Where a couple have failed to conceive, with no obvious reason for failing to do so, it is reasonable to consider assisting conception. This varies from simple counselling and advice to in-vitro fertilisation (IVF = test tube baby) and intracytoplasmic sperm injection (ICSI = injecting the sperm into the woman’s egg).
Many couples have unexplained subfertility. By this we mean that our checks on the sperm, the ovaries and tubes are normal. Stress, anxiety and unknown causes are included in this group. There are many doctors and nurses who take a special interest in teaching couples about their biological cycles, so helping them to conceive naturally, without the use of advanced scientific techniques. Ask your GP or gynaecologist to recommend someone if you fall into this category.
If the subfertility is unexplained, or if the woman has difficulty in producing eggs on a regular basis, the next step is to consider assisting the ovaries to produce eggs (ova). This can help with the timing of intercourse, and provide reassurance that eggs are being produced.
A woman has a few days around the time of producing the egg (ovulation) when she is fertile.
Types of ovulation induction
The simplest approach is to use a drug called Clomiphene. The main risk of using Clomiphene is the increased risk of having twins, and occasionally triplets. If you require Clomiphene it may be wise to discuss this with your gynaecologist/fertility specialist and ask about monitoring your ovary’s egg producing activity when you are on this treatment. More powerful methods of assisting ovulation include injecting hormones that stimulate the ovaries (e.g. follicle stimulating hormone FSH). As the risk of multiple pregnancy is very high when using these drugs, they should only be administered and monitored by medical staff familiar with their use.
Intra-uterine insemination of sperm
Intra-Uterine Insemination of sperm can be used to bypass normal intercourse, in an attempt to ensure that the sperm reaches the egg. It is typically used where there is unexplained subfertility, or where there are minor problems with sperm production. A sample of the partner’s sperm is specially prepared and introduced into the womb (the uterine cavity) using a syringe and a fine plastic catheter (tube).
A speculum is passed (in the same way as if you were having a smear) and the tube is passed into the cervix (neck of the womb). Intra-uterine Insemination is carried out just before ovulation. It is a procedure, which causes little discomfort and only takes a few minutes.
In-vitro fertilisation (IVF)
This is a more advanced technique. It is expensive, in terms of finance, time, emotion and relationships. It used where there are problems that can’t be solved with a simpler approach (e.g. blocked fallopian tubes), or where the easier steps (see above) have failed to produce a pregnancy.
The woman’s ovaries are stimulated to produce a large number of eggs. Eggs are produced in the ovary in little cysts (follicles). These are collected using ultrasound and a fine needle, just before they would burst out of the ovary. The partner produces a sperm sample and the sperm and embryo are mixed in a test tube. They are then incubated for 36 – 48 hours. If embryos are produced the best are selected and placed in the woman’s uterus (womb). The egg collection and embryo placement will usually take place in a special room in the IVF unit you attend. The woman needs careful monitoring during the IVF programme, with frequent ultrasound scans to check the activity of her ovaries.
Intra cytoplasm sperm injection (ICSI)
Where there is a problem with the quantity or quality of the sperm, intra cytoplasmic sperm injection (ICSI = injecting the sperm into the woman’s egg) may be used to increase the chances of the egg and sperm producing an embryo.
IVF and ICSI success
The treatment is not a guarantee of pregnancy. In a typical unit between a quarter and a third of IVF cycles will be successful. Check out the fertility units in your area and don’t be afraid to compare different units for their success rates.
IVF and ICSI failure
Where a treatment cycle is unsuccessful, the couple will be seen by the clinic and a plan made based on why the cycle failed (e.g. no eggs produce, no embryos produced, embryos produced but no pregnancy, miscarriage). Sometimes this plan involves accepting that a pregnancy will not happen with the couple’s eggs and sperm, and a discussion about using another person’s eggs or sperm will ensue. On other occasions the results will have been very encouraging and a second cycle will be recommended.
Gamete intra fallopian transfer (GIFT) places the sperm (using a laparoscopy) in the fallopian tube, either at the time of ovulation or when the eggs are collected after ovulation induction. There are also a number of modified intrauterine insemination techniques, where the sperm is placed higher in the womb, or in the pelvis.
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