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Assisted conception Q&As

Published by Bupa's health information team, March 2009.

Answers to questions about assisted conception

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

What is unexplained infertility? What can be done to treat it?

Unexplained infertility is when doctors have carried out tests on both you and your partner and been unable to find any reason why you have not become pregnant. This diagnosis is made after two years of trying if you are a woman under 35, or after one year if you are older. There are several different types of assisted conception techniques that can be used to treat unexplained infertility.

Explanation

A diagnosis of unexplained infertility is given if you have not become pregnant after one to two years of trying and medical tests on both you and your partner have found no reason for why you can't conceive. In couples where the woman is 35 or older, fertility investigations are started after a year. This is because after 35 female fertility starts to decline so there is a greater urgency to get treatment started.

Treatment for unexplained infertility relies heavily on your doctors own observations and experiences with other patients as there is no definitive diagnosis to guide treatment. It is possible for couples to become pregnant even if they have had unexplained infertility for two years or more. But for many, assisted conception techniques are needed to conceive.

Ovulation induction (OI), also referred to as superovulation, together with intra-uterine insemination (IUI) is often the first treatment used. It is an effective form treatment that can almost triple your fertility. However, research has shown that treatment with OI alone is of very little benefit.

IVF is also a common treatment option, especially if OI and IUI have failed - it's often the next step. Other treatments such as gamete intrafallopian transfer (GIFT) may also be considered. GIFT is an assisted conception technique that involves removing your eggs, mixing them with sperm and then immediately placing them into your fallopian tubes. This means that fertilisation happens inside your fallopian tubes rather than in a laboratory, as is the case with techniques such as IVF. You must have working fallopian tubes for this treatment to be possible. This treatment involves having a laparoscopy. A laparoscope is a long, thin telescope with a light and camera lens at the tip. It is passed into the abdomen through small cuts. Your surgeon will look directly through the laparoscope, or at pictures sent to a TV screen, to place the mixed egg and sperm into your fallopian tube.

You may be offered counselling before undergoing treatment for unexplained infertility to help you cope with the stresses of treatment and to manage your expectations.

Some doctors believe that unexplained infertility shouldn't be given as a diagnosis because nothing has been diagnosed. They feel that the quality of the tests carried out and how well the results of these tests are interpreted can be subjective and may lead to an inadequate diagnosis being made. The concern is that couples may be told they have unexplained infertility and no further tests done to find the true cause of their infertility.

In many cases, when couples with supposed 'unexplained' infertility are investigated further, tests reveal that there are fewer eggs than expected in the woman's ovaries or they have minor endometriosis. However, the value of lots of tests remains uncertain, as reaching an actual diagnosis may not alter the treatment options available to you. Talk to your doctor about what other tests are suitable for you.

If you have any questions or concerns about unexplained infertility, talk to your doctor.

Further information

Sources

  • Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics & Gynaecology. Oxford: Oxford University Press, 2004:589
  • Gleicher N, Barad D. Unexplained infertility: Does it really exist? Human Reproduction, 2006; 21(8):1951-1955
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What affects the success of assisted conception treatments?

There are several factors that affect how successful assisted conception treatments will be. The single most important factor is the age of the female partner. Other factors include the number of eggs in your ovaries, how long you have had fertility problems for, how many cycles of treatment you have tried previously and if you have had a successful pregnancy before.

Explanation

Assisted conception techniques are treatments that can help you to conceive. These procedures aim to bring the sperm and egg, or eggs, close together to increase the chances of fertilisation. The success of these treatments is dependent on many factors. Some of these are listed below.

  • A woman's fertility decreases with age, as such the success of assisted conception treatments also reduce as a woman gets older. IVF is most successful when a woman is aged between 25 and 35.
  • The length of time you have been have been unable to conceive for has an impact on the success of assisted conception techniques.
  • The best chances of conceiving are within the first three cycles of assisted conception treatments.
  • Women who have had a previously successful pregnancy, either naturally or through assisted conception techniques, have a higher chance of success, especially with IVF.

If you have any questions or concerns about assisted conception techniques, talk to your doctor.

Further information

Sources

  • Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics & Gynaecology. Oxford: Oxford University Press, 2004:608
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For which conditions and under what circumstances is IVF used?

In vitro fertilisation (IVF) is an assisted conception technique used to help couples become pregnant. It can be used to overcome several different kinds of health conditions or in addition to other methods of getting pregnant.

Explanation

IVF is when an egg and sperm are mixed together in a test tube in a laboratory to create a fertilised egg. IVF is considered for people with many health conditions, some of these are listed below.

  • It may be helpful if you have tubal diseases. This is when your fallopian tubes are blocked, damaged or diseased. The fallopian tubes carry eggs from your ovaries to your womb. IVF is generally the first choice in women with severe tubal damage. In some women, surgery may be able to restore their tubes to normal, but if this is not an option or you haven't conceived 12 months after successful surgery, IVF is advised.
  • It can be used for unexplained infertility. This is when you and your partner have both had tests to find out why you haven't become pregnant, and no reason can be found. OI and IUI may be tried before IVF is considered.
  • It can be used if you have endometriosis. This is where cells like the ones found in the womb lining (endometrium) grow on organs outside your womb. This commonly affects the ovaries. IVF is often used in cases where endometriosis is causing fertility problems. If you have minor endometriosis, your doctor may suggest you try OI and IUI first. Also, surgery can be used to treat endometriosis, you may wish to talk to your doctor about this treatment options before starting IVF.
  • It is useful for if a man has low or poor quality sperm.
  • It can be considered for women with ovulation disorders. This is when your ovaries are not producing eggs. IVF is usually considered if six to 12 cycles of OI have been unsuccessful.

IVF is also considered in the following situations.

  • If donor insemination has been unsuccessful. This is a procedure that uses donor sperm rather than your partner's sperm. The sperm is placed into your vagina using a syringe. If you have had between 10 and 12 cycles of donor sperm and not become pregnant, IVF may be an option for you.
  • In situations where egg donation is needed, IVF is used. Egg donation is when eggs from a female donor are used instead of your own eggs. There may be several reasons why your eggs can't be used, for example if you have had an early menopause because of medical treatments (ie cancer treatments such as chemotherapy) or you have a condition called premature ovarian failure which causes you to stop producing eggs at an early age.
  • It can be used in for surrogacy. This is when another woman's womb (uterus) is used to carry your fertilised egg for the term of the pregnancy. This is usually done in situations where you don't have a womb, but do have functioning ovaries. Eggs are taken from your ovaries and fertilised with your partner's or a donor's sperm through IVF, and then placed into the surrogates womb.

If you have any questions or concerns about IVF, talk to your doctor.

Further information

Sources

  • Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics & Gynaecology. Oxford: Oxford University Press, 2004:608
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Why have my partner and I been offered counselling while having assisted conception treatments?

It is a legal requirement for all UK clinics undertaking assisted conception techniques to offer couples counselling. This is to help you cope with any issues surrounding subfertility and the possible outcomes of treatment.

Explanation

Undergoing assisted conception treatments can cause a great deal of stress for many couples. This usually arises from issues around having subfertility and because of the possibility of treatment failing. Some couples experience a deep sense of bereavement if they are eventually unsuccessful in their treatment.

By offering an independent counselling service, fertility clinics in the UK are able to help couples come to terms with difficult feelings and emotions. A qualified counsellor will be able to offer you information, discuss the implications of having treatment and give you support throughout your treatment. All of this takes place in a confidential, safe environment.

If you have any questions or concerns about assisted conception and counselling, talk to your doctor.

Further information

Sources

  • Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics & Gynaecology. Oxford: Oxford University Press, 2004:608
  • Gleicher N, Barad D. Unexplained infertility: Does it really exist? Human Reproduction 2006; 21(8):1951-1955
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2009

 

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