Fertility services and treatments

Ovulation induction treatment helps to make ovulation happen at the right time when it does not happen naturally.

The most common cause of ovulation problems in young women who are trying to get pregnant is the hormonal condition Polycystic Ovary Syndrome (PCOS).

Other causes include problems with the master gland in the brain (the pituitary) which controls the monthly cycle. Being underweight and/or exercising too much can stop the pituitary gland from working normally which, in turn, stops the ovary from releasing eggs regularly (or at all).

In general, medical ovulation induction is achieved with letrozole, clomifene tablets, or daily Follicle Stimulating Hormone (FSH) injections. 

Getting pregnant involves two people and problems involving the sperm are quite common: in about half of couples struggling to get pregnant the quality of the sperm will be an important factor.

There is a tendency to focus on the female partner because women are born with all of their eggs and the biological clock is ticking:  the number and quality of the eggs are in decline.

Men make new sperm (with fresh genes / DNA) every 90 days. This means men can continue to have children for much longer. Male fertility does decline with age but sperm can still produce healthy babies for men in their 60s and 70s.

15 million sperm per ml of ejaculate; more than 40% must be moving; at least 4% must be normally-shaped

It is difficult to have too much sex when you are trying to get pregnant. It is important not to stop ejaculating for long periods of time (more than 6 days) even if you are not having intercourse. This makes sure that old sperm do not stay behind for too long and prevent the new healthy ones from working well. It is reasonable to try to have sex 2 to 3 times per week when you are trying to get pregnant. However, it is also important not to put yourself or your partner under extra pressure as this can be counterproductive to your performance and be a strain on your relationship.

Sperm quality is affected by lifestyle. In general, men should aim for a normal body weight for their height. Excess weight gain in men is associated with higher oestrogen hormone levels in the body, rather than testosterone, which is required for good sperm production. Other things to consider:

• Alcohol intake should be minimal.
• No cigarettes should be smoked.
• Recreational drugs should be avoided absolutely.
• Performance enhancing drugs from the gym should never be used: taking testosterone supplements turns off the internal testosterone production which is essential to produce sperm.
• Sometimes the effect can be very long-lasting or irreversible. A healthy diet containing lots of plant-based foods cooked from scratch is advised.
• Minimal processed foods should be eaten. Nuts which naturally contain selenium and zinc (e.g.brazil nuts and walnuts) are a handy snack.
• Regular moderate exercise is good. A multivitamin supplement may be helpful.
• Sleep and stress-relief (e.g. sport / exercise) are vital.

You should discuss your concerns with your GP, first of all. If you think something might be wrong it is usually quite easy to work out if that is the case or not. Erection problems are much more often due to anxiety or other stresses in your life than any physical problem. However, it is good to rule out anything serious. In addition, the problem can be helped quite easily with medication which is often only needed for a short period of time. The first hurdle to overcome is to talk to a doctor about it.

Leeds Centre for Reproductive Medicine has the expertise of a urology specialist, Mr Patrick Gordon who provides assessment and advice for men with specific issues.

In Vitro Fertilisation (IVF) has been successfully available for 40 years. In the early days, it was done with one egg at a time and success rates were low. Now, it is common to stimulate the ovary with a natural hormone injection to make several eggs grow at the same time.  This increases the chances of a good egg being amongst those removed from the body and then being able to successfully accept a sperm and begin new life.

IVF means ‘fertilisation in glass’. It involves putting a woman’s egg together with many sperm from her partner in a dish and watching natural fertilisation take place.

Intra Cytoplasmic Sperm Injection (ICSI) is a laboratory modification where one sperm is injected into the egg to increase the chance of fertilisation happening. It is used when the sperm count or quality is not normal.

1. The laboratory allows the fertilised eggs, now called embryos, to grow under observation for two to six days.
2. A process of selection takes place during this time, to identify as far as possible, the embryo(s) with the best chance of continuing to develop into a baby.
3. This embryo is then separated from the rest and transferred to the woman’s womb in a procedure that feels similar to having a cervical smear test. After the embryo transfer, further medicines are taken to give the embryo every chance to attach (implant) and start the journey of pregnancy. A standard urine pregnancy test should be positive after two weeks if the treatment has been successful.
4. If so, the first pregnancy ultrasound follows about three weeks later. At this stage, the pregnancy sac is large enough to see on the scan, along with a flickering heartbeat.

If you produce more good quality embryos than can be used for one treatment (transfer), they can be frozen and saved for use later on. Human embryos generally cope well with freezing and thawing (90% will survive) and this does not affect their ability to grow into a healthy child, regardless of how long they are frozen.

Assisted conception through IVF is a long process. Unfortunately, there is no guarantee of success and treatment can often involve several attempts at embryo transfer in order to achieve the goal of a live-born baby. For many decades, good quality embryos have been successfully frozen and then thawed to be used to produce healthy babies. IVF treatment stimulates the growth of several eggs and can sometimes produce more embryos than can be used in the first treatment cycle.

The aim of producing a single pregnancy by the transfer of embryos one at a time means that good quality embryos are sometimes remaining after treatment has been completed. These are not wasted but can be stored for future use, either if the fresh embryo does not produce a pregnancy from that cycle, or if there is a wish to have another child some time later.

On average about a third of cycles have spare embryos that are of good enough quality to freeze.

If an embryo is of poor quality before it is frozen, it will not have improved after freezing and thawing. Often, poor quality embryos have not survived or are degenerating (dying) upon thaw and we do not transfer these ones. 

The quality grade required to attempt freezing is quite high and this helps to maintain good survival of the embryo when it is thawed and also good chance of pregnancy after transfer. The chance of a single embryo surviving the process to reach the transfer stage is currently over 90%.

It is important to bear this in mind, especially if there is only one embryo available in storage. It is disappointing to prepare for transfer only to find on the day itself that no embryo is available for treatment.

There are several reasons why some couples need donated eggs in order to have the best chance, or any chance of having a family.

Some women may be born without ovaries or with ovaries but without eggs inside them. Women are born with all of the eggs they will ever have and there is no treatment to create or multiply them. The eggs are aging with the woman and their quality deteriorates with time. By the time of the menopause, when the menstrual cycle stops, all the eggs have been used up. Most of the eggs available in the ovary do not actually ovulate over a lifetime. They are lost with the day to day turnover of cells like hair and skin. For some women the ovaries age prematurely. This can be as early as the teenage years or in one’s 20s, long before parenthood is seriously considered for many people. This is called premature ovarian insufficiency.

Some women and girls will lose their eggs or whole ovaries as a result of surgery or cancer treatments including chemotherapy and radiotherapy. Unfortunately, unlike hair which regrows, new eggs do not develop.

The most common situation where egg donation is considered is in women whose own ovaries are too weak to try IVF or who have had unsuccessful IVF largely because of the poor quality of their own eggs. This is more common in women over 40 years old and can result in repeatedly unsuccessful treatments or miscarriages.

There are some rare conditions that are inherited through the female line via the egg genes. Some people may choose to avoid the risk of having a child with a serious disability by using an egg from a donor who does not carry the condition in her genes.

There are several reasons why you may need donated sperm in order to have the best chance, or any chance of having a family.

Some men may have problems with sperm production within the testes. Some men and boys will lose their ability to produce sperm or will lose both testes as a result of surgery or cancer treatments including chemotherapy and radiotherapy. Sometimes, sperm production may spontaneously recover in the testes, but when this does not happen, sperm donation may be needed.

Sperm donation is required for fertility treatment for women in a same-sex relationship and for single women.

There are some rare conditions that are inherited through the male line. Some people may choose to avoid the risk of having a child with a serious disability by using sperm from a donor who does not carry the condition in his genes.

Sometimes, people need help from egg or sperm donors to help them get pregnant because their own eggs or sperm are not of a good enough quality. Egg and sperm donation is also a way of helping same-sex couples to have a baby. 

Egg or sperm donation is a remarkable and special thing to consider. It is a voluntary act of kindness to help others to achieve their dream of having a family. In the UK, donating eggs or sperm is a gift, like blood and organ (kidney, heart etc) donation.

If you are interested in being an egg or sperm donor, first of all, thank you, and secondly, please contact CARE Fertility UK.

Genetic testing of embryos created through IVF techniques can be used to identify embryos affected by some serious genetic conditions that are known to run in certain families. This could be a disease that is caused by an isolated change in the genetic code that can be passed down from a parent to a baby (PGT-M). Cystic fibrosis is the commonest of these conditions. Alternatively the structure of the chromosomes may be altered and this can also be passed on to a baby (PGT-SR). Chromosomes contain the genetic code that determines the health and the physical appearance of the baby. Embryos can be tested when they are five days old to find out if they have inherited the genetic change in question. Only healthy embryos are chosen to be replaced into the womb. This helps to prevent a pregnancy that would give rise to a child with a serious health problem that may be fatal at an early age. It increases the chances of a healthy baby being born. This is a technique that allows couples with a particular inherited condition in their family to avoid passing it on to their children.

You may be offered treatment with PGT-M-SR at CARE Fertility Leeds or alternatively at Guy’s and St Thomas’ NHS Foundation Trust in London.

Genetic testing of embryos is also possible to screen for the most common genetic problems where the number or combination of chromosomes is faulty. These are called aneuploidies. Chromosomes contain the genetic code that determines the health and the physical appearance of the baby Down’s Syndrome is an example of an aneuploidy caused by the baby carrying three copies of chromosome 21 instead of two copies. Please note that this test is not a guarantee of a pregnancy. This test is called PGT-A and more information can be found on the CARE Fertility website

Miscarriage is when a pregnancy is lost any time up to 24 weeks of pregnancy. Miscarriage is not talked about very much but is actually very common. More than one in every five pregnancies ends in miscarriage. This is most common before 12 weeks and very often much earlier.

About half of all early miscarriages are caused by one-off genetic faults in the mother’s egg or the father’s sperm, or in how the fertilised egg develops. These pregnancies are not normal and are naturally lost because they are unhealthy.

It is very rare for miscarriage to happen as a result of an action (something you did or didn’t do). Often no specific cause is found and your next pregnancy (if you choose to try again) normally results in a healthy baby.

If you know that you have just had a miscarriage or suspect that this may be happening, we are here to help. In an emergency, you should contact your GP or local A&E department for assessment and advice.

Miscarriages are very common.  In most cases, the miscarriage is not caused by something you did or didn’t do. There is often no cause found and the next pregnancy (if you choose to try for another pregnancy) normally results in a healthy baby.

About half of all early miscarriages before nine weeks of pregnancy are caused by ‘one-off’ genetic faults in the mother’s egg or father’s sperm or in how the fertilised egg develops.

There are less common causes of miscarriage. These are usually discovered in those who experience repeated miscarriages (three or more miscarriages in a row with the same partner). If this has happened to you, we can offer investigations to look into these causes. Read more in our patient information leaflet about miscarriage.

There are some less common causes of miscarriage. These are usually identified with special tests for those who experience repeated pregnancy loss (three or more miscarriages in a row with the same partner). Leeds Teaching Hospitals has a specialist clinic to offer careful assessment and management of couples suffering this distressing sequence of events, based upon the latest scientific research and evidence.

Under natural circumstances, the sperm meets the egg in the fallopian tube and fertilisation happens here. The embryo then has about 5-6 days to travel into the heart of the womb where normal implantation should take place and the baby can grow to full size and deliver successfully. Sometimes a pregnancy can get stuck in the wrong place, such as in the tube. It continues to grow and divide but the tube is too small to contain it and support it properly. This is a dangerous situation which can lead to the tube bursting and life-threatening bleeding. It requires urgent hospital treatment, and often an operation. Sometimes it is not clear where the pregnancy is located or whether it is still growing. This is called a pregnancy of unknown location (PUL) and needs to be monitored until it has resolved safely; sometimes this happens naturally or sometimes other treatment is needed.

Ectopic pregnancies are a specific type of miscarriage and it is normal to feel a similar sense of loss when this happens.

Please read our patient information leaflets for more information:

Ectopic pregnancy leaflet

Pregnancy of unknown location leaflet

A normal menopause is defined as when a woman experiences no menstrual period for 12 months with no other medical explanation. The ovaries stop releasing eggs and the monthly bleed does not occur. It is usually accompanied by classical signs such as hot flushes and mood changes as hormone levels change, particularly oestrogen. The average age that this takes place in the UK is 51 years. A menopause occurring under 45 years is considered early and a menopause under 40 is premature. Premature menopause is now more commonly known as Premature Ovarian Insufficiency (POI).

For further advice and guidance on Premature Ovarian Insufficiency, and how we may be able to support you please see our patient information leaflet.