Debunking the myths of fertility treatment

In Chapter 10 of  Your Fertile Years, I will debunk the myths of fertility treatment.

Many women think that assisted conception, such as In Vitro Fertilisation (IVF) will enable them to become pregnant if they fail naturally. But fertility treatment is expensive and does not always work.

In Chapter 9, I explained the different causes of infertility and the investigations that can be performed when a man or woman is experiencing infertility. If these tests show any abnormalities, or even if the reason for infertility remains unknown, various treatments can be used to help the couple become pregnant. These include: Ovulation Induction; Intrauterine Insemination (IUI); In-Vitro Fertilization (IVF); Intracytoplasmic Sperm Injection (ICSI); egg and sperm donation; and surrogacy. They all have limitations and different success rates.

If a couple decide to embark on fertility treatment, they have to think about which treatment is best for them and this depends on their medical history and age. Some will say that fertility clinics offer IVF too early and some will say they offer it too late. Along this journey couples will be given conflicting information by different doctors. It is important for couples to know their options and to make their own decision.

In my book I will explain about fertility drugs and treatments. In this blog I will concentrate on IVF and IVF add-ons.

In-Vitro Fertilization (IVF)

IVF is suitable for patients who have had difficulty conceiving for a number of reasons, such as those with blocked fallopian tubes, ovulation problems, endometriosis, or those with unknown infertility.  Before an IVF cycle is started, the fertility specialist will check the sperm and the uterine cavity of the woman, perform an ovarian reserve test (Chapter 9) and check that the cervix is open to allow the passage of the catheter which will contain the embryos.

The woman will have an individual drug regime and be carefully monitored. When she is ready, the eggs will be collected. On the morning of the egg collection, the couple will need to attend the fertility clinic. The man needs to produce a sperm sample and it is prepared. The woman will undergo light sedation so the eggs can be aspirated from the follicles. An ultrasound probe is inserted into the vagina and a needle is used to aspirate the contents of each follicle. The procedure takes about 30 minutes and she will normally return home in the afternoon. There are minimal risks with the procedure. However, the aspirating needle which is used to collect the eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. In rare cases, no eggs are collected.

In the laboratory, the embryologists will store the eggs in dishes containing special culture media. The dishes are stored in incubators set at body temperature. If the sperm quality is good, the sperm will simply be mixed with the eggs so the sperm can ‘naturally’ fertilise the eggs. If the sperm is not good, intracytoplasmic sperm injection, ICSI, will be used.

The embryologists will monitor the development of the embryos to decide which embryo to put back and which to freeze. To transfer the embryos to the womb, a speculum is placed in the vagina so the doctor can see the cervix. The embryologist will pick up the embryo(s) in a fine catheter which is placed through the cervix into the womb and the embryos are gently expelled.

IVF add-ons, a hot topic

One of the most controversial areas of fertility treatment is the use of IVF add-ons or adjuncts. These are treatments that are added on to the routine IVF cycle, but for almost all there is no evidence that they will improve the success of IVF. This is a subject I have been working on for many years, because I believe patients should be given the correct information about these treatments.

I have been part of the HFEA committee, which has worked on a traffic light system to make the research on these add-ons more transparent. To determine if an add-on will increase the chance of a live birth, a study called a Randomised Controlled Trial (RCT) needs to be completed. For this, the patients are randomly allocated into the control or the treatment group. The control group goes through normal IVF and the treatment group has the add-on. Ideally, each group needs a few hundred patients to make the study valid, and live birth rate should be compared between the control and treatment groups. If the add-on works, it should significantly improve the live birth rates compared to the control. A green signal indicates that there is more than one good quality RCT that shows the procedure is effective and safe. An amber signal indicates that there is a very small or conflicting body of evidence, which means further research is required and the technique cannot be recommended for routine use. A red signal indicates that there is no evidence to show that the technique is effective or safe. This may be because no studies have been conducted, or because studies have been conducted but they show no evidence of an improvement in success rates. Currently none of the add-ons have been given a green light.

Read more
Your Fertile Years is available to pre-order on Amazon now. Contact joyce.harper@ucl.ac.uk if you would like Joyce to give a talk to any group or at any event.

Blogs
Chapter 1: Knowing Your Body; Understanding Your Menstrual Cycle And Fertile Window
Chapter 2: The biological clock, female fertility decline
Chapter 3: Optimising your reproductive health
Chapter 4: Everything you should know about sex
Chapter 5: If you do not want to become pregnant, how do you prevent it?
Chapter 6: How Can Sexually Transmitted Infections Affect Fertility?
Chapter 7: What you should know about pregnancy and childbirth
Chapter 8: Is egg freezing the answer to female fertility decline?
Chapter 9: What causes infertility and how we test for it

And videos to accompany the blogs on my YouTube Channel
Why I wrote Your Fertile Years
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10

9 things you should know if you want kids in the future