A B C D E F G H I J K L M N O P R S T U V W

ASSISTED CONCEPTION

What is Assisted Conception ?

If a couple are not able to be helped by the usual treatments for infertility they may be helped in other ways. These complicated treatments are known together as "assisted conception". They all involve special ways of handling the sperm or eggs.

What does Assisted Conception involve ?

All couples will already have been fully investigated for their fertility problem: any type of problem can be treated by assisted conception. Certain treatments, however, are more appropriate to certain problems. There is no guarantee of success and in test tube baby treatment (in-vitro fertilization or IVF) the very best success rate is only about 20% . By success we mean giving birth to a baby and not just conceiving. The treatment may be paid for by the Health Service or the GP may contribute to the costs of the drugs used. Most people have to pay for themselves which can be very expensive. All clinics offering assisted conception are responsible to the Human Fertilisation and Embryo Authority (HFEA). The HFEA now publishes "league tables" comparing the results of all clinics. You should interpret these with great caution. Many factors influence success, but they are not easily measured.

Types of Assisted Conception

INTRAUTERINE INSEMINATION

You will usually be asked to take a low dose of a fertility drug to help you produce an egg (ovulate). Regular scans are done which show when the egg is ripe. An injection is then given to release the egg. At the same time your partner will be asked to produce a fresh sample of semen. This can be filtered and prepared so that only the most active sperm are selected. These very good quality sperm are then gently injected through the neck of the womb (cervix). This is painless, and also the simplest and cheapest form of assisted conception. Unfortunately the success rate is not very high. It cannot to be used if the tubes are blocked.

IN-VITRO FERTILIZATION (IVF) OR "TEST TUBE BABY"

This procedure was developed to bypass the tubes, should they be blocked. It may also be used as in most other types of infertility. You will be asked to take a drug each day, usually starting about 7 days before your period is due. The purpose is to turn off your own hormonal control of ovulation. The drug is taken as an injection or as a nasal spray. When the period starts you will be given a daily injection of a fertility drug. The purpose of this is to make you ovulate. You may learn to give these injections to yourself. Sometimes your partner can do it for you. Regular ultrasound scans will show when enough eggs are ripe. Under an intravenous sedative or general anaesthetic, the eggs are first identified using an ultrasound scanning probe passed into the vagina. Eggs are then collected using a needle passed through the upper end of the vaginal wall. Fresh sperm from your partner is added to each egg in a container. Twenty-four hours later, microscope examination can tell if an egg has been fertilized by the sperm. If the fertilization has been successful and the eggs look healthy a very fine delicate tube is passed gently through the cervix. Three (or less if the couple request it) of the fertilized eggs are then put back into the womb. This procedure is called embryo transfer. Hormones may be given as pessaries or injections to support the fertilized eggs. Two weeks later a pregnancy test is done. If positive, hormones are often given to support the early pregnancy. If unsuccessful, a period comes 2 weeks after embryo transfer. If more than three eggs were successfully fertilized, the remainder can then be frozen and stored. Depending on how many there are, they can then be used for further cycles of treatment.

GAMETE INTRA FALLOPIAN TRANSFER (GIFT)

This procedure is similar to IVF, but cannot be used if your tubes are blocked. Eggs are collected by using a laparoscope. This is a slim telescope passed through a small cut in the abdomen wall, and through which the eggs can be withdrawn. At the time of laparoscopy, no more than three harvested eggs together with prepared fresh sperm are placed back in the tubes. Occasionally an already fertilized egg may be placed in the tube at laparoscopy (ZIFT). Both procedures carry a slightly better chance of pregnancy than IVF but do need a general anaesthetic. OVUM DONATION Some women may be unable to produce eggs. This may be because they have reached the menopause, occasionally as early as in their twenties. The ovaries may never have developed properly from birth, or have been removed surgically or damaged by radiation. In some cases, there may be a risk of the woman passing on an inherited disease via her own eggs. Under any of these circumstances IVF may be undertaken, but in this case using eggs donated by another woman. There is a long waiting list for this procedure because it is proving difficult to recruit women as egg donors.

INTRA CYTOPLASMIC SPERM INJECTION (ICSI)

This new technique is used if your male partner has a very poor sperm count. Even if there are no sperm at all in the semen, it may be possible to collect some from the testicle itself. This is a small operation requiring an anaesthetic. The procedure is the same as for IVF until the eggs have been collected. A single sperm is then injected into an egg. If fertilization has occurred, embryo transfer is performed the next day. This is a major advance in treating male fertility problems. In IVF, the eggs sometimes fail to fertilize apparently without reason. If this does happen, ICSI may be suggested for the next cycle of treatment.

During Assisted Conception

You will be seen very regularly by the clinic staff. Too many eggs may develop. This can lead to severe abdominal pain and large ovarian cysts. You may feel these yourself in your lower abdomen. This can be a serious problem and needs admission to hospital. It is also possible that enough eggs may not develop during the cycle. If this does happen you will be told. That cycle of treatment will probably be abandoned and a higher dose of drugs used in the next cycle.

After Assisted Conception

The success rate in most assisted conception techniques is low. For IVF the figures across the United Kingdom show that only about 18% of treatment cycles result in a successful pregnancy. Both miscarriages and ectopic pregnancies may occur. The treatment is emotionally very stressful for many couples. The disappointment when the treatment cycle has failed is profound. Counselling is always available. There is a risk of multiple pregnancy although more than triplets is most unlikely.

What is involved for family with Assisted Conception ?

Family need to be able to share the disappointment of failure. Most clinics have local support groups. There are national support groups also.