Is egg freezing right for you?

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If you’d like to have a family one day, egg freezing offers a way to preserve some of your younger, healthier eggs by storing them for future use. This option can help protect your future fertility, giving you the freedom to plan pregnancy when the time feels right – without feeling rushed by your biological clock – while increasing your chances of conceiving if any challenges arise.

At Newlife IVF, we believe egg freezing should be an accessible and affordable option for all women, no matter their reasons for choosing this path.

Why do women freeze their eggs?

In some cases, egg freezing is about timing – the right time for you to have a baby may not be the right time in terms of your fertility. Whether you’re focusing on your career, furthering your education, travelling, waiting for the right partner or achieving financial stability, egg freezing offers flexibility for those who aren’t yet ready to commence trying to conceive. Freezing your eggs at a younger age, when they are more likely to be of higher quality, helps preserve your fertility by ‘pressing pause’ on the natural decline in egg quality that comes with ageing. This gives you the option to revisit your family-building goals when the timing feels right for you.

Egg freezing for medical reasons

Certain health conditions and medical treatments can affect fertility, making egg freezing a valuable option. For example, it may be recommended before treatments such as chemotherapy or radiotherapy to help preserve future reproductive options.

Additionally, women with reproductive health concerns, such as endometriosis or polycystic ovary syndrome (PCOS), may consider egg freezing as a proactive step in preserving their fertility. Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, which can affect egg quality and reduce ovarian reserve. Similarly, PCOS, a hormonal disorder that disrupts ovulation, can lead to increased difficulties in conceiving. In these cases, freezing eggs may provide an option for future family planning, including the possibility of IVF if needed.

What is the best age to freeze your eggs?

Once you have made the decision to freeze your eggs, it’s best to get started as soon as possible – ideally in your late 20s or early 30s when you still have a reasonable number of good-quality eggs. The quantity and quality of eggs are the most important factors when going through fertility treatment.

Unfortunately, eggs collected from women over the age of 35 are not as successful when used in IVF cycles. Therefore, if you are over 35, we will typically try to collect a greater number of eggs which means that you may have to go through more egg freezing cycles. This increases the likelihood that one or more of the eggs we collect will be appropriate for IVF, should you need to go down this path in the future.

What does egg freezing involve?

This infographic outlines the various steps involved in egg freezing: obtaining a GP referral, consulting with a fertility specialist, meeting with other team members, awaiting your period before starting the medication, undergoing blood tests and scans, administering a trigger injection (to induce egg maturation), attending days surgery for egg collection, and freezing and storing eggs.

Step 1 – obtain a GP referral

You need a referral from your GP before seeing a fertility specialist to discuss egg freezing. This also allows you to access the Medicare rebate if you are eligible, e.g. where an underlying illness or medical treatment could impact your future fertility.

Step 2 – fertility specialist appointment

Your Newlife IVF fertility specialist will review your medical history, order any blood tests and ultrasounds required, and develop a personalised treatment plan based on your unique circumstances. Your specialist will also discuss with you the number of eggs they expect to be able to collect based on your age and other factors, the likely chance of pregnancy from using eggs frozen at your age, and whether multiple egg collection cycles might be beneficial for you.

Step 3 – additional appointments

You’ll have a session with one of our counsellors to ensure you feel informed and supported. We’ll arrange a finance meeting to provide a clear breakdown of all costs involved, and you’ll meet with one of our fertility nurses, who will guide you through the treatment process. Your nurse will tell you about the different medications involved in egg freezing, teach you how to self-inject the required hormonal medications at home, and let you know what to expect during the egg collection procedure at our day surgery.

Step 4 – preparing for treatment

Once your period begins (day 1), call the nursing team to inform them. On day 2, start your medication as directed to start stimulating your ovaries (see next step).

Step 5 – ovarian stimulation

In order to stimulate your ovaries to produce multiple eggs for collection, you will need to self-administer daily hormone injections over an 8–14 day period (we will show you how to do this safely and comfortably).

Step 6 – monitoring

Throughout the stimulation period, we will use ultrasound to monitor any developing follicles (which contain your eggs). This helps us determine the best time to collect your eggs.

Step 7 – egg collection

Once mature, we will collect your eggs while you are lightly sedated. Surgery takes 10–15 minutes and an average of 8–15 eggs are typically collected.

Step 8 – storage

From the eggs we collect, we will identify any mature eggs and freeze them. Your frozen eggs will be carefully stored in our quality-controlled facility until a time when you might choose to use them in the future (frozen eggs can be stored for up to ten years in Victoria).

What are the success rates for conceiving a baby using frozen eggs?

Egg freezing provides the potential for a future pregnancy, but success is not guaranteed. While over 98% of frozen eggs survive the thawing process, achieving pregnancy depends on several key IVF stages, including fertilisation, embryo development and implantation in the uterus – each with its own challenges.

The likelihood of a live birth from frozen eggs is further influenced by your age at the time of freezing and the number and quality of eggs collected. Age is the most reliable indicator of egg quality, with younger eggs generally having a higher chance of leading to a successful pregnancy. For example:

  • If a woman freezes 20 eggs before the age of 35, the estimated chance of having a baby from those eggs is around 80%
  • Freezing 40 eggs increases this likelihood to approximately 95%.

Therefore, if you are considering egg freezing, speaking with a fertility specialist earlier rather than later can help you explore your options. While each person’s fertility journey is unique, starting the conversation in your younger years typically provides more flexibility and choices for your future family planning. The natural biology of egg quality means that preserving eggs at a younger age may increase your chances of successful fertility treatment later on, should you choose that path.

The number of eggs collected in each cycle depends on a patient’s ovarian reserve and how their body responds to the medication. Because of this, egg freezing may require multiple treatment cycles to achieve an optimal number of eggs for future use.

What are the costs involved?

Newlife IVF is committed to offering reasonable pricing, reflecting our belief that egg freezing should be accessible to all. While elective (non-medical) egg freezing isn’t covered by Medicare, egg freezing for medical reasons is. You can visit our fees page for a general overview of the costs involved. We recommend booking an appointment with one of our fertility specialists for personalised advice and a clearer understanding of the costs based on your specific circumstances.

Your timeline, your choice

Life doesn’t wait for anyone – but you can make your eggs wait for you. Be fertility ready when you’re ready.

Talk to us about egg freezing.

How embryos develop – from egg retrieval to blastocyst

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After retrieval, the egg and sperm are combined, and if fertilisation is successful, your embryo spends the first few days growing in the lab under the expert care of our team. This blog will help guide you through these early embryo development steps before transfer or freezing.

Factors affecting embryo development

Embryo development is a complex process that requires a combination of genetic, environmental and physiological factors to progress successfully. To achieve good embryo development, we require:

Healthy egg and sperm

The egg and sperm provide the genetic blueprint for development. Each embryo needs a complete set of 46 chromosomes – 23 from the egg and 23 from the sperm. Some embryos inherit incorrect genetic instructions that can impact embryo development and make it harder for them to divide and grow as expected.

Mitochondrial energy

Embryos need energy to divide and grow, which is provided by mitochondria (tiny energy-producing structures in cells). Poor mitochondrial function can slow or stop embryo development.
Efficient metabolic function:

An embryo’s metabolic function provides both energy and the building blocks needed for development. This includes the creation of protein and fats, and the removal of waste products that can be toxic to the embryo. Together, these provide what the embryo needs for growth, cell division and viability.

Timely cell division

Embryos should ideally divide at a regular pace (2-cell, 4-cell, 8-cell, etc.). Uneven and/or delayed division can mean the embryo is of suboptimal quality and may not develop as expected.

Embryonic genome activation

Around Day 3 (see diagram below), embryos start using their own DNA instead of relying on maternal DNA (genetic code from the egg). If this DNA transfer is inadequate, interrupted or missing, this can slow or stop the development of an embryo.

Stable conditions

Embryos need the right temperature, oxygen and pH balance to grow. These factors are carefully assessed and monitored continuously in the laboratory environment.

Difficulties or inaccuracies in any of these processes can affect the way an embryo grows and can impact whether an embryo will reach the blastocyst stage (where it has divided into many cells), making it suitable for transfer or freezing.

Safeguarding your embryos is our highest priority

We understand how important every embryo is to your journey. That’s why we use the most advanced technology and scientifically proven methods to create the ideal environment for embryo development. From carefully performing every procedure to closely monitoring each embryo’s progress, our highly trained embryologists work tirelessly to give each embryo the best possible chance to grow and thrive.

We maintain strict laboratory conditions, including precise temperature, humidity and air quality control to mimic the natural environment as closely as possible. Our team carefully observes each embryo’s development at every stage. Even though not all embryos will reach the blastocyst stage, please know that we do everything in our power to maximise their potential. Your dream of building a family is at the heart of everything we do, and we are committed to providing the best possible care every step of the way.

If you have any questions about embryo development or your fertility journey, please reach out to Newlife IVF. In the meantime, let’s walk through the different stages of embryo development to help you better understand the process.

 

The Art of ART – our campaign honouring the craft of IVF

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IVF is often described in purely scientific terms. Yet behind every procedure is something profoundly human. For patients, the journey is deeply personal, complex and emotional. For embryologists, it is a discipline that demands not only technical mastery but care, intention and empathy. Every patient’s experience is unique – much like a work of art, shaped by its own story and meaning.

This campaign draws on that parallel. In art, skill and imagination come together to create something meaningful. In IVF, science and human insight unite to nurture the earliest stages of life.

Assisted reproductive technology depends on advanced tools and rigorous standards, but its true strength lies in the people guiding each step with expertise and compassion. It is this balance – between precision and humanity – that we wanted to honour.

Finding meaning in the microscopic

Within the laboratory, embryologists work with structures so small they are invisible to the naked eye, yet they carry immense significance. Interpreting patterns of cell development demands not only scientific expertise, but a trained eye and steady hand.

There is a quiet beauty to this work – one defined by intention, care and the possibility of new beginnings.

This perspective is captured visually through the work of artist Kaitlin Walsh of Lyon Road Art, whose practice interprets embryonic development as flowing, luminous forms. Her pieces mirror what embryologists observe each day: the intricate, ordered progression that arises from complexity, and the sense of hope held within life at its earliest stage.

 

Where ART meets science

The Art of ART also reflects our belief that great IVF outcomes rely on more than technology alone. Behind every embryo assessment, laboratory process and clinical decision is a team applying years of experience, scientific training and the kind of instinct that only comes from deep familiarity and practice. It also honours the partnership between our team and each patient – a relationship built on trust, empathy and shared purpose.

At Newlife IVF, our fertility specialists, embryologists, nurses and counsellors have cultivated a level of expertise that elevates their work beyond technical procedure. Their work is a craft shaped by science, refined through skill and grounded in humanity.

Celebrating the craft behind IVF

Through this campaign, we aim to show that IVF is not simply a series of steps, but a deeply considered process that supports both the technical and emotional aspects of treatment. Science drives what we do, but it is our people – and the trust our patients place in them – that bring it to life.

The Art of ART recognises this balance, celebrating the dedication of our team in delivering fertility care that is thoughtful, precise and compassionate. It honours the human side of IVF, and the expertise that makes every patient’s journey distinctly their own.

Victoria’s leading fertility clinic results – Newlife IVF recognised for excellence again

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Based on figures published by the Herald Sun, sourced from the Federal Government’s Your IVF Success website, Newlife IVF recorded the highest pregnancy rates in Victorian patients under 35 years (per treatment cycle attempt in 2024), achieving a 52% pregnancy success rate (compared with the national average of 41%). Exceptional outcomes were also achieved across older age groups, with pregnancy success rates of 43% for women aged 35–38 years (the national average is 35%) and 31% for women aged 39–42 years (the national average is 25%).

Newlife IVF also excelled in live birth rates across Victoria, achieving an outstanding result of 52% for patients under 35 years (46% is the national average), and 27% for 35–42 year olds (the national average is 24%).1 Notably, since its establishment nearly seven years ago, Newlife IVF has consistently delivered outcomes that surpass the national average.

‘We’re proud of what these results mean for our patients, with pregnancy and birth outcomes that continue to exceed the national average,’ said Dr Nicole Hope, fertility specialist and Medical Director at Newlife IVF. ‘Our approach is built on precision and care at every stage. Our specialists focus on optimising conditions for egg quality and embryo development and implantation, while our embryologists bring exceptional attention to the care of eggs, sperm and embryos. Alongside this, our wider team – including nurses, counsellors, genetic counsellors and administrative staff – provides dedicated support across the many aspects of fertility care that influence wellbeing and outcomes. Together, this depth of expertise creates a strong foundation for patient success.’

Outstanding success rates backed by best-practice patient care

Results like these are not achieved by chance. They reflect a clear and consistent philosophy that has guided Newlife IVF since its inception.

Newlife IVF was built on a shared vision to do things differently. From the beginning, the goal was to create a fertility clinic that puts patients before profits, combining best-practice science with genuinely personalised care and support. Every decision and every advancement have been guided by that principle.

As a clinician-owned and led fertility clinic, Newlife IVF is proud to be an independent specialist fertility centre. This independence enables a more supportive and patient-focused experience than is often possible within large corporate-owned clinics.

‘Our results are a reflection of how we work as a connected team,’ said Dr Tiki Osianlis, Managing Director and Scientific Director at Newlife IVF. ‘Clinical expertise and best scientific practice are essential, but they are only part of the picture. What truly sets our care apart is the way our team collaborates around each patient. We take the time to listen, to understand their circumstances, and to adapt treatment accordingly. That shared commitment across every role allows us to deliver care that is both highly individualised and deeply supportive as patients work towards building their family.’

A patient-first approach to fertility care

Every aspect of care at Newlife IVF is designed with patients in mind. From our state-of-the-art laboratory to the use of advanced scientific tools and techniques, expert-led care is combined with cutting-edge technology to maximise each patient’s chance of success.

At Newlife IVF, we believe everyone deserves the opportunity to build their family. That belief underpins our commitment to making high-quality fertility treatment as accessible as possible. We remain focused on delivering outstanding results alongside compassionate, personalised care, supporting our patients every step of the way as they work towards building the family they dream of.

Appointments with one of our fertility specialists are available for those ready to explore their next steps. Call us on (03) 8080 8933 or book an appointment online.

Footnotes

  1. These measures represent the births per completed egg retrieval cycle. Success rates are based on the number of live births that resulted from the eggs collected from women in 2022 that were fertilised and implanted as embryos in 2022 and 2023. Source: YourIVFsuccess. ↩

Witnessing systems at Newlife IVF

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What is IVF witnessing?

Witnessing in IVF refers to the process of confirming that the correct eggs, sperm and embryos are used for the correct patient at the correct time. It mitigates the risk of mismatched or misidentified samples.  At Newlife IVF, we take this responsibility extremely seriously, which is why we use both electronic and manual methods for accuracy and traceability.

RI Witness – electronic tracking for your peace of mind

Newlife IVF employs the RI Witness electronic witnessing system, which uses Radio Frequency Identification (RFID) technology to track and verify all eggs, sperm and embryos in the laboratory. Each patient is assigned an RFID card and every patient vessel (e.g. tubes, dishes and cryo-vessels) is labelled with a matching RFID tag, all of which are programmed with each patient’s unique IVF code and three points of identification.

How RI Witness works at Newlife IVF:

  • Patient RFID card: you are assigned an RFID card that is linked to your profile. This is used for identification during key procedures, such as egg retrieval and embryo transfer
  • RFID tags on all labware: all test tubes, dishes and cryo-vessels used to hold your biological material are labelled with RFID tags matched to your unique code and profile
  • Real-time monitoring: all lab workstations have RI Witness receivers that detect these tags automatically. The system logs and monitors every sample movement during the procedure in real-time
  • Mismatch protection: if a mismatch ever occurs – for example, if two different tags are brought into an area at the same time – RI Witness triggers an audible and visual alarm, and the procedure is stopped immediately to investigate and correct the issue. To further reduce the risk of mismatches, our embryologists strictly work with the biological materials of only one patient at a time at each workstation.

Cryostorage tracking

All biological material placed into cryostorage is barcoded and tagged using the RI Witness system.

Each cryo-vessel is labelled with:

  • Your full name
  • Date of birth
  • Unique IVF code
  • Date of freezing
  • Barcode is specific to the eggs, sperm or embryos stored inside.

These cold-resistant tags ensure identification is maintained even at ultra-low temperatures. When the material is removed from cryostorage, the barcode is scanned and cross-verified with RFID data and RI Witness, and double-witnessed by embryologists to confirm all points of identification.

Embryologist double-witnessing

In addition to RI Witness, every procedure is manually witnessed by two embryologists. This human double-checking system complements electronic witnessing and adds a layer of human judgement, visual verification and accountability.

Manual witnessing includes:

  • Verifying three patient identifiers (full name, DOB and patient unique IVF code)
  • Cross-referencing all vessel labels, barcodes and RI Witness tags
  • Confirming the procedure that is to take place
  • Checking the freeze dates and, for embryos, specific embryo numbers
  • Confirming the correct sample before and after thawing.

This step is essential when biological material is entering or exiting the laboratory, and before every procedure such as insemination, embryo transfer, embryo biopsy or cryopreservation.

Cryostorage safety – cryo-vessel monitoring and audits

Biological materials such as eggs, sperm and embryos are stored in specially designed devices (cryo-vessels) that are specific for very cold temperatures.  The cryo-vessel is tagged with a special tag that withstands very cold temperatures. The cyro-vessel includes the patient’s name, date of birth, unique IVF code and the date of the freezing, along with a unique barcode that is specific to that patient’s egg, sperm or embryo held within the individual device.

Every sample is:

  • Uniquely identified and traceable
  • Matched at any time using the RI Witness system and barcode
  • Manually verified when moved or thawed.

Regular audits are conducted, comparing all stored material against patient records, to ensure that what is in storage precisely matches what is documented in each individual file and the RI Witness log.

Thawing of stored biological material

When biological material is removed from cryostorage, the barcode is scanned and linked to the patient’s vessel via an RFID tag.  Removal of eggs, sperm or embryos from cryostorage is also witnessed manually by the embryologist performing the procedure and a second embryologist.  Before thawing the biological material, the embryologists will witness the three points of patient identification on the cryotag, the freeze date and, in the case of embryos, the specific embryo number on the cryotag. This is cross-referenced with the vessel the biological material will go into after thawing, and the RI witness system. A mismatch at any point will sound an alarm.

Only once all of these steps have been completed will the thawing of the eggs, sperm or embryos proceed.

Summary of witnessing measures at Newlife IVF:

  • Only one patient’s material is handled at each workstation at any time
  • All vessels and labware are RFID tagged and barcoded
  • The RI Witness system and the embryologist manual double-witnessing are used to confirm all details at every procedure
  • Cryostored material is linked to the patient via a barcode and the RI Witness system.
  • Regular audits verify that frozen material in storage matches patient records and the RI witness system.

Please ask us!

We understand IVF can be a time filled with both hope and uncertainty. Our systems are designed to mitigate risk and ensure your biological material is being managed with the highest levels of care, security and accountability. If you have any questions, please speak to a member of our team. We’re always happy to help you feel supported and informed.

The real cost of egg freezing – a candid conversation between Dr Nicole Hope and Victoria Devine

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Understanding egg freezing and the costs

Victoria Devine aims to make finance easier in every area of life, including fertility care. To do this, she strongly advocates that you take the time to do your research. Whether it be a new sweater, a first home or your future fertility – it pays to educate yourself first.

Victoria sat down with Dr Hope and asked her all about egg freezing. With a straightforward clarity that comes from her decades of fertility experience, Dr Hope outlined the egg freezing and IVF processes, and the differences between the two. She also explained how fertility care is timed to match the natural rhythms of your body. For this reason, a lot of fertility treatments are timed around your menstrual cycle.

‘The body has it all worked out and everything we do is actually trying to mimic or replicate what happens in the body,’ said Dr Hope.

Having covered the fundamentals, Victoria and Dr Hope then dived into the costs of egg freezing and IVF, as well as who is eligible for Medicare deductions to their fertility treatment. Dr Hope also discussed some of the patient financing options available to help people manage the costs of fertility care more comfortably.

Cutting out hidden fees at Newlife IVF

When it comes to any major expenses, Victoria recommends that it can be helpful to budget for both the known costs and any additional expenses that may come your way. In the case of egg freezing – depending on the healthcare provider you choose – you may have costs tacked on outside of the initial quote.

This is why at Newlife IVF, transparency with patients is a priority. It is rare for a patient to receive an unexpected or additional cost – and if there is a medical need for one, this will always be discussed beforehand.

‘People shouldn’t be getting too many extra costs outside what they are quoted,’ said Dr Hope.

Dr Hope also explained that all Newlife IVF patients receive an appointment with a member of the finance team before any treatment is started. This appointment helps people understand the costs of treatments and services, and the financing options available, which can help them make informed decisions about whether the treatment/service is right for them.

Infertility is more common than you may think

To complement Dr Hope’s fertility guidance, Victoria shared her own pregnancy experience, as well as the fertility journeys of some of her friends. It quickly became clear how varied fertility journeys can be and that there is no one-size-fits-all for family planning. This led Victoria to ask if there are any factors that can affect someone’s fertility.

Dr Hope explained that the quality of a woman’s eggs is one of the main contributors to their chances of having a baby. She added that although egg quality is affected by many factors, age is often the most crucial.

‘For women, the single biggest thing that predicts when we can get pregnant is our age,’ said Dr Hope.

Drawing on her proactive approach to fertility treatment, Dr Hope also talked through what people can do to improve their egg quality at any age.

A brief background about the webinar presenters

Victoria Devine is a multi-award-winning financial advisor, business owner, podcaster and author. She hosts the popular podcasts She’s on the Money and The Property Playbook, and is the CEO of Zella, a financial services company. Through all her ventures, Victoria aims to transform the way millennials think about money to make their financial dreams achievable.

Dr Nicole Hope is a highly experienced fertility specialist and the Medical Director of Newlife IVF. She also holds an advanced Certificate in Reproductive Endocrinology and Infertility (CREI). This is the highest level of qualification you can have in fertility care and less than 100 Australian fertility specialists have it! Above all, Dr Hope is passionate about helping her patients start or grow their families, and she prioritises the importance of providing the right information and support at each step of fertility care.

Learn more about the financial side of egg freezing

Watch the webinar for a full breakdown of egg freezing, the costs and the financing options available.

Single and ready to have a baby – what are my options?

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I’m a single woman – what are my options?

Donor sperm – clinic-recruited versus known donors

Essentially, there are two options for obtaining sperm: accessing donor sperm through a fertility clinic’s sperm bank, or using a sample provided by someone you know.

At Newlife IVF we have an on-site sperm bank containing samples recruited from local and international donors. The benefit of using sperm from our clinic-recruited donors is that it is thoroughly tested for infectious diseases and common genetic problems. After we freeze the sperm, it is then quarantined before donors are retested to make sure it is high quality and safe to use.

When you use a clinic-recruited donor, you also have the advantage of very clear legal boundaries. The donor has no legal connection to your child – they are not entitled to custody and do not have to pay child support. They also remain anonymous to a large extent; that is, you will not know the donor’s identity (but you will know their family medical history and some of their traits). However, your child can request that the donor’s identity be revealed to them when they turn 18.

If you choose not to go the clinic-recruited donor route, you may consider using a sperm sample from a friend or acquaintance. A benefit of using a known donor is you will likely have a good understanding of their appearance, background and traits. However, the social and legal boundaries are not as clear-cut as they are when using a clinic-recruited donor. Discussing expectations and creating firm boundaries with a known donor requires careful negotiation, and you may wish to seek legal advice on how best to proceed.

If you do decide to use a sample from someone you know, it’s best to involve a fertility clinic. That way, you can have the sample rigorously tested for safety and quality in the same way we test donor sperm.

In this video, Dr Chris Russell talks about donor sperm and its use in IVF and IUI procedures.

Insemination – how egg and sperm meet

The next consideration is how best to introduce the sperm sample to your egg. There are a few different options for insemination, and the most suitable will depend on your specific circumstances.

One possibility is home insemination. In this method, sperm is injected into the vagina using a syringe at home. As this mimics the natural fertilisation process, home insemination is effective when the donor has a normal sperm count. It is also one of the most cost-effective options. However, it does not afford the same degree of protection from infectious disease as undergoing a similar process via a fertility clinic.

The clinic-based alternative is intrauterine insemination (IUI). This is where a sperm sample is concentrated to contain a very high number of sperm. It is then injected directly into your uterus soon after your ovaries release an egg. Using a concentrated sperm sample increases the chances of a sperm fertilising your egg. Depending on your circumstances, your specialist may recommend combining IUI with a medication to stimulate the release of an egg from your ovaries, further increasing the chance of success.

The last option is in vitro fertilisation (IVF). In this process, several of your eggs will be introduced to sperm in laboratory dishes. When utilising clinic-recruited donor sperm, the best sperm may be selected and a single sperm injected directly into each egg, a process called intracytoplasmic sperm injection (ICSI). One of the best embryos resulting from IVF insemination will then be transferred back to your uterus. The rest can be frozen and stored for later use, if necessary.

There are a few reasons you may be advised to undergo IVF. If you have known infertility, you’re in your late 30s or early 40s (when female fertility naturally declines significantly), or you struggle to get pregnant through other forms of insemination, your specialist may recommend this procedure. Likewise, IVF may be advisable if you’re using a known sperm donor with low sperm quality or quantity for other methods of insemination. If you wish to do preimplantation genetic testing, which is the process of genetically testing your embryos before they are transferred to your uterus, IVF will be necessary. For more information about these procedures in relation to your particular circumstances, chat to your fertility specialist.

I’m a single man – what are my options?

To have a baby as a single man, you will need the help of an egg donor and a surrogate. According to Victorian law, these must be two different women.

You may choose to use a clinic-recruited egg donor, or a known donor, i.e. a friend, acquaintance, or a family member (note: the last is only okay if you are not using your own sperm). Egg donation must be altruistic in Australia, meaning no financial compensation is paid for providing eggs. Once the donor eggs are ready, your sperm will be introduced to them using IVF (discussed earlier in this article), and the best resulting embryo will be transferred to your surrogate’s uterus. If you are not using your own sperm, donor embryos may be an appropriate option for you.

It’s common to ask a friend, acquaintance or family member to be a surrogate. Surrogacy is also an altruistic process in Australia, however ‘reasonable’ medical costs can be paid by you. Keep in mind that in Victoria, multiple medical consultations, counselling sessions and legal advice are required for both you and the surrogate prior to proceeding. You will also need to seek permission from the Patient Review Panel (this is a legal requirement in Victoria), and the sperm or embryos must be quarantined. This process can take several months.

Seeking a surrogate overseas may also be an option. However, according to Australian law, this is only legal if it is altruistic. Be aware that this is a very expensive route and you will need to plan to potentially be overseas for a few months after your baby is born to organise their entry into Australia.

For advice related to your particular circumstances, you may wish to seek legal advice and talk to a fertility specialist. Unfortunately, Newlife IVF is not permitted to assist you in finding a surrogate (nor can any other IVF provider). However, our counsellors can certainly orientate you to the Victorian surrogacy community and provide support and information as you look for a potential surrogate.

Ready to have a baby on your own?

Make an appointment with one of our caring and experienced Newlife IVF fertility specialists to discuss the most appropriate way forward based on your medical history, circumstances and preferences. Call (03) 8080 8933 or book online and take the next step towards your dream.

Putting patients first – the secret to exceptional results

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Today, that vision, combined with the collective expertise and experience of our fertility specialists and support staff, has earned Newlife IVF recognition as one of Victoria’s top-performing IVF clinics.

According to the latest figures reported by the Herald Sun (sourced from the Federal Government’s Your IVF Success website), Newlife IVF holds the highest IVF success rate in Victoria for women under 35, with an impressive 62.5% of embryo transfers resulting in live birth.

For women aged 35 to 42, Newlife IVF also leads with the highest birth rates per embryo transfer in Metropolitan Melbourne (31.7%), placing us third overall in Victoria for this age group.

‘We are delighted to share that we have had another great year for our patients, with our pregnancy and birth success rates consistently above the national average. Our fertility specialist team focuses on providing the best possible milieu for eggs to mature and embryos to implant, and our amazing embryologists focus on every aspect of the egg, sperm and embryo care to provide a nurturing environment to achieve their developmental potential,’ said Dr Nicole Hope, fertility specialist and Medical Director at Newlife IVF.

A vision for exceptional fertility care

As a clinician-owned and led fertility clinic, we’re proud to be one of the few independent specialist fertility centres in Victoria. This independence allows us to offer a more personalised, supportive experience than corporate-owned clinics.

‘We feel so privileged to play a part in our patients’ journeys. Being able to provide a level of care that helps them achieve their dream of starting a family is truly an honour for us,’ said Dr Tiki Osianlis, Newlife IVF’s Managing Director and Scientific Director.

Every aspect of our practice is designed with our patients’ needs in mind. From our state-of-the-art laboratory to our use of advanced scientific tools and techniques, we combine expert-led care with cutting-edge science to give our patients the best possible chance of building the family they dream of.

‘Our IVF success rates highlight how effective our approach is. It’s not just about the science – it’s about the people. The entire team, from our fertility specialists and nurses to our embryologists, counsellors and admin staff, take the time to truly understand each patient’s unique journey. We adapt our care to fit their needs, and every single one of us is genuinely invested in helping our patients achieve their dream of becoming parents,’ said Dr Tiki.

Giving you Newlife in a different way

At Newlife IVF, we believe that everyone deserves the opportunity to build their family, which is why we’re committed to making quality fertility treatment in Melbourne as accessible as possible. We remain committed to delivering outstanding results and compassionate care, empowering our patients with the best possible chance of success.

If you’re ready to explore your options for having a baby, you can make an appointment with one of our specialists by calling (03) 8080 8933 or by booking online.

Understanding the IVF process and treatment

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What is IVF and how does it work?

IVF is an assisted reproductive technique that helps people overcome fertility challenges to start or grow their families. This process involves fertilising an egg with sperm in a specialised laboratory, with the resulting embryo carefully transferred into the uterus with the aim that it will lead to a pregnancy.

Whether you’re just beginning your fertility journey or considering your options, understanding the IVF process is an empowering first step. In this article, we’ll guide you through the process that we use at our fertility clinic in Melbourne, to help you make informed decisions about your next steps.

A step-by-step guide to the IVF process at Newlife IVF in Melbourne

From the initial consultation through to the embryo transfer procedure, IVF involves a series of carefully coordinated stages – tailored to your unique needs – that are designed to give you the best chance of pregnancy success.

Initial consultation with our Melbourne-based fertility specialist

If you’re concerned about your fertility and would like to seek advice from a fertility specialist, you will need a referral from your GP to attend our IVF clinic.

During your initial consultation, your fertility specialist will assess your health and the factors contributing to your fertility issues, as well as provide tailored advice, including recommendations about diet and lifestyle. This process involves taking a thorough medical history from you, performing relevant examinations and ordering appropriate tests. Your fertility specialist will also discuss all available treatment options with you so you can make an informed decision about whether the IVF process is right for you.

If it is decided that IVF treatment is appropriate, we will register you as a patient at our fertility clinic. At this stage, mandatory tests, such as screening for infectious diseases, will be conducted if they have not been done previously.

Personalised fertility treatment planning

As no two fertility journeys are the same, fertility care at our IVF clinic in Melbourne is never one-size-fits-all. Our approach begins with uncovering the root causes of your fertility challenges and guiding you through the treatment options that best suit your unique circumstances. These options can range from straightforward solutions like fertility optimisation and ovulation induction to advanced treatments, such as intrauterine insemination (IUI), IVF, or IVF with intracytoplasmic sperm injection (ICSI).

In some cases, and after a careful review of your medical and IVF history, your fertility specialist may prescribe adjuvant treatments to complement an IVF cycle.

Ovulation induction and hormone stimulation

Ovulation induction is a commonly used fertility treatment for individuals with ovulatory dysfunction. Often serving as an early intervention, it can be effective as a standalone treatment or combined with others, such as IUI or IVF, to improve the chances of conception. Ovulation induction involves using fertility medication to stimulate your ovaries to produce one or more mature eggs and assist with ovulation. For those undergoing IVF, hormone stimulation with fertility medications is used to stimulate your ovaries to produce a higher number of mature eggs than they normally would. This is a critical step in preparation for egg retrieval.

During this stimulation phase, self-administered hormonal injections are given over 8–14 days to encourage the development of multiple eggs, increasing the number available for retrieval and fertilisation.

Fertility blood tests and monitoring

Careful monitoring plays a vital role throughout the stimulation phase. Using a combination of blood tests and ultrasounds, your fertility specialist will closely track how your ovaries are responding and how the follicles (sacs in the ovaries that contain eggs) are developing. These tests allow your specialist to assess if everything is progressing as planned and fine-tune your fertility medication to optimise your results.

As you near the end of the stimulation phase, monitoring is used to determine the optimal time for the ‘trigger injection’, which prepares the eggs for ovulation (i.e. their release from the ovaries). Your fertility nurse will liaise with your fertility specialist and guide you on when to administer the injection, as precise timing is essential – the egg retrieval procedure must occur before natural ovulation. Monitoring usually takes place at one of our Newlife IVF locations in Melbourne. However, you don’t have to be in Melbourne to access treatment. We have patients that live in rural or interstate locations and we work with local pathology and ultrasound providers to assist with our patients’ monitoring needs.

Egg retrieval procedure at our IVF clinic in Melbourne

Egg retrieval, also known as egg collection or egg pickup, is a key step in the IVF process. This procedure involves collecting eggs from your ovaries, which can be frozen for future use or fertilised in the next stage of your IVF cycle.

Performed at our IVF clinic under sedation, egg retrieval is a straightforward procedure that typically takes 20–30 minutes. During this time, your fertility specialist carefully collects eggs from your ovaries using a fine needle guided by ultrasound imaging. On average, 8–12 eggs are retrieved, although the exact number depends on factors such as age, ovarian response to the medication and health history.

Collecting multiple eggs at once is important to IVF success. A higher number of eggs increases the chance of developing the healthy embryos needed for a successful embryo transfer and pregnancy.

Our team understands that undergoing egg retrieval can feel both exciting and a little nerve-wracking. But you can rest assured that we’re here to support you every step of the way so that you feel informed and comfortable throughout the entire IVF process.

Sperm collection and ICSI treatment

On the day of egg retrieval, fresh semen samples are collected from the male partner. If you’re using frozen or donor sperm, our embryologists will ensure the sample is thawed and ready for use.

For standard IVF, the semen sample is carefully prepared by removing the seminal fluid (the fluid that contains sperm), isolating the motile sperm and removing immotile sperm before the insemination procedure

For ICSI, the process is more precise. Only a single sperm is used for fertilisation, requiring experienced embryologists to select the healthiest and most viable sperm and inject it directly into the egg.

Selecting the ideal sperm is a delicate process requiring years of expertise. Our embryologists are trained to identify sperm with the best shape and structure to maximise the chances of successful fertilisation.

Fertilisation and embryo development

The next step in the IVF process is fertilisation, where egg and sperm are brought together.

In some cases, depending on the sperm quality and the patient’s previous history, we use standard insemination, where each egg is placed in a laboratory dish and exposed to thousands of prepared sperm. The fittest sperm may then fertilise the egg naturally, mirroring what would occur in the body.

However, if there are challenges such as low sperm count or abnormalities in sperm quality, an advanced technique called ICSI may be used. With ICSI treatment, a single, healthy-looking sperm is carefully injected into an egg to increase the chances of fertilisation. While this method offers additional precision, it’s important to note that not all eggs will successfully fertilise.

If fertilisation occurs, the resulting embryos are carefully placed in an incubator that mimics the conditions of the female body. Over the next five days, these embryos grow and divide, preparing for the next stage of the IVF process – embryo transfer.

The embryo transfer procedure

The embryo transfer is one of the quickest yet most important stages of the IVF process. During this procedure, a carefully selected embryo is placed into your uterus with the hope that it will successfully implant and lead to pregnancy.

Performed under ultrasound guidance, the transfer involves using a long, thin instrument to gently release the embryo through the vagina and cervix into the uterus. For most women, the procedure feels similar to a routine pap test. It is quick, requires no anaesthetic and allows you to resume your usual activities afterwards.

At Newlife IVF, our fertility specialists and embryologists are committed to providing the highest standard of care and technology to maximise your chances of IVF success.

Pregnancy testing and ongoing support

The pregnancy test represents the culmination of weeks of preparation. This fertility blood test measures the level of human chorionic gonadotrophin (hCG) in your body – a hormone produced when a fertilised egg (an embryo) implants into the uterus. Elevated hCG levels can indicate a successful IVF cycle and the achievement of pregnancy.

This test is performed approximately eleven days after the embryo transfer, giving your body the necessary time to respond to implantation. While waiting for results can be an emotional experience, our dedicated team is here to support you regardless of the outcome.

This webinar, presented by fertility specialists Dr Chris Russell and Dr Nicole Hope, provides a more detailed explanation of the IVF process.

 

Why choose Newlife IVF?

At Newlife IVF, we understand how significant the IVF process is, and we’re committed to walking beside you on your journey to parenthood. Whether celebrating your success or exploring the next steps, you’ll always have compassionate care and expert guidance from our team.

Clinician-owned and led fertility clinic in Melbourne

As one of few independent specialist fertility centres in Victoria, we take pride in offering a more personalised, compassionate and supportive experience compared to corporate-owned clinics.

State-of-the-art IVF treatment in Melbourne

Every aspect of our practice is thoughtfully designed with your needs in mind, from our expert-led care to our state-of-the-art laboratory and scientific tools and techniques.

Advanced scientific techniques and high IVF success rates

We incorporate cutting-edge scientific advancements into every step of our IVF treatment process, helping to give you the best possible chance of achieving a successful pregnancy.

Our approach includes the use of the EmbryoScope time-lapse system, which provides continuous monitoring of embryo development, sequential media to nurture embryos, and EmbryoGlue to enhance implantation potential when transferring embryos into the uterus.

For ICSI treatment, we take it a step further with egg spindle visualisation technology, allowing us to carefully select eggs with the greatest potential for fertilisation.

Our IVF success rates reflect the effectiveness of these methods, consistently exceeding the national average and giving our patients a better chance of achieving their dream of parenthood.

Accessible and affordable IVF treatment in Melbourne

At Newlife IVF, we believe that everyone deserves the opportunity to build their family, which is why we are committed to providing affordable IVF treatment. Our fee structure is designed to be transparent and accessible, ensuring that fertility care in Melbourne, including IVF, is reasonably priced and doesn’t involve the stress of unexpected costs.

Contact Newlife IVF – your trusted fertility clinic in Melbourne

To book an appointment for IVF treatment in Melbourne with one of our caring, experienced fertility doctors, please call (03) 8080 8933 or email [email protected].

Simple changes to help improve your egg quality

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Fertility is largely influenced by the quality of both eggs and sperm. Age is the biggest determinant of egg quality1, but other factors such as diet, weight, physical activity and exposure to toxins (including illicit drugs or medications) also play a role. The good news is that whilst you cannot modify your age, there are things that you can do to improve egg quality and your chances of getting pregnant.

This involves making changes (if needed) to areas of your life that can influence various biological processes in the body – fertility included. With the proper modifications, you can protect your eggs from the harm caused by these factors and increase your likelihood of conceiving.

Why is age such a big factor?

Fertility starts to decline at the beginning of a woman’s 30s, but the decline is more rapid after age 35.1 This is because women are born with a lifetime supply of eggs – around 1-2 million – and this reserve gradually decreases over time. Egg quality also declines with age as the DNA in eggs becomes more susceptible to damage.

Eggs of lower quality are less likely to fertilise and develop into an embryo, affecting the chances of pregnancy. Additionally, older eggs are more likely to be affected by chromosome imbalance, which is associated with difficulty falling pregnant, an increased risk of miscarriage and a higher incidence of children born with a chromosome disorder (e.g. Down Syndrome).2

Unfortunately, once an egg’s DNA is damaged or the egg has an incorrect number of chromosomes (we call this aneuploidy), it cannot be reversed or repaired. For this reason, it’s important to protect your egg quality as much as possible.

Tips to improve your egg quality

Smoking

Women who smoke or are exposed to second-hand smoke often face delays in conceiving. Smoking damages egg DNA, which reduces fertility and increases miscarriage risk.3 It also increases the chance of ectopic pregnancy and makes embryo implantation harder, while increasing the risk of pregnancy complications.4 Therefore, avoiding smoking and second-hand smoke is crucial when trying to conceive and during pregnancy.

Additionally, researchers are still learning about all the risks of e-cigarettes (vapes) on conception and pregnancy. At this stage, no amount of vaping is considered safe when trying to conceive.

Alcohol

If you’re trying to conceive, drinking alcohol can affect your ability to get pregnant and stay pregnant. Some studies suggest that even low to moderate alcohol consumption is associated with reduced fertility.5 Drinking alcohol can alter hormone levels and disrupt the menstrual cycle and the ability to ovulate, therefore reducing the chances of conceiving. So, cutting down or cutting out alcohol can improve your chances of falling pregnant, along with helping you embrace a healthier lifestyle.

Coffee/caffeine

Some studies have shown reduced fertility and increased risk of miscarriage with excessive caffeine consumption.6 Most studies also indicate that the risk of infertility rises with higher levels of caffeine intake. Unfortunately, a safe daily amount of caffeine has not been established. For this reason, we recommend limiting your intake to one caffeinated drink per day (<80–100 mg of caffeine). If you can go without all together, even better!

Illicit drugs

Taking recreational drugs reduces the chances of becoming pregnant and having a healthy baby. For instance, cannabis and opioids are known to disrupt normal hormone production, leading to problems with ovulation and menstrual cycle disturbances.7 Additionally, stimulants such as cocaine and crystal meth have been linked to higher rates of miscarriage.8 Therefore, avoiding illicit drug use is one of the simplest ways to preserve your fertility.

Extreme exercise

Over-exercising can hinder ovulation and hormone production – specifically progesterone production, which is critical in supporting a pregnancy as it helps to thicken the lining of the uterus (needed for embryo implantation). Excessive exercise has also been linked to miscarriage.9 Vigorous exercise should not exceed 4 hours a week. However, lighter activities, such as walking and Pilates, are not limited.

Diet Mediterranean Diet foods, including fresh fruit and vegetables, lean meats, eggs, nuts, seeds and healthy fats like avocado.

The Mediterranean diet is often recommended for individuals undergoing in vitro fertilization (IVF) due to its potential benefits for reproductive health – and this may include egg quality. This diet emphasises the consumption of whole foods, including fruits, vegetables, whole grains, legumes, nuts, fish and healthy fats like olive oil, while limiting processed foods, red meat and added sugars.

Research suggests that adherence to the Mediterranean diet may improve fertility outcomes by promoting a healthy weight, reducing inflammation and optimising insulin sensitivity, all of which can positively influence ovarian function and embryo quality.10,11

Maintaining a healthy weight

Being underweight or overweight is associated with reduced pregnancy rates. This is because carrying too little or too much weight can disrupt the balance of hormones in your body, leading to ovulatory issues and irregular periods, along with an increased risk of miscarriage. Even if a woman has a regular cycle, fertility may still be reduced compared to women within the healthy weight range (a body mass index between 18.5 and 25).

Weight loss in overweight people doesn’t have to be drastic to improve fertility. Research has shown that even a modest drop in body weight (5–10%) can increase the chances of pregnancy – not to mention many other health benefits, such as a reduced risk of conditions like diabetes and heart disease, and a lower rate of pregnancy-related complications.12 Weight training and improving your lean body mass is also crucial for optimising your metabolism and reducing insulin resistance.

Weight loss is difficult, but your care providers can help you navigate the weight management journey. Talking to your GP or fertility specialist about weight is a great first step. We’ll make sure you have the support you need.

Medical conditions and medications

Conception is most likely to occur when you’re in good health. Untreated medical conditions, especially hormonal disorders (e.g. thyroid issues) and gynaecological conditions (e.g. endometriosis), can hinder fertility. It’s essential to manage these conditions before trying to conceive. Additionally, ensure that any prescribed medications are safe to take during conception and pregnancy by discussing these with your fertility specialist.

Night shift work

Night shift workers may experience reduced fertility because disrupted or insufficient sleep can interfere with the body’s circadian rhythm, leading to hormonal imbalances. Research on patients undergoing IVF has shown that women working night shifts tend to produce fewer eggs suitable for embryo development.13 Meanwhile, other studies have linked shift work to higher miscarriage rates.14 If possible, avoid night shift work and stick to a regular shift schedule rather than rotating between day and night shifts, as consistency can help reduce the impact on hormone levels.

Supplements for improving egg quality

In addition to lifestyle changes, certain supplements are often recommended. While evidence supporting their impact on egg quality and IVF success rates is limited, some studies suggest potential benefits, whereas others show no significant improvements in fertility outcomes. However, when taken at recommended doses, these supplements are generally considered safe.11

For instance, antioxidants like vitamin E and coenzyme Q10 may enhance IVF outcomes by reducing DNA damage and improving egg quality, particularly in older women or those with diminished ovarian reserve. Other commonly suggested supplements include vitamin D (especially for those with a deficiency) and omega-3 fatty acids.11

Additionally, all women trying to conceive should take a supplement containing at least 400 mcg of folic acid, which is crucial for DNA synthesis and reducing neural tube defects, along with 150 mcg of iodine to support thyroid function.11

Small changes can lead to big results

Simple yet impactful lifestyle changes go a long way towards preserving egg quality, preventing egg damage and improving your overall fertility. By addressing these modifiable factors and prioritising your overall wellbeing, you can boost your chances of conception and a healthy pregnancy.

If you’re ready to explore your options for having a baby or are concerned about your fertility, you can make an appointment with one of our specialists by calling (03) 8080 8933 or by booking online.

References

 

  1. Better Health Channel. Age and fertility [internet]. Victoria (AU): Better Health Channel; 2023 [updated 2023; cited 2024 Oct]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility ↩ ↩
  2. Winship A, Stringer J, Liew S et al. The importance of DNA repair for maintaining oocyte quality in response to anti-cancer treatments, environmental toxins and maternal ageing. Hum Reprod Update. 2018;24(2): 19–134. doi: https://doi.org/10.1093/humupd/dmy002. ↩
  3. Pineles BL, Park E, Samet JM. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol. 2014;179(7):807–23. doi: 10.1093/aje/kwt334. Epub 2014 Feb 10. PMID: 24518810; PMCID: PMC3969532. ↩
  4. Better Health Channel. Pregnancy and smoking [internet]. Victoria (AU): Better Health Channel; 2022 [updated 2022; cited 2024 Oct]. Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-smoking ↩
  5. Fan D, Liu L, Xia Q et al. Female alcohol consumption and fecundability: a systematic review and dose-response meta-analysis. Sci Rep. 2017;7(1):13815. doi: https://doi.org/10.1038/s41598-017-14261-8 ↩
  6. Lyngsø J, Ramlau-Hansen CH, Bay B et al. Association between coffee or caffeine consumption and fecundity and fertility: a systematic review and dose-response meta-analysis. Clin Epidemiol. 2017;9:699–719. doi: 10.2147/CLEP.S146496. PMID: 29276412; PMCID: PMC5733907. ↩
  7. The Society of Obstetricians and Gynaecologists of Canada. Substance use and fertility [internet]. Ontario (CA): The Society of Obstetricians and Gynaecologists of Canada; 2024 [cited 2024 Oct]. Available from: https://www.pregnancyinfo.ca/before-you-conceive/fertility/substance-use-and-fertility/ ↩
  8. Smid MC, Metz TD, Gordon AJ. Stimulant use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women. Clin Obstet Gynecol. 2019;62(1):168–184. doi: 10.1097/GRF.0000000000000418. PMID: 30601144; PMCID: PMC6438363. ↩
  9. Barakat R, Zhang D, Silva-José C et al. The influence of physical activity during pregnancy on miscarriage-systematic review and meta-analysis. J Clin Med. 2023;12(16):5393. doi: 10.3390/jcm12165393. PMID: 37629435; PMCID: PMC10455409. ↩
  10. Hart RJ. Nutritional supplements and IVF: an evidence-based approach. Reprod Biomed Online. 2024;48(3):103770. doi: 10.1016/j.rbmo.2023.103770. ↩
  11. Yang J, Song Y, Gaskins AJ, et al. Mediterranean diet and female reproductive health over lifespan: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023;229(6):617-631. doi: 10.1016/j.ajog.2023.05.030. ↩ ↩ ↩ ↩
  12. Haase CL, Varbo A, Laursen PN et al. Association between body mass index, weight loss and the chance of pregnancy in women with polycystic ovary syndrome and overweight or obesity: a retrospective cohort study in the UK. Hum Reprod. 2023;38(3):471–481. doi: https://doi.org/10.1093/humrep/deac267 ↩
  13. Liu Z, Zheng Y, Wang B et al. The impact of sleep on in-vitro fertilization embryo transfer outcomes: a prospective study. Fertil Steril. 2023;119(1):47–55. doi: 10.1016/j.fertnstert.2022.10.015 ↩
  14. Mínguez-Alarcón L, Souter I, Williams PL, et al. Occupational factors and markers of ovarian reserve and response among women at a fertility centre. Occup Environ Med. 2017;74:426-431. doi: 10.1136/oemed-2016-103953 ↩