When you think of infertility, it's likely IVF (in vitro fertilisation) also comes to mind.
"IVF has become the go-to fertility treatment and I think everyone knows what IVF is now," says Karin Hammarberg, an adjunct senior research fellow at Monash University with 20 years' experience as a clinical coordinator of IVF programs.
And while in many cases IVF treatment is valid for individuals and couples who need help to conceive, Dr Hammarberg is concerned people aren't as aware of other treatment options.
This is partly due to what she says are "marketing ploys" when it comes to fertility advertising.
"Most fertility specialists, and even your GP, would suggest the less invasive [treatments] if there is something simple you can do.
"[But] there are a lot of problems in terms of the lack of transparency in advertising," she says, pointing to misleading claims, and social media and influencers as part of the issue.
Often in a vulnerable and desperate state, Dr Hammarberg says women are also marketed controversial products such as the "egg timer test", not to mention the amount of non-evidence-based products pushed by the wellness industry.
A basic understanding of available science-backed treatments can be helpful when navigating the world of infertility.
We look at what's available, the costs, and when alternatives to IVF might be relevant for you.
Lifestyle, regular sex and … waiting
If you've been trying to conceive for more than six months and you're not pregnant, Manuela Toledo says it's worth seeing a fertility specialist.
She's a board member with the Fertility Society of Australian and New Zealand, medical director at TasIVF, and a fertility specialist at Melbourne IVF.
"And that does not mean you will be [automatically] channelled into IVF. We don't want to do IVF on a couple who may not need it."
Preceding any treatment recommendations, Dr Toledo says a GP or specialist will organise baseline testing including blood tests, ultrasounds and sperm analysis.
Testing attracts varying costs, with Medicare rebates available.
The initial consultation fee with a fertility specialist is on average $220 to $350, and Medicare will reimburse a portion of that.
In some cases, people require surgery to investigate and treat symptoms and conditions.
Dr Hammarberg says being in good general health is a helpful starting point for anyone trying to conceive.
Making lifestyle changes to improve health can be done at home and with minimal cost.
"Having a balanced diet, exercising regularly, not smoking and not drinking are all really important for anyone trying to get pregnant," Dr Hammarberg says.
She advises women trying to conceive take iron (if levels are inadequate) and folate (to prevent birth defects), but save their money by avoiding most other supplements given they "don't have a lot of good evidence" to back up their use.
Dr Toledo says the two main lifestyle factors that will impact fertility are smoking and being overweight, and addressing that can make natural conception more possible.
If you do undergo IVF at some point, she says positive lifestyle changes can mean it may "work more quickly and with better outcomes".
Dr Toledo also recommends patients have regular sex, because ovulation tracking apps and kits can be inaccurate.
"Ideally for natural conception, couples should have sex twice during the week, and once on the weekend.
"The other advantage of that approach is that you have a new wave of sperm coming every two to three days, which is really good for sperm health."
With busy lives and distractions, frequent sex can feel like a lot of pressure for some couples, and we'll come back to that later.
There is also the option to simply wait, says Dr Hammarberg, especially if you are in your 20s or early 30s.
"There is a chance in the next 12 months you will conceive if there is nothing obviously wrong," she says.
Dr Hammarberg recommends using Your Fertility's unexplained infertility tool to help guide you.
"Sometimes the best advice is keep trying for another year."
Ovulation induction and IUI
Ovulation induction is an ideal option for people with irregular menstrual cycles, Dr Toledo says.
It involves taking medication to induce ovulation by encouraging eggs to develop in the ovaries and be released, increasing the chance of conception through timed intercourse or artificial insemination, also known as intrauterine insemination (IUI).
IUI involves inserting sperm into the uterus close to the time of ovulation.
"These are really good for same-sex couples using sperm, but also heterosexual couples that are just finding it difficult to have intercourse every second or third day," Dr Toledo says.
Ovulation stimulation and IUI can "take the pressure off", she says. That pressure can sometimes lead to sex feeling like a chore and even sexual difficulties such as erectile dysfunction.
"We can do the IUI at peak fertility … then couples can have intercourse when they feel like it."
Or, couples know when peak fertility is and can time intercourse more accurately, as the woman's cycle is tracked with ultrasound.
Ovulation induction can range from a few hundred dollars to about $1000 (and only receives a Medicare rebate when involving an insemination procedure.)
IUI can range from about $1,000 to $3,000, with a rebate available.
Most fertility clinics have costs for services available on their websites.
For women under 35 especially, Dr Toledo says ovulation induction with or without IUI can have positive outcomes.
Dr Hammarberg says overall, these treatments have lower success rates when compared to IVF, which is purely a numbers game.
"Imagine one menstrual cycle with IUI, but with IVF you might get 10 eggs and create five embryos, so cumulatively, each IVF cycle will give you more of a chance than IUI cycle."
When IVF is necessary
There are cases where IVF may be recommended to individuals and couples over less invasive options, says Dr Hammarberg.
"Age is the one thing that trumps everything else.
"If a woman is 39, it's not really a good time to think 'Maybe I could give myself a year to try something else'."
She says for patients with "clear cut" cases such as blocked fallopian tubes, IVF will be the best option.
Dr Toledo says for older women with unexplained infertility, she may still recommend less invasive treatments while "getting ready for IVF".
"Obviously if the women is mid to late 30s, we don't have that much time."
An IVF cycle can cost on average between $10,000 and $12,000, with about half reimbursed by Medicare.
This is general information only. For detailed personal advice, including up-to-date costs, you should see a qualified medical practitioner who knows your medical history.
