Baby & Pregnancy : Fertility Treatments

Couples who wish to have children but are experiencing fertility problems have several options open to them. Assuming they do not wish to explore the areas of donor eggs or sperm, surrogacy, embryo donation or adoption, then some kind of fertility treatment is their only other recourse.

Types Of Treatments

Below are some of the types of treatment currently offered.

Fertility Treatments: IVF

InVitroFertilisation treatment consists of stimulating egg production with fertility drugs, then removing eggs and mixing with sperm in a petri dish (in vitro means in glass). After a period of incubation, 2 to 3 of the resultant embryos are re-inserted into the womb.

IVF patients have a higher incidence of multiple births.

Fertility Treatments: Ovulation Induction

As in the first part of IVF, this treatment uses fertility drugs to stimulate ovulation in women who have irregular or no egg production. The procedure is carefully monitored in order to prevent Ovarian Hyper stimulation Syndrome.

Fertility Treatments: Artificial Insemination

This method is useful for, among other things, women with cervical mucus hostility, or mild endometriosis, men with ejaculatory problems and for the implantation of previously frozen sperm. There are several different techniques, the most popular being intrauterine insemination. Others include intracervical and intravaginal insemination.

Fertility Treatments: ICSI

Intra cytoplasmic sperm injection is a procedure that has been in operation for some 14 years now. It involves the direct injection of sperm through the wall of the egg. The procedure is useful to couples who cannot benefit from regular IVF treatment due to the mans sperm being unable to penetrate the egg wall.

Fertility Treatments: GIFT

Gameta Intra Fallopian Transfer has been around for nearly as long as IVF, and involves the mixing of sperm and egg in a nutrient medium. This mixture is injected into one of the woman’s fallopian tubes. The procedure enables fertilisation to happen in its natural environment, and thence implantation can also occur at its natural pace. For this procedure it is vital that the woman has one fully functioning fallopian tube.

Fertility Treatments: PESA and TESA

These are sperm extraction techniques used where there is a problem with the mans sperm production. Blockage of the vas deferens can occur due to several reasons including failed vasectomy reversal. In such instances PESA (Percutaneous Epididymal Sperm Aspiration) can be undergone. This is a minor surgical operation where sperm is extracted via a needle from the epididymis (a connecting tube that lies on the testicle). TESA (Testicular Sperm Aspiration) is a very similar operation but the needle is injected directly into the testicle. This is usually done when no sperm is found using the PESA method. The sperm thus extracted can then be used with a fertilisation method like IVF or ICSI.

Various other techniques exist for increasing the likelihood of a couple having a baby. These include:

Assisted hatching. Chemical methods and, the more accurate, laser assisted methods are used to weaken a shell which naturally exists around embryos to better enable them to break through it prior to implantation. One reason this technique may be needed is that the shell, or Zona Pellucida, can be made harder than it should be by the IVF process.

Blastocyst culture and transfer. This is a relatively new technique in IVF whereby the embryos are left to develop longer thus greatly improving the selection, and reducing the chances of multiple pregnancy. Instead of 2 to3 days, embryos are left to develop for 5 days in a special culture until they are at a stage of development known as a blastocyst. The chances of successful treatment are greatly improved by the use of blastocysts, and this could be a good option for women who have had an unsuccessful experience with normal IVF.

IVMTS. In Vitro Maturation of Testicular Sperm is a method of allowing sperm with poor or no ability to move, the chance to mature in a culture medium after extraction. This will improve their chances of developing motility and therefore their effectiveness.

Surgery. As well as surgery on males for sperm extraction, there are operations that can benefit women. One of these is using keyhole surgery techniques to unblock fallopian tubes.

Fertility Treatments on the nhs

The NHS may offer free IVF treatment if budgets will allow. Those wishing to pursue this option need to get in touch with their local health authority for details on getting sponsored by them for treatment. Guidelines from the National Institute of Clinical Excellence (NICE) recommend that people be offered up to 3 cycles of IVF provided that fertility problems have been diagnosed in one or other partner, or there has been infertility for at least 3 years, and that the woman is aged between 23 and 39 when the treatment occurs.

Waiting lists for IVF on the NHS can vary dramatically from clinic to clinic. This is due to how much money the individual trusts are able to allocate to IVF programs. A recent guide issued by the Human Fertilisation and Embryology Authority (HFEA) claims that NHS waiting times range from 2 weeks to 156 weeks. The NHS web site has pages for help with information on waiting times for consultant led services, and choice of hospital. These web addresses are at the end of this article. The recently introduced choice of hospital initiative only applies to the initial referral.

Fertility Treatments @ Private Clinics

Waiting times for treatment at private clinics are naturally much shorter. Programs and treatments can commence immediately in some cases, in others from one or 2 weeks after consultation. Plenty of choice is available in the private sector, although age is a factor just as in the NHS. Prices can be anything up to £3000 for IVF treatment, although this figure is probably not typical in what is quite a competitive industry. People concerned about costs can opt for egg donation or egg sharing as it is sometimes called. This is where some of the healthy eggs that are extracted are given to women who can’t produce their own. Agreeing to donate eggs can reduce fertility treatment costs dramatically. The CARE group of clinics are one organisation that offers an egg sharing program.

Success Rates Of Fertility Treatments

Success rates for fertility treatments vary from clinic to clinic and are affected by such things as age. IVF treatments average success rates have improved in the last 6 years from 15% to between 20-30%. Clinics usually provide their own statistics on their web sites.

Risks involved in Fertility Treatments

All risks will most probably be outlined and discussed at the clinic before appropriate treatment begins. There could be:

Reactions to fertility drugs. Including feeling sick, mood changes, hot flushes, headaches, heavy periods and gaining weight.
Ovarian Hyperstimulation Syndrome. A more serious reaction to fertility drugs where cysts appear in the ovaries and fluid builds up in the stomach. There is a possibility of blood related problems.
Risk of Ectopic pregnancy. This is where the embryo implants in the fallopian tube instead of the womb. Although this can occur in unassisted pregnancies, there appears to be slightly more risk of it happening to those undergoing fertility treatment.
Possibility of multiple births. This is the most common side effect of fertility treatments, although emerging techniques will help reduce this risk. Twins triplets etc can have increased mortality, lower birth weight and are more likely to be born prematurely. There are risks for the mother too.

Other Options and Resources

With clinics competing for price and the cost of traveling quite low, some people may wish to look into the notion of health treatment abroad. The recent ruling from the European Court of Justice on the case of Yvonne Watts may indicate that foreign treatment will be paid for by the NHS in certain circumstances. The HFEA warns that they have no control over the practices of any clinics outside the UK, and urges people thinking of such a route to consider all the implications, including ethics, confidentiality and what would happen in the event of treatment going wrong.

The HFEA is a valuable source of information on this entire issue and their web address, together with other useful web addresses, is below.

HFEA

http://212.49.193.187/cps/rde/xchg/hfea

NHS waiting times web page

http://www.nhs.uk/England/AboutTheNHS/WaitingTimes

NHS choosing your hospital web page

http://www.nhs.uk/England/Choice/

As an example of what is available privately, the CARE group has eight clinics.

http://www.carefertilityweb.co.uk/index.php

Another good resource is IVF.net

http://ivf.net/

Those considering treatment abroad could try here.

http://www.treatmentabroad.net/