Fertility first steps

Eggs only survive for up to 48 hours after ovulation (release from the ovary) and must be fertilised by the man’s sperm within that time. Infrequent intercourse may well miss the relatively small window of opportunity. If you have regular 28-day periods, and count the first day of your period as Day 1 of your cycle, ovulation will normally happen between Day 12 and Day 16. Irregular periods will make ovulation harder to predict.

Hormones can affect ovulation (the process of a female egg being released from the ovary) as well as the ability to maintain a pregnancy. In women who have regular menstrual cycles, ovulation normally happens once a month. In some women, due to hormonal imbalances or other problems, it happens irregularly, rarely or not at all. ‘Ovulation induction’ is a first-line treatment for women with such ovulation irregularities. It simply involves taking oral or injectable medication to stimulate ovulation.

Women are born with all the eggs they will ever have, and the quantity and quality starts to decline by the early 30s, with a major deterioration and greater potential for chromosomal abnormalities by age 40. Although science can help achieve great things, it is still much easier to start your family before age 35.

Damage to or infection of the fallopian tubes can create a blockage or impaired function, which prevents the sperm from meeting the egg and fertilising or prevents the embryo from travelling into the uterus. Different treatments will be recommended depending on the type and severity of the problem.

One of the most common pelvic problems is endometriosis (where developing cells from the lining of the uterus break away and grow outside of the uterus). Up to 70% of women with endometriosis experience some degree of infertility. A laparoscopic investigation can discover if this is a potential problem for you so you can have appropriate hormonal or surgical treatment. Fibroids and polyps in the uterus can also impair fertility.

Structural abnormalities of the cervix or vagina are a less common contributor to infertility.

Sometimes the man’s semen is the problem or part of the problem. There can be issues with the number of sperm, their motility (ability to move) and structure. Hormonal imbalances account for some of the abnormalities, and lifestyle factors can also have an effect. Some men have no sperm in their semen due to injury, illness (such as adult mumps), or genetic factors. Other less common problems include men who produce anti-bodies against their own sperm or whose ejaculate is diverted to the bladder.

If there are no detectable problems, the official diagnosis is ‘unexplained infertility’. Life Fertility can still recommend treatments and strategies to improve your chances of successfully becoming pregnant.

Blood tests for men and women allow us to determine hormone levels and any other factors that could be causing a fertility problem. For instance, if a woman’s thyroid gland is under-active it can interfere with ovulation and the quality of eggs. Progesterone may be measured on Day 21 of a 28-day cycle to check if you are ovulating.

You and your partner can expect to have blood tests that investigate the following:

– Reproductive and thyroid hormones
– Karyotype (to look at chromosomal abnormalities)
– Infectious Disease Screening
– Anti-Mullerian Hormone (AMH) – an indication of your possible egg reserve (female only)

A variety of features of the semen are checked, including: the number of sperm present (count), the proportion that are swimming (motility), how well they’re swimming (progression) and what they look like (morphology). You can read more in our fact sheet.

An ultrasound is the easiest way to check your ovaries, uterus and developing follicles and to exclude any gynecological abnormalities. While some things can be visualised using an ultrasound probe on the woman’s tummy, often a trans-vaginal ultrasound will give the most information.

This test uses a fibre-optic telescope to inspect the ovaries, fallopian tubes and uterus to identify any physical problems. Laparoscopy is a day procedure that takes approximately 45 minutes and is done under general anaesthetic in the surgeon’s operating theatre. Women typically report that there is little discomfort.

This is a simple matter of taking medication or having injections that help induce regular ovulation. The medication is normally taken at the beginning of the menstrual cycle and your response is monitored through the cycle using ultrasound. The clinician can then determine when you are due to ovulate and therefore the best time for intercourse or insemination.

Intrauterine Insemination (also known as IUI) is often one of the first treatment choices. It involves extracting and concentrating the swimming sperm from the man’s semen in the laboratory and then placing them directly into the uterus using a small catheter. It is often used in conjunction with ovulation induction to give couples a better chance of a successful conception. Our factsheet will tell you more, and you can find costs here.

If your tests have revealed endometriosis, cysts or other abnormalities, minor surgical intervention can improve these conditions so successful pregnancy is more likely.

In Vitro Fertilisation (IVF) is an increasingly popular and successful procedure that involves stimulating the ovaries and retrieving eggs, then fertilising them and developing embryos in the laboratory. After about 5 days, the best embryo is transferred back to the uterus.

There are a number of variations in IVF procedures that are recommended for different situations and embryos can be frozen for future cycles. Read more about IVF.

To understand the cost of IVF click here.

Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA) are surgical procedures that may be used to retrieve sperm directly from the testes where a man does not have sperm in his ejaculate. They are performed with a very fine needle under local anaesthetic or sedation, depending on the preference of the patient and the clinician. Our factsheet will tell you more.

We offer you a free counselling session with one of our fertility counsellors for each cycle of IVF. If you have any concerns at all, please take advantage of this. Additional sessions can be arranged whenever you need them.

Our Life Fertility Clinic Nurse Coordinators are available to discuss any issues experienced as a result of treatment. They are available by appointment or by phoning the clinic. Whether it’s a quick chat to check what you’re feeling is normal or a shoulder to cry on after a set-back, it’s good to know there’s someone who knows your situation and has the time to talk things through with you.

Healthy nutrition, moderate exercise, stress management and relaxation techniques help keep you on track before treatment and into pregnancy. Through our Health and Wellness Program we offer a range of resources, complimentary classes and sessions to make sure you are your best self heading into treatment and parenthood.

We can provide you with links to other organisations such as ACCESS – Australia’s National Infertility Network. ACCESS is a non-profit organisation committed to being a national voice in promoting the well-being and welfare of couples experiencing fertility issues.