Services / Fertility Services

Fertility Services

We’re here to help you on your fertility journey

Once you’ve made the all-important decision to try assisted reproductive techniques to improve your chances of conceiving a child, we’re all set to help you through.

Besides assuring you a compassionate and personalised experience, we also understand the emotional support, lifestyle and dietary guidance as well as counselling you’ll need along the way.

Creating possibilities with advanced reproductive techniques

Our unit offers an extensive selection of assisted reproductive services, ranging from the relatively simple IUI to complex fertility surgeries, each with its own set of considerations and risks. Our consultants will guide you through the best methods to pursue, based on your specific conditions and needs.

1. IUI: Intrauterine insemination

Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus.

Avisena Fertility only uses husband sperm for the IUI procedure. It is often combined with superovulation medicine to increase the number of available eggs.

The purpose of IUI is to achieve fertilisation and pregnancy and is a relatively simple procedure.

2. In vitro fertilisation

In vitro fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. It is a process of fertilisation by extracting eggs, retrieving a sperm sample, and then manually or by ICSI, combining an egg and sperm in a laboratory dish. The fertilised embryo(s) is then transferred to the uterus five days later or the transfer may be differed to a later date.

IVF can be used to treat infertility in the following situations:

Blocked or damaged fallopian tubes or women who have had their fallopian tubes removed
Male factor infertility including decreased sperm count or sperm motility
Women with ovulation disorders, premature ovarian failure
Individuals with a genetic disorders
Unexplained infertility

There are six basic steps in the IVF and embryo transfer process:

Step 1 – Fertility medications:

To stimulate egg production of multiple eggs desired, as some eggs will not develop or fertilise after retrieval
A transvaginal ultrasound is used to examine the ovaries

Step 2 – Oocyte/eggs retrieval:

Eggs are retrieved through a minor surgical procedure under ultrasound guidance
Medication is provided to reduce and remove potential discomfort (sedation)

Step 3 – Sperm preparation:

The male is asked to produce a sample of sperm, which is prepared for combining with the eggs

Step 4 – Insemination:

The sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilisation
In some cases where there is a lower probability of fertilisation, intracytoplasmic sperm injection (ICSI) may be used

Step 5 – Embryo culture:

Fertilised eggs divide and become 2 to 4 cell embryos 2 days after the egg retrieval
Embryos that have developed normally 5 days after fertilisation are called blastocysts
When planning PGD/PGS, the embryo biopsy is performed on day 5 or day 6 embryos – blastocysts

Step 6 – Embryo transfer:

A catheter or small tube is inserted into the uterus to transfer the embryos
This procedure is painless for most women, although some may experience mild cramping

IVF – Intracytoplasmic sperm injection (ICSI):

Intracytoplasmic sperm injection is an in vitro fertilisation procedure in which a single sperm cell is injected directly into the cytoplasm of an egg.

This technique is used in order to prepare the gametes for the obtention of embryos that may be transferred to a maternal uterus.

Time-Lapse by EmbryoScope

The fertilised eggs are considered embryos and are usually transferred into the woman’s uterus after three to five days or “freeze all” to be transferred later. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

The eggs are monitored with Time-Lapse by EmbryoScope to confirm that fertilisation and cell division are taking place.

Time-lapse imaging of embryo development is one example of an innovative technology that Avisena Fertility specialists have adopted to provide patients with the very best outcomes.

Side effects of IVF

Although you may need to take it easy after the procedure, most women can resume normal activities the following day. Some side effects after IVF may include:

Passing a small amount of fluid (may be clear or blood-tinged) after the procedure
Mild cramping
Mild bloating
Constipation
Breast tenderness

If you experience any of the following symptoms, call your doctor immediately:

Heavy vaginal bleeding
Pelvic pain
Blood in the urine
A fever over 38 °C

Some side effects of fertility medications may include:

Headaches
Mood swings
Abdominal pain
Hot flashes
Abdominal bloating
Rare: Ovarian hyperstimulation syndrome (OHSS)

Ovarian hyperstimulation syndrome (OHSS)

More severe risks associated with in vitro fertilisation:

Nausea or vomiting
Decreased urinary frequency
Shortness of breath
Faintness
Severe stomach pains and bloating
Ten-pound weight gain within three to five days

If you experience any of the symptoms above, contact your Avisena Fertility doctor right away.

3. Fertility surgery

Surgery can be the solution to some fertility challenges. Our reproductive specialists are experienced surgeons who routinely perform minimally invasive laparoscopic and hysteroscopic procedures, which require less recovery time than traditional ‘open’ surgery.

In fact, many Avisena Fertility patients who thought that IVF was their only option for becoming pregnant conceived naturally after undergoing relatively simple, minimally invasive surgical procedures. Surgeries performed include:

Laparoscopy

Laparoscopy is a surgical procedure to evaluate the pelvic cavity and commonly treat tubal disease and/or endometriosis. The procedure is done at Avisena Hospital, under general anesthesia.

A scope is placed through a small incision at the belly button. The abdomen is filled with gas allowing the pelvic organs to be seen clearly by the physician. The procedure is a day-care procedure. Recovery at home within 1-2 days of surgery is typical.

Hysteroscopy at AWCSH

Hysteroscopy

Hysteroscopy is a surgical procedure to evaluate the uterine lining. Most commonly a hysteroscopy is performed to remove uterine polyps or adhesions from previous infection or surgery.

Hysteroscopy is done under general anesthesia. A thin-lighted tube is passed through the cervix into the uterus with instruments passed through it to treat anything found. It is a day-care procedure. Most women are able to return to work the following day.

Testicular biopsy

In some cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility or to retrieve sperm for assisted reproductive techniques, such as IVF-ICSI.

Percutaneous Epididymal Sperm Aspiration (PESA)

Surgical sperm retrieval procedures can be used in cases where a mechanical blockage of the vas deferens, either congenital or acquired as the result of vasectomy or disease process. This means that the sperm produced by the testes cannot be released and remain stored in the epididymis. This trapped sperm can be removed by surgical sperm retrieval via a simple procedure known as PESA.

In this procedure a fine needle is inserted through the skin of the scrotum to remove the sperm from the epididymis. The procedure is a day-care procedure under general anaesthesia. Recovery at home within 1-2 days of surgery is typical.

Testicular Sperm Extraction (TESE)

TESE is performed when PESA has been unsuccessful and in men suffering from early signs of testicular failure where no sperm is likely to be present in the epididymis.

The procedure involves a small incision being made in the scrotum and testis, and a biopsy of testicular tissue is taken from which sperm is extracted in the laboratory.

Note:

PESA and TESE procedures are carried out as a day-care procedure under general anaesthesia, and are normally performed on the same day, but prior to the female partner’s egg recovery.
We strictly DO NOT accept donor sperm for our fertility procedures.

4. Genetic testing

Genetic testing is an optional test offered at Avisena Fertility that can put patients at ease regarding the health of their embryo(s) in addition to their chances for a successful pregnancy via in vitro fertilisation (IVF).

Each type of genetic screening is used prior to the embryo transfer procedure in order to help ensure a healthy embryo that is free of abnormalities.

PGS (Pre-implantation Genetic Screening)

PGS examines the chromosomes in several cells that have been removed from the embryo on day 5 or 6 of embryo culture. The cells are sent to a specialty genetic testing laboratory where the DNA is analysed. Each embryo is frozen individually after the cells are removed.

The DNA analysis reveals if each embryo has the correct number of chromosomes and the sex. This allows the transfer of embryo(s) with the correct number (46) chromosomes to reduce the risk of miscarriage or other congenital defects in the next cycle.

PGD (Pre-implantation Genetic Diagnosis)

Individuals or couples with a family history of a genetic disease, such as cystic fibrosis, can take advantage of PGD to determine if an embryo is a carrier, is affected with the disease, or does not have the disease.

Transfer of an unaffected embryo provides a much lower risk of passing along the disease.

Testing is available for many genetic diseases or may be customised in some cases for rare conditions.

5. Ovarian Tissue Cryopreservation (OTC)

OTC is a procedure that may allow girls and young women the opportunity to have children later in life by removing and freezing ovarian tissue before treatments start.

Cryopreserving, or freezing, ovarian tissue requires a surgical procedure, performed in which an ovary or part of an ovary is removed. The tissue containing immature eggs is frozen and stored for use later in life. This tissue may be re-implanted inside the body, or potentially, the eggs could be matured outside of the body and used later through in vitro fertilisation.

How is OTC different from other types of fertility preservation?

Embryo and egg freezing are established forms of fertility preservation available to females who have started menstruating

Freezing eggs requires that young women take a hormonal medication to make many eggs at one time
Embryo preservation requires an available source of sperm
These embryos or eggs are retrieved and frozen for future use. The processes involved may require 10 to 14 days to complete

Who are the appropriate candidates?

Patients who do not have time to undergo controlled ovarian stimulation (COS) for embryo or oocyte cryopreservation. COS is the more mature technology and should be the first-line treatment if time permits
Patients who are planning surgery for another reason may be good candidates for ovarian tissue cryopreservation. Specifically, this may include women planning an ovarian removal as part of their treatment for endometrial cancer, etc
Pre-pubertal girls who do not have the option of COS

OTC is generally not recommended in women who:

are >41 years old
have a large ovarian cyst on the ovary to be cryopreserved
have received prior chemotherapy that has significantly impaired ovarian function

Note:

For cancer patients, the general recommendation is to avoid transplantation of ovarian tissue in cases where there is concern about reseeding cancer cells, and instead, to consider in vitro maturation of oocytes.