Exploring different fertility treatments

There are many ways to have a baby. The most important thing you can do when making a decision about having fertility treatment is making sure you’re well informed. Francesca Steyn, Director of Peppy’s Fertility Services, gives you alternative options.

Quick facts

– IVF is a common fertility treatment, but there are other options, such as fertility drugs for men and women.

– Surgery could be another alternative. For example, surgical sperm extraction or keyhole surgery for blocked fallopian tubes.

– There is also the option of surrogacy, where another woman carries the baby.

In vitro fertilisation (IVF) is a common fertility treatment for people who can’t conceive naturally.

Latest figures show:

• Around 54,000 patients had 68,724 fresh and frozen embryo transfer (FET) IVF cycles
• 5,651 donor insemination cycles at Human Fertilisation and Embryology Authority (HFEA) licensed fertility clinics in the UK, in 2018.

Generally, to qualify for IVF, people fall into two groups:

• Those for whom this is the only option
• Those for whom other treatments haven’t worked. But it’s not the only option.

There are other ways to have a baby that are less invasive and not as expensive.

Fertility drugs

Fertility drugs taken on their own may be recommended in certain circumstances, for example if you have:

• Polycystic ovary syndrome (PCOS).
• A very irregular cycle, or ovulation is unpredictable.
• Fertility problems linked to your pituitary gland (hormones) — female or male.
• A low sperm count, or have sperm with abnormal motility.
• Infections of inflammations that are affecting your fertility — male.

Common fertility drugs include:

– Clomid – an effective treatment that stimulates the ovaries to produce more eggs. It’s often the first course of treatment for women with PCOS, but can also be used if you have irregular periods.

– Metformin – commonly used in the treatment of diabetes, but it can also be used in some cases of PCOS, if you’re not ovulating properly due to abnormal insulin levels as it reduces insulin in the body to normal levels, allowing ovulation to occur.

– Gonadotrophins – low sperm may occur in men, if the pituitary gland in the brain isn’t producing enough gonadotropins. These hormones stimulate the release of testosterone. This supports sperm production in the testicles.

– Antioxidants and vitamins – There is some evidence that certain antioxidants and vitamins may help to improve the fertility of men with a low sperm count or poor motility.

These include zinc, selenium, vitamin C and vitamin E. In a recent review, it was shown that men who took a combination of vitamin C, Co-enzyme Q10, vitamin E, zinc, folic acid, selenium and B12, daily for three months there was a significant improvement in sperm quality (concentration, motility, shape and vitality).

Surgery for women

– Blocked fallopian tubes – In some cases, where the blockage is not too severe, the blocked outer end of the fallopian tubes can be opened with keyhole surgery.

If you’ve had sterilisation before, this can be reversed by removing the clips used to close the tubes.

– Adhesions in the pelvis – These may be removed using keyhole surgery.

– Endometriosis – a condition where tissue (the same as in the uterus) grows outside of the womb. Laparoscopic tissue can be used to remove endometriotic tissue.

– Fibroids –  These benign growths can be removed in a number of ways.

Drugs may be used to shrink them or they may be removed by uterine artery embolisation where the arteries that feed the fibroids are blocked. Most commonly, fibroids are removed by surgery.

If you are not ovulating…

A lack of ovulation is the reason for around 30% of female infertility.

• Common signs that you aren’t ovulating include:
• Absent or irregular periods,
• Very light or excessively heavy periods,
• Lack of cervical (wet, slippery) mucus
• Irregular basal body temperature.

This is caused by an imbalance of the hormones that cause you to ovulate. These include:

– Follicle stimulating hormone (FSH), produced by the brain, which stimulates the growth and development of ovarian follicles (unfertilized eggs)

– Luteinizing hormone (LH), which triggers ovulation

– Oestrogen which causes growth and repair of the lining of the uterus.

If ovulation doesn’t occur, you may be given oral medication such as Clomid which stimulates egg production and release (ovulation).  If tablets are not effective then more powerful fertility injections may be necessary.

What happens:

• The standard fertility treatment to induce ovulation is the use of gonadotrophins. This involves a daily injection of FSH and LH, combined in a preparation that you self-inject.
• The response of the ovaries has to be monitored with ultrasound scans, every 3-7 days. This is to ensure that only one, or at least two, of the egg-containing follicles develop.
• The injections can take 8-35 days to work and sometimes the dose has to be increased.
• Another  injection is often given to achieve the release of the egg from the ovary. You need to have sex now in order to try and conceive.
• The monthly chance of conception is 20% (the same as natural conception). But, this also depends on your age.

Read more here

Surgery for men

Surgical sperm extraction

This is where sperm is extracted surgically. This is done by inserting a fine needle into the epididymis or testicle done under local or general anaesthetic.

The procedure is usually painless but there may be discomfort after. The sperm can then be used in IVF or intracytoplasmic sperm injection (ICSI). This involves sperm being directly injected into an egg.

Sperm extraction may be recommended if you have:

• a very low sperm count
• had a vasectomy
• had cancer treatment and your fertility hasn’t returned to normal
• a genetic condition that affects your fertility
• had a testicle removed (for example, cancer).

Reversal of vasectomy

This is effective in about 60 to 80 percent of cases. This involves rejoining the cut ends of the vas deferens (the tube that carries the sperm out if the testes).

Treatment of varicocele

This is a cluster of varicose veins around the vas deferens.

Surrogacy 

This is when a woman carries a baby for a person or couple. There are two types of:

– Gestational surrogacy is where there is usually no genetic connection between the surrogate and the child.

– Traditional surrogacy is where the surrogate’s egg is fertilised by your partner’s or a donor sperm. If you go down this route, it can take place by home insemination but it’s recommended you have treatment at a licensed fertility clinic.

Many people ask a family member or friend to be a surrogate as fertility clinics are not allowed to find a surrogate for you.

There are 4 main not for profit organisations that operate in the UK. You are not allowed to pay a surrogate in the UK, although you can provide reasonable expenses , usually around £10 to 15,000.

You’ll also need to draw up an agreement so that the surrogacy arrangement is clear. You also should seek independent legal advice.

After you have decided surrogacy is the right option for you, the process is likely to include these steps:

• Choosing a surrogate and deciding whose egg and sperm you will be using.
• Getting to know each other and drawing up a surrogacy agreement
• Conception
• Maternity
• The birth
• Transfer of legal parenthood
• When the time comes, supporting your child so they understand the circumstance of their birth

For more information on alternative fertility treatments, click here

Visit this link to access a directory of support lines for fertility issues.

5 steps to getting started with fertility treatment

If you have been trying for a baby for over a year and you’re struggling to get pregnant, it could be that there is a problem with your fertility or your partner’s if you have one.

So, now is the time to make an appointment with your GP. Here’s a timeline to help you make sense of next steps.

Tests with your GP

Your GP will look at your medical history and give you a physical examination. He/she will also arrange some initial tests:

GP fertility tests for women

• A cervical smear, if you haven’t had one recently.
• A urine test or swab to check for chlamydia, an STI that can cause blocked fallopian tubes.
• A blood test to see if you are ovulating (progesterone is measured usually around day 21 of a 28 day cycle before your period is due).
• A blood test to check for any hormone imbalances – measuring follicle stimulating hormone (FSH), luteinising hormone (LH) and oestradiol.

1. GP fertility tests for men

• A urine test for chlamydia (which can affect sperm function).
• A referral to your local hospital or fertility clinic for a semen analysis, to check sperm count, concentration, motility, vitality and morphology (shape).

2. Continue trying or get a specialist referral

If your tests are normal, you’ll be advised to continue trying to conceive naturally for another six months to a year. But, in that time it could help you to make a few lifestyle changes. This could include reducing stress, improving your diet, cutting down on alcohol and continuing to TTC for the next six months.

If your tests reveal possible fertility issues, you will be referred to a fertility specialist for further tests. These will include:

Specialist tests for women

• A full hormone profile (blood tests) to measure any imbalance.
• An ultrasound or X-ray to check if there are any structural abnormalities or blockage – eg: in the womb, ovaries or fallopian tubes.

Specialist tests for men:

• Depending on the results of your first sperm analysis, you may be referred for further tests.
• If there are any issues, you will have further tests to find out the reason for any sperm abnormalities.
• Chromosome analysis – If you have very low sperm count, or no sperm, you may have a chromosome analysis to check for any potential genetic disorders. This is usually done as a blood test.

3. Diagnosis of fertility problems

If there is a problem, the treatment you’re offered will depend on the cause of the problem. What you’re offered on the NHS will also depend on what’s available from your local clinical commissioning group (CCG). Your GP will advise you on your eligibility for treatment. You can also contact your local CCG directly.

4. Going private

If you are thinking of going to a private clinic, choose one that is licensed by the Human Fertilisation and Embryology Authority (HFEA)

Other points to think about now include:

• Do they offer the treatment you need?
• What are the costs?
• Do you feel confident about the staff?
• What is their success rate for your age group?
• Does treatment include fertility counselling if you feel you need that?

5. Types of treatment

There are three main types of fertility treatments that you may be offered on the NHS and also in a private fertility clinics:

• Medicines
• Procedures
• Assisted conception (IVF, ICSi etc)

Peppy offers workplace fertility support, for women at work going through fertility issues. Businesses can offer this service as a benefit for their employees.