In some circumstances, infertility can be due to the male partner having no sperm at all – sperm cannot even be attained through surgical approaches.
Couples in this situation might consider donor sperm. Donor sperm treatment might also be considered by women in same sex relationships, or by single women who wish to have a child.
Mark and Genea can help in these circumstances, when either a donor known to the woman or couple is planned, or when Genea will supply appropriate donor sperm.
A common problem that Mark encounters is when women in their early to mid 40s fail IVF as a result of a severe decline in egg number and function. Some women in this situation will consider egg donation. In most circumstances of egg donor treatment in Australia, the recipient woman sources her egg donor.
Cases of egg or sperm donation involve complex decisions as to whether such pathways are truly right for patients. There are also some legal requirements in NSW, including the need for record keeping and a requirement that egg or sperm donation in NSW is altruistic. Mark will provide experienced and empathetic advice to people in these difficult circumstances.
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Treatments like natural cycle IUI sound attractive to patients because of their simplicity, but the success rate is quite low. Particularly with unexplained infertility, the chance to conceive is elevated modestly with stimulation IUI but much more significantly with IVF. Very often, treatment decisions are made on the basis of the differential between intervention and return.
IVF involves similar hormone treatments to stimulation IUI but at a modestly higher dose, to attain a number of eggs. The eggs are collected via a vaginal ultrasound procedure, which Mark usually undertakes under local anesthetic and intravenous pain relief with minimal discomfort. A sperm sample is provided by the male partner and the eggs and sperm are placed together in the IVF laboratory. Following fertilization and early embryo development, a single embryo is returned to the woman’s uterus in a procedure as simple as a Pap smear. Other embryos can be frozen and kept for another attempt which would not require further injections nor a further egg collection.
At Genea, embryos are almost always grown to the day 5 (or blastocyst) stage and transferred one at a time. This leads to the highest chance of pregnancy with the lowest rate of complications.
You can read detailed descriptions of the IVF process at the Genea website.
In some causes of infertility, IVF is clearly indicated, for example blocked Fallopian tubes where surgery to repair the tubes has not been successful or is not indicated. IVF is also an excellent treatment for male factor infertility, often with a single sperm injected into each egg (a process called ICSI), to overcome issues such as a low sperm count or low sperm motility. However, studies increasingly show that IVF is also the best treatment for unexplained infertility. This is because IVF is the treatment most likely to overcome the multitude of subtle problems that may be present which cannot easily be tested for.
IVF can also be combined with genetic testing of embryos, using preimplantation genetic diagnosis or PGD. This technology is very useful for couples who carry a known genetic disease in their family, or for couples with repeated miscarriage. PGD also has an emerging role within general IVF.
Whether IVF is needed or not, when it should be employed and what form of treatment is best involves a highly individualized approach and discussion between Mark and the couple.