Fertility treatments and assisted reproduction

The fact that it has become more common to use different types of treatment to help women get pregnant is due to a variety of factors. In particular, involuntary infertility is more common these days, and constant improvements and developments in medical treatments are presenting more people with opportunities to receive help in their efforts to get pregnant. Assisted reproduction is a collective term used to describe methods where fertilisation takes place partially or completely outside the body, for example insemination and IVF. But there are more ways to help women get pregnant, and in this article we discuss the different types of treatments that are used. For women who want to try to conceive a child on their own, it is worth knowing that the healthcare service is obliged to offer the same opportunities for assisted reproduction as for heterosexual and lesbian couples.

Which type of treatment is suitable for me?

When the fertility investigation – which is always the starting point – is completed, you, together with your doctor, can determine which method suits you best, depending on the findings from the investigation regarding the cause of your involuntary infertility. In this context, age is also a factor that is taken into consideration, in particular the age of the woman who is to bear the child, as younger women have more time to get pregnant, and this can therefore be a factor in deciding how to proceed. Sometimes, the conclusion may be that you still have an excellent chance of getting pregnant on your own if you continue trying for a while longer, in which case a first step could be to start considering if it might help to change something in your health or lifestyle habits in order to increase your fertility.

These are the types of treatments available to women who are trying to get pregnant:

• Hormone treatment / Ovulation induction
• Insemination with the partner’s sperm
• In vitro fertilisation (IVF)
• Surgery, for example on the fallopian tubes or ovaries
• Egg or sperm donation

Hormone treatment / Ovulation induction (H3)

If it is believed that the inability to get pregnant is due to irregular ovulation, there are a number of treatments designed to stimulate the body and induce ovulation. The most common is hormone treatment in the form of tablets that are taken for five days. Then, after a further ten days, an examination is carried out with a vaginal ultrasound to see if the treatment has had any effect, which is visible in the form of growth in the ovarian follicles.

It is also possible to receive hormone injections if it turns out that the tablets are not working, in which case you take the injections at home (in the stomach or thigh) every day for about two weeks. If you are able to induce ovulation in this manner, it is usually best to then try to get pregnant on your own for a while before doing anything else.

Insemination with the partner’s sperm (H3)

Insemination involves introducing sperm into the uterus with the help of a thin plastic tube just prior to or at the time of ovulation. Before performing this procedure, it is necessary for the male partner to provide a sperm sample that is then prepared so that the most suitable sperm (the best swimmers!) are selected for insemination. As the sperm are inserted directly into the uterus, they don’t have to swim as far, and the chance of getting pregnant in this manner is therefore quite good, despite a slightly inferior sperm quality to begin with. Insemination with the partner’s sperm is also a common treatment if the woman who will be carrying the child has previously had surgery on the cervix. The actual insemination procedure is quick and does not usually cause any pain.

IVF treatment (H3)

In vitro fertilisation, or IVF, is the most advanced way to get pregnant and is usually only tried after several insemination attempts have failed to result in pregnancy, or if, from the very start, there is reason to believe that no other type of treatment will work.

Surgery on the fallopian tubes or ovaries (H3)

Sometimes, surgery is required in order to make it possible to get pregnant. There are a few different reasons why surgery may be needed; for example, it could be that there are polyps in the uterus, adhesions around the fallopian tubes or cysts affecting the ovaries. The most common surgical technique used in these instances is keyhole surgery. After the surgery, some women can try to get pregnant on their own, while others may need help in the form of assisted reproduction.

Egg or sperm donation (H3)

Sometimes, a donation is required in order to get pregnant. Insemination with donated sperm may be offered to childless people who do not have the opportunity to use their own sperm. In other words, this may be a viable solution for same-sex couples, single women or heterosexual couples where the man does not have sperm capable of fertilisation. Egg donation may be a viable option if, for example, you have several unsuccessful IVF attempts behind you, or if you have entered menopause too early or your ovarian reserve is starting to be diminished. Egg or sperm donation may also be a suitable form of help if you are the carrier of a genetic predisposition whereby there is a high risk of passing on a severe hereditary disease.

Emotionally, this is a solution that can raise some questions about carrying a child with no genetic connection to yourself or a husband or partner, and sometimes you may need a little time to properly consider and come to terms with such an important decision. In this context it is worth knowing that the clinic you visit must always offer support in the form of an opportunity to discuss all aspects of using someone else’s egg or sperm. Having a child is a major life-changing decision, regardless of the child’s genetic profile, and it can therefore be important to work through any feelings or uncertainties you may have before making such a decision. In the case of sperm donation, the actual fertilisation can be achieved through insemination, while IVF is the method used for egg donation.

Depending on which country you live in, it is important to find out what rules apply regarding the use of anonymous or open donors. For a child born through donation, such rules may prescribe a right for the child to know about his or her origin. For example, the child may be entitled to find out details of the sperm or egg donor when he or she reaches a certain age. Such rules may also address the rights of the parents as well as other issues, such as clarification of whether any legal or financial obligations exist between the donor and the child.

How much does it cost to receive a treatment to help get pregnant?

The price of the treatment can vary greatly, especially if it is undertaken at a private clinic rather than via the public healthcare service. Not only can the cost of treatment vary greatly from clinic to clinic, it is of course also dependent on the type and complexity of the treatment involved. It is therefore important to find out the cost of the treatment you are considering in the country where you live and/or at the clinic you intend to use.

Please note that all information above is based on Swedish recommendations.