FERTILITY ASSISTANCE - Embrace Fertility

Fertility Assistance

There are a number of reasons why a woman may be finding it difficult to conceive or carry to full term. It is our job at Embrace Fertility Adelaide to establish what the most likely cause is, and then plan our treatment accordingly. You can find some useful resources at Fertility Portal and below, we have listed some basic information regarding a few of the more common fertility issues:

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Endometriosis

Endometriosis is a condition where the lining of the womb grows outside the uterine cavity.
Symptoms include period pain, but they can vary a lot (and can be asymptomatic).
This can lead to difficulty in conceiving.
The reason is thought to be because endometriotic tissue breaks down in response to the normal cyclical hormones from the menstrual cycle, which generates inflammation and an immune response, thus creating an environment in which eggs, sperm and embryos are not able to function normally.
Treatment includes surgery to remove the lesions from the pelvic cavity and IVF to remove the eggs from the inflammatory pelvic environment.

Dr Hull is a world expert on endometriosis and has helped many women with this condition conceive.

Low Egg Numbers

Anti-Mullerian Hormone blood test (‘The Egg Timer test’) can indicate how many eggs are in the ovaries. This provides information on the likely number of eggs available during IVF and the optimal dose of medication. It also helps determine the speed of treatment and the time frame if considering hi-tech fertility options.
Women with low egg numbers can consider egg freezing to preserve fertility, although it doesn’t guarantee a pregnancy. Younger people undertaking chemotherapy, those with an inherited condition that lowers egg numbers, or those gender transitioning can freeze their eggs. Pregnancy rates are based on the age a woman freezes her eggs or embryos, not on the age she is when she uses her frozen eggs or embryos.
Some medications are thought to improve outcomes for women undertaking IVF with a low ovarian reserve, but more research is needed to determine their value.

Dr Hull has investigated and published a paper to see if growth hormone improved IVF outcomes for women with a low ovarian reserve.

Polycystic Ovarian Syndrome/Disorders of Ovulation

Polycystic ovarian syndrome (PCOS) is a common disorder in women that causes irregular menstrual cycles, hair growth, acne and many small cysts (follicles) in the ovaries.
Women with PCOS have a high number of eggs in the ovaries but their hormones are set in a way that makes it difficult for the eggs to grow and be released.
Treatment mainly involves taking oral tablets (Letrozole or Clomid) and/or injections of follicle-stimulating hormone (FSH) to release the eggs.
Diet and exercise improve fertility and ovulation in women with PCOS.
Many people with PCOS also have high insulin and sugar levels so treatment of these metabolic problems can improve fertility and reduce the risk of miscarriage.
There are other endocrinological or genetic conditions that disrupt ovulation that can be treated.

Dr Hull published two articles related to PCOS in 2018; one on how disorders of sugar metabolism can disturb embryos and the lining of the womb and alter fertility outcomes; the other outlining methods of ovulation induction and when and how to use it.

Recurrent Implantation Failure & Recurrent Miscarriage

Sometimes the reason the embryo hasn’t implanted is because it has too few or too many chromosomes in comparison to a normal, metabolically healthy embryo.
Embryos can be genetically tested to see if this is the reason why pregnancy hasn’t occurred.
Tests for recurrent implantation failure can also identify disorders in the lining of the womb which make it difficult for an embryo to implant.
Several conditions can alter the way the placenta develops, leading to recurrent miscarriage.
There are several treatments for recurrent implantation failure and recurrent miscarriage.

Dr Hull is currently involved in two research projects to develop new ways of identifying and diagnosing implantation disorders and to develop better care pathways for couples with recurrent implantation failure and/or pregnancy loss. She has published an article reviewing the therapeutic use of steroids in treating implantation disorders and has also investigated the use of Intralipid in recurrent pregnancy loss.

Male Factor

There are many causes for a low sperm count which should be fully evaluated. Changes in lifestyle and taking male fertility vitamin supplements can improve male factor infertility.
The technique of intracytoplasmic sperm injection has helped men with very low sperm counts conceive, and IUI and IVF can help men with a moderately low sperm count.
Men who have had a longstanding vasectomy can conceive if sperm is surgically extracted from the epididymis or testes (a procedure which Dr Hull carries out).
Men undertaking chemotherapy, with an unexpected low sperm count, having a vasectomy, gender transitioning, or who work in fly-in fly-out situations, can preserve their fertility by freezing sperm.
Sperm DNA damage can be assessed by specialised tests. New sperm selection methods can identify sperm with less DNA damage for injection in ICSI to improve pregnancy outcomes.