Fertility treatment

The type of treatment you might need to help with a fertility problem depends entirely on the nature of the problem. What is right for one person may not be right for another.

You may be advised to start with some simple lifestyle advice, for example losing weight or giving up smoking.

You may be offered drug therapies to stimulate regular ovulation or some kind of surgery (for example, to treat fibroids or endometriosis) or another type of fertility treatment may be suggested. This may be:

IUI (intrauterine insemination), where prepared sperm is injected directly into the womb (uterus), or
IVF (in-vitro fertilisation), where the ovaries are stimulated to produce a number of eggs, which are then extracted and fertilised in the laboratory before being returned to the womb.

For couples where there is a male fertility problem, ICSI (intra-cytoplasmic sperm injection) may be suggested which involves injecting a single sperm directly into the egg to improve the chances of conception. You may be offered some additional treatments too, and there is more information about these below.

Some couples may need to consider using sperm or eggs from a donor. Read more about using donor eggs and sperm.

British Fertility Society Fertility Education Initiative information on reproductive technologies
Information about the different fertility treatment options from Fertility Network UK
NICE lists the treatment that should be available to those who may need help to conceive, but in reality decisions about what is on offer are made locally and the treatment that you can access will depend on where you live.

The Fertility Fairness website gives the latest information on the provision of IVF services across England, Wales, Northern Ireland and Scotland. This is a useful guide as to what may be available, but you should check with your local Health Board or Clinical Commissioning Group as things can change rapidly and in some areas access to treatment may be further rationed by different rules about who is eligible for treatment.

Choosing a fertility clinic

If you qualify for NHS treatment, you may not have much choice as to where you will have your fertility treatment. If you are going to pay privately, you will have to make a decision as to where to go for your treatment.

The HFEA have a dedicated section on their website to assist anyone who is trying to choose a fertility clinic. There is an animation which explains why success rates may not be the only factor to take into consideration, and detailed statistics on each individual clinic.

Fertility Network UK factsheet on choosing a fertility clinic

Ovulation Induction

Quick guide to ovulation induction for women with low oestrogen levels due to reduced activity of the hypothalamus and pituitary gland ((WHO type 1 anovulation) from the British Fertility Society
Fertility Network UK information on ovulation induction which may be required by women with PCOS.
Fertility Network UK guide to ovulation prediction kits – how they are used and what they mean.

Intrauterine insemination (IUI)

It may be suggested that you try intrauterine insemination before IVF as it is cheaper and less invasive, although success rates are not high and it is not usually offered by the NHS unless there are specific reasons to consider it. During IUI a sperm sample is prepared, and sperm is inserted directly into the womb through the vagina just before ovulation is due. Sometimes a woman takes some drugs during a cycle of IUI but alternatively it may be carried out without drugs.

IVF (in-vitro fertilisation)

IVF is a type of assisted conception where sperm which have been specially prepared are mixed with eggs in the laboratory. It is used when there is damage to the tubes, for endometriosis and for unexplained infertility. If there is fluid in the tubes (hydrosalpinges) they may be removed as this may help to improve the chances of success. ICSI may be needed if there are serious male factor problems.

Egg and embryo donation and surrogacy all use IVF techniques.

Intracytoplasmic sperm injection (ICSI)

Risks of fertility treatment

Information from the HFEA about the risks of fertility treatment. The main risks are multiple pregnancy and Ovarian Hyperstimulation Syndrome (OHSS), which can happen if the ovaries are over-stimulated. This can make some women very ill and they may need to spend time in hospital and have intensive treatment.

Ovarian Hyperstimulation Syndrome (OHSS)

Additional treatments

Many clinics will offer a range of additional treatments which may be available at extra cost. These are often fairly new, and there may be limited evidence that they can make a difference to treatment outcomes. It is important to be informed about the evidence for any treatment you are considering.

Preimplantation genetic testing (PGT) formerly known as preimplanation genetic diagnosis (PGD)

People who have a serious inherited condition that they might pass on to their children can consider using IVF and preimplantation genetic testing which involves checking whether the embryos are affected before they are transferred.

Information from the HFEA about PGT

Surgical sperm retrieval

If there are male fertility problems which mean there are no sperm present in the semen, it may still be possible to retrieve sperm directly from the testes. This is particularly useful for men who have had a vasectomy.

Quick guide to surgical sperm retrieval from the British Fertility Society

Vasectomy reversal

If a male partner has had a vasectomy to prevent future pregnancies, it is possible to try to reverse this operation although this is not always successful and depends upon how long since the vasectomy was done.