Maintaining a healthy lifestyle before you try to conceive will improve your chances of getting pregnant and having a healthy pregnancy. If either of you smoke, giving up can greatly improve your fertility because smoking has been linked to problems at every stage of conception and with lower success rates of assisted-conception techniques.
Limiting how much alcohol both of you regularly drink can also improve your fertility, and if you do become pregnant, it’s advisable for women to cut out alcohol altogether, especially in the first trimester.
For women, having a body mass index (BMI) below 18 or above 30 can affect how often they ovulate. If your periods are irregular or have stopped, this is a sign that you might not be ovulating. Getting back to a healthy BMI, between 18 and 25, may regulate your ovulation and periods. Men are also advised to keep their BMI below 29 to maximise their fertility.
Having a balanced and varied diet will provide you with all the nutrients you need to conceive and maintain a pregnancy. Folic acid and vitamin D are particularly important for women who are planning a pregnancy and you’re likely to be advised to take a supplement of these.
Vitamins C, E, some minerals, such as zinc and selenium and omega-3 fats are important for the health of a man’s sperm. These important nutrients can be found in a variety of foods including nuts, oily fish, green vegetables and tomatoes, but if you think you may be missing out on some of these, you could add a daily supplement. See Related topics for more information about healthy eating.
If you aren't ovulating (eg if you have polycystic ovary syndrome), you can take medicines that can stimulate your ovaries to produce eggs. This is called ovulation induction.
There are two main medicines used for this; they are called clomifene (eg Clomid) and tamoxifen. You will take these medicines for five days each month. You can continue to take clomifene for a maximum of six months, although for most women a response to the medicine will be seen within three months. After this, your doctor will discuss other treatment options. You may be able to take tamoxifen for longer than 6 months.
If you have polycystic ovary syndrome and are overweight, your doctor may also prescribe a medicine called metformin. He or she will also advise you to take steps to eat more healthily and exercise because this has been shown to encourage weight loss, which can improve your chances of ovulating more regularly.
You can have keyhole surgery to make tiny holes in the surface of your ovary to stimulate it. This is known as laparoscopic ovarian drilling. It's as effective as hormone injections and it might be an option for you if clomifene or tamoxifen don't make you ovulate.
Hormone injections with human gonadotrophin hormone (follicle-stimulating hormone) may be offered if clomifene or tamoxifen haven’t worked for you.
There are a number of treatments that can help to improve the quality of your sperm, or help it to reach your partner's womb.
- If your sperm quality is affected by hormone problems such as male hypogonadism (where your pituitary gland doesn't produce enough of certain hormones called gonadotrophins), medicines may help.
- An operation may be able to remove any blockage in the epididymis (this is where the sperm are stored in each testicle).
- If you have ejaculation problems, medicines and other treatments may help.
Other treatments give you more help to conceive by controlling the way that the sperm and the egg are brought together. This is called assisted conception. There are three main types of assisted conception.
Intra-uterine insemination (IUI)
IUI involves taking fast-moving sperm and placing them inside the womb close to the time of ovulation. This is usually the first method offered to couples who have unexplained infertility. It can be used if you’re a woman who has mild endometriosis. Endometriosis is a condition in which the lining of the womb grows somewhere else inside your abdomen, such as on your ovaries, behind your womb or on your bowel or bladder.
IUI is also useful for men who have ejaculation problems or mild problems with the quality of their sperm. IUI is usually combined with injections to stimulate the ovaries. It’s important that this treatment is monitored carefully to reduce the chance of several eggs developing, which may result in multiple pregnancy (twins, triplets or higher).
In vitro fertilisation (IVF)
IVF is a procedure where eggs are removed and mixed with sperm in a laboratory. Once the eggs have been fertilised, they are placed in the womb. IVF can be carried out with your own sperm and eggs or with donor sperm or donor eggs. Sperm, eggs and embryos can also be frozen for future use, although there are strict legal rules, supervised by the Human Fertilisation and Embryology Authority, to regulate these procedures. You will need to discuss these methods with your specialist.
You may need IVF treatment if:
- your infertility is unexplained
- your fallopian tubes are blocked
- you have severe endometriosis
- other techniques, such as fertility drugs or intrauterine insemination (IUI), haven't worked
You will need to take medicines to control the timing of your monthly cycle accurately so that the eggs can be removed and fertilised on a specific day. A normal monthly cycle produces only one egg, but with this method, which uses different hormones given at specific times, you will produce several mature eggs at once. This is called superovulation and it increases your chances of a pregnancy, but the medicines can cause side-effects, such as feeling sick, vomiting and headaches.
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 a day case, so you won't need to stay overnight in hospital and you won't usually need a general anaesthetic. However, you may be offered a sedative before the procedure because it could feel uncomfortable and it’s important that you can remain still. A sedative relieves anxiety and helps you to relax.
At around the same time, your partner will need to give a sperm sample. The sperm are washed and spun at a high speed so that the healthiest sperm can be selected. If you're using donated sperm, it's removed from storage and prepared in the same way.
The sperm and eggs are then mixed together in the laboratory.
Successful fertilisation can be seen with a microscope after about 16 to 20 hours. If you're a woman under 40, one or two of the resulting embryos are transferred into your womb using a soft plastic tube passed through your vagina. As many as three embryos may be transferred if you're 40 or over and have previously failed to conceive with IVF.
Intracytoplasmic sperm injection (ICSI)
ICSI is very similar to IVF, but in ICSI a single sperm is injected into an egg in the laboratory and the resulting embryo is transferred to the womb. This means that as long as just a small number of sperm can be obtained, it's possible to fertilise the egg. This type of fertility treatment is used when there are more serious problems with the sperm, when the man has had a vasectomy, or when problems between the egg and sperm are preventing fertilisation.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
The medicines women take during IVF and ICSI may cause side-effects, such as hot flushes, changes in mood, night sweats, feeling sick, headaches and restlessness. Symptoms usually disappear after a short time but if they don't, you should see your doctor as soon as possible.
ComplicationsComplications are when problems occur during or after the treatment.
Having fertility treatment increases the chances of having a multiple pregnancy (such as twins or triplets). This is why there are restrictions on the number of embryos that can be transferred into your womb. A multiple pregnancy increases the risk of health problems for both you and your baby. Miscarriage, early labour and health problems in pregnancy, such as high blood pressure, are all more likely if you are having more than one baby.
Ovarian stimulation can cause a condition called ovarian hyperstimulation syndrome (OHSS). This is an over-reaction to the medicines used to stimulate the ovaries. When having IVF and ICSI, around five in 100 women will develop OHSS. For most women, the symptoms are mild. However, for a few, it can cause more serious health problems. You should contact your fertility clinic or GP straightaway if you have any symptoms including:
- feeling sick and vomiting
- severe pains and swelling in your abdomen (tummy)
- feeling short of breath
- feeling faint
- passing a smaller amount of urine compared to normal
The chances of having an ectopic pregnancy may be higher in women who have IVF or other fertility treatments, especially if there is damage to their fallopian tubes. An ectopic pregnancy is when the embryo starts to develop outside the womb, usually in a fallopian tube. The main symptoms include:
- one-sided low abdominal pain
- vaginal bleeding
- dark brown or red vaginal discharge
The pain will get worse as the pregnancy goes on. If you have these symptoms, you should see your doctor straight away.
Removing the eggs for IVF or ICSI involves passing a needle through the vagina and into the ovary. This means that there is a risk of infection. Symptoms of having an infection in your pelvis include having a high temperature, pain in your abdomen and unusual vaginal discharge. Usually symptoms begin within a few days or weeks of having the egg removal procedure. If this happens, it can usually be treated with antibiotics.
For which conditions and under what circumstances is in vitro fertilisation (IVF) used?
IVF is a fertility treatment used to help couples become pregnant. It can be used to overcome a number of health problems.
IVF is when an egg and sperm are mixed together in a laboratory to create a fertilised egg. IVF is considered for people with certain health conditions. Some of these are listed below.
- IVF may be helpful if you have fallopian tubes that are blocked, damaged or diseased. The fallopian tubes carry eggs from your ovaries to your womb. In some women, surgery may be able to restore the tubes so that they function better. IVF is generally the first choice for women with severe tubal damage.
- IVF can be used if you have endometriosis. This is where cells like the ones found in the womb lining (endometrium) grow outside your womb. This commonly affects the ovaries. IVF is often used when severe endometriosis is causing fertility problems.
- IVF can be used if a man has a low number of sperm or poor-quality sperm.
- IVF can be considered for women with ovulation disorders who don't respond to more straightforward treatments. For example, in women with polycystic ovaries, if simpler methods of ovulation induction have not been successful.
If you have any questions or concerns about IVF, talk to your doctor.
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 the 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.
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.
- Your fertility decreases with age, which means that the success of assisted-conception treatments also reduce as you get older. IVF is most successful when a woman is aged between 25 and 35.
- The best chances of conceiving are within the first three cycles of assisted-conception treatments.
- If you have had a previously successful pregnancy, either naturally or through assisted-conception techniques, you will have a higher chance of becoming pregnant from assisted conception.
- If you or your partner smokes, drinks more than one unit of alcohol per day or drinks excessive amounts of caffeine, you will lower your chances of successful assisted conception.
- If you're very overweight (with a BMI greater than 30) you may also reduce your chances of successful treatment.
If you have any questions or concerns about assisted-conception techniques, talk to your doctor.
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, but have been unable to find any reason why you have not become pregnant. There are several different types of assisted-conception techniques that can be used to treat unexplained infertility.
Unexplained infertility is not a condition in itself. It's when tests show no specific problem that explains why you and your partner can't get pregnant. Around a quarter of couples who are having difficulty getting pregnant have unexplained infertility. Without treatment, the chances of getting pregnant will depend on how long you have unexplained fertility. In general, the longer you have it, the smaller your chances are of becoming pregnant naturally. It's possible for couples to become pregnant even if they have had unexplained infertility for years, but some people will need assisted-conception techniques to conceive.
Ovulation induction (OI) and intra-uterine insemination (IUI) are often the first treatments used. If these don't work, then your doctor may suggest IVF. Some doctors believe that unexplained infertility shouldn't be given as a diagnosis, because nothing has been diagnosed. The type of fertility test carried out and how well the results of the tests are interpreted can vary from doctor to doctor and may mean specific causes of fertility problems are missed. However, the value of some fertility tests remains uncertain, as reaching an actual diagnosis may not alter the treatment options available to you. Talk to your doctor about what tests are suitable for you.
Why have my partner and I been offered counselling while having assisted-conception treatments?
All UK clinics offering assisted-conception techniques are required to offer couples counselling. This is to help you cope with any issues surrounding your fertility and the possible outcomes of treatment.
Undergoing assisted-conception treatments can be very stressful for many couples. Coming to terms with fertility problems, going through treatment and dealing with an unsuccessful fertility treatment can all place strain on you and your relationship. 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. Counselling can also help you to discuss the implications of treatment if you're using donated sperm, eggs or embryos. A qualified counsellor will be able to offer you information, discuss the implications of having treatment and give you support throughout your treatment. Counselling can give you the opportunity to talk openly and to find ways of coping that work for you. All of this takes place in a confidential, safe environment.
If you have any questions or concerns about fertility treatment and counselling, talk to your doctor.
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