Hormone injections
If there is no response to a medication such as clomifene, hormone injections can be used, which are more powerful. The risk of twins or triplets is relatively high with this treatment. This technique is usually used in in vitro fertilization (IVF).
Ovarian drilling
This is a surgical treatment that occurs at the time of laparoscopy and small holes are drilled in the surface of the ovary. The treatment seems to make the ovary more likely to produce eggs.
Treating a low sperm count
In cases where there is no sperm in the seminal fluid, the task is to determine whether there is a problem with production or whether the tubes connecting the testicles to the penis are blocked. Blockage can be treated surgically. If absolutely no sperm is being produced, this implies a problem with the testicles or hormones controlling sperm production and specialist help is required, such as hormone treatment. However, this can only help if the cause is a deficiency in the hormones that control sperm production and the male hormone testosterone.
It is rare for a man to have absolutely no sperm. More commonly, the sperm count will be low or there will be reduced sperm function, such as reduced ability of the sperm to move. As yet, no effective treatment has been proven to increase male fertility where the sperm function is impaired. This does not mean that nothing can be done. Effective treatment can be offered with the following assisted conception techniques:
• intracytoplasmic sperm injection (ICSI), although there is a chance that conception may still occur naturally
• donor insemination. The decision to embark on this line of treatment requires careful consideration and counselling from specialist clinics.
Treating blocked fallopian tubes
must know
Risks from surgery
Surgery carries a ten per cent risk of a subsequent ectopic pregnancy. In addition, the greater the level of tubal damage, the lower the likelihood of successful surgery and subsequent pregnancy.
One episode of pelvic infection can lead to infertility in up to 15 per cent of women. The more episodes of infection a woman has had, the greater the risk of tubal damage. It is therefore important that pelvic infection is treated promptly. Whether there has been pelvic infection, endometriosis or some other cause, sometimes the tubes are not actually blocked but are covered by adhesions at the ends or around the ovaries. These adhesions prevent release of the egg or stop the tube picking it up. In this instance, the best treatment is often in vitro fertilization (IVF).
Alternatively, you could have tubal surgery to try to release the blockage, which is particularly useful if adhesions are stopping the release of the egg or preventing it from being picked up by the tube. While microsurgical techniques can be used to correct a mildly blocked tube, success rates are variable and not usually as effective as IVF.
Reversing sterilization
Most women are happy with their decision to get sterilized. It is a highly effective method of contraception that is not designed to be reversible. But sometimes circumstances change and a couple want to try again for a baby. Sterilization is most commonly performed using keyhole or laparoscopic surgery. The tubes are blocked by a small plastic clip or ring that is surgically placed across them. Occasionally, sterilization is carried out by removing part or all of the tubes at the time of surgery. These procedures stop the sperm and egg from meeting.
Sterilization can be reversed successfully in many cases, providing there is not too much damage to the tubes and there is a reasonable amount of healthy tube remaining.
must know
Vasectomy reversal
Around ten per cent of men that have undergone vasectomy for sterilization subsequently want the procedure reversed, so that they can have more children, often with a new partner. Reversal is carried out surgically and microsurgical techniques appear best. Success will depend on the type of vasectomy performed and the length of time since the operation. The longer the time, the less chance of success. Indeed there is some evidence to suggest that success is most likely if reversal is carried out within five years of the vasectomy and success rates of over 90 per cent are achievable. After more than five to ten years have elapsed, success is less likely, but often still well over 50 per cent.
Obviously, if the tubes have been removed, this will not be possible. A surgical operation is required to rejoin the tubes. This is a specialized field, but microsurgery by an expert tubal surgeon has a reasonable chance of success. There is a small risk of ectopic pregnancy (around four per cent) after tubal surgery to reverse a sterilization. If your tubes have been removed or the damage is too extensive, then IVF is usually the best option.
Treating unexplained infertility
Unexplained infertility is diagnosed after the other causes of infertility have been excluded. It accounts for about a quarter of all cases of infertility. If you have unexplained infertility and have been trying to get pregnant for less than three years, your chances of falling pregnant without treatment is as much as five to ten per cent per month. If you appear to have unexplained infertility and have been trying to get pregnant for more than three years, your chances of getting pregnant without treatment are around one to two per cent each month, so you will probably want to consider specialist treatment as soon as possible.
For younger women, a ‘wait and see’ policy can be adopted as some will conceive naturally, particularly if they have been trying to get pregnant for less than three years. Where you are older or the infertility has been present for more than three years, other options should be considered. The treatments are ovulation induction or to use assisted conception techniques like IVF.
Treatment of fertility problems have been revolutionized by assisted conception techniques, bringing hope to many couples who could not otherwise have had a baby. Assisted conception is the use of fertility treatments to bring sperm and egg together and so facilitate conception and pregnancy. The main techniques are in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI) and donor insemination (DI).
Assisted conception clinics
There are now a large number of assisted conception clinics in the UK – over 80, in fact. Some of these clinics see only private patients and others see both private and NHS patients in the UK.
did you know?
Clinic information
The website of the Human Fertilization and Embryology Authority (HFEA) (www.hfea.gov.uk) provides up-to-date information on all the clinics in the UK. It includes:
• The type of treatments they offer
• The numbers of each type of treatment they perform each year
• The success rates. You can also contact clinics direct by telephone or website for more information.
Where