Infertility

General Information

Most couples should consult a doctor after a year of trying to conceive unsuccessfully. This is the main sign of infertility. If the woman is over age 35 and hasn’t conceived after trying for six months or has an irregular menstrual cycle, it’s best to see a doctor as soon as possible. Remember that the man should be evaluated, too. Male infertility is just as common as female infertility

Female Infertility

In another 40% of cases, the woman is diagnosed with a problem, such as:

  • Irregular ovulation (release of eggs)
  • Blocked fallopian tubes
  • Abnormalities in the cervix or uterus

Tracking Ovulation

In some cases, poor timing is the main obstacle. To find out when you’re ovulating (and determine the best time for sex), you can use over-the-counter ovulation tests. These detect a hormonal surge that occurs 12 to 36 hours before the ovary releases an egg. If the tests never yield a positive result, consult your doctor. Irregular ovulation accounts for about a third of all cases of infertility.

From my experience, I find that regular sex 2-3 times a week is less stressful than chasing ovulation with kits and also ‘cheaper’!


Fertility Drugs

If you are not ovulating normally, fertility drugs can help. The most common choice is clomiphene citrate, better known by the brand names Clomid . This drug is relatively inexpensive and effective. About half of women who take clomiphene will get pregnant, usually within three cycles. By causing the release of more than one egg at a time, Clomid increases the chances of multiple births ( but this is much less than hormonal injections).


Injectable Hormones

If you don’t get pregnant after taking clomiphene for six months, I would recommend injections of fertility hormones. A wide range of hormonal drugs are available, and they are highly effective in stimulating ovulation. Examples like Gonal F, Menopur and Puregon injections.Of those who ovulate, about half become pregnant. Like clomiphene, injectable hormones increase the chances of becoming pregnant with multiples. This chance will be significantly reduced with ultrasound scan monitoring.


Surgery for Blocked Fallopian Tubes

Some women have trouble getting pregnant because scar tissue prevents eggs from traveling down the fallopian tubes. This scarring can be caused by endometriosis, the overgrowth of tissue that lines the uterus, a history of pelvic infections, or previous surgeries. Laparoscopic surgery can remove scar tissue in the reproductive tract and boost the odds of getting pregnant for some women. It is usually day case surgery and does not need overnight stay. If referral for IVF is required, there is also strong evidence that removal of the damaged/ enlarged tubes (hydrosalpinx) will improve pregnancy rate by at least 50%.


Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a popular option for a wide range of fertility problems. In this procedure, the sperm is placed directly into the woman’s uterus while she is ovulating. This reduces the distance the sperm must swim to reach the egg. IUI is often used in combination with drugs that stimulate ovulation. It is less expensive and less invasive than IVF, but pregnancy rates are notably lower.


Male Infertility

In about 40% of infertile couples, the cause is traced to the man. Common problems include:

  • Low sperm count or no sperm at all (azoospermia)
  • Poor sperm motility
  • Malformed sperm
  • Blocked sperm ducts

In Vitro Fertilization (IVF)

IVF offers hope when other infertility treatments are unsuccessful. It eliminates any barriers between egg and sperm by combining them in a lab. The growing embryos are then placed inside the uterus. Undergoing IVF can be stressful and expensive, with an average cycle costing £3000. But success rates are growing every year. In general success rate is about 1 in 3 and could be higher in younger age (less than 35).

  • The first ‘test tube baby’, Louise Brown, was born in July 1978
  • By 1990, there had been 90,000 births resulting from fertility treatment

Five million babies have now been born by IVF – and HALF since 2007

More than 5 million babies have now been born through in vitro fertilization (IVF). Other therapies are successful, too — at least half of couples who seek treatment for infertility will get pregnant. Please watch this fascinating video of Journey of life


IVF With ICSI

When a man’s sperm count is extremely low or the sperm don’t move well, they may not be able to fertilize an egg without help. A procedure called intracytoplasmic sperm injection (ICSI) can overcome this problem by inserting a single sperm directly into an egg. The resulting embryos are then transferred to the uterus through the normal IVF procedure. The majority of IVF cycles now use ICSI. Sperms can also be obtained from the testes (TESE) if no sperms were found in the ejaculate and used for ICSI.


IVF and Multiples

To boost the odds of success with IVF, it’s common to transfer one to two embryos at a time. But this means the woman may become pregnant with twins or even, triplets. Carrying multiples raises the risk of miscarriage, anemia, high blood pressure, and other complications during pregnancy. It also makes premature birth more likely. We will discuss these issues with couples undergoing IVF in more details.


IVF with Blastocyst Transfer

A recent breakthrough in IVF technology is known as blastocyst transfer. In standard IVF, embryos are transferred to the womb when they reach the two- to eight-cell stage. In the newer procedure, the embryos are allowed to grow for five days until they reach the blastocyst stage. The healthiest one or two blastocysts are chosen for transfer. This eliminates the possibility of twins and triplets while maintaining a high success rate.


Natural Ways to Boost Fertility

No matter where you are in your quest to start a family, you can boost fertility with a few lifestyle changes. If you smoke, quit. Smoking reduces fertility and has a documented impact on pregnancy rates. In one study, men who stopped smoking saw their sperm counts climb . Next, eat nutritious foods and ask your doctor about supplements. Research suggests certain vitamins and minerals can improve fertility in men and women. If you are overweight, try and lose some weight to improve your natural fertility ,reduce miscarriage rate and improve result with IVF


Mr Faraj Provide various infertility management as follows:

Infertility

Mr Faraj provides various infertility investigations and treatment starting from simple ovulation induction to assisted conception with IVF/ICSI

You will have a high quality personal care from a highly experienced consultant who has interest in reproductive medicine since 1999

Conditions treated

Infertility due to

  • Ovulation problems (lack of regular ovulation)
  • Tubal block
  • Endometriosis
  • Male factor: low sperm count o no sperms at all (azoosperma)
  • Psychosexual factors

Polycystic Ovary Syndrome PCOS

Mr Faraj has wide experience in the management of PCOS. He leads a joint Gynaecology Endocrine clinic in his NHS hospital that deals with this condition

If you suffer from irregular cycles, excess facial hair with lack of ovulation then PCOS could be the cause.

Diagnosis: will be by Internal scan (transvaginal) to assess the shape and volume of the ovaries. Hormonal investigations: like testosterone level, FSH,LH ,TSH and Prolactin

Treatment of delay in achieving pregnancy because of PCOS: is usually by trying to improve your ovulation and make it more consistent.

One option is Oral tablets like Clomid: given from second day of period for 5 days. Metformen can be used which as insulin sensitizing drug in combination with Clomid will improve your ovulation. Gonadotrophin stimulation: these injections are usually used to stimulate ovulation and is monitored by ultrasound scan to assess your response

Surgical induction of ovulation: An alternatives to the injections and especially if there is another indication for operation like pain you can have (laparoscopic ovarian diathermy or drilling).

Tubal infertility

Investigations of tubal patency to ensure both fallopian tubes are open by either Hysterosalpingogram (dye test) or by Diagnostic laparoscopy (key hole operation)

Laparoscopic tubal surgery

Success rate depends on the severity of tubal disease and the cause. Most common causes are Pelvic infection like chlamydia, endometriosis or previous adhesions from pelvic surgery In mild tubal damage success can be up to 80%

Hysteroscopic tubal cannulation

This procedure will be offered if fallopian tube block was proximal (near the entrance into the womb) It can be done as a day case under laparoscopic control. Usually if at least one fallopian tube is open after operation, you stand a good chance of natural pregnancy.

Hysteroscopic surgery:

In certain cases, women may have problems inside the cavity of the uterus like:

Fibroids and polyps: Can be treated by Hysteroscopic resection of the fibroid. It is a day case operation and will improve your chances of pregnancy

Adhesions (synechiae) inside the uterus: This also can be divided hysterscopically and if it is mild it will improve your chances of pregnancy by 50-60%

Septum: some women are born with a ‘wall’ dividing the uterine cavity and can cause recurrent miscarriages. This also can be divided with a hysteroscopic knife with good results

Reversal of sterilisation: This will be offered to women who are keen to try natural pregnancy and has been sterilised before. This will be done via a small cut in the tummy and by microsurgery both ends of each tube will be connected again

Treatment of ovulation problem: In addition to hormonal stimulation with injections, another ovulation stimulation methods can be offered like

Ovarian diathermy (laparoscopic ovarian drilling) see link

Used for women with PCOs (Polycystic Ovary Syndrome) who are resistant to ovulation with tablets (Clomiphine and Metformin).

It is a day case operation, using diathermy energy, 4-5 points in the ovary will be cauterised. This will improve response to ovulation drugs. Results are encouraging and is less likely to produce twin pregnancy and is cost effective.

In Vitro Fertilisation IVF

Mr Faraj works closely with the 2 large IVF units in Sheffield (Jessop Fertility Unit and CARE Sheffield) and provides the Shared IVF Model.

Shared Care IVF:

You will have your initial IVF consultation with Mr Faraj and the baseline tests that include transvaginal scan. Further treatment as below:

  • 1. Decision on the IVF stimulation regime based on your age, reserve of the ovary and previous treatment
  • 2. Around 2-3 follow up visit when you start your hormone injections that include further blood test and internal scans to assess your response
  • 3. Once you are ready for egg collections; your ovaries showed a response of follicle size 17 mm and above, then you will have your injection to trigger ovulation
  • 4. Mr Faraj will book your next step of egg collection and then transfer of embryos in the IVF unit (Jessop ACU) in 36 hours
  • 5. Fourteen days later ,you will have pregnancy test and further follow up visit with Mr Faraj in Thornbury Hospital.
  • 6. Additional visits may be needed for other reasons like overstimulation of the ovaries, poor response and suspicion of failed pregnancy or ectopic pregnancy.

Please refer to Contact section for further details