An in-depth guide to infertility: part 2

In the second article of a two-part series, revered consultant gynaecologist and specialist in fertility Miss Petya Doncheva provides an in-depth guide, explaining treatment options and lifestyle changes for women experiencing infertility.

What treatment options are available for women experiencing infertility?

The treatment options open to women will depend on the patient’s history, the results of the investigations as well as the preferences of the couple. Women diagnosed with polycystic ovarian syndrome (PCOS) and a BMI above 30 should be advised that losing weight is the first line of treatment that could restore ovulation, improve fertility and reduce the rate of miscarriages. Those women should then be offered ovulation induction medications and may be prescribed Metformin. They should be informed about the risk of multiple pregnancies, risks of drug resistance and side effects associated with the medication. Women resistant to ovulation induction medications can subsequently be offered gonadotrophins (injections) or ovarian drilling (done via a keyhole surgery).

Women with a tubal or uterine disease can be offered surgical treatment depending on the underlying pathology. Women with hydrosalpinxes (fluid-filled fallopian tubes) should be offered removal of the affected tube to improve the pregnancy rates before IVF treatment. Hysteroscopy and removal of underlying polyps, fibroids or adhesions have also been proven to improve pregnancy rates. Women affected by endometriosis, depending on the extent the disease and its symptoms, can be offered either medical or surgical management.

Intrauterine insemination (IUI) is a treatment option for women unable to have regular penetrative intercourse, same-sex couples or where one of the partners is affected by an infectious disease where specific considerations should be taken. There is some evidence that stimulated IUI can be used in young women with unexplained infertility.

In vitro fertilisation (IVF) treatment is the most effective treatment option for couples suffering from infertility. The chance of having a baby depends on many factors such as female age, ovarian reserve, cause of infertility, previous treatment cycles and lifestyle factors. However, IVF is an invasive process that takes about 2- 3 weeks to be completed and can be expensive. It is associated with certain risks that has to be discussed including the risk of ovarian hyperstimulation syndrome, ectopic pregnancy and multiple pregnancies. The treatment should be individualised and led by a specialist in fertility and reproductive medicine.

Donor egg/ donor sperm treatment may be recommended in cases with depleted ovarian reserve/no sperm, respectively.  Couples should be offered implications counselling first according to the recommendations by the Human Fertilisation and Embryology Authority (HFEA).

Can lifestyle changes improve fertility in women?

All women trying to conceive should have the opportunity to discuss lifestyle modifications that can improve their chances of conception.

For those with a BMI of 30 or higher, it's important to know it may take longer to conceive because ovulation might not happen regularly. They should get support and be referred to a dietitian for advice on healthy eating and encouraged to exercise regularly. On the opposite side of the spectrum, women with a BMI below 19 are also at risk of ovulation issues, but they can increase their chances of conceiving by reaching a healthier weight.

Smoking and drinking alcohol can seriously affect fertility and harm the developing foetus. Even passive smoking can be a problem, therefore women should be offered help to quit smoking during fertility consultations. It's advised for women trying to conceive to limit alcohol intake to no more than 2-4 units per week.

While there isn't strong evidence linking caffeine intake to fertility issues, it's recommended to take folic acid (0.4 mg daily) for at least three months before and after conception to lower the risk of neural tube defects in the unborn baby.

If you would like to book a consultation with Miss Doncheva, do not hesitate to do so by visiting her Top Doctors profile today.

References:

Fertility-problems-assessment-and-treatment-pdf-35109634660549 (nice.org.uk)

Infertility (who.int)

Infertility - NHS (www.nhs.uk)

HFEA: UK fertility regulator