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Getting pregnant: more about fertility and conception

The basics of life

For most couples, expectations of a successful pregnancy are realised even if a little help is needed along the way. Before reading about Assisted Reproductive Techniques (ART), you may like to remind yourself of the stages involved in achieving pregnancy and the important role hormones play.

Step One

During the first half of the menstrual cycle, the follicle-stimulating hormone (FSH) stimulates growth and development of a single follicle within one of the ovaries. At the same time, the hormone oestrogen stimulates growth of the uterus lining in preparation for the fertilized egg.

Step Two

When the egg cell matures, luteinizing hormone (LH) levels surge and trigger the egg’s release. The exact timing of ovulation relates to a woman’s individual menstrual cycle or period. In an average 28-day cycle, ovulation occurs between days 14 and 16, day one being the first day of menstruation.

The egg follicle bursts, releasing a fertile egg, which migrates to the fallopian tube. What’s left of the spent follicle transforms into the corpus luteum, which in turn produces a hormone known as progesterone. Progesterone prepares the endometrium or uterus lining for the implantation of the fertilized egg.

Step Three

En route from the fallopian tube to the uterus, the egg may be fertilized. Sperm can live within the human body for 48-72 hours. But of the countless sperm that make it to this stage, only one may penetrate the egg’s protective membrane and fertilize the egg. During fertilization, the couple’s genes combine to create a new embryonic life.

Step Four

As the first few cells divide, the embryo continues its course toward the uterus. Just before implantation, it hatches from the egg’s protective membrane.

Step Five

Six days after fertilization, the embryo embeds itself into the lining of the uterus (endometrium). A placenta forms to exchange nutrients and gases between mother and embryo, and essential hormones are released to maintain pregnancy. If fertilization doesn’t occur, or if for some reason, the embryo fails to implant, the lining of the uterus is expelled, resulting in menstrual bleeding (the period) and the cycle starts again.

It’s natural for your stress levels to rise if you’re going through fertility treatment. But it’s crucial to maintain perspective and keep your emotions in check. Learn strategies for managing stress.

The importance of hormones

Achieving a pregnancy depends on the successful interaction of the hormones that regulate the reproductive cycles. Some hormones come from two glands in the brain, the hypothalamus and the pituitary. Specific female hormones are produced in the ovaries, while men’s specific reproductive hormones come from the testicles.

Follicle-stimulating hormone (FSH)

In women, FSH stimulates egg growth and development and contributes to production of oestrogen.
In men, it stimulates sperm production in the testicles.

Luteinizing hormone, (LH)

In women, this hormone is necessary for the production of estrogens and triggers the egg’s release from the ovary
In men, it stimulates the production of testosterone, the hormone that helps maintain male sexual characteristics and bring sperm cells to maturity.

Gonadotrophin-releasing hormone (GnRH)

The release of FSH and LH into the bloodstream is triggered by another hormone known as gonadotrophin-releasing hormone (GnRH).

Progesterone

This hormone prepares the lining of the female uterus for implantation of the fertilized egg.

A commitment to your future

the past three decades, scientific advances have helped millions of couples overcome problems with fertility. Treatments ranging from recombinant drugs to Assisted Reproductive Technologies (ART) have achieved unprecedented success.

According to the World Health Organisation, after medical examinations, the causes of infertility remain unexplained in only 5-10% of couples. So if you have concerns, there’s good reason to investigate possible solutions. Depending on the underlying cause, many relatively simple solutions are available.

Procedure	Description	Possible reason	Additional comments
In vitro fertilization (IVF)	Hormone therapy using gonadotrophins stimulates the ovaries to produce several mature eggs. Eggs are retrieved and fertilized in vitro with either partner or donor sperm. If fertilization occurs within 24 to 28 hours, one or more embryos are transferred to the uterus.	Female infertility due to fallopian tube blockage or endometriosis. Male infertility due to sperm abnormalities preventing fertilization. Some cases of unexplained infertility.	As fertilization occurs in vitro, sperm may be screened and excluded for abnormalities.
Intracyto- plasmic Sperm Injection) (ICSI)	An in vitro microsurgical fertilization technique in which a single sperm is selected and injected into an egg. Performed with eggs obtained after ovulation stimulation, as with IVF.	Male infertility when very few healthy sperm are available and/or Fertilizing capacity of sperm is dramatically reduced.	Has become an alternative to artificial insemination with donor sperm
Gamete Intra-Fallopian Transfer (GIFT)	Follows same procedures as IVF except that fertilization occurs in vivo or inside the body. Spermatozoa and eggs are placed directly into the fallopian tubes for fertilization to occur.	Infertility due to endometriosis and cervical disorders. Unexplained infertility. Some cases of male infertility.	Can only be conducted if fallopian tubes are healthy. Fertilization cannot be verified since it occurs in vivo.
Zygote Intra-Fallopian Transfer (ZIFT)	Same procedures as IVF except that fertilized eggs are placed in the fallopian tubes at the zygote stage of embryo development.	Same as for GIFT.	Can only be conducted if fallopian tubes are healthy.
Microsurgical Epididymal Sperm Aspiration (MESA)	Spermatozoa are retrieved directly from the epididymis, within the male testes. Fertilization is then attempted with ICSI.	Severe male infertility. Absence of sperm in the ejaculate known as azoospermia. Congenital abnormalities (e.g. absence of vas deferens).	Usually enough sperm can be retrieved from one procedure to be frozen for later use if required.
Testicular Sperm Extraction (TESE)	Biopsy of the testes is performed in order to obtain spermatozoa directly from testicular tissue. Fertilization is then attempted with ICSI.	Severe male infertility. Absence of sperm in epididymis. Absence of epididymis.	Option if MESA is not possible.

Zygote

The single cell formed when a sperm fertilizes an egg.

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.

Testicles or testes

The male sex glands, which are located in a sac below the penis called the scrotum. Their main functions are to produce sperm and to release the male sex hormone testosterone. In order to produce and nurture sperm, the temperature within the testicles remains around 1°C cooler than normal body temperature.

Testicular cancer

A malignant tumour that develops in the testicle may destroy testicular tissue. If not detected early enough it may also spread to other parts of the body.

Testicular Sperm Extraction

The extraction of sperm directly from the testicles (TESE) or from the epididymis (MESA) if sperm is not found in the ejaculate. A minor surgical procedure is carried out to remove tissue samples that may contain sperm. The sperm is then used in Intracytoplasmic Sperm Injection (ICSI) treatment.

Testosterone

The male hormone responsible for forming secondary sex characteristics, such as facial hair, and supporting the sex drive. Testosterone is also necessary for sperm development.

Tubal pregnancy

The development and attachment of an embryo in a fallopian tube. See also ectopic pregnancy.

Recombinant drugs

Drugs made using recombinant DNA techniques. These techniques involve modifying DNA to contain genes from two different sources. Recombinant technology is often used to produce extremely pure therapeutic drugs.

Pelvic Inflammatory Disease

A generic term for inflammation of the uterus, fallopian tubes and/or the ovaries, which may lead to scarring or adhesions to nearby tissues. PID can refer to viral, fungal, parasitic or bacterial infections and is often associated with sexually transmitted infections.

Penis

The male organ that delivers semen, containing sperm, into the vagina on ejaculation. During sexual stimulation, the penis becomes erect as its spongy tissue fills with blood.

Pituitary gland

The pituitary gland controls the function of other endocrine glands and is located at the base of the brain. It produces hormones including Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), which stimulate the ovaries and testicles.

Placenta

A temporary organ through which the mother nourishes the developing foetus, transfers oxygen and receives carbon dioxide waste from the foetus. After birth, the placenta detaches from the uterine wall and is expelled from the body as afterbirth.

Premature Menopause or Premature Ovarian Failure

Menopause that occurs at or before the age of 40, resulting from genetics, autoimmune disorders, medical procedures or treatments.

Polycystic Ovarian Syndrome (PCOS)

A hormonal imbalance that leads to the formation of ovarian cysts and disrupts ovulation. Without progesterone, a woman's menstrual cycle is irregular or absent.

Progesterone

A hormone secreted by the corpus luteum to prepare the body for pregnancy and, if pregnancy occurs, for maintaining it until birth via the placenta. If implantation does not occur, hormone levels drop, the endometrium breaks down and menstruation occurs.

Prolactin

A hormone produced in the brain, which stimulates lactation - the flow of breast milk.

Prostate gland

In men, a chestnut-sized gland below the bladder, which produces 60% of the seminal fluid used to transport sperm.

Puberty

The stage of adolescence marked by the development of secondary sex characteristics, including menstruation in females. In girls, puberty occurs between the ages of about 11 and 14, and between 13 and 16 in boys.

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.

Gamete

A reproductive cell: sperm (male) or egg (female).

Genital herpes

A sexually transmitted disease caused by the herpes simplex viruses type 1 or type 2, resulting in genital ulcers.

Genital warts

Benign growths on the genitalia, externally or internally, which are caused by the Human Papilloma Virus (HPV).

Gonadotrophin-releasing hormone

A hormone secreted from the brain, which in turn stimulates the pituitary gland to produce hormones involved in the fertility cycle, mainly Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH).

Gonadotrophins

Hormones secreted by the pituitary gland that control reproductive function, such as Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH).

GnRH analogues

Drugs that temporarily block the natural release of Luteinizing Hormone (LH) or Follicle Stimulating Hormone (FSH) to allow the hormonal cycle to be controlled clinically. By suppressing these hormones, doctors can precisely control ovarian stimulation and prevent spontaneous ovulation before egg retrieval takes place.

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.

Basal body temperature

The lowest temperature attained by the body, usually measured immediately after awakening and before any physical activity is undertaken. A rise in body temperature of about half a degree about 14 days into an average 28-day cycle suggests ovulation has taken place.

Biopsy

The removal of a small portion of body tissue for microscopic examination.

Biosynthesis

A process where chemical compounds are made in the body from simpler compounds or smaller molecules.

Bladder

The organ that collects urine excreted by the kidneys prior to disposal by urination.

Blastocyst transfer

A procedure whereby an embryo is left to develop for about 5 or 6 days to reach the ‘blastocyst stage’ before being transferred into the uterus for implantation.

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.

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)