Tests and treatments in a fertility clinic

Finding the cause

A complete diagnosis of you and your partner is fundamental to identifying a suitable treatment strategy. You will need to undergo a number of tests to establish the cause(s) of your conception problems. Most of the tests are designed to assess four key elements for successful conception:

To find out whether hormone production is balanced, allowing for egg and sperm development
To establish whether the ovarian reserve is plentiful and ovulation is taking place
That sperm is of sufficient quantity and quality
To determine whether both male and female reproductive systems allow for fertilization

Read about fertility investigations men and women undergo.

Tests can take time. It may take two or three visits to your doctor to complete investigations over a one to six month period. Some of the tests will need to be repeated. During this time, it’s important not to become disheartened. The goal is to set a course of positive action for you and your partner to pursue.

A step closer

The course you follow next will be different for each couple, depending on the results of tests and the kind of treatment you have already taken.
Low complexity treatments are often the first step. Depending on what causes of your fertility problem you may start with:

A surgical procedure
Oral medicine
Hormone treatment

Read about these treatment options here.

If the initial treatments have not been successful you may be offered to undergo treatments with Assisted Reproductive Technologies (ART). ART is the name given to a variety of fertility treatments or procedures that include the in vitro handling of both human oocytes and sperm, or embryos, for the purpose of establishing a pregnancy.

Possible procedures (depending on the exact cause of the difficulty in conceiving):

The process of In Vitro Fertilization (IVF) infertility treatment.

In Vitro Fertilization (IVF) is the most common ART treatment. Hormonal injections are given to a woman to stimulate the production and release of eggs. Eggs and sperm are united in a laboratory dish and then one or more embryos are transferred into the woman’s uterus.
Intracyto-plasmic Sperm Injection (ICSI) is a lab procedure where a single sperm is injected into the egg cell to help fertilization. ICSI is often performed in conjunction with IVF.
Gamete Intra-Fallopian Transfer (GIFT) following the same procedures as IVF, except fertilization occurs inside the body.
Zygote Intra-Fallopian Transfer (ZIFT) following the same procedures as IVF, except fertilized eggs are placed in the fallopian tubes at earlier stage of embryo development.
Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE) are used to obtain sperm in case no sperm can be found in the ejaculate.

Learn about treatments with Assisted Reproductive Technologies (ART) in greater detail.

Questions you may want to ask your doctor

How long has this clinic offered this procedure?
Which procedure has the greatest chance of success for us?
What are the side effects of this treatment?
May we have an information sheet describing the treatment?
What are our chances of having a baby if we have this treatment at this clinic?
How long will we have to be on this treatment before stopping or trying another treatment?
What are the risks of multiple pregnancies?
What should we do next if this treatment does not work?
What support or counselling is available?
What are the costs involved with this treatment and are they reimbursed?

The overall success rate for Assisted Reproduction Technologies (ART) is high. A Danish study from 2009 found that within five years of starting ART treatment, almost 70% of couples had succeeded in having at least one child.1 It’s important to remember however that the success rate for fertility treatment is not absolute. The outcome will be different for every individual couple and clinic.

Taking a longer view

Achieving success often takes time and multiple attempts. In a five year study conducted in Denmark, the number of successful couples doubled from 27.9% after a year of following ART treatments to 61.7% after three years. More than 40% went through 4 or more cycles during the period of the study.¹

What can you do to give yourself the best chance?

Doctors will do what they can to help. Your job is to make sure you and your partner learn to cope with the fertility stress and disappointment with failed treatment cycles. There are steps you and your partner can take:

^{1. Pinbourg A et al, Prospective longitudinal cohort study on cumulative 5-year delivery and adoption rates among 1338 couples initiating infertility treatment. Hum Reprod.2009;24: 991-999.}

Share this page with your partner.

Zygote

The single cell formed when a sperm fertilizes an egg.

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.

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.

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.

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.

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.