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How common is infertility?

Infertility is a growing issue for many couples. Infertility affects 1 in 6 couples of childbearing age in the UK.

25% of infertile couples have more than one cause of infertility.

The current increase in infertility might be the result of more women choosing to delay starting a family until later in life, when their reproductive health can be affected.

The increase of some sexually transmitted diseases such as Chlamydia can result in conditions such as blocked tubes, preventing pregnancy from occurring.


When is a woman’s most fertile time?

A woman’s most fertile time is during ovulation.

The average menstrual cycle is 28 days – that is counting day one as the first day of menstrual bleeding then the next period is due to start 28 days later.

The menstrual period comes because an egg fails to become fertilised. The period comes about 12 to 14 days after the egg is produced.

Therefore, in the average 28 day cycle the egg is produced around day 14. Sperms can live happily 48 hours in the vagina or the uterus so the most fertile time is from day 12 to day 16.


What things increase a woman's risk of infertility?

There are a number of factors which can increase a woman’s risk of infertility. These include:

  • Her age.
  • Being under or overweight.
  • Smoking.
  • Moderate or heavy caffeine and/or alcohol use.
  • Excessive exercise.
  • Certain environmental exposures.
  • Depression.
  • Sexually transmitted infections.
  • Hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency.


Can I get pregnant if I no longer have periods?

This depends on the reason of the lack of periods.

If in fact you are menopausal then you will need egg donation.

However, if the problem is hormonal, you may be treated with fertility medications.


Does infertility relate to the woman only?

No, infertility is not always a woman’s problem.  Both women and men can have problems that cause infertility.  About one-third of infertility cases are caused by women’s problems.  Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

With men, declining sperm counts and testicular abnormalities, are common causes of infertility.

With women, the most common causes are tubal blockage, endometriosis, PCOS, and advanced maternal age which affects egg quality/quantity.


How does lifestyle affect a man's fertility?

A man’s sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

  • Heavy alcohol use.
  • Recreational drugs.
  • Anabolic steroids and body building medications.
  • Certain medicines.
  • Smoking cigarettes.
  • Age.
  • Environmental toxins, including pesticides and lead.
  • Radiation treatment and chemotherapy for cancer.
  • Health problems such as mumps, serious conditions like kidney disease, or hormone problems.


What causes infertility in men?

Sometimes a man is born with the problems that affect his sperm.  Other times problems start later in life due to illness or injury.   Infertility in men is most often caused by:

  • Blockage.   A blockage in any part of the reproductive system that helps deliver sperm, such as the epididymis or vas deferens, can cause infertility.
  • Medications.  Certain medications, such as anabolic steroids, cancer drugs, have been associated with infertility in men.
  • Low sperm count. When a man produces too little sperm, it can cause problems with conception.
  • Sperm problems.  Sometimes sperm are shaped abnormally or move in abnormal ways, which can lead to male infertility.
  • Undescended testicle.  A testicle that doesn’t move down from the abdomen into the scrotum can affect sperm production.
  • Varicoceles.  This happens when the veins on a man’s testicle(s) are too large.  This heats the testicles.  The heat can affect the number or shape of the sperm.
  • Medical problems.  Some medical conditions, such as kidney failure, can lead to male fertility problems.


Do you do male infertility evaluations?

We do have a full male fertility service with male fertility specialists (Andrology) available in our department to deal with any male fertility issues.  Please contact our unit for more information.

How long should a couple try to conceive before going to the doctor?

If you are under 35 and have had frequent (about two or three times a week) unprotected sex for at least a year without conceiving (or three to six months if you’re 35 or older), you may want to consult a fertility expert.

Or see a doctor if you have a history of:


Can I find out earlier if I have fertility issues?

You always have the option of asking your health care provider to conduct a complete examination and perform initial investigations to determine if either partner has possible fertility issues.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology.

Doctors recommend specific treatments for infertility based on:

  • Test results.
  • How long the couple have been trying to get pregnant.
  • The age of both the man and woman.
  • The overall health of the partners.
  • Preference of the partners.


How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors.  Some things that affect the success rate of ART include:

  • The reason for infertility.
  • The age of the partners.
  • The type of ART treatment.
  • If the egg is fresh or frozen.
  • If the embryo is fresh or frozen.


Is there a waiting list? And how long would I have to wait for the start of my IVF treatment?

We aim to have no waiting list for IVF once you have had your treatment plan and completed your consents, beyond what is necessary due to period dates and the need to ensure your tests are up to date.  Most of our patients have their first initial consultation with our fertility specialist within a few months of first contact.  They usually begin treatment within 2 to 3 months after completing the consent forms and other documentation.

What if my IVF attempt failed? How long will I have to wait before trying again?

We may suggest waiting for a short period of time before starting another IVF treatment. This is to make sure that your hormones get back to normal before commencing another treatment cycle.

What happens with my remaining embryos that are not implanted?

Remaining embryos can be frozen with a specific technique.  Later they can be implanted into your womb without the hormonal stimulation.

How long can my embryos remain frozen?

Your embryos can be kept for 55 years, if you renew when contacted every 10 years.

What is Intra-cytoplasmic sperm injection (ICSI)? When is it useful?

ICSI (Intra-cytoplasmic Sperm Injection) is an infertility treatment that can be used with conventional IVF.  During ICSI, one single sperm is injected directly into an egg.

ICSI is especially useful in cases if there is a problem with a man’s sperm.


Do you perform intra-cytoplasmic sperm injection (ICSI) on all patients?

No, we do not.

We feel that ICSI should only be performed when necessary, for example when there is a problem with the sperm or there is a prior history of poor fertilisation through IVF.


What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm.

The fast moving sperm are then placed into the woman’s womb close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle.


Are urine pregnancy tests as reliable as blood tests?

No.  The urine test is predictable to about 25 mIU per mL of bHCG (the pregnancy hormone).  It also depends on your hydration level.

On the other hand, blood tests are sensitive to approximately 2 mIU per mL.

Therefore, a very early pregnancy may still be detected with blood tests but be missed with a urine pregnancy test.


Can embryos from egg donors be frozen?

Yes, embryos can be initially frozen for 10 years.

When is the best time to measure urine for ovulation?

We usually recommend that patients test their urine in the early afternoon.  If measured early in the morning, the urine can be concentrated and thus give you false positive results.

We recommend any time after 3.00 pm.


Do you only treat married couples?

We provide expert fertility medical treatment for married and unmarried couples, same sex couples and individuals.

Can I come to the consultation on my own?

You are both required to attend as a couple for the initial consultation to complete all the necessary paper work and consents.

How much will it cost?

If you meet the criteria for an NHS funded cycle there will not be any cost to you whilst undertaking your NHS funded treatment.

Do you accept single women and lesbian couples?

Yes we do.  As long as your Clinical Commissioning Group (CCG) agree to fund your treatment.

Are there any risks or side-effects with IVF?

As with any form of treatment, potential risks and side-effects do exist.  One or two embryos are 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, increasing 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 abdomen.  Symptoms of this include swelling in the abdomen, 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.  We have counselling facilities available in our Unit. There are also other support groups available in the UK.


What support is out there?

We have in-house counsellors, who are available to see you should you find this beneficial.

Visit our Counselling Service page here.

As well as counselling you may find further ‘couple counselling’ useful to work through issues brought up by the treatment.


How long can sperm be stored?

There is no practical limit to the length of time sperm, correctly maintained in liquid nitrogen, can be stored.

Is freezing harmful to the sperm?

A percentage of the sperm will not survive the freezing process. The survival rate varies greatly between individuals.

What is the procedure for using the frozen sperm?

You need to be seen in the clinic a few weeks prior to the date you anticipate needing the samples.  Contact the Andrology Department for further details.

The woman would need to be assessed by the doctor for some investigations. Some documentation needs to be completed prior to any insemination.  Be sure to communicate with your doctor in advance to avoid any delays.


How can I guarantee that I will become pregnant using the samples?

Regardless of how many samples are frozen it is impossible to guarantee success. The best advice is to carefully consult with both an Andrologist and your doctor before beginning any use of the samples.

What if the initial semen quality is poor, or concentration is very low?

Many cryopreserved samples may not be of sufficient quality for use with artificial insemination. However, IVF with ICSI is regularly performed with samples of poor quality or concentration.

How can I be sure my semen sample is not contaminated with another sample or mislabeled?

The specimen container used to collect the sample is labeled and verified by the patient prior to collection. Once the sample is received it is handled with extreme caution. All materials used in the process are labeled with the patient’s name, the current date, and a hospital number unique to the patient and the sample collected. Each sample is assigned a physically isolated workstation. All tools and solutions used in preparing the sample for cryopreservation are sterile and single-use. Certified Andrology technicians will ensure there is no confusion in the handling of semen samples.

What if I move out of the area?

Arrangements can be made to ship semen samples to another clinic or storage facility in the area you are moving to. Some documentation will be necessary to ensure proper handling and security of the samples.

Can we have IVF treatment if myself and my partner are not married?

Yes, you can, as long as neither of you are married to someone else. You would also need to provide proof that you are living together.

How many embryos can be implanted on an IVF cycle?

The maximum number of embryos implanted will depend on your age, number of previous IVF attempts, and quality of embryos.

Normally up to 2 embryos can be implanted.


What is a blastocyst?

A blastocyst is 5-day old embryo that has around 70-100 cells.

For many patients, these blastocysts may have a greater chance of implantation, permitting us to implant fewer embryos and lower the possibility of multiple births while, at the same time, increasing the chance of pregnancy.