Treatment and Fertility Preservation Options Â
Treatment Options
Your personalised fertility journey starts with an investigation of both partners health.
Your personalised fertility journey starts with an investigation of both partners’ health. We take a holistic (whole of body) approach, which includes assessing the influence of physical and lifestyle factors on your fertility such as age and weight. Working closely as a team, your fertility specialist will create a customised treatment plan outlining the ideal laboratory and clinical approaches for you. Our team will be with you every step of the way to provide support and advice so we can achieve our shared goal: for you to take home a healthy baby. It’s important to know you are not alone in seeking fertility treatment. It is probably much more common than you think. Assisted reproductive technology (ART) refers to the scientific methods that are used to unite sperm and eggs. The most common ART procedures are:
- in vitro fertilisation (IVF)
- intra-cytoplasmic sperm injection (ICSI)
- frozen embryo transfer (FET) cycles.
There are also some lower intervention ART procedures such as:
Many couples require minimal intervention to achieve a pregnancy, while others need to undergo procedures such as IVF or ICSI. In recent years, more than 70,000 cycles of treatment with ART have been performed in Australia each year, resulting in one in every 24 babies born in Australia a result of some form of ART – that’s approximately one child in every classroom. After more than 30 years of helping couples and individuals realise their dream of having a baby, we are here to provide advice that is suitable to your needs. If you are ready to embark on treatment, the next steps in your fertility journey are explained here.
Weight
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recognises that high Body Mass Index (BMI) is now one of the most common and important risk factors for infertility and adverse pregnancy outcomes. Such risks can present even before you start trying to conceive.
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For more information about lifestyle choices you can make to optimise your fertility, please see:
- https://staging.westmeadfertilitycentre.com.au/how-healthy-lifestyle-choices-can-improve-your-fertility/
- RANZCOG Pre-pregnancy Counselling Best Practice Statement (November 2021)
- RANZCOG Management of Obesity in Pregnancy (March 2022)>
- Best, Avenell and Bhattacharya. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence.Human Reproduction Update. 2017;23(6): 661-705.
Age
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From our experience providing fertility treatment at Westmead Fertility Centre, we know that by the age of 43 the chance of having a baby using the women’s own eggs is at most 5% and at 44 years of age or older, the chance is less than 1%. When we know the chance of success is so low, we do not consider it appropriate to offer treatment to a women using her own eggs if she has turned 43 years old. If you are 43 years of age, or older, you may wish to consider building your family using eggs from a donor. See more information on oocyte (egg) or embryo donation below.
For more information on the impact of age on fertility, please see https://staging.westmeadfertilitycentre.com.au/the-impact-of-age-on-fertility/
You can also estimate your chance of having a baby using the online success estimator that can be found at: https://yourivfsuccess.com.au/estimate
In vitro fertilisation (IVF)
This technique involves placing an oocyte (or egg) and sperm together in a laboratory. Once fertilisation takes place, the embryo is transferred to the uterus to hopefully implant and become a pregnancy. IVF is used to treat a range of fertility issues including:
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- low sperm count
- fallopian tube damage, for example as a result of endometriosis
- female’s age
- ovulation problems, for example, caused by polycystic ovary syndrome (PCOS).
Your Westmead Fertility Centre fertility specialist along with our embryologists will determine if IVF is the right course of treatment for you, based on your specific situation. In standard IVF treatment, a couple’s own sperm and oocytes are used. In certain circumstances when this is not possible, donated eggs or sperm will be used.
Intra-cytoplasmic sperm injection (ICSI)
This is a laboratory technique used when successful fertilisation of the oocyte (or egg) cannot be achieved with standard IVF. While IVF allows the sperm to penetrate the egg of its own accord, in ICSI, a single sperm is directly inserted into the oocyte. ICSI may be used if:
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- the number of sperm available is too few to expect fertilisation with IVF
- fertilisation has not occurred in previous IVF cycles despite a high number of sperm being present, or
- the only sperm available are those that have been collected directly from the testis.
It’s not always possible to say in advance whether IVF or ICSI will be necessary to achieve fertilisation of your oocytes. After taking into account the outcome of the sperm assessment, preparation and your relevant history, our embryologists, along with your fertility specialist, will decide whether to proceed with IVF or ICSI. Generally, if we believe that the sperm has the ability to fertilise the egg without assistance, we will proceed with IVF. If the sperm needs help, our embryologist will proceed with ICSI. Our recommendation will be discussed with you following oocyte pick-up (OPU) procedure. Unfortunately, not all oocytes are suitable for sperm injection. Some may be immature and may not survive the injection process.
Embryo cryopreservation
Intrauterine insemination (IUI)
This process, also known as assisted insemination (AI), involves placing specially prepared semen directly into the woman’s uterus. Sperm can be provided by the woman’s partner or from a sperm donor. IUI may be used if:
- the couple have unexplained infertility and wish to try a lower intervention form of assisted reproduction technology
- the couple need to use donor sperm
- the male partner is unable to ejaculate into the vagina near the cervix
- sperm may not be able to move from the vagina, through the cervix, into the uterus or
- there may be emotional or psychological problems which prevent normal sexual intercourse despite appropriate counselling.
Frozen embryo transfer (FET)
Freeze-all cycles
Ovulation tracking and ovulation induction
Ovulation is the process of an oocyte (or egg) being released from one of the ovaries. This usually happens once every month in women between the ages of 13 and 50 years, except when she is pregnant or taking the oral contraceptive pill. However, in some women, ovulation does not occur regularly. Ovulation may occur only once every six to eight weeks, once every few months, once or twice a year, or perhaps never, unless they are given treatment to stimulate the ovaries. It is also quite common for women who have regular periods to have one or two cycles a year in which they do not ovulate, but still have a period of bleeding around the expected time. Many couples want to know what they can do to improve their chance of conceiving. Your fertility specialist will discuss with you if ovulation tracking is right for you as a first step. It is a simple option that involves conducting a series of tests to help you understand your natural fertility and plan when to have sex to maximise the potential of getting pregnant. The term ‘ovulation induction’ (OI) is used to describe the process of stimulating the ovary to produce a mature oocyte (egg) and causing the release of the oocyte (ovulation). If sexual intercourse occurs at this time and the oocyte is fertilised by the sperm, a pregnancy may occur. The common medications used to induce ovulation can be either in the form of oral or injectable medications and may include:
- Clomiphene Citrate (Clomid, Serophene) and Letrozole (Fenara). These are oral medications used for five days in the early stage of the menstrual cycle. The dose may vary, depending on your history or previous response (if applicable).
- Metformin (Diabex, Diaformin). This is an oral medication which can help control insulin resistance or impaired glucose tolerance in women, a common finding in women with irregular cycles caused by polycystic ovarian syndrome (PCOS).
- Gonadotrophic injections (Gonal F, Puregon, Menopur). These are given by subcutaneous injection into the lower abdomen. Either medication can be used on a daily basis or until a mature follicle or follicles are seen by ultrasound monitoring. Due to the increased risk of multiple pregnancy, this treatment option will require frequent monitoring by testing hormone levels and ultrasounds. Once the chance of a multiple pregnancy has been excluded, ovulation will be triggered by an injection of another gonadotrophin (Pregnyl, Ovidrel).
Treatment add-ons
Your fertility specialist may suggest optional treatments in addition to your routine treatment offered at Westmead Fertility Centre, with a view that they may improve your chances of having a baby. These are sometimes called ‘treatment add-ons’, ‘adjuvant therapies’ or ‘supplementary treatments’. For some of these ‘treatment add-ons’, there is not enough evidence to show that they are safe and/or effective at increasing your chances of having a baby. Our fertility specialists use the Human Fertilisation & Embryology Authority website to provide you with more information on what some of these add-ons are and to assist you deciding if they are right for you.
If you do decide to use a ‘treatment add-on’, your fertility specialist will ask you to complete an additional consent form and provide you with the specific instructions.
Oocyte (egg), sperm and embryo donation
Oocyte donation
Oocyte donation may be an option if:
- A woman’s own ovaries do not produce oocytes, possibly due to premature menopause, following chemotherapy treatment for cancer, or other reasons.
- A woman has a known genetic disorder, or is a carrier to a genetic disorder that may be passed to her children.
- A woman has had her ovaries removed, or was born without ovaries.
- A woman has had several unsuccessful IVF or ICSI cycles where the problem has been attributed to her oocytes.
At Westmead Fertility Centre we are able to offer treatment to patients who wish to use donor oocytes (eggs). However, there is some criteria you must meet before we can help you with this. The criteria for your egg donor are:
- Your oocyte donor must be known to you and the donation must be altruistic in nature.
- Your oocyte donor must be between 25 – 38 years of age.
- Your Oocyte (egg) donor cannot be a close relative of the male receiving treatment and, ideally, they have completed their own family.
- Your oocyte donor should not have donated at another fertility centre.
- Your oocyte donor must be prepared and managed (‘worked-up’) using our procedures. That is, we cannot import donated samples from another fertility centre.
If you already have a known oocyte donor and all these criteria are met, more detailed information on using donor oocytes at Westmead Fertility Centre can be found here.
If you have not found someone who is willing to donate oocytes to you, unfortunately, we are unable to help you at this time. Please revisit this page once you have a known oocyte donor who meets the above criteria.
Sperm donation
Donor sperm may be an option if:
- A male has no sperm or a very poor semen analysis (for example, a low sperm count, poor ability to move and abnormally shaped sperm).
- A male has a known genetic disorder or is a carrier to a genetic disorder that may be passed to her children.
- For same-sex relationships.
At Westmead Fertility Centre we are able to offer treatment to patients who wish to use donor sperm. However, there is some criteria you must meet before we can help you with this. These criteria for your sperm donor are:
- Your sperm donor must be known to you and the donation must be altruistic in nature.
- Your sperm donor must be between 21 – 60 years of age.
- Your sperm donor must not be a close relative of the female receiving treatment.
- Your sperm donor should not have donated at another fertility centre.
- Your sperm donor must be prepared and managed (‘worked-up’) using our procedures. That is, we cannot import donated samples from another fertility centre.
If you already have a known sperm donor and all these criteria are met, more detailed information on using donor sperm at Westmead Fertility Centre can be found here.
If you have not found someone who is willing to donate sperm to you, unfortunately, we are unable to help you at this time. Please revisit this page once you have a known sperm donor who meets the above criteria.
Embryo donation
Please follow this link to access more detailed information on using donor embryos at Westmead Fertility Centre here.
Fertility preservation options
- Complete oocyte maturation in the laboratory. This is being researched around the world, but is not available clinically at the present time.
- Surgical reimplantation of the removed piece. It is possible to surgically replace the small piece of ovary once the chemotherapy or radiotherapy treatment has been completed. This has now been used successfully in a small number of women, resulting in the birth of healthy babies.
Westmead Fertility Centre is pleased to be able to offer bulk billed payment for some fertility preservation scenarios in order to provide additional support to our patients at this difficult time. Fertility preservation options for females
Fertility preservation for male cancer patients It is possible that the chemotherapy drugs or radiotherapy that you are due to receive may have an adverse effect on your sperm. This temporary, or sometimes permanent, effect may make it more difficult for you to father children. The likelihood of damage to your sperm production depends on the exact nature and dose of your treatment, but it is often not possible to predict the results. Whatever the treatment, you will still produce semen (fluid) when you ejaculate but there may be no sperm present in this fluid. Semen storage Freezing semen (semen cryostorage) may be an option for you. The aim of storing frozen semen before chemotherapy or radiotherapy, is to offer a potential backup in case the treatment does affect your sperm production. However, if your sperm function recovers after your treatment, you may not need to use these stored samples. The first step is to discuss your situation with your fertility specialist and obtain a request for fertility preservation at Westmead Fertility Centre. You will need to attend a laboratory appointment for our team to carry out an assessment of the sperm in the sample you provide and freeze the sample for storage until your fertility potential is reassessed. If you need to rely on stored semen to try to achieve a pregnancy, it will be thawed and used for either intrauterine insemination or in vitro fertilisation. Semen remains viable for many year when frozen and hundreds of thousands of children have been conceived worldwide using stored semen. Fertility preservation options for males
Success Rates
YourIVFSuccess.com.au >‘Success Estimator’ assists you to evaluate your chance of having a baby using IVF based on data from Australian fertility clinics (which is updated with the latest data each year). You will see that not all couples have an equal chance of achieving a pregnancy with the most important factors influencing success rates:
- the age of the women – as a female’s oocytes (or eggs) age, the chance of pregnancy decreases
- lifestyle factors such as smoking, drinking alcohol and obesity
- the reason for infertility
When comparing Westmead Fertility Centre to other clinics you will see that we perform very strongly against the National Averages – but we offer you access to our high-quality treatment at an affordable price, making Westmead Fertility Centre your choice for value.
Check out Westmead Fertility Centre’s Success Rates
Rather than visiting a fertility clinic’s own website, where data can be published in an incomplete way to paint them in the most favourable light, we encourage you to review the data directly at YourIVFSuccess.com.au.
The site provides information on how to interpret the results you see for each clinic.
And we won’t stop here – at Westmead Fertility Centre we are committed to attempting to continuously improve treatment outcomes through the ongoing investment in our laboratory and clinical approaches. For example, we have been leading the field in Australia by using freeze-all cycles
Read more about:
- Success rates in the Fertility Society of Australia’s consumer guide on how to choose an IVF clinic and understand success rates: How to choose an IVF clinic and understand success rates
- Our commitment to ongoing research and innovations at Westmead Fertility Centre.
- How to choose a fertility clinic
- Why IVF labs are important to fertility treatment success
- IVF clinics and success rates
Steps in your journey
- a couple has not conceived after 12 months of regular unprotected intercourse if the women is under 35 years of age, or
- a couple has not conceived after six months of regular unprotected intercourse if the women is over 35 years of age.
A more accurate term for most couples having difficulty conceiving is ‘sub-fertility’, which means the ability to become pregnant is diminished. It does not mean that you are unable to have children, but that you may require treatment or assistance to achieve a pregnancy. For most people, having trouble falling pregnant comes as a surprise, but in reality, up to one in six couples in Australia has difficulty conceiving. If the female partner is under 35 years of age and you have been having unprotected intercourse for less than 12 months, there is no need to be concerned about not falling pregnant. Contrary to popular belief, it is not ‘easy’ to become pregnant. However, there are some pre-existing or past medical conditions that may be playing a role. Use our checklist below to know when to seek help sooner. If you tick any of the boxes below and have not fallen pregnant within six months, regardless of your age, it is recommended that you make an appointment with one of our fertility specialists:
- irregular or absent menstrual periods
- have used an intrauterine device (or IUD) in the past for birth control
- difficulties with sexual intercourse
- a history of pelvic infection
- chronic pelvic pain
- breast discharge
- history of sexually transmitted infection
- excessive acne or facial hair
- experienced two or more miscarriages
- prostate infections in the male partner
- sterilisation reversal in either partner.
In summary, it is time to schedule an appointment with one of our fertility specialists if:
- you are a female under 35 year of age and have been having unprotected intercourse for more than 12 months, or
- you are a female under 35 yeas of age and you or your partner tick any of the boxes on the above list and have been having unprotected intercourse for more than six months, or
- you are a female over the age of 35 and you have been having unprotected intercourse for more than six months.
Next steps:
STEP 1: Referral
STEP 2: Make an appointment with one of our fertility specialists
STEP 3: Initial consultation with our fertility specialist
If you are a couple, you will both need to attend the initial consultation with our fertility specialist, which usually takes around one hour. You will need to bring your referral and any other prior test results. Your fertility specialist will discuss your medical history, conduct a physical examination and generally order further tests and investigations. The most appropriate treatment for your situation may be discussed and explained or this may occur at a later visit after test results have been received and reviewed.
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Please choose the path that best suits your stage, or give us a call for guidance.
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