In vitro fertilisation involves a stimulation cycle with ultrasound monitoring, similar to that described above. The eggs are retrieved, usually by ultrasound-guidance and conception takes place in the laboratory.
About 72-80 hours later, the embryos are replaced into the uterus, through the cervix. The success of IVF depends very much upon the age of the woman and the duration of infertility so far, but average success rates of 16-25% per cycle are usual.
Side effects are similar to those of ovarian stimulation and the risk of multiple pregnancies depends upon the number of embryos replaced.
Endometriosis is a condition where spots of the lining of the uterus (endometrium) are found inside the pelvis on the ovaries, the back of the uterus and the ligament supports of the uterus.
Although extensive endometriosis involving the tubes and distorting the ovary are clearly likely to interfere with egg transport and ovulation, it is less clear how mild to moderate endometriosis exerts an effect on fertility.
The aim of treatment is to remove all the endometriosis by either cutting it out or burning it away with diathermy or laser, break down any associated adhesions and leave as much normal ovary tissue as possible.
Mild to moderate endometriosis can usually be managed laparoscopically, but more severe cases require open surgery. Drug treatment may be useful after surgery, but as a primary treatment for infertility, it only delays pregnancy further.
Apart from being terribly frustrating, unexplained infertility means that treatment is not directed at any known cause. Approximately 60% of couples with unexplained infertility of less than 3 years duration will fall pregnant in the next 3 years without any treatment at all. Recent analysis of all the studies of clomiphene has not found it to be beneficial.
One useful treatment option is ovarian stimulation combined with a direct insemination of prepared and 'optimised' sperms from the partner. This involves the usual monitoring of ovarian stimulation and insemination around the time of ovulation, which is achieved by passing a speculum, as during a smear test, and injecting the sample into the uterus.
Pregnancy rates are typically 15% per cycle. If this is unsuccessful after 6 cycles, then IVF is usually advised.
For more information on female infertility check out our pregnancy videos.