24-30 September 2018

Join us for fertility discussions, advice & support

Treatment

Treatment

  • A couple where the woman is aged 30 has around a 47% chance of a baby from one IVF cycle.  If the woman is aged 40, this drops to 23%  (question around: celebrities with unlimited access to the best treatments available worldwide are able to conceive their own genetic children even in their late 40s)
  • Public funding is available for those that meet the criteria, with a waitlist in operation
  • Egg freezing may become an option for those wishing to delay parenthood, but it is expensive. In women aged 35 or younger, one egg freezing cycle may give up to a 50% chance of a child from using frozen eggs later (this varies depending on the number of eggs obtained)
  • Ovarian Hyperstimulation Syndrome (OHSS) is the most serious ‘potential’ complication that can arise from IVF treatment

 

Treatments for infertility

  • Treatments for fertility problems are many and varied. Some common treatments include medications to improve the production of eggs, surgery on the fallopian tubes to fix damage, insemination of the woman with either the partner’s sperm or with donor sperm, in vitro fertilisation (IVF) or IVF with intra cytoplasmic sperm injection (ICSI).
  • Though success rates vary, treatment does not carry any guarantee of success. 
  • There is no treatment for egg quality (due to age) – egg donation is sometimes the only option for women with poor ovarian reserve.
  • Some people try natural treatments such as acupuncture and naturopathic treatments.
  • Some couples choose not to seek treatment; infertility treatment can be emotionally draining, and although some publicly funded treatment is available in New Zealand, specific eligibility criteria must be met, and there may be a wait to access treatment.
  • A small number of New Zealanders will adopt children (around 60 non-relative adoptions per year), while others will remain without children.

Ask questions!

  • What is your diagnoses / diagnoses?
  • Options?
  • Chances of success of each option?
  • Likely costs?
  • Side effects?
  • Is a counselling session included?
  • Who will contact you with results?  Who can you contact with any concerns?  Who do you contact regarding appointments?
  • What complementary medicines do they support?

Other treatment options: Male Factor Infertility

There are new methods available which attempt to isolate mature, structurally-intact sperm with high DNA integrity which are then injected into the egg.

• PICSI selects a mature sperm which could bind to the Zona Pellucida, the soft ‘shell’ encasing the egg

• IMSI uses high magnification to select a sperm without vacuoles.

These methods may be suggested after a failed ICSI cycle. Studies are needed to confirm that PICSI and IMSI improve outcomes over conventional ICSI.

 

Funding

Your GP can conduct some tests free of charge, e.g. blood test to confirm ovulation and semen analysis.  Your GP or Family Planning clinic can refer you for a consultation with a fertility specialist.  You will need to pay for the visit to the GP, but not for the specialist appointment.  There are criteria for this consultation including age (the criteria differ slightly by region).  The GP makes the application to the relevant local authority, and the clinic will then contact you directly regarding the appointment (do not book the appointment directly).  Alternatively, you can pay privately for an initial consultation with a fertility clinic (prices are on the clinics’ websites).  Any application for publically funded treatment will not be affected by whether your initial consultation was referred by your GP, or booked/paid privately.

IVF is priced on a per cycle basis and the pricing may vary slightly by clinic. It will also depend on the exact treatment that you will require, for example, Intra-Cytoplasmic Sperm Injection (ICSI) alongside IVF will increase the treatment cost.  The New Zealand government currently funds up to 2 rounds of IVF per couple who meet the eligibility criteria. Passing the criteria allows couples (or infertile singles) to join a waiting list for these publicly funded cycles. There is a minimal (or non-existent) waiting list for privately funded IVF treatment. This may cost in excess of $10,000 per cycle.

 

Requirements for publicly funded treatment differ slightly by District Health Board, but these criteria include:

  • The couple have been trying to conceive for at least twelve months (or the deemed equivalent for single people and same sex couples)
  • If there is no diagnosed reason for infertility (‘unexplained infertility’), the couple must have been trying to conceive for four years
  • Woman’s age 39 or less at time of consultation
  • Woman’s BMI 32 or less
  • Woman must be a non-smoker (at least three months prior to application)
  • NZ citizenship, residency or visa of at least two years’ in duration (for both partners)

When to seek help

Learn when - and where - you should seek help with your fertility

Treatment options:

OPTION

DESCRIPTION

SUITABLE FOR

Waiting

Trying naturally for a further number of months

There is no diagnosed cause for infertility

The woman is relatively young

Clomiphene citrate

Drug which promotes egg production

No injections

Have sex to become pregnant

May or may not be part of a monitored cycle

Women who don’t ovulate

Women with short cycles

Women with short duration of unexplained infertility

Intra-uterine Insemination (IUI)

Preparing sperm in lab

Selecting best sperm for implantation in uterus

May be combined with fertility drugs such as Clomiphene to increase the number of eggs available

Can be conducted over course of several cycles

Mild male factor infertility

Short duration of unexplained infertility

IVF

Drugs to increase number of eggs that mature

Eggs collected

Sperm added in lab

Best embryo selected to replace any additional can be frozen for later use

Nearly any cause of infertility - tubal damage, endometriosis, unexplained infertility, ovulation problems

IVF with ICSI

IVF as per the above, with an extra step of the best sperm being selected by an embryologist and injected directly into an egg

Sperm defect has been identified or where there has been poor fertilisation with ordinary IVF (although ICSI is widely used now)

 

Age and Treatment

In 2014, the average age of women undergoing ART treatment cycles in NZ and Australia was 35.8 years and men 38.2 years. Women under 30 years of age undergoing fresh non-donor treatment achieved a live birth rate of 38.7%per treatment cycle.  In contrast, the rate of live births of women over 44 years was only 1.2% (2) (these data do not include any babies born from embryos frozen as part of these treatment cycles).

Egg freezing may become an option for those wishing to delay parenthood, but it is expensive. In women aged 35 or younger, one egg freezing cycle may give up to a 50% chance of a child from using frozen eggs later (this varies depending on the number of eggs obtained).

 

(2) UNSW Australia. National Perinatal Epidemiology and Statistics Unit – Assisted Reproductive Technology in Australia and NZ.

Emotional impact of treatment

Some couples, particularly those who have endured infertility over an extended period of time, may feel that treatment gives them a tangible process to focus their energies on. Others may feel uncertain or anxious about the physical intrusiveness of the process. Either way, the hormonal drugs given to the woman may cause any of a wide variety of side effects. Some women feel emotional and easily upset, others may experience headaches, bloating and tiredness amongst other symptoms.

Many IVF patients, especially women, find that the most difficult part of the treatment is the luteal phase. The luteal phase is otherwise known as the ‘two week wait’, and is the period between the embryo transfer and the pregnancy test.

Stress, frustration, anxiety and sensitivity are often felt during this time and there may be a sense of life being ‘on hold’.  It helps to keep busy during this time, and plan activities to try to keep your mind off pregnancy.

Avoid pregnancy tests, which are unlikely to be accurate before your period is due. Also, the hormone drugs may create pregnancy like symptoms, so try to divert your mind from ‘feeling’ pregnant.  Although you and your partner have been through this process together, it is best to retain some balance in your relationship. If it helps to limit all fertility/pregnancy conversations to 20 minutes, this may provide some compromise for both parties. A counsellor at your IVF clinic, or your local Fertility NZ volunteers may provide support and advice for this period which many IVF couples and singles have endured.


 

Same sex and single people

For more specific information, see here