Fertility treatments can be grouped into three categories:
- Medicines that help to improve fertility
- sometimes used alone, but are also used in addition to assisted conception.
- Surgical treatments
- which may be used when a cause of the infertility is found that may be helped by an operation.
- Assisted conception
- which includes several techniques such as intrauterine insemination (IUI), in vitro fertilisation
(IVF), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI).
We give information on each below:
Medicines
Medicines that may improve fertility - are mainly used to help with ovulation. Ovulation is when the ovary makes and
releases an egg it should occur about once a month in women up until the menopause. For various reasons, ovulation may not
occur at all, or it may occur less often than normal.
may be offered to women with polycystic ovary syndrome who have infertility and who have not responded to
clomifene. Metformin is a medicine that is commonly used to treat some people with diabetes. It has recently been shown to
help in some cases of polycystic ovary syndrome.
Clomifene is a medicine that has been used to help with fertility for many years. It is taken as a tablet. It works
by blocking a 'feedback' mechanism to the pituitary gland. This results in the pituitary making and releasing more gonadotrophin
hormones than normal. The extra amount of gonadotrophin hormones released into the bloodstream stimulate the ovary which may
result in ovulation.
Medicines that contain gonadotrophins are another type of treatment. These need to be injected and tend to be used
when clomifene does not work, or prior to IUI and IVF to cause ovulation. Gonadotrophin medicines may also improve fertility
in men with certain types of testes problems.
Medicines that contain gonadotrophin-releasing hormone are sometimes used. These stimulate the pituitary to releases
gonadotrophins (which in turn stimulate the ovaries).
It is essental that your discuss your option with your consultant so that you are aware of potential side affects that
these drugs have.
Surgical treatments
There are several situations where surgery may be an option to improve your, or your partners fertility they include:
- Surgery to blocked or scarred fallopian tubes may help some women with infertility caused by fallopian tube problems.
- Surgery may help to improve fertility in women with endometriosis.
- For women with fibroids, surgery to remove the fibroids may be considered if there is no other explanation for the infertility.
- One type of male infertility is caused by sperm being blocked by an abnormality in the epididymus in the testis. This
may be treated with surgery.
Assisted Conception
Intrauterine insemination (IUI)
This is the process by which sperm is placed in the woman's uterus. It is done by
using a fine plastic tube which is passed through the cervix into the uterus. Sperm are passed through the tube. It is a relatively
straightforward procedure. It is timed to coincide with ovulation (about half way through a monthly cycle). Fertility medicines
are commonly given beforehand, to maximize the chance of ovulation occuring. Women who have this procedure need to have healthy
fallopian tubes to allow the egg to travel from the ovary into the uterus. If successful, fertilisation takes place within
the uterus.
The sperm used can be either from the male partner, or from a donor.
- The male partner's sperm can be used when the cause of the infertility is unexplained and the sperm seems fine, or for
cases where the female cervical mucus seems to block or kill the sperm. Sperm is obtained by masturbation just prior to the
IUI procedure.
- Donor sperm is obtained from a 'sperm bank' of frozen sperm provided by donors.
In vitro fertilisation (IVF)
In vitro fertilisation means fertilisation outside of the body. In vitro literally
means 'in glass ' (that is, in a laboratory dish or test tube). IVF is mainly used for cases of infertility caused by blocked
fallopian tubes, or unexplained infertility.
IVF involves taking fertility medicines to stimulate the ovaries to make more eggs than usual. When the eggs have formed,
a small operation is needed to get them ('egg retrieval'). The eggs(s) are mixed with sperm which is obtained in the same
way as for IUI (described above). The egg/sperm mixture is left for 2-3 days in a laboratory dish (often referred to as a
'test tube'). The aim is for sperm to fertilise the eggs to form embryos. One or two embryos which have formed are then placed
in the woman's uterus using a fine plastic tube passed through the cervix. Any other embryos which have formed in the dish
are either discarded or, if you wish, frozen for further attempts at IVF at a later date if the initial attempt fails to result
in pregnancy. You may also be asked to consider donating any spare embryos to be used for research, or to be donated to other
infertile couples.
Gamete intrafallopian transfer (GIFT)
A gamete is an egg or sperm. Eggs and sperm are collected in the same way
as for IVF. The eggs are mixed with sperm. The mixture of eggs and sperm are then placed into a fallopian tube. Therefore,
unlike IVF, the sperm fertilises the egg 'naturally' inside the woman's fallopian tube or uterus, and not outside the body
in a laboratory dish. For this to work, the woman's fallopian tube needs to be healthy. GIFT tends mainly to be used in cases
of 'unexplained fertility'.
Intracytoplasmic sperm injection (ICSI)
This technique involves an individual sperm being injected directly into
an egg. This method bypasses any natural barriers that may have been preventing fertilisation. For example, some cases of
infertility are due to the sperm of a male partner not being able to 'penetrate' the outer part of the egg to fertilise the
egg. ICSI can also be used when a male partner has a low sperm count as only one sperm is needed.
If needed, a sperm can also be obtained by a small operation to the testis. This may be done when sperm cannot be produced
in the usual way (for example, if the male partner has a blocked vas, or has had a vasectomy).
The egg containing the sperm is then placed in the uterus in the same way as with IVF. ICSI is used for couples who have
failed to achieve fertilisation through IVF, or where the quality or number of sperm is too low for normal IVF to be likely
to succeed.
Egg donation
This involves stimulating the ovaries of a female donor with fertility medicines, and collecting the
eggs which form. The eggs are mixed with and fertilised by sperm of the recipient's partner (similar to IVF). After 2-3 days
embryos are placed in the uterus of the recipient via the cervix.
This method is an option for: women who have ovarian failure and cannot produce eggs (for example, after radiotherapy);
who have had their ovaries removed; who have conditions where the ovaries do not work or where there is a high risk of transmitting
a genetic disorder to the baby. It is also used in certain cases of IVF failure.
For more information check out 
