Dr Sharon Li

By Dr Sharon Xian Li, specialist at City Fertility Centre Brisbane Southside If you have come to the decision that having a baby on your own is what you want, congratulations! We know it can be a hard decision to arrive at. Going it alone may not have been how you thought your story would pan out, but rest assured you are not alone. Many women are having babies on their own, and loving every minute of it. Famous people, neighbours, professionals, siblings and friends – if you look around, there are people in similar situations everywhere. In Australia, the number of single women becoming parents without a partner is on the rise. Perhaps this is thanks to the availability of safer clinic-recruited donor sperm, and an increasing acceptance for single women having babies alone. So what are the necessary steps you need to consider and take when having a baby on your own? Treatment Options Firstly you need to understand the various treatment options available to single women using donor sperm. These include: Donor Insemination (DI): With DI, treated sperm is artificially inseminated directly into the woman’s uterus to provide a chance of conceiving. This method for single women usually involves the use of frozen sperm from a donor. In Vitro Fertilisation (IVF): IVF involves the fertilisation of the egg by a donor sperm in an incubator outside the body, followed by transfer of the embryo back into the uterus. This involves a full IVF cycle including an egg retrieval process. Intracytoplasmic Sperm Injection (ICSI): ICSI is a specialised form of IVF and involves the injection of a single sperm directly into a mature egg in a laboratory. This method would only be used for single women if the donor’s sperm quality is poor or previous IVF cycles showed a poor fertilisation rate. Before starting any of the above options, you will need to obtain a referral from your GP to a fertility specialist and book a consultation. At this meeting you will be given a personalised assessment of your chance of achieving a pregnancy and discuss the different options available to you. I always strive from the outset to provide clear and comprehensive information so you feel you can take part in, and make, well-informed decisions. Choosing a Sperm Donor A great variety of clinic-recruited donor sperm is now available in Australia, with a range of donor profiles, so you can select your closest match. To ensure the safety of our patients, all our sperm donors undertake both a semen analysis and a series of pathology tests as part of the routine screening process. Screening tests include: HIV Hepatitis B and C Syphilis Human T-lymphotropic virus (HTLV) 1+2 Cytomegalovirus (CMV) Cystic fibrosis, karyotype Blood group Fragile X syndrome (FXS) Spinal Muscular Atrophy (SMA) Thrombophilia Full blood count Chlamydia Gonorrhoea All our sperm donors have also consulted a qualified fertility counsellor so they fully understand what they are undertaking. The alternative to clinic-recruited donor sperm is to select a known sperm donor, and your clinic can advise you on the steps involved in this situation. Preparing for Treatment There are a number of important steps to follow when embarking on your single fertility journey. These include: Managing lifestyle factors: We strongly advise you to follow a healthy lifestyle before and during your treatment. A balanced diet, regular exercise and limited alcohol is recommended. Before treatment, you will be required to stop smoking and restrict your alcohol consumption. Medical consultation: You will need to attend a consultation with your fertility specialist, where you will learn about the medical procedures involved and have your medical details assessed. Pathology collection: Routine screening tests will be required before starting treatment. You will need to have your blood tested and your results checked. Counselling: It is compulsory for all single women considering using donated sperm to attend a counselling session. This will give you the chance to ask questions or raise any concerns you may have in regards to the treatment. Nurse information session: Before treatment, you will also need to attend a nurse interview. The nurse coordinator will advise you of your treatment, medications and their side effects, and discuss the daily requirements of your program. You will also be required to fill in and sign consent forms. Final review: Before you can start treatment, the specialist and nurse coordinators will perform a final review of the counselling reports, blood tests and consent forms to make sure everything is in order.

  By Dr Sharon Li, fertility specialist at City Fertility Brisbane Southside Baby number one came relatively easily, and now you have decided to focus on having another baby but it’s just not happening. Unfortunately, this is a relatively common story I hear, immediately followed by “but why?”. Secondary infertility defined as the inability to conceive a child or carry a pregnancy to full term after previously giving birth. There are several reasons why infertility might strike you second, third or even fourth time around and here are some of them: Causes of secondary infertility Maternal Age: Maternal age is a significant factor and often the most important indicator of a woman’s chance of conceiving as egg quantity and quality begins to decline as we age. Conception rates for healthy couples are, at best, 20-25 per cent per menstrual cycle. Once a woman reaches the age of 35, her fertility begins to decline. By age 40, it is estimated that her conception rate is in the range of 8-10 per cent per month and at age 43, the pregnancy rate is thought to be as low as 1-3 per cent per month. Female Factor:  – Irregular menstrual cycles may suggest a problem with ovulation and result in difficulty conceiving. The average length of the menstrual cycle is 28 days, but can range between 25-35 days. The female menstrual cycle is determined by a complex interaction of hormones, so any hormone imbalance can make your period irregular. While in most cases, irregular cycles are not dangerous, it is important to determine what is causing the irregularity. Pinpointing your precise ovulation dates is crucial too. – Blocked fallopian tubes are more common in secondary than primary infertility. If the egg can’t meet the sperm, normally due to a blockage, conception will be very difficult. Male Factor: Poor sperm function resulting in not having enough moving sperm per ejaculate can impact conception. Unfortunately, having a previous pregnancy is not proof that this is the case. Developing and transporting mature, healthy, functional sperm depends on a specific sequence of events occurring in the male reproductive tract. Many disturbances can occur along that path, preventing cells from maturing into sperm or reaching the woman’s fallopian tube where fertilisation occurs. Lifestyle: Weight is a common factor affecting fertility success. For women, ovulation can be impacted by being either underweight or overweight, and studies have shown that bringing BMI within the normal range can assist ovulation to occur normally, thus increasing the chances of pregnancy. It’s also very important for men to ensure a healthy BMI, and studies have consistently linked obesity to a lower sperm count because testosterone levels drop while oestrogen levels rise in men who are overweight. Unknown: Unfortunately, it is estimated that roughly ten per cent of infertility remains unexplained even after complete medical evaluation.   What are the options available if you are experiencing secondary infertility? As always, you should seek the advice of a fertility specialist after 12 months if you are under 35, or after six months if you are over 35, and have not fallen pregnant. Following a thorough investigation to try and determine the cause of secondary infertility, these are some of the more common treatment options I often recommend on a case-by-case basis: Ovulation Induction: This involves the use of medication (Clomid or follicle stimulating hormone) to stimulate the ovaries and encourage or regulate ovulation. Ovulation induction is often combined with Intra-Uterine Insemination – a procedure in which sperm is directly inserted into a woman’s uterus in order to improve the likelihood of fertilisation. Surgery: For women, surgery can often improve their chances of conception when the cause of infertility can be traced to past inflammation or infections which have created scarring, or conditions such as fibroids, endometriosis and other tubal or uterine issues. Intracytoplasmic Sperm Injection (ICSI): This method is used for more severe forms of male infertility. It involves the selection and direct injection of a single sperm into the substance (called cytoplasm) of the egg. In Vitro Fertilisation (IVF): IVF is used to treat infertility that has failed to respond to other medical or surgical interventions. IVF involves the fertilisation of the egg by the sperm in an incubator outside the body, and transfer of the embryo back into the uterus. Healthy lifestyle Encouraging the adoption of a balanced lifestyle where patients maintain a healthy weight, eat well, exercise, minimise stress, limiting caffeine and alcohol intake, stop smoking and drug use.   Watch Dr Sharon Li’s video for further advice. Please note: This video may not be copied or used, in whole or in part, without the prior written permission of City Fertility Centre © 2017.

By Dr Sharon Xian Li, director of City Fertility Centre Brisbane Southside.  Many people have heard of In Vitro Fertilisation (IVF) – but do you know how the actual process works? Whether you are just beginning to research fertility treatments or are about to start IVF, the more you understand about the procedures, the less stress you may feel. IVF literally means “fertilisation in glass”. The  process involves fertilising the egg with the sperm in an incubator outside the body, then transferring the embryo back into the woman’s uterus. The whole process up to the embryo transfer stage usually takes six to eight weeks.   An IVF treatment cycle usually follows these eight phases: Step 1: Pituitary Suppression – Starting Treatment During a regular menstrual cycle, hormones from the pituitary gland – Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) – generate the growth of an egg in a fluid-filled follicle within the ovary. While numerous follicles start growing each month, only one will become mature enough to ovulate. Ovulation (release of the egg from the ovary) is caused by an increase in LH about two weeks before menstruation starts. On the other hand, during an IVF cycle it is desirable for several eggs to mature at the same time with FSH injections, and a trigger injection is given to mature the developing eggs before collection. Your fertility coordinator will provide you with detailed information about your specific treatment cycle, including the timeline and medications. You will also be shown how to administer your daily FSH injections and given instructions for any other medications you may need during your treatment cycle. However, if you are undergoing what is called an antagonist cycle, there is usually no need for pituitary suppression. Your fertility specialist will have selected the best cycle type for your individual needs. Step 2: Ovarian Stimulation and Monitoring The next stage involves stimulating the ovaries with medication to promote the growth of follicles containing eggs. This is done via daily FSH injections for between 9 and 14 days. The FSH dose used is slightly higher than what a woman produces naturally – this is in the hope of stimulating growth of multiple follicles. The response of the ovaries is monitored with regular ultrasounds and blood tests. Most women learn to administer their own injections, or their partner may assist, and this helps to reduce the number of clinic visits. Step 3: Trigger Injection The ovarian stimulation phase ends once ultrasounds show that the number and size of the follicles are adequate. The FSH injections and the GnRH agonist are then stopped. Once your nurse has confirmed your procedure time with theatre, he or she will advise the exact time to administer your trigger injection. This is an injection of human chorionic gonadotrophin (hCG) to aid the egg’s final maturation and loosening from the follicle wall. Egg retrieval takes place on the second morning after the final injection (34-36 hours later). Your trigger injection timing is crucial, so ensure you write it down carefully with your instructions. Step 4: Egg Retrieval and Semen Collection Your fertility specialist will then perform the egg retrieval or egg “pick-up” while you are lightly sedated. This involves passing an ultrasound-guided probe, with a fine needle attached, through the vaginal canal and into each follicle in the ovary. The fluid in the follicle is then extracted into a test tube and studied under a microscope to look for eggs. This procedure takes 20 to 30 minutes, depending on the number of follicles that have developed. After the egg retrieval, you will rest for one hour before going home. City Fertility Centre recommends patients take the day off work and avoid any strenuous exercise. On the day of your egg retrieval procedure, your partner will be asked to produce his semen sample. A men’s room is available at each City Fertility Centre clinic. If you and your partner have any concerns about collecting the sample, please discuss this with staff before starting your cycle. It may be possible to produce the sample at home and drop it off at the clinic, or freeze one of your partner’s semen samples as a back-up. Step 5: Fertilisation (Insemination) and Embryo Development Next, the sperm sample is washed and concentrated, then added to the eggs about four hours after egg retrieval. The sperm and eggs are placed in an incubator overnight and the eggs are examined the next day for signs of fertilisation. Usually 60 to 70 per cent of eggs will fertilise if the sperm sample appears normal. An embryologist will contact you to discuss fertilisation outcomes and any questions you may have. The fertilised eggs are then kept in the incubator for an additional 48 hours. Your fertility specialist may suggest Intracytoplasmic Sperm Injection (ICSI) as part of your treatment if the sperm quality is low (sperm count or motility). ICSI is a specialised form of treatment for male infertility and involves injecting a single sperm directly into a single mature egg. Step 6: Embryo Transfer Embryo transfer occurs two to five days after egg retrieval. The embryo chosen for transfer is inserted into a thin plastic catheter (a soft tube), which is passed through the cervix, into the uterus and gently released. The process itself takes only a few minutes and is usually painless. Generally only one embryo is transferred, or two in exceptional cases – this will depend on your individual circumstances and embryo quality. After the transfer, some of the remaining embryos may be suitable for vitrification (rapid freezing), and this option is available to all patients undergoing IVF treatment. Frozen embryos can be used in subsequent cycles if the first cycle is not successful. To be suitable for freezing, embryos must not show any signs of abnormal/slow development or fragmentation (cell breakdown). Step 7: Luteal Phase The luteal phase is the two-week period between the embryo transfer and the pregnancy test. During this time it is important that you look after yourself and maintain good health and wellbeing. You will be encouraged to limit strenuous activity for 24 hours after the transfer. The progesterone medication you start taking after egg retrieval can sometimes cause tiredness, nausea, cramping and bloating. You may choose to take an analgesic if you experience any discomfort. If you are concerned by any symptoms, contact your fertility centre and speak with a nurse. Vaginal spotting or bleeding may happen before you are due for your pregnancy test, but this does not always mean treatment was unsuccessful. You should continue using any treatment medications until a full period begins and/or you and your specialist have received your blood test results. Step 8: Pregnancy Test Your pregnancy blood test is due about 14 days after the embryo transfer. Your nurse will phone to give you the results and advise you on the next steps to take on your journey to having a child.   We recognise that the time between embryo transfer and your pregnancy test can be emotionally charged with anxiety and expectation. We understand this can be a difficult time and encourage you to call your clinic for support if you are finding it hard to cope with the stress of waiting. Access to professional counsellors is also available as part of your IVF treatment. We provide personalised, compassionate care and will support you at every step of your fertility journey.   Image courtesy of Shutterstock.com