Reproductive Health

  • About fertility
    About Mobility

    Fertility
  • About fertility

    1 in 6 couples may experience problems in conceiving a child, a figure that appears to be rising partly due to the trend to delay pregnancy until an older age. The World Health Organization estimates that there are about 60 to 80 million cases of infertility around the world.

    Treatment of infertility is one of Ferring's key areas of expertise and we are firmly committed to progress in the field of Assisted Reproductive Technology (ART).

     Ferring's expertise

    Ferring's infertility portfolio consists of traditional highly purified and standardised urinary-derived products.

     

     

     

    Physical and emotional burden

    Infertility is more than just a physical problem. While many couples treated for infertility eventually experience the joy of having children, infertility and its treatment generally places a considerable amount of stress on couples' relationships and personal lives. The successful management of infertility includes both the physical and emotional care of the couple.

    All information on this site is intended for UK audiences only.

     

  • The process of reproduction
    The process of reproduction

    Fertility
  • The process of reproduction

    The process of reproduction

    Normal functioning of the male and female reproductive systems depends on complex hormonal communication signals between the endocrine system and the sexual organs: ovaries in women and testes in men.

    Role of hormones
    Like most of the body's systems, hormones direct the intricate processes involved in male and female fertility.

    Three key hormones responsible for controlling the reproductive systems and cycles in both sexes are:

    Gonadotropin-Releasing Hormone (GnRH) is secreted by the hypothalamus. This hormone stimulates the secretion of two gonadotropin hormones from the pituitary gland: Luteinising Hormone (LH) and the Follicle Stimulating Hormone (FSH). LH and FSH are key elements behind ovulation in women and development of sperm cells in men.

    The body must produce these hormones in the right amounts, in the right sequence and at the right time for ovulation and sperm production to occur. If not, the chances of conception will be reduced.

     

    Women's reproductive system

     Producing fertile eggs (oocytes)

    Women are born with about 400,000 immature eggs already in their ovaries. Each month, between puberty and menopause, one egg fully matures and starts its journey down the fallopian tubes in the anticipation of fertilisation.

    Menstrual cycle
    There are three stages to a woman's "monthly" menstrual cycle. On average, this cycle lasts 28 days.

     Stage one: follicular phase

    The first stage of the cycle lasts for about two weeks and starts from the first day of menstrual bleeding. During this stage, the secretion of FSH rises, stimulating the development of an egg-containing follicle and the maturation of the egg within it.

    The growing follicle secretes increasing amounts of the female hormone, oestrogen, which triggers changes in the lining of uterus (endometrium) and cervical mucus. The cervical mucus thins to allow sperm to pass through and the endometrium thickens making it ideal for the implantation of a fertilised egg.

     Stage two: Ovulation

    About 32 hours before an egg is ready to be released, the amount of oestrogen produced by the follicle sharply increases, causing a spike in the secretion of LH by the pituitary gland. This surge in LH production causes ovulation. The matured egg bursts out of the follicle and travels down the fallopian tube to eventually be fertilised by a sperm.

     Stage three: luteal phase

    The remains of the follicle become a corpus luteum, which secretes a second female hormone, progesterone. This helps maintain the best conditions for pregnancy should the egg be fertilised.

    If the egg is not fertilised within about 72 hours, the corpus luteum eventually degenerates and the egg is expelled from the uterus along with the lining, leading to menstruation approximately 14 days later.

     

    Men's reproductive system

     Sperm production

    LH is responsible for the production of the male hormone testosterone, which along with FSH is responsible for stimulating sperm production in the testicles.

    Sperm production, spermatogenesis, is a continuous process. It takes about 72 to 74 days for a male "germ" cell to develop into an active sperm. Several hundred million sperm are produced on a daily basis. From the millions of sperm cells available each day, only a small proportion has full fertilising potential.

    Spermatogenesis is most efficient at a temperature of 34°C. It is vulnerable to increases in temperature.

     

     

    Sperm cells

    A sperm cell consists of two main parts:

     1. The head which has the crucial role of clinging to an egg and penetrating its outer membrane, taking with it its genetic information 

     2. the tail, which enables the sperm cell to "swim" the length of the female reproductive tract to reach an egg.

     Problems affecting any of these components will affect the fertilising power of the sperm cell.

    Best time for conception

    Becoming pregnant is not always straightforward even for people without fertility problems. Humans are one of the least fertile creatures on earth, with only a 25 percent chance of conception each month.

    Sperm can only live for around 48 hours in the female reproductive tract and the egg needs to be fertilised within 72 hours following ovulation, leaving a narrow window for fertilisation. Thus, the best time for conception is around the middle of the menstrual cycle just before ovulation occurs.

     

    Pregnancy

     Under normal circumstances only a few hundred of the 14 million sperm deposited naturally into the vagina during intercourse are able to reach the end of the fallopian tube where the egg can be fertilised.

     After one sperm has successfully fertilised an egg, cell division begins and the fused cells become an embryo. Migration of the embryo happens at the same time and about a week following ovulation, the embryo finds itself in the uterus and implants itself into the endometrium. Successful implantation prevents the corpus luteum and endometrium from breaking down, therefore menstruation does not happen.

     At this point, a third gonadotropin, the human chorionic gonadotropin (hCG), is produced by the placenta which develops upon implantation. The hCG plays an important role in maintaining the pregnancy. It stimulates the corpus luteum to continue to produce high levels of oestrogen and progesterone.

    • Stage one: follicular phase
      The first stage of the cycle lasts for about two weeks. During this stage, the secretion of FSH rises, stimulating the development of an egg-containing follicle and the maturation of the egg within it.

      The growing follicle secretes increasing amounts of the female hormone, oestrogen, which triggers changes in the lining of uterus (endometrium) and cervical mucus. The cervical mucus thins to allow sperm to pass through and the endometrium thickens making it ideal for the implantation of a fertilised egg.
       
    • Stage two: Ovulation
      About 32 hours before an egg is ready to be released, the amount of oestrogen produced by the follicle sharply increases, causing a spike in the secretion of LH by the pituitary gland. This surge in LH production causes ovulation. The matured egg bursts out of the follicle and travels down the fallopian tube. 
       
    • Stage three: luteal phase
      The remains of the follicle become a corpus luteum, which secretes a second female hormone, progesterone. This helps maintain the best conditions for pregnancy should the egg be fertilised. 

      If the egg is not fertilised within about 72 hours, the corpus luteum eventually degenerates and the egg is expelled from the uterus along with the lining, leading to menstruation approximately 14 days later.

    All information on this site is intended for UK audiences only.

  • Causes of infertility
    Causes of infertility

    Fertility
  • Causes of infertility

    Causes of infertility

    The complex nature of the processes and interactions involved in egg/sperm production and fertilisation means that something can go wrong at various stages of the process.

     Infertility

    Infertility is usually defined as the inability of a couple to conceive after one year of unprotected intercourse. However, younger couples may be encouraged to wait for up to two years by some doctors before seeking treatment, while women over 35 or those with certain medical conditions, such as diabetes, should only wait six months.

     Statistics

    About one in six couples concerned end up seeking help. Within this group, the cause of infertility is found to lie with the woman in up to 40 per cent of cases and with the man about 30 per cent of the time. In the remaining cases, either both partners are found to have reduced fertility or the cause cannot be determined.

     

    Female factors

             Hormonal / ovulation: Hormonal problems affect follicular development as well as ovulation. Problems with ovulation are the most common cause for female infertility and account for up to a third of all cases.

             Tubal problems: Damage to the fallopian tubes is another common reason for infertility, preventing the egg from travelling down, affecting fertilisation or passage to the uterus.

             Uterine problems: Endometriosis can be a key problem in the uterus. In this condition, developing cells from the endometrium break away and stick to the ovaries and fallopian tubes affecting the way they function. Fibroids and polyps in the uterus can also cause problems with fertility.

             Cervix / vaginal problems: Structural abnormalities of the vagina or cervix can affect fertility as can the physical characteristics of the cervical mucus. The mucus can be hostile to sperm, perhaps containing antibodies or thick enough to block the movement of the sperm.

             Hyperprolactinaemia: This is a condition where excess levels of the hormone prolactin are found in the blood. This can cause symptoms including irregular or absent menstrual cycles, infertility and increased production of breast milk.

     

     

    • Male factors

       

      •         Sperm potency: The vast majority of cases of male infertility are due to a low sperm count, which is generally associated with a high rate of sperm defects (size, shape and movement).

       

      •         Hormonal imbalances: Hormonal imbalances related to FSH and LH do occur in men but are not very common.

       

      •         Testicular failure: Some men are found to have no sperm in their semen. This could be due to a failure to ejaculate or a failure of the testes to produce sperm.

       

      •         Varicocele: These are varicose veins in one or both scrotums, and are the most common anatomical abnormality in infertile men.

       

      •         Tubal blockage: Damage as a result of infections can prevent the sperm from getting into the semen. Occasionally the ejaculate of some men is diverted into the bladder.
      •         Sperm antibodies: A small group of men actually produce antibodies against their own sperm. This cause accounts for around 10 per cent of unexplained male infertility.

       

      Joint infertility problems

       

      Of the number of cases of infertility where the problem lies with both partners, some of the causes may be straightforward and quite simple to remedy. As the window of opportunity to fertilise an egg is quite limited in a woman's monthly cycle, the frequency and timing of intercourse may be factors. Some cases have been found to be related to technique (the sperm is not deposited high enough in the vagina). Fertility is also reduced with increasing age, especially in women. In men, testosterone levels can decline with age but not in the dramatic manner seen in women. Men continue to produce sperm but their motility and quality are reduced with advancing age.

    All information on this site is intended for UK audiences only.

  • Treating infertility
    Treating infertility

    Fertility
  • Treating infertility

     A variety of options are now available to help identify the cause(s) of infertility and ultimately provide couples with the highest chance of realising their dream of having a baby.

    Ferring has been helping couples to conceive for more than a decade with a portfolio of high quality products that work in the same way as the body's natural hormones. By correcting hormonal imbalances and stimulating ovulation, these products help to achieve a high pregnancy success rate.

     

     Treatment options


    The procedures and treatments available from infertility clinics can be divided into four main categories:

    •    Hormonal and anti-oestrogen therapy (includes induction of ovulation)
    •    Artificial insemination (AI) procedures
    •    Surgery
    •    Assisted reproductive technology (ART)

     

    The infertility specialist is likely to start with the simplest treatment that is suitable for the cause of infertility in a particular couple. Where a pregnancy is not achieved after a few cycles of treatment another procedure will be selected. Between 85% and 90% of infertility cases are treated with conventional medical therapies such as medication or surgery.

     

     Hormonal therapy

    Its objective is to replace, or enhance, the hormones produced naturally by the body. Gonadotropin treatment is also used to stimulate "super-ovulation" for assisted conception procedures, including in-vitro fertilisation (IVF).

     

     Ovulation induction

    Ovulation induction can be used as a treatment on its own or in combination with another infertility treatment such as artificial insemination or IVF.

    The treatment stimulates ovulation in women with infrequent or irregular periods, or in those whose menstrual cycles have stopped due to polycystic ovaries. Although successful for many women, they carry a high risk of multiple pregnancies.

     

     

    Artificial insemination
    Most often used in cases of infertility due to low sperm count or reduced motility, the procedure can also be used in cases where the woman has hostile cervical mucus, or produces antibodies against sperm. The sperm cells are collected, processed and washed and then inserted directly into the uterus, cervical canal or vagina.

     

     Surgery

    Surgery can be used to correct anatomical abnormalities of the reproductive system in either the woman or the man.

     

     Assisted Reproductive Technology

    ART is a general term covering a range of advanced procedures, including micro-manipulation of sperm, to aid fertilisation and implantation. The procedures all have one thing in common: they require the collection of multiple mature eggs (oocytes), which is achieved by hormonal stimulation of the ovaries often described as "super-ovulation".

     

     The main ART procedures include:

    • In-vitro fertilisation (IVF)

    • Intracytoplasmic sperm injection (ICSI) - for male infertility
    • Gamete intrafallopian tube transfer (GIFT)
    • Zygote intrafallopian transfer (ZIFT)
    • Blastocyst transfer (BT)

    All information on this site is intended for UK audiences only.

     

  • Obstetrics
    Obstetrics

    Obstetrics
  • About obstetrics

    Obstetrics is the branch of medicine related to pregnancy and giving birth. Most women have uneventful pregnancies with no complications, but some pregnancies will require further care and attention. Part of obstetric care is to try to identify and prevent problems occurring during pregnancy and labour that could affect the health of both mother and unborn baby.

     

    To learn more, please select one of the below topics:

    All information on this site is intended for UK audiences only.

  • Induction of labour
    Induction of labour

    Obstetrics
  • Induction of labour

    Most women have a normal pregnancy and a normal birth. Labour is a natural process which usually starts on its own. However, sometimes it may be started artificially (called induction of labour) by obstetricians in situations where it is considered better, for the mother or the unborn child, for the baby to be delivered as soon as possible.

     The most common reasons for induction are: 

    • To avoid a prolonged pregnancy lasting more than 42 weeks (the most common reason)
    • Prelabour rupture of membranes (where the woman’s waters break but labour does not start –from 34 weeks gestation

     A common method of inducing labour is to use drugs that act like the natural hormones that kickstart labour. These drugs are called prostaglandins.

    All information on this site is intended for UK audiences only.

     Prostaglandins are inserted into the vagina as a gel or tablet every 6 hours (maximum 2 doses in 24 hours) or as a long acting pessary (maximum one dose in 24 hours).

     Amniotomy is a method of induction in which the midwife or doctor artifically breaks a woman’s water.

     

     References:

    NICE induction of labour guidance (accessed 21st May 2015)

    NICE Induction of Labour - Information for the public (accessed 24th July 2015) 

  • Pre-term labour
    Pre-term labour

    Obstetrics
  • Pre-term labour

    Labour is when regular contractions lead to opening up of the cervix (neck of the womb). This normally occurs at between 37 and 42 weeks of pregnancy. If it occurs before 37 weeks, it is known as premature labour.

    In the UK, having a premature baby (before 37 weeks) is common: eight in 100 babies are born before 37 weeks. Very premature birth is much less common, with fewer than one in 100 babies being born at between 22 and 28 weeks of pregnancy.

     Premature babies have an increased risk of health problems, particularly with breathing, feeding and infection. The earlier the baby is born, the more likely it  is to have these problems and the baby may need to be looked after in a neonatal unit. However, more than eight out of ten premature babies born after 28 weeks survive and only a small number will have serious long-term disability. Many survivors (as children) who have long-term health problems still rate their quality of life as being good.

    If contractions start prematurely, the doctors may use drugs (tocolytics) to stop the contractions temporarily. This hopefully allows time for steroid injections to be given. Steroids will reduce the risk of the baby suffering from the complications of being born very early (particularly breathing difficulties and bleeding). They can take about 24 hours to work.

     References:

    NHS Choices - Premature labour and birth  (accessed 21st July 2015)

    RCOG Patient Information Leaflet on Preterm Labour (accessed 5th August 2015) 

    All information on this site is intended for UK audiences only.

     

  • Post partum haemorrhage
    Post partum haemorrhage

    Obstetrics
  • Post partum haemorrhage

    Bleeding after delivery, or postpartum haemorrhage, is the loss of greater than 500ml of blood following vaginal delivery, or 1000ml of blood following cesarean section. It is the most common cause of perinatal maternal death in the developed world and is a major cause of maternal morbidity worldwide.

     

     

    Uterine atony (inability of the uterus to contract), which leads to excessive bleeding, is responsible for 80 per cent of the cases. Retained placenta and infection can also lead to the inability of the uterus to regain sufficient muscle tone and results in excessive bleeding.

     All information on this site is intended for UK audiences only.

     

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Ferring Pharmaceuticals Ltd.
Drayton Hall, Church Road, West Drayton.
UB7 7PS

Telephone : +44(0)8449310050

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