Ovulation can be the first step and indication of fertility options. When analysing a monthly reproductive cycle if ovulation doesn’t happen or doesn’t occur with each of your monthly cycles it can make it difficult or prevent you from being able to conceive without support. Equally, even if you or your partner’s/co-parent’s body has no medical issue in relation to being able to conceive but you may need assistance with donor conception whether it be sperm, ovary or embryo donations.

 

Problem with ovulation are the most common cause of infertility for cisgender heterosexual couples. Whereas, gamete donation is the biggest need for LGBTQI and Queer couples in conceiving.

 

 -Independent Conception at Home-

 

ICI - Intracervical Insemination

 Artificial insemination can feel like a reliable, affordable and sometimes safer way to start your family.  It is a highly personal choice and should be discussed with your donor before any agreement is made. Although, it can work for many couples or people, it, like any other fertility treatment, is not a guarantee of conception.

 

ICI has a 10-15% success rate per menstrual cycle. It typically takes several ovulation cycles to conceive and there are many videos online to do it as accurately and as safely as possible if at home. The most important factor is to time the insemination with the peak time of your ovulation cycle to reach your most fertile window. Tracking your ovulation and using ovulation strips to track your ovulation can be paramount to a successful conception.

 

If you a single parent, in a same sex or queer couple using a donor or you have intercourse with someone with the intention of viewing a possible conception after as a donated sperm, the donor/person will be considered as one of the legal parents to any children you might have. This in turn means, they have rights over, responsibilities for and financial obligation to your child.  

 

Family lawyers can help you figure out where you stand or what the best process is for you to go with.

 

If using a donor from a licensed clinic, this ensures the donor in not the legal parent to your child and your partner if you have one, is legally recognised as your child’s second legal parent.

 

-Drugs and Medication-

 

If needed, you may be prescribed different drugs to stimulate ovulation or to treat other symptoms of conditions such as PCOS (polycystic ovary syndrome). Drugs that help with ovulation aren’t recommended for people with unexplained infertility as they haven’t been found to increase chances of getting pregnant.

 

·      Clomifene – encourages the monthly release of an egg. Commonly known as Clomid.

·      Letrozoke – is an alternative to clomifene.

·      Metformin – is not a fertility drug but it can help people with PCOS ovulate as it treats insulin resistance, which may regulate hormones.

·      Gonadotrophins – these are injected and can help stimulate ovulation in people and also improve fertility for those who produce sperm.

·      Gonadotrophin-releasing hormone and dopamine agonists – are other types of medication that can encourage ovulation.

·      Tamoxifen also an alternative to Clomifene may also be offered if you have ovulation problems.  

 

-Surgery-

 Surgical procedures are used to treat any physical blockages or scarring on any of the organs connected to your reproductive system.

 

 

Fallopian Tube Surgery

 If a HyCoSy has shown any blockages or scarring on your fallopian tubes, you may need surgery to remove any blockages to make it easier for your eggs ton pass through. Possible complications can occur with blocked fallopian tubes such as ectopic pregnancy when a fertilised egg implants in your fallopian tube rather than your uterus. Success of surgery will depend on the extent of the damage to the fallopian tubes.

 

 

Surgery of Endometriosis, Fibroids and PCOS

Laparoscopic surgery can be used in cases of endometriosis to destroy or remove endometrial tissues and cysts.

 

Surgery can also be used to remove fibroids; benign growths in the uterus.

 

Laparoscopic Drilling

 For people with PCOS a minor surgical procedure of laparoscopic drilling can be offered if ovulation drugs haven’t worked. It used heat or laser treatment on the ovary.

 

Epididymal Blockage

The epididymis is a coil-shaped structure in the testicles that helps to store and transport sperm. Sometimes this structure can become blocked, preventing sperm from ejaculating normally. Surgery can be used to attempt to correct this blockage.

 

Surgical Sperm Extraction

If you have a blockage that prevents the release of sperm, you were born without the Vas Deferens – the tube that drains the sperm from the testicles or if you’ve had a vasectomy or a failed vasectomy reversal.

 

The procedures are done through local anaesthetic. On the day of the procedure you’ll be advised of the quality and the tissues or sperm collected. These will then be frozen and placed in storage for you to use at a later stage.

 

-Assisted Conception-

Defined as the use of medical techniques to assist and help in the process of becoming pregnant.

 

IUI Intrauterine Insemination

High quality sperm is separated from sluggish sperm in samples or donations. The sperm is then transferred directly into the womb to meet the ovary. It is also the main procedure if needing to use sperm donation to conceive when you have no other fertility concerns.

 

IUI may be offered to you on the NHS if :

·      You’re unable to have vaginal sex due to a physical disability, sexual trauma or psychosexual problems.

·      You have a conditions that needs specific needs to help you to conceive i.e. if one of you has HIV or it’s not safe to have unprotected sex with people.

·      You’re in a queer or same-sex relationship and need to use donor sperm.

 

IVF – In Vitro Fertilisation

Your ovaries are stimulated using drugs so you produce more eggs than normal. The eggs are then extracted and fertilised with the sperm in the lab by mixing them in the dish together.  It is not a guaranteed method of fertilisation so if the sperm doesn’t meet the egg in the dish, it can be considered a failed cycle. It can be an extra cost if you’d like the sperm to be specifically injected into the ovaries (ICSI). It’s important to ask what processes your health board or clinic use and include in their IVF processes.

 

If successful, the resulting fertilised eggs are then known as embryos which are then transferred to the womb to develop and grow.

 

Intracytoplasmic Sperm Injection (ICSI)

Used as a treatment usually for cis het couples where there is a low sperm count or low sperm quality. It is connected to an overall IVF treatment but the sperm is then injected directly into the egg instead of leaving them to mix in a dish.

 

This added step in IVF improves the chances of conception as the sperm doesn’t need to then work to penetrate the egg as this part is done through the injection. From a treatment sense, it is an identical procedure and process for a couple going through IVF as the procedure has the added laboratory process to then specifically attempt to fertilise the egg.

 

Egg, Sperm and Embryo Donation

If you are struggling with fertility due to a lack of eggs or sperm or due to specific problems with your own, you may be able to receive egg or sperm donation to try to conceive.

 

As egg donation is quite an intricate process, treatment for donor eggs is carried out through IVF.

 

 If using donor sperm with no other underlining concerns, IUI is generally used to support conception.

 

Anyone who donated their eggs or sperm can no longer remain anonymous by law and need to provide information about their identity. A child who is born through donor eggs or sperm are legally entitled to find out the identity of their donor once they reach the age of 18.

 

Embryo donation can occur for three reasons. If someone has embryos left over from their own treatment or in fertility preservation, they can donate them to people or couples who need them. This allows someone to experience pregnancy (if they can biologically carry) which they mightn’t have been able to if seeking other options such as adoption and fertility.

 

People can also donate your embryos to research in infertility and genetic conditions for use in training. However, there are strict criteria for embryo donation for research.