Types of Infertility Treatment

Fertility Testing

Before the age of 26, fertility testing is free.. People who are 26-38 years of age have to pay for fertility testing.  The type of fertility treatment that may be used depends on the cause of the couple's infertility and what they can afford.

Fertility Drugs

Fertility drugs come in the form of a tablet or an injection. These help to release hormones that induce ovulation to boost egg production and make the uterus more recpetive to embryo implantation. This type of fertility treatment is useful for women who don't ovulate very regularly. These drugs are relatively cheap and convenient, and the fertilisation can still occur naturally. However, these drugs carry the risk of multiple births, ovarian cysts and premature birth.

Artificial Insemination

Artificial insemination is the process of injecting sperm into the uterus through a thin, flexible catheter.  The sperm is specially prepared, "washed" and concentrated to ensure the best chances of fertilisation. There are two types, AID and AIH. AID stands for artificial insemination by donor, where the sperm comes from a donor. This may be necessary if the male partner is infertile, its a same sex couple or AIH hasn't been successful for any of the following reasons. AIH means artificial insemination by husband.  Artificial insemination is best for cases where the male partner has slow moving sperm, lower quality sperm, a low sperm count, or where the female partner has developed antibodies against her partner's sperm, or whose cervical mucus is too scant, acidic or thick to transport the sperm to the egg.  This is a fairly simple procedure, which can be performed in the doctor's office, but it also carries the risk of multiple births. 

Donors and Surrogates

Donation in the UK; Depending on the cause of infertility, sometimes an egg or sperm donor is needed. Possible reasons for this include; prevention of genetic diseases being passed on, damaged gametes due to chemotherapy, or if an individual doesn't produce gametes at all.  It costs around £3,000 to purchase a sperm donation for IVF treatment or artificial insemination. Surrogacy in the UK: The law states that cash shouldn't be used as a means of paying surrogate mothers for their services. Mothers and daughters or sisters having children for each other is a common occurrence.  

In Vitro Fertilisation

'In vitro' means 'in glass' in Latin. Louise Brown was the first 'test tube baby' to be born in the 1980's. The sperm and egg cells are taken from the parents and fertilised in a laboratory. One or two fertilised egg cells are then implanted into the womb of the mother or surrogate and carried to term. The remaining healthy embryos are frozen.  The first cycle of IVF costs between £2,500-£3,000 in the first instance, and after that, any further cycles cost £1,000 to £2,000 each. Women who are undergoing IVF treatment are restricted in their diet; alcohol and raw foods shouldn't be eaten, and drugs and smoking are also prohibited. Women undergoing chemotherapy (especially if she is young and childless) some of her eggs will be frozen so she may be able to conceive via IVF in the future. IVF is also useful for older women, women with severely blocked or damaged fallopian tubes, men with very poor sperm quality and couples with unexplained infertility. (Statistically, 1 in 10 women have blocked fallopian tubes.) IVF can solve a lot of fertility problems, but it requires a rigorous regimen of fertility drugs before the start of each cycle and this introduces a long list of side effects.

https://www.youtube.com/watch?v=GeigYib39Rs (Enclavar)

Potential Problems with IVF

Multiple births - as several eggs are often implanted into the uterus in the hope that one will result in a healthy pregnancy, often more than one of the eggs results in a pregnancy. e.g.) There was a woman in America who gave birth to eight children at the same time because she used IVF. The use of surrogates and donors results in the child effectively having three parents; two biological ones and one who helps to raise the child. Having the embryos genetically screened before implantation gives parents the opportunity to select the embryo that has the most desirable characteristics.

What does the law say?

The Human Fertilisation and  Embryology Authority (HFEA) was set up under the 1990 Human Fertilisation and Embryology Act to license those providing fertility treatment and conducting fertility research, including the NHS, and this began in 1991. This law permits all types of fertility treatment to be performed in the UK. Clinics and researchers are obliged to adhere to the HFEA code of practice, and are subject to regular inspection. The HFEA also provides information and guidance for prospective parents looking to undergo fertility treatment. It is also required to ensure that cinics "take account of the welfare of any child who may be born a result of treatment (including the need of that child for a father) and of any other child who may be affected by the birth." The 1990 Act was amended in 2001 to allow the use of embryos for stem cell research and to provide for its regulation.

In January 2004, the government ruled that children conceived through artificial means would have a right to know who their biological parents are. However, egg and sperm donors would have no obligation to meet with their biological children or provide them with financial support. These new rules came into effect in April 2005, and are not retroactive, so this doesn't apply to any donor-conceived children who were conceived before April 2005, and would have no access to the details about egg and sperm donors. Recent changes in civil partnerships gave same sex couples the same rights as married couples, so that they are not discriminated against because of their sexuality.  Post 1990, the eligibility to raise a child included looking at the financial stability of the couple and this included "the need of the child to have a father." This obviously discriminates against lesbian couples. The chair of the British Fertility Society, Alison Murdoch argued that as long as the child is going to be raised in a loving, caring environment, then their parents' sexuality should not be an issue. 

Example Situations

Below are a selection of different circumstances where people may want to apply for fertility treatment.  An unemployed couple in their 30's cannot conceive. Thye cannot afford to pay for treatment. Mr A has had a vasectomy in his last relationship. He would like to have children with his new wife, but this is not possible. They want to have children via a sperm donor. Mrs A had cancer and is now infertile from chemotherapy. However, she had some of her eggs frozen and would like these to be fertilised by her husband. Mr and Mrs B are in their 60's and would like IVF as they did not have children. Miss and Miss C would like to have a sperm donor to allow them to conceive. They cannot afford treatment. Mr and Mrs D have two sons with the thalassemia that can be cured with a bone marrow transplant. They would like to select a suitable donor via IVF. Mr E has Huntington's disease and wants to use IVF to screen the embryos for this disease. They cannot afford treatment. Miss F is single and would like children, so she wants to use IVF and a sperm donor.  Is fertility treatment right? Is the answer the same for all cases?