Treatments for infertility

If a woman is not ovulating, there are certain drug treatments that can kick-start the ovaries into producing healthy eggs again.
Before you begin any drug treatments an endometrial biopsy will be done to check for hyperplasia (the thickening of the lining in the womb) or cancer of the uterine wall. Semen analysis will also be done to check for abnormalities and an ovarian ultrasound may be performed to check for ovarian cysts. Once these conditions have been ruled out, drug treatment may be introduced.

Clomiphene is the most widely used fertility drug in the UK, and is taken for five days at the beginning of each menstrual cycle. Clomiphene helps to release FSH, which is a follicle-stimulating hormone that triggers the ripening of a follicle and then ovulation. The plus sides to Clomiphene are that it has no major side effects and it has a low rate of multiple pregnancies. If you have attempted six cycles and are still not pregnant you may be advised to try alternative treatments, as there is a possibility of ovarian cancer after you’ve attempted 12 cycles.

Clomiphene resistant PCOS For women suffering from Polycystic Ovaries and who have been on Clomiphene for six months without getting pregnant, you may have to have surgery in the form of ovarian drilling. In this procedure, holes are drilled in your ovaries to stimulate ovulation. You may also be given an injection of FSH, the follicle-stimulating hormone.

Surgical procedures may have to be used if there is any damage to the fallopian tubes. Tuboplasty is a procedure which can un block the fallopian tubes if they are narrowed or scarred. Fimbrioplasty can open up the ends of the fallopian tubes if they close up and prevent eggs from entering the ovary.

Sterilisation Around three out of every 100 woman sterilised regret the decision and go on to have the sterilisation reversed.  The reversal procedure works by rejoining the severed ends of the fallopian tubes and the success rates are as high as 92 per cent.

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Egg Donation
Sometimes couples are unable to conceive even with the help of medical intervention, and may need sperm, eggs or even embryos donated by other people to help them have a child. Women can also have babies for other people and this is called surrogacy. All of these procedures are highly emotive and you’ll need plenty of thought, counselling and support if you decide to go ahead.

Some women are unable to produce eggs, so an egg donor can be used during IVF treatment. The process involves removing eggs from a donor’s ovary, fertilising them In Vitro and implanting them back into the uterus of the woman who will mother the child. The procedure is quite complex as hormonal drugs have to be used to stimulate the donor’s egg production and the eggs have to be collected by surgical techniques. For this reason donor eggs are hard to come by especially since the laws on anonymity are changing. A ‘known’ donor like a friend or relative can donate eggs, or an unknown donor can donate.

IVF
There are a series of complex steps, which have to be carried out in order for IVF to be successful.

The first step is harvesting your eggs. Your ovaries normally release only one egg each month but your ovaries will be stimulated with a drug treatment so they produce more then one egg. This is so you have more then one chance of a successful pregnancy. You will need to go into the clinic everyday so as the eggs mature they can be monitored. When ovulation is imminent, the eggs will be collected under ultrasound or laparoscopic guidance ready for fertilisation by your partner’s sperm.

The next step is when your eggs are mixed with your partner’s sperm outside of the body, under a microscope. Not all your eggs will fertilise but roughly two or three do. Fertilized eggs are incubated for about 48 hours until the cells start to divide, and as long as they show no signs of abnormalities a maximum of three embryos will be transferred to your uterus. Any additional embryos that have fertilised can be frozen for future use in case this attempt is not successful. Since a ruling in 1994, women over 40 can still receive three eggs per cycle, because success rates decrease with age. Women under 40 can only receive two eggs per cycle; this is to reduce the growing incidence of multiple births and the complications that can arise with them.
After about two weeks you can take a pregnancy test to see if the attempt has been successful.

How long will this take?
You will complete your cycle of IVF from beginning to end in around six weeks, and you will need to visit the clinic roughly 11/12 times for egg retrieval, fertilisation procedures and for transferring the eggs back into your uterus.

Can anyone have IVF?
Not everyone can have IVF on the NHS, so it is best to check with your GP about IVF funding in your area. If you are not eligible for IVF or the waiting lists are too long, you can have self-funded IVF.

How much does IVF cost?
The cost of IVF cycles varies greatly depending on where you have the treatment and how many cycles you have but can cost anywhere between £2,000 to £7,000.


Embryo Donation
Sometimes couples are unable to conceive even with the help of medical intervention, and may need sperm, eggs or even embryos donated by other people to help them have a child. All of these procedures are highly emotive and you’ll need plenty of thought, counselling and support if you decide to go ahead.

Couples who have been through the IVF treatment sometimes donate un-frozen embryos to a childless couple, usually after they have had a successful outcome and want other couples to benefit too. The embryo is implanted in the women’s uterus and she will give birth to the child.

Sperm donation
If the man has a low sperm count, is sterile or has undergone radiotherapy or chemotherapy treatment, a sperm donor can be used to conceive a child.  Fresh semen is collected and stored by immersing it in liquid nitrogen.  Up to 50 per cent of sperm don’t survive the thawing and freezing process, but the healthiest most robust sperm will survive the process. All semen is checked for infections such as HIV or hepatitis B, and can then be used for insemination in the woman. 
The feelings of the man have to be taken into consideration here, as he will be bringing up a child conceived with a donor’s sperm and his partner’s egg, and can lead to feelings of inadequacy.  The couple may also worry about what sort of man the donor was, and also whether their child will grow up and unknowingly meet a half sibling. The child may also want to meet their donor parent later in life.


Egg Donation
Some women are unable to produce eggs, so an egg donor can be used during IVF treatment. The process involves removing eggs from a donor’s ovary, fertilising them In Vitro and implanting them back into the uterus of the woman who will mother the child. The procedure is quite complex as hormonal drugs have to be used to stimulate the donor’s egg production and the eggs have to be collected by surgical techniques. For this reason donor eggs are hard to come by especially since the laws on anonymity are changing. A ‘known’ donor like a friend or relative can donate eggs, or an unknown donor can donate.
There are contentious issues which surround egg donation, such as the woman carrying, giving birth and bringing up a child who was conceived with their partner’s sperm and a donor’s egg. The child may also want to trace his or her ‘donor’ parent later in life.

What are the anonymity rules?
Since 2005, the anonymity rights for people donating eggs and sperm have changed. Children conceived through donations made after 31 March 2005 will have the right, at age 18 to have the details about their genetic parent. Donations made prior to 1 April continue to fall under anonymity rules.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.