WHAT is infertility?
For a fertile couple in their twenties having regular unprotected sex, the chance of conceiving each month is only 25 per cent. So how do you know when something’s amiss?
The answer depends on how old you are. While the man’s age is thought to play a role, the medical definition of infertility focuses on the woman. A woman under 35 is considered infertile if she fails to become pregnant after 12 months of regular unprotected sex. But for those over 35, the threshold is six months instead of 12.
There are degrees of infertility. The majority of infertile couples are actually sub fertile – they produce eggs and sperm but have difficulty conceiving due to disorders such as hormone imbalances and problems of the reproductive tract. Cases of total infertility – where no eggs or sperm are produced – are rare.
- One in six couples is infertile. In 40 per cent of cases the problem rests with the male, in 40 per cent with the female, ten per cent with both partners, and in a further ten per cent of cases, the cause is unknown.
- Fertility problems strike one in three women over 35.
- One in 25 males has a low sperm count and one in 35 is sterile.
- For healthy couples in their twenties having regular unprotected sex, the chance of becoming pregnant each month is 25 per cent.
- The chance of conceiving in an IVF cycle is on average around 20 per cent (but varies due to individual circumstances).
- More than one per cent of births in Australia involve the use of assisted reproductive technologies.
After 12 months of trying to conceive you should consult your GP or gynaecologist for a referral to a fertility specialist. You and your partner will undergo a series of tests – sometimes your GP may conduct these tests. The test results will give clues to the type of infertility and ultimately a treatment plan to overcome the problem.
Firstly, the specialist will look at the couple’s medical history. For the woman, this includes information on any previous pregnancies, the regularity of her periods; and whether she has had painful periods, pelvic pain, infections, or surgery. A specialist will want to know if the man has previously fathered children, suffered a testicular injury; or had any developmental problems, infections, surgery; or if he has been exposed to certain environmental factors.
Next there will be a physical examination, which may include:
Blood tests. A series of tests will establish if there is a hormonal basis for the couple’s infertility – this may be corrected by hormonal supplements. Other tests will check for rubella, blood group, sperm antibodies and sexually transmitted diseases such as HIV, Hepatitis B and C.
Ultrasound examination. This gives information on what the ovaries and uterus look like. Your doctor will look at the growth of eggs, the thickness of the lining of the uterus (if thin, it can indicate hormonal problems), the presence of fibroids or polyps on the uterus, as well as signs of endometriosis or ovarian cysts. Surgical laparoscopy may also be used to identify endometriosis or blocked fallopian tubes.
Semen analysis. Men need to provide a semen sample this allows specialists to assess the number of sperm, how well they swim (known as ‘motility’) and the presence of sperm antibodies.
Coping with infertility
Finding out that either you or your partner is infertile, or sub-fertile, can be a traumatic experience. One or both of you may experience feelings of blame, anger, denial, guilt, self-pity or jealously, this may place stress on your relationship. These feelings are common and IVF clinics provide counselling services to help you deal with them.
Going through infertility treatments can be an emotional rollercoaster, especially for patients who fail to become pregnant after a number of cycles. The beginning of a cycle is full of hope, anticipation and the anxiety of wondering “am I pregnant?” This can be quickly followed by dealing with the disappointment and despair of ‘failed’ cycles.
It may take a while before a couple undergoing infertility treatments becomes pregnant. It is hard to pinpoint why an IVF cycle doesn’t work as there are many factors to take into consideration. Ultimately, the prospect of never having children may have to be faced.
Many couples find fertility support groups useful for sharing coping strategies and experiences.
Article last reviewed: 09/05/07
Types of infertility
For centuries, if a couple were unable to have a baby, it was considered the woman’s problem. We now know both men and women suffer infertility problems and these are no more common in one sex than the other. Sometimes multiple factors are involved in one or both partners.
Among couples who are infertile, about 40 per cent of cases are exclusively due to female infertility, 40 per cent exclusively to male infertility, and ten per cent involve problems with both partners. In the remaining ten per cent, the cause is unknown.
Women can suffer from disorders such as hormone imbalances, blocked fallopian tubes, endometriosis, or abnormalities of the reproductive organs. Men can experience infertility if they have problems with the number and shape of their sperm, produce antibodies against their own sperm, or have blocked spermatic cords. In some cases, the exact cause of infertility cannot be explained.
Proper diagnosis of infertility will help in selecting an appropriate treatment plan that maximises the chance of becoming pregnant.
A delicate balance of sex hormones (oestrogen, progesterone, luteinizing hormone, follicle stimulating hormone) is needed for the timely growth and release of the egg from the ovary (ovulation).
Hormone imbalances can cause ovulation disorders in women and are the most common cause of infertility in women.
Fallopian tube damage
It is in the fallopian tube that fertilisation takes place, after the egg is released from the ovary into the tube and is met by sperm. Full or partial blockage of the fallopian tubes will prevent fertilisation taking place.
Fallopian tubes can be damaged by inflammation that results from viral or bacterial infections, some types of sexually transmitted diseases, or complications of surgery such as adhesions or scarring.
Uterus and cervical disorders
Benign growths on the uterine wall, such as fibroids or polyps, can also contribute to infertility as they interfere with the attachment of the embryo onto the uterus wall.
Abnormalities in the shape of the cervix or changes in the texture of the cervical mucus can make it difficult for the sperm to move from the vagina into the uterus.
Endometriosis is a condition where the lining of the uterus forms at inappropriate places within and outside of the reproductive tract. It can block the fallopian tubes and/or disrupt ovulation. It occurs in about ten per cent of women.
The presence of antibodies to sperm in cervical mucus can cause infertility. In other cases, the mother’s immune system prevents the embryo from attaching to the wall of the uterus and so causes a miscarriage.
Polycystic ovaries contain lots of small cysts, making the ovary larger than normal. The condition, called polycystic ovarian disease (PSOD), is also associated with high levels of androgen and oestrogen. Women with PSOD have irregular periods and may not ovulate, resulting in infertility.
Ovarian failure can be a consequence of medical treatments (for ovarian tumours for instance), or the complete failure of the ovaries to develop or contain eggs in the first place (for example, Turner’s Syndrome).
The treatment for ovarian tumours may involve surgical removal of all or part of the ovary. Ovarian failure can also occur as a result of treatments such as chemotherapy and pelvic radiotherapy for cancers in other body areas. These therapies destroy eggs in the ovary.
Age is a critical factor affecting a woman’s fertility woman. In our society many women choose to delay having children. Some of the common reasons for this include education and career demands, financial stability, second marriages/relationships and waiting for a suitable partner.
Reproductive function declines as a woman ages, particularly after the age of 35. Women are born with a finite number of eggs, unlike men who produce sperm most of their adult life. In the years approaching menopause, there are fewer and fewer eggs left in the ovary. The quality of eggs also diminishes as a woman gets older. When a woman is in her late thirties, there is an increase in chromosome abnormalities that can result in birth defects like Down syndrome.
Ageing can also affect other reproductive organs and functions, such as the uterus, hormone production, and ovulation. There is also a higher incidence of miscarriage in women in their late thirties.
Infertility treatments cannot reverse the ageing process and should not be thought of as a safeguard that will ensure a pregnancy at some point in the future. The success rates of IVF for women over 35 are much lower than for younger women.
A low sperm count is the most common cause of male infertility. Abnormalities in sperm shape or their ability to swim can also cause infertility problems. These can be due to hormonal imbalances, infection, or testicular varicocele.
A total absence of sperm (known as ‘azoospermia’) in the ejaculate can be caused by testicular damage, mumps, anatomical disorders, or lack of hormones.
Some men produce antibodies to their own sperm, which prevent the sperm from penetrating the egg. The exact cause is not known but may be due to infection or vasectomy.
Spermatic cord occlusion
The spermatic cord is the tube that transports the sperm from each testis to the penis and any blockages will cause infertility. Common causes are vasectomy, infection and some sexually transmitted diseases.
Some ejaculation disorders such as retrograde ejaculation – where the semen is ejaculated backwards into the bladder – can prevent proper transfer of sperm into the vagina without the man being aware of the problem.
Until recently, ageing was considered a risk factor only for female fertility. However, recent research shows ageing affects sperm function too. Sperm that swim in a straight line have a far better chance of making their way through the female reproductive tract to reach the egg. But the swimming ability of a man’s sperm declines as the man ages. The older a man gets the greater the chance of genetic abnormalities in the sperm itself.Unexplained infertility
In approximately ten per cent of couples, both partners may appear fine but are still unable to become pregnant. While it is easier to treat couples where the cause of infertility is obvious, couples with unexplained infertility can also be treated.
Identifying the cause of your infertility is important as it may affect the choice of treatment.
A series of hormone injections will be given to the woman in order to stimulate egg growth and ovulation. If ovulation can be successfully induced, conception may occur naturally.
Artificial insemination is used in cases where the male has a low sperm count, a high number of abnormal sperm or the woman has sperm antibodies present in her cervical mucus. Sperm is treated in the laboratory to increase the chances of fertilisation. Large numbers of sperm are then inserted directly into the uterus for easy access to the fallopian tubes.
IVF (In vitro fertilisation)
IVF is used to treat infertility that arises from blockages of the fallopian tubes, endometriosis, abnormal sperm, and some cases of unexplained infertility.
The woman is treated with hormones over a number of weeks to stimulate the growth of several eggs in the ovary. When ripe, the eggs are removed from the ovary and put into a dish with the partner’s (or donor’s) sperm. The fertilised eggs are then grown in the laboratory for a few days before being placed into the uterus.
GIFT (Gamete intrafallopian transfer)
This procedure is the same as that for IVF except that fertilisation takes place inside the body of the woman. The eggs and sperm are collected and placed directly into the fallopian tubes for fertilisation to occur. GIFT is used for cases of endometriosis, cervical disorders, and some types of male infertility. GIFT is suitable only for women with no abnormalities in the fallopian tubes.
ZIFT (Zygote intrafallopian transfer)
The same procedure as IVF except the very early embryo (zygote) is placed directly into the fallopian tube. This procedure is undertaken when there are abnormal sperm and/or problems with the ability of the sperm to fertilise the eggs.
ICSI (Intracytoplasmic sperm injection)
This is a technique in which a single sperm is inserted directly into the egg. Eggs are obtained the same way as for IVF and then fertilised by injecting a single sperm into them. The fertilised eggs can be transferred to the woman’s fallopian tubes or grown in the laboratory for a couple of days and then transferred to the uterus.
Epididymal and testicular sperm extraction
Sperm are removed from the epididymis or directly from the testis using a needle. Fertilisation is performed by ICSI (see above). This treatment is used in cases of male infertility (azoospermia), and spermatic cord abnormalities. Usually enough sperm can be collected so that samples can be frozen for later use if required.
Freezing of sperm and embryos
If more embryos are produced through IVF than are needed for transfer into the uterus of the patient, the extra embryos can be frozen. The stored embryos can be used later if the patient fails to become pregnant or if the couple wishes to have more children through IVF at a later date.
There is a limit to the number of years embryos can be stored frozen and laws governing this may differ in each state (see Costs & legal issues).
Similarly, sperm can be frozen for use in subsequent IVF cycles or as insurance against infertility due to procedures such as cancer therapies, vasectomy or prolonged absence from a partner (such as men in military service may experience). Sperm can also be frozen and kept in sperm donor banks.
Donor eggs, embryos and sperm
For women who have ovarian failure, men who do not produce sperm, or couples whose eggs fail to fertilise, the use of donor eggs, embryos or sperm may be an option. Older women may also wish to use donor eggs from younger women to overcome the problems of ageing.
Each state has its own laws relating to the use of donor eggs, embryos and sperm (see Costs & legal issues).
Egg donation is a big business in the United States. Women advertise the sale of their eggs in magazines, over the internet and in college newspapers, with price tags of US$6,000 upwards. For a larger fee, there are also ‘egg brokers’ who can arrange to recruit, screen and collect eggs from donors.
Pre-implantation genetic diagnosis (PGD)
PGD is an embryo-screening technique which can be used to identify embryos with chromosome abnormalities. A single cell is removed from an early-stage embryo and screened for genetic disorders using molecular techniques. Only the healthy defect-free embryos are transferred to the woman’s body.
Genetic disorders that can currently be detected in this way include cystic fibrosis, Duchenne muscular dystrophy, thalassemia, haemophilia A, muscular dystrophy, hydrocephalus, Huntington’s disease, imbalances in the number of chromosomes (aneuploidy), and sex-linked disorders. Research is ongoing to develop reliable tests for other genetic disorders.
Note: The information below is based on procedures at Monash IVF, but may vary at other clinics.
What does IVF involve?
Your GP will refer you and your partner to an IVF Clinic. You can chose which clinic you would like to attend or your GP can recommend one for you. In states with legislation, only accredited clinics can offer IVF services. These facilities, doctors and procedures have been thoroughly reviewed to ensure they adhere to certain guidelines. Accredited institutions are listed on the Fertility Society of Australia’swebpage.
Initially, the IVF clinic will perform routine tests to assess the degree of infertility that you and/or your partner may have. These include blood tests, semen analysis, and pelvic ultrasound (see What is infertility? – Diagnosis).
Once your fertility specialist analyses the test results, a treatment program will be planned.
In some states couples may be required to attend counselling before treatment begins. In Victoria it’s a legal requirement to attend one session, however in other states a couple’s participation is recommended but not compulsory. The counselling session give couples the opportunity to discuss any concerns they may have about the treatment with a registered psychologist (see Coping with infertility). The counselling sessions are not designed to assess suitability for infertility treatment.
Those using donor eggs and sperm, will need to discuss with the counsellor issues that relate to identification of the donor (see Costs & legal issues ).
You will need to decide on the number of embryos transferred and whether or not you wish to freeze any extra embryos that may be produced for use at a later date. Your doctor will discuss these issues with you (see Treatment – Freezing of sperm and embryos).
The number of embryos transferred has been an intense point of discussion worldwide. In Australia, generally only one to two embryos are transferred. The greater the number, the greater the chance of achieving a pregnancy, but more embryos also increase the chance of a multiple pregnancy (twins, triplets or more). This can pose an increased risk to the health of both mother and babies. Because IVF is generally less successful in older women, the risk of a multiple pregnancy through IVF declines with age.
An IVF cycle involves a series of steps that may require the administration of hormones (known as having a ‘stimulated’ cycle) and minor surgical procedures. For a stimulated IVF cycle, hormones are given to induce many eggs to grow. Some clinics may require you, your partner or a family friend to administer the hormones, this can be taken orally, through a nasal spray or via an injection. (In contrast, hormones are not used to induce egg growth in a ‘natural’ IVF cycle.) Ultrasound and daily blood tests are used to track egg growth, timing of ovulation and the growth of the lining of the uterus (important for implantation of the embryo.)
In general, you may need two to four IVF cycles to have a fair chance of getting pregnant. Initially you may be required to take the oral contraceptive pill for a minimum of 21 days. This will help to regulate your cycle.
Eggs grow within a multicellular unit called a follicle in the ovary – a fluid filled compartment much like a blister. To stimulate the growth of many follicles in the ovary, daily injections of a hormone called FSH are given for ten to 12 days. The more eggs that can be collected from the ovary, the greater the chance the required number of embryos will be produced.
During this time, one or two ultrasounds will be performed to find out how many follicles are growing, the size of the follicles and in which ovary they are developing. The scan is done by placing a sterile probe inside the vagina.
When the follicles are big enough, you will be given an injection to initiate ripening of the eggs in preparation for egg collection approximately 36 hours later.
Egg collection is a day procedure that is carried out in hospital. You will be given a light anesthetic, and once you are asleep the follicles will be viewed in the ovary using ultrasound. A needle is used to collect the egg from inside each follicle. With the aid of the ultrasound, the needle is pushed through the vaginal wall and into the ovary. The eggs are removed and then put into a special solution in sterile dishes and placed into an incubator in preparation for fertilization.
Your partner will be asked to provide a semen sample close to the time of egg collection. The sperm will be washed and prepared for fertilisation then added to the eggs. Fertilisation should occur 18 to 24 hours later (ie the day after egg collection). At this point you will be notified of the results.
Not all eggs will form embryos and not all embryos have the same chance of developing into a baby. If fertilisation has occurred, then the ‘best’ embryos will be selected for transfer. Some clinics may allow you and your partner to view your embryos in the laboratory before they are transferred.
Embryos may be transferred to the uterus any time from one to seven days after egg collection. The embryo transfer procedure is relatively painless and rarely requires the use of an anaesthetic. Embryos are transferred to the uterus using a fine sterile plastic tube that is passed from the vagina, through the cervix and up into the uterus.
If you have decided to freeze extra embryos it will be done at this point.
Finally, a pregnancy test will be preformed about 16 days after egg collection. The results of the test should be available the same day. If pregnancy is confirmed, further check-ups will be needed.
If you fail to become pregnant and have had extra embryos frozen, these embryos can be transferred at a later date.
What are the chances of success?
When assessing IVF, it must be kept in mind that even in healthy, fertile couples, the chances of becoming pregnant are relatively low.
The overall chance of a baby being born through assisted reproductive technologies is estimated to be 20 per cent – similar to the conception rate experienced by a fertile couple in their twenties having regular unprotected sex.
But the odds vary with the age of the woman, the nature of the infertility problem, the number of embryos transferred and the type of treatment. In general, the older the woman, the lower the success rate.
Rates also vary between clinics and you need to be aware how the information is compiled.
What are the risks?
There is no clear evidence of increase in birth defects in children born as a result of assisted reproductive technologies compared to children born through natural conception. But in cases where infertility is due to inherited factors, IVF may allow these factors to be passed on to children who may then grow up to be infertile themselves.
Multiple pregnancies are associated with lower birth weights and a higher risk of mortality for the baby and the mother. The number of embryos transferred to the uterus should be discussed with your fertility specialist before treatment begins.
IVF involves surgical procedures (for egg collection, or laparoscopy) where local or general anaesthetics are used. There are slight risks associated with these medical treatments, such as infection and bleeding. You should consult your doctor if you have any concerns.
The hormones used to help stimulate the ovary to produce ripe eggs for collection may have minor side effects and can cause a condition called ovarian hyperstimulation. This condition is life-threatening in two per cent of women and is more common in younger women or women with polycystic ovarian disease.
There have been concerns that the incidence of breast, ovarian, uterine or cervical cancers may be higher in IVF patients due to the hormones used to stimulate egg growth. Extensive studies have found no evidence this is the case. However, regular Pap smears and breast examinations before and during infertility treatment are encouraged.
Since IVF is still a relatively young science, long-term health risks for women or their children cannot be definitively ruled out.
For women, there are also risks such as miscarriage as well as hazards inherently associated with pregnancy and birth.
Cost and legal issues
How much does it cost?
The cost of a stimulated IVF cycle – where hormones are used to boost egg numbers – varies between clinics but is approximately $3000. There are additional costs for services such as donor programs, ICSI, PGD, artificial insemination, freezing of sperm and embryos.
Medical appointments and most infertility treatments are covered by Medicare.
If you have private medical insurance then hospital day surgery fees are covered (providing IVF is included in the level of private health insurance that you have).
The “Medicare Plus Safety Net” provides a rebate of approximately 80 per cent of “out of pocket ” fees paid for out-patient services that are provided outside a hospital . It is not applicable for procedures such as oocyte retrieval or ICSI.
More detailed information on the costs of infertility treatments may be obtained from the web sites of IVF clinics.
The laws regarding infertility treatments differ in each state.
Victoria has the most stringent legislation regulating the use of IVF in clinics and for research purposes. In 1995 the Victoria Parliament passed the Infertility Treatment Act 1995. It also set up a regulatory body called the Victorian Infertility Treatment Authority (ITA) to oversee the use of infertility treatments in clinics and research into infertility within Victoria. Doctors, scientists and counsellors involved in infertility treatments in Victoria must obtain approval from ITA.
In Western Australia, the Human Reproductive Technology Act 1991 governs the use of infertility treatments. Likewise in South Australia there is the Reproductive Technology Act, 1988. The remaining states do not have specific legislation but clinics adhere to strict guidelines set out by the National Health and Medical Research Council.
All infertility centres are inspected and accredited by a body of professionals and consumers (patients) established under the auspices of The Fertility Society of Australia. This body is called Reproductive Technology Accreditation Committee and is responsible for the setting of best practice guidelines and standards for infertility treatment in Australia and New Zealand. Failure to achieve accreditation status from this body means that treatment offered by the infertility centre is not covered by the Medicare rebate. Further information regarding RTAC is available on the FSA website http://www.fsa.au.com
Storage of eggs, embryos and sperm
There are laws that govern how long gametes (eggs and sperm) and embryos can be frozen. These laws are enforced to ensure the decision-making process regarding the use or disposal of gametes and embryos is kept with the couples who produced them.
In Victoria, eggs and sperm can be stored for a maximum of ten years, and embryos for a maximum of five years (although the ITA can grant an extension).
If you have stored eggs or embryos you have the following options:
- use them yourself
- donate them to another couple
- dispose of them
- donate them to research.
Donor eggs, embryos and sperm
Where legislation exists, donor gametes (eggs and sperm) can only be used if defects in the gametes will not allow fertilisation to occur or if there is the possibility that a gamete carries a genetic abnormality that can be passed onto the child.
In Australia, it is against the law to buy eggs from donors. Some clinics offer an egg donation service where women may donate their eggs to infertile couples. However, due to lengthy waiting lists and very few donors, clinics will encourage you to find your own donor.
With regard to parental rights, the law recognises that the woman who gives birth to the child is the mother, regardless of the child’s genetic origins.
There is different legislation for freezing sperm depending on the intended use. If sperm is to be used to fertilise your partner’s eggs to produce a child, then you will have legal and social obligations to care and support that child. If the sperm is to be donated, the only obligations you have are to undergo counselling and testing for transmissible diseases prior to donating.
Laws governing information access vary in each state. In Victoria, legislation dictates that a compulsory register must be kept detailing identifying information of donors and their offspring. Donors can find out how many children have been born from their donations. And children born from donated gametes or embryos can apply for their birth origin information once they reach the age of 18.
In NSW, there are no laws regarding identification issues for gamete and embryo donors or children. However, IVF clinics recommend that the donor be someone you know in order for the child to maintain some level of contact with their genetic ‘parent’.
Whether you are male or female, enhancing your general health can have positive effects on your fertility. Incorporating the following into your lifestyle before and during the time you are trying to conceive could be beneficial:
Quit smoking. Smoking has been linked to low sperm counts and sluggish sperm motility in men and an increase in miscarriage in women.
Reduce your alcohol intake. Alcohol (especially binge drinking or chronic abuse), affects the fertility of both men and women trying to conceive either naturally or through infertility treatments. Alcohol is toxic to sperm, reduces sperm counts, can interfere with sexual performance, disrupt hormone balances and increases the risk of miscarriage.
For women, no more than one to two standard drinks a day is recommended. For men, the limit is slightly higher – three to four standard drinks a day.
While the inability to conceive can place stress on a relationship, avoid the temptation to relieve the stress using alcohol. Other useful methods include meditation, relaxation, moderate physical activity and yoga.
Eat a balanced diet. A well-balanced diet includes carbohydrates, protein and fibre. All women should increase folic acid intake (found in green leafy vegetables, fruit, cereals, but also available as supplements) prior to and during the first three months of pregnancy.
Exercise moderately. Excessive exercise can lead to menstrual disorders in women and affect sperm production in men due to the heat build-up around the testicles.
Avoid environmental poisons and hazards such as pesticides, lead, heavy metals, toxic chemicals, and ionising radiation.
Check with your doctor that any medication or herbal remedies (prescribed or over-the-counter) that you may be taking do not affect fertility.
Give up recreational drugs such as marijuana and cocaine as these have been linked to low sperm counts in men and infertility in women.
Women in particular should:
Lose weight if you are overweight. Being overweight can decrease your chances of becoming pregnant. This can be achieved through moderate exercise and a balanced diet, both of which have positive effects on fertility.
Men in particular should:
Wear loose-fitting underwear such as cotton boxer shorts. Tight-fitting underwear can lower sperm production.
Prevent overheating. Stay clear of saunas, spas and hot baths, as heat around the testicles impairs sperm production.
New or improved infertility treatments are the subject of intensive scientific investigation. The following treatments are considered ‘experimental’:
Freezing eggs for the future
Having eggs collected and frozen during a woman’s twenties or early thirties may be one way of suspending the ageing process – or at least its effects on eggs. These could be thawed and used in IVF or GIFT procedures later in life.
But while embryos can be successfully frozen, eggs are more difficult and scientists are still working on protocols.
Ovarian tissue freezing and transplantation
Freezing and transplantation of ovarian tissue offers hope for preserving fertility in cancer patients whose eggs might otherwise be damaged by treatments such as chemotherapy or radiotherapy.
The strategy involves freezing pieces of ovarian tissue containing hundreds of eggs before cancer therapies begin. The tissue is then be transplanted back to its original place for conception to occur naturally at a later date. The tissue might even be able to be transplanted to other sites within the body (such as under the skin on the forearm) where the growth of eggs can be more readily monitored. In either case, the eggs might also be collected and fertilised through IVF.
One of the risks with this treatment is that that the stored tissue may contain cancer cells, which could reinfect the patient after transplantation. Therefore it may be appropriate only for patients with cancers that have virtually no chance of spreading to other parts of the body.
While the freezing of ovarian tissue is a simple and easy procedure – and may be offered already at some IVF clinics – its transplantation back into the body is still highly experimental. To date, three babies have been born using this technology. In light of these encouraging results, researchers continue to refine and evaluate this technique.
Long-term storage of ovarian tissue may allow options for women to better manage their fertility in the future. Ovarian tissue frozen during young adulthood could be used as an insurance policy against infertility in the future, either due to aging or other factors. Since ovarian transplants also produce sex hormones, the method could also be used as a form of hormone replacement therapy.
There are currently no safeguards for boys facing sterility after cancer treatments. They do not produce sperm – that could be collected and frozen for later use – until after puberty. However, the ability to transplant primitive sperm cells in the testes, known as stem cells, may be an option in the future.
Sperm start out as stem cells before undergoing a complex developmental process. Animal studies have shown these stem cells can be removed from the testes, frozen and transplanted back at a later date without harming their ability to grow into healthy sperm that can fertilise eggs and produce offspring.
This may be a strategy to guard against possible future infertility in adult men too. Although sperm itself can be frozen, having stored stem cells might mean an unlimited volume of sperm could be produced at a later time.
Adhesion – the abnormal formation of a fibrous tissue between two organs, usually as a result of surgery.
Antibodies – proteins produced by the immune system to destroy something it recognises as foreign. The abnormal presence of antibodies to sperm in a woman’s body can prevent sperm from recognising and therefore fertilising an egg.
Androgen – male sex hormone such as testosterone
Artificial insemination – placing sperm into the reproductive tract of a woman.
Azoospermia – the absence of sperm in an ejaculate.
Cervical mucus – mucus produced by the cervix through which sperm must pass to gain access to the uterus and fallopian tubes. The amount and texture of the mucus changes at the time of ovulation.
Cervix – opening of the uterus. It is found between the body of the uterus and the vagina.
Chromosome – package of highly-coiled DNA in a cell, usually shaped like an X. There are 46 chromosomes (23 pairs) in most body cells but just one from each of the 23 pairs exist in healthy eggs and sperm.
Conception – when a sperm fertilises an egg to from an embryo.
Cystic fibrosis – a genetically inherited disease that affects the lungs and gut.
Down Syndrome – a condition where an individual has an extra copy of chromosome 21 resulting in mental retardation, characteristic body shape and abnormalities of the heart and other organs.
Duchenne muscular dystrophy – an inherited type of muscular dystrophy characterised by rapid muscle weakness starting in the legs and pelvis.
Eggs – female sex cells, found in the ovary.
Ejaculate – fluid released from the penis during orgasm that normally contains sperm.
Embryo – An egg that has been fertilised by a sperm and has started to divide.
Embryo transfer – The placement of embryos into the uterus using a fine sterile tube.
Endometriosis – a condition where the lining of the uterus (which is shed each month), forms at abnormal places inside and outside of the uterus.
Endometrium – Lining of the uterus or womb.
Epididymis – structure on the outside of the testis which connect the testis to the spermatic cord. It is the location of sperm maturation and storage before ejaculation.
Fallopian tube – a tube that stretches from the ovary to the uterus.
Fertilisation – when a sperm enters the egg to form an embryo.
Fibroids – benign growths of the muscle layer of the uterus.
Foetus – an unborn individual in the later stages of development – in humans, from seven to eight weeks after fertilisation until birth.
Follicle – an egg surrounded by support cells.
Follicle stimulating hormone – FSH. Hormone produced by the brain that stimulates the growth of follicles in the ovary and sperm development in the testes.
Gametes – eggs and sperm.
GIFT – gamete intrafallopian tube transfer.
Haemophilia A – a rare heritable bleeding disorder where there is a shortage of one of the blood clotting factors (clotting factor VIII).
hCG – human chorionic gonadotrophin. A hormone produced by the embryo after it has attached to the uterus. It has similar properties to luteinizing hormone and is used to induce maturation of eggs in the ovary during an IVF cycle.
Hormone replacement therapy – a treatment where synthetic hormones are given to help overcome menopausal symptoms.
Huntington’s disease – a progressive genetic disorder involving the degeneration of nerve cells in the brain. It is characterised by abnormal movements of the body and mental decline.
Hydrocephalus – a disorder associated with the build up of fluid in the brain resulting in brain damage.
ICSI – intracytoplasmic sperm injection. A technique where a single sperm is injected directly into the egg.
IVF – in vitro fertilisation. Infertility treatment where eggs and sperm are placed in vitro (meaning ‘in glass’) for fertilisation to occur outside the body.
Laparoscopy – surgical procedure in which a small camera is inserted into the abdominal cavity so that internal organs can be viewed.
Luteinizing hormone – LH. Hormone produced by the brain that is involved in egg maturation and ovulation in women. In men, it is involved in the production of testosterone.
Miscarriage – spontaneous loss of an embryo or foetus from the uterus.
Muscular dystrophy – a group of diseases that results in progressive weakness and loss of muscle tissue.
Oestrogen – female sex hormone produced by the large growing follicles in the ovary.
Ovarian hyperstimulation – a condition (sometimes fatal) where the ovaries become enlarged, painful and release fluid into the abdomen. It can occur in response to over stimulation with hormones, usually follicle stimulating hormone, in infertility treatments.
Ovary – one of two reproductive organs in a female that produce eggs and secrete estrogen and progesterone.
Ovulation – the process where the follicle opens to release the egg from the ovary. Occurs in response to luteinizing hormone.
Polycystic ovarian disease – condition where the ovary contains numerous cysts, ovulation is disrupted and hormone levels (particularly testosterone) are abnormal.
Polyps – benign growths of the inner wall of the uterus
Progesterone – female sex hormone produced after ovulation in the ovary. The main hormone produced during pregnancy.
Sperm – the male sex cells, produced in the testes.
Sperm count – a method of analysing the volume of semen, number, shape and motility of sperm. A normal sperm count contains on average 60 million sperm per millilitre of semen, of which 50 per cent are healthy, motile sperm.
Spermatic cord – known also as vas deferens. A tube which connects the epididymis to the urethra.
Subfertility – having a reduced likelihood of becoming pregnant due to problems within the reproductive tract.
Testicular varicocele – swelling of the blood vessels around the testes.
Thalassemia – a group of genetic blood diseases where the molecules inside red blood cells that carry oxygen are decreased or absent.
Turner’s Syndrome – a genetic condition where the ovaries fail to fully develop and produce none or very few eggs resulting in total infertility. It occurs when one of the two X chromosomes are missing or incomplete.
Uterus – also known as the womb. The place where the embryo attaches and grows during gestation. It comprises an outer muscular layer called the myometrium and an inner glandular lining called the endometrium. The endometrium is shed each month, resulting in a period.
Vasectomy – surgical procedure where a segment of the spermatic cord is removed to prevent the sperm from being released into the ejaculate.
Zygote – a fertilised egg up to the time it first divides.
- IVF cycle: Interactive animation – Life Changing Science, ABC Science Online
- ACCESS – Australia’s national infertility network
- National Health and Medical Research Council
- Australian Institute of Health and Welfare National Perinatal Statistics Unit
- Donor Conception Support Group
- Australian Infertility Support Group – lists infertility clinics in Australia and New Zealand