One in six Australian couples will have a fertility issue at some point in their lives and one in 10 couples will have trouble conceiving their second child. You are not alone.
Don’t panic, your fertility journey doesn’t have to be an express service straight to IVF. Some simple changes can improve your chance of conceiving naturally.
It's important to remember the emotions, worries and thoughts you are currently trying to deal with are valid and common. You are not alone. Read on
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The World Health Organisation predicts that infertility will be the third most serious health condition in the 21st Century
We're dedicated to helping you achieve your dream - having a baby. We offer a range of services - from IVF to genetic diagnosis of pre-implantation embryos - all with the aim of easing your journey to successful pregnancy.
Are you a female struggling to conceive? Read through potential reasons why, or learn more about testing options.
With 40% of fertility issues being male related, find out what may be causing you troubles, or learn more about male fertility testing
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Because of the care, technology and expertise we put into your care, we maximise the potential of having a baby.
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Come along to hear local leading Fertility Specialist Dr Devora Lieberman explain the facts and dispel the fictions about egg freezing at a discussion at Sydney City Westfield.
Come along to hear local leading Fertility Specialist Dr Tween Low explain the facts and dispel the fictions about egg freezing in Canberra.
Come along to hear local leading Fertility Specialist Associate Professor Lionel Reyftmann and learn more about the fertility process.
Come along to hear local leading Fertility Specialist Dr Anthony Marren and learn more about the fertility process.
Now that you and your Genea Fertility Specialist have decided that IVF is the best fertility treatment for you, here is some deeper detail about the procedure you’re about to undergo.
Once you’ve completed your ovarian stimulation your egg pick-up (or OPU) and your partner’s sperm collection will be scheduled for the same day.
The main surgical procedure in your IVF cycle is the egg collection. You will also hear this procedure called egg pick-up, oocyte pick-up, OPU and sometimes egg harvesting. They all mean the same thing.
The procedure is carried out in an operating theatre. The doctor has a small needle attached to an internal ultrasound probe. The probe with the needle attached is inserted into your vagina and, when in position, the needle is advanced so that it passes gently through the top wall of the vagina.
Guided by the ultrasound (which you and your partner can see as well), the doctor inserts the needle into one follicle after another, draining the fluid from each through a tube and collecting the egg.
A typical egg collection procedure takes about 20 minutes. Generally during the procedure, all that you’re aware of is some pressure on the ovary, followed by an ache that subsides. Approximately one in 20 women will experience sharp pain, although it is usually very short in duration. There’s often a small amount of bleeding from the wall of the vagina. Other complications such as major bleeding, damage to an internal organ or infection are possible, but rare.
After the follicles have been emptied they often fill up again with fluid, so the feeling of fullness may return. Some women also complain of a cramping sensation for a few days following egg collection. You can relieve this cramping with paracetamol (with or without codeine).
Side effects are often more marked after the procedure, as the hormone processes following ovulation persist, even though the eggs have been taken out. These side effects include mood changes as before, but also physical effects indicative of heightened ovulation such as pronounced abdominal swelling and pain, breast tenderness and lower abdominal discomfort.
You have two options for pain management during the procedure. The first is a combination of sedation and local anaesthetic, the other is general anaesthesia.
At Genea, we perform the vast majority of egg collections under local anaesthetic with mild sedation. There are a number of advantages in being awake for the procedure, including:
Your Fertility Specialist will discuss and decide with you what’s right in your circumstances.
Your Genea embryologist (the scientist who looks after your embryos in the lab) will also be in the theatre during your OPU. As the follicles are emptied, the collected fluid is passed to the embryologist, who using a powerful microscope, begins locating and extracting the eggs, transferring them to special plastic dishes ready to be incubated. The microscope that the scientist uses is attached to a video camera which means you (and your partner) can watch it all happen.
After your OPU, we will take you to the recovery room. If you've had sedation or general anaesthesia, please make arrangements for an adult to be responsible for you and to accompany you home. Do not plan to drive yourself or travel alone; it's unsafe to do so, no matter how well you feel. Be sure not to carry out any critical activities - such as driving a car, operating machinery, or signing important documents - for 24 hours from the time of your sedation or anaesthesia. It is not usually necessary to take time off work on the days following the procedures, but if you feel that you need a medical certificate, you can discuss this with the nurses.
If your male partner requires a sperm extraction operation (known as PESA or TESA, depending on where the sperm is obtained) at the same time as you have your egg pick-up, you will need a someone else to take you home.
With the eggs safely collected, we need the other half of the equation. All our clinics have discreet, comfortable rooms where the male partner can provide a semen sample.
Compared to the effort required to collect eggs, collecting sperm can seem a very simple process, but it often proves tricky.
Sharing the egg collection experience with his partner can be traumatic and may leave the man distinctly unaroused. Other men have physical disabilities or impotence problems. Others possess moral objections to masturbation. Others still may be be overseas or similarly unavailable on the day of the egg collection.
Whatever the issue, let us assure you that we are accustomed to discussing these delicate matters on a daily basis, so please feel comfortable to discuss this openly with us and we can provide you with the most appropriate options. The most important issue is that a supply of sperm must be available when the eggs are ready for it. Without it, the whole cycle may be a wasted effort.
Luckily sperm freezes and thaws well so collecting a sample in advance is a possibility. There are a couple of techniques we can use to collect sperm in advance.
If masturbation is absolutely unacceptable to you, please obtain a special non-contraceptive condom from our andrology department. Do not collect the specimen with a regular condom as they contain chemicals that are toxic to sperm.
Surgical sperm retrieval is performed when a man cannot produce an ejaculated sample himself for a variety of reasons.
In some cases of a previous vasectomy, sperm retrieval may be undertaken rather than a vasectomy reversal attempt based on the length of time from the original vasectomy or the woman’s age.
Additionally, in cases of non-obstructive azoospermia (complete absence of sperm from the seminal fluid) or congenital conditions where there is an underlying problem with sperm production itself, it may be possible to harvest sperm directly from the testes (TESA procedure) or epididymis (PESA procedure).
The quantities of sperm retrieved surgically are quite small and generally must be combined with in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). The sperm can either be used fresh, or frozen for future uses.
Most males with spinal cord injury cannot ejaculate via sexual intercourse and require medically assisted procedures to obtain a semen sample. In this case, your Fertility Specialist is likely to recommend harvesting sperm directly from the testes (TESA procedure).
We now have the eggs and the sperm. So what happens exactly when we fertilise your precious eggs with sperm and then look after your resulting embryos in the lab during those five or six days? In conventional IVF, about 50,000 to 100,000 washed sperm are left in a small plastic dish with the eggs. The sperm spend the next few hours getting through the layers of cumulus cells, and hopefully one sperm will successfully fertilise the egg.
By the next day - some 15 hours after introducing the sperm to the eggs - our Genea scientists (these ones are called embryologists) will check to see if your eggs have fertilised by looking for the presence of pronuclei. In normal fertilisation there should be two pronuclei - one from the sperm and one from the egg.
Not all eggs will fertilise normally, which is common. We consider it a good result if 80 per cent of the eggs collected have two pronuclei on Day 1.
Once fertilisation has occurred, the embryo will divide and rapidly increase in cell number over the next few days.
By Day 4, the cells have divided rapidly but the embryo has not yet increased in size. It is now compacting (you can’t distinguish the cells) and is called a morula.
If your embryo is healthy and survives to Day 5 - the blastocyst stage - it will contain between 75 and 100 cells. It is a three dimensional ball of outer cells (the trophectoderm) surrounding a fluid-filled cyst in which an inner group of cells, the inner cell mass can be seen.
The trophectoderm or outer cells will go on to form the placenta, membranes and umbilical cord, while the inner cell mass will become the baby.
While many embryos can survive two or three days to reach the four to six cell stage, only the strongest will have the ability to keep developing into a blastocyst and then go onto to implant in your uterus and become a baby. One way of identifying the better, healthier embryos is to let them grow a little longer in the laboratory and to transfer them at the blastocyst stage. It is a good way of determining which embryos have the most developmental potential.
Our world-leading success with blastocyst culture and implantation means that blastocyst transfer is standard at Genea clinics - in fact we were the first clinic in Australia to routinely introduce this technique, which significantly improved success rates. An embryo needs two things to reach Day 5: enough energy, and normal chromosomes.
An embryo’s energy supply comes from tiny structures inside its cells called mitochondria. The embryo needs to survive on the energy produced by the mitochondria it inherits from the egg until it has implanted and formed a placenta. Because all the mitochondria in an embryo come from the egg, they are inherited from the mother. And because women are born with all their eggs for their lifetime already formed, the mitochondria in your eggs are as old as the eggs themselves - and, obviously, you.
Embryos must also have the right genetic makeup to develop normally. In humans, genes are contained in 23 pairs of chromosomes. An incorrect number of chromosomes can lead to failure of an embryo to implant or to progress to a normal birth. Pregnancy is a great filter of abnormal embryos. When chromosome analysis is performed on cells from Day 3 embryos, studies have shown that only one third will have the normal number. If an embryo progresses to Day 5 and becomes a blastocyst, it has a two-thirds chance of being chromosomally normal. Ninety per cent of chromosomally abnormal pregnancies will miscarry in the first trimester and 93 per cent of chromosomally normal pregnancies will continue to term.
The IVF procedure to transfer an embryo to your uterus is usually straightforward and painless: no more (or less) uncomfortable than having a Pap smear. After a speculum is placed in the vagina, a fine plastic catheter that has been loaded with the embryo is passed through the cervix into the uterus.
Many people think that the uterus looks like it does in most diagrams, with a cave-like interior in which transferred embryos can rattle around and even fall out! In reality, the endometrial cavity is a potential space. To quote an analogy our Medical Director Associate Professor Mark Bowman uses - the front and back walls of the uterus are in contact like two slices of bread with jam in the middle; the embryo is like a raspberry seed wedged in between.
No matter what you do, it won’t fall out!
If you are undergoing a cycle of IVF at the moment and have concerns, please see our "When to call" table which explains in what circumstances you may need to call someone as opposed to waiting until the morning.
An embryo whose cells have divided into two different types - usually occurs at Day 5 or...
The neck of the uterus, lying between the body of the uterus (its fundus) and the...
A long spiral string of genetic material (DNA) wound around supporting proteins. There are 46...
Embryo as a term is used to describe everything from a fertilised egg (or...
Procedure by which the embryo is placed in the uterus or into the fallopian...
A small fluid-filled cyst on the ovary in which the eggs grow until released and which produce...
When an egg (oocyte) is fertilised by a sperm outside of the body it is via a...
Where male fertility infertility is significant cause of trouble conceiving, ICSI will be...
A tiny structure inside the cell responsible for converting food molecules and oxygen to into...
The main surgical procedure in your IVF cycle is the oocyte pick-up. This in more general...
Dissection into the testis itself, in men with azoospermia to recover (by...
An imaging procedure like radar, but using high frequency sound...