Posts Tagged ‘fertilization’

Not Getting Pregnant FAQs.

We’re not getting pregnant what do we do now?
We’ve been trying to conceive for 12 months - can the doctor identify the problem?
There are many factors that can increase or decrease your chances of becoming pregnant, but if you have been trying for a year, it would be sensible to contact your doctor. After an initial assessment of your general health and lifestyle, your doctor will offer your partner a sperm test (see below) and you will be offered tests to see if you are producing eggs and check whether or not your Fallopian tubes are blocked. Blood tests will be carried out to check your iron levels, your red and white blood cell count, and to check how organs such as your liver and kidneys are functioning In addition, couples are asked to agree to a sexual health screening to check for previous or current STls, such as HIV and syphilis.

My wife has been tested and has the all clear - how can I tell if I’m causing our fertility problem?
You will be offered a semen analysis to determine your sperm quantity and quality — how sperm move (motility) and whether they are a normal form. A healthy sperm count should have a concentration of 20 million spermatozoa per millilitre of semen, with
75 per cent of these alive and 50 per cent of these ‘motile”, or moving as well as possible Differences can occur over time in both the quality and quantity of sperm, so if your first sample is poor, you will probably be tested again a couple of months later.
You are also likely to be advised to give up smoking, reduce alcohol intake to 1-2 units once or twice a week, and to wear loose-fitting underwear to avoid overheating the testes If a problem is found, you will be referred to a specialist for a consultation Try to avoid becoming stressed as this can also affect fertility Learning relaxation techniques with your partner and practising these regularly will help.

We can’t conceive naturally - what do we do now?
Assisted conception; or assisted reproduction, is the term used when women are helped to conceive without having intercourse There are five main procedures available, listed below. Your consultant will go through each one with you, and together you can make a decision about which is most suitable depending on your problem. You can also contact the National Institute for Health and Clinical Excellence (NICE) for more information (see p.310)
* Ovarian Stimulation (OS), or Super Ovulation (SO), involves injections of fertility hormones to boost egg production This is followed by intrauterine insemination (IUI) of sperm, whereby sperm are collected and sorted so that only the strongest remain and these are then artifically placed inside the uterus via a catheter. This is ideal for couples when the man’s sperm is “slow” or the woman has problems ovulating, or there is a combination of both. * Gamete Intra-Fallopian Transfer (GIFT). This is suitable for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed withsperm and replaced directly into the Fallopian tubes, allowing conception to occur inside the body.
* In Vitro Fertilization (IVF). This is the most widely used treatment and involves a seven-step process (see below and p.30) This is ideal for most problems including blocked tubes
* Intra-Cytoplasmic Sperm Injection (ICSI). This is used if the man’s sperm count is low, the motility of the sperm is very poor, or the woman is allergic to her partner’s sperm. The treatment involves injecting just one viable sperm into an egg (see box right). * Artificial Insemination by Donor (AID). This is simply the injection of donated sperm into the cervix This is used when a man is unable to maintain an erection or is sterile Similarly, women may require an egg donation if they are unable to produce their own eggs, although this is more complicated.
Whatever treatment is provided, it is important that you and your partner are treated as a couple rather than separate patients. It is also essential that you are kept informed throughout the process and given information on any risks and benefits.

What does IVF involve?
IVF, or In Vitro Fertilization, involves the surgical removal of an egg which is then mixed with sperm in a laboratory dish to fertilize and produce an embryo outside of the womb (see p.30).
IVF treatment occurs in cycles, as there are various stages that must be completed for it to be successful. Initially, a drug is used in the form of a nasal spray or injection to switch off the woman’s natural cycle of egg production in the ovaries, known as ”clown-regulation”. Fertility drugs are then given to stimulate the ovaries to produce more than one egg (ovulation induction). Mature eggs are collected from the ovaries using a fine needle guided by ultrasound. The procedure is usually uncomfortable rather than painful. On the same day, the partner’s sperm is collected and then the eggs and sperm are mixed in a dish. Within a few days, one or sometimes two embryos are transferred into the womb. If an embryo successfully attaches to the inside of the womb and continues to grow, a pregnancy results.

ICSI

This procedure may be used when it is thought that the quality of the partner’s sperm may be responsible for fertility problems. If the sperm count is low or movement is poor, sperm may be ”assisted” in fertilizing the egg. An individual sperm is injected directly into the egg and, if fertilization takes place, the resulting embryo is placed in the uterus.
What are the success rates of fertility treatments?
Success rates for treatments vary, depending on the treatments used and the health of the couple If you want to know the success rates of individual clinics, you can ask for their ratio of “live-births-per-cyclestarted”. This information is available from each clinic, but there are currently no nationally held data
Overall, couples have a better success rate if the woman is aged 23-39 years, has been pregnant or has had a baby, and has a normal body weight (a body mass index between 19 and 24). The older a woman is, the less likely she is to get pregnant
Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one PVT cycle; from 36 to 38 years around 15 will get pregnant at 39, around 10 will get pregnant; and in women over 40, around 6 will get pregnant

IVF is so expensive - can we get help with funding?
Since April 2005, women between the ages of 23 and 39 are entitled to one free IVF cycle on the NHS. However, you must meet the eligibility criteria set by your local Primary Care Trust (PCT), which varies across the country and depends on factors such as your marital status, weight, and whether you or your partner smoke Couples who can afford to, or who may have had one unsuccessful cycle already, often opt for a private clinic Although these are regulated by the Human Fertilisation and Embryology Authority (HFEA), this cannot set costs, and a private course of IVF can cost from E4,000 to £10,000
My partner is worried about producing his sperm sample. How can I reassure him?
As fertility problems affect 1 in 7 couples in the UK reassuring your partner that this is not an unusual situation is always a good start. You could try leaving out a leaflet on fertility problems for him to read for more information Try to empathize with him as much as possible by sharing your experiences and the tests you have undergone.
Your partner may be worried about ejaculating at the required time when he is already feeling anxious and is in a clinical environment Some men require a sex toy, magazines, or video clips to help. For others, restraining from sexual intercourse for a few days can make ejaculation easier If you live fairly close to the clinic, your partner may be able to produce the sample at home and deliver it.
Sometimes a medical condition such as diabetes prevents a man ejaculating If this is the case, sperm can be obtained through ‘’sperm recovery”, whereby a small needle is passed through the skin of the scrotum into the testes and sperm is withdrawn.

The drugs I’m taking for IVF are giving me terrible mood swings. Is this normal?
The drugs used in IVF treatment are female hormones (see p.30) to stimulate your ovaries to mature more than one egg at a time, and progesterone, which helps to sustain a pregnancy. Different levels of hormones can result in mood swings, as any woman who suffers with premenstrual tension (PMT) can testify, and this is also a common side effect of IVF treatment It’s worth considering too that couples undergoing IVF are under incredible stress, which has been linked to an increased risk of developing depression, so it’s important to decide whether you are feeling ”hormonal” or are in fact depressed. Your doctor can advise you and refer you if necessary.
My partner has a low sperm count - can you tell us what help is available for us?
Usually, two or three semen samples are taken to work out the average sperm count and to see if there are abnormal sperm present. A healthy semen sample of 2-5ml contains more than 20 million sperm per ml; a count below this is considered low If your partner has abnormal sperm, further testing may be necessary Lifestyle changes can boost sperm (see below). There are also hormonal treatments to improve sperm count and surgery to remove blockages You may be reassured to know that even poor-quality semen can be used to fertilize an egg with IVF or with ICSI (see p.29).
Can lifestyle changes really improve sperm?
Poor quality sperm has been linked to excessive drinking (more than three or four units of alcohol per day), smoking, and to wearing tight-fitting underwear,
which overheats the testicles and can affect their efficiency Excessive stress and a poor diet are also thought to affect sperm So yes, it is worth reviewing your lifestyle to see if improvements can be made Jobs that may expose you to harmful agents, such as pesticides, may also affect sperm, so if you think your partner’s job may pose a risk, it’s worth investigating.
I’m pregnant using a donor -what happens if my child wants to trace her biological dad?
From April 2005, children who were conceived using donor sperm have had a right when they reach 18 years of age to find out their parent’s identity. This also applies to children conceived using donor eggs and embryos. This right applies only to children conceived after this date and not retrospectively. Prior to this date, children had the right to know at 18 years of age if they were conceived using donor sperm, eggs, or embryos and to find out if they were related to someone they wanted to marry. The reason for this change in the law is that children conceived in this way are being given the same rights as adopted children regarding information on their genetic parents. However, some fertility experts fear that this will deter potential donors.
Is surrogacy allowed in the UK?
Currently, surrogacy is legal in the UK, although it is illegal to advertise it as a service However, the law does not recognize surrogacy
as a fixed agreement, which means that a surrogate can change her mind about the arrangement during the pregnancy and up to six weeks after the birth. It is usual for a surrogate to receive ”reasonable expenses”, although there is no definition of what is deemed as reasonable. Usually, this includes costs incurred by the surrogate relating to her pregnancy, If the father of the child is named on the birth certificate, this gives him equal rights to the child. If this is not the case, then six weeks after the birth the new parents can apply for a parental order that gives them full parental status At this point, the surrogate gives up any parental rights to the child.

Conception problems

There are a range of reasons why a couple may have difficulty in conceiving. Investigations and tests may uncover specific conditions, which may be treatable, or you may be offered help to conceive.
What can affect a man’s fertility? A semen analysis may reveal various reasons why sperm have difficulty in fertilizing an egg The sperm count may be low (less than 20 million sperm per ml); the motility of the sperm (how they move) may be poor, and there may be a high percentage of abnormally formed sperm Some men experience a failure to ejaculate at orgasm There may also be damage to the tubes that connect the testicles to the seminal vesicles where sperm are produced, and this may have been present from birth or caused by a later infection
What can affect a woman’s fertility? Conditions such as polycystic ovary syndrome
(a hormonal imbalance that causes ovarian cysts) and endometriosis (see p 19) can disrupt fertility. Other hormonal imbalances, such as low levels of FSH and LH, can affect ovulation; or levels of progesterone may be too low to sustain a fertilized egg. Damaged Fallopian tubes, caused by an ectopic pregnancy (see p 25), surgery endometriosis, or pelvic inflammatory disease, which may be caused by an infection such as chlamydia, can prevent conception. Damage to the ovaries can occur from scarring as a result of surgery or infection, or the supply of eggs may be low Some women have an abnormally shaped uterus, or have uterine scarring, that can prevent the successful implantation of an egg.

IVF treatment

In vitro fertilization or IVF, is a complex procedure with several stages, from the stimulation and harvesting of your eggs to the successful fertilization of the eggs, development of embryos and transfer of the embryos into the womb for implantation. Undergoing IVF can be a stressful and time-consuming undertaking, but knowing in advance how the procedure works and what you can expect at each stage can reduce anxiety and help you and your partner to cope.
What happens first? To optimize the chances of success with IVF more than one egg at a time is removed for fertilization Normally, your body produces one egg each month. In rVF, you will inject yourself with drugs, such as clomiphene and hMG (human menopausal gonadotrophin) to stimulate your ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic every one to two days over one or two weeks to monitor the development of the eggs. Once it is thought that the eggs are mature, you will be given a blood test to measure your levels of oestrogen, which is released around ovulation.

What happens next? Once your follicles are ripe and ready for ovulation, your eggs will be collected at the clinic using ultrasound or laparoscopy to guide a probe. Once the eggs have been collected, they will be mixed with your partner’s sperm in a Petri dish in a laboratory ready for fertilization Your partner needs to produce the sperm on the same day as the egg collection. He can either do this at home, or come into the clinic with you and produce the sperm while you are undergoing the egg collection procedure.What happens in the laboratory? Once the egg and the sperm have been mixed, they are placed in the laboratory and monitored closely for the next few days. They will first be inspected around 18 hours later to see how many of the eggs have been fertilized and the clinic will usually pass this information on to you the day after the procedure It’s quite common for not all of the eggs to be fertilized and for only two or three to develop into embryos. The fertilized eggs are incubated in the laboratory over the next couple of days and their progress measured. The laboratory technician watches cell division under a microscope, waiting for the eggs to divide into two or more cells on their journey to becoming a blastocyst (see p.21).
If one or more fertilized eggs develop in the laboratory, you will be called back in for the embryo transfer, This is done by injecting eggs through a catheter into the uterus. No more than two eggs will be transferred and you will have the option to freeze any remaining embryos.

Surrogacy
A surrogate mother is a woman who reaches an agreement to carry a baby on behalf of another woman. She can either conceive the baby with the partner’s sperm, in which case she is the maternal mother, or the infertile couple may fertilize their own egg through fertility treatment, which is then transferred into the uterus of the surrogate mother for her to carry the baby through pregnancy and deliver at birth. This process can be beset with problems: such as the conflicting emotions of both the surrogate mother and the receiving couple, or legal issues if, for example, the surrogate mother has a change of heart after the birth and wishes to keep the baby, For this reason, it is important that all parties entering into the agreement have carefully considered the implications and are confident and happy in their roles.