IVF PATIENT GUIDE

What is infertility?

Infertility is a condition where a couple fails to have children within a year of marriage and without using any means of contraception. Conception is a complicated process that depends upon many factors: production of healthy sperm by the man and healthy eggs by the woman, normal sperm shape and movement, unblocked fallopian tubes that allow the sperm to reach the egg, ability of the fertilised egg (embryo) to become implanted in the woman's uterus, and a good quality embryo.

A full term pregnancy requires healthy embryo and the normal mother's hormonal environment adequate for embryo development. When any of these factors is impaired, infertility can result.


Infertility is not a "woman's" problem. It is a medical problem of the male or female reproductive system. In about one third of cases, the cause is traced to the woman, another third of cases are traced to the man. The rest are caused by unknown factors or a physiological incompatibility.

Infertility is associated with emotional and social stress. Infertile couples need support and consideration from the treatment team, friends, family, and, of course, from each other.

 

What is the cause of male infertility and female infertility?

Roughly one-third of infertility cases can be attributed to male factors and another one-third to factors that affect women. For the remaining infertile couples, infertility is caused by a combination of problems in both partners (about 13%) or is unexplained (about 10%).

The most common causes of male infertility include azoospermia (no sperm cells are produced) and oligozoospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, male infertility is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality. It can also be due to immunological causes.

The most common cause of female infertility is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS), and endometriosis. Repeated miscarriages may be caused by congenital anomalies (birth defects) involving the structure of the uterus, uterine fibroids, and chromosomal abnormalities in the embryo.

 

How is infertility diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor conducts a physical examination of both partners to determine their general state of health and to evaluate physical factors that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place for conception.

If the physician cannot find a cause for infertility at this point, more specific tests may be recommended. For women, these include fertility hormones analysis, checking the patency of fallopian tubes, hysteroscopy of uterus, and sometimes laparoscopy. The male partner is usually requested to have semen analysis on two occasions.

Infertility treatment

Surgery and hormone therapy can correct some infertility problems. If those methods fail, doctors advise couples to enter an ART programme which may be the best chance and last hope for achieving pregnancy.
The evaluation and treatment of infertility requires a great deal of time, resources, and energy. It also requires the participation of the couple, physicians, nurses, technicians, counsellors, and many others.

 

How successful are infertility treatments?

Each couple's condition and response to infertility treatment is unique. The answer is difficult to calculate because it depends on several factors: the woman's body, the man's body, the clinic's success rate, and luck. Physiological factors that affect success include the age of the woman, uterine abnormalities, and whether both partners have infertility factors.

 

Initial visit

Your initial appointment is important as it helps set the agenda for your treatment programme. For most of the couples, the initial consultation includes a semen analysis as this can indicate a number of infertility causes and may let us move directly to specific treatments. This saves time and can eliminate a number of other tests at a later stage. Moreover, because it is a fixed price, it appeals to many couples as an excellent investment in first-stage analysis.

At the initial consultation, we will look at your medical and fertility history, as well as your partner’s one; the male partner may be asked to provide a semen sample at the beginning of the consultation so that the results are available for discussion with the doctor. The female partner will have a physical examination and, in some cases, the male partner may also be examined.

This examination and the semen analysis may help to identify the underlying problem and provide firm guidelines as to the most appropriate treatment, although this is not always the case.  The type of treatment the doctor decides for the highly couple depends on the cause of infertility being diagnosed.     

 

 Confidentiality

More than the usual degree of medical confidentiality covers information about IVF treatment. Except in case of an emergency, the Centre undertaking treatment is not allowed to communicate with others (including GPs) about it, except with the express written permission of the couple concerned. However, information is sometimes given to the couple to pass on to their doctor or to others. Because of this regulation, it may be necessary to obtain written permission to pass on some general details of treatment to hospital and Health Authority staff who may be involved in a peripheral way, and with the administration of its funding. This information would be treated with the same confidentiality as that accorded to other medical information.