It is important to understand the difference between an infertile couple that has been trying to conceive for a year (meaning at a rate of approximately one ovulation a month), which means twelve failed attempts and someone that has never tried to conceive. The probabilities of something going wrong for a couple who has tried for 12 or 24 attempts and has failed is higher that in the general population. This is how medicine works, it is all a matter of probabilities.
This is the reason why the approach to the single woman should be different than the approach to an infertile couple. Most probably, this woman has no problems and the treatments should work easier, just because she has never attempted to get pregnant. For this reason, she requires less tests and her prognosis with treatments is usually better. This is the reason why we tend to perform less invasive and less complicated treatment with them.
Here is an overview of some fertility investigations and treatments you might want to look into before starting treatment.
Your fertility would be assessed by certain hormone and ultrasound testing and would be advised treatment according to the results of your investigations.
Ovarian reserve investigations
These tests help us to assess how many egg you have. They don’t express their quality as quality is only predicted by age and maybe certain other factor like genetic or chromosomal alterations. These include
- AMH (anti mullerian hormone): this is a hormone produced by the eggs you still have not used.
- Transvaginal ultrasound scan including your antral follicle count: This test is just to make sure nothing evident is wrong in the womb, fallopian tubes or ovaries before starting. In this examination we will also count how many follicles are active in your cycle which also helps us predict your ovarian reserve.
Tubal patency testing
The fallopian tubes are two organs that act as transport for the egg, the sperm and then the formed embryo. They need to be open for fertility to work properly. This is the reason why these tests should only be done if you have risk factors, for example previous chlamydia infection, other STI’s, previous pelvic surgery, confirmed endometriosis, etc.
In the presence of risk factors one of the following three investigations would be required to assess your tubes:
- Saline infusion sonography (SIS) or HyFoSy. Both with ultrasound
- With x-ray
- In some circumstances you might need laparoscopic assessment of your tubes and pelvis. Surgery
Other female investigations
Few other blood investigations would be required once you have decided to go ahead with treatment
- Thyroid hormone levels
- Rubella immunity
- Viral screening ( including screening for hepatitis B , C and HIV)
- Blood group
- CMV IgG and IgM levels
There are three different treatment options
- IUI with donor sperm
- IVF/ICSI with donor sperm
- Egg freezing
Intrauterine insemination (IUI) with donor sperm
IUI with sperm donor is the introduction of sperm, coming from a donor, into the uterus by means of a catheter.
It is usually the first line of treatment offered to a single woman. IUI can be performed in natural cycle but it in most cases it is performed in stimulated cycle (ovulation induction) because of better results.
Success rates are higher in women under the age of 35yrs (16-18% live birth rate (HFEA 2016)) and success rate declines with advancing female age.
IVF/ICSI with donor sperm
If you are not a suitable candidate for IUI with donor sperm (blocked tubes) or you were not successful with donor IUI treatment then IVF/ICSI with donor sperm is the treatment of choice for you.
Please see information on our Donor Sperm Programme