It can be Primary infertility when couples who have not become pregnant after at least 1 year of unprotected sex or Secondary infertility where the couple have been pregnant at least once, but never again.
The reproductive medicine and infertility treatment section of Globe Health Tours is dedicated to help out couples with infertility in the diagnosis of the underlying cause of infertility as well as in treating them. We also help couples choose affiliated and best treatments abroad including male and female infertility treatments, assissted reproduction, surrogate motherhood etc.
Pre-conception Advice: How to Improve Your Chances of Conception
To maximise the chances of conception and eventually, the delivery of a healthy baby, there are a number of factors that need to be considered by both the man and woman in a couple. Some of these pointers are simple and obvious while others are more complex. But all are important for improving your chances of a successful pregnancy. They mostly relate to your own personal health and lifestyle. The healthier you are, the better your odds.
Here is our list of factors to consider:
1. YOUR OWN MEDICAL HISTORY
It is vital to recognise your own medical problems should you have any. These need to be controlled and regulated as thoroughly as possible. Your doctor will be able to help in this regard. It is therefore vital to seek some pre-pregnancy advice should you have any ongoing medical conditions. Examples include; diabetes mellitus, epilepsy, asthma, hypertension, psychiatric or psychological disorders, spina bifida, thalassaemia and many more.
2. OBSTETRIC HISTORY
It is important to recognise whether or not you are at higher risk than normal of having problems with conception, miscarriages or other complications during pregnancy. If you feel that you are at higher risk, you should approach your doctor or obstetrician for advice before trying to conceive as this may greatly reduce problems later. Factors which may be taken into account include;
- Maternal age: after 35 years of age, the older a woman is, the lower the chances of conception and the higher the rate of complications,
- Previous miscarriages, complications of pregnancy and assistance in conception,
- A history of multiple births, e.g. twins or triplets etc.
3. WEIGHT ISSUES
Problems in conceiving can arise if you are either underweight or overweight. Both may cause problems with ovulation. Being overweight may also lead to further complications during pregnancy. Therefore, ensure that you are as close to your ideal weight as possible. However, extreme dieting may be just as dangerous, especially if you are already pregnant.
4. DIET
It is important to eat a healthy, well balanced and nutritious diet. The types of food encouraged include fresh fruit and vegetables, wholemeal breads, pastas and cereals, lean meats, fish and pulses. These foods contain a balance of vital dietary elements such as proteins, carbohydrates, fats, vitamins and minerals including calcium, folate and iron. Try to limit salty, sugary and fatty foods as much as possible. There are also some foods which deserve a special caution. These are foods which may contain listeria e.g. undercooked meats and eggs, soft cheeses, pates, shellfish, raw fish and unpasteurised milk. Also reduce or stop caffeine and consider stopping peanuts.
5. ALCOHOL
It is always a good idea to limit your alcohol intake, whether trying to conceive or not. For further details, please refer to our alcohol worksheet. This advice is even more important when trying to fall pregnant. Your maximum alcohol intake should be no more then 1-2 units, once or twice a week. Drinking heavily can increase the risks of miscarriage, damage fetal growth and damage brain development in pregnancy. Alcohol can also directly affect fertility and specifically, can lower sperm counts in men.
6. MEDICATION
It is vital to be clear which medicines you should take and which to avoid, especially if you have an on-going medical problem. You should consult your doctor about your intention to conceive. You should also seek the assistance of your doctor or pharmacist regarding the use of over-the-counter drugs and herbal/natural remedies as even these can be harmful.
7. FOLIC ACID SUPPLEMENTS
In most countries, prospective mothers are encouraged to take folic acid supplementation from pre-conception to 12 weeks gestation at a dose of 400mcg (0.4milligrams) to reduce the risk of neural tube defects (defects of the baby's spinal cord causing disabilities such as spina bifida). If there is a high risk factor, then the dose should be increased to 5mg. These instances include;
- a previously affected pregnancy,
- a partner or 1st degree relative with neural tube defect,
- a woman with coeliac disease (reduced absorption),
- a woman taking anti-epileptic medication,
- women with sickle cell anaemia or thalassaemia.
8. SMOKING
Smoking can decrease the chances of ovulation, result in abnormal sperm production and increases the risk of miscarriage, premature labour and stillborn deliveries. It is vital that you take active steps to reduce and preferably stop smoking completely. For further details, please refer to the smoking worksheet.
9. KNOW YOUR RUBELLA STATUS
Rubella, sometimes called German Measles is an infection that can cause serious fetal damage if contracted by the mother during conception or pregnancy. Therefore, before the first pregnancy, prospective mothers should have their rubella status checked and immunisation given if found to be non-immune. Ideally, couples should wait at least 1 month before trying to conceive if a rubella jab is given. These days, rubella injections are given together with measles and mumps in a single shot known as MMR.
10. TOXOPLASMOSIS AVOIDANCE
This is another potentially serious infection commonly found in raw meat, sheep, lambs and cat faeces. Therefore, emphasis should be placed on personal hygiene such as washing foods generally and washing hands specifically after handling such foods or animals.
11. HEPATITIS B
This viral infection is common in some parts of the world. There may be occupational risks. Hepatitis B status should be checked if you feel that you are at risk and immunisation arranged accordingly.
12. EMPLOYMENT
Some types of jobs will increase your chances of exposure to many toxic chemicals and other dangers. Check to see whether there are extra risks such as exposure to chemicals, radiation, animals, bloods products, infections or trauma or other problems and seek advice on how to minimise these risks accordingly.
13. STREET DRUGS AND OTHER ELICIT SUBSTANCES
It is vital that you avoid all illegal drugs and elicit substances such as marijuana, cannabis, cocaine, crack etc. The use of these drugs can have serious consequences for your chances of conception and pregnancy.
14. EXERCISE
Taking regular exercise is important to stay in shape and as fit as possible. This is especially important if you are overweight. Exercise may also help in controlling symptoms of stress.
15. AVOID OVERHEATING
This advice applies specifically to men. Sperm are sensitive to over heating and are best being approximately 1 degree Celsius lower than the rest of the body. This is one reason why the testes in men are found outside the main body cavity. Having hot baths, saunas and the wearing of tight fitting clothes such as underwear and trousers should be avoided.
16. CONSIDER GOING TO THE DENTIST
It is increasing thought that some types of gum disease (periodontal gum disease - gum infection caused by plaque), can lead to premature labour and low birth weight. It is therefore important to have an oral health check before trying to conceive if possible and to see a dentist quickly during pregnancy should any symptoms arise.
17. CERVICAL (PAP) SMEARS
It is important to be up-to-date with your cervical smears. You should have one every 3-5 years depending on your age or sooner if you already have a history of cervical cell change.
18. SEXUAL HEALTH SCREEN
If you have symptoms of a possible sexually transmitted infection or you feel that you are at risk, you must be screened and treated before you start to conceive. Infections such as chlamydia can have a detrimental effect on your chances of conception.
19. GENETIC COUNSELLING
If there is a history of genetic disease in your or your partners family, then genetic counselling may be required to calculate the risk of your baby having the condition. Common genetic diseases include Cystic Fibrosis and Down's Syndrome. Your doctor should be able to arrange this if it is deemed necessary. Genetic counselling may be of particular value for consanguineous couples.
20. SEXUAL INTERCOURSE
The more regularly you have sex with your partner, the greater your chances of conception. Although this is mostly true for sexual intercourse around the time of ovulation, there is also some evidence to suggest that having more frequent sex at other times of the menstrual cycle can also increase your chances of conception.
Infertility Tests for Women
There are many different tests and investigative procedures that can be arranged. These include blood tests, various types of scans, X-ray imaging and various types of surgical procedures. All are designed to give your doctors information which will be vital in trying to identify the cause of infertility and in choosing the best approach to assist in conception. It is important to understand that not all women will need all of these tests. Your doctor will discuss with you those that he/she feels are necessary.
1. BLOOD TESTS
Many different parameters can be measured by taking a few millilitres of blood. These include;
- Haematology: full blood count, erythrocyte sedimentation rate and others,
- Biochemistry: electrolytes and renal function tests, liver function tests, thyroid tests, glucose level and others,
- Hormone Profiles: oestrogen, progesterone, follicle stimulating hormone, luteinising hormone, prolactin, testosterone and others,
- Microbiology: rubella and hepatitis B immunity checks
These blood tests are most often done at your General Practice Surgery or equivalent.
2. URINE TEST
This may be required for chlamydia testing and is usually done by your General Practitioner or Practice Nurse.
3. VAGINAL SWABS
Swabs may be taken from the vagina or cervix to test for various sexually transmitted infections such as chlamydia, gonorrhoea and many others.
4. ULTRASOUND SCAN
This pelvic scan can visualise your ovaries and uterus and determine their shape and size. The scan can also reveal the presence of abnormalities such as cysts, fibroids or other growths. Pelvic ultrasound scans can either be done through the abdominal wall or from inside the vagina using a vaginal probe to reveal more detail.
5. FOLLICLE TRACKING
This is essentially the same ultrasound scan as described above. However, serial scans can be used to track the development of eggs in the ovary.
6. HYSTEROSALPINGOGRAM
This is a special type of X-ray and is sometimes called a HSG or "tubogram". A radio-opaque dye is injected through the cervix into the uterus. The dye travels through the uterus and up into the fallopian tubes. A series of X-rays are then taken. The dye can then clearly be seen on the X-ray image, outlining the inside of the uterus and tubes. Any deformities of the uterus and tubes or any tubal blockages can also be clearly visualised as the path of the dye may be obstructed by any blockages in the tubes.
7. HYSTEROSCOPY
In this procedure, a thin tube containing a light and camera is inserted via the vagina, through the cervix and into the uterus. This enables the doctor to visualise and inspect the inside of the womb. Abnormalities that may be found include fibroids, polyps or other abnormal structures within the womb. At the same time, an endometrial biopsy can also be taken (a sample of the womb lining is collected and sent to a lab for detailed analysis).
8. LAPAROSCOPY
A thin tube called a laparoscope is inserted through a small incision in the abdomen. The scope contains a light and a camera to enable the doctor to visualise and inspect the pelvic organs. This procedure is usually done under a general anaesthetic. Sometimes, a dye is injected into the fallopian tubes via the cervix at the same time. The flow of dye can then be seen with the laparoscope. Any tubal obstructions can then be detected and localised.
9. HYSTEROSALPINGO-CONTRAST-SONOGRAPHY (HYCOSY)
As with laparoscopy, dye is injected into the fallopian tubes and ultrasound scans are used to detected the dye and localise any blockages of the tubes. This test gives similar but more detailed results compared with laparoscopy but is not suitable for every woman.
10. ENDOMETRIAL BIOPSY
A small catheter is inserted through the vagina and cervix, into the inside of the uterus. A sample of the womb lining (endometrium) is removed and sent to a lab for analysis. This test can be mildly uncomfortable. Therefore, pain killers may be offered before the test. Biopsies can also be taken with hysteroscopy.
Infertility Tests for Men
When dealing with infertility, doctors will tend to deal with couples. This obviously includes the male partner. In fact, male infertility is a substantial problem even though many patients see infertility as a predominantly female problem. Tests for men look mostly at sperm production and the exclusion of sexually transmitted infections.
This is done in the following ways.
1. URINE TEST
A sample of urine may be collected and sent to the lab for chlamydia screening.
2. SEMEN ANALYSIS
This forms the mainstay of male infertility testing. A semen sample is usually produced by masturbation. This is done close to or at the clinic or testing facility as rapid testing of a fresh sample is the only way to ensure accurate results. The semen sample is then processed and results obtained for several different parameters. These include;
- Sperm counts: a semen sample may contain normal numbers of sperm, a reduced number (oligozoospermia) or there may a complete absence of sperm (azoospermia).
- Sperm motility: this looks at how the sperm are moving or swimming. In some cases, adequate numbers of sperm may be present but they may have reduced motility.
- Sperm morphology: this looks at how sperm cells look. If they look abnormal in shape and appearance, they may not be able to travel to the egg or fertilise it.
If an abnormality is found, the doctor may then ask for further tests such as blood tests or ultrasound scans to determine the cause.
3. SPERM ANTIBODY TEST
This looks for proteins in the semen that may prevent successful fertilisation of the egg by sperm.
4. SPERM INVASION TEST
This looks at whether sperm are able to swim through the cervix and remain active thereafter.
Infertility: An Overview of Treatment
There are many different methods and techniques that doctors and clinics can employ to improve your chances of conception. These are summarised below. For a more detailed analysis of each of these treatments, please click onto the appropriate page.
1. DRUG TREATMENTS
Drugs used by women:
- Ovulation Induction Drugs
- Pituitary Stimulating Drugs
- Ovary Stimulators
- Cycle Suppressant Drugs
- Drugs That Maintain Pregnancy
- Other Drugs.
- Drugs used by men.
Please read "Drugs Used in Infertility Treatment" for further details.
2. SURGERY
Surgical procedures for women;
- To Unblock Fallopian Tubes
- Reversal of Sterilisation
- Vasectomy Reversal
- Varicocele Surgery
- Percutaneous Epididymal Sperm Aspiration (PESA)
- Testicular Sperm Extraction (TESE)
- Microsurgical Sperm Aspiration (MESA)
- Please read "Surgical Treatments in Infertility" for further details.
- Intrauterine Insemination (IUI) which places sperm into the uterus (womb),
- Intracervical Insemination which places the sperm into the neck of the womb (the cervix),
- Intrafallopian Insemination which places sperm into the fallopian tubes,
- Intraperitoneal Insemination which places sperm near the opening of the fallopian tubes next to the ovary,
- Intravaginal Insemination which places sperm into the vagina
- Donor Insemination (DI)
- Please read "Artificial Insemination" for further details.
- In Vitro Fertilisation (IVF)
- Intra-Cytoplasmic Sperm Injection (ICSI)
- Gamete Intra-Fallopian Transfer (GIFT)
- Zygote Intra-Fallopian Transfer (ZIFT)
- Blastocyst Transfer
- Assisted Hatching
THE AMOUNT OF INTERVENTION REQUIRED TO CONCEIVE
The differing techniques mentioned above and described in detail in the following few pages can by viewed on a scale from methods that are closest to natural conception (least amount of assisted conception required) to those furthest from nature (most amount of assisted conception required);- Least assisted -----------------------------------------> Most assisted
- AI ---> GIFT ---> ZIFT ---> IVF ---> Blastocyst Transfer ---> ICSI
In this scale, clearly, variations will be present as unstimulated cycles (those requiring no drugs) will be closer to natural conception as they require less intervention than stimulated cycles (those requiring drugs to stimulate egg development). Many assisted conception methods can also be combined with other techniques such as Assisted Hatching which again increase the complexity of the procedure.
Drugs Used in Infertility Treatment
There are many drugs used in the treatment of infertility. Although in most countries similar drugs are used, they may have different brand names. This complicates matters when trying to discuss the various drugs available. Here we will discuss the broad groups of drugs available, their function and side effects and give examples of some of these. Drugs for infertility can be taken orally in tablets or capsule form or by injection.
Though these medicines can be used alone for the treatment of infertility, they are mainly used in conjunction with various techniques for assisted conception. These drugs can also be used in combination with each other. As with most treatments for infertility, drugs increase the likelihood of multiple pregnancies such as twins or triplets.
DRUGS USED BY WOMEN
1. Ovulation Induction Drugs
Many women fail to ovulate or have unpredictable ovulatory cycles. This is a common cause for referral to an assisted conception unit. These drugs are therefore used to stimulate the ovaries and trigger ovulation. They may be used alone or in conjunction with Artificial Insemination (AI) or an Assisted Reproduction Technology (ART) such as IVF or ICSI. Ovulation inducing drugs are used for women with ovulation failure who are under 40 years of age.
The main drug in this group is Clomiphene citrate. This is sometimes known as Clomid or Serophene, which are brand names. It is the oldest and most widely used of all drugs in infertility treatment and has been around for approximately 30 years. It is taken in tablet form, initially at a dose of 50 milligrams per day for 5 days. You usually start taking the first dose on Day 3, 4 or 5 of your menstrual cycle. Ovulation occurs approximately 7 days after completing the 5 day course. If ovulation does not occur, the dose may be increased in 50 milligram steps each month to a maximum dose of 150 milligrams per day. It is usually used for no longer than 6 cycles. If no ovulation has occurred, other drugs may then be tried.
Clomiphene works by suppressing oestrogen. This has the effect of triggering the hypothalamus to release GnRH, which in turn triggers the pituitary to release follicle stimulating hormone (FSH) and Luteinising Hormone (LH), thereby stimulating the ovaries. Ovulation occurs in approximately 60-80% of women, mostly within the first 3 cycles.
Side effects are usually mild but can include;
- hot flushes,
- mood swings,
- blurred vision,
- nausea,
- bloating,
- breast tenderness,
- headaches,
- insomnia,
- increased urination,
- heavy periods,
- acne,
- weight gain,
- changes to cervical mucous.
2. Pituitary Stimulating Drugs
This group mainly consists of pulsed gonadotrophin releasing hormone (GnRH). Brand names for these include Gonadorelin, Factrel and Lutrepulse. These are usually given using a small pump worn on the upper arm. This delivers a precise "pulse" of the drug into the bloodstream. This stimulates egg production in the ovaries by stimulating the pituitary gland to secrete FSH and LH. These drugs are mainly used when their is failure to produce natural GnRH by the hypothalamus.
Possible side effects include;
- headaches,
- abdominal pains,
- nausea and vomiting,
- heavy periods.
3. Ovary Stimulators
There are several drugs in this group. These drugs contain FSH, either alone or in combination with LH. Examples of brand names include; Gonal-F, Puregon, Menogon, Menopur, Merional, Follistim, Fertinex and Bravelle. They are given by injection, either intra-muscularly (into a muscle) or sub-cutaneously (under the skin). Although they are usually given by a doctor or nurse, patients can be trained to self administer these injections at home.
Once the eggs have matured, another drug called human chorionic gonadotrophin (hCG) is also given as a single injection. This triggers ovulation to occur.
These drugs are used if your ovaries fail to respond to clomiphene and if you;
require ovulation to be stimulated for treatment cycles
have polycystic ovarian syndrome (PCOS).
These drugs can also be used when there is a failure of the pituitary gland or in some cases of male infertility.
Side effects can include;
- ovarian hyper-stimulation syndrome (OHSS) - see below,
- multiple pregnancy,
- allergies,
- skin reaction.
4. Cycle Suppressant Drugs
These drugs do not in themselves treat infertility but are used to give more control over treatment cycles. They can for example be used to stop the menstrual cycle if required. They are sometimes also known as gonadotrophin releasing hormone analogues (GnRH analogues). They block or inhibit the release of FSH and LH from the pituitary gland. Examples include Goserelin and Burserelin. They can be taken in nasal spray form or by injection in either daily or monthly formulations. They can also be used at the same time as the fertility drugs described above.
Side effects can include;
- hot flushes,
- headaches,
- night sweats,
- mood swings,
- vaginal dryness,
- acne,
- changes in breast size,
- aches & pains.
5. Drugs That Maintain Pregnancy
These drugs all contain the hormone progesterone. This thickens the lining of the womb (the endometrium) in preparation for implantation of a fertilised egg (embryo). Examples of these drugs include; Cyclogest, Gestone, Crinone and Progynova. These drugs come in vaginal pessary, gel, tablet or injectable forms. They are given after a dose of hCG or on the day of transfer of the embryos back into the uterus after an ART procedure.
Side effects can include;
- nausea and vomiting,
- swollen and painful breasts.
6. Other Drugs
There are several other types of drugs that may be used in various situations. These are not in themselves infertility drugs but may have a role to play in leading to a successful delivery. They include;
- aspirin: this may reduce the risk of miscarriage in certain women,
- heparin: this is used to thin blood (usually in patients who have blood clots or thrombosis). However, it may have a role in reducing miscarriage rates in those women who have recurrent spontaneous miscarriages,
- Bromocriptine and Cabergoline: these drugs are used to reduce levels of the hormone prolactin in those with prolactin secreting pituitary tumours. They can also reduce the size of these tumours.
DRUGS USED BY MEN
Drugs play a far lesser role in the treatment of male infertility than in females. They are used in certain specific situations.- Antibiotics: to treat various infections that may be responsible for inadequate sperm production,
- Vitamins C & E: although there is little evidence of their benefit in improving pregnancy rates, these vitamins are sometimes used to improve sperm motility (movement),
- Gonadotrophin: this can be given as injections or through a pump and is occasionally used in instances when there is no sperm production.
OVARIAN HYPER-STIMULATION SYNDROME (OHSS)
This is a well recognised potential side effect of trying to artificially stimulate the ovaries to produce eggs for ovulation. It occurs with the use of some of the infertility drugs described above. This condition can be dangerous and usually requires hospital assessment and monitoring in severe cases.
Fertility drugs over react and excessively stimulate the ovaries. Multiple cysts develop on the ovaries and fluid builds up in the abdomen. In more severe cases, the ovaries swell and fluid fills the abdomen and chest cavities. There then develops a risk of blood clots and kidney damage.
Symptoms include;
- abdominal swelling or distention
- nausea and vomiting
- abdominal pain
- breathlessness
- feeling faint
Women who are taking infertility drugs and who experience these symptoms should contact their clinic immediately. Treatment for infertility will usually be stopped. In severe cases, you may require urgent admission to hospital.
Failure of Treatment
No assisted conception clinic can possibly guarantee that you will conceive and successfully deliver a baby. At best, conception rates are around 30% per cycle which is about the same as natural conception. For some couples, especially where the woman is older than 35 years, conception rates are much lower than this.
Just as with natural conception, several attempts at assisted conception may be required before a pregnancy is successful. It is therefore safest to assume before starting treatment that more than one attempt will be required.
Infertility treatment can be demanding in many ways. It can stress you and your partner physically, emotionally and financially. It is therefore best to be well prepared for these eventualities. The more information you have access to and the more knowledgeable you become about infertility, the better the chances of coping with these stresses.
Despite this, the realisation of treatment failure is quite understandably devastating for most people. Most specialist clinics should offer counselling before, during and after your treatment. It is highly recommended that you make full use of any counselling available especially if your treatment is unsuccessful. Thereafter, most specialists would suggest that you defer any further treatment for about 2 months to recover from the psychological and physical effects of the failed treatment cycle.
Before resuming treatment, a full discussion with your specialist is vital to understand any potential problems, the cause of treatment failure (if known) and which method of assisted conception should be tried next.
A specific point to note is that when couples try to conceive naturally, many will have miscarriages that are unrecognised as such. This is because many miscarriages occur very early on in pregnancy before a woman is even aware she has conceived and carries out a pregnancy test. Menstruation may be delayed for a few days and then begins after the miscarriage. Women may simply see this as a late period. But when having infertility treatment, women are generally fully aware of what is happening. There is therefore no chance of missing a miscarriage and every miscarriage is therefore recognised. This gives the false impression of a higher failure rate when in fact, it may be very similar to nature.
WHY DOES TREATMENT FAIL?
Treatment can fail at any of the many complex steps that are required for conception. In IVF for example, treatment may fail due to;- a failure of the ovaries to respond to stimulation to produce eggs,
- the ovaries becoming hyper-stimulated because of infertility drugs. This may cause OHSS,
- a lack of eggs: empty egg sacs may form under stimulation from infertility drugs,
- a failure to fertilise eggs after successful collection. This may be due to a problem with the eggs or sperm,
- fertilised embryos failing to mature. No transfer into the womb can then take place,
- transferred embryos into the womb fail to implant or develop inside the womb.
- a developmental problem with the egg before fertilisation,
- failure of the embryo to develop properly before transfer. This may not be obvious before transfer,
- chromosomal disorders: though outwardly, many embryos may look healthy, they may contain defective chromosomes. These embryos have a much reduced chance of success. Please read the page entitled "Genetic Testing" for further details regarding this. A new test called PGS may help to solve such problems in the future,
- poor blood flow to the womb: this means that even if your embryos are healthy, they stand a lesser chance of developing into a healthy baby as the womb is unable to sustain a pregnancy,
- immunological problems: it has been recently suggested that several immunological disorders in the woman may be the reason for failure to conceive. This area is still open to debate but some clinics may be able to offer highly specialised tests to determine if this is the case,
- unexplained reasons: despite all the investigations that are available, it remains unclear in many cases why implantation and pregnancies fail.
WHAT SHOULD YOU DO NEXT?
This is an extremely difficult question to answer as the correct answer really varies from couple to couple and individual to individual. You should understand the options available to you and make an informed decision on what to do next. Your options include;- repeat the whole treatment cycle again, after a "rest" of around 2 months,
- use any eggs or embryos you have left from previous cycles so as to reduce the number of steps needed,
- consider the use of donor sperm, eggs or embryos if it becomes clear that there is a problem with your own,
- if the specialist considers it unlikely that you will conceive, then you need to re-evaluate the whole process of conception and what your options might be. This is an extremely difficult process.
Coming to terms with the fact that you may never conceive is a hugely traumatic experience.
WHAT HAPPENS THEN?
There are several options worth considering then. These include;- surrogacy: if you cannot fall pregnant yourself, you may wish to find a surrogate mother who may be willing to carry your unborn child to term. This is a highly controversial subject and there may be many legal barriers to negotiate before this is possible,
- fostering: this may be a realistic option and one which can help many unfortunate children. It can be a highly rewarding experience,
- adoption: this again can be highly rewarding as you become the legal guardian of a child. You will then become the main parental figure(s) in a child's life despite the child not being biologically your own.