Dr Georgiana Tang

  Fresh vs Frozen Embryo Transfers: Know the Differences Book your appointmentRequest an appointment with one of our specialists.   If you have been fortunate enough during an IVF cycle to have several eggs retrieved, fertilised with sperm, and good-quality embryos created, you may also have additional embryos to freeze for future use. This gives you the option to have with a fresh embryo transfer, and then if needed later, proceed with a frozen embryo transfer (FET). Some ask why not make every embryo transfer cycle a fresh one. The reality is that when women undergo an IVF embryo transfer, the aim is to collect as many high-quality eggs as possible to increase the chance of pregnancy. IVF can be a physically and emotionally challenging process, so reducing the number of cycles is always beneficial. Not every egg will fertilise or develop into a viable embryo, which is why being able to fertilise multiple eggs and potentially some embryos to freeze is fortunate and extends your pregnancy potential. Thanks to advances in IVF, success rates for fresh vs frozen embryo transfer are now considered comparable. So, what is the difference between a fresh embryo transfer and a frozen embryo transfer? Let’s look at the facts. What is a Fresh Embryo Transfer? A fresh embryo transfer is an embryo transfer procedure that usually takes approximately 5 days after egg retrieval in an IVF cycle. The embryologist will discuss with you which embryo will be transferred and why. Because the embryos are transferred a few days after egg retrieval in the same cycle, there is no need to freeze and thaw the embryo, avoiding any thawing delays. The procedure is simple, usually performed at the clinic with or without ultrasound guidance, requires no anaesthetic, and most patients can resume normal activities the same day. What is a Frozen Embryo Transfer (FET)? Following a fresh embryo transfer, the embryologists aim to freeze as many remaining embryos as possible using a rapid freezing process called vitrification. Not all embryos are suitable for freezing, but those that are can be stored for future use in a frozen embryo transfer (FET). These embryos are stored in specialised storage tanks containing liquid nitrogen, which are continuously monitored by laboratory alarm systems to ensure they are kept at the correct temperature. Thawing is a simple process that takes around 15 minutes, where the blastocyst is removed from liquid nitrogen and carefully rehydrated. Preparation for a FET cycle is generally easier than a fresh cycle, as it does not involve the same ovarian stimulation as used in a IVF cycle. Instead, the focus is on timing the transfer at the correct stage of your natural or medicated cycle. Your doctor will monitor the uterine lining at the beginning and again before transfer to ensure it is optimal for implantation. On transfer day, the IVF embryo transfer procedure is the same as in a fresh cycle, requiring no sedation or anaesthetic, and you can usually resume normal activities straight away. Because of the way embryos are frozen, they can be thawed and transferred even several years after storage, while remaining as strong as the day they were frozen. Importantly, a frozen embryo transfer is also more cost-effective than a full IVF cycle, as only a portion of the treatment process is repeated. Success Rates and Outcomes Several factors affect the success of an embryo transfer, including Patient’s egg source age, embryo quality, and the health of the endometrial lining. At City Fertility, outcomes for both fresh and frozen transfers are comparable, thanks to laboratory methods and vitrification techniques. For more details, you can view our IVF success rates Book your appointmentRequest an appointment with one of our specialists.   Frequently Asked Questions Which among fresh and frozen embryo transfer is better? Neither is inherently better. Both approaches can achieve successful pregnancies. The choice depends on factors such as your age, uterine readiness, and medical history. Your fertility specialist will recommend the best option for your unique situation. Are there any disadvantages of frozen embryo transfer? A frozen embryo transfer may involve additional costs for freezing, storage, and thawing. There is also a small risk that some embryos may not survive the thawing process. However, vitrification has made survival rates very high. Do fresh transfers require longer implantation times? Implantation time is not necessarily longer in fresh transfers. Instead, the success depends on synchronisation between the embryo’s development stage and the endometrial lining’s receptivity. When this alignment is optimal, implantation can occur in either fresh or frozen transfers. Are there any chances that frozen embryos grow slower than the fresh ones? Implantation time is not necessarily longer in fresh transfers. Instead, the success depends on synchronisation between the embryo’s development stage and the endometrial lining’s receptivity. When this alignment is optimal, implantation can occur in either fresh or frozen transfers.  

By Dr Georgiana Tang, Medical Director at City Fertility Centre Sydney Liverpool. Choosing to be a single mother is on the increase, and thankfully there is now more widespread acceptance for it, more services available to assist single mothers and, importantly, modern fertility treatments that can help women achieve motherhood on their own. There are many reasons why women choose to go it alone, whether it be because they haven’t met the right partner yet, they have just always wanted to be a single parent, or for an array of other reasons. City Fertility Centre provides a comprehensive range of services to help single women achieve parenthood, whether that be now or down the track. The first decision you need to think about is whether you want to try now to have a baby or preserve your fertility – by freezing your eggs – in order to try to have a baby at a later date. One of the most important factors that can influence your decision on what action to take is your age. Research shows that female fertility is at its optimum level until the age of 35. While women are born with their lifetime supply of eggs, these naturally begin to decline in quality and quantity from age 25, and more rapidly from 35. The egg supply is almost non-existent by the time of menopause. Therefore, if you are hoping to use your own eggs, age plays an important role. Here are some fertility treatment options to think about if you are a single woman wanting to achieve a pregnancy on your own. Donor Insemination (DI) This involves artificial insemination – a fertility procedure in which treated sperm is inserted into a woman’s uterus directly 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) In vitro fertilisation (IVF) literally means “fertilisation in glass”. For single women, it 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. In order for this to take place, the woman has to undergo a full IVF cycle, including an egg retrieval process. Any spare eggs can be frozen or fertilised with donor sperm and frozen as embryos. Intracytoplasmic Sperm Injection (ICSI) Intracytoplasmic Sperm Injection (ICSI) is a specialised form of IVF and involves the injection of a single sperm directly into a mature egg. This method would only be used with single women if the donor’s sperm quality is poor or previous IVF cycles showed a poor fertilisation rate. Egg freezing For a range of reasons, egg freezing can potentially be helpful for single women, including those who may wish to try to have children at a later date, those with a genetic disorder that could limit their fertility, and cancer patients who may need to undergo chemotherapy. The process of freezing female eggs has advanced rapidly over the past 10 years, and research studies are reporting equally successful fertilisation and embryo development rates for frozen eggs as compared to fresh ones. However, it is essential that egg freezing only happens after appropriate counselling. While there are many egg freezing success stories, there is no guarantee that a particular woman will have a baby down the track, frozen eggs or not. However, the younger the woman is when she freezes her eggs, the better quality they will be and hence the greater chance of a successful pregnancy at a later date.   Image courtesy of Shutterstock.com

By Dr Georgiana Tang, Medical Director at City Fertility Sydney Liverpool  When you are trying to fall pregnant and it is just not happening fast enough, it can be a challenging experience for everyone involved. So what are the reasons and when is the right time to seek further advice from a fertility specialist? Below are the most common reasons to seek further help, and if you do choose to seek help, rest assured you are not on your own, as one in every six couples have some form of difficultly achieving a pregnancy on their own. The good news is that fertility issues can mostly be treated, giving great hope for individuals and couples in this situation to achieve their dream of having a baby. City Fertility Centre offers treatments for a wide range of infertility conditions, and in fact, two-thirds of our patients do not even need to proceed to IVF. Common reasons to seek further help: Medical conditions A few of the more common medical conditions that can sometimes have an impact on conception include Polycystic Ovarian Syndrome (PCOS), Endometriosis, fibroids, blocked fallopian tubes and premature menopause.  Polycystic Ovarian Syndrome (PCOS): This is a condition where the ovaries secrete abnormally high amounts of androgens (male hormones), which often cause problems with ovulation. Endometriosis: Endometriosis results when endometrial-like cells (cells from inside the uterus) grow outside the uterus. Distortion of the anatomy due to endometriosis can block or change the function of the fallopian tubes and prevent the sperm from reaching and fertilising the egg.  Fibroids: These non-cancerous masses are found in the uterus or cervix. Uterine fibroids are found in one out of every four or five women in their 30s and 40s. Fibroids can cause tubal blockages, prevent the embryo from attaching to the uterine wall and cause miscarriage. The impact the fibroids have on fertility depends upon their size and location.  Blocked fallopian tubes: When fallopian tubes are blocked, the egg can be prevented from meeting the sperm. Premature menopause: Premature Ovarian Failure (POF) is also called early menopause and refers to a condition where the ovary stops ovulating earlier than is normal. The average age range for menopause is between 45 and 55. Other medical causes: Thyroid disorders and genetic conditions. Irregular periods Irregular cycles may suggest a problem with ovulation and can impact on your ability to conceive. The average length of the menstrual cycle is 28 days, but can range between 25 and 35 days. The menstrual cycle is determined by a complex interaction of hormones, so any hormone imbalance can make your period irregular. Although, in most cases, irregular cycles are not dangerous, it is important to determine what is causing the irregularity sooner rather than later. Known sperm issues Fertility advice should be sought if any of the following sperm issues are known: poor sperm morphology (abnormally shaped); poor motility (slow-moving); low sperm count; the presence of antisperm antibodies; ejaculatory problems or azoospermia (no sperm present); or vasectomy. The time factor You should seek help if you are under 35 years of age and have not fallen pregnant within 12 months of unprotected intercourse, or if you are over 35 and have not fallen pregnant within six months of trying. For women aged 40 and over, I recommend further investigations be initiated after three months of trying to fall pregnant, as female age is one of the most important predictors of whether pregnancy will be achieved. Genetic conditions If there is a history of a genetic condition in the family that can be passed down through the genes and it is concerning you, then it is wise to seek advice from a fertility specialist. There are now several methods of genetic testing in IVF known as Pre-implantation Genetic Diagnosis (PGD) to screen for anomalies before fertilisation or implantation occurs. Recurrent miscarriage After three or more miscarriages (known as recurring miscarriages), tests are commonly carried out to look for the cause. People experiencing recurrent miscarriage are often in a difficult situation as they are successfully conceiving which is positive, then hopes are dashed when the pregnancy fails. There are some common reasons for miscarriages and a fertility specialist will work with you to try and determine and rectify this. Donor required If you know you will require the help of a sperm or egg donor, then it is wise to seek the help of an experienced fertility specialist. A fertility specialist will be able to discuss and guide you through the process, helping you make informed decisions and find the right option for you. Fertility preservation If you are concerned about preserving your fertility due to medical, lifestyle or other factors then it is wise to meet with a fertility specialist to discuss the pros and cons and options available to you. While freezing sperm, eggs and embryos is now common practice, it can never guarantee a future pregnancy, but it can increase the odds.   Watch Dr Georgiana Tang’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.   Image courtesy of Shutterstock.com

By Dr Georgiana Tang, Medical Director, City Fertility Centre Sydney. It can be a confusing and heartbreaking time if you are experiencing problems falling pregnant with your second child when first time around it was relatively easy. This issue is often called “secondary infertility” and is defined as a couple who, despite having achieved a pregnancy in the past (which may or may not have resulted in the birth of a child), are unable to do so again after a year or more of regular unprotected intercourse. While there are few official statistics on the prevalence of secondary infertility in Australia, it is thought that it affects 1 in 10 couples. Sometimes an answer cannot be found for the cause of a couple’s secondary infertility, but it is thought that the following are the most common factors affecting success: Maternal Age Maternal age is a significant factor and often the most important indicator of a woman’s chance of conceiving. Conception rates for normal, 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 a month and at age 43, the pregnancy rate is thought to be as low as 1-3 per cent a 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 and 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. 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 the man not having enough normal moving sperm per ejaculate can impact on conception. Unfortunately, having a previous pregnancy is not proof that this is the case. Developing and transporting mature, healthy, functional sperm depend 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. Read male infertility causes for more information.   Lifestyle Weight is a common factor affecting fertility success. For women, ovulation can be negatively impacted on by being either underweight or overweight, and studies have shown that bringing your body mass index (BMI) within the normal range can help ovulation occur normally, thus increasing chances of pregnancy. It’s also important for men to ensure a healthy BMI, and studies have consistently linked obesity to a lower sperm count among overweight men because testosterone levels drop while estrogen levels rise.   Unknown Unfortunately, it is estimated that about 10 per cent of infertility remains unexplained even after complete medical evaluation.   Image courtesy of Shutterstock.com

City Fertility Centre’s first New South Wales clinic opened three months ago in Liverpool, and it already has five reasons to cheer. The clinic has achieved five pregnancies for local families since opening. Dr Georgiana Tang, a fertility specialist, gynaecologist and the clinical director of City Fertility Centre Liverpool, said she was delighted that the clinic was off to such a successful start. “We are now looking forward to helping many more families in the Liverpool area in their quest to have a baby of their own to cuddle and hold,” Dr Tang said. Dr Tang holds a Master of Reproductive Medicine and has more than 15 years’ IVF experience. Click here to learn more about her. City Fertility Centre offers the full range of fertility services, including early treatment options, IVF, fertility preservation, donor programs and support services. For more information about our fertility treatments, please visit our Fertility Services section.

A Sydney fertility specialist says couples relying on the internet to diagnose infertility could increase their stress levels and are better off consulting medical experts. Dr Georgiana Tang (pictured), a fertility specialist, gynaecologist and clinical director of City Fertility Centre’s Liverpool clinic, said while patients were more informed than ever, they were depending on “Dr Google” for important health advice, which could do more harm than good. “Overzealous internet research can lead to unfounded concerns for people with fertility issues,” Dr Tang said. “It’s important that anyone struggling to fall pregnant for six months or longer consults their GP or a fertility specialist to discuss their concerns in order to access credible information.” Australians are among the world’s most prolific online self-diagnosers, alongside China, New Zealand and the US, according to a recent Health Pulse survey conducted by Bupa. [1] Dr Tang, who holds a Master of Reproductive Medicine from the University of Western Sydney and has more than 15 years’ IVF experience, said there were a number of misunderstandings about assisted reproductive technology (ART). “One of the most common misconceptions is that fertility issues always require In Vitro Fertilisation (IVF) – often it is not necessary and only around 20 to 30 per cent of patients who see City Fertility Centre specialists go on to receive IVF treatment,” she said. “Non-IVF methods, including addressing sperm or ovulation problems as well as timing, can substantially increase chances of pregnancy.” Dr Tang’s most important piece of advice for couples trying to have a baby is to seek guidance early. City Fertility Centre is one of Australia’s largest privately owned IVF businesses and opened its first New South Wales clinic in Liverpool on April 7, 2014. Click here to learn more about the clinic. [1] Bupa Australia 2012 Health Pulse Survey http://blog.bupa.com.au/self-diagnosis-infographic/