Screening tests are investigations designed to gain baseline information about health functions. Some of these investigations will also investigate potential sources of infertility, including genetic conditions such as autoimmune disorders, thrombophilias, and other hereditary disorders.
All of Dr. Lolatgis’ patients are expected to have screening tests so that he can advise you appropriately when planning your fertility journey. Screening tests are also important to ensure the safety of healthcare staff who handle your biological samples.
Screening tests will need to be completed before your first consultation with Dr. Lolatgis
Most of the screening tests are simple blood tests, completed by visiting a pathologist at Melbourne Pathology. The female partner will also be required to have a baseline ultrasound, which can be completed by visiting Monash Ultrasound for Women. A baseline ultrasound is an invasive procedure, where an ultrasound probe is inserted vaginally to view your uterus and ovaries. The male partner will also be required have a sperm analysis, which can be completed by visiting specific Melbourne Pathology collection centres. A sperm analysis requires you to produce an ejaculate, usually on site – we advise you to speak with the collection centres for more information. Once results are available, Dr. Lolatgis will discuss them with you.
An allo-immunity assessment is an investigation designed to determine the DQ Alpha genes of the prospective parents.
DQ Alpha genes are inherited from parent to child, and the mother’s immune system reacts to these to produce protective factors for the growing embryo. If the male and female partners’ DQ Alpha genes are too similar, this reaction may not occur correctly, and the mother’s immune system can instead attack and destroy the growing embryo. If similar DQ Alpha genes are identified, a treatment called lymphocyte membrane immunotherapy (LMIT) can be completed to suppress the activity of the immune system and stimulate the immune system to produce protective antibodies for the growing embryo.
An allo-immunity assessment can be completed before starting your fertility journey, sometimes as part of your screening tests, but can also be completed when previous attempts to conceive have failed. LMIT treatment will be completed when an all-immunity assessment discovers compatible DQ Alpha genes, usually before trying to conceive if possible.
An allo-immunity assessment is a simple blood test, completed by visiting a pathologist at Melbourne Pathology. Once results are available, Dr. Lolatgis will discuss them with you.
A natural killer cell (NKC) biopsy is an investigation designed to assess the numbers of natural killer cells present in small sample of the cells of the endometrium.
NKC are part of a normal healthy immune system, but if elevated, can identify the growing embryo as an early aggressive cancer, and attack and destroy it.
A NKC biopsy is performed in a cycle that you are not trying to conceive, between Day 18 and Day 23 of your cycle.
A NKC biopsy is similar to having a cervical screening test (CST), also known as a Pap smear. A speculum is inserted into your vaginal cavity to allow access to the cervix. A very thin catheter will be inserted through your cervix to extract some cells from the endometrium. You may feel a momentary sharp pinch at the time; however, any discomfort should subside within a few minutes following the procedure. We recommend you take two Panadol 1 hour before your biopsy to assist with any discomfort during the procedure. Once elevated NKC are identified, a treatment regime can be started to suppress the activity of the NKC while trying to conceive and throughout pregnancy.
An ERA TRIO test consists of three separate investigations, the ERA test, the EMMA test, and the ALICE test. The ERA test is designed to test the expression of several genes to classify the endometrium as receptive or non-receptive at a particular time in the cycle. This then allows for the determination the time period where implantation of the embryo is most likely to occur, so that an embryo transfer can be performed within this interval. The EMMA test designed to check for the ten most abundant bacteria in the endometrium, and the ALICE test is designed to detect if there are bacteria causing chronic endometritis, so that these conditions can be treated before trying to conceive.
The uterus is the place where the growing embryo will implant, but the uterine environment must be agreeable for this to occur. The ERA TRIO test is usually recommended when previous attempts to conceive have failed to determine if embryo transfer timing or bacterial causes are responsible.
An ERA TRIO test is performed in a cycle that you are not trying to conceive, starting on Day 1 of the cycle and usually lasting for about three weeks.
An ERA TRIO test involves taking some medications. Dr. Lolatgis may prescribe you medications to suppress your hormones, if needed, and then medications to build up the lining of your uterus. You may have a blood test to determine whether your hormones have been successfully suppressed. You will then have an ultrasound scan to assess the lining of your uterus. Once the lining of your uterus is ready, a final medication is added, and a biopsy is performed.
An ERA TRIO biopsy is similar to having a cervical screening test (CST), also known as a Pap smear. A speculum is inserted into your vaginal cavity to allow access to the cervix. A very thin catheter will be inserted through your cervix to extract some cells from the endometrium. You may feel a momentary sharp pinch at the time; however, any discomfort should subside within a few minutes following the procedure. We recommend you take two Panadol 1 hour before your biopsy to assist with any discomfort during the procedure. Once the window of implantation has been determined and any bacterial conditions treated, then an embryo transfer can be planned.
Ovulation induction is a fertility treatment intended to assist conception in a minimally invasive way.
Ovulation induction is suitable for women who are having difficulty conceiving, especially if normal ovulation is an issue.
Ovulation induction is performed in a cycle that you are trying to conceive, starting on Day 1 of the cycle.
Ovulation induction involves taking from medications that encourage the development of a follicle containing an egg. After some time, you will have an internal ultrasound scan. This is an invasive procedure, where an ultrasound probe is inserted vaginally to monitor the growth of the follicles and the development of your uterine lining. Once suitable growth and development is seen, a medication is taken to trigger the release of the egg from the follicle, and intercourse is timed to maximise the chance of fertilisation occurring. If you get a period at the expected time, then the cycle is repeated. If you do not get a period, you contact Dr. Lolatgis’ nurses to confirm pregnancy with a blood test.
Lymphocyte membrane immunotherapy (LMIT) is a treatment intended to counter the autoimmune response that occurs in prospective parents with similar DQ Alpha genes.
When prospective parents have similar DQ Alpha genes, the mother’s autoimmune response can fail to function properly in protecting the growing embryo.
LMIT is performed before you start trying to conceive. The initial course of the treatment occurs in two separate appointments, four weeks apart. The treatment will last for six months, but a booster treatment consisting of a single appointment can be performed at that point to extend the effects for a further six months.
At each appointment, both partners have a role to play. The male partner attends Melbourne Pathology to supply blood on the morning of the treatment, which is sent for processing. The female partner comes into the clinic in the afternoon of the treatment for her partner’s processed blood product to be injected under her skin. Numbing creams and patches can be applied prior to the injections to counteract any discomfort during the procedure. The injected area may become red and itchy and small blister-like swellings may be present after the procedure, but these usually subside within two weeks.
Intralipid is sterile fat emulsion sometimes used as a food produce in hospitals for patients unable to take food orally.
Intralipid is also a treatment intended to suppress the immune system, especially to down regulate natural killer cells (NKC), and improve your chances of conception and retaining a pregnancy.
NKC are part of a normal healthy immune system, but if elevated, can identify the growing embryo as an early aggressive cancer, and attack and destroy it.
Intralipid infusions occur at an early stage in the woman’s cycle, usually between Day 7 and Day 10 of the cycle. Intralipid infusions are also repeated after a positive pregnancy test and every two weeks up to 14 weeks of pregnancy.
Intralipid infusions occur in the clinic. A cannula is inserted into your hand or forearm, and the Intralipid is infused intravenously over two to four hours. Intralipid is a sterile fat emulsion but cannot be administered to patients who are allergic to eggs, soy, or peanuts, so please let us know if this applies to you. You do not need to fast for this treatment, but it is important that you eat and drink before coming in for your treatment to ensure you are hydrated.
Filgrastim is a man-made form of granulocyte colony stimulating factor (G-CSF), a protein that occurs naturally in the body to produce neutrophils, a type of white blood cell which plays an important role in the immune system.
Filgrastim is a treatment intended to improve egg quality in stimulated cycles where an egg collection will occur, as well as increase the thickness and stickiness of the endometrial lining of the uterus to aid in implantation when an embryo transfer takes place.
Filgrastim may benefit you if you have experienced poor egg quality at egg collection, or experienced multiple miscarriages or failed implantation with IVF treatment.
Filgrastim treatment can occur at several points in the woman’s cycle, depending on the intended purpose. Subcutaneous injections of Filgrastim can be given from Day 1 of a stimulated cycle to improve egg quality. Intrauterine infusions and subcutaneous injections can be given in the days and hours before an embryo transfer to improve embryo implantation.
Filgrastim intrauterine infusions are administered by a doctor, while Filgrastim subcutaneous injections are most often self-administered by patients.
If you are having Filgrastim via both routes of administration to improve embryo implantation, you will need to collect a vial for the intrauterine infusion and a pre-filled syringe for subcutaneous injection before your appointment with Dr. Lolatgis for the uterine infusion.
An intrauterine infusion of Filgrastim is similar to having a cervical screening test (CST), also known as a Pap smear. A speculum is inserted into your vaginal cavity to allow access to the cervix. A very thin catheter will be inserted through your cervix to instill the Filgrastim into the uterine cavity.
Immunoglobulins are antibodies produced by B-lymphocytes, a type of white blood cell which plays and important role in the immune system. In the case of fertility treatment, intravenous Immunoglobulins (IVIG) is a treatment intended to suppress the immune system, especially the activity of natural killer cells (NKC).
IVIG has been shown to be effective in the treatment of recurrent implantation failure when administered a week or so prior to embryo transfer. IVIG may benefit you if you have experienced multiple miscarriages or failed implantation with IVF treatment.
IVIG infusions occur a day or so after the initial Intralipid infusion between Day 7 and Day 10 of the cycle. IVIG infusions can also be repeated after a positive pregnancy test and after the 7 week viability scan.
IVIG infusions occur at Epworth Hospital’s Day Oncology Unit. A cannula is inserted into your hand or forearm, and the IVIG is infused intravenously over three to four hours. You do not need to fast for this treatment, but it is important that you eat and drink before coming in for your treatment to ensure you are hydrated.
Platelet rich plasma (PRP) is part of your blood that can be harvested and administered into the ovaries or the uterus. PRP is a treatment intended to either restore the menstrual cycle, reactivate ovarian function, and improve folliculogenesis, or improve the thickness of the endometrial lining.
Filgrastim is a treatment intended to improve egg quality in stimulated cycles where an egg collection will occur, as well as increase the thickness and stickiness of the endometrial lining of the uterus to aid in implantation when an embryo transfer takes place.
PRP can be useful if you are peri-menopausal, menopausal, or have premature ovarian failure, or if you suffer from a thin endometrial lining.
Most often than not, you will be advised by Dr. Lolatgis when your PRP treatment will take place.
PRP treatment can occur in the clinic or as a day surgery, depending on the intended purpose. You will need to attend Melbourne Pathology to supply blood on the morning of the treatment, which is sent for processing.
Ovarian PRP occurs as a day surgery at Monash Surgical Private Hospital. You will be under a general anaesthetic and will need someone to drive you home on the day of the procedure and monitor you overnight, but you should be back to normal activity by the afternoon or morning following the procedure.
Uterine PRP occurs in the clinic. An intrauterine infusion of PRP is similar to having a cervical screening test (CST), also known as a Pap smear. A speculum is inserted into your vaginal cavity to allow access to the cervix. A very thin catheter will be inserted through your cervix to instill the PRP into the uterine cavity. Dr. Lolatgis recommends a pelvic ultrasound between Day 1 and Day 10 of your period before uterine PRP treatment, then again 6 weeks after uterine PRP treatment, to assess the effectiveness of your treatment.
SCUPE is a treatment intended to improve the thickness of the endometrial lining.
SCUPE can be useful if you suffer from a thin endometrial lining.
Most often than not, you will be advised by Dr. Lolatgis and Prof. Lyons when your SCUPE treatment will take place.
SCUPE treatment is organized by Professor Lyons, so a consultation with him is imperative. You may be asked to do some blood tests and prescribed some medications to take before your procedure.
SCUPE treatment occurs at Holmesglen Private Hospital as a day surgery. You will need to attend Melbourne Pathology to supply blood on the Friday before the treatment, which is sent for processing. Dr. Lolatgis recommends a pelvic ultrasound between Day 1 and Day 10 of your period before SCUPE treatment, then again 6 weeks after SCUPE treatment, to assess the effectiveness of your treatment.
SCORE is a treatment intended to reactivate ovarian function and improve folliculogenesis.
Most often than not, you will be advised by Dr. Lolatgis and Prof. Lyons when your SCORE treatment will take place.
Most often than not, you will be advised by Dr. Lolatgis when your PRP treatment will take place.
SCORE treatment is organized by Professor Lyons, so a consultation with him is imperative. You may be asked to do some blood tests and prescribed some medications to take before your procedure.
SCORE treatment occurs at Holmesglen Private Hospital as a day surgery. You will need to attend Melbourne Pathology to supply blood on the Friday before the treatment, which is sent for processing.
