Fertility treatments
Once infertility has been diagnosed, a number of options are available,
depending on the cause of the problem.
Fertility treatments (Image: couple)
In this article
Fertility drugs
Assisted reproduction treatments
Other options
Special checks
Fertility drugs
Fertility drugs are often the first treatment for women who aren't ovulating
Fertility drugs are often the first treatment for women who aren't ovulating.
They work in the same way as the body's own hormones, triggering the ovaries to
release eggs.
This method, known as ovulation induction, can sometimes lead to conception
after a few months without further intervention.
Possible side effects include premenstrual symptoms such as nausea, headaches
and weight gain.
Such drugs are also used as part of other more complicated assisted
reproduction treatments, such as in vitro fertilisation and intrauterine
insemination (see below). Other drugs - to help control the menstrual cycle or
thicken the lining of the womb to prepare it for pregnancy, for example - may
also be used. These can also cause side effects, such as hot flushes,
headaches, nausea and swollen breasts.
Assisted reproduction treatments
Intrauterine insemination (IUI)
What is it? Intrauterine insemination, also known as artificial insemination,
involves inserting sperm into the womb at the time of ovulation using a
catheter (a very fine needle or probe). The woman may need to take fertility
drugs to stimulate egg production. The sperm used may be her partner's or
donated.
Used to treat: unexplained infertility, premature ejaculation, erection
difficulties.
Success rate: ten to 15 per cent per cycle.
In vitro fertilisation (IVF)
What is it? Eggs and sperm are collected and fertilised in the laboratory
before the resulting embryo is transferred to the womb. The woman takes
fertility drugs to stimulate the production of eggs. Once these are mature,
they're collected by ultrasound guidance. The man produces a sperm sample,
which is prepared before being put with the eggs in a Petri dish and left for a
few days to see if fertilisation takes place. A resulting healthy embryo is
placed in the womb using a catheter (a very fine needle or probe). Any
remaining embryos that are suitable for freezing may be stored for future use.
The sperm and/or eggs used may be the couple's own or donated.
Why it's used: to treat unexplained infertility, blocked fallopian tubes,
endometriosis, PCOS.
Success rate: about 25 per cent per cycle.
Intracytoplasmic sperm injection (ICSI)
What is it? A single sperm is injected into the cytoplasm or centre of a single
egg. This is then transferred to the womb using the same process as IVF.
Why it's used: to treat male factor infertility, such as low sperm count or
poor motility (mobility or movement) or abnormally shaped sperm. ICSI may also
be used following previous unsuccessful attempts at fertilisation using IVF and
when sperm has been retrieved directly from the epididymis or the testicles
(see 'Sperm extraction', below).
Success rate: as for IVF, about 25 per cent per cycle, sometimes more.
Gamete intrafallopian transfer (GIFT)
What is it? Gametes - eggs and sperm - are collected as for IVF. Instead of
mixing sperm and eggs together in the laboratory, they're immediately
transferred to one of the woman's fallopian tubes so fertilisation takes place
inside the body. GIFT is an unlicensed treatment, which means it doesn't have
to take place in a clinic licensed by the HFEA.
Why it's used: unexplained infertility.
Success rate: about 25 per cent per cycle.
Sperm extraction
What is it? A small operation that removes sperm from the epididymis (the tube
where sperm mature in the man's body) or the testicles (where sperm cells are
made) for use in ICSI or another treatment. There are several different methods
of sperm extraction:
- PESA (percutaneous epididymal sperm aspiration) involves guiding a small
needle into the epididymis to draw out fluid containing sperm.
- TESE (testicular sperm extraction) uses the same method to remove tissue from
the testes.
- MESA (microsurgical sperm aspiration) uses a small needle to extract mature
sperm from the epididymis.
Why it's used: when a man can't produce sperm - for example, after a vasectomy
or failed reversal.
Success rate: when used in ICSI, about 25 per cent per cycle.
Embryo freezing
What is it? The HFEA stipulates that (with certain strict exceptions) only two
embryos may be transferred to the womb at a time in fertility treatments. This
is under review and may be reduced to one embryo due to the risk of pregnancy
complications, and of multiple and premature births. However, because IVF often
creates more embryos than can be transferred in a single cycle, most clinics
will freeze any remaining healthy embryos for use in future IVF treatments,
with the patients' consent.
Why it's used: to avoid the need for further fresh IVF cycles involving
invasive processes of egg stimulation and collection.
Success rate: normally only 60 per cent of embryos survive the freeze/thaw
process and those that do survive have a lower rate of implantation and so a
lower pregnancy rate than fresh embryos.
Other options
Clinics are increasingly using two newer techniques that may enhance the
chances of pregnancy in some patients.
Blastocyst transfer
If during previous IVF attempts, the embryos fail to implant in the womb, the
doctor may suggest a blastocyst transfer. The embryo is allowed to develop for
five or six days before being transferred to the womb. Because the embryo is
more developed and transfer occurs closer to the time that implantation would
occur naturally, the pregnancy rate is usually higher. However, some embryos
will die in the laboratory, so the number of embryos available for transfer and
freezing will be fewer. For this reason, it's generally only offered to women
who produce a large number of good quality embryos.
Assisted hatching
Before attaching itself to the wall of the womb, an embryo has to break out
(hatch) from a gel-like membrane known as the zona pellucida. This membrane can
be tough or thickened and some fertility experts think it may impede
implantation of the embryo in the womb. To help the embryo break through, the
embryologist may make a tiny hole in the membrane before it's transferred to
help the hatching process.
Special checks
Pre-implantation genetic diagnosis (PGD)
What is it? PGD involves checking the genes of embryos aged between two and
five days, created by IVF for genetic diseases such as haemophilia and cystic
fibrosis, as well as for some inherited diseases of later life such as breast,
ovarian and bowel cancer. Disease-free embryos may then be transferred to the
womb.
When it's used: if a couple has a child with a genetic disease and is at risk
of having another; if there have been several terminations because a genetic
disorder was diagnosed; if there's a strong family history of breast, bowel or
ovarian cancer.
Pre-implantation genetic screening (PGS)
What is it? PGS (sometimes called aneuploidy screening) involves checking IVF
embryos to ensure they have the correct number of chromosomes, and that these
are normal.
When it's used: if parents are older, around 45 years, with a high risk of
having a baby with chromosome disorder such as Down's syndrome or if the mother
has a history of recurrent miscarriages. Normal cells contain 23 pairs of
chromosomes, making a total of 46 chromosomes. PGS involves screening embryos
produced by IVF to ensure they have this number. This avoids embryos with the
wrong number of chromosomes being transferred to the womb. In Down's syndrome,
for example, there are three copies of the number 21 chromosome instead of the
usual two.<http://www.efunxone.com/features_treatments.html>
Your options if you're struggling to have a baby
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