Conception

Planning on getting pregnant | Signs of ovulation | Problems getting pregnant | Ovulation calculator

Fertility treatments

Clomid | Surgery | Assisted conception | Private vs NHS | Emotional toll of TTC

If tests reveal problems, there are three main types of fertility treatment:

• Medicines
• Surgical procedures
• Assisted conception

Medicines to assist fertility

If your tests suggest you're not ovulating normally, your GP may suggest Clomid (clomifene citrate) to kick-start and regulate ovulation. It's not the only medicine for this purpose, but it's a common one.

There are thousands of posts on Mumsnet about Clomid. This one is a 'starter' thread and will give you a flavour of the wealth of advice and information available, while this thread - and many others - have a serious amount of detail.

Another treatment for ovulation problems is Metformin, particularly if your problems are caused by PCOS. And some women are prescribed medicines containing gonadotrophins, to stimulate ovulation.

If the drug treatments don't do the trick, then the next step is...

Surgical procedures to assist fertility

For you:

• Fallopian tube surgery to repair your fallopian tubes if they're blocked or scarred, to make it easier for eggs to pass along them.
• Laparoscopic surgery - a thin, flexible microscope with a light on the end, called a laparoscope, is guided through a small incision in your abdomen so that a surgeon can see what's going on inside or perform surgery, for example ovarian drilling on women with polycystic ovaries.

For him:

• Surgery to repair blockages in the epididymis (the bit of the testicles that stores and transports sperm).

If none of these procedures lead to pregnancy, then prepare to enter a world of acronyms (IVF, IUI, ICIS etc) and more complex medical interventions.

"Make an appointment to see the fertility clinic. Then go on holiday, get married and get drunk for two weeks. Then realise you are pregnant. Don't then go for the appointment anyway just in case because the shouty nurse will slam your folder shut and glare at you before asking you to leave and come back when you are NOT pregnant. Oh, and stuff your DH full of sperm-boosting vitamins." MarkStretch

Assisted conception

This thread is a good introduction to assisted conception (and the bits in between).

• Intrauterine insemination (IUI)

IUI tends to be used when doctors can't figure out what the problem is, or when the problem is slightly abnormal sperm.

A fine tube, inserted through your cervix, is used to put sperm into your womb. (The sperm has been 'collected' from your other half and gone through a separate 'washing' procedure to select the grade-A specimens). IUI is done to coincide with ovulation to maximise your chance of conceiving.

The NICE guidelines are that couples should be offered up to six cycles of IUI on the NHS, but in reality it might depend on the budget decisions of your local primary care trust.

Some women continue to take Clomid while they're having IUI.

"My first IUI (two years ago), aged 35, was successful first time. My second attempt at IUI last year took a little longer - 5 times actually - but it finally worked. I used only Clomid on both occasions. Ultimately I found it less stressful than trying to seduce my partner into having sex at exactly the right time every month!" LiliAnjelika

"I've had it twice. First time it took 8 'goes' to conceive DD (most doctors won't keep going that long, by the way, we had private treatment). Second time it worked first month and I was a bit shock. It felt like a "surprise" baby, which is a bit daft when you're having fertility treatment. Even though the cycle-by-cycle success rate isn't great, it did work for us." MrsTittleMouse

• In vitro fertilisation (IVF)

In IVF, your natural cycle is 'turned off' (known as down-regulation) and then you take drugs to stimulate your ovaries to produce more than one egg.

These eggs are then removed from your ovaries and fertilised with sperm (either your partner's, or a donor's) in a laboratory and incubated for a few days.

Next the fertilised embryos are put into your womb and if an embryo gets settled in and attached, the result is pregnancy.

NICE, which sets clinical guidelines, says you should be offered up to three free cycles of IVF on the NHS if:

• you're aged between 23 and 39
• the cause of your fertility problems has been identified
• you've had infertility problems for at least three years

But in reality there are wide variations between primary care trusts as to the number of cycles funded (a minority don't fund any) and in waiting times.

Figures released by the Department of Health in June 2008 show 94 per cent of trusts don't provide the recommended three free cycles and all but a few trusts have imposed criteria for free treatment, eg rejecting patients who smoke, or who already have a child.

"You are doing well with two [cycles] on the NHS, I've got this too, but a lot of people have only one and I heard on the news this week that some primary trusts are offering NONE!" sootykalucy

• Intracytoplasmic sperm injection (ICSI)

If there's a problem with your partner's sperm - too few, too poor quality or none in the semen because of a blockage - you may be offered ICSI.

This procedure is a variation of IVF, which involves injecting a single sperm directly into one of your eggs. NICE says ICSI increases the chances of fertilisation more than if IVF is used on its own. But, of course, even once the eggs are fertilised it makes no difference to your chances of a successful pregnancy.

"I have had ICSI, resulting in my beautiful dd, now one. I've had ibe full cycle and one frozen cycle this year (BFNs, sorry to say) and am now waiting for the go ahead for our next try. It's a hard road, but worth travelling." swerve

• Egg and sperm donation

If it's clear that, for whatever reason, either you're not producing eggs or your partner isn't producing sperm, then you may consider using eggs, or sperm, from a donor. Fertility treatment with donor eggs is normally carried out using IVF.

Anyone who registered to donate either eggs, or sperm, after 1 April 2005, can no longer remain anonymous and has to provide information about their identity. Any child born as a result of donated eggs or sperm is legally entitled to find out the donor's identity once they reach 18.

"I have had successful donor insemination, due to DH having a zero sperm count. It has worked out very well for us, and we have had no regrets or doubts about it. I think that that's partly because we had fertility counselling first, to get all of the potential issues out in the open before we even started (things like mourning the biological child that you can't have together, whether/how to tell the child etc). I don't want to sugar coat it though, the diagnosis and the decision-making were really, really hard." hidingidentity

• Blastocyst transfer

Blastocyst transfer treatment is sometimes used if the problem is embryos failing to implant in the womb.

Embryos are allowed to develop for five to six days after fertilisation before they're put back in the womb.

"I had a blast transfer - we had nine excellent eight-celled embryos on day three. Because there was nothing between them the lab took them to day five - the theory is that the weak/abnormal embryos won't survive & you'll just be left with good ones to transfer. Of our nine only two made it to blast (which is kind of the point) both were transferred & I ended up pg with twins. Unfortunately we lost both of them (one early and one at 16 weeks). You do have a higher chance of identical twins as well (especially if you do assisted hatching too), blasts are much more likely than three-day embryos to split. I know a surprising number of people who transferred two blasts and ended up with triplets." minster

• Assisted hatching

Despite sounding more akin to chickens, a human embryo also has a gel-like shell (the zona pellucida) and an embryo has to 'hatch' from this to attach to your womb lining.

Assisted hatching is when the embryo is helped to hatch by making the shell of the embryo thinner, or by making a small hole in its 'shell'.

• In-vitro maturation

In IVM, immature eggs are removed from the ovaries without the use of drugs and matured in a laboratory before being fertilised. This is a new technique, which is best suited to younger women who have regular periods.

Its advantage is that, unlike IVF, women don't have to take hormones to stimulate their ovaries to produce mature eggs, which removes the risk of hyper-stimulation syndrome.

Private vs NHS

Criteria and waiting times for fertility treatments vary across the NHS. If time is of the essence, you may consider going private. The costs are considerable - a cycle of IVF at a private clinic typically costs between £4,000 and £8,000.

When comparing private clinics, find out what treatments they offer, their success rates, their waiting list length and costs. Make sure you choose a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA).

"We chose to go private for some fertility investigations and treatment. I would say if you can afford it (comfortably) then go for it. The difference between the time you get with the consultants, the extent to which you get taken seriously and the time frame over which you get treated can be staggering (sadly)." theowlwhowasafraidofthedark

"In your late thirties you cannot afford to wait around. Remember that private clinics are multi-million pound businesses and the most well-known ones will have waiting lists." Rocky12

"The most useful site I found is the HFEA site where you put in your postcode and it tells you the nearest clinics and their results etc and you can narrow the search fields down to suit the treatment you need and your age group etc to get the best results. The only thing is that the results on their for the clinics are the audited results so they aren't up to date all the time, best thing is to call the clinics and they can easily give you their up-to-date results." Onlyaphase

The emotional toll of trying to conceive

Fertility is elemental stuff - and the emotions it stirs up are pretty fundamental, too. Not only do you have to go through some invasive and side effect-laden treatments, but you (and your partner) are forced to examine all sorts of buried assumptions and hopes about your future.

So it's not particularly helpful that while you're going through all this, friends and relations can come out with some crass and unfeeling comments. Here are a selection of the main clangers guaranteed to reduce you to tears of rage or misery if TTC is dragging on and beset with dashed hopes.

• Friends

"The thing I find really galling are friends who 'plan' when they're gonna have children - I have friends who have said they will finish their travelling by end of 2008 so they can get pregnant in Jan 2009 and have a baby in Sept 2009. This 'fits' in with their life plan. My DH has tried to sympathetically tell them it doesn't often work like this (they know of our difficulties) and yet they just nod and smile smugly and knowingly at him as if to say, 'yes, but that wouldn't happen to us' thereby insinuating we are failures and obviously not trying hard enough." PicknMix

"Unless your friends are having trouble conceiving too, they just won't understand, and will do insensitive things like sending you an email at work to announce that they are pg again, cos, whoops, the Pill doesn't always work, when you've spent two years TTC." cmotdibbler

"I completely lost my mind in the first cycle. My hormones drove me mental, I screamed and shouted and cried buckets - and I'm not one to do that... ever. Didn't help that my first cycle was 41 days. Have just come off a 50-day cycle, thankfully I managed to remain in control emotionally this time. Didn't stop my non-ttc friends that know I'm ttc saying things like, 'just relax' and 'don't think about it too much', 'stress can delay your period'. Now THAT drove me nuts." digitalgirl

• Family

"I have to say the person who infuriates me most is my mother-in-law. She knows about all our problems, yet still if I mention I'm tired, she'll say 'oh, any news?' and she often gives as her all-knowing fertility advice 'you need to try and relax and then who knows what might happen?'" Move over Sir Robert Winston! Moomin

• The rest of the world

"Even if you don't think that you will have any problems, it's a bad idea to let on that you're TTC. Once someone knows, you can't untell them, and if you find out there is a problem then they are bound to ask how things are going, which can be awful. Some of the comments that we had (that I know are very common) are 'you can always adopt' and 'as soon as my friend relaxed then everything was just fine'." MrsTittleMouse

Surviving trying to conceive

And, in between fending off this 'helpful' advice, you've got your own reactions to the TTC rollercoaster:

"Was sitting here thinking how bored I am of ttc, bored of doing ovulation tests, bored of taking my temperature each morning, bored of thinking how many dpo I am. Bored, bored, bored, have had enough of ttc. Let's move on to pregnancy." ClairePO

"There are things that I found I couldn't say to my dh for fear of hurting his feelings. I also blamed myself a lot of the time and needed someone to talk this through with. I needed time and space to cry, rage, despair, hope and dream. I would definitely recommend counselling as a means of helping you cope with the strains and disappointments of infertility. You can find a local counsellor either through your GP, or through the British Association of Counsellors." Littlefish

What comes through strongly on the Talk forum conception discussions is that it's hugely helpful to be able to offload on people who understand what you're going through.

"Find online buddies going through the same thing. When you are in the midst of it you can get obsessed. Find some virtual friends who are equally obsessed." LadyMuck

And the following comment from one Mumsnetter is a reminder of why you're going through it all.

"It took me 10 years to have ds. He is my sun, moon and stars." ullabyloo

Planning on getting pregnant | Signs of ovulation | Problems getting pregnant | Ovulation calculator