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This Glossary Of Terms Will Help Unravel The Mysteries Around IVF

An A-Z of what you need to know.

Assisted reproductive technologies, more generally referred to as IVF or 'in vitro fertilisation', have revolutionised fertility treatment.

Since the first IVF-assisted birth back in 1978, an estimated five million babies have been born around the world. A beacon of hope for wannabe parents, the Australian and New Zealand Assisted Reproductive Technology Database estimates that more than 70,000 treatment cycles are performed each year in Australia and New Zealand -- and this number is steadily increasing.

But while conception rates are rising, so is the volume of information available on the array of pioneering treatments and techniques. So whether you're considering it, or you've already started the process, this IVF glossary, complete with expert advice, will unravel any confusion around the terms and treatments...

Also known as Intrauterine Insemination (IUI) artificial insemination involves inserting prepared semen into the uterus close to the time of ovulation.

Simple and much less invasive, the procedure is performed by a nurse and there's little to no downtime.

A technique that involves using a laser to gently thin the outer shell of the egg (zona) allowing for a better chance of the embryo 'hatching.'

"Sometimes the outer shell of the embryo can be quite thick. This means that the cells within the embryo are unable to implant in the uterus because they are contained within the shell," fertility and IVF Specialist at MelbourneIVF, Dr Joseph Sgroi said.

Using high resolution, high magnification technology, the most appropriate sperm can be selected to fertilise the egg.

"A couple may benefit from this if the semen is abnormal," Sgroi said. "It's thought that by selecting a sperm for injection into the egg under this high-powered magnification the chance of fertilisation and pregnancy rates increases. Furthermore, there is a reduction in the miscarriage rates."

Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age.

"Anti-Mullerian Hormone (AMH) is produced by developing follicles," Sgroi said.

"The more follicles the woman has, the higher the AMH level is. It is important to remember the AMH level does not influence the overall chance of pregnancy. A woman with a low AMH may conceive just as easily as a woman with a high AMH. It is used by fertility specialists to guide treatment and to provide more accurate dosing of medication in assisted reproduction such as ovulation induction, artificial insemination or IVF."

For women who are unable to conceive using their own eggs, egg donation is an option. In most cases donations come from friends or family members who should ideally be ages between 23 and 33 with no medical or genetic conditions. The donor will need to have the eggs collected during an IVF cycle co-ordinated with the recipient's cycle, which allows for a higher success rate.

A method of storing unfertilised eggs to allow for conception at a later date or to help when natural conception is unlikely.

"Egg Freezing is freezing an egg without joining with a sperm. So the egg is frozen on its own," Associate Professor Peter Illingworth, Medical Director of IVFAustralia explained.

"A woman will go through an IVF cycle, she will have drugs to stimulate all the eggs that are available that month, she will go through a procedure to have the eggs collected, and the eggs will be taken to the laboratory, and the eggs will be frozen."

"Egg freezing only really applies when a woman does not have a partner in mind. Where a woman is getting into her mid-30s and is concerned about her future, and her future fertility and wants to store some reproductive materials for the future."

As with both egg and sperm donation, the resulting child of an embryo (a female egg fertilised with male sperm) donation is considered the child of the woman who carried it and gives birth, not the child of the donor.

Everyone who is considering donating will undergo a process of medical assessments, infectious and genetic screening and compulsory counselling to explore the emotional and legal implications of embryo donation.

Can be carried out on both males and females either to further investigate the cause of infertility, or to overcome the problems.

Where a frozen embryo from a previous IVF cycle is thawed and transferred back into a woman's uterus.

"The success rates for frozen embryo are essentially the same, if not better, than fresh transfer," Dr Alex Polyakov, clinical director, Melbourne IVF at Royal Women's Hospital said.

"The (frozen) embryos can be stored indefinitely without any impact on their pregnancy potential. There are a number of ways that a frozen embryo can be implanted. These include a natural cycle, artificial cycle or stimulated cycle."

When planning to conceive, many couples will consider their own health, and that of their family, in terms of genetic conditions that they may pass on to their children. Genetics clinics offer testing for specific conditions or for chromosomal abnormalities, to minimise the possibility of passing these on.

IVF or 'in vitro fertilisation' is a form of assisted conception where fertilisation takes place in a laboratory dish rather than inside a woman's fallopian tubes.

The eggs are then fertilised in a lab to create embyros which grow for two to six days before being transferred back into the woman's uterus increasing the chance that a pregnancy will occur.

Intracytoplasmic sperm injection (ICSI) is performed as an add on to the IVF treatment cycle. Together with IVF it's one of the most common techniques in fertility treatment. Generally used to overcome severe male infertility, the procedure involves injecting a single sperm into each egg to assist fertilisation.

"It is the most successful treatment for all forms of male infertility," Dr David Molloy, Clinical Director of Queensland Fertility Group said. "Sperm can either be obtained from a fresh or frozen sample, or surgically collected from the testes if obstruction is present. Pregnancy rates with ICSI are generally equal to rates on IVF with very good sperm."

Intracytoplasmic Sperm Injection (ICSI) is an artifical fertilisation technique.
Intracytoplasmic Sperm Injection (ICSI) is an artifical fertilisation technique.

Ideal for patients who are at an increased risk of having a child with an inherited genetic condition, this technique tests embryos for the presence of a single gene disorder.

"It's a new, advanced genetic technique where sequences of DNA can be accurately analysed," Molloy explained.

"It's most useful for diagnosing complex genetic diseases such as cystic fibrosis," Molloy said.

"It can be used to diagnose a wide range of inherited diseases too, some of which are very rare. This means a genetic disease can be prevented from being passed down from parents to child."

Brand new research from the New England Journal of Medicine has found that a 100-year-old fertility treatment called Lipiodol -- a poppy seed oil with high iodine content -- could help couples trying to conceive.

The landmark study has shown significant increase in pregnancy rates following the use of Lipiodol flushing the fallopian tubes.

"If a couple is trying naturally (to conceive) and it is not working, they will normally go to see a fertility specialist. One of the first things a fertilily specialist will do is organise to check out if there are any blockages in the woman's tubes," Illingworth said.

"Pushing (lipidol) through the tubes allows us to tell whether the tubes have any blockages or not."

"What this evidence (from the study) tells us is that when checking out a womans tubes, it is better to use a fat based solution (lipidol), than a water based solution, because it gives a higher pregnancy rate afterwards."

The lining of the uterus contains immune cells. As they do in every other part of the body, these immune cells attack foreign bodies, therefore keeping both infections and cancer at bay. As a result, they play a significant role in keeping us healthy, hence why referred to as 'natural' killer cells.

Women who have fertility problems are more likely to have higher levels of activity of these Natural Killer cells -- or 'NK cells' -- than other women.

"It's thought that a higher than expected level of natural killer cells may be implicated in either miscarriage or a failure for the embryo to implant," Sgroi said.

"We can test for the presence of the NK cells through a blood test or by sampling the lining of the womb. Treatment may be offered to suppress the immune system but it is important to note that this area of treatment and testing is currently undergoing validation and further research."

Also known as 'chromosome testing', next-generation sequencing is a genetic testing technique that screens all 24 chromosomes in a developing embryo, enabling the selection of only embryos with a normal chromosome profile, which increases the chance of a successful pregnancy.

A technique which can be used to test embryos for either a known genetic condition or chromosome abnormality, allowing only chromosomally normal embryos or those unaffected by a specific disorder to be selected for transfer during an IVF cycle.

A simple process that can help you identify which days you're most fertile. Ovulation is triggered by a surge in luteinising hormone, which usually occurs 24 hours prior. A blood test can be performed to measure this, meaning that the best time for conception can be estimated.

"A woman will ovulate halfway through the month normally, but not every woman does. Some woman will ovulate at different stages of their cycle. So what cycle tracking involves, is a woman having regular blood tests -- sometimes helped by ultra sound -- to identify the hormone changes that take place around ovulation," Illingworth said.

"It's the sort of thing a couple would use when they're starting to have difficulty conceiving, but are not yet at the stage where they need complex fertility treatments," Illingworth said.

"Used to treat female infertility when the primary cause is failure to grow and release an egg on a regular basis," Molloy said.

"Ovulation induction can be done simply by using a course of tablets -- Clomid or Letrazole -- or, for more complicated cases, a course of egg-growing injections using a hormone called FSH."

This medication encourages eggs to develop in the ovaries and then be released, which is then followed by timed intercourse or artificial insemination to increase the chance of conception.

"Ovulation induction will help approximately half the patients with this disorder become pregnant," Molloy said. "About half will need further treatment with IVF. It needs to be carefully managed and monitored due to the higher risk of multiple pregnancies."

Also known as 'Oosight Technology', PolScope is a relatively new technique used to enhance ICSI (see above).

"It's thought that if the sperm is ingested into the egg on a particular angle it aligns better with the DNA of the egg," Molloy said. "This means better fertilisation of the egg may occur and pregnancy rates may be higher."

The most important male infertility test, the analysis measures the number of sperm, their mobility (ability to move) and their morphology (size and shape), to assess chances of conception.

The reasons for people needing to access donor sperm vary. There are a few ways of obtaining donated sperm, either through a known donor, such as a close relative or friend, an anonymous donor, or via commercial sperm banks.

"Sperm donation is when one man gives sperm to help somebody else have a family. The sperm donor may be known to the other person who is having the family, the sperm donor may not be known," Illingworth said.

"What is not allowed in Australia now is for a sperm donor to be truly anonymous, and that is because we have seen the experience of a generation of children who have grown up from truly anonymous sperm donation, and the distress that this has caused them -- not knowing where they've come from"

In Australia, individuals conceived through donor sperm are entitled to information detailing their sperm donor once they reach 18 years of age, but the donor must remain anonymous until then.

"It is not Australia wide law, but it is practised under the Reproductive Technology Accreditation Committee code, not to use anonymous sperm donors anywhere in Australia," Illingworth explained.

Particularly suitable for men working in dangerous situations or those about to start treatment for cancer (chemotherapy and radiotherapy can affect sperm production -- sometimes permanently) freezing sperm allows for future use. About 25-50 percent of the sperm will survive the process of freezing and they can be stored for many years.

A form of assisted reproductive technology where a woman -- the surrogate -- offers to carry a baby through pregnancy on behalf of another person or couple. An embryo is created using an egg and sperm from the parent(s) or donors and is transferred into the surrogate's uterus.

Surrogacy is a very complex process legally and various criteria must be satisfied before treatment is offered. It's illegal to pay for a surrogate or to advertise for someone to act as one.

Though the surrogate has no genetic link to the child, until parentage is legally transferred the child is considered to belong to the birth mother.

For men who have previously had a vasectomy and later decide they want children this can be achieved either via a vasectomy reversal or 'vasovasectomy.' Carried out in day surgery under general anaesthetic, microsurgery reconnects the vas deferens cut during a vasectomy.

After the procedure sperm usually returns progressively and by three months 90 per cent of men will have sperm present.

As members of Virtus Health, IVFAustralia, Melbourne IVF, Queensland Fertility Group and TasIVF create more babies than any other fertility group. If you're planning for pregnancy or already trying, get expert advice from our specialists today.

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