Fertility challenges and treatment

Updated August 2023 | 5 min read
Expert contributor Dr Raphael Kuhn, in vitro fertilisation (IVF) expert and author
Words by Karen Burge

Fertility can be difficult for many couples. Learn about when it’s time to see your doctor to talk about infertility treatments and what to expect on your fertility journey.

Tracey Porter had a gut feeling something wasn’t quite right after trying for a baby on and off for more than two years.

After another nine months of concerted effort, and a second medical opinion, Tracey and her husband Matthew were referred to a fertility clinic.

“In our case, it was found that I had an extremely low ovarian reserve and, at aged 35, was only around three years from menopause,” she explains. “Because my levels were so dire, we started the IVF process less than a week after I got the results from my fertility specialist.”

One in six Aussie couples experience infertility, which is an inability to conceive after a year of unprotected sex, or the inability to carry pregnancies through to a healthy delivery.

There are many reasons why a couple can’t fall pregnant, and in most cases, a physical problem can be diagnosed.

When to seek help for infertility

If you’re concerned about your fertility, the Royal Australian College of General Practitioners (RACGP) recommends a visit to your GP at any stage for tailored advice.

Dr Wendy Burton, Chair of the RACGP Antenatal and Postnatal Care Network, says you can expect your GP to take a good history (sometimes couples just don’t get their timing right) and examine you. They may also organise tests like:

• blood tests
• pelvic ultrasound
• ovulation confirmation
• sperm count. 

If your GP finds it necessary, they may then refer you to a specialist.

If you haven't conceived after a year of trying, and you’re aged under 35, it's a good idea to talk to your GP. If you’re 35 or older, it's recommended that you make an appointment after six months of trying without success.

Our partnership with GP2U, an online video GP service, makes it easier for eligible members to access telehealth services. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50. To register and make an appointment contact GP2U.

Seeing a specialist to explore fertility treatment options

In vitro fertilisation (IVF) expert and author, Dr Raphael Kuhn, says there can be a number of reasons why couples aren’t able to fall pregnant.

To get a clearer picture, your specialist will take a thorough medical, surgical and sexual history, do a physical examination and perhaps more targeted screening before recommending any treatment options.

Identifying the cause of infertility

In about 30% of infertility cases, the cause relates to male factors related to sperm production or the transport process, like:

• blocked or absent vas deferens (tubes that carry the sperm out of the tetes)
• low sperm number and/or poor sperm production
• high numbers of abnormally shaped sperm
• failure of sperm production
• anti-sperm antibodies
• sperm DNA fragmentation
• genetic diseases such as cystic fibrosis or a chromosomal variation.

Whereas, in another 30% of cases, the cause is found to be linked to female factors, like:

• age
• tubal disease or problems with the fallopian tubes
• ovulation disorders
• endometriosis
• polycystic ovarian syndrome
• fibroids
• salpingitis (pelvic inflammatory disease) caused by a sexually transmitted disease.

“Age is a very important factor because there’s an ever-increasing proportion of chromosomally abnormal eggs after the age of 30,” explains Dr Kuhn. “These eggs will either not fertilise, not fertilise normally, or if they do fertilise, the embryos will not fully develop.”

And in some cases, couples will have a combination of male and female factors.

Infertility treatments available

There are various fertility treatment options your specialist might consider, if appropriate for you and your partner:

• Lifestyle and weight improvement like healthy eating, quitting smoking and alcohol, losing any excess weight and moderate physical activity.
• Ovulation tracking to help confirm when you’re ovulating to help pinpoint your fertile window.
• Ovulation induction to encourage ovulation with medication or hormone injections, if you’re not ovulating naturally.
• Intra-Uterine Insemination (IUI), where sperm is deposited into the uterus around the time of ovulation.
• Fertility surgery in cases of endometriosis or pelvic adhesions (scarring).
• IVF, where sperm and unfertilised eggs are placed together (in a lab) before a fertilised egg (embryo) is then transferred into the woman's uterus.
• Pre-implantation genetic testing for genetic conditions.

Assisted reproductive technologies (ARTs) are interventions that involve medical technology, like IVF and IUI. In UNSW’s 2020 IVF report, it found that almost 96,000 ART treatment cycles were performed in Australia and New Zealand that year, resulting in the birth of 18,462 babies. This was a 7.6% increase in cycles compared to 2019, with one in 18 babies born in Australia conceived through IVF treatments.

Fertility treatment success stories

Success is often measured in different ways and this sometimes makes clinics or different fertility treatment hard to compare. Dr Kuhn says the average live birth rate per cycle in the IVF process, from fresh or frozen embryo transfer, is on average just above 20%. However, this figure is very age dependent.

To get a better understanding of how successful couples and individuals were over time following repeated cycles of ART, researchers have examined ‘cumulative live birth rates’.

In UNSW’s 2020 IVF report, it found that the overall live birth rate per embryo transfer increased to 29% in 2020, compared to 26% in 2016. For women aged between 30 and 34 years the live birth rate per embryo was around 36% for both fresh and thaw cycles. Whereas for women older than 44 years, it was 1.2% for fresh cycles and 7.7% for thaw cycles.

The link between infertility and emotional wellbeing

Tracey, who lives on the NSW Central Coast, says the impact of her IVF treatment was greater than she first imagined.

“There’s no such thing as an easy IVF ride,” she explains. “I never got immune to it – each failure cuts a little deeper until you realise you barely have any hope left. And yet, you have to have faith. IVF is a huge physical, emotional and financial commitment and there’s no point in even riding the roller coaster if you don’t believe (on some level at least) it’ll have a successful outcome.”

The Victorian Assisted Reproductive Treatment Authority explains that women can often experience depression and anxiety during IVF, particularly when waiting for results and if treatment fails. Deciding whether to continue or cease treatment can also be difficult.

If you’re going through an emotionally difficult time, reach out to the support services around you, including IVF clinic counsellors, online support services, like Access Australia or Beyond Blue, your team of medical professionals or local psychology/counselling services. Eligible HCF members can also access a free telehealth HealthyMinds Check-in with a PSYCH2U psychologist for a limited time^*.

For Tracey and Matthew, there was light at the end of the tunnel. After four rounds of IVF the final two embryos they had available took hold and Tracey gave birth to healthy twins, now aged 10.

If you need to talk to someone, contact Beyond Blue on 1300 22 4636 or the national Perinatal Anxiety & Depression helpline on 1300 726 306, between 9am to 7.30pm (AEST/AEDT). You can also call Lifeline on 13 11 14.

Understand more about infertility treatments

Find the answers to many of your questions about IVF, learn about the process and hear personal stories. Learn more about the process of IVF.