Normal fertility

At the beginning of the menstrual cycle the pituitary gland in your brain releases a hormone which stimulates the ovaries to produce follicles. One of these follicles grows faster to become the ‘dominant follicle’. It is from this follicle that the egg will be released.

The ovaries produce many hormones, most importantly oestrogen that promotes growth of the follicles and development of the endometrium (lining of the uterus), while progesterone, released after ovulation, prepares the endometrium for pregnancy.

When the egg is released, it is swept into the fallopian tube and then begins to move slowly downwards to be fertilised in the outer third of the tube. The fertilised egg continues to the uterus to implant in the lining resulting in a pregnancy. If the egg is not fertilised, or the embryo does not progress, the endometrium is shed as a menstrual period approximately 14 days after ovulation.

Infertility

Infertility is defined as the failure to conceive despite regular unprotected intercourse for 12 - 15 months. Several factors may mean that investigations start earlier than this, including an abnormal menstrual cycle, previous abdominal surgery, possibly the age of the woman or in some cases undescended testicles in the male.
Infertility is classified into two types:

• Primary infertility: in couples who have never conceived – approximately 40% of cases.
• Secondary infertility: in couples who have previously conceived – approximately 60% of cases.

Common causes of infertility in women

The London Women’s Clinic's principal objective when assessing our patients is to determine the cause of infertility and to make recommendations about the most appropriate treatments available whilst evaluating your chances of success.

Ovulatory disorders

Ovulatory disorders are the most common causeof female infertility. However, ovulatory disorders also result in the highest pregnancy success rates following treatment. The woman may suffer from either very light periods, irregular periods or no periods, known as Amenorrhoea. However, ovulation disorders do occur with apparently regular cycles. Sometimes women may notice an increase in body and facial
hair, obesity, acne, or milk secretion from her breasts.

Fallopian tube blockage

Fallopian tube damage or blockage prevents the egg from travelling to the fallopian tube. Damage to the cells lining the tube may inhibit sperm reaching the egg and achieving fertilisation. Blockage of the tube can prevent the fertilised egg from reaching the uterus and increases the chance of ectopic pregnancy, where the fertilised egg settles in the fallopian tube rather than the uterus.

Endometriosis

Endometriosis is a condition where the tissue which normally lines the uterus is found at other sites in the pelvis. Bleeding occurs from these tissues at the time of menstruation causing pelvic pain and painful periods. Cysts may develop within the ovaries, causing pelvic scarring that affects the fallopian tubes and leads to infertility.

Treatment of endometriosis is either medical (using drug therapy) or surgical (using laparoscopy or open surgery), depending on the extent of the disease. IVF is an appropriate treatment for endometriosis-induced infertility when other methods have failed.

Cervical mucus

Cervical mucus is produced in the cervical canal. Prior to ovulation it becomes very watery, allowing the sperm to swim through. After ovulation the
mucus becomes thick and prevents the sperm from swimming through. Once the sperm are in the mucus, they can stay there for a few days. Thus the mucus acts as a sperm reservoir.

Cervical mucus hostility is the inability of sperm to penetrate the cervical mucus, therefore preventing migration through the cervical canal. It may be possible to bypass hostile mucus by intrauterine insemination (IUI).

Unexplained Infertility

It is not always possible to determine if the eggs are actually released from the follicles, if the fallopian tubes are patent or if the sperm is capable of reaching and fertilising the egg.

Unexplained infertility affects up to 25% of infertile couples. IVF is an appropriate treatment for unexplained infertility.

Possible side effects of infertility drugs

Side effects from drugs used to treat infertility tend to be minor, although some patients have reported mood changes, tiredness and muscle aching. Rarely, allergic reactions have been reported. In less than 5% of women, a condition called Ovarian Hyperstimulation Syndrome (OHSS) can occur when using drugs for ovarian stimulation. OHSS is most commonly seen in younger women and those with polycystic ovaries. Symptoms include lower abdominal pain and swelling, nausea or vomiting. Women at risk of developing OHSS must stop drugs whilst continuing with GnRG analogue. Egg collection is arranged when oestrogen drops to an appropriate level or, alternatively, the cycle may be cancelled. The clinic must be contacted immediately for any symptom, however mild.

Counselling

The HFEA considers counselling to be a key element in the provision of infertility services for all patients. We are sensitive to the emotions experienced by the infertile couple and the stress of the treatment itself. Counselling is available to you at any time you are a patient at The London Women's Clinic, with the first session being free of charge. We offer implication counselling, which is compulsory where gamete donation is involved, and confidential support counselling.

Please see the patient information leaflet about counselling under downloadable information in the treatment section.
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