Why do I have to take oral contraceptives to become pregnant?

The oral contraceptives are supposed to provoke a bleeding in the females who have irregular menstrual cycles caused by PCO (polycystic ovaries) or no menstrual cycle at all. The oral contraceptives mimic a normal cycle enabling us to initiate treatment on Day 21 as in long-term treatment or a start of bleeding in short-term treatment.
It might prove beneficial to take Yasmin as an oral contraceptive, as this particular agent contains gestagen with anti-androgen effect.

 

I have heard that short-term treatment is possible instead of long-term treatment with nasal spray?

Short-term treatment is particularly used in women with PCO in order to avoid hyperstimulation and in women with relatively few eggs.
In principle, short-term treatment is very much similar to long-term treatment, the only difference being that the short-term treatment does not involve treatment with the hormone spray, and instead hormone stimulation is initiated immediately on Days 2-4 of the menstrual period. The first day on hormone injections is called Stimulation Day 1. The next scan is already made on Stimulation Day 6 or 7 in order to supplement hormone treatment with the GnRH antagonist, Orgalutran which also involves hormone injections. Orgalutran has the same function as the nasal spray that inhibits spontaneous ovulation.
Two days later, ie on Stimulation Day 8 or 9, a new scan is performed and we count the number of follicles as well as measure the size of them in order to determine the optimum time of egg retrieval. The rest of the procedure follows the same procedures as those of long-term treatment.

 

I have also heard that it is possible to receive low-stimulation treatment, also known as “eco” treatment?

This type of treatment applies the same principles as those of insemination treatment with male sperm (homologous intrauterine insemination – (IUI-H)). It is offered to very young, fertile females where the cause of infertility is the male’s reduced sperm quality. In some cases, this type of stimulation may also prove beneficial to females with PCOS (Polycystic Ovarian Syndrome).

 

Blastocyst cultivation – what is this?

After the fertilized egg has been transferred to the uterus, it will go through a number of cell divisions and finally attach to the lining of the uterus after three to four days. Before the egg hatches out of its protective layering, the cells inside the egg form into a very characteristic structure, a so-called blastocyst.

It is possible to cultivate the egg in the laboratory for another three to four days (a total of 5 days) to see if the cells continue to divide and develop into a blastocyst. Some eggs stop their development at the eight-cell stage and will therefore never develop into pregnancy. Females who have gone through numerous unsuccessful IVF treatments may benefit from blastocyst cultivation with a view to avoiding such a stop in cell division.

When performing blastocyst transfer, the pregnancy success rate is higher than that of embryo transfer. The disadvantage is that only approximately 25% of the eggs develop into blastocysts in the laboratory, whereas the rest do not develop any further and degenerate. Some of these eggs might have developed if they had attached to a uterus where the conditions of survival had been better than in the laboratory.

In order to perform blastocyst cultivation, it is of course necessary to have a relatively large number of fertilized eggs that can be further cultivated in the laboratory.

 

Assisted hatching (AHA)

Assisted hatching is a technique helping the embryo to hatch out of its protective layering. If the embryo does not hatch, it cannot implant in the uterus and become a foetus. Assisted hatching attempts to help these embryos break out away from the zona pellicuda by creating a small hole in this outer lining. This can be done either by using acid or laser. We use acidification as we believe that the acid is more gentle than the laser beams, since the process is easier to control and the egg is not subjected to heat.

 

Which females benefit from assisted hatching?

There is no doubt that some females will benefit from AHA, but scientific research of large groups of patients have not been able to demonstrate any significant difference in pregnancy success rates. AHA cannot damage the eggs. Especially females above the age of 37 or females who have undergone many unsuccessful IVF treatments are considered to benefit from assisted hatching. Studies also indicate that AHA may have an effect on thawed, fertilized eggs. At IVF-SYD we do not immediately recommend AHA til IVF patients unless they fall under the patient categories mentioned above.

 

Is there a risk of cancer after repeat hormone stimulations?

There is no documentation that hormone therapy leads to increased risk of ovarian or breast cancer. As the consequences of such increased risk would be very serious, we constantly follow up on females undergoing infertility treatment.