Fertility 101 - Types of fertility treatments and their pros and cons.

Published: 07/09/2022

Types of treatment (ovulation induction, IUI, egg freezing, IVF), pros and cons of treatment, risks associated with treatment, chances of success and the costs of fertility treatment.

If you need help along your fertility journey, there are different types of fertility treatments available. In this article we’ll explore the various options open to you. We’ll explain how they work, outline the risks associated with each treatment, their chances of success, and highlight a few pros and cons for each.


Fertility investigations and trying to conceive naturally 

You may have undergone initial fertility investigations such as semen analysis, Hycosy, or hormone blood tests, all of which returned as normal. If this is the case, you can expect to be given an option to continue to try to conceive naturally (if it has been less than two years since you began trying for a baby) or, depending on the outcome of investigations, the below treatment options may be discussed with you. 

Follicle tracking

Follicle tracking involves a series of scans. These are normally transvaginal scans, but they can be performed abdominally. These scans are looking at your ovaries and the lining of your womb. 

During a follicle tracking cycle, the clinician monitors the growth of a follicle and tries to pinpoint the day of ovulation. When the follicle is of a decent size and the lining of your womb is growing thicker, you will be advised to begin ovulation testing with ovulation test kits. 

These kits are used to help detect when your body wants to naturally release an egg.  The test kits show a ‘peak surge’ in LH (Luterine hormone) when ovulation is imminent. If you do not detect a ‘peak surge’, then a trigger (HCG) injection can be given to help you ovulate. 

Following this, you will be instructed to go home and have timed intercourse (sex), once a day for the next 3 consecutive days.  

Following ovulation in a natural cycle, the corpus luteum (ruptured follicle) that remains in the ovary at the site of ovulation produces the hormone progesterone to prepare the womb lining for implantation of an embryo. You may or may not be given progesterone support (pessary) to begin after ovulation. 

You will then take a pregnancy test 2 weeks later. 

Timeline 

This course of treatment is minimally invasive and requires 3-4 visits to the clinic on average per cycle (in a month). Follicle tracking is normally done for 3-6 months before review with a consultant to talk about next steps. 

Costs 

In a private clinic you normally pay per scan, and the average cost of a scan is approximately £200.

You would also pay for the medications used, if any, in the cycle such as the injections and progesterone supplements. Costs vary depending on the pharmacy.

Ovulation induction (OI) 

Ovulation induction involves a series of scans, normally transvaginal scans, but can be done abdominally. These scans look at your ovaries and the lining of your womb.

Tablets or injections are given at the beginning of your cycle to help with the recruitment of a follicle. Oral medications manipulate the oestrogen receptors which lead to increased production of your FSH (Follicle Stimulating Hormone) which increases the growth of follicles. 

Injections contain a hormone called follicle stimulating hormone. This is given to you to help your body produce a follicle. This injection can be taken daily, or every other day, depending on your body’s response. It is an injection that needs to be injected into fatty tissue (e.g. belly or upper thigh). You will be shown how to do this by the nurse at your fertility clinic. 

Normally, 1-2 follicles will grow in this cycle. If 3 or more follicles grow, the clinician will have a conversation with you about potentially cancelling the cycle due to risks of multiple pregnancy.

When the follicle is of a decent size and the lining of your womb is growing thicker, you will be advised to begin ovulation testing with ovulation test kits. 

These kits are used to help detect when your body wants to naturally release an egg.  The test kits show a ‘peak surge’ in LH (Luterine hormone) when ovulation is imminent. If you do not detect a ‘peak surge’, then a trigger (HCG) injection can be given to help you ovulate. 

You will be advised to have sexual intercourse post detecting a peak surge or taking the trigger (HCG) injection. The recommendation is having sex once a day for 3 consecutive days post ovulation. 

Following ovulation in a natural cycle, the corpus luteum (ruptured follicle) that remains in the ovary at the site of ovulation produces the hormone progesterone to prepare the womb lining for implantation of an embryo. You may or may not be given progesterone support (pessary) to begin after ovulation. 

You will then take a pregnancy test 2 weeks later. 

Timeline 

This is a minimally invasive treatment plan and requires 3-4 visits to the clinic on average per cycle (in a month), slightly more if you have taken injections to help with producing a follicle. Ovulation Induction is normally done for 3- 6 months before review with a consultant to talk about next steps. 

Costs 

In a private clinic you normally pay per scan and the average cost of a scan is approximately £200. You would also pay for the medications used in the cycle such as the injections and progesterone supplements if used. Costs vary depending on the pharmacy, choice of medication, and amount of medication. Average costs of medications can be up to £200, especially if you require injections.

Intrauterine insemination (IUI) 

Intrauterine insemination involves a series of scans, normally transvaginal scans, but can be done abdominally. These scans look at your ovaries and the lining of your womb.

You can have a natural IUI, an IUI with tablets, or an IUI with FSH injections. The plan will be dependent on your own personal fertility history, and whether you produce a follicle on your own.

Tablets or injections are given at the beginning of your cycle to help with the recruitment of a follicle. Oral medications manipulate the oestrogen receptors leading to increased production of your FSH (Follicle Stimulating Hormone) which increases the growth of follicles. 

Injections contain a hormone called follicle stimulating hormone. This is given to you to help your body produce a follicle. This injection can be taken daily, or every other day, depending on your body’s response. It is an injection that needs to be injected into fatty tissue (e.g. belly or upper thigh). You will be shown how to do this by the nurse at your fertility clinic. 

Normally, 1-2 follicles will grow in this cycle. If 3 or more follicles grow, the clinician will have a conversation with you about potentially cancelling the cycle due to risks of multiple pregnancy.

When the follicle is of a decent size and the lining of your womb is growing thicker, you will be advised to begin ovulation testing with ovulation test kits. 

These kits are used to help detect when your body wants to naturally release an egg.  The test kits show a ‘peak surge’ in LH (Luterine hormone) when ovulation is imminent. If you do not detect a ‘peak surge’, then a trigger (HCG) injection can be given to help you ovulate.

The IUI procedure is normally done 24-36 hours post ‘peak surge’, or 24-36hrs hours post taking the HCG trigger injection. On the day of your IUI, a semen sample will be required from the male partner 1.5 – 2 hours prior to your IUI. 

Partners should ejaculate once 2-3 days prior to providing the sample. If you are using donor sperm, then that donor sperm should be already stored and frozen in the clinic. The embryologist will thaw the donor sperm 1.5-2 hours before your IUI procedure.

The insemination procedure takes about 10-15 minutes. The procedure itself is very simple and causes little or no pain. The prepared sperm is drawn up into a syringe and using a very fine plastic catheter, is gently passed through the cervix into the uterus. 

Luteal support medications

Following ovulation in a natural cycle, the corpus luteum that remains in the ovary at the site of ovulation produces progesterone hormone to prepare the womb lining for implantation of an embryo. Following a medicated IUI cycle, your doctor may advise you to take progesterone supplements (vaginal/rectal pessaries (Cyclogest) and occasionally injectable formulation) for luteal support. 

Timeline 

IUI is the next step up from follicle tracking and ovulation induction (OI). However it is unlikely to be recommended if you have already done 3-6 months of OI or follicle tracking. 

It requires 3-4 visits to the clinic on average per cycle (in a month), slightly more if you have taken injections to help with producing a follicle. IUI is normally done for 3- 6 months before review with a consultant to talk about next steps. 

Success 

Success with IUI depends on your diagnosis and other factors such as age and any male fertility factors. The average success rate is 20-25% per cycle. 

Costs 

The average cost of an IUI cycle is £900 to £1200. This will include the scans and the procedure itself. However, it will not include any medication. Costs vary depending on the pharmacy, choice of medication, and amount of medication. Average costs of medications can be £200 upwards.

Pros of an IUI: 

  • Less invasive than IVF
  • Requires little if any medication
  • Takes a few minutes and very little discomfort 
  • Is cheaper than IVF

Cons of an IUI:

  • Risk of multiple pregnancies is higher 
  • Success rates are only as high as 20% per cycle

IVF 

In Vitro Fertilisation (IVF) is a series of procedures used to help with fertility, prevent genetic problems, and assist with the conception of a child. 

IVF is considered the most effective form of assisted reproductive techniques (ART). The procedure can be using your own eggs and sperm, or with donor eggs and sperm. 

IVF maybe performed due to: 

  • Unexplained infertility 
  • A genetic disorder 
  • Fertility preservation for cancer or other health conditions
  • Male factor impaired sperm 
  • Blocked or removed fallopian tubes 
  • Uterine fibroids 
  • Endometriosis 
  • Ovulation disorders

Step by Step IVF overview

Step 1: Ovulation Induction

You will be shown how to do Follicle Stimulating Hormone (FSH) injections daily. This is to stimulate the ovaries to produce multiple follicles (each follicle potentially containing an egg), over a period of approximately 2 weeks.

Step 2: Monitoring response

During this time you will have 3-4 scans (with blood tests) to monitor the number and size of the follicles, to help your clinician correctly time when they should be collected. 

Step 3: Preparing for collection

You will be given a trigger injection when the leading follicle reaches 17-22mm to mature the eggs in preparation for collection. This trigger injection is time sensitive and is your last injection.

Step 4: Egg collection

On the day of egg collection you will be admitted to the fertility clinic for your procedure. The admission will involve answering some health questions and recording your vital signs including temperature, pulse, blood pressure and oxygen saturations. 

You will be required to change into a hospital gown. If your partner is producing a fresh sperm sample, he should wait with you in your room until called forward by the embryology team. 

The consultant will see you and ask for your consent for the procedure. The clinician putting you to sleep will also pop in to say hello. 

The eggs will be collected using a minor vaginal procedure performed under either conscious sedation, sedation, or general anaesthetic, and under ultrasound guidance. 

The egg collection itself takes 20- 30 mins maximum. As your follicle is being drained, the liquid is simultaneously being passed to the embryologist who will be checking for an egg. 

Post egg collection you will likely be given an antibiotic to reduce infection. Post procedure you are kept for an hour or two to ensure you are fully recovered. In the recovery room you will have your vital signs monitored and you will be continuously assessed for pain. You will be informed of the number of eggs collected at this time. 

The embryologist will fertilise your eggs with your partner sperm or donor sperm. 

Step 5: The day after 

The day after egg collection you will need to commence progesterone support in the form of either pessaries or injections. This will help get the lining of the womb ready for embryo implantation. You will also get a call from the embryologist informing you of how many of your eggs are fertilised. 

Embryo transfer will take place on either day three or day five.

Costs 

A standard IVF cycle costs between £3,500-4,000 per cycle.

Medications can cost £1,000-3,000 per cycle.

Success rates 

The chances of conceiving and having a baby using IVF depends on many factors such as age and cause of infertility, and your ovarian reserve. Your percentage success rate will be discussed with you by your consultant during your initial consultation.

Pros of IVF 

  • Depending on your fertility history, the success rate can be up to 40% per cycle
  • It allows for pre-implantation genetic testing

Cons of IVF

  • The medication required to stimulate does have side effects. 
  • The significant financial cost
  • Can be time consuming especially if not successful at first attempt

Egg Freezing 

Egg freezing is a way of preserving a woman’s fertility so she can have a child in the future. Some women freeze their eggs because they have a medical condition, or are undergoing certain treatment that affects their fertility. 

Some women undergo this procedure to donate their eggs for someone else’s treatment. "Social" egg freezing allows women the option of freezing their eggs when younger. Thereby offering them a higher chance of being able to conceive when the time is right and they are older. Meaning they are less affected by the natural decline in their fertility. 

The process of egg freezing follows similar steps as IVF, but instead of your eggs being fertilised, they will be frozen as they are. You will know on the day of your egg collection how many eggs were mature enough to be frozen.

How many eggs need to be frozen? 

Current research suggests that for women under 40, 20-30 eggs should be frozen to give yourself a realistic chance of a live birth in the future. However, some women will achieve success with a few eggs, whereas some will be unsuccessful with more than 20 eggs.

What is the best age to freeze your eggs? 

There is no specific age. But the general consensus is the younger you are the better. What we do know is that the quality of your eggs declines with time and age. When you freeze your eggs at a younger age you lock in the quality of the good eggs. 

Costs 

The cost of an egg freezing cycle is anywhere between £3,000-£4,000. Some clinics offer a three cycle package for just under £10,000. This would include the scans, the procedure, and normally one years freezing costs. 

The cost of medication is anywhere between £1,000-£3,000.

The cost of keeping your eggs frozen every year is approx £350.

Cons 

  • Can provide you with a false sense of reassurance 
  • The cost of the procedure (you will likely need more than one cycle) 
  • The time required to go through with the procedure

Pros 

  • You have high quality eggs frozen for future use 
  • Eggs can be frozen for up to 55 years, eggs can also be donated

What are the risks of medications and treatment in general? 

Common side effects of hormones in general are: 

  • Hot flushes 
  • Mood swings 
  • Bloating 
  • Breast tenderness 
  • Pelvic pressure 
  • Abdominal pain 
  • Nausea 
  • Fatigue 
  • Headaches 
  • Irritation, burning and bruising around site of injection

There are risks to all surgeries, and yes, egg collection is a surgery. You could react to the anaesthesia, there can be bladder damage, bowel damage, or abdominal bleeding. These are all very rare side effects associated with egg collection, however they can occur. All side effects will be discussed with you by your clinician.

 

Similar articles

Close