Female Infertility & Investigations
Around a third of cases of infertility are due to known female causes, including tubal disease, endometriosis, ovulatory disorders, age-related factors, and mucus hostile to sperm.
Unexplained infertility, where the cause is not known, accounts for another third of cases, while male factor infertility makes up the remainder.
Before embarking on your IVF journey it is important that you have thorough investigations to try and identify any specific fertility problems you may have.
The RUH Reproductive Medicine clinic is hosted at Bath Fertility Centre. You may well be able to be referred through the NHS to this clinic through your GP.
It is also possible to have a private reproductive medicine consultation.
Diseased or damaged fallopian tubes (‘blocked’ tubes) account for about 20% of all cases of infertility in the UK.
This may be caused by pelvic infections such as chlamydia or pelvic inflammatory disease, or damage due to ectopic pregnancy and scar tissue formation following other pelvic surgery. If one or both tubes are blocked, eggs and sperm cannot meet for fertilisation to take place and so conception does not occur.
Despite the improvements in the surgery techniques used to repair blocked or damaged tubes, conception rates remain disappointingly low. In such cases IVF is the treatment of choice as it bypasses the blocked tubes to collect oocytes (eggs), fertilizing them in the laboratory and then replacing the embryos directly into the uterus (womb).
The endometrium is the inner lining of the uterus.
Endometriosis is a condition where the presence of functioning endometrium is found outside its normal environment, for example on the ovaries or tubes.
Its presence here may lead to adhesions or scar tissue, and it can cause painful periods or pain during intercourse.
The damage caused by endometriosis to the fallopian tubes or ovaries is diagnosed by laparoscopy, and IVF is the treatment of choice for infertility caused by endometriosis where other methods have not helped.
Polycystic Ovaries and Polycystic Ovarian Syndrome (PCOS)
Polycystic ovaries are quite common affecting as many as one in five women, many of whom may be completely symptom-free.
Some women with polycystic ovaries have PCOS. They may have a few or several symptoms including irregular, infrequent or no periods, complexion problems and excess weight.
Polycystic ovaries are diagnosed by ultrasound scans and blood tests.
PCOS may be treated in several ways, including taking oral contraceptives (‘the Pill’) to try to temporarily regulate the cycle, or surgery may be used to ‘kick-start’ the ovaries, or special diets and exercise may help some to rebalance their hormones and re-establish ovulation. For those with weight problems, weight loss is a key factor for a successful outcome.
The drug Clomiphene may be used to induce ovulation alternatively Tamoxifen can be used in a similar fashion. For those who are therapy resistant laporoscopic ovarian spot diathermy can be effective.
If these treatments are unsuccessful then IVF may be used, although polycystic ovaries are sometimes unpredictable in their response to the drugs used to stimulate the ovaries to produce eggs, either not responding at all or over-responding and producing too many follicles which may contain eggs of suboptimal quality. However most women are able to be treated with careful monitoring of their cycle to prevent or manage ovarian hyper stimulation syndrome (OHSS)
Age and infertility
Fertility drops dramatically with increasing age – at age 35 the chance of getting pregnant is half that at age 25, and at 40 the chance is much smaller again. Beyond the age of 43 the chances become very slim.
This is due to a combination of factors including a decreased supply of eggs in the ageing ovaries, an increased rate of chromosomal abnormalities in older eggs, and a higher risk of miscarriage for those who do become pregnant.
Older women (those 38 and over) may be treated with IVF providing their ovaries respond adequately to the drugs used to produce eggs.
The likelihood of this can be estimated by blood tests to establish hormone profiles and ultrasound scans.
At Bath Fertility Centre we offer all treatments to women up to the date of their 44th birthday. but hormone assessments will help us to provide you with a realistic idea of a positive outcome.
Unexplained infertility, where no obvious cause can be found, affects about a third of couples who have difficulty conceiving.
Intra-Uterine Insemination (IUI) and In Vitro Fertilisation (IVF) are options which may be suitable for couples with unexplained infertility, although for those who have been trying to conceive for a period of more than 3 years or in older women, earlier treatment with IVF may be more appropriate.
Tubal disease may be diagnosed by a combination of blood tests for chlamydia and one or more other methods.
A hysterosalpingogram (HSG) may be performed, which is a type of X-ray examination that shows inside the uterus and fallopian tubes and whether they are open or not.
Recently we have introduced the Hycosy ultrasound test which is tending to replace the HSG and avoids x-rays.
If there is a reason to suspect tubal damage or endometriosis we will offer a laparoscopy for a more complete assessment.
Laparoscopy is a minor operation where a small telescope (laparoscope) is passed through a tiny cut in the belly button and a view of the pelvic organs is obtained before flushing coloured dye through the cervix into the uterus and tubes to check whether they are open (patent) or blocked.
Endometriosis, adhesions and polycystic ovaries may also be seen and diagnosed this way.
Blood samples may be taken to obtain hormone profiles. Those usually measured include FSH (follicle stimulating hormone), progesterone, LH (luteinising hormone) and very occasionally oestradiol may be monitored during treatment.
FSH is measured to help discover any signs of decreasing follicle supply in the ovaries (diminishing ovarian reserve) that occur with ageing, as well as to establish what dose of follicle-stimulating drugs is most suitable for IVF treatment.
LH and progesterone levels may be checked to detect when and if ovulation is occurring, and may be used to determine treatment day for patients having frozen embryo transfers or IUI.
Polycystic Ovarian Syndrome (PCOS) is diagnosed by a combination of ultrasound scan to look at the ovaries, along with blood tests to check for hormone imbalances of FSH and LH.