New trends in infertility treatment

For the one in seven couples in the UK with fertility problems, getting pregnant is an elusive -and frustrating - dream.

If they seek medical help sooner rather than later, the outlook has never been brighter. Infertility treatments have improved, options have expanded and doctors are more skilled at the techniques. Evaluations are done earlier than in years past, and the trend is to treat more aggressively, especially if the mum-to-be is older.

"Success rates have improved dramatically in the last 10 years," says Dr Mousa Shamonki, a reproductive endocrinologist (a specialist in hormones and the glands that make them). The average success rates for births at fertility clinics have roughly doubled in the past decade, he says.

Success rates for IVF can be as high as 29% for women under 35.

The earlier the better

"Often couples [who can't conceive] are told by family members, 'Just relax and ... you will get pregnant’,” says Dr Eric Surrey, a fertility specialist.

That won't work for couples with underlying fertility problems, he says. At some point, seeking medical help is better than persisting on their own. If a woman is under 39 years old and has been attempting to conceive for a year without success, it's a good time to seek medical help, says Surrey. If she is over 39, the evaluation should be performed after six months of trying to conceive without success, he says.

Treatment options

Sometimes infertility can be treated with medication or surgical repair of reproductive organs. Another standard fertility treatment is to do up to six cycles of ovarian stimulation and intrauterine insemination (IUI), says the National Institute for Health and Clinical Excellence (NICE).

Dr Guy Ringler, a reproductive endocrinologist, says that IUI involves stimulating the ovaries to boost egg production by giving medicine such as clomifene and then inserting a thin catheter into the uterine cavity to place the sperm there.

The treatment, he says, "will increase the pregnancy rate from about 3% per month to about 12% to 15% in women under age 40 and to about 5% to 7% in those over age 40."

"But many couples are saying, 'I want to be more aggressive'," Ringler says. "Most often they say that due to age, but also to the success rate [of the more aggressive techniques]." Many ask to move on before the three months is up, he says.

If they move on to in vitro fertilisation (IVF), the chances of pregnancy are greatly increased, he says. In IVF the woman's eggs are surgically removed from the ovaries, mixed with sperm outside the body, and allowed to fertilise before the embryo is then transferred back into the uterus. "With IVF, if the woman is under age 40, the pregnancy rate is about 40% in the first attempt," Ringler says. In women over 40, the success rate is greatly dependent on age, he says.

For women over 40 years old IVF success rates are tied to their age, agrees Dr Steven J Ory, a reproductive endocrinologist, and president of the American Society for Reproductive Medicine (ASRM).

For women from 40 to 42, the success rate with IVF is about 11%, according to the NHS. It’s less than 5% for women over age 42 years old. Still, Ory says, proceeding to IVF quickly is one of the biggest trends now, whatever a woman's age.