Q1: What is Infertility?
A: Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
Q2: What Causes Infertility?
A: In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained. The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality. The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages. In some couples, no cause can be found for their failure to conceive, despite very intensive investigation. Both partners seem quite healthy, but they simply do not conceive together. This can be very distressing and seem quite incomprehensible, but it does happen reasonably frequently.
Q3: How is Infertility Diagnosed?
A: Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.
Q4: How is Infertility Treated?
A: Most infertility cases (85 to 90 per cent) are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.
Q5: What is In Vitro Fertilization?
A: In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.
In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 18 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes. IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatments.
Q6: When should I seek advice for infertility?
A: The first place to seek advice regarding a possible infertility problem is your GP. You and your partner should be assessed as a couple, at the same time, rather than one after the other. It is very important not to attach blame to yourself or your partner, even if one of you has an obvious problem.
Q7: What are my chances of getting pregnant?
The average success rate for IVF treatment using fresh eggs in the UK per cycle started (HFEA Guide to Infertility) is:
27.6% (for women under 35)
22.3% (for women aged 35-37)
18.3% (for women aged 38-39)
10.0% (for women aged 40-42).
Current results for IVFWales can be found at the HFEA website . These will be updated throughout the year.
Q8: Am I eligible for NHS funding for IVF treatment?
A: The Welsh Assembly Government currently provides two cycles of assisted reproduction in the form of In Vitro Fertilisation [IVF] or Intracytoplasmic Sperm Injection [ICSI]. Please refer to the eligibility criteria.
Your GP is aware of the eligibility criteria for referring you to the Unit and will refer you for funded treatment if appropriate.
Please note that IVF Wales is funded by the Welsh Health Specialised Services Committee. Any decisions affecting your funding should be directed to the Commissioners.
Q9. How long will I have to wait before I can start my treatment?
A: On receipt of your referral we will add you to the waiting list for your first New Patient appointment where you will discuss your eligibility and possible treatment with a Consultant.
Patients must wait 18 months from the date of referral before the first IVF NHS funded treatment can commence.
Patients who are unsuccessful at their first attempt at IVF are then offered a 2nd cycle within 9 months of the 1st attempt. This again is funded by the NHS in Wales.
Q10: Can I come to the consultation on my own?
A: You are both required to attend the initial consultation and you will be required to attend with photographic ID – without this your treatment will not proceed.
Q11: What happens after my 1st New Patient appointment?
A: Investigations will be undertaken to establish a diagnosis. Once we know what are the problems treatment options can be discussed and your name can be placed on the relevant waiting list.
When you have reached the top of the waiting list we will send you a letter with a date for a treatment planning consultation – this currently consists of two contacts, one to check your eligibility criteria hasn’t changed, to take and record your BMI and to take necessary blood tests. The second consultation will be to plan your treatment. Depending on your clinical status and menstrual cycle, you will then be booked directly into an proposed schedule week for egg collection.
Q12: Will I require a scan?
A: Yes, a scan will be performed at consultation. A scan will be internal and it is important to empty your bladder on arrival at the Unit. Scans are done as part of the diagnostic programme and as part of treatment to see how your ovaries are responding to the medication.
Q13: Will I need to have any more investigations?
A: It is possible at consultation that further investigations will be required prior to embarking upon the treatment and you will be advised accordingly at that time.
Q14: Why do we need to fill in consents for each treatment?
A: HFEA consent forms: We will check with you at every treatment cycle what your wishes are relating to treatment and will only renew any relevant consent forms if you have changed your mind, e.g. relating to freezing of embryos Some consent forms cover all treatments and some consents may change over time.
Q15: Do you have female doctors?
A: Yes our team is predominantly female. See our About Us section for more information about the team
Q16: How long will treatment take and what’s involved?
A: Before treatment commences, you’ll have a full assessment at a fertility clinic and be told all about what’s involved so you’re clear from the outset.
A cycle of IVF takes about four to six weeks to complete. When the treatment begins, a woman is given fertility drugs to stimulate the production of eggs. Ultrasounds and blood tests are performed regularly to check how the eggs are developing. When they’re deemed ready to be removed, sedation will be given and a doctor will surgically remove them from the ovaries with a fine hollow needle. The eggs are then mixed with sperm and left to fertilise in a laboratory (this is where the term ‘test tube baby’ came from, as it was often assumed that the sperm and eggs were mixed in a test tube).
Whilst the fertilisation is taking place, the woman is given hormones to prepare her body, and especially her uterus, for pregnancy. Fertilised eggs will form a ball of cells, called an embryo, and when they’re ready two or three embryos are implanted back into her uterus to, hopefully, achieve pregnancy. If any extra embryos have been formed, these are often frozen and used in future IVF cycles, where the first or more doesn’t work.
Q17: What are your success rates?
A: Our success rates can be found on the HFEA website.
Q18: How much will it cost?
A: If you meet the criteria for an NHS cycle there will not be any cost to you whilst undertaking your NHS funded treatment. The current costs of treatment for Self Funded treatment can be found under Self funding section on this site
Q19: Do you accept single women and lesbian couples?
A: Yes we do. IVFWales has a policy of examining every case on an individual basis
Q20: Will I be accepted?
A: There a several screening tests that you have to complete prior to commencing treatment. You also have to meet HFEA guidelines which we are obliged to follow. Following these and meeting one of the doctors (possible counsellors) and completed consent forms you will be accepted
Q21: Are There Any Risks or Side-Effects with IVF?
As with any form of treatment, potential risks and side-effects do exist. More than one embryo is often placed in the uterus, so there’s a higher chance that you could end up having twins or multiples, rather than a single pregnancy. Multiple pregnancies carry extra risks themselves, upping the chance of pregnancy complications or miscarriage.
Mild reactions to the drugs do occur sometimes, causing symptoms such as headaches, mood swings and hot flushes. A more severe reaction is called Ovarian Hyperstimulation Syndrome (OHSS), where cysts develop on the ovaries and fluid collects in the stomach. Symptoms of this include swelling in the stomach, pain, vomiting and nausea.
Sometimes it’s also possible to have an ectopic pregnancy, whereby the embryo develops in a fallopian tube, rather than the womb. If you’re having IVF and develop any unusual or concerning symptoms, then it’s important to speak to your doctor immediately.
Undergoing IVF can be emotionally challenging too, especially when treatment cycles are unsuccessful. You can receive counselling from IVF Wales, but there are also other support groups available in the UK.
Q22: What support is out there?
A: We have an in house counsellor who is available to see you should you find this beneficial. As well as counselling at IVFWales, you may find further 'couple counselling' useful to work through issues brought up by the treatment. Organisations such as Relate or BICA may be able to help with this, and support groups such as the Infertility Network UK can provide information on IVF and support patients throughout treatment (see our Useful Resources section for contact details). Some websites have forums and message boards so people can post questions and advice for others going through a similar experience. Ask your health professional if there are any support groups at the clinic too. Where possible, explain how you're feeling to family and friends. The more they understand about what you're going through, the more sensitive and supportive they can be.
