What treatment you’re offered will depend on why exactly you’re struggling to conceive and what’s available from your local clinical commissioning group (CCG), according to NHS.uk.
We asked Dr Marie Wren, fertility specialist and Deputy Medical Director at The Lister Fertility Clinic, to break down exactly what your options are.
“There are three main types of fertility treatment options,” Dr Wren explains, “ranging from medication, to surgical procedures and assisted conception, which includes in vitro fertilisation (IVF) and intrauterine insemination (IUI).”
If you’re struggling to get pregnant, your brain is likely in complete overdrive. Not only are you processing extreme and complex emotions, but you’re being met with a ton of information, stats, advice, and choices. It’s overwhelming to say the least.
This option is often recommended for women who do not ovulate regularly (or do not ovulate at all), and have no other fertility issues, and whose partners have good semen quality, Dr Wren says.
“Tablets such as Letrozole, Clomiphene (CLOMID) and Tamoxifen and fertility injections (FSH) may work to stimulate ovulation,” she says.
“Some women who have pre-existing conditions which can affect their ability to conceive – such as polycystic ovary syndrome (PCOS) – may be offered either Metformin or Inositol. These tablets may help to improve insulin resistance and lower blood sugar levels, which might help to improve natural ovulation.”
For women with unexplained infertility who are regularly ovulating without fertility drugs, medication to stimulate the ovaries is not usually recommended. “There is no evidence to suggest this can increase the chances of pregnancy,” says Dr Wren.
Aside from medication, there are various surgical procedures that can help with fertility.
“Laparoscopic surgery is often used to treat endometriosis – a condition that occurs when parts of the womb lining grows outside the womb – as it can often be associated with infertility,” explains Dr Wren. “Removal of the endometriotic deposits may in some women improve their chances to conceive naturally and, in some cases, relieve the menstrual cramps and painful intercourse that many women with endometriosis suffer with.”
However, if the pelvic damage caused by endometriosis is extensive, surgery is unlikely to be a permanent solution and IVF may be necessary.
Women with fibroids may require surgery to remove them. Dr Wren says: “Especially when the fibroids are large and are causing symptoms, or if the fibroids are distorting the uterine cavity (sub-mucosal fibroids). For some, key hole surgery may be possible (laparoscopic or hysteroscopic resection may be an option) but some women will require a conventional open myomectomy which requires a full abdominal incision, similar to the scar from a Caesarean Section.
“In a small number of patients with PCOS who do not ovulate with medication, but who have no other fertility problems, laparoscopic ovarian drilling may occasionally be suggested.”
For the 1% of men who suffer from azoospermia (when there is no sperm in the ejaculate), they may be candidates for surgical sperm retrieval.
“The sperm that is extracted would then be used in an IVF treatment cycle combining micro-manipulation techniques (ICSI) to fertilise the eggs that are collected from the female partner,” says Dr Wren. “In obstructive azoospermia, there is an obstruction as a likely consequence of either an absent or blocked tube that connects the testicles to the penis – for example, following a vasectomy – or in some men who are carriers of the defective cystic fibrosis gene. In these men, there is high chance of successfully finding suitable sperm that can be used in the ICSI process.”
In some men, sperm can be retrieved from one of two areas, and via these processes:
The epididymis (the structure next to the testicle where sperm are stored and mature prior to ejaculation):
- PESA (Percutaneous epididymal sperm aspiration): The simplest procedure, performed under local anaesthetic where sperm is aspirated using a fine needle and syringe
- MESA (Microsurgical epididymal sperm aspiration): This procedure requires a general anaesthetic to allow direct microscopic visualisation of the epididymis for sperm aspiration.
- Micro-TESE (Testicular sperm extraction): This more invasive procedure is required in those where epididymal retrieval has failed or with a non-obstructive cause of azoospermia. Under general anaesthetic, small biopsies are taken directly form the testicle under microscopic visualization which is then examined to find small numbers of sperm that can be used for treatment.
The sperm retrieval may be planned in advance and the sperm samples will then be frozen, however, for some couples a synchronous procedure is planned, with the man’s surgery being performed in the morning, to coincide with the day of his partner’s egg collection.
Couples will be advised to explore assisted contraception when other treatment options aren’t possible or are unsuccessful.
“IUI (intrauterine insemination) is a process which involves inserting sperm – which is specially prepared in the lab to concentrate those with the best quality – directly into the woman’s uterus around the time of ovulation via a thin plastic tube passed through the cervix,” explains Dr Wren.
IUI isn’t often recommended for couples who are having sex without any difficulties, but if donor sperm is required, then IUI may be considered first, before IVF.
How does it work? “An IUI is a simple, minimally invasive procedure (similar to having a cervical smear) and a fine catheter is passed into the uterus through the cervix to allow the prepared sperm to be placed in the uterus at the time that the woman is expected to be ovulating,” says Dr Wren. “The procedure usually only takes only a few minutes.”
The most widely used and probably the most successful fertility treatment option for most couples is in vitro fertilisation (IVF), says Dr Wren. “IVF involves fertilising eggs outside the body, then returning an embryo to the womb to grow and develop. For most women, this will involve the use of fertility drugs to increase follicle production and the egg harvest.
“The egg collection procedure is usually performed around the time that the woman might usually ovulate and most IVF clinics will perform this type of surgery under intra venous sedation, or general anaesthesia.”
For some, egg donation may be the best treatment option, explains Dr Wren. “The female egg donor will take the fertility drugs to encourage eggs to develop, and will have the egg collection operation,” she says. “The partner of the female recipient will provide the sperm sample that is used to fertilise the donated eggs, and then the female recipient will have the embryo replacement. In most cases the recipient will have taken HRT to prepare her uterus for the embryos transfer.”