Around 14% of couples have trouble conceiving and require outside help to make their dream of a baby a reality. Conception isn’t always a two-person job either, and sometimes needs the help of some medication, surgery, or even assistance from an embryologist to get that fetus growing. You’ll find a summary of the main treatments on the next few pages that you can discuss with your doctor or fertility clinic. Ensure you speak to them about all the risks, concerns and ask them any questions you may have about any of the mentioned options.
Medication
Some issues with fertility can be aided with the use of medication, some can help almost instantly, and some may take a while to get your fertility up and running again.
Common medications doctors recommend for fertility include:
- Clomifene - which helps aid the monthly release of eggs in those who do not ovulate regularly.
- Tamoxifen - an alternative to the above.
- Metformin - used in women who suffer from PCOS.
- Gonadotrophins - helps stimulate ovulation and can also help male fertility too.
Some of these medications cause side effects including nausea, vomiting and headaches. Make sure you discuss these medications in-depth with your GP.
Surgeries
When medications don’t help, or your fertility complication requires a bit more intervention, surgery may be the answer.
Common surgeries include:
- Fallopian tube surgery - if your tubes are scarred, you may need to get them repaired. Success depends on the extent of damage they had in the first place.
- Endometriosis, fibroid and PCOS surgeries - laparoscopic surgery is used to treat endometriosis to remove any cysts or to treat fibroids. For PCOS, laparoscopic ovarian drilling (heat or laser) can be used to destroy the affected part of the ovary if medication is unsuccessful.
For the males, any blockages to the epididymis can be surgically corrected to ensure sperm can be ejaculated properly and sperm is extracted, quality tested and frozen for later use.
Artificial Insemination (AI)
Artificial insemination isn't always an option when female infertility is an issue, but due to its high success rate, it can cut out the months of trying to conceive naturally. It consists of taking your partner’s (or a donor’s) sperm and placing it inside your fallopian tube whilst you’re ovulating, allowing conception to happen naturally whilst boosting your chances of successful fertilisation.
It is usually performed when sperm count or sperm mobility is low, for single mothers, or for same-sex couples to start their journey to becoming parents.
Intrauterine Insemination (IUI)
IUI is another method that gives sperm a little helping hand to get where they need to go, by bypassing the usual barriers - the vagina and the cervix. If infertility is unexplained, or the male has mild fertility problems, IUI is the go-to method. In conjunction with medication, at the time of ovulation, ‘washed’ sperm (that has had the chemical-filled, bacteria-ridden, seminal fluid separated from the sperm and motile/non-motile sperm are segregated, purified, and prepared for fertilisation) is injected via a flexible catheter directly into the uterus next to a fallopian tube. This cuts the amount of swimming the sperm needs to do and greatly improves the chances of fertilisation. IUI can either be done with frozen or fresh sperm. To improve sperm quality, men will be asked to abstain from ejaculating 48-hours prior to producing a sample which will be taken up to 2-hours before the insemination procedure. If IUI is unsuccessful after 3-4 rounds, you will be advised to try IVF.
IUI is not recommended for women who have significant blockages, scarring or conditions that affect the fallopian tubes, a history of pelvic infections, or advanced endometriosis. It is also not typically attempted in women over 40, if your male partner has a very low sperm count, or significant issues with sperm mobility and morphology, as IUI is unlikely to succeed.
In Vitro-Fertilisation (IVF)
Sometimes fertilisation doesn’t happen on its own, or with the assistance that IUI and AI offers. Sometimes, sperm and eggs need fertilising in a lab, and once successfully fertilised, are injected directly into the uterus. Ovulation suppressants are sometimes taken initially to control the timing of your ovulation, and you are then injected with hormones to stimulate egg release on-demand.
Most women can expect daily injections of LH and gonadotrophins. You will need to go to the fertility clinic every few days during this stimulation phase so a doctor can check, via an ultrasound, how many follicles are growing, and check on their development, as well as the thickness of the uterine lining. You will also be given a blood test to check your hormone levels. Once it is concluded that your follicles are mature, egg retrieval can begin.
You’ll receive an hCG injection to conclude the maturing process and begin ovulation. During this phase, you’ll be told to abstain from unprotected sex (use a condom) to avoid extra embryos being fertilised on their own - you won't want 6 babies at once! 9-14 days after stimulation, and within a day and a half of your hCG trigger, your doctor will retrieve up to 15 eggs through a 20–40-minute ultrasound-guided needle procedure.
Next comes the sperm sample - fresh or frozen. The sperm is washed and popped in a petri dish with your eggs and allowed to explore on their own or, through ICSI, whereby a single sperm is injected directly into an egg, allowing immediate fertilisation. This is how couples in some countries can choose if they want a boy or girl (in the UK, this selection is only granted if there is a genuine medical reason why either sex must/mustn’t be conceived). They are then left to incubate for 12-24 hours.
An embryologist will then monitor each embryo for the next week, assessing their growth and development. By day 6, there should be a healthy blastocyst. Only 30-50% of embryos make it to this stage. If there is a worry of any genetic problems, some couples prefer their embryos to be screened (preimplantation genetic diagnosis testing (PGD/PGS) to eliminate any risk of the genetic disorder passing down to the child.
Within 1-2 days of fertilisation, women will receive a progesterone supplement to prepare their body for pregnancy - optimising their uterus lining prior to transfer and implantation. 3-5 days after successful fertilisation and possible screening, the embryos are carefully transported into the uterus through an ultrasound-guided flexible catheter. Depending on your age, multiple embryos can be transferred. There is a high chance of multiple babies/twins through IVF when multiple fertilised embryos are implanted, so be sure to have in-depth discussions with your doctor about all the pros and cons of IVF and your chances of success.
Within a few days, you may feel cramping and get some spotting, bleeding, or discharge (but this is rarely a cause for alarm). This could be a sign of implantation and is a normal occurrence in early pregnancy. Around 9-12 days after transfer, you’ll have a blood test to confirm your pregnancy. But don’t be tempted to take an HPT before your blood test, as these can give false negatives.
If your blood test comes back positive, you’ll be told to stop taking progesterone and they’ll perform another check of your hCG levels to ensure your pregnancy is progressing. You will then get an ultrasound within 2-3 weeks. If negative, you and your partner will be told the next steps for subsequent cycles. Remember, not all IVF treatments are successful first time around.
IVF is typically the option for same-sex couples and couples who have fertility issues too severe for things to happen naturally. The main downside can be the cost. IVF can be extremely costly outside of NHS help. Women under 40 can be offered 3 rounds of IVF on the NHS if she’s been unable to conceive after 2 years of trying, or after 12 rounds of failed AI/IUI, depending on region and services available. Stricter criteria are in place for women aged 40-42 who are only offered 1 round of IVF on the NHS. Check the NHS website for more information about how to qualify for free IVF. Going down the private route can cost up to £5000 per cycle in the UK (as of 2021).
Egg/Sperm Donation
If either you or your partner suffers from infertility, you may be able to use an egg/sperm donor. This is typically done through IVF and can be done under the NHS, although waiting lists can be extremely long.
It is worth noting that anyone who registers to donate after 2005 can no longer claim anonymity and must provide information about their identity, medical history, and background. Children born because of egg/sperm donation have the legal right to find out the identity of the donor once they turn 18.
If going privately for any of the above treatments, the cost is certainly something to consider, as well as the clinic’s success rate, waiting lists, range of treatments offered and clinic location. Be sure to ask for a fully costed plan, personalised to you, find out exactly what is and isn’t included (medication, scans, fees) before committing to anything. You can ask your GP for advice and recommendations, as well as checking out the list of HFEA licensed clinics in the UK online.
We wish you the very best of luck and copious sprinkles of baby dust in your journey to becoming a parent!
