Dr David Wilkinson

Fertility Unpacked – Couple’s pregnancy joy after ‘soul-crushing’ loss and unexplained infertility

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By Dr David Wilkinson, Medical Director at City Fertility Centre Melbourne There are two main reasons that someone would want to test their egg reserve, firstly to test their fertility status and secondly to test their response to fertility medication. The commonly used test for this is the Anti-Mullerian Hormone (AMH) blood test. The AMH hormone is produced by the small follicles in the ovary which have not yet begun to develop into mature eggs or ova. These early developing follicles are called antral and pre-antral follicles. What Does AMH Test Measure? The level of AMH is a measure of eggs in the ovaries (or the ovarian reserve). Interestingly, the amount of AMH in the blood usually remains constant until the age of 25 then begins to decline. A steady decline of AMH occurs from the age of 35 until it becomes unmeasurable at menopause. AMH Testing for Fertility Status Your doctor may recommend an AMH test if: you are wanting to delay childbirth and are under 35 years old; you are having ongoing trouble falling pregnant; you are concerned about conditions that may have an impact on your fertility like a family history of premature menopause, multiple operations on the ovaries, chemotherapy, endometriosis, or PCOS. AMH Testing for Response to Fertility Treatment If you are undergoing fertility treatment your specialist may choose to do an AMH test to predict ovarian response to fertility medication and helps in deciding the dose of medication to be used. What the Results can Indicate? A low ovarian reserve result may indicate: it is better not to delay starting a family depending on situation and age, that further assisted fertility methods should be considered if already undergoing treatment, may call for a larger dose of fertility medication. A high ovarian reserve level may indicate: polycystic ovaries About the Test The AMH blood test can be performed at any time throughout the menstrual cycle. It may be performed in conjunction with an antral follicle count (simple ultrasound) as a predictor of ovarian reserve. An AMH test is a good snapshot of current ovarian reserve. However it is recommended to treat ‘normal results’ with caution and ongoing monitoring is wise as AMH levels decline at predictable rates. Patients must also remember that egg reserve levels are only one of the many factors that can impact fertility. It is therefore essential for this test to be ordered by gynaecologists and fertility specialists who are trained to interpret the results and explain them in detail to the woman involved. It is important to note that many women who have low AMH levels still fall pregnant. Watch Dr David Wilkinson’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 © 2015. Image courtesy of Shutterstock.com

By Dr David Wilkinson, Medical Director at City Fertility Centre Melbourne.  After all you have been through to try to achieve a pregnancy, there is finally the two-week waiting phase until your pregnancy test, to stretch your patience once more! Suddenly, during this phase, many people become hyper-aware of any changes and sensations they experience, wondering if it could indicate something either one way or the other. My best advice is to try to relax and distract yourself. These two weeks are considered the final phase of IVF. Called the luteal phase, it is the period of time between embryo transfer and the pregnancy test. These two weeks would be equivalent to the part of a non-stimulated 28-day cycle that happens between day 15 and 28. Progesterone and/or estrogen medication are working in your body to help produce the same levels of hormones that would normally occur naturally in the early stages of pregnancy. These also help prepare the lining of the uterus for implantation. Once transferred, the embryo needs to implant itself into the uterine lining, usually on about day 20 of the cycle, and then continue to grow into a fetus for pregnancy to occur. Why do you have to wait to do a pregnancy test? It takes about 10 days for all traces of the hormone you used as the trigger to be cleared from your body and in turn for less than 10% of it to show up in a blood test. This is why we wait 14 days to make sure the new pregnancy is producing enough of the hormone hCG (human chorionic gonadotropin) to be detected in a blood test. This is the most accurate indication of pregnancy. It is important to note that this may not be the case for a frozen embryo transfer cycle, as the hCG trigger injection may not be used with all patients. I do not recommend home pregnancy tests before the two-week mark as they can deliver false results, both positive and negative. One reason for this is that the hCG injection given to mature and release the eggs and as a booster can give a false positive urine test, which only adds to the emotional rollercoaster. Two weeks is generally the mark when we can have confidence in the results, whether the patient has undertaken a fresh or frozen embryo transfer. What is going on in your body during these two weeks? The hormone medication given to you to optimise your body for pregnancy may be having an impact on you emotionally and physically. You may feel more prone to tears, anxiety and irritability. You may also experience some cramping, spotting or light bleeding, abdominal bloating, fatigue, and breast tenderness. While any change can be alarming, they are normally fine and do not indicate whether you are pregnant or not. However, any extreme symptoms should be reported to your doctor immediately. What should you focus on in these two weeks? Limit activity for the first 24 hours after transfer. Gradually increase activity over the next few days to non-strenuous non-aerobic activity and return to work when ready – your treating specialist will guide you if you are unsure. Eat healthily and stay hydrated. Keep busy by planning meaningful or fun distractions. Practise your favourite relaxation activity to keep stress levels down. Set aside a time slot each day (15-30 minutes) to think about your journey and write down your thoughts or discuss them with someone. This may help you to stay aware of and process the range of feelings (i.e. fear, excitement etc.) that often occur during this time. If you are feeling overwhelmed by the range of emotions, or are finding it exceptionally hard to deal with the stress of waiting and not coping, you are not on your own. Call your treating specialist, IVF nurse or counsellor for help. You can also get in touch with support groups such as Access Australia www.access.org.au. If you are pregnant, what is next? With your obstetrician you will determine the expected birth date for the baby. This is determined from the start of your last menstrual cycle. Your first pregnancy ultrasound is then usually scheduled for between 6 and 7 weeks’ gestational age. If you are not pregnant, what are the next steps? If you have a negative pregnancy result, we will work closely with you to support you during this time. Your nurse will advise you to stop your medications and you will meet with your specialist to review your past cycle and make a decision together on what the next best steps are.   Image courtesy of Shutterstock.com

By Dr David Wilkinson, Medical Director at City Fertility Centre Melbourne. If going to see a fertility specialist and thinking you will automatically end up doing IVF makes you freeze with fear, then you can defrost, because I am pleased to tell you otherwise. There are in fact a range of early fertility treatment options to consider first. Our statistics show that only about 20 to 30 per cent of our patients who see our fertility specialists actually go on to IVF treatment. Often IVF is not required as there are a number of simpler fertility treatment options that can substantially improve a person’s chances of pregnancy. These include looking at lifestyle factors, timing, ovulation induction (OI), intra-uterine insemination (IUI), surgery, and hormone therapy. Lifestyle factors There are a number of lifestyle changes that can be implemented to maximise your chances of conception and give your baby the best start in life. When trying to conceive, the reproductive health of both the male and female is equally important. Factors like weight, stress, diet, alcohol, caffeine, medications and other habits can be assessed to determine if they are impacting your chances of success. Timing Timing of ovulation is critical to successfully conceiving. The general rule is ovulation usually occurs about two weeks before your period starts. With the help of a specialist you may be able to more accurately pinpoint your ovulation dates as it is very individual and dependent on how long the menstrual cycle is and will not always be on day 14. Ovulation induction This involves stimulating the ovaries to encourage or regulate ovulation. Various fertility medications are available for ovulation induction, and your physician will choose the drug or combination of stimulation drugs that is best in each case. The two most common methods are: Clomiphene citrate: This involves the use of medication (Clomid or Seraphine) to stimulate the ovaries and encourage or regulate ovulation. This medication is normally prescribed to women with infrequent periods and long ovulation cycles. Follicle-stimulating hormone (FSH): Ovarian stimulation is stronger with this method, stimulating the development of the fluid-filled sacs containing the eggs. At City Fertility Centre we are very careful to regularly monitor our patients to minimise possible complications relating to overstimulation. Intra-Uterine Insemination (IUI) Intra-uterine insemination is a procedure in which treated sperm is inserted into a woman’s uterus directly, in order to improve the likelihood of fertilisation. IUI can involve the use of fresh sperm (from the partner) or frozen sperm (from the partner or a donor). It can be useful in diagnoses of irregular ovulation, unexplained infertility or sexual dysfunction. Surgery For women, surgery can often improve the 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. The surgery aims to remove or minimise any issues that may be preventing successful conception. For men, surgery for a condition known as varicocele can sometimes help. This condition is where the veins of the scrotum become abnormally enlarged, may be surgically treated by clipping or tying the veins. Hormone therapy for men Hormonal imbalances that affect sperm development can be treated by gonadotrophin therapy. Gonadotrophins are protein hormones sometimes used to treat unexplained male infertility in the cases of abnormally low sperm counts or when less than 40% of sperm are mobile. Other drug treatments include using antibiotics to treat infertility caused by infections.   Careful consideration should be made when deciding which treatment options are right for you and these can be discussed with your fertility specialist. If you have not achieved a pregnancy after a year (or six months if you are over 35) of unprotected intercourse, you should seek medical advice from your GP or a specialist.   Image courtesy of Shutterstock.com

City Fertility Centre Melbourne is proud to be six years old. We now employ six highly qualified and experienced fertility specialists and have clinics or consulting rooms in 13 locations across Melbourne. We are committed to providing our patients with state-of-the-art fertility treatment in a confidential, compassionate and supportive environment. Our personalised approach focuses on the most important pregnancy of all … yours. At City Fertility Centre, we assess each patient individually to try to determine the cause of infertility first. Often the issue can be addressed through treatment and advice, without the patient proceeding to IVF.   City Fertility Centre Melbourne Specialists: Dr David Wilkinson, Dr Anne Poliness, Dr Alex Eskander, Dr Roshan Shamon, Dr Catarina Ang and Dr Vadim Mirmilstein.   Clinics and Consulting Locations: St Kilda Road, Melbourne City, North Melbourne, East Melbourne, Bundoora, Heidelberg, Mitcham, Donvale, Brighton, East Malvern, Clayton, Blackburn, Elsternwick and Point Cook. For a free fertility information pack, phone 1300 781 483 or visit cityf3.wpenginepowered.com.

During Fertility Week (September 3-9), City Fertility Centre specialist Dr David Wilkinson is keen to raise community awareness of the key factors that impact on fertility. Dr Wilkinson said based on current evidence, age, obesity, smoking and alcohol consumption were the biggest factors that could influence the chance of falling pregnant and having a healthy baby. In addition, he said, many common medical issues could impact on fertility, including endometriosis, ovulation disorders and blockages, but they were mostly treatable. “Just as people plan travel, careers and weddings, they can also plan for a family,” Dr Wilkinson said. “Individuals and couples should plan ahead and make informed and timely decisions regarding childbearing to prevent infertility and involuntary childlessness. “The fact is that one in six couples have trouble falling pregnant.” Dr Wilkinson said age was one of the top reasons why people had trouble conceiving, as fertility declined as age increased. He said women were most fertile in their 20s, but due to a change in lifestyle, many people were delaying having children until after this age. Official figures show the average maternal age in Australia has now reached 30. Dr Wilkinson said while the age clock could not be wound back, people could take other steps to optimise their fertility, including simple things such as managing their weight, exercising and following a healthy diet. Fertility Fit Tips: Follow a healthy, balanced diet that provides adequate protein, carbohydrate and fibre. Aim to undertake moderate exercise for an average of 30 minutes three times a week. Take folic acid for the three months before and the first three months of pregnancy (females only). Restrict alcohol intake. Stop smoking and any drug use. Check your medications/supplements intake with your doctor. Limit caffeine consumption. As a general rule, Dr Wilkinson said you should seek the help of a fertility specialist if you are under 35 and have been unsuccessfully trying to fall pregnant for 12 months, or if you are over 35 and have been unsuccessful after six months of trying to conceive. According to recent figures, the number of babies born as a result of assisted reproductive technology (ART) treatment is nearing 5 million worldwide. The first IVF baby, Louise Brown, was born in England 34 years ago, in July 1978. For further information on fertility, visit cityf3.wpenginepowered.com (City Fertility Centre) or http://yourfertility.org.au/ (Fertility Week).