HAVING a baby is, for many, a fundamental part of life, yet one in every seven couples in Britain and Northern Ireland struggle to conceive.
There are many different reasons for this, and numerous treatments to improve their chances of having a baby. However, many people assume the best way of overcoming fertility problems is through IVF (in-vitro fertilisation) – but that's often not the case, insists fertility expert Robert Winston.
Although one of the founding fathers of IVF himself, Professor Winston believes the technique, where an egg and sperm are mixed in a dish, creating an embryo which is then implanted in a woman's uterus, is used far too often before other, usually cheaper and less stressful options, are fully explored.
In his new book, The Essential Fertility Guide, Prof Winston outlines fertility treatment options and suggests that more than half of those referred to IVF clinics may be treated by alternatives. He says some doctors in the NHS don't take infertility seriously enough, too swiftly shunting patients into the private sector where expensive IVF, which only has a 25 per cent success rate, is a highly profitable industry.
"There are numerous causes of infertility," says Prof Winston, "and the best treatment may be different in each circumstance. Unfortunately, the massive publicity given to IVF has led to most people believing that it is almost the only treatment and the most successful. This is utterly wrong. Couples rush into IVF far too frequently."
So what are the alternatives to IVF? Depending on the cause, these include:
:: Drug treatments to encourage ovulation
:: Artificial insemination (AI)
:: Microsurgery
:: Laparoscopic (minimally invasive) surgery
:: Treatment for endometriosis
Prof Winston points out that many of the 47,000 women treated with IVF every year are referred to clinics "without the competence or interest in offering anything other than IVF". The National Institute for Health and Care Excellence (NICE), recommends three treatment cycles for those needing IVF, but the NHS frequently limits each patient to just one.
"Regrettably, in the commercial sector, where most IVF is done because NHS provision is so inadequate, the pressure for the clinic to offer profitable IVF rather than another treatment is strong," Prof Winston says.
He says that while there are of course ethical private practitioners, it's often easier to immediately put couples on the IVF treadmill rather than spend sufficient time investigating the underlying cause of infertility.
Failure to conceive is caused by a female problem in just over a third of cases, says Prof Winston. The most common cause of female infertility is failure to ovulate (around 30 per cent), damage to the fallopian tubes causes around 25 per cent of female infertility cases, while endometriosis is found in about 20 per cent of infertile women.
In another third of infertility cases, the problem is that the man is sub-fertile and may have a low sperm count, for example, and in the remainder, both partners are responsible.
In addition, a substantial number of couples have what is referred to as 'unexplained infertility' – although more detailed testing sometimes reveals a possible cause.
Many couples have two, or occasionally more, infertility causes.
"Do not go for IVF treatment without a clear idea about why you need it. Most infertile couples do not require this complex treatment," says Prof Winston, who stresses that couples need to ask the right questions and make sure they're properly tested to identify the cause of their infertility and the best treatment.
Only after investigations – ranging from testing women for ovulation, other hormone levels and chromosomal abnormalities, plus using imaging techniques and assessing the number and quality of the man's sperm, hormones and chromosomes – should treatment options be considered.
Prof Winston says IVF is appropriate when fallopian tubes are so badly damaged that tubal surgery has failed or can't be done, if a women isn't ovulating and ovulation-stimulating drugs have repeatedly failed, or if a man has an abnormal or low sperm count, but the sperm are still potentially capable of fertilising an egg.
It may also be useful in some cases of endometriosis and unexplained infertility, where there are problems with the cervix, where couples have multiple fertility problems, and when there's a high risk of couples having genetically abnormal babies so preimplantation genetic screening (PGS) is needed.
"IVF is not the only treatment for infertility, and it's often not the best treatment or the most successful. There are many treatments depending on the cause, and the cause should be established first," Prof Winston says.
"The desperation to get pregnant makes people very vulnerable and capable of being exploited, and one of the issues is to understand that very often expectant treatment, ie. waiting to get pregnant, is likely to be more effective than IVF.
"The reason for writing this book is to try to get couples to ask the right questions and to understand that if they've got a condition that would prevent IVF working, for example, they have to get that treated first."
:: The Essential Fertility Guide by Professor Robert Winston is published by Quadrille.
