Assisted Conception 

When the cause of subfertility cannot be managed with medical or surgical treatment you may require assisted conception. Read on to discover the different options and eligibility criteria.

• If you have not managed to conceive when all known causes have been ruled out or we have been unsuccessful in treating the cause (lack of ovulation, fallopian tube blockage, low sperm quality) we can bypass these steps using assisted conception
• The type of assisted conception we would recommend for you depends on the cause for your infertility
• Assisted conception is available for some couples funded by the NHS however it can be costly for those couples who do not meet the eligibility criteria
• We understand that fertility treatment can be distressing so we can offer therapy to couples who are struggling
• If you are eligible for NHS-funded assisted conception we can refer you to one of the specialist fertility centres in Sheffield depending on your preference:

o   Jessops Wing 

o   CARE Sheffield 

Types of Assisted Conception

further details can be found on the specialist centre website

Gonadotropin Stimulation

• Tertiary care centres can provide injections which stimulate the ovaries to produce more than one follicle
• This can then be followed with timed intercourse to maximise chance of conception, or by IUI/IVF
• The decision will be made jointly between you and your care provider, however not everyone will benefit from every treatment option and this will be discussed with you at your appointment  

Intrauterine Insemination (IUI)

• IUI is the manual insertion of a sperm sample into the uterus through a plastic tube inserted into the cervix
• You may also receive injection of hormones which will stimulate your ovaries to release a mature egg
• The sperm insemination will be timed to just after ovulation to maximise chances of fertilisation and will be a concentrated sample of healthy sperm
• This form of assisted conception is suitable for couples who have successful ovulation, patent (not blocked) fallopian tubes and good sperm quality
• This procedure can also be done using donor sperm if required 

In-Vitro Fertilisation (IVF)

• IVF is the mixing of eggs (removed from the ovaries) and sperm outside the body, allowing the sperm to fertilise the eggs, then return of the fertilised eggs back into the uterus
• Your ovaries may be stimulated to produce multiple mature eggs using hormonal medications such as injections of Gonadotrophins

o   A side effect of this medication is Ovarian Hyperstimulation Syndrome (see below)

• The eggs are removed from your ovaries by insertion of a thin needle through the vagina and into the ovaries
• Multiple fertilised eggs can be returned to allow the greatest chance of one implanting and developing into a viable pregnancy, although this may lead to a multiple pregnancy if more than one implants (non-identical twins)  
• IVF is suitable for couples who have difficulty with ovulation or have blocked fallopian tubes but who have good sperm quality
• This procedure can also be done using donor eggs or donor sperm in required 

Intra-Cytoplasmic Sperm Injection (ICSI)

• ICSI is similar to IVF but a single sperm is injected directly into a single mature egg
• The process of obtaining the mature egg and replacing the fertilised egg back into the uterus is the same as for IVF
• As the sperm is being injected manually this is suitable for couples with a low sperm quality
• The sperm chosen to inject will be the healthiest of the sample but does not require good motility or shape as it does not need to travel to get to the egg
• ICSI can also be used if IUI or IVF has failed

Ovarian Hyperstimulation Syndrome (OHSS)

• OHSS is a syndrome characterised by enlargement/swelling of the ovaries causing pain, and dilation/leaking of blood vessels following stimulation of the ovaries
  • By ovulation induction medication such as Clomid and Letrozole
  • By medications used to stimulate the ovaries before egg collection for IVF/ICSI
• The fluid leaking from the blood vessels collects in the abdomen causing swelling and discomfort
• The low fluid volume left in the blood vessels causes dehydration and can lower the function of the kidneys which filter out toxins and waste products to form urine
• Other symptoms you may notice include nausea/vomiting, increased thirst and reduced urine output (low volume of very concentrated/yellow urine)
• Risk factors which increase the risk of OHSS:
  • Polycystic ovaries
  • Previous OHSS
  • High response to stimulating medications
  • High levels of beta-hCG (hormone produced in early pregnancy)
    • OHSS can develop after implantation of a fertilised egg due to high beta-hCG, even if it did not develop following ovary stimulating medications
    • Beta-hCG is higher in multiple pregnancies (twins, triplets etc)
• Symptom onset:
  • A few days after finishing gonadotrophin injections
  • A few days after egg collection
  • Soon after onset of pregnancy (implantation of fertilised egg)
• Symptom resolution:
  • If you do not become pregnant the symptoms should settle down after your next period
  • If you become pregnant the symptoms usually settle after approx. 2 months
• Pregnancy and OHSS
  • Developing OHSS during fertility treatment will not affect your chance of getting pregnant
  • If you become pregnant/are pregnant when you develop OHSS it should not affect the pregnancy, but you will be closely monitored
• Management of mild-moderate symptoms
  • Regular drinking of clear fluid until you are no longer thirsty, aim for 2-3L per day
  • Simple painkillers such as paracetamol and codeine (avoid ibuprofen due to risks in pregnancy)
  • Keep moving to avoid development of blood clots in the legs (a rare complication of OHSS due to dehydration causing ‘sticky blood’ and lack of movement)
  • You may continue with fertility treatment depending on your specialist’s assessment of your risks and close monitoring
    • You may be asked to attend daily for weight and abdominal circumference measurements to assess the amount of fluid in the abdomen
    • We may repeat blood tests to check on your kidney function
  • We may recommend a hospital stay for closer monitoring and potentially fluid replacement therapy depending on your symptoms and blood tests
• Management of severe symptoms:
  • Usually requires an inpatient hospital stay for continual monitoring of your fluids (using blood pressure and urine measurements and kidney function blood tests)
  • Rest with regular drinking of clear fluids (and top up with IV fluids if required)
  • Painkillers such as codeine plus others if required
  • Anti-sickness medications through a drip or injection for vomiting
  • Blood-thinning medications to reduce the chance of a blood clot whilst you are in hospital and possibly for some time after you are discharged
  • Drainage of fluid in the abdomen using an ultrasound-guided needle if it is causing too much discomfort or shortness of breath
  • None of these treatment will affect the chance of you becoming pregnant
• Critical OHSS
  • Most cases of OHSS are self-limiting; this means that it will settle on its own without ‘treatment’, although we can help by managing the symptoms
  • Some people will develop OHSS which can worsen and cause reduced function of the kidneys, liver, lungs and circulatory system which requires more intensive monitoring and specialist treatments to prevent long-term damage

If you have these symptoms and think you may be developing OHSS you should call the clinic where you received your assisted conception treatment, or the gynaecology ward for advice outside of working hours. If you are unable to get through to us you can also contact your GP, NHS 111 or should visit the A+E department for assessment. 

NHS Funding Criteria

For couples with a woman aged 18-39 (up to day before 40^th birthday):

• Living in Rotherham can have 2 cycles; those living in Sheffield will only be offered 1 cycle
• The woman must have a BMI 19-30
  • Calculate your BMI using BMI = weight / height squared
  • Height in metres x height in metres = H², then weight in kilograms divided by H²
  • We can calculate this for you at your appointment with us
• You must be in a stable relationship of minimum of 2 years and be living at the same address
• Both individuals in the couple must have no living children (this includes any adopted children, children from previous relationships, children who do not live with you)
• Neither of the couple can have been sterilised in the past (even if this has been reversed)
• If either individual in the couple is a current smoker, they must be referred to a smoking cessation service and show active participation

Additional criteria if the women is aged 40-42 (from 40^th birthday to day before 43^rd birthday):

• Living in Rotherham can have 1 cycle; those living in Sheffield are not eligible for NHS funding
• Neither individual has have previous IVF treatment
• The woman must have a good ovarian reserve (determined using a blood test)
• There should be adequate time for any remaining investigations prior to the start of a cycle as it may not start after the 43^rd birthday

Same sex couples:

•  Couples may receive funding for up to 6 cycles of IUI with donor sperm and subsequent IVF if required

•  Patients in the East Midlands will only be funded by the NHS if have a defined cause for infertility or have self-funded 6 cycles of IUI and require NHS-funded IVF