Medical Treatment Glossary

For many couples medical assistance is required to help them on their way to pregnancy. These are some of the options available both on the NHS and privately. In West Dorset we are lucky enough to be offered these treatments with very little wait (no more than 18 weeks). The entitlement is currently two cycles of IVF / ICSI (providing the criteria is met) and three cycles of IUI. If you feel you need to discuss your options you can book in via your GP to see a fertility specialist or you can self refer privately (this can also be arranged via your GP).

Clomiphene / Clomid

A tablet given to induce ovulation, which women may be prescribed by their gynaecologist. Generally it is taken for a few days at the beginning of your cycle and you are then encouraged to have sex as normal around the time of ovulation (which happens naturally). Women can usually only take this drug for three months and then they move on to injectable variations.

Intra-Uterine Insemination (IUI)

This is a technique to enhance the chances of becoming pregnant by inserting the sperm directly into the uterus through the cervix. It is especially helpful if it is suspected that the woman's mucus is hostile to sperm, or if the man's sperm cannot swim that well. Ovulation can be induced by drugs and monitored by scan. Often the clinic will give the woman ovulation strips to pee on at home which will detect the Lutenising hormone surge indicating that ovulation will occur within the next 24 hours. The sperm sample is then washed and the best ones inserted back in. A course of three IUI's to run concurrently is often a good place to start for couples.

In Vitro Fertilisation (IVF)

This is used for couples with unexplained infertility or often for obstructive infertility (where a blockage in the male or female partner prevents the egg or sperm getting to where it needs to be). The woman is down regulated which means she is given drugs to take at home which quieten everything down and stop the body from producing any hormones which would usually regulate the cycle. This is done so that the clinic can introduce synthetic drugs to manipulate the cycle themselves and produce the results they want without the woman's body interfering! It has to be this way because they need to be able to stimulate more eggs to mature than on a normal cycle, and it is paramount that they can control when ovulation takes place otherwise eggs cannot be collected. The drugs for down regulation involve a small injection every night which the woman does for herself (or her partner can do it) in her tummy or thigh.

After down regulating for a few days (or a couple of weeks) the woman will have a period. The lining of the uterus (womb) is then shed (via the period) so everything is all clear and ready to start fresh. This drug continues to be given everyday so that the clinic can artificially take over the cycle with another course of drugs which are synthetic hormones to encourage lots of eggs to mature (ideally around ten) rather than the usual one or two which occur on a natural cycle. At this stage the woman will do two injections a day for around ten days. Regular scans are done to check on the progress of the follicles (which contain the eggs) and when they are big enough a further drug is injected to trigger the follicles to release the eggs (i.e. ovulate) and these eggs are collected by the clinic whilst the woman is either gently sedated or briefly anaesthetised. It is a really simple procedure and the woman is not aware of the egg collection taking place, but may feel some discomfort afterwards for which she can take pain killers for.

Once the eggs are collected they are mixed in the laboratory with a sample of the partner's sperm to enable fertilisation to take place. If the sperm need a little extra encouragement then a procedure called Intra Cytoplasmic Sperm Injection (ICSI) is used to inject a single sperm straight into the egg to enable fertilisation. The embryologist looks after the fertilised eggs (embryos) in the laboratory and will decide when is the optimum time to put the embryo(s) carefully back into the woman's uterus. It tends to be either day 2, 3 or 5 after egg collection. One, two or in rare cases, three embryos are replaced- although action is being taken to limit to just one in order to reduce multiple pregnancy rates. Other embryos are frozen if they are of good enough quality, to be used on another cycle if the couple wish.

The embryo transfer itself is a lot like a smear test, the woman is asked to have a full bladder, a scan is done at the same time as a tiny tube is inserted through the cervix into the uterus and the embryo(s) carefully placed in there. The couple then wait for around two weeks to do a pregnancy test. The process can involve side effects and some women breeze through them whilst others find it a little harder and perhaps need to take some time off from work to relax. The injections are very easy to learn to do, and need only a very small needle. It is often the drug being injected which causes the sensations, such as a brief sting or itchy sensation rather than the needle itself. Many women choose to rotate the site of their injections from thigh to tummy each day. The nurses at the clinic will teach the technique for injecting and it is often so much easier and more comfortable than you think.