In Vitro Fertilization

08 November 2009

Interview with

Julian Norman-Taylor, Chelsea and Westminster Hospital

Now to explain a bit more about the process of IVF and why some people need it, we're joined now by Julian Norman-Taylor. Now he's 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 someone's referred to see you because they're having problems with their infertility? How do you approach that case and start to work out what the problems are?

Human ovumJulian - Well, we take a full history from them and there's 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? It's not all that unusual for people to come and see me and they actually don't live in the same country, which obviously presents the problems.

But beyond that, we're 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 they've 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, hasn't it?

Julian - Or besides where the anatomy of the female is incorrect. That's right.

Helen - And what we're 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 - we never actually get to find out what the problem is and that's group called unexplained infertility.

Helen - So there's still quite a big question mark covering over some people who just aren't able to conceive?

Julian - Yes. Clearly, there is a problem but as I say to the patients it's not that the problem doesn't exist. It's just that we as scientists and doctors can't work it out yet.

Helen - You haven't yet got the answers to that one. Now how many people in general does this tend to affect - 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 it's a remarkably common thing and numerous people will know people who've had treatment.

Helen - Yes. We all hear about an IVF - in vitro fertilization - as one of the possibilities we have for treating infertility. What's going on with that? What happens when a couple goes to have that treatment?

Julian - Well, that's - is a very common treatment and it's 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 aren't so strong.

And what we do there is the hormone that drives the ovaries, it's 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 that's 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, there's 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 that's ICSI children would come out as somehow abnormal. There's a very reassuring though there's 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 - I'm afraid it's very much an age-related question so if you happen to have a simple problem like your tubes are blocked and you're age 28, you have a very good chance of conception per cycle - more than 60%. Once you get over 35, that's dropping significantly and then over 40 and only perhaps 10% of people will get pregnant and over 45, it doesn't 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 what's going on in infertility and the use of IVF. That was Julian Norman-Taylor. He's a consultant gynaecologist at the Chelsea and Westminster Hospital in London.

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