The ABC of IVF

Written by Dr Manny Mangat
06 Dec

 

 

At a glance
 

  • ‘Fertility talk’ can be littered with abbreviations, with OI, IUI, IVF and ICSI among the most commonly used, which can be confusing.
  • Asking questions – and deepening your understanding of the process – can contribute to a more informed and positive experience.

Exploring your fertility options can feel overwhelming at the best of times, but being hit with a dictionary full of medical jargon can puzzle even the most clinically clued up.

“It can be quite confusing,” admits Clinical Director of IVF Australia’s CBD clinic Dr Manny Mangat. “As fertility experts we’re so passionate about what we do that sometimes we throw out acronyms and expect people to understand what we live and breathe.” Which is why asking for clarification throughout the process is key.

 

Fluent in fertility

From ‘basal body temperature’ to ‘luteal phase’ and ‘anovulation’ there are a lot of medical terms that get thrown around when you’re going through fertility treatment. Here are a few that are commonly used by fertility specialists when discussing treatment options with patients:

OI or ovulation induction: medication offered – via tablet or injection – to induce follicle development and regular ovulation.

You might hear this if you are: struggling with irregular periods, occasional periods or no periods, which can make tracking ovulation a struggle

IUI or intrauterine insemination: recommended for short-term unexplained infertility or sexual difficulties. The procedure involves the manual insertion of pre-prepared sperm through the cervix and into the uterus just before ovulation.


You might hear this if you are: experiencing unexplained infertility, sexual difficulties or a couple/single using donor sperm, before moving onto more complex treatments like IVF.

IVFor in vitro fertilisation: assisted reproductive treatment used for female or unexplained fertility, whereby a woman’s ovaries are stimulated with a course of injectable fertility drugs, collected and fertilised with sperm from a male partner or donor.


You might hear this if you have: sperm abnormalities, endometriosis, tubal damage, unsuccessful OI results or unexplained infertility. Single women and same-sex couples using donor sperm are common candidates too.

Although IVF may be the fertility treatment that’s most talked about, bear in mind that you may not need IVF, and may be offered other procedures, medications or processes depending on your personal circumstances.

“IVF is only used for certain groups of people - it doesn’t help everyone,” stresses Dr Mangat. A fertility specialist will discuss whether the treatment is right for you.

ICSI or intracytoplasmic sperm injection: used to treat male infertility. The procedure involves injecting a single sperm directly into an egg, fertilising it and implanting it into a woman’s uterus.

You might hear this if you have: poor sperm quality, where conventional IVF is unlikely to result in fertilisation.

 

Found in translation

Becoming fluent in fertility takes time and involves asking lots of questions, but it has the potential to significantly affect your journey. Dr Mangat encourages patients to query any terms they’re unclear of as soon as they come up, to create a more empowering and informed experience. 

“If we can break down and simplify the process and patients gain the confidence to understand what they’re going through, it often gives them a much more positive experience,” she explains. “My biggest advice is to ask questions; we’re not scary people generally!”

If you need support, there is plenty available. See your GP or fertility expert for advice.

 

Sources

https://www.mivf.com.au/fertility-treatment/ovulation-induction-oi

https://www.mivf.com.au/fertility-treatment/artificial-insemination-iui

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Assisted-reproductive-technology-IVF-and-ICSI

 

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We hope this article was informative and useful to you. If you have any questions or feedback, feel free to get in touch at info@blogivf.com.au.



Related Articles

Children of IVF parents as healthy as those conceived spontaneously

In 2007 a local Melbourne paediatrician approached me curious about whether girls conceived through In-Vitro Fertilisation (IVF) and other Assisted Reproductive Treatments (ART) enter puberty earlier than those conceived spontaneously. With the first babies born through IVF now reaching their mid-30s, this query was my early motivation and the catalyst to initiate a study on the effects of IVF and ART on the health and wellbeing of children conceived through these technologies.

How healthy are IVF children?

This project was the largest of its kind ever attempted, worldwide.

We found that children conceived by IVF grew into healthy, normal adults when compared to children conceived spontaneously.

The collaborative study initially funded by Melbourne IVF prior to a National Health and Medical Research Council (NHMRC) grant involved researchers from Murdoch Children’s Research Institute, Monash IVF, the University of Melbourne and Monash University. Interviewing 656 mothers who used ART and their 547 young adult offspring aged between 18 and 29 years, and compared this to reports from 868 mothers and their 549 young adult offspring who were conceived spontaneously.

Self-report of their health and wellbeing for the first 18 years of life found the ART children had a normal body mass index and similar history of pubertal development to those spontaneously conceived. Educational outcomes, including tertiary admission ranked scores and completion of tertiary education, were also similar.

Were there differences in the health of IVF-conceived children?

Mothers did report a higher rate of hospitalisation, as well as a higher rate of asthma and hay fever in ART children. We found this to be in line with what we already know as a common mild condition in the whole community. The rate is not much higher at 23% of spontaneously conceived children experiencing allergies, compared to 30% of ART children.

These problems are more common in premature babies and we know a higher proportion of ART babies are born prematurely for reasons still largely unknown. Premature births may be because of the age of IVF mothers, as having a baby in your early 40s is generally harder than having a baby in your late 20s or early 30s.

ART parents might take their children to the GP more often and consequently they are diagnosed at a higher rate. We found ourselves speculating if parents of IVF-conceived children are more protective reducing their baby’s exposure to dust and dirt in turn increasing their risk factor for later allergies.

The finding of increased hospitalisations, including in the secondary school years, has not been examined in other studies to date and the reasons for hospitalisation varied, with no consistent set of conditions. Again, we wonder if this is due to parental vigilance.

What will be done to investigate further?

This study fills an important gap in our knowledge about the long term health outcomes of children conceived via IVF and ART. Our results indicate that the perceived physical, mental health, social and environmental quality of life reported by the 547 ART-conceived adults is very similar to that of their non-ART conceived peers.

We have a responsibility to continue this research and gather further clinical review in long term follow up of those conceived through IVF and other ART. Further research will evaluate their health status and follow up to determine if there are any important lifelong medical or other legacies of IVF.

What does this mean for those considering IVF?

This study provides reassurance to those requiring IVF that there are no apparent substantial negative long term health and wellbeing effects on young adults compared to those spontaneously conceived.

This study is published in Fertility and Sterility. 

Learn more about IVF in Queensland, Victoria and New South Wales.



 

Dr Manny Mangat
06 Dec

15 years of IVF patients – how have women changed?

The media is increasingly full of stories showcasing the latest 50 year old mum, or the celebrity who has undergone IVF. Even women who have used donor eggs are increasingly more comfortable discussing their medical history.

But, do these sensationalised stories really reflect the changing face of the IVF patient we see every day at our fertility clinic?

At Queensland Fertility Group Toowoomba we decided to assess the reality of these changes. In order to do this we conducted a retrospective study of 1587 women who had undergone IVF between 1998 and 2013 at our clinic in Toowoomba (based in the Darling Downs, west of Brisbane). We know that during this time there has been considerable social change, and we were interested to see how our patients may correspondingly have changed during this 15 year period.

Older women

Studies carried out by the Australian Institute of Health and Welfare informs us that the average age of women receiving treatment using their own eggs or embryos, is 36 years. We know too that over the last 20 years the average age of women giving birth has increased by 7.5%.

What did our study of 1,587 women show? The average age of women undergoing IVF treatment in Toowoomba has significantly increased by 6% - from 33 years in 1998 to 35 years in 2013.  Interestingly, the major shift has been the marked increase in the number of women aged over 39 completing treatment - which 15 years ago was just 3% and by 2013 had grown to 18%.

Rising obesity

The number of overweight and obese Australians has been gradually increasing for the past 30 years across all demographics – from wealthy, metropolitan suburbs to rural and disadvantaged communities.

An Australian Bureau of Statistics Australian Health Survey identified that between 1995 and 2011/12 the average adult woman’s weight had increased by 4kgs. The report likewise stated that in 2011/12 27% of all females aged 18 and over were overweight with a Body Mass Index (BMI) of 25 to 30.

Toowoomba is no exception to this trend. It’s therefore not surprising that the average IVF patient has become heavier. Women undergoing IVF treatment in 1998 at QFG Toowoomba had an average weight of 66kgs, and this had increased up to 77kgs by 2013. More significantly, their BMI (which also takes into account their height) moved from normal at 24 to overweight at 28 in 2013.

Single Women and Same-sex Couples

Shifts have occurred in the structure of families and as a result, we have seen a considerable increase over the past five years in single and same-sex couples accessing donor sperm to start their families.

Looking at the subset of patients where female cause was the sole reason for them having treatment, the proportion of single women and same-sex couples undergoing IVF increased from 2% in 2008 to 22% in 2013.

15 years later

Women attending our fertility clinic in 2013 are significantly older, heavier and have an increased BMI than they did in 1998. However, as women delay child bearing, by choice or circumstance, we need to ensure that there isn’t an unrealistic expectation that medical science can undo the effects of age.

What would you advise?

Unfortunately, we still cannot reverse the aging process, but we can ensure women are given the correct information to help them make informed decisions earlier. For example, the increasing use of the Anti-Mullerian Hormone (AMH) test or as it's more widely known, the egg timer test, can help a Fertility Specialist better assess a woman’s fertility and guide the direction of her fertility treatment.

Many women still remain unaware of the effect of weight on their fertility. We advise weight loss with simple lifestyle changes and, if necessary, dietician support. In addition to boosting a woman’s natural fertility, this can also have a beneficial impact on pregnancy and the health of the child.

This data was presented by Leita Fien, Fertility Nurse, Toowoomba at the 5th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2014) in conjunction with the Fertility Society of Australia Annual Conference held in Brisbane April 4-6, 2014.  Leita would like to acknowledge and thank her co-authors and colleagues Susan Lax, Julie Logan, Jeremy Osborn, and Dr John Esler, Clinical Director QFG Toowoomba.

Dr Manny Mangat
06 Dec

Understanding IVF success rates

If you’re starting IVF treatment or considering getting a second opinion, most patients will take a keen interest in a clinic’s IVF success rates. But what do these figures really mean and how do you compare them between clinics? 

Defining IVF success

The first thing to be aware of is that unfortunately, there is no standard definition for reporting ‘success’ when it comes to IVF. One approach is to report clinical pregnancy rates (a pregnancy confirmed by a blood test and ultrasound scan, usually at around 6-8 weeks).  However, it is important to remember that, as a result of miscarriages, not all clinical pregnancies will lead to live babies and clearly it’s the likelihood of welcoming a newborn baby into their family that is important.  However, as the birth takes place in the year after the cycle, the clinical pregnancy rate provides the most up to date statistic.

What is an IVF 'cycle'?

When a woman begins IVF she normally goes through a series of injections leading to an egg collection followed by transfer of an embryo.  Sometimes the cycle is cancelled before the eggs are collected, in which case, the normal charges of IVF do not apply.  Sometimes after the eggs have been successfully collected there may be no transfer because no embryos have developed.  In other cases, your doctor may advise you to postpone the transfer for instance, to carry out genetic testing on your embryos or to prevent complications if your hormone levels are very high.  In other cases, many embryo transfers can result from one egg collection.  Different clinics use different sub-groups to describe their results.  At IVFAustralia, we describe our success rates per each embryo transfer as this is a constant event that is easy to compare.  However you do need to be aware that, in some cases, you may not even have an embryo transfer.  In other cases, one egg collection can result in several embryo transfers to give you, overall, a higher chance of success from the egg collection.

Who is in the ‘successful’ group?

When comparing fertility clinics, this is generally when you realise that you’re often not comparing apples with apples.

The most important factor affecting the chance of pregnancy success, whether spontaneous or via IVF, is the age of the woman.  A woman’s fertility starts to decline slowly from her early 30’s onwards but declines rapidly after the age of 40.  It’s not too surprising then that the average age of a woman undergoing a fresh IVF cycle is 36*.  Look for a clinic that is transparent with its success rates and breaks them down into age bands.  If you’re 40 you simply cannot compare your chance of success with a 30 year old.

Here’s an example of IVF Australia’s Success Rates, which shows the variation between age bands:


IVF Success Rate

The other differences to look for are whether the success rates are based on all women starting an IVF cycle or only those that have an embryo to transfer, whether the rates include frozen embryo transfers, or whether their sample includes women using donor eggs.

Single embryo transfer

Australian fertility specialists have led the world in reducing the number of embryos transferred in an IVF treatment cycle – this reduces the chance of multiple pregnancies and therefore the risks to mothers and babies. At IVFAustralia 82% of all patients undergoing IVF treatment have a single embryo transfer, compared with 76.3% of the national cycles, and the chance of having a multiple birth through treatment at IVFAustralia is only 5.3% which is significantly lower than the national average of 6.5%.

It’s all in the numbers

As with all statistics, the higher the sample the more robust and reliable the figure. Larger clinic groups involving many fertility specialists caring for patients can offer you this, whereas individual clinics have a smaller patient population to draw from.

Also bear in mind that many clinics report cumulative rates, on average you will require more than one cycle before you are successful. Be aware of what you are trying to compare.

Is there an authoritative source of IVF success rates in Australia?

The University of NSW collates the success rates of all IVF cycles in Australia in an annual report. The most recent data available is for 2012 and includes pregnancy and live birth rates by a woman’s age, treatment type and the cause of infertility.

The latest average figures for all of Australia show that 22.8% of fresh IVF cycles result in a live birth and 22.2% of frozen/thawed embryo transfer cycles resulted in a live birth. Birth rates were much higher for younger women. Among those aged 30–34, the birth rate was 32.3% for fresh cycles and 26.4% for frozen/thaw cycles. For women aged 45 or over, it was less than 1.6% and around 5.4% respectively.* These figures are a good benchmark for you to compare any clinic success rates to. Be wary of any clinics that misrepresent this average in order to present a more dramatic looking result.

Can technology improve the likelihood of IVF success?

A number of technological interventions have been found to improve IVF success rates such as pre-implantation genetic diagnosis (PGD) to avoid chromosomal abnormalities, and, in some cases of male factor infertility,digital high magnification imaging of sperm. Other key advancements have been around fertilisation, embryo development and freezing methods. In addition, there are some emerging trial techniques (such as uterus scratching for repeat implantation failure) that are showing considerable promise.

Another example of this is the developments in cryopreservation techniques where the success rates after frozen embryo transfer are now equivalent to fresh cycle transfers, which ultimately reduces the number of cycles patients need to undertake to achieve a baby.

Make it about you

Whether you are embarking on fertility treatment for the first time, or seeking a second opinion after previous unsuccessful cycles, the best way to understand the likelihood of success for you and your partner is to have a consultation with a fertility specialist. Our role is to give you a thorough understanding of where you are now, and to work with you to develop the most suitable treatment plan moving forward.

Remember bar graphs are not always what’s important – achieving a pregnancy and delivering a baby is the definition of success. You need to find a fertility specialist you are comfortable with and who is caring for you, constantly refining your treatment to maximise the chance of success.  This may also include referring to an expert review of experienced colleagues for challenging cases and bringing the latest technology to bear where necessary.

Read more: IVF Success Rates for Greater Sydney, IVF Success Rates for Melbourne, IVF Success Rates for Qld


* Assisted reproductive technology in Australia and New Zealand 2012, National Perinatal Epidemiology and Statistics Unit, UNSW Australia 

 

Dr Manny Mangat
06 Dec

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