Newcastle Fertility Specialists : Dr Myvanwy McIlveen & Dr Robert Woolcott

Choosing an IVF Clinic

The key issues to consider when choosing an IVF clinic are:-

• People
  Does the clinic have the best qualified and most experienced people - both doctors and scientists?
  
  
• Research
  Does the clinic have an active research and development program - is it a leader in innovation?
  
  
• Technology
  Does the clinic use the best available technology - stage specific culture media, blastocyst culture, single embryo transfer?
  
  
• Quality Management
  Does the clinic have an externally audited comprehensive quality management system - is it certified to the International Standard organisation, ISO 9001 standard?

 

Choosing a fertility specialist

Not all doctors are equally qualified or skilled. In Australia the Royal Australian and New Zealand College of Obstetricians and Gynaecologists certifies doctors as sub-specialists in Reproductive Endocrinology and Infertility (CREI). This is the equivalent of Board certification as a fertility specialist in the USA. The CREI is the only recognised fertility specialist qualification in Australia. To maintain the CREI qualification fertility specialists must undergo a rigorous continuing professional development program and maintain a minimum proportion and standard of clinical activities within the sub-specialty of infertility. For the best advice you should seek out doctors who possess the CREI in order to be assured that you are seeing appropriately qualified and experienced practitioners. Both Dr McIlveen and Dr Woolcott are infertility specialists (CREI).

Your personal opinions

When considering whether IVF is right for you it is important to think through your own personal views. Your 'comfort zone' in regard to using science instead of sex to achieve a baby will influence your decisions. Personal tolerance of medical treatments and procedures is likely to effect how quickly you will move towards the use of assisted conception techniques.

 

Risks and difficulties of IVF

There are a number of hazards you should be aware of before undertaking treatment with IVF. In the latest completed report of the National Perinatal Statistics Unit (NPSU) the following hazards were identified or addressed. (source: NPSU Report; Assisted Conception Australia and New Zealand 2000 and 2001)

Delivery by caesarean section was higher among assisted conception pregnancies. There were 1,991 (46.7%) reported caesarean deliveries in 2000. The caesarean rate was 68.5% in twin pregnancies and 95.2% in triplet pregnancies.

In 2000, there were 5,275 live births and fetal deaths from assisted conception. The fetal death rate was 1%, the lowest reported in the series. Of those births, 4,801 infants were born in Australia accounting for 1.9% of all births in 2000.

In 2000 there were 109 reported perinatal deaths among births after assisted conception. Perinatal death rates have declined from 31.5 per 1,000 relevant births in 1991 to 20.7 per 1,000 relevant births in 2000. The perinatal death rate was about 2.5 times the overall perinatal death rate (8.3 per 1,000 relevant births) in Australia in 2000.

The overall risk of congenital abnormality is not increased over a similar population matched for age multiple pregnancy reproductive and medical history

 

Multiple pregnancy

From the same report these observations were made regarding multiple pregnancy.

• There were 945 (22.1%) multiple pregnancies in 2000. Twin pregnancies occurred in 21.1% of all pregnancies. Triplet and other higher order pregnancies occurred in 1.0%. GIFT treatment had the highest incidence (28.1%) of multiple pregnancies.
  
• Perinatal death rates are higher for multiple births than for singleton births. Perinatal death rate for twins was 34.3 per 1,000 relevant births and for triplets was 62.0 per 1,000 relevant births, compared with 11.7 per 1,000 relevant births in singletons in 2001.

The impact of in terms of death of babies in the first month of life is

Risks and difficulties of IVF
There are a number of hazards you should be aware of before undertaking treatment with IVF. In the latest completed report of the National Perinatal Statistics Unit (NPSU) the following hazards were identified or addressed. (source: NPSU Report; Assisted Conception Australia and New Zealand 2003 - the most recent report).

Overall, there were 8,365 IVF pregnancies reported in 2003. Of these pregnancies, 23.1%were less than 20 weeks gestation and 76.9% were at least 20 weeks gestation resulting in 7,479 liveborn babies and 108 fetal deaths. Half (50.0%, 3,203) of deliveries were by caesarean section, almost twice the proportion reported for all Australian births in 2003 (28.5%). More than a quarter (26.6%) of babies were born preterm with a gestational age of less than 37 weeks. This is a lower proportion than that reported in 2000 (32.6%), suggesting improved outcomes for babies following assisted reproduction. The average birthweight of all babies was 2,990 grams. Babies born with low birthweight (<2,500 g) made up 21.8% of all babies, which is less than the 26.4% of babies with low birthweight in 2000. However, babies born following ART in 2003 had a lower average birthweight than that reported for all babies in Australia in 2003 (3,372g). The average age of women giving birth to ART babies in 2003 was 34.4 years, 4.9 years older than the average age (29.5) of Australian mothers in 2003. For women aged 25–29 years, 80.6% of all pregnancies resulted in a live delivery. However, this steadily declined with advancing age and, for women aged 40–44 years, only 60.0% of all pregnancies resulted in a live delivery

There were 142 reported perinatal deaths among births after assisted conception in 2003. Perinatal death rates have declined from 31.5 per 1,000 relevant births in 1991 to 18.7 deaths per 1,000 births in 2003. The perinatal death rate remains higher than the overall perinatal death rate (8.3 per 1,000 relevant births) in Australia.

The overall risk of congenital abnormality is not increased over a similar population matched for age, multiple pregnancy, reproductive and medical history

Multiple pregnancy
From the same report these observations were made regarding multiple pregnancy.

• There were 1,163 (18.1%) multiple deliveries from assisted conception in 2003. Of these, most (98.1%, 1,141) were deliveries of twins and a small proportion (0.3%, 22) were triplets.

• Pregnancy outcomes for assisted reproduction are often poorer than with normally conceived pregnancies. A lot of this difference is related to multiple pregnancies and maternal age. Singletons had an average birthweight of 3,281 grams compared with twins whose average birthweight was 2,363 grams. Similarly, 8.4% of singletons were classified as low or very low birthweight compared with 50.6% of twins.

• Perinatal death rates are higher for multiple births than for singleton births. Perinatal death rate for twins was 34.3 per 1,000 relevant births and for triplets was 62.0 per 1,000 relevant births, compared with 11.7 per 1,000 relevant births in singletons.