RANGE OF INFERTILITY TREATMENTS AVAILABLE

Ovulation Induction
Ovulation induction involves taking medications which stimulate the ovaries to produce eggs.

Initially oral medications would be the most usual treatment. Clomiphene or Tamoxifen are two medications which may be used. Treatment usually commences on the second day of the menstrual cycle for a total of five days.

Monitoring of treatment involves a number of ultrasound scans which will determine whether follicles are being produced and whether they rupture to release any potential eggs. Follicles are the small fluid filled structures which develop in the ovaries, each of which will hopefully contain an egg. A blood test will be performed around Day 21 progesterone and this will provide additional information regarding the efficacy of the treatment. If the treatment is appropriate it would usually be continued for 6-9 months. Occasionally an injection of HCG may be given midcycle to further optimise ovulation.

In situations where tablets have not resulted in pregnancy injections of FSH and/or LH may be prescribed. There are varieties of formulations which may be prescribed and the dose can be varied according to individual needs. As there is a greater risk of multiple pregnancy more scans may be necessary than with tablets. HCG is given midcycle to prime ovulation when injections are used.

While the scans will need to done at the gynaecologists you may have you bloods taken at your GP if it is more convenient.

Intrauterine Insemination and Donor Insemination

Intrauterine insemination (IUI) is a treatment where a sample of fresh sperm is specially prepared to be passed into the cavity of the womb with a very fine catheter. The procedure is painless and is performed at a time when the woman is most fertile. In most situations medications for ovulation induction are administered and scans are performed to time the IUI. This treatment may be performed for: suboptimal semenalysis, hostile cervical mucus or unexplained infertility.

Donor insemination may be used for IUI (D) where the man is producing no sperm or very poor sperm.  It may also be used where the male has a genetic problem which could be passed on to a future offspring. Because of EU legislation it is now necessary to undertake additional blood tests prior to undergoing treatment.

It can be helpful for couples to consider a few sessions of counselling to explore the issues and emotions which may surround treatment. LINK TO COUNSELLING PAGE

IN VITRO FERTILISATION
In vitro fertilization (IVF) refers to the process where a woman’s eggs are fertilized outside of her body in the laboratory. The resulting embryos are then transferred back into the uterus a few days later

IVF is specifically recommended for:

• women with absent, blocked or damaged fallopian tubes;
•  cases of unexplained infertility;
•  some cases of male factor infertility and can be used in combination with ICSI (intracytoplasmic sperm injection) in cases of severe male factor infertility.

IVF involves stimulation of the ovaries with fertility medications to encourage development and maturation of the eggs.

During treatment there a number of visits for transvaginal ultrasound scan to determine the number and size of the developing follicles. The number of follicles will vary from woman to woman and from cycle to cycle.

The final preparation for egg retrieval involves a hormone injection which mimics the natural trigger for ovulation. Egg retrieval will take place 36-38 hours after this injection and is performed under light anaesthesia.

The transvaginal ultrasound probe is used to visualize the ovaries and a needle attached to the probe is passed through the vaginal wall into the follicles. The fluid within each follicle is aspirated and then examined in the IVF laboratory for the presence of an egg. After identification, the eggs are washed and transferred into special culture medium in Petri dishes in an incubator.

While the egg retrieval is proceeding, the sperm is also prepared. A semen sample is provided by the male partner and, in the laboratory, a concentrated preparation of the best motile sperm is extracted from the semen sample. This sperm preparation (containing approximately 150,000 sperm) is added to the dishes containing the eggs, and they are incubated together overnight.

Twenty four hours after egg retrieval an assessment is made by a laboratory scientist to determine if fertilisation of the eggs has occurred. If fertilisation has occurred then they are allowed to continue to grow for a number of days until they are embryos or blastocysts. The embryos or blastocysts are transferred into the womb via a very fine catheter. This is called an embryo transfer and is performed under ultrasound guidance; it is a painless procedure which only takes a few minutes.

In some couples an alternative form of insemination is required called ICSI, which involves injecting a single sperm into each egg using a very fine needle, rather than mixing the eggs and sperm in a dish. This procedure is necessary when the sperm count is deemed unlikely to fertilize the eggs due to a very low sperm count or very poor quality sperm movement.

Any additional embryos that are not transferred on either day 3 or day 5 can be frozen and implanted at a future date.

Chances of success vary between patients, particularly according to the age of the woman, but on average about 28% of patients will have a baby after one attempt at standard IVF.

Two weeks after embryo transfer the woman will do a pregnancy test. If the pregnancy test is positive special medications will be prescribed to help the womb “hold on” to the pregnancy. An ultrasound scan is organised two weeks later if there have been no complications. Pregnancy hormone can be measured as a blood test. If the pregnancy is viable the blood levels will double every 48hours. Doing the blood test may help to reduce the anxiety in the first few weeks.

IVF is available in a number of clinics in Dublin, Clane, Cork and Galway and Kilkenny.

 The Scotia Clinic is affiliated with Sims Clinic, Dublin www.sims.ie. This partnership allows people to have all of their care apart from egg retrieval and embryo transfer in Kerry. We refer to this type of care as Satellite IVF.
Initial consultations, semenalysis, blood tests, ultrasound scans and nurse consultations are performed at The Scotia Clinic, Tralee. We believe that reducing the number of long commutes for appointments will help to reduce stress for women. It also cuts down on financial outlay which could be channelled into complementary therapies such as nutritional advice, reflexology, acupuncture or Mind Body Programmes.  Link to Complementary therapy page

EGG DONATION

Egg donation may be the only option available for some women who cannot produce their own eggs. These may be women with Turners Syndrome, women who have undergone premature menopause or had radiotherapy or chemotherapy in the past. Some women who have previously undergone IVF may have had very poor quality eggs which failed to fertilize.
Some women may know a person who is willing to be an egg donor. However most women link into egg donation programmes overseas. Sims Clinic has a European Donor Egg Programme

EMBRYO DONATION
Embryo donation may be a suitable treatment option for couples who fail to produce any embryos after IVF. While this treatment option is not available in Ireland, there are a number of UK clinics with which the Scotia Clinic has established links such as The Lister Clinic, London. When couples are pursuing this treatment option we will endeavour to provide as much of the care as possible in Kerry.

COUNSELLING / MIND BODY PROGRAMME
Many people can find the process of fertility treatment very stressful. Research has also demonstrated that stress can have a negative impact on fertility treatment and early pregnancy. If you feel you might benefit from counselling or stress management the Scotia Clinic staff may be able to assist you in identifying an appropriate support service. 

WEIGHT MANAGEMENT / NUTRITION
There is now clear evidence that a high BMI can impact negatively on fertility treatments and may be associated with early miscarriage. We strongly recommend that women embark on weight reduction prior to starting treatment as even a 10% reduction in weight will improve matters. We use a GI Dietary programme which is particularly beneficial for women with PCOS as it assists in improving insulin resistance.