Getting Pregnant Now

The Pregnancy Miracle Ebook

Pregnancy Miracle by Lisa Olson is an in-depth guidebook showing readers the comprehensive information and tips about pregnancy. It begins with approximately 100 pages of informative content on the biological reproductive system, general methods to help conceiving, analysis of popular fertility treatments in West, and an introduction to less known ancient Chinese fertility techniques. Lisa outlines a three day juice cleansing following by a seven day parasite cleanse, plus a heavy metal cleanse and liver detoxification protocol. Cleansing your body of these harmful substances is important for a variety of reasons, as outlined in the book. When these toxins collect in your body, your digestive system becomes sluggish, which leads to blood intoxication which eventually results in a sluggish liver. Lisa Olson spent years developing the Pregnancy Miracle book so that people like her who are experiencing difficulties conceiving can have a chance to have their dreams of a new family member. Her program has helped thousands of women solve their fertility problems, but the program is designed to help men as well. More here...

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Author: Lisa Olson
Official Website: www.pregnancymiracle.com
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In Vitro Fertilization of Ciona intestinalis Ascidia

Many species of ascidian have been studied by developmental biologists here we cover only C. intestinalis. This species is cosmopolitan and common in the United Kingdom it is abundant in the vicinity of several major marine biology laboratories, including Plymouth, Southampton, and Millport. As with many other ascidian species, if adults are kept in constant illumination, they can be induced to spawn by moving them to the dark (2) animals can also be kept in the dark, and spawned by moving to the light. An alternative procedure to obtain embryos involves in vitro fertilization using gametes obtained by dissecting gonoducts. This method is convenient, since embryos can be obtained immediately after collection of animals. They can be spawned throughout the year or throughout summer in northern Europe.

Jumping the hurdles of IVF

You come across a range of health-care professionals on your way through IVF treatment and in Chapter 4 I introduce you to the many members of your IVF team. It's very important that you feel you receive the best possible care, so I also discuss how you can ensure that the members of your IVF team respond to your needs and what you can do if they don't. IVF is like a set of hurdles that you have to jump in order to get to the finishing line hopefully with a baby in your arms In Chapter 5 I describe the obstacle course, what it takes to get over those hurdles and what may go wrong along the way. IVF is often likened to an emotional roller-coaster ride. In Chapter 9 I explain how the ups and downs you go through during an IVF treatment cycle can throw you off course and how you can get back on track again. If you're interested in technical details, I explain the actions and possible side effects of the drugs you take for IVF in Chapter 6, what happens in the IVF lab in Chapter 7 and how...

Choosing a family planning method

On the following pages we describe different family planning methods. Before recommending a method, find out about the woman's needs. Does she want to be sure she will not get pregnant using this method Is the woman's partner willing to cooperate in using family planning How much can this woman spend on family planning Does the woman want a method that she can stop using if she wants to become pregnant or one that is permanent When thinking about family planning it is important to also think about HIV and other STIs. Sexual intercourse, which causes pregnancy, is also how STIs are passed. Some family planning methods, like condoms, help prevent pregnancy and protect against STIs. Some, like birth control pills and intrauterine devices (IUDs), only prevent pregnancy. When you are helping a woman choose a family planning method, you must help her think about her risk of STIs including HIV. See Chapter 18 to learn more about STIs. FAMiLY PLANNiNG METHOD Birth control pills, injections,...

Accessing IVF treatment

Various state laws cover who can access IVF, what you need to do before having IVF treatment and what happens when couples or individuals use donor sperm, eggs or embryos (see Chapter 13 for more detailed information on this process). All states and territories allow heterosexual married or de facto couples to access IVF treatment (although in South Australia you have to have lived together for at least five years to qualify ), but the situation isn't as clear cut for single women and State IVF laws The following states have their own laws regulating IVF clinics For single women and lesbian couples the rules for accessing IVF vary between the states. Some states distinguish between medical and social infertility and allow single women and lesbian couples who can't have babies because of a medical problem to access IVF, but don't allow access to women who don't have or don't want a male partner. Reproductive tourism is a term coined to describe women who cross state borders to access...

Artificial Insemination

Artificial insemination is a procedure in which sperm obtained by masturbation or other methods of mechanical stimulation are deposited in the vagina, cervix, or uterus of the female by means other than natural intercourse, with the specific intent to achieve pregnancy. Artificial insemination is a brief office procedure that may be performed using the fresh sperm of the male partner or the frozen thawed sperm of an anonymous sperm donor, and involves injection of the sperm into the female through a thin tube. Intrauterine insemination requires preliminary processing of the semen sample to isolate the sperm for insemination since seminal plasma cannot be directly injected into the uterus. To be effective, insemination must be performed in close proximity to the time of ovulation (release of an egg) in the female as both sperm and eggs have a relatively short lifespan. Situations in which artificial insemination may be a recommended procedure include (1) anatomical problems that...

Taking IVF One Step at a Time

Understanding the various technical terms Preparing for IVF treatment Taking drugs to stimulate your ovaries Collecting the eggs and sperm and making embryos Waiting for your pregnancy test results Using frozen embryos m VF treatment follows the stages of the menstrual cycle. That's why C you hear people referring to a 'treatment cycle' or an 'IVF cycle' or sometimes just a 'cycle' when they describe the steps involved in an IVF attempt. You also hear clinic staff use weird acronyms for different types of treatment instead of the often very long and technical real names of these treatments. An IVF cycle is like a series of hurdles that you have to jump over without falling. After you make it over one hurdle, another one is ahead of you. If you miss a hurdle, you go back to square one. In this chapter, I explain all the strange acronyms involved in IVF. I also give you a detailed description of what you can expect in each step of a treatment cycle, why treatment sometimes doesn't go...

Fluking it by getting pregnant without help

Some couples unexpectedly conceive another baby spontaneously even though they needed IVF to have their first baby. This can come as a bit of a shock, particularly if you get pregnant within a few months of giving birth. After the long hard road to having your first child, you may have trouble comprehending how you can possibly conceive without any help from the lab. Unless you know that you definitely can't conceive without IVF, there's always a chance that the stars will align and you'll conceive spontaneously. So, if you don't want a surprise pregnancy, talk to your doctor about contraception. But if you want more children and don't mind when, who knows you may just get lucky

One egg one sperm ICSI

If you're undergoing ICSI, the embryologist gives the sperm a helping hand to enter the egg. Since it takes only one sperm to fertilise an egg, the embryologist catches a single sperm and injects it directly into the centre of an egg. If you have several eggs, the embryologist repeats the process. ICSI sounds simple but is actually a very technically advanced procedure that requires complex equipment and a highly skilled operator. To perform the procedure, the embryologist uses a specialised piece of equipment called a micromanipulator, which has two 'arms' one arm has a specially designed holding pipette (which has a slight suction applied to it) to hold onto the egg and the other arm has an extremely thin, sharp and hollow needle attached to it to pick up and inject the sperm into the egg. The embryologist delicately steers the 'arms' using knobs and levers.

Ten Tips for New IVF Parents

M ongratulations You've cleared all the IVF hurdles and you're pregnant As you close the door on your IVF treatment and enter the world of antenatal care, you can start to count the days until you finally meet your baby. The transition to parenthood is an amazing and joyous period that starts in pregnancy. But becoming a parent for the first time can be pretty daunting and unsettling, even if you've endured a long hard road to get there. One of the difficulties that some IVF parents face is that their expectations of themselves as parents, their baby and life with a newborn are somewhat romantic and idealised, and don't match the real-life experience of caring for a little one. Added to this, friends and family expect IVF parents to be blissfully happy and find parenting a breeze. The truth is, kissing goodbye to your life as you knew it and getting on with your new role as a parent with responsibility for the care and survival of a newborn baby is a mammoth task for all new parents,...

Ten Tips for Surviving IVF

M VF is a very high-tech way of getting pregnant and you have to get your head around all sorts of medical jargon and complicated instructions, not to mention putting up with the inconvenience of numerous clinic visits and all that poking, probing and prodding of your body along the way. But that's the easy part The trickiest aspect of IVF for any couple is hanging on to each other and your sanity during the ups and downs of treatment. In this chapter, I give you ten survival tips to help you through IVF. Before undergoing IVF treatment you need to gather as much information as you can, so that you have an idea of what to expect and can make informed decisions about your treatment options. Most importantly, knowing how IVF can affect your emotional health and finding out about strategies to help you cope with treatment make you better equipped for the IVF journey. Refer to Chapters 9 and 11 for more information about the emotional aspects of IVF.

Table 135 Questions about Intimacy and Infertility to Ask Your Doctor

Regardless of where you are in terms of your treatment, improving intimacy with your partner is an important goal. Physical intimacy is a significant part of most adult couples' relationships, despite age and illness. But cancer can and does get in the way. As psychologist Leslie Schover writes in Sexuality and Infertility after Cancer, Sex and cancer are two words that do not seem to belong in the same sentence. We think of sexuality as a force for joy and new life, whereas cancer is a death force. Increasingly, however, men and women survive their cancers. . . . Being able to enjoy sex is one important battle in winning the war against cancer.

Cutting the Ties With Your IVF Team

When you undergo IVF treatment you're in constant contact with the members of your IVF team. But after your six-week scan confirms your pregnancy, you have to say goodbye to your team and move onto the obstetric team for antenatal care. However, the obstetric team members usually don't want to see you until several weeks after your first scan and during this wait some couples describe feeling a bit abandoned, unsure who to turn to with questions they have. If you're worried about something before you have your first antenatal visit, contact your IVF nurse The IVF nurses are always willing to help, and if they can't answer your queries, they'll point you in the direction of someone who can.

Offering Lowcost IVF in Developing Countries

IVF and other assisted reproductive technologies are very high-tech and expensive forms of treatment that are available almost exclusively in developed countries. However, the personal tragedy of childlessness is no different for men and women in developing countries. In fact, in some cultures women who can't have children may risk public humiliation, divorce, abandonment or withdrawal of food and financial support even if their infertility is due to a sperm problem. As a result, the Low Cost IVF Foundation has developed a very simplified IVF protocol that's being trialled in some African countries. The idea is that one IVF cycle shouldn't cost more than 300. To keep costs down, the protocol If this protocol produces reasonable rates of success, in the future IVF could become a feasible option for infertile couples in poorer countries. You can follow the progress of this initiative on the Low Cost IVF Foundation's website (www.lowcost-ivf.org).

Natural family planning methods

Natural family planning methods, which are also called rhythm methods, involve determining the days during your monthly cycle that you're fertile Calendar method. Using certain calculations, you determine the first and last days during which you can become pregnant in your cycle. The effectiveness of natural family planning methods depends on your diligence. Used perfectly, effectiveness ratings could reach 90 percent, which means that 10 out of 100 women who use natural family planning as birth control for a year will become pregnant. Few couples use natural family planning perfectly, so they experience slightly lower effectiveness rates. your cycles and observe physical signs of ovulation. Some research has shown that the timing of a woman's fertility window can be highly unpredictable, even if her cycles are regular. That means you may have the potential for becoming pregnant even when calculations suggest you're not ovulating.

Moving On When IVF Doesnt Work

Closing the IVF door Managing your disappointment Getting back into life A lthough the chances of having a baby with IVF have increased dramatically over recent years, the sad fact is that treatment still doesn't work for everyone. IVF clinics provide plenty of information about their 'success' rates, but you need to remember on the flip side that they also have a 'no success' rate.

Family planning programs that work

Midwives help individual women and men decide about family planning methods. In this work, they may find that family planning is difficult to get in their communities. Midwives may then get involved in making family planning programs work better. What makes a family planning program work to improve a woman's health, her knowledge, and her control over her body Health services that include family planning along with care before, during, and after birth, support for breastfeeding, treatment for infertility, and treatment and prevention of STIs. Respect for local health providers and safe traditional practices, including traditional methods of regulating monthly bleeding and family planning. Midwives often have good experience combining traditional methods with modern methods of care. Freedom from pressure and coercion. Coercion means a health worker or someone else pushes a woman to use family planning or a certain method when she does not want to. This happens when programs limit the...

Men must also be responsible for family planning

When men and women choose family planning together, it is much easier to use family planning successfully. Because men do not get pregnant, they do not always take the responsibility that women do for pregnancy and family planning. Many men think of family planning as the woman's problem. Some men do not want their partners to use family planning. They may want lots of children, or they believe family planning is wrong, or they may feel that family planning is expensive or inconvenient to use and do not see any benefits to using it. When men support the right of women to decide when and if they want to be pregnant, women can make the choice to use family planning if they want to. Then women and men can both have sex with less worry if they do not want a child. As a midwife, you may be able to influence men in your community to take more responsibility for family planning. The number Making family planning work for the community support their partners in whatever family planning method...

Understanding How IVF Knocks You About Emotionally

Of course, people are different and the way you feel about being infertile and having IVF treatment depends on several factors, such as 1 Your relationship If you and your partner support each other and talk openly about how you feel, chances are you'll have fewer emotional problems than if you have trouble communicating with your partner and don't feel loved and cared for. I give you some tips for working together with your partner throughout your IVF journey in Chapter 2. You may sail through IVF without any difficulties and, if you do, good for you. But if you're like most people, you'll experience some negative feelings from time to time during treatment and when you do it may help you to know that these feelings are normal and that you're not the only one feeling this way. How you cope emotionally with IVF depends largely on your personal circumstances. It goes without saying that if you're young, start IVF as soon as you find out you have a fertility problem and fall pregnant...

Realising How IVF Can Affect Your Mental Health

Realising how IVF plays havoc with your emotions Being there for your partner Coping with pregnancy loss Avoiding letting treatment run your life Healing over time A lthough IVF doesn't pose a great risk to your physical health (see Chapter 10), the possible risks to your mental health and general wellbeing from IVF are probably greater than from most other medical procedures. As well as your immediate reactions to the ups and downs of each step in the treatment process (which I describe in Chapter 9), IVF impacts on the way you feel about yourself, your partner and your life in general especially when the treatment doesn't work. In the last few years numerous researchers have studied the ways in which infertility and infertility treatments affect people's feelings and functioning. Evidence shows that such unexpected and unwelcome life events can shake you up in all sorts of ways. In this chapter, I draw on what's known from the research literature to explain how infertility and...

Understanding the Risks of IVF to Your Physical Health

Weighing up the risks involved for the female partner Checking out the risks involved for the male partner Considering the health of IVF children A s with all medical procedures, IVF involves some potential risks that you should be aware of before you decide to embark on treatment. You need to consider firstly the risks that relate directly to the IVF procedure and secondly health problems that may develop down the track because you've undergone IVF. But the most burning question for couples who have IVF is whether their child children will have more medical problems than children conceived spontaneously. In this chapter, I outline what's known about the possible short- and long-term risks of IVF treatment to the female and male partners, and to the baby. It's not always possible to say with certainty whether adverse health outcomes found in couples who've undergone IVF are caused by the IVF technique itself, the underlying cause of the infertility or the fact that, on average,...

Understanding the Risks of IVF

Rn n the hands of experts, IVF procedures are safe and medical complications are rare. But your emotional health can take a beating when you have IVF and sometimes, no matter how hard you try, the treatment doesn't work. In this part, I explain the potential risks involved with IVF to your physical and mental health and discuss how you can move on and get your life back on track if IVF doesn't work for you.

Riding the Emotional Roller Coaster of the IVF Cycle

A n IVF cycle is often described as an emotional roller-coaster ride during which you sometimes feel hopeful and optimistic and at other times sad and low-spirited. In this chapter, I describe the events that can make your emotions swing during an IVF cycle and give you some strategies for dealing with your feelings and staying in control while you're having treatment. In Chapter 11, I talk more about how the whole infertility and IVF experience can affect your life and sometimes almost drive you round the bend.

Type of fertility problem

Your chance of having a baby varies slightly depending on the type of infertility you have. Male factor infertility Couples with male factor infertility have the best odds of having a baby with IVF technology and in 2006 had a live birth rate of almost 22 per cent per started stimulated cycle and almost 17 per cent per frozen embryo transfer. Female factor infertility Couples with female factor infertility have slightly lower odds of having a baby with IVF technology and in 2006 had a live birth rate of just over 17 per cent per started stimulated cycle and just over 14 per cent per frozen embryo transfer.

Finding out exactly what happens in an IVF cycle

At most clinics, the nurses make sure that you know what to do throughout the course of your IVF cycle. So, before you start your cycle, you have a scheduled appointment with a nurse to find out what to expect and what you need to do at each step. This meeting is likely to cover

Coming to Grips with All the IVF Acronyms and What They Mean

Several forms of treatment have evolved from the original IVF technique developed in the late 1970s. These treatments all go by their short names, 1 IVF, in-vitro fertilisation In-vitro fertilisation literally means 1 ICSI, intracytoplasmic sperm injection IVF works only when the male partner has a normal or next-to-normal sperm count. (I tell you what's considered a normal sperm count in Chapter 1.) Scientists tried for a long time to work out how to help couples with male factor infertility and finally, in the early 1990s, they succeeded. ICSI helps many couples with male fertility problems. Instead of a sperm having to fight its way into the egg to fertilise it, the embryologist gives the sperm a helping hand. Using a so-called micro manipulator, the embryologist holds an egg still with a fine glass pipette called you guessed it a holding pipette. She or he then 'catches' a single sperm and injects it into the centre of the egg (the cytoplasm) using an extremely fine needle. The...

Legally Speaking Understanding How IVF Services Are Regulated

In Australia, assisted reproductive technologies such as IVF are heavily regulated by federal and state government legislation as well as professional bodies. Overall, such regulation is beneficial for couples seeking IVF treatment because you can be sure that clinics have high standards of care. All IVF programs have to abide by the following rules and regulations I The National Health and Medical Research Council (NHMRC) Ethical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research 2004, which cover the ethical side of providing IVF services. I The Fertility Society of Australia's Reproductive Technology Accreditation Committee (RTAC) Code of Practice for Assisted Reproductive Technology Units, which describes in detail how clinics should be run. The RTAC audits IVF clinics every year to make sure that clinics offer the highest possible standards of care. Only clinics that meet the terms of the code are certified.

Choosing an IVF Clinic

About 75 clinics around Australia provide IVF services. Your family doctor or the doctor looking after your infertility investigation may routinely refer his or her patients to a particular clinic, but you may prefer to choose the clinic yourself. If you live in a city you may have several IVF clinics within a ten-kilometre radius of your home or workplace. So how do you know which clinic's right for you Researching the clinics helps you make an informed decision. Start by gathering as much information as you can.

Improving Your Chances of IVF Success

The success rate for IVF treatment has greatly improved since the late 1970s when the technique was first introduced. Although your chance of having a baby with IVF depends largely on factors beyond your control such as how many eggs you produce in response to your drug protocol and whether your eggs and sperm turn into healthy embryos recent research shows that getting into shape before starting IVF treatment can influence the odds in your favour. This mostly involves things you should be doing anyway to stay healthy there's no rocket science to it

Has she had any miscarriages or abortions

Miscarriage A miscarriage (spontaneous abortion) is when a pregnancy ends before the woman is 6 months pregnant, while the baby is still too small to live outside the mother. This is common and often happens before the woman even knows she is pregnant It is usually difficult to know why a miscarriage happens, but some causes of miscarriage are preventable. Malaria, sexually transmitted infections, injury, Sometimes miscarriages happen because a woman has been near poisons or toxic chemicals. For example, women who work on farms often breathe or handle pesticides which can cause miscarriage. These women have more miscarriages than other women. Some miscarriages can be prevented by treating women for illness and infection and by helping them avoid chemical poisons and violence. But some women have one miscarriage after another, and you may not know why. Get medical advice to find the cause and to help her carry this pregnancy all the way through . Women who work with pesticides or other...

Reacting to Your Infertility Diagnosis

Even if you've long suspected that you have an infertility problem, the actual diagnosis of infertility can come as a shock. Like many people, your initial reaction to the news may be disbelief 'There must be a mistake here Maybe the test results are wrong, or they've been mixed up ' After it all sinks in you may feel angry 'Why us What have we done to deserve this This is so unfair ' You may also feel guilty, blaming your infertility on something you did in the past 'It's probably because I had that termination when I was 16', 'If only I'd been more careful when I went backpacking 20 years ago I wouldn't have been infected with Chlamydia '' Over time, you may also experience all or some of the following Feelings of isolation, because infertility can be difficult to talk about Sadness and grief about not being able to do what's 'only natural' Worry about whether you'll ever have a baby

Who can have IVF in Australia

There are laws and regulations governing IVF in many Australian states relating to who can access IVF treatment, what kinds of records clinics need to keep, what clinics need to do to make sure that couples can make an informed decision, how long eggs sperm embryos can be frozen, the rules for donation of eggs sperm embryos and other matters. These laws and regulations change from time to time and vary between the states. For example, in the past only legally married heterosexual couples were able to access IVF in some states, but today married and de facto couples can access IVF in all states and in some states same-sex couples and single women are also eligible for IVF. In addition, some states require identifying information about egg sperm embryo donors and recipients to I explain the legal and regulatory aspects of IVF in Chapter 4 and in Chapter 13 I outline the laws and regulations governing donor conception.

Moving On to IVF The Hightech Way to Get Pregnant

Whether you've already tried other forms of infertility treatment or are told that IVF is the only way for you to have a baby, making the decision to start IVF treatment is a big one. Nonetheless, many couples at this stage also feel a sense of relief that they're finally going to be actively doing something that gives them a chance of having a family. To help make your decision, you need to find out as much as you can about IVF before you start treatment. This includes what the law says about who can have IVF, what happens in an IVF cycle, what your chances are of the treatment working and what the risks of treatment are.

Finding an infertility specialist

There are several types of specialist that you may see for an infertility problem 1 Infertility specialists are gynaecologists who specialise in the treatment of infertility. If such a specialist practises in the area where you live, ask your family doctor for a referral straight to the top If you live in an urban area, you may have several infertility specialists to choose from. Rather than your family doctor simply referring you to one particular specialist, you may want to think about what's important to you and ask to be referred to the specialist who best fits your preferences in terms of the following issues 1 Distance to travel You're likely to need to see the infertility specialist a number of times, so not travelling too far may be an important consideration. 1 IVF expertise Not all gynaecologists perform IVF, so if you think you may need IVF ask about this before choosing a specialist. 1 IVF treatment location Infertility specialists sometimes practise in different...

Finding Out Why You Dont Get Pregnant

As soon as you suspect that you have a fertility problem, you need to confirm your suspicions and find out what sort of problem you have, because this determines your treatment. Some detective work is needed here and you may have to see several doctors before you discover the cause of your infertility. A fertility problem is a challenge that you and your partner should tackle together. Whenever possible, make sure that you can both attend the required medical appointments. Don't waste precious time doing nothing. Your chances of having a baby, with or without IVF, depend a great deal on the female partner's age (I give you statistics about this in Chapter 3). So, if you've been trying unsuccessfully for a year or more, don't get talked into waiting just a little longer especially if you're aged in your mid-thirties or above.

Getting Ready for IVF

Perhaps you've been trying for a baby for many months and nothing has happened. If you think you've waited long enough and want to start doing something to help you conceive, I suggest that you start reading here. In this part, I talk about the steps you can take to find out why you can't conceive and the possible treatment options. I devote a whole chapter to discussing how you may feel when you discover that you're infertile and how to handle the emotional aspects of infertility. I also talk about what you can do to improve your chances of IVF working and how to find an IVF clinic.

Realising How IVF Can Affect Your Mental Health 143

Understanding How IVF Knocks You About Chapter 12 Moving On When IVF Doesn't Work 153 Offering Low-cost IVF in Developing Part V Beyond 199 Cutting the Ties With Your IVF 203 Starting IVF 248 Fluking it by getting pregnant without help 249 Chapter 22 Ten Tips for Surviving IVF 253 Chapter 23 Ten Tips for New IVF Parents 259

Family planning

Having the number of children you want, when you want them, is called family planning. It is also sometimes called child spacing. There are many methods, both traditional and modern, that can be used for family planning. Family planning methods are sometimes called birth control or contraception. Why might a woman and a man want to use family planning by learning about family planning and sharing the information. by working with others to give couples more choices of family planning methods. by working with the community to get men more involved in using family planning.

Starting IVF again

If you know that you have to undergo IVF to conceive again, you need to bite the bullet and get on with it. Ask your family doctor for a new referral to your infertility clinic and then make an appointment to see the IVF doctor. Your IVF doctor will arrange for you to have any tests that need updating, then you can see the IVF nurse and get your instructions to start another IVF cycle (refer to Chapter 5 for a refresher on what the cycle entails). Having been there and done that already, you won't find the IVF experience as daunting as when you started your first cycle. Going back to IVF for baby number two can be easier in some ways because you know the ropes and what to expect. But the disappointment you feel if the treatment doesn't work isn't easier to take the second time around. And don't listen to people who say you should be grateful that you've been successful already If you want another baby, you're entitled to feel sad if the treatment doesn't work.

Male Infertility

According to three of four studies, oral vitamin E supplementation can effectively treat some forms of male infertility (Geva et al 1996, Kessopoulou et al 1995, Rolf et al 1999, Suleiman et al 1996). Doses used varied from 200 mg day to 800 mg day. As with many other conditions, treatment may be best suited to those individuals with elevated oxidative stress levels, although this requires further investigation.

Infertility

The ability to conceive a child is an issue with many different types of cancer, may affect both men and women, and can result from both adult and childhood cancers and treatments. Infertility can also be seen as a tragic consequence (a double whammy ) of surviving a life-threatening disease. For some people infertility is a source of terrific loss and may bring about intense feelings of sadness, shame, worry, and anger. Just the possibility of future infertility can interfere with relationships. As one of my patients who had Hodgkin's lymphoma as a child says, At what point do you tell someone you are dating that you might not be able to have children The inability to have the family you always Infertility may come as a surprise or may be an expected outcome of the cancer treatment. It may also be temporary, for example, when a young woman with breast cancer goes into menopause during chemotherapy treatment and then several weeks or months after the end of treatment resumes ovulation...

Miscarriage

Physically speaking, it generally takes one normal menstrual cycle for a woman to recover from a miscarriage. It's usually four to six weeks before your period comes back. It's possible to conceive in those weeks between the miscarriage and your first menstrual cycle. During this time, you If you and your partner feel ready to become pregnant again, there are several issues to consider. Before conceiving, talk to your health care provider about your plans. He or she can help you come up with a strategy that will optimize your chances of a healthy pregnancy and delivery. If you had a single miscarriage, your chances of a subsequent healthy pregnancy are virtually the same as someone who has never had a miscarriage. Your health care provider may suggest that you wait longer or have additional testing or monitoring if you've had recurrent miscarriages, an ectopic pregnancy or a molar pregnancy.

Age and IVF success

A common misconception (no pun intended ) is that IVF can help you have a baby if you put off starting a family until later in life. After all, movie stars seem to have no problems having babies in their forties. Well, in many cases these women use eggs donated by younger women to conceive, although such a fact isn't usually publicised. (I cover donor conception in Chapter 13.) Age is one of the most important factors in determining your chance of having a baby with IVF. In Chapter 8 I show you exactly how age affects your IVF treatment, but the long and the short of it is that your odds of having a successful pregnancy decrease dramatically as you approach age 40. The average age of women who have IVF is 35 years. Women under the age of 30 have a 26 per cent chance of having a baby after one IVF cycle. Women over the age of 40 have only a 6 per cent chance of having a baby after one IVF cycle. Taken together, the best advice if you're contemplating IVF is to get started now. In a...

Beyond IVF

An IVF pregnancy is a happy ending to a very trying time. But it's also the beginning of a new journey into the unknown. After you put the worries about getting pregnant behind you, you find that you start to worry about the pregnancy, the birth and the welfare of your baby. Of course, couples who conceive without IVF also have such worries, but new research shows that some aspects of pregnancy, childbirth and parenting are a bit different and perhaps more complex after assisted conception.

Fplus

More complex forms of treatment have evolved from the 'original' IVF treatment, some of which you may need in your quest to start a family i Third-party reproduction Today, some 10 per cent of IVF treatment cycles involve using donor gametes (eggs and sperm) or embryos to have a baby. The big question that arises in such cases is whether a child born as a result of the donation should be able to find out who the donor is. I discuss the arguments for and against in Chapter 13.

Supporting each other

Your greatest supporter is your partner. The two of you have the same goal and have decided to give it your all to have a baby together. However, at times you may both be feeling down and have trouble giving each other support. If that's the case it may be better to turn to someone else for support and focus on nurturing your relationship with your partner instead Have fun together, go to the movies, eat out, see your friends, go for walks, do anything you like to take a break from the 'IVF job' and to remind yourselves that there's more to your relationship than surviving IVF.

Putting Things on

A growing number of couples are completing their families as a result of IVF treatment but still have embryos in the freezer. That's why the number of embryos being stored in IVF clinics around Australia and indeed, around the world is increasing steadily. At some point couples with extra frozen embryos known as supernumerary embryos have to make the sometimes difficult decision about what to do with these embryos.

Looking at Future Possibilities

Undergoing IVF without all the injections Pinpointing the most viable embryos to transfer Helping embryos to implant Freezing your eggs when you're young Moving IVF technologies to developing countries Examining IVF spin-offs rom humble beginnings, assisted reproductive technologies have come W a long way. The birth of the first IVF baby, Louise Brown, in the United Kingdom in 1978 was the culmination of many years of research. In those days no fertility drugs were used doctors simply waited round the clock for the right time to retrieve the one and only egg that a woman releases every month, even if this meant performing surgery (that's how eggs were retrieved then) in the middle of the night. And, if doctors did manage to catch a woman's elusive egg, getting it to fertilise and divide was another major hurdle because lab culture systems were less than perfect. So, in the early days of IVF women went through an awful lot for only a microscopic chance of having a baby. Since then,...

Making the Embryos Stick

Some couples undergo embryo transfer after embryo transfer without getting pregnant. This implantation failure means that, for some couples, IVF just doesn't seem to work. Implantation failure is a devastating event for these couples and is therefore the focus of much research. Scientists are exploring several possible reasons for implantation failure, including In addition, scientists have identified certain gene patterns among women who experience implantation failure and are working on isolating these patterns as a predictor of IVF success. So, in the future, it may be possible to look at your gene pattern before you start IVF treatment in order to get a good estimate of your chances of having a baby with IVF. If your odds are really bad, you may decide not to go ahead with the treatment.

Wondering whether youre producing enough milk

We asked the IVF mums in our study how they I Compared with other mums, at three months fewer of the IVF mums were either fully breastfeeding (45 per cent versus 62 per cent) or partly breastfeeding (64 per cent versus 72 per cent) I Over half the IVF mums continued to breastfeed their baby for more than six months (54 per cent) I Compared with other mums, the IVF mums were more likely to breastfeed their baby Based on these figures and comments that the women shared with us, most IVF mums hope to breastfeed their babies and do indeed start.

Turning to a Counsellor

IVF clinics in Australia and New Zealand are required to make counselling services available to couples who attend their programs. Infertility counsellors are experts on the emotional aspects of infertility and infertility treatment and can help couples to make informed decisions about their treatment options. You can benefit from a counsellor's experience and expertise at any stage of your treatment. For example, you may want to talk to a counsellor if you Receive bad news about your treatment and need to talk to someone who understands IVF about what this means for your future chances of having a baby with IVF Suddenly feel overwhelmed by everything and unable to manage the strain of the infertility and the rigours of treatment

What Does This Mean A Glossary of Terms

Artificial insemination Placing washed sperm in the uterus to help a woman to conceive. ultrasound-guided procedure whereby eggs are removed from the ovaries for the purpose of IVF treatment. female factor infertility Couple infertility due to a female problem. A hormone produced by a growing pregnancy that is used in IVF to mature eggs because it has the same effect as luteinising hormone, which initiates oocyte (or egg) maturation and ovulation in the menstrual cycle. hysteroscopy Examination of the inside of the uterus. idiopathic infertility Infertility that has no apparent cause. infertility The inability to conceive after one year of unprotected intercourse. intracytoplasmic sperm injection (ICSI) A procedure used for male factor infertility where a single sperm is injected into an in-vitro fertilisation (IVF) Literally 'fertilisation in glass' refers to fertilisation occurring in a lab rather than in the body. in-vitro maturation (TVM) Immature eggs maturing in the lab. IVF...

Freezing Gametes and Embryos

Cryopreservation is really handy in many different situations, such as wanting to preserve some of your eggs or sperm before undergoing cancer treatment or when you have more than one or two really good-quality embryos after a stimulated IVF cycle. Although different methods are used for freezing gametes and embryos, after they're frozen they're stored in tanks of liquid nitrogen at a temperature of -196 degrees Centigrade. Material frozen at such a low temperature has no bioactivity, meaning that it can be frozen indefinitely without 'going off'. As a back-up during IVF treatment When you undergo IVF treatment, you're asked to produce sperm 'on demand', which can be pretty nerve-racking. If you suffer from performance anxiety, you may be reassured by having some back-up frozen sperm, in case you can't produce the sperm sample when it's needed. After undergoing testicular biopsy If you have very severe male factor infertility, sperm or small pieces of testicle can be removed...

Who looks after you now

A few years ago some colleagues and I carried out a large study of almost 200 women's experiences of pregnancy, childbirth and mothering post-IVF. We followed the women from early in their pregnancies until their children were 18 months old. These women very kindly shared their experiences by completing questionnaires in early and late pregnancy, and three, eight and eighteen months after childbirth. I Nina, who was 34 and fell pregnant with her first baby after two IVF cycles, said 'All I want is to feel normal again. The whole deal with getting pregnant with IVF I Sylvia, who was 39 and had experienced two miscarriages before finally having an ongoing pregnancy on her fifth IVF cycle, stated 'I feel so reassured every time I see my doctor, and best of all is to have a scan where I can see for myself that the baby is alive and growing. After my visits I feel relaxed and happy knowing that all is going well but after a week or so I start to worry about the baby again and count the...

What the Law Says About Surrogacy

The story of the first Australian baby born as a result of IVF and surrogacy made big headlines. Alice Kirkman was born in Melbourne in 1988. Her mother Maggie didn't have a uterus and her father Zev didn't have sperm, so Alice was conceived from one of her mother's eggs and donor sperm, and her aunt Linda carried the pregnancy and gave birth. After Alice's birth, surrogacy became illegal in Victoria, in spite of intense lobbying to allow altruistic surrogacy arrangements by Dr John Leeton, the doctor who made Alice's birth possible. So,

Undertaking Preimplantation Genetic Diagnosis

To avoid this dilemma, you can opt for your embryos to be tested in the lab before you fall pregnant. To do this, you undergo an IVF treatment cycle (I explain the cycle in Chapter 5) and then have the resultant embryos tested, to make sure that only those that aren't affected by the condition tested for and have the right number of chromosomes are transferred. This is called pre-implantation genetic diagnosis or PGD for short. If you've experienced several miscarriages, your doctor may suggest that you and your partner have a blood test to determine whether the miscarriages were the result of a balanced translocation (where a piece of chromosome breaks off and attaches to another chromosome). People with a balanced translocation don't normally have health problems as a result of the translocation because they have the full complement of genetic material but their sperm or eggs may have some missing or extra genetic material, which can lead to miscarriage. If your miscarriages were...

Preparing for Pregnancy Probing and Prodding

As an IVF mum, expect many check-ups, tests and examinations during your pregnancy. There are many reasons for this scrutiny 1 Doctors and midwives sometimes feel extra-protective of women who conceive with IVF. 1 IVF mums are generally older than other mums and therefore have a slightly higher risk of pregnancy complications. 1 Most IVF mums are first-time mothers. 1 Twins are more common after IVF than with spontaneous conception.

Producing a sperm sample

The infertility investigation inevitably involves a sperm test, so you should have had a chance to practise ejaculating into a small plastic jar before the big day However, when the pressure is on, ejaculating can be difficult. If you have an inkling that this may happen to you, speak to your doctor or nurse before the sperm sample is needed and they can discuss alternatives to make sure that sperm is available on the day of egg collection Embryologists recommend two to four days of abstinence before you produce sperm for IVF treatment because

Assessing the Odds of Your Dream Coming True

Understanding the statistics on IVF success rates Working out your chances of having a baby with IVF Having realistic expectations m he million-dollar question when you have IVF is Will the treatment m work There's no way of knowing exactly what your chance of IVF success is, so you have to turn to what's known about IVF success in general to help you estimate your chance of having a baby. In this chapter, I discuss the issues you need to be aware of when you're looking at how clinics present their results and at IVF statistics in general. I take you through some of the important facts about the odds of getting over the IVF hurdles. I also talk about how you can estimate your own chances of having a baby, considering your circumstances, and how you can try to set realistic expectations and goals.

Retrieving sperm surgically

If you have no sperm in the ejaculate (refer to Chapter 1), the sperm are retrieved via a surgical procedure under local or general anaesthesia. Depending on what type of infertility you have, the doctor retrieves either fluid or microscopic pieces of tissue from the testicles. I explain these procedures in the section 'Coming to Grips with All the IVF Acronyms and What They Mean' earlier in this chapter. Depending on the clinic and the type of procedure you're having, you may be asked not to eat or drink anything starting the night before your surgery.

Stimulating your ovaries

To understand the IVF process, ideally you need to be familiar with the relevant parts of the menstrual cycle, so here's a quick recap on how eggs are normally formed in your body. The pituitary gland in your brain regulates your menstrual cycle by producing two hormones follicle-stimulating hormone (FSH) and luteinising hormone (LH). Your pituitary gland releases follicle-stimulating hormone which, as the name suggests, stimulates the growth of several follicles in your ovaries. Follicles are fluid-filled sacks and each follicle contains one egg. As the follicles grow, one becomes dominant and the other follicles stop developing. When the dominant follicle reaches a certain size, your pituitary gland releases luteinising hormone, which causes the egg to mature and leads to ovulation, when the follicle bursts and releases the egg. Your fallopian tube captures the egg, which may then be fertilised. The drugs that are used in IVF 'trick' your body into bringing to maturity multiple...

Finding solutions to a poor sperm sample

Occasionally, the quality of the sperm produced on the day of egg collection is unexpectedly poor. This can happen if you had an episode of high fever some weeks beforehand but can also be part of the normal variations in sperm quality. If this happens to you and you were planning to have IVF, your doctor may suggest trying intracytoplasmic sperm injection as an alternative procedure (I explain this procedure in the section 'Coming to Grips with All the IVF Acronyms and What They Mean' earlier in this chapter). If you go ahead with this alternative procedure, there's a good chance the eggs may fertilise. i Your doctor may try to extract sperm directly from your testicles using a needle. If this procedure works, the embryologist can perform intracytoplasmic sperm injection.

Examining the Possible Risks to Baby

'What's the risk of IVF to my baby ' is the most common question asked by couples considering IVF. To date more than two million children have been born as a result of IVF, so doctors have a lot of reliable information with which to answer this question. Mostly the news is good, but there are some adverse outcomes that, rare as they are, are more common among IVF children than children in general. This is often because multiple births are more common with IVF, but it's impossible to exclude the possibility that the IVF technique itself may also contribute to the increased risks. Some extremely unusual conditions, such as Beckwith-Wiedemann syndrome (BWS), appear to be more common with IVF than with spontaneous conception. Children born with BWS experience overgrowth in certain parts of their body most commonly the tongue and abdominal wall and can have very low blood sugar levels and ear abnormalities. An Australian study found that whereas the overall incidence of BWS is one in every...

Understanding clinic statistics

To help you assess your chances of success, what you really want to know is, of all the couples who start an IVF treatment cycle, how many have a baby at the end of it IVF clinics provide various facts and figures about their success rates with couples in general. When you read this information keep in mind that data can be presented in many ways and this presentation can affect your interpretation of the results. Here are a few issues to look out for For example, if out of 100 couples who start IVF treatment 80 undergo egg collection, 70 have embryo transfer and 15 have a baby, the success rate per started cycle is 15 per cent (15 out of 100). However, counted as a percentage of couples who undergo transfer the rate jumps to 21 per cent (15 out of 70) which sounds much better. Either way, the result is the same It's just the presentation that differs. il Who the quoted success rate refers to IVF is more successful for some couples than for others, so check whether the quoted success...

Getting Over All the Hurdles What Are Your Odds

IVF is a series of hurdles that you have to jump over to get what you really want a baby. At every stage of treatment there's a chance that things may not go according to plan, and each time you make it over one of these hurdles another hurdle looms ahead. In this section I explain what you need to keep in mind when you read clinic statistics about IVF 'success rates' and take you through the 2006 National Perinatal Statistics Unit (NPSU) report, which is the most recent edition of this annual report at the time of writing. The NPSU report outlines the treatment results at each stage of IVF for all clinics in Australia and New Zealand. The term success rate is used to indicate a couple's chance of having a baby with IVF. Sometimes you see this framed as 'successful couples' which implies that those who don't have a baby after IVF are 'unsuccessful couples'. This terminology is one of my pet hates there are no unsuccessful couples, only unsuccessful IVF treatments. If treatment doesn't...

Leaving the incubator

According to the National Perinatal Statistics Unit, which collects and compiles data from all IVF clinics in Australia and New Zealand, blastocyst transfer is gaining in popularity and, in 2006, 27 per cent of all embryo transfers were blastocyst transfers (up from 14 per cent in 2002).

Labelling Dishes And Avoiding Mix Ups

The embryologists carefully label, check and recheck all the items of equipment that house your eggs, sperm and embryos to make sure that there's no possibility of mix-ups and you don't end up with the wrong embryos. Couples sometimes worry about mix-ups, but you can rest assured that the systems in place in Australian IVF labs to avoid mix-ups are extremely stringent. Australian IVF clinics have to follow the Reproductive Technology Accreditation Committee's Code of Practice in order to be licensed (you can read more about these licensing requirements in Chapter 4). This code states that Occasionally you see reports in the media of mix-ups in IVF labs. Mostly these mix-ups happen because staff fail to follow basic procedures like checking a woman's name before transferring the embryos. Several such cases have made the headlines in recent years i A young Japanese woman was mistakenly implanted with the embryo of a 40-year-old woman. The young woman became pregnant but had to have an...

Getting Ready for

1 Any special treatments requested by your doctor 1 Cause of your infertility i Number of follicles seen on ultrasound i Results of any previous treatment cycle(s) 1 Sperm test results (refer to Chapter 1) i Your age The embryologists also check that you've signed all the necessary consent forms, including giving permission for any special procedures that may be needed such as ICSI and embryo freezing.

Taking a Peek Inside the

He most important part of the IVF process happens behind closed doors in the lab, where a bunch of extremely dedicated and highly skilled embryologists work to make your dream of having a baby come true. The IVF lab is a place with strict rules The embryologists follow detailed protocols and rigorous quality control measures to provide the ideal environment for eggs and sperm to develop into healthy embryos and to guarantee foolproof systems for keeping track of which eggs, sperm and embryos belong to you. In this chapter, I take you inside the lab and show you how embryologists give nature a helping hand. I also explain how embryologists help you to boost your chances of IVF success by freezing some of your embryos.

Measuring your response to FSH

After follicles start growing, they grow by about 2 mm every day. If the scan shows that you have a good number of follicles but they haven't yet reached their optimum size, you're advised to take FSH for another few days before having the hCG trigger injection. Figure 6-2 shows an ultrasound image of an ovary with multiple large follicles (the black holes) An ideal response to IVF stimulation. A very small number of women develop a total over-the-top response to FSH and their ovaries become much enlarged because they're full of growing follicles. In Figure 6-4 you can see what that looks like on ultrasound Masses of follicles of all sizes crowding the entire ovary. This response is known as ovarian hyperstimulation syndrome and it's every IVF doctor's fear because of the potential danger for the woman. However, managed well the risk can be minimised, and in Chapter 10 I explain what your doctor does to limit your risks.

Deciding on your dosage of FSH

The dose of GnRH analogues is the same for all women and stays the same right through the treatment, but the dose of FSH varies for each woman. Your doctor has no way of knowing exactly how you'll respond to FSH when you have your first IVF cycle, but the following criteria can guide the decision regarding the dose of FSH most likely to result in you producing about a dozen eggs The most common FSH starting dose for IVF is 150 IU per day. If this dose doesn't result in a sufficient number of eggs, your doctor increases the dose next time. Most doctors won't increase the daily dose beyond 450 IU because for the majority of women this higher dosage doesn't actually help produce any more eggs.

Introducing the Common Stimulation Protocols

Not all women follow the same ovarian stimulation protocol Your protocol depends on your age, your IVF doctor's preference and the clinic's routine. Figure 6-1 shows a sample protocol demonstrating what drugs to take and when. IVF nurses and doctors use the term cycle day (cd for short) to tell you when to take the various drugs. The first day of your period is the first day of the cycle, cycle day 1 or cd 1, the second day is cd 2 and so on. The drugs in ovarian stimulation protocols start on different cycle days your nurse gives you all the instructions you need to complete your protocol.

Gonadotrophinreteasing hormone analogues

Gonadotrophin-releasing hormone (GnRH) is produced naturally in an area of the brain called the hypothalamus. This hormone controls the production of the two hormones that regulate the menstrual cycle follicle-stimulating hormone and luteinising hormone (I explain how these hormones operate in Chapter 5). When you have IVF, the last thing you want to do is ovulate all the eggs that you've worked so hard to produce before your doctor has a chance to retrieve them. The magic bullet to avoid this is a GnRH analogue, which your doctor includes in your stimulation cocktail. The GnRH analogue blocks your own GnRH and stops you from ovulating. Two types of GnRH analogues can be used 1 GnRH agonists Most IVF doctors prescribe an agonist (activator), which you take daily throughout the whole stimulation phase either as a nasal spray or an injection.

The contraceptive pill strange but true

Who'd have thought that you need to take the contraceptive pill when you're trying to have a baby Of course, there's a good reason for this. When you take the pill, your own hormones are put on hold and you don't ovulate (that's the whole point of taking the pill). So, a month or so before you start IVF treatment your doctor may prescribe the pill to suppress your own hormones in preparation for the drugs you need to take later to stimulate your ovaries. Your doctor gives you a prescription for the pill, which you can fill at any pharmacy. Your IVF nurse gives you instructions on how and when to take the pill.

Understanding What Drugs Are Used and

The main aim of IVF treatment is to make the most of every 'go'. So, while you normally release only one egg every month, which may or may not be 'perfect', with IVF the goal is to have about a dozen eggs reach maturity to improve the chance of at least one of them being 'just right'. To stimulate your ovaries to produce multiple eggs, your doctor gives you a carefully

Taking Drugs Drugs and More Drugs

Finding out the good and the bad about IVF drugs Understanding how your doctor works out what IVF drugs are best for you Measuring your response to stimulation 0rugs are an inevitable part of IVF treatment. The goal of treatment is to make your ovaries produce several eggs all at once rather than the one egg you normally release every month. When you undergo treatment you're likely to feel like a pincushion and have hormones coming out of your ears, but using drugs give you a much better chance of success than attempting to get pregnant drug-free, because with treatment every egg has a small chance of being the egg. And the more eggs you produce, the greater your chance of falling pregnant. In this chapter, I explain the various drugs used in IVF and what kinds of side effects you may experience conveniently, any mood swings you get during IVF can be blamed on the drugs. I also discuss the factors that can influence how your ovaries respond to the drugs and how stimulation protocols...

Having the Bonus of Frozen Embryos

The techniques for freezing eggs haven't yet been perfected (see Chapter 15) but scientists have developed very successful methods for freezing and thawing embryos (see Chapter 7). After a stimulated cycle, extra embryos are sometimes available that the embryologist judges as good quality and these embryos can be frozen for later transfers. Depending on how many embryos you have, these extra frozen embryos give you bonus chances of getting pregnant without having to go through all the hormone injections again

Arriving at Dday Your Pregnancy Test

Hard as it may be to believe, the day for your long-awaited pregnancy test does eventually arrive. For this test, most clinics require you to have a blood test, either at the clinic or locally if you live far from the clinic. The blood test measures the level of pregnancy hormone, 3-hCG (beta human chorionic gonadotrophin), in your blood. Thankfully, the result is usually available later the same day and your IVF nurse gives you the news. A positive pregnancy test marks the happy ending of a treatment cycle and the beginning of a pregnancy a negative pregnancy test confirms that the IVF cycle was unsuccessful. Occasionally, the pregnancy test is indefinite, which means that the gruelling wait for answers continues.

Understanding what can go wrong after embryo transfer

This last hurdle is the most difficult one to get over because, of all the embryos that are transferred, only some have what it takes to grow and develop into a healthy baby. Of course, this is true not only for IVF treatment but also for many spontaneously conceived pregnancies. Many pregnancies are lost at a very early stage, often even before the woman knows that she's pregnant. It's not uncommon for women to have a 'late' period delayed by a pregnancy that didn't continue beyond the first couple of weeks after conception. However, while couples who can conceive spontaneously can try again to become pregnant without too much effort, couples who need IVF have to start the whole process again or have another transfer of frozen embryos if they have any stored.

Enduring the Longest Wait

What you really need to do is to brace yourself for the longest wait of your life, because during the two weeks there won't be a waking moment when your mind isn't busy thinking about your uterus. Every study about the IVF experience that I'm aware of has found that the hardest part is the wait after embryo transfer to find out whether the treatment has worked. It beats hands down the pain of injections, the intrusiveness of vaginal ultrasound examinations and the disruption of frequent clinic visits.

Transferring the Embryos

If possible, both you and your partner should attend the clinic because you may well need each other to help take in all this information. Plus, embryo transfer is such a special moment in an IVF cycle, you'll want to share the experience. So, you need to weigh up the risk of having twins (which I explain in Chapter 10) against the possibility of a small increase in your chance of becoming pregnant if two embryos are transferred. 1 You're over 38 years of age and or have already had several unsuccessful IVF attempts. In the early days of IVF each patient had all her available embryos transferred at the same time, since each embryo had a very slim chance of surviving and the technique of freezing embryos hadn't been worked out. Yet the chance of pregnancy was still extremely low. However, over time laboratory techniques improved and embryos had a greater chance of surviving. In the 1980s and early 1990s, IVF often hit the headlines when record multiple births were reported. Between...

Performing magic in the lab

After selecting the mature eggs and cleaning the sperm, the embryologists start their part in the magic by adding a droplet with thousands of sperm to each egg if you're having IVF, or by injecting a single sperm into each egg if you're having intracytoplasmic sperm injection. Each egg sperm combination is kept in a dish in a special culture medium that has all the nutrients and trace elements embryos need to develop. The dishes are placed in an incubator where the environment mimics the inside of your fallopian tubes (where fertilisation normally happens). In most cases the magic works and fertilisation takes place so that after a few days the first stages of embryo development have taken place.

Recovering from the egg collection procedure

An hour or two after your egg collection, you get a bite to eat and then you're ready to go home. Before you leave, you're given details about when to contact the IVF clinic to find out if and how many of your eggs have fertilised and when you're needed back for embryo transfer. In most clinics you call the nurses for this information. You can use painkillers if you need to after the egg collection procedure but make sure that you use paracetamol, not aspirin, because aspirin has a blood-thinning effect, which can increase the bleeding from the puncture sites. When in doubt, ask your IVF doctor about which medications to use.

Suffering information overload

The sheer volume of information that you have to take in before you undergo IVF treatment is huge. Naturally, you may worry about not remembering it all or getting something wrong. Make sure that you and your partner attend as many of the appointments as possible during your treatment, because between the two of you, you'll retain more information than either of you would on your own And you can be sure that all the important stuff you need to know is included in the written information that the nurse gives you to take home, so, if in doubt, refer to your paperwork. Historically, IVF treatment used a woman's one and only egg that normally develops during the monthly menstrual cycle. The chances of getting this egg before ovulation and of fertilisation occurring normally were very slim, I discuss the drugs used in IVF in more detail in Chapter 6.

Consenting to treatment

As with other medical procedures, you have to give your permission for IVF treatment by signing consent forms. The exact content of the forms varies between clinics, but each form incorporates information about the procedures you agree to have and the risks of treatment, including the fact that the treatment may be unsuccessful.

Undergoing counselling

Most clinics offer couples the opportunity to meet with an infertility counsellor before starting treatment although in Victoria, this is actually required by law. Whether mandatory or not, many couples benefit from talking things over with a counsellor as part of preparing for treatment. Infertility counsellors are experts on the emotional aspects of infertility and infertility treatment and can offer you many useful tips on how to manage the stress of treatment. According to a guide to clinics published by the Victorian Infertility Treatment Authority, counsellors must discuss certain points with couples before they can have IVF treatment. For the purposes of section 11(1) of the Infertility Treatment Act (1995), counselling is required in relation to the following prescribed matters (b) The law relating to infertility treatment in Victoria and the rights of the woman and her husband under that law (c) The psychosocial and ethical issues related to infertility and infertility...

Completing some basic medical tests

You need to have several more medical tests before treatment can finally begin. These basic tests help your IVF doctor to manage your treatment effectively. 1 Other blood tests Depending on the cause of your infertility, you may need to have some of your hormone levels checked. 1 Ultrasound examinations Your eggs are collected via ultrasound, so an initial vaginal ultrasound examination allows your IVF doctor to see how accessible your ovaries are. Your doctor also uses the image to check the health of your ovaries and uterus, and determine the dose of fertility drugs that's best for you.

Fixing a communication breakdown

Good communication between members of the IVF team (including you) is crucial to ensure a smooth journey through the IVF process, whether the treatment ultimately is successful or not. The IVF team can't always help a couple to have a baby, but team members can and should make sure that the couple are always treated in a compassionate, respectful and sensitive way. When you experience problems with your IVF clinic you may not want to voice your complaints because you don't want to get a 'black dot' against your name or get a reputation for being 'difficult'. Think of IVF just like any other service you buy. If you stay at a hotel and the towels are dirty and the breakfast coffee is cold, wouldn't you complain to hotel management about the poor service And wouldn't you complain to the mechanic if your car still wasn't working after you paid a lot of money to have it fixed Similarly, if you're not happy with the care you receive when you have IVF, complain to the clinic. Putting pen to...

Getting the most out of your team

Despite the number of people on your IVF team, ideally you should Clinics usually have heaps of written information on most aspects of IVF that you can access either on the clinic website or as a hard copy from the clinic reception. If this material doesn't contain what you need, ask your IVF nurse to help or to point you in the right direction. If your query is more specific for example, you may want to know more about what causes male factor infertility, or look up IVF statistics for Australia or figure out how to find an egg donor ask your IVF doctor. From time to time having IVF treatment gets tough and you may want to talk to someone or get advice about how to manage the stress (I explain more about coping with stress in IVF in Chapter 9). The most obvious first port of call is, of course, the counsellors, so feel free to call the clinic to make an appointment with a counsellor. If that's not soon enough for you and you need to offload straight away, your best bet is to contact...

Introducing the team members

Your IVF team members are highly skilled professionals and in this section I explain the different roles they play. Each person has a particular job to do and each and every one of the IVF team is crucial to your journey through the IVF process. Don't forget to include yourself as part of the IVF team You're an expert on yourself You're as important as any other team member. So ensure you actively involve yourself in the treatment process Ask plenty of questions if you're not sure about something, consider carefully the options presented to you, make informed decisions and take charge of the things you can control. Infertility specialist Infertility specialists are doctors who've spent many years training in obstetrics and gynaecology with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). After they qualify these specialists become Fellows of the College and can add the very impressive string of letters 'FRANZCOG' after their name. Some take...

Making Treatment Work with Work

You're likely to experience frustrating time clashes between your IVF treatment and work commitments. During your course of IVF treatment you attend the clinic for appointments with doctors and nurses and for blood tests, ultrasound examinations, egg collection and embryo transfer. Some of these visits are scheduled well in advance, allowing you to plan ahead and reduce the disruption to your work. But sometimes you have to visit the clinic at short notice or at an inconvenient time work-wise, which adds to the stress of treatment. If you tell your employer that you need time off work to attend appointments for IVF treatment, you may well find that your employer is sympathetic and keen to accommodate the necessary interruptions. In such cases, disruptions can be minimised. However, you may not want people at work knowing that you're having infertility treatment. You can try making up excuses for your late arrivals and disappearances during the working day, but you won't find too many...

Private health insurance

Private health insurance helps you with the costs associated with in-hospital treatment for IVF, such as for egg collection, as well as pregnancy and childbirth-related costs you incur as an in-patient. Insurance companies vary in the length of time they want you to be a member before you can claim reimbursement for IVF-related expenses. They also vary in what they reimburse and how much, so if you don't already have private health cover, make sure that you check these conditions carefully before signing up.

Covering the Costs of Treatment

Australia is one of the few countries in the world where the health-care system covers a substantial proportion of the financial costs of IVF treatment and where women aren't limited in the number of treatments they can have. As a result, an Australian couple may pay ten times less than an American couple for an IVF cycle. Tax payers using IVF see their taxes at work A large proportion of the costs of IVF treatment are covered by Medicare. Currently, if your out-of-hospital medical expenses, including IVF, exceed 1,126.00 in one calendar year you're eligible for the Extended Medicare Safety Net (EMSN), under which Medicare covers 80 per cent of any additional out-of-hospital costs in that calendar year. However, Medicare sets an upper limit on the benefits that can be paid under the EMSN for IVF services. To enjoy Medicare benefits you need a current referral from your family doctor to your infertility specialist. Referrals to specialists are valid only for one year, so keep an eye on...

Narrowing down your choices

Success rates The ultimate success of IVF treatment and its related procedures is the birth of a healthy baby at term. The facts and figures about clinics' success rates at IVF treatment can be difficult to follow because clinics don't always measure the same things. For example, Australian statistics show that if 100 women start a stimulated IVF cycle (treatment with hormone injections to stimulate egg production) approximately Travel to and from the clinic You'll make many trips to the IVF clinic over the course of your treatment, so you need to consider travelling time to the clinic, transport options and parking facilities. If you don't drive or have access to a car, then the clinic that's serviced by public transport may be best for you. If time is important to you, find out which clinic is easiest to get to.

Checking out your local clinics

The best starting point for your research is the Fertility Society of Australia (FSA). This organisation represents doctors, scientists, counsellors, nurses and consumers in reproductive medicine. FSA's Reproductive Technology Accreditation Committee (RTAC) monitors clinics around the country to make sure that they provide services according to industry standards. IVF clinics can operate only if they pass the auditing process and are granted a licence by RTAC. The FSA's website (www.fsa.au.com) has a section listing the names and locations of all IVF clinics in the country. Click on the RTAC tab at the top of the page and then on Accredited Units The clinics appear, sorted by states. Use this information to find the clinics in your local area and then visit the websites of the clinics that interest you to check out what each clinic has to say about its services. Clinic websites are often very glossy and full of promises but they also contain useful information. By comparing the...

Calling in the professionals

If all else fails, or you feel that talking to an expert in the field of the psychological and social consequences of infertility would be beneficial, your best bet may be to see an infertility counsellor or psychologist. Counselling services are an integral part of all Australian IVF clinics and couples are encouraged to use these services whenever they need to before, during or after infertility treatment. Counsellors provide useful information, individual or couple support, relationship counselling and generally help you to stay sane during the course of infertility. I talk more about the role of counsellors in IVF in Chapter 4. If you're not yet part of an infertility clinic, you may not be able to access clinic counselling services. But you can still contact your local clinic and ask for the name of an independent psychologist or counsellor with an interest in infertility issues.

Joining a support group

Support groups are groups of people who get together because they share a problem, usually a medical condition. Members of infertility support groups give each other moral support and understanding. Joining such a group helps you realise that you're not the only couple in the world struggling to have a family. Most local support groups are associated with particular IVF clinics or are devoted to a particular type of infertility. You can find contact details for all IVF clinics in Australia and New Zealand on the Australian Infertility Support Group's website (www.nor.com.au community aisg). I list the largest support groups in Appendix C.

Discovering help online

Endless opportunities exist to connect online with people anywhere in the world with whom you share experiences, and infertility experiences are no exception. Hundreds of websites and chat rooms are dedicated to couples with fertility difficulties. You can access these virtual support groups from your desk at home. The groups can be very useful as a sounding board and for making you realise that you're not on your own. If you find talking about infertility or your feelings difficult, internet-based support may be more suitable for you you can stay anonymous and such interaction may be less confronting than sharing your feelings with someone close to you. ii ACCESS, Australia's National Infertility Network (www.access.org.au) I Australian Infertility Support Group (www.nor.com.au community aisg) Some websites provide infertility-related medical information and advice. The quality of this information varies considerably Treat all such information with caution. By all means, use the...

Having sex on demand where did the fun go

Infertile couples commonly feel that the joy and pleasure they used to experience in their sexual relationship goes out the window when the focus is on baby making rather than on love making. Trying hard to time sex at the most fertile stage can be the biggest turn-off and can dampen your enjoyment. It may even give him 'performance anxiety' and cause erection difficulties. And her libido may take a beating from tension about infertility and doubt about ever falling pregnant. Even if your sex life isn't as pleasurable as it used to be, don't forget to give each other plenty of affection and physical closeness. Going away for the weekend and deciding not to take your infertility problems with you gives you a break and may bring on lust and the urge to have sex just because you love each other

Treating yourself and each other kindly

When you're struggling with infertility, you can easily lose sight of the fun side of life. Suddenly, everything is overshadowed by your unfulfilled wish for a child. The infertility journey can be long, so you can't afford to let it consume you totally and rob you of all the pleasures in life.

Being on the same page

One of the tricky things about dealing with the emotional side of infertility is that each partner may be in a different phase of working out what to do. For example, your partner may be keen to start treatment, whereas you still feel angry and haven't yet reached a more constructive phase. Your different personalities can also make you handle the difficulties in different ways. One of you may want to forget all about the problem and hope that it goes away, while the other faces up to the problem and starts to look for ways to solve it.

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