The treatment selected is designed to give you the best possible chance of conceiving and will be, in the first instance, the least complex and most effective for your condition.
Please be sure that you have discussed your treatment programme with your Doctor and that you understand it fully before proceeding.
It is important to note that the female partner must have unblocked fallopian tubes for all treatment options with the exception of IVF.
In some situations couples may only require limited intervention. This can be achieved by accurately determining the time of ovulation for the female. Hormone levels are measured commencing from Day 8 or 9 of the cycle. An ultrasound scan to track the growth of follicles will establish the optimum time of ovulation. Intercourse should occur as close as possible to the time of ovulation.
This program will be monitored by your Fertility Doctor and information will be provided to you regarding ovulation by the Fertility Nurse.
Ovulation induction involves hormonal stimulation of the ovaries. Hormone stimulation will assist in the production and release of eggs. Also it will further improve the embryo’s chance of implanting successfully in the lining of the uterus. Hormone blood testing and ultrasound scanning will be conducted to determine when ovulation occurs.
Ovulation is triggered by a surge of hormones from the pituitary gland (Luteinising Hormone). This usually takes place 24 hours before ovulation. By carrying out simple blood and ultrasound tests to detect this hormone surge, we can advise you of the ideal time to have sex to give you the best chance of conception.
When the test results indicate ovulation is approaching you may be instructed to use a HCG injection to trigger ovulation.
This program will be monitored by your Fertility Doctor and information will be provided to you regarding ovulation by the Fertility Nurse. There is no need for a consultation appointment once you commenced on the program.
Intra-uterine Insemination (IUI)
IUI can be offered to patients with or without ovarian stimulation. However, the clinical team at Cairns Fertility Centre believe that the success rate of this programme is largely dependent on the female receiving some form of hormone stimulation to assist in producing eggs and utilisation of an optimal hormone program in the follicular and luteal phase of the cycle.
Oestrogen levels, together with endometrial thickness, follicular size and sperm delivery are extremely important to the success of the IUI programme. When female ovulation occurs, the male partner will be required to produce a semen sample. The laboratory will then wash and prepare this sperm sample for insemination.
The sperm is specially prepared in the laboratory to concentrate those with the best quality and then directly placed into the woman’s uterus around the time of ovulation.
In Vitro Fertilisation (IVF)
Following Clinical Assessment, you will be seen in the clinic by your Fertility Doctor and a mutual decision made to proceed with IVF. We will guide you through the process with regular contact by our Fertility Team.
What are the steps in an IVF treatment cycle?
Step 1: Ovulation Induction
Follicle Stimulating Hormone injections are given to stimulate the ovaries to produce multiple follicles - each follicle potentially containing an egg. These stimulation injections are given daily subcutaneously (under the skin) and our nurses will ensure you are comfortable with this injection process before you commence. A second type of medication (given as either a nasal spray or injection depending on the protocol that we have decided on) is also given to stop you releasing these eggs (ovulating) before we collect them.
Step 2: Monitoring Response
Over a period of approximately 2 weeks, whilst taking these injections, you will be scanned on to monitor the number and size of the follicles. These scans along with blood tests taken at each scan will help us correctly time when we should collect them and allows us to increase / decrease drug doses as needed to optimize your outcome. Generally we aim to collect between 4 to 8 eggs.
Step 3: Preparing for Collection
When the leading follicle reaches the optimum size (17-22mm), preparations will be made for egg collection. The final preparation for egg collection involves a hormonal injection (trigger injection) given 33-39 hours prior to egg collection. This triggers the eggs to reach maturity, making them ready for fertilisation.
Step 4: Egg Collection
The eggs are collected using a minor vaginal procedure performed under ultrasound guidance where a special needle is directed alongside the ultrasound probe, through the vaginal wall and into the follicles growing in the ovary. The fluid in each of the follicles that usually contains an egg is then aspirated into a test tube for the embryologist to assess. To minimize discomfort this is usually performed under a light general anesthetic or sedation.
It is difficult to predict the number of eggs available from the ultrasound scan picture. We therefore frequently collect fewer eggs and occasionally more eggs than we had anticipated pre-operatively. In rare circumstances we fail to collect any eggs despite the appearance of follicles on the scan picture. If this occurs, the treatment cycle cannot proceed to embryo transfer and you will be given an appointment to see the doctor to discuss your future options.
Just prior to egg collection and transfer, the Clinician will discuss the procedures with you. Egg numbers, embryo quality and any other particular circumstances associated with your procedure will be brought to your attention.
Step 5: Fertilisation and Embryo Culture
After the eggs are collected, if the sperm numbers are adequate approximately 50-100,000 sperm are placed with each egg in a culture dish and incubated overnight to undergo fertilization. If there are concerns with regard to sperm quality ICSI will be recommended to fertilise the eggs:
On average, approximately 65-75% of eggs will fertilise and fertilized eggs are now called embryos. They are then cultured in the laboratory and their development monitored for between 2-5 days. Once we are able to identify the best embryo or embryos, we will recommend transfer. Where possible we will aim to wait to Day 5 (blastocyst stage) before transfer.
Step 6: Embryo Transfer
Embryos may be transferred on Day 2/3 or 5/6 after collection. We are a Single Embryo Transfer (SET) clinic.
The embryo is placed through the cervix into the uterus using a small, soft catheter and the procedure is painless (similar to a smear test) and requires no anaesthetic. We encourage partners to attend the transfer.
Step 7: Post-transfer
There are many myths surrounding the period post-transfer but in essence it can be a stressful time waiting for the test day so we encourage women to resume normal activities. The pregnancy test will be two weeks after egg collection. You will be taking progesterone supplementation in this time to support the lining of the uterus and in the event of a positive pregnancy test, progesterone supplementation is continued until week 12 of the pregnancy.
Frozen Embryo Transfer (FET)
A frozen embryo transfer (FET) is a cycle where a frozen embryo from a previous fresh IVF cycle is thawed and transferred back into a woman's uterus. This means you won't have to undergo another cycle of egg collection.
Embryos will be transferred either in a natural cycle (without stimulation), a low dose FSH stimulation cycle or a cycle of Hormone Replacement Therapy (HRT) cycle. Most FET cycles are performed using HRT rather than Low Dose Stimulation to avoid the risks of multiple pregnancy. This decision on which form of stimulation to use will be made in consultation with a Doctor.
The transfer of the embryos is timed in relation to the age of the embryos and will coincide with the normal ovulation time within your transfer cycle. We routinely transfer one embryo.
On the morning of the transfer, the embryologist will inform you of the outcome of the thawing process. Sometimes embryos do not survive the thawing process and if there is any concern that the transfer may not proceed, this will be discussed with you by the embryologist at that time.
Microsurgical Epididymal Sperm Aspiration (MESA)
MESA is a surgical procedure available at CFC for patients who have previously had a vasectomy and in cases where they have been diagnosed with very low sperm counts or azoospermia (no sperm in the semen).
Azoospermia results due to a blockage or missing tubes which carry sperm from the testes (where sperm is produced) to the exterior, or due to absent sperm production in the testes. It is sometimes possible to collect sperm from the male genital tract, especially the testes and the tube close to the testes called the epididymis.
The MESA procedure is done under general anaesthetic and usually takes about 30-45 minutes; where we will aim to aspirate seminal fluid containing the spermatozoa from the epididymis. Once the fluid is collected and examined; spermatozoa found to be present will be assessed, processed and cryopreserved to be available for use in treatment cycles.
Cryopreservation of MESA aspirates are done as per the standard sperm cryopreservation techniques to isolate the best quality spermatozoa, which can then be used for ICSI upon thawing in standard IVF treatment cycles.
Risks & Complications are rare, but may include:
Moderate to severe discomfort
Impaired testicular function
Heavier than usual blood loss
Low Cost IVF
Cairns Fertility Centre offers low cost IVF cycles to patients that meet certain selection criteria. The IVF Treatment Cycle proceeds in the same way as the Standard regime with the main difference being minimal stimulation. We will guide you through the process with regular contact by our Fertility Team.
The out-of-pocket cost for the cycle will be $1500. Additional charges will apply if you are uninsured.
To be eligible, there is a Selection Criteria.
Contact our IVF Nursing Team at Cairns Fertility Centre on 07 4040 6888 for more information.