This document discusses IVF treatment options and provides information on when IVF may be needed and the process before undergoing IVF. It explains that couples should typically try conceiving naturally for 6-12 months before considering IVF. Initial tests and treatments may include ovulation induction medications or IUI before progressing to IVF, which involves stimulating egg production, retrieving eggs, fertilizing them in vitro, and embryo transfer. The success of IVF depends on factors like age, with average success rates of 15-50%.

1. Understanding your IVF Treatment Options

2. IVF Treatment is nothing to take on lightly and in fact
before you even consider talking to a specialist about any
form of IVF Treatment, remember its not unusual to take 6
- 12 months to conceive. For older women, it could take
considerably longer. This is why your GP may not seem too
interested in doing any tests or investigations let alone
offering you actual IVF treatment until you have been
trying for a baby for at least a year. And really trying
means lots of sex! As a rule, if you are under 35, you
should wait for a year before you start IVF treatment, but
if you are over 35, you should potentially start IVF
treatment after six months or at least be seriously
considering it. In some ways this is quite illogical, because
it tends to take older women longer to conceive than
younger women, but the whole process of fertility tests

3. IVF Treatment – why might you need it?

4. IVF Treatment maybe needed for a number of reasons;
often key causes of female fertility problems are:

5. •Issues with the womb or cervix

6. •Problems with ovulation

7. •Tubal problems – we’re not talking musical instruments!

8. Before IVF treatment is undertaken, investigations need to
uncover why the man’s sperm are not arriving at the egg,
and then to understand why a fertilised egg is not
implanting. This will involve checking:

9. • Your Ovulation and your hormonal cycle

10. • Egg pick-up, transport and potential for fertilisation in a
healthy tube

11. • The womb, the cervix, the womb cavity and lining

12. • Any relevant lifestyle factors that could affect
conception

13. • Healthy sperm

14. Thinking of the female reproductive system, as the London
Underground (albeit, somewhat less frequented!), there
could be holdups & congestion anywhere along the way.
These could be abnormalities you may have been born
with or damage related to a previous operation.

15. Before IVF Treatment - Understanding Fertility Problems

16. Go See The Doctor!

17. Before considering IVF treatment, your first port of call
should be to see your GP. They will access your medical
history and organise the ‘first-round’ of fertility tests. This
will involve blood tests to check whether you are actually
ovulating, and not to leave your other half out, a sperm
test to determine his sperm quality. Often the male side
can be set aside, however it is really important that the
man is investigated simultaneously, even if you believe
that its you who may have a problem.

18. Confirm Successful Ovulation

19. The primary, perhaps most important blood test to be
carried out is a progesterone test to confirm that your
ovaries are in fact producing and releasing an egg each
month – just like a Burford Brown! After ovulation the
individual follicle that formed this egg in your ovary will
then collapse, producing the hormone progesterone.

20. Its this significant rise in progesterone that confirms that
ovulation occurred. This test needs to be timed very
specifically for midway through the luteal phase (second
half) of your cycle. It is often referred to as the ‘Day 21’
progesterone test but it should only be done on Day 21 if
you have a 28-day cycle. The timing of this test can create
difficulties if you have irregular cycles.

21. Generally your progesterone test and your partners semen
analysis with occur at the same time (in separate rooms
you understand!) and your GP will also ensure that you
are immune to rubella. Until all these tests have been
completed there is generally no mention of IVF treatment
at this stage.

22. Additional Blood Tests

23. As a rule, three further blood tests are required on your
merry path to IVF treatment! But don’t worry you will get
used to the prodding & poking! Your GP will usually
arrange a blood test to be done between Days 1 and 3 of
your cycle. These will look at:

24. • Follicle stimulating hormone (FSH)

25. • Luteinising hormone (LH)

26. • Oestradiol

27. If you also experience irregular cycles or you display other
symptoms, your GP may also want to check:

28. • Testosterone levels

29. • Prolactin levels

30. • Your Thyroid function

31. Pre IVF Treatment Investigations – Impact of Age

32. If you have been trying to conceive for 6 months and you
are in your mid-to late thirties, the doctor may suggest a
further set of tests. These are really significant, because,
depending on their results, you might want to choose IVF
treatment at this point.

33. • an AMH blood test, which looks at your ovarian (egg)
reserve

34. • an antral follicle count, which with an ultrasound scan,
calculates the number of small resting follicles

35. The findings from these tests can be very helpful, for you
to decide whether you should consider going immediately
for IVF treatment, rather than through lengthy fertility
investigations. You should be aware that AMH tests may
not be available on the NHS. See here for more details:

36. Your GP may refer you to a fertility clinic at this point, so
that by the time you get to your appointment with the
fertility specialist, you will have the results of your blood
tests and a sperm analysis. Together all this information
will help give your IVF treatment specialist the ‘big picture’
enabling them to consider your treatment plan.

37. IVF Treatment Options – the small print!

38. Depending on the outcome of you fertility investigations,
whether the specialists have uncovered a possible cause
or whether you have ‘unexplained’ infertility, now you’ll
need to make a decision as to whether you need some
extra help with conception and therefore possibly IVF
treatment or a similar process. Your doctor will discuss
these options with you in detail. The main fertility
treatment options range from ovarian stimulation through
to IVF and beyond.

39. The diagram below sets out all your major choices, from
IUI, to IVF treatment, to Donor eggs – that’s why they call
it a ‘fertility journey’ – boy, they weren’t lying!

40. Although there is a logical progression from 1 to 6, starting
with the least invasive treatment option, you should bare
in mind that your situation unique to you and therefore
very few women will start at 1 and move through all 6
stages! Most will just travel from say; Ovarian Stimulation
to IVF with ICSI, or from IVF treatment with fresh eggs to
IVF treatment with donor eggs. Here’s the lowdown:

41. 2.Boost Ovulation with a Fertility Drug

42. If you are having problems with ovulation or erratic cycles,
then your doctor may suggest that you are suitable for an
ovulation stimulation or ‘boosting’ medications such as
Clomid or sometimes an alternative drug known as
Tamoxifen.

43. This is only appropriate if your partner has good-quality
sperm and your tubes are unblocked, know as patent. You
can take Clomid for up to six cycles, during which time you
will be monitored to check that the drug is actually
working. You will have a series of scans and a blood test
for progesterone to confirm that ovulation is occurring
plus you’ll need to have optimally timed natural sex –
spontaneity may go out the window at this point!

44. 3.Intrauterine Insemination (IUI)

45. If you haven’t conceived after three to six moths, your
doctor may suggest intrauterine insemination or IUI,
before moving onto IVF treatment. Depending on your
circumstances, with IUI you may or may not have
additional ovarian stimulation medications. IUI with
ovarian stimulation does tend to enjoy higher success
rates than natural cycle IUI. Your IUI cycles will be
monitored and, around the time of ovulation, your doctor
or specialist nurse inserts specially prepared sperm
through the cervix into the womb. It is highly important
that you have had appropriate tests to check your tubes
are clear before IUI is attempted.

46. 4./5. The big one: IVF Treatment, with or without ICSI

47. Women who have blocked tubes (non-patent) most often
go straight in the IVF treatment path. However is also an
option for women with patent fallopian tubes, but who
are experiencing unexplained infertility or who have tried
IUI for up to 6 cycles without success. With IVF, your
follicles are stimulated by a number of hormonally based
drugs to produce a large number of eggs so that they can
be collected, usually under general anaesthetic, and
fertilised by the sperm in a laboratory. A safe number of
embryos (usually one or two) will then be transferred into
the woman’s womb between two and five days after the
eggs have been collected. During an IVF cycle a woman
has to give herself injections of ovulation-stimulation
drugs and other drugs to support a pregnancy, while being
monitored carefully with ultrasound scans and blood tests.

48. There are two different ways that the egg can be fertilised
in the laboratory: either straight IVF, where prepared
sperm are placed next to the egg in a Petri dish; or ICSI
(intracytoplasmic sperm injection), where the
embryologist injects a single sperm directly into the egg,
but this does carry extra risks.

49. So, with ICSI, the woman goes through an IVF cycle in
exactly the same way; the only difference is that a more
complex technique is used in the laboratory to achieve a
successful fertilisation.

50. Choosing Your Fertility Treatment Options

51. Generally IVF clinics employ a step-by-step approach,
starting with the least invasive treatment before leading
up to full blown IVF treatment. EG, they may try ovulation
stimulation only, then proceed if necessary to IUI and
possibly only then IVF. Although this makes sense in that
for some couples, depending on the exact nature of your
fertility issue, a boost with Clomid might be all that you
need. But there is a very significant downside to this
approach, because it may take about a year to 18 months
to even arrive at the IVF treatment stage. So if you need 2-
3 completed IVF cycles to conceive, as the majority of
women indeed do, that unforgiving biological clock is
running against you! If you are in your late 30s or older,
there is a good argument for choosing IVF treatment
sooner rather than later.

52. That said, there does seem to be a good role for IUI in the
right situations. IUI can achieve around 15 per cent
success per cycle when combined with ovarian stimulation
drugs. However, there are currently debates among the
medical profession about the value of IUI for couples with
unexplained infertility as the success rates for this group
are so low. Especially when you compare this to average
success rates for IVF treatment standing at between 15%-
50% depending on your age.

53. Above all, opting for in vitro fertilisation is never an easy
decision. For some couples there may be religious or
ethical considerations and there’s the significant cost of
IVF. For others one partner may want to start IVF
treatment whilst the other doesn’t feel ready for it yet.

54. All in though it has to be said, that once a woman has
made up her mind to start IVF, they are generally very
driven in getting the process done! Clinics will often insist
that you have a minimum break between IVF cycles,
sometimes two months. Often this is real bone for
contention as many women literally can’t wait to get back
in the stirrups!

55. http://www.intertrustmedical.com/ivf-success-rates//