Fertility Treatments in 2024
In 2024, we have access to more fertility treatment options than ever before.
This year, Candice Reed, the first IVF baby born in Australia will turn 45.
IVF is now part of our everyday language, but this amazing technology has changed so much since the late 1970’s when IVF pioneers discovered how eggs and sperm could be fertilized outside of the human body to help women and couples to overcome infertility.
In 2024, we have access to more fertility treatment options than ever before.
Here is a quick glimpse of what is now possible, under the care of our Women’s Health Melbourne team, lead by RANZCOG Board Certified CREI Fertility Specialist and Reproductive Endocrinologist Dr Raelia Lew.
Surgical laparoscopy:
Laparoscopy with hysteroscopy (exploring the pelvis and inner womb’s structure using a tiny camera) is a day surgery procedure to diagnose and treat endometriosis, divide pelvic adhesions, achieve fallopian tubal flushing (hydrotubation) and to optimise female pelvic anatomy for the best chance of natural conception.
Ovulation induction:
Ovulation Induction is a category of treatment as opposed to a single method, aiming to help women who do not regularly ovulate, to release an egg, to achieve a normal, regular menstrual cycle and to restore their monthly chance of natural conception to that of other women their age.
Medications often used for ovulation induction include Letrozole, Clomiphine citrate (also known as Clomid), or injectable gonadotrophic hormones including Follicle stimulating hormone (FSH), Human Chorionic Gonadotropin (HCG) or Luteinizing hormone (LH). Diet and lifestyle measures are an important part of restoring regular ovulation and insulin metabolism regulating medications such as Metformin and Inositol / Myoinositol can also be useful.
IUI: Intra Uterine insemination
IUI, usually used in combination with Ovulation Induction techniques is a gentle assisted reproductive technology, often trialled to over come milder spectrum male factor infertility or to achieve pregnancy using donor sperm. This technique involves gentle cycle hormonal augmentation using hormone supporting medications to improve impaired fertility by stimulating release of an “extra egg). Monitoring the timing of ovulation precisely is achieved with ultrasound ovarian follicle tracking and hormonal blood test assessments. A procedure introducing laboratory optimised, concentrated sperm high in the female reproductive tract, beyond the cervix is performed at exactly the right time, just before a woman ovulates. In short, IUI controls for ovulation timing perfectly and gives sperm a boost to make finding and fertilizing an egg more likely.
IVF: In Vitro Fertilization
IVF refers to a category of treatment where multiple eggs are recruited and collected outside the female body in a single menstrual cycle. Egg and sperm are combined in the laboratory to form embryos which are subsequently placed back into the womb to attempt a pregnancy. IVF can be a process and on average it may take a few treatment cycles to successfully achieve a pregnancy. In many cases, embryos are created in one month and transferred back to the womb in another to achieve an embryos best chance of success.
ICSI and laser assisted ICSI
ICSI stands for Intra Cytoplasmic Sperm injection. Laser assisted ICSI is when a laser beam is used to make a gentle hole in the eggs outer shell. This allows the ICSI injection of a sperm inside the inner egg to be performed more gently and is highly useful when eggs are fragile. ICSI techniques have allowed men with very few normal sperm to achieve a pregnancy with their partner through IVF. ICSI is an amazing tool to assist male factor infertility.
IMSI:
IMSI refers to ultra high digital magnification used in advanced sperm selection for ICSI. This technique is useful where a man has a very low number of normally shaped sperm, with high concerns of DNA fragmentation. IMSI examines sperm at very high power, choosing sperm with the best micro architecture, a marker of DNA integrity. IMSI can be used with a goal to create embryos of higher quality and to reduce a female partner’s risk of miscarriage.
PGT: Pre-implantation Genetic Testing.
PGT technology refers to when we test an embryo’s DNA before returning it to the mother’s womb. We can do this to prevent genetic diseases (PGT-M, monogenic testing), or to detect chromosomal rearrangements, a cause of infertility that can come from either parent who may have an abnormal Karyotype (PGT-SR, chromosomal structural rearrangement testing). PGT-A refers to when PGT is used to detect spontaneous embryonic aneuploidy, chromosomal imbalances that are not inherited but happen spontaneously during embryo formation, which becomes a very common problem causing infertility in women aged over 35 years.
Morphokinetic analysis and Artificial Intelligence:
Time lapse embryo monitoring techniques and Artificial Intelligence techniques have been postulated to potentially improve embryo selection in IVF. While the idea shows promise, unfortunately so far the science of time lapse has not been able to show a benefit in terms of pregnancy and live birth rates in randomised controlled studies. It’s still very early days, not yet justifying the added expense for patients in terms of clinical benefit.
Continuous culture of embryos:
Being undisturbed while they grow may improve the quality of the embryos. For this reason, IVF lab systems have been developed that minimise the disturbance to embryos as they grow.
Testicular sperm retrieval including Micro-Tese:
Some men do not have any sperm in their ejaculate. They may have previously had a vasectomy, have a congenital or acquired blockage (known as obstructive azoospermia) or they may be making very little sperm due to a genetic issue or testicular failure (non-obstructive azoospermia). For many men in these circumstances, sperm can be retrieved surgically, directly from the testis for use in IVF.
Donor gamete conception and Gestational Surrogacy:
Not everyone can have a baby with their own eggs and sperm. Couples in same sex relationships may require the assistance of an egg donor, sperm donor and/or gestational surrogate. Some women can make embryos with their male partner but cannot successfully carry a pregnancy. There are many reasons and circumstances where gestational surrogacy may be needed. IVF can allow women and couples to have healthy families using technology to assist.
Preconception genetic screening:
Pre-conception genetic screening refers to genetic tests that should be offered to all people planning a pregnancy to consider.
Preconception genetic screening tests search our DNA for silent disease causing mutations. Examples include cystic fibroisis, spinal muscular atrophy and fragile X syndromes. It is good to know about your risk of having an affected child before getting pregnant so that all options can be considered. IVF can be used with embryo testing, ensuring the embryo we choose to create your baby has the highest chance of being born healthy.
Non-Invasive prenatal testing (NIPT)
NIPT is completely different from preconception genetic screening. It is a test conducted when you are already pregnant, from 9 weeks onwards. NIPT can assess your baby’s risk of having down syndrome and other spontaneous chromosome problems, including chromosomal microdeletions, and can, if you wish, disclose the sex of your baby.
Every day our team of dedicated fertility specialists and elite laboratory scientists are working together to innovate new technological advances with the common goals of improving IVF success rates to create more babies than ever before.
Women’s Health Melbourne is a comprehensive, patient care focussed Fertility and Women’s Health practice, lead by RANZCOG Board Certified CREI Fertility Specialist and reproductive Endocrinologist Dr Raelia Lew. We are proud to provide our patients with truth based care, providing a full spectrum of available evidence-based fertility treatment options proven to be effective, with the highest level of care in a safe and beautiful environment.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Lovers intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.