Fertility

Fertility affects many couples and the reasons vary. At Ritu Rana Medical we aim to find the quickest and more cost-effective options for couples trying to conceive.

Determining if infertility is a factor is the first step before deciding on the best course of treatment and we can identify potential reasons for infertility (male or female) through various testing measures including semen analysis, anti-mullerian hormone (AMH), fallopian tube evaluation, laparoscopy and hysteroscopy.

With an initial consultation we discuss your journey to conceive and consider the best type of testing for your needs.

Semen Analysis & Collection
A semen analysis is an essential step in diagnosing the cause of infertility as well as providing information on the most appropriate treatment options for a couple trying to conceive.

Your GP/specialist will give you a referral to attend a semen analysis in your initial investigations. A seminal sample is produced and delivered to the scientist at your local fertility specialist. The sperm is analysed under a microscope to make an accurate assessment on:

To find out more about the costs involved please visit our Pricing section.

Evaluation of Fallopian Tubes AMH)

The function of the fallopian tubes is to transport the egg from the ovary to the uterus, where fertilisation of the egg by the sperm generally occurs. There are tests which can be performed to ensure the fallopian tubes are functioning correctly which include:

• Hysterosalpingogram (HSG)
• Diagnostic Laparoscopy and Hysteroscopy

Hysterosalpingogram (HSG)

A HSG is an x-ray procedure used to determine if the fallopian tubes are open and the uterine cavity shape is normal. They are usually performed from day 5-12 of the menstrual cycle when menstruation has ceased and prior to ovulation, so early pregnancies are not disturbed.

A dye is inserted into the vagina/uterine cavity, whilst an x-ray is taken simultaneously showing the dye spilling outside of the fallopian tubes. It is a mildly uncomfortable and the less invasive procedure of the two.

Diagnostic Laparoscopy and Hysteroscopy

A keyhole surgery to examine the abdominal and pelvic cavities. This procedure is performed in hospital under a general anaesthetic.

This may be the preferred option for women who have symptoms or suspicion of endometriosis as it may be treated simultaneously if considered a contributing factor to your infertility.

A blood test will be performed prior to your initial consult to check if you are ovulating. Further investigations such as a HSG (hysterosalpingogram) may be performed after your consult with your fertility specialist to check if you have open (patent) fallopian tubes, alongside a normal semen analysis prior to commencing OI/OT.

The most common medication used in OI/OT is Letrozole. It is used if a woman is not ovulating and thus has irregular or long menstrual cycles. Its mode of action is to block the enzyme that converts testosterone to oestrogen therefore prompting the brain to release more FSH (follicle stimulating hormone). Inside the follicle is the egg, so by promoting the growth of the follicle it will hopefully reach the size needed to trigger ovulation.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a procedure used for couples who may not be able to have sexual intercourse or when using donor sperm. It involves a process of placing washed sperm directly into the uterus of the woman and is typically used with younger women who have no issues with their fallopian tubes.

What does the IUI treatment involve?

It’s important to obtain blood tests prior to the treatment to rule out potential infections, to identify when ovulation is due and as part of the antenatal screening.
The sperm is then prepared before the insemination process which is under the supervision of our doctors and medical staff.

Are there any risks of IUI?

As with any medical procedure, there are risks involved. There can be a small risk of infection in the fallopian tubes with this process and some patients report slight discomfort but it is minimal and not long lasting.

What is the success rate of IUI?

Success rates with IUI will vary according to the cause of infertility and the age of the woman and the male from whom the sperm is being used. They can be typically lower than success rates of IVF.

Whilst undergoing this cycle, you will be monitored very closely with ultrasounds and/or blood tests to check the number of follicles developing, this is essential to reduce the risk of multiple pregnancy.

You will be given a leaflet with instructions prior to your day 1. Letrozole is generally taken on days 3-7 of your cycle with an ultrasound between days 8-11 with your fertility specialist. At this ultrasound, you will be advised of when you will likely ovulate and the window in which you should undergo “timed intercourse”.

It is important to bear in mind that once an egg ovulates it will live for 12 hours (maybe up to 18 hours) unless it is fertilised and sperm lives for 2-3 days (maybe even up to 5 days). So ideally it is best to have sex just prior to ovulation.

What’s involved in IVF?

The IVF procedure is comprised of a series of steps, these include:

1. The ovaries are stimulated to produce follicles, hopefully containing eggs (Not all follicles will contain an egg). The aim is to achieve as many eggs as possible, without compromising the woman’s health risk and quality of eggs achieved. This is done using FSH (follicle stimulating hormone) by an injection, for roughly 11 days.

2. During the stimulation of ovaries, you will undergo at least 2 TVS (trans-vaginal scans) and blood tests to determine the date for egg collection.

3. At the selected date, you will undergo a general anaesthesia and your eggs are collected using a trans-vaginal scan with a very fine needle attached.

4. The eggs are placed in a sterile culture dish and placed into an incubator.

5. The semen, whether fresh or frozen on the day will be prepared by the scientist. The prepared semen and eggs are placed into the culture dishes and into the incubator overnight.

6. The following day, the fertilised eggs are then cultured for 2-6 days in an incubator, before the best quality embryo is transferred to the uterus. The remaining embryos will be frozen for future use.

7. Injections and or vaginal gel pessaries containing progesterone will be taken from day of egg collection.

8. A pregnancy test will be performed by blood approximately 7 days after embryo transfer.

Embryo Transfer (ET)

Embryo transfer is attended at the Mackay Specialist Day Hospital under ultrasound guidance without anaesthetic. It is usually done with a full bladder. The procedure itself is much like a pap smear and takes roughly 5 mins to perform.

Embryo Freezing

Storing embryos is an option to preserve fertility whether you are having treatment for cancer or rearing your first child. An embryo is created from the egg and sperm during an egg collection (IVF).

Occyte Freezing

Egg freezing is a method used to store a woman’s unfertilised eggs following an IVF cycle. They may later be used to conceive, when natural conception may be less likely (age) or for women whose fertility is at risk due to medical reasons such as needing cancer treatment.

Frozen eggs may be stored for many years without significant deterioration. When the woman is ready to use her eggs, they are thawed and then fertilised with sperm by injection of the sperm into the egg (ICSI). The process of egg collection is listed under IVF.

Frozen Embryo Transfer (FET)

A frozen embryo transfer (FET) is a cycle where a frozen embryo from a previous fresh IVF cycle is thawed and transferred back into a woman’s uterus. This means you won’t have to undergo another cycle of hormone stimulation and an egg collection. Frozen embryo cycles can be undertaken on your natural cycle or using hormone preparation, or ovulation induction.

What is the process of transferring a frozen embryo?

The endometrium (lining of the uterus) needs to be thickened prior to transfer in order to support the embryo. There are a number of ways this can be achieved; the individualised method for this will be discussed with your specialist.

Once the endometrium has achieved the desired thickness, seen by ultrasound throughout your cycle, the embryo is thawed and warmed on the day of transfer. The transfer takes place at the Mackay Specialist Day Hospital without any anaesthetic. Most women report it is much like a pap smear.

Please contact us at Ritu Rana Medical to increase your chances of conceiving with a consultation and plan created by our fertility specialists.