So, you’ve had some initial tests done - what next? This depends on the results: if everything looks ok, you may be sent away to make specific lifestyle changes (which can have a big impact on fertility) but if results are abonormal or you've been trying to get pregnant for a while, you might be referred to a fertility clinic or specialist. It also depends on you: for some, treatment is not an option, in which case, you might want to explore other avenues.
Funding and costs
You may be eligible for treatment on the NHS, good news. Unfortunately this varies depending on your whereabouts: some areas offer no funded cycles, whilst some offer up to three (determined by certain criteria) - such is the postcode lottery that currently exists within fertility treatment in England. Funding for fertility treatment in Scotland, Wales and Northern Ireland is set centrally, although still does not meet NICE recommendations. To find out more about your eligibility and up-to-date information about funding, this is the place to go: http://www.fertilityfairness.co.uk/nhs-fertility-services/ivf-provision-in-england/
If you’re not eligible for treatment on the NHS but are self-funding, or just want to know all your options and compare clinics, visit the Human Fertilisation and Embryology Authority (HFEA) http://www.hfea.gov.uk
Online forums are also a great source of more informal information and tips from other people going through treatment themselves (and general support).
As mentioned in the previous post, tests, referrals and excluding or diagnosing conditions can take a while. You can also pay for these tests privately (and quickly) if you want to and it’s worth shopping around as these can vary in price. Some clinics offer ‘add-ons’ (e.g. immune testing) – which, if you are not being treated through the NHS, you may also have to pay for. It’s good to get this information upfront, because it’s not always clear what overall costs will be, at the start – and things do crop up that you may wish to investigate, once you get going. Other clinics have very standard treatment protocols, which makes this more transparent.
Who will I see?
Depending on the clinic and your situation, you may be assigned to a specific clinician. However, sometimes you are just under the general care of the clinic. In some clinics, the doctors are heavily involved day to day, whereas in others, the nurses are the people that you will see the most. Either way, there should be some familiar, (hopefully!) friendly faces throughout your treatment – and this can be so important. I really clicked with a doctor who scanned me a few times, during one treatment cycle: she told me to ask if she was available to do the actual procedure, when the time came. I did and she was. It’s not always possible, but it’s ok to ask and for me, it made a huge difference to my experience.
If you’ve not had one already, at some point you will have an ultrasound scan to take a closer look at what’s going on inside and do an antral follicle count. This is a usually painless, internal scan. A follicle contains the immature egg cell, which is released once it's matured during ovulation. The follicle count is the number of these a woman has and a measure of egg supply (ovarian reserve) - some clinics combine it with other blood tests to give a fuller picture.
It’s sometimes at the first scan, a women is told she has PCO (polycystic ovaries), which is quite common. It's different to full blown PCOS (polycystic ovarian syndrome), which is a condition that produces a set of symptoms due to increased androgens (male hormones). PCO is not a condition, it’s a normal variant of a woman’s ovaries and just means there are more follicles on the ovaries. Both are treated quite differently in fertility treatment.
What are the different types of treatment available?
There are several options available in fertility treatment these days, but broadly speaking, it falls into the following categories:
- Ovulation induction (for those who aren’t producing eggs) and involves taking something like clomid
- Surgical procedures (for women who have endometriosis, for example, getting rid of scarring and for men, this could be surgical sperm retrieval (SSR))
- Assisted reproduction (IVF, ICSI, IUI) with or without donor gametes (egg and/or sperm)
Questions, questions, questions
The emotional impact of infertility can get overlooked (particularly, for men) but you are probably experiencing a range of feelings and wondering what will happen next. It’s not uncommon to be excited and nervous or anxious (procedures, needles), as well as the inevitable feeling of the complete lack of control that often goes hand in hand with treatment. It’s a good idea to question not just healthcare professionals but also yourself (and your partner, if you have one). Here's some thoughts to get you started:
- How far are you willing to go down the treatment route?
- How will you fund treatment, if you need to?
- Who will you tell?
- What and who is in your support network?
The answers may well change as you go along: you don’t know how you will feel as things progress but it’s good to at least start the conversation - it can help you to be clearer and deal with things more effectively as they come up. And the answers may just surprise you...