WHAT OTHER TREATMENTS ARE AVAILABLE?

IVF is not the solution to all fertility problems. If a woman's fallopian tubes are blocked they may be treated by tubal microsurgery. If she suffers from endometriosis, surgery or drug therapy may be appropriate and drugs can also resolve ovulatory disorders.

If a woman's fallopian tubes are not blocked and her infertility is unexplained, GIFT (Gamete Intrafallopian Transfer) may be of benefit.

In some cases, if the infertility is solely due to problems with the cervical mucus, difficulties with intercourse or a low sperm count, artificial insemination using the partner's sperm (AIH) may be the most suitable treatment. If a woman is fertile, but her partner's sperm is not fertile or if he carries an inherited disorder, then insemination using donated sperm (DI), may be considered. If the partner has a very low sperm count then ICSI could be suitable.

Before undergoing any treatment you should consider what is the most suitable and seek information from clinics and your GP.

If tests establish that there is nothing wrong with the woman's fallopian tubes or the causes of infertility cannot be explained, GIFT treatment may be offered. GIFT stands for Gamete Intra Fallopian Transfer and involves retrieving eggs from the woman, mixing them with sperm and quickly replacing up to three eggs in one or other of the woman's fallopian tubes so that they fertilise inside the body. The HFEA does not regulate GIFT if the woman's own eggs and the partner's sperm are used. However, if necessary, this treatment can be carried out using donated sperm or eggs, and these treatments are regulated and recorded by the HFEA. In these circumstances the HFEA allows no more than 3 eggs to be transferred in any single treatment cycle to lessen the risk of a multiple birth and the often severe problems which may then result.

ICSI is a relatively new technique whereby a single sperm is injected directly into an egg previously retrieved from the woman. If fertilisation occurs and embryos develop, up to three embryos created in this way can be transferred to the womb in same way as conventional IVF.

ICSI may be appropriate where the male partner has very few sperm or where the sperm have poor or no motility. It can also be used where the sperm sample is relatively small, for example, when sperm has to be extracted surgically. In some cases ICSI may be successful where conventional IVF fails to produce viable embryos because of a low fertilisation rate.

As the success of ICSI treatments is dependent to a very high degree on the skills and experience of its practitioners, the HFEA has introduced special competency assessment and licensing for them. In addition, some people have expressed concerns about the potential side effects of ICSI treatment, because of possible damage to the egg as a result of the technique and also the risk of injecting an abnormal sperm. So far there is mixed evidence about an increased risk of birth defects as a result of this treatment, and the HFEA keeps a very close eye on all aspects of ICSI, which it regulates it very closely. Clinics should discuss the potential risks with potential patients, and the HFEA inspects the information that clinics give to patients regarding ICSI.

Luckily the UK is one of the few countries in the world to gather and keep comprehensive data about all ICSI births, as well as all other forms of IVF treatment. 3,433 patients received nearly four thousand ICSI treatments in 1995, resulting in 782 births - a live birth rate of 20% per cycle.

There are a number of new clinical procedures which, while technically possible, have not yet been proven safe for both the intended child and the mother. For this reason treatment of patients using techniques such as the use of spermatids in ICSI and the freezing of eggs prior to fertilisation are prohibited in this country. Patients are warned that undergoing such techniques abroad may expose both their hoped for child and they themselves to risks.