A Guide to Fertility Treatments
For some people on the pregnancy journey, assistance with fertility is something for both women and men to consider as they look to start a family.
On this journey, people can encounter a variety of treatments aimed to improving overall fertility. Perhaps the most recognised process is In Vitro Fertilisation (IVF) but there are other types of assisted reproductive technology out there and in reality only 3% of cases require IVF treatment.
Clinical recommendations will be made depending on the individual situation. Here is a list of fertility treatments that may apply.
Fertility drugs are used in cases where infertility is caused by factors beyond the person’s control, such as irregular or no ovulation, lack of egg production and hormonal imbalances in both men and women.
A number of fertility drugs are available for both sexes, with different ones used for specific issues. Most of the drugs work by regulating the reproductive hormones to help you ovulate or trigger the growth of eggs. Some are oral treatments while others are injected hormones.
For women, the most commonly utilised fertility drugs are:
● Clomifene Citrate: This negates the effect of oestrogen in the body, thus boosting the woman’s follicle-stimulating (FSH) and luteinising (LH) hormones, the overall result of which causes eggs in the ovaries to grow, ripen and ovulate thus moving into one of the fallopian tubes.
● Gonadotrophins: Traditionally used in cases of polycystic ovary syndrome (PCOS), gonadotrophins may be administered via injections. The aforementioned luteinising and follicle-stimulating hormones are types of gonadotrophins which directly stimulate the woman’s ovaries to produce and ripen eggs.
● Metformin Hydrochloride: A recognised diabetes treatment but also successful at tackling ovulation struggles in specific instances, this drug makes the body more sensitive to insulin and is thus especially effective for women who have difficulties with their insulin levels. The drug lowers levels of insulin in the blood which decreases testosterone in order to allow the body to ovulate normally.
● Bromocriptine: Available in tablet form or as a vaginal suppository, this drug is used to correct a hormonal imbalance that can prevent ovaries from releasing an egg during the menstrual cycle.
60-80% of women who take fertility drugs ovulate, with half that amount getting pregnant. Fewer studies have been recorded on the success of men’s treatments, however they have a lower success rate than treatments for women.
For men, fertility drugs can be used for a number of issues too, such as tackling hormonal imbalances and improving sperm health. Again they can be oral or injection, but they only work on a small number of male fertility issues.
For some, issues with fertility can be fixed through surgery, of which a number of different options are available for both men and women.
● Fallopian Tube Procedures: If there is a fallopian tube blockage, surgery can correct this. A blockage prevents successful passage of the egg to the sperm or the fertilised egg to the uterus. Causes include pelvic inflammatory disease, previous surgery in the abdomen or pelvis and an infection of the uterus and fallopian tubes due to sexually transmitted infections (STIs) such as chlamydia or gonorrhoea. The type of surgery depends on the type and location of the blockage.
● Laparoscopic Surgery: This keyhole surgery procedure determines whether or not there are any defects including scar tissue endometriosis (the spread of tissue that lines the inside of the uterine cavity to the ovaries or elsewhere), fibroid tumours and other abnormalities where the uterus, fallopian tubes and ovaries are concerned.
● Myomectomy: Effectively a reconstruction of the uterus, this surgery removes uterine fibroids (growths on or in your uterus) in order to improve and alleviate fibroid symptoms such as heavy menstrual bleeding, endometrial disfiguration and pressure on the pelvis.
● Laparoscopic Ovarian Drilling: Used to trigger ovulation in cases where drugs or weight loss haven’t worked in women with PCOS. A small incision allows access to and an overview of the woman’s internal organs and the opportunity to destroy part of the ovaries in order to restore regular ovulation cycles.
● Varicocele treatment: A scrotal abnormality known as a varicocele is the result of poor oxygen supply, a higher than normal temperature in the testicles or poor blood flow to the testes, this issue occurs due to a dilation of a vein in the scrotum. It causes low sperm or abnormal sperm shape. Varicocele repair is used to correct male factor infertility and raise low levels of testosterone. It’s treated by surgically cutting the veins connected to the varicocele with the aim being to cease the backward flow of blood from the body to the scrotum, allowing the testicles to cool down.
● Block in the reproductive tract: With this problem, the man can produce sperm, however the sperm is blocked from getting out when ejaculating. This can occur where trauma or infection has caused an injury to the tubes which lead from the testicle to the penis. Alternatively men who have had a vasectomy will have an obstruction here too and need the reversal of a vasectomy. Surgery can remove this blockage. Alternatively men could also have a surgical sperm retrieval procedure to take a small biopsied piece of tissue from the testicle which supplies sperm for fertility treatment.
Intrauterine insemination (IUI)
This is used to treat both male and female infertility and is the most common form of artificial insemination. With this procedure, the man’s sperm is directly inserted into the woman’s uterus, therefore bypassing any complications preventing the sperm reaching the area. It’s commonly used when a treating ovulation problems with medicines and where the sperm is normal or just a little bit below par. The woman’s tubes must be open, ovulation occurring and the womb lining in receptive condition. Success rates have been found to be around 10-15% per monthly cycle.
In Vitro Fertilisation (IVF)
IVF is the process of fertilisation happening outside of the woman’s body. The eggs are surgically removed from the woman and fertilised using sperm that has been provided as a sample. The egg, now referred to as an embryo, is then surgically placed into the womb. A usually pain-free procedure, the process of transferring embryos begins when an instrument known as a speculum is inserted into the vagina in a process similar to cervical smear test. Following that, a catheter is passed through the cervix before the embryos are passed down the tube and into the womb. Around 20-25% of IVF treatment cycles result in a live birth, however younger women have a higher chance of success. Rates decline more when the woman is over 40 years of age.
This blog was written in partnership with Mr Declan Keane, founder and Senior Clinical Embryologist at ReproMed.