Low complexity fertility treatments

Once the causes of your fertility difficulties are established, your doctor may start with any of the following low complexity procedures. These treatments are the simplest and most common in comparison with more advanced infertility treatments such as IVF. Further fertility tests will be necessary along the way to monitor treatment and adjust course of action.

Surgical procedures

In some cases conception difficulties can be resolved through simple surgery. There are a variety of modern techniques available to both men and women that can be conducted during a simple day visit to a clinic.

Procedures involving women may include a laparoscopy or hysteroscopy to treat endometriosis or fibroids affecting the fallopian tubes. Surgery may also be used in conjunction with other therapies.

Questions to ask at this stage

How long will I be away from work?
Where will I need to go for the procedure?
Do you have an information sheet describing the treatment?
What are the side effects or complications of this treatment?
Is there any discomfort?
What are our chances of having a baby if we have this treatment at this clinic?
How long should we give this treatment to succeed?
What should we do next if this treatment doesn’t work?
What support or counselling is available?

With most procedures, you can begin trying to conceive naturally within a few weeks or months. Ask your doctor about the length of time in your particular case.

Hormonal therapies

In many cases, conception difficulties are caused by hormonal imbalances. Hormonal therapy replaces or enhances naturally-occurring hormones, and provides the hormonal stimulation necessary for a couple to conceive.

Clomiphene citrate is used to bring on ovulation. This prescription drug comes as a tablet and is often used as an initial treatment for women with ovulation problems. Clomiphene will induce ovulation in about 80% of properly selected patients. About 40% to 45% of women receiving clomiphene citrate will become pregnant within six cycles.¹

Questions to ask at this stage

Do you have an information sheet describing the treatment?
What are the side effects of this treatment?
What are our chances of having a baby if we have this treatment at this clinic?
How long should we give this treatment to succeed?
What are the risks of multiple pregnancies?
What should we do next if this treatment doesn’t work?
What support or counselling is available?

Most authorities suggest that clomiphene be given for no more than six cycles, because the chance of success is much less after six cycles. After that, alternatives may be considered.¹

If clomiphene citrate is ineffective, other drugs may be prescribed to bring on follicle development and ovulation.

Ovulation induction (OI) The medication is given in the form of injections, which you can do yourself at home using a pen device. Regular clinic checkups occur to ensure hormone levels achieve the desired level.

This is how it works. During the follicular phase of a woman’s reproductive cycle, a human follicle-stimulating hormone (FSH) is given for several days or weeks. FSH stimulates the development of follicles in the ovaries and helps produce eggs. Around the 11th day of the cycle, a single injection of choriogonadotropin (hCG) may be given to help eggs mature and trigger ovulation. The eggs are released, ready to be fertilized. At this point, fertilization is attempted either through sexual intercourse or artificial insemination.

Artificial Insemination or Intra-Uterine Insemination (IUI)

Artificial Insemination, also called Intrauterine Insemination (IUI), is often used to treat conception difficulties caused by low semen volume, low sperm concentration, or decreased sperm motility. It may also be used to treat conception difficulties caused by cervical mucus problems or immunologic factors in the woman. Sperm obtained by masturbation is refined and deposited into the uterus around the time of ovulation. The process, known as intrauterine insemination (IUI), is performed in a clinic by a specialist.

Under normal conditions, only one to ten of every 14 million sperm deposited naturally into the vagina reach the egg waiting the end of the fallopian tube. The advantage of IUI is that large numbers of sperm come into proximity with the egg cell.

Questions to ask at this stage

Which hormone treatment would achieve the best result for us?
How are these hormones made?
How are hormones administered?
Do you have an information sheet describing the treatment?
What are the side effects of this treatment?
Is there any discomfort?
What are our chances of having a baby if we have this treatment at this clinic?
How long should we give this treatment to succeed?
What are the risks of multiple pregnancies?
What should we do next if this treatment doesn’t work?
What support or counselling is available?

Expect to have hormone treatment for two to six months, depending on the effect of the treatment.

^{1. Medications for Inducing Ovulation. A Guide for Patients. ASRM 2006; http://www.asrm.org/Patients/patientbooklets/ovulation_drugs.pdf}

Vagina

The muscular opening through which sperm travels in order to reach an egg. The vagina also serves as a passage for menstrual flow and secretions, which may assist or obstruct sperm in their journey to fertilizing an egg.

Varicocele

The presence of varicose veins around the testicles caused by poor circulation. The increase in blood leads to a rise in the temperature in the testicles. This causes abnormal testosterone levels, which hinder the production of sperm.

Vas deferens

A long curving tube that forms part of the sperm storage and transport system.

Urologist

A medical specialist dealing with the treatment of the urinary tract and urogenital system.

Uterus

A pear-shaped organ also known as the womb that supports the developing foetus throughout pregnancy. The uterus consists of: the cervical opening, the cervix and the uterine cavity. The two fallopian tubes open into the uterus.

Ultrasound

A medical imaging technique used instead of X-rays to view the reproductive organs and monitor the development of follicles.

Scrotum

The pouch of skin below the penis, which holds the testicles or testes.

Semen

The fluid released by the penis during orgasm, which helps transport sperm manufactured in the testicles.

Seminal vesicles

Two pouches located behind the male bladder, which produce part of the seminal fluid used to transport and nourish sperm.

Sperm or spermatozoa

The gamete or reproductive cell that that carries the male’s genetic information to the female‘s egg.

Sperm count

The number of sperm contained in an ejaculate. Also called sperm concentration and given as the number of sperm per millilitre. Also see Azoospermia and Oligospermia.

Sperm motility

The percentage of all moving sperm in a semen sample.

Sterility

An irreversible condition that prevents conception.

Subfertility

A condition affecting couples who have already conceived, or have had an abortion, or have produced a first child but are now experiencing difficulty in adding to their family. Also see infertility or primary infertility.

Obstetrician/Gynaecologist

A doctor who delivers babies and specialises in the treatment of female reproductive organs.

Oestrogen

A hormone that stimulates secondary female sexual characteristics and controls the course of the menstrual cycle. Oestrogen is also produced in low quantities in males.

Oligospermia

A condition when a sperm sample contains less than 20 million spermatozoa per ejaculate. Many medical conditions reduce sperm concentration. The effects may be temporary or permanent. See also Azoospermia.

Outpatient

A Person undergoing a clinical procedure that does not require admission to hospital.

Ovarian failure

The failure of the ovary to respond to hormonal stimulation from the pituitary gland because of damage to or malformation of the ovary, or a chronic disease such as autoimmune disease or ageing process.

Ovarian follicle

The structure in which eggs are nurtured to maturation. Although in general only one egg is released at a time, somewhere between 10 and 20 follicles begin the process of maturation monthly. The excess ovarian follicles are reabsorbed before ovulation occurs.

Ovulation

The release of the matured egg or ovum from the ovarian follicle.

Ovum

A matured egg.

Ovulation Induction (OI)

Medical treatment carried out to initiate ovulation.

Ovarian Hyper Stimulation Syndrome

A condition characterised by enlargement of the ovaries, fluid-retention and weight gain. May occur when the ovaries are over-stimulated during assisted reproduction.

Ovaries, Ovary

Almond-sized organ(s) located on either side of the uterus, which produce and release mature egg cells and the hormones oestrogen and progesterone.

Manual palpation

A physical examination for any genital abnormalities or any other physical signs that might be associated with conception difficulties.

Myoma

A benign tumour in the uterus consisting of muscle tissue. Myomas are often the cause of persistent infertility or miscarriage.

Micromanipulation

A variety of techniques performed in a laboratory with microscopic guidance, such as Intracytoplasmic Sperm Injection (ICSI).

Menopause

Typically diagnosed 12 months after a woman’s last menstrual cycle. Natural menopause occurs when the ovaries begin decreasing their production of the sex hormones oestrogen and progesterone and marks the end of a woman’s fertility. See premature menopause.

Menstruation or menses

Shedding of the uterine lining by bleeding. In the absence of pregnancy, this normally occurs about once every 28 days.

Miscarriage

Spontaneous loss of a viable embryo or foetus from the uterus.

Motility

The ability of sperm to swim or move. Poor motility means sperm have less chance reaching and fertilizing the egg.

Multiple pregnancy

A pregnancy with two or more foetuses.

Mumps

A viral disease of the parotid (salivary) glands. Contraction of the virus after puberty may damage sperm-producing cells in the testicles. In most cases, only one testicle is affected. Some men could suffer permanent sterility.

Laparoscopy

Examination of the pelvic region by using a small telescope called a laparoscope.

Luteal phase

The days of the menstrual cycle following ovulation when progesterone is produced by the corpus luteum in preparation for embryo implantation.

Luteinizing Hormone

A pituitary hormone that stimulates the gonads. In a man, LH is necessary for the production of sperm and testosterone. In a woman, LH is necessary for the production of oestrogen.

Luteinizing Hormone Surge

The detection of increased luteinizing hormone (LH) levels indicates impending ovulation, i.e. a mature egg is about to be released from a follicle.

Idiopathic infertility

Unexplained infertility.

Infertility or primary infertility

The inability of a couple to achieve conception after a year of unprotected intercourse – six months if the woman is over 35 – or the inability to carry a pregnancy to live birth. Also see Subfertility.

Intracytoplasmic Sperm Injection (ICSI)

A single sperm is injected directly into an egg cell with microscopic guidance. If fusion takes place, the embryo is transferred into the uterus for implantation. This clinical procedure is often used in conjunction with In Vitro Fertilisation if the male partner has a very low sperm count, low sperm motility or poor-quality sperm.

Intrauterine device

(IUD): A contraceptive device consisting of a small piece of bent plastic, which prevents pregnancy by changing the environment of the uterus.

Intrauterine Insemination (IUI)

A procedure whereby sperm are deposited directly into the uterus via the cervix using a catheter.

Irregular ovulation

Menstrual cycles that vary more than a few days in length from month to month are considered irregular. Most menstrual cycles occur about every four weeks, with the normal range lasting between 24 and 35 days.

In Vivo

A process that occurs inside the body.

In Vitro Fertilization (IVF)

Eggs produced with the assistance of fertility drugs are retrieved from the woman’s body and fertilized by sperm in a laboratory environment. The resulting embryos are transferred via catheter to the uterus.

Immune system disorders

On rare occasions, an impaired immune system may regard the egg or sperm as a ‘foreign body,’ and attack it as an ‘intruder.’

Implantation

The process whereby the embryo embeds itself into the lining of the uterus. The cells from the embryo eventually connect with the mother’s blood vessels to form the placenta. See also ectopic pregnancy.

Hepatitis

A disease characterised by inflammation of the liver arising from various causes including a range of viruses (i.e. A, B, C, E).

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome

A disease of the human immune system caused by the HIV virus, which can be contracted through sexual contact.

Hormonal imbalance

An abnormal hormonal balance, which may arise for example, from a deficiency or excess of oestrogen or progesterone.

Hormones

Chemical messengers produced by the body that transmit instructions from one organ to another.

Human Chorionic Gonadotrophin

A hormone released by the placenta after implantation that keeps the corpus luteum producing estradiol and progesterone, and thus preventing menstruation. The hormone is also given via injection to trigger ovulation after some fertility treatments. In men, it is used to stimulate testosterone production.

Human menopausal gonadotrophin

Natural compounds found in the urine of postmenopausal women. Once extracted and sterilised, hMG is given to women to stimulate ovulation.

Hysteroscopy

A visual examination of the uterus via the vagina using a telescopic instrument, to identify any malformations in the uterus lining, the presence of myomas, fibroid growths or damage to the fallopian tubes. If necessary, minor surgery may be performed at the same time without the need for a large incision.

Hypogonadotrophic Hypogonadism

Impaired activity of the hypothalamus or pituitary glands resulting in below-average function of the ovaries or testicles and low in low production of the hormones Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), Oestrogen, Progesterone and Testosterone, which are necessary for reproduction.

Hypothalamus

The gland at the base of the brain that controls the release of hormones from the pituitary glands.

Fallopian tube

A funnel-shaped passage through which sperm are guided towards the egg, and fertilized eggs are conveyed to the uterine cavity.

Fertilization

The moment of conception when the genetic material contained in the sperm and egg combine to create an embryo. Fertilization usually occurs inside the fallopian tube. It may also occur in vitro during a clinical process. See also In Vitro Fertilization.

Fertility treatment

Any procedure used to enhance fertility or to help couples achieve pregnancy.

Fertility psychologist

A health specialist with professional qualifications in psychology and counselling relating to fertility issues.

Fibroid tumour

A benign (that is, not malignant or life-threatening) tumour made up of fibrous tissue that may form in the uterine wall. Fibroid tumours may be present without any symptoms, or may cause abnormal menstrual patterns or infertility.

Follicle

A fluid-filled sac in the ovary, which contains the egg released during ovulation. Each month a new egg matures and travels to the fallopian tube.

Follicle Stimulating Hormone

A hormone released by the pituitary gland in both sexes. In women, FSH stimulates the growth of the ovarian follicle necessary for egg production. In men, FSH stimulates and supports sperm production. Elevated FSH levels are associated with gonadotrophin failure in both men and women.

Freezing

(See Cryopreservation)

Ectopic pregnancy

A pregnancy in which the embryo implants outside the uterus and cannot be sustained.

Ejaculate

The seminal fluid discharged upon male orgasm, which helps transport sperm.

Egg retrieval

A procedure used to obtain eggs from ovarian follicles for use in In Vitro Fertilization. Retrieval may be performed during a laparoscopy procedure or via the vagina using a blunt syringe and with the aid of an ultrasound to locate the follicle in the ovary.

Embryo

The early stages of foetal growth from conception to the eighth week of pregnancy.

Embryo transfer

The process whereby an embryo is transferred into the uterus after the egg has been fertilized outside the body during a laboratory procedure.

Embryologist

A specialist involved in the various aspects of assisted reproduction laboratory procedures related to sperm, oocytes and embryos.

Endocrinologist

A medical specialist concerned with the study of hormones and infertility, having first trained as an obstetrician/gynaecologist.

Endometrial biopsy

The removal of a sample of the lining of the uterus for examination.

Endometriosis

A condition whereby cells that normally line the uterine cavity grow outside the womb, for example in the fallopian tubes, ovaries, or even the bladder or intestines. The cause is largely unknown. Scarring from endometriosis may cause conception difficulties.

Endometrium

The lining of the uterus, which is shed during the menstrual cycle. If conception takes place, the embryo implants itself into the rich vascular membrane, which nourishes the developing foetus.

Epididymis

A tightly coiled tube located above the testicles or testes, where sperm mature for fertilization.

Cervical mucus

A natural lubricant produced by the female body that aids the transportation of sperm and helps protect against infection.

Cervix

The cervix or neck of the uterus is the lower, narrow portion of the uterus where it joins with the top end of the vagina.

Chlamydia

A sexually-transmitted infection, which may be asymptomatic or cause genital inflammation and discharge, pelvic pain and fever. Untreated, chlamydia can lead to Pelvic Inflammatory Disease (PID) and fertility problems.

Chromosomes

Structures found in the nucleus of cells that contain genes and carry heredity information, such as eye colour, blood type and vulnerability to disease. Humans have 23 pairs of chromosomes. One set of 23 chromosomes is inherited from the biological mother via her egg and the other from the biological father, via his sperm. Each sperm cell contains either male or female sex chromosomes. As such, it determines the gender of the foetus. Genetic abnormalities occur when an individual is born missing a chromosome or has more copies of a chromosomal pair.

Clomiphene citrate

A prescription drug used to bring on ovulation. It comes as a tablet and is often used as an initial treatment for women with ovulation problems. Clomiphene citrate induces ovulation in 80% of women who have trouble ovulating on their own.

Conception

The moment of fertilization when the sperm meets and penetrates the egg.

Congenital abnormalities

Physical abnormalities present at birth.

Corpus luteum

A hormone-secreting mass within the ovary that forms from the remains of a follicle each time an egg is released. The hormones it produces prepare the uterus for embryo implantation. If pregnancy does not occur, the mass is shed during menstruation.

Cryopreservation

A technique used to store human tissue at very low temperatures. Embryos that are not used in an ART cycle may be preserved in this way for future use. Also known as “Freezing”.

Cryptorchidism

A condition usually detected at birth or childhood whereby the testicles fail to descend. When a male foetus develops in the uterus, his testicles normally form inside his abdomen and descend into the scrotum shortly before birth. Undescended testicles usually descend themselves by the sixth month of life, but are unlikely to descend after this period of their own accord.

Amenorrhoea

The absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and breastfeeding. Outside the reproductive years, there is an absence of menses during childhood and after menopause. See also premature menopause.

Andrologist

A medical specialist who deals with male health, particularly relating to the problems of the male reproductive system and urological problems unique to men.

Artificial Insemination (AI)

Procedure whereby sperm are deposited via the vagina into the cervix or uterus using a catheter. The technique is used to transfer donor sperm or to overcome problems with sexual performance, the interaction between sperm and mucus, or the quality of sperm.

Assisted hatching

A procedure whereby a small hole is drilled in the protective membrane of the embryo using a laser device or a dilute acidic solution to assist hatching and aid implantation.

Assisted Reproductive Technologies (ART)

A variety of procedures used to bring about conception without sexual intercourse, including In Vitro Fertilisation (IVF), Gamete Intra-Fallopian Transfer (GIFT) or Zygote Intra-Fallopian Transfer (ZIFT), Intracyto-plasmic Sperm Injection (ICSI), Microsurgical Epididymal Sperm Aspiration (MESA) and Testicular Sperm Extraction (TESE).

Autoimmune disease

A disease where the body attacks its own cells due to an overactive immune response.

Azoospermia

A complete absence of sperm in the semen. See also Oligospermia.

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Low complexity fertility treatments

Surgical procedures

Questions to ask at this stage

Hormonal therapies

Questions to ask at this stage

Questions to ask at this stage

Vagina

Varicocele

Vas deferens

Urologist

Uterus

Ultrasound

Scrotum

Semen

Seminal vesicles

Sperm or spermatozoa

Sperm count

Sperm motility

Sterility

Subfertility

Obstetrician/Gynaecologist

Oestrogen

Oligospermia

Outpatient

Ovarian failure

Ovarian follicle

Ovulation

Ovum

Ovulation Induction (OI)

Ovarian Hyper Stimulation Syndrome

Ovaries, Ovary

Manual palpation

Myoma

Micromanipulation

Menopause

Menstruation or menses

Miscarriage

Motility

Multiple pregnancy

Mumps

Laparoscopy

Luteal phase

Luteinizing Hormone

Luteinizing Hormone Surge

Idiopathic infertility

Infertility or primary infertility

Intracytoplasmic Sperm Injection (ICSI)

Intrauterine device

Intrauterine Insemination (IUI)

Irregular ovulation

In Vivo

In Vitro Fertilization (IVF)

Immune system disorders

Implantation

Hepatitis

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome

Hormonal imbalance

Hormones

Human Chorionic Gonadotrophin

Human menopausal gonadotrophin

Hysteroscopy

Hypogonadotrophic Hypogonadism

Hypothalamus

Fallopian tube

Fertilization

Fertility treatment

Fertility psychologist

Fibroid tumour

Follicle

Follicle Stimulating Hormone

Freezing

Ectopic pregnancy

Ejaculate

Egg retrieval

Embryo

Embryo transfer

Embryologist