FAQs about infertility
What are some of the causes of infertility?
Counselling and support groups
Donation and donors
Exporting embryos (national and international)
Living without children
What are some of the causes of infertility?
Some of the medical causes for infertility include:
Blocked fallopian tubes: blocked fallopian tubes can be surgically treated with the objective of repairing the blockage to allow an egg (ovum) to reach the uterus (womb). Or IVF can be used. Eggs are taken from the ovary during an IVF cycle, fertilised with sperm, then any resulting embryos are placed in the uterus via the vagina and cervix. In this way
the blockage in the fallopian tube is bypassed. Blockage of
the sperm ducts: see treatments outlined in Treatment section. Ovulation disorders: various causes and treatments, some referred to in Treatment section.
Sperm antibodies (or sperm autoimmunity): sperm antibodies occur when a man’s immune system develops antibodies against his own sperm. Commonly found after vasectomy, injury or infection. In many instances the cause is unexplained. Can be treated with drugs or with some ART treatments. See www.andrologyaustralia.org Women too can develop anti-sperm antibodies. This is diagnosed by a blood test and can be treated with drugs. Endometriosis: the lining of the uterus (endometrium) is found in sites outside the uterus. The misplaced tissue implants and grows on the tissue or organ where it has deposited resulting in pain, scar tissue and often infertility. See www.endometriosis.org.au
Polycystic ovarian disorder or syndrome (PCOD or PCOS):
A hormonal (endocrine) disorder that can interfere with ovulation. See www.posaa.asn.au
Pelvic inflammatory disease (PID): PID is an infection affecting the woman’s reproductive organs, mainly caused by chlamydia or gonorrhoea. It is a common cause of infertility as it can cause inflammation and scar tissue, leading to blocked or damaged fallopian tubes.
Age of either male or female, or both:
See Success Rates section.
Unexplained or Idiopathic: no cause has been
able to be diagnosed. Cancer treatment
What is IVF?
In Vitro Fertilisation is a treatment cycle in which a woman’s ovaries are stimulated by hormones to produce more than
the one egg that is usually produced in a natural cycle. Control over ovulation of these eggs is taken over by drugs so that an egg pick-up (EPU or OPU) can be scheduled. The eggs are sucked out of follicles on the ovaries by a fine needle. The eggs are fertilised by fresh sperm that has been provided by masturbation, or by thawed frozen sperm. Resulting embryos are grown ‘in vitro’ (in a glass dish) while in specially made fluid. Between two and five days after fertilisation, an embryo will be transferred to the woman’s uterus via a fine catheter inserted into the vagina and over the cervix. Two weeks later a pregnancy test will be performed. Remaining embryos can be frozen and used later in a frozen embryo cycle.
What is ICSI?
Intra Cytoplasmic Sperm Injection is a procedure performed
in the laboratory after egg pick-up. One healthy sperm is selected from a semen sample or by surgical methods (see details in Treatment section) and is injected into the centre
of an egg, to assist with fertilisation. The rest of the treatment cycle is the same as an IVF cycle. ICSI is used when there is male factor infertility, or when fertilisation has not occurred using standard IVF.
What is OI?
Ovulation Induction is used when a woman is not ovulating normally. Various drugs can be used to initiate ovulation, followed by sexual intercourse, artificial insemination or IVF.
What is AI?
Artificial Insemination, also know as IUI (IntraUterine Insemination), is the process where a sample of prepared sperm (i.e. thawed if it has been frozen, or specially treated
if fresh) is inserted into the woman’s vagina or into her uterus at the appropriate time in her cycle for fertilisation to occur.
It is also used with OI. Donor sperm or the woman’s partner’s sperm is used.
What is DI?
Also know as AI, but using donor sperm –
What is surgical sperm aspiration, or MESA, TESA/TESE, PESA/PESE, or testicular biopsy?
In cases of male factor infertility the man’s ejaculate may
not contain enough live normal sperm for fertilisation to take place. There can be a number of causes for this. Sufficient sperm can often be found using surgical removal – fine needle aspiration from the epididymis, testes, or by removing a piece of tissue from the testis (biopsy). The acronyms are Microsurgical Epididymal Sperm Aspiration, Percutaneous Epididymal Sperm Extraction/Aspiration, Testicular Sperm Extraction/Aspiration. Sperm retrieved by the above
methods is then used with ICSI for fertilisation of the egg.
What is GIFT and when is it used?
Gamete Intra Fallopian Transfer is not often used
as it is a more invasive treatment than IVF. However it is a treatment that can be chosen for ethical or religious reasons, as fertilisation does not take place outside the woman’s body. The woman has the usual hormone treatment with the aim
of her ovaries producing more than one egg. She undergoes
a laparoscopy, almost always under a general anaesthetic, to collect the eggs. One of the eggs will be replaced in her fallopian tube along with a sample of sperm. Fertilisation may then take place. Depending on the wishes of the patient, the remaining eggs will be left unfertilised, or can be fertilised and frozen for a later embryo transfer.
How can you deal with a complaint about your medical care?
The infertility experience is a frustrating and challenging one, which is difficult to deal with. If you feel that your medical care is not what you expect, you could feel disappointed and angry. The ACCESS fact sheet titled How to get the best from your health professional may also help you.
If you feel that you have been mistreated, physically harmed or abused by a health professional then this complaint procedure might not apply. A formal complaint to the Medical Board or the Health Care Complaints Commission in your state could be appropriate. If you have been sexually abused the Sexual Assault Clinic in your state could provide the immediate support you may need.
Helpful steps to assist you to deal effectively and appropriately with your complaint
- You should consider contacting the service provider directly to express your concern about the things that have upset you. This may be the doctor, nurse, scientist, counsellor or administrator. Many apparent misunderstandings can be clarified and resolved by speaking to the other person. If they have acted in a thoughtless manner it will give them an opportunity to rectify the matter or if you have misunderstood the situation it can be clarified quickly. This will help you to feel some resolution to the distress you are feeling and it could trigger better medical practices, with minimum distress to all concerned. To help you to assess the quality of care it would be useful to write down notes about those things causing you anger or concern. This will help you to clarify if actions are of themselves upsetting or if other circumstances are exacerbating your situation.
- The treatment and investigation of your infertility can be a very emotionally intense time. Sometimes it can be hard to see the wood for the trees. It would be helpful to seek the advice of a respected friend or professional to help you to clarify your concerns. It may be appropriate to confide in another member of the clinic staff with whom you already have good rapport. This person could act as your advocate through the clinic’s internal complaint procedure. Certainly, one of the counsellor’s duties is to be your advocate and that may be an appropriate source for you to receive confidential support and advice.
- If the matter remains unresolved, you should consider writing to the director of the clinic, sending a copy of your letter to the particular service provider. Keep your letter short and address specific concerns. Also, briefly explain your efforts to resolve the matter. Ask for a response in writing so that you are clear about the information being given to you. Make a diary note of any phone contact made at the time of the call and carefully note what is said.
If you receive no reply within a reasonable time, say two to three weeks, send another copy of the letter. If the matter remains unresolved you could consider contacting the following organisations: The Health Care Complaints Commission or Medical Board in your state. Look for their contact number in the Government Department section of your White Pages phone book. These bodies have specific mechanisms for handling complaints.
The Reproductive Technology Accreditation Committee (RTAC) accredits infertility clinics in Australia and New Zealand which comply with guidelines and a code of practice and also with the National Health & Medical Research Council (NH&MRC) guidelines and relevant statutes in some states. In addition, before conducting research or undertaking treatment with an ethical component not covered in the guidelines, individual clinics must apply to their local institutional ethics committee (IEC) for approval, before proceeding.
Clinics inspected by RTAC can receive full accreditation for three years or preliminary accreditation for twelve or eighteen months and there are therefore periodic mechanisms for reviewing general or specific concerns. Only those clinics with RTAC accreditation are included on the ACCESS referral list.
ACCESS appoints a consumer representative to RTAC. If you feel that any guidelines have been breached, please feel free to contact them at firstname.lastname@example.org, sending copies of your letters endeavouring to resolve your concerns. All contact with RTAC is confidential. Your name will not be divulged without your consent.
Please note that it is not a function of RTAC to deal with patient complaints and RTAC has no formal mechanisms for processing individual complaints about treatment. Information provided to RTAC will be used only in the context of compliance with guidelines.
You may choose to raise the issue with the federal or state Minister for Health or your local member of parliament. You can write to them c/- Parliament House in Canberra or your capital city.
What is Assisted Hatching?
Assisted hatching is a technique where the outer shell
of the embryo (the zona pellucida) is opened or thinned using chemical, mechanical or laser methods. This can assist the embryo to break out or hatch from the shell and therefore increase the likelihood of implantation of the embryo.
What is EPU or OPU?
Egg Pick-Up, or Oocyte Pick-Up, is the procedure where mature eggs or oocytes are removed from the follicles on the ovaries. Fluid is drawn out of each follicle, using a fine needle that passes through the wall of the vagina. This fluid is then examined in the laboratory to see if it contains an egg. Mature healthy eggs have sperm added to them, either in a glass dish (in vitro) or using ICSI, with the aim of fertilisation occurring. EPU/OPU is usually carried out in a hospital theatre using some form of sedation or anaesthetic.
What is FET?
Frozen Embryo Transfer is used when a stimulated cycle has produced enough eggs for more than one or two embryos to develop. Any embryos that are not transferred fresh during the stimulated cycle can be frozen, provided they are rated
as good enough quality to withstand the freezing process. Embryos are stored by the IVF clinic and are thawed one by one prior to a FET cycle. Not all embryos survive thawing. Your cycle will be guided and monitored to assess the best time to transfer the embryo.
What are the short-term risks of infertility treatment?
There are a number of short-term risks, such as bruising from injections, abdominal discomfort and heightened emotions, that usually resolve once a cycle is over. Some of the more serious risks are hyperstimulation and multiple pregnancy. Both of these should be well explained in the patient information given by the IVF clinic and should also be explained verbally. The Code of Practice for ART clinics places limitations on how many embryos are replaced in a treatment cycle, with the aim of avoiding multiple pregnancy.
What is hyperstimulation/OHSS?
Some women over-respond to the hormone drugs used
in the IVF cycle and can develop Ovarian HyperStimulation Syndrome. OHSS can range from mild symptoms requiring monitoring, to severe and potentially life-threatening symptoms requiring intensive care. Your IVF clinic should advise you, both verbally and in writing, of the symptoms
and of the need to contact the clinic or a hospital if such symptoms appear. OHSS usually becomes evident in the two to eight days following egg pick-up. If your doctor decides you are at risk of OHSS, it might be decided to delay your embryo transfer and freeze all the embryos for transfer in later cycles once the OHSS has resolved. This is because a pregnancy will exacerbate the symptoms of OHSS. If it becomes apparent during the stimulation phase of your IVF cycle
that you are at risk of OHSS, your doctor might decide to ‘coast’ your treatment and slow the process down until the risk subsides. Some of the symptoms of OHSS are severe nausea and vomiting, shortness of breath, and abdominal bloating. When in doubt, contact your IVF clinic.
What are the risks of multiple pregnancy?
The aim in ART is to reduce the incidence of multiple pregnancies, due to the increased risk of perinatal death, increased need for neonatal intensive care, the increased
risk of cerebral palsy, and the physical, emotional and financial strain of caring for more than one baby. These risks have been shown to be increased even in the case of twins. The aim of treatment is one healthy baby, and with a view
to this outcome the Code of Practice encourages single embryo transfers.
Haven’t I got less chance of a pregnancy if I only have one embryo transferred?
The current research around Australia shows that pregnancy rates, and most importantly, the ‘take home baby’ rates, have not decreased with the move towards single embryo transfer. Transferring two embryos rather than one doesn’t increase the chance of pregnancy, it only increases the risk of twins. While the idea of twins may be appealing, there is ample evidence that a singleton pregnancy is a safer option. Other embryos from an IVF cycle can be frozen and used in later cycles.
What are the long-term risks of infertility treatment?
Many studies have been carried out in Australia and overseas on the potential long-term risks of infertility treatment.
It is known that breast cancer and ovarian cancer are more common in women who have not had children. However the evidence so far does not seem to show an increased risk in women who have used fertility drugs in their treatment. Testicular cancer is more common in men with low sperm counts, so men accessing infertility treatments may be in
a higher risk category for this particular cancer.
What are my chances of conceiving and having a baby with infertility treatment?
The success rates of ART in Australia have gradually increased over the years since the various treatments were introduced. There have been many reasons for this and Australia has been at the forefront of the research that has contributed to these success rates. In 2006 the live birth rate per treatment cycle in Australia and New Zealand (the Australian and New Zealand Assisted Reproduction Database – ANZARD) was over 23 per cent. It is best to discuss success rates with your IVF clinic, as there are many factors that influence the outcomes. Success rate charts can be confusing and difficult to compare, as they may use different interpretations of the statistics. The most appropriate explanation of success rates is the live baby rate per treatment cycle.
What are my chances of conceiving with infertility treatment as I get older?
Unfortunately fertility, in both men and women, declines
with age. For women it begins to diminish in their thirties
and in their mid- to late-thirties this decline is significant, even with the assistance of infertility treatment.
This relates to the declining quality of a woman’s eggs,
rather than to health. While some women do conceive after age forty, it is much less likely and if they do conceive, the probability of miscarriage and birth abnormalities increases. This is because of increased chromosomal abnormalities in ‘older’ eggs. The exception to the above is if donor eggs are used. It is the age of the woman whose eggs are used, rather than the age of the woman who carries the pregnancy, that influences the pregnancy and live birth rates. Men’s sperm volume becomes less, motility is decreased (ability to move) and less sperm are produced as men age. There is also likely to be more abnormal sperm in older men’s ejaculate.
Counselling and Support Groups
Where can I find out about counselling or support groups?
Your IVF clinic will have an infertility counsellor available.
Each full IVF cycle, as covered by Medicare, provides for
one counselling session with an approved infertility counsellor. Check with your clinic if there is a cost for further counselling sessions. Your clinic should be able to advise you of any local patient support groups. Access Australia offers information and support for all infertility patients and their families
How do I find an egg or sperm donor?
Contact your IVF clinic for assistance with seeking a donor. There are few egg donors available through clinics so many encourage patients to find their own donor. Limited clinic-recruited sperm donors are available, but there is an option for seeking known sperm donors also.
Why don’t clinics take extra eggs from patients having their own IVF treatment so these can be donated?
This process would contravene the Reproductive Technology Accreditation Committee Code of Practice for IVF clinics,
which states that patients are not to be approached to donate gametes or embryos while undergoing their own fertility treatment. It is considered best for donors who have undergone their own infertility treatment to have completed this treatment prior to considering donation to others.
What do I have to do once I have a donor?
Your IVF clinic will advise you of the process for donor cycles. All parties involved in the donation, including the partner of the donor, must take part in counselling sessions with an approved infertility counsellor. Consent forms and lifestyle declarations have to be completed prior to any procedures.
A woman donating eggs has to undergo a stimulated IVF cycle which involves injections, ultrasound scans and an egg pick-up procedure. A man donating sperm will usually produce a number of sperm samples by masturbation, usually at
the IVF clinic.
What about embryo donation?
Donated embryos are made available by couples who have completed their own treatment, but still have some embryos frozen in storage. If they make the decision to donate their embryos to another couple or a single woman, the IVF clinic will usually have a waiting list of patients wanting treatment with donated embryos. The same identification requirements apply as for donated gametes (eggs or sperm)??????
If I have completed my treatment and I still have embryos frozen, what are my choices?
Embryos can be kept in storage, provided the annual fee is paid to the clinic, for a period of years. Some clinics accept embryos for scientific procedures, e.g. training for doctors and embryologists. Embryos can be donated to another couple or a single woman. Counselling about this process is compulsory for all parties involved. Identifying information has to be maintained by the IVF clinic, and any children born from a donation procedure can access this information at age 18. Alternatively you can select to allow your embryos to succumb, by being allowed to thaw. Some clinics will allow patients to take the thawed embryos home.
What costs are involved in a donor cycle?
Your IVF clinic will be able to advise their charges. Generally speaking no payment is made direct to the donor, except for covering the medical expenses for a woman donating her eggs.
Can we contact our child’s donor? Do I have to tell my child if he/she is the result of donation?
All clinics now have to keep identifying records of donors and their offspring. However you will only be given un-identifying information about the donor. When your child reaches 18, he or she is able to access the records of his/her own accord. Prior to this it is the child’s parents’ choice about whether
this information will be accessed. Donors have to agree at the time of donation that their identifying information is available to offspring at 18, or earlier by mutual agreement. Of course it is up to parents to decide if they will tell their child of their genetic origins, and the compulsory counselling will discuss the pros and cons of this.
How do we know if donated sperm or eggs are safe and free from disease?
All donors are screened for various transmissible diseases
and they complete lifestyle declarations prior to donation.
All donated sperm is then frozen; the donor is re-screened after six months quarantine of the sperm and then it is released for use if the tests are clear. Donor eggs are fertilised, and the resulting embryos are usually frozen
so that retesting of the donor can be carried out after six months. However as the risk of transmission of disease is less likely with donated eggs, fresh embryo transfers are carried out by some clinics, provided patients are made aware of the potential risks.
Can single women access donor sperm programs?
Yes, this is permitted in all states. Contact your IVF clinic to enquire.
Why is counselling compulsory for egg, sperm and embryo donation?
The decision to donate or receive gametes (eggs and sperm) or embryos is complex. It involves medical, ethical, social, emotional and psychological issues. Counselling provides
the opportunity to consider all aspects of this treatment;
to explore if and how to tell resulting children of their
genetic origins; advises all parties of their legal obligations and how identifying information is maintained; and explains the sometimes complex consenting process. The rights of
the children are considered to be most important, so the implications and effects for children are discussed.
When can sex selection be used?
Sex selection can be used in conjunction with
Preimplantation Genetic Diagnosis (PGD) to avoid
genetically inherited diseases, e.g. haemophilia
It is no longer permissible to have sex selection
for family balancing.
What is PGD?
PGD is a treatment used in conjunction with IVF where
the embryos are screened for chromosomal abnormalities.
A limited number of genetic conditions are assessed; it is
not an exhaustive process to exclude all genetic abnormalities. Sometimes sex selection is used in this process if a condition is carried by either males or females.
Do all clinics offer PGD?
No. Contact your clinic to ask if they offer this service
or if they are able to provide it through another clinic.
Does Medicare cover the cost of PGD?
No. There is no item number for PGD treatment
How much will infertility treatment cost?
This depends on the type of treatment, whether or not you have private health insurance, and on the individual clinic’s charges. It is best to contact clinics and ask for their costs. These can be quite complex due to varying treatment types, and whether or not there is a Medicare item number for the procedures used. Cost of infertility treatments are much less than they once were due to the introduction of item numbers into the Medicare Benefits Schedule (MBS) in 1989, and again in 2007 for ICSI.
Why are some parts of infertility treatment covered by Medicare and not others?
Access, with the assistance of its members, and IVF clinics have lobbied consistently over many years to have item numbers for various infertility treatments added to the Medicare Benefits Schedule (MBS). This can take many years, for example intracytoplasmic sperm injection (ICSI) was an accepted and commonly used treatment for ten years before
it was finally given a Medicare item number, and therefore became cheaper for patients.
How many times will Medicare contribute to the cost of my treatment?
Currently there is no limit to the number of treatment cycles Medicare will cover for an individual. In the past there was a limit of six cycles, and more recently there have been attempts by various governments to again limit the number of cycles covered by Medicare. So far Access, with the assistance of its members, and IVF clinics have been able to lobby governments to prevent a limit being implemented.
In comparison to most other countries, Australia is very fortunate to have such extensive Government funding for infertility treatment.
What is the Medicare Safety Net?
Medicare protects all Australians against big cumulative medical bills for Medicare services provided outside hospital. This includes specialist consultations and outpatient IVF services. The Safety Net pays eighty per cent of the out-of-pocket costs for Medicare services provided out of hospital once these costs reach a threshold amount. Contact Medicare for more information, or discuss this with your IVF clinic.
Is surrogacy available in Australia?
Altruistic (no payment made apart from expenses) surrogacy is available in some states provided the surrogate is not the provider of the eggs. The woman providing the eggs, and the man providing the sperm enter into an agreement for another woman to carry a child for them. There are complex considerations and decisions – medical, ethical, social, emotional and psychological. As a result extensive counselling of the issues is required, and approval must be sought and granted from the clinic’s Ethics Committee. Currently the surrogate is the legal mother of the resulting child and adoption processes have to be completed by the commissioning couple. Medicare does not cover
costs of surrogacy.
Can single men access surrogacy programs?
Currently there are no states in Australia which
allow for single men to access surrogacy programs
How can I find out about local adoption?
Please contact us for your state’s contact.
How can I find out about international adoption?
Please contact us for your state’s contact.
Exporting Embryos (National & International)
Can I arrange for my frozen embryos or gametes (eggs or sperm) or ovarian tissue to be transferred to another IVF clinic within Australia or overseas?
Living without Children
What alternatives are there
to having or adopting our own child?
There are long-term or short-term fostering options,
‘Big Brothers Big Sisters’ programs or other youth