Investigations and Treatments
It has been established that the Anti-Mullerian Hormone ,AMH, which is made by the ovarian follicle containing the egg, can tell us how a woman’s ovaries can respond to fertility drugs.
In young women many eggs start to grow each day and quite large numbers reach the final stages of development, where they can respond to fertility drugs. These women have high AMH values. In older women, there are fewer eggs left in the ovary and few will reach these latter stages of development. The blood level of AMH can tell us how many follicles (eggs) are likely be available.
View further information on AMH testing
Semen analysis
A test performed by a trained andrologist or embryologist to examine the sperm cells within the semen. Parameters of count, motility and morphology (shape) are examined and reported according to WHO (World Health Organization) guidelines.
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Ovulation induction (OI)
Ovulation induction is used for women who do not ovulate regularly or who do not ovulate at all. Fertility drugs are used to stimulate egg production.
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Intrauterine Insemination (IUI)
Intrauterine insemination is usually performed where a couple’s investigations have failed to detect a specific cause of infertility. The woman is usually given a course of fertility drugs and the man’s sperm is prepared so that the healthiest can be selected. IUI involves the introduction of sperm high in the uterus of the woman. This is a painless procedure.
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In-Vitro Fertilisation (IVF)
IVF is fertilisation outside the body and involves combining eggs with sperm in a culture dish…. ‘in vitro’ literally means 'in glass.' The woman is prescribed fertility drugs to encourage the ovaries to produce more eggs than usual in a normal monthly cycle. The eggs are collected under sedation. On the same day the male partner is asked to produce a sample of sperm. The sperm sample and the eggs are prepared and placed together in a special medium. They are kept in an incubator and examined the following day to see if they have fertilised. If embryos (fertilised eggs) have developed the embryo transfer can proceed.
In most cases two embryos may be transferred to the womb. In exceptional circumstances three embryos may be transferred. A fine tube is passed through the cervix and the embryos are placed high into the uterus. This is a simple, painless procedure.
A pregnancy test fourteen days after the embryo transfer will show if the treatment has been successful.
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Intracytoplasmic sperm injection (ICSI)
ICSI is used where the sperm count is low, where sperm motility is poor or where there is a high percentage of abnormally shaped sperm. It is also used for cases where sperm has been surgically collected from the man because of an obstruction or failed vasectomy reversal (see above). In ICSI a single sperm is injected directly into the centre of an egg and the embryo is then placed in the womb in exactly the same way as in the IVF treatment.
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Surgical Sperm Recovery
Where a blockage or absence of the tubes leading to the testes is the problem sperm are not present in the ejaculate. In these cases, minor surgery can be performed to obtain sperm from the reproductive tract, which is then used for ICSI.
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Assisted Hatching
All eggs are covered by a protective outer cover called the zona pellucida (egg shell). When the egg is fertilised this covering remains intact to protect the embryo until the embryo expands and the zona stretches so that the embryo breaks through. This is called hatching. At this stage the embryo will attach to the lining of the womb.
Assisted Hatching is often used where the woman's eggs have a tougher or thicker zona than usual. The technique involves making a tiny hole in the zona just before the embryo is placed into the womb.
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Embryo cryopreservation
Embryos not transferred to the womb during a fresh treatment cycle may be frozen (cryo-preserved), providing that the embryo quality meets the laboratory criteria. These embryos can be thawed for transfer in a subsequent treatment cycle, known as frozen embryo transfer (FET). About 70% of all frozen embryos survive the thawing process.
According to the regulations, embryos can be frozen for up to five years, although this can be extended to ten years in exceptional circumstances. The results following the transfer of frozen-thawed embryos depend on the number and quality of embryos available as well as the age of the woman. However, fresh embryo replacement generally has a higher success rate.
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Sperm cryopreservation
Sperm can be preserved by freezing and used for treatment at a later date. This is useful for men who find it difficult to ejaculate on demand, resulting in their inability to produce a sample on the day of egg collection. However, the quality of the semen is reduced after freezing.
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Donor Insemination
Tthe use of donor sperm to inseminate the female partner using the IUI technique.
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Egg donation & Egg sharing
Some woman are unable to produce their own eggs. There are many reasons for this such as early menopause, a side effect of cancer treatment or a genetic condition.
Egg donation is the donation of eggs from one woman to another. The donor can either be ‘known’ to the recipient i.e. friend or relative, or can be anonymous.
Egg sharing is used when both donor and recipient are receiving treatment and provides the opportunity for IVF treatment for infertile couples who are prepared to share some of their eggs.
The basic principle of egg sharing is that eggs are collected from the donor and shared equally between the donor and the recipient.
Egg sharing may help both couples – it provides eggs for those who need them and also allows subsidised IVF treatment for sub-fertile couples who are prepared to share their eggs.
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