When to get help
A healthy 30 year old woman has around a 20% chance of falling pregnant each month, so it is normal for it to take a little while to conceive. But the majority of couples (around 84%) will fall pregnant within a year from when they start trying. We would always encourage talking with your doctor about your fertility, at any time - even if you have no plans to have children yet. But if you have been trying for a year and it hasn’t happened so far then it would be a good idea for both partners to schedule in a visit to the GP who will discuss the next steps and start some investigations for you.
The one year rule doesn’t apply in all cases though and there are a number of reasons why you might be advised to visit your doctor sooner…
If you are aged 35 and over, due to age related declines in fertility, then the recommended time to try before seeking help reduces to 6 months. And if you have a pre-existing medical diagnosis that you have been told could impact on your ability to fall pregnant (for example polycystic ovarian syndrome or endometriosis) or you have any other concerns such as experiencing irregular or absent periods (which could be a sign you are not ovulating normally), please see your GP for advice sooner.
Making those first steps can feel daunting, but they are the first steps towards getting the right help and setting you on the path to any necessary treatment.
If you are aged 35 and over, due to age related declines in fertility, then the recommended time to try before seeking help reduces to 6 months. And if you have a pre-existing medical diagnosis that you have been told could impact on your ability to fall pregnant (for example polycystic ovarian syndrome or endometriosis) or you have any other concerns such as experiencing irregular or absent periods (which could be a sign you are not ovulating normally), please see your GP for advice sooner.
Making those first steps can feel daunting, but they are the first steps towards getting the right help and setting you on the path to any necessary treatment.
Referral process
GP Referral
The first step in the referral process for fertility is to see your GP. They will be able to set you on the right path to investigations and any necessary treatment. They will ask you questions such as how long you have been trying for and whether your periods are regular along with recommending any appropriate lifestyle changes (such as not to smoke and to reduce alcohol intake). It is likely that they will ask you to come back for blood tests during the second half of your monthly cycle (these are to check whether you are ovulating normally) as well as referring your partner for a semen analysis. Once the results of these tests are received a referral should be made to the Assisted Reproduction Unit (ARU) where both partners will be invited to attend an appointment and they will be able to interpret the results and arrange for any further tests that may be needed.
The Assisted Reproduction Unit (ARU)
At your first appointment with the ARU you will again be asked a number of questions to gain an overview of your fertility history. You may also have an ultrasound scan to look at your reproductive organs and some further blood tests to gain an indication of your egg reserves. If you have a partner, the results of their semen analysis will also be discussed at this appointment along with any recommended next steps. It is likely that you will be referred for a Hysterosalpingogram (a bit of a mouthful so often referred to as a HSG!). This is an x-ray test used to look at the shape of the uterus and identify any blockages within the fallopian tubes.
Treatment Types
Following the initial investigations into your fertility, the results will be discussed with you along with a plan for the next steps. Everyone is different and the advice will vary depending on the results of your tests, your age and whether there is any obvious diagnosis.
Further information on the types of treatment and the circumstances in which they are appropriate can be found on the NICE (national institute of health and care excellence) website here (www.nice.org.uk/guidance/cg156).
Further information on the types of treatment and the circumstances in which they are appropriate can be found on the NICE (national institute of health and care excellence) website here (www.nice.org.uk/guidance/cg156).
IVF and Living in Jersey
The majority of people undergoing IVF choose to have the first part of their treatment in Jersey and under the care of the Assisted Reproduction Unit who can facilitate scans, medication and liaise with your chosen clinic for you. Travel off-island is then necessary for egg collection and any resulting embryo transfers and usually requires 5 – 6 days away from home.
The majority of IVF treatment, including travel and accommodation while away is at the cost of the service user. Depending on your age and the number of treatment cycles you have had, you may qualify to have the cost of your medication covered. There is also some limited means-tested funding available to people with a joint combined income of no higher than £34,000 per annum. If you think you may be eligible for this, please discuss it with the Assisted Reproduction Unit for further information.
NICE guidance states that subject to certain clinical criteria, people under the age of 40 should be offered up to three fully funded cycles of IVF, with those over the age of 40 being offered one fully funded cycle. This is something that we as a charity are continually calling on local government and health service to adopt and we hope to see changes made to the funding available here in the future.
Choosing a clinic in the UK:
There are so many IVF clinics out there that choosing the one that is right for you can feel like an overwhelming task! Many people travelling from Jersey choose to use The Bristol Centre for Reproductive Medicine (BCRM) or The Lister Fertility Clinic due to their established links with the Assisted Reproductive Unit. However, you can have treatment at whichever clinic you feel is right for you. It is important that you do your research into any clinic you choose to use.
A few key considerations to have in mind when looking into which clinic is right for you are:
- their success rates for patients in your age bracket
- ease of travel to the clinic from Jersey and proximity to airport/port
- places to stay nearby and the cost of accommodation
- whether there are any additional costs you need to factor in (e.g. ICSI (link), embryo storage costs or any extra testing) that are not included in the headline figures displayed on the clinics website
- whether there is counselling included in the cost and how long the wait is to see the counsellor
- whether staff are friendly and if there is good and fast communication with the clinic
The Human Fertilisation and Embryology Authority (HFEA) also offer some great advice about how to choose a clinic on their website.
Choosing a clinic abroad:
For various reasons some people choose to travel further afield for their IVF treatment (often this is down to lower treatment costs or for donor egg treatment for which often, the waiting time is much shorter than in the UK). Success rates for clinics abroad are not published by a regulatory body, but published by the clinics themselves so make sure you are comparing like for like and that you do your research before choosing a clinic. If you can, find personal accounts from people who have used the clinic (often there are groups on Facebook that you can join to talk to others and ask questions to people who have been before). Make sure you ask lots of questions and look into travel and accommodation costs and factor these into your decisions.
It is important to be aware and to take into consideration that when travelling abroad for donor egg, sperm or embryo treatment that in many countries the donor is required by law, to remain anonymous. In the United Kingdom donor treatment is non-anonymous meaning that any children born as a result of treatment will be able to find out about their donor when they are older. If you are considering using a donor you will need to have implications counselling ahead of treatment and you will be referred for this via the Assisted Reproduction Unit.
Choosing a clinic abroad:
For various reasons some people choose to travel further afield for their IVF treatment (often this is down to lower treatment costs or for donor egg treatment for which often, the waiting time is much shorter than in the UK). Success rates for clinics abroad are not published by a regulatory body, but published by the clinics themselves so make sure you are comparing like for like and that you do your research before choosing a clinic. If you can, find personal accounts from people who have used the clinic (often there are groups on Facebook that you can join to talk to others and ask questions to people who have been before). Make sure you ask lots of questions and look into travel and accommodation costs and factor these into your decisions.
It is important to be aware and to take into consideration that when travelling abroad for donor egg, sperm or embryo treatment that in many countries the donor is required by law, to remain anonymous. In the United Kingdom donor treatment is non-anonymous meaning that any children born as a result of treatment will be able to find out about their donor when they are older. If you are considering using a donor you will need to have implications counselling ahead of treatment and you will be referred for this via the Assisted Reproduction Unit.
Travel information
If traveling off-island for treatment you will need to arrange your own travel and accommodation for the duration of your time away. If you need advice on which airlines to use, where to fly to or where to stay, often it is helpful to speak to others who have walked the path before you.
We have a private Facebook group where you can ask questions and seek advice from others who are going through or have been through treatment themselves and can offer a hive of information and experiences, so please utilise this support. You can find our Facebook group here.
We have a private Facebook group where you can ask questions and seek advice from others who are going through or have been through treatment themselves and can offer a hive of information and experiences, so please utilise this support. You can find our Facebook group here.
Overview of the treatment process
In vitro fertilisation (IVF) is the most effective assisted reproduction technique available. During IVF, eggs are collected from the ovaries and fertilised by sperm in a laboratory. The fertilised eggs are then left to develop with any resulting embryos being transferred to a uterus or frozen for potential future use. A full cycle of IVF usually takes about 3 weeks.
IVF can be performed using a couples own eggs and sperm or it could involve eggs, sperm or embryos from a known or anonymous donor. Sometimes a gestational carrier (surrogate) may also be used.
If you are having IVF for infertility, you may be able to try less-invasive treatments first and you will be advised of the options available to you by your doctor. IVF may be an option if you or your partner has:
- Damaged or blocked fallopian tubes
- Ovulation disorders
- Endometriosis
- Impaired sperm production or function
- Unexplained infertility
- Genetic disorder
- Fertility preservation for cancer or other health condition
What to expect
There are several steps to an IVF process; ovarian stimulation, egg retrieval, sperm retreival, fertilisation and embryo transfer. Before you begin you will likely need various screening tests including for infectious diseases, such as HIV and an up to date smear. Your clinic will be able to advise you of the tests they need you to complete.
Step 1 — Ovulation induction
An IVF cycle begins by using synthetic hormones to stimulate the ovaries to grow multiple eggs (during a natural cycle your body typically only grows a single egg each month). Eggs grow in the small fluid filled sacs in the ovaries known as follicles and these will be monitored regularly by ultrasound throughout this stage of the process. The more eggs that can be collected and hopefully fertilised later on, the more chances there are of success. Your clinic will monitor your progress and let you know which medications to take and when. And alongside the regular ultrasounds you will also have a number of blood tests to look at how you are responding to the follicle stimulation.
Stimulation generally lasts between 8 – 14 days and once the biggest follicles reach approximately 18 – 20mm in diameter a trigger shot is given to help aid ‘meiosis’. Meiosis is the important division of the eggs where their chromosomes halve from 46 to 23, in preparation for fertilisation. If you are having your ovulation induction at home in Jersey, this is usually the point at which you will be advised you are ready to travel off-island to your clinic in preparation for egg collection.
Occasionally an IVF cycle needs to be cancelled before egg collection. This can be down to a few reasons including; not enough follicles developing, premature ovulation, too many follicles developing (presenting a risk of ovarian hyper stimulation syndrome), or another medical issue.
Step 2 — Egg collection/retrieval
Egg collection is performed at your clinic under sedation. Once sedated, a transvaginal ultrasound is used to identify follicles and to guide a thin needle that will be passed through the vagina and into the follicles to retrieve the eggs. The eggs are removed from the follicles using the needle which is connected to a suction device. The process usually takes around 20 minutes and once retrieved, mature eggs are placed in a nutritive liquid and incubated. Eggs that appear to be healthy and mature will be mixed with sperm in the hope of creating embryos.
After your egg retrieval you may experience some cramping along with feelings of fullness or pressure.
Step 3 — Sperm retrieval
If you are using your partners sperm then a semen sample needs to be provided at your clinic on the morning of egg collection. It is also possible for a sample to be produced in advance and frozen ready for the procedure. Donor sperm can also be used. Sperm are separated from the semen fluid in the lab.
Step 4 — Fertilisation
In conventional IVF, eggs and healthy sperm will be mixed together in a petri dish and left overnight to hopefully fertilise. In some instances (for example when a low sperm count has been identified) then Intracytoplasmic Sperm Injection (ICSI) can be used to fertilise the eggs. When ICSI is used, an embryologist will use a microscope to select the healthiest looking sperm and inject it directly into the egg.
Step 5 — Embryo Transfer
Any embryos that result following fertilisation are then left to develop in a lab for the next few days. You will be updated regularly on their progress and informed if there are any embryos available to transfer. Usually embryos are transferred on day 5 when they have hopefully reached the blastocyst stage of development, sometimes slightly slower growing embryos will be transferred on day 6. It is usually advised that 1 embryo be transferred at a time to reduce the risks associated with multiple pregnancies and any leftover embryos can be frozen for future use.
During the embryo transfer procedure a speculum is inserted into the woman’s vagina and using ultrasound for accuracy, the doctor will pass a catheter through the cervix and into the womb. The embryos are then carefully passed through the tube and into the womb.
Step 6 — The two week wait
Following your embryo transfer you are able to return home to Jersey and there will be a period of time to wait before finding out whether your treatment has been successful.
LGBT+ Fertility Treatment Options
If you are a LGBT+ person or couple then you may require fertility treatment to grow your family. If you hope to have children with a biological connection to yourself or your partner then the following treatment options are available:
IUI - Intrauterine Insemination
This fertility treatment option is often used by female same-sex couples with no known fertility issues. It is available on-island through the Assisted Reproduction Unit and involves the injection of donor sperm directly into the womb of the person who hopes to carry the pregnancy. The treatment can be performed with or without the use of fertility drugs and is a relatively quick procedure.
You can find out more about the IUI process on the Human Fertilisation and Embryology Authority’s (HFEA) website here.
IVF - In vitro fertilisation
IVF can be used to treat people in female same-sex relationships who have fertility issues. It can also be used in female same-sex relationships to undergo reciprocal IVF, allowing both women to participate in the pregnancy. Eggs are collected from one partner, fertilised using donor sperm and the resulting embryo(s) implanted into her partner for pregnancy. The full IVF process cannot be undertaken here in Jersey. Initial scans, monitoring and the administering of medication can be performed here, but travel to a fertility clinic off-island is then required for egg collection, fertilisation and transfer.
For more information about the IVF process and living in Jersey click here.
Surrogacy
Surrogacy can be used by male same-sex couples who wish to grow their families with a biological connection. You will need to find a surrogate - someone who is willing to carry the pregnancy and give birth to the child for you - and one of the male partners sperm will be mixed with either the surrogate’s or donated eggs. If you are using the surrogate’s own eggs then IUI treatment would be an option, if using donated eggs then IVF would be required.
Some helpful links for further information on surrogacy, including how to find a surrogate are:
https://brilliantbeginnings.co.uk
Using a donor
If you are considering using a donor to conceive with fertility treatment, you will be required to undergo implications counselling to ensure that you understand the implications of donor treatment before you consent. This counselling will help you to understand and address the different scenarios that may arise in the future for your donor-conceived family and to understand the guidelines surrounding donor treatment, your rights, the rights of your future child or children and the rights of your egg or sperm donor. You will be referred for this by your fertility clinic ahead of treatment taking place.
More information on using a donor and finding a donor can be found of the HFEA website here.
Trans and non-binary people seeking fertility treatment
If you are considering treatment to physically alter your body then this may have an impact on your future fertility and you may want to explore fertility preservation ahead of any treatment. You can find out what fertility preservation options might be suitable for you on the HFEA website here.
Support
Our support is available to all who need it. Regardless of whether you are facing any particular struggles with your fertility, undergoing the treatment in itself can take its toll and is a hugely uncertain and emotional process. If you need our support, we are here. All our support options can be found on our support page or you can get in touch via email (hello@tinyseeds.je) to discuss how we can help.
Assisted Reproductive Law and Parental Rights
The law in Jersey has not kept pace with the many options that are now available when hoping to grow your family. This is particularly the case for same-sex couples or those who require the help of a surrogate to conceive and the absence of specific law relating to assisted reproduction can cause uncertainty during an already difficult time.
Local family law firm - Corbett Le Quesne - have extensive knowledge of the law as it currently stands and offer a free information meeting to anyone with questions relating to legal matters associated with assisted reproduction. In many cases, this initial meeting will be enough for people to then deal with matters themselves moving forward.
You can contact Corbett Le Quesne for further information or to book an appointment by phone on +44 (0) 1534 733030 or by email to enquiries@corbettlequesne.com
