Is IVF the only treatment available for conception problems?

Experiencing fertility problems can be stressful and confusing for couples wishing to start or expand their family. In this informative article, leading consultant in reproductive medicine Professor Rami Wakim offers expert insight on how fertility levels are assessed. He also offers reassurance on the improving success rates of the various methods currently used to aid conception.

What tests do doctors perform to investigate the cause of conception problems?

One of the easiest tests to perform when investigating conception problems is a semen analysis. This is a very simple test which can be performed after two or three days of abstinence. It’s important to remember that semen production is dynamic and a man’s supply will be renewed every three months. If a man’s semen analysis results come back as abnormal, it’s important to take a history to establish his condition over the last few months as viral conditions such as COVID-19 could be responsible. It is also advised that men with abnormal sperm analysis results repeat the test three months later so we can check the trend of this abnormality and establish if it is stable, improving or deteriorating.

In regards to the female counterpart, a tubal patency test, also known as a hystersalpingo-contrast-sonagraphy, or HyCoSy, is commonly performed to check that the fallopian tubes are working as usual. Additional to this, a hysterosalpingography can also tell us about the cavity contour of the uterus and can identify any polyps or fibroids that may be present. These tests may be performed by injecting a contrast dye in a radiology department within a hospital setting where films can be taken. We can also inject a contrast foam which shows on the ultrasound scan. This is very easy to perform and takes only ten minutes.

In the case that the patient is undergoing a laparoscopy for another problem, we can perform at the same time. This is known as a laparoscopy and a dye test, where the contrast dye is injected and we observe that it passes as expected through the tubes. These are the most important investigations that we start with. Not everyone would need to have a laparoscopy at the beginning, however, if there are risk factors, we like to investigate sooner and in greater depth.

Is IVF the only treatment available for conception problems?

Contrary to popular belief, IVF is not the only option available. I would stress that IVF has advanced a lot and the success rates are always improving. Around twenty years ago, we were quoting patients a success rate of around thirty five to forty per cent. These days, however, the rate is upwards of fifty per cent depending on the age and circumstances. Egg donation has also vastly improved and has a success rate of up to seventy per cent in some clinics.

Something I always explain to my patients is that I have stopped used the term infertility because these days there is almost no fertility problem that we are not able to treat through all of the options that we have in hand. So, the term infertility as such is only restricted to really severe situations, if someone doesn’t have a uterus, for example. Anything else, however, should be considered as sub-fertility whether in the male or the female.

Despite the many modalities of treatment on offer, many of my patients have been able to get pregnant simply through follicular monitoring regarding timing of the ovulation and timed sexual intercourse. Ovulation induction is another method which is especially useful for women with polycystic ovary syndrome or PCOS. For these women, we can induce the follicular stimulation in order to have several follicles combined with timed sexual intercourse. We can also can step this up with ovulation induction, administered by tablets or injections.

For same sex couples or women who have trouble having sexual intercourse due to vaginismus, for example, we can also offer intrauterine insemination (IUI). This method can also be used in other cases and does improve the chances of successful conception compared to the natural insemination method. This is because intrauterine insemination bypasses the cervical mucus and the cervix to deposit the semen sample very close to the opening of the fallopian tubes.

This pellet of sperm is centrifuged and is closely tailored to the necessary parameters, meaning it contains a good number of highly active sperm, just like in the IVF method. We also ensure that the female counterpart is ovulating at the same time and that the egg is ready to accept the sperm during IUI process. It’s an easy and simple process which is not overly expensive and can work well in some circumstances.

It’s important for patients going through this process to manage their expectations and to anticipate that they may not have success the first time round. I always tell my patients that they may need several rounds before conception successfully occurs which is why the NHS sometimes offers multiple cycles of IUI. However, this process requires motivation and does offer a smaller chance of getting pregnant than IVF.

Although IVF is often labelled as the last resort in treatment, this is not really accurate as it could be first resort in specifically indicated cases, especially taking into consideration that it gives you the highest chance of success in the shortest period of time. The reason behind the shorter timescale and higher success rate in IVF is that embryos are created by us as part of the process. This bypasses a lot of the hurdles of natural conception or other fertility treatments as we have achieved all but the last step before getting pregnant and implantation is all that remains to be done.

To conclude, IVF is absolutely not the only option for most people experiencing fertility problems. In some specific situations, however, it is the only option and we have to accept this. The many treatment methods that are now available mean that for most people, we can try to tailor a solution to best meet their needs. However, I have to stress that not every modality suits every couple so there is no one treatment that suits all. I would also reassure couples in this situation not to be anxious and to make an appointment with a specialist in order to discuss the available options and establish what would be the best plan going forward.

If you are affected by fertility problems and would like to discuss your options, you can make an appointment with Professor Wakim by visiting his Top Doctors profile.