Fertility Fertility

Fertility

Fertility Treatments

How can Avisena Fertility help you to start your family?

For many couples, the journey to parenthood does not always happen as quickly as they expect. Fortunately, advances in assisted conception treatments can make a real difference. We’re dedicated to giving you the best possible chance of having a baby. You’ll have the support of experienced local fertility specialists with access to the most advanced science and effective fertility treatments available in the world.

Whether you require a simple approach, such as Ovulation Induction or IUI (intra uterine insemination), or more complex infertility treatment, such as IVF (In Vitro fertilisation) or ICSI, Avisena Fertility can support you at every step of the way. We understand some of the people do not have the opportunity to start their family until they are over 35 and their fertility has already started to decline, by circumstance rather than by choice.

If you’ve been trying for 1 year or more (or 6 months if you are over 35 years of age), we recommend you to seek advice from our fertility specialist.

The first step is to undergo a number of routine tests and procedures, to identify any specific issues before we develop a treatment plan for you.


Routine test and Early Intervention Options

1) Ovarian Reserve Assessment (Egg Timer Test: AMH)

Your ovarian reserve is the number of eggs you have remaining in your body. Females are born with approximately 1 million eggs. How many eggs you have declines naturally with age and through ovulation. The rate your eggs decline is different for every woman. Around 10% of women will experience an accelerated loss where eggs decline at a faster than normal rate. A simple blood test measures anti-Mullerian hormone (AMH), can measure your ovarian reserve. It is known as the egg timer test, and it gives a good indication of your fertility and remaining eggs.

Results AMH Blood Level
Optimal Fertility 4.0 – 6.8 ng/ml
Satisfactory Fertility 2.2 – 4.0 ng/ml
Low Fertility 0.3 – 2.2 ng/ml
Very low/ Undetectable 0.0 – 0.3 ng/ml
High Level >6.8 ng/ml

 

AMH is produced by cells (granulosa cells) in the developing early antral follicles of the ovary. As your eggs decline, so do the number of antral follicles and the level of AMH. It is produced directly by early-stage ovarian follicles. Levels (over 3.0) are favorable, while low level (less than 3.0) indicates decreased ovarian reserve. AMH may be the best measure of the menopausal transition and ovarian age. It may also be useful in predicting ovarian hyperstimulation syndrome, the effects of chemotherapy, and in determining the treatment of PCOS.

AMH is a superior predictor of ovarian response compared to other markers, offers similar predictive value compared to AFC. AMH can be drawn at any time in the menstrual cycle and is not affected by hormonal therapy, including oral contraceptives.

What if my ovarian reserve is low?
  • If you’re in a relationship and ready for children, we recommend you try to get pregnant as soon as possible.
  • You can freeze your eggs, embryos or ovarian tissue.
Who is at risk of low AMH?
  • You may be at increased risk of low AMH if you have:
  • a family history of early menopause or reduced AMH
  • had ovarian surgery
  • severe endometriosis
  • had chemotherapy or radiotherapy.

2) Tubal Patency Test:

Hysterosalpingogram (HSG), laparoscopic tubal or other ultrasound-guided tubal patency tests To evaluate any abnormalities such as intrauterine anomaly or tubal occlusions. This is performed between days 6-14 of a cycle and provides an idea of the female reproductive tract and possible causes of the fertility problem.

What is a Hysterosalpingogram and what can I expect from the procedure?

The Hysterosalpingogram or (HSG) is an essential tool for evaluating fertility. Hystero (uterus) salpingo (tube) gram (study) is a test to evaluate not only whether the fallopian tubes are blocked or open but the status of the uterine cavity (where the embryo implants). This is the only non-invasive (meaning non-surgical) way to make sure fallopian tubes are open.

People often say, “My tubes can’t be blocked because I have periods” but it doesn’t work like that— you can have periods, no pain, no symptoms and still have blocked tubes.

Most women with blocked tubes will have a history of pelvic surgery, pelvic infection, or endometriosis but occasionally women with no risk factors will have this fertility issue.

The test itself is not the most comfortable—it is crampy but quick!


3) Male Testing: Semen Analysis

Most men will initially be diagnosed with a potential male factor problem based on the results of an ejaculated sperm specimen. Values tested in the Sperm Analysis, as defined by the World Health Organization (WHO), include:

Quantitative and Qualitative (Morphology) Sperm Test

Parameter Lower Reference Limit
Volume 1.5ml
pH 7.2
Concentration 15 million/ml
Total Sperm Number 39 million/ejaculate
Total Motility (PR+NP) 40% or PR 32%
Vitality 58% live spermatozoa
Normal Forms 4% (Strict Criteria)

 

A parameter in the Sperm Morphology Analysis is the morphology, or shape of the sperm. The shape of the sperm is a reflection of proper sperm development and maturation in the testicle, or spermatogenesis. Men with a defect in sperm morphology may be at risk for failure of their sperm to fertilize their partner’s eggs.


4) Ultrasound for Women at Avisena Fertility

A pelvic ultrasound assesses the female reproductive system, including the vagina, cervix, uterus, fallopian tubes, ovaries and other pelvic structures. It can provide helpful information for those experiencing

  • Heavy, irregular or infrequent periods
  • Pelvic pain
  • Follicle Tracking

Follicle tracking involves tracking the development of follicles that contain eggs within the ovary monitored with transvaginal ultrasound.

Tracking for timed intercourse/Intrauterine insemination (IUI)

Follicles may be tracked in a natural or stimulated cycle. When a leading follicle (18 X 18 mm) is seen, then intercourse or IUI may be appropriately timed. Alternatively, drugs which promote release of the mature egg may be administered (using hCG to trigger an ovulation).

Tracking for IVF

For most IVF treatments, the ovaries are artificially stimulated with follicle stimulating hormone (FSH) which produces multiple mature follicles which are then collected following administration of hCG.

In this setting, the follicular development is followed more closely with serial (2 to 3X) ultrasound scans, and with/without estradiol hormone levels blood test. The timing of an egg collection is based on the ultrasound. This information is relayed to patients by the Avisena Fertility nurse or specialist.

Early Pregnancy scans (as early as 5 weeks)

An ultrasound is performed to confirm the pregnancy, pregnancy location and the number of embryos/pregnancies. Fetal heart beat activity can be visualised by 6 weeks gestations.


5) Ovulation Induction

Ovulation induction treatment may be recommended to help patients get pregnant. For women with irregular menstrual cycles, it is a main treatment to make her ovulating, with the assistant of ovarian induction drugs.

What is ovulation (release the egg from the ovaries)?

Each month, in a regular cycle woman ovulation occurs (on average) 14 days before the start of her next period. It’s normal for women to ovulate anywhere from 12-18 days before their period starts.

What is ovulation induction treatment?

Inducing ovulation using medication (ovulation induction) allows an egg to mature and be released by the ovary. The cycle is tracked with ultrasound, to assist the best time to conceive.

Ovulation induction medication

There are two types of medication used to induce ovulation: tablets (oral medication) or daily injections of Follicle Stimulating Hormone (FSH.

Oral medications

The most common oral medication is Clomiphene Citrate, known as Clomid (Clomiphene Citrate) or Aromatase Inhibitor (Femara).

Clomiphene blocks oestrogen receptors in the body. This tricks the brain into increasing hormone production to stimulate the development of one or more follicles on the ovary. Clomiphene is usually taken for 5 -10 days in the first half of the menstrual cycle.

Clomiphene may have some side effects which usually pass within a few days of stopping the medication. They include hot flushes, thickening of cervical mucus, mood changes and irritability.

FSH injections

Follicle Stimulating Hormone (FSH) is a pure hormone injected daily in the first half of the menstrual cycle. It is injected just under the skin with a very fine needle.

It is easy to inject yourself with the needle, and our fertility nurses are on hand to show you how to do it and offer support.

Is ovulation induction right for me?

Ovulation induction may be the best choice if you:

  • don’t have a regular cycle
  • don’t have periods at all (in premenopausal patients)
  • have unexplained infertility
  • IUI and IVF Procedures
Multiple pregnancies

Ovulation induction medications can lead to multiple follicles developing and maturing in one cycle – more than one egg may be released in ovulation. This means there’s a higher chance of multiple pregnancy. This can be a risk to mother and babies. Avisena Fertility staff/specialist will monitor/tract the ultrasound progress of your follicle development and guide you on the appropriate next step.


For appointments or more information about fertility services at Avisena Fertility, please call Avisena Fertility at 603- 5515-1888 or Fax: 603-5515-1815 from 8 a.m. to 5 p.m., Monday through Friday. Avisena Fertility is located on the 8th Floor at Avisena Women’s & Children’s Specialist Hospital.