Treatment options
Once you have had the fertility assessment we will put all the information together to work out what the key factors affecting your fertility are, what your chances of conceiving are and what treatment options might be most appropriate.
Providing personalised care, tailored to your individual circumstances is really important to our team and we want to ensure you feel involved and cared for throughout your journey.
There are a number of potential treatment options which may be recommended:
Follicle tracking
This is a method of monitoring your menstrual cycle with ultrasound scans to identify when a leading follicle is produced and to try and help pinpoint ovulation, allowing you to have sex around the right time of the month. This treatment is most appropriate for women who aren’t sure if they are ovulating regularly or have slightly irregular cycles. It is often combined with ovulation induction.
Ovulation induction
Ovulation induction is a treatment commonly used for women who are not ovulating regularly, as can happen in PCOS or hypothalamic amenorrhoea, where you may have irregular or absent periods. During this treatment, medications are used to stimulate the ovaries to produce a small number of follicles each month. Most frequently this is with simple tables (Clomifene or Letrozole) taken from days 2-6 of your cycle. Some women require gonadotrophin (FSH and LH) injections depending on your history. This is then combined with follicle tracking scans, usually starting from around day 8 of your cycle so we can monitor your response to the medication. Once the follicle or follicles are mature, we then have the option of giving a one off hormonal injection (hCG) to trigger ovulation, or letting you ovulate naturally. You then can have intercourse at the correct time of the cycle to maximise the chances of success (timed intercourse) or intrauterine insemination (IUI) can be performed.
Intrauterine Insemination (IUI)
IUI is a fertility treatment where sperm are inserted into the womb at the correct time of the cycle. The menstrual cycle is monitored with scans, either in a natural cycle or combined with mild simulation medications (see ovulation induction). At the correct time in the cycle the semen is prepared in the lab and inserted into the womb so that hopefully fertilisation takes place naturally. The IUI procedure to insert the sperm is a bit like having a smear test and usually just takes a few minutes. A small flexible catheter is passed through the vagina and cervix into the womb and the sperm transferred. IUI can be done using partners or donor sperm.
Before having IUI we normally recommend having a tubal assessment carried out to make sure that IUI is appropriate for you.
In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI)
IVF and ICSI are where fertilisation of the egg and sperm takes place outside the body in the embryology lab. There are many reasons why IVF/ICSI may be recommended including fallopian tube problems, male factor, severe endometriosis, prolonged unexplained infertility or failure of other treatment.
Fertility preservation – egg or embryo freezing
Women are increasingly looking to preserve their fertility and this is most commonly done via egg or embryo freezing.
Egg freezing involves stimulating the ovaries with medications to produce multiple eggs, collecting the eggs and then freezing them. The eggs can then be thawed at a later date and used for fertility treatment.
Egg freezing might be right for:
- People who aren’t ready to have a child but are worried about their fertility declining
- People who are due to have a medical treatment which might affect their egg reserve (such as cancer treatment)
- Transgender people who would like to preserve fertility prior to hormonal or surgical treatment
An alternative option for fertility preservation is embryo preservation. This involves egg collection and then fertilisation with partner or donor sperm to create embryos which are then frozen.
The success rates of both these treatments depends largely on your age. We can offer consultations to discuss your options for fertility preservation and the likely chances of success. The first step is usually to have a fertility assessment and investigations (including AMH and pelvic ultrasound) to find out whether egg or embryo freezing may be suitable for you.
The HFEA offers lots more useful information on egg freezing and success rates.
Transgender people
Trans people are increasingly undertaking fertility preservation prior to having medical or surgical treatments. We can offer advice, baseline investigations and treatment for sperm, egg or embryo freezing. We also provide support and treatment for trans people who subsequently wish to conceive using their frozen sperm or eggs.
Normally we would start with a consultation to go through your medical history and advise whether any fertility investigations are recommended. We will then decide which treatment is right for you and explain the fertility preservation process. A number of investigations (blood tests) are then required in order to legally store eggs or sperm and you will be offered counselling with a specialist fertility counsellor.