The Patient's Guide to Embryology

Think you might need IVF? Read this first.

IVF isn’t always necessary for many couples who just need a little help to get pregnant. There are lots of simpler, less invasive, cheaper alternatives to try first.

Once you have decided you want to try for a baby, it can become all-consuming. Watching the months tick by and every time your period arrives again wondering why it is taking so long to get pregnant when other couples seem to find it so easy.

The reality is that you are attempting to create a human being and it can take time for that to happen successfully. A lot of precise, complex science needs to happen to create a new life. However, a fertile couple who are having regular sex should expect to get pregnant within 12 months. If you have still had no success after 12 months, you may start to think about some interventions.

You may think that the only option is IVF if you are struggling to get pregnant but this is often not the case. Here are some things you should consider before seeing your doctor.

Are you having sex at the right time?

If both partners are fertile and have sex at exactly the right time, they have around 30% chance of getting pregnant every month. However, it can be very difficult to know exactly when that right time is as ovulation is easy to miss. You may think that simply stopping using contraception is enough to get pregnant, but if your timings are wrong it can take a lot longer than you expect.

Get your timings right

The egg is released (ovulated) from the ovary in the middle of the menstrual cycle around 2 weeks after day 1 of your period (or more accurately 2 weeks before the first day of your next period, which is less easy to predict). To ensure the sperm gets into contact with the egg, you need to have sex at the time of ovulation. Men may have a constant supply of sperm, but women only release one egg every month and that egg will only live for 24 hours in the body. If it isn’t fertilised in these 24 hours, the egg dies and you need to wait until next month.

This means that you need to have sex right at the time of ovulation to get pregnant. Luckily sperm can live in the female body for up to 5 days to wait for the egg to be released, but your chance of success increases the closer you have sex to the day of ovulation.

Testing for ovulation

You can get an idea of when ovulation is approaching by testing the consistency of vaginal discharge and some women can literally feel the ovary release the egg with a small jolt of pain known as ‘mittelschmerz’. But this is the 21st century and there are much more reliable methods of testing for ovulation. The best way is to test for a specific hormone called luteinising hormone (LH) which can be detected in urine immediately before ovulation. This can be done easily by weeing on a test strip which tells you when the egg is about to be released.

Subfertility vs Infertility

Infertility is often referred to as ‘subfertility’ and vice versa but there is a big difference between the two.

Infertility means that there is 0% chance a person can have a baby naturally and IVF is the only way forward. For women this can range from reasons such as the menopause, to structural problems like blocked/missing fallopian tubes. Infertility in men most often means that they do not produce any sperm, or that the sperm that is being produced is unable to fertilise an egg.

Subfertility is much more common and can mean that a couple finds it more difficult to get pregnant naturally but IVF is not always necessary. For example, this might be because a woman has irregular periods or because a man’s sperm count is lower than average.

Alternatives to IVF

For 1 in 6 couples, no amount of carefully-timed sex will work because one or both or the partners has a fertility problem. IVF isn’t always necessary for many couples who just need a little help to get pregnant and there are lots of simpler, less invasive, cheaper alternatives to try first:

Ovulation inducers

Some women find that they can’t get pregnant because they don’t ovulate or they ovulate very irregularly. This is usually due to an imbalance of hormones and irregular periods (or no periods).

There is a very simple treatment used to induce ovulation called clomiphene citrate, also known as Clomid. Clomid comes in tablet form and it works by blocking the action of estrogen. As estrogen levels decrease, your body produces more of the hormone FSH and this is what causes eggs to grow and be released from the ovary. This treatment makes ovulation much more predictable so there is the opportunity to get pregnant naturally every month when the egg is released. There are also alternative drugs to induce ovulation such as metformin, Letrozole or gonadotrophins but they all function in a similar way.

Intrauterine insemination (IUI)

IUI is a simple fertility treatment where a sperm sample is prepared in the lab and then placed into the uterus just before an egg is ovulated.

Preparing the semen sample first means that the majority of the poor quality sperm are removed, leaving a small stock of the healthiest, fastest swimming sperm which are ready for fertilisation. Ultrasound scans are used to monitor the ovaries in the days leading up to the treatment to ensure an egg is mature and ready for ovulation. Just before the egg is released, the sperm sample is placed into the uterus in a quick procedure similar to a smear test. Millions of sperm enter the uterus and hopefully one is able to reach the egg and fertilise it successfully.

The success rate is relatively low compared to IVF at around 15-20% each time, but it can be a good, cheaper alternative if you find yourself lucky.

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