A: Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.
Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
A: In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.
The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality. The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.
In some couples, no cause can be found for their failure to conceive, despite very intensive investigation. Both partners seem quite healthy, but they simply do not conceive together. This can be very distressing and seem quite incomprehensible, but it does happen reasonably frequently.
Q3: How is Infertility Diagnosed?
A: Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.
If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.
Q4: How is Infertility Treated?
A: Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.
Q5: What is In Vitro Fertilization?
A: In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.
In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 18nhours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.
IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatments.
Q6: When should I seek advice for infertility?
A: The first place to seek advice regarding a possilbe infertility problem is your GP. You and your partner should be assessed as a couple, at the same time, rather than one after the other. It is very important not to attach blame to yourself or your partner, even if one of you has an obvious problem.
Q7: What are my chances of getting pregnant?
The average success rate for IVF treatment using fresh eggs in the UK per cycle started (HFEA Guide to Infertility) is:
27.6% (for women under 35)
22.3% (for women aged 35-37)
18.3% (for women aged 38-39)
10.0% (for women aged 40-42)
Current results for IVFWales can be found by clicking the results icon. These will be updates throughout the year.
Q8: Do you have female doctors?
A: Yes our team is predominantly female. If you click ‘About Us’ you will see more information about the team
Q9: How long will treatment take?
A: Approximately a month. This is dependant on the way your ovaries respond to fertility drugs
Q10: What are your success rates?
A: We are extremely pleased with our success rates which are above the national average. If you go to our 'Results' section of the web site you will see our recent success rates.
Q11: How much will it cost?
A: The current costs of treatment can be found under ‘Treatment’ on this site
Q12: Do you accept single women and lesbian couples?
A: Yes we do. IVFWales has a policy of examining every case on an individual basis
Q13: Do we have a Donor Egg / Egg sharing program?
A: Yes we do. We are please to announce the launch of our egg sharing scheme which will be carried out here at IVFWales. Often clinics have to send egg share patients to other clinics in the UK on the day of treatment. All of our egg sharing is 'in house'.
Q14: Will I be accepted?
A: There a several screening tests that you have to complete prior to commencing treatment. You also have to meet HFEA guidelines which we are obliged to follow. Following these and meeting one of the doctors (possible counsellors) and completed consent forms you will be accepted
Q15: Why should I choose your clinic?
A: We are very please with our current success rates which are above the national average. The team has undergone considerable change since mid 2006 with a completely new scientific team. The head of Embryology arrives to us from the IVF program at Harvard Medical school, Boston, USA – one of the most successful fertility programs in the world. This has led to increase pregnancy rates and new state of the art treatment options.The team has a very forward thinking drive to enable patients to receive individualized care and have the very latest treatments available to them. Our new purpose built IVF laboratories and theatre (October 2007) are amongst the most modern in the world, built to the exacting standards required by the European Tissue Directive. Our new facilities can only help to further improve our excellent results
Q16: What’s Involved?
A: Before treatment commences, you’ll have a full assessment at a fertility clinic and be told all about what’s involved so you’re clear from the outset.
A cycle of IVF takes about four to six weeks to complete. When the treatment begins, a woman is given fertility drugs to stimulate the production of eggs. Ultrasounds and blood tests are performed regularly to check how the eggs are developing. When they’re deemed ready to be removed, sedation will be given and a doctor will surgically remove them from the ovaries with a fine hollow needle. The eggs are then mixed with sperm and left to fertilise in a laboratory (this is where the term ‘test tube baby’ came from, as it was often assumed that the sperm and eggs were mixed in a test tube).
Whilst the fertilisation is taking place, the woman is given hormones to prepare her body, and especially her uterus, for pregnancy. Fertilised eggs will form a ball of cells, called an embryo, and when they’re ready two or three embryos are implanted back into her uterus to, hopefully, achieve pregnancy. If any extra embryos have been formed, these are often frozen and used in future IVF cycles, where the first or more doesn’t work.
Q17: Are There Any Risks or Side-Effects with IVF?
As with any form of treatment, potential risks and side-effects do exist. More than one embryo is often placed in the uterus, so there’s a higher chance that you could end up having twins or multiples, rather than a single pregnancy. Multiple pregnancies carry extra risks themselves, upping the chance of pregnancy complications or miscarriage.
Mild reactions to the drugs do occur sometimes, causing symptoms such as headaches, mood swings and hot flushes. A more severe reaction is called Ovarian Hyperstimulation Syndrome (OHSS), where cysts develop on the ovaries and fluid collects in the stomach. Symptoms of this include swelling in the stomach, pain, vomiting and nausea.
Sometimes it’s also possible to have an ectopic pregnancy, whereby the embryo develops in a fallopian tube, rather than the womb. If you’re having IVF and develop any unusual or concerning symptoms, then it’s important to speak to your doctor immediately.
Undergoing IVF can be emotionally challenging too, especially when treatment cycles are unsuccessful. You can receive counselling from IVFWales, but there are also other support groups available in the UK.
Q18: What support is out there?
A: We have an in house counsellor who is available to see you should you find this beneficial. Please click on 'support' then 'counselling' for further information. As well as counselling at IVFWales, you may find further 'couple counselling' useful to work through issues brought up by the treatment. Organisations such as Relate or BICA may be able to help with this, and support groups such as Fertility Friends and the Infertility Network UK can provide information on IVF and support patients throughout treatment (see help and info for contact details). This and other websites have forums and message boards so people can post questions and advice for others going through a similar experience. Ask your health professional if there are any support groups at the clinic too. Where possible, explain how you're feeling to family and friends. The more they understand about what you're going through, the more sensitive and supportive they can be.