As the name suggests, this type of treatment involves giving mother nature a helping hand in getting the sperm to meet the egg. There are three main forms of assisted conception:
IUI – Intrauterine Insemination
The least invasive form of assisted conception, IUI involves obtaining a sample of sperm, washing it and taking out the best ‘swimmers’. The sperm are then introduced to the womb directly through the cervix using a fine plastic tube at the time of ovulation. This technique can also be coupled with an ovulation stimulating hormone to increase the chances of success.
Although some women may experience some cramping during or immediately after the treatment (plus possible side effects if ovulation stimulating drugs have been used), the procedure should be painless and fairly straightforward.
The simplicity of IUI means that it is one for the most affordable forms of assisted conception. Provided that the man’s sperm and the woman’s tubes are healthy, the success rate for IUI in women under 35 is around 15% for each cycle of treatment.
IVF – In Vitro Fertilisation
IVF involves the manipulation of a woman’s cycle to maximise the chances of conception, outside of the womb! IVF involves six main stages:
- In order to control your hormone levels, your body’s natural cycle needs to be shut down – effectively going into menopause. This is usually done my taking a nasal spray or injection each day at the same time for about two weeks, so that the menstrual cycle is gradually suppressed. Once blood tests show that the hormones are at a based level, you’re ready for stage 2.
- Injections of FSH (follicle stimulating hormone) are given (usually self administered) for about 10 days to stimulate your ovaries to produce more eggs than usual.
- You’ll have regular internal ultrasounds to monitor the egg development, checking how many of follicles there are in each ovary (each follicle should contain an egg), and how big the follicles are. Once they are at the correct size, you’ll be given a final injection to help them to mature.
- The mature eggs needs to be collected. This involves inserting a needle through your vaginal wall into your ovaries, you’ll be given a sedative so that you’re not in any discomfort. At the same time, your partner will need to produce a sperm sample.
- The eggs are mixed with the sperm for a day to allow fertilisation to occur.
- The resulting embryos will be examined, and after up to 6 days, one or two the best quality ones will be transferred into the womb.
Once the embryo(s) have been returned to the uterus, nature takes over and there is a nail biting two week wait before the all important pregnancy test.
The chances of success vary according to the age of the woman and of course the reason for the infertility. The younger the woman, the greater the chance of success:
- 32.2% for women under 35
- 27.7% for women aged 35-37
- 20.8% for women aged 38-39
- 13.6% for women aged 40-42
- 5% for women aged 43-44
- 1.9% for women aged over 44
IVF is a complicated process and as such is expensive. If you are being treated privately, one cycle can cost up to £5000 so it’s worth finding out if you qualify for NHS treatment.
The process will take it’s toll not only on your bank balance, but on your emotions too. Setting aside your desire to become pregnant, the medications used during the treatment can cause mood swings, hot flushes and headaches. There is an increased chance of twins or triplets and a risk of ectopic pregnancy as well as ovarian hyperstimulation syndrome (OHSS) as a result of the production of too many eggs.
ICSI – (Intracytomplasmic Sperm Injection)
ICSI is a technique used in IVF whereby a single sperm in injected into a single egg, then transplanted into the womb as an embryo. ICSI is usually recommended when there are problems with sperm production:
- Low sperm count
- Poor motility (movement) or morphology (shape)
- A low fertilisation rate in previous IVF attempts
- Surgical sperm collection from the testes (testicular sperm aspiration / TESA) or from the epididymis (percutaneous epididymal sperm aspiration / PESA) as the result of ejaculatory problems, previous vasectomy or very low sperm production
- The use of frozen sperm
Once the sperm sample has been obtained, it will be examined by an embryologist who will select a single sperm and inject it into the egg. After this the process is much the same as IVF; if fertilisation occurs the embryo will be transferred to the uterus and hopefully implantation will take place and a pregnancy will begin.