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

Fresh Start – when to seek a second opinion

Dr Nicole Hope

Fertility Specialist
MBBS.Hon FRANZCOG CREI

View Dr Hope’s profile here

It can be incredibly frustrating if, after a few cycles of IVF, you are not pregnant.

There are different reasons why you may not have had success, and discussing these with your Fertility Specialist is the first step.

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 embryos 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, and 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. The Monash Research and Education Foundation is dedicated to carrying out world leading research in the field of Reproductive Medicine. Undertaking research in house results in continual improvements in patient treatments.

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.

Dr Nicole Hope is a gynaecologist who has completed post-graduate specialist training in reproductive endocrinology and infertility (CREI) and has been a member of the Monash IVF team since 2006. She completed her medical degree with honours at the University of Melbourne in 1998 and subsequently finished her internship and residency at St. Vincent’s Hospital, Fitzroy.

If you would like to book an appointment with Dr Nicole Hope, please complete our online booking form.

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