This year, Candice Reed, the first IVF baby born in Australia has turned 40.
IVF is now an every day term, 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 2020, we have access to more fertility treatment options than ever before.
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 is a category of treatment as opposed to a single method, aiming to help women who do not regularly ovulate, to release an achieve a normal, regular menstrual cycle and to restore their monthly chance of natural conception to that of other women.
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 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, timing ovulation precisely and a procedure introducing laboratory optimised, concentrated sperm high in the female reproductive tract, beyond the cervix. 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.
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 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 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-R, chromosomal rearrangement testing). PGT-A refers to when PGT is used to detect spontaneous embryonic aneuploidy, chromosomal imbalances that are not inherited per se 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 while in continuous uninterrupted culture has opened the door to developing artificial intelligence tools in IVF. Through AI analysis of an embryos behaviour and development, we learn more and more about its baby making potential. AI tools allow scientists to choose the embryo most likely to make a baby first, with greater certainty.
Embryonic antioxidant therapy is a novel idea, being offered to patients at Women’s Health Melbourne and Melbourne IVF, in context of a current randomised controlled scientific trial. We have high hopes that this technology will soon be proven to be of great benefit to our patients IVF success.
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 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 and NIPT:
Pre-conception genetic screening refers to genetic tests that should be offered to all people planning a pregnancy to consider. Testing searches 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 your baby has the highest chance of being born healthy.
NIPT stands for Non-Invasive prenatal testing. 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 CREI Fertility Sub specialist Dr Raelia Lew. We are proud to provide our patients with the full spectrum of available fertility treatment options, with the highest level of care in a safe and beautiful environment.