If you are 35 years old or younger and have been trying to get pregnant unsuccessfully for more than 12 months, it would be worthwhile seeking advice from a fertility specialist at this point. An expert assessment could be especially valuable if you have irregular cycles, or if you or your partner have a history of a known condition that could interfere with fertility.
If you are aged over 35 years old, or if you have a known history of gynaecological or endocrinological problems, you may seek advice after 6 months of trying to conceive.
We will take a complete medical history, perform a comprehensive clinical examination and, depending on your situation, order simple tests (for him: semen analysis and pelvic ultrasound; for her: hycosy test to check if the tubes are blocked, genetic screenings, and blood tests).
During the second consultation, we will draw conclusions and design a plan. Depending on the cause, Dr Reyftmann can offer some medication or lifestyle management (such as weight management or increasing physical exercise) to enhance fertility. If you have polycystic ovary syndrome, these lifestyle therapies can restore ovulation.
If you’re a woman with diagnosed obstructed tubes, a large uterine fibroid, or if Dr Reyftmann suspects endometriosis, he will suggest an operation to confirm the diagnosis and treat the potential causes of infertility. If your fallopian tubes are obstructed beyond any chance of repair, we will proceed to in vitro fertilisation (IVF). If you’re a man with a very low sperm count and motility, he may offer intracytoplasmic sperm injection (ICSI). Intrauterine insemination (IUI) is also a viable fertility treatment option for some patients.
Intrauterine insemination is a process by which sperm are injected in the uterus after having been washed and selected. Fertilisation occurs inside the body. Conversely, IVF is a complex technique where the ovaries are stimulated, and the eggs harvested and fertilised with the sperm to create an embryo outside the woman’s body.
At IRML, IUI is Dr Reyftmann’s first-line option for assisted reproductive technology. It is simpler and cheaper than IVF, but the success rate is also lower. Despite this, it is a good method of conception for single women using donor sperm, same-sex couples, or in case of couples who are experiencing unexplained infertility of short duration with a good prognosis.
Endometriosis is a gynaecological medical condition in which cells from the lining of the uterus (endometrium) appear and grow outside the uterus, most commonly on the ovaries. Symptoms often worsen with your menstrual cycle and may depend on the site of active endometriosis. Its main but not universal symptom is period pain, in various manifestations. Endometriosis is typically seen during your reproductive years. It affects roughly 12-14% of all women and is a common finding among those with infertility.
Imaging (transvaginal ultrasound and MRI) reported by specialists trained in endometriosis has significantly improved over the years to identify endometriosis and may give a diagnosis without surgery. However, laparoscopy (keyhole surgery) remains the best way to diagnose people with suspected endometriosis after a failed treatment trial, even if the ultrasound or MRI is normal.
Adenomyosis is a condition where tissue that normally lines the inside of the uterus grows into the muscle wall of the uterus. It is affected by oestrogen and can occur with or without endometriosis. Endometriosis and adenomyosis are very similar, but adenomyosis cannot be surgically removed most of the time. Hormonal therapy may be offered as a first-line treatment for adenomyosis, depending on your preference and specific situation.
Polycystic ovarian syndrome (PCOS) is a condition associated with increased levels of two hormones in the body – insulin and androgens (male-type hormones) – that cause symptoms such as irregular periods, excessive facial and body hair, pimples, and weight gain. The condition affects 1 in 10 women and is more common in some high-risk groups, such as Aboriginal and Torres Strait Islander women.
Lifestyle measures with weight loss programs are the first-line of treatment in case of metabolic syndrome and obesity. Ovulation induction tablets or injections are useful in case of infertility. Laparoscopic or fertiloscopic ovarian drilling are rarely needed though can be helpful in select cases. If all other approaches to falling pregnant have failed, Dr Reyftmann can offer IVF.
Infertility is estimated to affect 8-9% of males and about 15% of couples in Australia. It is involved in one third of cases referred for IVF.
It really depends on its cause. If your infertility is caused by lifestyle factors, we can support you to change your behaviour. If medication for a medical condition might be contributing to your infertility, we can find alternative treatments.
We sometimes prescribe hormonal treatment or other medications to treat your infertility, and surgical procedures can be performed to repair varicocele or obstructions of the urogenital tract if these are the cause of the infertility. If treatment of your infertility is unsuccessful, assisted reproductive technologies (ART) with intrauterine insemination (IUI), in vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI) may help you and your partner conceive.
