Fertility treatment options
In a nutshell...
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.
No luck so far?
If you’ve been trying to conceive for a while with no luck, or have a medical condition which impacts fertility, you might want to look at the next options for making a baby. This can be incredibly daunting and stressful.
Often, coming to terms with the reality that making a baby isn’t as easy as you imagined has its own grief attached.
We recommend that you take as much control as possible, and have a plan:
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You’re able to check all the lifestyle boxes. You can identify the fertile window and you feel confident about your general health. Even if you are years into a fertility journey, this information is essential!
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If you have been trying to conceive for 12 months (9 months if the woman is over 35, and 6 months if the woman is over 40), see your GP for preliminary tests
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If you meet the eligibility criteria, your GP can refer you for a consultation with a fertility specialist, or you can make a private appointment
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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%. Ovarian Hyperstimulation Syndrome (OHSS) is the most serious ‘potential’ complication that can arise from IVF treatment.
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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).
Ask questions
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What is your diagnosis / diagnoses?
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Options?
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Chances of success of each option?
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Likely costs?
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Side effects?
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Is a counselling session included?
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Who will contact you with results? Who can you contact with any concerns? Who do you contact regarding appointments?
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What complementary medicines do they support?
Options
Your fertility specialist can discuss these options with you and recommend them if appropriate:
Clomiphene Citrate
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Drug which promotes egg production
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No injections
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Have sex to become pregnant
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May or may not be part of a monitored cycle
SUITABLE FOR:
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There is no diagnosed cause for infertility
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The woman is relatively young
Intrauterine Insemination
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Preparing sperm in lab
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Selecting best sperm for implantation in uterus
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May be combined with fertility drugs such as Clomiphene to increase the number of eggs available
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Can be conducted over course of several cycles
SUITABLE FOR:
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Mild male factor infertility
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Short duration of unexplained infertility
IVF
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Drugs to increase number of eggs that mature
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Eggs collected
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Sperm added in lab
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Best embryo selected to replace any additional can be frozen for later use
SUITABLE FOR:
Nearly any cause of infertility - tubal damage, endometriosis, unexplained infertility, ovulation problems
IVF with ICSI
IVF with an extra step of the best sperm being selected by an embryologist and injected directly into an egg
SUITABLE FOR:
Sperm defect has been identified or where there has been poor fertilisation with ordinary IVF (although ICSI is widely used now)
Genetic testing of embryos
When clinics refer to PGS (Pre-implantation Genetic Screening) or PGT-A (Pre-implantation Genetic Testing – Aneuploidy) they are talking about the checking suitable embryos to see if they have the correct genetic make-up. To really understand this though we first need to understand a little more about human genetics.
SUITABLE FOR:
It will depend on each patient’s fertility journey and family genetic history. It is generally recommended to any patients that have a known genetic condition or Recurrent Implantation Failure (RIF). Genetic testing of embryos can help identify and eliminate one aspect that could be causing the failure of embryos to implant
In summary, a thorough and timely investigation is required before making a diagnosis of unexplained infertility. Various treatment modalities are available with maternal age and length of infertility with current ovarian reserve (as determined by AMH) being the best predictors of success.
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
If you have been trying to conceive for at least twelve months, your GP will be able to refer you for a consultation with a fertility specialist (First Specialist Appointment) in the same way that if your GP had identified a medical condition.
However, those with unexplained infertility must have been trying-to-conceive for five years to qualify for publicly funded fertility treatment.
Once you qualify, you can be enrolled for public treatment as for people with other causes of infertility.