There is a common misconception that most people with fertility issues will need IVF treatment. While many patients will benefit from IVF, there are also a number of low intervention treatments that can be suitable for patients. Lifestyle and health factors can also play a big role in conception and we have wellness advice for getting pregnant (link to preparing for pregnancy in information). The two most common low intervention treatments are ovulation induction and intrauterine insemination.
Ovulation Induction (OI) is a fertility treatment that uses medications to cause or regulate ovulation, or increase the number of eggs produced during a cycle, to increase the opportunity for pregnancy.
Conditions including Polycystic Ovary Syndrome, Hypothalmic Amenorrhea and Hyperprolactinaemia can affect ovulation and OI can be an effective treatment.
The medications are used to stimulate your ovaries to produce an egg. Close monitoring of your bloods and ultrasound scanning determines if ovulation has occurred, and timed intercourse gives you the best possible chance of conception.
Artificial insemination or intrauterine insemination (IUI) involves inserting the male partner’s (or donor’s) prepared semen through the neck of the womb (cervix) and into the uterus, close to the time of ovulation. It is a simpler, less invasive form of fertility treatment.
Blood tests and ultrasound scans are used to determine the time of ovulation. Then the male sperm is freshly collected o the day of the procedure.
Sometimes ovulation induction and intrauterine insemination will be used in combination.
IVF is a very common fertility treatment, with 1 in 25 Australian births now the result of IVF.
During an IVF cycle the ovaries are stimulated to produce an increased number of eggs. These eggs are then combined with sperm in our laboratory where they fertilise and an embryo is formed. Once the embryo develops to an appropriate stage, it is transferred back into the endometrial lining of the uterus in the hope that implantation will occur and a pregnancy will develop. Any additional embryos formed during the cycle can be frozen for future use.
ICSI (Intracytoplasmic Sperm Injection) may be used as part of your IVF cycle. It is a technique where a single sperm is placed inside your egg to try and increase the chance of fertilisation. It is most commonly used when sperm quality is low or if sperm have been retrieved by surgery.
IVF/ICSI are often recommended as a treatment option for the following fertility issues:
- Blocked or damaged fallopian tubes
- Male factor infertility
- Previous male / female sterilisation
- Unexplained infertility
An IVF cycle is a 30-day treatment pathway linked to a standard menstrual cycle. IVF procedures are safe and medical complications are rare. Our endeavour is to provide clear information to our patients and ensure the physical and mental wellbeing of our patients throughout their treatment. This includes access to our nurses and counsellors as needed throughout the process. Here is a breakdown of the cycle stages.
Ovarian Stimulation is where the growth of ovarian follicles is controlled by hormones. Stimulating the ovaries involves approximately 10-12 days of daily injections, which start on day 2 after the start of your period. The injections are self-administered, with our fertility nurses providing information and guidance. In a small number of cases, women can experience a complication called ovarian hyper stimulation syndrome (OHSS) where the body produces too many eggs. We monitor patients extremely carefully to minimise this risk but in a very small percentage of cases we may have to cancel the cycle for the health of the woman.
Monitoring occurs as the follicles develop, using both ultrasound and blood tests, to see the number and size of the follicles. You are likely to have several scans during your treatment cycle. Blood tests and scans are usually planned for 9 days after commencing your medication with the results used to decide on the ideal time to retrieve your eggs.
The Trigger describes a specific medication, used when your follicles reach the desired size for retrieval. This trigger medication is to prepare the ovaries to release the eggs ready for collection. The fertility nursing team will support you and inform you when exactly to take this next injection to enable us to correctly schedule the egg collection. The trigger is timed so that retrieval occurs approximately 34-36 hours following the trigger medication.
The egg collection process is conducted as a day procedure at St Andrews Hospital. A light general anaesthetic is used and the procedure takes about half an hour. The procedure involves your fertility specialist using an ultrasound to guide a needle into each ovary and drain the fluid from the follicles. This fluid is then immediately examined under a microscope by one of our embryologists for the presence of eggs. Following the procedure we will inform you how many eggs were able to be collected.
Sperm is collected on the same day as egg collection in order to fertilise the eggs. Or donor sperm is utilised for the same purpose.
The fertilisation of the eggs can occur using either standard IVF where the egg are combined with the sperm in a culture dish within the laboratory environment. This method relies on the sperm entering the egg naturally. ICSI involves the injection of each egg with a single immobilised sperm.
If the sperm successfully impregnates the egg and fertilisation commences there is potential for an embryo to develop. Our embryology team monitors their development over the next 5 – 6 days keeping them in the most optimal conditions for growth and development. It is at this stage that unfortunately not all eggs will fertilise and not all embryos will continue to develop.
Embryos that develop are developed for about 5-6 days to what is called the blastocyst stage. Our nursing and embryology team members work together with your fertility specialist to time the transfer. The transfer occurs at our day procedure suite at St Andrews Hospital. If there are any additional embryos, these will be frozen.
The time between an embryo transfer and the pregnancy test can be especially stressful for patients, and our fertility nurses and counsellors are there to support our patients. A pregnancy test takes place about 18 days after the egg retrieval to see if the IVF cycle has been successful.
The main option for preserving fertility is to freeze eggs, sperm or embryos.
Women who are at risk of losing the opportunity to conceive with their own eggs, including women with low ovarian reserve, imminent premature menopause, or undergoing cancer treatment, may wish to preserve their fertility by harvesting their eggs or creating embryos with their partner to freeze and store for future use. Some patients may be entitled to a Medicare rebate which results in a cost very similar to a regular IVF cycle.
We currently offer egg freezing with vitrification, which is a state of the art freezing technique that minimises damage to the eggs and gives the best opportunity for a successful pregnancy.
Men may also consider freezing a sample of their semen for later use. There are a number of reasons why you might consider this:
- When chemotherapy treatment is planned to treat testicular or other cancers
- When prostate surgery or vasectomy is planned
- During IVF and IUI treatments where a backup sample is used
A frozen embryo transfer (FET) is a cycle where a frozen embryo from a previous fresh IVF cycle is thawed and transferred back into the uterus. This pathway means you won’t have to undergo another cycle of hormone stimulation and an egg collection.
If you choose to have a frozen embryo transfer, we will monitor your cycle with bloods, as well as ultrasound scans. Monitoring usually begins 4 to 5 days before the expected day of ovulation and continues until blood hormone levels confirm that ovulation is imminent. Your embryos are thawed approximately 72 hours later.
Women who have regular cycles will usually have their natural cycles monitored. For women with irregular cycles where ovulation doesn’t occur, medication is required in order to time the transfer appropriately. This usually involves a combination of oral oestrogen tablets, sometimes additional oestrogen patches, as well as progesterone pessaries or vaginal gel.
Between 60-70% of frozen embryos will thaw successfully and can be used for transfer. However in some circumstance the embryos may not survive and a transfer may not be possible.
In the hands of medical specialists, IVF procedures are safe and medical complications are rare. Our endeavour is to provide clear information in regard to the potential for health effects to occur.
The most common complication during a stimulated treatment cycle is ovarian hyper stimulation syndrome (OHSS). This condition may arise as a result of the fertility medications used to stimulate the ovaries to produce multiple eggs. OHSS is a potentially serious condition that in very rare cases can result in hospitalisation.
Here at Fertility SA all patients are very carefully monitored to minimise the risk of OHSS. This condition occurs when an excessive number of follicles develop in response to the fertility medications. In the event this condition does occur the fertility specialist may recommend that the cycle be cancelled or a short acting ovulation drug be used prior to egg collection to avoid the risk of OHSS.
IVF treatments have been available for the relatively short period of 35 years and only the past two decades that treatments have been used by large numbers of women and their families. There is very little available research into the possible long term effects of IVF for women.
There has been limited, research into the long term use of fertility medications and an increase in cancer risk for women who undergo IVF treatments. Currently there is no conclusive evidence that an increase risk for either breast or ovarian cancer exists. As research continues to emerge regarding all aspects of IVF therapies new information will become available.
There are many factors contributing to IVF treatments having an impact on a woman / couples emotional wellbeing. The financial implications, treatments failing along with relationship strains all contribute to the demands of IVF therapies. Symptoms of both depression and anxiety can be experienced by both men and women within the relationship.
Support is important and here at fertility SA we work as a team to provide the emotional reassurance individuals require.
The fertility specialist, nursing team and our counsellors are all available to be used as required along the fertility journey.
The science of fertility medicine is constantly evolving. Fertility Doctors and scientists are constantly looking for ways to improve treatments that will improve the chances of getting pregnant through IVF or other assisted reproductive techniques (ART). Over time a number of therapy ‘add-ons’ have developed and been introduced into IVF clinics.
Procedures and medications have been introduced and included into treatment cycles.
Many of these new therapies are experimental and not been scientifically tested. We encourage you to ask questions to your fertility specialist about the pros and cons, along with associated costs of any additional treatments.
At Fertility SA we encourage all patients to apply a holistic approach to their health, using a range of life style approaches to improve both physical and emotional well-being. This will have an effect on your chances of conceiving naturally along with improve fertility health.
We support you every step of the way towards achieving your dream of having a baby. We recognise that the decision to pursue fertility treatment can be an emotive and difficult one. It is our goal to guide and support you through the highs and the lows.
Our counsellors, Rebecca Kerner and Julie Potts, are available free of charge and in total confidence throughout your journey with Fertility SA. They are here to help you weather the emotional storms associated with treatment, to help with pre-treatment planning, or to talk to you about any other concerns you might have.
Fertility problems can affect all areas of your life. In the general community, often it isnâ€™t recognised just how demanding and painful it is to have to wait or to try hard to conceive without success.
Our counsellors can support you at key points throughout your fertility treatment, recommend stress relief strategies, and help you navigate the sometimes complex decisions that arise in treatment.Â It can be a huge relief to talk to someone who fully understands the ups and downs associated with infertility, as well as the unique aspects of your treatment, and dealing with pregnancy loss.
Certain factors, such as knowing you have a family history of a genetic disease or being of an advanced maternal age can increase the likelihood of your baby being affected. We offer pre-implantation genetic testing (PGT) for patients.
What is PGT?
Pre-implantation Genetic Testing (PGT) involves carefully removing a small number of cells from an embryo for analysis. From this tiny sample, we are able to test whether an embryo has a wide range of genetic diseases such as Cystic Fibrosis (PGT-M) or provide better information on the number and integrity of the chromosomes in the embryo (PGT-A or PGT-SR).
In a standard IVF treatment where Embryos are tested at day 5 of growth.
PGT-M is recommended if you:
- Are affected by or carry a known genetic disease, such as cystic fibrosis.
PGT-SR is recommended if you:
- have changes with the normal size or arrangement of your chromosomes
PGT-A is recommended if you:
- Are of an advanced maternal age
- Need to prevent the transmission of sex-linked genetic disease
- Have had multiple miscarriages
- Have had a number of failed embryo transfers
Many fertility treatments attract a rebate from Medicare. The Medicare Safety Net also provides additional rebates for people with large medical expenses. Once you reach the Medicare Safety Net threshold in a calendar year, Medicare will pay an additional rebate on selected items.
To claim the Medicare rebate, you need a current referral from your GP or specialist gynaecologist/obstetrician and ensure it includes your, and if applicable, your partner’s name. This will enable you to reclaim all of the Medicare rebates you are entitled to.
|Tracking and intercourse timing||$495.00|
|Ovulation induction with Clomid||$545.00|
|Ovulation induction with FSH||$795.00|
|IUI||After safety net threshold||$1,790.45|
|IUI||Before safety net threshold||$2,504.00|
|FET||Frozen Embryo Transfer||$1,790.45|
|IVF||1st cycle in calendar year||$3,043.35|
|IVF||2nd and subsequent cycles||$2,490.90|
|ISCI||1st cycle in calendar year||$2,971.75|
|ISCI||1st cycle in calendar year||$3,524.20|
|All prices listed as out of pocket.|
Our prices are listed in a similar fashion to other fertility clinics to make it easier to compare prices. Our prices are after the estimated Medicare and safety net rebates.
All patients (both partners) require a referral from either their GP or Specialist. This step is a Medicare requirement and enables eligible people to claim any rebate applied to the consultation / treatment.
There are many variables to what services are covered by Private health insurance policies. We recommend prior to commencing any treatment you check eligibility with our own private health insurance policy.
Private hospital, anaesthetic fees along with treatment cycles for IVF all incur their own unique fees. You may be entitled to a rebate for some of the medications used for treatments, always check with your own health fund.
Medicare rebates apply to medical conditions that lead to infertility. There is no Medicare item number associated with donor sperm or storage fees, therefore these expenses will incur an out of pocket expense.
Those people without a Medicare card are not eligible for any rebate and therefore responsible for the full fee for any consult or treatment.
Fertility SA accepts credit card payments, Visa, MasterCard, Amex and direct funds transfer. If making a direct funds transfer please contact us for the banking details. If you are interested in the Compassionate Release of Super (CRS) program, you are able to contact https://mysupercare.com.au/
For any additional information please contact us at [email protected]
A gap payment enables you to make a reduced payment upfront and receive the Medicare Safety rebate afterwards. Be aware this payment has a 4-6 week wait to be processed. If possible we advise full payment upfront and the Medicare and Safety net rebates will be transferred directly into your account 2-7 days following egg collection.
For those patients undergoing Fertility preservation due to a cancer illness we offer a Fertility preservation assistance program (FPAP) please talk to one of our administrative team members if this applies to you [email protected]