Lots of women have fibroids, and in some situations, they contribute to infertility.
So, a woman needs very good advice as to whether a fibroid should be removed to improve fertility.
Fibroids are very common tumours, or growths found in the uterus of up to 40% of woman. They can be tiny (1cm across) or massive. The largest removed by Ballarat IVF, and SouthWest Fertility specialists was 3.5kg! They are almost always non cancerous and tend to grow slowly.
The larger a fibroid is, and the closer it is to the endometrium, (uterine lining) the more likely it is to be playing a role in infertility. Fibroids are also thought to cause fertility problems by changing the way the uterus contracts, possibly expelling a healthy embryo, and they can also release locally active hormones which adversely affect the uterine lining, even if they are not near it.
There are a number of ways to treat fibroids. Sometimes the best treatment is no treatment. Hormones can be prescribed to reduce the size of fibroids, or surgery performed to remove fibroids altogether.
If you are trying to conceive, and have fibroids, you need careful, considered advice about what to do about them. Removal of fibroids can be unnecessary, but on the other hand, can markedly improve your chances of conceiving.
Ballarat IVF and Southwest fertility specialists are experts in assessing and treating fibroids. Often there is no need for treatment, but if surgery is to be performed, it has to be done properly.
Endometriosis is when cells that line the uterus are found in other parts of the body and is a very common condition present in women trying to conceive. We look carefully for it, treat it by performing laparoscopic surgery and removing it. There is good evidence that treating endometriosis increases the chances of having a baby.
Adenomyosis is a condition of the uterus where the cells that form the lining on the inside of the uterus also grow in the muscle wall of the uterus. Each month, these buried areas of lining bleed, and cause inflammation, swelling and release of chemicals and hormones which lead to pain.
Adenomyosis and Endometriosis are often found together.
When a woman has painful heavy periods, and is having trouble conceiving, part of the cause of her symptoms may also be adenomyosis. There is new evidence accumulating which shows that adenomyosis, when present,
further adversely affects the chances of conception.
The diagnosis of adenomyosis involves careful examination, and ultrasound assessment of the uterus. MRI is sometimes used. The treatment offered depends on each woman’s situation, but can involve drug treatment, prior to IVF. With specific treatment of adenomyosis, the chances of having a baby can be significantly improved.
Your Ballarat IVF and SouthWest Fertility Gynaecologists are experts in assessing you for the presence of adenomyosis, and will give you personalized advice regarding the best treatment.
Did you know that in some clinics, over 70% of IVF cycles involve the use of ICSI?
The majority of women and couples attending Ballarat IVF and South West Fertility are able to achieve a pregnancy without having IVF. A detailed discussion with your fertility specialist looking for common contributors to infertility is the first step. Offering sensible and effective treatment for conditions, such as ovulation problems, PCOS, and endometriosis often leads to the birth of a healthy baby with very little fuss, or expense.
However, when ICSI is required, Ballarat IVF and South West Fertility have five IVF scientists who are experts in performing ICSI, and we have State of the Art equipment which is available for use every day.
Our scientists use ICSI in about 50% of treatment cycles. Some other clinics have ICSI rates of more than 70%.
The typical situation requiring ICSI is one where the male partner has a very low sperm count, or where sperm is retrieved from a man who has had a previous vasectomy. In these situations, the likelihood of an egg fertilizing, if combined with sperm without ICSI is very low.
Other situations where ICSI can be needed is when, despite all investigations, there is no obvious cause for not achieving a pregnancy. This is called idiopathic infertility. In some of these couples, the cause is a sperm binding problem. That is, that the egg and sperm don’t join properly to allow fertilization. There is no way to test for this problem.
If a couple, with idiopathic infertility, require IVF, we often will use ICSI on half of the eggs, and perform normal IVF on the other half. This step provides an “insurance policy” in case there is an underlying sperm binding problem. If we didn’t do ICSI on some of the eggs, we could all be very disappointed the day after egg collection if none of the eggs had fertilized with normal IVF.
At Ballarat IVF and South West Fertility, about 50% of our couples having IVF require ICSI. We try to keep the rate of ICSI as low as possible, without risking having poor egg fertilization results for our couples.
If you have questions as to whether you really need ICSI in your IVF cycle, feel free to contact Ballarat IVF or South West Fertility.
It is not surprising that the majority of the discussion about fertility in our community centres around the important female fertility issues such as age, PCOS, Endometriosis, tubal disease and lifestyle factors.
It does, however, take a sperm as well as an egg to form an embryo, and if the latest, and increasing quality of research is considered, as a species, we humans have big problems evolving, with declining sperm counts and quality.
Far from having all the time in the world to become a father, the biological clock is ticking for future dads as well as future mothers. Women are born with all the eggs they will ever have, whereas men produce sperm all their life. This should give blokes little to worry about, but a recent study has raised serious concerns.
In his article in Human reproduction in November 2017, Dr Hagai Levine reported results from a meta-analysis of 185 studies of sperm quality from wealthy countries from 1973 to 2011. He found that sperm counts and quality have dropped by 60 percent over the last 40 years! And sperm counts continue to drop 1.6% per year.
Importantly, the studies collated DID NOT include men with known fertility problems, so at a population levels, these findings are important. It means that increasing numbers of men in our community have sperm counts that adversely impact on fertility. The impact of these findings may be that 10-15 % of men may have counts so low that they require IVF to conceive, and a further 20-25% could expect a prolonged wait to achieve a natural pregnancy.
SO what is the cause of this rapid decline? Well, it’s likely to be lifestyle related, and environmental in origin, as genetic selection pressures take much longer to cause an effect. The first impact on sperm production is thought to occur during pregnancy, and this sets the maximum counts the man will achieve. Maternal smoking is the only proven cause for this, but clearly, there are other factors yet to be discovered.
Other suspected environmental culprits are endocrine disruptors, such as BEP in plastics, pesticides, and some painkillers. Once the boy develops into a man, there are a range of other factors which can further worsen their “best case scenario”. Smoking, Obesity, Anabolic steroid use, and a poor diet adversely impact sperm quality.
There is some evidence that prolonged use of laptops may impact on sperm counts, and reasonable evidence that using tight underwear, and Jacuzzis also have an adverse effect.
If you are a cyclist, you’re in the clear! There is no evidence that this sport has a negative effect.
How about remedying the problem of a low sperm count? Well, there are no miracle cures, but stopping smoking, reducing BMI, wearing loose fitting underwear, and a Mediterranean style diet, will likely help, and common sense suggests that careful handling of chemicals in the work place may also help.
If you are worried about your, or your partner’s sperm count, a high quality semen analysis through Ballarat IVF’s Andrology Laboratory will provide some initial information. Feel free to contact the fertility nurses or Specialist Gynaecologists at Southwest fertility or Ballarat IVF for more information.
All the best
Just a quick Happy New Year to all our Ballarat IVF and South West Fertility Friends, and patients.
We had a great year in 2017 working with our clients as they strive to achieve their dream of having a baby. Many couples are still going through the challenges of IVF, and I wish you all the best for the year ahead. You can be assured that we will continue focusing on providing the highest standard of care for you in a personalized setting.
Dr Kristin Cornell and I have been very pleased to establish South West Fertility in Warrnambool this year. Many of you will know Kristin, who lives and works as a full time Consultant Obstetrician & Gynaecologist in Warrnambool, providing local fertility services on a daily basis.
We are delighted to be able to provide fertility treatment & IVF planning for so many women and couples in South West Victoria, and South Australia, including rapid access to fertility preservation for women and men with a diagnosis of Cancer.
Ballarat IVF and SWF have had one of our most successful years, with outstanding results for our patients. In the Latest VARTA report, we generated a Clinical pregnancy rate for fresh embryo transfer of 30%, with 96% of these being single embryo transfers. This compares to a state average of 26% with 82% being single Embryo transfers.
Our frozen Embryo transfer pregnancy rate is a spectacular 39% per embryo transfer, with 100% being single embryo transfer, compared with a State average of 33%, and 91% single Embryo transfer.
In our work, there is nothing like the sight of a smiling woman, or couple, when they see their baby on the ultrasound for the first time. That’s really what drives our approach to fertility care.
All the best
There has been a lot of information in the media regarding Egg freezing for women who don’t want to have a baby at the moment, or for those without a partner. Much of this information suggests that all women should freeze eggs, and the sooner, the better. So, what are the facts associated with this important issue?
Firstly, there is no doubt that irrespective of how fertile a woman is, as she ages, her ability to conceive decreases. This is due to time related reduction in the quality of the eggs a woman produces, but also due to a reduction in her ovarian reserve. A reduction in ovarian reserve, generally speaking, means a reduction in the time until a woman becomes menopausal, and a reduction in the number of eggs she will produce during an IVF stimulation cycle.
Whilst it is an imperfect test, and can fluctuate, Anti Mullerian Hormone, (AMH), is a reasonable indicator of ovarian reserve. The baseline quality of a woman’s eggs, and hence her personal “level” of fertility, is mainly predetermined by genetic factors, which obviously can’t be changed. There are a number of factors, in addition to getting older which can adversely affect a woman’s ovarian reserve and AMH level. Lifestyle factors such as smoking, a poor diet, and having a high BMI adversely influence AMH.
Unfortunate situations, such as having endometriosis affecting the ovaries, having surgery for ovarian cysts, or having an ovary removed reduces AMH levels. If a woman has chemotherapy, this significantly reduces ovarian reserve, and a family history of early menopause is also a risk factor.
Some type of fertility preservation, either IVF with embryo freezing, or egg freezing is worth considering if you have any condition or situation which further reduces your ovarian reserve. That might include being at a certain age where there is little prospect, for a number of reasons, of having a baby in the near future.
The exact time for you to choose fertility preservation depends on a range of factors, and needs discussion with your fertility specialist. If you have obvious factors in your history which are likely to accelerate the normal decline in fertility, and ovarian reserve, the sooner you undertake fertility preservation, the better.
So how good is egg freezing for increasing the likelihood of having a baby? Well, it depends on the age at which it is done, and whether any of the above factors are present in a woman’s history. The older the woman, the more eggs she needs to have a good chance of having a baby. There is no guarantee.
For a 40 year old woman, she needs 15 eggs to have a 50% chance of a live birth AND 40 eggs for 80% chance live birth.
For a 37 year old woman, she needs 7 eggs to have a 50% chance of a live birth AND 20 eggs for 80% chance of live birth.
For a 30 year old woman, she needs 4 eggs to have a a 50% chance of live birth AND 12 eggs for 80% chance of live birth.
So, what does a woman who is thinking about fertility preservation do?
Firstly, consider whether you can alter lifestyle factors which adversely affect your fertility.
Next, if you have other risk factors for reduced fertility, consider having an AMH level performed, then speak to one of the Fertility Nurses or Specialists at Ballarat IVF or South West Fertility. You may need to consider egg freezing, but maybe not.
In the November edition of the Australian & New Zealand Journal of Obstetrics & Gynaecology, two articles were published regarding the Ethics of the restriction of access of women with a high BMI to Assisted Reproduction. The Royal Australian College of O&G, in its policies, says that having a BMI over 35 should be a complete barrier to having IVF. The Fertility Specialists at Ballarat IVF and South West Fertility do not support this position.
One of the articles argued that it is unethical to restrict access to services on the basis of BMI, and that all women should be provided with Fertility treatments, irrespective of their BMI. The second article looked at the topic from a different perspective. That is, from the view that women should be assisted to lose weight, and be made aware of the challenges, and relative risks involved with fertility treatment and pregnancy with a high BMI prior to embarking on assisted reproduction.
Strong arguments in favour of each position were presented. Looking at the factors in each argument which were agreed upon, of which there were many, the main ones were as follows:
1. Women who are of high BMI usually struggle to lose weight. There are a number of ways to tackle this important health issue, and some are more preferable to some women than others.
2. The more conservative the approach to weight loss taken, for example dietary modification, the slower it occurs. More radical approaches, such as gastric bypass surgery result in rapid weight loss, but do carry important risks in themselves, as well as the ideal (but not essential) requirement that a steady state of body weight be maintained for a period of time before trying for a pregnancy.
3. There are additional, well defined additional risks for women who undergo fertility treatments, and subsequently become pregnant, which include lower success rates for conception, and higher rates of adverse outcome in pregnancy, such as caesarean section, pregnancy loss, and pre-eclampsia
4. Despite these additional risks, the vast majority of women with a high BMI have an excellent outcome to their pregnancy, and in fact have better success rates for conception with Assisted Reproduction, when compared to other groups of women having Assisted reproduction. For example, a 35 year old woman with a BMI of 40 has a much higher likelihood of conceiving and having a healthy baby with IVF compared to a 42 year old woman with a BMI of 25.
So how do The Fertility Specialists at Ballarat IVF and South West Fertility provide advice to women of high BMI who wish to conceive?
As is the case with all of our patients, we take a personalized approach.
After undertaking a careful health assessment to exclude pre existing conditions, such as Hypertension, Diabetes, Kidney disease and heart problems, we work with our patients to formulate a treatment plan. The younger a woman is, and the higher her BMI, the more likely we are to advise dietary measures, or sometimes weight reduction surgery. Weight loss, even if 5%, has been shown to increase the chances of spontaneous pregnancy. Many women who are overweight have PCOS, so we work with you to treat this. The older a woman is, the less BMI influences her chances of conception. Above the age of 38, changing your BMI has virtually no positive effect on your chances of conception.
So, when caring for women, say over 36 with elevated BMI, much of the benefits of reducing BMI are centered on reducing the procedure based risks of IVF, if it is needed, and the pregnancy related risks.
Finally, after providing information regarding risks, and benefits, of all treatment options, including progression directly to IVF, we listen to, and will respect our patients plans and wishes for having a baby.
All the best
There are a number of factors which prevent women conceiving when they want to. In a perfect world, across all ages, the natural conception rate is about 20-25% per month.
A major reason for this relatively low back ground rate of conception is that, depending on a woman’s age, between 35% and 60% of embryos which form, either naturally, or with IVF, are abnormal.
At around 35 years of age, 50% of embryos have an abnormal chromosome make-up.
When a woman has IVF, it is now possible to test embryos’ chromosomal make up to assess the likelihood of them being normal. This process is called Preimplantation Genetic Screening, or PGS.
In the United States, 70% of IVF cycles involve PGS. In Australia, the rate is 15%, and climbing. Whilst this may seem like a basic and logical step to increase the likelihood of having a baby, there are a number of important matters to consider before deciding to use PGS in your IVF cycle.
The first point to consider is that the process of testing embryos can’t make them normal. When a group of embryos are formed from a fresh IVF cycle, they have a predetermined outcome, and PGS can’t change this.
Next, the PGS testing process does not always generate a useful answer regarding whether the embryo is normal. This is due to the testing process sometimes failing, and the occurrence of “mosaicism” in an embryo. This means that an embryo can have two, and sometimes three “cell lines” which may have different chromosomal make up. In this situation, depending on cells analyzed, a predominantly normal embryo may be called abnormal, wasting the embryo.
Additionally, the process of performing embryo biopsy has the potential to damage and stress an embryo, reducing the likelihood that a normal embryo will implant and grow.
Finally, whilst it is generally true that chromosomally normal embryos “look” the best under the microscope, this is not always the case. Hence, when an embryologist selects an embryo, or number of embryos for PGS on the basis of their appearance, and score, there may be some embryos, which don’t score as well, which may have a normal chromosomal make up, and potential to generate a pregnancy. Because PGS is expensive, scientists try to be “selective” when choosing embryos to test. In order to have PGS, a woman needs to have at least 3 high quality, day 5 embryos.
There is no doubt that there are a number of women and couples who will benefit from PGS for their embryos. A typical example is a woman who develops a large number of normal looking, high scoring embryos, who doesn’t conceive after a number of embryo transfers.
After PGS, the pregnancy rates per embryo transferred increase significantly, because, theoretically all embryos transferred are normal. However, the cumulative pregnancy rate, and live birth rate, PER Oocyte collection cycle, in fact, decreases. This is because normal embryos may be lost, discarded, or damaged during the whole PGS process.
If you wish to discuss PGS further, consult your Ballarat IVF or South West Fertility IVF specialist to see if it will be of any benefit to you.
All the best
You probably won be surprised to know that one in 4 women and couples have a significant “male” or sperm related issue contributing to their challenge of having a family. In many cases, the problem is one of a low sperm count, or poor motility, but in an increasing number of situations, there is no sperm available at all. The most obvious situation where this occurs is where a woman doesn’t have a male partner. This may be due to sexual preference, social situation, life dramas, and a number of other possible reasons. Fortunately, and directly as a result of the generosity of our caring donors, Ballarat IVF has a limited amount of donor sperm to help these women, and other couples who need donor sperm.
Additionally, there are a number of men, who, often to their complete surprise have no sperm in their semen. Generally, and to some degree, simply speaking, this is caused by low levels of sperm production in the testicle, or blockage in the flow of sperm through the male reproductive system. The good news is that it is very common, using a couple of simple procedures, to be able to obtain sperm for these men, so that they can father a child with their own sperm. The most common procedure used for obtaining sperm is a PESA (percutaneous epididymal sperm aspiration). This can be performed under Local Anaesthetic, but at Ballarat IVF we have Specialist Anaesthetists working with us who offer light sedation. Sometimes, a testicular biopsy is performed, either by a Ballarat IVF fertility specialist, or a Urologist. All sperm retrieved is frozen for the couple’s use in the future during treatment. Both procedures are performed as day case operations, and men are able to go back to work the next day.
If you are a man who has, or thinks he has, no, or low sperm counts, you will benefit from a detailed consultation with your Ballarat IVF fertility specialist, as the diagnosis, and treatment plan can be complex. Overall, however, you should be optimistic about your chances of having a family using your own sperm.
All the best
A group in Sydney has recently published results of a study which suggests that taking Vitamin B3 reduces miscarriage rates, and fetal abnormality rates – in mice.
They have taken this information, and suggested that the same benefits can be expected in humans.
Whilst it is true that, as animals, and mammals, humans do have many similarities to mice, it is well beyond the scope of the published article to conclude that Vitamin B3 supplements could benefit humans.
Vitamin B3 is a common component of a healthy diet, which includes fresh vegetables, cereals, and Vegemite! As many people’s diet can be at times, unhealthy, there may be some who are deficient in vitamin B3.
When planning a pregnancy, it is recommended to take a pregnancy multi vitamin, as it has been proven, in humans, that particular vitamins, such as folate, reduce the risk of abnormalities. The other vitamins in theses preparations MAY further reduce the risks.
There is no vitamin, unfortunately, that has been proven to reduce the overall risk of miscarriage.
Whilst this latest report is interesting, we should wait until studies in large numbers of humans have been performed to see whether Vitamin B3 supplements are of benefit to women planning pregnancy.
In the meantime, if you are planning to have a baby, keep active, eat a healthy diet, and take a multivitamin supplement!
All the best