Current Research | Monash IVF Group

Groundbreaking Research Project

The mitoHOPE (Healthy Outcomes Pilot and Evaluation) Program.
Prof John Carroll, Dr Deepak Adhikari, Dr Meenakshi Choudhary, Prof John Christodoulou, Prof David Coman, Prof Martin Delatycki, A/Prof Carolyn Ellaway, Prof Michael Fahey, A/Prof Ilias Goranitis, Dr Christopher Gyngell, Dr Karin Hammarberg, Dr Tristan Hardy, Prof Mary Herbert, A/Prof Ryan Hodges, Prof Lisa Hui, Dr Louise Hyslop, Dr Benjamin Kamien, Dr Janet Long, A/Prof Karinne Ludlow, Prof David Mackey, Prof Andrew Mallett, Prof Jeffrey Mann, Prof Catherine Mills, Prof Rebecca Robker, Prof Luk Rombauts, Prof Michael Ryan, Dr Suzanne Sallevelt, Prof Christopher Semsarian, Prof Robert Sparrow, Dr Michel Tchan, Prof David Thorburn, Dr Meaghan Wall, Dr Mathew Wallis, Dr Narelle Warren, Dr Wai Yan Yau, Prof Deirdre Zander-Fox, Prof Sophia Zoungas Monash University, Monash IVF, Murdoch Children’s Research Institute, Adelaide University, Newcastle University, and the Mito Foundation

Monash IVF researchers, in collaboration with Monash University and Murdoch Children’s Research Institute, are establishing an Australian-first clinical program to investigate a lifesaving technique known as mitochondrial donation or ‘three-person IVF’. Mitochondrial donation aims to ensure only healthy mitochondria, the powerhouses of our cells that are vital to our survival, are passed on to an embryo by minimising the risk of prospective mothers passing on devastating mitochondrial disease to their children. Used in conjunction with IVF, mitochondrial donation techniques allow an embryo to be created that contains the nuclear DNA from a man and a woman (the prospective mother) and mitochondria in an egg donated by another woman (the mitochondrial donor).

The mitoHOPE Program is a mitochondrial pilot program to test the safety, efficacy, and feasibility of mitochondrial donation to help determine whether mitochondrial donation could be introduced into clinical practice in Australia. The program includes a clinical trial for at-risk individuals. For more information go to the mitoHOPE Program website. The mitoHOPE Program is funded by a $15 million Medical Research Future Fund (MRFF) grant, as well as contributions from program partners.

Key Research Projects

Establishment and validation of the ‘exposome’ as a prognostic predictor of female fertility.

A/Prof Mark Green, A/Prof Bradley Clarke, Prof Deirdre Zander-Fox, Prof Luk Rombauts

Monash IVF Group and University of Melbourne

There is now an increasing reliance on Assisted Reproductive Technology (ART) to conceive. It is postulated that the rising trend in infertility can be partially attributed to exposure to man-made environmental toxicants, such as endocrine disrupting chemicals (EDCs), found in many everyday household items and personal care products. The aims of this project are to firstly, establish and validate methodologies to quantify the ‘exposome’, and secondly, the accurate quantification of EDCs in the blood, urine and follicular fluid of patients. EDC concentrations will then be analysed with respect to clinical measurements of fertility to determine whether a negative correlation exists between EDCs and patient outcomes measures (i.e. number of eggs, as well as fertilisation, blastocyst and utilisation rates). The findings of this study will provide preliminary data to determine whether the exposome can be used as a reliable prognostic marker for egg quality and thus fertility. The project outcomes have substantial scope for understanding how exposure to chemicals can influence clinical success rates.

Impact of Early Pregnancy Screening on Perinatal and Childhood Welfare – a Fourteen Year Review.

A/Prof Andrew McLennan, Dr Kata Kraljevic, Dr Jonathan Morris, Dr Jillian Patterson

Monash IVF Group – Sydney Ultrasound for Women, University of Sydney and Kolling Institute

In conjunction with the Women and Babies Research Group at the Kolling Institute, this project will examine 17 years of early prenatal screening for genetic abnormalities and adverse pregnancy outcome (2006‐2022). During that time Sydney Ultrasound for Women has screened approximately 220,000 obstetric patients with over 600,000 ultrasound examinations. Pregnancy, perinatal and childhood outcomes for this cohort will be identified through linkage with multiple NSW Health databases covering both short‐term pregnancy outcomes and longer‐term childhood development. This research will provide assessment of screening accuracy and long‐term outcomes for chromosomal and genetic anomalies, adverse pregnancy outcome risk prediction, fetal structural abnormality diagnostic accuracy, pre‐term birth prediction using cervical length screening, fetal growth restriction assessment and adverse twin pregnancy outcome prediction. This is a unique opportunity to highlight the benefits of innovative clinical research in private practice and to assess the potential for translation into improved perinatal and childhood development outcomes.

Parental diet and IVF outcomes.

Dr Jessica Grieger, Prof Kelton Tremellen, Dr Juliette Koch, Prof Deirdre Zander-Fox, Cathy Tully, Dr Nicole McPherson, Kimberly Lush, Pavlina Vagner

Adelaide University and Monash IVF Group

There is increasing focus on the relevance of preconception care to maximize pregnancy success and child health, to support environmental and lifestyle influences, and create awareness around infertility. Infertility affects millions of couples worldwide and is associated with significant emotional and economic burden. However, despite the increased recognition and importance of nutrition for reproductive health, consistent evidence-based research identifying key dietary factors to support fertility, especially in couples, remains unclear.

Clomiphene in male infertility (CIMI) trial: A double-blind randomised placebo-controlled trial of clomiphene in normogonadotrophic idiopathic male infertility.

Dr Sarah Catford, Prof Robert McLachlan, Prof Luk Rombauts, Dr Ie-Wen Sim, A/Prof Darren Katz, Dr Tristan Hardy, A/Professor Kate Stern

Monash IVF Group, Hudson Institute of Medical Research, Men’s Health Melbourne and The Royal Women’s Hospital

Male infertility affects 2.5-12% of men worldwide and contributes to 30-50% of couple infertility. Studies suggest that medical therapies including clomiphene may be a therapeutic option in idiopathic male infertility with normal levels of gonadotrophins. Clomiphene has been used to treat male infertility since the1960s with some studies showing its use can improve semen parameters, sperm retrieval rates and pregnancy rates. However, existing data are conflicting and of poor quality with no clear evidence of benefit. Due to limited data, Clomiphene has not been approved by regulatory authorities for this indication. This study will evaluate whether Clomiphene improves sperm quantity and quality in men with idiopathic oligozoospermia and normal gonadotrophins. Eligible men will be recruited from fertility clinics in Melbourne and consenting participants will be randomised to clomiphene or placebo for 6 months. During the study, participants will complete online surveys, and undergo clinical reviews, blood, and semen testing to monitor hormone levels, semen parameters and any side-effects.

ANZCTR Trial ID: ACTRN12623000329662

Characterising changes in circadian rhythms, eating architecture, glucose control and activity in IVF pregnancy (CREATE).

Dr Amy T Hutchison, Kimberly Lush, Dr Jessica Grieger, Cathy Tully, Prof Leonie Heilbronn, Dr Juliette Koch, Prof Deirdre Zander-Fox

Monash IVF Group, Adelaide Medical School, and Robinson Research Institute

This study is exploring what changes in the body’s natural sleep and activity rhythms occur early in pregnancy (for example waking and eating earlier in the day) and establishing whether these changes in circadian rhythm are associated with positive or negative health outcomes in pregnancy (i.e. does the natural shift in sleep and/or meals earlier during pregnancy, affect blood glucose control?)

Non-invasive prenatal testing using extracellular vesicle derived fetal DNA.

Prof Benjamin Thierry, Dr Emily Button, Dr Tristan Hardy, Prof Deirdre Zander-Fox, Dr Marnie Winter, Kieran Sparkes

Adelaide University and Monash IVF Group

During pregnancy placental DNA is released into the maternal circulation and this DNA (named cell-free fetal DNA) usually reflects the fetus and therefore, is useful for non-invasive prenatal testing (NIPT). Despite the widespread use of NIPT, surprisingly little is known about the origin and structural associations of cell-free fetal DNA. This project aims to characterise the origin and structural association of cell-free fetal DNA and in particular their associations with placental extracellular vesicles (EVs). Better defining the relationship between EVs and cell-free fetal DNA would improve our understanding of the biological processes which lead to their release. This knowledge may be used to develop technologies and methodologies to increase the fetal fraction (proportion of DNA which is fetal vs maternal) which currently limits NIPT. Increasing the fetal fraction could enable more cost effective NIPT and foster the development of next generation NIPT.

Exploring the impact of antibiotic use on vaginal microbiome composition and subsequent outcomes in an IVF setting.

Dr Eliza Curnow, Dr Matthew Payne, Dr Katrina Rowan, Dr Tammie Roy, Dr Ross Turner

Monash IVF Group and University of Western Australia

The vaginal microbiome (VM) is widely recognised as having a major role in reproductive success and pregnancy outcomes. A healthy VM is typically dominated by one or more Lactobacillus spp., the presence of which is associated with successful outcomes in both natural and IVF pregnancies. However, when VM diversity is increased and Lactobacillus spp. abundance reduced, higher rates of idiopathic infertility, implantation failure, miscarriage and preterm birth have been reported. In the context of IVF, all studies to date have focussed on evaluating the baseline VM relative to IVF outcome, however, none have considered how clinical IVF practices may impact the VM during treatment. Our study will investigate if these practices impact the VM, and document if any such changes are associated with IVF and pregnancy outcomes.

Can transport and freezing of ovarian tissue be improved?

Dr Amy Hicks, Dr Tamara Hunter, Dr Debra Gook, A/Prof Kate Stern, Dr Genia Rozen, Jason Conceicao, Anastasia Kirillova

Monash IVF Group and The Royal Women's Hospital

For over two decades, the Royal Women's Hospital (RHW) in Melbourne has provided ovarian tissue freezing for children and young women with cancer, with over 600 patients accessing this service. Outside Melbourne, particularly in other states and regional areas, access remains limited. Although pregnancies have been achieved using transported, slow frozen and transplanted ovarian tissue, the impact of transport on follicle number and survival has not been quantified. An opportunity exists to study and validate our current processes within Australia to ensure equitable access to ovarian tissue freezing as an effective method of fertility preservation.

Development of an artificial intelligence model for sperm and oocyte selection in assisted reproduction.

Prof Deirdre Zander-Fox, A/Prof Reza Nosrati, Prof Moira O'Bryan, Prof Rob McLachlan, Sahar Shahali, Dr Ozlem Tunc, Jennifer Lorimer

Monash IVF Group, Monash University and University of Melbourne

With effective sperm selection we aim to increase the number and the quality of embryos produced through ICSI in IVF and increase the likelihood of pregnancy. An AI sperm selection tool will reduce the time taken for the ICSI procedure, limiting the gametes, and resulting embryos exposure to suboptimal conditions.

Comparison of PIEZO-ICSI and conventional ICSI pregnancy and birth outcomes.

Jasmin Thompson, Prof Deirdre Zander-Fox, A/Prof Mark Green, Dr Melissa Caddy

Monash IVF Group

The aims of this study are to assess the pregnancy and birth outcomes of PIEZO-ICSI compared to conventional ICSI to determine its clinical efficacy and provide additional evidence of the safety and effectiveness of PIEZO-ICSI technology using the new operating fluid, perfluoro-n-octane, especially in the context of longer-term pregnancy and birth outcomes.

The relationship between season at egg pickup and embryo transfer on clinical outcomes.

Anthony McAlpine, Prof Deirdre Zander-Fox, Prof Luk Rombauts, A/Prof Mark Green, Dr Ross Turner

This project aims to identify whether the clinical outcomes of patients who underwent egg pickups (EPUs) and an embryo transfer (ETs) or Frozen Embryo Transfer (FETs) are affected by season and whether this effect is observed across different environments.

Enlargement of the Fetal Fourth Ventricle on Prenatal Ultrasound: A Retrospective Case Series of Genetic and Chromosomal Findings.

A/Prof Daniel Rolnik, Joyce Sung, Prof Simon Meagher, Megan Wimmers, Anna Meshkova

Monash IVF Group – Monash Ultrasound for Women and Monash University

The primary objective is to determine the prevalence of chromosomal and genetic abnormalities in fetuses with fourth ventricle enlargement. Secondary objectives include describing associated structural abnormalities and assessing pregnancy and neonatal outcomes in this cohort. As this study uses retrospective, de-identified data, there will be no direct patient contact and no impact on clinical care. The findings of this study aim to improve understanding of fourth ventricle enlargement and support clinical decision-making in prenatal care.

For more information on a research study or to participate in a clinical trial, please send all enquiries to mivfgresearch@monashivfgroup.com.