Fertility Treatments

After your Fertility MOT and medical consultation, we’ll go through suitable fertility treatments and design a programme specifically for you. Your fertility programme takes into account your fertility screening results, your age (and that of your partner), your overall health, and how long you’ve been trying to become pregnant. We’ll also offer you an individualised patient support program that includes counselling.

In vitro fertilisation (IVF)

In vitro fertilisation, or IVF, is where the ovaries are stimulated (using hormonal injections) to produce eggs. The eggs are harvested from the ovaries using ultrasound guidance and then fertilised with sperm in a laboratory incubatorThe fertilised eggs (called embryos) are then grown for up to five days. One or two of the best quality embryos are then transferred into the womb to achieve a pregnancy.

When is IVF advised?

You may be advised to have IVF for more than one reason, including:

  • One or both of your fallopian tubes are damaged or blocked
  • The sperm is reduced in quantity and/or quality
  • Your infertility is unexplained
  • Your ovarian reserve is low
  • To allow egg donation
  • As part of an egg or embryo freezing program

How does IVF work?

During natural conception, an egg is released each month from the ovary. It travels down the fallopian tube to meet sperm that have swum through the cervix and womb. Fertilisation of the egg will only occur if sperm have reached the egg in sufficient numbers and are of good quality.

Once fertilised, the egg starts to divide to form an embryo and travels down the fallopian tube to reach the womb about five days later. At this point, the embryo is called a blastocyst and tries to implant.

For implantation to be successful, the womb lining has to be prepared and thickened by the hormone progesterone.

The single most important factor enabling the blastocyst to continue to grow in the womb, leading to pregnancy, is the embryo’s genetic health. This depends on both the egg and the sperm.

Intracytoplasmic Sperm Injection (ICSI)

ICSI is when a single, healthy sperm is injected into each egg during the IVF Laboratory stage rather than just placing the sperm in a dish with the eggs.

For eggs to be successfully fertilised in IVF, at least 100,000 motile sperm need to be present in each petri dish with the egg. So, for men with low sperm count, low motility or other quality issues, IVF would not lead to a good chance of the eggs being fertilised. In these cases we may recommend ICSI.

We may also recommend ICSI if you have unexplained infertility, or when there has been low fertilisation in previous IVF cycles. It’s also used if DNA fragmentation levels in sperm are high.

In men with low sperm count, low motility or other quality issues, IVF would not lead to a good chance of the eggs being fertilised. In these cases ICSI is recommended. This is when a single healthy normal looking sperm is injected into each egg.

“Our baby girl was born in December and without our ICSI procedure, we wouldn’t have become parents. To us she is an absolute miracle.”

Ovulation Induction

Ovulation induction is a treatment for women who have irregular menstrual cycles and don’t produce an egg each month (anovulation).  Anovulation is the commonest cause of infertility, but the good news is, it’s also the easiest to treat. Ovulation induction aims to restore ovulation in the most natural way possible.

Anovulation can be caused by a condition called polycystic ovary syndrome (PCOS). Other causes include stress, weight loss or weight gain, or excessive production of a hormone called prolactin, which stimulates milk production in the breasts.

What does ovulation induction involve?

Ovulation induction involves taking fertility drugs, either as tablets or injections, to help the ovaries produce and release a single egg each month. You’ll only be offered hormone injections if the milder tablets you’ve been prescribed aren’t effective.

We’ll carefully monitor how you respond to your medication. We do this by carrying out a series of transvaginal ultrasound scans during the first half of your cycle (called follicle tracking). We’ll also take a blood test seven days after ovulation. This is to check your levels of progesterone.

Intrauterine insemination (IUI)

IUI is the simplest form of assisted conception; it involves injecting specially prepared sperm into the womb.

Before we can recommend this treatment, we need to know whether the fallopian tubes are open (patent) and healthy. We usually advise that you have a urine test to check for chlamydia. If this is positive, you’ll be offered a tubal patency test such as a HyCoSy.

What does IUI treatment involve?

IUI treatment is similar to having a cervical screening test. During a speculum examination a fine catheter is passed through your cervix to allow the sperm to pass directly into the womb.

An IUI treatment cycle can be natural (without medication) or medicated using injections that boost egg production. The insemination itself is timed to correspond with ovulation so that you have the best chance possible of becoming pregnant.

If you are using your partner’s sperm, this is referred to as AIH (artificial insemination by ‘husband’) and if donor sperm is used it is referred to as DI (donor insemination).

Who might need IUI?

We may recommend IUI if:

  • You have unexplained infertility
  • There are problems with ovulation
  • Your partner has erectile dysfunction (ED) or impotence
  • The sperm are mildly abnormal
  • There are antisperm antibodies
  • You do not have a male partner but are using donated sperm

 

Embryo Freezing

If there are any good quality spare embryos left over from your treatment cycle, these can be frozen and stored for future use. They can be used if your treatment is unsuccessful or for a sibling pregnancy.

Embryos are frozen by removing the fluid from inside the cells before freezing them in liquid nitrogen. This is called vitrification. Embryos rapidly frozen in this way have excellent survival rates – over 95% – after being thawed. In recent years, success rates using frozen embryos have really improved. We now see very similar success rates using frozen embryos to our fresh IVF cycles.

Embryos are best frozen either on Day 1 or Day 5 after egg collection. Only top-quality embryos can survive the process.

Frozen Embryo Transfer

Frozen Embryo Transfer (FET) is when eggs that have already been collected, fertilised and frozen in our laboratory are transferred into the womb. The embryo then needs to attach itself to the wall of the womb in order for the pregnancy to develop.

The management of FET cycles is simpler and cheaper than fresh cycles because IVF stimulation medication is not required.

What’s involved in a FET cycle?

Thawed embryos may be replaced during a natural cycle when no hormonal medication is used. Or in a medicated cycle when small doses of oestrogen and progesterone are given to mimic a woman’s natural cycle. Your Fertility Consultant will discuss both options with you and advise which is best based on your age, previous medical history and your own preference. Pregnancy outcomes are similar in both types of frozen embryo transfer cycles.

Around 95% of embryos survive the thawing process. Success rates depend on the quality of the embryos frozen but are now very similar to the results with a fresh cycle. The Embryologist will discuss your individual requirements, advise on the quality of your embryos, and discuss the chances of success.