Fertility treatments

Investigation first

Treatment without diagnosis is guesswork. Initial assessment covers ovarian reserve (blood tests and ultrasound), tubal patency (usually hysterosalpingography), the uterine cavity, hormonal and thyroid function, and semen analysis — with sperm DNA fragmentation testing where indicated.

Ovulation induction and IUI

For women who ovulate irregularly or not at all, medication to induce ovulation may be sufficient. Intrauterine insemination places prepared sperm directly into the uterus at the time of ovulation. It suits mild male factor, cervical factor and some unexplained cases. It does not help where the tubes are blocked or where sperm quality is significantly reduced.

IVF

Eggs are collected after ovarian stimulation, fertilised in the laboratory, and one or more embryos are transferred to the uterus. IVF is used for tubal disease, endometriosis, significant male factor, unexplained infertility that has not responded to simpler treatment, and where fertility preservation or genetic testing is needed.

Ovum pickup (egg collection)

Performed under sedation, usually as a day case, by ultrasound-guided needle through the vaginal wall. It takes around twenty minutes. I perform this procedure myself.

Embryo transfer

Usually performed without anaesthetic. Embryos may be transferred fresh or frozen and transferred in a later cycle; which is appropriate depends on the individual case.

Cryopreservation

Surplus good-quality embryos can be frozen for later use. Egg freezing is available for fertility preservation.

ICSI

Intracytoplasmic sperm injection — a single sperm is injected directly into each egg. Used where sperm number, movement or morphology is significantly reduced, where previous fertilisation has failed, or where surgically retrieved sperm is being used. It is not routinely better than standard IVF where sperm parameters are normal.

Fertility preservation

Egg or embryo freezing before medical treatment that may affect fertility — including cancer treatment — or for personal reasons. Timing matters: where treatment is imminent, this can be arranged urgently.

Fertility surgery

Hysteroscopy to correct polyps, adhesions or a uterine septum; laparoscopy for endometriosis, ovarian cysts or tubal disease. Dr Aggrwal performs laparoscopic and robotic-assisted gynaecological surgery. Surgery is offered where it improves the chance of pregnancy, not as a routine step.

Common questions