The release of an egg from the ovary is necessary for spontaneous pregnancy to occur. If this does not happen naturally, various medications can be used to stimulate the ovaries. This is called ovulation induction. There are a couple of tablets available, Letrozole and Clomiphene. They are only taken for five days in each cycle and are effective ovulation induction agents. These tablets can be used if the cycles are irregular or infrequent, or if the progesterone levels are low.
Letrozole is an increasingly used medication to induce ovulation. It appears to have a lower incidence of side effects when compared with Clomiphene in terms of mood disturbance and the risk of multiple pregnancy.
Clomiphene Citrate (Clomid) is a commonly used treatment that has been available for over 50 years.
- The side effects are generally uncommon and mild, and can include mood changes, hot flushes, headaches and visual disturbances
- There is an increased risk of multiple pregnancy
- The treatment is monitored by a combination of blood tests and scans to ensure correct dosage
- A typical course of treatment will usually last no longer than six months
- Gonadotrophin injections
These injections are self-administered subcutaneously (administered just under the skin), at a similar time each day.
- You will be taught at the start of treatment on how to safely administer the injections
- Treatments generally start within the first two to four days of the cycle and typically last between seven to ten days. Side effects are generally uncommon
- The gonadotrophin injections stimulate the growth of follicles on the ovaries; these contain the developing eggs
- Treatment is monitored using transvaginal ultrasound scans
- The first scan usually takes place after the first seven days of injections, with further scans arranged according to the ovarian response
- Scans measure the number and size of the follicles
Once the follicles have reached the correct size you will be given the ovulatory trigger injection. This will lead to the release of the mature egg after 37-40 hours.
Assisted Fertility Treatments
- Intrauterine insemination
In some cases, couples can improve their chance of conceiving by having a combination of ovulation induction; using either tablets or injections, combined with a timed insemination of prepared sperm directly into the uterus. This is more commonly known as stimulated intrauterine insemination (IUI)
Scans will monitor the treatment to ensure adequate ovarian response and to also perfect the timing of the insemination. The scans will also let us know if the ovaries have under or over-responded. If there are many follicles (potential eggs) the cycle will be abandoned because of the increased risk of a multiple pregnancy. Normally it will take between seven and ten days to achieve a satisfactory ovarian response.
Ovulation is normally induced with a ‘trigger’ injection, this is given approximately 24 hours before the insemination is scheduled to take place. Unless donor sperm is being used, your partner will need to produce a semen sample at the unit two hours before the insemination; this is to enable the sperm preparation in the laboratory.
For the insemination itself, a fine tube is passed through the neck of the womb, so that the prepared sperm can be injected slowly into the cavity of the uterus. It is normal to rest for up to 30 minutes after the insemination, following which patients can go home. A pregnancy test can be performed no sooner than two weeks later.
For more information on intrauterine insemination please see our information leaflet.
- In vitro fertilisation (IVF)
The IVF cycle is a treatment that has five main stages.
- Stimulation - this is the process of stimulating the woman’s ovaries using a combination of medications to produce follicles. The follicles are the small cystic areas on the ovary that contain the eggs. The medications are usually given as injections. The treatment is monitored by ultrasound scans. When the ovaries have responded sufficiently you are then ready for the egg collection. The final, precisely timed injection which acts as the ovulatory trigger, is administered 36 hours before the planned egg recovery.
- Egg collection – this procedure can be carried out under sedation or even local anaesthetic. It is normally an ultrasound scan procedure that can take around 15-20 minutes to perform. You would expect to be going home within several hours of the procedure. Unless frozen sperm is being used, a fresh sperm sample would be produced in the hour before the egg collection takes place. The sperm will then be prepared for the insemination of the eggs later that day.
- Insemination – a few hours after the egg collection has taken place, the embryologists will put the eggs and prepared sperm together in the laboratory.
- Embryo culture – the morning following the egg collection, the eggs are examined to check for fertilisation. The fertilized eggs are called embryos. The embryos will be monitored over the next few days to make sure they are developing and are suitable for transfer after three to five days.
- Embryo Transfer – the procedure is usually straightforward, with no fasting or anaesthetic required. Usually with a partially full bladder a speculum is inserted in the vagina, the cervix (neck of the womb) is then visualized, and a very fine tube inserted along the cervical canal into the uterus. Once in place a much finer tube is fed down the tube and the embryo(s) transferred.
The treatment cycle is relatively short (about four weeks). The antagonist pathway has become the most popular drug regime. Starting with injections (gonadotrophins) that stimulate the ovaries to produce follicles, and then adding in a second injection (the antagonist) on day 5 or 6 of the cycle. With regular monitoring, most women are ready for egg recovery after 8 to 12 days of injections.
- Intracytoplasmic Sperm Injection (ICSI)
The difference between IVF and ICSI is in the way that the eggs and sperm are manipulated in the laboratory on the day of the egg collection. ICSI is the process by which an individual sperm is injected into the individual egg.
Otherwise the treatment pathway is the same as for IVF.
Once injected, the eggs are then moved to an incubator to allow fertilisation to take place. They would be assessed approximately 18 hours later to look for evidence of fertilisation.
The main reasons for undergoing ICSI treatment are:
- ‘Male factor’ infertility
- Previous poor fertilisation rate with IVF treatment
- Previous unsuccessful fertilisation with standard IVF
- Embryo transfer
The procedure is usually straightforward, with no fasting or anaesthetic required. Usually with a partially full bladder a speculum is inserted in the vagina, the cervix (neck of the womb) is then visualized, and a very fine tube inserted along the cervical canal into the uterus. Once in place a much finer tube is fed down the tube and the embryo(s) transferred.
The aim of this procedure is to transfer a single day five embryo (blastocyst). Depending on numbers and quality of the embryos, it may even be decided that is more appropriate to replace the embryos on day three of the development. This decision would be made following discussions with the embryologist.
- Post-treatment care
The day after the egg recovery, progesterone hormone luteal phase support is commenced. This is continued until at least the day of the pregnancy test.
A pregnancy scan is arranged within two to three weeks of the positive pregnancy test. It is also advisable to contact your GP to arrange antenatal booking appointments.
If treatment is unsuccessful, a follow-up appointment will be arranged to discuss further treatment options.
- Frozen Embryo Transfer
Frozen embryos can be replaced in either a natural cycle (without the use of any drugs) or a medicated cycle. If your periods are infrequent of irregular, it may not be possible to use the natural cycle as the transfer is timed to follow the ovulatory Luteinising Hormone (LH) surge. This would be determined by ultrasound scans and LH testing (using either urine or blood tests).
The embryo transfer is the same as for fresh embryos when replacing frozen thawed embryos.
If pregnancy is achieved in a medicated transfer cycle, those medications will need to be continued until the pregnancy has reached 12 completed weeks. The drugs used are a mixture of oestrogen and progesterone, which can be administered by a variety of routes.
At Fertility Fusion we are proud to offer a specialised, professional counselling service for people undergoing fertility treatment.
Fertility treatment can be both physically and emotionally stressful. It’s not unusual to feel anxious, stressed and even depressed, which can affect not only your own wellbeing but also your relationships.
Not everyone will be able to understand what you are going through and some people don’t want to share with others that they are experiencing problems with fertility and are undergoing treatment. This is where counselling can be really helpful.
All sessions with our counselling service are confidential.
In line with the Human Fertilisation and Embryology Act 1990 (amended HFEA, 2008), Counselling is offered in combination with the treatment provided by Fertility Fusion. There are many benefits to the counselling that will be offered to patients during their fertility treatment. It will always include the opportunity to talk through the implications of the treatment that have been suggested and it will also include elements of support and therapy.
How to contact the service?
Counsellor: Andrea Hollinghurst
Telephone: 01942 264028 (Confidential answering machine service if unavailable)
All Counselling staff respect and maintain confidentiality at all times in line with the law.
Counsellors are members of the British Association of Counselling and Psychotherapy (BACP), the British Infertility Counselling Association (BICA) and adhere to the HFEA licensing regulations and guidance.