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Dr Gillian Lockwood specialises in reproductive medicine. Jill Anthony-

Ackery is a former fertility patient. Sharon Perkins is a Fertility Clinic

Nurse Coordinator. Jackie Meyers-Thompson is a former fertility patient.

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A Reference for the Rest of Us! ™ UK Edition

Dr Gillian LockwoodMedical Director of Midland Fertility Services

Jill Anthony-AckerySuccessful former fertility patient

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Your complete guide to understanding fertility and getting pregnant

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Fertility &Infertility

FOR

DUMmIES‰

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by Dr Gillian Lockwood, Jill Anthony-Ackery,Jackie Meyers-Thompson, and Sharon Perkins

Fertility &Infertility

FOR

DUMmIES‰

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Fertility & Infertility For Dummies®

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About the AuthorsDr Gillian M. Lockwood BM BCh MA (Oxon) DPhil MRCOG is the MedicalDirector of Midland Fertility Services (www.midlandfertility.com). Gillwas a late recruit to medicine. She read Philosophy, Politics and Economicsat Oxford University and then worked as a Government Statistician. A televi-sion documentary encouraged her to change careers to Medicine and shequalified in 1986. A chance meeting with Professor Robert Edwards (the ‘test-tube’ baby pioneer) introduced her to the science of IVF and since 1990 shehas specialised in Reproductive Medicine.

For 10 years Gill was Senior Clinical Research Fellow and Lead Clinician at theOxford Fertility Unit, where her research interests included polycystic ovarysyndrome, premature ovarian failure, and recurrent miscarriage.

She lectures and broadcasts on ethical and social issues in reproductive med-icine, has chaired the British Fertility Society Ethics Sub-Committee, and is amember of the RCOG Ethics Committee. She is an Associate Editor of HumanReproduction and a member of the Editorial Board of Human Fertility. She haspublished over 30 ‘first author’ articles in international journals and has con-tributed to many text books and review publications.

Since 2000 Gill has been the Medical Director of Midland Fertility Services(MFS), in the West Midlands. MFS is a ‘nurse led’ fertility unit at which thenursing staff perform all procedures required for IVF including surgical spermretrieval (TESA), egg retrieval, and embryo transfer. MFS recently announcedthe successful delivery of the UK’s first ‘frozen egg’ babies; a developmentthat has given new hope of becoming ‘genetic mothers’ to the thousands ofyoung women who each year have to undergo sterilising chemotherapy orradiotherapy.

Jill Anthony-Ackery BA (Hons) is the Communications Manager at MidlandFertility Services. Jill is a relatively recent entrant to the world of fertilitytreatment, with responsibility for the communications and marketing of MFSsince 2003, initially as a consultant public relations director and then as amember of the clinic staff since 2004.

Her qualifications for such a role? A degree in art and film history (!) and 18years’ experience managing the reputations of client companies from a smallUK trade association to international cosmetics, steel, and photographicequipment manufacturers. Oh! and also two years of ICSI treatment at MFS,during which she and her husband Gwyn conceived twins, suffered a miscar-riage at around 12 weeks, then had an unsuccessful frozen embryo transfer,followed by a second full cycle, resulting in the birth of their daughter Conniein 2002.

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When she returned to work in 2003, she combined her almost evangelical zealabout those miracle workers at MFS with her professional experience andpatient perspective – and got paid for doing so! It’s a dream job where shecontinues to be inspired daily by the team and patients.

Jill has written countless articles in a range of newspapers, consumer maga-zines, and trade publications from many industry sectors. She was also theoriginal editor and a contributor to Beyond the Lens, the business bible forprofessional photographers. In 2006, her work at MFS won a gold award fromthe Chartered Institute of Public Relations and she works closely with nationaland regional press, television, and radio to satisfy the unquenchable mediainterest in assisted conception.

Jackie Meyers-Thompson is managing partner of Coppock-Meyers PublicRelations/For Your Information Communications, and a ‘professional’ fertilitypatient.

Sharon Perkins is the nurse coordinator for the Cooper Center for In VitroFertilization in Marlton, New Jersey, one of the largest infertility centres inthe United States. She previously worked in labour and delivery and neonatalintensive care.

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DedicationFrom Gill: This book is dedicated to my family. To my husband, Michael, whomade it possible for me to study medicine; to my three sons, Nick, Jamie, andSam, who remind me every day what a blessing children are; to my mother,Ivy, who makes it possible for me to work, travel, do research, give lectures,and still know my boys will be well fed and have their homework completedon time.

From Jill: This book is dedicated to my husband Gwyn who let me reveal socandidly some of the personal stories about our fertility treatment, and toour darling daughter Constance Lydia, who is the reason for my being able to contribute to this book.

From Jackie: This book is dedicated to my Darling Husband (DH!), DarrenThompson, who has loved me and believed in us, through it all. And to mymother, Larissa Meyers, and my father, the late Leonard Meyers, who taughtme early and well that I could climb any mountain.

From Sharon: This book is dedicated to my father, who always believed Icould do anything.

Authors’ AcknowledgementsFrom Gill: This book is written with thanks to all the colleagues with whom Ihave worked since my first day as a clinical medical student in 1983. From thekind nurses who showed me how to take a blood sample without making amess of the patient, to the patient professors who encouraged me to studyfor a PhD in Oxford when I’d discovered that reproductive medicine was themost exciting, rewarding, and interesting job ever.

My thanks also go to the patients. Being a fertility patient is tough but I havebeen fortunate to have the privilege of caring for a group of people who,almost without exception, have met the challenges of fertility treatment with patience, warmth, courage, and humour. And some got babies too!

From Jill: Gill and I have worked together at Midland Fertility Services since2004 and while I learn something new/interesting/amazing/funny from herduring every conversation, I thank her for the huge privilege of workingtogether on this project.

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My route to writing such a book was unplanned and a wonderful outcome tothe dark moment, back in 1999, of being told ‘you need fertility treatment’. Ofcourse, our daughter Connie was the greatest result of that time and as thefertility experts at MFS are now my colleagues, I need to thank them all –mainly for helping us to have Connie, but also for the continuous learningprocess I enjoy from our work and which has helped me write this book –especially Su Barlow, Judith Baron, Heidi Birch, Jo Johnson, Anna Kavanagh,Vicki Robinson, and Linda Tanner.

Thanks to my parents David and Sheila Anthony (the oracles!) who made mebelieve I could achieve whatever I set my heart on. I hope to pass the samemind-set on to Connie, as unstinting belief in your child is a wonderful andlasting gift. They know how huge my thanks are.

While I have incorporated Gwyn’s and my own personal stories into the book,I have also remembered the experiences of some of the MFS patients whohave shared their stories with me over the last few years to re-tell throughthe media, including Vivian Barnes, Michelle Brookes, Shara Brookes, ElaineEades, Julie Griffiths, ‘Lucy’, and Tom and Li McLoughlin-Yip. While their sto-ries aren’t explicitly included in the book, they have helped shape some ofthe content, so that readers in similar circumstances may find the bestadvice and a possible way ahead.

Also thanks to Mrs (Isobel) Watts – your influence continues!

Finally, to Samantha Clapp and Rachael Chilvers at Wiley – we took it to thewire, but we did it! Many thanks.

From Jackie: Thanks to Dr Jerome Check, Dr Jung Choe, and the CooperCenter for In Vitro Fertilization in Marlton, New Jersey. It was at the CooperClinic that I met my writing partner and friend, Sharon Perkins. Her humor,caring, and expertise make her as great of a nurse as it does a writer.

Thanks to Cousin Sandy, the Thompsons, the Jaffes, the Cicecklis, thePerlsteins, Melissa, Camille, Suzanne, Courtenay, Susan, Leslie, Sharon, and Nancy. Thanks too to Stephanie Smart and Jennifer R. Bloome.

From Sharon: Thanks to Jackie Meyers-Thompson; my husband, John; mychildren, John, Matt, Kim, Greg, Cindy, Ben, and Molly; Matthew Ryan, themost wonderful grandson in the world; my mother, Lois Orchard; my sister,Sue Collins; and my sister-in-law, Louise Kalmouni. My father, father-in-law,and mother-in-law would all have loved to see this book become a reality. Asmy mother says, they’re having a book party in heaven!

Thanks to Dr Check, Dr Choe, Dr Nazari, Dr Krotec, and Carol. And to all thewonderful patients I’ve met over the years, this book is really for – andbecause of – you.

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Publisher’s AcknowledgementsWe’re proud of this book; please send us your comments through our Dummies online registrationform located at www.dummies.com/register/.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Project Editor: Rachael Chilvers

Development Editor: Tracy Barr

Copy Editor: Anne O’Rorke

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Technical Editor: Dr Christian Becker,University of Oxford

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Cartoons: Ed McLachlan

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Publishing and Editorial for Consumer Dummies

Diane Graves Steele, Vice President and Publisher, Consumer Dummies

Joyce Pepple, Acquisitions Director, Consumer Dummies

Kristin A. Cocks, Product Development Director, Consumer Dummies

Michael Spring, Vice President and Publisher, Travel

Kelly Regan, Editorial Director, Travel

Publishing for Technology Dummies

Andy Cummings, Vice President and Publisher, Dummies Technology/General User

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Debbie Stailey, Director of Composition Services

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Contents at a GlanceIntroduction .................................................................1

Part I: Making Babies as Nature Intended......................5Chapter 1: In the Beginning...............................................................................................7Chapter 2: Taking Baby Steps .........................................................................................21

Part II: Planning a Pregnancy .....................................43Chapter 3: We’re Trying! We’re Trying! (to Get Pregnant) ..........................................45Chapter 4: You, Your Fertility, and Your GP ..................................................................71Chapter 5: Great Expectations . . . But: Early Pregnancy Loss ...................................81

Part III: Tests and Investigations .................................95Chapter 6: Moving on Up: Seeing a Specialist...............................................................97Chapter 7: Finding the Female Problem: Testing, Testing, 1, 2, 3.............................107Chapter 8: It’s a Man Thing: When Tests Reveal Sperm Problems .........................133

Part IV: Eureka! Possible Solutions ............................145Chapter 9: Doing Your Homework: Researching Fertility Clinics

and Funding Treatment...............................................................................................147Chapter 10: All The ‘I’s: Introducing IUI, IVF, and ICSI ...............................................165Chapter 11: Giving Mother Nature a Helping Hand:

Intrauterine Insemination (IUI) ..................................................................................177Chapter 12: Making Test-Tube Babies: IVF..................................................................189Chapter 13: ICSI: It Only Takes One Good Sperm! ......................................................207Chapter 14: ‘Babies on Ice’: Egg Freezing and Fertility Treatment .........................211Chapter 15: Giving, Receiving, and Sharing: Egg Donor Treatments .......................219Chapter 16: Creating an Embryo: Amazing Teamwork in the Lab ...........................227

Part V: Post-First Cycle: How You May Feel and What You Can Do ...............................................241Chapter 17: Waiting and Hoping: Surviving the Two-Week Wait

after Embryo Transfer.................................................................................................243Chapter 18: What’s in Your Freezer? Frozen Embryo Transfers...............................261Chapter 19: If at First You Don’t Succeed: Trying IVF More than Once...................269

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Part VI: Different Strokes for Different Folks: Options for Non-Traditional Families ..........................281Chapter 20: Third-Party Reproduction: You and You and Me

and Baby Make . . . Four! .............................................................................................283Chapter 21: Safe Options for Same-Sex Couples and Single Mums..........................295Chapter 22: Ready-Made Families and Other Choices...............................................305Chapter 23: New Advances and Ethical Dilemmas.....................................................317

Part VII: The Part of Tens ..........................................333Chapter 24: Ten Tips to Get You Through Treatment (and Keep You Sane!) .........335Chapter 25: Ten (Okay, Seven) Groups of Fertility Medications

and Where to Find Them ............................................................................................339

Index .......................................................................345

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Table of ContentsIntroduction..................................................................1

About This Book...............................................................................................1How This Book Is Organised...........................................................................2

Part I: Making Babies as Nature Intended ...........................................2Part II: Planning a Pregnancy ................................................................3Part III: Tests and Investigations ..........................................................3Part IV: Eureka! Possible Solutions ......................................................3Part V: Post-First Cycle: How You May Feel and What You Can Do...3Part VI: Different Strokes for Different Folks: Options

for Non-Traditional Families..............................................................4Part VII: The Part of Tens ......................................................................4

Icons Used in This Book..................................................................................4

Part I: Making Babies as Nature Intended ......................5

Chapter 1: In the Beginning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Making Babies: An Inefficient Process at Best..............................................8How Aging Affects Fertility .............................................................................9

Calculating your fertility odds at different ages.................................9Understanding how much age itself matters ....................................10When is 40-something ‘too old’?.........................................................11

Things to Think About Before You Conceive..............................................12Examining the state of your union .....................................................12Pregnancy and work.............................................................................13Babies aren’t superglue .......................................................................14The cost of a baby in pounds and pence ..........................................15

Timing Your Baby: The Big Picture..............................................................16Understanding the Long-Term Effects of Birth Control ............................17Gene Genie: Looking at the Family Tree......................................................18

Gathering info .......................................................................................18Before you panic...................................................................................19

Getting Pregnant: Was It Easier for Grandma? ...........................................19

Chapter 2: Taking Baby Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Biology for Baby Makers: Reviewing Male and Female Anatomy ............21

Looking at female accessories (besides shoes and handbags)......22Putting all the parts together: Your menstrual cycle ......................27Hanging out with the guys...................................................................28

Putting Male and Female Parts Together: Having Sex (At the Right Time).....................................................................................30

Conceiving a Baby: How Sex Should Work..................................................31

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Making Sure That You’re Healthy – Before Conception ............................33What you can’t see: Common infections

that may cause problems ................................................................33Behaving Yourself When Trying to Conceive .............................................36

Getting the proper nutrition ...............................................................36Taking vitamins.....................................................................................39

Finding Information .......................................................................................39Turning to books and the Internet for information..........................39Talking to friends..................................................................................40Listening to the old wives ...................................................................41

Part II: Planning a Pregnancy......................................43

Chapter 3: We’re Trying! We’re Trying! (to Get Pregnant) . . . . . . . . . .45Predicting Ovulation: Kits, Sticks, and Software........................................45

Using an ovulation predictor kit.........................................................46Adding computer power with a fertility monitor.............................48Just spit here – the saliva test ............................................................48Tracking your fertility with software .................................................49Taking your morning temperature .....................................................50Home sperm tests ................................................................................51

Practice Makes Perfect ..................................................................................52Positive Thinking – Home Pregnancy Tests................................................52

Dealing with a false positive ...............................................................54Coping with That Time of the Month Again:

The Pain of Not Getting Pregnant.............................................................55Looking at medications and your work environment for answers...56Considering religious practices..........................................................57Synchronising calendars .....................................................................57

Looking at Your Lifestyle ..............................................................................58Giving up smoking................................................................................58Eliminating alcohol...............................................................................58Say ‘no’ to drugs ...................................................................................59Cut back on caffeine.............................................................................59Stay out of the sauna ...........................................................................60Exercise with caution...........................................................................60Avoid anabolic steroids .......................................................................60Dump the douche.................................................................................60

Eating for Two? Sampling a Fertility Diet ....................................................61Looking at Supplements – Vitamins, Minerals, Herbs, and More ............62

Multivitamins have got it in one.........................................................63Herbs......................................................................................................64Folic acid ...............................................................................................66Supplements for better sperm production .......................................67

Turning to Complementary Therapies........................................................68On pins and needles – acupuncture for infertility ...........................68Saying ‘Om’: Meditation and yoga......................................................69Massaging away what ails you............................................................69

Fertility & Infertility For Dummies xiv

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Chapter 4: You, Your Fertility, and Your GP . . . . . . . . . . . . . . . . . . . . . . .71Deciding When the Time is Right to See Dr G Practitioner ......................71

When not to wait – even a few months..............................................72First visit to your GP ............................................................................73

Thinking About FAQs for Your First Visit ....................................................74Carrying Out Tests on Your First Visit.........................................................75

Some initial tests ..................................................................................76‘Take two Clomid and call me in three months’ ...............................76

Choosing Over-the-counter Remedies: Placeboes or Simple Solutions?...78

Chapter 5: Great Expectations . . . But: Early Pregnancy Loss . . . . . .81Getting ‘a Little Bit’ Pregnant – It’s Possible...............................................81Suffering a Miscarriage..................................................................................83

Will you need a D&C?...........................................................................84Playing the blame game.......................................................................85Playing the guessing game: Why did things start off so well? ........86Playing the age game ...........................................................................87Suffering the insensitive remarks of family and friends ..................87

Ectopic Pregnancy: When the Embryo Is Developing in the Wrong Place......................................................................................88

What to do if you suspect an ectopic pregnancy.............................89Treating ectopic pregnancies ............................................................90Understanding why ectopic pregnancies happen............................91Recurrent miscarriage: Why it happens............................................92

Picking Yourself Up after a Loss...................................................................93What to do while you’re waiting.........................................................93What not to do ......................................................................................94

Part III: Tests and Investigations ..................................95

Chapter 6: Moving on Up: Seeing a Specialist . . . . . . . . . . . . . . . . . . . .97Seeking Dr Specialist......................................................................................98

Who are these specialists?..................................................................99Choosing between a Ford and a Ferrari: NHS or Private? .............100

Working with Dr Specialist..........................................................................101What Dr Specialist will want to know ..............................................101Investigations Dr Specialist may want to do...................................102Dr Specialist and his amazing corrective surgery..........................103IUI at your DGH...................................................................................104When to see Dr Man-Specialist .........................................................104

Facing the Stranger in Your Sex Life ..........................................................105Understanding What Dr Specialist Says....................................................105

Chapter 7: Finding the Female Problem: Testing, Testing, 1, 2, 3 . . .107Cataloguing the Common Tests: ABCD HSG .............................................108

Baseline blood tests...........................................................................108HSG (don’t even try to spell out the word).....................................109

xvTable of Contents

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Saline-enhanced ultrasound (sonohysterogram)...........................111HyCoSy (hysterocontrastsalpingography):

Don’t even try to say it!..................................................................111Hysteroscopy ......................................................................................112Laparoscopy........................................................................................112Post-coital tests ..................................................................................113Thyroid tests.......................................................................................115FSH, AMH (anti-Müllerian hormone), and inhibin B ......................116CCCT (clomiphene citrate challenge test) ......................................117

Understanding Female Infertility Problems..............................................117Looking in the uterus .........................................................................117Checking out the Fallopian tubes.....................................................118The complications of scar tissue .....................................................120Testing for immune disorders...........................................................122Endometriosis: A ‘bloody’ pain ........................................................124Amenorrhoea – not getting your period at all ................................126Failing to ovulate ................................................................................126

Reversing Sterilisation ................................................................................128Understanding Diseases That Affect Fertility...........................................129

Diabetes: More than a sugar problem..............................................129Lupus: Not just a rash........................................................................130Cancer and female fertility: Good news?.........................................131

Chapter 8: It’s a Man Thing: When Tests Reveal Sperm Problems . . .133Sounding Out Semen Analysis....................................................................134

Collecting a sample ............................................................................134Looking under the microscope.........................................................134

Interpreting Your Partner’s Test Results...................................................136Disappearing act: Where’s the sperm? ............................................136Judging sperm performance: Swimmers and non-swimmers.......139Considering ejaculation issues: A sensitive topic..........................139Handling the emotional effect of male problems on both of you ...141

Reversing a Vasectomy................................................................................142Overcoming Cancer and Male Fertility:

The News Is Cautiously Optimistic ........................................................143

Part IV: Eureka! Possible Solutions.............................145

Chapter 9: Doing Your Homework: Researching Fertility Clinics and Funding Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147

Dealing with First Reactions .......................................................................148Understanding that assisted conception may not work ...............149Getting real: Managing your expectations ......................................149

Researching Fertility Clinics .......................................................................150First steps to finding a fertility clinic...............................................150‘Lies, damn lies, and statistics’: Tapping into HFEA data..............151Other considerations when looking for a clinic ............................152

Fertility & Infertility For Dummies xvi

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Surfing fertility clinic Web sites........................................................153Personality match or clash?..............................................................154

Footing the Bill: Who Will Pay?...................................................................156NHS-funded treatment .......................................................................156Funding your own treatment ............................................................160Getting creative when you’re out of other options........................161A word about health insurance ........................................................164

Chapter 10: All The ‘I’s: Introducing IUI, IVF, and ICSI . . . . . . . . . . . . .165Doing the Groundwork ................................................................................165

Initial consultation .............................................................................166Baseline tests ......................................................................................167Calculating your fertility age.............................................................169Routine infection screening ..............................................................169Genetic screening ...............................................................................169Follow-up appointment and treatment planning............................170Tailor-made treatment .......................................................................170

Deciding How Much Treatment You Need ................................................171Discovering IUI, IVF, and ICSI – the Basics ................................................171

ICI and IUI ............................................................................................171In vitro fertilisation (IVF)...................................................................172Intra cytoplasmic sperm injection (ICSI) ........................................173

Deciding How Long to Keep Trying ...........................................................174Growing sick of getting stuck............................................................174Being sensitive to your partner’s feelings.......................................174Coping when you’re both sick of everything,

including each other ......................................................................175Thinking Ahead: Health Effects of Fertility Treatment............................175

Effects on the mother ........................................................................175Effects on the baby.............................................................................176

Chapter 11: Giving Mother Nature a Helping Hand: Intrauterine Insemination (IUI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177

Deciding How Much Treatment You Need ................................................177Treating Luteal Phase Defects ....................................................................178Acquiring Help through AI ..........................................................................179

Measuring your chance for success ................................................180Collecting sperm.................................................................................180Checking out your egg .......................................................................181

Moving Up to Controlled Ovarian Hyperstimulation...............................182Getting injections ...............................................................................183Defining gonadotrophins...................................................................184

Boosting Progesterone ................................................................................187

Chapter 12: Making Test-Tube Babies: IVF . . . . . . . . . . . . . . . . . . . . . .189Starting an IVF Cycle: A Roller Coaster Ride of Emotions ......................189

Looking at your drugs protocol........................................................190Working with the staff at your IVF centre........................................192

xviiTable of Contents

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Dealing with a disappearing doctor .................................................193Taking your medications without having a nervous breakdown ...194Monitoring your progress (more poking and prodding)...............195Waiting for the phone to ring . . . again and again..........................197Feeling as if everyone in the waiting room

is doing better than you.................................................................197Feeling as if you’ve been on gonadotrophins your whole life ......198Recognising when your oestradiol level is too high......................198Feeling blue is normal........................................................................199

Taking a Shot in the Dark: Time for hCG ...................................................199Going for the Gold: The Egg Retrieval .......................................................200

Reducing the anxiety with medication ............................................200Signing here . . . and here . . . and here . . . ......................................200Meeting the retrieval team ................................................................202Undergoing the egg retrieval procedure .........................................202Knocking you out: Anaesthesia choices for the retrieval .............203

Doing His Duty: Your Partner Is Busy, Too ...............................................204Answering Common Egg Retrieval Questions ..........................................205

Chapter 13: ICSI: It Only Takes One Good Sperm! . . . . . . . . . . . . . . . .207Understanding How ICSI Works..................................................................208Knowing Who Can Benefit from ICSI..........................................................209Recognising a Good Sperm When You See One .......................................209Thinking Ahead: Things to Know about ICSI ............................................209

Chapter 14: ‘Babies on Ice’: Egg Freezing and Fertility Treatment . . .211Freezing Eggs: Coming In from the Cold....................................................212Reaping the Benefits of Egg Freezing.........................................................213

Cancer patients ..................................................................................213People with religious objections to embryo freezing ....................214Women with poor ovarian reserve...................................................214The Bridget Joneses of the world.....................................................215

Completing the Job: Thawing, Fertilisation, and Transfer......................216Creating a Storm in a Test Tube – The Controversy

over Freezing Eggs....................................................................................216

Chapter 15: Giving, Receiving, and Sharing: Egg Donor Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219

Using Donor Eggs: The Whys and Wherefores ........................................219Finding an Egg Donor...................................................................................220

Knowing your options: Who ya gonna call?....................................220Considering legalities, duties, and other fun stuff .........................221Preparing for a wait............................................................................222

Taking Steps to Egg Donation .....................................................................222Checking out your donor: Necessary screenings ..........................223Signing the documents ......................................................................224Synchronising your timing ...............................................................225

Getting Support ............................................................................................226

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Chapter 16: Creating an Embryo: Amazing Teamwork in the Lab . . .227Recognising a Good Egg .............................................................................227Sorting Suitable Sperm ................................................................................228IVF: Making an Embryo ‘in Glass’...............................................................229

Normal insemination..........................................................................229ICSI: Injecting for male factor............................................................229Going pronuclear: Getting good embryos.......................................230

Taking the Call from Embryology...............................................................230Grading an Embryo......................................................................................232

Fragmentation.....................................................................................232Is it wise to transfer that embryo? ...................................................232

Looking at Your Uterine Lining...................................................................233Hatching Embryos – Come on Out, Guys..................................................234Blast Off! Considering a Blastocyst Transfer............................................234‘One Embryo or Two?’ .................................................................................236Transferring Your Embryo ..........................................................................236

Getting comfy......................................................................................237Talking to the embryologist ..............................................................237Time to transfer ..................................................................................237Putting your feet up ...........................................................................238

Keeping Your Feet and Your Spirits Up after the Transfer......................238Restricting your activity....................................................................238Dealing with your partner .................................................................239

Do’s and Don’ts for the Two-Week Wait ....................................................239

Part V: Post-First Cycle: How You May Feel and What You Can Do................................................241

Chapter 17: Waiting and Hoping: Surviving the Two-Week Wait after Embryo Transfer . . . . . . . . . . . . . . . . . . . . .243

Technically, You’re Pregnant – Waiting for the Proof ..............................243Seeking support during an uncertain time......................................245Making your to-do or not-to-do list ..................................................245

Sensing Every Little Twinge: The Truth about Pregnancy Symptoms ...247Signs, omens, and other portents ....................................................247Don’t be so sure that you’re not pregnant! .....................................248

Preparing for ‘But What If?’ – Having a Plan B..........................................249Saying ‘No’ to Home Pregnancy Tests .......................................................249Responding to Positive News .....................................................................251

Continuing the tests...........................................................................251Celebrating your success, within limits ..........................................253Saying goodbye to your fertility doctor ..........................................255Defining high-risk pregnancy ............................................................255

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Considering the Next Step If IVF Doesn’t Work ........................................256Figuring out what happened .............................................................256Questions for God and your doctor

(who are not one and the same)...................................................257Going through the grieving process.................................................259Taking time out for you and your partner.......................................260

Chapter 18: What’s in Your Freezer? Frozen Embryo Transfers . . . . .261Facing a Few Facts about Frozen Embryos...............................................262

Who uses them ...................................................................................262Success rates with ‘frosties’..............................................................262

Discovering Why Embryos Are Frozen......................................................263Freezing excess embryos created during IVF .................................263Saving younger eggs for ageing women...........................................263Preserving the possibility of parenthood

for those facing medical issues.....................................................264Understanding the Process of Cryopreservation ....................................264

Freezing the embryos ........................................................................264Thawing the embryos ........................................................................265Using natural cycle or hormone control for embryo transfer? ...266

Dealing with the Ethical Issues of Embryo Freezing................................267

Chapter 19: If at First You Don’t Succeed: Trying IVF More than Once . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269

Calculating the Odds: Success Rates per IVF Cycle.................................269Going Back for Seconds? Considering Your Options...............................270

Deciding when to start another cycle..............................................271Switching clinics and protocols – or not.........................................274Reaching out for more help ..............................................................275

I’m Okay, You’re Okay – Checking On the State of Your Union ..............276Exploring Some Controversial Fertility Treatments ................................277

Leukocyte immune therapy (LIT) ....................................................277Intravenous immunoglobulin (IVIG) ................................................277Steroids................................................................................................278

Gearing Up for More Cycles........................................................................278Giving Up on Fertility Treatments? Considering When to Let Go..........280

Part VI: Different Strokes for Different Folks: Options for Non-Traditional Families...........................281

Chapter 20: Third-Party Reproduction: You and You and Me and Baby Make . . . Four! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283

Preparing Yourselves for Using a Donor ...................................................283Getting ready to ride the emotional roller coaster ........................284Understanding the legal issues.........................................................284Protecting yourselves – the least you can do.................................285

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Borrowing from the Sperm Bank................................................................286Why fewer couples are using donor sperm ....................................286Picking a ‘dad’ from a catalogue.......................................................287Asking someone you know to donate ..............................................288

Using Donor Eggs .........................................................................................289Receiving Donor Embryos – Embryo Adoption .......................................289Surrogacy: Borrowing a Uterus for Nine Months.....................................290

Finding a willing woman ....................................................................290Going through the surrogacy process .............................................291

Traditional Surrogacy – The Road Less Travelled...................................292Telling the Family or Keeping It to Yourself..............................................293

Chapter 21: Safe Options for Same-Sex Couples and Single Mums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295

Examining the Issues That You May Face as a Same-Sex Couple...........295Gay couples.........................................................................................296Lesbian couples..................................................................................297Finding the right clinic.......................................................................298

Adoption in the Gay and Lesbian Community .........................................299Going It Alone: Fertility Issues for the Single Parent ...............................300

If you’re a woman alone.....................................................................300If you’re a man alone..........................................................................302Adopting a child as a single parent..................................................303

Chapter 22: Ready-Made Families and Other Choices . . . . . . . . . . . .305Opting to Adopt............................................................................................306

Children available for adoption........................................................306Adoption agencies and organisations .............................................307Who can adopt? ..................................................................................308The cost of adoption..........................................................................308Matchmaking you and your child.....................................................309Getting through the assessment – more hurdles to clear.............309Moving in and getting legal ...............................................................310Being aware of adoptive-family issues.............................................310Adopting abroad.................................................................................311

Trying Out Foster Parenting First ..............................................................313Who can foster? ..................................................................................313Foster grants .......................................................................................314

Deciding to Live Child Free.........................................................................314Working with Children.................................................................................316

Chapter 23: New Advances and Ethical Dilemmas . . . . . . . . . . . . . . .317Looking Down the Road: Long-Term Health Effects

of Fertility Medication..............................................................................318Effects on the mother ........................................................................318Effects on the baby.............................................................................319

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Selecting the Sex: When You Absolutely, Positively, Want a Boy Or a Girl.................................................................................319

Sperm sorting .....................................................................................320Preimplantation genetic diagnosis (PGD) .......................................321

Selective Reduction: Making the Hardest Choice ....................................322Dividing Up the Leftover Embryos ............................................................323Putting Old Genes into New Skins: Cytoplasmic Transfer ......................324Posthumous Conception: Legal and Ethical Issues .................................325Cloning and Human Concerns ....................................................................326Saving Stem Cells for Research ..................................................................327‘Welfare of the Child’: Asking Clinics to Decide Who’s Fit to Parent .....328Making Mistakes in the Lab: When Saying You’re Sorry Isn’t Enough....329Where Is All This Leading? New Fertility Frontiers .................................330

Part VII: The Part of Tens...........................................333

Chapter 24: Ten Tips to Get You Through Treatment (and Keep You Sane!) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .335

Give Yourself Time .......................................................................................335Don’t Panic....................................................................................................335Remember You’re Not Alone ......................................................................336Don’t Blame Yourself ...................................................................................336Listen to Friends – Occasionally ................................................................336Don’t Delay Treatment.................................................................................336Don’t Freak about the Financing ................................................................337Don’t Get Needled about Needles ..............................................................337Share Your Treatment Experience ............................................................337Coming to Terms with No Success ............................................................337

Chapter 25: Ten (Okay, Seven) Groups of Fertility Medications and Where to Find Them . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .339

Gonadotrophins ...........................................................................................339GnRH Agonists..............................................................................................341GnRH Antagonists ........................................................................................342hCG (Human Chorionic Gonadotrophin) Intramuscular ........................342hCG Subcutaneous Recombinant...............................................................343Progesterone.................................................................................................343Clomiphene Citrate ......................................................................................343Locating What You Need ............................................................................344

Index........................................................................345

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Introduction

Making babies is supposed to be fun and easy. Most people want to makebabies, assume that they can, and for a long time the big priority is

avoiding making babies in the wrong place at the wrong time. But if you’repart of the one in six couples who have problems making babies, then this isthe book for you.

Infertility is a medical problem for about 3.5 million people in the UnitedKingdom. You are certainly not alone. But treatment is out of reach financiallyfor some people and a tremendous personal strain on most. Many people(the ‘just relax and you’ll get pregnant’ crowd) misunderstand fertility, and a few(the ‘drink this vile potion and you’ll get pregnant, guaranteed!’ group) evenexploit it. Clinical and scientific aspects of infertility continue to improve, yetthe emotional considerations are often side-lined.

Fertility & Infertility For Dummies is the result of combining Sharon’s expertiseas an infertility nurse; Jackie’s expertise as a patient; Gill’s wealth of informa-tion as a leading fertility consultant; and Jill’s experience of infertility as apatient and subsequently as the PR consultant for one of the UK’s biggest fer-tility clinics. We wrote this book so that people trying to conceive will knowwhen to seek help, what sort of help to seek (and avoid!) and what the emo-tional, financial, and medical considerations of assisted conception can be.We hope this book finds its way to the bookshelves and bedsides of everyonewho needs emotional support or specialist help to have the baby they want.

About This BookYou can’t pick up a magazine or turn on daytime television without hearing it:The great fertility debate over when women should have babies. But the qual-ity of the information doesn’t match the quantity of the coverage, becausemuch of it is inappropriate or just plain inaccurate.

Meanwhile, for the 30,000 infertility patients being treated in the UnitedKingdom alone (which doesn’t take into account the many people whohaven’t sought or can’t afford fertility treatment), the question isn’t ‘when?’but ‘if?’! Will they ever be able to conceive, carry, and deliver the child theyare seeking, and will they be one of the fertility patients who sometimes payup to £20,000 for the privilege of being told again, ‘Sorry, the pregnancy testwas negative’?

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This book is intended to help you walk into a GP’s or consultant’s office andfeel in control of the questions, investigations, and treatments for infertility.Our aim is to provide fertility patients – both those at the starting line andthose close to the finish – with comprehensive information about the optionsavailable to them. We discuss topics ranging from the scientific to the spiri-tual, from the empirically proven to the fantasist, quasi-voodoo, providing athought, an idea, or just a giggle along the way.

You can read through this book from front to back and feel confident that youcan find the answer to just about any fertility issue, from natural family plan-ning to cloning. But if you’re like most people, you’ll probably look through thetable of contents, home in on the chapters that affect you, and jump directly tothem. This book is a resource, to go back to whenever a new issue or questionarises, to find the answer you need without reading through everything thatgoes before. It’s good for people with every level of fertility expertise, fromthe novice to the jaded, been-there-done-that patient. The no-tech and low-tech fertility chapters come first, so you can skip them if you’re already a veteran and move right into high-tech and really high-tech stuff found in thesecond half of the book.

We intersperse personal stories throughout the book; these (hopefully!) makeinteresting reading from the viewpoint of ‘I did it, so you can too’ stories.

How This Book Is OrganisedFertility & Infertility For Dummies is divided into seven parts. If you’re justbeginning to think about getting pregnant, you may want to start with thefirst couple of chapters. If you’re familiar with infertility treatment, you maywant to skip to the sections that apply to your current treatments, or tothose you may be moving up to in the future. If you want to read through theentire book, you’ll be well informed on all the latest infertility issues and thenewest technological advances in the field.

The following sections explain the organisation of this book:

Part I: Making Babies as Nature IntendedIf you’re a newcomer to the wonderful world of baby making, we suggest thatyou start reading here. In this part, we explain male and female anatomy(including everything you ever wanted to know about reproductive organs),look at the logistics and implications of getting pregnant, and review any habitsand behaviour you could change – or not – before trying to get pregnant.

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Part II: Planning a PregnancyThis part helps you fine-tune your conception efforts using methods to pre-dict ovulation, and helps you understand how complicated getting pregnantreally is. We also assess the value of male and female fertility home-test kits,guide you through your first visits to your GP about possible infertility, andhelp you understand and deal with pregnancy loss. We also take a look atsome alternative approaches to conception, from herbs to acupuncture.

Part III: Tests and InvestigationsThis part explains the tests you may be doing and those your GP may advise,to find out why you’re not yet pregnant; we explain what the tests are andwhat the results may mean. We also accompany you on your visits to a consultant, and help you decipher what the doctor tells you, including theinvestigations that he or she may recommend. We explain tests for male infertility and what fertility treatments your hospital consultant can offer.We also take a look at the choices you have if you’re told you need fertilitytreatment.

Part IV: Eureka! Possible SolutionsThis part explains how to research and choose a fertility clinic and optionsfor paying for your treatment, including possible NHS funding. We explainintrauterine insemination (IUI), in vitro fertilisation (IVF), and intracytoplas-mic sperm injection (ICSI) and what each involves. We take you through thestimulation process, the egg retrieval, and look at how an embryo is createdin a lab. We also look at embryo and egg freezing and at egg sharing treat-ments in this part.

Part V: Post-First Cycle: How You MayFeel and What You Can DoThis part supports you through the two-week wait between IUI or embryotransfer before your pregnancy test and guides you through your options ifthe result is negative, including frozen embryo transfers, and consideringanother treatment cycle.

3Introduction

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Part VI: Different Strokes for DifferentFolks: Options for Non-Traditional FamiliesThis part considers third-party reproduction – the use of surrogacy or usingdonor eggs, sperm, or embryos to get pregnant. We also discuss parenting for‘non-traditional’ families (gays, lesbians, and singles) and discuss fosteringand adoption for every kind of family. Finally, we look at new – and sometimescontroversial – treatments including fertility preservation and cloning.

Part VII: The Part of TensWant to read some tried and tested advice to keep you sane during yourtreatment? Want to know the difference between a gonadotrophin, an antago-nist, and a recombinant? This is the part for you.

Icons Used in This BookIf either of us has a personal story that is funny, informative, inspirational, orotherwise interesting, we identify it with the Personal Story icon. These anec-dotes are never essential reading, but they’re usually entertaining!

If something’s really important for you to keep in mind during your fertilitytreatment, we mark it with a Remember icon.

If something’s technically interesting but not really essential to know, you seethe Technical Stuff icon.

The Tip icon highlights practical information that may make the road to babysomewhat smoother.

If you see the Warning icon, pay special attention. It tells you about potentialproblems or difficulties.

4 Fertility & Infertility For Dummies

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‘Well, for a start, let’s get back to basics.’

Part I Making Babies asNature Intended

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In this part . . .You may not have given much thought to the difficul-

ties of getting pregnant – more likely you’ve spentmany years trying to avoid getting pregnant! However,after you make the decision to have a baby, you need tolook at all the factors that go into having a successfulpregnancy, from health issues to lifestyle changes. In thispart we look at questions you need to ask before trying toget pregnant, and we give you some basic information onhow human reproduction works – and how it will hope-fully work for you.

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