Managing Fertility

Careful Assessment

Most of us take for granted that when the time is right we will be able to conceive, but around 1 in 6 couples require assistance in starting a family.  Some will realise that they are likely to have difficulties from past health issues, others fear that time may be running out and don’t want to try for a year or more before seeking medical help and some women want to conceive either as a single woman or in a same sex relationship where clearly intervention will be required straight away.

Mr Lower uses his experience to assess patients based on a careful medical history and assessing their individual circumstances and wishes.  A few simples tests and an ultrasound scan are usually all that is needed to come up with a plan

The table below lists some of the common causes of infertility seen in the practice and strategies to manage them.

Click on the headings for more information.

Causes of infertility include:

Ovulation Failure

Each month the ovary usually produces at least one egg that matures and is released to be picked up by the Fallopian tube.

Many conditions can prevent ovulation occurring.

  • Polycystic Ovaries
  • Premature ovarian failure
  • Exercise related amenorrhoea
  • Thyroid disease
  • Pituitary disease
    • Hyperprolactinaemia
  • Hypothalamic disease
    • Hypothalamic failure
    • Kallman’s disease
    • Weight related amenorrhoea


Treatment is targeted at treating specific problems, for example correction of hormone imbalances and making lifestyle changes to restore ovulation.  Sometimes ovulation can be restored using tablets such as clomid or letrozole.  Mr Lower is also happy working with complementary therapists using modalities such as acupuncture.

Sometimes ovulation cannot be restored, for example in cases of premature ovarian failure. In such cases Mr Lower recommends egg donation. He has worked closely with Shady Grove Fertility Centre in the US. They offer a shared risk protocol for many of their patients, where there is a larger up front cost, but they will offer as many cycles as is required to have a baby. If you do not have a live baby as a result of treatment they will offer a refund of the fees. In the last 20 years Mr Lower has only had one patient who has needed a refund from Shady Grove.

Blocked and Damaged Tubes

The Fallopian tubes are very fragile structures and can be damaged as a result of:

  • Infection
  • Previous Surgery
  • Endometriosis

The most common infection to cause tubal damage is Chlamydia.  Gonorrhoea is less common but equally damaging.  Generalised pelvic infection from the appendix or damage to the bowel can also result in scarring around the Fallopian tubes.

Previous operations, for example for ovarian cysts or ectopic pregnancy, can also lead to damage to the Fallopian tube caused by scarring, limiting their ability to pick up the egg when it is released from the ovary.

Endometriosis is known to be associated with infertility, but we are still not sure of the exact cause.  It is unusual for the Fallopian tubes to be blocked unless there has been previous surgery.


Sometimes the damage to the Fallopian tubes can be repaired using laparoscopic surgery, where a narrow telescope is introduced through the skin of the abdominal wall at the umbilicus or belly button.  With a further 2 small incisions on the bikini line, instruments such as scissors or a surgical laser can be used to remove the adhesions and restore the function of the Fallopian tubes. 


This is a condition where the endometrium (the tissue lining the uterus) grows outside the uterus.  It can grow on the ovaries where it may form cysts, the bowel, the lining of the abdominal cavity, the bladder and even in the pleural cavity around the lungs.

Endometriosis can interfere with natural conception, but the exact mechanism is unclear.  The good news is that endometriosis does not seem to adversely affect the chances of conceiving with IVF.


Laparoscopic treatment using a surgical laser to ablate the endometrium can lead to up to 60% pregnancy rate in the first year after surgery. Laser treatment of endometriosis can also lead to a reduction in the symptoms of endometriosis such as heavy and painful periods and pain with sex. Mr Lower is highly experienced in this surgery and often recommends it, particularly for younger women where there is less concern for diminishing ovarian reserve.


These are benign tumours which grow in the wall of the uterus.  Submucosal and intramural fibroids can interfere with the process of implantation and cause early miscarriage and can reduce the chance of conception by up to 50%.


The only successful way of treating fibroids that are adversely affecting fertility is by surgery. Provided the fibroids are not too big they can be removed using laparoscopic or hysteroscopic surgery.  Mr Lower is a renowned expert in the surgical treatment of fibroids.  He is also now offering a new outpatient treatment for fibroids called Sonata, where a radio frequency probe is introduced into the uterus under ultrasound control. The radio frequency energy heats and thus shrinks the fibroids. For more information follow this link.  (Link to fibroids page)

Male Factor

Around 20% of all cases of infertility have a predominantly male factor.  The sperm have to swim from the vagina through the uterus and up the Fallopian tubes to meet the egg.  Any defect of the sperm including shape and motility (swimming ability) mean that the numbers of sperm arriving in the tube are reduced.  Sometimes the sperm duct in the man (vas deferens) can be blocked by infection, surgery or as a birth abnormality.  This blockage leads to absence of sperm in the ejaculate (azoospermia).  Mr Lower does not treat men himself, but refers to colleagues with particular expertise in this area – Andrologists.  


Andrologists may recommend treatment of underlying medical and hormonal issues or sometimes surgery to improve the sperm count and function.  Unfortunately it can take many months before the sperm count returns to normal and there is often concern about the age of the woman.  IVF with ICSI is often recommended in cases of male factor infertility.


Mr Lower will always attempt to tailor recommendations for treatment to a couple’s individual needs and wishes.  Sometimes correction of the underlying defect using hormones or surgery is enough to allow couples the chance to try to conceive naturally, although this may take some time.  

A couple of normal fertility only have a 30% chance of conception in any one month, rather less as a woman approaches or goes beyond the age of 40.  After a year of unprotected intercourse around 80% of couples will conceive.  We are unable to improve on this by relying on timed intercourse for natural conception after defects have been corrected.

Assisted conception

Sometimes due to age or if couples are anxious to conceive as soon as possible, assisted conception will usually reduce the time to conception, provided the woman has a satisfactory egg reserve.  

Assisted conception refers to any laboratory procedure designed to improve the chance of conception.  This may involve intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) which is used where there is a significant male factor.  Assisted conception also includes egg donation and IVF surrogacy.

If you are prepared to compromise and consider any option, we can almost guarantee that you will be able to have a family. 

Mr Lower is able to offer the following assisted conception treatments through satellite arrangements with licensed centres in the UK and the USA.  Please click on the buttons below for more information.

Assisted Conception treatment

  • Intrauterine insemination
  • In vitro fertilisation
  • Intracytoplasmic sperm injection – ICSI
  • Egg Donation
  • Surrogacy
  • Gender Selection