Is infertility becoming less of a taboo?

• Nearly three quarters of women (73.9%) under 30 would have IVF in the future if they needed it
• New research shows positive signs that infertility and fertility treatment are becoming less of a taboo in the UK

IVI recently commissioned a nationwide survey of women aged 25 – 45 to illustrate the many different perspectives, concerns and motivations towards motherhood. One section of our study asked questions about infertility and fertility treatment.

Natural conception – step-by-step

In natural conception, a sperm cell fertilises an egg that has been released from the ovary during the ovulation cycle. To do this, sperm must enter the female reproductive tract and begin a long journey towards the fallopian tubes. There’s a relatively short window of time (between 5 – 7 days) where fertilisation can take place. If fertilised, the egg becomes a single cell known as a zygote. As the zygote travels the fallopian tube, it divides into two cells, two cells into four, four into eight in a process of rapid cleavage (cell division). By the time it reaches the uterus, it’s a bundle made up of hundreds of cells known as a blastocyst. 

The inner cell mass of the blastocyst contains the genetic code that will allow a baby to grow. It’s protected by a thick outer layer called the zona pellucida. As it enters the womb, the blastocyst must ‘hatch’ from its protective layer to attach to the womb lining, which has thickened in preparation thanks to a surge in reproductive hormones. In the weeks after it attaches, the embryo implants deeper into the endometrium as it develops into a pregnancy.

How does assisted reproductive technology (ART) work?

Assisted reproductive technology (ART) bypasses certain steps in natural conception by allowing these processes to take place outside of the body. It is designed to help people who cannot conceive naturally. The most established fertility treatment is In Vitro Fertilisation, or IVF. ‘In vitro‘ comes from Latin, meaning ‘within the glass‘. In this case, ‘in vitro fertilisation‘ refers to the mixing of an egg with sperm to facilitate fertilisation and create an embryo inside a laboratory.

“In a natural cycle, women are likely to produce one egg each month, which explains why most of us will have a singleton pregnancy. IVF is a treatment that helps women to develop a multiple number of eggs that can be collected and mixed with sperm so embryos can be created and, if necessary, stored for later use,” explains Dr Mireia Galian, IVF Consultant at IVI London. “It is important to understand that IVF is not only a treatment. It’s also a very interesting opportunity to assess the quality of the eggs and the sperm, and how well they work together to create a baby.“

Although it may seem somewhat straightforward, the process of conception is complex: there are many things that influence if, and how, a pregnancy develops. Some of the most common include:

• Problems with the sperm: A low sperm count (<15 million per ml of semen), abnormally-shaped sperm, or sperm with low motility (ability to swim) can significantly impact whether a sperm cell reaches and fertilises an egg.
• Problems with the fallopian tubes: The fallopian tubes are the narrow passageways where sperm travel to the egg and that allow the egg to reach the womb. Women normally have two fallopian tubes that connect to each ovary. Problems with the fallopian tubes, such as blockages caused by adhesions, can cause infertility. It is rare to experience symptoms of blocked fallopian tubes, so many women do not realise their fallopian tubes are blocked until they try to conceive.
• Ovulatory disorders: Ovulation plays a critical role in getting pregnant. It is the process that occurs when the ovaries release an egg into the fallopian tubes. This takes place once normally at the middle of each menstrual cycle. Disordered ovulation, such as anovulation, is one of the most common causes of infertility.
• Poor egg quality: The most significant factor that determines a woman’s egg quality is age. Egg quality is defined by the presence of chromosomal abnormalities, which become more and more common as women get older. Egg quality impacts the development potential of an embryo. Lower quality eggs are more likely to generate embryos with genetic abnormalities, which have lower chances of developing into a pregnancy.
• Low ovarian reserve: Like egg quality, the most significant factor that determines the ovarian reserve level is age. Although it is not possible to count how many eggs remain, the ovarian reserve indicates a woman’s fertility potential. The ovarian reserve decreases naturally with each menstrual cycle.
• Endometriosis: Endometriosis is a chronic gynaecological disorder that affects 1 in 10 women. It is characterised by the growth of endometrial-like tissue in areas outside of the uterus, such as the fallopian tubes and ovaries. Between 30-50% of women with endometriosis have difficulty getting pregnant. Watch our informative webinar led by Dr Mireia Galian on endometriosis here.
• Polycystic Ovarian Syndrome (PCOS): PCOS is a common metabolic disorder that affects the production of hormones. It can cause irregular or missed periods, which can lead to disordered ovulation. PCOS is linked to infertility and it is highly treatable.

While female reproductive disorders such as polycystic ovary syndrome (PCOS) and endometriosis are among the most common, 1 in 3 couples struggle to conceive due to low sperm count. In fact, around half of all infertility cases are caused by a male factor.

Assisted reproduction – how much do you know?

Today, fertility treatment is an increasingly common form of family creation. In the UK, the Human Fertilisation and Embryology Authority (HFEA) reports nearly 70,000 IVF cycles were performed in 2019, with the proportion of cycles undertaken by women over 40 doubling since 1991.

This is also reflected in the findings of our survey. While nearly two thirds of respondents know or knew someone who had undertaken fertility treatment, more than 1 in 10 (13.4%) had direct experience themselves. But perhaps the most interesting finding was that the majority of respondents said they would have fertility treatment, if they needed it, in the future. This proportion was significantly higher among women under 30 (73.8%) versus women between 35 – 39 (49%), indicating a more positive attitude of younger generations towards ART.

“Our survey shows that the stigma surrounding IVF is lessening. People are talking about fertility struggles with their friends and family – it is no longer marked with the stigma it once was,” comments Dr Cesar Diaz-Garcia, Medical Director of IVI London.

“However, we still have a way to go. IVI created a movement in 2021 called the ‘Language of Fertility’ where we asked women who had experienced infertility to share with us comments from friends, family members, the media and even healthcare professionals that had caused them emotional distress. We then proposed a new vocabulary and encouraged society to ‘pledge’ to do better.“

“Despite the World Health Organisation (WHO) recognising infertility as a disease, it’s clear that women experiencing it are not often given the same care and consideration as women with other medical conditions,” adds Dr Diaz.

Another positive finding from the research is that people are talking more openly about infertility. Among the women surveyed, more than half (65.3%) knew someone who has had difficulty conceiving, the majority being close friends.

Twin pregnancies and fertility treatment

A multiple pregnancy, such as a twin pregnancy, is one of the biggest dangers to babies conceived through IVF. In addition to an increased likelihood of being born prematurely, around 40% of newborn twins require immediate attention in intensive care. Studies also show twins are significantly more likely to be affected by birth defects compared to singleton pregnancies. All multiple pregnancies, whether twins, triplets or a higher-multiple, are automatically classified as high risk.

Due to the common practice of transferring more than embryo to the uterus at a time, IVF is known for carrying a higher risk of a multiple pregnancy. Based on our survey data, this is common knowledge to many women: the vast majority (80.4%) agreed you’re more likely to have twins with IVF.

It is important to remember this is not always the case. At IVI, we promote a Single Embryo Transfer (SET) policy to ensure we provide the safest treatment for both mother and baby. We are proud to achieve a multiple pregnancy rate that’s ten times lower than the UK national average. Learn more about our SET policy here.