Knowledge Centre

Fertility preservation methods can be a great way for people to put having kids on hold, or preserve their fertility if they need to for medical reasons. Here we go through the main procedures available to women and those assigned female-at-birth. Quick facts: What is fertility preservation? Fertility preservation involves freezing your eggs, embryos, reproductive tissues or sperm, so they can be used in the future and you can hopefully have a biological family. For women or those assigned female-at-birth, there are a few different fertility preservation methods available. Which one is right for you will depend on your age, medical history and personal fertility goals.  Each method involves removing either eggs or tissues, freezing and storing them in liquid nitrogen—a process called cryopreservation. When you are ready to use them, they can be thawed and used to help you conceive.  These processes are all designed to help those at risk of potential infertility or to assist those who can’t conceive naturally. Who might use fertility preservation? There are lots of different reasons why someone may undergo fertility preservation. Generally, the reasons can be categorised as either medical or social preservation.  In the UK as of July 2022, you can store your eggs for 55 years for both medical and social reasons, as long as you renew your consent every 10 years. Medical fertility preservation Medical fertility preservation is for anyone undergoing fertility preservation for medical reasons. This could include possibly losing their ability to conceive naturally because of impending medical treatment. Reproductive health conditions Some reproductive health conditions such as Premature Ovarian Insufficiency (POI) and early menopause can affect fertility. Additionally, conditions such as endometriosis or fibroids might require surgery around the pelvic organs to manage it, your doctor may suggest fertility preservation before this in case there is a risk of damage to the ovary. Cancer Certain cancers and cancer treatment, including chemotherapy and radiotherapy (especially targeting the pelvic organs), or surgeries impacting the ovaries, can impact our fertility. Egg freezing may be suggested on a case-by-case basis for those who are looking to have children post-cancer treatment. Gender-affirming care If you’re undergoing gender-affirming care, you might want to preserve your fertility before starting hormone therapy or having reconstructive surgery. Although anyone with or undergoing the above may still be able to get pregnant naturally, there might be a risk of impacting their ovarian reserve, which may make it difficult to conceive. This is why considering fertility preservation is recommended before starting therapy.  Social fertility preservation Social fertility preservation is when you freeze your eggs or embryos for ‘social’ reasons. This can include if we are worried about our natural fertility decline with age, but we aren’t quite ready to have children yet. Or if we aren’t sure if we want children at all, but would like to keep our options open for the future.  As we age, our egg quantity and quality decline. This can make getting (and sometimes, staying) pregnant more difficult. Age, also increases the risk of pregnancy-related complications, like miscarriage, genetic disorders in the baby and gestational diabetes, especially after our mid to late 30s. In our early to mid-20s, we are at our most fertile—but there’s still only a 25–30% chance of us getting pregnant each cycle. This gradually reduces during our 30s to around 5% by age 40.  What are the different types of fertility preservation? Fertility-preservation options for women and AFAB people include egg freezing, embryo freezing, ovarian tissue cryopreservation, ovarian transposition and gonadal shielding. Egg freezing (Oocyte cryopreservation):  Egg freezing is a medical procedure which can help us to plan for our future fertility. It’s what’s known as a ‘fertility preservation method’, or scientifically speaking, ‘oocyte cryopreservation’. Egg freezing involves taking medicine to encourage the growth of the eggs in our ovaries, which will then be collected during a short surgical procedure. Viable eggs will be frozen and stored in liquid nitrogen (-196°C). They do not decline in quality—like they would do if they remained in your ovaries as you age.  These eggs can be thawed at a later date whenever you are ready to start a family through fertility treatment. This whole process is what’s called an ‘egg freezing cycle’.  Technically, you can freeze your eggs at any age before menopause, but eggs retrieved in your 20s and early 30s usually result in better outcomes than those in your late 30s and 40s. This is largely to do with the quality of the eggs at the time they are retrieved, as generally, our eggs begin to decline more rapidly from 35 onwards. Embryo cryopreservation (embryo freezing) This is a procedure that involves removing eggs from the ovaries, fertilising them with either a partner or donor sperm to create embryos and then freezing the resulting embryos for future use. Embryo cryopreservation would usually require an in-vitro fertilisation (IVF) cycle.  The egg retrieval process is similar to the one used in egg freezing. Once retrieved the eggs will be analysed in the lab by an embryologist and then fertilised with sperm from your partner or donor once. They are then placed into an incubator to allow the resulting fertilised egg (embryo) to develop.  The embryos are then frozen and stored in liquid nitrogen. Once you are ready to conceive, the embryo will be thawed, cultured and will be transferred to the uterus.  The number of embryos transferred is dependent on your age, the quality of the embryo(s) and if you have had failed IVF cycles in the past. It’s generally preferred to transfer just one embryo because this reduces the chances of complications associated with multiple pregnancies.  If you have good-quality embryos left over at this stage, you can opt to freeze them for future cycles, discard them or donate them to someone else. Sometimes, if a sufficient number of embryos are not collected in one cycle, your doctor will recommend another cycle. Ovarian tissue cryopreservation Ovarian tissue cryopreservation is the only fertility preservation option to help younger people who have not gone […]

Endometriosis is a common reproductive health condition that affects 1 in 10 in the UK. It’s characterised by painful, heavy periods as well as other, often debilitating symptoms. Here we go through each of the main symptoms in detail, so you know what to look out for and when to get checked.  Quick facts: Endometriosis in the UK In the UK, endometriosis affects around 1.5 million women and people assigned female-at-birth (AFAB). That’s 1 in 10 who are currently living with the condition, regardless of race or ethnicity (1). People with endometriosis often experience very painful periods as well as a host of other symptoms. Many people live with endometriosis for a long time before getting diagnosed. Sometimes up to 7 years or more.  This is often the result of a general lack of awareness about the condition, dismissal of women’s pain and symptoms having a lot of crossover with other conditions. So what are the main symptoms of endometriosis? Here’s what to look out for if you suspect you, or someone close to you, may have the condition. What is endometriosis? Endometriosis is a chronic reproductive health condition where cells similar to those lining the uterus grow in other parts of the body. Endometrial tissues and lesions are found in the ovaries and Fallopian tubes.  They can sometimes also grow in the vagina, cervix, vulva, bowel, bladder and rectum. Rarely, do they appear in other parts of the body, like the lungs, brain, and skin (2). Just like the lining of the uterus, these cells build up and eventually shed. But unlike your period which drains through the vagina, this blood and tissue has nowhere to go. This can cause inflammation, crippling pain and a long list of other symptoms. Endometriosis can affect women of any age, including teenagers. What are the main symptoms of endometriosis? Here are the most common symptoms of endometriosis (3):  Severe period pain  Severe period and pelvic pain are often reported to be the most debilitating symptoms of endometriosis. This pain is often described as ‘a razor blade pain’.  During your menstrual cycle, the lining of your uterus (endometrium) is built up to support a potential pregnancy. If its baby-making dreams are not fulfilled, your body releases chemicals called prostaglandins.  Prostaglandins cause the uterus to contract and your endometrium sheds. Cue, your period. These contractions are what cause period pain. With endometriosis, the endometrial-like cells that have grown outside of the uterus also build up and shed. This internal bleeding leads to inflammation, intense pain and a buildup of scar tissue and adhesions (a type of tissue that can bind your organs together).  Usually, the first or second day of your period is the most painful. But in cases of endometriosis, the crippling pain usually kicks in a few days before your period’s arrival. It can also make an unwelcome return during ovulation or even throughout the month.  People can also experience chronic pain, increased lower back and pain around their legs which increases around their periods. “Endo belly” is a common term used to refer to the uncomfortable abdominal symptoms associated with endometriosis. Heavy periods Another common endometriosis symptom is heavy periods. Heavy periods are defined as: If your periods are painful or heavy it’s important to seek medical advice. Monthly heavy bleeding can increase the risk of anaemia (iron deficiency) which can result in symptoms of fatigue, feeling cold often and hair thinning. Pain during or after sex Another common symptom of endometriosis is pain during or after vaginal penetration. This can be caused by endometrial lesions growing in the pelvic region and becoming inflamed during or after sex. This pain is called dyspareunia. It has been reported to feel like a stabbing shooting pain, usually felt deep inside the pelvis. Any unwanted pain during sex is not normal. If you experience any pain during or after sex or any bleeding, get it checked out. There is also mental health support available if you feel your intimacy is being affected by pain during sex. Bowel and urination pain Endometrial lesions can sometimes find their way to the surface of the bowel or even penetrate its wall. This can cause uncomfortable symptoms such as pain when urinating or passing bowel movements or noticing blood in your urine or poo. Pain during urination can sometimes be misdiagnosed as a UTI. If you’re in pain when passing urine or poo or if you notice any blood in either, get it checked out to understand what might be the cause. Bloating and gastrointestinal issues People with endometriosis can also experience bloating and gastrointestinal issues. These symptoms are similar to those of irritable bowel syndrome (IBS). Including diarrhoea, constipation and bloating. These symptoms are often affected by your cycle and can worsen in the days before your period. Fertility problems Unfortunately, endometriosis can affect your fertility. Infertility affects about 30-50% of those with endometriosis, but there are no definitive answers (yet) as to why—only theories.   However, this does not mean that if you have endometriosis you can’t conceive. Even in cases of severe endometriosis, natural conception is possible.  Mental health impacts Living with a chronic condition can be tough and often isolating. Endometriosis can affect various aspects of life from personal to professional relationships, which can impact your mental health.  If you feel like endometriosis is impacting your mental health, there are online support communities like Endometriosis UK. You can also talk to our Fertility Counsellors for any mental health concerns relating to your fertility.  Getting to the bottom of symptoms Just like any reproductive health condition, endometriosis varies from person to person. Not everyone with endometriosis will experience all of these symptoms to the same severity. Some people may not experience any of these symptoms at all.  Having severe pain or very heavy periods is not necessarily a sign of more severe endometriosis. It’s also important to remember that each of these symptoms can also be caused by other conditions.  If you’re experiencing any of the […]

Have you been diagnosed with endometriosis? Discover our top tips for managing endometriosis pain and the treatment options available to you. From painkillers to surgery.  Quick facts: Living with endometriosis If you live with endometriosis, you probably know that one of the biggest symptoms of endometriosis is pain… a lot of it. Experiencing chronic pain amongst other, often equally debilitating symptoms, can have big physical and emotional consequences.  Sadly, there is currently no cure for endometriosis. And with limited research and understanding of the condition, it can be difficult for both doctors and endo warriors to get a handle on managing endometriosis symptoms.   But you don’t have to put up with pain. There are several treatments available to manage symptoms and help improve your quality of life. Lots of people report huge improvements with these treatments—it’s just about finding what works for you. Medication for managing symptoms The first step in managing pain is usually exploring the use of painkillers. Your doctor may recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, ibuprofen) or paracetamol as a first line of treatment to manage any pain.  However, there are lots of different types of painkillers and your doctor can help you to find ones that work for you and your pain level.  Depending on the severity of your endometriosis pain, you may try a course of painkillers for a few months until you assess whether or not they are working for you.  But if you’re finding that these aren’t making the cut and you’re unable to go to work, uni, school, work or other plans, don’t suffer in silence! This is just the first option for managing endometriosis, so push your doctor for alternatives. Tips for endometriosis pain management Endometriosis UK suggests some extra tips for pain management: Heat and comfort Hot water bottles, heated wheat bags or special heat pads can really help to soothe pain, cramping and inflammation.  Remember to never put them directly onto the skin and always have a layer in between. Partnered with your comfies, hopefully, this can help you to feel more comfortable. Physiotherapy Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. TENS machines Transcutaneous Electrical Nerve Stimulator (TENS) machines are small devices with electrodes that send electrical pulses into the body. This can block the pain messages as they travel through your nerves. Pain clinics Your doctor can refer you to your nearest pain clinic to see chronic pain specialists. Push for your doctor to get you the expert advice you deserve to manage your endometriosis pain. Hormone treatment for endometriosis When you’re diagnosed with endometriosis, hormone treatment is another common avenue to explore. You should discuss hormone treatment with your doctor or specialist to decide if it’s right for you. For those with endometriosis, similar cells to those lining the womb exist outside of the womb (usually in the abdomen).  These cells also respond to your sex hormones, particularly oestrogen and progesterone, in the same way as your womb lining. They thicken, break down and bleed during your period. This bleeding causes inflammation and scarring, leading to chronic pain.  Hormone treatment is commonly used to reduce the growth of this endometrial tissue.  How does hormone treatment help endometriosis? Hormone treatment aims to maintain low levels of oestrogen in the body, as oestrogen has been found to encourage the growth of endometrial tissue. Hormone therapy can help reduce heavy flow or even stop periods and therefore improve symptoms.  Whilst most endo warriors find that hormonal treatment reduces their symptoms, it is not a permanent fix to manage endometriosis. Types of hormonal treatment used to manage endometriosis? There are lots of different types of hormone treatment available. Some of the most common are also used as contraceptive methods including: Unfortunately, not everyone gets on with hormonal contraception and side effects can be common. It’s important to consider which hormone treatment is right for you. Surgery for endometriosis A last resort if the above treatments aren’t keeping your symptoms at bay, is endometriosis surgery. This aims to remove or destroy areas of endometrial tissue.  This can include laparoscopic surgery or a hysterectomy. The kind of surgery you have will depend on where the endometriosis is and how much of it there is. Laparoscopic surgery for endometriosis Initial surgery will almost always involve gynaecological laparoscopy for both diagnosis and excision. In laparoscopic surgery, also known as keyhole surgery, your surgeon inserts a small tube with a light source and a camera, through a small incision near your belly button.  They use this to be able to look inside your tummy or pelvis and then use fine tools to remove endometrial tissue (excision) or use intense heat to destroy the tissues (ablation). They can also remove any scar tissue that has built up in the area.  This form of surgery can be difficult, as many of the lesions are below the surface and not visible, so a highly skilled practitioner is required to remove them.  It might be the most long-lasting treatment, and people do notice relief in symptoms, but many who undergo surgery find their endometriosis grows back over time. This is why endo warriors may have to undergo surgeries multiple times. Hormone treatment might be used after surgery to help get better, longer-lasting results. Hysterectomy for endometriosis Sometimes healthcare professionals will also suggest undergoing a hysterectomy, a surgery where the womb is removed. This can be a very big decision as post-surgery, you will no longer be able to become pregnant or carry a pregnancy.  If you want children, you can discuss egg freezing before this procedure with your doctor. This means that you will then have the option of trying to have a baby using fertility treatments such as in vitro fertilisation (IVF) with the help of a surrogate. In some cases, someone might still experience symptoms after getting a hysterectomy done as a form of endometriosis management. If the ovaries […]

How can your thyroid be affecting your fertility? Your thyroid is a butterfly-shaped gland located at the front of your throat. It plays a crucial role in influencing metabolism, temperature, growth, and development, via the production of thyroid hormones. The main thyroid hormones are thyroid stimulating hormone (TSH) thyroxine (T4) and triiodothyronine (T3). Whilst many are aware that the imbalance of these hormones could cause changes in weight and mood, not quite so many of you know that your thyroid can also affect your fertility and menstrual cycle. If you think of your thyroid as a conductor in an orchestra, conducting many different instruments (organs) as they play their music (produce hormones), then it’s easier to understand how if one your organs is off key, it tends to mess up the whole song. If your cycles are out of sync or you’re trying to conceive, it’s probably a good idea to check your thyroid is in tune and working optimally. Check your fertility   What are thyroid disorders? About 2-4% of women of reproductive age struggle with a thyroid imbalance. When your thyroid is underactive, it is known as hypothyroidism. The main symptoms of hypothyroidism are weight gain, thinning hair, severe fatigue, slowed heart rate, depression, decreased libido, and sensitivity to cold. When your thyroid is overactive, it is known as hyperthyroidism. These two issues are like yin and yang, so the main symptoms of this are pretty much the opposite of hypothyroidism. That is, rapid weight loss, increased appetite, increased sensitivity to heat, frequent bowel movements, menstrual irregularities and irritability. Also not ideal. How can thyroid dysfunctions affect your reproductive health? Thyroid disorders can mess with your metabolism, as well as disrupt your hormones in general. The hormonal issues that arise as a result can include anovulation, or the inability to ovulate, as well as luteal phase defects, hyperproalctinemia, and general sex hormone imbalance. As the thyroid plays a crucial role in growth and development, a healthy thyroid is necessary for maintaining a healthy pregnancy as well. Is there a connection with your thyroid and fertility? While thyroid issues are problematic, they are a confounding factor in your fertility, rather than a direct problem. For example, when a car blocks you in and you can’t leave, it’s not an issue with your car, but rather the other car in your way. Same goes for this –  fertility resolves once the thyroid problem resolves. One study demonstrated that 76% of women who fixed their thyroid were able to conceive between 6 weeks to 1 year afterwards. Testing your thyroid levels is the best place to start to help you understand whether you may be suffering from a thyroid disorder. In hypothyroidism, TSH would be high, while T3 and T4 would be low. With hyperthyroidism, the opposite is true, and TSH would be low, while T3 and T4 would be high. Once you have an understanding of where your thyroid stands, you can then treat this issue, which is primarily done with oral medication. Hypothyroidism is typically treated with thyroxine (T4) replacement, and Cytomel, or T3 replacement, may also be required in specific cases. Hyperthyroidism is a bit more complicated, and is treated with antithyroid medication, iodine, or surgery. Sometimes, drugs known as beta-blockers are used as well. It is important to find an endocrinologist that you trust, and possibly to even get a second opinion, if you feel like there is an issue with the treatment you’ve been prescribed. If this has got you scratching your head about your own thyroid levels or questioning your overall fertility, Hertility are here to fill in the blanks. With our at-home tests, we can give you a better insight into your health, and if this little gland isn’t in check, we’ll lead you down the path to fixing it.