Infertility Treatments Women

Assisted hatching
 
The process of assisted hatching is sometimes used to try to increase the chances of success with IVF, often for older women or those who have had repeatedly unsuccessful attempts. It involves thinning the outer layer of the embryo or making a small hole in it before transferring it into the womb. The idea is that this may help the embryo implant, but there is no clear evidence that it makes a difference to the outcome.
 

Infertility Treatments Women

Frozen embryo transfer
 
If you've had spare embryos frozen, you can have them transferred later in a separate treatment cycle. The frozen embryos are thawed and can be replaced in a natural cycle if you ovulate normally. If you have an irregular cycle, or have ovulation problems, your clinic may suggest taking some fertility drugs when you are going to transfer the embryos.

Going through a frozen embryo cycle is less invasive than a full IVF cycle, and although you will need to be closely monitored to make sure the embryos are put into the womb at the optimum moment in the cycle, it is generally far less intrusive. The embryo transfer is done in the same way as during a normal IVF cycle, and is then followed by the same two-week wait.

'The frozen cycle was fantastic. I felt completely fine. There was none of the pain of egg collection, none of the worry. In fact, I felt a bit of a fraud.' Elaine, 39

'It was easier because I wasn't having the injections and things, but it wasn't any easier when it didn't work. That was just the same, if not worse.' Sheona, 44

ICSI

ICSI, or Intra-cytoplasmic sperm injection, is a type of IVF that is recommended for men with low sperm counts. ICSI is now carried out widely, despite being a relatively new process. Most of an ICSI cycle is exactly the same as IVF, but sperm is injected into the egg rather than being left to fertilize it naturally. This increases the chances of successful fertilization, and ICSI may be offered if there have been problems with this in a previous IVF cycle.

For more severe male fertility problems where there are no sperm in the semen at all, it may be possible to first remove some sperm from the testicles surgically and then carry out ICSI.
 
GIFT/ZIFT

Gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFF) are variations of IVF, neither of which are carried out very often now. During a GIFT cycle, the eggs are collected from the woman's ovaries, but instead of being fertilized in a laboratory, they are returned to the fallopian tube along with the partner's sperm. ZIFT involves embryos being transferred to the fallopian tubes rather than the womb after the eggs have been fertilized in the laboratory.

IVM

IVM, or in-vitro maturation, is a new process pioneered in Denmark that involves taking immature eggs from the ovaries and maturing them in the laboratory before mixing them with sperm. This technique is less expensive than IVF and doesn't involve the use of such strong fertility drugs, which would be very welcome for many patients. Research in the field is ongoing, and IVM is not yet widely available. 

PGD 

PGD, or pre-implantation genetic diagnosis, is used to help couples who risk passing on certain inherited conditions to their children. The couple go through a normal IVF cycle, but the embryos are left to develop in the laboratory until they have divided into eight cells. An embryologist will then extract one or two cells from the embryo in order to test them for the inherited condition. Any embryos that are affected are not used, but those that are clear can be implanted or frozen for future use. PGD can help couples who risk passing on a wide range of conditions such cystic fibrosis, muscular dystrophy, haemophilia or. sickles-cell anaemia.

PGS

PGS, or pre-implantation genetic screening, is similar to PGD, as cells are taken from the embryo in the same way, but PGS checks for any chromosomal problems in the embryos that might cause miscarriage or abnormality. PGS may be offered to women who are older or to any others who are more at risk of chromosomal problems. To find out more, you can check out Infertility Treatments Women.

IUI Infertility Treatment

Intrauterine insemination (lUl) 

IUI, or Intrauterine insemination, may be offered to couples with unexplained infertility, for women with mild endometriosis or polycystic ovary syndrome and for minor male factor sperm problems. IUI is often suggested as a precursor to IVF, as it is less invasive and less expensive.
 
During an IUI treatment cycle, the man's sperm is placed inside his partner's womb to increase the chances of pregnancy. IUI is sometimes carried out without using any fertility drugs, in what is called an unstimulated cycle. Alternatively, drugs may be used to induce ovulation in a stimulated cycle, but this increases the risk of a multiple birth.

IUI Infertility Treatment

 
During an IUI cycle, the follicles that are developing in the ovaries are regularly monitored with ultrasound to check on their progress, and you may be asked to use an ovulation prediction kit too. When the time is right, you go to the clinic where your partner is asked to produce a sperm sample. The sample is 'washed', which ensures only good-quality sperm are used for the insemination. They are put right into the womb in a thin catheter, which is passed through the cervix.

Usually, you wiIl have the sperm put into the womb only once during each cycle. Some clinics do offer two inseminations, but there is no evidence that this improves the chances of a successful outcome. If you are having IUI, do check that your clinic is open at weekends and bank holidays. Otherwise, if you ovulate at the wrong time, the treatment won't be able to go ahead.
 
'It was fairly nightmarish. We'd go through it all, and then if I ovulated at the weekend or on a bank holiday, that was that. They couldn't do the treatment. I found it so stressful. We never knew if we would have the treatment or not.' Lulu, 39 

You may be offered up to six cycles of IUI, although few couples actually seem to get through that many, often preferring to move on to IVF if the IUI is unsuccessful. The success rates for an individual cycle of IUI are not high, at around 12 per cent, but the chances of getting pregnant are increased in stimulated cycles. IUI is often regarded as much 'easier' than IVF from the patient's perspective, but the emotional trauma of unsuccessful treatment cycles is the same, and some women find it just as hard to deal with.
 
'I did IUI for six months. There was always a risk that you would either overdo it or under-do it, so one month the cycle would be cancelled because I didn't have any follides, and the next month it would be cancelled because there were too many, because if there were more than three they wouldn't inseminate. It was stressful. You just felt like you never knew where you were.' Naomi, 39

IVF 

One of the most established forms of assisted reproduction, IVF has been used for about 30 years. IVF stands for 'in-vitro fertilization', and it involves eggs being taken out of the woman's body and fertilized with her partner's sperm in a laboratory, before being returned to the womb as embryos. Most couples don't imagine they will ever get as far down the line of treatment as IVF, and it can be a daunting prospect. 

There is a general assumption, probably partly because we have all read so much about miracle test-tube babies, that IVF will inevitably work. In fact, even now with much improved success rates, an individual IVF cycle is more likely to fail than it is to succeed. That can be hard to accept when you are investing so much emotion, time and often money too, in your first treatment cycle.

 
'You go into it quite naively really. You hear about IVF in the media, and you think you do IVF and get a baby at the end. Thinking back we were so unrealistic. We went into the first one really excited and hopeful, thinking that now we were going to get our baby. It was only when the first one failed that we realized actually it doesn't work like that.' Mary, 38. To find out more, you can check out IUI Infertility Treatment.

Female Infertility Treatments

Gonadotrophin hormone treatment
 
Hormone treatment using gonadotrophins is the next level of drug treatment for women with ovulatory problems. Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are gonadotrophins, which are produced naturally in our bodies, and are a vital part of our reproductive cycle. The drugs using these hormones may contain just FSH alone, or FSH and LH, and are given by injection. When you are taking these drugs it is essential that you are properly monitored using ultrasound, as there is a risk of multiple births. It is also possible that the ovaries can be oversfimulated, leading to ovarian hyperstimulation syndrome (OHSS), which can pose serious health problems.
 

Female Infertility Treatments

Bromocriptine, cabergoline and dopamine agonists
 
These drugs may be prescribed for women who have a disorder of the pituitary gland called hyperprotactinaemia, which causes them to produce too much prolactin. This condition an lead to irregular periods, and thus infertility. These drugs can have side effects such as nausea, sickness, headaches and dizziness.
 
Laparoscopic ovarian drilling

Laparoscopic ovarian drilling is sometimes offered to women with polycystic ovaries, particularly those who have not responded to clomifene citrate. It involves a general anesthetic and a laparoscopy. A tiny telescope (a laparoscope) is inserted through a small incision into the abdomen, and heat is used to burn small holes on the surface of the ovaries. This process seems to help trigger ovulation in some women.

'They go in through the belly button and they make holes all over the ovaries. It was only day surgery, and I was home in the evening. It was a little bit tender, but painless. The only discomfort you have is in your shoulder from the build up of gas, but it does go very quickly if you lie flat for a couple of hours.' Sarah, 34
 
Treatment for problems with fallopian tubes
 
There are a number of procedures that may be offered to patients who have blocked or damaged fallopian tubes to try to clear the tubes so that eggs can pass freely along them and pregnancy can occur. One of the simplest ways to try to unblock the tubes involves using a fine catheter, which is inserted through the cervix. A narrow wire is pushed through the catheter to try to clear the blockage away. The process is often successful, but does carry a risk of damaging or perforating the tube, and some women find it painful. Sometimes doctors try to clear blockages in the tubes by inserting a small balloon into the tubes and inflating it.
 
Tubal surgery
 
It may be possible to remove blockages in the tubes and scar tissue by surgery. Women who have blocked tubes are now generally offered IVF rather than surgery, as this by-passes the fallopian tubes, and has a higher chance of producing a pregnancy. If surgery is offered, it should be done laparoscopically, and the chances of success will depend on the nature and severity of the problem. Sometimes a blocked portion of tube will be cut out and the ends joined together, and scar tissue, which can glue up the reproductive organs by covering them like sticky cobwebs, can be removed.

Tubal surgery is only generally considered when both tubes are blocked. Although it will probably take longer to get pregnant with just one open tube, there is a risk that attempting to repair the blocked tube could leave scarring that might damage the clear tube. There is an increased risk of ectopic pregnancy after tubal surgery.

Uterine surgery 

Some women will be offered surgery to remove fibroids or scar tissue in the womb. Many of these operations on the womb are now done using keyhole surgery where possible, rather than open surgery. To find out more, you can check out Female Infertility Treatments.
 

PCOS Infertility Treatment

Fertility Treatment 

When we talk about fertility treatment, it is usually IVF and other assisted conception techniques that spring to mind, but there may be much simpler solutions for some women who are having difficulty getting pregnant. Your individual situation and the nature of your fertility problem will determine the type of treatment that is appropriate.  
Drug treatments 

Many women are offered some kind of fertility drug as a first treatment, which can boost your fertility if you have ovulation problems.
 

PCOS Infertility Treatment

Clomifene citrate and tamoxifen
 
Clomifene citrate is probably the most commonly prescribed drug, along with tamoxifen. These drugs are used to stimulate the ovaries. Clomifene citrate can help women who don't usually ovulate to produce eggs, and can regulate your cycle if you aren't ovulating every month. It may also be given to women who have unexplained infertility. Although the drug undoubtedly helps many women to conceive, it is sometimes prescribed in a rather ad hoc fashion to anyone who is trying to get pregnant unsuccessfully, when there may be other fertility problems that have not been identified.

Clomifene citrate is given in the form of tablets, which are taken for five days each month early in the menstrual cycle. Women usually start with a dose of 50mg, which may be increased if you aren't responding to the drug. It is not advisable to take clomifene citrate for more than six months at a time, as there are questions about long-term use of the drug and possible links to ovarian cancer.

When you are taking clomifene citrate, you should be monitored to check whether you are ovulating. Some women are given the drug without any checks or monitors, and so have no idea whether it is working, whereas others may be offered just blood tests. It is good practice to monitor the use of clomifene citrate or tamoxifen with ultrasound scans in at least the first cycle, as this allows doctors to see how your ovaries are responding. It can also alert them if there is a risk of a multiple pregnancy, as the drugs may stimulate the ovaries to produce not just one but a number of viable eggs.

'They put me straight on clomifene. They didn't check whether ovulation was a problem. They weren't tracking me at all. I was on these strong drugs with no supervision. I had no appointment to go back. It was a situation of take this and go away for six months even though the drug is probably going to do nothing for you.' Nicol, 33.

Some women take clomifene citrate and tamoxifen without any problems, but others have unpleasant side effects. These are usually described in literature about the drugs as menopausal symptoms such as headaches and hot flushes. In fact, what most women find difficult to cope with is the way the drug affects their moods.
 
'The first time I took clomifene I had really bad mood swings and was depressed. I didn't get many physical side effects; it was more emotional and mental. I did take it first thing in the morning, but now I take it at night, so hopefully I sleep through the worst of it. I've just had it this month and I've had pains and hot flushes. It's the first time it has affected me like that.' Lisa. 32

Metformin
 
Women with polycystie ovary syndrome may be offered metformin, either instead of or along with clomifene citrate. Metformin was developed to treat age-related diabetes by lowering blood-sugar levels and reducing high insulin levels. Women who have PCOS produce high levels of insulin. Metformin can help by making the body more sensitive to insulin, which means less is produced. However, it is not licensed for use for fertility problems, as it was not originally intended for this purpose.

Metformin is most commonly prescribed for women who have PCOS who are also overweight, and for those who haven't responded to clomifene citrate or tamoxifen. Combining metformin with these drugs increases the chances of ovulation. Metformin works better for women who are overweight, although it is no substitute for weight loss. The drug can have side effects such as nausea, vomiting and diarrhea.

 
'Just for a few weeks I had some bad side effects. I had diarrhea, and was a little bit sick but once that wore off I've not had anything since. I think some women just don't get over the side effects of metformin and simply aren't able to take it, but I got used to it relatively quickly.' Lucy, 27. To find out more, you can check out PCOS Infertility Treatment.