘known donation’ whereby a recipient (and their partner, if applicable) present with a donor known to them. Westmead Fertility Centre does not import oocytes, sperm or embryos for the purpose of donation nor locate a donor for a recipient or vice versa.

Oocyte, sperm or embryo donation is a complex process with various social, emotional and medical implications. As an accredited ART facility, Westmead Fertility Centre complies with various State and Federal legislations and guidelines and prioritises the safety and well being of all parties involved in the donation process. The donation journey can therefore be a lengthy process with a requirement for a number of essential medical appointments and tests (for both the recipient/s and donor/s), counselling sessions (which partners, if applicable, are required to participate in) and genetic counselling and screening requirements. Both the donor and recipient must be willing and able to attend various appointments at Westmead Fertility Centre, understanding that the process may take several months to complete and that there is no guarantee of success.

Since the introduction of the NSW Central Register in 2010, the birth of any child conceived using donor oocytes, sperm or embryos must be recorded on the ‘Central Register’, in addition to certain identifying information about the donor and the recipient. A donor-conceived child can access their donor’s identifying information from the Register once they reach 18 years of age. It’s important to be aware that the donor has no legal obligations to any child born as a result of the donation and the recipient (and her partner, if applicable) will be the legal parents of any child(ren) born. We encourage you to seek further legal advice regarding the laws surrounding oocyte, sperm and embryo donation and your particular scenario.

At Westmead Fertility Centre, you will be assisted and supported along the donation journey by our dedicated Donor Coordinator. Your questions are welcomed at any time and we will endeavour to explain each step and ensure clarity and understanding throughout the process. 

The donation journey commences with ‘the donor work-up’. Briefly, this commences with both the recipient and donor having a phone consultation with the Donor Coordinator to determine initial eligibility and to explain the donation process. Next, the donor will have an appointment with their Fertility Specialist for pre-approval to donate. Both the donor and recipient (and their partners, if applicable) will then be ready to commence the counselling sessions to discuss the implications of donation. Genetic screening and further counselling will follow, with a final medical consult scheduled at the conclusion of the work-up process to sign consents and discuss the treatment cycle.

It’s important to note that, in Australia, donors receive no financial gain, consideration or similar benefit from donation. Any donor coming from overseas must travel on the appropriate visa and hold adequate medical insurance for the procedures to be performed in Australia.  Our team or Donor Coordinator can provide more detailed information.

Oocyte donation

Oocyte donation may be an option if:

  • A woman’s own ovaries do not produce oocytes, possibly due to premature menopause, following chemotherapy treatment for cancer, or other reasons.
  • A woman has a known genetic disorder, or is a carrier to a genetic disorder that may be passed to her children.
  • A woman has had her ovaries removed, or was born without ovaries.
  • A woman has had several unsuccessful IVF or ICSI cycles where the problem has been attributed to her oocytes.

At Westmead Fertility Centre, a woman requiring donated oocytes is required to have an identified oocyte donor between 25-38 years of age who has not travelled to a country with current Zika virus infection in the last six months. Following the donor work-up process and oocyte collection, any embryos created will be frozen in quarantine for three months and the donor will be re-screened at the end of this period. Once cleared, the embryos may be utilised by the recipient in a frozen embryo transfer cycle.

It’s important to note that the donor is able to alter or withdraw their consent up until the embryo(s) are created using the recipient partner’s sperm.

Sperm donation

Donor sperm may be an option if:

  • A male has no sperm or a very poor semen analysis (for example, a low sperm count, poor ability to move and abnormally shaped sperm).
  • A male has a known genetic disorder or is a carrier to a genetic disorder that may be passed to her children.
  • For same-sex relationships.

At Westmead Fertility Centre, a woman or couple requiring donated sperm must have an identified sperm donor aged between 21-60 years of age who has not travelled to a country with current Zika virus infection in the last six months. Following the work-up process, the sperm donor will make several donations and the sperm will be frozen. The sperm will remain frozen in quarantine for three months and the donor will be re-screened at the end of this period. Once cleared, the donated sperm may be utilised by the recipient either in an intrauterine insemination cycle or to create embryos following the recipient’s oocyte collection cycle.

It’s important to note that the donor is able to alter or withdraw their consent up until the sperm is utilised via intrauterine insemination or the embryos/s are created using the recipient oocytes.

Embryo donation

Embryo donation may be an option if a couple or individual requires both oocyte and sperm donation.

Some Westmead Fertility Centre patients may have completed their family and have embryos remaining in storage. Depending on the number and quality of embryos remaining and the age of the couple (the female of the donating couple must have been aged 38 years or younger and the male 60 years or younger at the time the embryos were created), these couples may choose to donate their remaining embryos to a recipient known to them. Due to the complex nature of embryo donation, donation cannot occur until at least three months following the donors’ initial individual counselling session.

It’s important to note that embryo donors can alter or withdraw their consent up until the recipient’s embryo transfer procedure.

Fertility preservation options

Fertility preservation for female cancer patients

Some forms of medical treatment, particularly chemotherapy and radiotherapy, can have an adverse effect on fertility in women. This generally occurs as a result of a toxic effect on the ovary leading to permanent death of the oocytes (eggs) in the ovary.

When girls are born, they have all the eggs they will ever have, which are released over time throughout the rest of their life. Unlike men who continually make sperm throughout their lifetime, women cannot make any new eggs. Therefore, any eggs which are lost or damaged through medical treatment can never be replaced.

Oocyte and embryo storage

At present, there is unfortunately no proven way to protect the ovaries against the effects of cancer treatment. The only option that is readily available, and which offers a reasonable chance of future pregnancy, is for the woman to undertake in vitro fertilisation (IVF) before she undergoes the medical treatment that could damage her ovaries, followed by storage of the resulting oocytes or fertilised embryos.

The IVF procedure takes approximately two weeks to complete, so the patient needs to be able to safely delay chemotherapy or radiotherapy treatment over this time. For some forms of cancer treatment, delay or ovarian stimulation with hormones is not advisable. Our team of fertility specialists are experts in this area and will work with the other members of your medical team to advise you of the options available to you.

Ovarian tissue storage

By having a small piece of your ovary collected now and stored deep-frozen, you may be able to use it at a later date in one of two ways:

  1. Complete oocyte maturation in the laboratory. This is being researched around the world, but is not available clinically at the present time.
  2. Surgical reimplantation of the removed piece. It is possible to surgically replace the small piece of ovary once the chemotherapy or radiotherapy treatment has been completed. This has now been used successfully in a small number of women, resulting in the birth of healthy babies.

Westmead Fertility Centre is pleased to be able to offer bulk billed payment for some fertility preservation scenarios in order to provide additional support to our patients at this difficult time.

Fertility preservation options for females

 

Fertility preservation for male cancer patients

It is possible that the chemotherapy drugs or radiotherapy that you are due to receive may have an adverse effect on your sperm. This temporary, or sometimes permanent, effect may make it more difficult for you to father children. The likelihood of damage to your sperm production depends on the exact nature and dose of your treatment, but it is often not possible to predict the results. Whatever the treatment, you will still produce semen (fluid) when you ejaculate but there may be no sperm present in this fluid.

Semen storage

Freezing semen (semen cryostorage) may be an option for you. The aim of storing frozen semen before chemotherapy or radiotherapy, is to offer a potential backup in case the treatment does affect your sperm production. However, if your sperm function recovers after your treatment, you may not need to use these stored samples.

The first step is to discuss your situation with your fertility specialist and obtain a request for fertility preservation at Westmead Fertility Centre. You will need to attend a laboratory appointment for our team to carry out an assessment of the sperm in the sample you provide and freeze the sample for storage until your fertility potential is reassessed.

If you need to rely on stored semen to try to achieve a pregnancy, it will be thawed and used for either intrauterine insemination or in vitro fertilisation. Semen remains viable for many year when frozen and hundreds of thousands of children have been conceived worldwide using stored semen.

Fertility preservation options for males

Success Rates

The chance of a couple with no fertility problems achieving a pregnancy naturally in any month is approximately 25 percent. If this couple keeps trying, over 12 months the cumulative chance of pregnancy increases to approximately 85 percent. Similarly, with fertility treatment the overall chance of achieving a pregnancy increases with the number of treatment cycles completed.

It’s important to understand that not all couples have an equal chance of achieving a pregnancy. The most important factors influencing success rates are:

  • the age of the women – as a female’s oocytes (or eggs) age, the chance of pregnancy decreases (read more about how age can affect fertility).
  • lifestyle factors such as smoking, drinking alcohol and obesity (read more about how healthy lifestyle choices can improve your fertility)
  • the reason for infertility.

When comparing success rates between clinics, you should ask if their success rates are compliant with Reproductive Technology Accreditation Committee (RTAC) guidelines. For further information on success rates, refer to the Fertility Society of Australia’s consumer guide on how to choose an IVF clinic and understand success rates.

How to choose an IVF clinic and understand success rates

At Westmead Fertility Centre, we are committed to improving outcomes from fertility treatment through consistent investment in our laboratory and clinical approaches.

For example, we have been leading the field in Australia by using freeze-all cycles

Read more about our commitment to ongoing research and innovations at Westmead Fertility Centre.

How to choose a fertility clinic

Why IVF labs are important to fertility treatment success

IVF clinics and success rates

Westmead Fertility Centre 2017 treatment cycle clinical pregnancy and live births per embryo transfer. Data is presented in accordance with the Reproductive Technology Accreditation Committee (RTAC) Code of Practice.

  1. Fresh embryo transfers include IVF, ICSI and some PGT cycles
  2. Frozen embryo transfers include some PGT and 28 donor oocyte and 3 donor embryo cycles.

Steps in your journey

The first step in your fertility journey is to consider how long you’ve been trying to get pregnant.

The term ‘infertility’ is generally used if:

  • a couple has not conceived after 12 months of regular unprotected intercourse if the women is under 35 years of age, or
  • a couple has not conceived after six months of regular unprotected intercourse if the women is over 35 years of age.

A more accurate term for most couples having difficulty conceiving is ‘sub-fertility’, which means the ability to become pregnant is diminished. It does not mean that you are unable to have children, but that you may require treatment or assistance to achieve a pregnancy. For most people, having trouble falling pregnant comes as a surprise, but in reality, up to one in six couples in Australia has difficulty conceiving.

If the female partner is under 35 years of age and you have been having unprotected intercourse for less than 12 months, there is no need to be concerned about not falling pregnant. Contrary to popular belief, it is not ‘easy’ to become pregnant. However, there are some pre-existing or past medical conditions that may be playing a role. Use our checklist below to know when to seek help sooner.

If you tick any of the boxes below and have not fallen pregnant within six months, regardless of your age, it is recommended that you make an appointment with one of our fertility specialists:

  • irregular or absent menstrual periods
  • have used an intrauterine device (or IUD) in the past for birth control
  • difficulties with sexual intercourse
  • a history of pelvic infection
  • chronic pelvic pain
  • breast discharge
  • history of sexually transmitted infection
  • excessive acne or facial hair
  • experienced two or more miscarriages
  • prostate infections in the male partner
  • sterilisation reversal in either partner.

In summary, it is time to schedule an appointment with one of our fertility specialists if:

  • you are a female under 35 year of age and have been having unprotected intercourse for more than 12 months, or
  • you are a female under 35 yeas of age and you or your partner tick any of the boxes on the above list and have been having unprotected intercourse for more than six months, or
  • you are a female over the age of 35 and you have been having unprotected intercourse for more than six months.

Next steps:

  • Ask your general practitioner (GP) or specialist to provide you with a referral to a Westmead Fertility Centre fertility specialist. See ‘Meet our experts’ tab > ‘Fertility specialist team’ tab for a complete list of our fertility specialist and their bios. This will ensure you are able to claim benefits from Medicare, which will cover a significant amount of the treatment costs. It is important that both partners’ names are included in the referral letter as further testing and treatment will usually involve both partners (if you are a couple). Download a printable referral letter to take to your GP or specialist.

  • If you are a couple, you will both need to attend the initial consultation with our fertility specialist, which usually takes around one hour. You will need to bring your referral and any other prior test results. Your fertility specialist will discuss your medical history, conduct a physical examination and generally order further tests and investigations. The most appropriate treatment for your situation may be discussed and explained or this may occur at a later visit after test results have been received and reviewed.

There are many benefits of having treatment at Westmead Fertility Centre and its important you let your fertility specialist know your preference for our centre at the time of your consultation. You will be asked to sign treatment consent forms specific to Westmead Fertility Centre and be advised about our affordable treatment fees.

It’s important to note that an appointment with a fertility specialist does not necessary mean you will embark on fertility treatment with assisted reproductive technology. Your treatment may include other testing or investigations, medications, lifestyle changes, or low-intervention strategies to assist you to achieve a pregnancy.

Start your fertility journey with Westmead Fertility Centre

There are many ways to start your fertility journey.
Please choose the path that best suits your stage, or give us a call for guidance.