Fresh Start – When to seek a second opinion - | IVF Treatment | Monash IVF Australia

Fresh Start – When to seek a second opinion

It can be incredibly frustrating for couples when the New Year rolls around and after what seems like a lifetime – they’re still not pregnant. 

It’s around this time that many start to struggle with why this isn’t happening as quickly as they may have hoped. There are many different reasons why you may not have had success and discussing these with a fertility specialist is the best step. Monash IVF Fertility Specialist Dr Nicole Hope answers your questions about what to do next.

What is my chance of achieving a pregnancy?

It is helpful to have a frank discussion with your doctor about your individual chance of success. As women age, the pregnancy rates decline, and increasing male age also contributes to lower pregnancy rates.

Even if a woman is young, her chances may be reduced by other gynaecological conditions, such as endometriosis, fibroids or other anatomical abnormalities.

Lifestyle factors also play a part. Being over or underweight both have a negative impact, as well as excessive exercise, smoking, alcohol and caffeine consumption.

Are there any extra investigations I need?

Sometimes it is good to go back to the drawing board and make sure all the basic investigations have been done.  These include hormone blood tests and an ultrasound for women, and a semen analysis (through a fertility laboratory) for men.  A hysteroscopy and laparoscopy (for the woman) is also useful and may diagnose polyps, endometriosis, adhesions, anatomical abnormalities and tubal problems that may have been missed, even if previous ultrasounds have been normal.

Chromosome abnormalities are uncommon, but can be assessed via a blood test for both partners. Investigations for blood clotting and immune disorders in the female can be considered, however, there is limited medical research to support this.

Am I having the right treatment?

Sometimes there is a definable problem which can be addressed with a change of medications or treatment cycle regime.  For example, women with particular hormone deficiencies may benefit from additional hormone supplementation.

While there is no magic pill yet, Monash IVF continues to investigate new therapies and treatment regimes.  It is worthwhile to discuss with your Fertility Specialist about the medical trials currently being offered by Monash IVF, and whether you would be a suitable candidate.

What other options can I consider?

Extended culture of embryos means growing embryos to Day 5 or 6, rather than Day 2 or 3.  While not all embryos will make it to the blastocyst stage (this is the stage of development expected by Day 5 or 6), it is a good way to identify the embryos with the best potential for successful implantation.  Data analysis from Monash IVF and around the world support improved pregnancy rates from blastocyst embryo transfer, compared with Day 2 or 3 embryo transfer.

Pre-Implantation Genetic Screening (PGS) involves further testing of blastocyst embryos to identify those with a normal chromosome pattern. If a woman transfers an embryo that has been identified as normal after PGS, then her chance of pregnancy is significantly increased, even if she is older.  PGS is fast becoming a popular choice for many patients.

Should I change doctors/clinic?

A good fertility specialist should be able to discuss all these investigations and options with you, explain which procedures are appropriate for you and why other options may not be appropriate.

You should also have confidence that your IVF laboratory operates at the highest standards and in-line with current research.  The information communicated between the laboratory and your IVF clinician is vital to give your doctor the information required to identify what extra investigations or treatment changes are required.

While we cannot guarantee all patients will achieve a pregnancy, Monash IVF’s dedication to individualised patient care, rather than a blanket ‘one-size-fits-all’ approach, is a key to our ongoing successes.

We also have the Monash Research and Education Foundation who are dedicated to carrying out world leading research in the field of Reproductive Medicine. Undertaking research in-house allows us to continuously improve our patient treatments.

Monash IVF has a number of fertility specialists with a range of different areas of interest and specialities to assist you on your journey.

What if I want to change my specialist?

If you would like to consult with another Monash IVF fertility specialist and would like to see who might be the best person for you to see, please contact our fertility nurses on 1800 628 533 and they will assist you.  


Nicole Hope 1_Nov 2010Dr Nicole Hope
Fertility Specialist

Dr Nicole Hope is a fertility specialist and gynaecologist who has completed post-graduate specialist training in reproductive endocrinology and infertility (CREI). As a Clinical Director with Monash IVF, Dr Hope specialises in both male and female infertility, offering patients a wide range of treatments including ovulation induction, IUI, IVF, donor treatments and egg freezing.

Dr Hope consults from Box Hill, Bundoora and Clayton. To make an appointment to consult with Dr Hope, please contact us.

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