In addition, if, after investigation of your fertility problem, a specific cause is found that can be treated, the underlying condition would be treated rather than proceeding to assisted conception treatment. Assisted conception therapy would only be recommended if there is a reasonable chance of success. Usually your GP can advise you if you are eligible for NHS-funded assisted conception treatment.
Counselling
did you know?
Counselling
Visiting a counsellor gives you the chance to talk easily about your emotions. It allows you to explore your feelings and gain support in finding the right path for you, by helping you to understand the issues involved, without feeling judged in any way.
It is recommended that all couples with fertility problems are offered counselling by their clinic. This is because the diagnosis and treatment for fertility can be something that you and your partner find hard to deal with. It can cause problems with your relationship and so it is often good to talk it through with someone else who is removed from the situation.
Assisted conception clinics will offer you the opportunity of counselling to discuss the implications of the treatment you are planning on using. This ensures that you really understand what is involved in the process and how it will affect you, your partner and your family. A particularly important issue that you should talk through with your partner is using donated eggs or sperm. If this option applies to you, it is vital that you explore how both you and your partner feel about the related issues, as well as considering any legal implications before deciding if this is the right treatment for you.
Once you embark upon fertility treatment, you may require additional support and just one or two sessions with a counsellor can help you get through what can be a daunting and emotionally exhausting process. This kind of support can be particularly helpful if you have not managed to achieve a successful pregnancy.
About in vitro fertilization (IVF)
The phrase ‘in vitro fertilization’ means that the fertilization occurs ‘in glass’ in the laboratory. The eggs recovered after ovulation induction are mixed with sperm in the laboratory to produce a fertilized egg that develops into an embryo. The embryo is then replaced into the woman’s womb.
must know
Cycle suppression side effects
Side effects may include hot flushes and night sweats as you are experiencing hormonal changes similar to the menopause. You might also experience vaginal dryness, headaches and a change in the size of your breasts. All these side effects are reversible on stopping the treatment.
How IVF works
Ideally, the doctor will want you to produce several eggs in a single cycle. The techniques used vary a little between clinics and specialists but, in general terms, the overall process remains the same.
First, your menstrual cycle is suppressed so that the doctors have greater control when it comes to stimulating the production of eggs. The usual way of suppressing your cycle is with either a long-acting injection given once per month or a nasal spray taken daily. These are usually started before a specific fertility treatment cycle.
The hormones that are injected are called gonadotrophins and they stimulate the body to trigger egg production. They are injected either into a muscle or under the skin depending on the preparation used. Many women, after being shown how to do this, are comfortable injecting themselves at home, so avoiding the need to attend clinics for injections.
The response of the ovaries to this stimulation is checked by ultrasound. The frequency of checks will depend partly on your response to treatment, but will usually occur around two to four times. (Some checks involve measuring hormone levels in the blood.) An ultrasound probe is inserted into the vagina and the doctor is then able to see each ovary and the eggs developing within.
Once the eggs have reached maturity after ten to twelve days, a further injection is used to finalize the maturation of the eggs. This injection must be given about 36 hours before the eggs are collected and so timing is critical. This form of ovulation induction often stimulates the production of several eggs, which can be very useful as, after fertilization, there may be several embryos resulting from one cycle of treatment. Any embryos not used in this ‘fresh’ cycle of IVF can be stored and used over several subsequent cycles without the need to go through ovulation induction again.
Collecting the eggs
When the eggs have reached maturity, they are retrieved. The woman is injected with a drug to make her drowsy or a general anaesthetic. The eggs are then collected by passing a needle through the
watch out!
An uncommon but serious complication for the mother from injecting gonadotrophins is called ovarian hyperstimulation syndrome. This occurs when the ovaries respond too vigorously to the stimulation, and dramatic changes in the body, including fluid retention and a risk of blood clots, occurs. These drugs, therefore, require careful monitoring when they are used.
must know
IVF success rates
Using fresh embryos, the average success rate, per cycle of treatment started is:
• Almost 30 per cent (in some clinics this figure is higher) in women under 35 years of age; 23-24 per cent for women aged 35-37 years; around 18 per cent for women aged 38-39 years; around 10 per cent for women aged 40-42 years.
• Where frozen embryos are used, success rates are usually slightly lower. For example, in women below 35 years of age, the average success rate is around 18 per cent.
vagina into the ovary. The needle is guided into position using an ultrasound scan with the ultrasound probe in the vagina, then the eggs are sucked down the needle and passed to the laboratory. After the eggs have been collected, it is usual to give the woman progesterone tablets or vaginal suppositories to ensure that the lining of the womb is fully prepared for the embryo to implant.
Fertilizing the eggs
In the laboratory, the collected eggs are mixed with your partner’s, or donor’s sperm, if this is being used. Your partner will have provided a fresh sample of sperm shortly before the eggs are collected. The sperm is prepared just as for intrauterine insemination (IUI) and the eggs and sperm are mixed together in a laboratory dish. After around 20 hours, the eggs are checked to see if fertilization has occurred. Those that have been fertilized are left for another one to two days to allow the embryos to form.
Transferring the embryos
Finally, a few days after fertilization, one or two healthy embryos are replaced into the woman’s womb. To do this, the doctor or nurse inserts a plastic device called a speculum into the vagina to separate the walls, so allowing them to see the cervix or neck of the womb. A fine tube like a thin straw is inserted through the neck of the womb and one or two embryos replaced through the tube. If there are other healthy embryos, these can be frozen and stored and used in subsequent treatment cycles without the need for ovulation induction.
did you know?
Moving frozen embryos
If you have frozen embryos in storage from previous IVF cycles, these can be transferred to another clinic so that you can have an embryo transfer and a further opportunity to become pregnant. Clinics can arrange to transfer embryos, but you are likely to have to pay for this service.
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