What happens when you see your doctor?
See your GP in the first instance, if you have any reason for concern.
Your doctor will want to know about your development as a teenager and your periods. You’ll be asked when they started, how regular they are, whether you’ve ever been pregnant before or whether you’ve ever had a pelvic infection or sexually transmitted infection.
You can use our ovulation calendar to help identify when your most fertile days are.
It’s also important to mention any other illnesses you’ve had and any medication you may be taking.
Your doctor will examine you, including an internal examination, and send you for blood tests to check your blood count and hormone levels.
Your doctor may ask your partner about his development too, check his medical history for problems such as mumps, examine him and give him instructions to collect a semen sample for testing.
You may then be referred to a specialist clinic to a specialist clinic for further tests and advice. This is usually done once you’ve been trying to get pregnant for at least 18 months, but may be sooner if you’re in your mid-30s or older.
What can specialists do?
Once referred to a fertility specialist (a reproductive medicine specialist), the cause of your infertility will be investigated.
IVF and ICSI
IVF involves removing eggs from the woman’s ovaries and mixing them with either her partner’s or a donor’s sperm in a laboratory. If the eggs are fertilised successfully, they may then be placed back in the womb……….CLICK & SEE
This is a demanding treatment for the couple and only about one in three women will become pregnant after a single IVF/ICSI cycle. Some of these pregnancies will be lost in the early stages. Many cycles may be required before achieving successful pregnancy, and these treatments are not successful for everyone, no matter how many times they’re attempted.
ICSI is sometimes recommended to couples who’ve had no success with IVF. It involves injecting a single sperm into the egg. If a healthy embryo develops, it’s then placed back in the womb as in IVF………..CLICK & SEE
Access to IVF is limited on the NHS. Guidelines from the National Institute for Health & Clinical Excellence (NICE) say women aged 23 to 39 who have an identified cause of infertility or have had unexplained infertility for at least three years should be entitled to three cycles of IVF.
The Government has suggested that each primary care trust starts by offering couples one cycle, working up to three when possible. Access to NHS treatment varies, however, and it can depend on where you live, and what other local conditions are placed on you, such as your age.
A number of drugs are used to try to stop early labour, but most have serious side effects.
Trichostatin A (TSA) is known to promote the death of cancer cells.
The researchers got permission to take samples of the muscles of women undergoing caesarean sections at the Royal Victoria Infirmary in Newcastle, the Cellular and Molecular Medicine journal reported.
They exposed the muscle to TSA and measured the effects on both spontaneous contractions and those induced by the labour drug, oxytocin.
They found an average 46% reduction in contractions for the spontaneously contracting tissue and an average 54% reduction in the oxytocin induced contractions.
It has been previously shown that a protein kinase A (PKA) is involved in controlling the relaxation of the uterus during pregnancy.
The researchers showed that TSA increased the levels of a protein sub-unit of PKA.
Professor Nick Europe-Finner, who led the research, said: “We will not give this drug to a patient because it can damage as many as 10% of the genes in a cell.
“But it does show us that other more specific agents that act on the same enzymes but only one at a time are worth investigating.”
Dr Yolande Harley, deputy director of research at Action Medical Research which funded the study, said: “This project has uncovered some of the molecular pathways that regulate uterine contractions and so could be linked to premature birth.
“It could have a role in preventing premature birth – finding a new treatment for early labour would be a major step forward.”
Professor Jane Norman, a spokeswoman for the Royal College of Obstetrics and Gynaecology (RCOG), said: “At the moment, it’s not possible to treat preterm labour effectively. We only have drugs that delay it by 24 hours or so – not enough to deliver the baby safely.
“One of the interesting things about this research is that they are using a new kind of drug – the drugs we are currently using have been around for a long time.
“And they are targeting pathways we have not known about before.
“When you consider that preterm birth rates are rising in all four countries of the UK a new more effective drug is badly needed.”
It’s difficult to believe but true that despite our 1.2 billion population in India, many of our young adults have difficulty in producing children. They may be called “sterile, infertile or sub fertile”. But before a couple is labelled “infertile”, they should have had at least 12 months of regular contraception-free intercourse.
Worldwide, infertility affects 7-10 per cent of the population. Although women actually produce the babies, if the reasons for the infertility are investigated the woman is at fault in a third of the cases; in a third it is the man and in the remainder either both are responsible or no real cause can be found.
Before embarking on a planned pregnancy, the woman should have had immunisations for measles, mumps rubella (MMR) and hepatitis B (3 doses). She should also start folic acid supplements (5mg/day). Children born with physical or mental defects because these basic facts were forgotten are a human tragedy. Both partners need to keep their body mass index (BMI, or weight in kilograms divided by height in metre squared) at around 23 and be physically active for around 40 minutes a day. They also need to treat any existing underlying disease like diabetes, high blood pressure or thyroid problems.
Studies show that caffeine (found in tea, coffee and cola drinks) affects fertility. Women who drink alcohol can produce babies with “foetal alcohol syndrome”. It also reduces the sperm count in men. Smoking affects the quality of the sperms and inhaled passive smoke is bad for the growing baby. Sperm counts may be reduced by inhaling hazardous chemicals in the work place or by working in high temperatures.
Women ovulate cyclically and the egg is released 14 days before the next period. For a woman to conceive, intercourse must take place around this time and the sperm count must be optimal. Initially, if a menstrual calendar is maintained, the fertile days can be calculated. A semen analysis for sperm count is a non-invasive simple test. Also, after intercourse lie down, don’t douche, and avoid lubricants and cleansing agents.
If these simple methods fail in a couple where the woman menstruates regularly and the man has a normal sperm count, a visit to a reproductive medical unit is warranted. Further investigations to establish the patency of the tubes and quality of the sperm may be needed. Depending on the problem, medication or surgical correction of a specific defect may be needed.
Conservative medical treatments are usually tried for periods varying from 6 months to a year. If they fail, assisted reproductive technology (ART) techniques are started.
In IUI (intrauterine insemination) the woman is scanned during her most fertile period to determine ovulation. Healthy treated sperms from her partner are then inserted into the uterus. The technique is used when the sperm count is low, the motility unsatisfactory or if donor sperm is being used.
In IVF (in vitro fertilisation) the eggs are harvested and fertilised with sperm in the laboratory. The resulting embryos are then placed in the uterus. This is used in cases where the fallopian tubes are blocked, the fertility unexplained or when several attempts with the other forms of ART have failed. It can result in multiple pregnancies. Some clinics offer “natural cycle IVF”. This involves collecting and fertilising the one egg released during the normal monthly cycle. It avoids the side effects of fertility drugs and multiple pregnancies are less likely.
Donor eggs from other women can be used if the woman has no eggs of her own, or if she is over 40 and the eggs are of poor quality. Sperm from donors can be used if the husband has a low count (oligospermia) or no sperms (azoospermia). Surrogate mothers can be hired to carry the baby to term.
There is no right time to seek medical help, but if sexual intercourse at least three times a week without contraception for a year has been unsuccessful, it is probably time for proactive action. If, however, the woman has periods at intervals less than 21 days or more than 90 days, the flow is unpredictable (if it starts it does not stop and if it stops it does not start) or if there has been pelvic infection in the past, an evaluation should be done at the earliest. In men, if the testes are not felt in the scrotum, or there is a hydrocoele (swelling) or a past prostate infection, investigation and treatment should be started sooner.
IVF or in vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the woman’s womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilize them in a fluid medium. The fertilized egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy.
IVF was developed in the 1970s. The first Britishtest tube baby was Louise Brown, who was born in 1978.Some 30,000 test tube babies have been born in the UK since then.
There are several different techniques, but the main process involves the women taking fertility drugs to help her produce more eggs.The eggs are then harvested and fertilised in the laboratory.
The woman is given hormone drugs to prepare her womb to receive the fertilised eggs. The fertilised eggs are placed inside the womb and a normal pregnancy follows.
The term in vitro, from the Latin root meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains insided the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, test tube babies, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However in vitro fertilization is usually performed in the shallower containers called petri dishes. (Petri-dishes may also be made of plastic resins.) However, the IVF method of Autologous Endometrial Coculture is actually performed on organic material, but is yet called in vitro.
Around 6,000 babies a year are born in the UK to otherwise infertile couples as a result of in vitro fertilisation.
But the techniques used often arouse huge controversy and some say the process can falsely raise would-be parents’ hopes since it only has a success rate of around 15%.
There have also been cases of fertilised eggs being mixed up in the laboratory and the wrong embryo being transferred to the woman, leading to fears about how the process is carried out.
New techniques coming on stream:
One of the biggest and most controversial advances in IVF in recent years has been the introduction of a technique called ICSI – intra-cytoplasmic sperm injection.
This works by injecting a single sperm directly into an egg.
Some people fear the technique could increase the risk of genetic defects that make the donor infertile being passed on to babies.
ICSI was introduced during the 1990s, but new advances are helping men with a very low sperm count to benefit from it.
These include operations to search for sperm which can be retrieved and injected into an egg.
For example, it can test whether there are any blockages in a woman’s fallopian tubes that could harm her chances of having a healthy pregnancy.
Other doctors at the hospital are pioneering a technique that could mean an end to hormone treatments and the painful retrieval of eggs from infertile women.
The technique involves collecting thousands of immature eggs from the ovary and developing them in the laboratory.
It works by removing a bit of the skin of the ovary which masks the place where immature eggs develop.
It takes five months to grow there properly and lots of nourishment.
The eggs can be frozen so that they can be used whenever the woman wants.
Again, the technique is controversial because it means a woman could store the eggs and use them at any age.
It is likely to be available in the next 10 years, say doctors at the hospital.
Dr Ian Findlay is also developing a test that can check for 10 genetic abnormalities in one go before a fertilised egg is placed in the womb. He said: “This could lead to a dramatic reduction in miscarriages as the vast majority of miscarriages are due to abnormalities.”
The politics of IVF
IVF is only successful in 15% of cases and a recent report from the College of Health shows that success rates vary widely across the country.
Only 18% of IVF treatment is funded by the NHS and waiting times can differ greatly.
It can cost up to £2,000 per cycle for a couple to go private.
Most couples have three cycles at an average cost of £3,420.
One way of getting free treatment is for women to donate their eggs to other infertile couples.
Opponents of IVF argue that it falsely raises would-be parents’ hopes that they will be able to have a baby when the chances are not that high.
They also argue that it can be a traumatic experience to go through repeated IVF attempts, only to find that the woman does not get pregnant.
Another possible drawback is the fact that IVF treatment increases the chance of having multiple births which the couple may not have planned for.
One to two per cent of pregnant women give birth to more than one child, but with fertility treatment the odds are raised to 25%.
Most of the babies born are twins, but bigger births are on the rise.
Many doctors are worried that they are being put under increasing pressure to use more of the fertility drugs to produce more eggs and so increase the chance of the woman getting pregnant.
Some believe fertility drugs could cause ovarian cancer.
Liz Tiberis, author of ‘No Time to Die’, believes her ovarian cancer was the result of nine attempts at IVF.
But fertility doctors say the link has not been proven.
One area of controversy involves the processes clinics have for ensuring mix-ups do not occur over embryos.
This follows a US case where one woman wrongly received the fertilised egg of another.
Fertility experts say procedures in the UK are very tight and there is unlikely to be the same mix-up here.
But the Medical Protection Society recently reported the case of an expert who transferred three embryos from one woman into another by mistake.
However, he realised his error in time.
Calls have been made for procedures for matching eggs with mothers to be tightened, for example, by stipulating that doctors have to do a DNA test before implantation goes ahead rather than relying on written records.
Given a choice, Gita Kapoor, a 37-year-old banker in Bangalore, would have preferred just one child. She and her software engineer husband knew that with their busy work schedules raising even one child wouldn’t be an easy job. Two years ago, they opted for in vitro fertilisation (IVF) at a fertility clinic in their city. Today the Kapoors are proud parents of a pair of chubby twins — a boy and a girl.
It isn’t that the Kapoors are not happy to have more than one child. But they have two children not by choice but because of an inherent shortcoming in the assisted reproduction technique they opted for.
“So far there is no technique available to choose a single, viable embryo for implantation,” says Dr Trichnopoly Chelvaraj Anand Kumar, a veteran andrologist in Bangalore.
As a result, fertility doctors normally implant more than one embryo to increase the chances of pregnancy. “With a single embryo, the success rate of IVF is about 30 to 35 per cent. It goes up to 45 per cent with two embryos,” says Dr Indira Hinduja, who is the first Indian doctor to have produced a test tube baby in India in the 1980s.
There are a number of problems associated with multiple pregnancies. Often, babies born in a multiple birth are premature, have low birth weight and are prone to infections. Also, their mortality rate is slightly on the higher side, notes Dr Hinduja.
But thanks to a team of medical researchers in Australia and Greece, doctors may soon be able to find a way of successfully employing genetic screening to identify embryos that can lead to healthy babies.
In a paper reported in the latest issue of the journal Human Reproduction, the researchers say that DNA fingerprinting, a technique more commonly used in forensic applications and in resolving parenthood controversies, can be a useful tool in fertility clinics. The technique can help pinpoint a handful of genes that can help spot a better embryo that would lead to a successful pregnancy, says Gayle Jones, a researcher at Monash Immunology and Stem Cell Laboratories, Monash University, Australia.
When a couple attends a fertility clinic for IVF, eggs from the woman are fertilised with sperm from the man and the fertilised eggs are allowed to develop in the laboratory until they reach what doctors call the blastocyst phase, or the early stages of embryo formation. This normally takes about five days.
One of the difficult decisions, even for a better-trained fertility expert, is to decide which fertilised egg is to be chosen. With little help from technology to distinguish a viable blastocyst from a non-viable one, they often resort to implanting more than one to increase the chances. This often leads to multiple pregnancy.
But this need not be the case anymore, say researchers at Monash University and the Centre for Human Reproduction at Genesis Athens Hospital in Greece.
For their study, the scientists removed a few cells each from the outermost layer of the resulting blastocysts of 48 women who attended the clinic for IVF treatment.
Of the 48 women, 25 became pregnant, leading to the delivery of 37 babies. Once the babies were born, blood from the umbilical cords or swabs of cheek cells was collected. Subsequently, the scientists used DNA fingerprinting to see which genes were common to the material collected after delivery as well as the blastocyst biopsy.
“By analysing these genes, we have been able to identify those that are key to the processes involved in embryo implantation,” Jones told KnowHow.
Though it is too early, she thinks that they would be in a position to refine the gene set further to a smaller number of genes that are more highly predictive of a viable blastocyst. “The ability to select a single, most viable embryo from a cohort available for transfer will revolutionise the practice of IVF, not only improving pregnancy rates but also eliminating multiple pregnancies and the attendant complications,” Jones said.
The Monash University researchers hope that the technique would be available for clinical use within a couple of years if they achieve further success.
IVF being the most common and cheapest of all assisted reproductive methods in use, such improvements in its success rate will be a boon to a large number of infertile couples, says Dr Kumar.