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Welcome to the Freeze Fertility Newsletter, a corner of Substack dedicated to Fertility, the Universe, and Everything.

Jan 20, 2023

This is a place to learn more about reproductive medicine & related hot topics in science, philosophy & psychology, as well as culture, the arts & literature.

My name is Dr Violet Kieu & I am a Fertility Specialist in Melbourne, Australia. As a doctor with specialist knowledge, I want to share my experience on the multiple facets of human fertility.

The aim is to tackle one topic per month, with links to research, debate and practical suggestions.

I am driven to improve pre-conception health for both men and women. I perform cycle tracking, ovulation induction (OI), intra-uterine insemination (IUI), in vitro fertilization (IVF) & intra cytoplasmic injection (ICSI), with expertise in donor, surrogacy, single, same sex & medically complicated cases.

My love of science began as a little girl, sitting around my grandmother’s coffee table in her apartment in Collingwood. I would have been 11 years old when my teacher set up as task on biotechnology, and I wrote about Dolly the sheep. I learnt all about the DNA base pairs, that partner up from four subunits A-C-G-T. I learnt about the Double Helix shape and saw an old black & white photo of Watson & Crick who documented that scientific breakthrough. I continued to write about science, on the planets, the human body, as well as energy efficient housing.

I learnt that science can do amazing things, but we have to use it responsibly.

That is my philosophy around Assisted Reproductive Technology (ART) and IVF.

The advancements are there, the science and medicine are available, but we must have informed education about the benefits and risks, limitations & unknowns of any treatments undertaken, while also addressing any misinformation or stigma.

For me, the top 3 advancements in ART have been:

the first successful IVF in 1978,
then ICSI in 1992, to treat male factor infertility,
and now egg freeze.

Oocyte vitrification is a major step, both scientifically and culturally, offering women choice, with the American Society of Reproductive Medicine (ASRM) deeming it no longer experimental in 2012.

Start with the big one, IVF.

Break the IVF Plan down into 5 simple steps:

(And for egg freeze, steps 1-2-3).

01. The Decision

Patient autonomy in decision-making is vital. A thorough medical history of all reproductive parties (male & female), informed consent, explaining risks & benefits of IVF, alternatives & the option of not undertaking treatment. We offer an excellent team of supportive counsellors, fertility nurses & patient liaison officers.

02. The Stimulation

Commonly three medications are used: follicle stimulating hormone (FSH) to grow ovarian follicles, anti-ovulation medication such an GnRH antagonist (a gonadotropin releasing hormone blocker) to prevent early loss of eggs, & a trigger injection for final maturation of follicles.

03. The Egg Retrieval

Also known as oocyte pick up (OPU), this is a day procedure in theatre where eggs are collected under sedation. Using an ultrasound guided needle, follicles are drained trans-vaginally. An embryologist is nearby identifying all the eggs to go to the laboratory. There eggs can be fast frozen (vitrified) for the future or fertilized to form embryos. Vitrification is a process of freezing eggs into a glass like state. They are put through cryoprotectants then placed in liquid nitrogen to reach a temperature of minus 196 degrees Celsius, where biological activity is placed on hold.

04. Adding Sperm

Sperm can be added via conventional insemination in IVF, where one egg is surrounded by tens of thousands of sperm, or via intra-cytoplasmic sperm injection (ICSI), when there is an indication to inject one sperm directly into an egg. Much magic happens in the lab - sperm can be assessed, chosen by advanced selection techniques, or even thawed from frozen storage.

05. The Embryo Transfer

The final step. The final frontier to ask the embryo and endometrium to work in sync to achieve a pregnancy, then a live birth. This is a day procedure usually done on day 5 of embryonic development. Embryos can be graded by embryologists, and now even with artificial intelligence (AI), to choose the ‘best’ one for transfer. Then, the long two-week wait to see if you are pregnant. Fingers crossed.

Success rates - Your IVF Success Estimator

A common question is: what is my chance of success with IVF?

Based on bi-national data from the Australian & New Zealand Assisted Reproduction Database (ANZARD), there a ‘calculator’ that takes into account some personal information to generate a percentage of having a baby after one, up to three, full IVF stimulation cycles.

This uses big population data, of all the IVF cycles performed in our two countries, to use Real World Data (RWD) in a practical way to provide a prognostic tool to help people know their chances realistically.

https://www.yourivfsuccess.com.au/estimate

Several questions:

Female age
Previous pregnancy >20 weeks
Male age
Cause of infertility: endometriosis, tubal, other female factor, male factor, unexplained, no tests yet performed
Previous IVF

What I think is important is not just the estimated success rate after one cycle of having a baby, but the cumulative live birth rate after three cycles. This gives a more realistic expectation that it may take more than one cycle to have a better chance of pregnancy, particularly with an increase in female age.

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