“I think the hardest part is actually making the initial appointment to see a Fertility Specialist. The whole fertility/IVF pathway can seem quite daunting until you actually realise that we will support you the whole way through the journey.” If there were any words to hear before embarking on IVF, these are it...
Comfort and reassurance from Fertility Specialist Dr Rachael Rodgers from Genea, who has simplified and explained in detail how the entire IVF process works and what you can expect when you make your first appointment with a fertility doctor.
From knowing when to get fertility help (only 50% of Genea patients actually need IVF to fall pregnant), to understanding how the process works, what the future holds for IVF and how egg freezing, age and miscarriages can impact on future pregnancies, this is the ultimate guide in understanding IVF and all that it encompasses.
For more information, go to www.genea.com.au
If you are considering undertaking IVF, or are about to undergo a cycle, Genea’s Dr Mark Livingstone will help you understand the process
Can you explain IVF?
IVF stands for in vitro fertilization. It refers to any procedure in which we fertilize an egg outside of the body, with the later transfer of an embryo back into the uterus. In IVF, we stimulate the woman to encourage her body to produce as many eggs as possible before collecting them in a short procedure in day surgery. Once we’ve collected the eggs and then the sperm from the man, we bring them together in a dish in our lab and then develop the resulting embryos in our world-leading incubation system, Geri.
The right time to consider IVF is different depending on each individual’s situation. I generally encourage couples to come and see me after a few months of unsuccessfully trying to conceive. This allows me to do a full fertility workup to make sure that there is no obvious reason that a couple would have difficulty conceiving. For example, I always check that the fallopian tubes are unblocked, that a woman is ovulating regularly and that there is an adequate amount of sperm in the male partner’s semen analysis. If there is a problem with any of these factors, conceiving naturally would be difficult (or impossible in some situations) so medical treatment – which may or may not involve IVF – would be immediately indicated.
If there is no problem found, it might just be that the couple needs to try naturally for a little longer. They may also want to enrol in Genea’s ovulation tracking program, so they can track three menstrual cycles for free to find out exactly when the woman is ovulating so the couple can ensure that they are having intercourse at the right time in order to conceive. It’s important to note that only 50% of patients who see a Genea Fertility Specialist actually need IVF to get pregnant.
An early fertility assessment means that couples aren’t going to waste time trying to conceive when the likelihood of natural conception is very low. If all the results are acceptable then, as a general rule, I would suggest couples under 35 years of age try to conceive for 12 months, and couples over the age of 35 years trying to conceive for six months before we start talking about interventions.
“ As a general rule, I would suggest couples under 35 years of age try to conceive for 12 months, and couples over the age of 35 years trying to conceive for 6 months before we start talking about interventions ”
Take us through the stages/steps of IVF at Genea?
The first step is always to see a Genea Fertility Specialist for a full fertility assessment of both partners. If the decision is made to proceed with IVF, your Fertility Specialist will write a personalised treatment plan which is sent through to your Nursing Team at Genea. A Genea treatment co-ordinator will then be in contact to arrange an appointment so the couple can meet their nurse and see one of our specialist Fertility Counsellors.
The actual IVF cycle involves the woman having a series of fertility medication injections, with monitoring of blood tests and ultrasounds over a period of approximately 10 days. Once the woman’s follicles have reached the right size and number, her nurse will instruct her to have the trigger injection. Two days after the trigger injection, the woman will come into our day surgery for a short egg collection procedure. The male partner provides a sperm sample on the same day. We then combine the eggs with the sperm in the lab before developing any resulting embryos in an undisturbed environment in our unique incubators called Geri. These incubators are installed with time-lapse cameras, allowing our patients to see photos and short videos of their developing embryos through the Grow by Genea™ app. After five or six days of development, the embryos are ready to be implanted into the uterus and then we wait two weeks before sending the woman for a pregnancy test.
What stage do women typically find to be the most challenging and how do you help them through this stage?
I always allow a full hour for the initial appointment, as it not only allows me to take a detailed medical history from both partners, it also provides time for the couple to ask all questions they need to and for us to discuss any hesitations or concerns they have regarding the fertility treatment process.
Many women are initially apprehensive about having daily injections, but most of our hormone injections can be given by an injecting pen (a bit like the injecting pens that people with diabetes use). Often patients tell me that the injections were not nearly as bad as they thought they would be.
Other people find that the most challenging time is the five days in which their embryos grow in the lab as they are no longer playing an active role and instead simply have to wait. The Grow app helps with this time, as it gives our patients a greater connection and understanding of what’s happening with their precious embryos in the lab.
The other really challenging period for patients is what’s known as the ‘Two Week Wait’. That’s after all of the treatment has taken place and the patients are waiting until it’s the right time to do a pregnancy test. I encourage my patients to focus on themselves during this period, to spend time doing things that they enjoy and find relaxing, rather than constantly worrying about the pregnancy test result.
What is the typical success rate of IVF?
This is a question that I frequently get asked and can be very difficult to answer. A couple’s chance of having successful fertility treatment largely depends on the age of the female partner and the reason they are having difficulty conceiving. The likelihood of success for one couple may be very different to the likelihood of success for another couple. I can provide general statistics such as that at Genea, women under the age of 30 years have a 45.8% chance of having a baby per embryo transfer, and that many couples only require one IVF cycle to generate all the embryos they require to have their whole family, but couples want to know their individual likelihood of success and for me to provide this I need to do a full assessment first.
Rather than focusing on exact figures, the aim I have when caring for a couple is to do everything medically possible to maximise their individual chances of having a healthy child. There are numerous components to this – taking a detailed history, fully investigating all the possible causes of a couple’s difficulty conceiving, and making sure I have the best possible IVF lab to back me up, as chances of success can differ significantly depending on the quality of the lab. Genea is well known as a world leader in fertility treatment, having developed the Geri incubators with time-lapse photography which mean we don’t have to disturb (and potentially damage) embryos by taking them out of the incubator each day to check their development.
What should you expect out of the IVF process?
You should expect that we will do everything medically possible to optimise your chances of having a healthy child. You can be assured that we will support you throughout the process and treat you in a respectful and compassionate manner.
“ The other really challenging period for patients is what's known as the 'Two Week Wait'. That's after all of the treatment has taken place and the patients are waiting until it's the right time to do a pregnancy test. I encourage my patients to focus on themselves during this period, to spend time doing things that they enjoy and find relaxing, rather than constantly worrying about the pregnancy test result ”
Are there any other risks to know about?
There is a degree of risk with every medical treatment. Usually the risks associated with fertility treatment are very low, however, I discuss the specific risks with every couple to ensure they completely understand the treatment they’re about to undertake.
Is there anything important for men to do in preparation for IVF?
The saying “it takes two to tango” is very true when it comes to both natural conception and IVF. The health of the male partner is very important. Difficulty conceiving can be due to either men or women (or both) having problems. Both men and women should try to optimise their health prior to attempts to conceive. Basic steps such as ensuring they are a healthy weight, they eat a balanced diet with lots of fresh fruit and vegetables, they don’t drink excessive alcohol and they don’t smoke are important.
Why is age such an important factor in IVF? Do you imagine there will be other options for women beyond IVF in the future?
Age is a big issue for fertility. Women are born with all of the eggs they will ever have and those eggs decrease in both quantity and quality as the woman gets older. Sadly, we can’t yet overcome the damage that ageing causes to eggs. The age of the male partner is also important although it is much easier to achieve a pregnancy in which the male partner is older than for couples in which the female partner is older.
There have been many attempts worldwide to overcome the impact of older female age on egg quality, but unfortunately, none of these attempts have been successful. I’m not convinced that we will ever overcome age as being a significant factor, that’s why women who want to defer pregnancy until later in life should seriously consider freezing eggs whilst they are in their twenties or thirties. When we freeze eggs for a woman, the eggs are effectively ‘frozen in time’, they don’t continue to age whilst frozen.
Where is IVF research headed?
One of the reasons I love working as a Fertility Specialist is that our knowledge regarding fertility and how to effectively treat infertility is constantly evolving. Genea has always been committed to research, with a whole division of the company (Genea Biomedx) dedicated to constantly improving our patient outcomes at our clinics here in Australia and across the globe.
I’ve been actively involved in research for several years. I’m currently halfway through a PhD at the University of NSW where I’m using a hormonal treatment to try and protect the ovaries from damage during chemotherapy.
