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Ovulation Induction
Ovulation Induction is a treatment for women who, for some reason, do not ovulate (release an egg) every month. By stimulating the ovaries with mild type fertility drugs and monitoring the effects with ultrasound scans, ovulation can be induced. The couple are then advised to have sexual intercourse over the next three days. //Back to top
Artificial Insemination
This is a technique that is used for couples with ‘unexplained’ infertility. This procedure is carefully co-ordinated with the woman’s cycle. The correct day for insemination is determined by using mild fertility drugs and ultrasound scans to predict the day when ovulation will occur.
The husband / partner is asked to produce a fresh semen sample on the day of treatment. This is prepared by the embryologists and can take up to 2 hours. The woman then attends clinic later on the same day. The insemination procedure itself is a simple one, similar to having a cervical smear test. //Back to top
IVF – In vitro fertilisation
IVF is suitable for:-
- Unexplained infertility
- Ovulation disorders
- Tubal damage
- Older women
- Male factor problems
What is it?
IVF literally means fertilisation ‘in glass’ hence the familiar name of ‘test tube baby’. Eggs are removed from the ovaries and fertilised by sperm in a laboratory dish and the resulting embryos are placed into the woman’s womb.
What does it involve?
For her
IVF involves taking fertility drugs which are tailored to your individual needs. Your own hormone production is temporarily switched off and your ovaries are stimulated to produce more eggs than usual. The development of the eggs is monitored by regular ultrasound scans. When the eggs are ready to be released, you will have a minor operation to collect them (egg collection).
For him
You will be asked to produce a sperm sample at the clinic on the day of the egg collection. The sperm are collected in a sample pot and after a short time are washed and spun at high speed to select the best sperm which are mixed with the eggs.
If for any reason you are likely to be unable to produce a sample on the day, sperm may be frozen in advance.
What happens next?
The eggs are mixed with sperm in the laboratory and left to fertilise. After two or more days, one or two embryos are placed in your womb. Any other good quality embryos may be frozen and stored for your future use.
How successful is it?
Success rates depend on a number of factors, but most importantly the woman’s age. The chance does improve as each hurdle in the treatment process is overcome, therefore it is helpful to know what the success rate is after egg collection and embryo transfer. We regularly publish our success rates, so ask for our latest results or check our website. //Back to top
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ICSI: Intra Cytoplasmic Sperm Injection
Intra-Cytoplasmic Sperm Injection (ICSI) is a technique that has been developed to assist fertilisation using very few sperm. If sperm quality is poor, either due to low numbers, or because they do not swim very well, or because they are not able to penetrate the barriers surrounding the egg, then infertility can result. ICSI is used successfully to treat these conditions.
Who should have this treatment?
• men with very low numbers of sperm.
• men with poor quality sperm
• men who produce semen in which no sperm is present (see Surgical Sperm Retrieval).
• couples who have had previous failure to achieve fertilisation in routine IVF, or when very few eggs have fertilised following IVF.
What specific tests may need to be done prior to ICSI?
There are conditions associated with severe sperm problems. These include chromosome abnormalities, cystic fibrosis, or a hormonal imbalance.
1. Chromosomes carry the genetic information from one generation to the next. They are responsible for determining not only what we look like, but making sure that everything works normally. We take blood from the man to check his chromosomes.
2. Cystic Fibrosis is a condition affecting the lungs and bowels and is also associated with defects that cause male infertility. The chance that a healthy person may carry a risk factor for this condition is 1 in 20. In men with some types of sperm problem, this risk is higher. If both you and your partner carry the risk factor then there is a 1 in 4 chance that your child may be affected. We take blood to screen for this condition.
3. A hormonal imbalance may be the cause of the abnormal sperm production. Blood is taken to check this.
What does it involve?
For her
The cycle is the same as for IVF treatment.
For him
This will depend upon whether a fresh or frozen sample is used, or surgical sperm retrieval is required.
What happens next?
ICSI treatment involves injecting a single sperm directly into the centre of an egg to assist fertilisation. Once there, the nucleus from the sperm can fuse with the nucleus of the egg completing the normal fertilisation process.
The treated eggs are checked to see if fertilisation has occurred. After two or more days, one or two embryos are placed in your womb. Any other good quality embryos may be frozen and stored for your future use.
How successful is it?
As for IVF treatment, success rates depend on a number of factors, but most importantly the woman’s age. The chance does improve as each hurdle in the treatment process is overcome, therefore it is helpful to know what the success rate is after egg collection, and embryo transfer.
We publish our success rates, so ask for our latest results or check our website. //Back to top
Embryo Freezing and Frozen Embryo Transfer (FET)
Embryos may be frozen and stored for a number of reasons. The most common reason is to preserve spare embryos after IVF or ICSI. Usually only good quality embryos will be frozen, as these have the highest chance of surviving the freezing and thawing process.
Frozen embryos may be stored for up to 10 years, or in exceptional circumstances, until the woman reaches the age of 55. Embryos must by law, either be used by the end of this period, or they will be removed from storage. It is the policy of the Unit to offer storage for up to 5 years in the first instance, but this may be extended where appropriate.
During a FET cycle drugs are used to ensure the lining of the womb (endometrium) is ready to receive the embryos. It is much less involved than a full cycle of IVF as there is no stimulation of the ovaries, no egg collection, and no anaesthetic. The clinic also offers natural cycle FET, where no drugs are used. This is available after discussion with a clinician. //Back to top
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Blastocyst Culture
If you are fortunate and have a number of high quality embryos, one option is to allow these embryos to develop for five days outside the body, to what is termed the ‘blastocyst stage’.
We may suggest you consider blastocyst culture if you have many good embryos, as the chances of becoming pregnant with this treatment within one cycle are much higher. Having only one blastocyst put into the womb reduces the risk of having twins.
Couples who have had a previous multiple pregnancy, or who are at high risk of a multiple pregnancy will be advised to have a single blastocyst replaced. //Back to top
Assisted Hatching
Occasionally the embryo may have difficulty implanting in the womb because the outside coat from the egg is too thick or tough. In the laboratory we can make a hole in this outer coating to increase the chance that the embryo can ‘hatch’. This procedure can be carried out either using a chemical solution or a laser.
We generally offer this treatment to patients who have had a number of treatment cycles without a pregnancy. //Back to top
Surgical Sperm Retrieval
When there are no sperm in the ejaculate, sperm can sometimes still be recovered from the testicles by an operation. There are a variety of techniques:
PESA (Percutaneous Epididymal Sperm Aspiration) - A fine needle is inserted into the epididymis (the sperm reservoir) at the upper area of the testicle and any sperm will be drawn through the needle into a syringe.
TESA (Testicular Sperm Aspiration) - A fine needle is inserted into the testicles and any sperm are drawn through the needle into a syringe.
TESE (Testicular Sperm Extraction) - If few or no sperm are obtained from the above procedures a biopsy (tissue sample) is taken from the testicles through a small incision. After the procedure 2–3 sutures are placed in the skin, these will dissolve after about 10 days.
These procedures are carried out either under local or general anaesthetic. The sperm can be used either for diagnosis, immediate treatment or frozen for use in future treatments.
Sperm obtained from this procedure normally need to be used for ICSI treatment. //Back to top
Compensated Egg-Sharing
If you are not eligible for NHS funding (see funding), one way of helping to pay for IVF/ICSI treatment is through our Egg Sharing Programme. In this programme you get your treatment at a subsidised price. In return you agree to share the eggs collected from you in that cycle with a woman who requires egg donation.
Suitability
For a woman to be considered for the Egg Sharing Programme she must be aged less than 35 years and six months, with no personal or family history of inherited illnesses or congenital abnormalities. She will be seen by a doctor and a specialist nurse for assessment, and she will also have independent counselling. The response to any previous fertility treatment she may have had, and the result of hormonal tests will be reviewed before deciding on her suitability. The GP will also be contacted (with the patient’s permission) for details about medical and family history.
Prior to treatment she will be screened for sexually transmitted diseases (syphilis, chlamydia and gonorrhoea), hepatitis, HTLV 1&2, HIV and cystic fibrosis.
Egg Sharing Arrangements
The egg sharing works as follows:-
The woman sharing your eggs will remain anonymous to you. You will also be anonymous to her. If you get 6 eggs or more the eggs will be equally shared. If you get less than 6 eggs then we believe there are too few eggs to share. You will keep them all yourself and have your treatment as planned (at no extra cost).
The Human Fertilisation and Embryology Act 1990 states that as a donor, you will not be the legal parent of any child resulting from your donated eggs, however any child born from donor eggs will be able to find out your identity when they reach the age of 18. //Back to top
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Using an Egg Donor
If a woman is unable to produce her own eggs, an egg from another woman can help her to have a baby. This may be from our compensated egg sharing scheme, an altruistic donor, or a known or crossed-donor.
Egg donation may be the answer if you:-
• Have had an early menopause
• Have no ovaries or had them removed
• Have had cancer treatment which has damaged the ovaries
• Are producing few or low quality eggs
• Have tried to conceive unsuccessfully using IVF
• Have a high risk of passing on an inherited disorder
What does this treatment mean?
Eggs from another woman are fertilised with your male partner’s or donor sperm and implanted into your womb.
What does it involve?
For her
The lining of your womb is prepared to receive the embryos using hormone tablets. After the eggs are collected from the donor and fertilised, the best embryos are transferred into your womb as in an IVF cycle.
For him
On the day of egg collection you will be asked to give a sperm sample (unless donor sperm is being used). This is mixed with the donor eggs and is used either to fertilise the eggs for use in IVF, unless you have a low sperm count or poor quality sperm then the eggs may be fertilised by ICSI.
How successful is it?
The chances of success are often higher than conventional IVF. This is because the eggs are donated by women aged under 36 who are usually more fertile.
Ways to find a donor
There is a shortage of donors which means you may have to wait two years or more to be matched with a suitable donor.
You may:-
• Wait for a suitable anonymous donor. These donors undergo the procedure voluntarily.
• You may share the eggs from another woman participating in our egg sharing programme (see Compensated Egg Sharing).
NB: The donor will remain anonymous to you. However, children born as a result of donated eggs will be able to discover the identity of the donor on reaching the age of 18. This information will be held by the Human Fertilisation and Embryology Authority (HFEA).
• Ask a relative or friend to donate their eggs either directly to you or anonymously to someone else on the waiting list so that you automatically reach the top of the waiting list and have the next suitable anonymous donor.
• Advertise for a donor yourself or ask the National Gamete Donation Trust for help to locate a donor.
Egg donation needs careful consideration; there are complex emotional and psychological issues that you need time and support to consider. All couples have an appointment with our counsellor and with a nurse to discuss the implications of this treatment. //Back to top
Embryo Donation
Embryo donation is the treatment of a couple using embryos created by the fertilisation of another woman's egg with her partner’s sperm. These embryos would have been frozen during that couple’s IVF/ICSI cycle for their future use. That couple may then have decided that they no longer require those embryos for their own treatment, but have agreed to them being used for the treatment of other people.
Receiving donated embryos
Donated embryos are normally frozen so this is essentially a Frozen Embryo Transfer (FET) cycle. Currently very few couples donate embryos, so treatment is rarely available through this route. //Back to top
Surrogacy
Surrogacy involves the transfer of embryos created using the eggs and sperm of a couple undergoing treatment, into the womb of another woman, the “surrogate”, and is carried out when for some reason a woman cannot carry a child herself.
The Unit will consider surrogacy on a case-by-case basis. You would need to find your own surrogate as we cannot do this for you. Further information is available on application. //Back to top
Using Donor Sperm
Donor sperm can be used to treat couples where there is a male factor infertility problem - a very low or absent sperm count, a vasectomy, the risk of transmitting a genetically inherited condition, or to treat single women.
Sperm donors are recruited from a wide range of backgrounds. They are required to be fit and healthy, of normal intelligence and with no family history of hereditary disease.
Donors are screened for sexually transmitted disease, including HIV infection. This screening is repeated at regular intervals. As far as possible we use sperm from a donor who has the same physical characteristics as any male partner, e.g. race, skin, hair and eye colour.
Donor insemination involves placing sperm directly into the womb (intrauterine insemination) during the woman’s fertile period.
The clinic will monitor and time treatment by asking you to test for urine hormone surges (natural cycles), or by follicle tracking using ultra sound scans. We may ask you to take fertility drugs - tablets and/or injections (stimulated cycles).
Donor sperm can also be used in IVF cycles to form embryos.
The Human Fertilisation and Embryology Act (HFEA, 1990) provides a legal framework to protect the interests of the donor, any children born as a result of treatment and also the legal parents of those children. This ensures that the husband or partner of the woman being treated would be the legal father of any child born as a result of donor insemination.
The HFEA keep a confidential register of all patients treated by donor insemination, the children born, and the donors themselves.
Sperm donors remain anonymous as far as patients are concerned, but, on reaching the age of 18, the children may discover the identity of their donor by contacting the HFEA.
Treatment using donor sperm requires careful consideration, given the emotional and psychological issues that surround this type of treatment. Anybody considering treatment must see the ACU counsellor before meeting one of our senior nurses, to discuss both the emotional, legal and practical issues involved.
Under the new 2008 HFEA act there is clear legal provision around parenthood. For more information see our Fertility and You page.
There is a general shortage of donors in this country, which means there may be a wait before we can offer you treatment.
//Back to top
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Egg Freezing
What is egg freezing?
For many years it has been possible for couples undergoing IVF treatment to have embryos frozen and stored for future use. It has taken longer to develop methods for freezing eggs, as they are more vulnerable to the damage that can take place when cells are cooled. Techniques have now been developed that enable eggs to survive freezing and thawing, to be fertilized, develop into embryos, and form normal pregnancies. Eggs are treated using very specialised solutions, and are cooled very slowly, under computer control. They are then transferred to storage tanks containing liquid nitrogen.
Who needs egg freezing?
Egg freezing may be used in any situation where eggs are collected from a woman’s ovaries and there are no sperm available to fertilise them and create embryos. Women who have cancer may require treatment that will harm their ovaries and restrict their future fertility. If they do not have partner, and are therefore unable to store embryos, it is possible to freeze eggs so that their future fertility may be preserved (if only in a limited way). As it is necessary to use drugs to stimulate the ovaries in order that enough eggs develop for freezing to be carried out, women with certain types of cancer will not be able to undergo freezing, either because they need to start treatment immediately, or because their disease is sensitive to the drugs that are used in ovarian stimulation (e.g. oestrogen sensitive tumours).
Women who are suffering from a condition that may lead to premature ovarian failure, and, as a result, infertility, may also consider egg freezing.
Egg freezing is also available to women who are unable to start a family at present, but who are concerned about their future fertility.
Finally, egg freezing may be used as an emergency procedure for couples undergoing IVF, if for any reason, the male partner is unable to provide sperm at the time of treatment.
What does egg freezing involve?
In order to collect enough eggs to freeze, women must undergo drug treatment to stimulate their ovaries, in the same way as women undergoing IVF treatment. This takes two to five weeks.
The eggs are then collected under general anaesthetic as they would be normally for IVF or ICSI. Only eggs that are mature, i.e. are ready to be fertilized, can be frozen, and the embryologist will check the maturity of each egg prior to freezing.
When the eggs are required for treatment, they are thawed and fertilised using the ICSI technique as described above, in order to give the maximum chance of fertilisation.
How successful is egg freezing?
Egg freezing is a new technique and it takes time to accumulate results, as eggs may be stored for several years before they are used. Over a hundred babies have now been born worldwide, with no reports of any abnormality, but this is a very small number, and we cannot yet draw any definite conclusions about the safety of the technique.
What are the risks of oocyte freezing?
Early experiments on egg freezing suggested that cooling eggs resulted in damage to the arrangement of chromosomes, which prevented fertilization and normal development. Current techniques appear to have overcome this problem, and there have been no reports of abnormalities in babies born from frozen-thawed eggs. However, the numbers are still low, so we cannot yet draw any definite conclusions. Nevertheless, the data so far does not suggest any cause for concern.
How long can eggs be stored?
You may store your eggs for 10 years, but under certain circumstances this can be extended until you reach the age of 55. //Back to top
Sperm Freezing and Storage
Why do we need sperm storage?
Unfortunately, certain medical and surgical treatments can affect reproductive function and fertility, sometimes permanently. Sperm storage prior to treatment therefore provides an alternative by preserving fertility, and with advances with assisted conception techniques, offers a realistic chance of achieving a future pregnancy.
Who is it appropriate for?
Any male of reproductive age undergoing treatment, which is likely to impair his fertility, may be suitable for sperm storage.
These include:-
• Chemotherapy/radiotherapy
• Bladder neck surgery
• Urological surgery e.g. prostate
• Vasectomy
• Men with low sperm counts whose partners are going to have ICSI treatment
The sperm are analysed and mixed with a preservative that protects your sperm during the freezing process. Space is allocated in our special freezers and the samples will remain in storage at temperatures as low as -190°C until required or until we are instructed to dispose of them.
How long can sperm be stored?
The maximum storage period permissible by law is until you reach the age of 55 or for 10 years, whichever is longer.
How do I use my sperm in the future?
To use your sperm to achieve a pregnancy, you will need some form of help from either our clinic or another. This help could take the form of a simple insemination, timed to the ovulation (release of the egg) of your partner, or occasionally more involved forms of treatment such as IVF or ICSI (please link). In some cases treatment is not available on the NHS and there is a cost implication. To pursue treatment, the clinic requires a letter from your GP or hospital doctor. You will then be seen by one of our specialists who will advise you on which treatment will give you the best chance of a pregnancy. However, you must bear in mind that we cannot give firm guarantees of treatment success.
What if my sperm are poor?
Sperm can be poor for a number of reasons and sperm can be damaged during the freezing process itself, reducing their ability to fertilise the egg. If this happens, we can offer treatments such as IVF or ICSI to help poor sperm in fertilising the egg. //Back to top
Single Embryo Transfer
The ACU has adheres to a policy, adopted across all Midlands clinics that is designed to meet HFEA requirements and reduce the number of twin pregnancies. This means that if there is a high probability of you having twins only a single embryo may be transferred. More information is available via the clinic. For general information about single embryo transfer and multiple pregnancies www.oneatatime.org.uk. //Back to top
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