Julian Norman-Taylor, Chelsea and Westminster Hospital
Now to explain a bit more about the process of IVF and why some people need it, weíre joined now by Julian Norman-Taylor. Now heís a consultant gynaecologist at the Chelsea and Westminster Hospital in London and he also runs IVFChelsea. Hello, Julian.
Julian - Good evening.
Helen - Hi. Thanks for joining us at The Naked Scientists. Now to start us off, could you perhaps describe to us what happens when someoneís referred to see you because theyíre having problems with their infertility? How do you approach that case and start to work out what the problems are?
Julian - Well, we take a full history from them and thereís a couple of things we want to check out first before we get to the fertility aspects and that would be their general health. Are they diabetic or have any other problems and are they generally fit and ready for pregnancy? Importantly, have they been immunized to rubella and are they taking their folic acid vitamins? But beyond that, we start taking a history directly related to fertility.
So the obvious thing is, are they in a relationship where fertility is possible? Itís not all that unusual for people to come and see me and they actually donít live in the same country, which obviously presents the problems.
But beyond that, weíre looking really to see if the lady is making some eggs, whether the chap has some sperm and whether the anatomy is in correct functioning order. And so to do that, we take a full history from the woman and the most important thing really would be her age and the regularity of her menstrual cycle. So a woman with a regular menstrual cycle is generally ovulating okay and quite often theyíve done little tests such as one from your previous contributor where they measure their temperature or check the urine for hormones to see if they are indeed ovulating.
Helen - So the problems often will come down to a lack of eggs or something going wrong with the sperm? I suppose it has to be one or two of those things, hasnít it?
Julian - Or besides where the anatomy of the female is incorrect. Thatís right.
Helen - And what weíre looking at is the common causes for some of these problems. What sort of things do you see going wrong?
Julian - Well, it divides up roughly equal to about a quarter of the patients have some sort of ovulation problem, a quarter have some sort of male factor, others has some anatomical problem and then another significant proportion Ė we never actually get to find out what the problem is and thatís group called unexplained infertility.
Helen - So thereís still quite a big question mark covering over some people who just arenít able to conceive?
Julian - Yes. Clearly, there is a problem but as I say to the patients itís not that the problem doesnít exist. Itís just that we as scientists and doctors canít work it out yet.
Helen - You havenít yet got the answers to that one. Now how many people in general does this tend to affect Ė this problem of general infertility?
Julian - Well, the oft quoted figure is one in seven couples will consult a doctor. Though not quite that many would actually require treatment but itís a remarkably common thing and numerous people will know people whoíve had treatment.
Helen - Yes. We all hear about an IVF Ė in vitro fertilization Ė as one of the possibilities we have for treating infertility. Whatís going on with that? What happens when a couple goes to have that treatment?
Julian - Well, thatís Ė is a very common treatment and itís usually when the fallopian tubes have been damaged, most commonly by Chlamydia or something called endometriosis and other common reason is the male factor - the sperm just arenít so strong.
And what we do there is the hormone that drives the ovaries, itís called FSH or follicle-stimulating hormone and when a period begins, we give the patient or give the woman some extra FSH. And so, instead of just the one egg they would normally grow, over a period of 11 days or so and they end up growing maybe 8 or 10. And thatís monitored by ultrasound and then we do a small procedure where we put a needle into each of the follicles that have grown in the ovary and suck the eggs out and we have those in the lab. Then the gentleman produces a sperm sample, we fertilize the eggs in the lab and then, hey presto, with any luck, 48 hours later, we have some embryos and we put one or sometimes two of those back into the female.
Helen - And is there any effect on the health of the babies conceived this way with IVF or is it from that point onwards? Is it just the same as the natural pregnancy?
Julian - More or less, thereís a particular type of fertilization called ICSI or intracytoplasmic sperm injection where there is a male factor problem and we take a single sperm and inject that directly into the egg and therefore bypassing all the natural selection procedures you might imagine that would happen. And for years, we did worry thatís ICSI children would come out as somehow abnormal. Thereís a very reassuring though thereís a small increase in abnormalities in those children.
Helen - What success rate do you have with IVF these days as presumably been going on for quite a while? How likely is this going to help someone?
Julian - Iím afraid itís very much an age-related question so if you happen to have a simple problem like your tubes are blocked and youíre age 28, you have a very good chance of conception per cycle - more than 60%. Once you get over 35, thatís dropping significantly and then over 40 and only perhaps 10% of people will get pregnant and over 45, it doesnít work unfortunately.
Helen - So it really is a case of time on that one. Well, thank you very much, Julian, for getting us into the basics of whatís going on in infertility and the use of IVF. That was Julian Norman-Taylor. Heís a consultant gynaecologist at the Chelsea and Westminster Hospital in London.