Experienced, insightful and caring is an apt description for City Fertility Sydney’s Professor Bill Ledger. With over 30 years of working in fertility, obstetrics and gynaecology across England and Australia, he has a depth of knowledge and experience that helps him to work out the best approach for his patients.
His research in the field includes over 300 peer-reviewed papers and journal articles and over 50 book chapters. He has joint-authored 16 books on infertility and reproductive medicine, including the 2020 Oxford Textbook of Obstetrics and Gynaecology.
Despite his research accolades, caring for his patients in the clinical setting is still his priority, and he works with his patients to ensure that they are well informed and develop an agreed, individually tailored treatment plan.
We recently asked Prof. Ledger a few questions about his work and the answers provide a wonderful insight into what makes him tick.
Q. You have been labelled “the friendly face of IVF”, what are your top tips for patients struggling on their fertility journey?
A. While IVF is easy for some, needing only one or two cycles in order to achieve the family they wished for, for others it can become a long haul with many medications and many procedures.
My top advice for patients is:
- It is important to keep an open mind about how likely IVF is to work for you. The ANZARD and Your IVF success websites are helpful when looking at statistics,
- sometimes a second opinion can be helpful,
- make use of the counselling services we offer – I have often seen this help and never see any harm from engagement with a good counsellor.
- your GP can also be an independent and sensible resource, so use them too.
- always remember that you can stop if you wish – taking a break can be a wise move and can restore physical and mental strength, and can let you move on.
Q. Having been involved with countless research projects in the field of fertility, what has been one of the most interesting and why?
A. IVF moves incredibly quickly, and we have been able to contribute to a few of the new developments in the field. I really like research that makes a difference to how we treat patients, so having been involved in the clinical trials of the GnRH antagonists in the late 90’s was exciting. We were seeing far too many healthy young women develop severe ovarian hyperstimulation after IVF. Introducing the new medication protocols with antagonists immediately halved the risk of developing this condition. We later contributed to the ‘agonist trigger’ research that has almost eradicated the severe form of OHSS, to such a degree that it’s difficult to teach my young trainees how to deal with it as we rarely see a case.
Q. What has been one of the best advances you witnessed in fertility medicine during your career?
A. Embryo cryopreservation (freezing) – this used to be a very hit and miss affair. We would slow freeze embryos on day three of development. Often we would then thaw them months or years later and they would not survive or would not implant. Pregnancies were rare. We moved to day five blastocyst culture and rapid freezing with vitrification and overnight the pregnancy rates improved. We now see equivalent chances of a baby after IVF with frozen blastocyst (embryo) transfer as we see with a fresh transfer.
Q. With the field of fertility and IVF medicine constantly advancing, what’s your prediction for fertility and IVF advances in the next 20 years?
A. It looks like one in 23 births in Australia are now from IVF. That is a huge number, and there is no sign that this trend will slow down. As more and more people defer trying for a family until they are older, we will see more egg and embryo freezing to avoid the effects of ageing on fertility and egg (and sperm) quality.
We also have some interesting preliminary findings from our UNSW lab suggesting that, in future, we may be able to slow down the ageing process of the egg with diet supplements, perhaps taken when a woman is in her early 30s to allow her a better chance of a healthy baby in her 40’s. Not ready yet but maybe in a few years’ time. I think we will also improve ways of treating sub-fertile men to help them have a family naturally, perhaps reducing the need for IVF with ICSI for this group. The science will continue to advance. We may see the end of the hormone injections, just collect eggs and grow them in the lab, and we may see improvement in our ability to screen embryos for single gene abnormalities. A non-invasive prenatal test for embryos would be a great step forward.
Q. You’re originally from England, why did you choose Australia to move to and what do you most like about it?
A. Theresa and I were lucky to be able to spend a year in South Australia in 1990. I came from Edinburgh to learn how to do IVF with Prof Colin Mathews and his team. We loved the whole year, came out with two boys and went home with three, and promised ourselves we would come back if we could. Years later our youngest (Aussie) son left home for university and we were free to return. Sydney is home now – we love all the usual great things it has to offer, but I also really enjoy working in Australian healthcare. It is a civilised and fair system, with reasonable Government funding and a strong private sector. I can also play bad tennis all year round!
If you would like to discuss your fertility with Prof. Bill Ledger please don’t hesitate to contact our Fertility Advice centre team.
Phone: 1300 354 354