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Fertility and the Female
Every month a fertile woman releases an egg and her body prepares for a fertilised egg to implant. Her cycle is controlled by hormones secreted by her brain and is most noticeably marked by her ‘period’.
Women have a limited number of eggs within their ovaries and these reduce in number and quality as you get older. Every month the hormone signal from the brain causes a number of eggs to start to grow. Each egg is encased within a special set of cells called the follicle which helps the egg develop and grow. In a normal cycle only one egg will develop to maturity and be released. This is why most naturally occurring pregnancies result in a single baby.
During the time the egg is growing the lining of the womb also starts to thicken. This is a highly specialised environment where the early embryo will attach and implant.
Approximately 14 days after the start of her last period (and therefore 14 days before the next) the woman will release the ripe egg in a process termed ‘ovulation’. This is therefore the best time to have intercourse and try for a baby.
The egg then enters the fallopian tubes and for about 24 hours remains at a stage in which it may be fertilised. If the egg is fertilised it will begin to develop into an embryo as it passes down the tube. Between five and nine days later the embryo will reach the womb and implant.
If the egg has not fertilised, or the embryo does not implant, then the woman will have her normal monthly ‘period’. This is where all the extra lining of the womb prepared for the embryo breaks down and is lost in a process that seems similar to bleeding.
Different problems can occur at any of these stages from ovulation not occurring, through blocked tubes to problems with the womb lining. All of these will be assessed before and during your clinical treatment.
Fertility and the Male
From his teenage years until beyond the age of seventy a fertile man will produce around 1000 sperm cells per heartbeat. These are produced in his testicles and then stored in a long coiled tube on the back of the testicle until ejaculation. However, just producing sperm does not make a man fertile, what really matters about sperm is quantity and quality. This is assessed by having a sperm count.
Often fertility problems are caused by sperm not being able to swim properly or because very few sperm are produced. Some men produce semen that does not contain any sperm. This is called azoospermia. Half of azoospermic men have normal sperm production from the testes, but there is a blockage which prevents sperm from entering the semen.
This may be due to:-
1. Failure of the sperm passages to develop.
2. A blockage of the sperm transport tubes.
3. A previous vasectomy operation (male sterilisation).
All of these can potentially be treated via surgical sperm retrieval (see later).
For the other 50% there is a failure of adequate sperm production by the testes, this could be caused by a genetic problem, as a result of previous disease or cancer treatment.
Fertility and the Couple
There needs to be sufficient numbers of good quality sperm available when the woman is ovulating (producing eggs). Regular sexual intercourse around the expected time for ovulation should increase the chance of conception, you do not need periods of "sexual abstinence" to improve sperm count. In general a couple who have sex three times a week should be having sex frequently enough to catch ovulation.
Many couples are surprised that the woman does not get pregnant as soon as they try to have a baby. If a couple have no fertility problems then there is about a 25% chance of getting pregnant each month. If there is no problem requiring medical help you will generally be pregnant within two years of trying. If a woman is over 35 years old or the couple already know they are likely to have a problem then they should ask to be referred for investigations after six months of trying.
Legal Parenthood
These provisions relating to legal parenthood apply to consent given after April 6th 2009, in relation to treatment taking place after April 6th 2009.
Under the new provisions couples in civil partnerships will both be considered legal parents of any child born from treatment, in the same way that the law applies to married couples where treatment involves donated sperm or embryos created with donated sperm.
The new law also makes provisions for the partners of women who are not married or in a civil partnership, and who are being treated with donated sperm or embryos created with donated sperm, to be recognised as a legal parent of any resulting child, if consent is given by both partners.
Who needs to give consent?
These consent forms apply to:-
Married couples or couples in a civil partnership undergoing treatment by insemination with donated sperm
• Husbands and civil partners will be asked to sign a form to confirm that they have no objection to being the legal parent of any child resulting from treatment.
Married couples or couples in a civil partnership undergoing IVF with donated sperm or embryos created with donated sperm.
• Married couples or couples in a civil partnership need to complete these forms if the couple wish the husband or civil partner of the woman to whom embryos are to be transferred to be considered the legal parent of any child born from embryos transferred after the death of the husband or civil partner. N.B This only applies where the embryos have been created prior to the death of the husband or civil partner.
Couples who are not married or in a civil partnership
• Unmarried heterosexual couples where the female partner is receiving treatment with donated sperm or embryos, and the couple wish the male partner to be considered the legal parent of any resulting child.
• Same sex couples not in a civil partnership where one partner is receiving treatment with donated sperm or embryos and the couple wish the other partner to be considered the legal parent of any resulting child.
When
You will be asked to complete these forms before treatment commences. With the exception of married men or those in a civil partnership completing a consent to legal parenthood after death, both partners will need to complete forms.
The Forms
Consent to parenthood after death
Husbands or civil partners of women undergoing IVF with donated sperm will need to complete a “PP” form to confirm that they do not object to being the legal parent of any child resulting from treatment. This form also allows them to indicate whether they wish to be considered the legal parent of any child resulting from the transfer of embryos after their death. This only applies to the transfer of the embryos created prior to the death of the husband or civil partner.
Consent to legal parenthood
Women who have a partner, but are not married or in a civil partnership, and are undergoing treatment with donated sperm or embryos created using donated sperm, will be asked to complete a “WP” form, naming their partner and consenting to them being the legal parent of any child resulting from treatment. Partners of these women will need to complete a “PP” form, naming their partner and consenting to be the legal parent of any child resulting from treatment.
Implications for registration of the birth
From the 6th April 2009, both legal parents can be registered and appear on the birth certificate regardless of gender.
Withdrawal of consent
If either partner wishes to withdraw consent (to their partner being the legal parent, or to being the legal parent), they may do so at any time up to the time of insemination or embryo transfer. This should be done using form WC which can be provided to you. However, if you wish to withdraw consent and do not have access to this form you may do so in writing, stating your name and your partner’s name and making if clear that you are withdrawing your consent to legal parenthood.
If consent is withdrawn we would consider that the woman receiving sperm or embryos was being treated as a single woman, and would expect her to undergo counselling accordingly prior to commencing/recommencing treatment.
Refusal to give consent
If the woman being treated refuses to consent to her partner being the legal parent of any child resulting from treatment, or the partner of a woman being treated who is not her husband or civil partner, does not wish to consent to being the legal parent of any resulting child, we would expect there to be a break in treatment while the couple consider their relationship and whether treatment should continue. Should she choose to continue, the woman being treated would be regarded as a single woman for the purposes of treatment and we would expect her to undergo counselling accordingly.
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