Fertility treatments

Fertility can be treated with drugs to stimulate the normal reproductive cycle, procedures to start a pregnancy or both.

Fertility drugs

The drugs that are used to stimulate fertility have been used for 50 years and remain the basis for fertility drug treatment.

There are two sorts of fertility drug:

• Clomid acts on the pituitary gland, forcing it to release more follicle stimulating hormone (FSH) and more luteinising hormone (LH) than it normally would. This encourages your ovaries to produce follicles and for the follicle containing the egg to grow and develop to ovulation. The chance of having twins, if you take Clomid, is around 8 per cent, and the risk of triplets is one in 200.
• Follicle Stimulating Hormone (FSH) is a drug that works directly on the ovary. Follicles are the fluid filled sacs in which the eggs grow to maturity. There is a risk of multiple follicle development and therefore multiple pregnancy with this treatment. 

See the our fact sheets on ovulation induction and the risk of multiple pregnancy for more information.

Assisted reproduction therapy (ART)

This is treatment to get pregnant by means other than having sex. It includes intra-uterine insemination (IUI) and in-vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI) – sperm injection directly into the egg.

Intra-uterine insemination (IUI)

This treatment really just replicates what happens during sex. A small amount of sperm is placed inside your cervix when you ovulate. Because it is done in a clinical setting, the sperm is washed and concentrated.

The success of the treatment will vary depending upon why you are having it. It may be done as part of your normal cycle without the use of medication, or in a cycle after you have had fertility drugs such as FSH to develop one or two extra ovulated eggs.

Your doctor may suggest IUI for the following reasons:

• Your partner’s semen is normal but your cervical mucus is absent or hostile. Treatment is usually successful in this situation.
• Your partner’s semen is normal and your mucus is receptive to sperm. In this situation the treatment is less successful.
• Your partner has a low sperm count and/or low motility. Treatment is much less successful in this situation.
• Treatment is performed for social reasons; for example, your partner is interstate or overseas – this is quite successful if his sperm freeze and thaw well.
• Donor insemination – this is quite successful if you are younger than 36.

Generally, if you do not become pregnant within the first three or four attempts, the chances of further success are low and it is time to consider IVF.

In-vitro fertilisation (IVF)

IVF involves fertilising the egg outside of the uterus. The usual method is as follows:

• FSH injections stimulate the ovaries to produce follicles. The aim is to develop six to 16 mature, egg-containing follicles, which are around two 2–2.5cm  in diameter
• A vaginal ultrasound monitors follicle growth.
• When the scan shows that there are enough follicles and they are big enough, a ‘trigger’ injection is given to stimulate ovulation.
• The doctors collect your eggs using a vaginal ultrasound and procedure called ‘guided egg collection’. This is done with a light general anaesthetic.
• The eggs and sperm are placed together in a dish with ‘culture fluid’ (standard IVF). Alternatively a single sperm is injected into the egg (ICSI). The method used depends on how fertile the sperm were found to be before IVF treatment.
• The combined egg and sperm are observed to see if there are signs of early fertilisation.
• One or possibly two embryos are transferred into the uterus between two and five days after fertilisation, depending on individual circumstances.
• For two weeks, a supplementary course of progesterone is given through the vagina, starting from the second day after fertilisation.
• Any other embryos that have developed normally are frozen in liquid nitrogen for transfer later.

IVF often requires multiple attempts before achieving a pregnancy and may never do so. Overwhelmingly, the chances of success relate to the age of the woman and the genetic quality of her eggs. This means an adequate number of eggs must be retrieved, and a number of high-quality eggs need to be developed to produce good-quality embryos.

There is some evidence that children of couples who become pregnant after IVF or ICSI have a slightly higher rate of birth abnormalities, although these conditions are rare and the overall risk of having a child with a birth anomaly is low. If you are in this situation, your fertility specialist should discuss this potential risk with you.

Alternative therapies for fertility

It is very important, if you are having IVF, to tell your treating doctor what you are doing or taking to improve your chances of getting pregnant. This might include growth hormones, DHEAS, acupuncture, testosterone and steroids. Unfortunately, scientific research has not conclusively demonstrated a significant benefit, and the safety of many of these treatments has not yet been established.

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