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Assisted conceptionPublished by Bupa's health information team, January 2008. This factsheet is for people who would like information about assisted conception. Assisted conception is the range of medical treatments available to make it easier to achieve a pregnancy.
About assisted conceptionAccording to the Human Fertilisation and Embryology Authority (HFEA), about one in seven couples in the UK have difficulty conceiving. Having sex every two to three days is the best way to conceive. Trying to time intercourse with when you produce eggs (ovulation) can put you both under stress and this is unlikely to improve the chance of successful conception. Subfertility in womenA woman's fertility gets lower as she gets older, so older couples are more likely to have difficulty conceiving children. With regular unprotected sex, 94 percent of fertile women aged 35 will get pregnant after three years of trying. This drops to 77 percent for women who are 38. Women who smoke and who are underweight or overweight (BMI less than 18.5 or over 25kg/m2 - please see our BMI calculator) are also more likely to have trouble conceiving. Subfertility in menAround one in 20 men may be subfertile. The main problem is usually to do with the structure of the sperm. Lifestyle can have an effect on sperm quality - smoking, drinking too much and wearing tight-fitting pants (which keep the testicles too warm) can reduce male fertility. If you have been trying for a baby for a year without success, you may be experiencing subfertility and your GP should consider referring you to a specialist. If you are a woman over 35 or have had problems in the past such as an ectopic pregnancy or pelvic infection, it may be worth being referred earlier than this. Why some people need help with conceptionThe most common reasons for people needing help with conception are:
However, in up to a quarter of people attending a fertility clinic, the causes of subfertility or infertility are unexplained because current testing methods are unable to determine what is causing the subfertility. DiagnosisTests and treatments are available for both male and female fertility problems. Both partners will need to be tested and it's usually best if you attend appointments together - but follow the advice of your specialist. Initial tests of your fertility can be started by your GP, who can give support and lifestyle advice. It's best to have treatment for fertility problems under the care of a specialist team. This team will include a doctor - usually a specialist in women's health (obstetrics and gynaecology), and a counsellor. Seeing a counsellor can help you to cope with the stresses and strains that come with fertility problems and having fertility treatment. For womenIf you have a regular cycle, you will have a test for your levels of the hormone progesterone seven days before your period is due. This checks that you are producing eggs (ovulating). Your blood will also be tested for the other hormones involved in getting pregnant. You will have an ultrasound scan of your womb, fallopian tubes and ovaries. The best quality pictures are seen when the scanning probe is placed in the vagina (a transvaginal ultrasound). Your specialist may also suggest you have a laparoscopy, which is a keyhole operation to look directly at your ovaries and fallopian tubes. An alternative to a laparoscopy to check your fallopian tubes is a test called a hysterosalpingogram (HSG). This is a test where your doctor will inject a dye through your cervix while you have an X-ray. If your fallopian tubes are open, the dye can be seen to flow through them. HSG is an outpatient test, which means that you won't need to stay overnight in hospital. For menYou will need to take a sample of your semen to the clinic for testing. This will look at the numbers of sperm, how they move and whether they have a normal structure. TreatmentThe treatment that is best for you will depend on the cause of subfertility. Helping you to ovulateIf all or part of the subfertility is to do with not ovulating (eg if you have polycystic ovary syndrome), treatments can stimulate your inactive ovaries to produce eggs. This is called ovulation induction. At its simplest, this involves taking a medicine called clomiphene (eg Clomid) or tamoxifen for six days each month. Your doctor may also prescribe a medicine called metformin if you have polycystic ovary syndrome and clomiphene wasn't effective on its own. Controlling ovulation and collecting eggsA more complex form of ovulation induction is used if you are preparing for the fertility treatments called in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). The aim is to control the timing of your monthly cycle accurately so that your eggs can be removed and fertilised on a specific day. A normal monthly cycle will produce only one egg, but with this method, which uses three hormones given at different times, you produce several ripe eggs at once. This is called superovulation and it increases your chances of a pregnancy. Usually, the eggs are collected while you have an ultrasound scan. A thin needle is passed through your vagina and into your ovary. This is done as an outpatient procedure, so you won't need to stay overnight in hospital and you usually won't need a general anaesthetic. Assisted conceptionThere are many different technologies that can help you to conceive. All of these aim to bring the sperm and an egg, or eggs, close together. The three main methods are as follows. Intra-uterine insemination (IUI for short)Sperm that have been washed and specially prepared are put inside your womb just before ovulation is due. This is usually the first method offered to couples who have unexplained infertility. It's also useful if there are ejaculation problems or mild problems with the quality of the sperm. IUI can be combined with ovulation induction (see Helping you to ovulate). In vitro fertilisation (IVF)IVF can be carried out with donor sperm or donor eggs. The sperm and embryos can also be frozen for future use, although there are strict legal rules, supervised by the HFEA, to regulate these procedures. You will need to discuss these methods with your specialist. In the UK, the Human Fertilisation and Embryology Authority (HFEA) licenses clinics offering advanced fertility treatments such as IVF. Eggs and sperm are mixed in a test tube in a laboratory - this is where the phrase "test-tube baby" comes from. Successful fertilisation can be seen with a microscope after about 12 to 20 hours. One or two embryos are transferred into your womb using a soft plastic tube passed through your vagina. IVF is useful if your fallopian tubes are damaged or have been removed. It can also work well if your subfertility is caused by endometriosis (for women) and for mild sperm problems (for men). Intracytoplasmic sperm injection (ICSI)A single sperm is injected into an egg in the laboratory and the resulting embryo is transferred to the womb, as with IVF. The cytoplasm is just the scientific name for the insides of the egg cell. This type of fertility treatment is used when there are more serious problems with the sperm or when problems between the egg and sperm are preventing fertilisation. ComplicationsComplications are when problems occur during or after the treatment. Ovulation induction increases the chances of having a multiple pregnancy (such as twins). This raises the risk of problems for the mother and baby. Ovulation induction can also produce a rare condition called ovarian hyperstimulation syndrome, in which the ovary is overstimulated and produces too much of the hormone oestrogen. As a result, the woman is at an increased risk of getting blood clots and chest problems, and may need to go into hospital for monitoring and treatment. Pregnancies that result from IVF can still be ectopic (the embryo starts to develop outside the womb, usually in a fallopian tube). Also, any technique that involves putting instruments into your body can cause infection or damage to internal organs. Success ratesThe success of assisted conception is very variable and depends on the reason for subfertility and, for women, your age. The success rate goes down sharply over the age of 40. If you are having IVF or ICSI, your clinic should tell you its live birth rate - the so-called "take home baby" rate. Each year the figures for the UK are published by the HFEA (see Further information). Further information
Related topicsSources
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: January 2008
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