IVF Fertility Treatment

IVF is a process by which medication is taken to stimulate multiple egg-containing follicles in the ovaries. These eggs are then collected via a procedure. The embryologist then fertilise the eggs with sperm outside of the body and culture the embryos within the lab for 5-6 days. Typically, the best quality embryo is transferred back into the uterus on day 5. Any remaining embryos are either frozen or tested and frozen.

IVF has many indications. The most common are:

• Female factors:
  • Ovulatory infertility with a lack of success with OI;
  • Tubal issues;
  • Endometriosis;
• Male factors:
  • Moderate-to-severe male factor;
    
• Multiple factors to infertility;
  
  
• Unexplained infertility;
  
  
• Need for embryo chromosome/ genetic testing;
  
  
• Women/ couples wanting to preserve their fertility.

Dr Anthony Marren partners with Genea Fertility. Patient Relationship Coordinators (PRCs) will provide a quote based on the treatment plan plus Medicare/ insurance status.

For further information on costs of fertility treatment in Sydney: https://www.genea.com.au/treatment-costs.

Those treatments that hopefully result in a successful pregnancy (e.g. ovulation tracking, ovulation induction (OI), intrauterine insemination (IUI), and in vitro fertilisation (IVF) will typically take 1-month.

Egg freezing cycles typically will take 2-weeks.

Cycles that require chromosome/ genetic testing of embryos and then their subsequent transfer will take approximately 2-months.

The risks of IVF can be divided into ‘maternal risks’ and ‘fetal risks’. Maternal risks can be further subdivided into short-term risks (or risks associated with the IVF cycle itself) and long-term risks (or potential, future risks).

• Maternal risks:
  • Short-term risks:
    • Medication side effects: mild side effects such as bloating, headaches, nausea, irritability, mood swings and breast tenderness are common.
    • Ovarian Hyper-Stimulation Syndrome (OHSS): a syndrome characterised by ovarian enlargement and fluid accumulation within the abdominal and/or chest cavities, following treatment with ovarian stimulating hormones. One in 3 women will experience mild OHSS. Hospitalisation is required in approximately 0.5%. Complications include blood clots and kidney failure.
    • Ovarian torsion: one in 1,000 will experience ovarian torsion whereby an enlarged ovary rotates and cuts off its blood supply. Unless corrected surgically and in a timely fashion, ovarian function may be jeopardised.
    • Anaesthetic/ sedation complications: the ovum pick-up procedure is usually performed under anaesthesia or sedation. Anaesthetic complications are uncommon but will be detailed by the Anaesthetist or person(s) responsible for sedation.
    • Bleeding: one in 5,000 - 10,000 will experience significant bleeding at the time of ovum pick-up necessitating blood transfusion or further surgery.
    • Infection: one in 1,000 will experience infection at the time of ovum pick-up. Patients with certain risk factors (e.g. prior pelvic inflammatory disease, and presence of a hydrosalpinx, endometriosis and/or ovarian cyst) are at increased risk.
    • Injury to internal organs: one in 5,000 - 10,000 will experience injury to internal organs (bladder, bowel and/or blood vessels) at the time of ovum pick-up necessitating further surgery.
    • Ectopic pregnancy: this occurs when the pregnancy implants outside of the uterus - usually within the fallopian tube. The incidence is 1% for spontaneous pregnancies and 2% for IVF pregnancies.
    • Miscarriage: IVF does not reduce the rate of miscarriage.
    • Multiple pregnancy: in IVF, most twin pregnancies occur because more than one embryo is transferred. Where one embryo is transferred, the risk of twins is approximately 1%. Maternal risks include (but not limited to): miscarriage, high blood pressure, diabetes, anaemia, and surgical intervention. Fetal risks include (but not limited to): prematurity, 4-7 fold increase in cerebral palsy, and 10-fold increase in mortality. There is also the possibility that one pregnancy is chromosomally normal and the other is not. These risks do not consider the emotional, physical, and financial burdens.

• Long-term risks:
  • In response to the ongoing debate on the long-term effects of IVF and gynaecological cancers, Siristatidis C et al, conducted a comprehensive review of published data. Nine studies that included 109,969 women exposed to ART were included. When compared to the general population, IVF was associated with an increase in the risk of ovarian and uterine but not cervical cancer. However, when compared to the infertile population that did not have ART, there was no increase in the risk of ovarian and uterine cancer. (Siristadidis C 2013) This highlights the importance of selecting an appropriate comparator group (i.e. infertility contributes to an increase in risk as opposed to exposure to IVF).
  • Stewart LM et al, analysed 21,646 Australian women exposed to ART between 1982-2002. Women exposed to IVF who then had a successful pregnancy did not appear to have an increase in the risk of ovarian cancer. There is some uncertainty about women exposed to ART that did not subsequently have a successful pregnancy. (Stewart LM 2013) Women exposed to ART had in increase in the risk of borderline ovarian tumours. Borderline tumours are also known as tumours of low malignant potential. The risk is approximately 2.5 fold. (Stewart LM 2013) Women exposed to IVF did not have an increase in the risk of breast cancer. However, if IVF occurs less-than 24-years then there was a slight increase - the risk is approximately 1.6 fold. (Stewart LM 2012).

• Fetal risks:
  • Davies MJ et al, analysed 308,974 births in South Australia.
    • Women who used IVF tended to be: older; more likely to be nulliparous (no previous pregnancies) and white; reside in less disadvantaged postcodes; less likely to smoke; more likely to have a twin or higher-order multiple pregnancy; and more likely to have a pregnancy complicated by diabetes, high blood pressure and anaemia.
    • Women who used IVF were more likely to have: a stillborn pregnancy; deliver via Caesarean Section; have a small for gestational age or growth restricted fetus; and deliver before 37-weeks gestation.
    • Births after IVF were associated with a significantly increased risk of any birth defects - 8.3% vs 5.8%. The defects predominantly affected the cardiovascular, musculoskeletal, and urogenital systems. Cerebral palsy was also more common.
    • After taking into consideration various factors the risk of birth defects became not significant for IVF-alone. However, the risk persisted when fertilisation was via ICSI (Intra-Cytoplasmic Sperm Injection). Interestingly, the risk became not significant when ICSI embryos where replaced as frozen embryos. Other forms of assisted conception (e.g. Clomiphene citrate ovulation induction and intra-uterine insemination) were also associated with an increase in the risk of birth defects. Spontaneous conception after a prior IVF birth was also associated with an increase in risk. (Davies MJ 2012)

• A comprehensive review of published data (45 studies; 92,671 ART pregnancies and 3,870,760 spontaneous pregnancies) by Hansen M et al, concluded that the risk of birth defects with IVF is increased by approximately one-third. The background risk of birth defect was 5%; with IVF the risk increased to 6.5 - 7.0%. (Hansen M 2013)
  
  
• Another review of published data succinctly concluded: “On the basis of the current literature, it is not possible to distinguish the effect of parental sub-fertility, the effect of ovarian stimulation, and the IVF laboratory techniques on the risk of congenital anomalies, but it has clearly been shown that children conceived without fertility treatment in sub-fertile couples also carry a higher risk of congenital anomalies compared with singletons conceived by fertile couples.” (Pinborg A 2013)