IVF (IN-VITRO FERTILIZATION)

Recruiting Eggs

One of the ways IVF works is by creating a statistical advantage - entering multiple eggs simultaneously in “a numbers game”, improving your chance of making a healthy embryo.

During the first phase of your IVF cycle, hormone medications (in the form of subcuticular injections) help several eggs grow within cellular structures in your ovaries – called follicles.

In a natural menstrual cycle – it is usual for only one egg to develop each month and not every egg is capable of becoming a baby. An IVF cycle can amplify your chance of conception by making more eggs available each month to try.

Your treatment cycle

Dr Raelia Lew, the founder of Women’s Health Melbourne, carefully takes your situation into account and expertly tailors your hormonal regimen to achieve the best number of eggs your ovary can produce. Every pregnancy is precious to her.

IVF shouldn’t be a protocol driven, “one size fits all” procedure, and Dr Raelia Lew stands out amongst many Melbourne IVF experts by adjusting and individualising your treatment to maximise your chance of successful conception.

Dr Raelia Lew is an expert in all treatment cycle types used in IVF, including GnRH agonist and GnRH antagonist treatments, Flare, Micro-flare, long down regulation and short down regulation cycles.

Monitoring your IVF cycle

Dr Raelia Lew will review your progress on several occasions during your treatment. She closely monitors your ovaries using high resolution trans-vaginal ultrasound during your treatment cycle. Eggs grow nested in supportive structures known as ovarian follicles.

Your hormone levels will be precisely measured, requiring several blood tests at specific points during your IVF treatment. At the right time, Dr Raelia Lew will order a “trigger” medication be timed, which acts at a cellular level to release your eggs from the follicle walls, making their collection possible.

When the ovarian follicles surrounding your eggs have grown to approximately 20mm in diameter in response to stimulation medications, your egg collection procedure will be scheduled.

Egg collection is performed under ultrasound guidance. The procedure is sometimes called an oocyte pick up (OPU) or egg pick up (EPU). While you are sleeping, under ultrasound vision, your eggs will be gently collected using a fine needle introduced trans-vaginally (through the vagina, into the ovary). Fluid from each of the follicles is aspirated and searched for your microscopic egg cells.

Elite IVF scientists use high power microscopy to locate your eggs. Our WHM and Life Fertility Clinic specialists are highly skilled, having each performed thousands of egg collection procedures. Frances Perry House within the Royal Womens’ Hospital precinct is Melbourne’s safest hospital in which to have an egg collection. Our patients are cared for beautifully by our bespoke hand picked multidisciplinary team.

Timing your egg collection for your personalised best outcome sets WHM patients up for the best chance of future IVF success.

Sperm is ideally collected on the same day as your egg collection, although using previously frozen sperm is another option.

Usually sperm is collected via masturbation, but in some cases, surgical sperm retrieval may be necessary (e.g. if a man has previously had a vasectomy).

Dr Raelia Lew is highly skilled at testicular sperm retrieval by both fine needle biopsy and open surgical sperm retrieval techniques.

Following collection, sperm is prepared in the IVF andrology lab – with specialized techniques employed to remove dead cells and debris, and to select the best swimming sperm for use in IVF or ICSI.

Standard In Vitro Fertilization is achieved by placing >100,000 sperm in close proximity to each egg and allowing sperm binding and fertilization to occur naturally. If a severe sperm problem has been detected, a helping hand for the sperm ICSI (Intra Cytoplasmic Sperm Injection) may be needed.

Growing Embryos

After fertilization has been confirmed, embryos are nurtured under strict and continuous culture conditions in purpose-designed incubators.

Limiting the degree to which embryos are disturbed in the first few days can boost their chances of developing normally. We therefore only check in on embryos’ progress at specific time points.

Advanced Embryo Screening Technologies

Dr Raelia Lew and Women’s Health Melbourne, are proud to offer our patients access to cutting edge technologies involving safe embryo biopsy and advanced screening to detect genetic errors.

Technology including Karyomapping, PCR, SNP array and CGH array testing allows Dr Lew to only transfer embryos proven to be normal and healthy. This can reduce your risk of miscarriage, as many pregnancies featuring genetic errors fail to progress during the first, and sadly sometimes second trimester.

Embryos can be transferred to the womb via a gentle procedure with the patient awake. This is an exciting moment, part of the theatre of IVF.

It is a great privilege to be able to see your embryo at such an early stage - one that parents who conceive naturally never experience.

An embryo transfer should not cause any pain. It is a procedure where your embryo is placed gently via your cervical canal, into the cushioned cavity of your womb (the endometrium).

Preparing for Embryo Transfer

During your embryo transfer, an ultrasound will be placed on your tummy. Having a full bladder is really important to help you specialist see your womb clearly on ultrasound. This helps us place your embryo perfectly.

At WHM, our preferred method is frozen embryo transfer. This allows your precious embryo to return to an optimised uterine environment, without excess IVF hormones, lower levels of inflammation and often requiring less progesterone luteal support in a more natural cycle.

The luteal phase refers to the earliest stage of pregnancy, before the placenta has formed. During this time, the embryo relies heavily on hormonal support from the ovary.

In an IVF cycle, this support is known to be deficient, specifically in regards to production of the hormone Progesterone. Without heavily topping up your body’s natural progesterone, your embryo’s chance of implanting is severely impaired. Choosing to freeze first and implant your embryo in a more optimal womb environment can dramatically improve your chance of successful conception in an IVF context.

Progesterone as a medication used in IVF can be delivered in several ways. Common methods include vaginal gels, tablets, capsules or pessaries (dissolving formulations of micronised progesterone which are inserted into the vagina).

Other methods include subcuticular or intramuscular progesterone injections.

In a natural frozen embryo transfer cycle, much lower amounts of progesterone as medication is required as most if not all of what you need is produced by your ovary.

When a pregnancy has been achieved, we continue to care for our patients until their antenatal obstetric care has been arranged.

We perform a pregnancy dating ultrasound at 6 weeks gestation and discuss your preferred model of care. We can arrange non-invasive prenatal testing and arrange and interpret first trimester fetal anatomy screening investigations.

As a respected IVF expert, Dr Raelia Lew works closely with Melbourne’s best obstetricians. Based on your preferences, and taking into account your personality, she will help you to find the perfect private obstetrician to deliver your baby if this is your choice.

We can ensures that your transition to obstetric care is seamless – you will feel cared for and supported from conception to delivery and beyond.

WHM Shared Pregnancy Care

Dr Tzippi Ben Harim is an expert WHM Obstetrician and Gynaecologist with many years experience caring for expectant mothers.

Patients who would like to deliver their baby at Sandringham Public Obstetric Hospital but also have the confidence of being cared for beautifully and expertly during their pregnancy in a shared care model by Dr Tzippi and our gorgeous multidisciplinary team can continue their pregnancy care at Women’s Health Melbourne.