IVF isn’t the first step in fertility treatment for everyone

Did you know…. There are numerous treatments available to support couples who can’t conceive. The treatments offered will depend on your individual circumstances.

I have written this blog to share other fertility treatments that are available to you. We are here to help you make an informed decision and let you know that IVF isn’t the only route you can take in order to become pregnant.

IVF is one type of assisted reproductive technology (ART). ART is used when you are not able to conceive through sexual intercourse.

If you are having difficulty conceiving your doctor will perform investigations to try to find an underlying cause or medical condition that is related to why you aren’t conceiving. If that underlying cause of infertility or medical condition can be treated, it’s possible that you could then conceive from sexual intercourse.

IVF may be the first fertility treatment offered in some situations, for example, if you have

• Premature ovulation failure (also called premature menopause) with donor eggs (Donor egg IVF)

• If you are using your own frozen eggs or donor eggs for other medical reasons e.g., after certain cancer treatments

• If the reason you can’t conceive is due to problems affecting the sperm.

But it’s worth considering that other treatments are available

and IVF treatment isn’t always needed.

Other Fertility Treatment Options

Ovulation Induction: If you are not ovulating

The most common length of a menstrual cycle is between 26-28 days long and therefore most women have a menstrual period every month. Some people have slightly longer or slightly shorter menstrual cycles than this. However, if you do not bleed for months, it could be because you aren’t ovulating.

When an egg isn’t released by the ovaries during your menstrual cycle, it’s called anovulation. This usually shows up as infrequent or absent menstrual periods.

When anovulation is temporary i.e., when you don’t ovulate for one, two or even three months, it is not worrying and can be normal as long as it happens on one-off, isolated or rare occasions. This can occur after taking certain drugs e.g., progestogens used to stop your period when you are travelling on holiday or after a miscarriage where it may take one or two cycles for your usual menstrual cycle to restore.

If you are ovulating infrequently e.g., every 2-6 months or more it could take longer for you to conceive through sexual intercourse than someone with a much shorter menstrual cycle. Fertilisation cannot occur in the female reproductive system without the presence of an egg.

If you have sex just before or very soon after ovulation, you could become pregnant. If you haven’t ovulated for months and have sex, the sperm will not meet an egg and it won’t be possible to become pregnant until the next time you ovulate.

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If you are not having periods at all you should see your GP for investigation.

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You should see your GP if you are trying to get pregnant and have not conceived within:

· 6 months if you are 36 years of age or over

· 12 months if you are 35 years of age or under

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Ovulation induction is the term used to give drugs to stimulate the egg to ovulate. Ovulation induction may be offered if you ovulate infrequently or do not ovulate.

The World Health Organisation (WHO) classifies anovulation based on blood tests that look at your reproductive hormone levels.

WHO Group I ovulation disorders

Women with WHO Group I ovulation disorders have abnormal levels of the hormones that affect the growth and maturation of eggs in the ovaries, that increase the oestrogen levels, that cause the lining of the womb to become thick each month ready to potentially accept a fertilised egg and cause the egg to ovulate so that it can potentially meet a sperm and be fertilised.

These hormones are called Follicle Stimulating Hormone (FSH) and Luteinising hormone (LH). Together FSH and LH are called gonadotrophin hormones. FSH and LH are produced by endocrine glands in the brain. In group 1 ovulation disorders these glands are not working properly and therefore there are low levels of gonadotrophin hormones and low oestrogen levels. This stops ovulation and therefore stops menstrual periods.

If you have Group I anovulatory infertility and have a BMI of less than 19 you will be advised to increase your body weight. This alone might restore ovulation. If you perform high-intensity exercise frequently you may be advised to moderate the amount of exercise you take and again this could restore ovulation.

Alternatively, ovulation induction will be needed. If you have group I anovulatory infertility ovulation induction involves the injection of a combination of the gonadotrophins (FSH and LH) at an amount that only encourages 1 or 2 follicles to develop. Once the follicles are large and sufficiently mature, an injection containing HCG (human chorionic gonadotrophin) is given to complete the maturation and release the egg. Your fertility specialist will advise you on when to have sex.

WHO Group II ovulation disorders

WHO Group II ovulation disorders include women with Polycystic ovary syndrome (PCOS) and women with high prolactin levels. High prolactin levels are found in conditions such as benign tumours of the pituitary gland, hypothyroidism, cirrhosis of the liver, PCOS and Cushing’s syndrome. The gonadotrophin and oestrogen levels are normal

If you have PCOS, ovulation induction may only be offered if your BMI is below 30. Obesity is common in women with PCOS, and it can be very difficult to lose weight. This may lead to a delay in getting the treatment. You can find registered dieticians, that specialise in PCOS, to help you with weight loss

If you have a group II ovulation disorder you may receive ovulation induction with the drug clomiphene citrate (Clomid). Metformin is another drug that may be used or a combination of clomiphene citrate and metformin if clomiphene citrate isn’t successful.

Laparoscopic ovarian drilling is another treatment that may be offered to you or gonadotrophins drugs e.g. Letrozole (unlicensed for ovulation induction) may be used if Clomid is not successful if there are problems using Clomid or not tolerated. The ovaries are monitored by ultrasound scan and again sexual intercourse is advised at a particular time.

If you have anovulation due to high prolactin levels, bromocriptine treatment may be effective.

Intra-uterine Insemination (IUI)

Intra-uterine insemination (IUI) is another form of ART and may be more suitable than IVF in the early stages of your infertility journey.

• If you are in a same-sex relationship or using a sperm donor.

• If you can’t have sex due to a disability or problems with having sex (read the next paragraph)

• If the sperm needs to be treated before insemination e.g.if your partner is HIV positive.

Psychosexual counselling

If you or your partner are having difficulty with having sexual intercourse; you can be referred for psychosexual counselling.

Issues your partner may be related to getting or maintaining an erection or ejaculation.

You could be affected by pain during sex, tightness, vaginismus (involuntary but tight vaginal spasms), vulvodynia (painful vulval area).

One or both of you could have issues with libido (desire to have sex).

Surgery and Male factor infertility

There are several surgical techniques that can be used to reduce or release any obstructions within the male genital tract.

Depending on the age of you and your partner and how long you have been trying to conceive, following surgical treatment, you may be advised to try to conceive by sexual intercourse and not require any further fertility treatment.

Treatments for male factor infertility will be covered in a future blog and you can find information on infertility surgery for men at the end of this blog.

Surgery and Female factor infertility

Surgery may be offered for certain medical conditions such as endometriosis e.g., ovarian cystectomy to remove endometrioma cysts in deep endometriosis or fibroids e.g. Trans Cervical Resection of Fibroid (TCRF) -removal of fibroids that affect the lining of the womb (submucosal).

Such surgery may help you conceive naturally, or potentially improve the outcome of IVF treatment. Your surgeon will assess and discuss whether these options are relevant for you and your condition.

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Please remember to get help if you are having difficulty trying to conceive.

Living with infertility is an everyday whirlwind of emotions and experiences; frustration, grief, stress, exhaustion, resilience and hope.⁠

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Having a solid support system surrounding your journey is essential if you have feelings of fear, worry, low mood, and lack of motivation.⁠

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At Your Trusted Squad we provide support so that you don't feel alone. We have a tailored approach that will reduce the overwhelm and stress of your journey. You will have a dedicated experienced doctor as your fertility coach who will mentor and support you.

We provide a personalised fertility optimisation plan that includes a selection of curated information and services. We can also book appointments, arrange for medications to be delivered to you and much more!

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Book a discovery consultation to find out how we can reduce the stress and overwhelm of your infertility journey.

Other Information Resources

HFEA, Infertility surgery for men

HFEA, Infertility surgery for women

NICE, Fertility Problems: Assessment and Treatment

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Written by GP, Dr Belinda Coker, our free guide will help you prepare for the fertility assessment consultation with your GP.

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