Once you and your partner have undergone a thorough investigation, we have a range of treatments to help you achieve the results you want.
Intrauterine insemination (IUI)
This is the least invasive and technically easiest form of treatment, with minimal complications.
In an intrauterine insemination cycle, a sample of mobile sperm is prepared by the embryologist and placed directly inside the uterus using a very fine catheter. The sperm is deposited before the release of an egg or eggs in a natural or stimulated cycle. Conception occurs naturally inside the body.
IUI is usually the first step in treating couples with unexplained infertility.
IUI can be offered on a natural or stimulated cycle.
On a stimulated cycle (super ovulation), the size and number of follicle are measured using ultrasonography; a human chorionic gonadotrophin (HCG) injection is given to mature the eggs when the follicles reach a certain size. IUI is performed 24-36 hours after the administration of the HCG injection.
The success rate of IUI is 10% - 12% per cycle. It is recommended that three to six cycles of treatment are attempted before considering other options.
Indications for intrauterine insemination:
- unexplained infertility
- male infertility (mild)
- failure to conceive after ovulation induction treatment
- immunological (anti sperm antibodies)
- ejaculatory failure
- retrograde ejaculation.
In-vitro fertilisation (IVF)
IVF is an acronym for in vitro fertilization ('in vitro' meaning 'in glass'). This is often used when a male partner’s sperm is put into the female’s eggs in a laboratory to produce embryos.
- the woman's hormone production is temporarily switched off using medication, this enables us to control egg production and release. This is known as down regulation
- the ovaries are stimulated with hormone injections to produce eggs. This is monitored using ultrasound scans
- when the follicles reach the right size, and the uterus lining is of the correct thickness, the eggs are collected from the female
- the eggs and sperm (produced by the partner on the day of egg collection) are placed together in a laboratory dish to allow fertilisation and embryo growth to occur
- the embryo is placed in the female's uterus – usually on the second, third or the fifth day after egg collection when the fertilised egg has divided and contains two to eight cells. A day five transfer is known as blastocyst transfer.
We estimate 10% of cycles being cancelled before the planned egg collection because the response to stimulation is excessive and the risk of hyperstimulation syndrome (known as ovarian hyperstimulation syndrome, or OHSS) is substantial or because the response to ovarian stimulation is poor.
Indications for IVF treatment:
- tubal damage
- bilateral salpingectomy (both tubes have been surgically removed)
- male infertility
- idiopathic infertility
- immunological infertility
- failure of IUI treatment.
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection is used when the sperm quality is suboptimal. This is a highly technical procedure where by a single sperm is injected into the centre of an egg to achieve fertilisation.
Stimulation and egg collection in an ICSI cycle are the same as in an IVF cycle. The difference between the two is that in an ICSI cycle, mature eggs are directly injected with sperm instead of being placed together in a dish.
Fertility preservation treatment for oncology
We provide female and male fertility preservation treatments, sperm banking, egg or embryo freezing, rapid access service for NHS funded patients. This is available to patients who will be embarking on treatment that may impair their fertility, such as chemotherapy.
Preimplantation genetic diagnosis (PGD)
Preimplantation genetic diagnosis (PGD) is a specialised treatment for couples who carry an inherited genetic defect that could cause serious health risks for their children, such as cystic fibrosis, sickle cell disease or Huntington's disease.
PGD involves the use of assisted reproductive techniques (ART) such as IVF or ICSI (normally offered to patients with fertility problems) to stimulate the ovaries to produce multiple eggs. The aim is to obtain and fertilise a number of eggs. The resulting embryos are allowed to develop for three (or sometimes five) days, before a single cell is removed from each embryo and the genetic material (DNA and chromosomes) tested for the disorder.
Up to two unaffected embryos are then transferred into the uterus. If successful, the pregnancy should be unaffected.
The assisted conception works closely with the genetics department to offer this service. We are the largest and most successful unit in the UK for PGD. We have had over 600 babies born as a result of this treatment.
Frozen embryo transfer (FET)
Based on current HFEA (human fertilisation and embryology authority) guidelines, only two embryos (or a maximum of three if the woman is over 40) may be transferred after a treatment cycle.
If the treatment produced more than two (or three) good quality embryos, those that aren't used may be frozen for future use.
These embryos will be frozen at extremely low temperature, which ensures that they do not deteriorate over the number of years they are stored.
In a frozen embryo replacement cycle the woman takes medications to prepare her womb to receive these embryos. The advantage of this treatment is that there is no need to use hormone injections to stimulate the ovaries.
An ultrasound scan is performed to assess the lining of the uterus to determine whether it is ready to receive the embryo. Once the lining is ready, embryos are thawed and transferred.
The number of embryos to be thawed in any one attempt will be discussed in advance with the ACU doctor or the embryologist.
The current clinical pregnancy (live birth) rate for frozen embryo transfer is 34%. This compares favourably with the average national rate.
Donor sperm and eggs
In certain cases, patients need to embark on treatment using donated sperm or eggs. Patients may have relatives or friends who may wish to donate. These are known donors.
For patients who opt to use anonymous donors, we work with a number of independent organisations that specialise in sourcing donors. We will provide you with the guidance and put you in contact with these organisations. These organisations will work with you to match a donor that meets your requirements.
Legal advice on conceiving using donor eggs or sperm (PDF 255Kb).
Assisted hatching involves thinning or making an opening in the shell (zona pellucida), which surrounds the embryo (fertilised egg). It can help the embryos to 'hatch' out of the shell and improve the likelihood of implanting in the uterus.
Surgical sperm retrieval for azoospermia
Patients with certain ejaculatory disorders or no sperm in the ejaculate may be offered surgical sperm retrieval (with an ICSI treatment cycle).
We offer the following types of SSR techniques:
- percutaneous epididymal sperm aspiration (PESA)
- testicular sperm aspiration (TESA)
- testicular sperm extraction (TESE).
For PESA, a small number of sperm is obtained directly from the epididymis, which is the beginning of the outlet tube from the testicle.
If PESA is unsuccessful, TESA or TESE may be offered. In this procedure the sperm is obtained directly from the testicle.
These procedures are carried out under general anaesthetic on the day of egg collection.
Indications for SSR:
- congenital bilateral absence of vas deferens
- obstruction of both ejaculatory ducts
- failed vasovasostomy
- failed epididymovasostomy.
Freezing and storage of embryos and sperm
Patients can choose to store their unused embryos following treatment. We have a dedicated storage facility on-site where we can store your embryos. These embryos can then be used in a future FET treatment cycle.
We are also able to offer short or long term storage for sperm.
Storage and freezing sperm and eggs
This procedure is becoming more common for patients who would like to store their eggs and sperm for later use. We have a dedicated storage facility on-site where we can store your eggs and sperm for up to 10 years. We use a cryopreservation technique called vitrification. This technique allows us to freeze and subsequently thaw your samples for your future use, with almost the same success rates as using fresh samples.