Fertility treatment

Fertility drugs

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 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 the doctor, using ultrasound to guide the collecting tube. 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. If a healthy embryo develops, this is placed in the womb using a catheter (a very fine needle or probe). Usually, no more than one or two are placed. Any remaining embryos 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. Only a few clinics offer this in the UK.
• Why it's used: unexplained infertility.
• Success rate: lower than IVF, but it’s difficult to be certain as sometimes it’s offered to couples for whom IVF has already failed.

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. 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.