MELBOURNE IVF & FERTILITY CLINIC

Your first appointment at WHM is often with one of our fertility specialist GPs. This appointment helps us to triage your needs and ensure pretreatment investigations and holistic lifestyle and allied health interventions have been arranged to maximise your chance of IVF success. We’ll provide you with resources and education so that you can better understand treatment options before you meet Dr Raelia Lew, your CREI Fertility Specialist.

At your second appointment, you will get to know Dr Raelia Lew as your chosen WHM CREI Fertility Specialist. This appointment will be explanatory, educational and strategic. Raelia will review your history and test results in depth. Together, we will consider the most effective treatment options open to you. We will create a fertility treatment plan that addresses your needs specifically to help plan your family.    

Fertility tests are performed to help Dr Raelia as your CREI Fertility Specialist understand, to the best of her ability, why you have not become pregnant naturally and also how she might be able to help you.

These include: 

• Blood tests checking for immunity, metabolism, genetic issues (karyotype evaluation) and hormones (for both men and women)

• Pelvic Imaging assessing your uterus, ovaries, fallopian tubes and pelvic anatomy

• Preconception genetic screening checks 

• Sperm testing and follow up imaging if needed of the male genital tract

• For some women and couples, surgical procedures may be indicated prior to IVF treatment - for example a laparoscopic or hysteroscopic pelvic evaluation and management of underlying issues such as endometriosis.

• Men may likewise require surgical management of conditions such as varicocoele or surgical sperm retrieval such as microtese prior to IVF.   

Dr Raelia  will rely on your test results to create a treatment plan individualised to address the fertility concerns and challenges faced by you and your partner. 

Prior to IVF treatment, necessary preparations are made. You will meet several people who will support you on your journey. Informed consent for all elements of your treatment will be formally documented. You will be provided with video resources to watch and ensure you fully understand the treatment Dr Lew has planned for you.  

A formal counselling session with an ANZICA trained fertility counsellor is legally  mandatory prior to having IVF treatment in Victoria. Your counsellor will educate you and your partner about the Victorian legal environment, how regulations relate to IVF treatment and also to the long term storage of eggs, sperm and embryos. They are also present to offer you emotional support throughout your IVF treatment.  

A second pre-treatment session will be booked with a Melbourne IVF nurse specialist. They will educate and guide you so that you understand every single element of your individual IVF treatment plan on a very practical level. 

You will learn about your prescribed medications and will come to understand and feel confident in actioning self directed elements of your IVF treatment plan.

Our kind and extremely knowledgeable Melbourne IVF and WHM nurses will always be there in the background to support and guide you throughout your IVF journey.

Depending on your treatment plans and goals your IVF cycle may commence: 

1. On the second to third day of your menstrual period. In order to be organised, we ask that you alert our nursing team of your intention to commence treatment on Day 1 of your menstrual cycle. This is the day you get your period. 

2. A planned start IVF cycle can commence any time in the menstrual cycle and can be organised in advance, planned and diarised. This type of IVF cycle is suitable for embryo or egg freezing cycles.

IVF aims to create a statistical advantage by collecting multiple eggs for you. Eggs can be fertilised with sperm in order to give you the chance to create several embryos if you can. Each embryo created through IVF represents a chance for you to become pregnant.

In your natural menstrual cycle, usually only a single egg will ripen and release. 

In IVF treatment, your WHM CREI Fertility Specialist Dr Raelia Lew will prescribe hormone medications including one or more forms of FSH (follicle stimulating hormone). By stimulating and collecting multiple eggs, we create “a numbers game”, improving your chance of creating at least one healthy embryo.

Through numerical advantage, IVF can amplify your chances of conception by making more eggs and embryos available each month that you undertake an IVF treatment.

Medications used in different IVF treatment approaches vary substantially and are administered in different ways. Many IVF medications are delivered as subcuticular injections that are self administered. However in modern IVF practices, other medication formats including oral tablets, nasal spray delivery systems and subcutaneous implants may also be used in IVF cycle where we stimulate your ovaries.

During your IVF treatment cycle, you will have valuable and available support from our specialist nursing team. At least one ( and sometimes more than one ) ultrasound  monitoring appointment will need to be attended in person during your treatment. 

Depending on the type of treatment planned for you, monitoring may or may not include blood tests in addition to pelvic ultrasound progress tracking. Trans-vaginal pelvic ultrasound is commonly recommended, however a transabdominal assessment may be offered in specific cases.

Your egg retrieval procedure will be scheduled once your ovarian follicles on ultrasound assessment reach an appropriate size. 

You will be prescribed a “trigger” medication and will be asked to action this at a specific time. Your trigger medicine is planned with precision, 35 to 37 hours prior to your oocyte retrieval procedure time. 

The trigger medication starts a cascade reaction in the ovarian follicle allowing eggs to complete the maturation process necessary for successful collection and fertilisation of mature MII oocytes. 

There are different types and different doses of IVF trigger medication that may be prescribed. Both the choice of trigger and the coasting time between trigger medication administration and your egg collection procedure will relate to your individual clinical circumstances and personal IVF plan.     

Your egg collection will occur in hospital under sedation anaesthetic. This type of anaesthetic, often called a twilight sedation, is a very safe and  gentle form of anaesthesia. Under this treatment you will feel no pain and have no significant recollection of your egg collection procedure. After your procedure you will awaken quickly and in most cases will be able to go home within 1 to 2 hours. 

An egg collection is an ultrasound guided follicle aspiration. A fine needle is passed, via your vagina into your ovary, follicles are aspirated and eggs are retrieved. Both ovaries are drained wherever possible so that a maximal number of available eggs can be used in IVF. Dr Raelia Lew is a firm believe in egg and embryo centred care. She will schedule your egg collection procedure at the optimal time for your best clinical outcome. To accomplish this goal, Dr Lew leads a team of exceptional Melbourne IVF fertility specialists in a collaborative care arrangement to perform egg collection procedures 5 days a week. Your egg collection procedure will be performed with expertise and kindness at the perfect time predicted to achieve your best success. 

Sperm for IVF treatment can come from various sources including 

1. A freshly ejaculated sample provided by a partner on the morning of your egg retrieval that is subsequently filtered, prepared, concentrated and optimised in the IVF andrology laboratory. 

2. A frozen sperm sample stored in advance (created by a partner or sperm donor) 

3. Testicular sperm that is procedurally retrieved, for example post vasectomy or in the case of obstructive or non obstructive azoospermia. Examples of testicular sperm retrieval techniques include fine needle testicular sperm aspiration (TESE), per-epidydimal sperm aspiration (PESE), open testicular biopsy or micro-TESE.

Once mature eggs have been retrieved and successfully transported to the IVF laboratory, in order to create embryos, eggs and sperm must be brought together. There are broadly speaking two main modalities via which eggs and sperm are united. 

1. Standard IVF insemination: IVF refers to when eggs are exposed to a concentrated droplet of laboratory optimised sperm. We require a normal concentration of motile sperm in the ejaculate for this technique to be recommended. 

2. ICSI (Intacytoplasmic sperm injection). This is where a single sperm is injected with micro-manipulation to enter into the oocytes cytoplasm (eggs interior) to achieve fertilisation. ICSI is recommended in contexts where sperm is of poorer concentration or quality. ICSI is also recommended in some other circumstances such as where genetic testing of embryos for inherited diseases is planned, or where the male partner has a serious communicable disease such as HIV. 

We expect in IVF treatment that half of the mature eggs collected will successfully fertilise on average. It is normal and expected that a proportion of eggs will fail to fertilise normally for biological reasons. 

We can tell that an oocyte has successfully and normally fertilised when we observe the sign of two discrete pronuclei on the day after sperm and egg were united (2PN).   

In our Melbourne IVF laboratory, your embryos will be closely observed and scored, both by human embryology experts and AI empowered technology systems, from the time of fertilisation to embryo transfer or embryo vitrification.

Human embryo development is beautiful to watch and involves the exponential division of cells within the embryo.

Stages of normal embryo development are as follows: 

Day 0: Egg and sperm unite 

Day 1: We observe the formation of a single celled embryo known as the zygote

Day 2: The embryo cleaves forming 2-4 cells 

Day 3: Further cleavage development results in a higher discrete number of cells 

Day 4: The embryo becomes a morula, where individual cells become harder to see

Days 5 to 7: The embryo compacts, forms an inner fluid filled cavity, and expands to become a blastocyst.  

In modern IVF, embryos are generally transferred, biopsied and stored by vitrification cryopreservation at the blastocyst stage of development. 

Only one in 5 eggs collected on average will successfully complete normal development to reach the blastocyst stage of development.    

Advanced Embryo Screening Technologies

WHM in collaboration with Melbourne IVF and Virtus Diagnostics are proud to offer our patients access to cutting edge technologies involving safe embryo biopsy and advanced screening to detect genetic errors where required.

To achieve a pregnancy, an embryo will be transferred inside your uterus. 

For some patients it may be appropriate and the best plan for you to transfer an embryo “fresh”,  5 days after an egg collection treatment. 

For other patients a frozen embryo transfer may be recommended. This may often occur preferentially in a natural or hormonally optimally prepared cycle. 

It is known that luteal phase deficiency is a major problem that always occurs in stimulated IVF cycles where a fresh embryo transfer is planned. For this reason, if a fresh embryo is transferred in your case, high dose progesterone medication must begin following your egg collection to balance out this problem. 

Medical progesterone supplementation represents luteal phase rescue therapy. This level of mandatory progesterone replacement can be avoided with natural cycle embryo transfer. 

Different forms of progesterone medication is available. Progesterone is most commonly available and prescribed in the form of vaginal gels, vaginal tablets, vaginal capulets, vaginal compounded pessaries, subcuticular injections or intramuscular injections. Due to side effect and absorption profiles, micronised progesterone is seldom administered in oral forms, however oral dose top up may be utilised in combination progesterone therapy regimens.  

How does the embryo transfer procedure occur? 

Embryos can be transferred to the womb via a gentle procedure with the patient awake. This is an exciting moment. It is amazing to be able to see your embryo at such an early stage - one that parents who conceive naturally never experience. Embryo transfers can proceed 7 days a week and will be timed optimally to coincide with your best chance of becoming pregnant. Dr Raelia Lew will endeavour, in most circumstances, to perform your embryo transfer personally. In her IVF practice,  Dr Lew  also enjoys the back up and support of her esteemed Melbourne IVF Fertility Specialist colleagues. You will always receive the highest level of expert care and respect in our practice.   

An embryo transfer should not cause any pain. It is a procedure where your embryo is placed gently via your cervical canal, into the cushioned cavity of your womb (the endometrium) using a specially designed very small, flexible device known as an embryo transfer catheter.

Preparing for your  Embryo Transfer

During your embryo transfer, an ultrasound will be placed on your tummy. Having a full bladder is really important to help your specialist see your womb clearly on ultrasound. This helps to place your embryo perfectly, providing you with your highest chance of becoming pregnant.

Where a fresh or frozen embryo transfer has occurred, we must wait for approximately two weeks ( a minimum of 10 days) before we can know if you have become pregnant. 

Pregnancy hormone, secreted by the developing baby’s placenta (trophectoderm and trophoblast cells) can be detected in the maternal urine or blood once this pregnancy tissue has developed to a critical mass.

Many patients find the two week wait to be both an exciting and stressful time. Support can be provided if you find this stage of treatment challenging emotionally.

This can represent a day of hope or a day of sorrow. 

Many IVF patients who ultimately conceive will require more than one treatment before they find success. Most women and couples who go through IVF will therefore have the experience of receiving news of a negative pregnancy test. 

We are here to help and support you to move forward with confidence, even if you experience this disappointment. 

A positive pregnancy test is exciting, however we encourage you to  guard your emotions in early pregnancy. If you register a positive pregnancy test, you may be asked to repeat the test in 48 hours to assess your pregnancy hormone levels. In normal circumstances, a healthy early pregnancy will display an approximate doubling of b-HCG hormone levels every 48 hours. Patterns of b-HCG rise that differ from this expectation can sometimes represent failing biochemical pregnancies or ectopic pregnancies. 

We are usually unable to visualise a pregnancy on ultrasound prior to the pregnancy hormone having risen to > 1000 IU/L.

A pregnancy ultrasound is arranged for patients who have conceived through IVF at approximately 6.5 weeks gestation. At this time a baby is approximately the size of a grain of rice and has developed a heartbeat. 

This ultrasound is to assess the location and viability of your IVF pregnancy.