speaker-1: Back again today with a slightly different episode format. We've been discussing a lot of medical terms in our series so far, and we thought it might help our listeners who are new to this complex world of fertility to get a little explainer about some of these acronyms we've been throwing about. Like, what do IUI, IVF, or ICSE actually stand for? What is FSH or PGTA? And what is AMH? And does a low result really mean you'll struggle to get pregnant? Dr. Alex Alexander has come in to talk us through these terms and a little about what they might mean in regards to your own fertility. Thanks for coming in, Dr. Alex. What fertility acronym would you like to get started with today?
speaker-0: Thank you for being here again. There are a lot of terms that we as specialists use and we take it for granted that the patient understands it. But we will talk a little bit more about what we are doing in a assisted reproductive cycles. So we'll start with the less invasive one, which is the intrauterine insemination. IUI, intrauterine insemination. of a partner sperm or it can be a donor sperm. So this is a simple procedure where we monitor the cycle and put the sperms through a catheter all the way up to the cavity of the uterus.
speaker-1: So this is as close to a natural way of doing things as possible, right? Instead of the sperm getting there through intercourse, it's injected in. Obviously this makes sense for donor sperm, but can you tell us why you would use IUI for a couple?
speaker-0: We do IUI if the sperms are borderline. So if the female has no pathology, tubes are normal, ⁓ they are open, she has a good ovarian reserve, she's young, and ⁓ the problem is male factor, ⁓ but a borderline male factor, not severe male factor, then IUI can help. Sometimes IUI can also help in some one who doesn't have enough cervical mucus at around ovulation time. ⁓ sometimes that happens if the woman had multiple surgery on the cervix, like ⁓ for cervical abnormalities or cervical dysplasia. They lack that mucus that form a carrier for the sperms. So we bypass that mucus by instilling the the sperms all the way up to the uterus. We do the insemination ⁓ at ovulation time.
speaker-1: So how do you know when that is? How do you time the IUI?
speaker-0: So the tracking of the cycle is monitor the cycle. ⁓ any ⁓ in a cycle that is textbook twenty eight day cycle, ovulation is gonna be around day fourteen. ⁓ so we will try to do a scan around day twelve, maybe thirteen, check the follicle and ⁓ measure the follicle, measure the lining. If the cycles are irregular, it is possible that the patient might need two scans, if not more. And sometimes we stimulate cycles by a tablet called letrazole or clomid. The ovulation ⁓ determination of ovulation can be by a blood test, measuring the LH levels, or in some instances we trigger ovulation by injection called ovidril. Twenty-four hours later, we go to the lab at Janaya. The partner would have delivered the sperms in the morning. ⁓ they do a sperm wash. So they isolate the good sperms from the bad sperms and put them in a special medium and we introduce the sperms into the cavity of the uterus through a catheter. And then we do a pregnancy test ⁓ ten days later.
speaker-1: So it's really important that you get the timing of the IUI right. Do you only get one go at this?
speaker-0: ⁓ the timing of ⁓ ovulation and the insemination is very important. Some studies showed that double insemination is better than one insemination, but some other studies showed no difference. It is very costly ⁓ however, to do double insemination, which means that we do one one day and another one twenty four hours later.
speaker-1: Okay, let's move on to the most common acronym in fertility, IVF. It's often kind of used as an umbrella term for all fertility treatments now, but it's actually one specific technique. Can you talk us through what IVF actually is?
speaker-0: When we say IVF it's a general term, but as a matter of fact, IVF is in vitro fertilization, which means that we are fertilizing the egg outside the human body. We put the egg and sperm together in a petri dish, leave it overnight with a special medium, and then we wake up in the morning and find that there is an embryo. There is fertilization. For that to happen, the scientist will prepare the egg. And then put around 300,000 sperms around that egg. Now the sperm has to produce enzymes ⁓ to enter the shell of the egg and the egg has to accept those enzymes. So if there is no receptors on the egg shell to accept the enzymes, or if the sperm enzymes are lacking, then obviously there is no fertilization. So there is a ⁓ if you wanna call it a key and a keyhole. So they both have to exist for fertilization to occur. So when we have embryos, we're gonna grow these embryos to day five under ⁓ supervision by the scientists. ⁓ there is special medium and ⁓ they will be followed up daily until day five. Day five is the stage of blastocyst. It has passed through the stages of one ⁓ two cells, four cells, eight cells, morula, and then the cells come together and then start to separate between inner cell mass, which is the baby, and the outer cell mass, which is the placenta, future placenta. And this is called the blastocyst. And They stage the ⁓ the blastocyst and they give it a grade. And then the blastocyst can be frozen or can be put back fresh into the uterus. If we are doing a fresh cycle, we call it, then we put the embryo back at day five after the egg pickup. If we are freezing ⁓ for multiple purposes, then we freeze the embryo ⁓ at day five and use it at a later stage. Sometimes the embryo does not reach that blastocyst at day five and we grow it another day to day six and some other places grow it to day seven even.
speaker-1: The other acronym we hear a lot is IXE, and this is a good example of the word IVF being used as an umbrella term because a lot of people doing IXE might say they're doing IVF, but it's actually a bit different. So what is IXE and how is it different?
speaker-0: So ICE forced fertilization. It's ⁓ intracytoplasmic sperm injection. Obviously there is a lot of preparation for that to happen by the scientists. They have to prepare the egg and they have to prep the sperms ⁓ and they inject the sperm DNA into the cytoplasm of the egg.
speaker-1: So let me be sure I get the difference. Where in IVF, the scientists put those three hundred thousand sperm you mentioned in a petri dish with the eggs and let nature take its course. In ICSE, the scientist is selecting one sperm and injecting it into the egg. So how do they do that?
speaker-0: The process of IC is actually preparing the sperms and inject the DNA of the sperms under the microscope into the cytoplasm of the egg through the membrane. So you can imagine that ⁓ there is a puncture of the egg shell, so it's post fertilization. So if somebody asks me, is IC traumatic? ⁓ it yes, it can be traumatic to the egg. ⁓ but there is no long term consequences on the baby whatsoever. ⁓ and we do it if we have to do it. Obviously we prefer IVF, but ⁓ we have no hesitancy to do the XE if sperms are not strong enough to fertilize the egg or not ⁓ enough quality or quantity to fertilize the egg.
speaker-1: If someone's doing Ixy, does that necessarily mean that there's something wrong with the sperm or the eggs?
speaker-0: ⁓ needing IXI does not necessarily mean that there is a abnormality in the genetic material of the egg or sperm. It's just simply means we don't have enough of it. We don't have enough sperms and so we are picking the best one prepare it for IC. But the genetic material is completely normal and as I said there is no consequence on the future baby whatsoever.
speaker-1: Great. The next term on my hit list is F E T. What is it and how does a F E T cycle work?
speaker-0: ⁓ the other acronym is ⁓ FET or frozen embryo transfer. It is what it says. It is a transfer of an embryo that has been frozen previously at most likely at day five at the level of blastocyst. And it is a cycle where again we monitor the cycle, in a natural cycle, we monitor the cycle and we determine the time of ovulation. And we transfer the embryo five days later because it is aged five. So we try to ⁓ put the embryo ⁓ in synchronism with the age of the endometium. So as we know at ovulation time, the endometium is at a certain maturation and it continue to mature throughout the second. ⁓ part of the cycle and therefore we need to put the embryo at the right time of that maturation process for us to succeed in ⁓ in forming a pregnancy. We try to do it five days after ovulation.
speaker-1: That was a nice quick one. What about PGTA then and what's it looking for? And does doing this test improve success rates? I guess because it flags embryos that otherwise would have perhaps either failed to implant or miscarried later.
speaker-0: PGTI is a ⁓ another acronym which is ⁓ pre-implantation genetic testing. We check for trisomes and aneuploidy. ⁓ it is an abnormality in the ⁓ genetic material. ⁓ and that is determined by a biopsy of the embryo at day five, most commonly. And the biopsy, the the ones that are a a high grade embryos, they try to biopsy the outer cell mass, which is the future placenta, and ⁓ wait two, three weeks for the results to come back and during that time we freeze the embryo. Now the problem with the PGTA ⁓ is that we are ⁓ biopsying the outer cell mass, which is the future placenta, but we are not biopsying the obviously the inner cell mass. And sometimes there is a discrepancy between the placenta and and the baby. And therefore having a normal PGTA embryo ⁓ and forming a pregnancy does not necessarily mean that the baby, the future baby, is gonna be completely genetically normal. ⁓ and therefore we still need to do ⁓ during the pregnancy, ⁓ particularly in the ⁓ first trimester, ⁓ what we call a non-invasive prenatal testing, like the NIPT these days. ⁓ the scanning at thirteen weeks and plus or minus amyrocentesis, ⁓ depending on the findings, obviously. So ⁓ this is another myth that ⁓ patients ⁓ think that if they have a normal PGTA embryo, then they do not need these assessments at the first trimester. ⁓ so ⁓ yes you do need the assessment at the first trimester because ⁓ the biopsy of the placenta might not necessarily reflect The genetically well being of the baby.
speaker-1: Why might you decide to make the recommendation to do this PGTA test? And does doing the test improve success rates?
speaker-0: Sometimes when we have multiple implantation failure, ⁓ we need to know what is the cause of that. And obviously forming abnormal embryos ⁓ all the time will cause implantation failure. So we need to know is it the embryo quality or is it something that we can adjust sometimes ⁓ hormonally through the lining? Is the lining adequately ⁓ prepared? mature. ⁓ so in that sense PGTA will help a diagnosis and yes it improves, although we do not do it routinely, but it improves the implantation success.
speaker-1: I also want to really get your take on AMH because that AMH test can cause women quite a bit of stress. What is it and what does it actually mean for a woman's chance of falling pregnant?
speaker-0: So AMH is an acronym for anti-molarian hormone. It is a hormone produced by ⁓ the primordial follicles. And it will give us a an idea as to ovarian reserve. Because we do know that as the woman age, the primordial follicles, when we do a scan at day two of the cycle or so, ⁓ we don't find many, whereas The age of 25 and 30, hopefully there are plenty of primordial follicles. And so the AMH is an indirect measure of the ovarian reserve. This is not a measure of whether the patient can fall pregnant or not. Sometimes, if it is a repeated low AMH, the patient might think of more ⁓ active management like ⁓ egg-freezing. But low AMH does not. tell the patient or myself whether the patient can fall pregnant or not. It has no relation whatsoever. The AMH helps the patient determine whether she needs to do something about it. And it helps the doctor also in determining whether they are gonna be a little bit more proactive, especially at a later age. And ⁓ it can also determine our dosage when we ⁓ stimulate and do an a cycle. So in that sense AMH is important. ⁓ there are a lot of conditions that can cause false negative or false ⁓ low, I should say, AMH.
speaker-1: Just as we wrap up, I want to get your perspective on one last thing. As someone who's done IVF, I remember being a bit bewildered by the amount of information coming at me in that first appointment. I went home and did a bunch of Googling because my brain just didn't retain what the doctor said very well. I know some people don't really feel the need to learn everything about it and are just happy to leave it all up to the doctor. But I guess what I want to know is What do you want your patients to know about getting to grips with what's happening to them medically while they go through this fertility treatment?
speaker-0: It is a process. It may be overwhelming the first time we ⁓ sit with a patient, but ⁓ there is a lot of ⁓ teaching ⁓ by ⁓ nurses, by myself. There are a lot of ⁓ stuff on the internet and Google. Sometimes they are true, sometimes they are false, ⁓ sometimes they cause more anxiety than than help the patient. But it is an ongoing ⁓ learning process. But I find that ⁓ nurses play a big role in the teaching process. And ⁓ all that I can say is that we keep ourselves available for any questions. So sometimes we see a patient and then the that particular patient rings the day after or two hours later actually, asking questions about what we've discussed and ⁓ That makes a big difference when you make yourself available for these ⁓ ongoing processes.
speaker-1: That's really nice that you extend that invite for patients to call with questions after their appointment. And it's also probably a lot better than the random Googling I did. That's great that you're you make yourself available for that. Well thanks again, Dr. Alex. It's always a pleasure to have you here in the studio.
speaker-0: Thank you very much. I'm very happy to be back.
speaker-1: If you would like to make an appointment to see Dr. Alex Alexander for a gynecology, obstetrics, or fertility consultation, you can contact his South Brisbane Clinic. For fertility patients, Dr. Alex also consults regularly at Genea Bowen Hills. I'm Joe Morgan and thanks for listening.
speaker-0: Thank you for being here again. There are a lot of terms that we as specialists use and we take it for granted that the patient understands it. But we will talk a little bit more about what we are doing in a assisted reproductive cycles. So we'll start with the less invasive one, which is the intrauterine insemination. IUI, intrauterine insemination. of a partner sperm or it can be a donor sperm. So this is a simple procedure where we monitor the cycle and put the sperms through a catheter all the way up to the cavity of the uterus.
speaker-1: So this is as close to a natural way of doing things as possible, right? Instead of the sperm getting there through intercourse, it's injected in. Obviously this makes sense for donor sperm, but can you tell us why you would use IUI for a couple?
speaker-0: We do IUI if the sperms are borderline. So if the female has no pathology, tubes are normal, ⁓ they are open, she has a good ovarian reserve, she's young, and ⁓ the problem is male factor, ⁓ but a borderline male factor, not severe male factor, then IUI can help. Sometimes IUI can also help in some one who doesn't have enough cervical mucus at around ovulation time. ⁓ sometimes that happens if the woman had multiple surgery on the cervix, like ⁓ for cervical abnormalities or cervical dysplasia. They lack that mucus that form a carrier for the sperms. So we bypass that mucus by instilling the the sperms all the way up to the uterus. We do the insemination ⁓ at ovulation time.
speaker-1: So how do you know when that is? How do you time the IUI?
speaker-0: So the tracking of the cycle is monitor the cycle. ⁓ any ⁓ in a cycle that is textbook twenty eight day cycle, ovulation is gonna be around day fourteen. ⁓ so we will try to do a scan around day twelve, maybe thirteen, check the follicle and ⁓ measure the follicle, measure the lining. If the cycles are irregular, it is possible that the patient might need two scans, if not more. And sometimes we stimulate cycles by a tablet called letrazole or clomid. The ovulation ⁓ determination of ovulation can be by a blood test, measuring the LH levels, or in some instances we trigger ovulation by injection called ovidril. Twenty-four hours later, we go to the lab at Janaya. The partner would have delivered the sperms in the morning. ⁓ they do a sperm wash. So they isolate the good sperms from the bad sperms and put them in a special medium and we introduce the sperms into the cavity of the uterus through a catheter. And then we do a pregnancy test ⁓ ten days later.
speaker-1: So it's really important that you get the timing of the IUI right. Do you only get one go at this?
speaker-0: ⁓ the timing of ⁓ ovulation and the insemination is very important. Some studies showed that double insemination is better than one insemination, but some other studies showed no difference. It is very costly ⁓ however, to do double insemination, which means that we do one one day and another one twenty four hours later.
speaker-1: Okay, let's move on to the most common acronym in fertility, IVF. It's often kind of used as an umbrella term for all fertility treatments now, but it's actually one specific technique. Can you talk us through what IVF actually is?
speaker-0: When we say IVF it's a general term, but as a matter of fact, IVF is in vitro fertilization, which means that we are fertilizing the egg outside the human body. We put the egg and sperm together in a petri dish, leave it overnight with a special medium, and then we wake up in the morning and find that there is an embryo. There is fertilization. For that to happen, the scientist will prepare the egg. And then put around 300,000 sperms around that egg. Now the sperm has to produce enzymes ⁓ to enter the shell of the egg and the egg has to accept those enzymes. So if there is no receptors on the egg shell to accept the enzymes, or if the sperm enzymes are lacking, then obviously there is no fertilization. So there is a ⁓ if you wanna call it a key and a keyhole. So they both have to exist for fertilization to occur. So when we have embryos, we're gonna grow these embryos to day five under ⁓ supervision by the scientists. ⁓ there is special medium and ⁓ they will be followed up daily until day five. Day five is the stage of blastocyst. It has passed through the stages of one ⁓ two cells, four cells, eight cells, morula, and then the cells come together and then start to separate between inner cell mass, which is the baby, and the outer cell mass, which is the placenta, future placenta. And this is called the blastocyst. And They stage the ⁓ the blastocyst and they give it a grade. And then the blastocyst can be frozen or can be put back fresh into the uterus. If we are doing a fresh cycle, we call it, then we put the embryo back at day five after the egg pickup. If we are freezing ⁓ for multiple purposes, then we freeze the embryo ⁓ at day five and use it at a later stage. Sometimes the embryo does not reach that blastocyst at day five and we grow it another day to day six and some other places grow it to day seven even.
speaker-1: The other acronym we hear a lot is IXE, and this is a good example of the word IVF being used as an umbrella term because a lot of people doing IXE might say they're doing IVF, but it's actually a bit different. So what is IXE and how is it different?
speaker-0: So ICE forced fertilization. It's ⁓ intracytoplasmic sperm injection. Obviously there is a lot of preparation for that to happen by the scientists. They have to prepare the egg and they have to prep the sperms ⁓ and they inject the sperm DNA into the cytoplasm of the egg.
speaker-1: So let me be sure I get the difference. Where in IVF, the scientists put those three hundred thousand sperm you mentioned in a petri dish with the eggs and let nature take its course. In ICSE, the scientist is selecting one sperm and injecting it into the egg. So how do they do that?
speaker-0: The process of IC is actually preparing the sperms and inject the DNA of the sperms under the microscope into the cytoplasm of the egg through the membrane. So you can imagine that ⁓ there is a puncture of the egg shell, so it's post fertilization. So if somebody asks me, is IC traumatic? ⁓ it yes, it can be traumatic to the egg. ⁓ but there is no long term consequences on the baby whatsoever. ⁓ and we do it if we have to do it. Obviously we prefer IVF, but ⁓ we have no hesitancy to do the XE if sperms are not strong enough to fertilize the egg or not ⁓ enough quality or quantity to fertilize the egg.
speaker-1: If someone's doing Ixy, does that necessarily mean that there's something wrong with the sperm or the eggs?
speaker-0: ⁓ needing IXI does not necessarily mean that there is a abnormality in the genetic material of the egg or sperm. It's just simply means we don't have enough of it. We don't have enough sperms and so we are picking the best one prepare it for IC. But the genetic material is completely normal and as I said there is no consequence on the future baby whatsoever.
speaker-1: Great. The next term on my hit list is F E T. What is it and how does a F E T cycle work?
speaker-0: ⁓ the other acronym is ⁓ FET or frozen embryo transfer. It is what it says. It is a transfer of an embryo that has been frozen previously at most likely at day five at the level of blastocyst. And it is a cycle where again we monitor the cycle, in a natural cycle, we monitor the cycle and we determine the time of ovulation. And we transfer the embryo five days later because it is aged five. So we try to ⁓ put the embryo ⁓ in synchronism with the age of the endometium. So as we know at ovulation time, the endometium is at a certain maturation and it continue to mature throughout the second. ⁓ part of the cycle and therefore we need to put the embryo at the right time of that maturation process for us to succeed in ⁓ in forming a pregnancy. We try to do it five days after ovulation.
speaker-1: That was a nice quick one. What about PGTA then and what's it looking for? And does doing this test improve success rates? I guess because it flags embryos that otherwise would have perhaps either failed to implant or miscarried later.
speaker-0: PGTI is a ⁓ another acronym which is ⁓ pre-implantation genetic testing. We check for trisomes and aneuploidy. ⁓ it is an abnormality in the ⁓ genetic material. ⁓ and that is determined by a biopsy of the embryo at day five, most commonly. And the biopsy, the the ones that are a a high grade embryos, they try to biopsy the outer cell mass, which is the future placenta, and ⁓ wait two, three weeks for the results to come back and during that time we freeze the embryo. Now the problem with the PGTA ⁓ is that we are ⁓ biopsying the outer cell mass, which is the future placenta, but we are not biopsying the obviously the inner cell mass. And sometimes there is a discrepancy between the placenta and and the baby. And therefore having a normal PGTA embryo ⁓ and forming a pregnancy does not necessarily mean that the baby, the future baby, is gonna be completely genetically normal. ⁓ and therefore we still need to do ⁓ during the pregnancy, ⁓ particularly in the ⁓ first trimester, ⁓ what we call a non-invasive prenatal testing, like the NIPT these days. ⁓ the scanning at thirteen weeks and plus or minus amyrocentesis, ⁓ depending on the findings, obviously. So ⁓ this is another myth that ⁓ patients ⁓ think that if they have a normal PGTA embryo, then they do not need these assessments at the first trimester. ⁓ so ⁓ yes you do need the assessment at the first trimester because ⁓ the biopsy of the placenta might not necessarily reflect The genetically well being of the baby.
speaker-1: Why might you decide to make the recommendation to do this PGTA test? And does doing the test improve success rates?
speaker-0: Sometimes when we have multiple implantation failure, ⁓ we need to know what is the cause of that. And obviously forming abnormal embryos ⁓ all the time will cause implantation failure. So we need to know is it the embryo quality or is it something that we can adjust sometimes ⁓ hormonally through the lining? Is the lining adequately ⁓ prepared? mature. ⁓ so in that sense PGTA will help a diagnosis and yes it improves, although we do not do it routinely, but it improves the implantation success.
speaker-1: I also want to really get your take on AMH because that AMH test can cause women quite a bit of stress. What is it and what does it actually mean for a woman's chance of falling pregnant?
speaker-0: So AMH is an acronym for anti-molarian hormone. It is a hormone produced by ⁓ the primordial follicles. And it will give us a an idea as to ovarian reserve. Because we do know that as the woman age, the primordial follicles, when we do a scan at day two of the cycle or so, ⁓ we don't find many, whereas The age of 25 and 30, hopefully there are plenty of primordial follicles. And so the AMH is an indirect measure of the ovarian reserve. This is not a measure of whether the patient can fall pregnant or not. Sometimes, if it is a repeated low AMH, the patient might think of more ⁓ active management like ⁓ egg-freezing. But low AMH does not. tell the patient or myself whether the patient can fall pregnant or not. It has no relation whatsoever. The AMH helps the patient determine whether she needs to do something about it. And it helps the doctor also in determining whether they are gonna be a little bit more proactive, especially at a later age. And ⁓ it can also determine our dosage when we ⁓ stimulate and do an a cycle. So in that sense AMH is important. ⁓ there are a lot of conditions that can cause false negative or false ⁓ low, I should say, AMH.
speaker-1: Just as we wrap up, I want to get your perspective on one last thing. As someone who's done IVF, I remember being a bit bewildered by the amount of information coming at me in that first appointment. I went home and did a bunch of Googling because my brain just didn't retain what the doctor said very well. I know some people don't really feel the need to learn everything about it and are just happy to leave it all up to the doctor. But I guess what I want to know is What do you want your patients to know about getting to grips with what's happening to them medically while they go through this fertility treatment?
speaker-0: It is a process. It may be overwhelming the first time we ⁓ sit with a patient, but ⁓ there is a lot of ⁓ teaching ⁓ by ⁓ nurses, by myself. There are a lot of ⁓ stuff on the internet and Google. Sometimes they are true, sometimes they are false, ⁓ sometimes they cause more anxiety than than help the patient. But it is an ongoing ⁓ learning process. But I find that ⁓ nurses play a big role in the teaching process. And ⁓ all that I can say is that we keep ourselves available for any questions. So sometimes we see a patient and then the that particular patient rings the day after or two hours later actually, asking questions about what we've discussed and ⁓ That makes a big difference when you make yourself available for these ⁓ ongoing processes.
speaker-1: That's really nice that you extend that invite for patients to call with questions after their appointment. And it's also probably a lot better than the random Googling I did. That's great that you're you make yourself available for that. Well thanks again, Dr. Alex. It's always a pleasure to have you here in the studio.
speaker-0: Thank you very much. I'm very happy to be back.
speaker-1: If you would like to make an appointment to see Dr. Alex Alexander for a gynecology, obstetrics, or fertility consultation, you can contact his South Brisbane Clinic. For fertility patients, Dr. Alex also consults regularly at Genea Bowen Hills. I'm Joe Morgan and thanks for listening.
