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Fertility Problems

Reproductive Medicine


Causes of Infertility

Infertility is generally the inability to conceive after one year of regular intercourse.  One in six couples in the UK are referred for investigation and treatment. There are many causes as listed below. The most common are shown in percentages on the pie chart above right.

Ovulatory Dysfunction

Ovarian Cysts, PCOS

Tubal Disease

Blocked fallopian tubes

Uterine Disease

Fibroids, endometriosis

Male Infertility

Sperm abnormality, motility

Congenital Abnormalities

Genetic Abnormalities

Ovulatory Dysfunction

  • Uterus & Fallopian Tubes
  • Normal Uterus & Ovaries
  • Ovarian Cyst
  • Endometriomas
  • PCOS Section of Ovary
  • PCOS “String of Pearls”

Women have two ovaries, which are small organs inside the body where eggs (ova) mature and are then released. This happens about once a month. The ovaries produce the hormones oestrogen, progesterone and testosterone.

The image on the right shows a diagram of the uterus and it’s two ovaries either side.

Ovulatory Dysfunction is any condition that prevents ovulation, that is the release of a mature egg from a woman’s ovaries. Possible symptoms and infrequent periods or the lack of periods altogether or abnormally light or heavy bleeding. These symptoms could indicate annovulation, a failure to ovulate, or irregular ovulation.

There are a variety of conditions that cause ovulatory dysfunction. Fertility drugs and IVF (in-vitro fertilisation) are possible solutions.

Ovarian Cysts

Ovarian cysts are very common and can happen to a woman at any age. Most cysts are follicle cysts which are functional cysts that are harmless, fluid-filled sacs of tissue which are formed in the ovaries as part of the menstrual cycle. Occasionally, one of the sacs doesn’t break open to release an egg and, instead, fails to dissolve and keeps on growing. These cysts are usually painless and benign (non-cancerous) and will often dissolve naturally and disappear without treatment within a few months.

Ovarian cysts, such as corpus luteum cysts, fail to dissolve and grow very large, changing into a hormone producing yellow body filled with fluid or blood. If ruptured they can cause bleeding. Birth control pills may help make the cyst smaller and lessen the chance of new ones forming.


Endometriomas or Chocolate Cysts are tiny cells that line the uterine cavity which can become transplanted to form small cysts on the outside of the ovary. These cysts respond to hormone stimulation during the menstrual cycle and can enlarge to produce endometriosis of the ovary and can even replace normal ovarian tissue.  These cysts are called chocolate cysts because they are filled with a thick, chocolate-type material which can rupture and spill into the pelvic area, around the uterus, bladder and bowel, causing adhesions to develop which can cause pelvic pain.  Endometriomas can also interfere with egg follicle development and therefore a possible cause of infertility.

Some ovarian cysts can grow to almost four inches in size and can bleed or twist the ovary and cause pain.  These “Dermoid cysts” can contain can contain a range of tissues, such as hair, skin or teeth, because they form from cells that make eggs in the ovaries.  Dermoid cysts are rarely malignant and can be removed with laparoscopic surgery by a skilled surgeon, irrespective of their size.

Most ovarian cysts don’t cause any symptoms. If they do, ultrasound can be used to monitor the size of the cyst to see if treatment is needed. A pelvic exam can be used to monitor more larger cysts.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a condition in which small follicles (cysts) in the ovaries fail to develop into larger, mature follicles. Typically a woman with PCOS will have a number of small cysts around the edge of her ovaries. It’s also characterised by hormone imbalances typically caused by high levels of the male hormone testosterone, which is produced by the ovaries, and unpredictable ovulation patterns. Irregular periods, excessive hair growth, acne and obesity can also indicate PCOS.

Polycystic Ovary Syndrome cannot be cured, but the symptoms can be effectively treated.  Diet and exercise and hormone treatment and IVF may be possible solutions.  Elevated blood insulin levels are common in women with PCOS.  In excess this can cause over stimulation of the ovaries and induce them to produce greater amounts of the male hormone, testosterone, which then prevents ovulation.  Losing weight can therefore reduce the amount of insulin and therefore testosterone levels to improve the chances of ovulation. Metformin, a drug used for treating diabetes, is a new treatment for PCOS which, together with other fertility drugs and treatment, can also help increase ovulation and may also reduce the effect of abnormal levels of male hormones.

Some of the symptoms ovarian cysts can cause:

  • Pressure, swelling, pelvic pain or pain in the abdomen.
  •  Dull ache in the lower back and thighs.
  • Problems passing urine completely.
  • Breast tenderness.
  • Abnormal bleeding.
  • Pain during sexual intercourse.
  • Pain during your period.
  • Nausea or vomiting.
  • Weight gain.

Tubal Disease

  • Uterus & Fallopian Tubes.
  • HyCoSy Fallopian Tubes.
  • HSG Fallopian Tubes.
  • Opening to Fallopian Tube.
  • Drawing Ectopic Pregnancy.
  • View of Hydrosalpinx.

Fallopian Tubal Blockage

The fallopian tubes are two thin tubes, one on each side of the uterus (the womb). When ovulation occurs each month an egg is released from one of the ovaries and travels down one of the fallopian tubes into the womb. Fallopian tubes have little hairs on the inside, cilia, which move with a wave-like motion to encourage the egg towards the womb. Fertilisation usually occurs while the egg is travelling through the tube.

Click “Uterus & Ovaries” opposite to see a drawing of the uterus and ovaries with its fallopian tubes.

Hysterosalpingo Contrast Sonography (HyCoSy) is a method used to assess the fallopian tubes. The procedure uses ultrasound and levovist which is a contrast agent that makes the tubes stand out because they can’t be seen by ultrsound alone. A HyCoSy can also detect abnormalities of the uterus and endometrium.  More about  Uterine Disease  follows on the next page.

Click “HyCoSy Fallopian Tubes” to see an image of normal, left and right fallopian tubes using the HyCoSy examination.

Sometimes a fallopian tube can become blocked or the cilia damaged therefore obstructing the egg from traveling down the tube. This can occur on one or both sides and is known as tubal factor infertility and the cause of infertility in 40% of infertile women. Blocked fallopian tubes are frequently diagnosed with a hysterosalpingogram (HSG).


Hydrosalpinx ocurs when a blockage in a fallopian tube causes the tube to dilate (increases in diameter) and fill with fluid.  The fluid blocks the egg and sperm preventing fertilisation and pregnancy.  If only one fallopian tube is blocked it may still be possible to achieve pregnancy but this depends on how well the ovaries are functioning and what caused the blocked tube in the first place.

An HSG with a contrast dye can detect whether fallopian tubes are normal (patent) or blocked.

Click “Hydrosalpingogram (HSG)”  showing normal fallopian tubes where the contrast dye can be seen flowing freely from the end of each tube.

Click “HSG Hydrosalpinx” showing an HSG of a blocked fallopian tube where the contrast dye is pooling on the left-hand side.

Ectopic Pregnancy 

It’s also possible for a fallopian tube to become partially blocked which can increase the risk of a tubal pregnancy, also known as an ectopic pregnancy where the fertilised egg has implanted outside the womb or in one of the fallopian tubes instead. An ectopic pregnancy can also occur in other places, eg. the ovary, the abdomen, the cervix and at the join between the tube and the womb, the cornua.

An ectopic pregnancy can never be viable and ultimately ends in death of the foetus.  If left untreated, it can also be fatal for the mother. An ectopic pregnancy can also cause the fallopian tube to split (rupture) causing internal abdominal bleeding and life threatening blood loss.

Without timely diagnosis and treatment an ectopic pregnancy can become a life-threatening situation. In most cases both the fallopian tube and the foetus would have to be surgically removed.

There are a number of factors known to cause blockages in the fallopian tubes:

  • Advanced age.
  • Pelvic Inflammatory Disease.
  • Tubal Surgery.
  • Previous termination of pregnancy.
  • IVF and Ovulation induction.
  • Previous ectopic pregnancies.
  • Congenital.

Uterine Disease

  • Uterine Endometriosis.
  • Uterine Fibroids.
  • Intramural Uterine Fibroid.
  • Submucosal Uterine Fibroids.
  • Excision Pedunculated Fibroid.
  • Uterine Polyp.

Uterine disease isn’t a common cause for infertility and usually arises as a result of pelvic inflammatory disease, fibroids, endometriosis,  previous surgery or it can be congenital. In cases of severe uterine damage, surrogacy is the only treatment. Fortunately, uterine factor infertility is relatively uncommon.


Endometriosis is a common condition where small pieces of tissue which form the lining of the womb (the endometrium) spread outside the womb and into and around other organs in the pelvic area. Endometriosis is most commonly found in and around the fallopian tubes, ovaries, bladder, bowel, vagina or rectum. Endometriosis is totally benign but becomes a problem because, like the endometrium during menstruation, endometrial tissue outside the womb also undergoes cyclic bleeding.

Normally, when the hormone oestrogen is released during the menstrual cycle, the endometrium lining the womb thickens, ready to receive a fertilised egg. When an egg is not fertilised or a pregnancy is not viable, the endometrium breaks down and leaves the body through the vagina as menstrual bleeding (a period). Endometrial tissue anywhere else in the body will go through the same process of thickening and bleeding, but remains trapped.

Some women have few or no symptoms at all but, depending on the location, endometriosis can cause pain and swelling in the lower abdomen (tummy), pelvis or lower back and may also lead to scarring, a lack of energy, depression and fertility problems. The cause of endometriosis is uncertain, but thought to be a combination of genetic, immune system and hormonal factors.

One theory is that retrograde menstruation occurs where the lining of the womb flows backwards through the fallopian tubes and into the abdomen instead of leaving the body through the vagina. This tissue embeds itself onto the organs in the pelvis and grows and can cause pain and infertility.

There is no known cure for endometriosis. It is a chronic (long-term) condition. However, symptoms can be managed and fertility improved with pain medication, hormone treatment or surgery, so that the condition does not interfere with daily life.


Fibroids are abnormal growths of the smooth muscle that formsthe wall of the uterus. They can also contain fibrous tissue and vary in shape and size. Fibroids can differ in type depending on where they are located.

Intramural uterine fibroids form in the inner wall of the uterus and the most common type of fibroid found in women. Subserosal fibroids grow on the outside the wall of the uterus and into the pelvis and can become very large. Submucosal fibroids can develop in the muscle beneath the inner lining of the uterus wall and can grow into the middle of the uterus.

Pendunculated fibroids grow from the outside wall of the uterus and are attached by a narrow stalk. Cervical fibroids develop in the wall of the cervix (the neck of the uterus).

The cause of fibroids is unknown.  There is often a history of women in the same family developing fibroids. For reasons unknown fibroids are three times more common in non-Caucasian women. Women who are overweight are also more likely to develop fibroids. There is some link between fibroid growth and the hormone oestrogen which is produced by the ovaries. They tend to increase in size when oestrogen levels are high, such as during pregnancy. They are also known to shrink when oestrogen levels are low, such as after the menopause and therefore why they are most likely to occur in women between the ages of thirty and fifty.

Many women are unaware they have fibroids because they don’t have any symptoms and, over time, fibroids will often shrink and disappear without any treatment being necessary. While fibroids do not always cause symptoms, their size and location can lead to problems, including pressure symptoms and painful or heavy periods which can have a significant impact on everyday life.  Large fibroids, may cause discomfort or bloating (swelling) in your stomach.  They may also cause pain in the back and legs, frequent urination (if they press on the bladder) and Constipation. If fibroids grow near the vagina or the cervix sexual intercourse may become painful.

High levels of oestrogen during pregnancy can cause fibroids to develop or increase in the size and may lead to complications with the development of a baby or cause problems during labour.  In rare cases fibroids can cause miscarriage.  When fibroids are very large infertility may occur as they can sometimes prevent a fertilised egg attaching itself to the lining of the womb.  If you have a submucosal fibroid it may block a fallopian tube preventing eggs from passing from the ovaries to the womb making it harder to conceive.  An ultrasound scan of the womb or hysteroscopy, a small telescope that can see inside the womb, is often used to confirm a diagnosis of fibroids. A transvaginal scan can also aid diagnosis and involves inserting a small scanner into the vagina to take a closeup image of the womb.  A laparoscopy can also be used to take a biopsy (a tissue sample) of the inside lining or outer layer of the womb which will be sent to a laboratory for further examination. Medication, frequently hormonal treatment and other non-surgical techniques, may be prescribed. If these prove ineffective it may be necessary to use surgical techniques if symptoms are particularly severe.

Uterine Polyps

A uterine polyp is an overgrowth of tissue that arises from the endometrium – the lining of the uterus. This tissue is expelled during the menstrual cycle. After a period, the endometrium regenerates rapidly under the influence of hormones. Polyps occur in areas where the lining grows in excess. Uterine polyps are oval or round, they remain attached to the uterine wall by a large base (sessile) or a thin stalk (peduncular).

Polyps usually occur in perimenopausal or postmenopausal women. Although polyps are usually contained within the uterus, they may occasionally arise on the surface of the cervical canal. The main difference between uterine polyps and uterine fibroids is that fibroids are composed of muscle tissue and polyps are made of endometrial tissue. Unlike fibroids small polyps may shrink at any stage but can also cause infertility. Polyps are usually benign and rarely cancerous. Endometrial adenocarcinomas, which are malignant tumours of the glandular component of the endometrium, have only been reported in 0.6% of cases of endometrial polyps.

Diagnosis & Treatment 

Endometrial polyps are usually diagnosed by taking a biopsy of the endometrium after D&C (dilation and curettage) where the cervix is gradually dilated to allow removal of the uterine lining at which time any endometrial polyps that are found can be removed. However, removal of polyps or other structural abnormalities may be missed by D&C alone therefore techniques such as curettage using ultrasound for guidance or hysteroscopy is useful. Using hysteroscopy, the inside of the uterus is examined by introducing a small camera with a light source on the end of a tube (hysteroscope) directly into the uterus by passing it through the vagina and cervix.

Symptoms of polyps include:

  • Irregular menstrual bleeding that varies in duration and heaviness.
  • Spotting, or bleeding between menstrual periods.
  • Vaginal bleeding after menopause.
  • Endometrial polyps account for 25% of abnormal bleeding  (in both premenopausal and postmenopausal women).
  • More images showing the conditions that can occur with Uterine Disease can be seen using the links (opposite).

Male Infertility

  • Sperm Under Microscope.
  • Sperm Count Decline.
  • Sperm Morphology.
  • Sperm Motility.
  • Sperm DNA Fragmentation.
  • Testicular Sperm Extraction.

Male Factor Causes for Infertility

Almost 50% of cases of infertility can be attributed to male factor causes. The decline in the number of sperm found per litre of semen (sperm count) using semen analysis has been dropping drastically since the 1950s. In the 1950s an average of 113 million sperm were found per litre. By 1998 the number had dropped to around 62 million and today the average sperm count for a male is around 47 million. If a man’s sperm count drops below 20 million per litre of semen then this would be classified as being sub-fertile.

It is thought environmental factors such as uncontrolled pollution and changes in lifestyle and diet caused by the progressive demands of industry combined with sedentary working conditions are a major cause of this decline. Certainly, the healthier and more active a man’s lifestyle is, the better his chances of becoming a Dad.

Semen Analysis

Semen Analysis evaluates certain characteristics of a male’s semen and the sperm contained in the semen. It may need to be done while investigating a couple’s infertility or after a man has had a vasectomy to verify that the procedure was successful. It is also used for testing donors for sperm donation.

Sperm Morphology

Sperm morphology refers to the size and shape of sperm which can be investigated by semen analysis. When sperm are viewed under a microscope. abnormal sperm morphology may be seen which is one cause of male infertility.

When looking for normal sperm, doctors look for sperm that have oval heads and a long tail. This is considered normal. Abnormal sperm can have many defects such as head and tail defects including crooked or double tails or even double heads. These abnormal sperm have a very difficult time reaching the egg and fertilising it.

There are many causes for abnormal sperm morphology including:

  • Infections.
  • Exposure to toxins or drug and alcohol abuse.
  • Varicocele veins in the scrotum.
  • Fever and extreme heat.
  • Lifestyle.
  • Testicular abnormalities.


The motility of the sperm is evaluated. The World Health Organization defines normal motility as 50% of observed sperm, measured within 60 minutes of collection, or at least 8 million per millilitre showing good forward movement.

However, a man can have a total number of sperm far over 20 million sperm cells per millilitre but have bad quality sperm because too few of them are motile. Conversely, a man can have a sperm count far less than 20 million sperm cells per millilitre and his sperms still have good motility and show good forward movement. The motility of sperm are divided into four different grades:

Grade 4

These are the strongest sperm and swim fast, in a straight line with progressive motility.

Grade 3

These sperm move forward but tend to travel in a curved or crooked motion.

Grade 2

These sperm have non-progressive motility because they do not move forward, despite moving their tails.

Grade 1

These sperm fail to move at all.

Sperm Aneuploidy

Approximately 2 to 13% of all sperm are genetically abnormal (aneuploid) in normally fertile men. There is evidence that this percentage may be increased in men who are sub-fertile.

It has been recently found that there is no direct correlation between sperm morphology and aneuploidy as sperm aneuploidy can also be found in sperm with normal morphology.  However, particular types of morphological defects may be linked to sperm aneuploidy including globozoospemia (also called round-headed spermatozoa) where a lacking a chrosome containing enzymes for penetrating the oocyte is often found.  Amorphous heads, multiple heads and severe tail defects may also be linked with aneuploid sperms.

Sperm DNA Fragmentation Assay (SDFA)

Recent studies are now revealing that men with very poor sperm quality results using routine semen analysis can have sperm with very little DNA damage. Conversely men with relatively normal results can have sperm with a high degree of DNA damage which can be revealed by Sperm DNA Fragmentation Assay (SDFA). The degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth, regardless of the technology used to fertilise the egg such as insemination, IVF or ICSI (intra cytoplasmic sperm injection).

Abnormal sperm DNA fragmentation is found in around 20-30% of men with sub-fertility, nearly ten times higher than that found in fertile men.  Sperm with high DNA fragmentation may fertilise an egg yet embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation (SFDA test) many cases of formally “unexplained” infertility can now be explained.

The SDFA test evaluates sperm DNA damage, The test uses a high precision light microscope and an orange stain to determine DNA damage, intact DNA showing fluorescent green and broken DNA staining yellow to red. Yellow indicates ICSI as a possible method of IVF treatment, red indicating that the sperm are more likely to be beyond the DNA repair capacity of the egg.


Total azoospermia is the total absence of sperm present in a man’s semen after ejaculation. This can be due to a blockage, absence of the vas deferens (a coiled tube that carries the sperm out of the testes) or failure of the testes to produce spermatozoa.

It is quite easy to recover sperm directly from a testis or from the epididymis, which are spermatic ducts that store, mature and transport spermatozoa between the testis and the vas deferens. Sperm collected in this way are not able to fertilise an egg naturally therefore assisted conception using ICSI will be necessary with a success rate for fertilisation of around 65%.

It is also possible to collect a few sperm by  performing testicular biopsies. If some motile sperm are recovered the chances of these sperm fertilising an egg are good.

Percutaneous Epididymal Sperm Aspiration (PESA) uses a needle to penetrate the scrotal skin and draw a small amount of sperm from the epididymis. Percutaneous Testicular Biopsy (PTBX) removes small cores of testes tissue.

The PESA and PTBX procedures are either performed through the skin (percutaneous) or through a small opening in the skin about half an inch in size. With microsurgical techniques in a process known as Microscopic Epididymal Sperm Aspiration (MESA), sperm can be gathered from the epididymis. Epididymal Sperm Aspiration (MESA), sperm can be gathered from the epididymis.

Testicular Sperm Extraction (TESE) involves removing small samples of testis tissue for processing and eventual extraction of sperm. Microscopic TESE (MicroTESE) is a very exacting search for sperm under high magnification in cases of extremely low sperm production.

Congenital Abnormalities

  • 3D View Uterus & Ovaries.
  • Picture of Normal Uterus.
  • Picture of Uterine Septum.
  • Hysteroscopic Septotomy.
  • Turner Syndrome Karyotype.
  • Absence of Vas Deferens.

Uterine Septum

Congenital abnormalities of the uterus can also be the cause of recurrent miscarriages and infertility. One example is a uterine septum which is caused by abnormal development of the Müllerian ducts during the embryonic stage of a foetus. The Mullerian ducts disappear completely in a male foetus but go on to form the genital passages in a female. The external surface of a “septate” uterus usually looks normal and doesn’t cause any symptoms.

Diagnosis of a uterine septum is made using a procedure called hysterosalpingography.  Sometimes a diagnostic hysteroscopic procedure may be necessary to make a final diagnosis.  A more recent, non-invasive technique, has therefore been developed called an HSG – hysterosonography.

A hysterosonography involves the slow infusion of sterile saline solution into a woman’s uterus while ultrasound imaging is recorded on film. If a uterine septum is found only then will the surgeon need to proceed to operative hysteroscopic surgery to correct the abnormality.

Turner Syndrome

A girl with Turner Syndrome only has one X sex chromosome rather than the usual XY chromosome pair. This is a random chromosomal variation which happens when the baby is conceived in the womb.  It isn’t linked to the mother’s age.

Females with Turner Syndrome often have a wide range of symptoms and some distinctive characteristics. Almost all girls with Turner syndrome are shorter than average and have underdeveloped ovaries resulting in a lack of monthly periods and infertility and therefore a failure to ovulate.

Turner Syndrome may not be diagnosed until a girl fails to show sexual development associated with puberty, usually between the ages of 8 and 14 years. Other characteristics of Turner syndrome can vary significantly between individuals.

There is no cure for Turner Syndrome and many of the associated symptoms can be treated but even with years of hormone replacement therapy (HRT) the failure to ovulate and conceive a child naturally is extremely rare. There are many options available however to help a woman with Turner Syndrome start a family.

Adoption is one answer but for women who wish to try and have a biological child the options are the same as those for women with other reproductive problems but don’t have Turner Syndrome.  Two common treatments are:

• Unfertilised egg donations
• In-Vitro Fertilisation (IVF)

Congenital Absence of the Vas Deferens (CAVD)

The vas deferens is a major part of the male reproductive system which connects to the epidydimis, a muscular, partially coiled tube that sits behind the testes to collect sperm.  It is the vas deferens that then transports sperm from the epididymis into the pelvic cavity in preparation for ejaculation.

Congenital absence of the vas deferens (CAVD) is a rare condition.  Although testicular function is normal, the vas deferens is mssing and therefore unable to contribute sperm to the ejaculate.  In such cases, however, sperm cells can be collected directly from the epididymis and used for in-vitro fertilisation (IVF) using intra-cytoplaspic sperm injection  (ICSI).

Many men with this problem are carriers of the cystic fibrosis gene and should also go through genetic screening.


Unexplained infertility is when all the usual medical tests and assessments carried out fail to find any cause yet a couple is still unable to conceive, usually after a period of 18 months or longer. The latest studies suggest that there is a 33-60% chance that such couples will conceive naturally over three years.

From the group that were advised to keep trying over the six month period, 32% conceived and 27% went on to have healthy babies. It appears, however, that the longer the period of unexplained infertility, the less likely the couple will be able to conceive naturally. After 5 years of infertility, a couple with unexplained infertility has less than a 10% chance for success without assistance.

What can be frustrating is that where one infertility specialist might decide the reason for this is unexplained, since all appears to be working well, another may decide that your infertility hasn’t been investigated thoroughly enough and it is likely this can often be the case.  Often there is a reason, however,  but its just not known what the reason is.

The following factors must be evaluated before no reason for infertility can be found.  This is to ensure that a women is:

  • Ovulating regularly.
  • Ovarian reserves are good.
  • Fallopian Tubes are patent – e.g. not blocked.
  • There is no uterine disease.
  • No congenital abnornalities can be found.

Her partner must also have semen analysis to ensure his:

  • Sperm count is good.
  • Sperm morphology (shape) is normal.
  • Sperm movement is normal.
  • No congenital abnormalities can be found.

More recently some underlying conditions have been found to cause infertility including Celiac Disease, Diabetes, a thyroid disorder and types of autoimmune disease.  A hostile cervical mucus has also been found to cause infertility due to:

  • Thick, dry or sticky mucus.
  • Acidic Mucus.
  • Inflammatory Cells.
  • Anti-sperm antibodies.

Unexplained fertility problems account for about 40% of female infertility and 8-28% of infertility in couples and appears to increase with women over the age of thirty-five. In a recent study at the Academic Medical Centre in Amsterdam, focussing on couples that had been experiencing unexplained infertility, half were given fertility treatment for six months, IUI (Intra Uterine Insemination) with controlled ovarian hyper-stimulation, and the other half were asked just to keep trying naturally for six months. Of those who had undertaken the fertility treatment 33% conceived and 23% went on to have babies.

There is no doubt that infertility problems, whether a cause is found or not, places couples under considerable psychological and financial pressure and sometimes gentle reassurance and measures to try and relieve their anxieties can work wonders alone. Nataly is committed to offer couples and individuals reassurance, immediate treatment, if found to be necessary, and peace of mind.

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