Early Intervention Options

Timed Intercourse :

What is Timed Intercourse?

Timed intercourse is a simple treatment to help couples pinpoint their most fertile window. It’s a completely natural approach, and often the starting point of a couple’s fertility journey.
Your fertility specialist will usually do some blood tests, maybe a urine test, and an ultrasound to confirm when you’re due to ovulate.


Ovulation and conceiving

Each month, your body has a menstrual cycle where an egg is released from the ovaries – this is called ovulation. Ovulation occurs (on average) 14 days before the start of your period; however it’s completely normal for women to ovulate (release the egg from the ovaries) anywhere from 12-18 days before their period starts.
Once it is released from the ovary into the fallopian tube, the egg has a maximum of 24 hours to be fertilised.
Sperm can survive in the female reproductive tract for 2-3 days waiting for the egg. By accurately predicting when ovulation will occur, we can advise the right time to have sex to give the best chance of conception.
Your fertility specialist will recommend you don’t have sex for 2-3 days prior to your fertile window to allow the sperm to build up to the best levels for fertilisation.


Help with ovulation

For timed intercourse to be successful, ovulation must occur.
Women who do not ovulate regularly may need medication to make sure ovulation occurs at the predicted time. Your fertility specialist will discuss with you whether medication is needed to induce ovulation.

Ovulation Induction :

For women with irregular menstrual cycles, it is hard to know when or if ovulation is occurring. This makes it tricky to try for a baby. Ovulation induction treatment may be recommended to help you get pregnant.

What is ovulation?

Each month, your body has a menstrual cycle where an egg is released from the ovaries. Ovulation is when the egg is released. Ovulation occurs (on average) 14 days before the start of your period. It’s normal for women to ovulate (release the egg from the ovaries) 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 blood tests and ultrasound, to confirm 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). If you are having ovulation induction at the same time as IUI treatment, either type of medication is suitable.

Oral medications

The most common oral medication is Clomiphene Citrate.
Clomiphene blocks oestrogen receptors in the body. This tricks the brain into increasing hormone production to stimulate development of one or more follicles on the ovary. Follicles are the small fluid filled sacs on the ovary which contain an egg. If they develop, and mature, they release an egg (ovulation). Clomiphene is usually taken for 5 days in the first half of your 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 your menstrual cycle. It is injected just under the skin with a very fine needle (usually as a pen-device). 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 healthy tubes
• have unexplained infertility.

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. Your fertility specialist will use blood tests and ultrasound to track ovulation and check on how many follicles mature.

What if it doesn’t work?

If ovulation induction is unsuccessful, we’ll talk about other treatment options like Intrauterine Insemination (IUI) or In Vitro Fertilisation (IVF).

IUI – Assisted Insemination

Intrauterine Insemination (IUI) can sometimes be referred to as Artificial Insemination (AI), a simple treatment procedure aimed to provide assistance to sperm in inseminating the uterus.

Intrauterine insemination (IUI) is one of the simpler, less complex and less invasive treatment options available to you. It is often the starting point for many individuals or couples who experiencing difficulty trying to conceive.

IUI might be the first step in your fertility treatment journey if you:

• Have been diagnosed with unexplained infertility
• Have been diagnosed with mild male factor infertility
• Have scarring of the cervix or other concerns that prevent sperm penetration
• Have irregular or absent ovulation
• Cannot have regular or penetrative sexual intercourse
• Need to use donor sperm

IUI treatment would generally not be recommended to patients who have severe male factor infertility or blocked fallopian tubes or severe endometriosis.

The purpose of IUI treatment is to increase the number of sperm that reach the fallopian tube which therefore increases the chance of fertilisation. The technique provides sperm with an advantage by giving it a head start with where it needs to go, but it still needs to reach and fertilise the egg on its own.

After you’ve consulted with your fertility specialist and completed some preliminary fertility testing, you will have a better idea as to whether IUI is a suitable treatment option for you.

The IUI treatment process

For this procedure, the fertility specialist will insert a speculum into your vagina in order to better visualise your cervix.

They will then pass a soft, thin catheter through the opening of your cervix and into the uterus. The pre-prepared sperm will then be introduced to the uterus via the catheter. The procedure will only take a few minutes to complete and can be likened to a pap smear.

You will be able to return to your daily activities as soon as the IUI is completed. You will not require anaesthesia unless you do not tolerate speculum examinations. There is an option to complete the procedure under light sedation if required and this is something you should discuss with your fertility specialist.

Important components to IUI treatment

Different IUI treatment types
If your fertility specialist recommends IUI treatment for you, there are three different methods of treatment that you may undertake. They are:

• Natural Insemination Cycle – This option allows patients to complete IUI without being required to take any medication. This cycle will follow your natural menstrual cycle and is commonly used for individuals or couples who are unable to have intercourse.
• Medication Cycle – This treatment options involves using a drug to help stimulate the ovaries. The is pill taken orally and is commonly used to assist women with ovulation disorders as reflected by infrequent or irregular menstrual cycles.
• FSH Ovulation Induction Cycle – Follicle stimulating hormone (FSH) injections can also be used in an IUI treatment cycle to help stimulate the ovaries. FSH stimulates the production of eggs in the ovaries from the pituitary gland in the brain.

Sperm Washing

Our specialised team of scientists prepare each sperm sample with a procedure commonly known as “sperm washing” in our laboratory. Sperm washing involves placing the sperm sample in a test tube. A centrifuge spins the sample at high speed, resulting in the sperm collecting in a “pellet” at the bottom of the test tube. The scientist removes the seminal fluid and places the fluid (media) above the sperm pellet. The most active sperm will then swim up into the media. The final sample consists of the most active sperm concentrated in a small volume of media taken from the top of the test tube.

Timing the Insemination

IUI treatment procedures will be timed around your time of ovulation. However the exact timing of insemination is not critical to the exact time of ovulation. Both the sperm and the egg remain viable in the female genital tract for many hours, so your fertility specialist may time the insemination within a window of several hours around the time of ovulation.

If you have taken hormones, you may need to take daily supplemental progesterone—usually in the form of a capsule inserted into your vagina twice a day— or injections, to support the endometrial lining of the uterus and implantation of the embryo.

Natural And Complementary Therapies

• Some of our patients use natural or complementary therapies (also called alternative therapies) as part of their fertility treatment. Everyone seems to know someone who has achieved a miraculous pregnancy through the use of holistic therapies.
• Whilst definitive scientific data is somewhat limited, we do know that these treatments can produce results for patients in some circumstances. Whether it is the treatments, the patient management, the sense of being assisted, or the feeling of wellbeing, self-confidence or calm that comes from these treatments is unknown.
• Fertility and complementary therapies
• There is somewhat limited scientific evidence that complementary therapies improve your chances of having a baby. What we do know is, these therapies can improve your general health and wellbeing.
• Fertility treatment and its uncertainty can be a stressful experience. Some research has shown a link between stress and fertility treatment. We understand some natural or complementary therapies are designed to reduce stress and anxiety. We support you if you want to try these therapies as part of your fertility journey.
• It is important to tell your fertility specialist about any therapies or supplements you’re taking so we can check nothing will interfere with your fertility treatments.

Yoga and Meditation

• Meditation trains the mind to promote relaxation. While there’s no evidence of a direct link between meditating and increased fertility, it can be a useful process when having fertility treatment. It doesn’t affect your fertility treatment or medication, so stick with it if it helps you feel calm.
• Studies have shown meditation can help lower blood pressure, boost mental health, slow down your heart rate and reduce stress.


Acupuncture

• Acupuncture is a form of natural health care that takes a holistic approach to the prevention of illness as well as treatment. It’s based on the idea that energy flows through the body’s meridians (invisible pathways). During treatment, these pathways are stimulated with tiny needle injections to help the flow of energy.
• Acupuncturists claim acupuncture can stimulate blood flow to the uterus, assisting menstruation and ovulation, and reducing stress. However, there is convincing evidence now that acupuncture does not improve the chances of having a baby. Acupuncture may help to reduce stress and anxiety.
• If acupuncture has a positive impact for you, you can continue your treatment. Please make sure you see a qualified acupuncturist and let your fertility specialist know about the therapy.

Naturopathy

• Naturopathy takes a holistic approach focused on treating the underlying causes and symptoms of health issues. A naturopath would aim to boost your general health and wellbeing to try to boost your fertility.
• Herbal medicines and supplements
• Herbal medicines are mainly made up of plants or parts of plants (roots, stems, flowers, bark, and seeds) and come in forms including capsules, tablets and ointments. While they are considered natural, they can contain powerful compounds and should not be taken without the supervision of your GP or your fertility specialist.
• Some herbal medicines and supplements claim to increase fertility. It is important you discuss this with your fertility specialist as they can interfere with your fertility or fertility medications.

Ultrasound For Women

Our ultrasound clinics offer pregnant women state of art imaging services..

There are a range of services provided by an expert team of sonologists, sonographers and genetic counsellors who use state of the art ultrasound technology, which includes:

• Pre-pregnancy scanning
• Transvaginal Ultrasound

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 in premenopausal women
• Pelvic pain
• Post menopausal bleeding
• Infertility
• Follicle Tracking

Follicle tracking involves tracking the development of follicles that contain eggs within the ovary monitored with transvaginal ultrasound in combination with blood levels of the female hormones oestrogen and progesterone.

Tracking for timed intercourse

Follicles may be tracked in a natural cycle. When a leading follicle is seen, then intercourse may be appropriately timed. Alternatively, drugs which promote release of the mature egg may be administered.

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 luteinising hormone (LH). In this setting, the follicular development is followed more closely with 2 to 4 ultrasound scans, and regular blood tests track hormone levels. The timing of an egg collection is based on the ultrasound and blood results. This information is relayed to patients by their IVF nurse or fertility specialist.

Pregnancy scans

The Early Pregnancy ultrasound

An ultrasound is performed at this stage of pregnancy to confirm the viability, location, the number of embryos and to visualise the embryo’s heart beating.

The first trimester ultrasound

The 11-14 week scan provides important information about a pregnancy.

Combined screening test for Down Syndrome

Different types of tests are available during your pregnancy. A screening test shows if a pregnancy is at an increased risk for Down syndrome and other chromosome abnormalities. Unfortunately, the screening tests do not give a definite answer, but they can tell us which babies have an increased risk of having Down syndrome. The results may then help you in your decision about further diagnostic testing during pregnancy. Screening tests are simple and non invasive but do have out-of-pocket expenses attached for the ultrasound and blood test.

The mid trimester ultrasound

A 20 week scan provides important information about fetal anatomy, position of the placenta, amniotic fluid volume, pelvic anatomy and cervix health.

Third trimester ultrasound

Some patients may require a third trimester ultrasound to check fetal growth, assess placental position and review findings from prior ultrasounds.

Chorionic Villous Sampling

Chorionic Villous Sampling is a procedure that collects a small sample of placental tissue. As the cells of the placenta have the same genetic material as the fetus, it can therefore be tested for genetic abnormalities such as Down Syndrome.

Amniocentesis

Amniocentesis is a procedure in which a fine needle is passed through the maternal abdomen and uterine wall into the amniotic fluid around the fetus in order to obtain a sample of the amniotic fluid. Because cells within the amniotic fluid have the same genetic material as the fetus, they can be tested for genetic abnormalities such as Down syndrome.

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