By Dr Lauren Saunders, specialist at City Fertility Melbourne Bundoora
If you are on the receiving end of fertility treatment, it is important to understand that the first treatment plan prescribed to you may need to be adjusted in order to maximise your chance of success, should you not succeed the first time around.
Unfortunately, early diagnostic tests (eg. blood tests, medical history and examinations) can only tell us so much information and there are many unknowns in human reproduction. However, by continually reviewing results and tailoring your treatment it will help towards getting the perfect formula for your individual success.
Your specialist will normally work with you to review what worked and what didn’t for your past cycle and if any part of your treatment should be altered. The most common areas that can be tailored to each treatment cycle are medication type and dose; treatment type; and possibly introducing pre- implantation genetic testing of embryos.
Medication
One of the most common areas to tailor after an unsuccessful cycle is the medication.
By altering medication it can assist with increasing or decreasing the number of follicles, altering the uterine lining thickness and adjusting other elements of the menstrual cycle.
Clomiphene (Clomid) is the most common fertility medication used to induce ovulation, and your doctor may increase or decrease the dose depending on the outcome of the first cycle. While it can work well for most patients, over time it can cause thinning of the endometrial lining and a decrease in cervical mucus, which can negatively impact on fertility success and embryo implantation. If side effects from Clomid are experienced then alternative medications, such as Letrozole (Femara), may be used to induce ovulation and can be more effective for some patients. Injectable hormones, such as FSH, may also be an alternative for ovulation induction in some women. These injectable hormones are also used in IVF cycles and will be adjusted according to the requirements of the individual patient.
Treatment
There are many types of fertility treatments to assist patients with fertility issues. Depending on your situation, your specialist will often start by offering some of the simpler fertility treatment options that can substantially improve the chances of pregnancy. These may include looking at lifestyle factors, undertaking timed intercourse, ovulation induction, intra-uterine insemination (IUI), surgery, and hormone therapy.
Our statistics show that only about 20 to 30 per cent of our patients who see our fertility specialists actually go on to require IVF treatment.
If the early-intervention fertility treatments do not result in a successful pregnancy, then IVF, with or without ICSI may be considered as the next step and treatment option. Further specialised medical procedures performed within the laboratory may also be recommended for certain cases, These include altering the embryo culture media or embryo transfer media, laser-assisted hatching, and genetic testing.
Genetic testing
Your specialist may also suggest Pre-implantation Genetic Screening (PGS), which allows for the selection of the best embryos for implantation and is also known as Advanced Embryo Selection. This screening method can detect anomalies in the number or structure of chromosomes in embryos.
Often embryos with abnormal chromosomes can have trouble implanting to the uterine lining (endometrium), lead to early pregnancy loss, or can result in the birth of a child with disabilities.
PGS can be considered and is beneficial in maximising the chance of success, for a range of patients. These include those with recurrent miscarriage; advanced maternal age; a family history of chromosomal disorders or X-linked disease; previous unsuccessful IVF cycles; severe male infertility; and any IVF patient wishing to increase their chance of a successful cycle.
Lifestyle
Patients also need to be aware that before and during fertility treatment there are a number of lifestyle changes that can be implemented to maximise your chances of conception and give your baby the best start in life. When trying to conceive, the reproductive health of both the male and female is equally important. Factors like weight, stress, diet, alcohol, caffeine, smoking, medications and other habits should be assessed to determine if they are having any potential impact your chances of success.
