FAQs
Browse the FAQs for answers on fertility, medical terms and more
How do I prepare for pregnancy?
Before you start trying to conceive, see your GP to have your medical history checked. This is to make sure you’re in optimum pre-pregnancy health. Your doctor will carry out blood tests to check rubella and chickenpox immunity, perform a pap smear and breast check, and review any medications you may be taking. You and your partner should also be checked for hepatitis B, hepatitis C and HIV. Don’t forget to bring these results to your first appointment.
What’s a fertility window and how do I work out when it is?
A woman produces one egg each month. It’s released from the ovary and collected by the fallopian tube. To conceive naturally, the egg needs to meet with sperm and be fertilised at this point. The fertilised embryo will then enter the uterus, and implant.
So to fall pregnant, the sperm needs to meet the egg at a certain point in your cycle. Taking into account the lifespan of the sperm (five days) and the lifespan of the egg (24 hours), your fertile days are the five days before ovulation, through to the day of ovulation. These six days are known as your ‘fertile window’, and are technically the only time in your cycle you can become pregnant.
Approaching the day of ovulation, your chances of conceiving increase. If you have sex six or more days before you ovulate, it is very unlikely you would conceive. The next day, your chance will have increased to about ten per cent. Over the next few days, the chance will increase steadily, until two days before ovulation, and the day of ovulation. If you have sex on any of these three days, your chance of pregnancy is about 30 per cent, in a normally fertile woman. Once you know your fertile window, you should have sex at least every two days during this time for the best chance of conception.
In the 12 to 24 hours following ovulation, your fertile window quickly closes and it becomes unlikely for you to fall pregnant during that cycle.
To work out your fertile window, you need to know your cycle length. This is calculated from day 1, being the first day of your period, until the next day 1. Once you know your cycle length, you can work out your likely ovulation day. Ovulation day is 14 days before your expected period. In a 28 day cycle, this will be day 14 but in a 35 day cycle, ovulation day will be day 21. Now you can work out your fertile window because it will start 5 days before your ovulation day and finish the day after ovulation day.
If you’re not sure about when your fertile window is, I can help you to track your cycle, and the good news is that sometimes this is all that’s needed for a couple to conceive naturally.
Find out more about your ovulation cycle.
Predict your chance of falling pregnant naturally with the ovulation calculator.
What could be the cause of my infertility?
There are a few issues that could be causing a woman’s infertility. The most common is age, particularly the age of a woman’s eggs. Once you turn 36, your chance of conceiving naturally is half that when you were 20. Women are born with all the eggs they will ever have. As you get older, the number of healthy eggs you produce declines, and chromosomal errors may occur more frequently. If embryos are abnormal, they may not implant, or sadly result in early pregnancy loss.
Endometriosis
Endometriosis is quite a common condition for women, and occurs when the endometrial cells lining the uterus grow outside the uterus. In more severe cases it can have a significant impact on your fertility. Surgery, known as laparoscopy, can be used to both diagnose and treat endometriosis.
Fibroids
Fibroids are also quite common – especially in older women – and they can prevent embryos from implanting. Some fibroids, depending on their location within the uterus, do not reduce fertility. These benign growths in your uterus may not have any associated symptoms. Surgery to remove fibroids is sometimes all you need to be able to fall pregnant naturally.
Polycystic Ovarian Syndrome (PCOS)
This is a hormonal problem that can make it harder to fall pregnant naturally. If you have irregular periods, I may check for PCOS using an ultrasound and blood test. Treatment options include improving your diet and doing moderate exercise, and we can also look at ovulation inducing medication and IVF treatment.
Lifestyle
Health issues and lifestyle factors can also affect your fertility – smoking, excessive alcohol consumption and obesity can all reduce your ability to conceive.
Whatever the problem may be, as you age it becomes more important to act quickly when it comes to your fertility. Seeing a specialist is an important first step to finding out more.
What causes male fertility issues?
Half the couples I treat have issues with male fertility. It can arise from hormonal problems, chromosomal abnormalities or lifestyle factors. Smoking, drinking excess alcohol and obesity can all affect your hormones and your semen quality. But some men simply produce poor quality sperm, regardless of how healthy and active they are, while others might have more serious medical problems.
The most common male fertility problems include:
Azoospermia, where no sperm are produced
Oligospermia, where few sperm are produced
Teratospermia, where a high proportion of sperm is abnormally shaped
Blockages in the vas deferens – the tubes connecting the testes to the outside of the body – due to injury, vasectomy or genetic abnormality.
Sperm can also become malformed or die before they reach the egg. In rare cases, a genetic disease or congenital disorder could be at play, causing your infertility.
To diagnose male infertility, we may need to perform blood tests, chromosome analysis or other tests. The good news is, most causes of male infertility can be overcome. Treatment could include microsurgery, or IVF treatment with ICSI (intracytoplasmic sperm injection).
As age is always a factor in your fertility – especially if your female partner is over 36 – it’s important to see a fertility specialist if you are having trouble conceiving, and to act quickly. I work closely with specialist urologists, if needed, to provide the most up-to-date treatment options and help many couples with male infertility issues to go on to have healthy children.
What is a fertility appointment like?
It’s about getting to know you and your partner, and the issues you’re having falling pregnant. When you come in for your first appointment, my goal is to investigate the potential causes of the difficulties you’re having. We’ll chat about you and your partner’s medical histories, your general health, any previous pregnancies, and how long you’ve been trying to conceive. I might suggest a general examination, a gynaecological examination, and an ultrasound to have a look at the fertility organs. After this initial consultation, there’ll be more to come and as we organise these along the way, I’ll make sure you’re comfortable at every step.
What tests are available to investigate infertility?
Depending on your situation and potential causes of infertility, will determine which tests you may need. I’ll discuss these with you to ensure you understand all you can about them. Some of the most common fertility tests are:
Ovulation investigation
A normal menstrual cycle length is 25 to 35 days. If this is occurring, there is a good chance that an egg is being released each month. There are different ways that this can be confirmed:
Progesterone, which should rise a week after ovulation, can be tested with a blood test
A urinary ovulation test can give you 24 hours warning for when ovulation is likely to occur
A temperature rise can be seen after ovulation
In some cases, I will track your cycle with ultrasounds
Semen analysis
If this is required, I’ll organise it through Melbourne IVF. The sample can be done at home or onsite. If the test day coincides with the day your partner is likely to ovulate, I recommend that you rebook the test.
Blood tests
There are many different types of blood tests that are used to investigate infertility. These tests will be tailored to your individual circumstances. Please bring along any blood tests your GP may have already organised.
Egg timer (AMH) test
The egg timer test is a type of blood test – it’s also known as the Anti-Mullerian Hormone (AMH) blood test. This test gives an indication of whether your egg numbers are low, normal or high for your age, although it doesn’t provide information about egg quality.
Tubal patency test
This test is done to confirm that there is a pathway for sperm and eggs to meet. It involves the passage of a catheter through the cervix and the injection of a liquid, which can be seen on ultrasound. Some women do experience period-like cramping, so pain relief medication needs to be taken an hour before the procedure.
Laparoscopy
A laparoscopy is performed as a day procedure. It’s keyhole surgery – a minimally invasive procedure that involves passing a telescope through the umbilicus. It can be used to diagnose and treat some causes of infertility, and is commonly used to correct endometriosis. It’s often combined with a hysteroscopy, which involves passing a telescope through the cervix to look at the inside of the uterus.
If you need any of these investigations, I’ll talk to you about them, give you all the information you need and you can ask all the questions you want!
Other than IVF, what treatments can help us conceive?
Tracking your cycle
Understanding your ‘fertile window’ is important, and whether your periods are regular or infrequent. For many women, having spent many years trying not to fall pregnant, it can be difficult to know where to start when you decide to reverse all that. Especially if you’ve been on the pill, I understand that you may need some advice on where to start. If your cycle is irregular, we may need to consider medication to help you get back on track, or more fertility tests.
You can try keeping track of your cycles yourself. Record your first day of bleeding – this is your day one – and how many days there are until your next period starts – your cycle length. A typical cycle is about 28 days, but can vary quite a lot. Make note of this information – it will be helpful for me, and ultimately, you.
A period calculator can help you manage your cycles. There are some good apps you can use to help guide you, but it’s not essential to use these.
Ovulation tests are also helpful to let me know which day of your cycle you ovulate, which may vary slightly from month to month. Urine tests are good ways to determine when this is, and much more reliable than the saliva tests available. There are different brands of urine tests out there – be mindful that cheap ones may not be as effective.
Working out when you ovulate is crucial, and I can help you do this if need be. Once we understand that, we can calculate the best time in your cycle to have sex. I have seen how couples trying to conceive for a long time often find it difficult to have sex day after day. Narrowing down the days when you need to try can help both of you, emotionally and physically.
Ovulation induction
I always like to start with the least invasive techniques, and this is one of them. For women with irregular periods, occasional periods or no periods, I will usually recommend medication to induce normal follicle development and regular ovulation, with the goal of conceiving naturally. Depending on your situation, I may also suggest this to you if you have regular menstrual cycles but unexplained infertility.
Treatment for ovulation induction
The most common medicine for this is clomiphene citrate. It blocks oestrogen receptors, tricking the brain into producing increased amounts of follicle stimulating hormone (FSH). Usually this causes one or more mature follicles to develop, and ovulation follows. It’s common for women who have this treatment to experience temporary hot flushes, because their oestrogen receptors have been blocked.
Another common method of Ovulation Induction involves injections of FSH, which work directly on the ovaries to develop a follicle or (follicles). Both of these methods, especially FSH injections, carry the risk of multiple follicles developing. If you’re having one of these treatments, I’ll perform ultrasounds to check the number and growth of the follicles, and will discuss any risks with you.
After the follicle has developed I may also use another injection of synthetic human chorionic gonadotropin (hCG) to trigger the release of the egg from the follicle. I’ll guide you about when the best time to have sex will be. Ovulation Induction may be used in conjunction with timed intercourse or intrauterine insemination (IUI), which introduces the sperm into the uterus at the optimal moment.
What Causes Ovulation Disorders?
Often the problem behind irregular or absent ovulation is hormonal, such as polycystic ovarian syndrome. It may also involve a signalling problem between the brain and the ovaries, which occurs often in women who exercise at a very high level, women who are underweight, and women who do shift work, like flight attendants.
Other less common and more serious causes are premature menopause or premature ovarian failure with damage to eggs and follicles. These conditions cannot usually be helped by ovulation induction, so I will discuss other options with you.
Artificial insemination
I may recommend artificial insemination if you’re experiencing short-term unexplained infertility or sexual difficulties, or minor sperm quality issues. This is a simple, non-invasive procedure. Because it involves fewer hormones and no surgical procedure, it’s often used as an initial treatment before moving onto more complex ones like IVF.
Intrauterine insemination (IUI)
The method of artificial insemination used by Melbourne IVF fertility specialists is intrauterine insemination, which involves inserting the prepared sperm sample into the uterus immediately before ovulation, using a very thin catheter.
Sperm is prepared so that the best and fastest moving sperm are used for insemination. I place the sperm close to the eggs, but not directly beside them – the sperm still need to find and fertilise the eggs naturally. The chance of pregnancy with IUI is lower than with IVF, but because it is a less involved, less invasive procedure, it is a good first step for some couples.
We can perform this procedure during a natural cycle or in conjunction with Ovulation Induction. I’ll discuss the best option with you.
Before the procedure, we’ll track your natural or hormone cycle with one or two ultrasounds a few days apart. If used with Ovulation Induction, I’ll induce ovulation with an injection of human chorionic gonadotropin (hCG). The insemination will be arranged for ovulation time, using sperm provided by your partner on the day.
About two weeks after the procedure I’ll ask you to take a pregnancy test, and repeat the process if necessary. It’s normal to have to repeat this procedure several times, before moving into other treatments.
Using donor sperm
When using donor sperm, artificial insemination is one method we can use to help you conceive. Donor sperm may be recommended for serious abnormalities in the man’s sperm production, or if there is a high chance of passing on a genetic disease. It’s also an option for single women and same-sex couples.
Donors are screened to exclude genetic diseases and are quarantined to prevent infection. You can access donor sperm either through the Melbourne IVF sperm bank, or from someone you know, once the appropriate counselling and quarantine has occurred. Find out more about using donor sperm.
What is IVF?
IVF Treatment
IVF, or in vitro fertilisation, is the best chance many couples or single women have of becoming pregnant. Depending on your needs, I may recommend IVF to help you fall pregnant if you have any one of a number of fertility issues. We can also use IVF in cases of sperm abnormalities, endometriosis, tubal damage, unsuccessful ovulation induction or unexplained infertility.
How does the IVF process work?
During IVF, the sperm fertilises the egg in the laboratory, rather than in the woman’s fallopian tube. The egg is placed with many thousands of sperm and fertilisation occurs over a number of hours in a culture dish maintained under ideal conditions in the laboratory.
The fertilised embryo grows in the lab for two to five days, before it’s transferred into the woman’s uterus in a simple procedure called embryo transfer. This procedure involves a very fine tube being passed through the cervix and into the uterine cavity.
Additional embryos are usually stored by freezing them for use in later treatments if needed, or for future children.
ICSI Treatment
If there are issues with sperm quality, I may recommend intracytoplasmic sperm injection (ICSI). This is a procedure conducted as part of IVF, which involves a single sperm being injected into each egg. As human eggs are a tenth of a millimetre in diameter and sperm 100 times smaller, ICSI is a very delicate procedure performed by highly skilled embryologists using a very sophisticated microscope.
We can also use ICSI when sperm has been obtained directly from the testes – after vasectomy reversal or in cases of absent vas deferens, for example.
IVF injection videos
Handy reminder videos by our amazing nurse, Eloise, on how to self administer the IVF injections. Most people are a bit worried about the injections, but don’t worry, we will teach you, no problem. Injection teach videos.
If the fertility process is stressful for me, what can I do?
You may want to share your feelings with someone else, like a trusted GP or counsellor. If you’re feeling anxious or depressed, I absolutely recommend it. Talk to your partner about how you’re feeling and make sure you check in with each other regularly, and look after one another on your journey. Regular exercise, sleeping and eating well and time out for yourself is important for keeping balance in your life. Doing things you like to do, planning fun activities with friends or having projects that make you happy, plus having things to look forward to can help you maintain perspective. While your fertility journey may feel all encompassing at times, it’s important not to let it overtake your life.
Who is the best IVF doctor in Melbourne?
Dr Fleur Cattrall: “The best IVF doctor for you, is the one who makes you feel empowered with information, in charge and ready to take your next steps. Choose your IVF clinic wisely, check out the Australian government funded website, yourivfsuccess.com.au to compare clinics, but there are many small clinics in Melbourne that have not been open long enough to publish proven success rates.”