infertility, IVF and assisted conception treatment

Assisted conception (or ‘fertility treatment’ or often referred to collectively as Assisted Reproduction Technology “ART”) is a general term to describe all the methods used to help a woman achieve a pregnancy when she is having difficulty conceiving. Some of the more complex activities are currently regulated by the Human Fertilisation and Embryology Act 1990.
The world’s first ‘test-tube baby’. Louise Brown. was born in the UK in 1978. Her birth offered hope to infertile couples across the world. Since then. thousands of couples have made use of in vitro fertilisation (IVF) and other assisted conception techniques. The success rates of these treatments continue to improve.
Today. assisted conception treatments are tailored to individual patients’ unique conditions. These procedures are usually paired with more conventional therapies. such as fertility drugs. to increase success rates. On average. one in five couples who use assisted conception techniques gives birth to a baby or in some cases twins or even triplets depending on the technique.
However. the procedures are invasive and expensive. In addition. although no long-term health effects have been linked to children born using the new reproductive technologies. most doctors recommend reserving such procedures as a last resort for having a baby.
What are the reasons for having assisted conception?
No one knows for certain how many couples have difficulty conceiving. since some will decide not to seek medical treatment. In the UK. however. approximately one in six couples do seek medical help to have a baby. In most cases there will be one or more causes that a specialist can pinpoint and. possibly. treat.
Contrary to popular belief. infertility is not just a woman’s problem. In fact. it strikes men and women almost equally. About 35 per cent of cases can be attributed to men. 35-40 per cent to women. and the rest to multiple factors affecting both partners. some of which remain unexplained.
The three most common reasons for assisted conception are that the woman’s ovaries are not producing eggs. her fallopian tubes (tubes from the uterus to the ovary) are damaged or that the man’s sperm are too few or unhealthy. These reasons account for about 90 per cent of all cases. Treatments are available for both male and female fertility problems.
Ovulation and egg quality
Conditions in this category include polycystic ovary syndrome. poor egg quality. and irregular ovulation or failure to ovulate (because of hormonal deficiencies or imbalances). These problems. especially deteriorating egg quality. are often age-related. and apply most often to women aged over 37.
Possible solutions: Treatments include fertility drugs. in vitro fertilisation (IVF). and use of a donor egg.
Blocked fallopian tubes
Infections. endometriosis. scar tissue. adhesions. and damaged tube ends (fimbria) can result in blocked or otherwise abnormal fallopian tubes. Even if you ovulate regularly. blocked tubes make pregnancy next to impossible. since your egg can’t get to your uterus. and sperm can’t get to your egg.
Possible solutions: The main treatment is usually IVF. However. if the blockage is found to be limited to a small area it might be possible to clear it by keyhole or open tubal surgery to remove the blocked portion. Infections such as chlamydia tend to damage the whole length of the tube and are less amenable to surgery. A laparoscopy is usually carried out to determine which is the most appropriate treatment for you.
Male-factor problems
In men. infertility can be the result of a blocked vas deferens or epididymis. poor sperm quality. low sperm motility (the sperm’s ability to move). a semen deficiency. or not having enough (or any) sperm to begin with.
Possible solutions: Just as women often undergo surgery to open blocked fallopian tubes. men may have an operation to clear their blocked tubes (again. a full assessment. including hormonal tests and an evaluation of sperm motility. precedes surgery). If something else is at the root of the problem. fertility drugs may boost sperm production. or a man’s sperm can be used to artificially inseminate his partner. Other options include using donor sperm or injecting sperm directly into the egg (intracytoplasmic sperm injection or ICSI).
Other causes
A minority of cases include pelvic inflammatory disease (PID). recurrent miscarriage. endometriosis (also under blocked fallopian tubes) or some other unexplained condition as a reason for assisted conception. Discuss possible solutions and treatments with your GP who will refer you to an infertility specialist if necessary.
What are the Treatment Options ?
Your treatment options will vary according to the cause of your infertility. Your doctor may well suggest trying the least invasive options first. The newer and more high-tech treatments. such as in vitro fertilisation (IVF). are considered a last resort. largely because of their cost and complexity. However. drug treatment and surgery are very effective. In fact. of those couples who successfully go on to have children. most are treated with fertility drugs or surgery only.
The right treatment for each couple depends on many factors. including:& ;
  • 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.
Your treatment options – from least to most invasive – are:
Fertility drugs
When hormones are out of balance or in short supply for women (and. in some cases. for men). these drugs may get your reproductive system back on track.
Artificial insemination (AI)
In some cases. sperm just need a shortcut to the egg. A concentrated dose of your partner’s sperm placed in your uterus or fallopian tubes can aid fertilisation. AI. also known as Intrauterine insemination (IUI) can also help couples where the man’s sperm is unable to get through the woman’s cervical mucus. Donor sperm may also be used.
Blocked tubes. endometriosis. fibroids and ovarian cysts – all implicated in fertility problems – are often treated with surgery.
Assisted Conception Treatments
Fertility drugs and other conventional treatment options are combined with high-tech procedures. such as egg collection. to treat low sperm counts. fallopian tube problems. or ovulation problems. These procedures include in vitro fertilisation (IVF). gamete intrafallopian transfer (GIFT). zygote intrafallopian transfer (ZIFT). intracytoplasmic sperm injection (ICSI). and the use of donated eggs or sperm. The use of a surrogate mother is considered by some couples.
Investigations and treatment for infertility are normally undertaken in a specialised fertility clinic. To decide what treatment to use. some routine tests are carried out by the specialist. To see whether the woman is ovulating (producing eggs) her blood is tested for the levels of some hormones called progesterone. luteinising hormone. follicle-stimulating hormone (FSH) and testosterone. She will have an ultrasound scan of the womb. tubes and ovaries.xx
The specialist may decide to carry out a laparoscopy an operative procedure to examine the inside of the abdomen using a long. thin instrument (laparoscope) and a hysterosalpingogram (a special X-ray of the womb and fallopian tubes). These tests show whether the ovaries look normal and whether the tubes are damaged or blocked.xx
The man needs to produce a sample of semen for a sperm test to check the numbers of sperm. whether they are motile (able to move normally) and whether they have a normal structure.

What happens during treatment for female infertility?

Ovulation induction
Ovulation induction is a technique that stimulates the inactive ovary to produce eggs. At its simplest it involves the woman taking a drug called clomiphene for six days each month. This method is most often used for women who have conditions such as polycystic ovary syndrome. in which the ovaries do not produce eggs.
Ovulation induction is also the first stage of preparation for in-vitro fertilisation (IVF). which is the treatment needed by most women whose tubes are damaged. Three hormones are used: one to suppress the ovaries. one to stimulate several eggs to develop simultaneously and one to ripen the eggs. The aim is to control the timing of the woman’s cycle accurately so that eggs can be removed to be fertilised on a specific day. A normal monthly cycle will produce only one egg but this method produces several ripe eggs at once to increase the chances of a pregnancy. This is called ‘superovulation’.
The first hormone. buserelin. is usually given as a nasal spray taken every day from the first day of the period. After two weeks the woman has an ultrasound scan to make sure the ovaries are inactive. She then starts the next hormone. FSH. which is given by a daily injection. A second scan is done after 10 days of taking FSH to make sure enough eggs are developing and then the woman has one injection of HCG (human chorionic gonadotrophin). The eggs should then be ready for collection 36 hours later.
Egg collection
Egg collection is the process of removing the ripe eggs in order to fertilise them. It is carried out in an operating theatre while the woman is awake. but with an injection of a strong painkiller and a tranquilliser. A speculum is put into the vagina. similar to the procedure for a smear test. A thin needle is passed through the vagina and into the ovary to collect the eggs (the doctor can see the ovaries by using an ultrasound scanner on the abdomen). The procedure takes about 20 minutes in total.
The eggs are mixed with the partner’s sperm on the same day and after 12-18 hours they are checked under a microscope to see if they have fertilised. Embryos (fertilised eggs) can be introduced into the womb using a thin tube passed through the cervix (neck of the womb). This is done about 36 hours after fertilisation and it is very quick and painless. The final stage is a pregnancy test after about 12 days.
What happens during treatment for male infertility?
If the man has a very low sperm count or the sperm are not motile enough. the specialist may advise the couple to have intracytoplasmic sperm injection (ICSI). The woman undergoes ovulation induction and the embryos are transferred as described above. but in the fertilisation process the sperm is actually injected into the egg through a very fine glass tube. This technique can result in pregnancy even with sperm of very low motility.
Surgical sperm collection may be suitable for men who have no sperm at all in their semen. This may be because the man has a blocked vas deferens. the duct that takes sperm from the testis. or because he has had a vasectomy; sometimes the testicles simply produce very few sperm. Sperm can be sucked out of the tubes below the level of the blockage or from the testicle itself. Both of these procedures are carried out with a fine needle under local anaesthetic at the same time as the woman’s eggs are being collected. The eggs can be fertilised by ICSI and then transferred into the womb.
Other techniques
IVF can be carried out with donor sperm or donor eggs. The sperm and embryos can also be frozen for future use. You will need to discuss these methods with your specialist. There are other techniques that are similar to IVF. such as GIFT (gamete intrafallopian transfer). but these are undertaken less often because they tend to be less successful.
Donor insemination :
If the man has no sperm at all (azoospermia) or very few sperm present (severe oligospermia) donor insemination (sperm donation) may be the only option open to them. Sperm is inseminated into the womb after ovulation has been precisely timed.
Egg donation :
This may be offered to women who have undergone a premature menopause. which may occur for a variety of reasons. or to women who consistently respond poorly to ovarian stimulation in IVF. If you are unable to conceive using your own eggs. an egg donated by another woman can be used. The donor must be prepared to undergo stimulation of the ovaries with drugs and egg collection as if she were undergoing IVF herself. The eggs are then fertilized with sperm from the infertile woman’s partner and the embryos replaced in the infertile woman’s womb. This procedure can also be done with a donated embryo.
Gamete intrafallopian transfer (GIFT):
‘Gamete’ refers to the basic genetic contribution from each partner — a sperm or an egg. In GIFT. your eggs are removed. mixed together with your partner’s sperm in a dish in a laboratory. then placed into your fallopian tubes. Fertilisation happens inside your body and the embryo implants naturally. A variation on this technique is Zygote Intrafallopian Transfer (ZIFT). ‘Zygote’ is a term used to refer to a newly fertilised egg. In ZIFT. your collected eggs are fertilised with your partner’s sperm in a dish in a laboratory and then replaced in your fallopian tubes.
Another woman carries your embryo. or a donor embryo. to term and gives the baby to you after birth.
Cryopreservation (Embryo freezing and storage).
Clinics are only allowed to replace up to 3 embryos during a treatment cycle because of the risks of multiple pregnancies (it is normally 2 with the exception of& ;some circumstances). Ask if the clinic has freezing and storage facilities so that any spare embryos can be frozen for future treatments. If any spare embryos are not required for further treatment you can donate them to others for treatment. donate them for research purposes or allow them to perish. It is very important that you discuss these options between yourselves and with your clinic as joint consent must be given. There is usually an annual cost associated with freezing and storage although this is fairly minimal.
What are the possible complications of assisted conception?
Ovulation induction increases the chances of having a multiple pregnancy. The most important maternal complications associated with multiple gestation are pre-eclampsia, preterm labor and delivery, and gestational diabetes as well as the potential risks involved with prolonged bedrest (venous thromboembolism) and cesarean delivery. Prematurity, and the complications associated with it (including increased infant mortality and increased incidence of cerebral palsy), is the greatest risk for the child.
Ovulation induction can also produce a rare condition called ovarian hyperstimulation syndrome, in which the ovary is overstimulated and produces an excess of the hormone oestrogen and which occurs in about 0.5 per cent of cycles. Also, any technique that involves the introduction of instruments into the body can cause infection or damage to internal organs.
What are the chances of a Multiple Pregnancy ?
Multiple gestation, especially triplet and higher order pregnancy, is not the desired consequence of assisted conception technologies since it increases the risk of complications for both mother and baby. The goal of any reproductive technology is the birth of a single healthy child and the conception of twins or higher is considered a complication. Ovulation induction increases the chances of having a multiple pregnancy (twins, triplets etc). The rate of multiple pregnancy is increased compared to spontaneous conception. Unlike natural conception where the chance of having a multiple birth is relatively low (1 in every 65 pregnancies), assisted conception brings with it a high chance of a multiple birth (roughly 1 in 4 IVF deliveries is of twins i.e. the chance of twins is approximately 20 to 25 per cent.). Although most twins are born healthy, the chance of complications during pregnancy and delivery is much greater than with a singleton. The high incidence of multiple births following IVF is largely due to the fact that more than one embryo is usually transferred to the womans womb during an IVF cycle. This is done to increase the chance of conception.
Will we have to pay for treatment?
For many years in the UK, there was no central government guidance on what health authorities should offer couples seeking infertility treatment, so what was available on the NHS depended on where you lived and what treatments were offered locally – a situation sometimes referred to as “babies by postcode”.
However, the government has announced that, from April 2005, all infertile couples will be entitled to one free cycle of IVF on the NHS, provided that the woman is under 40 years old and that the couple meet local eligibility criteria. Priority will be given to couples who don’t yet have any children.
Until then, every couple has the right to be assessed for treatment but not all couples will be deemed by their Primary Care Trust as eligible for treatment. You may also find that what is available to you is rationed. For example, you may be offered fertility drugs, but nothing else, GIFT, but not IVF, tubal microsurgery, but not IVF, or a maximum of three cycles of IVF. However, some Primary Care Trusts offer no help at all for infertile couples.
Most Primary Care Trusts also have criteria determining who they will fund for treatment. You may find that you need to be married, under 35, or to have lived in the district for a certain number of years. There are also long waiting lists for treatment in many areas.
Many couples, where they can afford it, use a mix of both NHS and private treatment. To be treated at a private clinic, you have to conform to the clinic’s eligibility criteria (a clinic may not treat you if you are over 45, for example). Costs vary widely between clinics, often by several thousand pounds. Always ask in advance what the full cost of each treatment cycle is likely to be. Don’t forget the hidden costs, too, of taking time off work and travel expenses – you may need to make many journeys to the clinic.
Although all clinics have their own price list you can expect IVF or GIF or Egg Donation to cost between £1000 – £3000 per attempt. NHS units will probably not charge for basic infertility investigations and some treatments. However they may have to charge for the more advanced assisted conception techniques but usually less than at a private unit.& ;Basic investigations, i.e. blood tests, semen analysis etc, can be expected to cost £150 – £200 and consultations can cost as much as £100 each time at a Private unit. The cost of drugs used in assisted conception is rarely covered. One average cycle may cost from £500 – £750.
What is the outcome of assisted conception?
Success depends largely on the cause of your infertility and your age – younger women are more likely to get pregnant than women over 40. Making sure you are in the best of health, perhaps limiting alcohol and caffeine, improving your diet, and giving up smoking can go a long way toward bettering your odds of getting pregnant (a dad-to-be’s diet matters, too).
Don’t discount the emotional stresses involved. Find a willing friend, support group, or professional to talk to before tackling infertility and also while you’re going through fertility treatment.
Your clinic will give you figures relating to the various types of treatment on offer and you may like to compare these to the national average success rates. The most recent information on IVF and donor insemination statistics is available from the Human Fertilisation and Embryology Authority (HFEA) which monitors the clinics that provide these treatments. To give you an idea of the success rates for IVF, the national average “take-home baby rate” is around 17 per cent.
However, do not judge a clinic by its statistics alone; it may specialise in treating older women, for example, where success rates are naturally lower. If a clinic has a great deal of experience in treating your particular problem, that clinic may be your best option. Another factor to bear in mind is how long the clinic has been established. The HFEA a government body that licence fertility treatment and research clinics in the UK, now provides information about choosing a clinic which allows patients to search for clinics in their location and see success rates and the different services they offer. It is designed to help you make informed choices. It contains a full list of information which you may want to consider before beginning treatment and questions to ask at prospective treatment centres.
The HFEA have recently updated their website and focused especially on making it as informative as they can for patients, i.e. allowing them to see exactly what to expect when embarking upon fertility treatment or considering donation.
Your doctor may suggest you move on after three tries with any treatment option; some experts believe a treatment isn’t likely to work if it hasn’t by your third round. But keep in mind that each couple’s case is individual; six attempts with IVF is certainly not unheard of.
Good luck!
Useful Addresses
Human Fertilisation Embryology Authority,
Paxton House,
30 Artillery Lane, LONDON
El 7LS.
Tel: 020 7377 5077
British Infertility Counsellors Association,
69 Division Street
Sheffield, S. Yorkshire.
DC Network (Donor Conception Network)
Tel: 0208 245 4369.
Set up by and for parents of Dl children and those contemplating or undergoing treatment using donated gametes.
COTS (Childlessness Overcome Through Surrogacy),
Loandhu Cottage, Gruids Lairg, Sutherland, SCOTLAND IV27 4EF.
Tel: 01549 402401.
Multiple Birth Foundation,
Queen Charlotte’s &; Chelsea Hospital,
Goldhawk Road, LONDON W6 OXG
National Infertility Awareness Campaign,
PO Box 2106, LONDON W1A 3DZ.
Tel: 0800 716345 (Freephone).
Clare Brown IN UK
Tel: 08701 188088

Fertility treatment: intrauterine insemination (IUI)

Fertility treatment: intrauterine insemination (IUI)

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.

Could IUI benefit us?

IUI may help you as a couple if:

  • Your spouse has a borderline low sperm count or low motility. This is when the sperm’s ability to move is impaired. But there must be enough healthy, motile sperm to make the treatment worthwhile. If not, IVF or ICSI may be more suitable.
  • You are unable to have sex because of disability, injury, or if your spouse experiences premature ejaculation.
  • You have mild endometriosis.
  • You or your spouse’s fertility problems are unexplained.

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.

How is IUI carried out?

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.

How long will treatment last?

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.

What are the success rates of IUI?

Success rates depend on the cause and severity of the infertility and your age. UK success rates for IUI using donor sperm are about:

  • 16 per cent if you are under 35
  • 11 per cent if you are between 35 and 39
  • five per cent if you are between 40 and 42
  • one per cent if you are between 43 and 44
  • 0nought per cent if you are over 44

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.

Are there any downsides to IUI?

Despite the benefits (see top section, Could IUI benefit us?) IUI is not for everyone.

  • The timing of the insemination is crucial, so your spouse must be able to produce a sperm sample by ejaculating into a cup on demand at the clinic.
  • It may be uncomfortable if it proves difficult to insert the catheter. And the procedure may cause cramps similar to period pains.
  • With stimulated cycles there is a very small risk of developing ovarian hyperstimulation syndrome (OHSS). This serious condition happens when your ovaries respond too well to the fertility drugs that cause you to ovulate. The ovaries rapidly swell up to several times their normal size and can leak fluid into your tummy, making you gain weight and feel full and bloated.

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.


Conceptionmoons: can a holiday help you get pregnant?

Conceptionmoons: can a holiday help you get pregnant?

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.

What is a conceptionmoon?

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.

How do conceptionmoons work?

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.

How can we make the most of our break?

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.

What if we can’t get away?

If you just can’t take a break, try to reduce stress levels at home. You can do this by:

  • enjoying good, healthy food
  • getting some exercise
  • practising yoga
  • taking time out to meditate

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.

Last reviewed: April 2013

How to boost your chances of getting pregnant

How to boost your chances of getting pregnant

How can we get pregnant fast? The simple way to boost your chances is to have unprotected sex every few days throughout your cycle. This ensures a supply of sperm where you need it when you ovulate.

Having a healthy diet and lifestyle may help, as may keeping your stress levels low.

What if we’re too busy to plan our sex life?

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!

Last reviewed: April 2013

Is it OK to exercise on my most fertile days?

Is it OK to exercise on my most fertile days?

Yes. Ovulation isn’t like that magical note from home that used to get you out of PE. If working out is already a part of your lifestyle, there’s no reason for you to slam on the brakes on your fertile days. A little huffing and puffing at your kickboxing class won’t disrupt your cycle.

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.

Last reviewed: April 2013

Assisted conception treatments

Assisted conception treatments

If you are considering assisted conception treatments, you’ve probably spent a long while trying for a baby.

If you or your partner has a fertility problem, assisted conception techniques may offer you the chance of having a much-wanted child. As treatment success rates continue to improve, more and more couples are choosing to take this route.

What are assisted conception treatments?

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.

What are the risks of assisted conception treatments?

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.

What assisted conception treatment options are there?

Assisted conception treatments include:

  • Intrauterine insemination (IUI). Sperm are inserted directly into your uterus (womb) at the time of ovulation.
  • In vitro fertilisation (IVF). Eggs are gathered from your ovaries and combined with your partner’s sperm in a laboratory dish. The resulting embryos are transplanted into your uterus.
  • Intracytoplasmic sperm injection (ICSI). A single sperm is injected straight into a single egg in the laboratory and the resulting embryo is transplanted into your uterus.
  • Donated sperm. If your partner has a low sperm count, or produces no sperm at all, donor sperm may be used for donor insemination or IVF.
  • Donated eggs or embryos. If you are unable to conceive using your own eggs, an egg donated by another woman can be combined with your partner’s sperm. The resulting embryo is then implanted in your uterus. A donated embryo can be used in the same way.
  • Surrogacy. Another woman carries your baby, or a baby from a donor embryo, to term. She then entrusts the baby’s care to you after the birth.

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.

Last reviewed: May 2013

Treatment options and success rates

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:

your age
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.


Coping with a fertility problem

Coping with a fertility problem

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.

The key to coping is to acknowledge that you’re going through a tough time. It’s normal to feel sad, angry, desperate or overwhelmed. Go with it, and don’t try to fight your emotions. Allowing yourself to experience these powerful feelings can help you to move beyond them.

I keep thinking I should have tried for a baby earlier. Is it my fault?

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.

I feel so helpless. What can I do to feel more empowered?

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.

How do we stop our fertility problems damaging our relationship?

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.

I can’t cope with any more baby showers. Would it be rude not to go?

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.

Can counselling help with fertility problems?

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:

Your doctor

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.

Other couples

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.

We’ve been trying for a baby for years. How will we know when to give up?

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.

What about the financial pressures of fertility treatment?

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:

  • How are you going to pay for it? Are you comfortable borrowing the money, or using up all your savings?
  • If your first round of treatment doesn’t work, can you afford another? And another after that?
  • How much money are you prepared to spend in total?
  • If you’re having IVF, are you both comfortable with the odds? You may only have a slim chance of a successful pregnancy.

Want to talk with others about infertility? Find others struggling to get pregnant in our community.

Last reviewed: May 2013

How can I cope with my sadness at our secondary infertility?

How can I cope with my sadness at our secondary infertility?

Coping with infertility is not easy. You and your partner may be emotionally exhausted by the struggle to get to grips with what can be a significant life crisis. Chances are you’re both dealing with feelings of intense grief and loss.

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.

Last reviewed: June 2014

Fertility treatment: intracytoplasmic sperm injection (ICSI)

Fertility treatment: intracytoplasmic sperm injection (ICSI)

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 is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments.

ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).

Could ICSI help us?

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:

  • can’t get to the egg at all
  • can get to the egg, but for some reason can’t fertilise it

ICSI is likely to be recommended if your spouse has:

  • A very low or zero sperm count.
  • A high percentage of abnormally shaped sperm. This can result in poor motility, which means the sperm can’t swim well.
  • Sperm that can’t be ejaculated but can be collected from the testicles or from the duct where sperm is stored (epididymis). This may be needed if your spouse has had an irreversible vasectomy or injury.
  • Problems with getting an erection and ejaculating, due to spinal cord injuries or diabetes, for example.

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.

Is ICSI the answer for all male fertility problems?

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.

How is ICSI carried out?

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:

  • epididymis, in a procedure known as percutaneous epididymal sperm aspiration (PESA), or
  • testicle, in a procedure known as testicular sperm aspiraction (TESA)

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.

How long does ICSI treatment last?

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.

What are the success rates of ICSI?

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:

  • 35 per cent if you are under 35
  • 29 per cent if you are between 35 and 37
  • 21 per cent if you are between 38 and 39
  • 14 per cent if you are aged between 40 and 42
  • six per cent if you are between 43 and 44
  • five per cent if you are over 44

What are the advantages of ICSI?

  • ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you.
  • If your spouse is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI.
  • ICSI can also be used to help couples with unexplained infertility, though experts haven’t found that ICSI makes pregnancy any more likely than standard IVF.
  • ICSI doesn’t appear to affect how children conceived via the procedure develop mentally or physically.

What are the disadvantages of ICSI?

  • ICSI is a more expensive procedure than IVF.
  • ICSI has been in use for a shorter time than IVF. So experts are still learning about its possible effects.
  • The same risks associated with standard IVF procedure, such as multiple births and ectopic pregnancy, apply to ICSI.
  • You may have a higher risk of congenital conditions such as cerebral palsy in your baby. The risk rises from three per cent for naturally conceived children to about six per cent after IVF or ICSI. One large study found a higher rate of abnormalities in ICSI babies when compared with IVF babies. But this risk is still low.
  • During natural conception, only the hardiest sperm manage to travel great distances and break through the membrane of an egg to fertilise it. Weaker sperm don’t make it. But because ICSI bypasses this natural selection process, there’s an increased risk of rare genetic problems carried by the sperm being passed on to the child. Some but not all genetic problems can be tested for before you have the treatment.
  • ICSI is a more expensive procedure than IVF.

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.