Expert / 17 July, 2023 / Ellie Thompson
Professor Geeta Nargund, Medical Director of CREATE Fertility, shares an overview of what you can expect when starting fertility treatment.
Starting fertility treatment can be exciting for many women and couples, but it undoubtedly comes with many questions and worries. If you’re due to start your fertility journey or just starting to think about looking into fertility treatment, we have the answers to some common fertility questions you might have.
As a general rule of thumb, if you are under 35 and have been trying for a baby for over 12 months with no success, you should first speak to a doctor who will able to advise you on the next steps. They will assess your situation and test both you and your partner’s fertility to determine what could be causing your difficulty with conceiving and suggest the options available to you and the best course of treatment.
Women who are over 35, however, should seek advice from a doctor after six months of trying to conceive naturally since an age-related decline in fertility is more common in the mid to late 30s and 40s.
It is correct that higher doses of stimulatory drugs used as part of IVF treatment can cause side effects for some women. There are options, however, for women wanting gentler treatment without the use of so many stimulatory drugs.
Natural IVF is a gentler form of treatment, using no added stimulatory drugs. It works with your own cycle, rather than the typical procedure of shutting down and restarting the cycle and selects a mature egg to collect and fertilise before reinserting into the womb lining.
Meanwhile, mild IVF also works with a woman’s own cycle, using low doses of stimulating drugs for a shorter period of time. While a conventional cycle of IVF might require a woman to take stimulatory drugs for up to 21 days, a mild cycle only uses a 7–10-day course of drugs, leading to a milder response. This helps to reduce the physical and emotional burden on a woman during treatment.
These two options are used with the woman’s and baby’s health in mind and focus on the quality of eggs collected rather than quantity.
Around half of infertility cases are due to a male factor, so your partner is not alone. Where the fertility issue lies with the woman, the procedure will usually be intrauterine insemination (IUI) and in vitro fertilisation (IVF).
However, for male factor infertility the treatment slightly differs and the procedure is called intracytoplasmic sperm injection (ICSI). This involves the sperm being injected directly into the egg rather than mixed with the egg in the lab, and is mainly used where sperm count is low, abnormally shaped or low quality.
ICSI has similar success rates to IVF, so while the process is a little different, the chances of treatment resulting in a live birth is similar to other forms of treatment.
Previously, NHS funding requirements meant same-sex couples had to self-fund at least six cycles of intrauterine insemination (IUI) before qualifying for funded treatment, at huge personal cost to couples. The government has since pledged to reduce these additional hurdles to treatment, although the impact of this remains yet to be seen.
In terms of process, there are lots of options available to female same-sex couples looking to have a baby. Typically, IUI is the treatment most used by couples starting a family, which can be done either with or without fertility drugs. Female couples who are suffering with fertility issues, or are struggling to conceive with IUI can also use IVF treatment.
Another thing to note is that female same-sex couples will likely need a sperm donor as part of their treatment. You can usually find a suitable donor at your fertility clinic, but if you have specific criteria in mind you can also look at other sperm banks to find the right donor sperm for you. When using a donor, there are some considerations you need to factor in – specifically around donor anonymity laws in the UK. For further detail about these laws and the other factors you’ll need to keep in mind, you can read the HFEA’s guide here.
Your doctor will ensure your treatment plan takes any medical issues, such as PCOS, into account. If you are struggling to conceive naturally due to any existing issues, your doctor may suggest you try IVF treatment, where eggs are allowed to mature in a controlled environment before being replaced back into the womb.
Typically, women with PCOS tend to respond well to treatment. In fact, patients with PCOS are more responsive to the stimulatory drugs used in treatment, and in higher-stimulation forms of treatment there is a risk of the woman experiencing negative side effects, such as ovarian hyperstimulation syndrome (OHSS). As such, Mild IVF may be the best course of treatment for women with PCOS to reduce the risk of developing OHSS and lower the impact of treatment.
Secondary infertility is actually a very common problem for women and couples looking to have another baby. Luckily, the treatment options available for primary and secondary infertility are much the same and given previous success having children, your doctor’s first port of call might be to address any lifestyle factors that could be impacting your fertility. Exercising more, eating a balanced and nutritional diet, reducing alcohol intake and quitting smoking are all factors that can help improve both male and female fertility so if you are planning to conceive again, it is worth introducing these lifestyle changes beforehand if you can.
If there is a medical cause for infertility, either with female or male factor, specific treatment will be necessary. Current eligibility criteria for NHS funding means that couples who already have children (even from a previous relationship) are not eligible for funded treatment, so most couples facing secondary infertility and requiring treatment often have to explore their options with private clinics.
Article by Professor Geeta Nargund, Medical Director of CREATE Fertility