Question 1: How common is infertility?
Infertility is a growing issue for many couples. Infertility
affects 1 in 6 couples of childbearing age in the UK.
25% of infertile couples have more than one cause of
The current increase in infertility might be the result of more
women choosing to delay starting a family until later in life, when
their reproductive health can be affected.
The increase of some sexually transmitted diseases such as
Chlamydia can result in conditions such as blocked tubes,
preventing pregnancy from occurring.
Question 2: When is a woman’s most fertile time?
A woman's most fertile time is during ovulation.
menstrual cycle is 28 days - that is counting day one as the
first day of menstrual bleeding then the next period is due to
start 28 days later.
The menstrual period comes
because an egg fails to become fertilised. The period comes about
12 to 14 days after the egg is produced.
Therefore, in the average 28 day
cycle the egg is produced around day 14. Sperms can live happily 48
hours in the vagina or the uterus so the most fertile time is from
day 12 to day 16.
Question 3: What things increase a woman's risk of infertility?
There are a number of factors which can increase a woman's risk
of infertility. These include:
- Her age.
- Being under or overweight.
- Moderate or heavy caffeine and/or alcohol use.
- Excessive exercise.
- Certain environmental exposures.
- Sexually transmitted infections.
- Hormonal changes, such as polycystic ovarian syndrome and
primary ovarian insufficiency.
Question 4: Can I get pregnant if I no longer have periods?
This depends on the reason of the lack of periods.
If in fact you are menopausal then you will need egg
However, if the problem is hormonal, you may be treated with
Question 5: Does infertility relate to the woman only?
No, infertility is not always a woman's
problem. Both women and men can have problems that cause
infertility. About one-third of infertility cases are caused
by women's problems. Another one third of fertility problems
are due to the man. The other cases are caused by a mixture
of male and female problems or by unknown problems.
With men, declining sperm counts and testicular abnormalities,
are common causes of infertility.
With women, the most common causes are tubal blockage, endometriosis, PCOS, and advanced maternal age which affects
Question 6: What increases a man's risk of infertility?
A man's sperm can be changed by his overall health and
lifestyle. Some things that may reduce the health or number of
- Heavy alcohol use.
- Recreational drugs.
- Anabolic steroids and body building medications.
- Certain medicines.
- Smoking cigarettes.
- Environmental toxins, including pesticides and lead.
- Radiation treatment and chemotherapy for cancer.
- Health problems such as mumps, serious conditions like kidney
disease, or hormone problems.
Question 7: What causes infertility in men?
Infertility in men is most often caused by:
- Blockage. A blockage in any part of the
reproductive system that helps deliver sperm, such as the
epididymis or vas deferens, can cause infertility.
- Medications. Certain medications, such
as anabolic steroids, cancer drugs, have been associated with
infertility in men.
- Low sperm count. When a man produces too
little sperm, it can cause problems with conception.
- Sperm problems. Sometimes sperm are
shaped abnormally or move in abnormal ways, which can lead to male
- Undescended testicle. A testicle that
doesn't move down from the abdomen into the scrotum can affect
sperm production. Sometimes a man is born with the problems
that affect his sperm. Other times problems start later in
life due to illness or injury. For example, cystic fibrosis
often causes infertility.
- Varicoceles. This happens when the veins
on a man's testicle(s) are too large. This heats the
testicles. The heat can affect the number or shape of the
- Medical problems. Some medical
conditions, such as kidney failure, can lead to male fertility
Question 8: Do you do male infertility evaluations?
We do have a full male fertility services with male fertility
specialist (Andrologist) available in our department to deal with
any male fertility issues. Please contact our unit for more
Question 9: How long should a couple try to conceive before going to the doctor?
If you are under 35 and have had frequent (about two or three
times a week) unprotected sex for at least a year without
conceiving (or three to six months if you're 35 or older), you may
want to consult a fertility expert.
Or see a doctor if you have a history of:
Question 10: Can I find out earlier if I have fertility issues?
You always have the option of asking your health care provider
to conduct a complete examination and perform initial
investigations to determine if either partner has possible
Question 11: How do doctors treat infertility?
Infertility can be treated with medicine, surgery, artificial
insemination, or assisted reproductive technology. Many times
these treatments are combined. In most cases infertility is
treated with drugs or surgery.
Doctors recommend specific treatments for infertility based
- Test results.
- How long the couple has been trying to get pregnant.
- The age of both the man and woman.
- The overall health of the partners.
- Preference of the partners.
Question 12: What about fertility treatments?
Fertility treatments can increase the likelihood of getting
Treatments can include lifestyle changes, supplements, surgery,
medication, or assisted reproduction.
There are several treatments under assisted reproduction such as
vitro Fertilisation (IVF), Gamete
Intra-Fallopian Transfer (GIFT), and Zygote
Intra-Fallopian Transfer (ZIFT). All these procedures
involve harvesting a number of eggs in the hope of fertilising at
least one egg, and then inserting the fertilised egg(s) into the
Question 13: How often is assisted reproductive technology (ART) successful?
Success rates vary and depend on many factors. Some things
that affect the success rate of ART include:
- The reason for infertility.
- The age of the partners.
- The type of ART treatment.
- If the egg is fresh or frozen.
- If the embryo is fresh or frozen.
Question 14: Is there a waiting list? And how long would I have to wait for the start of my IVF treatment?
We have no waiting list for IVF at all. Most of our
patients have their first initial consultation with our fertility
specialist within a few weeks of first contact. They usually
begin treatment within a month or two after completing the consent
forms and other documentation.
Question 15: How soon can we start receiving treatment?
Usually we are able to arrange your first visit to our clinic
within few weeks. All the required investigations are
performed on Day 2 of your period. Following that you will be
seen in the clinic to complete the consent forms. After that
your treatment can commence.
Question 16: What if my IVF attempt failed? How long will I have to wait before trying again?
It's best to wait for at least 2-3 months before starting
another IVF treatment. This is to make sure that your
hormones get back to normal before commencing another treatment
Question 17: What happens with my remaining embryos that are not implanted?
Remaining embryos can be frozen with a specific technique.
Later they can be implanted into your womb without the
Question 18: How long can my embryos remain frozen?
Your embryos can remain frozen up to for 10 years for social
Question 19: What is Intra-cytoplasmic sperm injection (ICSI)? When is it useful?
ICSI (Intra-cytoplasmic Sperm Injection) is an infertility
treatment that can be used with conventional IVF. During
ICSI, one single sperm is injected directly into an egg.
ICSI is especially useful in cases if there is a problem with
Question 20: Do you perform intra-cytoplasmic sperm injection (ICSI) on all patients?
No, we do not.
We feel that ICSI should only be performed when necessary, for
example when the there is a problem with the sperm or there is a
prior history of poor fertilisation through IVF.
Question 21: What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI) involves a laboratory procedure
to separate fast moving sperm from more sluggish or non-moving
The fast moving sperm are then placed into the woman's womb
close to the time of ovulation when the egg is released from the
ovary in the middle of the monthly cycle.
Question 22: Can I receive treatment with donated sperm or donated eggs?
Question 23: Can embryos from egg donors be frozen?
Yes, embryos can be frozen for the maximum of 5 years.
Question 24: Are urine pregnancy tests as reliable as blood tests?
No. The urine test is predictable to about 25 mIU per mL
of bHCG (the pregnancy hormone). It also depends on your
On the other hand, blood tests are sensitive to approximately 2
mIU per mL.
Therefore, a very early pregnancy may still be detected with
blood tests but be missed with a urine pregnancy test.
Question 25: When is the best time to measure urine for ovulation?
We usually recommend that patients test their urine in the early
afternoon. If measured early in the morning, the urine can be
concentrated and thus give you false positive results.
We recommend any time after 3.00 pm.
Question 26: Do you only treat married couples?
In our Unit we provide expert fertility medical treatment for
married and unmarried couples, same sex couples and
Question 27: Can I come to the consultation on my own?
You are both required to attend as a couple for the initial
consultation to complete all the necessary paper work and
Question 28: How much will it cost?
If you meet the criteria for an NHS funded cycle there will not
be any cost to you whilst undertaking your NHS funded
Question 29: Do you accept single women and lesbian couples?
Yes we do. As long as your Clinical Commissioning Group
(CCG) agree to fund your treatment.
Question 30: Are there any risks or side-effects with IVF?
As with any form of treatment, potential risks and side-effects
do exist. One or two embryos are 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, increasing 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 abdomen.
Symptoms of this include swelling in the abdomen, 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
Undergoing IVF can be emotionally challenging too, especially
when treatment cycles are unsuccessful. We have counselling
facilities available in our Unit. There are also other support
groups available in the UK.
Question 31: What support is out there?
We have a in-house counsellors, who are available to see you
should you find this beneficial.
Visit our Counselling Service page
As well as counselling you may find further 'couple counselling'
useful to work through issues brought up by the treatment.
Question 32: How long can sperm be stored?
There is no practical limit to the length of time sperm,
correctly maintained in liquid nitrogen, can be stored.
Question 33: Is freezing harmful to the sperm?
A percentage of the sperm will not survive the freezing process.
The survival rate varies greatly between individuals.
Question 34: What is the normal volume of an ejaculate?
2 to 5 milliliters (2-5cc).
Question 35: What is the ideal abstinence time before giving a semen sample for assessment?
Between four and five days is ideal.
Question 36: What is the procedure for using the frozen sperm?
You need to be seen in the clinic a few weeks prior to the date
you anticipate needing the samples. Contact the Andrology
The woman would need to be assessed by the doctor for blood
tests or a current pap smear and to assess tubal patency (to make
sure there are no blockages in her fallopian tubes). Some
documentation needs to be completed prior to any insemination.
Be sure to communicate with your doctor in advance to avoid
Question 37: How can I guarantee that I will become pregnant using the samples?
Regardless of how many samples are frozen it is impossible to
guarantee success. The best advice is to carefully consult with
both an Andrologist and your doctor before beginning any use of the
Question 38: What if the initial semen quality is poor, or concentration is very low?
Many cryopreserved samples may not be of sufficient quality for
use with artificial insemination. However, IVF with ICSI is
regularly performed with samples of poor quality or
Question 39: How can I be sure my semen sample is not contaminated with another sample or mislabeled?
The specimen container used to collect the sample is labeled and
verified by the patient prior to collection. Once the sample is
received it is handled with extreme caution. All materials used in
the process are labeled with the patient's name, the current date,
and a hospital number unique to the patient and the sample
collected. Each sample is assigned a physically isolated
workstation. All tools and solutions used in preparing the sample
for cryopreservation are sterile and single-use. Certified
Andrology technicians will ensure there is no confusion in the
handling of semen samples.
Question 40: What if I move out of the area?
Arrangements can be made to ship semen samples to another clinic
or storage facility in the area you are moving to. Some
documentation will be necessary to ensure proper handling and
security of the samples.
Question 41: Can we have IVF treatment if I and my partner are not married?
Yes, you can, as long as neither of you is married to someone
else. You would also need to provide proof that you are living
Question 42: How many embryos can be implanted at on IVF cycle?
The maximum number of embryos implanted will depend on your age,
number of previous IVF attempts, and quality of embryos.
Normally up to 2 embryos can be implanted.
Question 43: What is a blastocyst?
A blastocyst is 5-day old embryo that has around 70-100
We now have the ability to grow the embryos for 7 days until
they reach the blastocyst stage. For many patients, these
blastocysts may have a greater chance of implantation, permitting
us to implant fewer embryos and lower the possibility of multiple
births while, at the same time, increasing the chance of