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Care Program

Dr Sterling has developed a concise set of clinical pathways that make up the Sterling Fertility Care Program only available at Life Fertility Clinic.

TREATMENT OPTIONS

The majority of all infertility cases, (both male and female factor), are overcome through treatment, using surgical, medical and scientific techniques.

The fertility specialists at Life Fertility Clinic are committed to developing a treatment plan that will lead to the desired result of conceiving a child.

We regard you as a partner in treatment and work with you to determine the treatment option that will be most fitting for you.

Dr Sterling is highly regarded for his skills and knowledge in determining diagnosis, intervention and prognosis.

Surgery
Surgery can be the corner stone to treatment. Examples of how surgery can be therapeutic include:

• Laparoscopy can remove endometriosis that prevents pregnancy.
• Laparoscopy can treat PCOS with ovarian drilling.
• Hysteroscopy can identify and remove lesions such as a polyp that can act like an IUD in the uterus.
• Treating an abnormal tube can enhance the uterine environment and make it more likely that an embryo will implant.
• The removal of fibroids can enhance fertility.

Ovulation Induction
Ovulation induction medications, often referred to as fertility drugs, are used to stimulate the ovaries resulting in the production and maturation of multiple follicles and multiple eggs in one cycle.

IVF (In vitro Fertilisation)
The basic steps in procedures, listed below, are designed as an overview only as your cycle steps may be different, catering to your individual needs.
At Life Fertility Clinic IVF treatment involves 6 main steps.

STEP ONE: STIMULATING EGG DEVELOPMENT
In the IVF Program we usually prescribe a combination of drugs to induce the growth of multiple egg follicles. The drugs most commonly used are given by nasal spray and daily injection. Soon after Follicle Stimulating Hormone (FSH) treatment has started, regular vaginal ultrasound scans are required to carefully monitor the growth of these follicles. Blood tests may also be used to monitor hormonal levels. Occasionally treatment may have to be cancelled during this process if the ovary does not respond or too many eggs are produced. If this occurs, a different protocol and/or starting dose of FSH will be employed for the next IVF attempt.

STEP TWO: EGG RETRIEVAL
After the follicles have reached a diameter of at least 17mm in size on ultrasound, another hormone called hCG (Human Chorionic
Gonadotrophin) is administered. This hormone is administered exactly 36 hours before egg collection. hCG controls the final maturation and release of the eggs so that they are ready to be collected. You will come to our IVF theatres at Life Fertility Clinic half an hour prior to the scheduled egg collection. The egg retrieval procedure is conducted under general anaesthesia or sedation and uses the same vaginal ultrasound probe that was used for follicle monitoring. An aspiration needle is attached to the probe and inserted through the vaginal wall and into the follicles of the ovary. It is important to note that not every follicle will contain an egg. The follicle fluid and eggs are aspirated into a test tube and the fluids are handed over to laboratory staff to examine the fluid and search for an egg. Once the egg retrieval is complete, you will go to a recovery area to rest until the effects of the anaesthetic have worn off. When eggs are found they are examined under a microscope. Each egg is then cultured for approximately four hours before being exposed to sperm.

STEP THREE: SPERM COLLECTION
When needed, the male partner will be asked to produce a semen sample by masturbation around the time of the egg retrieval. Some men do not produce sperm in their ejaculate, and in this instance, a procedure called Percutaneous Epididymal Sperm Aspiration (PESA) or Testicular Sperm Aspiration (TESA) can be used to retrieve sperm. Both of these procedures can be performed at the Life Fertility Clinic. Men who have poor sperm quality or low numbers of sperm may have a single sperm injected into each egg using a micromanipulation technique known as Intracytoplasmic Sperm Injection or ICSI. The use of donor sperm is another option that should be discussed with your IVF specialist prior to starting IVF treatment.

STEP FOUR: IN VITRO FERTILISATION (IVF)
After a process in which the sperm are separated from the semen, each mature egg is mixed with the appropriate number of sperm. If the sperm are of poor quality, injecting sperm into an egg using the ICSI micromanipulation technique mentioned in Step Three can facilitate fertilisation. The eggs are examined for the presence of two small round structures. One is the male pronucleus, which represents the genetic material from the sperm and the other is the female pronucleus, which represents the genetic material from the egg. These two pronuclei fuse and the fertilised egg then begins to divide, becoming what is now called a pre-implantation embryo (pre-embryo).

STEP FIVE: EMBRYO TRANSFER AND EMBRYO FREZING (CRYOPRESERVATION).
If fertilisation is successful, the embryo(s) will be transferred into the woman’s uterine cavity in our transfer room at Life Fertility Clinic two to five days after egg collection. It is usual to transfer only one or two embryos to minimise the risk of multiple pregnancy. The decision regarding the number of embryos transferred depends on the age of the patient, the cause of their infertility and their past history of IVF treatment. This transfer technique is accomplished by placing the embryos (in a small droplet of fluid Ð a culture medium) inside a fine plastic tube called a transfer catheter. The transfer catheter is then inserted into the uterus through the cervix during a vaginal examination. The process lasts only a few minutes. Rarely an anaesthetic may be required. For the period after embryo transfer, patients will generally need to use progesterone vaginally to support the lining of the uterus as the embryo implants. We call this ‘luteal support’. Embryo Freezing (Cryopreservation) Couples who have more suitable embryos than they can use may have the ‘extra’ embryos frozen for their future use. However, to do so, the couple must have signed the appropriate consent forms to freeze and store embryos.

STEP SIX: FOLLOW - UP
A pregnancy test will be arranged 14 Ð 16 days after the embryo transfer. While a pregnancy can be confirmed by a urinary home pregnancy test, a blood test to detect hCG, the hormone secreted by the developing placenta, is more sensitive and will detect even very low levels of hCG. If the test is positive a repeat blood test will be ordered. hCG levels usually double every two days. It is important to note that bleeding prior to the pregnancy test date may not be a period, so you must continue on all medication until advised otherwise. Once a pregnancy is confirmed it is important to remain on medication until advised to cease.
An ultrasound examination will be arranged within the next two to three weeks. If the pregnancy test is negative patients are instructed to discontinue all medications. The menstrual cycle may take anytime up to two weeks to start and may be slightly heavier than normal. Progesterone may delay a period, even if the patient is not pregnant. You are advised to make an appointment with your doctor to discuss the results of your previous IVF cycle and plan future treatment. IVF nurses and counsellors are available to help you through this often difficult and distressing time.

 

Your specific fertility plan will be explained to you in detail by your Life nurse co-ordinator prior to commencing any treatment cycles.

For more detailed information on each of these steps please refer to our comprehensive PATIENT’S HANDBOOK which you will be provided with at your first consultation.