If tests reveal that you or your partner have fertility problems, there are three main types of fertility treatment:
- Surgical procedures
- Assisted conception
Medicines to assist fertility
If your tests suggest you're not ovulating normally, your GP may suggest Clomid (clomifene citrate) to kick-start and regulate ovulation. It's not the only medicine for this purpose, but it's a common one.
There are thousands of posts on Mumsnet's Conception Talk board about Clomid, which can give you a wealth of advice and some seriously detailed information. Just put Clomid into the search box.
Another treatment for ovulation problems is Metformin, particularly if your problems are caused by PCOS. And some women are prescribed medicines containing gonadotrophins, to stimulate ovulation.
• Signs of ovulation
• Secondary infertility
• Basal body temperature
• Coming off the pill
• Male fertility
• Problems getting pregnant
If the drug treatments don't do the trick, then the next step is...
Surgical procedures to assist fertility
- Fallopian tube surgery to repair your fallopian tubes if they're blocked or scarred, to make it easier for eggs to pass along them.
- Laparoscopic surgery - a thin, flexible microscope with a light on the end, called a laparoscope, is guided through a small incision in your abdomen so that a surgeon can see what's going on inside or perform surgery, for example ovarian drilling on women with polycystic ovaries.
- Surgery to repair blockages in the epididymis (the bit of the testicles that stores and transports sperm).
If none of these procedures lead to pregnancy, then prepare to enter a world of acronyms (IVF, IUI, ICIS etc) and more complex medical interventions.
- Intrauterine insemination (IUI)
IUI tends to be used when doctors can't figure out what the problem is, or when the problem is slightly abnormal sperm.
A fine tube, inserted through your cervix, is used to put sperm into your womb. (The sperm has been 'collected' from your other half and gone through a separate 'washing' procedure to select the grade-A specimens). IUI is done to coincide with ovulation to maximise your chance of conceiving.
The NICE guidelines are that couples should be offered up to six cycles of IUI on the NHS, but in reality it might depend on the budget decisions of your local primary care trust.
Some women continue to take Clomid while they're having IUI.
- In vitro fertilisation (IVF)
In IVF, your natural cycle is 'turned off' (known as down-regulation) and then you take drugs to stimulate your ovaries to produce more than one egg.
These eggs are then removed from your ovaries and fertilised with sperm (either your partner's, or a donor's) in a laboratory and incubated for a few days.
Next the fertilised embryos are put into your womb and if an embryo gets settled in and attached, the result is pregnancy.
NICE, which sets clinical guidelines, says you should be offered up to three free cycles of IVF on the NHS if:
- you're aged between 23 and 39
- the cause of your fertility problems has been identified
- you've had infertility problems for at least three years
But in reality there are wide variations between primary care trusts as to the number of cycles funded (a minority don't fund any) and in waiting times.
Figures released by the Department of Health in June 2008 show 94 per cent of trusts don't provide the recommended three free cycles and all but a few trusts have imposed criteria for free treatment, eg rejecting patients who smoke, or who already have a child.
- Intracytoplasmic sperm injection (ICSI)
If there's a problem with your partner's sperm - too few, too poor quality or none in the semen because of a blockage - you may be offered ICSI.
This procedure is a variation of IVF, which involves injecting a single sperm directly into one of your eggs. NICE says ICSI increases the chances of fertilisation more than if IVF is used on its own. But, of course, even once the eggs are fertilised it makes no difference to your chances of a successful pregnancy.
- Egg and sperm donation
If it's clear that, for whatever reason, either you're not producing eggs or your partner isn't producing sperm, then you may consider using eggs, or sperm, from a donor. Fertility treatment with donor eggs is normally carried out using IVF.
Anyone who registered to donate either eggs, or sperm, after 1 April 2005, can no longer remain anonymous and has to provide information about their identity. Any child born as a result of donated eggs or sperm is legally entitled to find out the donor's identity once they reach 18.
- Blastocyst transfer
Blastocyst transfer treatment is sometimes used if the problem is embryos failing to implant in the womb.
Embryos are allowed to develop for five to six days after fertilisation before they're put back in the womb.
- Assisted hatching
Despite sounding more akin to chickens, a human embryo also has a gel-like shell (the zona pellucida) and an embryo has to 'hatch' from this to attach to your womb lining.
Assisted hatching is when the embryo is helped to hatch by making the shell of the embryo thinner, or by making a small hole in its 'shell'.
- In-vitro maturation
In IVM, immature eggs are removed from the ovaries without the use of drugs and matured in a laboratory before being fertilised. This is a new technique, which is best suited to younger women who have regular periods.
Its advantage is that, unlike IVF, women don't have to take hormones to stimulate their ovaries to produce mature eggs, which removes the risk of hyper-stimulation syndrome.
Private vs NHS fertility treatment?
Criteria and waiting times for fertility treatments vary across the NHS. If time is of the essence, you may consider going private. The costs are considerable - a cycle of IVF at a private clinic typically costs between £4,000 and £8,000.
When comparing private clinics, find out what treatments they offer, their success rates, their waiting list length and costs. Make sure you choose a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA).
What Mumsnetters say about fertility treatments
- Make an appointment to see the fertility clinic. Then go on holiday, get married and get drunk for two weeks. Then realise you are pregnant. Don't then go for the appointment anyway just in case because the shouty nurse will slam your folder shut and glare at you before asking you to leave and come back when you are NOT pregnant. Oh, and stuff your husband full of sperm-boosting vitamins. MarkStretch
- My first IUI, aged 35, was successful first time. My second attempt at IUI took a little longer - five times actually - but it finally worked. I used only Clomid on both occasions. Ultimately, I found it less stressful than trying to seduce my partner into having sex at exactly the right time every month! LiliAnjelika
- I have had ICSI, resulting in my beautiful daughter. It's a hard road, but worth travelling. swerve
- I have had successful donor insemination, due to my husabdn having a zero sperm count. We had fertility counselling first, to get all of the potential issues out in the open before we even started (things like mourning the biological child that you can't have together, whether/how to tell the child etc). I don't want to sugar-coat it though, the diagnosis and the decision-making were really, really hard. hidingidentity
- I had a blast transfer - we had nine excellent eight-celled embryos on day three. Because there was nothing between them the lab took them to day five - the theory is that the weak/abnormal embryos won't survive and you'll just be left with good ones to transfer. Of our nine, only two made it to blast (which is kind of the point) both were transferred and I ended up pregnant with twins. Unfortunately, we lost both of them (one early and one at 16 weeks). I know a surprising number of people who transferred two blasts and ended up with triplets. minster
- We chose to go private for some fertility investigations and treatment. I would say if you can afford it (comfortably) then go for it. The difference between the time you get with the consultants, the extent to which you get taken seriously and the time frame over which you get treated can be staggering (sadly). theowlwhowasafraidofthedark
- In your late thirties you cannot afford to wait around. Remember that private clinics are multi-million pound businesses and the most well-known ones will have waiting lists. Rocky12