Monash Health Fertility can help individuals and couples who have fertility issues to identify the cause, and subsequently, provide treatment for certain conditions or intervene with assisted reproductive technologies to help create the family they desire.
Our services include:
An ultrasound is an examination that uses sound waves to produce an image of structures in the body. The soundwaves are delivered and received back into a transducer or ‘probe’, and are at very high frequency so can’t be heard. Ultrasounds are very safe diagnostic tests and do not emit radiation. Diagnostic studies are performed by sonographers (health professionals who have a specialised postgraduate qualification) who work with specialist doctors (sonologists) to determine the possible cause of infertility.
A pelvic ultrasound looks specifically at structures within the pelvis, including the uterus, ovaries, bladder and bowel. A good overall picture of the pelvis is obtained by an external view where a transducer is moved over the skin surface, however, for the best detail and improved diagnoses, an internal or ‘transvaginal’ ultrasound is also performed. In this, a thin probe is inserted into the vagina, providing an unobstructed view of the pelvic organs and producing very high-quality images. The transvaginal ultrasound is, in general, a painless diagnostic test, but may sometimes be uncomfortable if a woman has certain conditions such as severe endometriosis.
Pelvic ultrasound is used to diagnose a range of conditions that affect fertility, including endometriosis, fibroids and the shape of the uterus, as well as to assess the function of the ovaries and correlate the appearance of the endometrium (lining of the uterus).
This examination helps to assess the patency of the fallopian tubes and structure of the uterus as well as better visualise the endometrium (lining of the uterus). It is essentially an extension of a pelvic ultrasound where a specialist doctor (sonologist) inserts a catheter into the cavity of the uterus (where a baby grows during pregnancy) so that fluid (‘normal saline’) can be injected in. As the fluid passes through the fallopian tubes the movement can be seen using the ultrasound machine.
As well as helping to diagnose problems with the fallopian tubes, uterus and endometrium, flushing the fallopian tubes with fluid may help clear blockages and is therefore considered therapeutic, that is, it can help treat a cause of infertility.
Laparoscopy or ‘keyhole surgery’ of the abdomen and pelvis enables the organs to be examined by inserting a fibre-optic camera (laparoscope) through a small incision in the abdominal wall. A laparoscope is particularly useful in diagnosing and treating endometriosis and assessing for scar tissue. For more information, visit the Victorian Better Health Channel.
Analysis of semen is carried out in a laboratory. A sample of semen is assessed for the presence and volume of sperm as well as their structure and function (how they move). If an abnormality is identified another sample may need to be assessed, or an ultrasound or biopsy of the testes performed.
Monash Health Fertility provides counselling to support patients/participants in making decisions before, during and after their fertility procedures (eg. IVF, ICSI) or when undertaking a donor or surrogacy program. Further to this, the infertility counsellor can assist patients in managing the emotional and psychological challenges of infertility and is able to provide relationship counselling. These consultations can be delivered in face-to-face sessions or via telehealth, and can be done on an individual basis or as a couple or group.
Monash Health Fertility dietitians provide education and guidance on weight management and nutrition to help promote conception and prepare your body for pregnancy. Those with Polycystic Ovarian Syndrome may especially benefit from this service.
Ovulation induction (OI) is an assisted reproductive technology primarily used in those women who have irregular periods. It involves taking medications (hormones) to stimulate the development of follicles in the ovary. The follicle size and number are monitored carefully through blood tests and ultrasound scans. Sometimes a ‘trigger injection’ of hormone is required to complete the last stage in follicle development before ovulation (release of an egg from the ovarian follicle). It is around this time that sperm are required to fertilise the egg, therefore, couples are encouraged to have sexual intercourse, or alternately, intrauterine insemination (IUI) is undertaken.
Intrauterine insemination (IUI), sometimes referred to as Artificial Insemination (AI) is when sperm are inserted into the uterus from where they can swim to or directly fertilise an egg. Having received a semen sample from the partner or donor, the sperm is analysed and a concentrated sample of motile sperm is used. The doctor may also prescribe progesterone for the woman to help the lining of the uterus thicken ready for pregnancy implantation. IUI in combination with ovulation induction (OI) provides the best chance of getting pregnant.
IVF, or in vitro fertilisation, is probably the most widely known type of assisted reproductive technology (ART). It is used to achieve conception – when an egg or ‘ovum’ is fertilised by sperm to eventually develop into an embryo. Follicles on a woman’s ovaries are monitored to identify when they have matured enough for egg retrieval or ‘egg pick up’ to be performed. This minor day surgery procedure is done under anaesthesia, with the eggs being immediately assessed by an embryologist so that a healthy, mature egg can then be fertilised with a sperm collected earlier from the partner or donor.
A ‘fresh’ embryo transfer is then performed a few days later, or alternatively, the embryo can be frozen and then transferred at a later date. An embryo transfer is carried out under ultrasound control, that is, ultrasound is used to guide the placement of the embryo in the uterine cavity. This is a simple procedure similar to a pap smear.
Once the embryo has been transferred, there is a 2 week wait until a pregnancy test can be undertaken. A blood test is used instead of a home pregnancy test as it is more accurate in detection of early pregnancy.
Intra cytoplasmic sperm injection (ICSI) is performed when infertility is due to male factors such as low sperm count, sperm structure and function (motility), or if an egg’s outer layer is too thick or hard for the sperm to penetrate.
As with IVF, a woman’s eggs are retrieved and can then be fertilised via the ICSI process where a tiny needle is used to inject a single sperm into the centre of the egg. The embryo can then be transferred into the cavity of the uterus as with the IVF embryo transfer process.
Monash Health Fertility provides preimplantation genetic testing (PGT) for monogenic disorders (where there is a defect in a single specific gene) including cystic fibrosis, fragile X, and Huntington’s disease. Any couples who know they are carriers of a serious inherited condition may be interested in PGT-M.
PGT firstly requires the creation of an embryo through the ICSI process. In the very early stages of embryo development, about 5 or 6 days after fertilisation, a sample of cells are carefully biopsied and tested for the genetic condition in question. The embryos are then cryopreserved (frozen) until the results of the test are available. Embryos without the monogenic disorder can then be selected for transfer into the woman’s uterus, and the genetic disorder is not passed down from parent to child.
Currently being established, the Victorian Sperm and Egg Bank will enable patients from Monash Health Fertility and other Victorian public fertility services to access donor egg and/or sperm. It is anticipated that donor egg and sperm will be sought by those experiencing infertility due to physical conditions or diseases, medical treatment such as chemotherapy, or by single people or those of the LGBTIQ+ community.
A further update will be provided upon the introduction of the sperm and egg bank service.
Surrogacy is an arrangement in which a woman (the surrogate) agrees to carry and give birth to a child on behalf of another person or couple (the intended parent/s).
Monash Health Fertility can support individuals and couples through the surrogacy process and operates in accordance with the Assisted Reproductive Treatment Act 2008 (Vic). More information on surrogacy in Victoria can be found on the Surrogacy Australia website.
Embryo freezing, or embryo cryopreservation, is a process of freezing and store embryos for later use. Once embryos are created through the IVF or ICSI process the cryopreservation is undertaken. This involves adding a special liquid to the embryo which acts like antifreeze and protects the cells from forming ice crystals. The embryos are then transferred to tanks of liquid nitrogen where they are essentially ‘snap frozen’ at about 195 degrees Celsius.
Cryopreservation is also a technique that can be used to preserve fertility. For example, a woman with cancer may want to save eggs before beginning chemotherapy or radiation therapy, or, a transgender man (transitioning to male) may want to freeze eggs before undertaking gender reassignment surgery.
When the embryos, eggs or sperm are needed for fertility treatment, an embryologist ensures that they are thawed under strict laboratory conditions so that damage to cells can be avoided.