Do you have questions on the subject of fertility, infertility and IVF? You’re not alone.
Here Genea Medical Director Associate Professor Mark Bowman discusses some of the key issues that arose from questions from the Bub Hub forum community.
Starting IVF
Patients are understandably very keen to know about practical issues like the cost of IVF treatment and things like health fund cover, as well as how long they should continue with a particular course of treatment, clinic or doctor.
When you’re considering starting IVF it’s important to check your private health insurance coverage for eligibility. The cover for IVF offered by Australian private health insurance funds differs significantly from fund to fund. Some levels of cover will not reimburse for IVF and those that do have 12 month waiting periods.
However, any health fund reimbursement only relates to those aspects of the IVF cycle which are “inpatient” – that is, require admission (if only short term) to a day surgery or hospital.
We recommend you ask each fund if they cover fertility treatments and, if so, what are their waiting periods. It is always useful to know the Medicare item numbers for fertility treatment when speaking with private health insurance funds: 13212 is an OPU (oocyte pick-up) and 13215 is an ET (embryo transfer).
Additionally, some health funds have specific contracts with IVF day surgeries. Using a health fund contracted with Genea means we will process the amount based on your level of cover and this reduces any gap fees you would face with non-contracted health funds, on the procedure fees that Genea charge.
Once you begin treatment, many women and couples will at some point begin to question their treatment and wonder about seeking a second opinion or trying something different.
At Genea we conduct significant testing before beginning treatment to ensure we put together the most appropriate treatment plan for your specific situation. Also, the IVF cycle itself can often provide insights as to underlying fertility issues and can give pointers as to the likelihood of success with further treatment. After each cycle we make time to discuss the outcome and whether we need to adapt your treatment as a result.
If you don’t feel that your Fertility Specialist or Fertility Clinic is tailoring your treatment to your personal situation, you should feel comfortable asking for a review or seeking a second opinion, even if that is before you start treatment or after your first cycle.
The question of when to stop treatment is intensely personal and will depend on a variety of factors. This should be discussed with your Fertility Specialist. Additionally, we have highly experienced Fertility Counsellors at Genea to help you come to a decision that’s right for you.
Embryo Development
The growth and development of embryos outside of the body is obviously a major element of fertility treatment. Because it’s not something many of us have ever considered, it’s an area which raises many questions. So, what are the important issues with respect to embryo development in IVF?
When to transfer the embryo back to the uterus is a question that invokes differing opinions. Research has shown that waiting until Day 5 (when the embryo is a blastocyst) rather than Day 3 to transfer the embryo increases the chance of success per embryo transfer. This is because growing the embryos longer in the lab before transferring them lets the embryologist determine which embryos have the highest development potential and best chance of a successful pregnancy. Genea pioneered this approach in Australia and it’s one of the keys to our success rates.
Around 50 per cent of embryos that look good at Day 3 will fail to develop in the laboratory over the next 48 hours so therefore watching embryos to Day 5 will avoid unnecessary embryo transfers and save you time and money. It also gives greater confidence for single embryo transfer.
The question of the viability of Day 6 embryos has been raised. Some embryos will not develop into blastocysts until Day 6 but whilst the fresh embryo transfer rate for these embryos might be a little lower, the pregnancy rates are still quite good. Also, an internationally published Genea study showed that frozen, thawed Day 5/6 embryos used later in a frozen cycle implant just as well as fresh blastocysts. (Fertility and Sterility May 2014)
Regardless, it is vitally important that an IVF unit has the appropriate culture media and incubation techniques to ensure that embryos are not compromised through growing them outside of the body for longer. Genea scientists have been developing culture media – the vital fluid used to nurture and support embryos outside of the human body for more than two decades and more than 600 clinics around the world use our formula.
Specific information about embryo development, including whether or not an embryo has hatched is often shared with couples having IVF. Quite naturally, couples are very keen to glean as much information as they can about the development of their embryos but the descriptions and stages discussed can be confusing.
A blastocyst embryo is a hollow ball of cells contained within a soft protein shell. Embryologists evaluate things like the number of cells in the ball, the expansion of the ball and other factors to determine the grade of the embryo. They will also often comment as to whether an embryo is hatching or not.
Hatching is a term that describes the protein shell thinning to a point whereby the blastocyst cell ball begins to protrude through the protein shell. Complete hatching of the embryo is required before connecting with the wall of the uterus. However, whether or not this has happened before transfer does not particularly predict your chance of getting pregnant.
Sperm
Approximately four in 10 infertility issues are male fertility related so questions about sperm often form part of the picture. We received a question asking what the “normal” number of sperm in a sample so, for the record, the WHO laboratory manual for the Examination and Processing of Human Semen (5th edition) states that the lower reference limit for total sperm number is 39 million spermatozoa per ejaculate.
Andrology labs also report on the sperm concentration (in millions/mL), which is calculated by dividing the volume of the ejaculate (mL) into the total number of sperm. The minimum normal volume is 1.5mL and the minimum normal concentration is 15million/mL.
Keep an eye out for the next post with more questions answered!
Note: Whilst we welcome questions about infertility treatment and fertility issues, the best source of information about your specific circumstances is always your fertility specialist.
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This blog post is sponsored by Genea.
Genea has almost 30 years’ experience helping people achieve their dreams of a healthy baby and has sponsored this post to answer some of your fertility questions.