By Dr Stephen Elgey, City Fertility Centre Brisbane Southside.
It might come as a surprise to many people that only about 20 to 30 per cent of patients who see our fertility specialists go on to IVF treatment. Often IVF is not required as there are a number of other, simpler options that can substantially improve your chances of pregnancy, depending on your circumstances, medical condition and previous care.
Alternative pre-IVF options that your fertility specialist might advise include:
1. Intra-Uterine Insemination (IUI)
Intra-uterine insemination is a procedure in which treated sperm is inserted into a woman’s uterus directly at the time of ovulation, to improve the likelihood of fertilisation. The procedure can involve the use of fresh sperm (from the partner) or frozen sperm (from the partner or a donor). The success rate is not markedly higher than that achieved with timed sexual intercourse.
Intra-uterine insemination treatment options include:
a. Natural cycle insemination: This doesn’t involve any medication and follows the woman’s natural menstrual cycle. It may be used for patients who are unable to conceive with natural intercourse. It’s not usually successful for women whose partners have poor sperm quality or in women older than 37.
b. Ovulation induction – clomiphene citrate: This involves the use of medication (Clomid or Seraphine) to stimulate the ovaries and encourage or regulate ovulation. Using this medication in conjunction with intra-uterine insemination has been shown to increase pregnancy rates over natural cycle insemination.
c. Ovulation induction – follicle-stimulating hormone (FSH): Ovarian stimulation is stronger with this method and it has been shown to increase pregnancy rates over natural cycle insemination and clomiphene citrate ovulation induction. We are very careful to regularly monitor our patients to minimise possible complications relating to overstimulation and reduce the risk of multiple pregnancy.
It is worth noting that studies suggest that the most successful pregnancy results from intra-uterine insemination are achieved using clomiphene citrate or follicle-stimulating hormone (FSH) treatments. With any IUI, a “trigger” injection may be needed the day before.
2. Hormonal Therapy for men
Hormonal imbalances that affect sperm development may be treated by gonadotrophin therapy. Gonadotrophins are protein hormones sometimes used to treat unexplained male infertility in the cases of abnormally low sperm counts or when less than 40% of sperm are mobile.
Other drug treatments include using antibiotics to treat infertility caused by infections.
For women, surgery can often improve chances of conception when the cause of infertility can be traced to past inflammation or infections that have created scarring, or conditions such as fibroids, endometriosis and other tubal or uterine issues.
For men, a condition known as varicocele, where the veins of the scrotum become abnormally enlarged, may be surgically treated by clipping or tying the veins.
To reverse sterilisation treatments such as tubal ligation and vasectomy, surgery requiring an operating microscope, known as microsurgery, can be used. Our preferred surgical method is a laparoscopic or keyhole procedure, whereby abdominal operations are performed through small incisions in the abdominal wall or navel.
Careful consideration should be made when deciding which treatment options are right for you and these can be discussed with your fertility specialist.
For more information on exact fees and other information relating to these fertility treatment options, please contact City Fertility Centre’s nurse coordinators on 1300 354 354.
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