What are the reasons for having assisted conception?
What are the Treatment Options ?
- the age of the woman
- the quality of the man’s sperm
- how long the couple have been infertile
- whether or not the woman has had a previous pregnancy.
Intrauterine insemination (IUI) is a form of assisted conception. During IUI, your doctor will place washed, prepared sperm into your uterus (womb) and near to your egg at your time of ovulation. This procedure is often combined with fertility drugs to increase your chances of conceiving.
IUI may help you as a couple if:
For IUI to work, your fallopian tubes must be open and healthy. To find this out, you will need to have a tubal patency test. This can be done using laparoscopy, which is a form of keyhole surgery, or a hysterosalpingogram, which is a form of X-ray. These may locate any problems or blockages in your uterus or fallopian tubes.
IUI isn’t recommended if your tubes have adhesions or scarring that might stop an egg travelling from the ovary to your uterus. But if you have at least one working tube and ovary on the same side, IUI may be an option for you.
Depending on your particular fertility problem, you may need to use fertility drugs alongside your IUI treatment. If you do take fertility drugs it’s called a stimulated cycle, because the drugs stimulate ovulation. If drugs are not used it’s called an unstimulated cycle, or natural cycle.
Stimulating ovulation is not recommended if only your spouse has a fertility problem, or if the reason for infertility is unexplained. This is because there is a much greater risk of a multiple pregnancy when taking fertility drugs.
You may think that twins or more would be a great way to start a family if you have fertility problems. But multiple pregnancies increase your risk of miscarriage and other pregnancy complications.
In unstimulated cycles, IUI is timed to take place at the time of natural ovulation. You may be asked to detect ovulation using an ovulation predictor kit, or your doctor may track your cycle using blood tests and ultrasound scans. IUI is usually done between day 12 and day 16 of a natural menstrual cycle, but the exact day will depend on your individual cycle.
If your fertility specialist has offered IUI during a stimulated cycle, you’ll probably be given fertility drugs in the form of tablets or injections. You’ll start taking the drug near the beginning of your menstrual cycle to stimulate your ovaries to develop several mature eggs for fertilisation. This is rather than your usual one egg per month.
An ultrasound scan helps to locate the egg and check that it is mature. This will allow insemination to take place at the best time. You may ovulate naturally, or be given an injection of a hormone called human chorionic gonadotrophin (hcg) to bring it on.
Sperm is then inserted into your uterus within 24 hours and 40 hours of the hcg injection, or when you have a rise (surge) in luteinising hormone (LH). Your husband will be asked to provide a sperm sample which will be washed to extract the best quality and most mobile sperm.
Using a catheter (tube) through your cervix, your doctor will then put this sperm directly into your uterus near a fallopian tube. This is the passage the egg travels along from an ovary to your uterus.
If you have unexplained infertility, the sperm may be inserted within a larger volume of fluid than usual. This allows it to wash up into your fallopian tubes more easily (fallopian sperm perfusion). This technique takes a few minutes more than standard IUI and may increase your chance of success.
After IUI you will rest for a short time and then carry on life as normal. You’ll be able to take a pregnancy test in about two weeks.
The insemination itself is straightforward and takes only a few minutes. If you are having a stimulated cycle, you’ll need to take fertility drugs before you ovulate.
Success rates depend on the cause and severity of the infertility and your age. UK success rates for IUI using donor sperm are about:
Up to six cycles of IUI treatment are recommended for unexplained infertility or mild endometriosis, or if your spouse has a low sperm count. If you keep trying for up to six times you do increase your chances of becoming pregnant.
Despite the benefits (see top section, Could IUI benefit us?) IUI is not for everyone.
It’s vital that you seek medical help if you think you are experiencing OHSS. You may need to stay in hospital while your ovaries settle down, and your doctor will probably advise cancelling your IUI treatment for this cycle. That’s because the risks of conceiving a multiple pregnancy will be too great.
You can talk about IUI and artificial insemination in our BabyCenter community.
as most couples know, getting pregnant often takes more than one night of magic. The reasons for the long wait, up to a year or longer for many couples, can be many and complicated. But one thing that can hinder conception is something we all face from time to time – stress.
A conceptionmoon is a break that you and your partner dedicate to getting pregnant. The idea is to relax, rekindle the fire in your relationship and make conception special.
A survey of UK BabyCentre mums found that 18 per cent of mums who conceived on holiday had planned their break around getting pregnant. Incredibly, a survey of US mums on babycenter.com revealed that nearly half of all couples who took a conceptionmoon did actually conceive while they were away.
Conceptionmoons work by relaxing you and your partner, and reminding you why you fell in love in the first place. Stress may inhibit conception because it can affect the part of your brain (the hypothalamus) that regulates your hormones.
The hypothalamus is the gland in the brain that controls the hormones required to release your eggs. This gland also regulates your partner’s testosterone levels.
Not only that, but if you or your partner is feeling stressed, you may feel less interested in having sex. It goes without saying that having sex less frequently is not going to help your chances of conceiving.
Stress can even play havoc with your menstrual cycle, leading you to ovulate later than usual, or not at all.
Take a good look at how you like to relax. Ask yourselves whether you prefer the beach or the countryside, or if a city break is more your thing.
You don’t have to go far or spend a lot of money. Just make sure the environment you choose will help you unwind. Then get out the calendar and plan a break when you’re likely to be most fertile.
Once you’re away, look out for the natural signs of ovulation or pinpoint it exactly, using tests or charts. Either way, put those baby-making sexual positions to the test in the days before and during ovulation to boost your chances.
If you have other children, see if you can arrange for a family member to look after them. (If your mum has been nagging you for more grandchildren, call her first.)
Don’t bring your stress with you on holiday. Leave your mobile phones at home. If you can’t bring yourself to be truly out of touch, take your phone but promise yourself to switch it off after a certain time.
Finally, relax. Catch up on sleep, eat good food, and enjoy each other, in and out of bed.
If you just can’t take a break, try to reduce stress levels at home. You can do this by:
Basically, do whatever helps you to take a deep breath and get some peace.
At the same time, make an effort to spend time with your partner. Try a dinner for two. If you can afford to, take a day off work together. And if you know you’re ovulating and can arrange it, consider a night in a nearby hotel.
Having a healthy diet and lifestyle may help, as may keeping your stress levels low.
If your lifestyle makes it tricky to have regular sex (because of work trips away or the demands of existing children), you could learn to pinpoint your fertile window.
Women with an irregular cycle may also prefer to take some control over trying for a baby. (If you’re on a cycle of assisted conception treatment, your doctor may have asked you to detect ovulation as part of the process.)
An easy and accurate way to do this is by using urine-based ovulation predictor kits. You can buy the kits from pharmacies, or you may be able to cut your costs by bulk buying online. This method is seen as more useful than some other ways of spotting ovulation.
A more time-consuming but cheaper way of working out when you are likely to be ovulating is to track your basal body temperature (BBT) and cervical mucus (CM) using a BBT or fertility thermometer.
Using this method, you have to chart your cycle every day, first thing in the morning, for a few months. Then you can recognise your pattern and have a better chance of predicting your most fertile days. Most women see a spike in their temperature, signalling that they’ve ovulated, and notice that their mucus looks and feels like raw egg white at around the same time. When the two coincide, it tells you that you have ovulated.
Provided you have a regular cycle, you can work out the days in future cycles when you’re more likely to conceive and so make sure that you have sex at least once at those times until, hopefully, you conceive. In general, though, timing sex in this way has not been found to improve your chances of natural conception compared to just having sex every two to three days.
Check out the sample chart to see how a completed one will look. Then, if you decide you’d like to try charting your BBT and CM, you can print out a blank chart for use at home.
Remember, every woman’s cycle is different. Yours may not look like the sample, or may be different every month. There are also some disadvantages to using this method of ovulation prediction – see our articles on how to chart your BBT and cervical mucus and charting vs. ovulation predictor kits for more information.
Whether your approach to conception is to make love regularly and see what happens or to focus on your fertile window, we wish you luck!
If you are a competing athlete with extremely low body fat, your chances of getting pregnant could be impaired. Some female athletes stop ovulating, but this isn’t the case with most women.
If you don’t work out regularly, start adding more activity into your life, such as a 20 to 30-minute walk every day. By starting and sticking to an exercise routine, you’ll be rewarded with a healthy body that’s fit for pregnancy. Plus, working up a little sweat is a great way to relieve stress, which can make it more difficult for you to get pregnant.
Stress can interfere with ovulation by delaying it or suppressing it, which can result in your menstrual cycle stopping altogether.
While it’s good to be aware of when you might be ovulating, it’s more important to relax and try not to obsess about this time of the month. Disrupting your routine each month may leave you feeling anxious or overwhelmed. That’s why it’s a good idea to keep on hitting the gym if that’s your thing. You might also want to try a yoga class to help you focus on letting go of daily stresses while stretching your muscles.
If you are considering assisted conception treatments, you’ve probably spent a long while trying for a baby.
Assisted conception treatments are often paired with fertility drugs to increase your chance of conceiving. The younger you are, the greater your chance of success of conceiving through these treatments.
For women under 35, the number of babies born as a result of fertility treatments is as high as one in three.
Though the treatments can be invasive and expensive, there is little evidence of long-term health effects for most women and babies from the procedures or the fertility drugs used. Fertility drugs are always used at the lowest dose for the shortest time possible to reduce side effects and potential risks.
Some assisted conception techniques create a slightly higher risk of your baby being born with a problem. Rest assured that these problems are not common. Links have been made between assisted conception treatments and a greater risk of pregnancy, labour or birth complications, but age and multiple pregnancies go some way to explain these increased risks.
The older you are, the more likely you are to need fertility treatment and to experience complications, such as miscarriage, premature birth and caesarean.
While twins or triplets may sound like an ideal way to kick-start your family, there are risks associated with multiple pregnancies. Clinics follow strict guidelines to reduce the rate of multiple births resulting from assisted conception.
These risks mean doctors treat assisted conception procedures as a last resort for having a baby.
Assisted conception treatments include:
If you are considering fertility treatment, the British Infertility Counselling Association offers advice and contact details for counsellors. And you can talk to others about assisted conception treatments in our community. Talking through your options may help you to deal with the many emotions and decisions which you will face along the way.
Your treatment options will vary according to the cause of your fertility problems. Your doctor may suggest trying the least invasive procedures first. Treatments such as in vitro fertilisation (IVF) are well-known and increasingly successful, but they can be expensive and complex procedures.
Drug treatment and surgery can be very effective. You may be treated successfully with fertility drugs or just with surgery.
The right treatment for you depends on many factors, including:
the cause of your or your spouse’s fertility problem
the quality of your spouse’s sperm
how long you and your spouse have had fertility problems
whether you have had a previous pregnancy
Here are the types of fertility treatments that are available, from the least invasive to the most invasive:
Fertility drugs. If your or your spouse’s hormones are out of balance, these drugs may get your reproductive system back on track.
Intrauterine insemination (IUI). In some cases, sperm just need a shortcut to the egg. A concentrated dose of your spouse’s sperm placed in your uterus (womb) or fallopian tubes can help with fertilisation. IUI can also help if your spouse’s sperm are unable to get through your cervical mucus. Donor sperm may be used for this, if needed.
Surgery. Blocked tubes, endometriosis, fibroids and ovarian cysts all play a part in fertility problems and may be treated with surgery. However, if you have blocked tubes or endometriosis you may be likely to choose IVF.
Assisted conception treatments. Fertility drugs and other conventional treatment options are combined with high-tech procedures, such as egg collection, to treat both male and female fertility problems.Procedures include IVF, intracytoplasmic sperm injection (ICSI), and using donated sperm or donated eggs or embryos. Surrogacy is another option.
What are my chances of getting pregnant with treatment?
Success depends largely on the cause of your fertility problem and your age. You are more likely to get pregnant if you are under 35. Success rates start to fall dramatically once you are more than 35. But you and your spouse can take positive steps towards increasing your chances by adjusting your lifestyles.
Limiting your alcohol and caffeine intake, improving your diet, and giving up smoking, can all help to boost your chances of getting pregnant. And a dad-to-be’s diet matters, too.
It’s important for you to take a folic acid supplement or a multivitamin supplement containing folic acid, too. It won’t improve your chances of getting pregnant, but it does reduce the risk of abnormalities, such as spina bifida, in your baby.
You may consider complementary therapies, such as acupuncture or homeopathy, to try to increase your chances of conception with fertility treatment. However, there’s not much evidence on how effective these treatments are . Always talk to your doctor before taking any supplements, such as herbs, with fertility drugs. They may affect how your fertility drugs work.
Trying for a baby through fertility treatment can be emotionally draining, bringing a mixture of high hopes and potential disappointment. So it helps to mentally prepare for what lies ahead.
For some couples, anxiety and depression become part of the challenge of infertility. Early on, try to think of ways to cope. It’s best not to bottle up your feelings. Find a willing friend, support group, or professional to talk to before tackling infertility, and while you’re going through fertility treatment.
Whatever your treatment, your clinic should be able to offer you counselling. If you would rather not have formal face-to-face counselling, ask for details about group sessions.
Or visit our community where you’ll find other couples in your situation.
Infertility may be one of the most difficult things you’ll ever face. It’s easy to underestimate how stressful it can be until you experience it for yourself. It can make you question everything about your life, from your confidence in yourself and your body, to your relationship.
Of course not! No one is to blame for infertility. You might find, though, that you go through a stage of feeling guilty. Remember, infertility is not your fault, and there’s no sense in giving yourself a hard time, however frustrated you feel. The only thing that matters now is how you and your partner are going to face the future.
Be informed. Read, read, read and ask questions. Assisted conception treatments can be complex and some methods advance quickly. If you understand what’s happening medically, you’ll be able to make better choices.
Plan regular treats for yourself, such as a manicure or a massage, or cooking your favourite foods. Remember, too, that laughter can be a powerful mood-lifter. See a funny film, head out to a comedy club, or read a funny novel. Do anything that works for you, and takes the focus off your fertility issues.
Try not to put your life on hold while you’re going through tests and treatment. Keeping up with hobbies that bring you pleasure is the key to living a satisfying, full life, rather than existing from one cycle to the next.
If your old activities are painful, for example, if they involve friends who are all parents now, look for new diversions. Always wanted to learn the guitar? Then do it! If hiking is your thing, be sure to make time for it. Or enrol for classes in painting, dance, or anything else that’s always tempted you.
Try not to give in to the temptation to blame each other or, for that matter, yourself. Neither of you should feel guilty about having trouble providing the other with a child. Guilt, like all negative thoughts, is a waste of energy.
You’ll be able to cope with your fertility issues much better if you approach them as a team, so keep lines of communication open. Look after each other’s emotional needs. Pay attention to what your partner is going through, and listen to and reassure each other.
Practical issues can also help you to work with, not against, each other. If you’re undergoing treatment, let your partner take on the household duties. Or if you need hormone injections, you may like him to administer them. Try to find ways to work together to share the burden.
Many couples find that, ironically, their sex life is affected. Making love becomes a scheduled duty rather than a spontaneous pleasure. If this is how things are for you, read about how to put the joy back into your sex life.
If certain gatherings with friends who are parents are too painful for you, it’s perfectly all right to give them a miss. That’s particularly the case if the invitation arrives just when you’re going through a hard time. To avoid any hurt feelings, send a present and a hand-written note instead.
If you do decide to attend, remember that it’s fine to go just for a short time, then make your excuses and leave. Plan to do something nice afterwards, like a meal out or a trip to the cinema, so you have something to look forward to.
Coping with infertility or going through fertility treatment can be an isolating experience. You may feel you have to put a brave face on things. You may not have told anyone other than very close friends and family that you have been trying for a baby. You may even feel embarrassed or ashamed.
Counselling is one way to help cope with the strain. You can find the support you need through the following sources:
If you’re having fertility treatment, you should be offered counselling alongside it; ideally before, during and after any investigations or treatments, no matter what their outcome. This will give you the opportunity to find out more about what’s involved and to explore your feelings. This will be particularly important to you if you’re using donated sperm or donated eggs, embryos or surrogacy in your treatment. You will also be offered specialist counselling if your treatment involves checking for genetic disorders, or if you or your partner test positive for an infection, such as HIV or hepatitis.
Counselling can also address the strain that fertility treatment can put on your relationship. You’ll be helped to work out ways to cope that suit you and your partner best. Be aware that if you’re using a private fertility clinic, you may have to pay for counselling.
Talking through your experiences with someone else who’s going through the same thing can be helpful. It can reassure you that you’re not alone. Visit BabyCentre’s friendly and supportive community to meet other people online who are in the same situation as you.
You can also ask your GP or fertility clinic to put you in touch with someone. Or you can contact the Infertility Network UK to find a local support group.
You might feel that counselling or support groups are not for you. Bear in mind, though, that studies have found that sessions can be effective. Counselling therapies, such as cognitive behavioural therapy, may help you to cope with the psychological strain of infertility and improve your chances of success.
If you do need IVF (in vitro fertilisation), some experts have found that mind and body sessions, involving a range of therapies such as meditation, can improve your chances. Other reviews of the evidence have found that your stress levels don’t affect your chances of conceiving.
It may seem unthinkable to give up on your dream, but fertility treatment can be stressful. It may not be possible to cope with the psychological strain for ever. The stress of IVF is one of the main reasons why couples stop their treatment before completing all the cycles they’ve been offered.
Some couples find it a relief to stop thinking about fertility treatment. It may open the way for you to consider alternatives, such as adoption or surrogacy.
For some couples, even seeking medical help in the first place is too stressful. You may decide fertility treatment is not right for you. The important thing is to keep talking to your partner, so you can make a joint decision that’s fair to both of you.
Infertility treatment can be an expensive business, so start by seeing what’s available to you on the NHS. Every infertile couple has the right to be assessed for fertility treatment, and you may be offered up to three free cycles of IVF depending on your age and circumstances.
However, not all couples will be considered for treatment, as local guidelines vary widely. You may be offered fertility drugs on the NHS, but nothing else. Some local hospital trusts have problems funding complex fertility treatments, such as IVF or ICSI, all year round. It’s possible that what’s available to you is rationed.
You may decide to seek treatment privately or, as many couples do, use a combination of NHS and private treatment. If that’s the case, always find out what the full cost of each treatment cycle is likely to be. Include the hidden costs of taking time off work and travel expenses. You may need to make many journeys to the clinic.
Once you know how much your treatment is likely to cost, sit down with your partner and talk about the following:
Want to talk with others about infertility? Find others struggling to get pregnant in our community.
Don’t worry if you seem to be taking it harder than your partner. This is natural. Not only do women tend to feel the loss of fertility more intensely than men, they also have different coping strategies.
Your partner may find it easier to take a break from the problem, particularly if you’re the one doing most of the childcare. While you can enjoy being a mum, the flip side is never escaping the world of children. Visits to toy shops, playgrounds, playgroups or schools are just a part of your day.
Sometimes, you may feel as if you are surrounded by pregnant mums. Try not to be shocked if you suddenly feel intensely jealous. Such feelings are a natural reaction to secondary infertility.
You may feel under pressure because of the growing age gap between your child and the baby you’re trying for. It won’t help if your child is also asking when their baby brother or sister is going to turn up.
All of this becomes even worse if people assume you don’t need comfort and support, because you already have a child.
Acknowledging that you have a problem can be part of your coping strategy, along with taking action.
You may try to find out what is causing the secondary infertility. You may decide to try for fertility treatment. Or you may seek help from a counsellor or infertility support group. The charity Infertility Network UK can help you track down a local group.
Fertility problems can put a strain on your relationship. So take up any offers of support that could help you both to cope.
But perhaps you and your partner feel that you don’t need outside help. You give each other plenty of support and can also call on families or friends. However, fertility experts say all couples desperate to conceive should be offered counselling, even if they eventually do go on to have a baby.
Always remember that you’re not alone in your desire for another child. Visit our community and talk to others in the same situation. They can support you in your struggle to conceive.
Intracytoplasmic sperm injection (ICSI) can be used as part of an in vitro fertilisation (IVF) treatment to help you and your spouse to conceive a child.
ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).
During ICSI the sperm doesn’t have to travel to the egg or penetrate the outer layers of the egg. This means that it can help couples where the man’s sperm:
ICSI is likely to be recommended if your spouse has:
If you have tried IVF you may move on to ICSI if not enough eggs could be retrieved, or if eggs retrieved for IVF were not successfully fertilised.
ICSI isn’t the solution to every male fertility problem. If your spouse has a low sperm count as a result of a genetic problem, this could be passed on to any sons you have together. Your doctor will usually recommend that your spouse has a blood test before you start the ICSI cycle.
You and your spouse may find should be offered counselling before and after taking the test, to help you through both the decision and the process. Your doctor could to refer you to a counsellor. You can also read our Fertility A-Z page for more information.
As with standard IVF treatment, you will be given fertility drugs to stimulate your ovaries to develop several mature eggs for fertilisation. When your eggs are ready for collection, you and your spouse will undergo separate procedures.
Your spouse may produce a sperm sample himself by ejaculating into a cup on the same day as your eggs are collected. If there is no sperm in his semen, doctors can extract sperm from him under local anaesthetic. Your doctor will use a fine needle to take the sperm from your spouse’s:
If these techniques don’t remove enough sperm, your doctor will try another tactic. He’ll take a biopsy of testicular tissue, which sometimes has sperm attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope.
TESE is sometimes carried out before the treatment cycle begins, and under local anaesthetic. The retrieved sperm are frozen. Any discomfort felt by your spousepartner should be mild and can be treated with painkillers.
After giving you a local anaesthetic, the doctor will remove your eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist then isolates individual sperm in the lab and injects them into your individual eggs. Two days later the fertilised eggs become balls of cells called embryos.
The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into your uterus and through your cervix using a thin catheter.
If you are under 40 you can have one or two embryos transferred. If you are 40 or over you can have a maximum of three embryos transferred if using your own eggs, or two if you’re using donor eggs. Extra embryos, if there are any, may be frozen in case this cycle isn’t successful.
Embryos may be transferred two to three days after fertilisation, or five days after fertilisation. Five days after fertilisation the embryo will be at the blastocyst stage. If you’re just having one embryo transferred (called elective single embryo transfer, or eSET), having a blastocyst transfer can improve your chances of a successful, healthy, single baby.
If all goes well, an embryo will attach to your uterus wall and continue to grow to become your baby. After about two weeks, you will be able to take a pregnancy test.
One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You’ll go back anywhere between two days and six days later for the embryo transfer procedure.
The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success.
The percentage of cycles using ICSI which result in a live birth are:
Rest assured that ultrasound scans during early pregnancy will monitor your baby’s development. And if you have any worries, you will be able to talk to your doctor.
You can chat to others about ICSI in our community.