London Bridge Hospital

HCA Outpatient & Diagnostic

The Shard, 32 St Thomas Street, London SE1 9BS

Westminster Maternity Suite

12th Floor, North Wing

St Thomas' Hospital

London SE1 7EH

The Portland Hospital
205-209 Great Portland Street
London
W1W 5AH

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Fertility Assessment

To make an appointment to see Mr Kunde at London Bridge Hospital or the Westminster Maternity Suite contact us now.

Frequently Asked Questions – Fertility Assessment

Although achieving a healthy weight, eating a balanced diet, cutting out alcohol and cigarettes, and taking regular exercise can all enhance your fertility, if you are still struggling to conceive despite following this advice, there could be an underlying reason why you are finding it difficult to get pregnant. If you are unable to conceive after a year, you should seek medical advice, though if you are over 35, you should consider seeing a doctor after six months of trying to conceive. Although your GP may run some initial tests, a fertility specialist can help you to identify the cause of your difficulties conceiving and advise on the most suitable treatment.

Which Fertility Treatment Will I Receive?

 

There is no universal fertility treatment that suits everyone. The best treatment for you is determined by the reason behind your difficulties conceiving, the medical conditions you suffer from and your age. Your specialist may discuss fertility medicines, undergoing a surgical procedure or assisted conception with you. All three options help couples to conceive, though your doctor will guide you to the one best suited to your needs.

What Fertility Medicines Are Available?

 
If tests show that you are not ovulating, medications are available to help you ovulate. For instance, if you have polycystic ovaries, there is good evidence that metformin increases the likelihood of ovulation and conception. Other fertility drugs include clomifene and gonadotrophins. However, you won't receive these medications if the cause of your infertility is unexplained, as they are not effective when anovulation isn't present.

What Surgical Options Are Available to Help with Fertility Problems?

 

If investigations show your fallopian tubes have scarring or a blockage, which can occur in pelvic inflammatory disease, this can make it difficult for an egg to travel along your tubes. Surgery can repair your fallopian tubes, though the success rate depends on the extent of the initial damage. However, you should be aware that having surgery on your fallopian tubes increases the risk of an ectopic pregnancy, where implantation occurs outside your womb.

 

Alternatively, if you have endometriosis, where tissue from the womb grows elsewhere and reduces fertility, laparoscopic surgery is used to treat this condition. In polycystic ovaries, laparoscopic ovarian drilling uses either heat or a laser to remove the ovarian tissue that secretes testosterone, increasing your chances of successful ovulation. If you have fibroids then they can also interfere with your chances of getting pregnant particularly when they distort the shape of the uterine cavity where the pregnancy normally grows.

 Mr Kumar Kunde

MBBS MD FRCOG DNB DGO

Consultant Obstetrician and Gynaecologist

Surgical options are also open to your partner if their epididymis - the structure needed for the storage and transportation of sperm - becomes blocked. However, surgery may also be necessary to extract sperm if your partner has an alternative obstruction preventing the passage of sperm, often caused by an infection or injury, or they were born without the tubes that transfer the sperm from their testicles.

What Is Assisted Conception?

 

If other treatments haven't worked, there is a problem with your partner's sperm or you have unexplained infertility, assisted conception will often increase your chances of conception. There are two main types of assisted conception: intrauterine insemination and in-vitro fertilisation.

 

Intrauterine insemination is helpful if there are minor problems with your partner's sperm, such as a reduced sperm count or reduced mobility. However, the technique is also helpful if your partner has erectile dysfunction or you have mild endometriosis. It introduces sperm to your womb after selecting the best quality sperm, judged by their movement. This technique introduces the sperm by way of a tube that is passed through your cervix and into your womb, and is carried out at the same time as ovulation to maximise the chance of success. It is a painless procedure and all you may notice is some mild cramping at the time of the procedure or just after it. To give you an idea of its success rate, for women aged under 35, as long as your fallopian tubes are healthy and your partner's sperm have no major problems, conception occurs in around 15% of cases for each cycle of treatment.

 

If IVF is more appropriate for your fertility problems, you will receive drugs to stimulate the production of extra eggs, which are collected from your ovaries and fertilised with sperm in the lab. The fertilised egg is then reintroduced to your body. The success rate for IVF is higher than intrauterine insemination, offering around 30-40% success rate with each cycle if you are aged less than 35. Although more than one embryo is sometimes transferred, when this is the case you are more likely to have multiples, which increases the risk of premature delivery.