WEBVTT
00:00:01.439 --> 00:00:09.919
Welcome to Prepare, the Mercy Perinatal podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood.
00:00:10.160 --> 00:00:22.399
Mercy Perinatal would like to begin by acknowledging the Rawundri Wuiwarung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today.
00:00:22.640 --> 00:00:31.679
We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.
00:00:32.320 --> 00:00:34.960
Hi everyone, welcome back to another episode of Prepare.
00:00:35.280 --> 00:00:44.000
My name is Rangy DeSilva, and I'm an obstetrician and gynecologist here at the Mercy Hospital for Women, and I'm so excited to be joined again by the lovely Dr.
00:00:44.079 --> 00:00:50.479
Sylvia Ross, who is, as we introduced in our last episode, a fertility specialist based here in Melbourne.
00:00:50.640 --> 00:00:59.359
And she's also the co-host of the podcast Fertility Untamed, which will give you even more information into all of the topics we're talking about.
00:00:59.600 --> 00:01:00.719
But welcome Sylvia.
00:01:00.880 --> 00:01:01.359
Thanks so much.
00:01:01.439 --> 00:01:02.320
It's great to be back.
00:01:02.640 --> 00:01:03.600
Thanks so much.
00:01:04.000 --> 00:01:11.680
Last episode we talked about fertility, what is infertility, when to see any fertility specialist, and what might you expect.
00:01:12.239 --> 00:01:26.640
So the next step, if you are one of those individuals who might need help getting pregnant with what we call assisted reproductive technology or ART for short, what does that actually mean?
00:01:26.799 --> 00:01:30.079
What are all the different options and when might you need that?
00:01:30.400 --> 00:01:31.760
Yeah, look, great question.
00:01:31.920 --> 00:01:37.840
And I and I think it's really important to cover because everyone just assumes that it's IVF and that's all, but also no one really knows what that means.
00:01:38.079 --> 00:01:38.319
Exactly.
00:01:39.519 --> 00:01:40.879
Which we'll have a whole nother episode about.
00:01:41.200 --> 00:01:41.359
Yes.
00:01:41.680 --> 00:01:47.680
Essentially, it's any time that you need to use some kind of medical intervention or assistance to help someone fall pregnant.
00:01:47.840 --> 00:01:53.040
So I like to think of there's sort of your three main treatments that you can have under ART.
00:01:53.280 --> 00:01:58.319
And you're we always start with the simplest where it's appropriate, so something like ovulation induction treatment.
00:01:58.560 --> 00:02:04.159
So this is where people don't ovulate on their own, they're not releasing an egg, so they can't fall pregnant month to month.
00:02:04.319 --> 00:02:05.359
And that's the simplest.
00:02:05.439 --> 00:02:08.400
And this is appropriate for people who are not ovulating.
00:02:08.479 --> 00:02:09.840
So that's important, isn't it?
00:02:10.159 --> 00:02:15.280
Very important and not always adhered to, but it doesn't improve your chances if you're already ovulating.
00:02:15.520 --> 00:02:22.800
But in people, for example, with polycystic ovarian syndrome who don't ovulate on their own month to month, we can help make that happen with medications.
00:02:22.879 --> 00:02:30.400
And that can be either tablets that you just take for five days at the beginning of your period, or through hormone injections as well, for some people who need it.
00:02:30.560 --> 00:02:52.080
And essentially, you would have the treatment, you would come in and have a scan where we would visualize the ovaries and the uterus and try and work out are you growing one of these beautiful follicles on your ovary, which is that little house for the egg that's looking like it might release that egg, at which time we would advise this is your fertile window, and you should be having intercourse, you know, a couple of times this week, for example.
00:02:52.240 --> 00:02:56.159
So that's your most natural method as such, given that it's still intercourse.
00:02:56.240 --> 00:02:58.080
We're just encouraging that egg to release.
00:02:58.400 --> 00:02:59.120
Yeah, great.
00:02:59.360 --> 00:03:03.439
Your next step up would be intrauterine insemination or IUI.
00:03:03.520 --> 00:03:09.039
Um, and this is the treatment which starts very much the same as ovulation induction, where we try and boost that ovulation.
00:03:09.120 --> 00:03:13.280
We may try and get someone to release two eggs, for example, to increase their chances.
00:03:13.520 --> 00:03:21.919
And just when we know ovulation is about to occur, we would have the couple come into the clinic, we'd have the partner with sperm produce a sample.
00:03:22.080 --> 00:03:31.199
The lab would process that down to get the very best sperm in a very small volume, and then that would be placed through a very narrow catheter directly inside the uterine cavity.
00:03:31.360 --> 00:03:42.080
So that's great for people, for example, who have problems with intercourse or they have mild male factor infertility, so sort of mild abnormalities in the semen analysis, but there's still a good number that swim.
00:03:42.240 --> 00:03:44.479
People with a timing, they just haven't quite got it right.
00:03:44.639 --> 00:03:44.800
Yeah.
00:03:44.960 --> 00:03:54.080
Or it's also really good for people with unexplained infertility, so where we haven't found a specific reason conception hasn't occurred, but we can help increase those chances through IUI.
00:03:54.400 --> 00:04:01.680
And then with both of those, I suppose, more with the medical assisted reproduction that you described.
00:04:01.840 --> 00:04:06.639
What are some of the things that we might worry about or some of the risks that people might hear about?
00:04:07.039 --> 00:04:10.080
Risks are exceptionally low with both of those treatments, to be honest.
00:04:10.240 --> 00:04:13.520
I think historically it had a very bad name for multiple pregnancy.
00:04:13.599 --> 00:04:13.840
Yes.
00:04:14.000 --> 00:04:16.639
And of course, our goal is to give you a healthy baby.
00:04:16.720 --> 00:04:16.879
Yeah.
00:04:17.040 --> 00:04:18.720
And one healthy baby.
00:04:18.959 --> 00:04:19.439
Yes.
00:04:19.759 --> 00:04:22.319
It's much less likely if you grow two or three.
00:04:22.480 --> 00:04:22.720
Yes.
00:04:22.879 --> 00:04:26.240
So we know that the risk from multiple pregnancy is significantly higher.
00:04:26.319 --> 00:04:27.920
I'm sure you've got an episode on this.
00:04:28.240 --> 00:04:29.839
We will have an episode on this.
00:04:31.120 --> 00:04:33.360
And we try and avoid multiple pregnancy.
00:04:33.439 --> 00:04:43.439
But look, even in unmonitored cycles where we don't even necessarily know how many follicles people have had, if we look at the data, the rate of twins is still under 5%.
00:04:43.920 --> 00:04:47.120
That's not that different, really, from baseline rate.
00:04:48.000 --> 00:04:52.480
So although although technically I always warn patients it can increase your chance, it's not so bad.
00:04:52.639 --> 00:05:00.959
It used to be higher because people used to be a little bit more rogue with the dosing, and they maybe would let people go ahead where they had three or four eggs released.
00:05:01.120 --> 00:05:03.439
I think for the most part, one or two would be the goal.
00:05:03.600 --> 00:05:14.720
And it would be rare circumstances where you would allow three, and that would usually be people who are sort of much older with a long-standing history of infertility where their chance of conception was so low, it would be reasonable to push it a bit further.
00:05:14.879 --> 00:05:16.639
So overall, very low risk.
00:05:16.800 --> 00:05:18.319
Pretty low risk if it's managed appropriately.
00:05:18.639 --> 00:05:21.519
Yeah, if it's managed appropriately by a fertility specialist.
00:05:21.839 --> 00:05:22.079
Exactly.
00:05:22.319 --> 00:05:24.000
Yeah, with the appropriate monitoring.
00:05:24.800 --> 00:05:26.079
Really good to know.
00:05:27.680 --> 00:05:36.800
On average, how long would you say you find people might need to be trying one of these methods before they can see?
00:05:37.839 --> 00:05:49.439
So if you think about ovulation induction, if someone's not ovulating and we get them to ovulate, we're really just giving them that baseline chance of conception that anyone else would have if there's no other risk factors.
00:05:49.600 --> 00:05:52.160
So, you know, you can't expect to be pregnant from one cycle.
00:05:52.480 --> 00:05:56.800
If you're if you're, you know, 25, you might be 25% chance per cycle.
00:05:57.360 --> 00:06:01.040
If you're 40 or 40 plus, it's going to be low single figures.
00:06:01.360 --> 00:06:04.319
So you have to be realistic and patient selection is important.
00:06:04.560 --> 00:06:10.959
I usually tell someone doing ovulation induction, we will do three cycles before review because we're not really expecting a miracle here.
00:06:11.120 --> 00:06:13.120
We're just trying to get your statistics up there.
00:06:13.439 --> 00:06:18.879
And at the time of review after three cycles, that's when I would start doing further investigation if not previously done.
00:06:19.040 --> 00:06:26.959
So if you haven't assessed tubal patency, which we talked about in the last episode, if you haven't done a semen analysis, that would be the time I'd be doing that.
00:06:27.199 --> 00:06:29.600
Just to say, let's just make sure we haven't missed something else.
00:06:29.759 --> 00:06:31.040
Yeah, and that's we keep going.
00:06:35.120 --> 00:06:35.360
Absolutely.
00:06:35.680 --> 00:06:39.759
So you're going down that treatment path, but you want to make sure you're not missing anything else.
00:06:40.079 --> 00:06:40.879
Yeah, that's right.
00:06:40.959 --> 00:06:47.920
And so that's very well accepted management to not necessarily start with everything and give them an opportunity first.
00:06:48.000 --> 00:06:50.560
And if at that point everything's still normal, they can carry on.
00:06:50.639 --> 00:06:51.519
It's totally reasonable.
00:06:51.839 --> 00:06:59.519
Intraudine insemination, it'll depend a bit on things like um why you're doing IUI, you know, what is the age of the patient, things like that.
00:06:59.759 --> 00:07:10.319
I again often tell people try three before we review the plan if you want to do this anyway, because based on age, you know, your chance of success per cycle is still going to be well under 50%.
00:07:10.800 --> 00:07:14.240
And so we have to be realistic about the number of opportunities we give it.
00:07:14.720 --> 00:07:15.759
Good to know.
00:07:16.079 --> 00:07:26.480
And how long do you, I suppose, recommend someone might keep going with something like their medication before you might think about something else?
00:07:27.120 --> 00:07:32.399
I think sometimes this is often patient-driven, and it depends, you know, how their patients are and how they're going.
00:07:32.800 --> 00:07:38.720
I think if they're a good candidate for ovulation induction, it it's not unreasonable to do that for up to a year if patients want to.
00:07:38.959 --> 00:07:39.120
Okay.
00:07:39.439 --> 00:07:41.600
And you've got to also consider family sizing.
00:07:41.680 --> 00:07:41.920
Yes.
00:07:42.079 --> 00:07:43.120
You know, and age.
00:07:43.279 --> 00:07:51.199
If you have a patient in front of you who is 25 and they want two kids, you're okay to continue if there's no other reason not to.
00:07:51.360 --> 00:07:51.600
Yeah.
00:07:51.839 --> 00:07:56.560
If you have a patient who is 38 and they want two kids, different kind of story.
00:07:56.879 --> 00:08:08.000
Because we know that there's such a significant fertility decline that we don't want to use too much time if something's not working, or we might want to consider moving on to something more active that may give them a higher chance in the future.
00:08:08.160 --> 00:08:13.759
For example, they may do IVF with embryo banking where they're kind of putting some embryos aside for subsequent child.
00:08:14.160 --> 00:08:18.639
And so we don't want to spend too long doing other things if we've got other goals in mind as well.
00:08:18.879 --> 00:08:19.839
Yeah, that's fair enough.
00:08:20.000 --> 00:08:21.600
And again, same with IUI.
00:08:21.920 --> 00:08:23.360
What is the reason that we're doing it?
00:08:23.519 --> 00:08:33.440
If the only reason we're doing it is their intercourse is too difficult for the couple or there's a problem there, there's no reason why you you can't continue for, you know, six plus times, that would be totally fine.
00:08:33.600 --> 00:08:35.759
Um, but it's very personalized.
00:08:35.840 --> 00:08:37.919
You know, there's absolutely no one size fits all.
00:08:38.000 --> 00:08:42.080
You have to look at the couple or the person in front of you and take everything into account.
00:08:42.240 --> 00:08:46.000
You know, for some people the treatment burden, even with simple treatment, can be really high.
00:08:46.159 --> 00:08:46.399
Yeah.
00:08:46.559 --> 00:08:51.600
And they don't have the appetite to continue and want to move on to something else more quickly.
00:08:52.080 --> 00:08:53.039
Yeah, that's important.
00:08:53.120 --> 00:08:58.000
It's all always individualized and personalized, depending on your no couple is the same.
00:08:58.080 --> 00:09:01.679
You know, you're never going to treat one couple the same as the one that just walked out of your door.
00:09:02.080 --> 00:09:03.840
There's so many factors to take into account.
00:09:04.399 --> 00:09:05.200
Really important.
00:09:23.919 --> 00:09:29.200
And you touched on this, the sort of emotional burden of these processes.
00:09:29.600 --> 00:09:35.759
How do you recommend people might deal with that and what is available to help them deal with that?
00:09:36.159 --> 00:09:41.600
So fertility clinics will have a really specific counsellor essential, essentially.
00:09:41.840 --> 00:09:43.519
So they will be available.
00:09:43.679 --> 00:09:49.679
And most places, you know, with each treatment cycle will offer a further session if needed, and people can always take up more if they want.
00:09:49.919 --> 00:09:55.919
Some people will use their GP to get a mental health plan to help them access that in a more financially viable way if they're needing more sessions.
00:09:56.159 --> 00:10:06.000
I think there's a lot to be said for partner support and making sure that you're going into it with the same goals and it can be very difficult because people manage things very differently in a partnership.
00:10:06.159 --> 00:10:06.480
Yes.
00:10:06.639 --> 00:10:08.879
And also having support from people around you.
00:10:09.120 --> 00:10:16.480
So I feel like it's one of the saddest things is there's so much stigma around infertility that often people don't want to tell anyone they know.
00:10:16.639 --> 00:10:16.799
Yeah.
00:10:17.039 --> 00:10:18.559
And I always think this is so crazy.
00:10:18.720 --> 00:10:21.440
If you had a heart problem, you would take heart medication, right?
00:10:21.600 --> 00:10:24.240
And you have a fertility problem, you take fertility medication.
00:10:24.639 --> 00:10:24.879
Exactly.
00:10:25.519 --> 00:10:27.360
People don't see it that way because it's so personal.
00:10:27.519 --> 00:10:27.919
Yes.
00:10:28.080 --> 00:10:31.519
And I think that it's important to have someone to talk to.
00:10:32.080 --> 00:10:38.000
Some people find even listening to podcasts and getting support from that, knowing that there are other people out there is useful.
00:10:38.240 --> 00:10:45.840
The kind of support that I think is probably not so useful would be things like joining Facebook groups where people who have all had a bad experience are talking about it.
00:10:45.919 --> 00:10:46.080
Yeah.
00:10:46.240 --> 00:10:48.320
Because you don't want to fill yourself with negativity.
00:10:48.399 --> 00:10:50.960
You've got to be in a good mind space to get through.
00:10:51.039 --> 00:10:51.200
Yeah.
00:10:51.360 --> 00:10:54.720
And looking after yourself on a really holistic level is important.
00:10:54.799 --> 00:11:02.240
So, you know, everyone we see, we talk about diet, exercise, what what things are you doing for yourself, how are you keeping your body healthy?
00:11:02.399 --> 00:11:02.480
Yeah.
00:11:02.639 --> 00:11:04.480
Because that will also help to keep your mind healthy.
00:11:04.639 --> 00:11:04.799
Yeah.
00:11:05.440 --> 00:11:06.000
What did you think?
00:11:06.159 --> 00:11:06.879
What helped you?
00:11:07.360 --> 00:11:13.840
Yeah, I mean, I found it really difficult that I was not conceiving when I wanted to.
00:11:14.240 --> 00:11:22.240
I also went through a period of of medical ART with a medication called letrazole for about six months.
00:11:22.480 --> 00:11:28.240
And I was ovulating in that time, but we just weren't conceiving, and then moved on to IBF after that.
00:11:28.720 --> 00:11:34.879
Mainly because I was 35 when we started the fertility process, and as you said, age was a factor.
00:11:35.039 --> 00:11:38.799
I knew I wanted more than one, so we didn't want to wait for too long.
00:11:39.200 --> 00:12:06.000
But I did really find that very stressful, and to be honest, particularly because of what I do as an obstetrician gynecologist, coming to work every day became really challenging because, as much as I I love my job, I was finding it really difficult to deal with pregnant patients and delivering babies and seeing gynecology patients, dealing with people having miscarriages, which I also had at one point.
00:12:06.159 --> 00:12:08.159
You know, all of those things were really stressful.
00:12:08.559 --> 00:12:10.960
So emotive, you know, emotional area.
00:12:11.279 --> 00:12:14.399
And you know, even if you're not experiencing it yourself, it's hard.
00:12:14.480 --> 00:12:15.279
So it's hard.
00:12:15.440 --> 00:12:17.039
It's like a whole nother level, isn't it?
00:12:17.120 --> 00:12:17.679
I mean, exactly.
00:12:18.000 --> 00:12:27.600
We did a whole episode on mental health in our first season, um Infertility Untamed, because the three of us in that podcast have also all had infertility, all for different reasons.
00:12:27.919 --> 00:12:28.720
And that's the other thing.
00:12:28.799 --> 00:12:29.759
It's so common.
00:12:30.000 --> 00:12:30.399
Yes.
00:12:30.720 --> 00:12:36.080
Like I mean, I s I know so many people that have suffered with it from one reason or another.
00:12:36.159 --> 00:12:36.320
Yeah.
00:12:36.480 --> 00:12:38.159
And that's the other reason to talk about it.
00:12:38.480 --> 00:12:39.519
Absolutely, that's right.
00:12:39.679 --> 00:12:47.440
And you know, often when people start to open up in their workplace or with their peers, they find out that actually half the people there have been through the same thing and they can become great supports for them.
00:12:47.519 --> 00:12:47.840
Yeah.
00:12:48.000 --> 00:12:52.879
And that can be great when you're trying to juggle working and coming in for scans and doing bits and pieces.
00:12:52.960 --> 00:12:55.279
If you have someone who's there to support you, it's actually really helpful.
00:12:55.519 --> 00:12:55.759
Definitely.
00:12:56.000 --> 00:13:03.759
I think COVID did great things for fertility because working from home became this huge option and now people can kind of sneak away to get things done without feeling like the stigma.
00:13:04.000 --> 00:13:04.480
That's true.
00:13:04.639 --> 00:13:09.600
Yeah, because I did also find that a challenge, trying to fit in the scans and the acute obstetrics.
00:13:09.679 --> 00:13:10.960
You know, the babies aren't gonna wait.
00:13:11.039 --> 00:13:12.799
You can't just niff off for a for a scan.
00:13:12.879 --> 00:13:13.679
It's really hard, isn't it?
00:13:13.759 --> 00:13:14.480
It was the same for me.
00:13:14.879 --> 00:13:15.919
Yeah, yeah, exactly.
00:13:16.080 --> 00:13:20.080
As you said, found it really helpful to talk to friends, talk to colleagues.
00:13:20.159 --> 00:13:26.320
Uh, I did see a psychologist at one point for a period of weeks, and that was really helpful.
00:13:26.399 --> 00:13:26.720
Yeah.
00:13:26.960 --> 00:13:35.759
She was fantastic and I think really helped me as an individual, helped us as a couple, because it was stressful for my partner as well.
00:13:35.840 --> 00:13:39.919
So I think it's really hard, and the way that you deal with the stress is often very different.
00:13:40.240 --> 00:13:43.120
There are not many partnerships where you both deal with stress in the same way.
00:13:43.279 --> 00:13:43.519
Yes.
00:13:43.679 --> 00:13:48.080
You know, there's usually the person who's like, oh, you know, it should be right, we'll just don't worry about it.
00:13:48.240 --> 00:13:50.639
You know, and that's their that's kind of the extent of it.
00:13:50.960 --> 00:13:58.000
Whereas then there's the other partner, not naming any genders, who's, you know, constantly thinking about it, googling, taking that emotional.
00:13:58.559 --> 00:14:02.080
The supplements, working out what's going wrong and blaming themselves, essentially.
00:14:02.159 --> 00:14:05.440
So it's a really hard time.
00:14:05.759 --> 00:14:06.960
It it can be, yeah.
00:14:07.039 --> 00:14:14.720
But I think it's important to know that there's lots of help out there, lots of people that are also dealing with it, and information is important.
00:14:15.120 --> 00:14:15.600
Absolutely.
00:14:15.679 --> 00:14:17.440
And correct information is really important.
00:14:17.519 --> 00:14:23.279
And I think something which I'm really very passionate about is realistic expectations of treatment.
00:14:23.600 --> 00:14:29.600
And it's really important going into treatment to know the likelihood of something working.
00:14:29.840 --> 00:14:36.320
Because and I always say to people, you know, I'm not trying to scare you with the numbers, but I want you to know that if this doesn't work, that's okay.
00:14:36.399 --> 00:14:37.440
That's not unexpected.
00:14:37.519 --> 00:14:38.320
We just keep going.
00:14:38.399 --> 00:14:43.440
There's lots of other things we can do, and not to take that on and take that as an additional burden on yourself.
00:14:43.679 --> 00:14:43.840
Yeah.
00:14:44.080 --> 00:14:51.759
And I think blame is a common or guilt, I suppose I should say, is a common emotion that people might feel.
00:14:52.000 --> 00:14:57.440
So, as you said, it's important to set those expectations and reassure people that it's not their fault.
00:14:57.759 --> 00:14:58.320
That's right.
00:14:58.480 --> 00:15:07.360
And look, I think, you know, with a population where we're seeing people trying for pregnancy later, there's a lot of regret often around, you know, why didn't I try earlier?
00:15:07.519 --> 00:15:11.840
Or many people who have potentially had an unwanted pregnancy previously and decided not to continue.
00:15:12.080 --> 00:15:17.279
And the thing that's really important in those situations is that you made the right choice for you in that time.
00:15:17.360 --> 00:15:17.519
Yeah.
00:15:17.679 --> 00:15:18.879
And you have to accept that.
00:15:18.960 --> 00:15:22.159
You can't go back and worry about you should have done something earlier.
00:15:22.480 --> 00:15:23.919
That's not going to change anything.
00:15:24.159 --> 00:15:24.480
Exactly.
00:15:24.720 --> 00:15:28.080
You did what was right for you then, you do what's right for you now, and you just keep going.
00:15:28.320 --> 00:15:31.679
Yeah, that's really good advice for everything in life in general.
00:15:32.320 --> 00:15:32.879
Write that one down.
00:15:33.279 --> 00:15:33.519
Yeah.
00:15:33.759 --> 00:15:34.879
Have it stuck on my wall.
00:15:35.759 --> 00:15:44.240
Um in terms of the costs of ART, I suppose we'll talk about IVF as a separate topic altogether.
00:15:44.559 --> 00:15:52.080
But for some of these methods that we've just talked about in this episode, what might people expect to pay?
00:15:52.480 --> 00:15:54.639
So, you know, you've got your consult fees.
00:15:54.720 --> 00:15:58.639
So when you see a specialist, you would probably clinics vary quite a lot.
00:15:58.720 --> 00:16:02.080
There'd probably be a three or four hundred dollar type fee for a first consult.
00:16:02.240 --> 00:16:04.639
That's usually a really long consult with both partners.
00:16:05.120 --> 00:16:07.279
If you both attend, there's a rebate for both of you.
00:16:07.600 --> 00:16:11.440
That would be sort of a rough starting point for most first consults.
00:16:11.759 --> 00:16:14.399
Treatment, so something like an ovulation induction cycle.
00:16:14.639 --> 00:16:26.480
So a cycle means from, as we said in the previous episode, from first day period to next first day period, or each opportunity that would be for ovulation induction around$400 or something like that.
00:16:26.879 --> 00:16:30.799
Intrauterine insemination, you're probably looking at more around$2,500.
00:16:31.759 --> 00:16:35.279
And that's every time you get the lab involved, the cost is going to increase.
00:16:35.440 --> 00:16:36.559
There's so many people, you know.
00:16:36.639 --> 00:16:38.159
We all say it takes a village.
00:16:38.240 --> 00:16:42.320
You know, we have something like 30 people working at our clinic, which is quite small in boutique.
00:16:42.480 --> 00:16:45.919
That's just what it takes to run it and to have everything looked after really well.
00:16:46.240 --> 00:16:47.919
And have it be safe and thorough.
00:16:48.240 --> 00:16:48.639
That's right.
00:16:48.720 --> 00:16:53.039
And in Australia, we're really lucky that we have Medicare and there's so many rebates.
00:16:53.200 --> 00:16:59.039
The treatment here is just so much more affordable than in New Zealand where I'm from, and it's amazing, really.
00:16:59.279 --> 00:17:03.200
And the other thing which we should, of course, mention is that in Victoria we have public fertility now.
00:17:03.360 --> 00:17:03.519
Yeah.
00:17:03.759 --> 00:17:06.559
So people who are eligible can be referred to the Royal Women's.
00:17:06.640 --> 00:17:06.799
Yeah.
00:17:06.960 --> 00:17:12.799
We have satellite sites, so I work at the Women's, I also work out at Sunshine or the Western in the public fertility clinics.
00:17:12.880 --> 00:17:20.160
And essentially, if you're eligible for that, you can have treatment where all you pay is your prescription fee for medications and nothing else.
00:17:20.559 --> 00:17:24.319
So the accessibility is really increasing and it is available.
00:17:24.880 --> 00:17:27.759
It's so good, and that's a relatively new thing, isn't it?
00:17:27.920 --> 00:17:28.000
Yeah.
00:17:28.400 --> 00:17:29.200
Which is fantastic.
00:17:29.680 --> 00:17:36.480
Is there a limit to how many cycles or or how long someone can be with that public clinic for?
00:17:36.960 --> 00:17:42.240
So with the public clinic, ovulation induction essentially is you can keep going with that.
00:17:42.400 --> 00:17:46.720
It's not a huge cost to the unit for that, so you can keep going as long as necessary.
00:17:47.200 --> 00:17:56.480
Intraudriine insemination, if eligible for that medically, you could have two cycles of intrautine insemination, and IVF would be two cycles as well.
00:17:56.799 --> 00:17:57.839
You can't go backwards.
00:17:57.920 --> 00:18:04.319
So for example, you might be eligible for two cycles of IUI, and if they don't work, you can still move on to IVF, which is amazing.
00:18:04.640 --> 00:18:06.799
If you start with IVF, you can't go backwards.
00:18:07.279 --> 00:18:08.160
And usually if you start with the same.
00:18:09.839 --> 00:18:10.000
Yeah.
00:18:10.640 --> 00:18:18.559
The problem with that is that if you took a hundred couples and you wanted more than half of them to have a baby, everyone would be doing three cycles.
00:18:18.960 --> 00:18:22.319
So there'll be a lot of people who won't actually get a baby through that process.
00:18:22.559 --> 00:18:28.240
But we also see a lot of people who have done treatment elsewhere then come or that might move on to treatment elsewhere if they need to as well.
00:18:28.400 --> 00:18:28.559
Yeah.
00:18:28.799 --> 00:18:32.799
But it certainly gives people an opportunity who otherwise may not have had it, which is really incredible.
00:18:33.039 --> 00:18:34.160
Yeah, it is incredible.
00:18:34.240 --> 00:18:34.640
Yeah.
00:18:34.960 --> 00:18:35.519
Great.
00:18:35.680 --> 00:18:36.400
Awesome.
00:18:36.640 --> 00:18:38.240
Well, thank you so much, Sylvia.
00:18:38.400 --> 00:18:45.200
That was a really great summary of assisted reproductive techniques other than IVF, sort of before you get to that process.
00:18:45.279 --> 00:18:49.359
And we will of course talk about that in much more detail because there's lots to chat about there.
00:18:49.680 --> 00:18:56.960
But I really appreciate you sharing a bit of your own personal history as well, and obviously your expertise in this area.
00:18:57.039 --> 00:18:59.119
It's really reassuring and important information.
00:18:59.279 --> 00:19:00.160
So thank you so much.
00:19:00.400 --> 00:19:01.599
Thank you so much for having me again.
00:19:01.680 --> 00:19:02.400
It was great.
00:19:02.720 --> 00:19:04.319
Every pregnancy is unique.
00:19:04.480 --> 00:19:09.759
The information provided in today's podcast is for educational and general purposes only.
00:19:09.920 --> 00:19:13.759
It is not intended to be substitute for professional medical advice.
00:19:13.920 --> 00:19:23.839
It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.
00:00:01.439 --> 00:00:09.919
Welcome to Prepare, the Mercy Perinatal podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood.
00:00:10.160 --> 00:00:22.399
Mercy Perinatal would like to begin by acknowledging the Rawundri Wuiwarung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today.
00:00:22.640 --> 00:00:31.679
We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.
00:00:32.320 --> 00:00:34.960
Hi everyone, welcome back to another episode of Prepare.
00:00:35.280 --> 00:00:44.000
My name is Rangy DeSilva, and I'm an obstetrician and gynecologist here at the Mercy Hospital for Women, and I'm so excited to be joined again by the lovely Dr.
00:00:44.079 --> 00:00:50.479
Sylvia Ross, who is, as we introduced in our last episode, a fertility specialist based here in Melbourne.
00:00:50.640 --> 00:00:59.359
And she's also the co-host of the podcast Fertility Untamed, which will give you even more information into all of the topics we're talking about.
00:00:59.600 --> 00:01:00.719
But welcome Sylvia.
00:01:00.880 --> 00:01:01.359
Thanks so much.
00:01:01.439 --> 00:01:02.320
It's great to be back.
00:01:02.640 --> 00:01:03.600
Thanks so much.
00:01:04.000 --> 00:01:11.680
Last episode we talked about fertility, what is infertility, when to see any fertility specialist, and what might you expect.
00:01:12.239 --> 00:01:26.640
So the next step, if you are one of those individuals who might need help getting pregnant with what we call assisted reproductive technology or ART for short, what does that actually mean?
00:01:26.799 --> 00:01:30.079
What are all the different options and when might you need that?
00:01:30.400 --> 00:01:31.760
Yeah, look, great question.
00:01:31.920 --> 00:01:37.840
And I and I think it's really important to cover because everyone just assumes that it's IVF and that's all, but also no one really knows what that means.
00:01:38.079 --> 00:01:38.319
Exactly.
00:01:39.519 --> 00:01:40.879
Which we'll have a whole nother episode about.
00:01:41.200 --> 00:01:41.359
Yes.
00:01:41.680 --> 00:01:47.680
Essentially, it's any time that you need to use some kind of medical intervention or assistance to help someone fall pregnant.
00:01:47.840 --> 00:01:53.040
So I like to think of there's sort of your three main treatments that you can have under ART.
00:01:53.280 --> 00:01:58.319
And you're we always start with the simplest where it's appropriate, so something like ovulation induction treatment.
00:01:58.560 --> 00:02:04.159
So this is where people don't ovulate on their own, they're not releasing an egg, so they can't fall pregnant month to month.
00:02:04.319 --> 00:02:05.359
And that's the simplest.
00:02:05.439 --> 00:02:08.400
And this is appropriate for people who are not ovulating.
00:02:08.479 --> 00:02:09.840
So that's important, isn't it?
00:02:10.159 --> 00:02:15.280
Very important and not always adhered to, but it doesn't improve your chances if you're already ovulating.
00:02:15.520 --> 00:02:22.800
But in people, for example, with polycystic ovarian syndrome who don't ovulate on their own month to month, we can help make that happen with medications.
00:02:22.879 --> 00:02:30.400
And that can be either tablets that you just take for five days at the beginning of your period, or through hormone injections as well, for some people who need it.
00:02:30.560 --> 00:02:52.080
And essentially, you would have the treatment, you would come in and have a scan where we would visualize the ovaries and the uterus and try and work out are you growing one of these beautiful follicles on your ovary, which is that little house for the egg that's looking like it might release that egg, at which time we would advise this is your fertile window, and you should be having intercourse, you know, a couple of times this week, for example.
00:02:52.240 --> 00:02:56.159
So that's your most natural method as such, given that it's still intercourse.
00:02:56.240 --> 00:02:58.080
We're just encouraging that egg to release.
00:02:58.400 --> 00:02:59.120
Yeah, great.
00:02:59.360 --> 00:03:03.439
Your next step up would be intrauterine insemination or IUI.
00:03:03.520 --> 00:03:09.039
Um, and this is the treatment which starts very much the same as ovulation induction, where we try and boost that ovulation.
00:03:09.120 --> 00:03:13.280
We may try and get someone to release two eggs, for example, to increase their chances.
00:03:13.520 --> 00:03:21.919
And just when we know ovulation is about to occur, we would have the couple come into the clinic, we'd have the partner with sperm produce a sample.
00:03:22.080 --> 00:03:31.199
The lab would process that down to get the very best sperm in a very small volume, and then that would be placed through a very narrow catheter directly inside the uterine cavity.
00:03:31.360 --> 00:03:42.080
So that's great for people, for example, who have problems with intercourse or they have mild male factor infertility, so sort of mild abnormalities in the semen analysis, but there's still a good number that swim.
00:03:42.240 --> 00:03:44.479
People with a timing, they just haven't quite got it right.
00:03:44.639 --> 00:03:44.800
Yeah.
00:03:44.960 --> 00:03:54.080
Or it's also really good for people with unexplained infertility, so where we haven't found a specific reason conception hasn't occurred, but we can help increase those chances through IUI.
00:03:54.400 --> 00:04:01.680
And then with both of those, I suppose, more with the medical assisted reproduction that you described.
00:04:01.840 --> 00:04:06.639
What are some of the things that we might worry about or some of the risks that people might hear about?
00:04:07.039 --> 00:04:10.080
Risks are exceptionally low with both of those treatments, to be honest.
00:04:10.240 --> 00:04:13.520
I think historically it had a very bad name for multiple pregnancy.
00:04:13.599 --> 00:04:13.840
Yes.
00:04:14.000 --> 00:04:16.639
And of course, our goal is to give you a healthy baby.
00:04:16.720 --> 00:04:16.879
Yeah.
00:04:17.040 --> 00:04:18.720
And one healthy baby.
00:04:18.959 --> 00:04:19.439
Yes.
00:04:19.759 --> 00:04:22.319
It's much less likely if you grow two or three.
00:04:22.480 --> 00:04:22.720
Yes.
00:04:22.879 --> 00:04:26.240
So we know that the risk from multiple pregnancy is significantly higher.
00:04:26.319 --> 00:04:27.920
I'm sure you've got an episode on this.
00:04:28.240 --> 00:04:29.839
We will have an episode on this.
00:04:31.120 --> 00:04:33.360
And we try and avoid multiple pregnancy.
00:04:33.439 --> 00:04:43.439
But look, even in unmonitored cycles where we don't even necessarily know how many follicles people have had, if we look at the data, the rate of twins is still under 5%.
00:04:43.920 --> 00:04:47.120
That's not that different, really, from baseline rate.
00:04:48.000 --> 00:04:52.480
So although although technically I always warn patients it can increase your chance, it's not so bad.
00:04:52.639 --> 00:05:00.959
It used to be higher because people used to be a little bit more rogue with the dosing, and they maybe would let people go ahead where they had three or four eggs released.
00:05:01.120 --> 00:05:03.439
I think for the most part, one or two would be the goal.
00:05:03.600 --> 00:05:14.720
And it would be rare circumstances where you would allow three, and that would usually be people who are sort of much older with a long-standing history of infertility where their chance of conception was so low, it would be reasonable to push it a bit further.
00:05:14.879 --> 00:05:16.639
So overall, very low risk.
00:05:16.800 --> 00:05:18.319
Pretty low risk if it's managed appropriately.
00:05:18.639 --> 00:05:21.519
Yeah, if it's managed appropriately by a fertility specialist.
00:05:21.839 --> 00:05:22.079
Exactly.
00:05:22.319 --> 00:05:24.000
Yeah, with the appropriate monitoring.
00:05:24.800 --> 00:05:26.079
Really good to know.
00:05:27.680 --> 00:05:36.800
On average, how long would you say you find people might need to be trying one of these methods before they can see?
00:05:37.839 --> 00:05:49.439
So if you think about ovulation induction, if someone's not ovulating and we get them to ovulate, we're really just giving them that baseline chance of conception that anyone else would have if there's no other risk factors.
00:05:49.600 --> 00:05:52.160
So, you know, you can't expect to be pregnant from one cycle.
00:05:52.480 --> 00:05:56.800
If you're if you're, you know, 25, you might be 25% chance per cycle.
00:05:57.360 --> 00:06:01.040
If you're 40 or 40 plus, it's going to be low single figures.
00:06:01.360 --> 00:06:04.319
So you have to be realistic and patient selection is important.
00:06:04.560 --> 00:06:10.959
I usually tell someone doing ovulation induction, we will do three cycles before review because we're not really expecting a miracle here.
00:06:11.120 --> 00:06:13.120
We're just trying to get your statistics up there.
00:06:13.439 --> 00:06:18.879
And at the time of review after three cycles, that's when I would start doing further investigation if not previously done.
00:06:19.040 --> 00:06:26.959
So if you haven't assessed tubal patency, which we talked about in the last episode, if you haven't done a semen analysis, that would be the time I'd be doing that.
00:06:27.199 --> 00:06:29.600
Just to say, let's just make sure we haven't missed something else.
00:06:29.759 --> 00:06:31.040
Yeah, and that's we keep going.
00:06:35.120 --> 00:06:35.360
Absolutely.
00:06:35.680 --> 00:06:39.759
So you're going down that treatment path, but you want to make sure you're not missing anything else.
00:06:40.079 --> 00:06:40.879
Yeah, that's right.
00:06:40.959 --> 00:06:47.920
And so that's very well accepted management to not necessarily start with everything and give them an opportunity first.
00:06:48.000 --> 00:06:50.560
And if at that point everything's still normal, they can carry on.
00:06:50.639 --> 00:06:51.519
It's totally reasonable.
00:06:51.839 --> 00:06:59.519
Intraudine insemination, it'll depend a bit on things like um why you're doing IUI, you know, what is the age of the patient, things like that.
00:06:59.759 --> 00:07:10.319
I again often tell people try three before we review the plan if you want to do this anyway, because based on age, you know, your chance of success per cycle is still going to be well under 50%.
00:07:10.800 --> 00:07:14.240
And so we have to be realistic about the number of opportunities we give it.
00:07:14.720 --> 00:07:15.759
Good to know.
00:07:16.079 --> 00:07:26.480
And how long do you, I suppose, recommend someone might keep going with something like their medication before you might think about something else?
00:07:27.120 --> 00:07:32.399
I think sometimes this is often patient-driven, and it depends, you know, how their patients are and how they're going.
00:07:32.800 --> 00:07:38.720
I think if they're a good candidate for ovulation induction, it it's not unreasonable to do that for up to a year if patients want to.
00:07:38.959 --> 00:07:39.120
Okay.
00:07:39.439 --> 00:07:41.600
And you've got to also consider family sizing.
00:07:41.680 --> 00:07:41.920
Yes.
00:07:42.079 --> 00:07:43.120
You know, and age.
00:07:43.279 --> 00:07:51.199
If you have a patient in front of you who is 25 and they want two kids, you're okay to continue if there's no other reason not to.
00:07:51.360 --> 00:07:51.600
Yeah.
00:07:51.839 --> 00:07:56.560
If you have a patient who is 38 and they want two kids, different kind of story.
00:07:56.879 --> 00:08:08.000
Because we know that there's such a significant fertility decline that we don't want to use too much time if something's not working, or we might want to consider moving on to something more active that may give them a higher chance in the future.
00:08:08.160 --> 00:08:13.759
For example, they may do IVF with embryo banking where they're kind of putting some embryos aside for subsequent child.
00:08:14.160 --> 00:08:18.639
And so we don't want to spend too long doing other things if we've got other goals in mind as well.
00:08:18.879 --> 00:08:19.839
Yeah, that's fair enough.
00:08:20.000 --> 00:08:21.600
And again, same with IUI.
00:08:21.920 --> 00:08:23.360
What is the reason that we're doing it?
00:08:23.519 --> 00:08:33.440
If the only reason we're doing it is their intercourse is too difficult for the couple or there's a problem there, there's no reason why you you can't continue for, you know, six plus times, that would be totally fine.
00:08:33.600 --> 00:08:35.759
Um, but it's very personalized.
00:08:35.840 --> 00:08:37.919
You know, there's absolutely no one size fits all.
00:08:38.000 --> 00:08:42.080
You have to look at the couple or the person in front of you and take everything into account.
00:08:42.240 --> 00:08:46.000
You know, for some people the treatment burden, even with simple treatment, can be really high.
00:08:46.159 --> 00:08:46.399
Yeah.
00:08:46.559 --> 00:08:51.600
And they don't have the appetite to continue and want to move on to something else more quickly.
00:08:52.080 --> 00:08:53.039
Yeah, that's important.
00:08:53.120 --> 00:08:58.000
It's all always individualized and personalized, depending on your no couple is the same.
00:08:58.080 --> 00:09:01.679
You know, you're never going to treat one couple the same as the one that just walked out of your door.
00:09:02.080 --> 00:09:03.840
There's so many factors to take into account.
00:09:04.399 --> 00:09:05.200
Really important.
00:09:23.919 --> 00:09:29.200
And you touched on this, the sort of emotional burden of these processes.
00:09:29.600 --> 00:09:35.759
How do you recommend people might deal with that and what is available to help them deal with that?
00:09:36.159 --> 00:09:41.600
So fertility clinics will have a really specific counsellor essential, essentially.
00:09:41.840 --> 00:09:43.519
So they will be available.
00:09:43.679 --> 00:09:49.679
And most places, you know, with each treatment cycle will offer a further session if needed, and people can always take up more if they want.
00:09:49.919 --> 00:09:55.919
Some people will use their GP to get a mental health plan to help them access that in a more financially viable way if they're needing more sessions.
00:09:56.159 --> 00:10:06.000
I think there's a lot to be said for partner support and making sure that you're going into it with the same goals and it can be very difficult because people manage things very differently in a partnership.
00:10:06.159 --> 00:10:06.480
Yes.
00:10:06.639 --> 00:10:08.879
And also having support from people around you.
00:10:09.120 --> 00:10:16.480
So I feel like it's one of the saddest things is there's so much stigma around infertility that often people don't want to tell anyone they know.
00:10:16.639 --> 00:10:16.799
Yeah.
00:10:17.039 --> 00:10:18.559
And I always think this is so crazy.
00:10:18.720 --> 00:10:21.440
If you had a heart problem, you would take heart medication, right?
00:10:21.600 --> 00:10:24.240
And you have a fertility problem, you take fertility medication.
00:10:24.639 --> 00:10:24.879
Exactly.
00:10:25.519 --> 00:10:27.360
People don't see it that way because it's so personal.
00:10:27.519 --> 00:10:27.919
Yes.
00:10:28.080 --> 00:10:31.519
And I think that it's important to have someone to talk to.
00:10:32.080 --> 00:10:38.000
Some people find even listening to podcasts and getting support from that, knowing that there are other people out there is useful.
00:10:38.240 --> 00:10:45.840
The kind of support that I think is probably not so useful would be things like joining Facebook groups where people who have all had a bad experience are talking about it.
00:10:45.919 --> 00:10:46.080
Yeah.
00:10:46.240 --> 00:10:48.320
Because you don't want to fill yourself with negativity.
00:10:48.399 --> 00:10:50.960
You've got to be in a good mind space to get through.
00:10:51.039 --> 00:10:51.200
Yeah.
00:10:51.360 --> 00:10:54.720
And looking after yourself on a really holistic level is important.
00:10:54.799 --> 00:11:02.240
So, you know, everyone we see, we talk about diet, exercise, what what things are you doing for yourself, how are you keeping your body healthy?
00:11:02.399 --> 00:11:02.480
Yeah.
00:11:02.639 --> 00:11:04.480
Because that will also help to keep your mind healthy.
00:11:04.639 --> 00:11:04.799
Yeah.
00:11:05.440 --> 00:11:06.000
What did you think?
00:11:06.159 --> 00:11:06.879
What helped you?
00:11:07.360 --> 00:11:13.840
Yeah, I mean, I found it really difficult that I was not conceiving when I wanted to.
00:11:14.240 --> 00:11:22.240
I also went through a period of of medical ART with a medication called letrazole for about six months.
00:11:22.480 --> 00:11:28.240
And I was ovulating in that time, but we just weren't conceiving, and then moved on to IBF after that.
00:11:28.720 --> 00:11:34.879
Mainly because I was 35 when we started the fertility process, and as you said, age was a factor.
00:11:35.039 --> 00:11:38.799
I knew I wanted more than one, so we didn't want to wait for too long.
00:11:39.200 --> 00:12:06.000
But I did really find that very stressful, and to be honest, particularly because of what I do as an obstetrician gynecologist, coming to work every day became really challenging because, as much as I I love my job, I was finding it really difficult to deal with pregnant patients and delivering babies and seeing gynecology patients, dealing with people having miscarriages, which I also had at one point.
00:12:06.159 --> 00:12:08.159
You know, all of those things were really stressful.
00:12:08.559 --> 00:12:10.960
So emotive, you know, emotional area.
00:12:11.279 --> 00:12:14.399
And you know, even if you're not experiencing it yourself, it's hard.
00:12:14.480 --> 00:12:15.279
So it's hard.
00:12:15.440 --> 00:12:17.039
It's like a whole nother level, isn't it?
00:12:17.120 --> 00:12:17.679
I mean, exactly.
00:12:18.000 --> 00:12:27.600
We did a whole episode on mental health in our first season, um Infertility Untamed, because the three of us in that podcast have also all had infertility, all for different reasons.
00:12:27.919 --> 00:12:28.720
And that's the other thing.
00:12:28.799 --> 00:12:29.759
It's so common.
00:12:30.000 --> 00:12:30.399
Yes.
00:12:30.720 --> 00:12:36.080
Like I mean, I s I know so many people that have suffered with it from one reason or another.
00:12:36.159 --> 00:12:36.320
Yeah.
00:12:36.480 --> 00:12:38.159
And that's the other reason to talk about it.
00:12:38.480 --> 00:12:39.519
Absolutely, that's right.
00:12:39.679 --> 00:12:47.440
And you know, often when people start to open up in their workplace or with their peers, they find out that actually half the people there have been through the same thing and they can become great supports for them.
00:12:47.519 --> 00:12:47.840
Yeah.
00:12:48.000 --> 00:12:52.879
And that can be great when you're trying to juggle working and coming in for scans and doing bits and pieces.
00:12:52.960 --> 00:12:55.279
If you have someone who's there to support you, it's actually really helpful.
00:12:55.519 --> 00:12:55.759
Definitely.
00:12:56.000 --> 00:13:03.759
I think COVID did great things for fertility because working from home became this huge option and now people can kind of sneak away to get things done without feeling like the stigma.
00:13:04.000 --> 00:13:04.480
That's true.
00:13:04.639 --> 00:13:09.600
Yeah, because I did also find that a challenge, trying to fit in the scans and the acute obstetrics.
00:13:09.679 --> 00:13:10.960
You know, the babies aren't gonna wait.
00:13:11.039 --> 00:13:12.799
You can't just niff off for a for a scan.
00:13:12.879 --> 00:13:13.679
It's really hard, isn't it?
00:13:13.759 --> 00:13:14.480
It was the same for me.
00:13:14.879 --> 00:13:15.919
Yeah, yeah, exactly.
00:13:16.080 --> 00:13:20.080
As you said, found it really helpful to talk to friends, talk to colleagues.
00:13:20.159 --> 00:13:26.320
Uh, I did see a psychologist at one point for a period of weeks, and that was really helpful.
00:13:26.399 --> 00:13:26.720
Yeah.
00:13:26.960 --> 00:13:35.759
She was fantastic and I think really helped me as an individual, helped us as a couple, because it was stressful for my partner as well.
00:13:35.840 --> 00:13:39.919
So I think it's really hard, and the way that you deal with the stress is often very different.
00:13:40.240 --> 00:13:43.120
There are not many partnerships where you both deal with stress in the same way.
00:13:43.279 --> 00:13:43.519
Yes.
00:13:43.679 --> 00:13:48.080
You know, there's usually the person who's like, oh, you know, it should be right, we'll just don't worry about it.
00:13:48.240 --> 00:13:50.639
You know, and that's their that's kind of the extent of it.
00:13:50.960 --> 00:13:58.000
Whereas then there's the other partner, not naming any genders, who's, you know, constantly thinking about it, googling, taking that emotional.
00:13:58.559 --> 00:14:02.080
The supplements, working out what's going wrong and blaming themselves, essentially.
00:14:02.159 --> 00:14:05.440
So it's a really hard time.
00:14:05.759 --> 00:14:06.960
It it can be, yeah.
00:14:07.039 --> 00:14:14.720
But I think it's important to know that there's lots of help out there, lots of people that are also dealing with it, and information is important.
00:14:15.120 --> 00:14:15.600
Absolutely.
00:14:15.679 --> 00:14:17.440
And correct information is really important.
00:14:17.519 --> 00:14:23.279
And I think something which I'm really very passionate about is realistic expectations of treatment.
00:14:23.600 --> 00:14:29.600
And it's really important going into treatment to know the likelihood of something working.
00:14:29.840 --> 00:14:36.320
Because and I always say to people, you know, I'm not trying to scare you with the numbers, but I want you to know that if this doesn't work, that's okay.
00:14:36.399 --> 00:14:37.440
That's not unexpected.
00:14:37.519 --> 00:14:38.320
We just keep going.
00:14:38.399 --> 00:14:43.440
There's lots of other things we can do, and not to take that on and take that as an additional burden on yourself.
00:14:43.679 --> 00:14:43.840
Yeah.
00:14:44.080 --> 00:14:51.759
And I think blame is a common or guilt, I suppose I should say, is a common emotion that people might feel.
00:14:52.000 --> 00:14:57.440
So, as you said, it's important to set those expectations and reassure people that it's not their fault.
00:14:57.759 --> 00:14:58.320
That's right.
00:14:58.480 --> 00:15:07.360
And look, I think, you know, with a population where we're seeing people trying for pregnancy later, there's a lot of regret often around, you know, why didn't I try earlier?
00:15:07.519 --> 00:15:11.840
Or many people who have potentially had an unwanted pregnancy previously and decided not to continue.
00:15:12.080 --> 00:15:17.279
And the thing that's really important in those situations is that you made the right choice for you in that time.
00:15:17.360 --> 00:15:17.519
Yeah.
00:15:17.679 --> 00:15:18.879
And you have to accept that.
00:15:18.960 --> 00:15:22.159
You can't go back and worry about you should have done something earlier.
00:15:22.480 --> 00:15:23.919
That's not going to change anything.
00:15:24.159 --> 00:15:24.480
Exactly.
00:15:24.720 --> 00:15:28.080
You did what was right for you then, you do what's right for you now, and you just keep going.
00:15:28.320 --> 00:15:31.679
Yeah, that's really good advice for everything in life in general.
00:15:32.320 --> 00:15:32.879
Write that one down.
00:15:33.279 --> 00:15:33.519
Yeah.
00:15:33.759 --> 00:15:34.879
Have it stuck on my wall.
00:15:35.759 --> 00:15:44.240
Um in terms of the costs of ART, I suppose we'll talk about IVF as a separate topic altogether.
00:15:44.559 --> 00:15:52.080
But for some of these methods that we've just talked about in this episode, what might people expect to pay?
00:15:52.480 --> 00:15:54.639
So, you know, you've got your consult fees.
00:15:54.720 --> 00:15:58.639
So when you see a specialist, you would probably clinics vary quite a lot.
00:15:58.720 --> 00:16:02.080
There'd probably be a three or four hundred dollar type fee for a first consult.
00:16:02.240 --> 00:16:04.639
That's usually a really long consult with both partners.
00:16:05.120 --> 00:16:07.279
If you both attend, there's a rebate for both of you.
00:16:07.600 --> 00:16:11.440
That would be sort of a rough starting point for most first consults.
00:16:11.759 --> 00:16:14.399
Treatment, so something like an ovulation induction cycle.
00:16:14.639 --> 00:16:26.480
So a cycle means from, as we said in the previous episode, from first day period to next first day period, or each opportunity that would be for ovulation induction around$400 or something like that.
00:16:26.879 --> 00:16:30.799
Intrauterine insemination, you're probably looking at more around$2,500.
00:16:31.759 --> 00:16:35.279
And that's every time you get the lab involved, the cost is going to increase.
00:16:35.440 --> 00:16:36.559
There's so many people, you know.
00:16:36.639 --> 00:16:38.159
We all say it takes a village.
00:16:38.240 --> 00:16:42.320
You know, we have something like 30 people working at our clinic, which is quite small in boutique.
00:16:42.480 --> 00:16:45.919
That's just what it takes to run it and to have everything looked after really well.
00:16:46.240 --> 00:16:47.919
And have it be safe and thorough.
00:16:48.240 --> 00:16:48.639
That's right.
00:16:48.720 --> 00:16:53.039
And in Australia, we're really lucky that we have Medicare and there's so many rebates.
00:16:53.200 --> 00:16:59.039
The treatment here is just so much more affordable than in New Zealand where I'm from, and it's amazing, really.
00:16:59.279 --> 00:17:03.200
And the other thing which we should, of course, mention is that in Victoria we have public fertility now.
00:17:03.360 --> 00:17:03.519
Yeah.
00:17:03.759 --> 00:17:06.559
So people who are eligible can be referred to the Royal Women's.
00:17:06.640 --> 00:17:06.799
Yeah.
00:17:06.960 --> 00:17:12.799
We have satellite sites, so I work at the Women's, I also work out at Sunshine or the Western in the public fertility clinics.
00:17:12.880 --> 00:17:20.160
And essentially, if you're eligible for that, you can have treatment where all you pay is your prescription fee for medications and nothing else.
00:17:20.559 --> 00:17:24.319
So the accessibility is really increasing and it is available.
00:17:24.880 --> 00:17:27.759
It's so good, and that's a relatively new thing, isn't it?
00:17:27.920 --> 00:17:28.000
Yeah.
00:17:28.400 --> 00:17:29.200
Which is fantastic.
00:17:29.680 --> 00:17:36.480
Is there a limit to how many cycles or or how long someone can be with that public clinic for?
00:17:36.960 --> 00:17:42.240
So with the public clinic, ovulation induction essentially is you can keep going with that.
00:17:42.400 --> 00:17:46.720
It's not a huge cost to the unit for that, so you can keep going as long as necessary.
00:17:47.200 --> 00:17:56.480
Intraudriine insemination, if eligible for that medically, you could have two cycles of intrautine insemination, and IVF would be two cycles as well.
00:17:56.799 --> 00:17:57.839
You can't go backwards.
00:17:57.920 --> 00:18:04.319
So for example, you might be eligible for two cycles of IUI, and if they don't work, you can still move on to IVF, which is amazing.
00:18:04.640 --> 00:18:06.799
If you start with IVF, you can't go backwards.
00:18:07.279 --> 00:18:08.160
And usually if you start with the same.
00:18:09.839 --> 00:18:10.000
Yeah.
00:18:10.640 --> 00:18:18.559
The problem with that is that if you took a hundred couples and you wanted more than half of them to have a baby, everyone would be doing three cycles.
00:18:18.960 --> 00:18:22.319
So there'll be a lot of people who won't actually get a baby through that process.
00:18:22.559 --> 00:18:28.240
But we also see a lot of people who have done treatment elsewhere then come or that might move on to treatment elsewhere if they need to as well.
00:18:28.400 --> 00:18:28.559
Yeah.
00:18:28.799 --> 00:18:32.799
But it certainly gives people an opportunity who otherwise may not have had it, which is really incredible.
00:18:33.039 --> 00:18:34.160
Yeah, it is incredible.
00:18:34.240 --> 00:18:34.640
Yeah.
00:18:34.960 --> 00:18:35.519
Great.
00:18:35.680 --> 00:18:36.400
Awesome.
00:18:36.640 --> 00:18:38.240
Well, thank you so much, Sylvia.
00:18:38.400 --> 00:18:45.200
That was a really great summary of assisted reproductive techniques other than IVF, sort of before you get to that process.
00:18:45.279 --> 00:18:49.359
And we will of course talk about that in much more detail because there's lots to chat about there.
00:18:49.680 --> 00:18:56.960
But I really appreciate you sharing a bit of your own personal history as well, and obviously your expertise in this area.
00:18:57.039 --> 00:18:59.119
It's really reassuring and important information.
00:18:59.279 --> 00:19:00.160
So thank you so much.
00:19:00.400 --> 00:19:01.599
Thank you so much for having me again.
00:19:01.680 --> 00:19:02.400
It was great.
00:19:02.720 --> 00:19:04.319
Every pregnancy is unique.
00:19:04.480 --> 00:19:09.759
The information provided in today's podcast is for educational and general purposes only.
00:19:09.920 --> 00:19:13.759
It is not intended to be substitute for professional medical advice.
00:19:13.920 --> 00:19:23.839
It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.
